Endocrine

A nurse evaluates laboratory results for a male client who reports fluid secretion from his breasts. Which hormone value should the nurse assess first? Select one: a. Adrenal medulla hormones b. Posterior pituitary hormones c. Parathyroid hormone d. Anterior pituitary hormones

Breast fluid and milk production are induced by the presence of prolactin, secreted from the anterior pituitary gland. The other hormones would not cause fluid secretion from the client's breast. The correct answer is: Anterior pituitary hormones

After teaching a young adult client who is newly diagnosed with type 1 diabetes mellitus, the nurse assesses the client's understanding. Which statement made by the client indicates a correct understanding of the need for eye examinations? Select one: a. "At my age, I should continue seeing the ophthalmologist as I usually do." b. "My vision will change quickly. I should see the ophthalmologist twice a year." c. "Diabetes can cause blindness, so I should see the ophthalmologist yearly." d. "I will see the eye doctor when I have a vision problem and yearly after age 40."

Diabetic retinopathy is a leading cause of blindness in North America. All clients with diabetes, regardless of age, should be examined by an ophthalmologist (rather than an optometrist or optician) at diagnosis and at least yearly thereafter. The correct answer is: "Diabetes can cause blindness, so I should see the ophthalmologist yearly."

A nurse cares for a client who is prescribed a drug that blocks a hormone's receptor site. Which therapeutic effect should the nurse expect? Select one: a. Unchanged hormone response b. Increased hormone activity c. Decreased hormone activity d. Greater hormone metabolism

Hormones cause activity in the target tissues by binding with their specific cellular receptor sites, thereby changing the activity of the cell. When receptor sites are occupied by other substances that block hormone binding, the cell's response is the same as when the level of the hormone is decreased. The correct answer is: Decreased hormone activity

While assessing a client with Graves' disease, the nurse notes that the client's temperature has risen 1° F. Which action should the nurse take first? Select one: a. Turn the lights down and shut the client's door. b. Calculate the client's apical-radial pulse deficit. c. Call for an immediate electrocardiogram (ECG). d. Administer a dose of acetaminophen (Tylenol).

A temperature increase of 1° F may indicate the development of thyroid storm, and the provider needs to be notified. But before notifying the provider, the nurse should take measures to reduce environmental stimuli that increase the risk of cardiac complications. The nurse can then call for an ECG. The apical-radial pulse deficit would not be necessary, and Tylenol is not needed because the temperature increase is due to thyroid activity. The correct answer is: Turn the lights down and shut the client's door.

A nurse assesses a client with hyperthyroidism who is prescribed lithium carbonate. Which assessment finding should alert the nurse to a side effect of this therapy? Select one: a. Profuse nausea and diarrhea b. Blurred and double vision c. Decreased attention and insomnia d. Increased thirst and urination

Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. This manifests with increased thirst and urination. Lithium has no effect on vision, gastric upset, or level of consciousness. The correct answer is: Increased thirst and urination

A nurse assesses clients for potential endocrine disorders. Which client is at greatest risk for hyperparathyroidism? Select one: a. A 66-year-old female with moderate heart failure b. A 29-year-old female with pregnancy-induced hypertension c. A 72-year-old male who is prescribed home oxygen therapy d. A 41-year-old male receiving dialysis for end-stage kidney disease

Clients who have chronic kidney disease do not completely activate vitamin D and poorly absorb calcium from the GI tract. They are chronically hypocalcemic, and this triggers overstimulation of the parathyroid glands. Pregnancy-induced hypertension, moderate heart failure, and home oxygen therapy do not place a client at higher risk for hyperparathyroidism. The correct answer is: A 41-year-old male receiving dialysis for end-stage kidney disease

A nurse assesses a female client who presents with hirsutism. Which question should the nurse ask when assessing this client? Select one: a. "How do you feel about yourself?" b. "What medications are you prescribed?" c. "What are you doing to prevent this from happening?" d. "How do you plan to pay for your treatments?"

Hirsutism, or excessive hair growth on the face and body, can result from endocrine disorders. This may cause a disruption in body image, especially for female clients. The nurse should inquire into the client's body image and self-perception. Asking about the client's financial status or current medications does not address the client's immediate problem. The client is not doing anything to herself to cause the problem, nor can the client prevent it from happening. The correct answer is: "How do you feel about yourself?"

