Chapter 52: Assessment and Management of Patients With Endocrine Disorders
Dilutional hyponatremia occurs in which disorder? 1. Pheochromocytoma 2. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) 3. Diabetes insipidus (DI) 4. Addison disease
Correct response: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Explanation: Clients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.
A young client has a significant height deficit and is to be evaluated for diagnostic purposes. What could be the cause of this client's disorder? 1. pituitary disorder 2. adrenal disorder 3. thyroid disorder 4. parathyroid disorder
Correct response: pituitary disorder Explanation: Pituitary disorders usually result from excessive or deficient production and secretion of a specific hormone. Dwarfism occurs when secretion of growth hormone is insufficient during childhood.
A nurse is completing an assessment of a client with suspected acromegaly. To assist in making the diagnosis, which question should the nurse ask? 1. "Has your shoe size increased recently?" 2. "Is there any family history of acromegaly?" 3. "Do you experience skin breakouts?" 4. "Have you had a recent head injury?"
Correct response: "Has your shoe size increased recently?" Explanation: Excessive skeletal growth occurs only in the feet, the hands, the superciliary ridge, the molar eminences, the nose, and the chin, giving rise to the clinical condition of acromegaly.
The most common type of goiter is caused by lack of which of the following? 1. Calcium 2. Potassium 3. Iodine 4. Sodium
Correct response: Iodine Explanation: The most common type of goiter is often encountered in geographic regions where there is lack of iodine. If too little iodine exists, the level of thyroxine will decrease, causing the stimulation of thyroid-stimulating hormone (TSH) from the anterior pituitary.
The nurse assesses a patient who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease? 1. Glucose of 100 mg/dL 2. Potassium of 6.0 mEq/L 3. A blood pressure reading of 135/90 mm Hg 4. Sodium of 140 mEq/L
Correct response: Potassium of 6.0 mEq/L Explanation: Addison's disease is characterized by hypotension, low blood glucose, low serum sodium, and high serum potassium levels. The normal serum potassium level is 3.5 to 5 mEq/L.
Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects? 1. Sympathetic 2. Respiratory effects 3. Parasympathetic 4. Gastrointestinal effects
Correct response: Sympathetic Explanation: Beta-adrenergic blocking agents are important in controlling the sympathetic nervous system effects of hyperthyroidism. For example, propranolol is used to control nervousness, tachycardia, tremor, anxiety, and heat intolerance.
A patient has been placed on corticosteroid therapy for an Addison's disease. The nurse should be aware of which of the following side effects with this type of therapy? Select all that apply. 1. Hypertension 2. Weight loss 3. Hypotension 4. Alterations in glucose metabolism 5. Poor wound healing
Correct response: - Hypertension - Alterations in glucose metabolism - Poor wound healing Explanation: Side effects of corticosteroid therapy include hypertension, alterations in glucose metabolism, weight gain, and poor wound healing.
A client is suspected of having acromegaly. What definitive diagnostic testing is the most reliable method of confirming acromegaly? 1. Growth hormone levels 2. A serum glucose level 3. Glucose tolerance test in combination with a GH measurement 4. Bone radiographs
Correct response: Glucose tolerance test in combination with a GH measurement Explanation: A glucose tolerance test in combination with a GH measurement is the most reliable method of confirming acromegaly. Ingestion of a bolus of glucose should lower GH levels, but GH levels remain elevated in persons with acromegaly. Increased blood levels of IGF-1 can also indicate acromegaly in nonpregnant women; they typically have IGF-1 levels two to three times higher than normal in pregnant women. A serum glucose level is not an indicator of acromegaly. Growth hormone levels and bone radiographs may support the diagnosis but are not reliable indicators.
Which of the following clinical signs are associated with diabetes insipidus? 1. Bradycardia 2. Hypertension 3. Oliguria 4. Hypotension
Correct response: Hypotension Explanation: Diabetes insipidus, which causes profound polyuria, may cause clinical signs of volume depletion such as tachycardia and hypotension.
A nurse is completing an assessment of a client with suspected acromegaly. To assist in making the diagnosis, which question should the nurse ask? 1. "Do you experience skin breakouts?" 2. "Is there any family history of acromegaly?" 3. "Have you had a recent head injury?" 4. "Has your shoe size increased recently?"
Correct response: "Has your shoe size increased recently?" Explanation: Excessive skeletal growth occurs only in the feet, the hands, the superciliary ridge, the molar eminences, the nose, and the chin, giving rise to the clinical condition of acromegaly.
The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin? 1. E 2. B 3. C 4. D
Correct response: D Explanation: The actions of PTH are increased by the presence of vitamin D.
Which of the following would the nurse expect to find in a client with severe hyperthyroidism? 1. Striae 2. Buffalo hump 3. Tetany 4. Exophthalmos
Correct response: Exophthalmos Explanation: Exophthalmos that results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball is seen in clients with severe hyperthyroidism. Tetany is the symptom of acute and sudden hypoparathyroidism. Buffalo hump and striae are the symptoms of Cushing's syndrome.
The nurse is reviewing a client's history which reveals that the client has had an oversecretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? 1. Gigantism 2. Simmonds' disease 3. Acromegaly 4. Dwarfism
Correct response: Gigantism Explanation: When oversecretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.
A nurse is teaching a client recovering from addisonian crisis about the need to take fludrocortisone acetate and hydrocortisone at home. Which statement by the client indicates an understanding of the instructions? 1. "I'll take the entire dose at bedtime." 2. "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." 3. "I'll take my hydrocortisone in the late afternoon, before dinner." 4. "I'll take all of my hydrocortisone in the morning, right after I wake up."
Correct response: "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." Explanation: Hydrocortisone, a glucocorticoid, should be administered according to a schedule that closely reflects the body's own secretion of this hormone; therefore, two-thirds of the dose of hydrocortisone should be taken in the morning and one-third in the late afternoon. This dosage schedule reduces adverse effects.
A nurse is teaching a client recovering from addisonian crisis about the need to take fludrocortisone acetate and hydrocortisone at home. Which statement by the client indicates an understanding of the instructions? 1. "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." 2. "I'll take all of my hydrocortisone in the morning, right after I wake up." 3. "I'll take the entire dose at bedtime." 4. "I'll take my hydrocortisone in the late afternoon, before dinner."
Correct response: "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." Explanation: Hydrocortisone, a glucocorticoid, should be administered according to a schedule that closely reflects the body's own secretion of this hormone; therefore, two-thirds of the dose of hydrocortisone should be taken in the morning and one-third in the late afternoon. This dosage schedule reduces adverse effects.
A client with Cushing syndrome is admitted to the hospital. During the initial assessment, the client tells the nurse, "The worst thing about this disease is how awful I look. I want to cry every time I look in the mirror." Which statements by the nurse is the best response? 1. "I can refer you to a support group. Talking to someone may help you feel better." 2. "I do not think you look bad and I am sure your family loves you very much." 3. "If treated successfully, the major physical changes will disappear with time." 4. "I can show you how to change your style of dress so that the changes are not so noticeable."
Correct response: "If treated successfully, the major physical changes will disappear with time." Explanation: If treated successfully, the major physical changes associated with Cushing syndrome disappear with time. The client may benefit from discussion of the effect the changes have had on his or her self-concept and relationships with others. Weight gain and edema may be modified by a low-carbohydrate, low-sodium diet, and a high protein intake may reduce some of the other bothersome symptoms.
A nurse is assigning beds to four new clients being admitted to the cardiac telemetry floor. Which client should she assign to the bed at the end of the hall, away from the nurses' station? 1. A 24-year-old client with unstable hyperthyroidism with sinus tachycardia 2. An 80-year-old client with sinus tachycardia who is confused and agitated 2 days after a prostatectomy 3. A 48-year-old client in sinus rhythm transferring from intensive care unit 3 days after coronary artery bypass grafting (CABG) 4. A 38-year-old client with mitral valve prolapse in sinus rhythm who is newly diagnosed with diabetes
Correct response: A 24-year-old client with unstable hyperthyroidism with sinus tachycardia Explanation: The client with hyperthyroidism is probably irritable and anxious and needs uninterrupted rest. The nurse should assign him to a quiet room away from the noise at the nurses' station. The client who had a CABG is most likely to develop an arrhythmia on his third postoperative day. The unstable client with diabetes mellitus could experience hypoglycemia or hyperglycemia and requires frequent monitoring of blood glucose levels. The elderly male is confused and agitated. The nurse should assign these three clients to beds as close to the nurses' station as possible.
A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience? 1. A decrease in appetite 2. A decrease in urine output 3. A decrease in blood pressure 4. A decrease in blood glucose levels
Correct response: A decrease in urine output Explanation: Desmopressin (DDAVP), a synthetic vasopressin without the vascular effects of natural ADH, is particularly valuable because it has a longer duration of action and fewer adverse effects than other preparations previously used to treat the disease. DDAVP and lypressin (Diapid) reduce urine output to 2 to 3 L/24 hours. It is administered intranasally; the patient sprays the solution into the nose through a flexible calibrated plastic tube. One or two administrations daily (i.e., every 12 to 24 hours) usually control the symptoms (Papadakis, McPhee, & Rabow, 2013). Vasopressin causes vasoconstriction; thus, it must be used cautiously in patients with coronary artery disease.
A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience? 1. A decrease in blood pressure 2. A decrease in appetite 3. A decrease in blood glucose levels 4. A decrease in urine output
Correct response: A decrease in urine output Explanation: Desmopressin (DDAVP), a synthetic vasopressin without the vascular effects of natural ADH, is particularly valuable because it has a longer duration of action and fewer adverse effects than other preparations previously used to treat the disease. DDAVP and lypressin (Diapid) reduce urine output to 2 to 3 L/24 hours. It is administered intranasally; the patient sprays the solution into the nose through a flexible calibrated plastic tube. One or two administrations daily (i.e., every 12 to 24 hours) usually control the symptoms (Papadakis, McPhee, & Rabow, 2013). Vasopressin causes vasoconstriction; thus, it must be used cautiously in patients with coronary artery disease.
The nurse is reviewing a client's laboratory studies and determines that the client has an elevated calcium level. What does the nurse know will occur as a result of the rise in the serum calcium level? 1. A rise in serum calcium stimulates the release of T lymphocytes. 2. A rise in serum calcium stimulates the release of erythropoietin. 3. A rise in serum calcium inhibits the release of calcitonin. 4. A rise in serum calcium stimulates the release of calcitonin from the thyroid gland.
Correct response: A rise in serum calcium stimulates the release of calcitonin from the thyroid gland. Explanation: Calcitonin, another thyroid hormone, inhibits the release of calcium from bone into the extracellular fluid. A rise in the serum calcium level stimulates the release of calcitonin from the thyroid gland.
A nurse understands that for the parathyroid hormone to exert its effect, what must be present? 1. Decreased phosphate level 2. Increased calcium level 3. Functioning thyroid gland 4. Adequate vitamin D level
Correct response: Adequate vitamin D level Explanation: Adequate vitamin D must be present for parathyroid hormone to help regulate calcium metabolism. Vitamin D promotes calcium absorption from the intestines.
After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate? 1. Administer an oral calcium supplement as ordered. 2. Start administering oxygen at 2 L/min via a cannula. 3. Administer a sedative as ordered. 4. Administer IV calcium gluconate as ordered.
Correct response: Administer IV calcium gluconate as ordered. Explanation: When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered.
Which of the following hormones controls secretion of adrenal androgens? 1. Adrenocorticotropic hormone (ACTH) 2. Thyroid-stimulating hormone (TSH) 3. Calcitonin 4. Parathormone
Correct response: Adrenocorticotropic hormone (ACTH) Explanation: ACTH controls the secretion of adrenal androgens. When secreted in normal amounts, the adrenal androgens appear to have little effect, but when secreted in excess, as in certain inborn enzyme deficiencies, masculinization may result. The secretion of T3 and T4 by the thyroid gland is controlled by TSH. Parathormone regulates calcium and phosphorous metabolism. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.
Which type of cell secretes glucagon and promotes gluconeogenesis? 1. Alpha 2. Omega 3. Beta 4. Delta
Correct response: Alpha Explanation: The alpha cells of the pancreas secret the hormone glucagon. It promotes gluconeogenesis, thus increasing the blood glucose level. The beta cells of the pancreas secrete insulin. Delta cells secrete somatostatin, which reduces the rate at which food is absorbed from the gastrointestinal tract.
