Chapter 52: Assessment and Management of Patients with Endocrine Disorders

A patient has been placed on corticosteroid therapy for an Addison's disease. The nurse should be aware of which of the following side effects with this type of therapy? Select all that apply. - Hypertension - Alterations in glucose metabolism - Poor wound healing - Hypotension - Weight loss

Answer: - Hypertension - Alterations in glucose metabolism - Poor wound healing Rationale: Side effects of corticosteroid therapy include hypertension, alterations in glucose metabolism, weight gain, and poor wound healing.

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. - Tachycardia - Hypothermia - Hypotension - Hypoventilation - Hyperactivity

Answer: - Hypothermia - Hypotension - Hypoventilation Rationale: The client will experience signs of hypothermia, hypotension, and hypoventilation with myxedema. Clients with myxedema will have bradycardia, not tachycardia, and will have lethargy, not hyperactivity.

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

Answer: A.) adrenal function

Which feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism? A.) Cardiac dysrhythmia B.) Hand flexing inward C.) Moon face and buffalo hump D.) Bulging forehead

Answer: B.) Hand flexing inward

A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching? A.) "I will avoid friends and family members who are sick." B.) "I will eat lots of chicken and dairy products." C.) "I may stop taking this medication when I feel better." D.) "I will see my ophthalmologist regularly for a check-up."

Answer: C.) "I may stop taking this medication when I feel better."

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? A.) Thyrotropin B.) Iodine C.) Thyroxine D.) Calcitonin

Answer: B.) Iodine

A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder? A.) Blood pressure varying between 120/86 and 240/130 mm Hg B.) Heart rate of 56-64 bpm C.) Shivering D.) Complaints of nausea

Answer: A.) Blood pressure varying between 120/86 and 240/130 mm Hg Rationale: Hypertension associated with pheochromocytoma may be intermittent or persistent. Blood pressures exceeding 250/150 mm Hg have been recorded. Such blood pressure elevations are life threatening and can cause severe complications, such as cardiac dysrhythmias, dissecting aneurysm, stroke, and acute kidney failure.

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? A.) Diabetes insipidus (DI) B.) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) C.) Pituitary tumor D.) Hypothyroidism

Answer: A.) Diabetes insipidus (DI)

Which outcome indicates that treatment of a client with diabetes insipidus has been effective? A.) Fluid intake is less than 2,500 ml/day. B.) Urine output measures more than 200 ml/hour. C.) Blood pressure is 90/50 mm Hg. D.) Heart rate is 126 beats/minute.

Answer: A.) Fluid intake is less than 2,500 ml/day. Rationale: 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.

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

Answer: A.) Hypocalcemia

Which of the following glands is considered the master gland? A.) Pituitary B.) Thyroid C.) Parathyroid D.) Adrenal

Answer: A.) Pituitary Rationale: 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.

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? A.) Positive Chvostek's sign B.) Positive Trousseau's sign C.) Positive paresthesias D.) Positive Babinski's sign

Answer: A.) Positive Chvostek's sign

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? A.) Tetany B.) Hemorrhage C.) Thyroid storm D.) Laryngeal nerve damage

Answer: A.) Tetany Rationale: 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.

For a client with hyperthyroidism, treatment is most likely to include: A.) a thyroid hormone antagonist. B.) thyroid extract. C.) a synthetic thyroid hormone. D.) emollient lotions.

Answer: A.) a thyroid hormone antagonist. Rationale: Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.

Trousseau sign is elicited A.) by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. B.) by tapping sharply over the facial nerve just in front of the parotid gland and anterior to the ear, causing spasm or twitching of the mouth, nose, and eye. C.) after making a clenched fist and opening the hand; the palm remains blanched when pressure is placed over the radial artery. D.) when the foot is dorsiflexed and there is pain in the calf.

Answer: A.) by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff.

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 is the gland that is responsible for regulating the hypothalamus." B.) "It regulates the function of other endocrine glands." C.) "The gland does not have any other function other than to cause secretion of the growth hormones." D.) "It regulates metabolism."

Answer: B.) "It regulates the function of other endocrine glands."

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? A.) Administer a sedative as ordered. B.) Administer IV calcium gluconate as ordered. C.) Start administering oxygen at 2 L/min via a cannula. D.) Administer an oral calcium supplement as ordered.

Answer: B.) Administer IV calcium gluconate as ordered. Rationale: 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 nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? A.) Pitting edema of the legs B.) An irregular apical pulse C.) Dry mucous membranes D.) Frequent urination

Answer: B.) An irregular apical pulse Rationale: Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.

