Complex Ch 52: Endocrine
A nurse should expect a client with hypothyroidism to report: a) puffiness of the face and hands. b) increased appetite and weight loss. c) nervousness and tremors. d) thyroid gland swelling.
Answer: A Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter). (page 1474)
The nurse is aware that the best time of day for the total large corticosteroid dose is between: a) 7:00 AM and 8:00 AM b) 4:00 PM and 6:00 PM c) 8:00 PM and 9:00 PM d) 4:00 AM and 5:00 AM
Answer: A The best time of day for the total large corticosteroid dose is in the early morning, between 7:00 AM and 8:00 AM, when the adrenal gland is most active. Therefore, dosage at this time of day will result in the maximum suppression of the adrenal gland. (page 1501)
The nurse knows to advise the patient with hyperparathyroidism that he or she should be aware of signs of the common complication of: a) Heart palpitations b) Kidney Stones c) Gastric esophageal reflex d) Bone fractures
Answer: A The formation of stones in one or both kidneys is caused by the increased urinary excretion of calcium and phosphorus. It occurs in more than 50% of patients with primary hyperparathyroidism. Renal damage causes the kidney stones. (page 1488)
Which of the following precautions would be most appropriate when caring for a client being treated with radioactive iodine (RAI) for a thyroid tumor? a) Handle body fluids carefully. b) Administer prescribed corticosteroids carefully. c) Administer the prescribed medications at the same time each day. d) Monitor the respiratory status.
Answer: A The nurse handles body fluids carefully to prevent spread of contamination. Corticosteroids are not prescribed for thyroid tumor. Monitoring the respiratory status and administering prescribed medicines at the same time each day are unrelated to the care of a client receiving RAI. (page 1480)
The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes, a type of white blood cell involved in immunity. Which of the following best identifies the location of this gland? a) In the upper part of the chest above or near the heart b) Attached to the thalamus in the brain c) Connected by a stalk to the hypothalamus in the brain d) Positioned above the kidneys
Answer: A The thymus gland is located in the upper part of the chest above or near the heart. The pineal gland is attached to the thalamus, and the pituitary gland is connected by a stalk to the hypothalamus in the brain. The adrenal glands are located above the kidneys. (page 1464)
Which of the following hormones is secreted by the posterior pituitary? a) Vasopressin b) Somatostatin c) Calcitonin d) Corticosteroids
Answer: A Vasopressin causes contraction of smooth muscle, particularly blood vessels. Calcitonin is secreted by the parafollicular cells of the thyroid gland. Corticosteroids are secreted by the adrenal cortex. Somatostatin is released by the anterior lobe of the pituitary. (page 1468)
Following a thyroidectomy, a patient develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which of the following actions by the nurse is appropriate? a) Administer the IV calcium gluconate ordered. b) Start administration of oxygen at 2 L/min per cannula. c) Administer the oral calcium supplement ordered. d) Administer the sedative ordered.
Answer: A When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not decrease neuromuscular irritability and seizure activity immediately, sedative agents such as pentobarbital may be administered. (page 1490)
The nurse knows to assess a patient with hyperthyroidism for the primary indicator of: a) Intolerance to heat b) Fatigue c) Constipation d) Weight gain
Answer: A With hypothyroidism, the individual is sensitive to cold because the core body temperature is usually below 98.6°F. Intolerance to heat is seen with hyperthyroidism. (page 1479)
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? a) Regulates metabolism b) Helps the body adjust to stress c) Maintains blood pressure d) Slows the body's response to inflammation
Answer: B Cortisol, a glucocorticoid, affects almost every organ in the body, helping it respond to a variety of stressors. Its most important function is helping the body adjust to stress. (page 1494)
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? a) The symptoms are permanent side effects of the corticosteroid therapy. b) The moon face and acne will resolve when the medication is tapered off. c) The dose of the medication must be too high and should be lowered. d) Those symptoms are not related to the corticosteroid therapy.
