Endocrine Review

The client who has undergone a bilateral adrenalectomy is concerned about persistent body changes and unpredictable moods. What should the nurse teach the client about these changes? A) the body changes are permanent and the client will not be the same as before this condition. B) the body and mood will gradually return to normal C) the physical changes are permanent but the mood swings will disappear D) the physical changes are temporary but the mood swings are permanent

The body and mood will gradually return to normal

A 60-year-old female is diagnosed with hypothyroidism. What additional information should the nurse obtain when conducting a focused assessment? A) tachycardia B) weight gain C) diarrhea D) nausea

Weight gain

A client diagnosed with Cushings is admitted to the hospital and scheduled for a dexamethasone suppression test. What should the nurse do during this test? A) collect a 24-hour urine specimen to measure serum cortisol levels B) administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning C) draw blood samples before and after exercise to evaluate the effect of exercise on serum cortisol levels D) administer an injection of ACTH 30 minutes before drawing blood to measure serum cortisol levels

administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning

Which medication should be available to provide emergency treatment if a client develops tetany after a thyroidectomy? A) sodium phosphate B) calcium gluconate C) echothiphate iodide D) sodium bicarbonate

Calcium gluconate

A client with Addisons disease has fluid and electrolyte loss due to inadequate fluid intake and to fluid loss secondary to inadequate adrenal hormone secretion. As the clients oral intake increases, which fluids would be most appropriate? A) milk and diet soda B) water and eggnog C) chicken broth and juice D) coffee and milkshakes

Chicken broth and juice

The nurse is teaching the client with Addisons to anticipate the need for increased glucocorticoid supplementation. When will the client likely need to increase the dose of glucocorticoids? A) returning to work after the weekend B) going on vacation C) having oral surgery D) having a routine medical checkup

Having oral surgery

Which outcome is a priority for the client with Addisons? A) maintenance of medication compliance B) avoidance of normal activities with stress C) adherence to 2g sodium diet D) prevention of hypertensive episodes

Maintenance of medication compliance

The nurse is caring for a client who is scheduled for an adrenalectomy. Which drug may be included in the preoperative prescriptions to prevent Addisons crisis following surgery? A) prednisone orally B) fludrocortisones subQ C) spironolactone IM D) methylprednisolone sodium succinate IV

Methylprednisolone sodium succinate IV

One day following a thyroidectomy, a client begins to have tingling in the fingers and toes. What should the nurse do first? A) encourage the client to flex and extend the fingers and toes B) notify the HCP C) assess the client for thrombophlebitis D) ask the client to speak

Notify the HCP

A client with a large goiter is scheduled for a subtotal thyroidectomy to treat thyrotoxicosis. SSKI is prescribed preoperatively for the client. What should the nurse explain to the client about the expected outcome of using this drug? A) slow progression of exophthalmos B) reduce the vascularity of the thyroid gland C) decrease the body's ability to store thyroxine D) increase the body's ability to excrete thyroxine

Reduce the vascularity of the thyroid gland

Cortisone acetate and fludrocortisone acetate are prescribed as replacement therapy for a client with Addisons. What administration schedule should be followed for this therapy? A) Take both drugs 3 times a day B) Take the entire dose of both drugs first thing in the morning C) Take all the fludrocortisone acetate and two thirds of the cortisone acetate in the morning, and take the remaining cortisone acetate in the afternoon D) Take half of each drug in the morning and the remaining half before bed

Take all the fludrocortisone acetate and two thirds of the cortisone acetate in the morning, and the remaining cortisone acetate in the afternoon

The nurse should monitor the client with Cushings for which finding? A) postprandial hypoglycemia B) hypokalemia C) hyponatremia D) decreased urine calcium levels

Hypokalemia

After a bilateral adrenalectomy for Cushing's disease, the client will receive periodic testosterone injections. The expected outcome of these injections is: A) Balanced reproductive cycle. B) Restored sodium and potassium balance. C) Stimulated protein metabolism. D) Stabilized mood swings.

