ENDOCRINE

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? 1. No increase in TSH level after 30 minutes during the TSH stimulation test. 2. A decreased TSH level. 3. An increase in the TSH level after 30 minutes during the TSH stimulation test. 4. Below-normal levels of T3 and T4 as detected by radioimmunoassay.

1. No increase in TSH level after 30 minutes during the TSH stimulation test. Rationale: 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.

When caring for a client with a history of hypoglycemia, the nurse should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description? 1. Sulfisoxazole (Gantrisin) 2. Mexiletine (Mexitil) 3. Prednisone (Orasone) 4. Lithium carbonate (Lithobid)

1. Sulfisoxazole (Gantrisin) Rationale: Sulfisoxazole and other sulfonamides are chemically related to oral antibiotic agents and may precipitate hypoglycemia. Mexiletinem an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesn't cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia.

A female client is being successfully treated for Cushing's syndrome. The nurse should expect a decline in: 1. serum glucose level. 2. hair loss. 3. bone mineralization. 4. menstrual flow.

1. serum glucose level. Rationale: Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism, not hair loss, is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth declines. Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.

A client is being discharged after undergoing a thyroidectomy. Which discharge instructions are appropriate for this client? Select all that apply. 1. "Report signs and symptoms of hypoglycemia." 2. "Take thyroid medication as ordered." 3. "Watch for signs in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry skin, and report these changes to the physician." 4. "Recognize the signs of dehydration." 5. "Carry injectable dexamethasone at all times."

2. "Take thyroid medication as ordered." 3. "Watch for signs in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry skin, and report these changes to the physician." Rationale: After the removal of the thyroid gland, the client needs to take thyroid replacement medication. The client also needs to report such changes as lethargy, restlessness, cold sensitivity, and dry skin, which may indicate the need for a higher dosage of medication. The thyroid gland doesn't regulate blood glucose levels; therefore, s/s of hypoglycemia aren't relevant for this client. Dehydration is seen in diabetes insipidus. Injectable dexamethasone isn't needed for this client.

A nurse explaining the action of insulin to a client with diabetes mellitus. During client teaching, the nurse reviews the process of insulin secretion in the body. The nurse is correct when she states that insulin is secreted from the: 1. adenohypophysis 2. beta cells of the pancreas 3. alpha cells of the pancreas 4. parafollicular cells of the thyroid

2. beta cells of the pancreas Rationale: The beta cells of the pancreas secrete insulin. the adenohypophysis, or anterior pituitary gland, secretes many hormones, such as GH, prolactin, TSH, corticotropin, FSH and LH, but not insulin. The alpha cells of the pancreas secrete glucagon, which raises the blood glucose level. The parafollicular cells of the thyroid secrete the hormone calcitonin, which plays a role in calcium metabolism.

A nurse explains to the client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites? 1. Insulin is absorbed more slowly at abdominal injection sites than at other sites. 2. Insulin is absorbed rapidly regardless of the injection site. 3. Insulin is absorbed more rapidly at abdominal injection sites than at other sites. 4. Insulin is absorbed unpredictably at all injection sites.

3. Insulin is absorbed more rapidly at abdominal injection sites than at other sites. Rationale: Subcutaneous insulin is absorbed most rapidly at abdominal injection sites, more slowly at sites on the arms, and slowest at sites on the anterior thigh. Absorption after injection in the buttocks is less predictable.

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: 1. an ectopic corticotropin-secreting tumor. 2. adrenal carcinoma. 3. a corticotropin-secreting pituitary adenoma. 4. an inborn error of metabolism

3. a corticotropin-secreting pituitary adenoma. Rationale: 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 in older men and are commonly associated with weight loss. Adrenal carcinoma isn't usually accompanied by hirsutism. A female with and inborn error of metabolism wouldn't be menstruating.

A client with type 1 diabetes has been on a regimen of multiple day injection therapy. He's been converted to continuous subcutaneous insulin therapy. While teaching the client about continuous subcutaneous insulin therapy, the nurse should tell him that the regimen includes the use of: 1. intermediate- and long-acting insulins. 2. short- and long-acting insulins. 3. short-acting insulin only 4. short- and intermediate-acting insulins.

3. short-acting insulin only Rationale: A continuous subcutaneous insulin regimen uses a basal rate and boluses of short-acting insulin. Multiple daily injection therapy uses a combination of short-acting and intermediate- or long-acting insulins.

An elderly female client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse should expect which disorder? 1. Diabetes mellitus 2. Diabetes insipidus 3. Hypoparathyroidism 4. Hyperparathyroidism

4. Hyperparathyroidism Rationale: Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone. Clients also exhibit hypercalciuria-causing polyuria. Although clients with diabetes mellitus and diabetes insipidus have polyuria, they dont have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than by polyuria.

A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering: 1. insulin. 2. furosemide (Lasix). 3. potassium chloride. 4. vasopressin (Pitressin).

4. vasopressin (Pitressin). Rationale: Vasopressin is given subq to manage DI. Insulin is used to manage DM. Furosemide causes diuresis. Potassium chloride is given for hypokalemia.

Addison's disease

A life-threatening condition characterized by fatigue, hypotension, loss of appetite and weight, nausea or vomiting, and increased hyperpigmentation of the skin and mucous membranes. It results from partial or complete loss of glucocorticoid, mineralocorticoid, and androgenic function of the adrenal glands caused by tuberculosis, an autoimmune process, or other disease. Also called Addisonism, Addison's syndrome, chronic adrenocortical insufficiency.

Cushing's Syndrome

A metabolic disorder caused by chronic, excessive production of adrenocortical hormones or by prolonged high-dose glucocorticoid therapy. It's characterized by such signs and symptoms as hypertension, diabetes mellitus, dusky complexion with purple striae, muscle wasting, weakness, and sudden development of fat around the face, neck, and trunk.

Hypothyroidism

Disorder involving deficient production of thyroid hormone, leading to a metabolic imbalance.

Hirsutism

In women, means that hair follicles are being over-stimulated by testosterone or other androgen hormones. Androgens are the dominant sex hormones in men. Women normally have low levels of androgens, but abnormally high levels of androgens can lead to excess hair growth.