PrepU Assignment | Chapter 45 | Assessment and Management of Patients with Endocrine Disorders
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
A client with acromegaly is complaining of severe headaches. What does the nurse suspect is the cause of the headaches that is related to the acromegaly?
A pituitary tumor
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 client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add?
Related to bone demineralization resulting in pathologic fractures
Which nursing diagnosis is most appropriate for a client with Addison's disease?
Risk for infection
A client with symptoms of Cushing syndrome is admitted to the hospital for evaluation and treatment. The nurse is creating a plan of care for the client. Which is an appropriate nursing diagnosis?
Self-care deficit related to weakness, fatigue, muscle wasting, and altered sleep patterns
Patients with hyperthyroidism are characteristically:
Sensitive to heat
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
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
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany?
Calcium gluconate
Trousseau's sign is elicited by which of the following?
Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff.
When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted:
Calcitonin
A client with hypothyroidism is afraid of needles and doesn't want to have his blood drawn. What should the nurse say to help alleviate his concerns?
"I'll stay here with you while the technician draws your blood."
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?
"Maintain a moderate exercise program."
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
The primary function of the thyroid gland includes which of the following?
Control of cellular metabolic activity
Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?
Cushing syndrome
The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin?
D
A client with hypofunction of the adrenal cortex has been admitted to the medical unit. What would the nurse most likely find when assessing this client?
Decreased blood pressure
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority?
Decreased cardiac output
A client sustained a head injury when falling from a ladder. While in the hospital, the client begins voiding large amounts of clear urine and reports being very thirsty. The client states feeling weak and having experienced an 8-pound weight loss since admission. What condition does the nurse expect the client to be tested for?
Diabetes insipidus (DI)
A client who is scheduled for a thyroid test reports having an allergy to shellfish. What should the nurse do?
Document the allergy and inform the physician.
A patient has been diagnosed with thyroidal hypothyroidism. The nurse knows that this diagnosis is consistent with which of the following?
Dysfunction of the thyroid gland itself
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
A client with a history of Addison's disease and flu-like symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by IV infusion?
Hydrocortisone
The nurse is aware that the clinical symptoms of a patient with hypoparathyroidism are the result of the initial physiologic response of:
Hypocalcemia
The typical triad of manifestations seen in a client diagnosed with pheochromocytoma does notinclude which of the following?
Hypotension
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
A client with a 20-year history of hypothyroidism who has not been compliant with taking thyroid replacement therapy is brought into the ED with a diagnosis of myxedema coma. What client symptoms are consistent with this life-threatening event? Select all that apply.
Hypothermia Hypotension Hypoventilation
Following a thyroidectomy, a client exhibits signs of tetany. The nurse anticipates administering which medication?
IV calcium gluconate
Which nursing diagnosis takes highest priority for a client with hyperthyroidism?
Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
A nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture?
Incomplete
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
One of the most frequently occurring complications (55% occurrence) of primary hyperparathyroidism is:
Kidney stones.
An instructor has just finished teaching a class about the endocrine system. The instructor determines that the students need additional instruction when they identify which of the following as an endocrine gland?
Kidneys
A client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse help to prepare the client for?
Magnetic resonance imaging (MRI)
Which intervention is the most critical for a client with myxedema coma?
Maintaining a patent airway
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 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 in acute addisonian crisis. Which test result does the nurse expect to see?
Serum potassium level of 6.8 mEq/L
A client with a history of diabetes insipidus seeks medical attention for an exacerbation of symptoms. Which laboratory finding indicates to the nurse that the client has been restricting fluids in an attempt to control the symptoms?
Sodium level of 150 mEq/L
The nurse palpates the thyroid gland of a patient suspected of having hyperthyroidism. The nurse documents the positive finding of a gland that is:
Soft with poorly defined borders.
Parathyroid hormone (PTH) has which effects on the kidney?
Stimulation of calcium reabsorption and phosphate excretion
A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?
Tetany
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?
The functioning of endocrine glands
The nurse is attempting to locate the thyroid gland in order to determine if it is enlarged. Where should the nurse palpate the thyroid gland?
The lower neck anterior to the trachea
A patient taking corticosteroids for exacerbation of Crohn's disease comes to the clinic and informs the nurse that he wants to stop taking them because of the increase in acne and moon face. What can the nurse educate the patient regarding these symptoms?
The moon face and acne will resolve when the medication is tapered off.
The nurse auscultates a bruit over the thyroid glands. What does the nurse understand is the significance of this finding?
The patient may have hyperthyroidism.
