Coursepoint Endocrine
Which is a clinical manifestation of diabetes insipidus? A) Low urine output B) Excessive thirst C) Weight gain D) Excessive activities
B) Excessive thirst Explanation: Urine output may be as high as 20 L in 24 hours. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weight loss develops.
What does a positive Chvostek's sign indicate? A) Hypocalcemia B) Hyponatremia C) Hypokalemia D) Hypermagnesemia
A) Hypocalcemia Explanation: Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. If the client's facial muscles twitch, it indicates hypocalcemia. Hyponatremia is indicated by weight loss, abdominal cramping, muscle weakness, headache, and postural hypotension. Hypokalemia causes paralytic ileus and muscle weakness. Clients with hypermagnesemia exhibit a loss of deep tendon reflexes, coma, or cardiac arrest.
Which of the following is the primary hormone for the long-term regulation of sodium balance? A) Aldosterone B) Antidiuretic hormone (ADH) C) Calcitonin D) Thyroxin
A) Aldosterone Explanation: Aldosterone is the primary hormone for the long-term regulation of sodium balance. Vasopressin (ADH) release will result in reabsorption of water into the bloodstream, rather than excretion by the kidneys. Calcitonin is secreted in response to high plasma levels of calcium, and it reduces the plasma level of calcium by increasing its deposition in bone. Thyroxin is important in brain development and is necessary for normal growth.
After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. Which electrolyte should the nurse anticipate administering? A) Calcium gluconate B) Potassium chloride C) Sodium bicarbonate D) Sodium phosphorus
A) Calcium gluconate Explanation: Immediate treatment for a client who develops hypocalcemia and tetany after thyroidectomy is calcium gluconate. Potassium chloride and sodium bicarbonate aren't indicated. Sodium phosphorus wouldn't be given because phosphorus levels are already elevated.
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 evidence of hormone hypersecretion. B) Detecting information about possible tumor growth. C) Determining the presence or absence of testosterone levels. D) Determining the size of the organs and location.
A) Detecting evidence of hormone hypersecretion Explanation: The evaluation of body structures helps the nurse detect evidence of hypersecretion 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. Antidiuretic hormone (ADH) levels determine the presence or absence of ADH and testosterone levels.
The adrenal cortex is responsible for producing which substances? A) Glucocorticoids and androgens B) Catecholamines and epinephrine C) Mineralocorticoids and catecholamines D) Norepinephrine and epinephrine
A) Glucocorticoids and androgens Explanation: The adrenal glands have two divisions, the cortex and medulla. The cortex produces three types of hormones: glucocorticoids, mineralocorticoids, and androgens. The medulla produces catecholamines — epinephrine and norepinephrine.
A physician orders laboratory tests to confirm hyperthyroidism in a client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis? A) No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test B) A decreased TSH level C) An increase in the TSH level after 30 minutes during the TSH stimulation test D) Below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as detected by radioimmunoassay
A) No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test Explanation: In the TSH test, failure of the TSH level to rise after 30 minutes confirms hyperthyroidism. A decreased TSH level indicates a pituitary deficiency of this hormone. Below-normal levels of T3 and T4, as detected by radioimmunoassay, signal hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease and may result from administration of phenytoin and certain other drugs.
A nurse is caring for a client with suspected hyperparathyroidism. Which condition may contribute to hyperparathyroidism? A) Renal failure B) Thyroidectomy C) Decreased serum calcium level D) Steroid use
A) Renal failure Explanation: Kidney damage can result from the precipitation of calcium phosphate in the renal pelvis and parenchyma, which causes renal calculi (kidney stones), obstruction, pyelonephritis, and kidney injury. Parathyroid hormone release increases, causing hyperparathyroidism. Serum calcium level may rise as a result of hyperparathyroidism. Thyroidectomy may lead to hypoparathyroidism if the parathyroid is also removed during surgery. Steroid use causes calcium to leave bone, suppressing parathyroid hormone.
