Endocrine.- Test II

What should the nurse include in dietary instructions provided to a patient who is diagnosed with hyperthyroidism?

Consume a high-calorie diet. Eat snacks high in protein. Avoid caffeinated beverages.

Which interventions does the nurse use when caring for a patient recovering from a transsphenoidal hypophysectomy?

Elevate the head of the bed 30 degrees Monitor for and report clear nasal drainage Monitor for and report increased urinary output

What is a nursing priority in the care of a patient with a diagnosis of hypothyroidism?

Patient teaching related to levothyroxine. A euthyroid state most often is achieved in patients with hypothyroidism by the administration of levothyroxine.

A patient's laboratory findings show a decrease in urine cortisol levels and a positive adrenocorticotropic hormone stimulation test. What does the nurse anticipate based on these findings?

Secondary adrenocortical insufficiency

A patient with hyperaldosteronism is prescribed eplerenone. What advice would the nurse give the patient regarding eplerenone?

"Avoid grapefruit juice."

Which hormone deficiency may lead to a life-threatening condition?

Adrenocorticotropic hormone (ACTH)

A patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) has a serum sodium level of 130mEq/L and complains of a severe backache. What are the most appropriate nursing interventions?

Assessing the patient's weight Positioning the head of the bed flat Restricting fluid intake to 900 mL/day. Positioning the head of the patient's bed flat enhances venous return to the heart and increases left atrial filling pressure, thereby reducing the release of antidiuretic hormone. When the patient's serum sodium levels are at or above 125 mEq/L, fluid intake should be restricted to 800 to 1000mL/day to prevent severe symptoms. Opioid drugs are contraindicated in patients with SIADH, because they stimulate the release antidiuretic hormone (ADH). Administration of intravenous hypertonic solution is not required when the symptoms are mild.

The nurse is caring for a patient who is postoperative following a thyroidectomy. A priority of the patient's nursing care includes which action?

Assessment of Chvostek's sign

The nurse expects that which drug will be prescribed for the treatment of a patient diagnosed with hyperthyroidism, asthma, and heart disease?

Atenolol, a β-Adrenergic blocker, is prescribed to control the stimulation of the sympathetic nervous system that often occurs with hyperthyroidism. Atenolol manages tachycardia, nervousness, irritability, and tremors. Methimazole is used to treat hyperthyroidism; however, it is not the drug of choice for patients with concurrent diagnoses of asthma and heart disease. Lugol's solution is an antithyroid drug that is used in treatment of thyrotoxicosis. Propylthiouracil, although appropriate for the treatment of hyperthyroidism,

Which syndrome would be suspected in a patient who has Addison's disease along with other endocrine conditions?

Autoimmune polyglandular syndrome

The nurse is caring for a patient with hyperthyroidism. What should the nurse teach the patient about dietary intake?

Avoid highly seasoned and high-fiber foods.

The nurse should monitor for increases in which laboratory value in a patient being treated with dexamethasone?

Blood glucose

A patient with hypertension undergoes testing on his or her serum electrolyte and plasma aldosterone levels. The laboratory findings showed plasma 18-hydroxycorticosterone levels as 60 ng/dL, potassium level as 2.5 mEq/L, and sodium level as 150 mEq/L. What could be the diagnosis?

Conn's syndrome. Conn's syndrome, or hyperaldosteronism, is characterized by increased aldosterone secretion, increased serum sodium levels, and decreased serum potassium levels. The normal level of 18-hydroxycorticosterone in blood is less than 50 ng/dL; 60 ng/dL indicates an increase in aldosterone secretion. The normal range of serum potassium is 3.5 to 5 mEq/L; a value of 2.5 mEq/L indicates hypokalemia. The normal range of serum sodium is 135 to 145 mEq/L; a value of 150 mEq/L indicates hypernatremia. Addison's disease is characterized by abnormal levels of adrenocorticotropic hormone, hyperkalemia, and hyponatremia. Cushing syndrome is characterized by abnormal adrenocorticotropic hormone levels, hyperglycemia, and eosinopenia. Pheochromocytoma is characterized by increased levels of catecholamines such as epinephrine and norepinephrine.