Answer: B 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). (page 1497)
A nurse educator is teaching a chapter on, "The Function of the Endocrine System." Which of the following hormones would she not include as one of the six hypothalamic hormones? a) Gonadotropin-releasing hormone b) Prolactin c) Corticotropin-releasing hormone d) Thyrotropin-releasing hormone
Answer: B Hypothalamic dopamine inhibits the release of prolactin from the anterior pituitary gland. Corticotropin-releasing hormone (CRH) causes the anterior pituitary gland to secrete adrenocorticotropic hormone (ACTH). Thyrotropin-releasing hormone (TRH) stimulates the release of thyroid-stimulating hormone (TSH) from the anterior pituitary gland. Gonadotropin-releasing hormone (GnRH) triggers sexual development at the onset of puberty and continues to cause the anterior pituitary gland to secrete luteinizing hormone (LH) and follicle-stimulating hormone (FSH). (page 1465)
Which nursing diagnosis takes highest priority for a client with hyperthyroidism? a) Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess b) Imbalanced nutrition: Less than body requirements related to thyroid hormone excess c) Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing d) Disturbed body image related to weight gain and edema
Answer: B In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. These changes put the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements related to thyroid hormone excess the most important nursing diagnosis. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing and Disturbed body image related to weight gain and edema may be appropriate for a client with hypothyroidism, which slows the metabolic rate. (page 1482)
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? a) Glucocorticoids b) Mineralocorticoids c) Testosterone d) Estrogen
Answer: B Mineralocorticoids, primarily aldosterone, maintain water and electrolyte balances. The androgenic hormones convert to testosterone and estrogens. Glucocorticoids, such as cortisol, affect body metabolism, suppress inflammation, and help the body withstand stress. (page 1465)
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? a) Exophthalmos b) Myxedema coma c) Thyroid storm d) Tibial myxedema
Answer: B 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. (page 1474)
Which type of cell secretes glucagon and promotes gluconeogenesis? a) Omega b) Alpha c) Beta d) Delta
Answer: B The alpha cells of the pancreas secret the hormone glucagon. It promotes gluconeogenesis, thus increasing the blood glucose level. The beta cells of the pancreas secrete insulin. Delta cells secrete somatostatin, which reduces the rate at which food is absorbed from the gastrointestinal tract. (page 1247)
During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in which of the following? a) Detecting information about possible tumor growth b) Detecting evidence of hormone hypersecretion c) Determining the size of the organs and location d) Determining the presence or absence of testosterone levels
Answer: B The evaluation of body structures helps the nurse detect evidence of hyper secretion or hyposecretion of hormones. This helps in the assessment of findings that are unique to specific endocrine glands. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and its location. (page 1468)
A patient with a traumatic brain injury is producing an abnormally large volume of dilute urine. Which alteration to a hormone secreted by the posterior pituitary would the nurse expect to find? a) A deficient amount of somatostatin b) A deficient production of vasopressin c) An increase in oxytocin d) An increase in antidiuretic hormone
Answer: B The most common disorder related to posterior lobe dysfunction is diabetes insipidus, a condition in which abnormally large volumes of dilute urine are excreted as a result of deficient production of vasopressin. Diabetes insipidus may occur following surgical treatment of a brain tumor, secondary to nonsurgical brain tumors, and traumatic brain injury. (page 1468)
During the physical examination of a client with a suspected endocrine disorder, the nurse observes an abnormal bulging of the eyes. The nurse documents this finding as which of the following? a) Hypopigmentation b) Exophthalmos c) Thyroid enlargement d) Tremor
Answer: B The nurse would document the finding of abnormal bulging of the eyes as exophthalmos. Palpation of the thyroid would reveal thyroid enlargement. Hypopigmentation would suggest a loss of color to an area. Tremor would be used to denote shaking or quivering. (page 1479)
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 role of parathormone? a) Decreases serum calcium level b) Increases serum calcium level c) Promotes urinary secretion of calcium d) Inhibits release of calcium into extracellular fluid