Which nursing diagnosis is most appropriate for a client with Addison's disease? A) Risk for infection B) Excessive fluid volume C) Urinary retention D) Hypothermia
A) Risk for infection Explanation: Addison's disease decreases the production of all adrenal hormones, compromising the body's normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison's disease include Deficient fluid volume and Hyperthermia. Urinary retention isn't appropriate because Addison's disease causes polyuria.
The nurse is developing a care plan for a client diagnosed with Cushing syndrome. What issue would have the highest priority in this care plan? A) Risk for injury related to weakness B) Ineffective breathing pattern related to muscle weakness C) Risk for loneliness related to disturbed body image D) Autonomic dysreflexia related to neurologic changes
A) Risk for injury related to weakness Explanation: The nursing priority is to decrease the risk of injury by establishing a protective environment. The client who is weak may require assistance from the nurse in ambulating to prevent falls or bumping corners of furniture. The client's breathing will not be affected and autonomic dysreflexia is not a plausible risk. Loneliness may or may not be an issue for the client, but safety is a priority.
A client is undergoing testing for suspected adrenocortical insufficiency. The care team should ensure that the client has been assessed for the most common cause of adrenocortical insufficiency. What is the most common cause of this health problem? A) Therapeutic use of corticosteroids B) Pheochromocytoma C) Inadequate secretion of adrenocorticotropic hormone (ACTH) D) Adrenal tumor
A) Therapeutic use of corticosteroids Explanation: Therapeutic use of corticosteroids is the most common cause of adrenocortical insufficiency. The other options also cause adrenocortical insufficiency, but they are not the most common causes.
A nurse is performing an examination and notes that the client exhibits signs of exophthalmos. What has the nurse observed? A) abnormal bulging or protrusion of the eyes B) excessive hair growth C) enlarged thyroid gland D) changes in pigmentation
A) abnormal bulging or protrusion of the eyes Explanation: When there is an increase in the volume of the tissue behind the eyes, the eyes will appear to bulge out of the face. Exophthalmos is a bulging of the eye anteriorly out of the orbit.
A client presents at the walk-in clinic reporting diarrhea and vomiting. The client has a documented history of adrenal insufficiency. Considering the client's history and current symptoms, the nurse should anticipate that the client will be instructed to increase intake of: A) sodium. B) potassium. C) simple carbohydrates. D) calcium.
A) sodium. Explanation: The client will need to supplement dietary intake with added salt during episodes of GI losses of fluid through vomiting and diarrhea to prevent the onset of addisonian crisis. While the client may experience the loss of other electrolytes, the major concern is the replacement of lost sodium.
Which hormones are secreted by the posterior lobe of the pituitary gland? Select all that apply. A) Vasopressin B) Oxytocin C) Thyroid-stimulating hormone (TSH) D) Follicle-stimulating hormone (FSH) E) Luteinizing hormone (LH)
A, B Explanation: Important hormones secreted by the posterior lobe of the pituitary gland include vasopressin and oxytocin. TSH, FSH, and LH are secreted by the anterior lobe of the pituitary gland.
A nurse is caring for a client recovering from a hypophysectomy. What would be included in the client's care plan? Select all that apply. A) Assess for neurologic changes. B) Closely monitor nasal packing and postnasal drainage. C) Encourage deep breathing and coughing. D) Offer the client a straw when drinking liquids.
A, B Explanation: The client undergoes frequent neurologic assessments to detect signs of increased intracranial pressure and meningitis. The nurse monitors drainage from the nose and postnasal drainage for the presence of cerebrospinal fluid. The client is advised to avoid drinking from a straw, sneezing, coughing, and bending over to prevent dislodging the graft that seals the operative area between the cranium and nose.
A patient is having diagnostic testing for suspected hyperthyroidism. Which of the following diagnostics correlate with this endocrine disorder? Select all that apply. A) Decrease in serum thyroid-stimulating hormone (TSH) B) Increased T3 C) Increased T4 D) Increase in radioactive iodine uptake E) Increases in serum TSH
A, B, C, D Explanation: Laboratory findings include a decrease in serum TSH (with primary disease), increased Ts and T4, and an increase in radioactive iodine uptake.
