Prep U Chapter 52: Assessment and Management of Patients With Endocrine Disorders - ML5
A nurse is caring for a client who was recently diagnosed with hyperparathyroidism. Which statement by the client indicates the need for additional discharge teaching? a."I will take my pain medications according to the schedule we developed." b. "I will increase my fluid and calcium intake." c. "I'll schedule a follow-up visit with my physician as soon as I get home." d. "I'll call my physician if I notice tingling around my lips."
"I will increase my fluid and calcium intake." Explanation: The client requires additional teaching if he states that he will increase his calcium intake. Hyperparathyroidism causes extreme increases in serum calcium levels. The client should increase his fluid intake, but he should limit his calcium and vitamin D intake. The client should continue to take pain mediations as scheduled and have regular follow-up visits with his physician. Tingling around the lips is a sign of hypercalcemia and should be reported to the physician immediately.
A nursing student asks the instructor why the pituitary gland is called the "master gland." What is the best response by the instructor?
"It regulates the function of other endocrine glands." Explanation: The pituitary gland is called the master gland because it regulates the function of other endocrine glands. The term is somewhat misleading, however, because the hypothalamus influences the pituitary gland. The gland has many other hormones that it secretes.
A nursing student asks the instructor why the pituitary gland is called the "master gland." What is the best response by the instructor? a) "It regulates the function of other endocrine glands." b) "It is the gland that is responsible for regulating the hypothalamus." c) "The gland does not have any other function other than to cause secretion of the growth hormones." d) "It regulates metabolism."
"It regulates the function of other endocrine glands." Explanation: The pituitary gland is called the master gland because it regulates the function of other endocrine glands. The term is somewhat misleading, however, because the hypothalamus influences the pituitary gland. The gland has many other hormones that it secretes.
Which of the following would the nurse expect to find in a client with severe hyperthyroidism?
Exophthalmos Explanation: Exophthalmos that results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball is seen in clients with severe hyperthyroidism. Tetany is the symptom of acute and sudden hypoparathyroidism. Buffalo hump and striae are the symptoms of Cushing's syndrome.
A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: a. hypotension. b. thick, coarse skin. c. deposits of adipose tissue in the trunk and dorsocervical area. d. weight gain in arms and legs.
deposits of adipose tissue in the trunk and dorsocervical area. Explanation: Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.
A nurse explains the role of the ovaries. Which hormones would be included in that discussion? a. estrogen and progesterone b. estrogen and progestin c. testosterone and progesterone d. estrogen and testosterone
estrogen and progesterone Explanation: The ovaries produce estrogen and progesterone. Progestin is a synthetic compound. Testosterone is involved with the development and maintenance of male secondary sex characteristics, such as facial hair and a deep voice.
A client has been experiencing a decrease in serum calcium. After diagnostics, the physician proposes the calcium level fluctuation is due to altered parathyroid function. What is the typical number of parathyroid glands?
four Explanation: The parathyroid glands are four (some people have more than four) small, bean-shaped bodies, each surrounded by a capsule of connective tissue and embedded within the lateral lobes of the thyroid.
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.
hypocalcemia. Explanation: 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.
A client is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by altered thyroid function? a) metabolic rate b) growth c) fluid/electrolyte balance d) sleep/wake cycles
metabolic rate Explanation: The thyroid concentrates iodine from food and uses it to synthesize thyroxine (T4) and triiodothyronine (T3). These two hormones regulate the body's metabolic rate.
A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan? a) "Maintain a moderate exercise program." b) "Rest as much as possible." c) "Lose weight." d) "Jog at least 2 miles per day."
"Maintain a moderate exercise program." Explanation: The nurse should instruct the client to maintain a moderate exercise program. Such a program helps strengthen bones and prevents the bone loss that occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise. Because of weakened bones, a rigorous exercise program such as jogging is contraindicated. Weight loss might be beneficial but it isn't as important as developing a moderate exercise program.
The preferred preparation for treating hypothyroidism includes which of the following? a. Levothyroxine (Synthroid) b. Radioactive iodine c. Propylthiouracil (PTU) d. Methimazole (Tapazole)
Levothyroxine (Synthroid) Explanation: 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 nurse is aware that the best time of day for the total large corticosteroid dose is between: a. 7:00 AM and 8:00 AM b. 8:00 PM and 9:00 PM c. 4:00 AM and 5:00 AM d. 4:00 PM and 6:00 PM
7:00 AM and 8:00 AM Explanation: The best time of day for the total large corticosteroid dose is in the early morning, between 7:00 AM and 8:00 AM, when the adrenal gland is most active. Therefore, dosage at this time of day will result in the maximum suppression of the adrenal gland.
