Endocrine System EVOLVE
the nurse is caring for a client with Addison disease. Which dietary modification should the nurse include in the client's teaching plan? increase potassium intake to replace renal loss increase protein intake to heal the adrenal tissue and thus cure the disease take supplemental vitamins to supply energy and assist in regaining the weight that was lost consume extra salt to replace the amount being lost due to a lack of sufficient aldosterone needed to conserve sodium
answer: consume extra salt to replace the amount being lost due to a lack of sufficient aldosterone needed to conserve sodium lack of aldosterone leads to loss of sodium and subsequent hyponatremia. Potassium intake is not encouraged; hyperkalemia is a problem bc of insufficient mineralocorticoids. increasing protein is needed to heal the adrenal tissue and cure the disease caused by idiopathic atrophy of the adrenal cortex; tissue repair of the gland is not possible. Vitamins are not directly energy-producing; nor will they help the client gain weight. 7
which is secondary cause of adrenal insufficiency? hemorrhage tuberculosis pituitary tumors metastatic cancer
answer: pituitary tumors adrenal insufficiency is also called Addison disease. Secondary causes include pitutary tumors. Primary causes, which are responsible for adrenal insufficiency, include hemorrhage, TB, and metastatic cancer.
when assessing a client with diabetes insipidus, which signs would the nurse anticipate finding? select all that apply. excessive thirst increased blood glucose dry mucous membranes increased blood pressure decreased serum osmolarity decreased urine specific gravity
answer: 1,3,6 as excessive fluid is lost through urination, dehydration triggers the thirst response. As excessive fluid is lost through urination, dehydration occurs, resulting in dry mucous membranes and poor skin turgor. Because water is not be reabsorbed, urine is dilute, resulting is low specific gravity. Diabetes insipidus is not a disorder of glucose metabolism; blood glucose levels are not affected. Diabetes mellitus affects glucose metabolism. Loss of fluid may decrease the blood pressure because fluid is lost from the intravascular compartment. As fluid is lost from the intravascular compartment, serum osmolarity increases, not decreases.
which symptom might the nurse identify when assessing a client with hyperthyroidism? fatigue dry skin anorexia bradycardia
answer: fatigue excessive metabolic activity associated with hyperthyroidism causes fatigue. Warm, moist skin is expected because of increased peripheral perfusion associated with increased metabolism. Increased appetite is expected because of the increased metabolism associated with hyperthyroidism. tachycardia is expected because of the increased metabolism associated with hyperthyroidism.
which classic sign will a nurse find in a client with Addison disease? ecchymosis hyperreflexia exophthalmos hyperpigmentation
answer: hyperpigmentation hyperpigmentation, or "bronzing" is a classic sign of Addison disease. Ecchymosis (bruise) is the discoloration of the skin as a result of rupture of blood vessels beneath the skin. Hyperreflexia is a sign of hypoparathyroidism. Exophthalmos is the classic sign of hyperthyroidism.
a client is diagnosed with Cushing syndrome. the nurse would monitor the client for which cardiovascular complication? chest pain tachycardia hypertension afib
answer: hypertension hypertension is a cardiovascular complication found in clients with Cushings due to increased metabolic demands. Chest pain is seen in patients with hyperthyroidism and hypothyroidism. tachycardia and afib are manifestations of dysrhythmias, which are associated with hypothyroidism or hyperthyroidism, parathyroidism, and pheochromocytoma.
which symptom would the nurse expect in a client with cushings to exhibit? lability of mood postural hypotension increased skin thickness ectomorphism with a moon face
answer: lability of mood excess adrenocorticoids can cause emotional lability, euphoria and psychosis. Increased secretion of androgens results in hirsutism, HTN, and hyperglycemia. Capilary fragility results in multiple ecchymotic areas, not skin thickness. Although a moon face is associated with corticosteroid therapy, ectomorphism is a term for a tall, thin, genetically determined body body that is not related to adaptations to Cushing syndrome.
which parameter monitoring would be nurse's priority while caring for a client with hypothyroidism? pulse blood pressure respiratory rate body temperature
answer: respiratory rate hypothyroidism is associated with a decreased respiratory rate. Therefore, monitoring the client's respiratory rate should be the nurse's top priority. Although hypotension, hypothermia, and pulse rate are important they are not they priority.
the nurse is caring for a client with type 2 diabetes mellitus and renal insufficiency. The client is scheduled for a CT scan with contrast. Which medication would the nurse withhold to prevent lactic acidosis? pioglitazone insulin glyburide metformin
answer: metformin the metformin would be held in clients with renal impairment, as this medication along with contrast dye can cause lactic acidosis.
which neurological manifestation is associated with hyperthyroidism? confusion hearing loss tremors slowness of speech
answer: tremors tremors is a neuro manifestation in a client associated with hyperthyroidism. confusion, hearing loss, and slowness of speech are caused by hypothyroidism.