The nurse is assessing the endocrine system of a client. Which statement indicates to the nurse that the client is experiencing a condition that affects endocrine function? Select all that apply. A) "I cannot stand to be in hot weather." B) "I do not have any energy to do what I normally do." C) "I do not know why my skin has gotten so dry lately." D) "It seems like the fat on my legs moved to my stomach." E) "I get up in the middle of the night to void only occasionally."
A, B, C, D Explanation: The nursing assessment of the client with endocrine dysfunction includes a health history and physical examination that evaluates the effects of endocrine disorders on the client. Findings that indicate a condition that affects the endocrine system include a change in tolerance to heat or cold, change in energy level, change in skin texture, and change in body proportions and muscle mass. Needing to occasionally get up in the middle of the night would not indicate a condition affecting the endocrine system.
A patient has been diagnosed with Cushing's syndrome. The nurse would expect which of the following features to be present upon physical examination? Select all that apply. A) "Buffalo hump" B) Thin extremities C) "Moon face" D) Truncal obesity E) Purple striae
A, B, C, D, E Explanation: Manifestations of Cushing's syndrome (excessive adrenocortical hormones may cause "moon face," "buffalo hump," thinning of the skin, obesity of the trunk and thinness of the extremities, and purple striae.
The nurse is planning care for a client with Cushing syndrome. Which complications will the nurse monitor for in this client? Select all that apply. A) Fluid balance B) Sodium intake C) Risk for infection D) Pain management E) Potential for injury F) Body image changes
A, B, C, E, F Explanation: Cushing syndrome can be caused by the use of corticosteroid medications or excessive glucocorticoid production caused by hyperplasia of the adrenal cortex. Problems that can occur in this syndrome include fluid balance since fluid retention occurs in this condition. Sodium intake is an issue as this contributes to fluid retention. The client is at risk for infection because of the effect of the corticosteroids on immune function. The client with Cushing syndrome is at risk for injury because of the effects of corticosteroids on muscle tissue and bone structure. Corticosteroids can cause muscle wasting and redistribution of fat. The face becomes moon-shaped and a hump of tissue at the base of the neck can develop. These body image changes will need to be addressed. Pain is not a problem typically associated with Cushing syndrome.
The nurse is preparing a client for a thyroid test. Which medications that the client is taking should be documented on the laboratory slip as possibly affecting the thyroid test? Select all that apply. A) Phenytoin B) Metoclopramide C) Lisinopril D) Furosemide E) Amphetamine
A, B, D, E Explanation: If a client has recently taken a drug that contains iodine or has had radiographic contrast studies that used iodine, thyroid test results may be inaccurate. Other drugs also affect the results of thyroid tests. Phenytoin can lower T4 values. Metoclopramide can raise TSH levels. Amphetamine can lower TSH levels. Furosemide can increase T4 level. Be sure to enter on the laboratory request slip all drugs the client is taking or has taken within the past 3 months. The other drugs do not have relevance to the thyroid test.
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) Administration of calcitonin B) Administration of calcium carbonate C) Intravenous isotonic saline solution in large quantities D) Monitoring the patient for fluid overload E) Administration of a bronchodilator
A, C, D 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.
During a client education session, a nurse describes the role of endocrine glands to the client. Which homeostatic processes regulated by hormones should the nurse include in the teaching? Select all that apply. A) Pregnancy maintenance B) Blood pressure regulation C) Growth D) Fluid balance E) Sleep
A, C, D, E Explanation: Hormones circulate in the blood until they reach receptors in target cells or other endocrine glands. The hormones play a vital role in regulating homeostatic processes such as metabolism, growth, fluid and electrolyte balance, reproductive processes such as pregnancy maintenance, and sleep and wake cycles. The endocrine glands do not regulate blood pressure.
A nurse is aware that several laboratory results are present in a patient diagnosed with diabetes insipidus. Select all that apply. A) Urine specific gravity of 1.001 B) Serum ADH level of 2.3 pg/mL C) Serum osmolality of 310 mOsm/kg D) Urine osmolality of 800 mOsm/kg E) Serum sodium level of 149 mEq/L
A, C, E Explanation: A urine specific gravity of 1.001, serum osmolality of 310 mOsm/kg, and serum sodium level of 149 mEq/L are all indicative of diabetes insipidus.