Stimulated protein metabolism

A client has been diagnosed with Addisons disease. The nurse should plan with the client to manage which effect of the disease? A) weight gain B) hunger C) lethargy D) muscle spasms

Lethargy

The nurse is completing a health assessment of a 42-year-old female with suspected Graves disease. When conducting a focused assessment, what should the nurse assess the client for? A) Anorexia B) Tachycardia C) Weight gain D) Cold skin

Anorexia

A client with hypothyroidism has started to take thyroid replacement therapy and asks the nurse about the reason for feeling sad and depressed. What should the nurse say? A) the feelings of sadness and depression are caused by the side effects of thyroid hormone replacement therapy and will diminish over time B) the feelings of sadness and depression are caused by a condition unrelated to hypothyroidism and require follow up C) are caused by having a chronic illness and are normal D) are caused by low thyroid hormone levels and will improve with the replacement therapy.

Are caused by low thyroid hormone levels and will improve with the replacement therapy.

The nurse is conducting discharge education with a client newly diagnosed with Addisons. Which information should be included in the client and family teaching plan? SATA A) addisons disease will resolve itself over a few weeks, requiring no further treatment. B) avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations C) fatigue, weakness, dizziness, and mood changes need to be reported to the HCP D) a medical identification bracelet should be worn E) family members need to be informed about the warning signs of adrenal crisis F) dental work or surgery will require adjustments of daily medications.

Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. Fatigue, weakness, dizziness and mood changes need to be reported to HCP Family members need to be informed about the warning signs of adrenal crisis Dental work or surgery will require adjustments of daily medications.

A client with hyperthyroidism is to have a thyroidectomy. The healthcare provider has prescribed propranolol. In reviewing the client's history, the nurse notes that the client has asthma. What should the nurse do next? A) Take the clients pulse and withhold the propranolol if pulse is <100 bpm. B) Count the clients respirations and withhold the propranolol if the respirations are <20. C) Contact the HCP and discuss the prescription for propranolol because the client has a history of asthma. D) Instruct the client to make position changes slowly.

Contact the HCP and discuss the prescription for propranolol because the client has a history of asthma.

Which indicator is best for determining whether a client with Addisons is receiving the correct amount of glucocorticoid replacement therapy? A) skin turgor B) temperature C) thirst D) daily weights

Daily weights

A 34-year-old female is diagnosed with hypothyroidism. What information should the nurse obtain from conducting a focused assessment? SATA: A) Rapid pulse B) Decreased energy and fatigue C) Fine, thin hair with hair loss D) Constipation E) Menorrhagia F) Weight gain of 10 lbs (4.5kg)

Decreased energy and fatigue Constipation Menorrhagia Weight gain of 10 lbs (4.5kg)

A client who is recovering from an adrenalectomy has a PCA system with morphine sulfate. What should the nurse do to manage safe administration of the morphine? A) observe the client at regular intervals for opioid addiction B) encourage the client to reduce analgesic use and tolerate the pain C) evaluate pain control at least every 2 hours D) increase the amount of morphine if the client does not administer the medication

Evaluate pain control at least every 2 hours

A client is being evaluated for hypothyroidism. To plan care, the nurse should ask the client about which sign or symptom? A) corneal abrasion B) weight loss C) diarrhea D) fatigue

Fatigue

The nurse is evaluating a client with hyperthyroidism who is taking PTU 100mg/day in 3 divided doses for maintenance therapy. Which statement from the client indicates this drug is effective? A) I have excess energy throughout the day. B) I am able to sleep and rest at night. C) I've lost weight since taking this medication. D) I do perspire throughout the entire day.

I am able to sleep and rest at night.

A client newly diagnosed with Addisons disease asks the nurse about the cause of the disease. What should the nurse tell the client? A) The disease is caused by insufficient secretion of growth hormone B) dysfunction of the hypothalamic pituitary C) idiopathic atrophy of the adrenal glands D) oversecretion of the adrenal medulla

Idiopathic atrophy of the adrenal glands

The client with Addisons is concerned about the bronze color of his skin. What should the nurse tell the client about the cause of the bronze skin? A) hypersensitivity to sun exposure B) increased serum bilirubin level C) adverse effects of the glucocorticoid therapy D) increased secretion of ACTH

Increased secretion of ACTH

A client undergoing a bilateral adrenalectomy has postoperative prescriptions for hydromorphone hydrocholride 2 mg to be administered subcutaneously every 4 hours as needed for pain. Why should the nurse adminiter hydromorphone in small doses? A) it is less likely to cause dependency B) it is less irritation to subcutaneous tissues in small doses C) it's less potent as morphine in larger doses D) it is excreted before accumulating in toxic amounts in the body

