ENDOCRINE EAQ

What are the *primary causes of adrenal insufficiency*? Select all that apply.

1. Autoimmue 2. TB 3. Mastastatic cancer 4. AIDS 5. Hemmorage 6. Gram-NEG sepsis 7. adrenalectomy 8. abdominal radiation therapy 9. Drugs (mitotane & toxins)

Cypro hept adine is effective for the

treatment of PITUTARY Cushing's syndrome.

Range-of-motion exercises after thyroidectomy should not begin until

two to four days postoperatively because they can disrupt the suture line.

A client with type 2 diabetes, who is taking an oral hypoglycemic agent, is to have a serum glucose test early in the morning. The client asks the nurse, "What do I have to do to prepare for this test?" Which statement by the nurse reflects accurate information?

"Do not ingest anything before the test." Fasting before the test is indicated (8 hours) for accurate and reliable results; food before the test will increase serum glucose levels through metabolism of the nutrients.

When preparing a client for discharge after a thyroidectomy, the nurse teaches the signs of hypothyroidism. When teaching when to call the primary healthcare provider, what statement made by the client shows that teaching was effective?

"I should call the primary healthcare provider for dry hair and an intolerance to cold.

A nurse is caring for a client who has just returned from the postanesthesia care unit after having a thyroidectomy. Which action has priority during the first 24 hours after surgery when the nurse is concerned about thyroid storm?

*Checking vital signs helps detect complications* such as t*hyrotoxic crisis, hemorrhage*, and *respiratory obstruction* that may occur early in the postoperative period.

Headaches, gastric irritation, and orthostatic hypotension are associated with

*bromocriptine*, which is used to treat hyperpituitarism.

Androgen therapy may cause

1. baldness, 2. gynecomastia, and 3. acne.

What are the *secondary causes of adrenal insufficiency*? Select all that apply.

1. pitutary tumors 2. postparttium necrosis 3. Hypophysectomy 4. high-dos pit - whole brain radiaiton

The normal value of sodium is

136 to 145 mEq/L,

The normal level of potassium is

3.5 to 5.0 mEq/L.

A client suspected to have hyperpituitarism is sent by the primary healthcare provider to undergo a suppression test. Which laboratory value would indicate a positive result?

6 ng/mL

Normal level of total calcium is

9 to 10.5 mg/dL.

causes decreased muscle strength and decreased bone density.

A growth hormone deficiency

results in hirsutism and menstrual abnormality

A thyroid-stimulating hormone deficiency

results in hirsutism, weight gain, and menstrual abnormalities.

A thyroid-stimulating hormone deficiency

ablation therapy

A treatment for hyperthyroidism using radioactive iodine

A client has undergone nasal hypophysectomy surgery. During post-operative care, which finding indicates cerebrospinal leakage?

A yellow edge around nasal discharge

Which hormone synthesis does the nurse state is inhibited by hypokalemia?

Aldosterone *Hypokalemia inhibits synthesis of aldosterone hormone.*

causes a reduced growth of axial and pubic hair in women.

An adrenocorticotropic hormone deficiency

causes postural hypotension, hypoglycemia, and anorexia.

An adrenocorticotropic hormone deficiency

causes excessive urine output and a low urine specific gravity.

An antidiuretic hormone deficiency

What other name can the nurse use for vasopressin?

Antidiuretic Hormone Antidiuretic hormone is also called vasopressin. Growth hormone can be called somatotropin. Luteinizing hormone is a gonadotropin. Thyroid-stimulating hormone can be called thyrotropin.

Which side effect should the nurse monitor for when administering androgen therapy?

Baldness Androgen therapy may cause baldness, gynecomastia, and acne. Headaches, gastric irritation, and orthostatic hypotension are associated with bromocriptine, which is used to treat hyperpituitarism.

Which catecholamine receptor is responsible for increased heart rate?

Beta 1

A nurse explains to a client with diabetes that self-monitoring of blood glucose is preferred to urine glucose testing. Why is blood glucose monitoring preferred?

Blood glucose testing is a more direct and accurate measure; urine testing provides an indirect measure that can be influenced by kidney function and the amount of time the urine is retained in the bladder. Whereas blood and urine testing is relatively simple, testing the blood involves additional knowledge. Both procedures can be done by the client. Whether or not it is influenced by drugs is not a factor. Although some urine tests are influenced by drugs, there are methods to test urine to bypass this effect.

client with type 1 diabetes is transported via ambulance to the emergency department of the hospital. The client has dry, hot, flushed skin and a fruity odor to the breath and is having Kussmaul respirations. Which complication does the nurse suspect that the client is experiencing?

DKA

the cardiovascular manifestation observed in the client with hypothyroidism

Decreased blood pressure is

Which hormones does the nurse state are released by the hypothalamus? Select all that apply.

Melanocyte-inhibiting hormone (MIH)??? Corticotropin-releasing hormone (CRH) Growth hormone-releasing hormone (GHRH

Which medical condition could most probably result in clients developing primary diabetes insipidus (DI)?