The nurse is performing a shift assessment of a client with aldosteronism. What assessment(s) should the nurse include? Select all that apply. A) Urine output B) Signs or symptoms of venous thromboembolism C) Peripheral pulses D) Blood pressure E) Skin integrity
A, D Explanation: The principal action of aldosterone is to conserve body sodium. Alterations in aldosterone levels consequently affect urine output and BP. The client's peripheral pulses, risk of VTE, and skin integrity are not typically affected by aldosteronism.
A nurse understands that for the parathyroid hormone to exert its effect, what must be present? A) Decreased phosphate level B) Adequate vitamin D level C) Functioning thyroid gland D) Increased calcium level
B) Adequate vitamin D level Explanation: Adequate vitamin D must be present for parathyroid hormone to help regulate calcium metabolism. Vitamin D promotes calcium absorption from the intestines.
A patient comes to the clinic with complaints of severe thirst. The patient has been drinking up to 10 L of cold water a day, and the patient's urine looks like water. What diagnostic test does the nurse anticipate the physician will order for diagnosis? A) Complete blood count (CBC) B) Fluid deprivation test C) Urine specific gravity D) TSH test
B) Fluid deprivation test Explanation: Diabetes insipidus (DI) is the most common disorder of the posterior lobe of the pituitary gland and is characterized by a deficiency of ADH (vasopressin). Excessive thirst (polydipsia) and large volumes of dilute urine are manifestations of the disorder. The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost. The patient is weighed frequently during the test. Plasma and urine osmolality studies are performed at the beginning and end of the test. The inability to increase the specific gravity and osmolality of the urine is characteristic of DI.
The nurse is planning the care of a client with hyperthyroidism. What should the nurse specify in the client's meal plan? A) A reduced calorie diet, high in nutrients B) Small, frequent meals, high in protein and calories C) Three large, bland meals a day D) A diet high in fiber and plant-sourced fat
B) Small, frequent meals, high in protein and calories Explanation: A client with hyperthyroidism has an increased appetite. The client should be counseled to consume several small, well-balanced meals. High-calorie, high-protein foods are encouraged. A clear liquid diet would not satisfy the client's caloric or hunger needs. A diet rich in fiber and fat should be avoided because these foods may lead to GI upset or increase peristalsis.
When teaching a client diagnosed with hypothyroidism about medical intervention, which is important for the nurse to communicate? A) TH may decrease blood glucose concentrations. B) TH may increase the effect of digitalis preparation. C) Normal dosages of sedative agents are prescribed. D) Increased resorption occurs with TH.
B) TH may increase the effect of digitalis preparation. Explanation: Thyroid hormones may increase the pharmacologic effects of digitalis glycosides, anticoagulant agents, and indomethacin, necessitating careful observation and assessment by the nurse for side effects.
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'll soon experience improvement in her looks as the medication corrects her hormone deficiency. C) Tell the client she needs to learn to accept herself as she is and be compliant during treatment. D) Tell the client that she looks fine and offer to help her with makeup.
B) Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency. Explanation: 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.
The nurse is caring for a client with Addison disease who is scheduled for discharge. When teaching the client about hormone replacement therapy, the nurse should address what topic? A) The possibility of precipitous weight gain B) The need for lifelong steroid replacement C) The need to match the daily steroid dose to immediate symptoms D) The importance of monitoring liver function
B) The need for lifelong steroid replacement Explanation: Because of the need for lifelong replacement of adrenal cortex hormones to prevent Addisonian crises, the client and family members receive explicit education about the rationale for replacement therapy and proper dosage. Doses are not adjusted on a short-term basis. Weight gain and hepatotoxicity are not common adverse effects.
A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by: A) dry, waxy swelling and abnormal mucin deposits in the skin. B) protruding eyes and a fixed stare. C) a wide, staggering gait. D) more than 10 beats/minute difference between the apical and radial pulse rates.