Which clinical manifestations does the nurse expect during the assessment of a hospitalized patient experiencing exophthalmos?

Exophthalmos is a classic finding in Graves' disease, which is caused by hyperthyroidism. Clinical manifestations anticipated by the nurse upon assessment include a bounding, rapid pulse; cardiac hypertrophy; and dyspnea. Clinical symptoms such as celiac disease and distended abdomen are associated with hypothyroidism.

The nurse is caring for a hospitalized patient with bronze-colored skin and signs of hyperpigmentation, especially in a sun-exposed area. The clinical findings are as follows. Which drug should be prescribed by the primary health care provider in this case?

Fludrocortisone. Tolvaptan is used to treat euvolemia hyponatremia. Octreotide and bromocriptine are prescribed for acromegaly.

A patient is prescribed levothyroxine. To promote optimal absorption, the nurse should instruct the patient to take the medication at which time?

For maximum absorption, levothyroxine should be taken first thing in the morning on an empty stomach 30 minutes before breakfast.

A patient has recently undergone transsphenoidal hypophysectomy and reports a severe supraorbital headache. The nurse maintains the patient's head in an elevated position and requests the patient stay on bed rest for four days. Which finding in the laboratory report is the reason for this nursing action?

Glucose level 40 mg/dL in the nasal drainage

A nurse completes an assessment and notes that a patient's thyroid gland is enlarged. With which condition is this finding consistent?

Goiter

The nurse is reviewing a patient's laboratory reports that show increased levels of plasma insulin-like growth factor 1. What does this finding indicate about growth hormone levels?

Growth hormone levels are elevated.

A patient is just returning to the surgical floor from the recovery room after undergoing a thyroidectomy. What is the nurse's priority nursing intervention?

Have a tracheostomy tray at the bedside.

A patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) after a head injury. What condition does the nurse suspect that correlates with this disorder?

Increased intravascular volume

Which is a sign of syndrome inappropriate antidiuretic hormone (SIADH)?

Increased intravascular volume

Which effect may be observed if large amounts of endogenous corticosteroids are released into systemic circulation during surgery on a patient with Cushing syndrome?

Infections

The nurse is educating family members regarding postsurgical complications for a patient who is undergoing hypophysectomy. Which complication should the nurse include in the teaching?

Infertility

The nurse is caring for a patient who underwent transsphenoidal hypophysectomy to treat acromegaly. Which is the best nursing action to prevent leakage of cerebrospinal fluid?

Instructing the patient to avoid vigorous coughing, sneezing, and straining at stool

A patient with hypertension reports a severe pounding headache and profuse sweating. Upon assessment, the patient is found to have tachycardia. What drug should be prescribed by the primary health care provider?

Metyrosine

Which nursing intervention is most important for a patient with diabetes insipidus?

Monitoring fluid intake and output. Polyuria and polydipsia are the major clinical manifestations of diabetes insipidus. Therefore, strict monitoring of fluid intake and output is a priority nursing intervention.

A patient with pituitary adenoma underwent transsphenoidal hypophysectomy. What nursing actions are most effective for prevention of complications?

Monitoring the pupillary response Elevating the head of the patient's bed Observing the patient for any signs of bleeding Monitoring extremity strength to detect neurologic complications

The nurse is preparing to administer levothyroxine to a patient newly diagnosed with hypothyroidism. The patient's resting heart rate is 110. Which initial action should the nurse take?

Obtain a blood pressure measurement.When thyroid hormone therapy is initiated, patients must be monitored carefully for increased pulse and blood pressure, because increased pulse and blood pressure may lead to angina and cardiac dysrhythmias.

What are the characteristic signs and symptoms of hyperparathyroidism?

Osteoporosis Nephrolithiasis Fractures

What treatment is given to a patient with pheochromocytoma to control high blood pressure during preoperative care?

Phenoxybenzamine

The nurse is caring for a patient who is diagnosed with the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention would promote a reduction in the release of antidiuretic hormone (ADH)?

Positioning the head of the bed flat

A young adult female patient with normal body weight has excessive hair growth on her face. Other symptoms include bitemporal hemianopsia, infrequent menstruation, and infertility. What type of endocrine disorder is suspected in the patient?

