Endocrine PrepU Questions
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. -"Buffalo hump" -Truncal obesity -Purple striae -"Moon face" -Thin extremities
-"Buffalo hump" -Truncal obesity -Purple striae -"Moon face" -Thin extremities 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 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. -"I get up in the middle of the night to void only occasionally." -"I do not have any energy to do what I normally do." -"I do not know why my skin has gotten so dry lately." -"I cannot stand to be in hot weather." -"It seems like the fat on my legs moved to my stomach."
-"I do not have any energy to do what I normally do." -"I do not know why my skin has gotten so dry lately." -"I cannot stand to be in hot weather." -"It seems like the fat on my legs moved to my stomach." 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 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. -"I use lotion on my skin 2 to 3 times a day since my skin is so dry and itchy." -"My children tell me that my eyes appear to be bigger, almost buldging, particularly when I tell them to do the dishes." -"I switched from knitting to glue projects since I have developed tremors in my hands." -"I always carry an extra sweater with me since I'm always cold no matter the temperature outside." -"Even sitting still, sometimes it feels like my heart is racing."
-"My children tell me that my eyes appear to be bigger, almost buldging, particularly when I tell them to do the dishes." -"I switched from knitting to glue projects since I have developed tremors in my hands." -"Even sitting still, sometimes it feels like my heart is racing." 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.
The following clients are scheduled for thyroid testing. Which client would be at greatest risk for inaccurate results? -A client diagnosed with low blood sugar -A client who was given salicylates last month -A client who avoids kelp -A client who received corticosteroids 4 months ago
-A client who was given salicylates last month Explanation: Drugs such as salicylates and corticosteroids affect the results of thyroid tests if taken within past 3 months. Therefore, inaccurate thyroid test results will be obtained for the client who was given salicylates last month but not for the client who was administered corticosteroids 4 months ago. Kelp is high in iodine, which affects the thyroid test results. However, this factor will not affect the results of the thyroid test for a client avoiding kelp. A client's history of low blood sugar will not affect thyroid test results.
What pharmacologic therapy does the nurse anticipate administering when the patient is experiencing thyroid storm? (Select all that apply.) -Acetaminophen -Dexamethasone (Decadron) -Propylthiouracil -Iodine -Synthetic levothyroxine
-Acetaminophen -Dexamethasone (Decadron) -Propylthiouracil -Iodine Explanation: Treatments for thyroid storm include the following: a hypothermia mattress or blanket, ice packs, a cool environment, hydrocortisone, and acetaminophen (Tylenol); propylthiouracil (PTU) or methimazole to impede formation of thyroid hormone and block conversion of T4 to T3, the more active form of thyroid hormone; and iodine, to decrease output of T4 from the thyroid gland.
Before discharge, what should a nurse instruct a client with Addison's disease to do when exposed to periods of stress? -Drink 8 oz of fluids. -Administer hydrocortisone I.M. -Continue to take his usual dose of hydrocortisone. -Perform capillary blood glucose monitoring four times daily.
-Administer hydrocortisone I.M. Explanation: Clients with Addison's disease and their family members should know how to administer I.M. hydrocortisone during periods of stress. Although it's important for the client to keep well hydrated during stress, the critical component in this situation is to know how and when to use I.M. hydrocortisone. Capillary blood glucose monitoring isn't indicated in this situation because the client doesn't have diabetes mellitus. Hydrocortisone replacement doesn't cause insulin resistance.
A nurse is caring for a client with Cushing's syndrome. Which interventions would the nurse include in the client's plan of care? Select all that apply. -Provide a high sodium diet. -Administer prescribed diuretics. -Report systolic BP greater than 139 mm Hg or diastolic BP greater than 89 mm Hg. -Examine extremities for pitting edema. -Monitor weight.
-Administer prescribed diuretics. -Report systolic BP greater than 139 mm Hg or diastolic BP greater than 89 mm Hg. -Examine extremities for pitting edema. -Monitor weight. Explanation: Fluid retention is manifested by swelling in dependent areas, pitting when pressure is applied to the skin over a bone by 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. The client's weight needs to be monitored for fluid balance. The client needs to limit sodium to reduce the potential for fluid retention.