B) protruding eyes and a fixed stare. Explanation: Exophthalmos is characterized by protruding eyes and a fixed stare. Dry, waxy swelling and abnormal mucin deposits in the skin typify myxedema, a condition resulting from advanced hypothyroidism. A wide, staggering gait and a differential between the apical and radial pulse rates aren't specific signs of thyroid dysfunction.
The nurse visits the home of a client recovering from a thyroidectomy. Which finding(s) indicates to the nurse that the client is developing hypocalcemia? Select all that apply. A) Hypoactive bowel sounds B) New onset of dysphagia C) Report of stiff hands and feet D) Numbness and tingling of the hands E) +3 pitting edema of the lower extremities
B, C, D Explanation: During thyroid removal surgery, the risk of removing the parathyroid glands is great. When these glands are removed, hypoparathyroidism occurs which leads to the development of hypocalcemia. Clinical manifestations of hypocalcemia include dysphagia, stiffness of the hands and feet, and numbness and tingling of the hands. Hypoactive bowel sounds and pitting edema are not manifestations of hypocalcemia.
A nurse is reviewing the laboratory test results of a client diagnosed with SIADH. Which result would the nurse identify as reflecting this condition? Select all that apply. A) Sodium 140 mEq/L B) Serum osmolality 260 mOsm/Kg C) Urine sodium 28 mEq/L D) BUN 14 mg/dL (4.998 mmol/L) E) Uric acid 2.5 mg/dL (148.7 µmol/L)
B, C, E Explanation: The clinical manifestations of SIADH include the following: hyponatremia (sodium below 134 mEq/L); decreased serum osmolality (less than 280 mOsm/kg) with inappropriately increased urine osmolality (greater than 100 mOsm/kg—reveals impaired ability of the kidneys to dilute the urine); urine sodium over 20 mEq/L; low blood urea nitrogen (BUN) (below 10 mg/dL), and hypouricemia (uric acid below 4 mg/dL).
A client has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this client's immediate care? Select all that apply. A) Administering diuretics to prevent fluid overload B) Administering beta blockers to reduce heart rate C) Administering insulin to reduce blood glucose levels D) Applying interventions to reduce the client's temperature E) Administering corticosteroids
B,D,E Explanation: Thyroid storm necessitates interventions to reduce heart rate and temperature. IV corticosteroids may be given to replace depletion that results from overstimulation of the adrenals. Diuretics and insulin are not indicated to address the manifestations of this health problem.
A 40-year-old male client with a history of childhood non-Hodgkin lymphoma and radiation treatment is being admitted for thyroid cancer. The client is a commercial airline pilot, does not smoke, exercises regularly, and eats mostly take-out food. What risk factors are primarily associated with his diagnosis? A) Childhood cancer and physical activity B) Employment and smoking history C) Age and radiation history D) Dietary choices and gender
C) Age and radiation history Explanation: Cancer of the thyroid is less prevalent than other forms of cancer, but the incidence of the condition is increasing. Thyroid cancer is more likely to develop in clients younger than 50 years old. Exposure to radiation or external radiation of the head, neck or chest in infancy and childhood increases the risk of this condition. Women, not men, are at a greater risk for this condition. Additional risk factors include smoking, low physical activity, unhealthy eating habits, and high stress levels.
When caring for a client who's being treated for hyperthyroidism, the nurse should: A) provide extra blankets and clothing to keep the client warm. B) monitor the client for signs of restlessness, sweating, and excessive weight loss during thyroid replacement therapy. C) balance the client's periods of activity and rest. D) encourage the client to be active to prevent constipation.
C) Balance the client's periods of activity and rest. Explanation: A client with hyperthyroidism needs to be encouraged to balance periods of activity and rest. Many clients with hyperthyroidism are hyperactive and complain of feeling very warm. Consequently, it's important to keep the environment cool and to teach the client how to manage his physical reactions to heat. Clients with hypothyroidism — not hyperthyroidism — complain of being cold and need warm clothing and blankets to maintain a comfortable temperature. They also receive thyroid replacement therapy, commonly feel lethargic and sluggish, and are prone to constipation. The nurse should encourage clients with hypothyroidism to be more active to prevent constipation.
