115 PrepU Ch 45: Assessment and Management of Patients with Endocrine Disorders

The nurse is aware that the best time of day for the total large corticosteroid dose is between:

7:00 AM and 8:00 AM

Before discharge, what should a nurse instruct a client with Addison's disease to do when exposed to periods of stress?

Administer hydrocortisone I.M.

Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?

Cushing syndrome

Which is a clinical manifestation of diabetes insipidus?

Excessive thirst

Which of the following would the nurse expect to find in a client with severe hyperthyroidism?

Exophthalmos

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

Which of the following would the nurse need to be alert for in a client with severe hypothyroidism?

Myxedemic coma

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.

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

Which diagnostic test is done to determine suspected pituitary tumor?

computed tomography scan

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 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 nurse is caring for a client who was recently diagnosed with hyperparathyroidism. Which statement by the client indicates the need for additional discharge teaching?

"I will increase my fluid and calcium intake."

A client who is postpartum is receiving intravenous oxytocin, and the client asks the nurse about the function of oxytocin in the body. How should the nurse respond?

"It stimulates the contraction of the pregnant uterus before birth and stimulates the release of breast milk after childbirth."

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."

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.

What clinical manifestations does the nurse recognize would be associated with a diagnosis of hyperthyroidism? Select all that apply.

An elevated systolic blood pressure Muscular fatigability Weight loss.

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?

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.

The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin?

D

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 nurse should perform which intervention for a client with Cushing's syndrome?

Explain that the client's physical changes are a result of excessive corticosteroids.

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 resulting in which condition?

Gigantism

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

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 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 patient is diagnosed with Addison's disease, a condition that results in insufficient production of cortisol. Which of the following is the most important function of cortisol that the nurse needs to consider when caring for a patient with Addison's disease?

Helps the body adjust to stress

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?

Hypocalcemia

A client diagnosed with meningitis says, "I'm just so thirsty. I keep drinking and drinking but I just can't seem to get enough. I've been urinating a lot, too." The nurse checks the client's urine specific gravity and finds it to be very dilute. The nurse suspects that the client may be developing diabetes insipidus. Which assessment finding would support the nurse's suspicion? Select all that apply.

Hypotension Poor skin turgor Dry mucous membranes

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

The preferred preparation for treating hypothyroidism includes which of the following?

Levothyroxine (Synthroid)

Which of the following would the nurse expect the physician to order for a client with hypothyroidism?

Levothyroxine sodium

Which are correct statements about the relationship between the hypothalamus and the pituitary gland? Select all that apply.

Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain. Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones.

The nurse is caring for a client who has an excess amount of potassium being excreted and has a serum level of 6.2 mEq/L. What group of adrenal hormones is likely to be impacting the laboratory result?

Mineralocorticoids

A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit?

Moon face

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 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

A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do?

Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.

Which glands regulate calcium and phosphorous metabolism?

Parathyroid

A client visits the clinic to seek treatment for disturbed sleep cycles and depressed mood. Which glands and hormones help to regulate sleep cycles and mood?

Pineal gland, melatonin

The nurse is reviewing the plan of care for a client with a disorder of the thyroid gland. Which diagnostic test would the nurse expect the physician to order to evaluate thyroid hormones?

Radioimmunoassay

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

Restricting fluids

A client has a decreased level of thyroid hormone being excreted. What will the feedback loop do to maintain the level of thyroid hormone required to maintain homeostatic stability?

Stimulate more hormones using the negative feedback system

A nurse explains to a client with thyroid disease that the thyroid gland normally produces:

T3, thyroxine (T4), and calcitonin.

When teaching a client diagnosed with hypothyroidism about medical intervention, which is important for the nurse to communicate?

TH may increase the effect of digitalis preparation.

Which group of clients should not receive potassium iodide?

Those who are allergic to seafood

Which of the following hormones would the nurse identify as being secreted by the thyroid gland?

Thyroxine

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

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 nurse explains the role of the ovaries. Which hormones would be included in that discussion?

estrogen and progesterone

A client presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What could be causing this client's symptoms?

hyperpituitarism

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

Cardiac effects of hyperthyroidism include

palpitations

Which glands regulate calcium and phosphorous metabolism?

parathyroid

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

Which assessment would a nurse perform on a client with Cushing's syndrome who is at high risk of developing a peptic ulcer?

Observe stool color.

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.

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