chapter52

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

"You must avoid hyperextending your neck after surgery." Explanation: 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.

Which of the following diagnostic tests are done to determine suspected pituitary tumor? a) Radiographs of the abdomen b) Measuring blood hormone levels c) A computed tomography scan d) A radioimmunoassay

A computed tomography scan Correct Explanation: A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and their location. However, measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma.

Which of the following diagnostic tests are done to determine suspected pituitary tumor? Choose the correct option. a) Measurement of blood hormone levels b) A computed tomography scan c) Radiographs of the abdomen d) A radioimmunoassay

A computed tomography scan Explanation: A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and their location. However, measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma

The nurse is reviewing a client's laboratory studies and determines that the client has an elevated calcium level. What does the nurse know will occur as a result of the rise in the serum calcium level?

A rise in serum calcium stimulates the release of calcitonin from the thyroid gland. Explanation: Calcitonin, another thyroid hormone, inhibits the release of calcium from bone into the extracellular fluid. A rise in the serum calcium level stimulates the release of calcitonin from the thyroid gland.

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

Calcium gluconate Explanation: 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

What interventions can the nurse encourage the client to do in order to control thirst and compensate for urine loss? a) Come to the clinic for IV fluid therapy daily. b) Weigh daily. c) Consume adequate amounts of fluid. d) Limit the fluid intake at night.

Consume adequate amounts of fluid. Correct Explanation: 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.

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

Cushing's syndrome

Margaret Lawson, a 52-year-old grocery clerk, has been experiencing a decrease in serum calcium. She has undergone diagnostics, and her physician proposes her calcium level fluctuation is due to altered parathyroid function. What is the typical number of parathyroid glands? a) Four b) Two c) One d) Three

Four Correct Explanation: The parathyroid glands are four (some people have more than four) small, bean-shaped bodies, each surrounded by a capsule of connective tissue and embedded within the lateral lobes of the thyroid.

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? a) Hypophosphaturia b) Hypercalcemia c) Hypocalcemia d) Hyperphosphatemia

Hypercalcemia Explanation: Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low (hyperphosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased.

What does a positive Chvostek's sign indicate? a) Hypermagnesemia b) Hyponatremia c) Hypocalcemia d) Hypokalemia

Hypocalcemia

Which intervention is the most critical for a client with myxedema coma? a) Measuring and recording accurate intake and output b) Administering an oral dose of levothyroxine (Synthroid) c) Maintaining a patent airway d) Warming the client with a warming blanket

Maintaining a patent airway Correct Explanation: Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. Although myxedema coma is associated with severe hypothermia, a warming blanket shouldn't be used because it may cause vasodilation and shock. Gradual warming with blankets is appropriate. Thyroid replacement is administered I.V., not orally. Although recording intake and output is important, these interventions aren't critical at this time.

A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit? a) Weight loss b) Hypotension c) Moon face d) Pale thick skin

Moon face Correct Explanation: 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 with adrenal insufficiency is brought into the ED where you practice nursing. The client is gravely ill and presents with nausea, vomiting, diarrhea, abdominal pain, profound weakness, and headache. The client's family reports that the client has been doing strenuous yard work all day and was sweating profusely. Nursing management of this client would include which of the following? a) Observe for signs of hypernatremia and hyperkalemia in clients experiencing adrenal crisis. b) Observe for signs of hyponatremia and hypokalemia. c) Observe for signs of hyponatremia and hyperkalemia. d) Observe for signs of hypernatremia and hypokalemia in clients experiencing adrenal crisis.

Observe for signs of hyponatremia and hyperkalemia. Correct Explanation: Adrenal crisis may be sudden or gradual. Clients experiencing an adrenal crisis should be monitored for hyponatremia and hypokalemia. Observe for signs of hyponatremia and hyperkalemia in clients experiencing adrenal crisis.

Which medication is the treatment of choice for pregnant women diagnosed with hyperthyroidism? a) PTU b) SSKI c) Potassium iodide d) Methimazole

PTU Explanation: PTU is the treatment of choice during pregnancy for those diagnosed with hyperthyroidism. Reference: Hinkle, J.L., and Cheever, K.H. Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th ed. Philadelphia: Lippincott Williams & Wilkins, 2014, Chapter 52: Assessment and Management of Patients With Endocrine Disorders, p. 1481.