the nurse is educating a client with hypothyroidism about the use of levothyroxine. Which information would the nurse provide? select all that apply. take dose same time each day refrain from switching brands have regular bloodwork draw hold medication for pulse > 60 bpm report weight loss more than 3 pounds
answer: 1,2,3 clients taking levothyroxine should take the same dose the same time each day and should not switch medication brands. The client should have regular thyroid levels drawn to ensure accurate dosage. the medication should be held if the patient is experiencing tachycardia, or a HR greater than 100 bpm. The client with hypothyroidism will begin to lose weight with medication as thyroid levels stabilize.
which signs and symptoms will a client admitted to the hospital with a diagnosis of Cushing syndrome exhibit? hyperkalemia and edema hypotension and sodium loss muscle wasting and hypoglycemia muscle weakness and frequent urination
answer: muscle weakness and frequent urination Increased gluconeogenesis may lead to hyperglycemia and glycosuria, which can produce urinary frequency;
which intervention would the nurse include in the plan of care for a client with Addison disease? encourage exercise protect from exertion restrict fluid intake monitor for hypokalemia
answer: protect 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 fo hypovolemia. The nurse would assess for hyperkalemia and hyponatremia.
Which clinical manifestation would the nurse expect a client with hypothyroidism to exhibit? select all that apply. cool skin photophobia constipation periorbital edema decreased appetite
answer: 1,3,4,5 cool skin is related to the decreased metabolic rate associated with insufficient thyroid hormone. Constipation results from a decrease in peristalsis related to the reduction in the metabolic rate associated with hypothyroidism. Periorbital and facial edemas are caused by changes that cause myxedema and third space fluid effusion seen in hypothyroidism. Decreased appetite is related to metabolic and GI manifestations of the hypothyroidism. Photophobia is associated with exophthalmos that occurs with hyperthyroidism.
the nurse is assessing a client with moon shaped face and thin arms and legs. The nurse expects which other assessment findings? select all that apply weight loss gastric ulcer pain in bones poor appetite muscle weakness
answer: 2,3,5 the presence of these symptoms as a moon shaped face and thin arms and legs indicates Cushings. In Cushings, the cortisol level rises resulting in gaatric ulcer formation caused by increased hydrochloric acid secretion and decreased production of protective gastric mucus. Osteoporosis is common in cushings; therefore bone pain is common. Clients may also feel muscle weakness. Clients with cushing experience increased appetite and weight gain, therefore they display truncal obesity and a buffalo hump.
which finding would be expected in a client with a history of hypothyroidism? select all that apply. cold intolerance lethargy and fatigue hemoglobin 11.2 15 pound weight gain heart rate 59 beats/min
answer: all a client with hypothyroidism would report feeling cold all the time, lethargy, and fatigue. These symptoms occur as a result of decreased metabolism from low thyroid hormone levels. Clients with hypothyroidism may also be anemic, report weight gain, and have bradycardia.
which assessment findings are associated with Cushing disease? select all that apply. round face dependent edema in the feet and ankles increased fatty deposition in the extremities thin, translucent skin with bruising increased fatty deposition in the neck and back
answer: 1,2,4,5 Changes in fat distribution may result in a round face and fat pads in the neck, back, and shoulders. There are increased levels of steroids and aldosterone, causing sodium and water retention in clients with Cushings. This increased fluid retention results in dependent peripheral edema. Skin changes result from increased blood vessel fragility and include bruises and thin or translucent skin. The extremities appear thinner from muscle wasting and weakness, not thicker from fatty deposition.
Which symptoms would the nurse include when teaching a client to recognize symptoms of hypoglycemia? Select all that apply. rapid heartbeat emotional changes abdominal cramping nausea and vomiting weakness and fatigue numbness of fingers, toes, or mouth
answer: 1,2,6 a rapid heartbeat, emotional changes, and numbness of the fingers, toes, or mouth are all signs of hypoglycemia. abdominal cramping, nausea and vomiting, and weakness and fatigue are indicative of hyperglycemia.
which client is at risk for developing T2DM? Select all that apply. 15 year old male who plays video games 6 hrs per day 36 yr old female with a history of gestational diabetes 47 yr old male who weighs 250 pounds and is 5'9 28 yr old female with polycystic ovarian syndrome (POS) 60 yr old male of Native American descent who abuses alcohol
answer: all a sedentary lifestyle can lead to obesity. obesity increases the risk for T2DM. clients with history of gestational diabetes and/or BMI great than 25 are at increased risk. clients with POS are at increased risk because the condition can affect insulin resistance. Clients of Native American ancestry are already at increased risk because of their ethnicity, and abusing alcohol further increases the risk.
