Endocrine #2
A nurse is reviewing the laboratory reports of a client and notes an elevated thyroid-stimulating hormone (TSH) level. Which of the following findings should the nurse expect? A. Bradycardia B. Tremors C. Low-grade fever D. Diaphoresis
a. Bradycardia ** An elevated TSH level indicates hypothyroidism, which is characterized by weight gain, bradycardia, cold intolerance, paresthesia, hearing loss, depression, and many other manifestations.
Which of the following endocrine disorder causes the patient to have dilutional hyponatremia? a. Syndrome of inappropriate antidiuretic hormone (SIADH) b. Diabetes insipidus (DI) c. Hyperthyroidism d. Hypothyroidism
a. Syndrome of inappropriate antidiuretic hormone (SIADH)
Which of the following would the nurse expect to find in a client with severe hyperthyroidism? a. Striae b. Exophthalmos c. Tetany d. Buffalo hump
b. Exophthalmos
A nurse is collecting an admission history from a client who has hypothyroidism. Which of the following findings should the nurse expect? (Select all that apply) a. Diarrhea b. Menorrhagia c. Dry skin d. Increased libido e. Hoarseness
b. Menorrhagia c. Dry skin e. Hoarseness
A nurse is assessing a client who has Addison's disease. Which of the following skin manifestations should the nurse expect to find? A. Purple striae on the chest and abdomen B. Butterfly rash across the bridge of the nose C. Bronze pigmentation of the skin D. Jaundice of the face and sclera
c. Bronze pigmentation of the skin
A client with severe hypoparathyroidism is experiencing tetany. What medication, prescribed by the physician for emergency use, will the nurse administer to correct the deficit? a. Sodium bicarbonate b. Methylprednisolone c. Calcium gluconate d. Fludrocortisone
c. Calcium gluconate
A client with hypofunction of the adrenal cortex has been admitted to the medical unit. What would the nurse most likely find when assessing this client? A. Increased body temperature B. Jaundice C. Copious urine output D. Decreased Blood Pressure
d. Decreased blood pressure
An older adult female client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse should suspect which disorder? a. Hypoparathyroidism b. Diabetes insipidus c. Diabetes mellitus d. Hyperparathyroidism
d. Hyperparathyroidism ** Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone. Clients also exhibit hypercalciuria-causing polyuria. Although clients with diabetes mellitus and diabetes insipidus have polyuria, they don't have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than by polyuria.
A nurse is monitoring a client who has Graves' disease for the development of thyroid storm. The nurse should report which of the following findings to the provider? A. Constipation B. Headache C. Bradycardia D. Hypertension
d. Hypertension ** A client who is experiencing a thyroid storm will have an exaggerated condition of hyperthyroidism associated with the development of a fever, hypertension, abdominal pain, and tachycardia. Graves' disease is a common cause of hyperthyroidism, which is an imbalance of metabolism caused by overproduction of thyroid hormone.
The nurse is aware that the clinical symptoms of a patient with hypoparathyroidism are the result of the initial physiologic response of: a. Decreased levels of vitamin D. b. Increased serum levels of phosphate. c. Cardiac arrhythmias. d. Hypocalcemia.
d. Hypocalcemia
A nurse is caring for a client in acute addisonian crisis. Which test result does the nurse expect to see? a. Serum glucose level of 236 mg/dl b. Serum sodium level of 156 mEq/L c. Blood urea nitrogen (BUN) level of 2.3 mg/dl d. Serum potassium level of 6.8 mEq/L
d. Serum potassium level of 6.8 mEq/L
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? a. inhibit release of calcium into extracellular fluid b. decrease serum calcium level c. promote urinary secretion of calcium d. increase serum calcium level
d. increase serum calcium level
1.) A nurse is caring for a client with Addison's disease who has been admitted with muscle weakness, dehydration, and nausea and vomiting for the past 2 days. Which of the following prescribed medications should the nurse plan to administer? A. Rifampin B. Loperamide C. Hydrocortisone D. Spironolactone 2.) A nurse is caring for a client who has been diagnosed with an Addisonian crisis and has a blood pressure of 74/42 mmHg. Which of the following prescriptions should the nurse anticipate? A. Desmopressin B. Hydrocortisone C. Dopamine D. Furosemide
1.) c. Hydrocortisone 2.) b. Hydrocortisone ** The nurse should identify that a client who has Addison's disease will require hydrocortisone to assist with replacing cortisol levels. A client who has Addison's disease has adrenal corticoid insufficiency, which is the inability of the pituitary to produce cortisol. Illness and stress can require steroids like hydrocortisone to restore hormone levels.