Which type of cell secretes glucagon and promotes gluconeogenesis? 1. Beta 2. Alpha 3. Delta 4. Omega
Correct response: Alpha Explanation: The alpha cells of the pancreas secret the hormone glucagon. It promotes gluconeogenesis, thus increasing the blood glucose level. The beta cells of the pancreas secrete insulin. Delta cells secrete somatostatin, which reduces the rate at which food is absorbed from the gastrointestinal tract.
A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder? 1. Complaints of nausea 2. Blood pressure varying between 120/86 and 240/130 mm Hg 3. Shivering 4. Heart rate of 56-64 bpm
Correct response: Blood pressure varying between 120/86 and 240/130 mm Hg Explanation: Hypertension associated with pheochromocytoma may be intermittent or persistent. Blood pressures exceeding 250/150 mm Hg have been recorded. Such blood pressure elevations are life threatening and can cause severe complications, such as cardiac dysrhythmias, dissecting aneurysm, stroke, and acute kidney failure.
A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder? 1. Complaints of nausea 2. Shivering 3. Blood pressure varying between 120/86 and 240/130 mm Hg 4. Heart rate of 56-64 bpm
Correct response: Blood pressure varying between 120/86 and 240/130 mm Hg Explanation: Hypertension associated with pheochromocytoma may be intermittent or persistent. Blood pressures exceeding 250/150 mm Hg have been recorded. Such blood pressure elevations are life threatening and can cause severe complications, such as cardiac dysrhythmias, dissecting aneurysm, stroke, and acute kidney failure.
When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted: 1. Phosphorus 2. Thyroxine 3. Parathyroid 4. Calcitonin
Correct response: Calcitonin Explanation: Calcitonin, secreted in response to high plasma levels of calcium, reduces the calcium level by increasing its deposition in the bone.
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany? 1. Tapazole 2. Synthroid 3. Propylthiouracil (PTU) 4. Calcium gluconate
Correct response: Calcium gluconate Explanation: Sometimes in thyroid surgery, the parathyroid glands are removed, producing a disturbance in calcium metabolism. Tetany is usually treated with IV calcium gluconate. Synthroid is used in the treatment of hypothyroidism. PTU and Tapazole are used in the treatment of hyperthyroidism.
Trousseau's sign is elicited by which of the following? 1. The patient complains of pain in the calf when his foot is dorsiflexed. 2. Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. 3. After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery. 4. A sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye.
Correct response: Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. Explanation: A positive Trousseau's sign is suggestive of latent tetany. A positive Chvostek's sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. A positive Allen's test is demonstrated by the palm remaining blanched with the radial artery occluded. A positive Homans' sign is demonstrated when the patient complains of pain in the calf when his foot is dorsiflexed.
A pheochromocytoma is a rare adrenal tumor that causes increased heart rate, blood pressure, and metabolism because of increased levels of circulating: 1. Aldosterone. 2. Catecholamines. 3. Glucocorticoids. 4. Cortisol.
Correct response: Catecholamines. Explanation: A pheochromocytoma releases high levels of the catecholamines epinephrine and norepinephrine. These levels directly affect the incidence and severity of side effects such as headache, diaphoresis, palpitations, and hypertension. Blood pressure readings exceeding 250/150 have been recorded.
A pheochromocytoma is a rare adrenal tumor that causes increased heart rate, blood pressure, and metabolism because of increased levels of circulating: 1. Catecholamines. 2. Aldosterone. 3. Cortisol. 4. Glucocorticoids.
Correct response: Catecholamines. Explanation: A pheochromocytoma releases high levels of the catecholamines epinephrine and norepinephrine. These levels directly affect the incidence and severity of side effects such as headache, diaphoresis, palpitations, and hypertension. Blood pressure readings exceeding 250/150 have been recorded.
A pheochromocytoma is a rare adrenal tumor that causes increased heart rate, blood pressure, and metabolism because of increased levels of circulating: 1. Cortisol. 2. Catecholamines. 3. Aldosterone. 4. Glucocorticoids.
Correct response: Catecholamines. Explanation: A pheochromocytoma releases high levels of the catecholamines epinephrine and norepinephrine. These levels directly affect the incidence and severity of side effects such as headache, diaphoresis, palpitations, and hypertension. Blood pressure readings exceeding 250/150 have been recorded.
Which diagnostic test is done to determine a suspected pituitary tumor? 1. Measuring blood hormone levels 2. Radiography of the abdomen 3. Radioimmunoassay 4. Computed tomography
Correct response: Computed tomography Explanation: CT or magnetic resonance imaging is used to diagnose the presence and extent of pituitary tumors.
What interventions can the nurse encourage the client with diabetes insipidus to do in order to control thirst and compensate for urine loss? 1. Limit the fluid intake at night. 2. Consume adequate amounts of fluid. 3. Weigh daily. 4. Come to the clinic for IV fluid therapy daily.
Correct response: Consume adequate amounts of fluid. Explanation: The nurse teaches the client to consume sufficient fluid to control thirst and to compensate for urine loss. The client will not be required to come in daily for IV fluid therapy. The client should not limit fluid intake at night if thirst is present. Weighing daily will not control thirst or compensate for urine loss.
Undersecretion of thyroid hormone during fetal and neonatal development can cause which of the following? 1. Myxedema 2. Diabetes insipidus 3. Hypothyroidism 4. Cretinism
Correct response: Cretinism Explanation: During fetal and neonatal development, undersecretion of thyroid hormone may cause cretinism (stunted growth and mental development). In adults, hyposecretion of thyroid hormone causes myxedema or hypothyroidism. Diabetes insipidus is caused by undersecretion of antidiuretic hormone (ADH/vasopressin).
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? 1. Impaired physical mobility 2. Decreased cardiac output 3. Imbalanced nutrition: Less than body requirements 4. Risk for infection
Correct response: Decreased cardiac output Explanation: An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse. The client with Addison's disease is at risk for infection; however, reducing infection isn't a priority during an addisonian crisis. Impaired physical mobility and Imbalanced nutrition: Less than body requirements are appropriate nursing diagnoses for the client with Addison's disease, but they aren't priorities in a crisis.
A client with a traumatic brain injury is producing an abnormally large volume of dilute urine. Which alteration to a hormone secreted by the posterior pituitary would the nurse expect to find? 1. Increased oxytocin 2. A deficient amount of somatostatin 3. Increased antidiuretic hormone 4. Deficient production of vasopressin
Correct response: Deficient production of vasopressin Explanation: The most common disorder related to posterior lobe dysfunction is diabetes insipidus, a condition in which abnormally large volumes of dilute urine are excreted as a result of deficient production of vasopressin. Diabetes insipidus may occur following surgical treatment of a brain tumor, secondary to nonsurgical brain tumors, and traumatic brain injury.
During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in which of the following? 1. Determining the presence or absence of testosterone levels 2. Detecting information about possible tumor growth 3. Determining the size of the organs and location 4. Detecting evidence of hormone hypersecretion
Correct response: Detecting evidence of hormone hypersecretion Explanation: The evaluation of body structures helps the nurse detect evidence of hypersecretion or hyposecretion of hormones. This helps in the assessment of findings that are unique to specific endocrine glands. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and its location.
The nurse obtains a complete family history of a client with a suspected endocrine disorder based on which rationale? 1. An allergy to iodine is inherited. 2. It helps determine the client's general status. 3. Endocrine disorders can be inherited. 4. Diet and drug histories are related to the family history.
Correct response: Endocrine disorders can be inherited. Explanation: Some endocrine disorders are inherited or have a tendency to run in families. Therefore, it is essential to take a complete family history. A complete blood count and chemistry profile are performed to determine the client's general status and to rule out disorders. Obtaining information about an allergy to iodine is important because diagnostic testing may involve the use of contrast dyes. However, an allergy to iodine is not related to endocrine disorders. Diet and drug histories, although important information, are not associated with the family history.
A group of students is reviewing material about endocrine system function. The students demonstrate understanding of the information when they identify which of the following as secreted by the adrenal medulla? 1. Glucagon 2. Glucocorticoids 3. Epinephrine 4. Mineralocorticoids
Correct response: Epinephrine Explanation: The adrenal medulla secretes epinephrine and norepinephrine. The adrenal cortex manufactures and secretes glucocorticoids, mineralocorticoids, and small amounts of androgenic sex hormones. Glucagon is released by the pancreas.
A group of students is reviewing material about endocrine system function. The students demonstrate understanding of the information when they identify which of the following as secreted by the adrenal medulla? 1. Glucagon 2. Mineralocorticoids 3. Glucocorticoids 4. Epinephrine
Correct response: Epinephrine Explanation: The adrenal medulla secretes epinephrine and norepinephrine. The adrenal cortex manufactures and secretes glucocorticoids, mineralocorticoids, and small amounts of androgenic sex hormones. Glucagon is released by the pancreas.
A nurse should perform which intervention for a client with Cushing's syndrome? 1. Offer clothing or bedding that's cool and comfortable. 2. Suggest a high-carbohydrate, low-protein diet. 3. Explain that the client's physical changes are a result of excessive corticosteroids. 4. Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather.
Correct response: Explain that the client's physical changes are a result of excessive corticosteroids. Explanation: The nurse should explain to the client that Cushing's syndrome causes physical changes related to excessive corticosteroids. Clients with hyperthyroidism, not Cushing's syndrome, are heat intolerant and must have cool clothing and bedding. Clients with Cushing's syndrome should have a high-protein, not low-protein, diet. Clients with Addison's disease must increase sodium intake and fluid intake in times of stress of prevent hypotension.
A nurse is caring for a client with suspected diabetes insipidus. Which test does the nurse anticipate the physician will order to confirm the diagnosis? 1. Capillary blood glucose test 2. Fluid deprivation test 3. Urine glucose test 4. Serum ketone test
Correct response: Fluid deprivation test Explanation: The fluid deprivation test involves withholding water for 4 to 18 hours and periodically checking urine and plasma osmolarity. A client with diabetes insipidus will have an increased serum osmolarity of less than 300 mOsm/kg. Urine osmolarity won't increase. The capillary blood glucose test rapidly measures glucose level in whole blood. The serum ketone test is used to diagnose diabetic ketoacidosis. The urine glucose test monitors glucose levels in urine; however, diabetes insipidus doesn't affect urine glucose levels, so this test isn't appropriate.
Which outcome indicates that treatment of a client with diabetes insipidus has been effective? 1. Blood pressure is 90/50 mm Hg. 2. Fluid intake is less than 2,500 ml/day. 3. Urine output measures more than 200 ml/hour. 4. Heart rate is 126 beats/minute.
Correct response: Fluid intake is less than 2,500 ml/day. Explanation: Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.
The nurse is reviewing a client's history which reveals that the client has had an oversecretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? 1. Acromegaly 2. Gigantism 3. Simmonds' disease 4. Dwarfism
Correct response: Gigantism Explanation: When oversecretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.
Which hormone would be responsible for increasing blood glucose levels by stimulating glycogenolysis? 1. Glucagon 2. Insulin 3. Somatostatin 4. Cholecystokinin
Correct response: Glucagon Explanation: Glucagon is a hormone released by the alpha islet cells of the pancreas that raises blood glucose levels by stimulating glycogenolysis (the breakdown of glycogen into glucose in the liver). Somatostatin is a hormone secreted by the delta islet cells that helps to maintain a relatively constant level of blood glucose by inhibiting the release of insulin and glucagons. Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises beyond normal limits. Cholecystokinin is released from the cells of the small intestine that stimulates contraction of the gall bladder to release bile when dietary fat is ingested.
The nurse is caring for a client with diabetes who developed hypoglycemia. What can the nurse administer to the client to raise the blood sugar level? 1. Glucagon 2. Cortisone 3. Estrogen 4. Insulin
Correct response: Glucagon Explanation: Glucagon, a hormone released by alpha islet cells, raises blood sugar levels by stimulating glycogenolysis, the breakdown of glycogen into glucose, in the liver. Insulin is released to lower the blood sugar levels. Cortisone and estrogen are not released from the pancreas.
A client with a history of Addison's disease and flu-like symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by IV infusion? 1. Hypotonic saline 2. Insulin 3. Potassium 4. Hydrocortisone
Correct response: Hydrocortisone Explanation: Emergency treatment for acute adrenal insufficiency (addisonian crisis) is IV infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic — saline solution.