A nurse cares for a client who is recovering from a parathyroidectomy. When taking the client's blood pressure, the nurse notes that the client's hand has gone into flexion contractions. Which laboratory result does the nurse correlate with this condition? Select one: a. Serum sodium: 122 mEq/L b. Serum magnesium: 1.7 mEq/L c. Serum calcium: 6.9 mg/dL d. Serum potassium: 2.9 mEq/L

Hypocalcemia destabilizes excitable membranes and can lead to muscle twitches, spasms, and tetany. This effect of hypocalcemia is enhanced in the presence of tissue hypoxia. The flexion contractions (Trousseau's sign) that occur during blood pressure measurement are indicative of hypocalcemia, not the other electrolyte imbalances, which include hypokalemia, hyponatremia, and hypomagnesemia. The correct answer is: Serum calcium: 6.9 mg/dL

A nurse assesses a client who is prescribed levothyroxine (Synthroid) for hypothyroidism. Which assessment finding should alert the nurse that the medication therapy is effective? Select one: a. Heart rate is 70 beats/min and regular. b. Thirst is recognized and fluid intake is appropriate. c. Weight has been the same for 3 weeks. d. Total white blood cell count is 6000 cells/mm3.

Hypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and constipation. If a client's heart rate is bradycardic while on thyroid hormone replacement, this is an indicator that the replacement may not be adequate. Conversely, a heart rate above 100 beats/min may indicate that the client is receiving too much of the thyroid hormone. Thirst, fluid intake, weight, and white blood cell count do not represent a therapeutic response to this medication. The correct answer is: Heart rate is 70 beats/min and regular.

A nurse cares for a client with excessive production of thyrocalcitonin (calcitonin). For which electrolyte imbalance should the nurse assess? Select one: a. Sodium b. Potassium c. Calcium d. Magnesium

Parafollicular cells produce thyrocalcitonin (calcitonin), which regulates serum calcium levels. Calcitonin has no impact on potassium, sodium, or magnesium balances. The correct answer is: Calcium

A nurse cares for a client who has a family history of diabetes mellitus. The client states, "My father has type 1 diabetes mellitus. Will I develop this disease as well?" How should the nurse respond? Select one: a. "Female children do not inherit diabetes mellitus, but male children will." b. "The risk for becoming a diabetic is 50% because of how it is inherited." c. "No genetic risk is associated with the development of type 1 diabetes mellitus." d. "Your risk of diabetes is higher than the general population, but it may not occur."

Risk for type 1 diabetes is determined by inheritance of genes coding for HLA-DR and HLA-DQ tissue types. Clients who have one parent with type 1 diabetes are at increased risk for its development. Diabetes (type 1) seems to require interaction between inherited risk and environmental factors, so not everyone with these genes develops diabetes. The other statements are not accurate.

A nurse teaches a client about self-monitoring of blood glucose levels. Which statement should the nurse include in this client's teaching to prevent bloodborne infections? Select one: a. "Use gloves when monitoring your blood glucose." b. "Blot excess blood from the strip with a cotton ball." c. "Do not share your monitoring equipment." d. "Wash your hands after completing each test."

Small particles of blood can adhere to the monitoring device, and infection can be transported from one user to another. Hepatitis B in particular can survive in a dried state for about a week. The client should be taught to avoid sharing any equipment, including the lancet holder. The client should be taught to wash his or her hands before testing. The client would not need to blot excess blood away from the strip or wear gloves. The correct answer is: "Do not share your monitoring equipment."

A nurse plans care for an older adult who is admitted to the hospital for pneumonia. The client has no known drug allergies and no significant health history. Which action should the nurse include in this client's plan of care? Select one: a. Palpate the client's thyroid gland. b. Offer fluids every hour or two. c. Initiate Airborne Precautions. d. Place an indwelling urinary catheter.

A normal age-related endocrine change is decreased antidiuretic hormone (ADH) production. This results in a more diluted urine output, which can lead to dehydration. If no contraindications are known, the nurse should offer (or delegate) the client something to drink at least every 2 hours. A client with simple pneumonia would not require Airborne Precautions. Indwelling urinary catheterization is not necessary for this client and would increase the client's risk for infection. The nurse should plan a toileting schedule and assist the client to the bathroom if needed. Palpating the client's thyroid gland is a part of a comprehensive examination but is not specifically related to this client. The correct answer is: Offer fluids every hour or two.

A nurse is teaching a client with diabetes mellitus who asks, "Why is it necessary to maintain my blood glucose levels no lower than about 60 mg/dL?" How should the nurse respond? Select one: a. "Your brain needs a constant supply of glucose because it cannot store it." b. "Without a minimum level of glucose, your body does not make red blood cells." c. "Glucose is the only fuel used by the body to produce the energy that it needs." d. "Glucose in the blood prevents the formation of lactic acid and prevents acidosis."