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. -Administering insulin to reduce blood glucose levels -Administering corticosteroids -Administering diuretics to prevent fluid overload -Applying interventions to reduce the client's temperature -Administering beta blockers to reduce heart rate
-Administering corticosteroids -Applying interventions to reduce the client's temperature -Administering beta blockers to reduce heart rate 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.
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. -Administration of a bronchodilator -Administration of calcitonin -Monitoring the patient for fluid overload -Intravenous isotonic saline solution in large quantities -Administration of calcium carbonate
-Administration of calcitonin -Monitoring the patient for fluid overload -Intravenous isotonic saline solution in large quantities 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.
Long-term use of antithyroid medication is not generally recommended for elderly clients because of which events? -Renal disease and mental confusion -Cardiac arrhythmias and fatigue -Gastrointestinal complications and weight loss -Agranulocytosis and hepatic injury
-Agranulocytosis and hepatic injury Explanation: Long-term use of certain antithyroid medications, such as propylthiouracil (PTU), is not recommended for treatment of toxic nodular goiter in older clients because of the risk of side effects. Although rare, evidence indicates that PTU can result in agranulocytosis and hepatic injury. However, use of antithyroid medications versus radioactive iodine or surgery may be the client's preferred choice or the option for some older clients and other ill clients with "limited longevity" who can be monitored at least every 3 months.
When thyroid hormone is administered for prolonged hypothyroidism for a patient, what should the nurse monitor for? -Hypoglycemia -Depression -Mental confusion -Angina
-Angina Explanation: Angina or dysrhythmias can occur when thyroid replacement is initiated because thyroid hormones enhance the cardiovascular effects of catecholamines.
Which symptom of thyroid disease is seen in older adults? -Restlessness -Weight gain -Atrial fibrillation -Hyperactivity
-Atrial fibrillation Explanation: Symptoms seen in older adults include weight loss and atrial fibrillation. Older adults may not experience restlessness or hyperactivity.
A client with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus? -Above-normal urine and serum osmolality levels -Above-normal urine osmolality level, below-normal serum osmolality level -Below-normal urine osmolality level, above-normal serum osmolality level -Below-normal urine and serum osmolality levels
-Below-normal urine osmolality level, above-normal serum osmolality level Explanation: In diabetes insipidus, excessive polyuria causes dilute urine, resulting in a below-normal urine osmolality level. At the same time, polyuria depletes the body of water, causing dehydration that leads to an above-normal serum osmolality level. For the same reasons, diabetes insipidus doesn't cause above-normal urine osmolality or below-normal serum osmolality levels.
The nurse is performing a shift assessment of a client with aldosteronism. What assessments should the nurse include? Select all that apply. -Blood pressure -Urine output -Skin integrity -Signs or symptoms of venous thromboembolism -Peripheral pulses
-Blood pressure -Urine output Explanation: The principal action of aldosterone is to conserve body sodium. Alterations in aldosterone levels consequently affect urine output and blood pressure (BP). Hypertension is the most prominent and almost universal sign of primary aldosteronism. The client's peripheral pulses, risk of venous thromboembolism (VTE), and skin integrity are not typically affected by aldosteronism.
A nurse is performing a physical examination on client suspected of having an endocrine disorder. Which assessment finding might be indicative of a problem with the thyroid gland? -Sudden weight loss without dieting -Cold intolerance -Diarrhea -Dilated pupils
-Cold intolerance Explanation: The thyroid releases hormones that regulate the body's metabolic rate. A client with a malfunctioning thyroid gland may experience weight gain, constipation, cold intolerance, and slowing of body functions. Dilation of the pupils would more likely be related to the adrenal medulla secreting epinephrine and norepinephrine.