Answer: B The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level. Parathormone increases the level of calcium in the blood when there is a decrease in the serum level. (page 1487)
What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking his antithyroid medication? a) Syndrome of inappropriate antidiuretic hormone secretion b) Thyrotoxic crisis c) Diabetes insipidus d) Myxedema coma
Answer: B Thyrotoxic crisis, an abrupt and life-threatening form of hyperthyroidism, is thought to be triggered by extreme stress, infection, diabetic ketoacidosis, trauma, toxemia of pregnancy, or manipulation of a hyperactive thyroid gland during surgery or physical examination. Although rare, this condition may occur in clients with undiagnosed or inadequately treated hyperthyroidism. Myxedema coma is the opposite in symptoms that thyrotoxic crisis. DI and SIADH clinical manifestations do not correlate with medication taken for hyperthyroidism. (page 1480)
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 has had an 8-lb weight loss since admission. What should the client be tested for? a) Hypothyroidism b) Diabetes insipidus (DI) c) Pituitary tumor d) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Answer: B 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. (page 1468)
A nurse is preparing to palpate a client's thyroid gland. Which action by the nurse is appropriate? a) Have the client hyperextend his neck and take slow, deep inhalations while she palpates his neck with her fingertips. b) Encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. c) Have the client flex his neck onto his chest and cough while she palpates the anterior neck with her fingertips. d) Place her hands around the client's neck, with the thumbs in the front of the neck, and gently massage the anterior neck.
Answer: B When palpating the thyroid gland, the nurse should encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. As the client swallows, the gland is palpated for enlargement as the tissue rises and falls. Having the client flex his neck wouldn't allow for palpation. Massaging the area or checking during inhalation doesn't allow for the movement of tissue that swallowing provides. (page 1471)
A patient is diagnosed with a deficiency in vasopressin, a posterior pituitary hormone. Therefore, a primary nursing responsibility is to assess for: a) Glycosuria b) Serum calcium levels. c) Indicators of dehydration. d) Indicators of hyponatremia.
Answer: C A deficiency in vasopressin, also known as the antidiuretic hormone, would result in increased urinary output, thirst, and dehydration. No glucose is lost in the urine. Hypernatremia occurs with dehydration. (page 1468)
What is the most common cause of hyperaldosteronism? a) Excessive sodium intake b) Deficient potassium intake c) An adrenal adenoma d) A pituitary adenoma
Answer: C An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake and pituitary stimulation. (page 1284)
Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects? a) Parasympathetic b) Respiratory effects c) Sympathetic d) Gastrointestinal effects
Answer: C 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. (page 1479)
For a client with Graves' disease, which nursing intervention promotes comfort? a) Restricting intake of oral fluids b) Limiting intake of high-carbohydrate foods c) Maintaining room temperature in the low-normal range d) Placing extra blankets on the client's bed
Answer: C 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. (page 1479)
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) Complaints of nausea b) Heart rate of 56-64 bpm c) Blood pressure varying between 120/86 and 240/130 mm Hg d) Shivering
Answer: C 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. (page 1492)
During an assessment of a patient with SIADH, the nurse notes the unexpected result of: a) Moist mucous membranes. b) Normal skin turgor. c) Pitting edema in the lower extremities. d) A blood pressure reading of 120/85 mm Hg.
Answer: C In SIADH, the patient does not appear to retain fluids because reabsorbed water is intracellular rather than interstitial. (page 831)
A nurse working on a medical-surgical unit is caring for a client with Cushing's syndrome. After receiving repot, the nurse reads through the client's nursing diagnoses and prioritizes her interventions. Which of the following would the nurse not include in her plan of care? a) Examine extremities for pitting edema. b) Report systolic BP that exceeds 139 mm Hg or diastolic BP that exceeds 89 mm Hg. c) Provide a high-sodium diet. d) Administer prescribed diuretics.