Because the brain cannot synthesize or store significant amounts of glucose, a continuous supply from the body's circulation is needed to meet the fuel demands of the central nervous system. The nurse would want to educate the client to prevent hypoglycemia. The body can use other sources of fuel, including fat and protein, and glucose is not involved in the production of red blood cells. Glucose in the blood will encourage glucose metabolism but is not directly responsible for lactic acid formation. The correct answer is: "Your brain needs a constant supply of glucose because it cannot store it."

A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the second postoperative day the client states, "I feel numbness and tingling around my mouth." What action should the nurse take? Select one: a. Assess for Chvostek's sign. b. Ask the client orientation questions. c. Loosen the dressing. d. Offer mouth care.

Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which could progress to cause tetany and seizure activity. The nurse should assess the client further by testing for Chvostek's sign and Trousseau's sign. Then the nurse should notify the provider. Mouth care, loosening the dressing, and orientation questions do not provide important information to prevent complications of low calcium levels. The correct answer is: Assess for Chvostek's sign.

A nurse evaluates the following laboratory results for a client who has hypoparathyroidism: Calcium 7.2 mg/dL Sodium 144 mEq/L Magnesium 1.2 mEq/L Potassium 5.7 mEq/L Based on these results, which medications should the nurse anticipate administering? (Select all that apply.) Select one or more: a. 50% magnesium sulfate b. Oral calcitriol (Rocaltrol) c. Intravenous calcium chloride d. Oral potassium chloride e. 3% normal saline IV solution

The client has hypocalcemia (treated with calcium chloride) and hypomagnesemia (treated with magnesium sulfate). The potassium level is high, so replacement is not needed. The client's sodium level is normal, so hypertonic IV solution is not needed. No information about a vitamin D deficiency is evident, so calcitriol is not needed. The correct answers are: Intravenous calcium chloride, 50% magnesium sulfate

A nurse prepares to palpate a client's thyroid gland. Which action should the nurse take when performing this assessment? Select one: a. Ask the client to swallow after palpating the thyroid. b. Place the client in a sitting position with the chin tucked down. c. Palpate the right lobe with the nurse's left hand. d. Stand in front of the client instead of behind the client.

The client should be in a sitting position with the chin tucked down as the examiner stands behind the client. The nurse feels for the thyroid isthmus while the client swallows and turns the head to the right, and the nurse palpates the right lobe with the right hand. The technique is repeated in the opposite fashion for the left lobe. The correct answer is: Place the client in a sitting position with the chin tucked down.

A nurse assesses a client diagnosed with adrenal hypofunction. Which client statement should the nurse correlate with this diagnosis? Select one: a. "I have a terrible craving for potato chips." b. "I get hungry even after eating a meal." c. "I no longer have an appetite for anything." d. "I cannot seem to drink enough water."

The nurse correlates a client's salt craving with adrenal hypofunction. Excessive thirst is related to diabetes insipidus or diabetes mellitus. Clients who have hypothyroidism often have a decrease in appetite. Excessive hunger is associated with diabetes mellitus. The correct answer is: "I have a terrible craving for potato chips."

A nurse cares for a client who presents with bradycardia secondary to hypothyroidism. Which medication should the nurse anticipate being prescribed to the client? Select one: a. Propranolol (Inderal) b. Epinephrine (Adrenalin) c. Atropine sulfate d. Levothyroxine sodium (Synthroid)

The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine sodium. If the heart rate were so slow that it became an emergency, then atropine or epinephrine might be an option for short-term management. Propranolol is a beta blocker and would be contraindicated for a client with bradycardia. The correct answer is: Levothyroxine sodium (Synthroid)

A nurse cares for a client who is prescribed pioglitazone (Actos). After 6 months of therapy, the client reports that his urine has become darker since starting the medication. Which action should the nurse take? Select one: a. Assess for pain or burning with urination. b. Review the client's liver function study results. c. Instruct the client to increase water intake. d. Test a sample of urine for occult blood.

Thiazolidinediones (including pioglitazone) can affect liver function; liver function should be assessed at the start of therapy and at regular intervals while the client continues to take these drugs. Dark urine is one indicator of liver impairment because bilirubin is increased in the blood and is excreted in the urine. The nurse should check the client's most recent liver function studies. The nurse does not need to assess for pain or burning with urination and does not need to check the urine for occult blood. The client does not need to be told to increase water intake. The correct answer is: Review the client's liver function study results.