Which of the following is considered a late symptom of hypothyroidism? -Physical sluggishness -Cold intolerance -Brittle nails -Loss of libido
-Cold intolerance Explanation: Late symptoms of hypothyroidism include cold intolerance, weight gain, apathy, slow speech, and constipation. Early symptoms include physical sluggishness, loss of libido, and brittle nails.
A patient has been diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following manifestations would be expected in this patient? -Hypernatremia -Dilute urine -Concentrated urine -Increased serum osmolality
-Concentrated urine Explanation: Because SIADH patients do not excrete dilute urine, the urine osmolality will be increased. Also, serum sodium levels will show low levels because of the retention of urine. There is a decreased serum osmolality with an inappropriately increased urine osmolality.
Hypophysectomy is the treatment of choice for which endocrine disorder? -Hyperthyroidism -Pheochromocytoma -Acromegaly -Cushing syndrome
-Cushing syndrome Explanation: Transsphenoidal hypophysectomy is the treatment of choice for clients diagnosed with Cushing syndrome resulting from excessive production of adrenocorticotropic hormone (ACTH) by a tumor of the pituitary gland. Hypophysectomy has an 80% success rate.
The nurse is reviewing the laboratory and diagnostic test findings of a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following would the nurse expect to find? -Elevated serum sodium levels -Elevated urine calcium levels -Decreased urine sodium levels -Decreased serum osmolarity
-Decreased serum osmolarity Explanation: With SIADH, serum sodium levels and serum osmolarity are decreased. Urine sodium levels and osmolarity are high. Calcium levels are not involved with this disorder.
The nurse is reviewing the laboratory and diagnostic test findings of a client diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following would the nurse expect to find? -Elevated serum sodium levels -Elevated urine calcium levels -Decreased serum osmolarity -Decreased urine sodium levels
-Decreased serum osmolarity Explanation: With SIADH, serum sodium levels and serum osmolarity are decreased. Urine sodium levels and osmolarity are high. Calcium levels are not involved with this disorder.
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? -Complete blood count (CBC) -TSH test -Urine specific gravity -Fluid deprivation test
-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 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? -Furosemide -Phenytoin -Metoclopramide -Amphetamine -Lisinopril
-Furosemide -Phenytoin -Metoclopramide -Amphetamine 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.
A patient whose laboratory studies indicates a prolactin level of 200 ng/mL is assessed for a pituitary tumor. During the physical exam, the nurse practitioner notices a number of signs and/or symptoms suggestive of this condition. Which of the following is the most common indicator of a pituitary tumor? -Headaches and visual disturbances -Galactorrhea -Inappropriate responses to stimuli -Tremors and palpitations
-Galactorrhea Explanation: All choices are indicators of a pituitary tumor, but the most common form is indicated by the spontaneous and inappropriate flow of milk from the male or female breast in the absence of pregnancy or breastfeeding. A normal prolactin level is less than 20 ng/mL
A client with Addison disease has a blood glucose level above 80 mg/dL 30 minutes after receiving 15 g of carbohydrates for symptoms of hypoglycemia. Which action would the nurse take next? -Check the client's blood glucose level before each meal. -Give the client milk and graham crackers. -Instruct the client to remain in bed. -Inform the physician immediately.
-Give the client milk and graham crackers. Explanation: Milk and graham crackers contain forms of carbohydrates that take longer to absorb and tend to maintain the blood glucose level for an extended period. The physician should be informed if the client continues to be symptomatic and the blood glucose level is below 80 mg/dL. Maintaining bed rest protects the client from injuries from a fall but does not address the blood glucose issue. Assessing the client's blood glucose level provides a numeric assessment of the blood glucose level and would be performed in an ongoing fashion.
Antithyroid medications are contraindicated in late pregnancy due to the fact that which of the following may occur? Select all that apply. -Goiter -Cretinism -Fetal tachycardia -Fetal hypothyroidism -Fetal bradycardia
-Goiter -Cretinism -Fetal hypothyroidism -Fetal bradycardia Explanation: Antithyroid medications are contraindicated in late pregnancy because the fetus may develop fetal hypothyroidism, fetal bradycardia, goiter, and cretinism.
