Adult health: Endocrine PrepU

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: 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.

What pharmacologic therapy does the nurse anticipate administering when the patient is experiencing thyroid storm? (Select all that apply.)

Propylthiouracil Iodine Acetaminophen: Treatments for thyroid storm include the following: a hypothermia mattress or blanket, ice packs, a cool environment, hydrocortisone, and acetaminophen (Tylenol); propylthiouracil (PTU) or methimazole to impede formation of thyroid hormone and block conversion of T4 to T3, the more active form of thyroid hormone; and iodine, to decrease output of T4 from the thyroid gland

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: After a subtotal thyroidectomy, swelling of the surgical site (the tracheal area) may obstruct the airway. Therefore, the nurse should keep a tracheostomy set at the client's bedside in case of a respiratory emergency. Although an indwelling urinary catheter and a cardiac monitor may be used for a client after a thyroidectomy, the tracheostomy set is more important. A humidifier isn't indicated for this client.

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: 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.

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

restricting fluids: To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

When caring for a client with diabetes insipidus, the nurse expects to administer

vasopressin: Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

The nurse practitioner who assesses a patient with hyperthyroidism would expect the patient to report which of the following conditions?

weight loss: Weight loss is consistent with a diagnosis of hyperthyroidism. The other conditions are found in hypothyroidism.

During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement?

"You must avoid hyperextending your neck after surgery.": To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesn't affect swallowing.

The physician has ordered an outpatient dexamethasone suppression test to diagnose the cause of Cushing syndrome in a client who works at night, from 11:00 PM to 7:00 AM, and normally sleeps from 8:00 AM to 4:00 PM. The client has been given the dexamethasone. To ensure the most reliable test results, the nurse arranges for the plasma cortisol concentration to be tested at which time?

5:00 pm: An overnight dexamethasone suppression test is used to diagnose pituitary and adrenal causes of Cushing syndrome. It can be performed on an outpatient basis. Dexamethasone is administered orally late in the evening or at bedtime, and a plasma cortisol concentration is measured at 8 AM the next day. However, in a client who sleeps during the day, the medication would be given before bed and the plasma concentration would be measured soon after awakening in the late afternoon.

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: When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered

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?

BP & HR: Blood pressures exceeding 250/150 mm Hg have been recorded in cases of pheochromocytoma. Such BP elevations are life-threatening and can cause severe complications. Consequently, constant monitoring of BP and heart rate is a priority over other assessments, even though each of the listed assessments is relevant and appropriate.

Hypophysectomy is the treatment of choice for which endocrine disorder?

Cushing syndrome: Transsphenoidal hypophysectomy is the treatment of choice for clients diagnosed with Cushing syndrome resulting from excessive production of adrenocorticotropic hormone (ACTH) by a tumor of the pituitary gland. Hypophysectomy has an 80% success rate

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: 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

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: The nurse should observe the color of each stool and test the stool for occult blood.

A client has had a thyroidectomy. Which of the following would lead the nurse to suspect that the client is developing thyrotoxic crisis?

hyperthermia: Thyrotoxic crisis is manifested by hyperthermia (temperature possibly as high as 106oF (41Co). The pulse is rapid and cardiac dysrhythmias are common. The client may experience persistent vomiting, extreme restlessness with delirium, chest pain, and dyspnea. Hoarseness may be noted due to trauma to the vocal cords during surgery. Tetany indicating hypocalcemia would be manifested if the parathyroid glands are accidentally removed.

Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany?

Calcium gluconate: 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

A client with severe hypoparathyroidism is experiencing tetany. What medication, prescribed by the physician for emergency use, will the nurse administer to correct the deficit?

Calcium gluconate: Tetany and severe hypoparathyroidism are treated immediately by the administration of an IV calcium salt, such as calcium gluconate. The other medications are not effective for the treatment of calcium deficit.

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: Efforts are made to spare parathyroid tissue to reduce the risk of postoperative hypocalcemia with resultant tetany.

