endocrine-- adult I

A 30-year-old male client having an annual health physical reports that all of the following changes have developed during the past year. Which ones alert the nurse to possible pituitary hyperfunction? Select all that apply. A. 15 lb weight gain B. Decreased libido C. Four sinus infections D. Frequent constipation E. Increased foot callus formation F. Occasional dripping of clear fluid from both breasts G. Severely sprained ankle from a volley ball injury

: A, B, F

hich statement made by the client who is going home after a transsphenoidal hypophysectomy indicates to the nurse correct understanding of actions to prevent complications from this treatment? "While I am awake, I will be sure to cough and deep breathe at least every 2 hours." "I will keep the cat food bowl on my counter so that I do not have to bend over." "Whenever I am out-of-doors in the sunshine, I will wear dark glasses." "If the dressing gets wet, I will wash the incision line and redress it immediately."

After this surgery, the client must take care to avoid activities that can increase intracranial pressure. They should avoid bending from the waste and should not bear down, cough, or lay flat. Wearing dark glasses while outside is not necessary to prevent complications from the surgery.

What effect on circulating levels of sodium and glucose does the nurse expect in a client who has been taking an oral cortisol preparation for 2 years because of a respiratory problem? Decreased sodium; decreased glucose Increased sodium; increased glucose Increased sodium; decreased glucose Decreased sodium; increased glucose

Any of the glucocorticoids have some mineralocorticoid activity and increase the reabsorption of sodium from the kidney tubules, thus increasing the serum sodium level. Cortisol also increases liver production of glucose (gluconeogenesis) and inhibits peripheral glucose uptake by the cells. Both these actions increase blood glucose levels.

Which items are most important for the nurse to ensure are in the room when a client returns from having a thyroidectomy? (Select all that apply.) Select all that apply. Hypertonic saline Furosemide Calcium gluconate Oxygen Suction Emergency tracheotomy kit

Calcium gluconate needs to be available at the bedside to treat hypocalcemia and tetany that might occur if the parathyroid glands have been injured during the surgery. Equipment for an emergency tracheotomy must be kept at the bedside in the event that hemorrhage or edema occludes the airway. Oxygen always needs to be at the bedside and especially for the thyroidectomy client who may experience respiratory distress from swelling or damage to the laryngeal nerve leading to spasm. It is also important to have suction available at the client's bedside because of the risk for increased secretions.Furosemide is a diuretic used to treat hypercalcemia associated with hyperparathyroidism. However, hypocalcemia from inadvertent parathyroid removal during thyroidectomy is the greater concern. Hypertonic saline is not necessary for this client. This client is not expected to have hyponatremia after surgery.

Which precaution is most important for the nurse to teach a client who has cardiovascular autonomic neuropathy (CAN) from diabetes to prevent harm? "Check your hands and feet weekly for chronic excessive sweating." "Change positions slowly when moving from sitting to standing." "Avoid drinking caffeine or caffeinated beverages." "Be sure to take your blood pressure drug daily."

Cardiovascular autonomic neuropathy (CAN) affects sympathetic and parasympathetic nerves of the heart and blood vessels. This problem contributes to left ventricular dysfunction, painless myocardial infarction, and exercise intolerance. Most often, CAN leads to orthostatic (postural) hypotension and syncope (brief loss of consciousness on standing). These problems are from failure of the heart and arteries to respond to position changes by increasing heart rate and vascular tone. As a result, blood flow to the brain is interrupted briefly. Orthostatic hypotension and syncope increase the risk for falls, especially among older adults.Although taking blood pressure medication daily is important, it does not prevent orthostatic hypotension and in fact, may make orthostatic hypotension worse. Sensation changes are associated with peripheral neuropathy, not cardiovascular autonomic neuropathy. Avoiding caffeine is no longer a recommended action.

Which urine characteristics indicate to the nurse that the client being managed for diabetes insipidus is responding appropriately to interventions? A. Urine output volume increased; urine specific gravity increased B. Urine output volume increased; urine specific gravity decreased C. Urine output volume decreased; urine specific gravity increased D. Urine output volume decreased; urine specific gravity decreased

Diabetes insipidus (DI) occurs with reduced or absent secretion of vasopressin (ADH). As a result, water is excessively excreted, causing a decrease in blood volume and an increase in urine volume. Blood is concentration indicating dehydration and urine is very dilute, as measured by specific gravity, is very low. When interventions to counter act DI are effective, the adult increases water reabsorption so that urine output volume decreases at the same time that urine concentration increases, seen as an increased urine specific gravity.

