EAQ-Endocrine
A nurse is assessing a client with a suspected pituitary tumor. Which assessment finding is consistent with a pituitary tumor? 1 Tetany 2 Seizures 3 Lethargy 4 Hyperreflexia
2 Seizures are common in clients who have pituitary tumors. Tetany is associated with severe hypocalcemia; that condition can be caused by hypoparathyroidism. Lethargy is found in clients with hypothyroidism. Hyperreflexia is observed in clients with hyperthyroidism and hypoparathyroidism.
A client with a small nodule of the thyroid gland is to have a subtotal thyroidectomy. The client asks the nurse for clarification about what this surgery involves. What information should the nurse include in a response to the question? 1 The entire thyroid gland is removed. 2 A small part of the gland is left intact. 3 One parathyroid gland is removed also. 4 A portion of the thyroid is removed with the parathyroids.
2 A small portion of the gland is left in the hope that it will provide enough hormone for adequate function. The entire gland is not removed. The parathyroids are not removed.
After reviewing the client's laboratory reports, the physician concludes that the client has primary hypofunction of the adrenal gland. Which clinical manifestation is likely to be observed in that client? 1 Edema at extremities 2 Uneven patches of pigment loss 3 Reddish-purple stretch marks on the abdomen 4 "Buffalo hump" between shoulders on the back
2 Vitiligo is manifested by the presence of large patchy areas of pigment loss. This is mainly caused by primary hypofunction of the adrenal gland. Presence of edema at extremities indicates fluid and electrolyte imbalances mainly observed in a client with thyroid problems. Presence of reddish-purple stretch marks on the abdomen and "buffalo hump" between shoulders on the back of the neck often indicates excessive adrenocortical secretions.
Which is the best advice the nurse can give regarding foot care to a client diagnosed with diabetes? 1 Remove corns on the feet 2 Wear shoes that are larger than the feet 3 Examine the feet weekly for potential sores 4 Wear synthetic fiber socks when exercising
4 Research demonstrates that socks with synthetic fibers wick away moisture better than other fabrics when participating in vigorous activities. Self-removal of corns can result in injury to the feet. Shoes that do not fit appropriately will create friction causing sores, blisters, and calluses. The feet should be examined daily, not weekly.
Which drug acts as an abortifacient in female clients? 1 Mifepristone 2 Metyrapone 3 Cyproheptadine 4 Aminoglutethimide
1 Mifepristone is an antiprogesterone that blocks the progesterone receptors and acts as an abortifacient. Metyrapone, cyproheptadine, and aminoglutethimide are used to treat hyperfunctioning of the adrenal glands (Cushing's disease/syndrome).
A client's blood gases reflect diabetic ketoacidosis. Which clinical indicator should the nurse identify when monitoring this client's laboratory values? 1 Increased pH 2 Decreased PO2 3 Increased PCO2 4 Decreased HCO3
4 The bicarbonate-carbonic acid buffer system helps maintain the pH of body fluids; in metabolic acidosis, there is a decrease in bicarbonate because of an increase of metabolic acids. The pH is decreased. The PO2 is not decreased in diabetic acidosis. The PCO2 may be decreased by the body's attempt to eliminate CO2 to compensate for a decreased pH.
A nurse is assessing a client with Cushing syndrome. Which signs should the nurse expect the client to exhibit? Select all that apply. 1 Hirsutism 2 Round face 3 Pitting edema 4 Buffalo hump 5 Hypoglycemia
1, 2, 4 Hirsutism is caused by excess adrenocortical activity associated with Cushing syndrome. A moon face results from an accumulation of adipose tissue associated with hypercortisolism. A buffalo hump results from an accumulation of adipose tissue associated with hypercortisolism. Pitting edema does not occur, except with concurrent severe heart failure. Hypercortisolism increases gluconeogenesis, causing hyperglycemia, not hypoglycemia.
A client has had a resection of an aldosterone-secreting tumor of an adrenal gland. The client says to the nurse, "It will be good for me to return to work soon." Based on an understanding of the problem, what is the nurse's response? 1 Caution the client about high expectations because the prognosis is variable; the outcome depends on many factors. 2 Prepare to apply for permanent disability. 3 Advise the client to investigate other occupational alternatives if the client wishes to stay in the workforce. 4 Tell the client that returning to work is possible if the client takes prescribed hormone supplements.
