HESI Prep: Endocrine

A client with an aldosterone-secreting adenoma is scheduled for surgery to remove the tumor. The client asks what will happen if surgery is canceled. Which response is accurate? 1. Heart and kidney damage may occur if the tumor is not removed. 2. Surgery will prevent the tumor from metastasizing to other organs. 3. Chemotherapy is as reliable as surgery to treat adenomas of this type. 4. Radiation therapy or surgery can be just as effective if the tumor is small.

1. Heart and kidney damage may occur if the tumor is not removed. Renal and cardiac complications will occur if hypertension is not arrested. An aldosteronoma is a benign tumor; metastasis is not possible. Medications are not used; the tumor must be removed. It is not true that radiation therapy or surgery can be just as effective if the tumor is small; the tumor must be removed by surgical means.

The client who has hypofunction of the adrenal gland is prescribed fludrocortisone. Which nursing action in the follow-up visit minimizes risk of a potential side effect of the medication? 1. Monitoring the client's blood pressure 2. Monitoring the client's body temperature 3. Instructing the client to take the medication along with food 4. Instructing the client to report occurrence of uncontrolled watery stools

1. Monitoring the client's blood pressure Fludrocortisone administered to treat adrenal gland hypofunction could cause hypertension as a side effect. The nurse should monitor the client's blood pressure. A client on prednisone therapy should be monitored for fever by checking body temperature. The dose of prednisone needs to be altered in case of fever. Cortisone causes gastrointestinal irritation as a side effect. The nurse should instruct the client on cortisone therapy to take the medication along with food. The dose of prednisone needs modification if the client develops infection or illness. The nurse should instruct the client on prednisone therapy to report any occurrence of diarrhea or watery stools.

In anticipation of a client returning to the room after a subtotal thyroidectomy, which intervention would be highest priority for the nurse to perform? 1. Have sterile dressing supplies in the room. 2. Place a tracheostomy set at the bedside. 3. Place the client in semi-Fowler position. 4. Have pencil and paper in the room so the client can communicate needs in writing.

2. Place a tracheostomy set at the bedside. Thyroid surgery sometimes results in accidental removal of the parathyroid glands. A resultant hypocalcemia may lead to contraction of the glottis, causing airway obstruction; edema around the operative site also may cause an airway obstruction. Although not common, airway obstruction after thyroid surgery is an emergency situation. Oxygen, suction equipment, and a tracheostomy tray should be readily available in the client's room. Speaking is important to determine the status of the laryngeal nerve so having pen and paper available is appropriate. The semi-Fowler position is indicated to maximize respiratory excursion. However, a patent airway takes priority over these interventions.

A client with a family history of goiter is experiencing changes in voice and breathing. Which diagnostic study would the nurse consider to be beneficial in confirming a diagnosis? 1. Thyroglobulin 2. Thyroid antibodies 3. Thyroxine (free T4), total 4. Thyroid-stimulating hormone (TSH)

2. Thyroid antibodies Changes in voice and breathing can be seen in Hashimoto thyroiditis if the thyroid gland enlarges rapidly and constricts the trachea and laryngeal nerves. Clients with a family history of goiter may have this condition. A thyroid antibody test is used diagnose Hashimoto thyroiditis by differentiating thyroid dysfunction from thyroiditis. Thyroglobulin is used to detect thyroid cancer. Total thyroxine (free T4) and TSH are used to evaluate thyroid function.

While reviewing the client's laboratory reports, the nurse finds that there is an elevation in the client's growth hormone levels. Which key physical changes would the nurse expect to find if acromegaly is suspected? Select all that apply. One, some, or all responses may be correct. 1. Facial shape 2. Body weight 3. Chest shape 4. Lip thickness 5. Length of hands

3. Chest shape 4. Lip thickness 5. Length of hands Acromegaly may occur as a result of overproduction of growth hormone by the pituitary gland, which results in a few physical changes. The client with acromegaly would experience a barrel-shaped chest, thickened lips, and enlarged hands and feet. Clients who have hyperfunction of adrenocorticotropic hormone have weight gain and changes in facial shape called "moon face."

Which information would the nurse include in a teaching plan when teaching a client with diabetes about the advantages of using an insulin pump? Select all that apply. One, some, or all responses may be correct. 1. It prevents ketoacidosis. 2. It helps cause weight loss. 3. It can improve A1c levels. 4. An insulin pump costs less than subcutaneous injections. 5. Clients may be able to exercise without eating more carbohydrates.