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: A positive Trousseau's sign is suggestive of latent tetany. A positive Chvostek's sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. A positive Allen's test is demonstrated by the palm remaining blanched with the radial artery occluded. A positive Homans' sign is demonstrated when the patient complains of pain in the calf when his foot is dorsiflexed.

What interventions can the nurse encourage the client with diabetes insipidus to do in order to control thirst and compensate for urine loss?

Consume adequate amount of fluids: The nurse teaches the client to consume sufficient fluid to control thirst and to compensate for urine loss. The client will not be required to come in daily for IV fluid therapy. The client should not limit fluid intake at night if thirst is present. Weighing daily will not control thirst or compensate for urine loss.

A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority?

Decreased CO: 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.

What should the nurse suspect when hourly assessment of urine output on a postcraniotomy patient exhibits a urine output from a catheter of 1,500 mL for 2 consecutive hours?

Diabetes insipidus: Diabetes insipidus is an abrupt onset of extreme polyuria that commonly occurs in patients after brain surgery. Cushing's syndrome is excessive glucocorticoid secretion resulting in sodium and water retention. SIADH is the result of increased secretion of antidiuretic hormone (ADH). The patient becomes volume-overloaded, urine output diminishes, and serum sodium concentration becomes dilute. Adrenal crisis is undersecretion of glucocorticoids resulting in profound hypoglycemia, hypovolemia, and hypotension.

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: Urine output may be as high as 20 L/24 hours. Urine is dilute, with a specific gravity of 1.002 or less. Limiting fluid intake does not control urine exertion. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weakness, dehydration, and weight loss develop. SIADH will have the opposite clinical manifestations. The client's symptoms are related to the trauma and not a pituitary tumor. The thyroid gland does not exhibit these symptoms.

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.: The nurse should explain to the client that Cushing's syndrome causes physical changes related to excessive corticosteroids. Clients with hyperthyroidism, not Cushing's syndrome, are heat intolerant and must have cool clothing and bedding. Clients with Cushing's syndrome should have a high-protein, not low-protein, diet. Clients with Addison's disease must increase sodium intake and fluid intake in times of stress of prevent hypotension.

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: Fine needle biopsy of the thyroid gland is often used to establish the diagnosis of thyroid cancer. The purpose of the biopsy is to differentiate cancerous thyroid nodules from noncancerous nodules and to stage the cancer if detected. The procedure is safe and usually requires only a local anesthetic.

Which outcome indicates that treatment of a client with diabetes insipidus has been effective?

Fluid intake is less than 2,500 ml/day: Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.

Which feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism?

Hand flexing inward: 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.

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: 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.

Hypoventilation, hypothermia & hypotension: 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.

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

Levothyroxine sodium: Hypothyroidism is treated with thyroid replacement therapy, in the form of desiccated thyroid extract or a synthetic product, such as levothyroxine sodium (Synthroid) or liothyronine sodium (Cytomel). Methimazole and propylthiouracil are antithyroid agents used to treat hyperthyroidism. Propranolol is a beta blocker that can be used to treat hyperthyroidism.

For a client with Graves' disease, which nursing intervention promotes comfort?

Maintaining room temperature in the low-normal range: Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss. To reduce heat intolerance and diaphoresis, the nurse should keep the client's room temperature in the low-normal range. To replace fluids lost via diaphoresis, the nurse should encourage, not restrict, intake of oral fluids. Placing extra blankets on the bed of a client with heat intolerance would cause discomfort. To provide needed energy and calories, the nurse should encourage the client to eat high-carbohydrate foods.

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: Clients who are receiving long-term high-dose corticosteroid therapy often develop a cushingoid appearance, manifested by facial fullness and the characteristic moon face. They also may exhibit weight gain, peripheral edema, and hypertension due to sodium and water retention. The skin is usually thin, and ruddy.

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: 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.

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: 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 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 the stool: The nurse should observe the color of each stool and test the stool for occult blood. Bowel patterns, vital signs, and urine output do not help in determining the development of peptic ulcers.

Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects?