After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. Which electrolyte should the nurse anticipate administering? a. Calcium gluconate b. Potassium chloride c. Sodium bicarbonate d. Sodium phosphorus
a. Calcium gluconate
A nurse is caring for a client who is postoperative following a bilateral adrenalectomy. The nurse should expect to administer glucocorticoids following the procedure to enhance which of the following therapeutic effects? A. Compensation for decreased cortisol levels B. Inhibition of glucose metabolism C. Diuretic action to maintain urine output D. Decreased susceptibility to infection
a. Compensation for decreased cortisol levels
Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? a. Cushing syndrome b. Graves disease c. Addison disease d. Hashimoto disease
a. Cushing syndrome
A nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings should the nurse expect? (Select all that apply) a. Decreased blood sodium b. Urine specific gravity 1.001 c. Blood osmolarity 230 mOsm/L d. Polyuria e. Increased thirst
a. Decreased blood sodium c. Blood osmolarity 230 mOsm/L ** - an increase in the secretion of ADH leads to dilutional hyponatremia - a decrease in blood osmolarity is caused by an increase in the secretion of ADH leading to water retention and dilution of blood components
A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: a. Graves' disease. b. thyroiditis. c. multinodular goiter. d. Hashimoto's thyroiditis.
a. Grave's disease ** Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).
A client with a 20-year history of hypothyroidism who has not been compliant with taking thyroid replacement therapy is brought into the ED with a diagnosis of myxedema coma. What client symptoms are consistent with this life-threatening event? Select all that apply. a. Hypotension b. Tachycardia c. Hypothermia d. Hypoventilation e. Hyperactivity
a. Hypotension c. Hypothermia d. Hypoventilation
A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize are progressing to myxedema coma? Select all that apply. a. Hypoventilation b. Hypotension c. Hyperventilation d. Hypertension e. Hypothermia
a. Hypoventilation b. Hypotension e. Hypothermia
A nurse is planning care for a client who has Cushing's disease. The nurse should identify that clients who have Cushing's disease are at increased risk for which of the following? (Select all that apply) a. Infection b. Gastric ulcer c. Renal calculi d. Bone fractures e. Dysphagia
a. Infection b. Gastric ulcer d. Bone fractures
Which intervention is the most critical for a client with myxedema coma? a. Maintaining a patent airway b. Measuring and recording accurate intake and output c. Administering an oral dose of levothyroxine (Synthroid) d. Warming the client with a warming blanket
a. Maintaining a patent airway
A nurse in a provider's office is planning care for a client who has a new diagnosis of Graves' disease and a new prescription for methimazole. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) a. Monitor CBC b. Monitor triiodothyronine (T3) c. Instruct the client to increase consumption of shellfish d. Advise the client to take the medication at the same time every day e. Inform the client that an adverse effect of this medication is iodine toxicity
a. Monitor CBC b. Monitor triiodothyronine (T3) d. Advise the client to take the medication at the same time every day
A nurse in an intensive care unit is planning care for a client who has myxedema coma. Which of the following actions should the nurse include? (Select all that apply) a. Observe cardiac monitor for dysrhythmias b. Observe for evidence of UTI c. Initiate IV fluids using 0.9% sodium chloride d. Administer a levothyroxine IV bolus e. Provide warmth using a heating pad
a. Observe cardiac monitor for dysrhythmias b. Observe for evidence of UTI c. Initiate IV fluids using 0.9% sodium chloride d. Administer a levothyroxine IV bolus
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? a. Serum potassium level of 5.8 mEq/L b. Serum sodium level of 134 mEq/L c. Blood glucose level of 90 mg/dl d. Blood urea nitrogen (BUN) level of 12 mg/dl
a. Serum potassium level of 5.8 mEq/L
A nurse is reviewing laboratory results for a client who has Addison's disease. Which of the following laboratory results should the nurse expect for this client? (Select all that apply) a. Sodium 130 b. Potassium 6.1 c. Calcium 11.6 d. BUN 28 e. Fasting blood glucose 148
a. Sodium 130 b. Potassium 6.1 c. Calcium 11.6 d. BUN 28 ** Na below norm range; hyponatremia is an expected finding in Addison's K above norm range; hyperkalemia is an expected finding in Addison's Ca above norm range; hypercalcemia is an expected finding in Addison's BUN above norm range; which is an expected finding in Addison's d/t dehydration
A nurse is reviewing the laboratory findings of a client who has Cushing's disease. Which of the following findings should the nurse expect for this client? (Select all the apply) a. Sodium 150 b. Potassium 3.3 c. Calcium 8.0 d. Lymphocyte count 35% e. Fasting glucose 145
a. Sodium 150 b. Potassium 3.3 c. Calcium 8.0 e. Fasting glucose 145 ** Na above norm range; hyponatremia is an expected finding in Cushings. K below norm range; hypokalemia is an expected finding in Cushings. Ca below norm range; hypocalcemia is an expected finding in Cushings. Blood glucose above norm range; this is an expected finding in Cushings.
