Sherpath Ch. 49 - Endocrine

To promote optimal absorption, the nurse would instruct a patient to take their levothyroxine at which time? A. 0600 B. 1200 C. 1600 D. 2100

A. 0600 Rationale: For maximum absorption, levothyroxine should be taken first thing in the morning on an empty stomach 30 minutes before breakfast. 1200, 1600, and 2100 may not result in adequate absorption.

Which clinical manifestation is seen with Addison's disease? A. Delusions B. Hypokalemia C. Hyperglycemia D. Truncal obesity

A. Delusions Rationale: Addison's disease occurs due to the hypofunction of adrenal cortex. This hypofunction manifests as delusions, which occur due to decreased levels of glucocorticoids. Hypokalemia, hyperglycemia, and truncal obesity are clinical manifestations of Cushing syndrome that occur due to hyperfunction of the adrenal cortex.

Activity intolerance in a patient with hypothyroidism is related to which side effect? A. Fatigue B. Diarrhea C. Weight loss D. Nervousness

A. Fatigue Rationale: Activity intolerance in a patient with hypothyroidism is related to weakness and fatigue. Patients with hyperthyroidism, not hypothyroidism, experience weight loss, diarrhea, and nervousness.

A nurse completes an assessment and notes that a patient's thyroid gland is enlarged. With which condition is this finding consistent? A. Goiter B. Fibroma C. Thyrotoxicosis D. Hyperthyroidism

A. Goiter Rationale: Thyroid abnormalities consist of three basic forms: goiter (enlarged thyroid gland), hypothyroidism, and hyperthyroidism. Goiter may be present in hyper- or hypofunction of the gland. A fibroma is a fibrous encapsulated connective tissue tumor not usually occurring in the thyroid gland. Thyrotoxicosis results from extreme hyperthyroidism or increased secretion of T3 and T4. Thyrotoxicosis is also known as thyroid storm or thyroid crisis. Hyperthyroidism is aa condition resulting from an increase in production of T3 and T4.

Which condition may be linked to Conn's syndrome? A. Hyperaldosteronism B. Hypoaldosteronism C. Hyperparathyroidism D. Hypoparathyroidism

A. Hyperaldosteronism Rationale: Conn's syndrome is associated with the excessive production of aldosterone (hyperaldosteronism) by the adrenal glands. Conn's syndrome is characterized by high BP, headache, poor vision, and various complications. Hypoaldosteronism, hyperparathyroidism, and hypoparathyroidism may not be linked with Conn's syndrome.

A patient has a dysfunction of the pituitary gland. Which hormone secretion may be altered in a patient with a dysfunction of the pituitary gland? A. Prolactin B. Thyroxine C. Erythropoietin D. Parathormone

A. Prolactin Rationale: Prolactin is secreted by the pituitary gland. Thyroxine hormone is secreted by the thyroid gland. The kidney secretes erythropoietin. Parathormone is secreted by the parathyroid gland.

Which rationale is accurate for checking Trousseau's sign in a patient following a subtotal thyroidectomy? A.To assess for parathyroid gland injury B. To assess for serum hypercalcemia C. To assess for high phosphorous levels D. To assess for an iodine deficiency

A. To assess for parathyroid gland injury Rationale: In a patient following a subtotal thyroidectomy, there is aa risk of hypocalcemia as a result of inadvertent manipulation or removal of the parathyroid glands. This results in hypoparathyroidism, which causes serum hypocalcemia. The nurse checks Trousseau's sign and Chovstek's sign to assess for tetany, which is a sign of hypocalcemia. Trousseau's sign does not indicate iodine deficiency, phosphorous level, or hypercalcemia.

A patient diagnosed with acromegaly has developed speech difficulties and asks what is causing the problem. Which response by the nurse is accurate? A. "You have developed the condition from numbness of the vocal cords." B. "You have developed the condition due to overgrowth of the tongue" C. "You have developed the condition from an overgrowth of soft tissue in the neck" D. "You have developed the condition related to upper airway narrowing"

B. "You have developed the condition due to overgrowth of the tongue" Rationale: Acromegaly most often occurs because of a benign growth hormone (GH)-secreting pituitary adenoma. The excess GH results in an overgrowth of soft tissues and bones in the hands, feet, and face. Overgrowth of the tongue leads to dental and speech difficulties. The voice may deepen due to overgrowth of the vocal cords, but there is not a change in sensation. Soft tissue of the neck may overgrow, leading to difficulties with skin conditions such as acne. Upper airway narrowing can predispose the person with acromegaly to sleep apnea, not speech difficulties.

Which condition can result if hypersecretion of growth hormone (GH) occurs after epiphyseal plate closure? A. Dwarfism B. Acromegaly C. Gigantism D. Cretinism

B. Acromegaly Rationale: Excess GH after closure of the epiphyseal plates results in acromegaly. When there is excess GH before the epiphyseal plates close, gigantism can result. Dwarfism is associated with a deficiency, not an excess, or GH, and cretinism can result as an effect of congenital hypothyroidism.

Which condition is the goal for treating hypocalcemia? A. Increasing the pH B. Decreasing the pH C. Maintaining the pH D. Decreasing the calcium ionization level

B. Decreasing the pH Rationale: A decreased pH will cause an acidic environment and increase the calcium ionization, which will in turn increase the available calcium in the blood and help the patient to recover from hypocalcemia. An increased pH will decrease calcium ionization, thereby decreasing the calcium level in the blood. If the pH is maintained, then there will be a nullifying effect on the calcium level. If the calcium ionization level is decreased, then the available calcium in the blood will become low.