4 Surgery is most often performed by laparoscopic procedure. The body has two adrenal glands; an aldosteronoma is a unilateral tumor. The prognosis usually is excellent. The client should be able to return to normal activities and work; however, the client will be receiving hormone replacement until the remaining adrenal gland can produce an adequate amount of hormone. Hormone therapy could last up to two years.
Upon assessment of the client, the nurse observed the following condition (see image). What is the cause for the condition of the client represented in the image? 1 Decreased cardiac output 2 Decreased erythropoietin levels 3 Accumulation of mucopolysaccharides in blood vessel wall 4 Accumulation of hydrophilic mucopolysaccharides in tissues
4 The accumulation of hydrophilic mucopolysaccharides in tissues and dermis results in a condition called myxedema, which is seen in the image. Decreased cardiac output leads to decreased perfusion to the brain and other body systems. Decreased erythropoietin levels cause anemia in clients with hypothyroidism. Accumulation of mucopolysaccharides in blood vessel wall results in coronary atherosclerosis.
The nurse is caring for a client who reports sweating, tachycardia, and tremors. The laboratory report of the client reveals serum cortisol below normal and a blood glucose level of 60 mg/dL. What is the primary care to be provided to the client? 1 Administer glucagon 2 Administer kayexalate 3 Administer hydrocortisone 4 Administer insulin with dextrose in normal saline
1 A decrease in cortisol levels impairs the glucose metabolism. The client's blood glucose level is 60 mg/dL, which is indicative of hypoglycemia. Therefore the nurse should administer glucagon as per the prescription to manage the low glucose levels. Kayexalate is a potassium-binding resin that facilitates potassium excretion and is used to manage hyperkalemia. Intramuscular hydrocortisone is given concomitantly every 12 hours as part of hormone replacement in adrenal insufficiency. Insulin with dextrose in normal saline is given to manage hyperkalemia by causing an intracellular shift of potassium.
A primary healthcare provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. Two months after being started on the antithyroid medication, the client calls the nurse and complains of feeling tired and looking pale. What should the nurse do? 1 Advise the client to get more rest. 2 Schedule the client for an appointment. 3 Instruct the client to skip one dose daily. 4 Tell the client to increase the medication.
2 The client should be examined by the primary healthcare provider, and blood tests should be prescribed; anemia may result from the bone marrow depressant effect of PTU. Advising the client to get more rest is unsafe; a physical examination and blood tests are necessary to determine the cause of the client's fatigue and paleness. It is unsafe to skip one dose of PTU daily without a primary healthcare provider's prescription; advising the client to alter the dosage of a drug is not within the legal role of the nurse. It is unsafe to increase the dose of PTU without a primary healthcare provider's prescription; advising the client to alter the dosage of a drug is not within the legal role of the nurse.
The nurse is caring for a client newly diagnosed with diabetes. When preparing the teaching plan about the importance of yearly eye examinations, the nurse should instruct the client on which eye problem most associated with diabetes? 1 Cataracts 2 Glaucoma 3 Retinopathy 4 Astigmatism
3 Diabetic retinopathy is a leading cause of blindness in diabetics. Glaucoma and cataracts also are associated with diabetes, but retinopathy is the most common eye problem. Astigmatism is not associated with diabetes.
A nurse is caring for a client who has had type 1 diabetes for 25 years. The client states, "I have been really bad for the last 15 years. I have not paid attention to my diet and have done little to control my diabetes." What common complications of diabetes might the nurse expect to identify when assessing this client? Select all that apply. 1 Leg ulcers 2 Loss of visual acuity 3 Thick, yellow toenails 4 Increased growth of body hair 5 Decreased sensation in the feet
1, 2, 3, 5 Leg ulcers are a common response to the microvascular and macrovascular changes associated with diabetes. Retinopathy, damage to the microvascular system of the retina (e.g., edema, exudate, and local hemorrhage), occurs as a result of the occlusion of the small vessels in the eyes, causing microaneurysms in the capillary walls. Thick, yellow toenails result from prolonged inadequate arterial circulation to the feet. Pedal pulses diminish, which can result in gangrene, necessitating amputation. Diabetic neuropathies affect 60% to 70% of people with diabetes. It is theorized that consistent hyperglycemia causes a buildup of sorbitol and fructose in the nerves that results in impairment via an unknown process. Inadequate arterial circulation to hair follicles results in a lack of hair on the feet and ankles. The skin becomes dry and cracks, predisposing it to leg ulcers and infection.