A nurse is assigning beds to four new clients being admitted to the cardiac telemetry floor. Which client should she assign to the bed at the end of the hall, away from the nurses' station? a. A 24-year-old client with unstable hyperthyroidism with sinus tachycardia b. A 38-year-old client with mitral valve prolapse in sinus rhythm who is newly diagnosed with diabetes c. A 48-year-old client in sinus rhythm transferring from intensive care unit 3 days after coronary artery bypass grafting (CABG) d. An 80-year-old client with sinus tachycardia who is confused and agitated 2 days after a prostatectomy
A 24-year-old client with unstable hyperthyroidism with sinus tachycardia Explanation: The client with hyperthyroidism is probably irritable and anxious and needs uninterrupted rest. The nurse should assign him to a quiet room away from the noise at the nurses' station. The client who had a CABG is most likely to develop an arrhythmia on his third postoperative day. The unstable client with diabetes mellitus could experience hypoglycemia or hyperglycemia and requires frequent monitoring of blood glucose levels. The elderly male is confused and agitated. The nurse should assign these three clients to beds as close to the nurses' station as possible.
A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience?
A decrease in urine output Explanation: Desmopressin (DDAVP), a synthetic vasopressin without the vascular effects of natural ADH, is particularly valuable because it has a longer duration of action and fewer adverse effects than other preparations previously used to treat the disease. DDAVP and lypressin (Diapid) reduce urine output to 2 to 3 L/24 hours. It is administered intranasally; the patient sprays the solution into the nose through a flexible calibrated plastic tube. One or two administrations daily (i.e., every 12 to 24 hours) usually control the symptoms (Papadakis, McPhee, & Rabow, 2013). Vasopressin causes vasoconstriction; thus, it must be used cautiously in patients with coronary artery disease.
What is the most common cause of hyperaldosteronism?
An adrenal adenoma Explanation: An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake and pituitary stimulation.
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority?
An irregular apical pulse
A nurse is assigned to care for a patient with increased parathormone secretion. Which of the following serum levels should the nurse monitor for this patient? a. Glucose b. Sodium c. Calcium d. Potassium
Calcium Explanation: Increased secretion of parathormone results in bone resorption. Calcium is released into the blood, increasing serum levels.
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 Explanation: Sometimes in thyroid surgery, the parathyroid glands are removed, producing a disturbance in calcium metabolism. Tetany is usually treated with IV calcium gluconate. Synthroid is used in the treatment of hypothyroidism. PTU and Tapazole are used in the treatment of hyperthyroidism.
Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? a. Cushing syndrome b. Addison disease c. Graves disease d. Hashimoto disease
Cushing syndrome Explanation: The client with Cushing syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. Regardless of the cause, the normal feedback mechanisms that control the function of the adrenal cortex become ineffective, and the usual diurnal pattern of cortisol is lost. The signs and symptoms of Cushing syndrome are primarily a result of the oversecretion of glucocorticoids and androgens, although mineralocorticoid secretion also may be affected.
The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin? a. D b. C c. B d. E
D Explanation: The actions of PTH are increased by the presence of vitamin D.
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority?
Decreased cardiac output Explanation: An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse. The client with Addison's disease is at risk for infection; however, reducing infection isn't a priority during an addisonian crisis. Impaired physical mobility and Imbalanced nutrition: Less than body requirements are appropriate nursing diagnoses for the client with Addison's disease, but they aren't priorities in a crisis.
A nurse is preparing to palpate a client's thyroid gland. Which action by the nurse is appropriate? a) Have the client flex his neck onto his chest and cough while she palpates the anterior neck with her fingertips. b) Place her hands around the client's neck, with the thumbs in the front of the neck, and gently massage the anterior neck. c) Encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. d) Have the client hyperextend his neck and take slow, deep inhalations while she palpates his neck with her fingertips.
Encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. Explanation: When palpating the thyroid gland, the nurse should encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. As the client swallows, the gland is palpated for enlargement as the tissue rises and falls. Having the client flex his neck wouldn't allow for palpation. Massaging the area or checking during inhalation doesn't allow for the movement of tissue that swallowing provides.
