Honan Nursing Management: Patients With Endocrine Disorders
Which of the following would the nurse expect to find in a client with severe hyperthyroidism?
Exophthalmos
A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect:
Graves' disease.
Thyroid storm is a severe form of hyperthyroidism that can be fatal if not treated. Medical management includes pharmacotherapy. Which of the following drugs have proved helpful? Select all that apply.
Hydrocortisone Acetaminophen Methimazole Iodine
The nurse is closely monitoring the blood work of a patient who has a diagnosis of primary hyperparathyroidism. The nurse should be aware that the fluid and electrolyte disturbances associated with this disease create a significant risk of what problems?
Renal calculi and urinary obstruction
The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find?
Reports of increased appetite
A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease?
Serum potassium level of 5.8 mEq/L
A nurse is caring for a client with hypoparathyroidism. During assessment, the nurse elicits a positive Trousseau's sign. What does the nurse observe to verify this finding?
hand flexing inward
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany?
Calcium gluconate
An adult patient has undergone extensive testing that has resulted in a diagnosis of a basophilic pituitary tumor. The pathophysiological effects of the patient's tumor include excessive secretion of adrenocorticotropic hormone (ACTH). As a result, this patient is likely to exhibit signs and symptoms that are characteristic of what endocrine disorder?
Cushing's disease
The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin?
D
Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance?
Desmopressin (DDAVP)
A client sustained a head injury when falling off of a ladder. While in the hospital, the client begins voiding large amounts of clear urine and states he is very thirsty. The client states that he feels weak, and he has had an 8-lb weight loss since admission. What should the client be tested for?
Diabetes insipidus (DI)
The nurse obtains a complete family history of a client with a suspected endocrine disorder based on which rationale?
Endocrine disorders can be inherited.
A patient is diagnosed with overactivity of the adrenal medulla. What epinephrine value does the nurse recognize is a positive diagnostic indicator for overactivity of the adrenal medulla?
450 pg/mL
What is the most common cause of hyperaldosteronism?
An adrenal adenoma
Patients with hyperthyroidism are characteristically:
Sensitive to heat
A client reports extremely frequent urination, sometimes urinating 10 to 12 times each day. What fluid balance disorder would be expected with these symptoms?
dehydration
A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering:
vasopressin.
A nurse practitioner is aware of the high incidence and prevalence of hypothyroidism and regularly encourages many patients to undergo screening of their thyroid secreting hormone (TSH) levels. Which of the following individuals likely faces the greatest risk of developing hypothyroidism?
A 55-year-old woman who complains of fatigue
A nurse is preparing an IV dose of hydrocortisone that is to be administered to an adult patient on an acute medical unit. The endocrine disorder for which this treatment is most clearly indicated is:
Addison's disease
After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate?
Administer IV calcium gluconate as ordered.
A health care provider suspects that a thyroid nodule may be malignant. The nurse knows to prepare information for the patient based on the usual test that will be ordered to establish a diagnosis. What is that test?
Fine-needle biopsy of the thyroid gland
A patient who is postoperative day 1 following neck dissection surgery has rung his call bell complaining of numb fingers, stiff hands, and a tingling sensation in his lips and around his mouth. The nurse should anticipate that this patient may require the IV administration of:
Calcium gluconate
A patient has been taking oral corticosteroids for several weeks to a treat a chronic inflammatory skin condition. When performing health education with this patient, the nurse should emphasize the need to:
Avoid stopping the drug abruptly
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?
Blood pressure (BP) and heart rate
Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy.
Calcium
A nurse is caring for a client with suspected diabetes insipidus. Which test does the nurse anticipate the physician will order to confirm the diagnosis?
Fluid deprivation test
Which outcome indicates that treatment of a client with diabetes insipidus has been effective?
Fluid intake is less than 2,500 ml/day.
A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine condition should the nurse expect the health care provider to diagnose?
Goiter
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?
Iodine
A nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy?
Levothyroxine (Synthroid)
Which intervention is the most critical for a client with myxedema coma?
Maintaining a patent airway
The nurse is teaching a client about the dietary restrictions related to his diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid?
Milk
When preparing teaching plan for a client with an endocrine disorder, the nurse includes information about hormone regulation. Which of the following would the nurse include?
Most disorders result from over- or underproduction of the hormone.
A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication?
Myxedema coma
A client with acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client?
Pressure on the optic nerve
A 50-year-old male patient has been admitted to the postsurgical unit from the PACU after having a total thyroidectomy. The nurse is now conducting an admission assessment and planning the patient's subsequent care. When providing this patient's care, the nurse should emphasize which of the following actions?
Protecting the patient's airway
Dilutional hyponatremia occurs in which disorder?
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Which of the following endocrine disorder causes the patient to have dilutional hyponatremia?
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug?
Tachycardia
A patient is prescribed corticosteroid therapy. What would be important information for the nurse to give the patient who is prescribed corticosteroid therapy?
The patient is at an increased risk for developing infection. SUBMIT ANSWER
Which group of clients should not receive potassium iodide?
Those who are allergic to seafood
Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client (who now has nausea) and records a temperature of 105°F (40.5°C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?
Thyroid crisis
A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for:
decreased body temperature and cold intolerance.
An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and periorbital area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of:
myxedema coma.