A patient has been placed on corticosteroid therapy for an Addison's disease. The nurse should be aware of which of the following side effects with this type of therapy? Select all that apply. 1. Hypotension 2. Poor wound healing 3. Weight loss 4. Alterations in glucose metabolism 5. Hypertension
Correct response: Hypertension Alterations in glucose metabolism Poor wound healing Explanation: Side effects of corticosteroid therapy include hypertension, alterations in glucose metabolism, weight gain, and poor wound healing.
The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with? 1. Diabetes insipidus (DI) 2. Hyperthyroidism 3. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) 4. Hypothyroidism
Correct response: Hyperthyroidism Explanation: Clients with hyperthyroidism characteristically are restless despite felling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball. Neck swelling caused by the enlarged thyroid gland often is visible. Hypothyroidism clinical manifestations are the opposite of what is seen as hyperthyroidism. SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client.
The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with? 1. Hypothyroidism 2. Diabetes insipidus (DI) 3. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) 4. Hyperthyroidism
Correct response: Hyperthyroidism Explanation: Clients with hyperthyroidism characteristically are restless despite felling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball. Neck swelling caused by the enlarged thyroid gland often is visible. Hypothyroidism clinical manifestations are the opposite of what is seen as hyperthyroidism. SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client.
A client has experienced several autoimmune disorders over the last 25 years, and lately has developed a new set of symptoms. What assessments would the nurse expect to find with a client with suspected Addison disease? Select all that apply. 1. Depression 2. Weight gain 3. Hypotension 4. Increased appetite 5. Hypoglycemia
Correct response: Hypoglycemia Depression Hypotension Explanation: Addison disease is characterized by muscle weakness, anorexia, GI symptoms, fatigue, emaciation, hypotension, low blood glucose levels, low serum sodium levels, high serum potassium levels, and dark pigmentation of the mucous membranes and the skin, especially of the knuckles, knees, and elbows. Depression, emotional lability, apathy, and confusion may also be present.
The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes, a type of white blood cell involved in immunity. Which of the following best identifies the location of this gland? 1. Attached to the thalamus in the brain 2. In the upper part of the chest above or near the heart 3. Connected by a stalk to the hypothalamus in the brain 4. Positioned above the kidneys
Correct response: In the upper part of the chest above or near the heart Explanation: The thymus gland is located in the upper part of the chest above or near the heart. The pineal gland is attached to the thalamus, and the pituitary gland is connected by a stalk to the hypothalamus in the brain. The adrenal glands are located above the kidneys.
A patient is diagnosed with a deficiency in vasopressin, a posterior pituitary hormone. Therefore, a primary nursing responsibility is to assess for: 1. Indicators of hyponatremia. 2. Glycosuria 3. Serum calcium levels. 4. Indicators of dehydration.
Correct response: Indicators of dehydration. Explanation: A deficiency in vasopressin, also known as the antidiuretic hormone, would result in increased urinary output, thirst, and dehydration. No glucose is lost in the urine. Hypernatremia occurs with dehydration.
A client is experiencing an increase in blood glucose levels. The nurse understands that which of the following hormones would be important in lowering the client's blood glucose level? 1. Melatonin 2. Insulin 3. Calcitonin 4. Parathormone
Correct response: Insulin Explanation: Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises above normal limits. Parathormone increases the level of calcium in the blood when a decrease in serum calcium levels occurs. Melatonin aids in regulating sleep cycles and mood. Calcitonin is a thyroid hormone that inhibits the release of calcium from the bone into the extracellular fluid.
Which of the following would the nurse expect the physician to order for a client with hypothyroidism? 1. Methimazole 2. Levothyroxine sodium 3. Propranolol 4. Propylthiouracil
Correct response: Levothyroxine sodium Explanation: Hypothyroidism is treated with thyroid replacement therapy, in the form of desiccated thyroid extract or a synthetic product, such as levothyroxine sodium (Synthroid) or liothyronine sodium (Cytomel). Methimazole and propylthiouracil are antithyroid agents used to treat hyperthyroidism. Propranolol is a beta blocker that can be used to treat hyperthyroidism.
The nurse is caring for a client who has an excess amount of potassium being excreted and has a serum level of 6.2 mEq/L. What group of adrenal hormones is likely to be impacting the laboratory result? 1. Glucocorticoids 2. Mineralocorticoids 3. Testosterone 4. Estrogen
Correct response: Mineralocorticoids Explanation: Mineralocorticoids, primarily aldosterone, maintain water and electrolyte balances. The androgenic hormones convert to testosterone and estrogens. Glucocorticoids, such as cortisol, affect body metabolism, suppress inflammation, and help the body withstand stress.
A patient experiences a life-threatening hypercalcemic crisis. The provider orders a cytotoxic agent. Which of the following is most likely the drug that is prescribed? 1. Calcitonin 2. Aredia 3. Didronel 4. Mithramycin
Correct response: Mithramycin Explanation: Mitramycin is a cytotoxic agent commonly used in a hypercalcemic crisis. Didronel and Aredia are bisphosphonates that decrease serum calcium levels. Calcitonin can be ordered but it is not a cytotoxic agent.
A patient with a history of hypothyroidism is admitted to the intensive care unit unconscious and with a temperature of 95.2ºF. A family member informs the nurse that the patient has not taken thyroid medication in over 2 months. What does the nurse suspect that these findings indicate? 1. Diabetes insipidus 2. Syndrome of inappropriate antidiuretic hormone (SIADH) 3. Thyroid storm 4. Myxedema coma
Correct response: Myxedema coma Explanation: Myxedema coma is a rare life-threatening condition. It is the decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious (Ross, 2012a). This condition may develop with undiagnosed hypothyroidism and may be precipitated by infection or other systemic disease or by use of sedatives or opioid analgesic agents. Patients may also experience myxedema coma if they forget to take their thyroid replacement medication.
Which of the following assessments should the nurse perform to determine the development of peptic ulcers when caring for a patient with Cushing's syndrome? 1. Monitor bowel patterns. 2. Monitor vital signs every 4 hours. 3. Observe urine output. 4. Observe the color of stool.
Correct response: Observe the color of stool. Explanation: The nurse should observe the color of each stool and test the stool for occult blood. Bowel patterns, vital signs, and urine output do not help in determining the development of peptic ulcers.
An instructor is preparing a teaching plan for a class on the various pituitary hormones. Which hormone would the instructor include as being released by the posterior pituitary gland? 1. Oxytocin 2. Prolactin 3. Adrenocorticotropic hormone 4. Somatotropin
Correct response: Oxytocin Explanation: The posterior pituitary gland released oxytocin and antidiuretic hormone. Somatotropin, prolactin, and adrenocorticotropic hormone are released by the anterior pituitary gland.
Which medication is the treatment of choice for pregnant women diagnosed with hyperthyroidism? 1. PTU 2. SSKI 3. Potassium iodide 4. Methimazole
Correct response: PTU Explanation: Propylthiouracil (PTU), rather than methimazole (MMI), is the treatment of choice during pregnancy for those diagnosed with hyperthyroidism due to the teratogenic effects of MMI.
Vision and visual fields are altered in disorders of which of the following endocrine glands? 1, Parathyroid 2, Pituitary 3. Pancreas 4. Thyroid
Correct response: Pituitary Explanation: The pituitary gland is located close to the optic nerves and hence causes pressure on these nerves; thus, changes in the vision and the visual fields may occur.
The nurse assesses a patient who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease?
Correct response: Potassium of 6.0 mEq/L Explanation: Addison's disease is characterized by hypotension, low blood glucose, low serum sodium, and high serum potassium levels. The normal serum potassium level is 3.5 to 5 mEq/L.
A client with acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client? 1. Retinal detachment 2. Pressure on the optic nerve 3. Glaucoma 4. Corneal abrasions
Correct response: Pressure on the optic nerve Explanation: Partial blindness may result from pressure on the optic nerve. Glaucoma does not occur suddenly, and the client did not report injury to suspect corneal abrasions or retinal detachment.
A nurse is caring for a client with suspected hyperparathyroidism. Which condition may contribute to hyperparathyroidism? 1. Steroid use 2. Renal failure 3. Decreased serum calcium level 4. Thyroidectomy
Correct response: Renal failure Explanation: Kidney damage can result from the precipitation of calcium phosphate in the renal pelvis and parenchyma, which causes renal calculi (kidney stones), obstruction, pyelonephritis, and kidney injury. Parathyroid hormone release increases, causing hyperparathyroidism. Serum calcium level may rise as a result of hyperparathyroidism. Thyroidectomy may lead to hypoparathyroidism if the parathyroid is also removed during surgery. Steroid use causes calcium to leave bone, suppressing parathyroid hormone.
A nurse is caring for a client with suspected hyperparathyroidism. Which condition may contribute to hyperparathyroidism? 1. Thyroidectomy 2. Decreased serum calcium level 3. Renal failure 4. Steroid use
Correct response: Renal failure Explanation: Kidney damage can result from the precipitation of calcium phosphate in the renal pelvis and parenchyma, which causes renal calculi (kidney stones), obstruction, pyelonephritis, and kidney injury. Parathyroid hormone release increases, causing hyperparathyroidism. Serum calcium level may rise as a result of hyperparathyroidism. Thyroidectomy may lead to hypoparathyroidism if the parathyroid is also removed during surgery. Steroid use causes calcium to leave bone, suppressing parathyroid hormone.
A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? 1. Serum potassium level of 5.8 mEq/L 2. Serum sodium level of 134 mEq/L 3. Blood glucose level of 90 mg/dl 4. Blood urea nitrogen (BUN) level of 12 mg/dl
Correct response: Serum potassium level of 5.8 mEq/L Explanation: Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.
A client has a decreased level of thyroid hormone being excreted. What will the feedback loop do to maintain the level of thyroid hormone required to maintain homeostatic stability? 1. Stimulate more hormones using the positive feedback system 2. Stimulate more hormones using the negative feedback system 3. The feedback loop will be unable to perform in response to low levels of thyroid hormone. 4. Produce a new hormone to try and regulate the thyroid function
Correct response: Stimulate more hormones using the negative feedback system Explanation: Feedback can be either negative or positive. Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland.
Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects? 1. Respiratory effects 2. Gastrointestinal effects 3. Sympathetic 4. Parasympathetic
Correct response: Sympathetic Explanation: Beta-adrenergic blocking agents are important in controlling the sympathetic nervous system effects of hyperthyroidism. For example, propranolol is used to control nervousness, tachycardia, tremor, anxiety, and heat intolerance.
Dilutional hyponatremia occurs in which disorder? 1. Addison disease 2. Pheochromocytoma 3. Diabetes insipidus (DI) 4. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Correct response: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Explanation: Clients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.
Which of the following endocrine disorder causes the patient to have dilutional hyponatremia? 1. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) 2. Diabetes insipidus (DI) 3. Hyperthyroidism 4. Hypothyroidism
Correct response: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Explanation: Patients diagnosed with SIADH retain water and develop a subsequent sodium deficiency known as dilutional hyponatremia. In DI, there is excessive thirst and large volumes of dilute urine. Patients with DI, hypothyroidism, or hyperthyroidism do not exhibit dilutional hyponatremia
A nurse explains to a client with thyroid disease that the thyroid gland normally produces: 1. T3, thyroxine (T4), and calcitonin. 2. TSH, triiodothyronine (T3), and calcitonin. 3. iodine and thyroid-stimulating hormone (TSH). 4. thyrotropin-releasing hormone (TRH) and TSH.
Correct response: T3, thyroxine (T4), and calcitonin. Explanation: The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.
A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug? 1. Leg cramps 2. Blurred vision 3. Tachycardia 4. Dysuria
Correct response: Tachycardia Explanation: Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse reactions to this agent include tachycardia. Dysuria, leg cramps, and blurred vision aren't associated with levothyroxine.
A nurse is caring for a female client with hypothyroidism. The client is extremely upset about her altered physical appearance. She doesn't want to take her medication because she doesn't believe it's doing any good. What should the nurse do? 1. Tell the client she needs to learn to accept herself as she is and be compliant during treatment. 2. Tell the client she'll feel better if she consistently takes the thyroid replacement medication. 3. Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency. 4. Tell the client that she looks fine and offer to help her with makeup.