Defect in hypothalamus

the pulmonary manifestation observed in the client with hypothyroidism.

Difficulty in breathing is

Hot Dry Flushed skin Fruity breath odor Kassamaul resp - Suspected Diabetes

Dx: Diabetic ketoacidosis

Which hormone secretion does the nurse state is an example of a positive feedback mechanism?

Estradiol secretion pattern is an example of a positive feedback mechanism.

During a home visit to a client, the nurse identifies tremors of the client's hands. When discussing this assessment, the client reports being nervous, having difficulty sleeping, and feeling as if the collars of shirts are getting tight. Of the additional assessment findings, which one should the nurse report to the practitioner?

Fluttering in the chest Many of these problems are associated with hyperthyroidism; palpitations may indicate cardiovascular changes requiring prompt intervention. The increased metabolism associated with hyperthyroidism can lead to heart failure. Although an increased appetite becomes a compensatory mechanism for the increased metabolism associated with hyperthyroidism, it is not life threatening. Although unexplained weight loss can result from catabolism associated with hyperthyroidism, it is not life threatening. Although a feeling of warmth caused by the increased metabolism associated with hyperthyroidism is uncomfortable, it is not life threatening.

temporary and not life threatening post op thyroidectomy ; .

Hoarseness and voice weakness usually are

Hyperosmolarity cause __kalemia

Hyperkalemia (HYPERosmolartiy causes HYPERkalemia)

After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). What manifestations are exhibited with excessive levels of antidiuretic hormone?

Hyponatremia and decreased urine output

the *neuromuscular manifestation* of hypothyroidism.

Impaired memory is

A nurse is caring for a client with type 1 diabetes who is experiencing a fluid imbalance. Which fluid shift associated with diabetes should the nurse take into consideration when assessing this client?

Intracellular to intravascular as a result of hyperosmolarity

Catecholamines secretion is controlled by the nervous system.

It is secreted by the sympathetic nervous system.

Which procedure is preferred to find out the composition of a thyroid nodule and ascertain the need for further surgical intervention in a client?

Needle biopsy

A client with type 1 diabetes is admitted to the hospital for major surgery. Before surgery, the client's insulin requirements are elevated but well controlled. What insulin requirements will the nurse anticipate for this client postoperatively?

Remain elevated Emotional and physical stress may cause insulin requirements to remain elevated in the postoperative period.

24-hour urine test is prescribed for a client who has a tentative diagnosis of pheochromocytoma. What should the nurse do first?

Start the time of the test after discarding the first voiding

A client, visiting the health center, reports feeling nervous, irritable, and extremely tired. The client says to the nurse, "Although I eat a lot of food, I have frequent bouts of diarrhea and am losing weight." The nurse observes a fine hand tremor, an exaggerated reaction to external stimuli, and a wide-eyed expression. What laboratory tests may be prescribed to determine the cause of these signs and symptoms?

T3, T4, and thyroid-stimulating hormone (TSH

When growth hormone level falls below 5 ng/mL, this indicates a negative result, which means

The client is not suffering with hyperpituitarism.

A client who has had a subtotal thyroidectomy does not understand how hypothyroidism can develop when the problem was initially hyperthyroidism. On what fact should the nurse base her response?

There may not be enough thyroid tissue to supply adequate thyroid hormone.

Dry, sparse hair and cold intolerance are characteristic responses to

low serum thyroxine.

causes atrophy of the breasts.

luteinizing hormone deficiency

Pheochromocytoma

a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine

Needle biopsy is

an ambulatory surgical procedure. A fine needle is used to aspirate the contents of thyroid nodules to study the composition and ascertain the need for further surgical interventions.

Hypothyroidism is a.

decrease in thyroid functioning, not a slowing of the entire body's functions

Computed tomography scans are useful for.

evaluation of ovaries, adrenal glands, and the pancreas.

Alpha receptors are present in such organs as

eyes, skin, and liver.

Cushing's syndrome is manifested by

moon face, truncal obesity, and hypertension.

Transsphenoidal hypophysectomy is

removal of the pituitary gland.

Low thyroxine levels reduce the metabolic rate, resulting in

weight gain and bradycardia,

Vasopressin regulates

fluid level and blood pressure.

Luteinizing hormone is a.

gonadotropin

Beta1 receptors are responsible for .

increased heart rate

The relationship between calcium and parathormone is also an example of a

negative feedback mechanism.

Fluctuating insulin requirements usually are associated with

noncompliance

causes decreased bone density and pathologic fractures.

growth hormone deficiency

When the growth hormone level in a suppression test is above 5 ng/mL, this indicates a positive result, which means

the client is suffering from hyperpituitarism.

The hypothalamus is a small area of nerve and endocrine tissue located beneath the thalamus in the brain. MIH, CRH, and GHRH are released by

the hypothalamus.