For which symptoms will the nurse instruct the family and client who is being treated for diabetes insipidus (DI) to call 911 or go to the nearest emergency department? (Select all that apply.) Decreased urine output Hypotension Weigh gain of more than 2.2 lb (1 kg) in 24 hours Persistent headache Hyperglycemia Acute confusion

Drug therapy for DI can cause a greatly increased kidney reabsorption of water and lead to life-threatening water toxicity. Indications of water toxicity are a relatively rapid onset of acute confusion, rapid weight gain, decreased urine output, persistent headache, and nausea and vomiting. Clients become hypertensive (not hypotensive). Usually blood glucose levels are unaffected but can be diluted below normal levels.

Which assessment finding in a client with hyperaldosteronism indicates to the nurse that the condition is becoming more severe? Urine output for the past 24 hours has increased. Client reports numbness and tingling around the mouth. Temperature is now elevated. pH is now 7.43.

Hyperaldosteronism causes potassium to be excreted excessively. As hypokalemia becomes more severe, paresthesias occur with numbness and tingling around the mouth and of the fingers and toes.Alkalosis is possible, but the pH shown is normal. Temperature elevation and increased urine output are not associated with a worsening of hyperaldosteronism.

Which statements regarding hyperthyroidism are accurate? (Select all that apply.) Select all that apply. Has a sudden onset of symptoms. Is much more common among women than among men. Produces symptoms of a hypermetabolic state. Most common form is Graves disease. Can be diagnosed by the presence of a goiter. Often occurs weeks after exposure to ionizing radiation.

Hyperthyroidism increases the metabolism and function of all systems. The most common cause of hyperthyroidism is Graves disease, which is an autoimmune disorder, often occurring after an episode of thyroid inflammation leading to the production of autoantibodies (thyroid-stimulating immunoglobulins [TSIs]) that attach to the thyroid-stimulating hormone (TSH) receptors on the thyroid gland. The increased stimulation of TSH receptors greatly increases thyroid hormone production. All thyroid problems are from five to ten more common among women than men.The onset is so slow and insidious that clients may not even notice them until severe changes are present. A goiter only indicates a thyroid problem and can occur with both hypothyroidism and hyperthyroidism. Exposure to ionizing radiation can induce hypothyroidism, not hyperthyroidism.

Which signs, symptoms, or behaviors will the nurse expect to find when assessing a client who has just been diagnosed with hypothyroidism? (Select all that apply.) Select all that apply. Goiter Nonpitting edema of hands and feet Warm, moist skin Decreased deep tendon reflexes Agitation and inability to sleep Pulse rate below 60 beats/min

Hypothyroidism slows the metabolism and function of all systems and the ones that are usually first noticed and can lead to life-threatening complications are the cardiac and central nervous systems. Thus, the heart rate is usually slower than 60 beats/min, and the deep tendon reflexes are decreased. Metabolites that are compounds of proteins and sugars called glycosaminoglycans (GAGs) build up inside cells, which increase the mucus and water, forming cellular edema that is nonpitting.The onset is so slow and insidious that clients may not even notice them until severe changes are present. A goiter only indicates a thyroid problem and can occur with both hypothyroidism and hyperthyroidism. The skin reflects the client's overall decreased metabolism and is cool and dry.

Which signs and symptoms in a client who has hyperthyroidism indicate to the nurse possible progression to a thyroid storm? (Select all that apply.) Select all that apply. Elevated temperature Tachycardia Somnolence Elevated systolic blood pressure Abdominal pain and nausea Slow respiratory rate

Symptoms of thyroid storm are caused by excessive thyroid hormone release, which dramatically increases metabolic rate. Key symptoms include fever, tachycardia, and systolic hypertension. Additional symptoms include abdominal pain, nausea, vomiting, diarrhea, tremors, and anxiety. The increased metabolic rate causes the respiratory rate to increase. Clients are agitated, not somnolent.