Correct response: Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency. Explanation: Telling the client that she'll soon experience improvement is supportive and encouraging and offers direction in a way that motivates her to take her medication consistently. Telling the client that she looks fine and that she'll soon feel better discount the feelings she's currently experiencing. Advising the client to accept
A nurse is reviewing a laboratory order for a client who is scheduled to be tested for a suspected endocrine disorder. The client was recently seen in the office for bronchitis, and you note that he is still taking cough medication. The nurse explains to the client that he will not be able to get his lab testing done today. Why has the testing been postponed? 1. The client is being tested for a pituitary disorder 2. The client is being tested for a thyroid disorder 3. The client is being tested for a parathyroid disorder 4. The client is being tested for a parathyroid disorder 5. The client is being tested for an adrenal disorder
Correct response: The client is being tested for a thyroid disorder Explanation: If a client has recently taken a drug that contains iodine (e.g., some cough medicines) or has had radiographic contrast studies that used iodine, thyroid test results may be inaccurate.
A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following? 1. The functioning of endocrine glands 2. Details about the size of the organ and its location 3. The client's blood sugar level 4. The concentration of a substance in plasma
Correct response: The functioning of endocrine glands Explanation: Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma. The measurement of blood hormone levels will not reveal a client's blood sugar level. Radiographs of the chest or abdomen determine the size of the organ and its location.
The nurse is attempting to locate the thyroid gland in order to determine if it is enlarged. Where should the nurse palpate the thyroid gland? 1. Distal to the carotid arteries 2. The lower neck anterior to the trachea 3. The upper neck posterior to the trachea 4. Mid trachea
Correct response: The lower neck anterior to the trachea Explanation: The thyroid gland is located in the lower neck anterior to the trachea. It is divided into two lateral lobes joined by a band of tissue called the isthmus.
The nurse auscultates a bruit over the thyroid glands. What does the nurse understand is the significance of this finding? 1. The patient may have hypothyroidism. 2. The patient may have thyroiditis. 3. The patient may have Cushing disease. 4. The patient may have hyperthyroidism.
Correct response: The patient may have hyperthyroidism. Explanation: If palpation discloses an enlarged thyroid gland, both lobes are auscultated using the diaphragm of the stethoscope. Auscultation identifies the localized audible vibration of a bruit. This is indicative of increased blood flow through the thyroid gland associated with hyperthyroidism and necessitates referral to a physician.
Which group of clients should not receive potassium iodide? 1. Those who are pregnant 2. Those taking medications such as cough medicines 3. Those who are allergic to seafood 4. Those who are allergic to corticosteroids
Correct response: Those who are allergic to seafood Explanation: Potassium iodide should not be administered to anyone who is allergic to seafood, which is also high in iodine. Clients who take corticosteroids or cough medicines and those who are pregnant would be appropriate candidates for potassium iodide therapy.
A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside? 1. Cardiac monitor 2. Tracheostomy set 3. Indwelling urinary catheter kit 4. Humidifier
Correct response: Tracheostomy set Explanation: After a subtotal thyroidectomy, swelling of the surgical site (the tracheal area) may obstruct the airway. Therefore, the nurse should keep a tracheostomy set at the client's bedside in case of a respiratory emergency. Although an indwelling urinary catheter and a cardiac monitor may be used for a client after a thyroidectomy, the tracheostomy set is more important. A humidifier isn't indicated for this client.
A client with thyroiditis has undergone surgery and is concerned about the barely visible scar. Which suggestion should the nurse give the client to cope with the condition? 1. Undergo a skin graft 2. Apply medicines to remove the scar 3. Consider cosmetic surgery 4. Wear clothing that covers the neck
Correct response: Wear clothing that covers the neck Explanation: The nurse may suggest that the client wear clothing that covers the neck and assure the client that the scar is almost invisible. Application of medicines, skin graft, and cosmetic surgery are not appropriate suggestions.
A nurse working in the ED at a level 1 trauma center is notified that casualties from a multivehicle car accident are currently in transit. The nurse's heart is pounding and mouth is dry. What gland is responsible for this nurse's physiologic response? 1. adrenal cortex 2. pineal gland 3. adrenal medulla 4. thyroid gland
Correct response: adrenal medulla Explanation: The adrenal medulla secretes epinephrine and norepinephrine. These two hormones are released in response to stress or threat to life. They facilitate what has been referred to as the fight-or-flight response.
A client has been experiencing a decrease in serum calcium. After diagnostics, the physician proposes the calcium level fluctuation is due to altered parathyroid function. What is the typical number of parathyroid glands? 1. two 2. four 3. one 4. three
Correct response: four Explanation: The parathyroid glands are four (some people have more than four) small, bean-shaped bodies, each surrounded by a capsule of connective tissue and embedded within the lateral lobes of the thyroid.
A client presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What could be causing this client's symptoms? 1. panhypopituitarism 2. panhyperpituitarism 3. hypopituitarism 4. hyperpituitarism
Correct response: hyperpituitarism Explanation: Acromegaly (hyperpituitarism) is a condition in which growth hormone is oversecreted after the epiphyses of the long bones have sealed. A client with acromegaly has coarse features, a huge lower jaw, thick lips, a thickened tongue, a bulging forehead, a bulbous nose, and large hands and feet. When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica are common.
A client has been experiencing a decrease in serum calcium. After diagnostics, the physician believes the calcium level fluctuation is due to altered parathyroid function. What is the role of parathormone? 1. decrease serum calcium level 2. increase serum calcium level 3. promote urinary secretion of calcium 4. inhibit release of calcium into extracellular fluid
Correct response: increase serum calcium level Explanation: The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level.
Although not designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones involved in increasing blood pressure and volume and maturation of red blood cells? 1. liver 2. brain 3. cardiac atria 4. kidneys
Correct response: kidneys Explanation: The kidneys release renin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys also secrete erythropoietin, a substance that promotes the maturation of red blood cells.
A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of: 1. profound neuromuscular irritability. 2. excessive thirst. 3. severe hypotension. 4. acute gastritis.
Correct response: profound neuromuscular irritability. Explanation: Hypoparathyroidism may slow bone resorption, reduce the serum calcium level, and cause profound neuromuscular irritability (as evidenced by tetany). Hypoparathyroidism doesn't alter blood pressure or affect the thirst mechanism, which usually is triggered by fluid volume deficit. Gastritis doesn't cause or result from hypoparathyroidism.
A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of: 1. chloride and magnesium abnormalities. 2. sodium and potassium abnormalities. 3. calcium and phosphorus abnormalities. 4. sodium and chloride abnormalities.
Correct response: sodium and potassium abnormalities. Explanation: In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes directly.
A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of: 1. sodium and potassium abnormalities. 2. chloride and magnesium abnormalities. 3. sodium and chloride abnormalities. 4. calcium and phosphorus abnormalities.
Correct response: sodium and potassium abnormalities. Explanation: In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes directly.
A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering: 1. potassium chloride. 2. furosemide. 3. insulin. 4. vasopressin.
Correct response: vasopressin. Explanation: Vasopressin is given subcutaneously to manage diabetes insipidus. Insulin is used to manage diabetes mellitus. Furosemide causes diuresis. Potassium chloride is given for hypokalemia.
A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering: 1. vasopressin. 2. insulin. 3. potassium chloride. 4. furosemide.
Correct response: vasopressin. Explanation: Vasopressin is given subcutaneously to manage diabetes insipidus. Insulin is used to manage diabetes mellitus. Furosemide causes diuresis. Potassium chloride is given for hypokalemia.
A nurse is aware that several laboratory results are present in a patient diagnosed with diabetes insipidus. Select all that apply. 1. Urine osmolality of 800 mOsm/kg 2. Serum osmolality of 310 mOsm/kg 3. Urine specific gravity of 1.001 4. Serum ADH level of 2.3 pg/mL 5. Serum sodium level of 149 mEq/L
Correct Answer: Urine specific gravity of 1.001 Serum osmolality of 310 mOsm/kg Serum sodium level of 155
A patient has been diagnosed with Cushing's syndrome. The nurse would expect which of the following features to be present upon physical examination? Select all that apply. 1. Purple striae 2. Truncal obesity 3. Thin extremities 4. "Buffalo hump" 5. "Moon face"
Correct response: "Buffalo hump" Thin extremities "Moon face" Truncal obesity Purple striae Explanation: Manifestations of Cushing's syndrome (excessive adrenocortical hormones may cause "moon face," "buffalo hump," thinning of the skin, obesity of the trunk and thinness of the extremities, and purple striae.
A nurse is teaching a client recovering from addisonian crisis about the need to take fludrocortisone acetate and hydrocortisone at home. Which statement by the client indicates an understanding of the instructions? 1. "I'll take the entire dose at bedtime." 2. "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." 3. "I'll take my hydrocortisone in the late afternoon, before dinner." "4. I'll take all of my hydrocortisone in the morning, right after I wake up."
Correct response: "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." Explanation: Hydrocortisone, a glucocorticoid, should be administered according to a schedule that closely reflects the body's own secretion of this hormone; therefore, two-thirds of the dose of hydrocortisone should be taken in the morning and one-third in the late afternoon. This dosage schedule reduces adverse effects.
A nurse is teaching a client recovering from addisonian crisis about the need to take fludrocortisone acetate and hydrocortisone at home. Which statement by the client indicates an understanding of the instructions? 1. "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." 2. "I'll take all of my hydrocortisone in the morning, right after I wake up." 3. "I'll take my hydrocortisone in the late afternoon, before dinner." 4. "I'll take the entire dose at bedtime."
Correct response: "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." Explanation: Hydrocortisone, a glucocorticoid, should be administered according to a schedule that closely reflects the body's own secretion of this hormone; therefore, two-thirds of the dose of hydrocortisone should be taken in the morning and one-third in the late afternoon. This dosage schedule reduces adverse effects.
A patient has been diagnosed with Cushing's syndrome. The nurse would expect which of the following features to be present upon physical examination? Select all that apply. 1. "Moon face" 2. "Buffalo hump" 3. Purple striae 4. Truncal obesity 5. Thin extremities
Correct response: - "Buffalo hump" - Thin extremities - "Moon face" - Truncal obesity - Purple striae Explanation: Manifestations of Cushing's syndrome (excessive adrenocortical hormones may cause "moon face," "buffalo hump," thinning of the skin, obesity of the trunk and thinness of the extremities, and purple striae.
The nurse is conducting discharge education with a client newly diagnosed with Addison's disease. Which information should be included in the client and family teaching plan? Select all that apply. 1. Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. 2. A medical identification bracelet should be worn. 3. Addison's disease will resolve over a few weeks, requiring no further treatment. 4. Dental work or surgery will require adjustment of daily medication. 5. Family members need to be informed about the warning signals of adrenal crisis. 6. Fatigue, weakness, dizziness, and mood changes need to be reported to the health care provider (HCP).
Correct response: - Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. - Fatigue, weakness, dizziness, and mood changes need to be reported to the health care provider (HCP). - A medical identification bracelet should be worn. - Family members need to be informed about the warning signals of adrenal crisis. - Dental work or surgery will require adjustment of daily medication. Explanation: Addison's disease occurs when the client does not produce enough steroids from the adrenal cortex. Lifetime steroid replacement is needed. The client should be taught lifestyle management techniques to avoid stress and maintain rest periods. A medical identification bracelet should be worn, and the family should be taught signs and symptoms that indicate an impending adrenal crisis, such as fatigue, weakness, dizziness, or mood changes. Dental work, infections, and surgery commonly require an adjusted dosage of steroids.
Antithyroid medications are contraindicated in late pregnancy due to the fact that which of the following may occur? Select all that apply. 1. Cretinism 2. Fetal bradycardia 3. Fetal tachycardia 4. Goiter 5. Fetal hypothyroidism
Correct response: - Fetal hypothyroidism - Fetal bradycardia - Goiter - Cretinism Explanation: Antithyroid medications are contraindicated in late pregnancy because the fetus may develop fetal hypothyroidism, fetal bradycardia, goiter, and cretinism.
Antithyroid medications are contraindicated in late pregnancy due to the fact that which of the following may occur? Select all that apply. 1. Goiter 2. Fetal hypothyroidism 3. Cretinism 4. Fetal tachycardia 5. Fetal bradycardia
Correct response: - Fetal hypothyroidism - Fetal bradycardia - Goiter - Cretinism Explanation: Antithyroid medications are contraindicated in late pregnancy because the fetus may develop fetal hypothyroidism, fetal bradycardia, goiter, and cretinism.
Which are correct statements about the relationship between the hypothalamus and the pituitary gland? Select all that apply. 1. The pituitary gland is called the master gland because it regulates the function of the hypothalamus and other endocrine glands. 2. The hypothalamus is called the master gland because it regulates the function of the pituitary gland. 3. Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain. 4. Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones.
Correct response: - Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain. - Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones. Explanation: Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain. Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones. Even though the pituitary gland is called the 'master gland,' the hypothalamus influences the pituitary gland. The pituitary gland is called the 'master gland' because it regulates the function of other endocrine glands.