Parathyroid hormone (PTH) has which effects on the kidney? a. Stimulation of calcium reabsorption and phosphate excretion b. Increased absorption of vitamin E and excretion of vitamin D c. Increased absorption of vitamin D and excretion of vitamin E d. Stimulation of phosphate reabsorption and calcium excretion
a. Stimulation of calcium reabsorption and phosphate excretion
A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? (Select all that apply.) A. Tachycardia and hypertension B. Respiratory rate 16/min C. Negative Chvostek's sign D. Laryngeal stridor and hoarseness E. Positive Trousseau's sign
a. Tachycardia and hypertension d. Laryngeal stridor and hoarseness e. Positive Trousseau's sign ** Tachycardia and hypertension are unexpected findings that can indicate the occurrence of thyroid storm following removal of the thyroid gland, especially if the client was in a hyperthyroid state prior to the surgery. Thyrotoxicity (thyroid storm) is a life-threatening condition with a sudden onset that includes tachycardia, a fever, sweating, restlessness, and tremors. Congestive heart failure and pulmonary edema can develop rapidly and lead to death. Laryngeal stridor and hoarseness are unexpected findings and can indicate swelling in the area of the surgery or damage to the laryngeal nerve. This should be reported to the provider before respiratory distress develops. A positive Trousseau's sign is an indication of hypocalcemia, which is a complication of thyroid removal. This occurs when the parathyroid glands are also removed and regulation of serum calcium is impaired.
At the beginning of a shift, a nurse is assessing a client who has Cushing's disease. Which of the following findings is the priority? a. Weight gain b. Fatigue c. Fragile skin d. Joint pain
a. Weight gain
The nurse is performing a physical examination on a client suspected of having an endocrine disorder. Which assessment finding might be indicative of a problem with the thyroid gland? a. cold intolerance b. cataracts c. muscle twitching d. shortness of breath
a. cold intolerance
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany? a. Tapazole b. Calcium gluconate c. Propylthiouracil (PTU) d. Synthroid
b. Calcium gluconate
A nurse is planning care for a client who has Cushing's syndrome due to chronic corticosteroid use. Which of the following actions should the nurse include in the plan of care? A. Check the client's blood glucose for hypoglycemia B. Check the client's urine specific gravity C. Weigh the client weekly D. Insert an indwelling urinary catheter for the client
b. Check the client's urine specific gravity ** The nurse should check the client's urine specific gravity to assess for fluid volume overload.
A nurse in a provider's office is reviewing laboratory results of a client who is being evaluated for secondary hypothyroidism. Which of the following laboratory findings is expected? a. Elevated T4 b. Decreased T3 c. Elevated thyroid stimulating hormone d. Decreased cholesterol
b. Decreased T3
A nurse in a provider's office is reviewing the health record of a client who is being evaluated for Graves' disease. The nurse should identify that which of the following laboratory results in an expected finding? a. Decreased thyrotropin receptor antibodies b. Decreased thyroid-stimulating hormone (TSH) c. Decreased free thyroxine index d. Decreased triiodothyronine
b. Decreased thyroid-stimulating hormone (TSH) ** Low TSH because the pituitary gland decreases the amount of thyroid stimulating hormone if there's already a lot of T3 and T4 hormone already in circulation (hyperthyroidism/ Graves' disease)
A nurse is caring for a client who has diabetes insipidus. Which of the following urinalysis laboratory findings should the nurse expect? a. Presence of glucose b. Decreased specific gravity c. Presence of ketones d. Presence of RBCs
b. Decreased urine specific gravity ** The urine of a pt with DI will be diluted, with a urine specific gravity of less than 1.005
A nurse is reviewing the manifestations of hyperthyroidism with a client. Which of the following findings should the nurse include? (Select all that apply). a. Anorexia b. Heat intolerance c. Constipation d. Palpitations e. Weight loss f. Bradycardia
b. Heat intolerance d. Palpitations e. Weight loss
A nurse is reinforcing teaching with a client who has a new prescription for levothyroxine to treat hypothyroidism. Which of the following information should the nurse include in the teaching? (Select all that apply) a. Weight gain is expected b. Medication should not be discontinued without the advice of the provider c. Follow-up blood TSH levels should be obtained d. Take the medication on an empty stomach e. Use fiber laxatives for constipation
b. Medication should not be discontinued without the advice of the provider c. Follow-up blood TSH levels should be obtained d. Take the medication on an empty stomach