Answer: C Limiting sodium reduces the potential for fluid retention. Fluid retention is manifested by swelling in dependent areas, pitting when pressure is applied to the skin over a bone, tight-fitting shoes or rings, the appearance of lines in the skin from stockings, and seams in the shoes or areas where they lace. Hypertension is defined as a consistently elevated BP above 139/89 mm Hg. One factor that contributes to hypertension is excess circulatory volume. Diuretics promote the excretion of sodium and water. (page 1496)
Although not being designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones which are involved in increasing blood pressure and volume and maturation of red blood cells? a) Liver b) Brain c) Kidneys d) Cardiac atria
Answer: C The kidneys release renin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys also secrete erythropoietin, a substance that promotes the maturation of red blood cells. (page 1465)
When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of: a) restricting sodium. b) restricting potassium. c) encouraging fluids. d) restricting fluids.
Answer: C The nurse should encourage fluid intake to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn't necessary in hyperparathyroidism. (page 1488)
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) "The gland does not have any other function other than to cause secretion of the growth hormones." c) "It regulates the function of other endocrine glands." d) "It regulates metabolism."
Answer: C The pituitary gland is called the master gland because it regulates the function of other endocrine glands. The term is somewhat misleading, however, because the hypothalamus influences the pituitary gland. The gland has many other hormones that it secretes. (page 1466)
A patient has been diagnosed with thyroidal hypothyroidism. The nurse knows that this diagnosis in consistent with which of the following? a) Inadequate secretion of TSH b) Disorder of the hypothalamus c) Dysfunction of the thyroid gland itself d) Failure of the pituitary gland
Answer: C Thyroidal hypothyroidism results from thyroid gland dysfunction. The other causes result in central, secondary, or tertiary causes if there is inadequate secretion of TSH. (page 1474)
A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering: a) potassium chloride. b) insulin. c) vasopressin (Pitressin). d) furosemide (Lasix).
Answer: C Vasopressin is given subcutaneously to manage diabetes insipidus. Insulin is used to manage diabetes mellitus. Furosemide causes diuresis. Potassium chloride is given for hypokalemia. (page 1468)
Karen is a 51-year-old client who has suffered from several autoimmune disorders over the last 25 years. Lately, she has developed a new set of symptoms and her healthcare provider suspects Addison's disease. Which of the following symptoms would the nurse not expect to see? a) Hypoglycemia b) Depression c) Weight gain d) Hypotension
Answer: C Weight loss, anemia, anorexia, and gastrointestinal symptoms are signs and symptoms of adrenal insufficiency. The consequences of decreased adrenal cortical function include decreased available glucose and hypoglycemia. Nervousness and periods of depression are often seen in clients with adrenal insufficiency. Weakness, fatigue, dizziness, hypotension, postural hypotension, and hypothermia are often seen in clients with adrenal insufficiency. (page 1494)
A patient who is being tested for syndrome of inappropriate antidiuretic hormone (SIADH) secretion asks the nurse to explain the diagnosis. The nurse explains that there is an excessive secretion of antidiuretic hormone (ADH) from which of the following glands? a) Adrenal b) Thyroid c) Anterior pituitary d) Posterior pituitary
Answer: D Antidiuretic hormone is secreted by the posterior pituitary gland. (page 1462)
The nurse is administering a medication to a client with hyperthyroidism to block the production of thyroid hormone. The client is not a candidate for surgical intervention at this time. What medication should the nurse administer to the client? a) Propranolol (Inderal) b) Propylthiouracil (PTU) c) Spironolactone (Aldactone) d) Levothyroxine (Synthroid)
Answer: D Antithyroid drugs, such as propylthiouracil(PTU) and methimazoleare given to block the production of thyroid hormone preoperatively or for long-term treatment for clients who are not candidates for surgery or radiation treatment. Levothyroxine (Synthroid) would increase the level of thyroid and be contraindicated in this client. Spironolactone (Aldactone) is a diuretic and does not have the action of blocking production of thyroid hormone and neither does propranolol (Inderal), which is a beta-blocker. (page 1480)
The nurse is teaching a client about the dietary restrictions related to his diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid? a) Chicken livers b) Bananas c) Hamburger d) Milk
Answer: D Clients with hyperparathyroidism should use a low-calcium diet (fewer dairy products) and drink at least 3 to 4 L of fluid daily to dilute the urine and prevent renal stones from forming. It is especially important that the client drink fluids before going to bed and periodically throughout the night to avoid concentrated urine. Bananas, chicken livers, and hamburgers do not require avoidance. Milk is the highest in calcium content. (page 1489)
A nurse is caring for a female client with hypothyroidism. The client is extremely upset about her altered physical appearance. She doesn't want to take her medication because she doesn't believe it's doing any good. What should the nurse do? a) Tell the client she'll feel better if she consistently takes the thyroid replacement medication. b) Tell the client she needs to learn to accept herself as she is and be compliant during treatment. c) Tell the client that she looks fine and offer to help her with makeup. d) Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency.