Which is a clinical manifestation of diabetes insipidus? a) Low urine output b) Excessive thirst c) Weight gain d) Excessive activities
Excessive thirst Explanation: Urine output may be as high as 20 L in 24 hours. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weight loss develops.
Which intervention is the most critical for a client with myxedema coma?
Maintaining a patent airway Explanation: Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. Although myxedema coma is associated with severe hypothermia, a warming blanket shouldn't be used because it may cause vasodilation and shock. Gradual warming with blankets is appropriate. Thyroid replacement is administered I.V., not orally. Although recording intake and output is important, these interventions aren't critical at this time.
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 Explanation: Signs and symptoms of hyperthyroidism reflect the increased metabolic rate and would include reports of increased appetite, weight loss, and intolerance to heat. Sleepiness, thick hard nails, and intolerance to cold are associated with hypothyroidism.
Parathyroid hormone (PTH) has which effects on the kidney? a) Stimulation of calcium reabsorption and phosphate excretion b) Stimulation of phosphate reabsorption and calcium excretion c) Increased absorption of vitamin D and excretion of vitamin E d) Increased absorption of vitamin E and excretion of vitamin D
Stimulation of calcium reabsorption and phosphate excretion Explanation: PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.
Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects?
Sympathetic Explanation: Beta-adrenergic blocking agents are important in controlling the sympathetic nervous system effects of hyperthyroidism. For example, propranolol is used to control nervousness, tachycardia, tremor, anxiety, and heat intolerance.
The nurse is reviewing a client's history which reveals that the client has had an over secretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following?
Gigantism Explanation: When over secretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.
The nurse is reviewing a client's history which reveals that the client has had an over secretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? a) Gigantism b) Dwarfism c) Acromegaly d) Simmonds' disease
Gigantism Explanation: When over secretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.
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 disorder should the nurse expect the physician to diagnose?
Goiter Explanation: A goiter can result from inadequate dietary intake of iodine associated with changes in foods or malnutrition. It's caused by insufficient thyroid gland production and depletion of glandular iodine. Signs and symptoms of this malfunction include an enlarged thyroid gland, dizziness when raising the arms above the head, dysphagia, and respiratory distress. Signs and symptoms of diabetes mellitus include polydipsia, polyuria, and polyphagia. Signs and symptoms of diabetes insipidus include extreme polyuria (4 to 16 L/day) and symptoms of dehydration (poor tissue turgor, dry mucous membranes, constipation, dizziness, and hypotension). Cushing's syndrome causes buffalo hump, moon face, irritability, emotional lability, and pathologic fractures.
Which feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism? a) Bulging forehead b) Moon face and buffalo hump c) Cardiac dysrhythmia d) Hand flexing inward
Hand flexing inward Explanation: Carpopedal spasm is evidenced by the hand flexing inward. Cardiac dysrhythmia is a symptom of hyperparathyroidism. Moon face and buffalo hump are the symptoms of Cushing syndrome. A bulging forehead is a symptom of acromegaly.
The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with?
Hyperthyroidism Explanation: Clients with hyperthyroidism characteristically are restless despite felling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball. Neck swelling caused by the enlarged thyroid gland often is visible. Hypothyroidism clinical manifestations are the opposite of what is seen as hyperthyroidism.SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client.
The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with? a) Hypothyroidism b) Hyperthyroidism c) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) d) Diabetes insipidus (DI)
Hyperthyroidism Explanation: Clients with hyperthyroidism characteristically are restless despite felling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball. Neck swelling caused by the enlarged thyroid gland often is visible. Hypothyroidism clinical manifestations are the opposite of what is seen as hyperthyroidism.SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client.
On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery? a) Hypocalcemia b) Hyponatremia c) Hyperkalemia d) Hypermagnesemia
Hypocalcemia Explanation: Hypocalcemia may follow thyroid surgery if the parathyroid glands were removed accidentally. Signs and symptoms of hypocalcemia may be delayed for up to 7 days after surgery. Thyroid surgery doesn't directly cause serum sodium, potassium, or magnesium abnormalities. Hyponatremia may occur if the client inadvertently received too much fluid; however, this can happen to any surgical client receiving I.V. fluid therapy, not just one recovering from thyroid surgery. Hyperkalemia and hypermagnesemia usually are associated with reduced renal excretion of potassium and magnesium, not thyroid surgery.