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? a. Diabetes insipidus b. Myxedema coma c. Syndrome of inappropriate antidiuretic hormone (SIADH) d. Thyroid storm
b. Myxedema coma
A nurse is providing medication teaching for a client who has Addison's disease and is taking hydrocortisone. Which of the following instructions should the nurse include? (Select all that apply) a. Take the medication on an empty stomach b. Notify the provider of any illness or stress c. Report any manifestations of weakness or dizziness d. Do not discontinue the medication suddenly e. Eat a low-sodium diet
b. Notify the provider of any illness or stress c. Report any manifestations of weakness or dizziness d. Do not discontinue the medication suddenly
A client has a dysfunction in one of his glands that is causing a decrease in the level of calcium in the blood. What gland should be evaluated for dysfunction? a. Thyroid gland b. Parathyroid gland c. Adrenal gland d. Thymus gland
b. Parathyroid gland **
A nurse is admitting a client who has acute adrenal insufficiency. Which of the following prescriptions should the nurse expect? (Select all that apply) a. IV therapy with 0.45% sodium chloride b. Regular insulin c. Hydrocortisone sodium succinate d. Sodium polystyrene sulfonate e. Furosemide
b. Regular insulin c. Hydrocortisone sodium succinate d. Sodium polystyrene sulfonate e. Furosemide
A nurse is planning care for a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH) with mild manifestations. The nurse should expect the provider to prescribe which of the following medications? A. Chlorpropamide B. Tolvaptan C. Vasopressin D. Desmopressin
b. Tolvaptan ** SIADH is a disorder of water intoxication due to the inappropriate continuous secretion of antidiuretic hormone by the posterior pituitary gland, causing hypervolemia and hyponatremia. Treatment of SIADH includes fluid restriction, sodium replacement with small amounts of 0.9% sodium chloride, and a vasopressin antagonist such as tolvaptan. Tolvaptan promotes the excretion of water, which helps correct the fluid imbalance in clients who have 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. a. Liver function tests b. Urine and blood chemistry c. Signs of dehydration d. Neurologic function e. Strict intake and output
b. Urine and blood chemistry d. Neurologic function e. Strict intake and output
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: a. severe hypotension. b. profound neuromuscular irritability. c. excessive thirst. d. acute gastritis.
b. profound neuromuscular irritability.
A nurse is assessing a client who has Graves' disease. Which of the following findings should the nurse expect the client to display? A. Constipation B. Cold intolerance C. Difficulty sleeping D. Anorexia
c. Difficulty sleeping ** A client who has Graves' disease can have difficulty sleeping and anxiety due to the overproduction of thyroid hormone.
A nurse is assessing a client who is 12 hr postoperative following a thyroidectomy. Which of the following findings is indicative of thyroid crisis? (Select all that apply) a. Bradycardia b. Hypothermia c. Dyspnea d. Abdominal pain e. Mental confusion
c. Dyspnea d. Abdominal pain e. Mental confusion
A nurse is monitoring a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect? A. Polyuria B. Dehydration C. Hyponatremia D. Hyperthermia
c. Hyponatremia ** A client who has SIADH will have hyponatremia caused by the excessive release of antidiuretic hormone (ADH). As a result of the excess ADH, the client retains water, which causes dilutional hyponatremia.
A nurse is providing teaching to a client who has Addison's disease about healthy snack foods. Which of the following food choices by the client indicates an understanding of the teaching? A. Sliced bananas B. Baked potato C. Turkey and cheese sandwich D. Plain yogurt with peaches
c. Turkey and cheese sandwich ** A turkey and cheese sandwich is high in protein, carbohydrates, and sodium. A client who has Addison's disease requires a diet low in potassium and high in sodium, carbohydrates, and protein. Addison's disease is a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex). Addison's disease occurs when the adrenal glands do not produce enough cortisol and, in some cases, aldosterone.
A nurse in the emergency department is caring for a client who has Addison's disease and reports nausea, vomiting, diarrhea, and abdominal pain. To prevent an Addisonian crisis, the nurse should prepare to administer which of the following medications? A. Calcium B. Potassium C. Iodine D. Hydrocortisone
d. Hydrocortisone ** Addison's disease causes adrenal gland hypofunction and inadequate production of glucocorticoids. Acute adrenal insufficiency is life-threatening and can lead to severe fluid and electrolyte imbalances. Without treatment, sodium levels fall, and potassium levels increase. Rapid infusion of IV fluids such as 0.9% sodium chloride and IV administration of high dose corticosteroids such as hydrocortisone are vital to correct the glucocorticoid deficiency.