It is less potent as morphine in larger doses

Adrenal function is affected by the drug ketoconazole, an antifungal agent used to treat severe fungal infections. How is this effect manifested? A) Ketoconazole suppresses adrenal steroid secretion B) It destroys adrenocortical cells, resulting in a medical adrenalectomy. C) It increases ACTH induced corticosteroid serum levels D) It decreases duration of adrenal suppresion when administer with corticosteroids

Ketoconazole suppresses adrenal steroid secretion

In the early postoperative period after a bilateral adrenalectomy, the client has a temperature of 101 F (38.3 C). What should the nurse assess first to determine the cause of the elevated temperature? A) dehydration B) lung expansion C) wound infection D) UTI

Lung expansion

Bone resorption is a possible complication of Cushings disease. To help the client prevent this complication, what should the nurse recommend to the client? A) Increase the amount of potassium in the diet B) Maintain a regular program of weight-bearing exercise C) limit dietary vitamin D intake D) perform isometric exercises

Maintain a regular program of weight-bearing exercise

Immediately following a thyroidectomy, the nurse asks the client to say hello. The client moves their lips but is not able to speak the word. What should the nurse do next? A) give the client a sip of water B) have the client take a deep breath and cough C) notify the surgeon D) check the clients pupillary response

Notify the surgeon

A client has had an adrenalectomy. What is the priority goal for this client in the first 24 hours after surgery? A) beginning oral nutrition B) promoting self care activities C) preventing adrenal crisis D) ambulating in the hallway

Prevent adrenal crisis

Which goal is the priority for a client in addisonian crisis? A) controlling hypertension B) preventing irreversible shock C) preventing infection D) relieving anxiety

Preventing irreversible shock

The client with Cushings needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate? A) increase calories B) restrict sodium C) restrict potassium D) reduce fat to 10%

Restrict sodium

A client with Addisons disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effects of corticosteroids? SATA A) hyperkalemia B) skeletal muscle weakness C) mood changes D) hypocalcemia E) increased susceptibility to infection F) hypotension

Skeletal muscle weakness Mood changes Hypocalcemia Increased susceptibility to infection

PTU is prescribed for a client with Graves disease. Which symptom should the nurse teach the client to report? A) sore throat B) excessive menstruation C) constipation D) increased urine output

Sore throat

A client with hyperthyroidism is to be treated with radioactive iodine (RAI - I 131). Following treatment, what should the nurse teach the client to do? A) monitor for signs and symptoms of hyperthyroidism B) rest for 1 week to prevent complications of medication C) take thyroxine replacement for the remainder of clients life D) assess for hypertension and tachycardia resulting from altered thyroid activity.

Take thyroxine replacement for the remainder of clients life

Which information should the nurse include in the teaching plan of a female client with bilateral adrenalectomy? A) the client will need steroid replacement for the rest of her life B) the client must decrease the dose of steroid medication carefully to prevent crisis C) the client will require steroids only until her body can manufacture sufficient quantities D) the client will need to take steroids whenever her life involves physical or emotional stress

The client will need steroid replacement for the rest of her life

A client with Cushings tells the nurse that the HCP said the morning serum cortisol level was within normal limits. The client asks " how can that be? I'm not imagining all these symptoms!" The nurse's response will be based on what information? A) Some clients are very sensitive to the effects of cortisol and develop symptoms even with normal levels B) a single random blood test cannot provide reliable information about endocrine levels C) the excessive cortisol levels seen in Cushings commonly result from loss of the normal diurnal secretion pattern D) tumors tend to secrete hormones irregularly and the hormones are generally not present in the blood

The excessive cortisol levels seen in Cushings commonly result from loss of the normal diurnal secretion pattern

Which topic is most important to include in the teaching plan for a client newly diagnosed with Addisons disease who will be taking corticosteroids? A) the importance of watching for signs of hyperglycemia B) the need to adjust the steroid dose based on dietary intake and exercise C) to notify the HCP when the blood pressure is suddenly high D) how to decrease the dose of the corticosteroids when the client is experiencing stress

The importance of watching for signs of hyperglycemia

The nurse is instructing the client with hypothyroidism who takes levothyroxine 100 mcg, digoxin, and simvastatin. The nurse judges that the teaching regarding the use of these medication is effect if the client will take: A) the levothyroxine with breakfast and the others after breakfast B) the levothyroxine before breakfast and the others 4 hours later C) all medications together 1 hour after eating breakfast D) all medications before going to bed