A client visiting the clinic is scheduled for an outpatient thyroid scan in 2 weeks. Which instructions should the nurse include to ensure that this client is prepared for the test? Select all that apply. 1. Do not consume any food or fluids after midnight on the night before the scan. 2. Do not take prescribed thyroid medication until the results of the scan are known. 3. Stop using iodized salt or iodized salt substitutes 1 week before the scan. 4. Maintain bed rest for 24 hours after the scan. 5. Stop eating seafood 1 week before the scan. 6. Do not take any prescribed thyroid medication on the day of the scan.
Correct response: - Stop using iodized salt or iodized salt substitutes 1 week before the scan. - Stop eating seafood 1 week before the scan. - Do not take any prescribed thyroid medication on the day of the scan. Explanation: A thyroid scan visualizes the distribution of radioactive dye in the thyroid gland. Interventions before the scan include stopping the ingestion of iodine, which is found in iodized salt, salt substitutes, and seafood. The client should also be instructed not to take thyroid medication because it may interfere with the scan. The client does not have to refrain from consuming food or fluids after midnight if the scan is done on an outpatient basis. The radioactive dye is administered intravenously. Routinely prescribed medications can be taken after the scan. Bed rest is maintained with a thyroid biopsy, not a scan.
A client is being discharged after having a thyroidectomy. Which discharge instructions are appropriate for this client? Select all that apply. 1. Take thyroid replacement medication, as ordered. 2. Avoid over-the-counter medications. 3. Recognize the signs of dehydration. 4. Report any signs and symptoms of hypoglycemia. 5. Watch for changes in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry skin. Report them to the physician. 6. Carry injectable dexamethasone at all times.
Correct response: - Take thyroid replacement medication, as ordered. - Watch for changes in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry skin. - Report them to the physician. Explanation: After removal of the thyroid gland, the client needs to take thyroid replacement medication. The client needs to report to the physician changes in body functioning, such as lethargy, restlessness, cold sensitivity, and dry skin. These changes may indicate the need to increase the medication dose. The thyroid gland does not regulate the serum glucose level; therefore, the client would not need to recognize the signs and symptoms of hypoglycemia. Dehydration is seen in diabetes insipidus. A client with Addison's disease should avoid over-the-counter medications and carry injectable dexamethasone.
A client who suffered a brain injury after falling off a ladder has recently developed syndrome of inappropriate antidiuretic hormone (SIADH). Which findings indicate that the treatment being received for SIADH is effective? Select all that apply. 1. absence of wheezing 2. increase in urine output 3. decrease in body weight 4. rise in blood pressure and drop in heart rate 5. decrease in urine osmolarity
Correct response: - decrease in body weight - increase in urine output - decrease in urine osmolarity Explanation: SIADH is an abnormality involving an excessive release of ADH. The predominant feature is water retention with oliguria, edema, and weight gain. Successful treatment would result in a reduction in weight, increased urine output, and a decrease in urine osmolarity (concentration). Wheezes are not typically associated with SIADH. The client's blood pressure would remain the same or decrease after treatment.
A client diagnosed with hypothyroidism (myxedema) is receiving levothyroxine. Which assessment findings would require a nursing intervention? Select all that apply. 1. dysuria 2. heart rate of 132 beats/min 3. adventitious breath sounds 4. dysrhythmias 5. mild chest pain
Correct response: - mild chest pain - dysrhythmias - heart rate of 132 beats/min Explanation: Levothyroxine (thyroid hormone replacement medication) increases cardiac demand, which can cause increased heart rate, palpitations, and chest pain. These clients are at risk for a myocardial infarction. Adventitious breath sounds are abnormal, extra sounds, but are not related to receiving levothyroxine. Dysuria means painful urination and is not a side effect of levothyroxine.
The nurse is caring for a client with Cushing's disease. During change of shift report, which assessment laboratory data would the nurse anticipate communicating? Select all that apply. 1. white blood cell count 2. serum sodium level 3. hemoglobin and hematocrit 4. blood glucose level 5. serum potassium level 6. creatinine clearance total
Correct response: - serum sodium level - serum potassium level - blood glucose level - white blood cell count Explanation: Cushing's disease results in an excess cortisol in the blood typically caused by a pituitary tumor secreting adrenocorticotropic hormone (ACTH). ACTH stimulates the adrenal glands to produce cortisol. Cortisol is important in controlling blood pressure and metabolism. Electrolyte disturbance is common for the nurse to report. Sodium retention is typically accompanied by potassium depletion. Clients exhibit frequent hyperglycemia. The white blood cell count is commonly elevated because of an increased number of neutrophils. There is no impact of the hemoglobin or hematocrit or kidney function.
A patient experiences a life-threatening hypercalcemic crisis. The provider orders a cytotoxic agent. Which of the following is most likely the drug that is prescribed? 1. Calcitonin 2. Didronel 3. Aredia 4. Mithramycin
Correct response: 5:00 PM Explanation: An overnight dexamethasone suppression test is used to diagnose pituitary and adrenal causes of Cushing syndrome. It can be performed on an outpatient basis. Dexamethasone is administered orally late in the evening or at bedtime, and a plasma cortisol concentration is measured at 8 AM the next day. However, in a client who sleeps during the day, the medication would be given before bed and the plasma concentration would be measured soon after awakening in the late afternoon.
The physician has ordered an outpatient dexamethasone suppression test to diagnose the cause of Cushing syndrome in a client who works at night, from 11:00 PM to 7:00 AM, and normally sleeps from 8:00 AM to 4:00 PM. The client has been given the dexamethasone. To ensure the most reliable test results, the nurse arranges for the plasma cortisol concentration to be tested at which time? 1. 8:00 PM 2. 8:00 AM 3. 5:00 PM 4. 12:00 PM
Correct response: 5:00 PM Explanation: An overnight dexamethasone suppression test is used to diagnose pituitary and adrenal causes of Cushing syndrome. It can be performed on an outpatient basis. Dexamethasone is administered orally late in the evening or at bedtime, and a plasma cortisol concentration is measured at 8 AM the next day. However, in a client who sleeps during the day, the medication would be given before bed and the plasma concentration would be measured soon after awakening in the late afternoon.
A nurse is assigning beds to four new clients being admitted to the cardiac telemetry floor. Which client should she assign to the bed at the end of the hall, away from the nurses' station? 1. A 38-year-old client with mitral valve prolapse in sinus rhythm who is newly diagnosed with diabetes 2. A 48-year-old client in sinus rhythm transferring from intensive care unit 3 days after coronary artery bypass grafting (CABG) 3. A 24-year-old client with unstable hyperthyroidism with sinus tachycardia 4. An 80-year-old client with sinus tachycardia who is confused and agitated 2 days after a prostatectomy
Correct response: A 24-year-old client with unstable hyperthyroidism with sinus tachycardia Explanation: The client with hyperthyroidism is probably irritable and anxious and needs uninterrupted rest. The nurse should assign him to a quiet room away from the noise at the nurses' station. The client who had a CABG is most likely to develop an arrhythmia on his third postoperative day. The unstable client with diabetes mellitus could experience hypoglycemia or hyperglycemia and requires frequent monitoring of blood glucose levels. The elderly male is confused and agitated. The nurse should assign these three clients to beds as close to the nurses' station as possible.
A nurse is assigning beds to four new clients being admitted to the cardiac telemetry floor. Which client should she assign to the bed at the end of the hall, away from the nurses' station? 1. A 48-year-old client in sinus rhythm transferring from intensive care unit 3 days after coronary artery bypass grafting (CABG) 2. An 80-year-old client with sinus tachycardia who is confused and agitated 2 days after a prostatectomy 3. A 38-year-old client with mitral valve prolapse in sinus rhythm who is newly diagnosed with diabetes 4. A 24-year-old client with unstable hyperthyroidism with sinus tachycardia
Correct response: A 24-year-old client with unstable hyperthyroidism with sinus tachycardia Explanation: The client with hyperthyroidism is probably irritable and anxious and needs uninterrupted rest. The nurse should assign him to a quiet room away from the noise at the nurses' station. The client who had a CABG is most likely to develop an arrhythmia on his third postoperative day. The unstable client with diabetes mellitus could experience hypoglycemia or hyperglycemia and requires frequent monitoring of blood glucose levels. The elderly male is confused and agitated. The nurse should assign these three clients to beds as close to the nurses' station as possible.
The following clients are scheduled for thyroid testing. Which client would be at greatest risk for inaccurate results? 1. A client who avoids kelp 2. A client who received corticosteroids 4 months ago 3. A client diagnosed with low blood sugar 4. A client who was given salicylates last month
Correct response: A client who was given salicylates last month Explanation: Drugs such as salicylates and corticosteroids affect the results of thyroid tests if taken within past 3 months. Therefore, inaccurate thyroid test results will be obtained for the client who was given salicylates last month but not for the client who was administered corticosteroids 4 months ago. Kelp is high in iodine, which affects the thyroid test results. However, this factor will not affect the results of the thyroid test for a client avoiding kelp. A client's history of low blood sugar will not affect thyroid test results.
When thyroid hormone is administered for prolonged hypothyroidism for a patient, what should the nurse monitor for? 1. Angina 2. Depression 3. Hypoglycemia 4. Mental confusion
Correct response: Angina Explanation: Angina or dysrhythmias can occur when thyroid replacement is initiated because thyroid hormones enhance the cardiovascular effects of catecholamines.
A nurse is caring for a client recovering from a hypophysectomy. What would be included in the client's care plan? Select all that apply. 1. Offer the client a straw when drinking liquids. 2. Encourage deep breathing and coughing. 3. Assess for neurologic changes. 4. Closely monitor nasal packing and postnasal drainage.
Correct response: Assess for neurologic changes. Closely monitor nasal packing and postnasal drainage. Explanation: The client undergoes frequent neurologic assessments to detect signs of increased intracranial pressure and meningitis. The nurse monitors drainage from the nose and postnasal drainage for the presence of cerebrospinal fluid. The client is advised to avoid drinking from a straw, sneezing, coughing, and bending over to prevent dislodging the graft that seals the operative area between the cranium and nose.
During the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently? 1. Weigh the client. 2. Administer oral hydrocortisone. 3. Assess vital signs. 4. Test urine for ketones.
Correct response: Assess vital signs. Explanation: Because the client in addisonian crisis is unstable, vital signs and fluid and electrolyte balance should be assessed every 30 minutes until he's stable. Daily weights are sufficient when assessing the client's condition. The client shouldn't have ketones in his urine, so there is no need to assess the urine for their presence. Oral hydrocortisone isn't administered during the first 24 hours in severe adrenal insufficiency.
Which symptom of thyroid disease is seen in older adults? 1. Weight gain 2. Atrial fibrillation 3. Hyperactivity 4. Restlessness
Correct response: Atrial fibrillation Explanation: Symptoms seen in older adults include weight loss and atrial fibrillation. Older adults may not experience restlessness or hyperactivity.
A client with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus? 1. Above-normal urine and serum osmolality levels 2. Below-normal urine and serum osmolality levels 3. Above-normal urine osmolality level, below-normal serum osmolality level 4. Below-normal urine osmolality level, above-normal serum osmolality level
Correct response: Below-normal urine osmolality level, above-normal serum osmolality level Explanation: In diabetes insipidus, excessive polyuria causes dilute urine, resulting in a below-normal urine osmolality level. At the same time, polyuria depletes the body of water, causing dehydration that leads to an above-normal serum osmolality level. For the same reasons, diabetes insipidus doesn't cause above-normal urine osmolality or below-normal serum osmolality levels.
A client with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus? 1. Above-normal urine and serum osmolality levels 2. Below-normal urine osmolality level, above-normal serum osmolality level 3. Below-normal urine and serum osmolality levels 4. Above-normal urine osmolality level, below-normal serum osmolality level
Correct response: Below-normal urine osmolality level, above-normal serum osmolality level Explanation: In diabetes insipidus, excessive polyuria causes dilute urine, resulting in a below-normal urine osmolality level. At the same time, polyuria depletes the body of water, causing dehydration that leads to an above-normal serum osmolality level. For the same reasons, diabetes insipidus doesn't cause above-normal urine osmolality or below-normal serum osmolality levels.