Which glands regulate calcium and phosphorous metabolism? a) Pituitary b) Thyroid c) Adrenal d) Parathyroid

Parathyroid Explanation: Parathormone (parathyroid hormone), the protein hormone produced by the parathyroid glands, regulates calcium and phosphorous metabolism. The thyroid gland controls cellular metabolic activity. The adrenal medulla at the center of the adrenal gland secretes catecholamines, and the outer portion of the gland, the adrenal cortex, secretes steroid hormones. The pituitary gland secretes hormones that control the secretion of additional hormones by other endocrine glands

A patient visits the clinic to seek treatment for disturbed sleep cycles and depressed mood. Which glands and hormones help in regulating sleep cycles and mood? a) Parathyroid glands: parathormone b) Adrenal cortex: corticosteroids c) Pineal gland: melatonin d) Thymus gland: thymosin

Pineal gland: melatonin Correct Explanation: The pineal gland secretes melatonin, which aids in regulating sleep cycles and mood. Melatonin plays a vital role in hypothalamicpituitary interaction. The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes. The parathyroid glands secrete parathormone, which increases the level of calcium and phosphorus in the blood. The adrenal cortex secretes corticosteroids hormones, which influence many organs and structures of the body

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

Sympathetic Correct Explanation: 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.

Parathyroid hormone (PTH) has which effects on the kidney? a) Increased absorption of vitamin D and excretion of vitamin E b) Increased absorption of vitamin E and excretion of vitamin D c) Stimulation of phosphate reabsorption and calcium excretion d) Stimulation of calcium reabsorption and phosphate excretion

Stimulation of phosphate reabsorption and calcium excretion

A nurse is performing a physical examination on an adolescent male suspected of having an endocrine disorder. Which of the following assessment findings might be indicative of a problem with the thyroid gland?

Sudden weight loss without dieting Correct Explanation: The thyroid releases hormones that regulate the body's metabolic rate, which aids in regulating sleep. The adrenal medulla secretes epinephrine and norepinephrine. Responses include increased blood pressure and pulse rate, dilation of the pupils, constriction of blood vessels, bronchodilation, and decreased peristalsis.

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 Explanation: 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).

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) Thyroid storm c) Laryngeal nerve damage d) Hemorrhage

Tetany Correct Explanation: 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 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) Humidifier c) Cardiac monitor d) Tracheostomy set

Tracheostomy set Explanation: 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.

Trousseau's sign is elicited a) by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. b) when the foot is dorsiflexed and there is pain in the calf. c) by a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear that causes spasm or twitching of the mouth, nose, and eye. d) after making a clenched fist and the palm remains blanched when pressure is placed over the radial artery.

by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. Explanation: A positive Trousseau's 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 spasm or twitching of the mouth, nose, and eye. The palm remaining blanched when the radial artery is occluded demonstrates a positive Allen's test. The radial artery should not be used for an arterial puncture. A positive Homans' sign is demonstrated when the patient complains of pain in the calf when his foot is dorsiflexed.

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

c) The functioning of endocrine glands Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma. The measurement of blood hormone levels will not reveal a client's blood sugar level. Radiographs of the chest or abdomen determine the size of the organ and its location.

Which of the following would the nurse need to be alert for in a client with severe hypothyroidism? a) Thyroid storm b) Acromegaly c) Myxedemic coma d) Addison's disease

coma

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 disorder should the nurse expect the physician to diagnose? a) Diabetes mellitus b) Diabetes insipidus c) Cushing's syndrome d) Goiter

goiter 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 this malfunction 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

Cardiac effects of hyperthyroidism include which of the following? a) Decreased pulse pressure b) Palpitations c) Decreased systolic blood pressure d) Bradycardia

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: a) potassium. b) magnesium. c) phosphorus. d) sodium.

phosphorous

The nurse is caring for a patient with hyperparathyroidism and observes a calcium level of 16.2 mg/dL. What interventions does the nurse prepare to provide to reduce the calcium level? (Select all that apply.) a) Monitoring the patient for fluid overload b) Administration of calcium carbonate c) Administration of calcitonin d) Administration of a bronchodilator e) Intravenous isotonic saline solution in large quantities

• Administration of calcitonin • Intravenous isotonic saline solution in large quantities • Monitoring the patient for fluid overload Explanation: Acute hypercalcemic crisis can occur in patients with hyperparathyroidism with extreme elevation of serum calcium levels. Serum calcium levels greater than 13 mg/dL (3.25 mmol/L) result in neurologic, cardiovascular, and kidney symptoms that can be life threatening (Fischbach & Dunning, 2009). Rapid rehydration with large volumes of IV isotonic saline fluids to maintain urine output of 100 to 150 mL per hour is combined with administration of calcitonin (Shane & Berenson, 2012). Calcitonin promotes renal excretion of excess calcium and reduces bone resorption. The saline infusion should be stopped and a loop diuretic may be needed if the patient develops edema. Dosage and rates of infusion depend on the patient profile. The patient should be monitored carefully for fluid overload.

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. a) Hypotension b) Poor wound healing c) Hypertension d) Alterations in glucose metabolism e) Weight loss

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