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? A.) Serum immunoassay for TSH B.) Fine-needle biopsy of the thyroid gland C.) Free T4 analysis D.) Ultrasound of the thyroid gland

Answer: B.) Fine-needle biopsy of the thyroid gland Rationale: 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.

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? A.) Diabetes mellitus B.) Goiter C.) Diabetes insipidus D.) Cushing's syndrome

Answer: B.) Goiter Rationale: 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 goiter 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.

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: A.) thyroiditis. B.) Graves' disease. C.) Hashimoto's thyroiditis. D.) multinodular goiter.

Answer: B.) Graves' disease. Rationale: 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%).

The most common type of goiter is caused by lack of which of the following? A.) Calcium B.) Iodine C.) Potassium D.) Sodium

Answer: B.) Iodine

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

Answer: B.) Positive Chvostek's sign

When describing the difference between endocrine and exocrine glands, which of the following would the instructor include as characteristic of endocrine glands? A.) The glands contain ducts that produce the hormones. B.) The secretions are released directly into the blood stream. C.) The secreted hormones act like target cells. D.) The glands play a minor role in maintaining homeostasis.

Answer: B.) The secretions are released directly into the blood stream.

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? A.) Indwelling urinary catheter kit B.) Tracheostomy set C.) Cardiac monitor D.) Humidifier

Answer: B.) Tracheostomy set Rationale: 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 nurse is assessing a client with hyperthyroidism. What findings should the nurse expect? A.) Weight gain, constipation, and lethargy B.) Weight loss, nervousness, and tachycardia C.) Exophthalmos, diarrhea, and cold intolerance D.) Diaphoresis, fever, and decreased sweating

Answer: B.) Weight loss, nervousness, and tachycardia Rationale: Weight loss, nervousness, and tachycardia are signs of hyperthyroidism. Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea. Weight gain, constipation, lethargy, decreased sweating, and cold intolerance are signs of hypothyroidism.

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: A.) folic acid. B.) vitamin D. C.) potassium. D.) iron.

Answer: B.) vitamin D.

During an assessment of a client's functional health pattern, which question by the nurse directly addresses the client's thyroid function? A.) "Do you have to get up at night to empty your bladder?" B.) "Have you experienced any headaches or sinus problems?" C.) "Do you experience fatigue even if you have slept a long time?" D.) "Can you describe the amount of stress in your life?"

Answer: C.) "Do you experience fatigue even if you have slept a long time?" Rationale: With the diagnosis of hypothyroidism, extreme fatigue makes it difficult for the person to complete a full day's work or participate in usual activities.

Which disorder results from excessive secretion of somatotropin (growth hormone)? A.) Cretinism B.) Dwarfism C.) Acromegaly D.) Adrenogenital syndrome

Answer: C.) Acromegaly

Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? A.) Addison disease B.) Graves disease C.) Cushing syndrome D.) Hashimoto disease

Answer: C.) Cushing syndrome Rationale: 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.

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? A.) Testosterone B.) Mineralocorticoids C.) Glucocorticoids D.) Estrogen

Answer: C.) Glucocorticoids Rationale: Glucocorticoids, such as cortisol, affect body metabolism, suppress inflammation, and help the body withstand stress. Mineralocorticoids, primarily aldosterone, maintain water and electrolyte balances. The androgenic hormones convert to testosterone and estrogens.

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

Answer: C.) The functioning of endocrine glands

Which of the following hormones would the nurse identify as being secreted by the thyroid gland? A.) Parathormone B.) Thymosin C.) Thyroxine D.) Somatotropin

Answer: C.) Thyroxine Rationale: 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.

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.) hypercalcemia. B.) hypokalemia. C.) hypocalcemia D.) hyperkalemia.

Answer: C.) hypocalcemia

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.

Answer: C.) myxedema coma.

During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement? A.) "The head of your bed must remain flat for 24 hours after surgery." B.) "You should avoid deep breathing and coughing after surgery." C.) "You won't be able to swallow for the first day or two." D.) "You must avoid hyperextending your neck after surgery."

Answer: D.) "You must avoid hyperextending your neck after surgery." Rationale: 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.

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? A.) Glucocorticoids B.) Mineralocorticoids C.) Glucagon D.) Epinephrine

Answer: D.) Epinephrine Rationale: The adrenal medulla secretes epinephrine and norepinephrine. The adrenal cortex manufactures and secretes glucocorticoids, mineralocorticoids, and small amounts of androgenic sex hormones. Glucagon is released by the pancreas.

Which of the following endocrine disorder causes the patient to have dilutional hyponatremia? A.) Diabetes insipidus (DI) B.) Hypothyroidism C.) Hyperthyroidism D.) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Answer: D.) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)