A nurse, caring for a client with uncontrolled diabetes, suspects that a client is experiencing hypoglycemia in response to insulin administration. What clinical manifestations lead the nurse to this conclusion? Select all that apply. 1 Headache 2 Confusion 3 Extreme thirst 4 Profuse sweating 5 Increased urination
1, 2, 4 Neurologic responses occur when there is an insufficient supply of glucose to the brain, thus causing clinical manifestations such as headache and confusion. Profuse sweating is a classic sign of hypoglycemia. This is triggered by lack of glucose to the nerve cells. Thirst (polydipsia) is a classic symptom of hyperglycemia. Increased urination (polyuria) is a classic sign of hyperglycemia.
What interventions should the nurse implement in caring for a client with diabetes insipidus (DI) following a head injury? Select all that apply. 1 Providing adequate fluids within easy reach 2 Reporting an increasing urine specific gravity 3 Administering prescribed erythromycin 4 Assessing for and reporting changes in neurological status 5 Monitoring for constipation, weight loss, hypotension, and tachycardia
1, 4, 5 Diabetes insipidus is a condition resulting in underproduction of antidiuretic hormone. The focus of care is on maintaining fluids and electrolytes. Oral fluids must be easily accessible at the bedside to balance urinary losses and prevent severe dehydration. The nurse monitors for, and reports, changes in neurological status associated with hypernatremia and high serum osmolality. Constipation and weight loss indicate fluid volume deficit and must be reported. Hypotension and tachycardia are signs of impending shock. Massive polyuria results in dilute urine. Decreasing urine specific gravity must be reported. There is no indication that an antibiotic is required; therefore erythromycin would not be prescribed. The primary pharmacologic treatment for diabetes insipidus, then, is replacement of antidiuretic hormone (ADH) with an exogenous vasopressin, such as desmopressin acetate (DDAVP).
When obtaining a health history from a client recently diagnosed with type 1 diabetes, the nurse expects the client to report what clinical manifestations? 1 Irritability, polydipsia, and polyuria 2 Polyuria, polydipsia, and polyphagia 3 Nocturia, weight loss, and polydipsia 4 Polyphagia, polyuria, and diaphoresis
2 Excessive thirst (polydipsia), excessive hunger (polyphagia), and frequent urination (polyuria) are caused by the body's inability to metabolize glucose adequately. Although polydipsia and polyuria occur with type 1 diabetes, lethargy occurs because of a lack of metabolized glucose for energy. Although polydipsia and weight loss occur with type 1 diabetes, frequent urination occurs throughout a 24-hour period because glucose in the urine pulls fluid with it. Although polyphagia and polyuria occur with type 1 diabetes, diaphoresis occurs with severe hypoglycemia, not hyperglycemia.
A nurse teaches a client with type 1 diabetes how to best treat hypoglycemia. If the teaching is effective, which foods does the client identify to manage hypoglycemia? 1 Hard candy and fruit juice 2 Cheese sandwich and sugar 3 Chocolate candy and an orange 4 Peanut butter crackers and a glass of milk
2 The suggested treatment for hypoglycemia is to give a conscious client a simple sugar (e.g., two packets of sugar) followed by a complex carbohydrate (e.g., bread) and protein (e.g., cheese); the simple sugar elevates blood glucose rapidly; the complex carbohydrate and protein produce a more sustained response. Hard candy and fruit juice are fast-acting sugars that will increase blood glucose rapidly; neither provides a sustained response. Chocolate candy and an orange are fast-acting sugars that will increase blood glucose rapidly; neither provides a sustained response. Neither peanut butter crackers nor a glass of milk provides fast-acting sugars; peanut butter crackers and milk can maintain the glucose level after it has been raised.
Which clinical manifestations in a client indicate hyperfunctional thyroid gland? Select all that apply. 1 Anemia 2 Diarrhea 3 Weight loss 4 Decreased appetite 5 Distant heart sounds
2, 3 Diarrhea and weight loss are the characteristic manifestations of a hyperfunctional thyroid gland. Anemia is seen in a client with a hypofunctional thyroid and decreased levels of thyroid hormone. Decreased appetite and distant heart sounds are symptoms of a hypofunctional thyroid gland.