Antithyroid medications are not generally recommended for elderly patients because of which side effect? -Fatigue -Mental confusion -Granulocytopenia -Weight loss
-Granulocytopenia Explanation: Antithyroid medications are not generally recommended for elderly clients because of the increased incidence of side effects such as granulocytopenia and the need for frequent monitoring.
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. -Growth -Blood pressure regulation -Sleep -Fluid balance -Pregnancy maintenance
-Growth -Sleep -Fluid balance -Pregnancy maintenance 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 patient has been placed on corticosteroid therapy for an Addison's disease. The nurse should be aware of which of the following side effects with this type of therapy? Select all that apply. -Weight loss -Hypotension -Hypertension -Alterations in glucose metabolism -Poor wound healing
-Hypertension -Alterations in glucose metabolism -Poor wound healing Explanation: Side effects of corticosteroid therapy include hypertension, alterations in glucose metabolism, weight gain, and poor wound healing.
A client has had a thyroidectomy. Which of the following would lead the nurse to suspect that the client is developing thyrotoxic crisis? -Hoarseness -Bradycardia -Tetany -Hyperthermia
-Hyperthermia Explanation: Thyrotoxic crisis is manifested by hyperthermia (temperature possibly as high as 106oF (41Co). The pulse is rapid and cardiac dysrhythmias are common. The client may experience persistent vomiting, extreme restlessness with delirium, chest pain, and dyspnea. Hoarseness may be noted due to trauma to the vocal cords during surgery. Tetany indicating hypocalcemia would be manifested if the parathyroid glands are accidentally removed.
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. -Increased appetite -Hypoglycemia -Hypotension -Depression -Weight gain
-Hypoglycemia -Hypotension -Depression 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 patient is having diagnostic testing for suspected hyperthyroidism. Which of the following diagnostics correlate with this endocrine disorder? Select all that apply. -Increase in radioactive iodine uptake -Decrease in serum thyroid-stimulating hormone (TSH) -Increased T4 -Increased T3 -Increases in serum TSH
-Increase in radioactive iodine uptake -Decrease in serum thyroid-stimulating hormone (TSH) -Increased T4 -Increased T3 Explanation: Laboratory findings include a decrease in serum TSH (with primary disease), increased Ts and T4, and an increase in radioactive iodine uptake.
A client has been hospitalized with myxedema. Which of the following actions will the nurse take to care for this client? Select all that apply. -Measure the client's arterial blood gases -Monitor the client's oxygen saturation levels -Apply heating pads to the client -Give fluids to the client with caution -Turn and reposition the client at regular intervals
-Measure the client's arterial blood gases -Monitor the client's oxygen saturation levels -Give fluids to the client with caution -Turn and reposition the client at regular intervals Explanation: Myxedema requires nursing management measures to maintain the client's vital functions. Oxygen saturation levels and arterial blood gases should be monitored and measured to determine the need for assisted ventilation. Caution should be used when giving fluids because of the risk of water intoxication. The client should be turned and positioned to minimize risks associated with immobility. Active warming should be avoided to prevent the client's oxygen demands from increasing and to prevent hypotension. Instead passive warming with a blanked is recommended.
A patient experiences a life-threatening hypercalcemic crisis. The provider orders a cytotoxic agent. Which of the following is most likely the drug that is prescribed? -Calcitonin -Aredia -Didronel -Mithramycin
-Mithramycin Explanation: Mitramycin is a cytotoxic agent commonly used in a hypercalcemic crisis. Didronel and Aredia are bisphosphonates that decrease serum calcium levels. Calcitonin can be ordered but it is not a cytotoxic agent.
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? -Below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as detected by radioimmunoassay -No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test -A decreased TSH level -An increase in the TSH level after 30 minutes during the TSH stimulation test
-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.
Which hormones are secreted by the posterior lobe of the pituitary gland? Select all that apply. -Follicle-stimulating hormone (FSH) -Oxytocin -Thyroid-stimulating hormone (TSH) -Luteinizing hormone (LH) -Vasopressin
-Oxytocin -Vasopressin 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.