The levothyroxine before breakfast and the others 4 hours later

After stabliztion of Addisons disease, the nurse teaches the client about stress management. What should the nurse instruct the client to do? A) remove all sources of stress from daily life B) use relaxation techniques such as music C) take anti anxiety drugs daily D) avoid discussing stressful experiences

Use relaxation techniques such as music

The client with Addisons is taking glucocorticoids at home. Which statement indicates that the client understands how to take the medication? A) Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage. B) My need for glucocorticoids will stabilize, and I will be able to take a predetermined dose once a day. C) Glucocorticoids are cumulative so I will take a dose every third day. D) I must take a dose every 6 hours to ensure consistent blood levels of glucocorticoids.

Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage.

A client with Graves disease has exophthalmos. What should the nurse teach the client to do to prevent corneal irritation? A) Massage the eyes every 4 hours B) Instill an ophthalmic analgesic as prescribed C) wear dark colored glasses when awake D) Cover both eyes with moistened gauze pads at night.

Wear dark colored glasses when awake

When teaching a client about taking oral glucocorticoids, how should the nurse instruct the client to take medications? A) with a full glass of water B) on an empty stomach C) at bedtime to increase absorption D) with meals or with an antacid

With meals or with an antacid

As the nurse assists the postop client out of bed, the client reports having gas pain in the abdomen. To reduce this discomfort, what should the nurse do? A) encourage the client to ambulate B) insert a rectal tube C) insert a NG tube D) encourage the client to drink carbonated liquids

encourage the client to ambulate

A client with thyrotoxicosis says to the nurse, "I'm so irritable. I'm having problems at work because I lose my temper very easily." Which response by the nurse would give the client the most accurate explanation of this behavior? A) You are experiencing temporary confusion brought on by your illness. B) you are experiencing excess thyroid hormone in your system. C) you are experiencing worry about the seriousness of your illness. D) You are experiencing stress of trying to manage a career and cope with illness.

you are experiencing excess thyroid hormone in your system

When conducting a health history with a female client with thyrotoxicosis, the nurse should ask about which changes in the menstrual cycle? A) Dysmenorrhea B) Metorrhagia C) Oligomenorrhea D) Menorrhagia

Oligomenorrhea

Following a subtotal thyroidectomy, the nurse asks the client to speak immediately upon regaining consciousness. The client is not able to make a sound. The nurse determines that the client is experiencing which complication of the surgery? A) internal hemorrhage B) decreased level of consciousness C) laryngeal nerve damage D) upper airway obstruction

Laryngeal nerve damage

What is an expected finding in a client with adrenal crisis? A) fluid retention B) pain C) peripheral edema D) hunger

Pain

The nurse is instructing a college student with Addisons how to adjust the dose of glucocorticoids. The nurse should explain that the client may need an increased dosage of glucocorticoids in which situation? A) completing course work B) gaining 4 lbs (1.8 kgs) C) becoming engaged D) having wisdom teeth extracted

Having wisdom teeth extracted

A client has an adrenal tumor and is scheduled for a bilateral adrenalectomy. During preoperative teaching, the nurse teaches the client how to do deep breathing exercises after surgery. What should the nurse tell the client to do? A) Sit in an upright position and take a deep breath B) Hold your abdomen firmly with a pillow and take several deep breaths C) Tighten your stomach muscles as your inhale and breathe normally D) Raise your shoulders to expand your chest

Hold your abdomen firmly with a pillow and take several deep breaths

A client has had a bilateral adrenalectomy. For which potential complication should the nurse assess the client? A) postop confusion B) delayed wound healing C) pulmonary emboli D) malnutriton

Delayed would healing

A client with hyperthyroidism is to take SSKI. What should the nurse do when administering this drug? A) Pour the solution over ice chips B) Mix with an antacid C) Dilute with water, milk, or juice and have client drink with a straw D) disguise the solution in a pureed fruit or vegetable

Dilute with water, milk, or juice and have client drink with a straw

A client is receiving an infusion of 5% dextrose in normal saline running at 125 mL/hr. When hanging a new bag of fluid, the nurse notes swelling and hardness at the IV site. The nurse should first: A) discontinue the infusion B) apply a warm soak to the site C) stop the flow of solution temporarily D) irrigate the needle with normal saline

Discontinue the infusion