A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize are progressing to myxedema coma? Select all that apply. a. Hypothermia b. Hypertension c. Hypotension d. Hypoventilation e. Hyperventilation
Hypothermia Hypotension Hypoventilation Explanation: Severe hypothyroidism is called myxedema. Advanced, untreated myxedema can progress to myxedemic coma. Signs of this life-threatening event are hypothermia, hypotension, and hypoventilation. Hypertension and hyperventilation indicate increased metabolic responses, which are the opposite of what the client would be experiencing.
A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize are progressing to myxedema coma? Select all that apply.
Hypothermia Hypotension Hypoventilation Explanation: Severe hypothyroidism is called myxedema. Advanced, untreated myxedema can progress to myxedemic coma. Signs of this life-threatening event are hypothermia, hypotension, and hypoventilation. Hypertension and hyperventilation indicate increased metabolic responses, which are the opposite of what the client would be experiencing.
A client is experiencing an increase in blood glucose levels. The nurse understands that which of the following hormones would be important in lowering the client's blood glucose level? a) Insulin b) Parathormone c) Melatonin d) Calcitonin
Insulin Explanation: Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises above normal limits. Parathormone increases the level of calcium in the blood when a decrease in serum calcium levels occurs. Melatonin aids in regulating sleep cycles and mood. Calcitonin is a thyroid hormone that inhibits the release of calcium from the bone into the extracellular fluid.
Dilutional hyponatremia occurs in which disorder? a) Diabetes insipidus (DI) b) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) c) Pheochromocytoma d) Addison disease
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Explanation: Clients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.
Which intervention is the most critical for a client with myxedema coma? a. Administering an oral dose of levothyroxine (Synthroid) b. Warming the client with a warming blanket c. Measuring and recording accurate intake and output d. Maintaining a patent airway
Maintaining a patent airway Explanation: Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. Although myxedema coma is associated with severe hypothermia, a warming blanket shouldn't be used because it may cause vasodilation and shock. Gradual warming with blankets is appropriate. Thyroid replacement is administered I.V., not orally. Although recording intake and output is important, these interventions aren't critical at this time.
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? a. The gland becomes enlarged leading to a deficiency of the hormone. b. Most disorders result from over- or underproduction of the hormone. c. The gland slows hormone secretion when the hormone level decreases. d. Hormone secretion occurs as a straight-line continuous process.
Most disorders result from over- or underproduction of the hormone. Explanation: Most endocrine disorders result from an overproduction or underproduction of specific hormones. A negative feedback loop controls hormone levels, such that a decrease in levels stimulates the releasing gland. Glandular enlargement is not involved with hormonal regulation.
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 Explanation: Myxedema coma, severe hypothyroidism, is a life-threatening condition that may develop if thyroid replacement medication isn't taken. Exophthalmos (protrusion of the eyeballs) is seen with hyperthyroidism. Although thyroid storm is life-threatening, it's caused by severe hyperthyroidism. Tibial myxedema (peripheral mucinous edema involving the lower leg) is associated with hypothyroidism but isn't life-threatening.
Which of the following would the nurse need to be alert for in a client with severe hypothyroidism? a) Thyroid storm b) Myxedemic coma c) Addison's disease d) Acromegaly
Myxedemic coma Explanation: Severe hypothyroidism is called myxedema and if untreated, it can progress to myxedemic coma, a life-threatening event. Thyroid storm is an acute, life-threatening form of hyperthyroidism. Addison's disease refers to primary adrenal insufficiency. Acromegaly refers to an oversecretion of growth hormone by the pituitary gland during adulthood.
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.
Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. Explanation: 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.
Which glands regulate calcium and phosphorous metabolism?
Parathyroid Explanation: Parathormone (parathyroid hormone), the protein hormone produced by the parathyroid glands, regulates calcium and phosphorous metabolism. The thyroid gland controls cellular metabolic activity. The adrenal medulla at the center of the adrenal gland secretes catecholamines, and the outer portion of the gland, the adrenal cortex, secretes steroid hormones. The pituitary gland secretes hormones that control the secretion of additional hormones by other endocrine glands.
Which of the following glands is considered the master gland? a. Pituitary b. Thyroid c. Parathyroid d. Adrenal
Pituitary Explanation: Commonly referred to as the master gland, the pituitary gland secretes hormones that control the secretion of additional hormones by other endocrine glands. The thyroid, parathyroid, and adrenal glands are not considered the master gland.
