Honan-Chapter 31: Nursing Management: Patients With Endocrine Disorders

A patient presented to the unit with an ADH-secreting tumor. Upon diagnostic and physical evaluation, the nurse suspects the patient is experiencing SIADH. Which of the following is a clinical manifestation of SIADH? Select all that apply. A. Hyponatremia B. Hypernatremia C. Increased serum osmolality D. Reduced serum osmolality E. Dry mucous membranes F. Low urine output

A. Hyponatremia D. Reduced serum osmolality F. Low urine output RATIONALE The patient with SIADH has hyponatremia (plasma sodium concentration of less than 135 mEq/L) and is not hypernatremia. Unlike healthy people, patients with SIADH cannot excrete diluted urine. As a result, they retain water (thus the serum osmolality decreases) and hyponatremia is seen.

A client with acromegaly has been given the option of a surgical approach or a medical approach. The client decides to have a surgical procedure to remove the pituitary gland. What does the nurse understand this surgical procedure is called? A. Hypophysectomy B. Hysteroscopy C. Thyroidectomy D. Ablation

A. Hypophysectomy RATIONALE The treatment of choice is surgical removal of the pituitary gland (transsphenoidal hypophysectomy) through a nasal approach. The surgeon may substitute an endoscopic technique using microsurgical instruments to reduce surgical trauma. A hysteroscopy is a gynecologic procedure. The thyroid gland is not involved for a surgical procedure. Ablation is not a removal of the pituitary gland.

The preferred preparation for treating hypothyroidism includes which of the following? A. Levothyroxine (Synthroid) B. Radioactive iodine C. Propylthiouracil (PTU) D. Methimazole (Tapazole)

A. Levothyroxine (Synthroid) RATIONALE Synthetic levothyroxine (Synthroid or Levothroid) is the preferred preparation for treating hypothyroidism and suppressing nontoxic goiters (enlargements of the thyroid gland). Radioactive iodine is the most common form of treatment for Graves' disease in North America. Both PTU and Tapazole are used for hyperthyroidism.

The nursing management of a patient who underwent transsphenoidal removal of a pituitary tumor yesterday includes which of the following actions? Select all that apply. A. Maintaining oral care B. Removing nasal pack to check for bleeding and CSF leak C. Giving fluid after nausea, and then slowly progressing to normal diet D. Raising the head of the bed to promote drainage E. Brush teeth to prevent bacterial overgrowth with hard toothbrush

A. Maintaining oral care C. Giving fluid after nausea, and then slowly progressing to normal diet D. Raising the head of the bed to promote drainage RATIONALE Nasal packs are not removed until the third or fourth postoperative day. Removing the nasal pack the day after surgery may exacerbate bleeding. If a sublabial approach is used, the patient is advised not to brush his or her teeth until the incision above the teeth has been healed.

Upon evaluation of the patient's laboratory data and clinical signs and symptoms, the nurse suspects that the patient may have pheochromocytoma. Which of the following is directly related with pheochromocytoma? Select all that apply. A. Severe headache; pain score of 9 out of 10 B. Perspiration C. Blood pressure 80/90 mm Hg D. Pallor E. Lethargy

A. Severe headache; pain score of 9 out of 10 B. Perspiration RATIONALE Severe headache, perspiration, are indicative of pheochromocytoma. High, not low, blood pressure is strongly associated with pheochromocytoma. The massive release of catecholamines is associated with tremor, and nervousness, not lethargy. Palpitations may also be seen.

A client reports extremely frequent urination, sometimes urinating 10 to 12 times each day. What fluid balance disorder would be expected with these symptoms? A. dehydration B. diluted urine C. hyponatremia D. hypokalemia

A. dehydration RATIONALE If the client with diabetes insipidus fails to drink a compensatory volume of fluid, dehydration with concentrated levels of electrolytes occurs.

For the first 72 hours after thyroidectomy surgery, a nurse should assess a client for Chvostek's sign and Trousseau's sign because they indicate: A. hypocalcemia. B. hypercalcemia. C. hypokalemia. D. hyperkalemia.

A. hypocalcemia. RATIONALE A client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal of or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek's sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau's sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren't present with hypercalcemia, hypokalemia, or hyperkalemia.