The nurse is assessing a client with a "moon-shaped" face and thinner arms and legs. Which other assessment findings would the nurse suspect to be present in this client? Select all that apply. 1 Weight loss 2 Gastric ulcer 3 Pain in bones 4 Poor appetite 5 Muscle weakness
2, 3, 5 The presence of such symptoms as "moon" face and thinner arms and legs indicates Cushing's syndrome. In Cushing's syndrome, the cortisol level rises resulting in gastric ulcer formation caused by increased hydrochloric acid secretion and decreased production of protective gastric mucus. Osteoporosis is common in Cushing's syndrome; therefore, bone pain is common. Clients may also feel muscle weakness. Clients with Cushing's syndrome experience increased appetite and weight gain, therefore, they display truncal obesity and a "buffalo hump."
The nurse is teaching a client who underwent bilateral adrenalectomy about self-management after discharge. Which statements given by the client indicate effective learning? Select all that apply. 1 "I will monitor my weight once a week." 2 "I will procure an influenza vaccination yearly." 3 "I will call the health care provider if I gain 2 pounds in 1 week." 4 "I will visit the hospital frequently for my lifelong hormonal therapy." 5 "I will immediately notify my primary health care provider if I have fever."
2, 4, 5 The client should be advised to have a yearly influenza vaccination. The client who undergoes bilateral adrenalectomy should be on hormonal replacement therapy throughout his/her lifetime and needs frequent hospital visits. The client should inform the primary health care provider of fever because this would be an indication of an infection and needs early management. The client should monitor weight on a daily basis since daily variations in weight of 1 to 2 pounds require immediate notification of the primary health care provider. The client should notify the primary health care provider when there is more than a 3-pound increase in weight per week.
The laboratory reports of a client reveal selective hypopituitarism related to growth hormone (GH). What other findings does the nurse anticipate in the client? Select all that apply. 1 Decreased body hair 2 Decreased serum cortisol 3 Decreased muscle strength 4 Increased serum cholesterol 5 Decreased tolerance to cold
3, 4 The deficiency of GH results in a decrease in the body's muscle strength because GH regulates bone and muscle growth. GH deficiency also results in an increase in serum cholesterol levels because GH also plays a role in lipid metabolism. Hyposecretion of gonadotropins results in decreased body hair. The serum cortisol levels decrease when there is deficiency of adrenocorticotropic hormone that regulates cortisol secretion. Thyroid-stimulating hormone (TSH) regulates thyroid hormones secretions, which are involved in thermoregulation. Therefore hyposecretion of TSH results in decreased tolerance to cold.
A client has an abdominal perineal resection with the formation of a colostomy for cancer of the rectum. The nurse evaluates that teaching about colostomy care is understood when the client makes what statement? 1 "I will call the clinic and report if I notice a loss of sensation to touch in the stoma tissue." 2 "I will call the clinic and report when mucus is passed from the stoma between irrigations." 3 "I will call the clinic and report expulsion of flatus while the irrigating fluid is running out." 4 "I will call the clinic and report if I have difficulty inserting the irrigating tube into the stoma."
4 Difficulty inserting the irrigating tube into the stoma occurs with stenosis of the stoma; forcing insertion of the tube may cause injury. Loss of sensation to touch in the stomal tissue is expected; there is no need to call the clinic. Mucus exiting the stoma between irrigations is expected; there is no need to call the clinic. Expulsion of flatus while irrigating fluid is running out is expected; feces and flatus accompany fluid expulsion.
A nurse is providing postoperative care for a client who has begun taking levothyroxine after undergoing a thyroidectomy. Which findings in the client may indicate potential thyrotoxic crisis? 1 Elevated serum calcium 2 Sudden drop in pulse rate 3 Hypothermia and dry skin 4 Rapid heartbeat and tremors
4 Thyrotoxic crisis (thyroid storm) refers to a sudden and excessive release of thyroid hormones, which causes pyrexia, tachycardia, and exaggerated symptoms of thyrotoxicosis; surgery, infection, and ablation therapy can precipitate this life-threatening condition. Hypercalcemia is not related to thyrotoxic crisis; hypocalcemia results from accidental removal of the parathyroid glands. Tachycardia is an increased, not decreased, heart rate, which occurs with thyrotoxic crisis because of the sudden release of thyroid hormones; thyroid hormones increase the basal metabolic rate. Fever, not hypothermia, and diaphoresis, not dry skin, occur with thyrotoxic crisis because of the sudden release of thyroid hormones, which increase the basal metabolic rate.