A patient with a history of hypoparathyroidism would be assessed for which condition? A. Hypertension B. Thyroidectomy C. Use of cocaine D. Hypermagnesemia

B. Thyroidectomy Rationale: Because of the location of the parathyroid glands within the thyroid gland, a thyroidectomy sometimes results in the accidental surgical removal of one or more of the parathyroid glands, which in turn causes hypoparathyroidism. Hypertension and cocaine use are important items to note in a medical history, but they are not directly related to hypoparathyroidism. Hypomagnesemia, not hypermagnesemia, can lead to suppression of parathyroid hormone secretion.

Which clinical manifestations would the nurse assess in a patient with hyperthyroidism? SATA. A. Enlarged, scaly tongue B. A positive bruit upon auscultation of the thyroid gland C. Dry, thick, inelastic, and cold skin D. A goiter E. Clubbing of the fingers

B., D., E. Rationale: In a patient with hyperthyroidism, auscultation of the thyroid gland reveals bruits and palpation of the thyroid gland reveals goiter, and the nurse may observe the acropachy (clubbing of the digits). Enlarged, scaly tongue and dry, thick, inelastic, and cold skin are observed in patients with hypothyroidism.

Which laboratory results would confirm overt hyperthyroidism? SATA. A. Elevated thyroid-stimulating hormone (TSH) level B. Elevated triodothyronine (T3) level C. Low free thyroxine (T4) level D. Elevated free T4 level E. Low TSH level

B., D., E. Rationale: The primary laboratory findings to confirm the diagnosis of hyperthyrodism are low or undetectable TSH levels and elevated free thyroxine levels and T3 levels. Low free T4 levels and elevated TSH levels are found with hypothyroidism.

Which clinical manifestation is a classic finding in Graves' disease? A. Gingivitis B. Cretinism C. Exophthalmos D. Muscular dystrophy

C. Exophthalmos Rationale: Exophthalmos is the protrusion of eyeballs from the orbits; it results from increased fat deposits and fluid in orbital tissues. It is a classic clinical manifestation in Graves' disease. Gingivitis, cretinism, and muscular dystrophy are not classic clinical manifestations associated with Graves' disease.

Which clinical manifestation would the nurse assess in a patient admitted with hyperparathyroidism? A. Tremor B. Urinary incontinence C. Lethargy and weakness D. Hyperactive bowel sounds

C. Lethargy and weakness Rationale: Hyperparathyroidism can cause hypercalcemia. Signs of hypercalcemia include muscle weakness, polyuria, constipation, nausea and vomiting, lethargy, and memory impairment. Tremor and urinary incontinence are seen with hypoparathyroidism. Hyperparathyroidism is associated with constipation, so the nurse would assess hypoactive bowel sounds, not hyperactive.

A transsphenoidal hypophysectomy involves surgical resection of which gland? A. Thyroid B. Adrenal C. Pituitary D. Parathyroid

C. Pituitary Rationale: Transsphenoidal hypophysectomy is the surgical removal of the pituitary gland. The surgical approach to the pituitary gland is made through an incision through the upper gum and nare into the base of the skull. Transsphenoidal hypophysectomy does not involve removal of the thyroid, adrenal, or parathyroid gland.

Which endocrine problem is more common in men than in women? A. Graves' disease B. Thyroid nodules C. Hyperaldosteronism D. Ectopic adrenocorticotropic hormone production

D. Ectopic adrenocorticotropic hormone production Rationale: Ectopic adrenocorticotropic hormone production is more common in men. Graves' disease affects four to eight times more women than men. Thyroid nodules affect up to four times more women than men. Hyperaldosteronism affects two times as many women as men.

Which hormone has both mineralocorticoid and glucocorticoid properties? A. Cortisol B. Prednisone C. Aldosterone D. Hydrocortisone

D. Hydrocortisone Rationale: Hydrocortisone is an exogenous hormone that has both mineralocorticoid and glucocorticoid properties and is used to treat adrenal insufficiency. Cortisol is the primary glucocorticoid secreted by the adrenal cortex. Prednisone is an exogenous corticosteroid that is used to treat Cushing syndrome. Aldosterone is the primary mineralocorticoid secreted by the adrenal cortex.

Which factor would be seen in syndrome of inappropriate antidiuretic hormone secretion (SIADH)? A. Decreased antidiuretic hormone (ADH) B. Excessive urine output C. Increased serum osmolality D. Increased intravascular volume

D. Increased intravascular volume Rationale: SIADH is characterized by an increase in ADH levels in the body. As a result, the patient will have an increased intravascular volume. Decreased ADH, excessive urine output, and increased serum osmolality are features of diabetes insipidus.

Which disorder is characterized by excessive secretion of the hormone vasopressin? A. Thyrotoxicosis B. Diabetes insipidus C. Hyperosmolar hyperglycemic nonketotic syndrome D. Syndrome of inappropriate antidiuretic hormone secretion

D. Syndrome of inappropriate antidiuretic hormone secretion Rationale: Another term for antidiuretic hormone (ADH) is vasopressin. Syndrome of inappropriate antidiuretic hormone secretion is characterized by excessive release of ADH from the posterior pituitary gland, resulting in the inability of the kidneys to dilute urine. The patient retains water and experiences increased extraacellular fluid volume and hypnatremia. The disorder can cause cardiopulmonary overload and neurologic problems as a result of water intoxication. Thyrotoxicosis, also known as thyroid storm or thyroid crisis, results from an abrupt increase in T3 and T4 thyroid hormones. Diabetes insipidus results from a decrease in ADH. Hyperosmolar hyperglycemic nonketotic syndrome results from hyperglycemia in type 2 non-insulin-dependent diabetes mellitus.