The nurse has just received report on a group of clients. Which client is the nurse's first priority? A 26 year old with type 1 diabetes whose insulin pump is beeping "occlusion." A 30 year old with type 1 diabetes who is reporting thirst. A 40 year old with type 2 diabetes who has a blood glucose of 150 mg/dL (8.3 mmol/L). A 50 year old with type 2 diabetes with a blood pressure of 150/90 mm Hg.

The client the nurse sees first is the client with type 1 diabetes whose insulin pump is beeping "occlusion." Because glucose levels will increase quickly in clients whose continuous insulin pumps malfunction, the nurse must assess this client and the insulin pump first to avoid hyperglycemia or diabetic ketoacidosis.Thirst is an expected symptom of hyperglycemia and, although important, is not a priority. The nurse could delegate fingerstick blood glucose to unlicensed assistive personnel while assessing the client whose insulin pump is beeping. Although a blood glucose reading of 150 mg/dL (8.3 mmol/L) is mildly elevated, this does not require immediate action. Mild hypertension does not require immediate action. The nurse can later assess if this is within the client's usual range or represents a change before taking action.

In collaboration with the registered dietitian nutritionist, which dietary alterations will the nurse instruct a client with Cushing disease to make? High carbohydrate, low potassium, and fluid restriction Low carbohydrate, high calorie, and low sodium Low protein, high carbohydrate, and low calcium High protein, high carbohydrate, and low potassium

The client with Cushing disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of total calories and carbohydrates to prevent or reduce the degree of hyperglycemia. The sodium retention causes water retention and hypertension. Clients are encouraged to moderately restrict sodium intake

hat action will the nurse advise to prevent harm for a client with diabetes who has a 3-cm callus on the ball of the right foot? "Make an appointment with your podiatrist as soon as possible." "Make an appointment with a pedicurist and have them cut or file off the callus." "Soak your feet nightly in warm water and peel of a little of the callus every day." "Apply an over-the-counter callus-dissolving pad and follow the package directions."

The client with diabetes is taught to see his or her diabetes health care provider or a podiatrist for calluses, corns, or any other foot lesion and never to self-treat such problems. The risk for development of an ongoing injury with chronic infection is very high could lead to eventual amputation.

What is the nurse's best response to a client newly diagnosed with diabetes who asks why he is always so thirsty? "Without insulin, glucose is excreted rather than used in the cells. The loss of glucose directly triggers thirst, especially for sugared drinks." "The extra glucose in the blood increases the blood sodium level, which increases your sense of thirst." "Without insulin, glucose combines with blood cholesterol, which damages the kidneys, making you feel thirsty even when no water has been lost." "The extra glucose in the blood makes the blood thicker, which then triggers thirst so that the water you drink will dilute the blood glucose level."

The high blood glucose levels that are present, because movement of glucose into cells is impaired, increase the osmolarity of the blood. The increased osmolarity stimulates the osmoreceptors in the hypothalamus, which triggers the thirst reflex. In response, the person drinks more water (not sugary fluids or hyperosmotic fluids), which helps dilute blood glucose levels and reduces blood osmolarity.

Which action is most important for the nurse to take first after finding a client who has severe hypothyroidism to be unresponsive to attempts to waken her and have a heart rate of 46 beats/min? Increasing the IV infusion rate Initiating the Rapid Response Team Assessing temperature Applying oxygen by mask

The most common cause of death with severe hypothyroidism is respiratory failure with decreased gas exchange. The nurse would apply oxygen first and then initiate the Rapid Response Team. Although a decreased body temperature would support the findings that a client with severe hypothyroidism is worsening, assessing it would not be helpful in this situation. Increasing the IV flow rate may not even improve cardiac output because the slow heart rate is not related to a volume deficit but to reduced myocardial contractility.