Sympathetic: 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 on the telemetry floor is caring for a patient with long-standing hypothyroidism who has been taking synthetic thyroid hormone replacement sporadically. What is a priority that the nurse monitors for in this patient?

Symptoms of acute coronary syndrome: The nurse must monitor for signs and symptoms of acute coronary syndrome (ACS), which can occur in response to therapy in patients with severe, long-standing hypothyroidism or myxedema coma, especially during the early phase of treatment. ACS must be aggressively treated at once to avoid morbid complications (e.g., myocardial infarction).

Which of the following endocrine disorder causes the patient to have dilutional hyponatremia?

Syndrome of inappropriate antidiuretic hormone secretion (SIADH): Patients diagnosed with SIADH retain water and develop a subsequent sodium deficiency known as dilutional hyponatremia. In DI, there is excessive thirst and large volumes of dilute urine. Patients with DI, hypothyroidism, or hyperthyroidism do not exhibit dilutional hyponatremia

A patient who is receiving treatment for hyperthyroidism is being monitored closely by the care team. When observing this patient for signs and symptoms of thyroid storm (thyrotoxicosis), the nurse should prioritize which of the following assessments?

Temp & HR: The nurse closely monitors the patient with hyperthyroidism for signs and symptoms that may be indicative of thyroid storm. The nurse assesses cardiac and respiratory functions by measuring vital signs and cardiac output, electrocardiographic (ECG) monitoring, arterial blood gases, and pulse oximetry. Reflexes, peripheral pulses, LOC, and sensory disturbances are not closely associated with thyrotoxicosis.

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: Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.

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: Cushing syndrome is commonly caused by the use of corticosteroid medications and is infrequently the result of excessive corticosteroid production secondary to hyperplasia of the adrenal cortex. The patient develops a "moon-faced" appearance and may experience increased oiliness of the skin and acne. If Cushing syndrome is a result of the administration of corticosteroids, an attempt is made to reduce or taper the medication to the minimum dosage needed to treat the underlying disease process (e.g., autoimmune or allergic disease, rejection of a transplanted organ).

Which group of clients should not receive potassium iodide?

Those allergic to seafood: 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?

Thyroid crisis: 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.

Trousseau sign is elicited

by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff: A positive Trousseau sign is suggestive of latent tetany. A positive Chvostek sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes the mouth, nose, and eye to spasm or twitch. The palm remaining blanched when the radial artery is occluded demonstrates a positive Allen test. The radial artery should not be used for an arterial puncture. A positive Homans sign is demonstrated when the client reports pain in the calf when the foot is dorsiflexed.

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?

cushings disease: Basophilic pituitary tumors give rise to Cushing's disease; manifestations are associated with excessive secretion of adrenocorticotropic hormone (ACTH) in the pituitary gland. The patient will not develop Addison's disease, hyperthyroidism, or diabetes insipidus.

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: Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).

A 24-year-old male patient is being cared for in the intensive care unit following a motorcycle accident. In addition to musculoskeletal injuries, he has developed syndrome of inappropriate antidiuretic hormone (SIADH) from the traumatic head injury. Which of the following imbalances is consistent with this diagnosis?

hyponatremia: The clinical manifestations of SIADH include: hyponatremia (sodium <134 mEq/L), decreased serum osmolality (<280 mOsm/kg) with inappropriately increased urine osmolality, and urine sodium >20 mEq/L. Hyperkalemia, hyperbilirubinemia, and hypoglycemia do not typically accompany SIADH.

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 1-2 weeks: Potassium iodide reduces the vascularity of the thyroid gland and is used to prepare the gland for surgery. Potassium iodide reaches its maximum effect in 1 to 2 weeks. PTU blocks the conversion of thyroxine to triiodothyronine, the more biologically active thyroid hormone. PTU effects are also seen in 1 to 2 weeks. To relieve symptoms of hyperthyroidism in the interim, clients are usually given a beta-adrenergic blocker such as propranolol (Inderal).

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: Oversecretion of thyroid hormones is usually associated with an enlarged thyroid gland known as a goiter. Goiter also commonly occurs with iodine deficiency.