A client with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus? 1. Below-normal urine and serum osmolality levels 2. Above-normal urine osmolality level, below-normal serum osmolality level 3. Below-normal urine osmolality level, above-normal serum osmolality level 4. Above-normal urine and serum osmolality levels
Correct response: Below-normal urine osmolality level, above-normal serum osmolality level Explanation: In diabetes insipidus, excessive polyuria causes dilute urine, resulting in a below-normal urine osmolality level. At the same time, polyuria depletes the body of water, causing dehydration that leads to an above-normal serum osmolality level. For the same reasons, diabetes insipidus doesn't cause above-normal urine osmolality or below-normal serum osmolality levels.
Evaluation of an adult client reveals oversecretion of growth hormone. Which of the following would the nurse expect to find? 1. Weight loss 2. Bulging forehead 3. Constant thirst 4. Excessive urine output
Correct response: Bulging forehead Explanation: Oversecretion of growth hormone in an adult results in acromegaly, manifested by coarse features, a huge lower jaw, thick lips, thickened tongue, a bulging forehead, bulbous nose, and large hands and feet. Excessive urine output, weight loss, and constant thirst are associated with diabetes insipidus.
Trousseau's sign is elicited by which of the following? 1. A sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. 2. After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery. 3. Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. 4. The patient complains of pain in the calf when his foot is dorsiflexed.
Correct response: Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. Explanation: A positive Trousseau's sign is suggestive of latent tetany. A positive Chvostek's sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. A positive Allen's test is demonstrated by the palm remaining blanched with the radial artery occluded. A positive Homans' sign is demonstrated when the patient complains of pain in the calf when his foot is dorsiflexed.
A nurse is performing a physical examination on client suspected of having an endocrine disorder. Which assessment finding might be indicative of a problem with the thyroid gland? 1. Cold intolerance 2. Diarrhea 3. Sudden weight loss without dieting 4. Dilated pupils
Correct response: Cold intolerance Explanation: The thyroid releases hormones that regulate the body's metabolic rate. A client with a malfunctioning thyroid gland may experience weight gain, constipation, cold intolerance, and slowing of body functions. Dilation of the pupils would more likely be related to the adrenal medulla secreting epinephrine and norepinephrine.
Which of the following is considered a late symptom of hypothyroidism? 1. Brittle nails 2. Cold intolerance 3. Physical sluggishness 4. Loss of libido
Correct response: Cold intolerance Explanation: Late symptoms of hypothyroidism include cold intolerance, weight gain, apathy, slow speech, and constipation. Early symptoms include physical sluggishness, loss of libido, and brittle nails.
Which of the following is considered a late symptom of hypothyroidism? 1. Brittle nails 2. Physical sluggishness 3. Loss of libido 4. Cold intolerance
Correct response: Cold intolerance Explanation: Late symptoms of hypothyroidism include cold intolerance, weight gain, apathy, slow speech, and constipation. Early symptoms include physical sluggishness, loss of libido, and brittle nails.
A nurse is teaching a client about hormones within the endocrine system. Which hormones would be included as the hypothalamic hormones? Select all that apply. 1. Thyrotropin-releasing hormone 2. Gonadotropin-releasing hormone 3. Prolactin hormone 4. Corticotropin-releasing hormone 5. Arginine vasopressin
Correct response: Corticotropin-releasing hormone Thyrotropin-releasing hormone Gonadotropin-releasing hormone Explanation: Corticotropin-releasing hormone causes the anterior pituitary gland to secrete adrenocorticotropic hormone. Thyrotropin-releasing hormone stimulates the release of thyroid-stimulating hormone from the anterior pituitary gland. Gonadotropin-releasing hormone triggers sexual development at the onset of puberty and continues to cause the anterior pituitary gland to secrete luteinizing hormone and follicle-stimulating hormone. Arginine vasopressin is secreted from the posterior pituitary and prolactin hormone is secreted from the anterior pituitary gland.
The nurse is reviewing the laboratory and diagnostic test findings of a client diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following would the nurse expect to find? 1. Decreased urine sodium levels 2. Elevated urine calcium levels 3. Decreased serum osmolarity 4. Elevated serum sodium levels
Correct response: Decreased serum osmolarity Explanation: With SIADH, serum sodium levels and serum osmolarity are decreased. Urine sodium levels and osmolarity are high. Calcium levels are not involved with this disorder.
The nurse is reviewing the laboratory and diagnostic test findings of a client diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following would the nurse expect to find? 1. Elevated serum sodium levels 2. Elevated urine calcium levels 3. Decreased serum osmolarity 4. Decreased urine sodium levels
Correct response: Decreased serum osmolarity Explanation: With SIADH, serum sodium levels and serum osmolarity are decreased. Urine sodium levels and osmolarity are high. Calcium levels are not involved with this disorder.
The nurse is reviewing the laboratory and diagnostic test findings of a client diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following would the nurse expect to find? 1. Elevated urine calcium levels 2 .Elevated serum sodium levels 3. Decreased urine sodium levels 4. Decreased serum osmolarity
Correct response: Decreased serum osmolarity Explanation: With SIADH, serum sodium levels and serum osmolarity are decreased. Urine sodium levels and osmolarity are high. Calcium levels are not involved with this disorder.
A nurse is following the progress of a client being treated for hypothyroidism. Which findings indicate that thyroid replacement therapy has been inadequate? Select all that apply. 1. nervousness 2. dry mouth 3. low body temperature 4. ECG changes 5. bradycardia 6. tachycardia
Correct response: ECG changes low body temperature bradycardia Explanation: In hypothyroidism, the body is in a hypometabolic state. Therefore, ECG changes with bradycardia and subnormal body temperature would indicate that replacement therapy was inadequate. Tachycardia, nervousness, and dry mouth are symptoms of an excessive level of thyroid hormone; these findings would indicate that the client has received an excessive dose of thyroid hormone.
Antithyroid medications are contraindicated in late pregnancy due to the fact that which of the following may occur? Select all that apply. 1. Goiter 2. Cretinism 3. Fetal hypothyroidism 4. Fetal tachycardia 5. Fetal bradycardia
Correct response: Fetal hypothyroidism Fetal bradycardia Goiter Cretinism Explanation: Antithyroid medications are contraindicated in late pregnancy because the fetus may develop fetal hypothyroidism, fetal bradycardia, goiter, and cretinism.
A patient whose laboratory studies indicates a prolactin level of 200 ng/mL is assessed for a pituitary tumor. During the physical exam, the nurse practitioner notices a number of signs and/or symptoms suggestive of this condition. Which of the following is the most common indicator of a pituitary tumor? 1. Galactorrhea 2. Headaches and visual disturbances 3. Tremors and palpitations 4. Inappropriate responses to stimuli
Correct response: Galactorrhea Explanation: All choices are indicators of a pituitary tumor, but the most common form is indicated by the spontaneous and inappropriate flow of milk from the male or female breast in the absence of pregnancy or breastfeeding. A normal prolactin level is less than 20 ng/mL
A patient whose laboratory studies indicates a prolactin level of 200 ng/mL is assessed for a pituitary tumor. During the physical exam, the nurse practitioner notices a number of signs and/or symptoms suggestive of this condition. Which of the following is the most common indicator of a pituitary tumor? 1. Inappropriate responses to stimuli 2. Galactorrhea 3. Tremors and palpitations 4. Headaches and visual disturbances
Correct response: Galactorrhea Explanation: All choices are indicators of a pituitary tumor, but the most common form is indicated by the spontaneous and inappropriate flow of milk from the male or female breast in the absence of pregnancy or breastfeeding. A normal prolactin level is less than 20 ng/mL
A client with Addison's disease has a blood glucose level above 80 mg/dL 30 minutes after receiving 15 g of carbohydrates for symptoms of hypoglycemia. Which of the following would the nurse do now? 1. Check the client's blood glucose level before each meal. 2. Give the client milk and graham crackers. 3. Instruct the client to remain in bed. 4. Inform the physician immediately.
Correct response: Give the client milk and graham crackers. Explanation: Milk and graham crackers contain forms of carbohydrates that take longer to absorb and tend to maintain the blood glucose level for an extended period. The physician should be informed if the client continues to be symptomatic and the blood glucose level is below 80 mg/dL. Maintaining bed rest protects the client from injuries from a fall but does not address the blood glucose issue. Assessing the client's blood glucose level provides a numeric assessment of the blood glucose level and would be performed in an ongoing fashion.
A client with Addison's disease has a blood glucose level above 80 mg/dL 30 minutes after receiving 15 g of carbohydrates for symptoms of hypoglycemia. Which of the following would the nurse do now? 1. Check the client's blood glucose level before each meal. 2. Instruct the client to remain in bed. 3. Inform the physician immediately. 4. Give the client milk and graham crackers.
Correct response: Give the client milk and graham crackers. Explanation: Milk and graham crackers contain forms of carbohydrates that take longer to absorb and tend to maintain the blood glucose level for an extended period. The physician should be informed if the client continues to be symptomatic and the blood glucose level is below 80 mg/dL. Maintaining bed rest protects the client from injuries from a fall but does not address the blood glucose issue. Assessing the client's blood glucose level provides a numeric assessment of the blood glucose level and would be performed in an ongoing fashion.
A client is suspected of having acromegaly. What definitive diagnostic testing is the most reliable method of confirming acromegaly? 1. Bone radiographs 2. Growth hormone levels 3. Glucose tolerance test in combination with a GH measurement 4. A serum glucose level
Correct response: Glucose tolerance test in combination with a GH measurement Explanation: A glucose tolerance test in combination with a GH measurement is the most reliable method of confirming acromegaly. Ingestion of a bolus of glucose should lower GH levels, but GH levels remain elevated in persons with acromegaly. Increased blood levels of IGF-1 can also indicate acromegaly in nonpregnant women; they typically have IGF-1 levels two to three times higher than normal in pregnant women. A serum glucose level is not an indicator of acromegaly. Growth hormone levels and bone radiographs may support the diagnosis but are not reliable indicators.
Antithyroid medications are not generally recommended for elderly patients because of which side effect? 1. Weight loss 2. Mental confusion 3. Fatigue 4. Granulocytopenia
Correct response: Granulocytopenia Explanation: Antithyroid medications are not generally recommended for elderly clients because of the increased incidence of side effects such as granulocytopenia and the need for frequent monitoring.
A client has been diagnosed with nephrogenic diabetes insipidus (DI), and the physician is initiating treatment. What medication does the nurse prepare to administer for this client? 1. Hydrochlorothiazide 2. Bumetanide 3. Furosemide 4. Metolazone
Correct response: Hydrochlorothiazide Explanation: The physician prescribes a thiazide diuretic, such as hydrochlorothiazide. The thiazide acts at the proximal convoluted tubule, leaving less fluid for excretion in the distal convoluted tubules, the portion affected by nephrogenic diabetes insipidus (DI). Consequently, the client excretes water, but the total volume is less than in an untreated state. The other diuretics listed do not work on the proximal convoluted tubule and would not be effective in treatment.
A client with a history of Addison's disease and flu-like symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by IV infusion? 1. Hydrocortisone 2. Hypotonic saline 3. Insulin 4. Potassium
Correct response: Hydrocortisone Explanation: Emergency treatment for acute adrenal insufficiency (addisonian crisis) is IV infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic — saline solution.
A patient has been placed on corticosteroid therapy for an Addison's disease. The nurse should be aware of which of the following side effects with this type of therapy? Select all that apply. 1. Hypotension 2. Hypertension 3. Weight loss 4. Poor wound healing 5. Alterations in glucose metabolism
Correct response: Hypertension Alterations in glucose metabolism Poor wound healing Explanation: Side effects of corticosteroid therapy include hypertension, alterations in glucose metabolism, weight gain, and poor wound healing.
A client has had a thyroidectomy. Which of the following would lead the nurse to suspect that the client is developing thyrotoxic crisis? 1. Hoarseness 2. Hyperthermia 3. Tetany 4. Bradycardia
Correct response: Hyperthermia Explanation: Thyrotoxic crisis is manifested by hyperthermia (temperature possibly as high as 106oF (41Co). The pulse is rapid and cardiac dysrhythmias are common. The client may experience persistent vomiting, extreme restlessness with delirium, chest pain, and dyspnea. Hoarseness may be noted due to trauma to the vocal cords during surgery. Tetany indicating hypocalcemia would be manifested if the parathyroid glands are accidentally removed.
Which of the following clinical signs are associated with diabetes insipidus? 1. Bradycardia 2. Hypertension 3. Hypotension 4. Oliguria
Correct response: Hypotension Explanation: Diabetes insipidus, which causes profound polyuria, may cause clinical signs of volume depletion such as tachycardia and hypotension.