3. It can improve A1c levels. 5. Clients may be able to exercise without eating more carbohydrates. Maintaining a consistent acceptable blood glucose level will improve A1c results. Because insulin is administered only as needed, the client will be able to exercise without having to increase the carbohydrate intake. Ketoacidosis may occur if the catheter becomes dislodged and the client does not receive insulin for hours. Insulin pumps can cause weight gain, not loss. An insulin pump is more expensive than subcutaneous insulin injections.

The home health nurse is educating a client with adrenal insufficiency regarding the disease process and medication safety. Which statement made by the client indicates a need for further education? 1. "I should not skip any doses of my medication." 2. "It is important to never switch brands of medication." 3. "I should weigh myself every day and report weight gain." 4. "I only need a medical alert bracelet when in the hospital."

4. "I only need a medical alert bracelet when in the hospital." A client with adrenal insufficiency must take adrenal hormone replacement medication for life and must always wear a medical alert bracelet with the name of the condition and the medication. Therefore the statement about needing to wear the bracelet only in the hospital requires further education. The client is correct to avoid skipping any medication doses, to avoid switching brands of medication, and to perform daily weight checks and report weight gain.

When evaluating for nerve injury after a thyroidectomy, which action would the client be asked to do? 1. Speak 2. Swallow 3. Purse the lips 4. Turn the head

The laryngeal nerve is close to the operative site and can be damaged inadvertently. Loss of the gag reflex occurs with general anesthesia; the ability to swallow signifies its return. The ability to purse the lips tests the seventh cranial (facial) nerve, which is not affected in thyroid surgery. The nerves involved in turning the head are not near the thyroid gland.

Which clinical indicators are consistent with the diagnosis of hyperthyroidism? Select all that apply. One, some, or all responses may be correct. 1. Emotional lability 2. Dyspnea on exertion 3. Abdominal distention 4. Decreased bowel sounds 5. Hyperactive deep tendon reflexes

1. Emotional lability 2. Dyspnea on exertion 5. Hyperactive deep tendon reflexes Lability of mood is a psychological/emotional manifestation related to excess thyroid hormones. Dyspnea with or without exertion can occur as the body attempts to meet oxygen demands related to the increased metabolic rate associated with hyperthyroidism. Hyperactive reflexes are a neurological manifestation related to excessive production of thyroid hormones. Abdominal distention is associated with hypothyroidism; it is related to constipation and weight gain. Bowel sounds increase, not decrease, as a result of hyperperistalsis associated with the elevated metabolic rate. Hypoactive bowel sounds are related to hypothyroidism.

Which clinical findings are commonly associated with hyperglycemia? Select all that apply. One, some, or all responses may be correct. 1. Polyuria 2. Polydipsia 3. Polyphagia 4. Polyphrasia 5. Polydysplasia

1. Polyuria 2. Polydipsia 3. Polyphagia Polyuria is excessive urination associated with osmotic diuresis. Polydipsia is excessive thirst associated with hyperglycemia; thirst is the response to osmotic diuresis and glycosuria. Polyphagia is associated with the catabolic state induced by insulin deficiency. Polyphrasia is excessive talking associated with mental illness, not hyperglycemia. Polydysplasia is related to multiple developmental abnormalities and is unrelated to hyperglycemia.

A client reports feeling nervous, irritable, and extremely tired. The client states, "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. Based on the assessment findings, it is likely that which laboratory tests will be prescribed? 1. Partial thromboplastin time (PTT) and prothrombin time (PT) 2. Thyroxin (T3), triiodothyronine (T4), and thyroid-stimulating hormone (TSH) 3. Venereal disease research laboratory (VDRL) test and complete blood count (CBC) 4. Adrenocorticotropic hormone (ACTH), antidiuretic hormone (ADH), and corticotropin-releasing factor (CRF)

2. Thyroxin (T3), triiodothyronine (T4), and thyroid-stimulating hormone (TSH) The T3, T4, and TSH provide a measure of thyroid hormone production; an increase is associated with the client's signs and symptoms. PT and PTT assess blood coagulation. The VDRL test is for syphilis; the CBC assesses the hematopoietic system. ACTH stimulates the synthesis and secretion of adrenal cortical hormones. ADH increases water reabsorption by the kidney. CRF triggers the release of ACTH.

The nurse is caring for a client who reports sweating, tachycardia, and tremors. The laboratory report of the client reveals serum cortisol less than normal and a blood glucose level of 60 mg/dL. Which medication would be administered to this client? 1. Glucagon 2. Kayexalate 3. Hydrocortisone 4. Insulin with dextrose in normal saline

1. Glucagon A decrease in cortisol levels impairs the glucose metabolism. The client's blood glucose level is 60 mg/dL, which is indicative of hypoglycemia. 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.