Which action has the highest priority for the nurse to take when a client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." and has vital signs of: T 98.4° F (36.9° C), P 112 beats/min, R 38 breaths/min, BP 91/54 mm Hg, and O2 saturation 99% on room air? Administering oxygen Connecting a cardiac monitor Assessing arterial blood gas (ABG) values Assessing blood glucose level

The nurse would first obtain the client's glucose level. Breathing deeply and stating, "I can't catch my breath" is indicative of Kussmaul respirations which is a sign of diabetic ketoacidosis (DKA).Based on the oxygen saturation, oxygen administration is not indicated. The diagnosis of DKA does not require ABGs. Cardiac monitoring may be implemented, but the first action would be to obtain the glucose level. Question 12 of 26

A nurse caring for a client with Cushing's syndrome who must remain on continued corticosteroid therapy for another health problem will use which of the following actions to prevent harm? A. Urging the client to salt his or her food. B. Testing voided urine for the present of glucose. C. Using non-adhesive methods to secure an IV access. D. Ensuring that the prescribed corticosteroid drug is given on an empty stomach.

The skin of a client on chronic corticosteroid therapy is thin, very fragile, and easily injured. The client also is a increased risk for infection and an open skin site increases that risk. Using nonadhesive methods to secure an IV access protects the skin from injury. Usually the client on a corticosteroid has problems with sodium retention and is on a salt-restricted diet. Urine testing for glucose not accurate and is no longer performed. Corticosteroids irritate the stomach lining and can cause GI bleeding for many reasons. They are recommended to be taken with food to prevent GI irritation.

Which assessment finding in a client with diabetes mellitus indicates to the nurse that the disease is damaging the kidneys? White blood cells (WBCs) in the urine during a random urinalysis Ketone bodies in the urine during acidosis Glucose in the urine during hyperglycemia Protein in the urine during a random urinalysis

Urine should not contain protein and the presence of proteinuria in a client with marks the beginning of renal problems known as diabetic nephropathy, that progresses eventually to end-stage renal disease. Chronically elevated blood glucose levels cause renal hypertension and excess kidney perfusion with leakage from the renal vasculature. The excess leakiness allows larger substances, such as proteins, to be filtered into the urin

What is the nurse's best action when finding that a client who has had diabetes for 15 years has decreased sensory perception in both feet? Testing the sensory perception of the client's hands Examining both feet for indications of injury Explaining to the client that peripheral neuropathy is now present Documenting the finding as the only action

When reduced peripheral sensory perception is present, the likelihood of injury is high. Any open area or other problem on the foot of a person with diabetes is at great risk for infection and must be managed carefully and quickly. Checking for sensory perception on the hands and other areas is important but can come after a thorough foot examination.

Which assessment finding in a client with diagnosis of diabetes insipidus (DI) indicates to the nurse that desmopressin therapy is effective? Urine output of 30 to 50 mL/hr Blood glucose level of 110 mg/dL (6.1 mmol/L) Respiratory rate of 20 breaths/min Potassium level of 3.9 mEq/L (mmol/L)

With DI, insufficient amounts of vasopressin (antidiuretic hormone [ADH]) prevent reabsorption of water, leading to profound diuresis that can result in dehydration. Desmopressin, a synthetic form of ADH, is the drug of choice to stop fluid loss.A blood glucose result of 110 mg/dL (6.1 mmol/L) is within the range of normal blood glucose levels, as are the respiratory rate and the potassium level.

After instructing a client about the correct procedure for a 24-hour urine test, which client statement indicates to the nurse a need for further teaching? "I will not eat any fatty foods when I am collecting urine for this test." "To end the collection, I must empty my bladder and add this urine to the collection." "I need to keep the urine container cool in a separate refrigerator or cooler." "I won't save the first urine sample of the day."

a

Which client assessment finding indicates to the nurse the need to assess further for a possible endocrine problem? Increased facial hair and absent menses in a 28-year-old nonpregnant woman Increased appetite in a 40-year-old man who started an aerobic exercise program 1 week ago Male-pattern baldness in a 32-year-old man Dry skin on the shins of a 70-year-old woman

a

Which primary health care provider order will the nurse perform first for a client with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 105 mEq/L (105 mmol/L)? Administering an infusion of 150 mL hypertonic saline over the next 3 hours Drawing blood for hemoglobin and hematocrit levels Measuring serial weights at the same daily with the client wearing the same amount of clothing Inserting an indwelling catheter and monitoring urine output

a.

Which action is most important for the nurse to perform when caring for an older client decreased antidiuretic hormone (ADH) production? Inspecting feet and legs for ulcers Planning for weight-bearing activities Stressing the important of fiber in the diet Encouraging fluids every 2 hours

d