Answer: D Telling the client that she'll soon experience improvement is supportive and encouraging and offers direction in a way that motivates her to take her medication consistently. Telling the client that she looks fine and that she'll soon feel better discount the feelings she's currently experiencing. Advising the client to accept herself is parental and direct at a time when the client needs support and understanding. (page 1483)
Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease? a) Use nasal desmopressin acetate (DDAVP). b) Keep an accurate record of intake and output. c) Exercise to improve cardiovascular fitness. d) Have regular follow-up care.
Answer: D The nurse should instruct the client with Graves' disease to have regular follow-up care because most cases of Graves' disease eventually result in hypothyroidism. Annual thyroid-stimulating hormone tests and the client's ability to recognize signs and symptoms of thyroid dysfunction will help detect thyroid abnormalities early. Recording intake and output is important for clients with fluid and electrolyte imbalances but not thyroid disorders. DDAVP is used to treat diabetes insipidus. Although exercise to improve cardiovascular fitness is important, the importance of regular follow-up is most critical for this client. (page 1479)
A client with hypothyroidism is afraid of needles and doesn't want to have his blood drawn. What should the nurse say to help alleviate his concerns? a) "The physician has ordered this test so you can get better sooner." b) "It's only a little stick. It'll be over before you know it." c) "When your thyroid levels are stable, we won't have to draw your blood as often." d) "I'll stay here with you while the technician draws your blood."
Answer: D The nurse should tell the client that she will stay with him as the blood is drawn. This response provides the client with the reassuring presence of the nurse and enhances the therapeutic alliance, possibly providing a greater opportunity to educate the client. Although telling the client that blood won't need to be drawn as often when thyroid levels are stable provides the client with a rationale for needing blood work, it's more appropriate for the nurse to stay with the client. Saying that the procedure will be over quickly or that the physician has ordered the blood draw ignores the client's stated fear. (page 1474)
A patient has been hospitalized with myxedema coma. Which of the following acid-base imbalances would be expected in this patient? a) Metabolic acidosis b) Respiratory alkalosis c) Metabolic alkalosis d) Respiratory acidosis
Answer: D The patient's respiratory drive is depressed, resulting in alveolar hypoventilation, progressive carbon dioxide retention, narcosis, and coma. These symptoms, along with cardiovascular collapse and shock, require aggressive and intensive therapy if the patient is to survive. (page 1474)
Vision and visual fields are altered in disorders of which of the following endocrine glands? a) Pancreas b) Parathyroid c) Thyroid d) Pituitary
Answer: D The pituitary gland is located close to the optic nerves and hence causes pressure on these nerves; thus, changes in the vision and the visual fields may occur. (page 1468)
When thyroid hormone is administered for prolonged hypothyroidism for a patient, what should the nurse monitor for? a) Hypoglycemia b) Angina c) Mental confusion d) Depression
Answer: B Angina or dysrhythmias can occur when thyroid replacement is initiated because thyroid hormones enhance the cardiovascular effects of catecholamines. (page 1475)
A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by: a) an ectopic corticotropin-secreting tumor. b) a corticotropin-secreting pituitary adenoma. c) an inborn error of metabolism. d) adrenal carcinoma.