The nurse obtains a complete family history of a client with a suspected endocrine disorder based on which rationale? A. An allergy to iodine is inherited. B. Endocrine disorders can be inherited. C. It helps determine the client's general status. D. Diet and drug histories are related to the family history

B. Endocrine disorders can be inherited. RATIONALE Some endocrine disorders are inherited or have a tendency to run in families. Therefore, it is essential to take a complete family history. A complete blood count and chemistry profile are performed to determine the client's general status and to rule out disorders. Obtaining information about an allergy to iodine is important because diagnostic testing may involve the use of contrast dyes. However, an allergy to iodine is not related to endocrine disorders. Diet and drug histories, although important information, are not associated with the family history.

A 70-year-old female patient is admitted to the unit with enlargement of thyroid gland, hypertension, high TSH levels, and bulging eyes. What nursing intervention is most appropriate for this patient? A. Providing a blanket B. Instilling eye ointment C. Providing a warm bath D. Keep room temperature comfortable at 85°F

B. Instilling eye ointment RATIONALE A patient with Graves' disease is likely to show signs of exophthalmos (protrusion of eyeball that exposes the cornea). Instillation of eye ointment is necessary to minimize corneal damage. Patients with Graves' disease perspire easily and we should keep room temperature cool rather than warm.

The nurse assesses a patient who has an obvious goiter. What type of deficiency does the nurse recognize is most likely the cause of this? A. Thyrotropin B. Iodine C. Thyroxine D. Calcitonin

B. Iodine RATIONALE Oversecretion of thyroid hormones is usually associated with an enlarged thyroid gland known as a goiter. Goiter also commonly occurs with iodine deficiency.

A 55-year-old female presents to the clinic with complaints of fatigue and tiredness. The nurse notices that the patient's skin is thin, fragile, and easily traumatized. Ecchymosis and purple striae are noted over the thighs and abdomen. She presents with a slight kyphosis and a protruding abdomen. Which of the following methods of management might be appropriate for her? A. Increase dose of corticosteroids B. Unilateral or bilateral adrenalectomy C. Increase dose of Spironolactone D. Diet that is high in carbohydrates and low in protein

B. Unilateral or bilateral adrenalectomy C. Increase dose of Spironolactone RATIONALE Adrenalectomy is the treatment of choice for patients with primary adrenal hypertrophy. Spironolactone might be prescribed if high BP and hypokalemia. It is a drug that treats fluid retention and maintains potassium levels in the body. Corticosteroids should be reduced or tapered rather than increased. Diet high in carbohydrate and high in protein should be encouraged.

When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect: A. BP of 130/70 mm Hg. B. BG level of 130 mg/dl. C. bradycardia. D. BP of 176/88 mm Hg.

D. BP of 176/88 mm Hg. RATIONALE Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.

A 42-year-old man with a history of pheochromocytoma is being treated in the intensive care unit after experiencing an acute exacerbation of his condition. This patient will require the nurse to perform which of the following assessments most frequently? A. Motor and sensory function B. Orientation and cognition C. Urine testing for osmolality D. Blood pressure (BP) and heart rate

D. Blood pressure (BP) and heart rate Blood pressures exceeding 250/150 mm Hg have been recorded in cases of pheochromocytoma. Such BP elevations are life-threatening and can cause severe complications. Consequently, constant monitoring of BP and heart rate is a priority over other assessments, even though each of the listed assessments is relevant and appropriate.

A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? A. Monitor laboratory values daily for elevated thyroid-stimulating hormone. B. Observe for swelling of the neck, tracheal deviation, and severe pain. C. Evaluate the quality of the client's voice postoperatively, noting any drastic changes. D. Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.

D. Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. RATIONALE Muscle twitching and numbness or tingling of the lips, fingers, and toes are signs of hyperirritability of the nervous system due to hypocalcemia. The other options describe complications for which the nurse should also be observing; however, tetany and neurologic alterations are primary indications of hypocalcemia.

A 24-year-old male patient is being cared for in the intensive care unit following a motorcycle accident. In addition to musculoskeletal injuries, he has developed syndrome of inappropriate antidiuretic hormone (SIADH) from the traumatic head injury. Which of the following imbalances is consistent with this diagnosis? A. Hyponatremia B. Hyperkalemia C. Hyperbilirubinemia D. Hypoglycemia

Hyponatremia RATIONALE The clinical manifestations of SIADH include: hyponatremia (sodium <134 mEq/L), decreased serum osmolality (<280 mOsm/kg) with inappropriately increased urine osmolality, and urine sodium >20 mEq/L. Hyperkalemia, hyperbilirubinemia, and hypoglycemia do not typically accompany SIADH.