Prolactinomas

A patient reports to the nurse having visual problems, and is found to have a compressed optic chiasm. Which condition could be the reason for this complication?

Prolactinomas are among the most common type of pituitary adenomas; compression of the chiasm nerve is a complication of this condition and can cause visual problems with signs of increased intracranial pressure, including headache, nausea, and vomiting.

The nurse is teaching the patient with adrenocortical insufficiency and the caregiver about management of corticosteroid therapy. What should the nurse tell the patient and the caregiver?

Recognize edema and ways to restrict sodium intake.

The nurse recalls that excessive secretion of the hormone vasopressin characterizes:

Syndrome of inappropriate antidiuretic hormone secretion is characterized by excessive release of ADH from the posterior pituitary gland, resulting in the inability of the kidneys to dilute urine.

The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instructions regarding desmopressin acetate would be most appropriate?

The patient should alternate nostrils during administration to prevent nasal irritation.Desmopressin acetate is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking.

The nurse creates a plan of care for a patient with Graves' disease. What is an appropriate expected outcome?

The patient will demonstrate maintenance of his weight.

A nurse is caring for a patient admitted for hyperthyroidism. What laboratory results will the nurse expect to see in the electronic chart to confirm hyperthyroidism?

The primary laboratory findings to confirm the diagnosis of hyperthyroidism are low or undetectable TSH levels and elevated free thyroxine levels.

Which medication does the nurse expect to be prescribed for a patient diagnosed with metastatic thyroid cancer that has a calcitonin level of 25 pg/mL?

Vandetanib is a drug that is used to treat metastatic thyroid cancer. Cisplatin is used to treat solid malignancies such as lung cancer, ovarian cancer, and bladder cancer. Doxorubicin and cyclophosphamide are used to treat follicular thyroid cancer and also are used after excision of tumors.

While assessing a patient with suspected Cushing's syndrome, of what most prominent clinical manifestation is the nurse aware?

Weight gain, including truncal obesity

Which condition can result if hypersecretion of growth hormone (GH) occurs after epiphyseal plate closure?

Dwarfism Correct. Acromegaly Gigantism Cretinism

What treatment would be provided to a patient with bilateral adrenal hyperplasia to block aldosterone synthesis?

Aminoglutethimide

The nurse is caring for patients with thyroid cancer. The nurse recognizes that the one with the poorest prognosis is the patient with which type of cancer?

Anaplastic thyroid cancer

The nurse teaches a patient about diagnostic tests for ascertaining the presence of Cushing syndrome. Which advice would the nurse tell the patient to do to confirm the diagnosis?

"Collect a 24-hour urine sample for testing free cortisol and 17-ketosteroids." "Undergo computed tomography (CT) scan or magnetic resonance imaging (MRI)." "Check plasma adrenocorticotropic hormone (ACTH) levels."

The nurse is teaching a patient with Addison's disease about corticosteroid therapy. The nurse should prioritize which of these teaching points?

"Do not stop taking the medication abruptly." Patients taking corticosteroids should not consume a high-carbohydrate diet, because corticosteroids increase blood sugar. Patients should also increase their daily intake of calcium to prevent bone loss due to the side effects of corticosteroids. Patients should also decrease, not increase, their daily intake of sodium to avoid fluid retention.

A patient being treated conservatively for hyperparathyroidism is being given discharge instructions. What statement made by the patient informs the nurse that the discharge instructions have been understood?

"I should exercise regularly." Hyperparathyroidism is a condition of increased parathyroid hormone (PTH) secretion. PTH regulates serum calcium levels by stimulating bone resorption. When PTH levels are elevated, calcium resorption is accelerated. This loss of calcium from the bones causes hypercalcemia and puts the bones at risk for pathologic fractures. Patients with hyperparathyroidism can decrease bone loss through regular weight-bearing exercises. While high impact exercises put the patient at risk for pathologic fracture, walking is an important means of decreasing the rate of bone resorption. Hypercalcemia leads to constipation. The patient with hyperparathyroidism benefits from a high-fiber diet. Hypercalcemia predisposes the patient to renal stones; adequate fluid intake decreases the risk of renal stones. Tingling in the hands and around the mouth is associated with tetany, a condition resulting from a sudden drop in serum calcium.