Answer: B A corticotropin-secreting pituitary adenoma is the most common cause of Cushing's syndrome in women ages 20 to 40. Ectopic corticotropin-secreting tumors are more common in older men and are commonly associated with weight loss. Adrenal carcinoma isn't usually accompanied by hirsutism. A female with an inborn error of metabolism wouldn't be menstruating. (page 1496)
A pheochromocytoma is a rare adrenal tumor that causes increased heart rate, blood pressure, and metabolism because of increased levels of circulating: a) Cortisol. b) Catecholamines. c) Aldosterone. d) Glucocorticoids.
Answer: B A pheochromocytoma releases high levels of the catecholamines epinephrine and norepinephrine. These levels directly affect the incidence and severity of side effects such as headache, diaphoresis, palpitations, and hypertension. Blood pressure readings exceeding 250/150 have been recorded. (page 1492)
After teaching a class about the endocrine system, the instructor determines that the students need additional instruction when they identify which of the following as an endocrine gland? a) Adrenal gland b) Kidneys c) Testes d) Pancreas
Answer: B Although the kidneys secrete renin and erythropoietin, they are typically not considered endocrine glands. The pancreas, adrenal glands, and testes are considered endocrine glands. (page 1464)
A patient is being evaluated for a diagnosis of pheochromocytoma. He is scheduled for epinephrine and norepinephrine laboratory tests. Which of the following plasma levels is a positive value that is diagnostic for pheochromocytoma? a) Epinephrine @ 450 pg/mL b) Norepinephrine @ 200 pg/mL c) Norepinephrine @ 550 pg/mL d) Epinephrine @ 100 pg/mL
Answer: A A plasma level of epinephrine that is more than 400 pg/mL is diagnostic of a pheochromocytoma. Refer to Table 31-4 in the text. (page 1493)
Undersecretion of thyroid hormone during fetal and neonatal development can cause which of the following? a) Cretinism b) Hypothyroidism c) Myxedema d) Diabetes insipidus
Answer: A During fetal and neonatal development, undersecretion of thyroid hormone may cause cretinism (stunted growth and mental development). In adults, hyposecretion of thyroid hormone causes myxedema or hypothyroidism. Diabetes insipidus is caused by undersecretion of antidiuretic hormone (ADH/vasopressin). (page 1471)
A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? a) Dry mucous membranes b) Frequent urination c) Pitting edema of the legs d) An irregular apical pulse
Answer: D 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. (page 1498)
An instructor is preparing a teaching plan for a class on the various pituitary hormones. Which hormone would the instructor include as being released by the posterior pituitary gland? a) Prolactin b) Oxytocin c) Somatotropin d) Adrenocorticotropic hormone
Answer: B The posterior pituitary gland releases oxytocin and antidiuretic hormone. Somatotropin, prolactin, and adrenocorticotropic hormone are released by the anterior pituitary gland. (page 1465)
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 play a minor role in maintaining homeostasis. b) The glands contain ducts that produce the hormones. c) The secretions are released directly into the blood stream. d) The secreted hormones act like target cells.
Answer: C The endocrine glands secrete hormones, chemicals that accelerate or slow physiologic processes, directly into the bloodstream. This characteristic distinguishes endocrine glands from exocrine glands, which release secretions into a duct. Hormones circulate in the blood until they reach receptors in target cells or other endocrine glands. They play a vital role in regulating homeostatic processes. (page 1463)
A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by I.V. infusion? a) Insulin b) Hypotonic saline c) Potassium d) Hydrocortisone
Answer: D Emergency treatment for acute adrenal insufficiency (addisonian crisis) is I.V. infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic — saline solution. (page 1496)
A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland? a) Adrenal cortex b) Adrenal medulla c) Parathyroid d) Pancreas
Answer: A Excessive secretion of aldosterone in the adrenal cortex is responsible for the client's hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone. (page 1491)