Nursing care for a client in addisonian crisis should include which intervention? -Encouraging independence with activities of daily living (ADLs) -Allowing ambulation as tolerated -Placing the client in a private room -Offering extra blankets and raising the heat in the room to keep the client warm
-Placing the client in a private room Explanation: The client in addisonian crisis has a reduced ability to cope with stress as a result of an inability to produce corticosteroids. A private room is easy to keep quiet, dimly lit, and temperature controlled. Also, visitors can be limited to reduce noise, promote rest, and decrease the risk of infection. The client should be kept on bed rest, receiving total assistance with ADLs to avoid stress as much as possible. Because extremes of temperature should be avoided, measures to raise the body temperature, such as extra blankets and turning up the heat, should be avoided.
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. -Potential for injury -Sodium intake -Risk for infection -Fluid balance -Pain management -Body image changes
-Potential for injury -Sodium intake -Risk for infection -Fluid balance -Body image changes 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.
A nurse is caring for a client with suspected hyperparathyroidism. Which condition may contribute to hyperparathyroidism? -Steroid use -Renal failure -Decreased serum calcium level -Thyroidectomy
-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.
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. -Report of stiff hands and feet -Numbness and tingling of the hands -New onset of dysphagia -+3 pitting edema of the lower extremities -Hypoactive bowel sounds
-Report of stiff hands and feet -Numbness and tingling of the hands -New onset of dysphagia 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 client is transferred to a rehabilitation center after being treated in the hospital for a stroke. Because the client has a history of Cushing's syndrome (hypercortisolism) and chronic obstructive pulmonary disease, the nurse formulates a nursing diagnosis of: -Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing's syndrome. -Decreased cardiac output related to hypotension secondary to Cushing's syndrome. -Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. -Risk for imbalanced fluid volume related to excessive sodium loss.
-Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. Explanation: Cushing's syndrome causes tissue catabolism, resulting in thinning skin and connective tissue loss; along with immobility related to stroke, these factors increase this client's risk for impaired skin integrity. The exaggerated glucocorticoid activity in Cushing's syndrome causes sodium and water retention which, in turn, leads to edema and hypertension. Therefore, Risk for imbalanced fluid volume and Decreased cardiac output are inappropriate nursing diagnoses. Increased glucocorticoid activity also causes persistent hyperglycemia, eliminating Ineffective health maintenance related to frequent hypoglycemic episodes as an appropriate nursing diagnosis.
The nurse is developing a care plan for a client with Cushing syndrome. What nursing diagnosis should the nurse prioritize? -Risk for injury related to weakness -Ineffective breathing pattern related to muscle weakness -Risk for loneliness related to disturbed body image -Autonomic dysreflexia related to neurologic changes
-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 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. -Sodium 140 mEq/L -BUN 14 mg/dL (4.998 mmol/L) -Serum osmolality 260 mOsm/Kg -Uric acid 2.5 mg/dL (148.7 µmol/L) -Urine sodium 28 mEq/L
-Serum osmolality 260 mOsm/Kg -Uric acid 2.5 mg/dL (148.7 µmol/L) -Urine sodium 28 mEq/L 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 nurse is aware that several laboratory results are present in a patient diagnosed with diabetes insipidus. Select all that apply. -Serum osmolality of 310 mOsm/kg -Urine specific gravity of 1.001 -Urine osmolality of 800 mOsm/kg -Serum sodium level of 149 mEq/L -Serum ADH level of 2.3 pg/mL
-Serum osmolality of 310 mOsm/kg -Urine specific gravity of 1.001 -Serum sodium level of 149 mEq/L 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.
Which of the following agents suppress release of thyroid hormones? Select all that apply. -Methimazole -Sodium iodide -Potassium iodide -Saturated solution of potassium iodide (SSKI) -Dexamethasone
-Sodium iodide -Potassium iodide -Saturated solution of potassium iodide (SSKI) -Dexamethasone Explanation: Sodium iodide, potassium iodide, dexamethasone, and SSKI suppress the release of thyroid hormones. Methimazole blocks the synthesis of thyroid hormone.