The nurse determines that the patient who is receiving radioactive iodine therapy for the treatment of hyperthyroidism needs additional instructions when the patient makes which statement?

"I will need to take antithyroid drugs for three months after I begin RAI therapy." The maximum effect of RAI therapy may not occur for three months, and therefore the patient usually continues to be treated with antithyroid drugs for three months after the initiation of radioactive iodine therapy.

Which patient statement indicates the need for further education regarding the management of both cardiac disease and hypothyroidism?

"I will use an enema for constipation." Enemas cause vagal stimulation that can lead to fainting. The patient is taught to use laxatives, stool softeners, and to consume a fiber-rich diet to treat constipation, rather than using enemas.

Which statement by the patient who is postoperative following a transphenoidal hypophysectomy indicates a need for further education?

"It is important that I brush my teeth every day."

A patient diagnosed with acromegaly has developed peripheral neuropathy and asks what is causing the discomfort. What is the nurse's best response?

"You have developed the condition due to overgrowth of muscles and tissues."

The patient with small cell lung cancer experiences a sudden 5-pound weight gain without edema and a decreased urinary output. Serum sodium is 128 mEq/L. Which strategy does the nurse anticipate will be prescribed for the patient?

1000 mL per day fluid restriction. Small cell lung cancer is one of the most common causes of SIADH. In the patient with SIADH, there is an excess of antidiuretic hormone (ADH); this causes excess water reabsorption by the kidneys, with a resulting increase in vascular volume. The decreased excretion of water by the kidneys and resulting increase in intravascular volume leads to weight gain without edema, decreased urinary output with an increase in urine-specific gravity, decreased plasma osmolarity, and dilutional hyponatremia.

What level of urine cortisol indicates Cushing syndrome?

130 mcg/24 hr

A patient with a severe pounding headache has been diagnosed with hypertension that is not responding to traditional treatment. What should the nurse expect as the next step in management of this patient?

A 24-hour urine collection for fractionated metanephrines. In a patient with pheochromocytoma preoperatively an α-adrenergic receptor blocker is used to reduce blood pressure. Abdominal palpation is avoided to avoid a sudden release of catecholamines and severe hypertension. Potassium-sparing diuretics are not needed; most likely they would be used for hyperaldosteronism, which is another cause of hypertension.

A patient with adrenocortical insufficiency develops Addisonian crisis. What should be the immediate nursing action?

Administer large volumes of saline and dextrose.

What may be the cause of iatrogenic Addison's disease?

Adrenal hemorrhage

A nurse creating a plan of care for a patient with Addison's disease expects that primary treatment will include:

Adrenocorticosteroid replacement therapy

Adrenocortical insufficiency develops secondary to inadequate secretion of which pituitary hormone?

Adrenocorticotropic hormone (ACTH)

A nurse is caring for a patient who underwent subtotal thyroidectomy because of the overproduction and release of thyroid hormone. Postoperative nursing interventions are important to prevent complications after surgery. Which nursing interventions should the nurse implement for safe, effective care?

Assess for signs of tetany secondary to hypoparathyroidism. Assess the patient every two hours for signs of bleeding or tracheal compression. Control postoperative pain by administering medication.

Which nursing intervention is a priority for a patient recovering from removal of a pituitary gland tumor?

Assessing for signs of increased intracranial pressure (ICP)

Which nursing interventions are appropriate when providing care to a patient that is recovering from a thyroidectomy?

Assessing for tetany Monitoring vital signs Assessing the patient every two hours on the first postoperative day

A nurse caring for a patient with hyperparathyroidism should monitor the patient for which complication?

Cardiac dysrhythmias may result because of the increased serum calcium level in hyperparathyroidism.

The nurse provides a patient with a list of foods that fall under the category of goitrogens. What food item should be included on the list?

Cauliflower

The nurse reviews lab values for a patient who underwent thyroidectomy 48 hours ago. Which finding is of most concern?

Decreased serum calcium

What is the clinical manifestation of Addison's disease?

Delusions

What complications may arise if pheochromocytoma is left untreated?