When describing the difference between endocrine and exocrine glands, which of the following would the instructor include as characteristic of endocrine glands?
The secretions are released directly into the blood stream.
What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking the prescribed antithyroid medication?
Thyrotoxic crisis
Which of the following hormones would the nurse identify as being secreted by the thyroid gland?
Thyroxine
A nurse is aware that several laboratory results are present in a patient diagnosed with diabetes insipidus. Select all that apply.
Urine specific gravity of 1.001 Serum osmolality of 310 mOsm/kg Serum sodium level of 149 mEq/L
A nurse working in the ED at a level 1 trauma center is notified that casualties from a multivehicle car accident are currently in transit. The nurse's heart is pounding and mouth is dry. What gland is responsible for this nurse's physiologic response?
adrenal medulla
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
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.
When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of:
encouraging fluids
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
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:
hypocalcemia
Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU). The nurse should expect the client's symptoms to subside:
in 1 to 2 weeks.
Although not designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones involved in increasing blood pressure and volume and maturation of red blood cells?
kidneys
The nurse is completing discharge teaching with a client with hyperthyroidism who has been treated with radioactive iodine at an outpatient clinic. The nurse instructs the client to
monitor for symptoms of hypothyroidism.
Cardiac effects of hyperthyroidism include
palpitations
During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and:
phosphorus
A young client has a significant height deficit and is to be evaluated for diagnostic purposes. What could be the cause of this client's disorder?
pituitary disorder
A client who is being tested for syndrome of inappropriate antidiuretic hormone secretion asks the nurse to explain the diagnosis. While explaining, the nurse states that excessive antidiuretic hormone is secreted from which gland?
posterior pituitary
A nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will order daily supplements of calcium and:
vitamin D.
A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of:
sodium and potassium abnormalities.
Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects?
Sympathetic
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.
Which of the following would the nurse expect to find in a client with severe hyperthyroidism?
Exophthalmos
A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect?
Weight loss, nervousness, and tachycardia
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.
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.
A group of students is reviewing material about endocrine system function. The students demonstrate understanding of the information when they identify which of the following as secreted by the adrenal medulla?
Epinephrine
The nurse is caring for a client diagnosed with hypothyroidism secondary to Hashimoto thyroiditis. When assessing this client, what sign or symptom would the nurse expect?
Fatigue
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
The nurse is reviewing a client's history which reveals that the client has had an oversecretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following?
Gigantism
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
A client is having chronic pain from arthritis. What type of hormone is released in response to the stress of this pain that suppresses inflammation and helps the body withstand stress?
Glucocorticoids
Which of the following precautions would be most appropriate when caring for a client being treated with radioactive iodine (RAI) for a thyroid tumor?
Handle body fluids carefully.
Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease?
Have regular follow-up care.
Which condition may occur during the postoperative period in a client who underwent adrenalectomy because of sudden withdraw of excessive amounts of catecholamines?
Hypoglycemia
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?
Hypophysectomy
For a client with Graves' disease, which nursing intervention promotes comfort?
Maintaining room temperature in the low-normal range
A client with pheochromocytoma is scheduled for an adrenalectomy. Which of the following would the nurse perform preoperatively?
Monitor blood pressure (BP) frequently.
A patient with a history of hypothyroidism is admitted to the intensive care unit unconscious and with a temperature of 95.2ºF. A family member informs the nurse that the patient has not taken thyroid medication in over 2 months. What does the nurse suspect that these findings indicate?
Myxedema coma
Which of the following assessments should the nurse perform to determine the development of peptic ulcers when caring for a patient with Cushing's syndrome?
Observe the color of stool.
The nurse is evaluating a client's neck for thyroid enlargement. Which action by the nurse is appropriate during the evaluation?
Palpate the thyroid gland gently.
Which glands regulate calcium and phosphorous metabolism?
Parathyroid
The nurse is caring for a client with hypoparathyroidism. When the nurse taps the client's facial nerve, the client's mouth twitches and the jaw tightens. What is this response documented as related to the low calcium levels?
Positive Chvostek's sign
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?
Positive Chvostek's sign
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 nurse explains to a client with thyroid disease that the thyroid gland normally produces:
T3, thyroxine (T4), and calcitonin.
The nurse is caring for a patient with hyperthyroidism who suddenly develops symptoms related to thyroid storm. What symptoms does the nurse recognize that are indicative of this emergency?
Temperature of 102ºF
A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside?
Tracheostomy set
A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by:
a corticotropin-secreting pituitary adenoma.