A patient has been taking tricyclic antidepressants for many years for the treatment of depression. The patient has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this patient? Select all that apply. -Strict intake and output -Signs of dehydration -Urine and blood chemistry -Liver function tests -Neurologic function
-Strict intake and output -Urine and blood chemistry -Neurologic function Explanation: Close monitoring of fluid intake and output, daily weight, urine and blood chemistries, and neurologic status is indicated for the patient at risk for SIADH.
When teaching a client diagnosed with hypothyroidism about medical intervention, which is important for the nurse to communicate? -Increased resorption occurs with TH. -TH may increase the effect of digitalis preparation. -TH may decrease blood glucose concentrations. -Normal dosages of sedative agents are prescribed.
-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 reviewing a laboratory order for a client who is scheduled to be tested for a suspected endocrine disorder. The client was recently seen in the office for bronchitis, and you note that he is still taking cough medication. The nurse explains to the client that he will not be able to get his lab testing done today. Why has the testing been postponed? -The client is being tested for an adrenal disorder -The client is being tested for a thyroid disorder -The client is being tested for a pituitary disorder -The client is being tested for a parathyroid disorder
-The client is being tested for a thyroid disorder Explanation: If a client has recently taken a drug that contains iodine (e.g., some cough medicines) or has had radiographic contrast studies that used iodine, thyroid test results may be inaccurate.
A client is undergoing testing for suspected adrenocortical insufficiency. The care team should screen the client for what common cause of this health problem? -Pheochromocytoma -Inadequate secretion of ACTH -Adrenal tumor -Therapeutic use of corticosteroids
-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 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? -Homans sign and deep vein thrombosis -Trousseau sign and overt tetany -Thyroid storm and elevated triiodothyronine -Chvostek sign and hypocalcemia
-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).
When caring for a client who's being treated for hyperthyroidism, the nurse should: -monitor the client for signs of restlessness, sweating, and excessive weight loss during thyroid replacement therapy. -provide extra blankets and clothing to keep the client warm. -encourage the client to be active to prevent constipation. -balance the client's periods of activity and rest.
-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 client reports extremely frequent urination, sometimes urinating 10 to 12 times each day. What fluid balance disorder would be expected with these symptoms? -hypokalemia -diluted urine -hyponatremia -dehydration
-dehydration Explanation: If the client with diabetes insipidus fails to drink a compensatory volume of fluid, dehydration with concentrated levels of electrolytes occurs.
A client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with: -neuropathy. -hypoglycemia. -depression. -hyperthyroidism.
-depression. Explanation: Agitation, irritability, poor memory, loss of appetite, and neglect of one's appearance may signal depression, which is common in clients with Cushing's syndrome. Neuropathy affects clients with diabetes mellitus — not Cushing's syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite.
A client presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What is the most reliable method of confirming the client's condition? -skull radiography + glucose level -MRI + GH measurement -glucose tolerance test + GH measurement -skull radiography alone
-glucose tolerance test + GH measurement Explanation: A glucose tolerance test in combination with a growth hormone measurement is the most reliable method of confirming acromegaly.
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: -simple carbohydrates. -sodium. -calcium. -potassium.
-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.
A nurse is teaching a client recovering from addisonian crisis about the need to take fludrocortisone acetate and hydrocortisone at home. Which statement by the client indicates an understanding of the instructions? -"I'll take all of my hydrocortisone in the morning, right after I wake up." -"I'll take my hydrocortisone in the late afternoon, before dinner." -"I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." -"I'll take the entire dose at bedtime."
Explanation: Hydrocortisone, a glucocorticoid, should be administered according to a schedule that closely reflects the body's own secretion of this hormone; therefore, two-thirds of the dose of hydrocortisone should be taken in the morning and one-third in the late afternoon. This dosage schedule reduces adverse effects.