While assessing a client with hypoparathyroidism, the nurse taps the client's facial nerve and observes twitching of the mouth and tightening of the jaw. The nurse would document this finding as which of the following? a. Positive Trousseau's sign b. Positive Chvostek's sign c. Hyperactive deep tendon reflex d. Tetany
Positive Chvostek's sign Explanation: If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek's sign. The nurse may elicit a positive Trousseau's sign by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Deep tendon reflexes include the biceps, brachioradialis, triceps, and patellar reflexes. Tetany would be manifested by reports of numbness and tingling in the fingers or toes or around the lips, voluntary movement that may be followed by an involuntary, jerking spasm, and muscle cramping. Tonic (continuous contraction) flexion of an arm or a finger may occur.
The nurse assesses a patient who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease?
Potassium of 6.0 mEq/L Explanation: Addison's disease is characterized by hypotension, low blood glucose, low serum sodium, and high serum potassium levels. The normal serum potassium level is 3.5 to 5 mEq/L
A nurse is caring for a client with Cushing's syndrome. Which would the nurse not include in this client's plan of care?
Provide a high-sodium diet. Explanation: Limiting sodium reduces the potential for fluid retention. Fluid retention is manifested by swelling in dependent areas, pitting when pressure is applied to the skin over a bone by tight-fitting shoes or rings, the appearance of lines in the skin from stockings and seams in the shoes or areas where they lace. Hypertension is defined as a consistently elevated BP above 139/89 mm Hg. One factor that contributes to hypertension is excess circulatory volume. Diuretics promote the excretion of sodium and water.
A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following? a. The concentration of a substance in plasma b. Details about the size of the organ and its location c. The functioning of endocrine glands d. The client's blood sugar level
The functioning of endocrine glands Explanation: Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma. The measurement of blood hormone levels will not reveal a client's blood sugar level. Radiographs of the chest or abdomen determine the size of the organ and its location.
Which group of clients should not receive potassium iodide? a. Those who are allergic to corticosteroids b. Those who are pregnant c. Those taking medications such as cough medicines d. Those who are allergic to seafood
Those who are allergic to seafood Explanation: Potassium iodide should not be administered to anyone who is allergic to seafood, which is also high in iodine. Clients who take corticosteroids or cough medicines and those who are pregnant would be appropriate candidates for potassium iodide therapy.
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? a) Diabetic ketoacidosis b) Thyroid crisis c) Hypoglycemia d) Tetany
Thyroid crisis Explanation: Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia. Hypoglycemia is likely to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.
Which of the following hormones would the nurse identify as being secreted by the thyroid gland? a.Parathormone b. Thymosin c. Thyroxine d. Somatotropin
Thyroxine Explanation: The thyroid gland secretes thyroxine (T4 or tetraiodothyronine), triiodothyronine (T3), and calcitonin. Parathormone is secreted by the parathyroid glands. Thymosin is secreted by the thymus gland. Somatotropin is secreted by the anterior pituitary gland.
Hyperthyroidism symptom
Weight loss Explanation: Weight loss is consistent with a diagnosis of hyperthyroidism. The other conditions are found in hypothyroidism.
When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect:
a blood pressure of 176/88 mm Hg.
When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect: a) a blood pressure of 130/70 mm Hg. b) a blood glucose level of 130 mg/dl. c) bradycardia. d) a blood pressure of 176/88 mm Hg.
a blood pressure of 176/88 mm Hg. Explanation: Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.
A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. What is being tested? a. adrenal function b. thyroid function c. thymus function d. parathyroid function
adrenal function Explanation: The adrenal cortex manufactures and secretes glucocorticoids, such as cortisol, which affect body metabolism, suppress inflammation, and help the body withstand stress.
Which diagnostic test is done to determine suspected pituitary tumor? a) computed tomography scan b) measurement of blood hormone levels c) radioimmunoassay d) radiographs of the abdomen
computed tomography scan Explanation: A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and their location. Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma.
During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted?
decrease in hormonal levels Explanation: Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland. In positive feedback, the opposite occurs.
A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find:
deposits of adipose tissue in the trunk and dorsocervical area.
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: a) thyroid storm. b) cretinism. c) myxedema coma. d) Hashimoto's thyroiditis.
myxedema coma. Explanation: Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.