The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes, a type of white blood cell involved in immunity. Which of the following best identifies the location of this gland? 1. Positioned above the kidneys 2. Attached to the thalamus in the brain 3. In the upper part of the chest above or near the heart 4. Connected by a stalk to the hypothalamus in the brain
Correct response: In the upper part of the chest above or near the heart Explanation: The thymus gland is located in the upper part of the chest above or near the heart. The pineal gland is attached to the thalamus, and the pituitary gland is connected by a stalk to the hypothalamus in the brain. The adrenal glands are located above the kidneys.
The nurse assesses a patient who has an obvious goiter. What type of deficiency does the nurse recognize is most likely the cause of this? 1. Iodine 2. Calcitonin 3. Thyrotropin 4. Thyroxine
Correct response: Iodine Explanation: Oversecretion of thyroid hormones is usually associated with an enlarged thyroid gland known as a goiter. Goiter also commonly occurs with iodine deficiency.
A patient experiences a life-threatening hypercalcemic crisis. The provider orders a cytotoxic agent. Which of the following is most likely the drug that is prescribed? 1. Calcitonin 2. Didronel 3. Mithramycin 4. Aredia
Correct response: Mithramycin Explanation: Mitramycin is a cytotoxic agent commonly used in a hypercalcemic crisis. Didronel and Aredia are bisphosphonates that decrease serum calcium levels. Calcitonin can be ordered but it is not a cytotoxic agent.
On assessment of a patient with early-stage hypothyroidism, the nurse practitioner assesses for a vague yet significant sign which is: 1. Hypotension 2. Paresthesia 3. Hypothermia 4. Bradypnea
Correct response: Paresthesia Explanation: Paresthesia refers to numbness and tingling of the fingers. It is a vague sign that is frequently ignored, yet it is linked with hypothyroidism.
On assessment of a patient with early-stage hypothyroidism, the nurse practitioner assesses for a vague yet significant sign which is: 1. Hypothermia 2. Paresthesia 3. Hypotension 4. Bradypnea
Correct response: Paresthesia Explanation: Paresthesia refers to numbness and tingling of the fingers. It is a vague sign that is frequently ignored, yet it is linked with hypothyroidism.
On assessment of a patient with early-stage hypothyroidism, the nurse practitioner assesses for a vague yet significant sign which is: 1. Paresthesia 2. Bradypnea 3. Hypothermia 4. Hypotension
Correct response: Paresthesia Explanation: Paresthesia refers to numbness and tingling of the fingers. It is a vague sign that is frequently ignored, yet it is linked with hypothyroidism.
Nursing care for a client in addisonian crisis should include which intervention? 1. Allowing ambulation as tolerated 2. Placing the client in a private room 3. Encouraging independence with activities of daily living (ADLs) 4. Offering extra blankets and raising the heat in the room to keep the client warm
Correct response: Placing the client in a private room Explanation: The client in addisonian crisis has a reduced ability to cope with stress as a result of an inability to produce corticosteroids. A private room is easy to keep quiet, dimly lit, and temperature controlled. Also, visitors can be limited to reduce noise, promote rest, and decrease the risk of infection. The client should be kept on bed rest, receiving total assistance with ADLs to avoid stress as much as possible. Because extremes of temperature should be avoided, measures to raise the body temperature, such as extra blankets and turning up the heat, should be avoided.
Nursing care for a client in addisonian crisis should include which intervention? 1. Encouraging independence with activities of daily living (ADLs) 2. Offering extra blankets and raising the heat in the room to keep the client warm 3. Placing the client in a private room 4. Allowing ambulation as tolerated
Correct response: Placing the client in a private room Explanation: The client in addisonian crisis has a reduced ability to cope with stress as a result of an inability to produce corticosteroids. A private room is easy to keep quiet, dimly lit, and temperature controlled. Also, visitors can be limited to reduce noise, promote rest, and decrease the risk of infection. The client should be kept on bed rest, receiving total assistance with ADLs to avoid stress as much as possible. Because extremes of temperature should be avoided, measures to raise the body temperature, such as extra blankets and turning up the heat, should be avoided.
The nurse is reviewing the plan of care for a client with a disorder of the thyroid gland. Which diagnostic test would the nurse expect the physician to order to evaluate thyroid hormones? 1. Radioimmunoassay 2. Computed tomography (CT) 3. Magnetic resonance imaging 4. Cortisol level determination
Correct response: Radioimmunoassay Explanation: A radioimmunoassay determines the concentration of a substance in plasma. A T3 determination by radioimmunoassay evaluates thyroid hormone function. A CT or magnetic resonance imaging scan is done to detect a suspected tumor and to determine organ size and placement. Cortisol levels determine adrenal hyperfunction.
A nurse is caring for a client with suspected hyperparathyroidism. Which condition may contribute to hyperparathyroidism? 1. Decreased serum calcium level 2. Thyroidectomy 3. Steroid use 4. Renal failure
Correct response: Renal failure Explanation: Kidney damage can result from the precipitation of calcium phosphate in the renal pelvis and parenchyma, which causes renal calculi (kidney stones), obstruction, pyelonephritis, and kidney injury. Parathyroid hormone release increases, causing hyperparathyroidism. Serum calcium level may rise as a result of hyperparathyroidism. Thyroidectomy may lead to hypoparathyroidism if the parathyroid is also removed during surgery. Steroid use causes calcium to leave bone, suppressing parathyroid hormone.
A nurse is caring for a client with Cushing's syndrome. Which interventions would the nurse include in the client's plan of care? Select all that apply. 1. Administer prescribed diuretics. 2. Examine extremities for pitting edema. 3. Report systolic BP greater than 139 mm Hg or diastolic BP greater than 89 mm Hg. 4. Provide a high sodium diet. 5. Monitor weight.
Correct response: Report systolic BP greater than 139 mm Hg or diastolic BP greater than 89 mm Hg. Examine extremities for pitting edema. Administer prescribed diuretics. Monitor weight. Explanation: Fluid retention is manifested by swelling in dependent areas, pitting when pressure is applied to the skin over a bone by tight-fitting shoes or rings, the appearance of lines in the skin from stockings and seams in the shoes or areas where they lace. Hypertension is defined as a consistently elevated BP above 139/89 mm Hg. One factor that contributes to hypertension is excess circulatory volume. Diuretics promote the excretion of sodium and water. The client's weight needs to be monitored for fluid balance. The client needs to limit sodium to reduce the potential for fluid retention.
A nurse is caring for a client with Cushing's syndrome. Which interventions would the nurse include in the client's plan of care? Select all that apply. 1. Administer prescribed diuretics. 2. Monitor weight. 3. Provide a high sodium diet. 4. Report systolic BP greater than 139 mm Hg or diastolic BP greater than 89 mm Hg. 5. Examine extremities for pitting edema.
Correct response: Report systolic BP greater than 139 mm Hg or diastolic BP greater than 89 mm Hg. Examine extremities for pitting edema. Administer prescribed diuretics. Monitor weight. Explanation: Fluid retention is manifested by swelling in dependent areas, pitting when pressure is applied to the skin over a bone by tight-fitting shoes or rings, the appearance of lines in the skin from stockings and seams in the shoes or areas where they lace. Hypertension is defined as a consistently elevated BP above 139/89 mm Hg. One factor that contributes to hypertension is excess circulatory volume. Diuretics promote the excretion of sodium and water. The client's weight needs to be monitored for fluid balance. The client needs to limit sodium to reduce the potential for fluid retention.
A nurse is caring for a client with Cushing's syndrome. Which interventions would the nurse include in the client's plan of care? Select all that apply. 1. Monitor weight. 2. Report systolic BP greater than 139 mm Hg or diastolic BP greater than 89 mm Hg. 3. Administer prescribed diuretics. 4. Examine extremities for pitting edema. 5. Provide a high sodium diet.
Correct response: Report systolic BP greater than 139 mm Hg or diastolic BP greater than 89 mm Hg. Examine extremities for pitting edema. Administer prescribed diuretics. Monitor weight. Explanation: Fluid retention is manifested by swelling in dependent areas, pitting when pressure is applied to the skin over a bone by tight-fitting shoes or rings, the appearance of lines in the skin from stockings and seams in the shoes or areas where they lace. Hypertension is defined as a consistently elevated BP above 139/89 mm Hg. One factor that contributes to hypertension is excess circulatory volume. Diuretics promote the excretion of sodium and water. The client's weight needs to be monitored for fluid balance. The client needs to limit sodium to reduce the potential for fluid retention.
Which nursing diagnosis is most appropriate for a client with Addison's disease? 1. Risk for infection 2. Excessive fluid volume 3. Urinary retention 4. Hypothermia
Correct response: Risk for infection Explanation: Addison's disease decreases the production of all adrenal hormones, compromising the body's normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison's disease include Deficient fluid volume and Hyperthermia. Urinary retention isn't appropriate because Addison's disease causes polyuria.
The nurse recognizes that which of the following agents suppress release of thyroid hormones? Select all that apply. 1. Methimazole 2. Sodium iodide 3. Potassium iodide 4. Saturated solution of potassium iodide (SSKI) 5. Propylthiouracil (PTU)
Correct response: Sodium iodide Potassium iodide Saturated solution of potassium iodide (SSKI) Explanation: Sodium iodide, potassium iodide, and SSKI suppress the release of thyroid hormones. Methimazole inhibits the synthesis of thyroid hormone. Propylthiouracil blocks the synthesis of hormones.
The nurse recognizes that which of the following agents suppress release of thyroid hormones? Select all that apply. 1. Propylthiouracil (PTU) 2. Sodium iodide 3. Methimazole 4. Potassium iodide 5. Saturated solution of potassium iodide (SSKI)
Correct response: Sodium iodide Potassium iodide Saturated solution of potassium iodide (SSKI) Explanation: Sodium iodide, potassium iodide, and SSKI suppress the release of thyroid hormones. Methimazole inhibits the synthesis of thyroid hormone. Propylthiouracil blocks the synthesis of hormones.
The nurse palpates the thyroid gland of a patient suspected of having hyperthyroidism. The nurse documents the positive finding of a gland that is: 1. Hard as a result of hypertrophy. 2. Soft with poorly defined borders. 3. Nodular due to diminished blood flow. 4. Tiny in size and difficult to palpate.
Correct response: Soft with poorly defined borders. Explanation: In hyperthyroidism, the thyroid gland is soft to the touch, may pulsate, and sometimes is not clearly defined on ultrasound. This appears due to increased blood flow through the gland.
The nurse palpates the thyroid gland of a patient suspected of having hyperthyroidism. The nurse documents the positive finding of a gland that is: 1. Soft with poorly defined borders. 2 .Tiny in size and difficult to palpate. 3. Nodular due to diminished blood flow. 4. Hard as a result of hypertrophy.
Correct response: Soft with poorly defined borders. Explanation: In hyperthyroidism, the thyroid gland is soft to the touch, may pulsate, and sometimes is not clearly defined on ultrasound. This appears due to increased blood flow through the gland.
A patient has been taking tricyclic antidepressants for many years for the treatment of depression. The patient has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this patient? Select all that apply. 1. Strict intake and output 2. Liver function tests 3. Urine and blood chemistry 4. Neurologic function 5. Signs of dehydration
Correct response: Strict intake and output Neurologic function Urine and blood chemistry Explanation: Close monitoring of fluid intake and output, daily weight, urine and blood chemistries, and neurologic status is indicated for the patient at risk for SIADH.
A patient has been taking tricyclic antidepressants for many years for the treatment of depression. The patient has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this patient? Select all that apply. 1. Urine and blood chemistry 2. Strict intake and output 3. Signs of dehydration 4. Liver function tests 5. Neurologic function
Correct response: Strict intake and output Neurologic function Urine and blood chemistry Explanation: Close monitoring of fluid intake and output, daily weight, urine and blood chemistries, and neurologic status is indicated for the patient at risk for SIADH.
A patient has been taking tricyclic antidepressants for many years for the treatment of depression. The patient has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this patient? Select all that apply. 1. Liver function tests 2. Strict intake and output 3. Signs of dehydration 4. Urine and blood chemistry 5. Neurologic function
Correct response: Strict intake and output Neurologic function Urine and blood chemistry Explanation: Close monitoring of fluid intake and output, daily weight, urine and blood chemistries, and neurologic status is indicated for the patient at risk for SIADH.