A defect in the hypothalamus (thirst center) could be

the most probable cause of primary DI.

Cold intolerance and decreased body temperature are the.

*metabolic manifestations* observed in a client with hypothyroidism

What is hyperosmolar hyperglycemic state?

-Insulin deficiency resulting in dehydration and HYPERosmolarity -Extremely high blood sugars Type ii

After a subtotal thyroidectomy

the thyroxine output may be inadequate to maintain an appropriate metabolic rate. - thus causing HYPOTHYROID

Thyroid-stimulating hormone can be called.

thyrotropin

Normal level of bicarbonate is,

23 to 30 mEq/L

Which hormones are secreted by the posterior pituitary gland? Select all that apply.

1. ADH 2. OXYTOCIN

Transsphenoidal hypophysectomy is close to the brain. Clear drainage from the nares could indicate a cerebral spinal fluid (CSF) leak. The nurse should

1. contact the primary healthcare provider 2. send the drainage to the laboratory for glucose evaluation. 3. If the glucose level is greater than *30 mg/dL*, this would indicate a CSF leak. This is not a normal occurrence postoperatively for this procedure.

A client with malignant hot nodules of the thyroid gland has a thyroidectomy. What is the nurse's priority action immediately postoperative?

Monitor the trachea for deviation to the right or left

A client who is taking an oral hypoglycemic daily for type 2 diabetes develops the flu and is concerned about the need for special care at home. What should the nurse instruct the client to do?

Take the oral hypoglycemic pill, drink warm fluids, and check blood sugar before meals and at bedtime. Physiological stress increases gluconeogenesis, requiring continued pharmacological therapy despite an inability to eat; fluids prevent dehydration and monitoring blood sugar levels permits early intervention if necessary. Skipping the oral hypoglycemic can precipitate hyperglycemia; serum glucose levels must be monitored. Food intake should be attempted to prevent acidosis; oral hypoglycemics should be taken and serum glucose levels should be monitored. Telling the client to eat as much as possible, increase fluid intake, and call the office again the next day are incomplete instructions; oral hypoglycemics should be taken and serum glucose levels should be monitored. Eating as much as possible can precipitate hyperglycemia.

Exercise increases the metabolic rate, and glucose is needed for cellular metabolism; therefore,

excess glucose is consumed during exercise. Regular vigorous exercise increases cell sensitivity to insulin.

A pituitary infarction is caused by

postpartum hemorrhaging; this condition is known as Sheehan's syndrome.

The laboratory value of the potassium in the client is 2.9 mEq/L, which is below the normal level. Therefore, it may indicate the

presence of adrenal gland hyperfunction in the client.

Lithium therapy affects the

renal response to ADH and results in nephrogenic DI, or drug-related DI.

A sharp increase in the client's insulin requirements post-op may indicate

sepsis

Growth hormone can be called.

somatotropin

A vasopressin deficiency causes

hypotension. Impotence, amenorrhea, and

A deviated trachea is an

imminent sign of airway compromise which requires immediate intervention. The client is at high risk for bleeding within the first 24 hours postoperative.

In hypothyroidism the level of TSH from the pituitary usually is

increased.

Norepinephrine (also known as noradrenaline) & *Somatostatin* also known as Growth Hormone Inhibiting Hormone (GHIH) inhibits the synthesis of

insulin

Meningitis or a brain tumor could

interfere with the synthesis, transport, or release of antidiuretic hormone (ADH) and cause central DI.

A humidifier can contribute to the spread of bacteria and infection and

is contraindicated post-op thyroidectomy.

Schwartz-Bartter syndrome, also called syndrome of inappropriate antidiuretic hormone, is manifested by

loss of appetite, nausea, and vomiting.

Insulin secretion pattern is an example of a

negative feedback mechanism.

priority post-op thyroidectomy

observe for 1. thyroid storm, 2. hemorrhage, and 3. respiratory obstruction

The nurse is caring for the client posttranssphenoidal hypophysectomy. When assessing the client, the nurse observes clear drainage from the nares. What could be the cause of this drainage?

A cerebral spinal fluid leak from an opening to the brain.

MITOtane is prescribed for the treatment of.

ADRENAL Cushing's syndrome

Muscle cramping is associated with

hypocalcemia.

Mass spectrometry is

an assay in which several different hormone concentrations can be simultaneously analyzed.

FSH and TSH are released by the

anterior pituitary gland.

Cabergoline and bromocriptine mesylate

are effective for the treatment of hyperpituitarism.

Beta2 receptors are present in such organs as

blood vessels, kidneys, *bronchioles*, and bladder.

Low thyroxine levels reduce the metabolic rate, resulting in ,

fatigue

Physiological stress increases

gluconeogenesis,

The average blood glucose level over 2 to 3 months is revealed by a

glycosylated hemoglobin test

Addison's disease is manifested by

hyperkalemia, hypotension, and hypoglycemia.