A 30-year-old client has been diagnosed with Cushing syndrome. What psychosocial nursing diagnosis should the nurse prioritize when planning the client's care? A) Decisional conflict related to treatment options B) Spiritual distress related to changes in cognitive function C) Disturbed body image related to changes in physical appearance D) Powerlessness related to disease progression
C) Disturbed body image related to changes in physical appearance Explanation: Cushing syndrome causes characteristic physical changes that are likely to result in disturbed body image. Decisional conflict and powerlessness may exist, but disturbed body image is more likely to be present. Cognitive changes take place in clients with Cushing syndrome, but these may or may not cause spiritual distress.
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 Explanation: 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.
A client has experienced several autoimmune disorders over the last 25 years, and lately has developed a new set of symptoms. What assessments would the nurse expect to find with a client with suspected Addison disease? Select all that apply. A) Weight gain B) Increased appetite C) Hypoglycemia D) Depression E) Hypotension
C, D, E Explanation: Addison disease is characterized by muscle weakness, anorexia, GI symptoms, fatigue, emaciation, hypotension, low blood glucose levels, low serum sodium levels, high serum potassium levels, and dark pigmentation of the mucous membranes and the skin, especially of the knuckles, knees, and elbows. Depression, emotional lability, apathy, and confusion may also be present.
A client seeks medical attention for new onset of weight loss and heat intolerance. Which additional statements indicate to the nurse that the client is experiencing hyperthyroidism? Select all that apply. A) "I always carry an extra sweater with me since I'm always cold no matter the temperature outside." B) "I use lotion on my skin 2 to 3 times a day since my skin is so dry and itchy." C) "I switched from knitting to glue projects since I have developed tremors in my hands." D) "Even sitting still, sometimes it feels like my heart is racing." E) "My children tell me that my eyes appear to be bigger, almost buldging, particularly when I tell them to do the dishes."
C, D, E Explanation: Clients with hyperthyroidism exhibit a characteristic group of signs and symptoms. Clinical manifestations are related to the increase in metabolic rate and increased oxygen consumption and include tremors, tachycardia, and exophthalmos (bulging eyes). Symptoms associated with hypothyroidism include cold intolerance and dry skin.
A client has been assessed for aldosteronism and has recently begun treatment. What are priority areas for assessment that the nurse should frequently address? Select all that apply. A) Pupillary response B) Creatinine and BUN levels C) Potassium level D) Peripheral pulses E) Blood pressure
C, E Explanation: Clients with aldosteronism exhibit a profound decline in the serum levels of potassium, and hypertension is the most prominent and almost universal sign of aldosteronism. Pupillary response, peripheral pulses, and renal function are not directly affected.
A client has been diagnosed with nephrogenic diabetes insipidus (DI), and the physician is initiating treatment. What medication does the nurse prepare to administer for this client? A) Metolazone B) Bumetanide C) Furosemide D) Hydrochlorothiazide
D) Hydrochlorothiazide Explanation: The physician prescribes a thiazide diuretic, such as hydrochlorothiazide. The thiazide acts at the proximal convoluted tubule, leaving less fluid for excretion in the distal convoluted tubules, the portion affected by nephrogenic diabetes insipidus (DI). Consequently, the client excretes water, but the total volume is less than in an untreated state. The other diuretics listed do not work on the proximal convoluted tubule and would not be effective in treatment.
A nurse is preparing to palpate the thyroid gland. Where would the nurse expect to find this gland? A) In the upper part of the chest near the heart B) In the abdomen, directly above the kidneys C) In the right to left upper quadrant of the abdomen D) In the lower neck, anterior to the trachea
D) In the lower neck, anterior to the trachea Explanation: The thyroid gland is located in the lower neck, anterior to the trachea. The thymus gland is located in the upper part of the chest above or near the heart. The adrenal glands are located in the abdomen above the kidneys. The pancreas is located below the stomach, with the head close to the duodenum, spanning the right to left upper quadrants.
A nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy? A) Methimazole (Tapazole) B) Thyroid USP desiccated (Thyroid USP Enseals) C) Liothyronine (Cytomel) D) Levothyroxine (Synthroid)
D) Levothyroxine (Synthroid) Explanation: Levothyroxine is the agent of choice for thyroid hormone replacement therapy because its standard hormone content provides predictable results. Methimazole is an antithyroid medication used to treat hyperthyroidism. Thyroid USP desiccated and liothyronine are no longer used for thyroid hormone replacement therapy because they may cause fluctuating plasma drug levels, increasing the risk of adverse effects.
A client has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the client knows to take what action? A) Take the drug concurrent with levothyroxine. B) Take each dose of prednisone with a dose of calcium chloride. C) Gradually replace the prednisone with an over-the-counter (OTC) alternative. D) Slowly taper down the dose of prednisone, as prescribed.
D) Slowly taper down the dose of prednisone, as prescribed. Explanation: Corticosteroid dosages are reduced gradually (tapered) to allow normal adrenal function to return and to prevent steroid-induced adrenal insufficiency. There are no over-the-counter (OTC) substitutes for prednisone and neither calcium chloride nor levothyroxine addresses the risk of adrenal insufficiency.
A nurse explains to a client with thyroid disease that the thyroid gland normally produces: A) iodine and thyroid-stimulating hormone (TSH). B) thyrotropin-releasing hormone (TRH) and TSH. C) TSH, triiodothyronine (T3), and calcitonin. D) T3, thyroxine (T4), and calcitonin.
D) T3, thyroxine (T4), and calcitonin Explanation: The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.
Which laboratory test results should a nurse expect to find in a client diagnosed with Hashimoto's thyroiditis? A) Thyroxine (T4), 22 µg/dl; triiodothyronine (T3), 320 ng/dl; thyroid-stimulating hormone (TSH) undetectable B) T4, 22 µg/dl; T3, 200 ng/dl; TSH 0.1 mIU/ml C) T4, 2 µg/dl; T3, 200 ng/dl; TSH 5.9 mIU/ml D) T4, 2 µg/dl; T3, 35 ng/dl; TSH 45 mIU/ml
D) T4, 2 µg/dl; T3, 35 ng/dl; TSH 45 mIU/ml Explanation: Normal thyroid function tests are as follows: T4, 5 to 12 µg/dl; T3, 65 to 195 ng/dl; TSH 0.3 to 5.4 mIU/ml. With Hashimoto's thyroiditis, T4 and T3 levels are typically subnormal and TSH is elevated. With primary hyperthyroidism, T4 and T3 levels are elevated and TSH is subnormal. With hypothyroidism, T4 is subnormal and T3 and TSH levels are elevated.
A client is admitted to a surgical unit after a thyroidectomy. The nurse takes and maintains the inflated blood pressure cuff on the client and observes a carpopedal spasm. What does this result indicate? A) Chvostek sign and hypocalcemia B) Thyroid storm and elevated triiodothyronine C) Homans sign and deep vein thrombosis D) Trousseau sign and overt tetany
D) Trousseau sign and overt tetany Explanation: The Trousseau sign is positive when carpopedal spasm (spasms of the hand or, less commonly, the feet) is induced by occluding the blood flow to the arm for 3 minutes and indicates tetany. Chvostek sign is positive when a sharp tapping over the facial nerve causes spasm, or twitching of the mouth, nose and eye. Chvostek sign also indicates tetany (neuronal excitability), which is usually associated with hypocalcemia. This result is not the product of a thyroid storm, which involves the excessive release of thyroid hormones given the client's surgery. Although blood pressure can be acquired on the leg; this is not the test for the Homans sign. A positive Homans sign is pain in the calf of the leg upon dorsiflexion of the foot and would suggest a deep vein thrombosis (DVT).
A client on corticosteroid therapy needs to be taught that a course of corticosteroids of 2 weeks' duration can suppress the adrenal cortex for how long? A) Up to 4 weeks B) Up to 3 months C) Up to 9 months D) Up to 1 year
D) Up to 1 year Explanation: Up to 1 year or longer after use of corticosteroids, the client still may be at risk for adrenal insufficiency in times of stress.
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) sodium. B) potassium. C) magnesium. D) phosphorus.
D) phosphorus Explanation: PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.