Which laboratory test results should a nurse expect to find in a client diagnosed with Hashimoto's thyroiditis? 1. T4, 2 mcg/dl; T3, 200 ng/dl; TSH, 5.9 μIU/ml 2. Thyroxine (T4), 22 mcg/dl; triiodothyronine (T3), 320 ng/dl; thyroid-stimulating hormone (TSH), undetectable 3. T4, 22 mcg/dl; T3, 200 ng/dl; TSH, 0.1 μIU/ml 4. T4, 2 mcg/dl; T3, 35 ng/dl; TSH, 45 μIU/ml
Correct response: T4, 2 mcg/dl; T3, 35 ng/dl; TSH, 45 μIU/ml Explanation: Normal thyroid function tests are as follows: T4, 5 to 12 mcg/dl; T3, 65 to 195 ng/dl; TSH, 0.3 to 5.4 μIU/ml. With Hashimoto's thyroiditis, T4 and T3 levels are typically subnormal and TSH is elevated. With primary hyperthyroidism, T4 and T3 levels are elevated and TSH is subnormal (options 1 and 2). With hypothyroidism, T4 is subnormal and T3 and TSH levels are elevated (option 3).
When teaching a client diagnosed with hypothyroidism about medical intervention, which is important for the nurse to communicate? 1. Increased resorption occurs with TH. 2. TH may increase the effect of digitalis preparation. 3. TH may decrease blood glucose concentrations. 4. Normal dosages of sedative agents are prescribed.
Correct response: TH may increase the effect of digitalis preparation. Explanation: Thyroid hormones may increase the pharmacologic effects of digitalis glycosides, anticoagulant agents, and indomethacin, necessitating careful observation and assessment by the nurse for side effects.
A patient taking corticosteroids for exacerbation of Crohn's disease comes to the clinic and informs the nurse that he wants to stop taking them because of the increase in acne and moon face. What can the nurse educate the patient regarding these symptoms? 1. The symptoms are permanent side effects of the corticosteroid therapy. 2. Those symptoms are not related to the corticosteroid therapy. 3. The dose of the medication must be too high and should be lowered. 4. The moon face and acne will resolve when the medication is tapered off.
Correct response: The moon face and acne will resolve when the medication is tapered off. Explanation: Cushing syndrome is commonly caused by the use of corticosteroid medications and is infrequently the result of excessive corticosteroid production secondary to hyperplasia of the adrenal cortex. The patient develops a "moon-faced" appearance and may experience increased oiliness of the skin and acne. If Cushing syndrome is a result of the administration of corticosteroids, an attempt is made to reduce or taper the medication to the minimum dosage needed to treat the underlying disease process (e.g., autoimmune or allergic disease, rejection of a transplanted organ).
A nurse is aware that several laboratory results are present in a patient diagnosed with diabetes insipidus. Select all that apply. 1. Serum sodium level of 149 mEq/L 2. Urine osmolality of 800 mOsm/kg 3. Urine specific gravity of 1.001 4. Serum ADH level of 2.3 pg/mL 5. Serum osmolality of 310 mOsm/kg
Correct response: Urine specific gravity of 1.001 Serum osmolality of 310 mOsm/kg Serum sodium level of 149 mEq/L Explanation: All are indicative of diabetes insipidus, except for B and D, which are normal results. Refer to Table 31-1.
A nurse is performing an examination and notes that the client exhibits signs of exophthalmos. What has the nurse observed? 1. enlarged thyroid gland 2. changes in pigmentation 3. abnormal bulging or protrusion of the eyes 4. excessive hair growth
Correct response: abnormal bulging or protrusion of the eyes Explanation: When there is an increase in the volume of the tissue behind the eyes, the eyes will appear to bulge out of the face. Exophthalmos is a bulging of the eye anteriorly out of the orbit.
The nursing is caring for a newly admitted client with diabetes insipidus. When forming the plan of care, which nursing diagnoses are anticipated? Select all that apply. 1. fluid volume, excess 2. activity intolerance 3. anxiety 4. self-care deficit 5. impaired physical mobility 6. hyperglycemia
Correct response: anxiety activity intolerance Explanation: Diabetes insipidus is characterized by excessive output of dilute urine. Common signs and symptoms include massive diuresis, dehydration, and thirst. Additional findings include malaise, lethargy, and irritability. Nursing diagnoses that aim at providing interventions to decrease the symptoms include Anxiety (irritability) and activity intolerance (due to lethargy). The client has a fluid volume deficit due to the excessive output of urine. Though the client urinates frequently, there is no reason to believe that there is an impaired physical mobility or self-care deficit. A client has symptoms of hyperglycemia with diabetes mellitus.
When caring for a client who's being treated for hyperthyroidism, the nurse should: 1. encourage the client to be active to prevent constipation. 2. provide extra blankets and clothing to keep the client warm. 3. monitor the client for signs of restlessness, sweating, and excessive weight loss during thyroid replacement therapy. 4. balance the client's periods of activity and rest.
Correct response: balance the client's periods of activity and rest. Explanation: A client with hyperthyroidism needs to be encouraged to balance periods of activity and rest. Many clients with hyperthyroidism are hyperactive and complain of feeling very warm. Consequently, it's important to keep the environment cool and to teach the client how to manage his physical reactions to heat. Clients with hypothyroidism — not hyperthyroidism — complain of being cold and need warm clothing and blankets to maintain a comfortable temperature. They also receive thyroid replacement therapy, commonly feel lethargic and sluggish, and are prone to constipation. The nurse should encourage clients with hypothyroidism to be more active to prevent constipation.
Which condition may contribute to hyperparathyroidism? 1. chronic renal failure 2. steroid use 3. thyroidectomy 4. elevated serum calcium level
Correct response: chronic renal failure Explanation: Because failing kidneys can't convert vitamin D, the serum calcium level declines. Parathyroid hormone release increases, causing hyperparathyroidism. Thyroidectomy may lead to hypoparathyroidism if the parathyroid is also removed during surgery. Serum calcium level may rise as a result of hyperparathyroidism, so it isn't a contributing factor. Steroid use causes calcium to leave bone, suppressing parathyroid hormone.
Which diagnostic test is done to determine suspected pituitary tumor? 1. measurement of blood hormone levels 2. radiographs of the abdomen 3. radioimmunoassay 4. computed tomography scan
Correct response: computed tomography scan Explanation: A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and their location. Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma.
A 34-year-old female is diagnosed with hypothyroidism. What information should the nurse obtain from conducting a focused assessment? Select all that apply. 1. fine, thin hair with hair loss 2. constipation 3. menorrhagia 4. decreased energy and fatigue 5. rapid pulse 6. weight gain of 10 lb (4.5 kg)
Correct response: decreased energy and fatigue weight gain of 10 lb (4.5 kg) constipation menorrhagia Explanation: Clients with hypothyroidism exhibit symptoms indicating a lack of thyroid hormone. Bradycardia, decreased energy and lethargy, memory problems, weight gain, coarse hair, constipation, and menorrhagia are common signs and symptoms of hypothyroidism.
A client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with: 1. hypoglycemia. 2. depression. 3. hyperthyroidism. 4. neuropathy.
Correct response: depression. Explanation: Agitation, irritability, poor memory, loss of appetite, and neglect of one's appearance may signal depression, which is common in clients with Cushing's syndrome. Neuropathy affects clients with diabetes mellitus — not Cushing's syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite.
A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which finding would indicate that the client has developed fluid overload? 1. dyspnea and hypertension 2. hypertension and weight gain without edema 3. confusion and diarrhea 4. pulmonary congestion and muscle cramps
Correct response: dyspnea and hypertension Explanation: Signs of fluid overload would include confusion, dyspnea, pulmonary congestion, and hypertension. Muscle cramps, diarrhea, and weight gain without edema would be indicative of hyponatremia.
When administering spironolactone to a client who has had a unilateral adrenalectomy, a nurse should instruct the client about which possible adverse effect of the drug? 1. hypokalemia 2. constipation 3. menstrual irregularities 4. hypernatremia
Correct response: menstrual irregularities Explanation: Spironolactone can cause menstrual irregularities and decreased libido. Men may experience gynecomastia and impotence. Diarrhea, hyponatremia, and hyperkalemia are also adverse effects of spironolactone.
A physician orders laboratory tests to confirm hyperthyroidism in a client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis? 1. below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as detected by radioimmunoassay 2. a decreased TSH level 3. no increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test 4. an increase in the TSH level after 30 minutes during the TSH stimulation test
Correct response: no increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test Explanation: In the TSH test, failure of the TSH level to rise after 30 minutes confirms hyperthyroidism. A decreased TSH level indicates a pituitary deficiency of this hormone. Below-normal levels of T3 and T4, as detected by radioimmunoassay, signal hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease and may result from administration of phenytoin and certain other drugs.
A nurse is caring for a client with a kidney disorder. What hormone released by the kidneys initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume? 1. erythropoietin 2. cholecystokinin 3. gastrin 4. rerenin
Correct response: renin Explanation: Renin is released from the kidneys and initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys secrete erythropoietin, a substance that promotes the maturation of red blood cells. Cholecystokinin released from cells in the small intestine stimulates contraction of the gallbladder to release bile when dietary fat is ingested. Gastrin is released within the stomach to increase the production of hydrochloric acid.
Which of the following clinical signs are associated with diabetes insipidus? 1. Bradycardia 2. Hypotension 3. Hypertension 4. Oliguria
Correct response: Hypotension Explanation: Diabetes insipidus, which causes profound polyuria, may cause clinical signs of volume depletion such as tachycardia and hypotension.
A patient has been diagnosed with Cushing's syndrome. The nurse would expect which of the following features to be present upon physical examination? Select all that apply. 1. Thin extremities 2. Purple striae 3. Truncal obesity 4. "Moon face" 5. "Buffalo hump"
Correct response: "Buffalo hump" Thin extremities "Moon face" Truncal obesity Purple striae Explanation: Manifestations of Cushing's syndrome (excessive adrenocortical hormones may cause "moon face," "buffalo hump," thinning of the skin, obesity of the trunk and thinness of the extremities, and purple striae.
When caring for a client who's being treated for hyperthyroidism, the nurse should: 1. provide extra blankets and clothing to keep the client warm. 2. balance the client's periods of activity and rest. 3. monitor the client for signs of restlessness, sweating, and excessive weight loss during thyroid replacement therapy. 4. encourage the client to be active to prevent constipation.
Correct response: balance the client's periods of activity and rest. Explanation: A client with hyperthyroidism needs to be encouraged to balance periods of activity and rest. Many clients with hyperthyroidism are hyperactive and complain of feeling very warm. Consequently, it's important to keep the environment cool and to teach the client how to manage his physical reactions to heat. Clients with hypothyroidism — not hyperthyroidism — complain of being cold and need warm clothing and blankets to maintain a comfortable temperature. They also receive thyroid replacement therapy, commonly feel lethargic and sluggish, and are prone to constipation. The nurse should encourage clients with hypothyroidism to be more active to prevent constipation.
A nurse explains the role of the ovaries. Which hormones would be included in that discussion? 1. testosterone and progesterone 2. estrogen and progestin 3. estrogen and testosterone 4. estrogen and progesterone
Correct response: estrogen and progesterone Explanation: The ovaries produce estrogen and progesterone. Progestin is a synthetic compound. Testosterone is involved with the development and maintenance of male secondary sex characteristics, such as facial hair and a deep voice.
A nurse is completing an assessment of a client with suspected acromegaly. To assist in making the diagnosis, which question should the nurse ask? 1. "Has your shoe size increased recently?" 2. "Have you had a recent head injury?" 3. "Is there any family history of acromegaly?" 4. "Do you experience skin breakouts?"
Correct response: "Has your shoe size increased recently?" Explanation: Excessive skeletal growth occurs only in the feet, the hands, the superciliary ridge, the molar eminences, the nose, and the chin, giving rise to the clinical condition of acromegaly.
Before discharge, what should a nurse instruct a client with Addison's disease to do when exposed to periods of stress? 1. Administer hydrocortisone I.M. 2. Drink 8 oz of fluids. 3. Perform capillary blood glucose monitoring four times daily. 4. Continue to take his usual dose of hydrocortisone.
Correct response: Administer hydrocortisone I.M. Explanation: Clients with Addison's disease and their family members should know how to administer I.M. hydrocortisone during periods of stress. Although it's important for the client to keep well hydrated during stress, the critical component in this situation is to know how and when to use I.M. hydrocortisone. Capillary blood glucose monitoring isn't indicated in this situation because the client doesn't have diabetes mellitus. Hydrocortisone replacement doesn't cause insulin resistance.
