EAQ- Endocrine

Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)?

Administering fluid replacement As a result of osmotic pressures created by an increased serum glucose level, the cells become dehydrated; the client must receive fluid and then insulin. Oxygen therapy is not necessarily indicated. Carbohydrates will increase the blood glucose level, which is already high. Although dietary instruction may be appropriate later, such instruction is inappropriate during the crisis.

A female client is undergoing treatment for infertility. After therapy with clomiphene the client comes for follow-up visits and no results are seen. What further treatment does the nurse anticipate administering?

Human chorionic gonadotropin Clomiphene is used to induce pregnancy by triggering ovulation. If the desired result is not obtained, the second alternative is to administer human chorionic gonadotropin and gonadotropin-releasing hormone to stimulate ovulation. A combination of estrogen and progesterone is generally administered to treat female clients who have a gonadotropin deficiency. Human growth hormone injections are administered to treat adults with growth hormone deficiency.

A client has a tentative diagnosis of Cushing syndrome. What physical symptoms will the client exhibit?

Hypertension and moon face Increased glucocorticoids cause sodium and water retention, hypertension, and fat deposition, resulting in a moon face. Fever, tachycardia, hyperactivity, and exophthalmos are associated with hyperthyroidism. Lethargy and constipation are associated with hypothyroidism.

Which health problem is most likely to precipitate acute hypoglycemia in a client?

Liver disease Clients with liver disease have a decreased ability to metabolize carbohydrates because of a decreased ability to form glycogen (glycogenesis) and to form glucose from glycogen (glycogenolysis). Hypertension is not related to a decreased serum glucose level. Hyperthyroidism is not related to a decreased serum glucose level. Cushing syndrome causes hyperglycemia.

Blood studies are being performed on a client with the potential diagnosis of hyperparathyroidism. What serum blood level should the nurse expect to be decreased when reviewing this client's hematologic studies?

Phospohorus Because of its inverse relationship with calcium, when serum calcium levels increase, serum phosphorus levels decrease (greater than 3 mg/dL; greater than 0.17 mmol/L). Serum calcium levels will increase because of the action of elevated levels of serum parathormone; serum calcium levels usually exceed 10 mg/dL (2.50 mmol/L). Serum chloride levels will increase, not decrease, with hyperparathyroidism. Parathormone, produced in the parathyroid gland, will increase with hyperparathyroidism.

A client has undergone hypophysectomy. Which action would the nurse consider to be most appropriate during postoperative care to prevent a cerebrospinal fluid (CSF) leak?

Prohibiting coughing or sneezing Hypophysectomy is the surgical removal of the pituitary gland and tumor for the treatment of hyperpituitarism. Coughing and sneezing should be avoided because this may lead to increased pressure in the incision area and CSF leak. Performing deep-breathing exercises would help in preventing pulmonary problems. Nasal drainage should be assessed to determine the leakage of CSF. Neurologic status of the client should be monitored to determine intracranial pressure.

Which important intervention should the nurse include in the plan of care for a client with Addison disease?

Protecting the client from exertion Exertion, either physical or emotional, places additional stress on the adrenal glands. This stress may precipitate an addisonian crisis because increased metabolic demands decrease levels of adrenocortical hormones, causing fatigue. Restricting fluid intake is contraindicated because of the risk for hypovolemia. The nurse should assess for hyperkalemia and hyponatremia.

A primary healthcare provider writes prescriptions addressing the needs of a client with Addison disease. Which outcome does the nurse conclude is the main focus of treatment for this client?

Restoration of electrolyte balance Lack of mineralocorticoids causes hyponatremia, hypovolemia, and hyperkalemia. Dietary modification and administration of cortical hormones are aimed at correcting these electrolyte imbalances, which can be life threatening. There is no disturbance in the eosinophil count. Lymphoid tissue does not change. Although glucocorticoids are involved in metabolic activities, including carbohydrate metabolism, the primary aim of therapy is to restore electrolyte imbalance.

Which condition is characterized by hemorrhage after a pregnant female delivers?

Sheehan's syndrome A pituitary infarction is caused by postpartum hemorrhaging; this condition is known as Sheehan's syndrome. Cushing's syndrome is manifested by moon face, truncal obesity, and hypertension. Addison's disease is manifested by hyperkalemia, hypotension, and hypoglycemia. Schwartz-Bartter syndrome, also called syndrome of inappropriate antidiuretic hormone, is manifested by loss of appetite, nausea, and vomiting.

A client with type 1 diabetes who has been adhering to a prescribed insulin regimen is admitted to the hospital in ketoacidosis. Which factor may have precipitated the ketoacidosis?

Upper respiratory infection Infection is a stress that increases adrenocortical secretion of glucocorticoids, which will increase the blood glucose level. Exercise requires glucose for muscle contraction, which decreases the blood glucose level. Decreased food intake will decrease the blood glucose level. Working the night shift will have no impact on the blood glucose level.

A client is admitted to a medical unit with a diagnosis of Addison disease. The client is emaciated and reports muscular weakness and fatigue. Which disturbed body process does the nurse determine is the root cause of the client's clinical manifestations?

Protein Catabolism Glucocorticoids help maintain blood glucose and liver and muscle glycogen content. A deficiency of glucocorticoids causes hypoglycemia, resulting in breakdown of protein and fats as energy sources. Muscular weakness and fatigue are related to fluid balance, but emaciation is not. Emaciation results from diminished protein and fat stores and hypoglycemia, not from an alteration in electrolytes. Masculinization does not occur in this disease.