Diabetes mellitus

A patient diagnosed with hyperthyroidism presents with neck nodules that are less than 3 cm in size. Biopsy reveals the nodules are non-malignant. Which treatment does the nurse expect for this patient?

Endoscopic thyroidectomy - surgical procedure performed on a patient's neck nodules that are less than 3 cm in size and non-malignant. Iodine is used with other antithyroid drugs in preparation for a thyroidectomy. Iodine therapy/radioactive iodine therapy treats hyperthyroidism by gradually shrinking the thyroid. Radioactive iodine therapy has a delayed effect on the thyroid gland, and it limits the thyroid hormone secretion by damaging thyroid tissue.

The nurse, providing care to a patient with Cushing's syndrome, understands that the disorder is primarily related to:

Excessive secretion of adrenocorticosteroid hormones

The nurse is caring for a patient diagnosed with a toxic nodular goiter with painless thyroiditis. The nurse suspects that the patient has an autoimmune disease based on what assessment finding?

Exophthalmos Exophthalmos is a clinical manifestation associated with Graves' disease. Enophthalmos is a clinical manifestation associated with Horner's syndrome. A rounded rosy face is associated with Cushing syndrome. Hypopigmentation is seen in vitiligo.

Which condition shows a clinical presentation of purplish red striae?

Hyperfunction of glucocorticoids - Purplish red striae are seen in Cushing syndrome, which occurs due to excess corticosteroids, particularly glucocorticoids. In Addison's disease, all three classes of adrenal corticosteroids (glucocorticoids, mineralocorticoids, and androgens) are reduced. A striking integumentary sign of Addison's disease is bronze-colored skin hyperpigmentation, not purplish red striae.

Which finding is consistent with a diagnosis of hyperaldosteronism?

Hypernatremia

A nurse is caring for a patient who has Addison's disease. The nurse should assess the patient for which symptoms? .

Hyperpigmentation Weakness and fatigue Orthostatic hypotension

Which nursing diagnostic statement is the highest priority for a patient with myxedema?

Hypothermia

The patient is brought to the emergency department following a car accident and is wearing medical identification that says the patient has Addison's disease. What should the nurse expect to be included in the collaborative care of this patient?

Increased glucocorticoid replacement. The patient with Addison's disease needs lifelong glucocorticoid and mineralocorticoid replacement and has an increased need with illness, injury, or stress, as this patient is experiencing. The patient with Addison's also may need a high-sodium diet. Suppression of pituitary ACTH synthesis is done for Cushing's syndrome. Elimination of mineralocorticoid replacement cannot be done for Addison's disease.

The nurse is caring for a patient admitted with suspected hyperparathyroidism. Because of the potential effects of this disease on electrolyte balance, the nurse should assess this patient for what manifestation?

Lethargy and weakness. Hyperparathyroidism can cause hypercalcemia. Signs of hypercalcemia include muscle weakness, polyuria, constipation, nausea and vomiting, lethargy, and memory impairment.

A patient is scheduled for a total thyroidectomy. What information does the nurse include when teaching this patient about recovery after the procedure?

Life-long hormone replacement will be needed.

A patient is scheduled for a bilateral adrenalectomy. What does the nurse include in the discharge teaching for this patient?

Lifelong replacement of corticosteroids will be required.

The patient with systemic lupus erythematosus has been diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What should the nurse expect to include in this patient's plan of care?

Limit fluids to 1000 mL per day Keep the head of the bed at 10 degrees or less elevation

A patient with adrenocortical insufficiency is prescribed hydrocortisone. Which drugs should be avoided in the patient's prescription?

Oral hypoglycemics, anticoagulants, and nonsteroidal antiinflammatory drugs (NSAIDs)

The nurse is educating patients about having a screening colonoscopy every three to four years, because they are at risk for developing colon polyps and colorectal cancer. What patient is at greatest risk for this complication?

Patients with acromegaly are at higher risk for colon polyps and colorectal cancer, and should have a screening colonoscopy performed every three to four years. Prolactinomas are the most common type of pituitary adenomas; these types of adenomas do not require colonoscopy.

A patient diagnosed with acromegaly is to receive medication to block the hepatic production of insulin-like growth factor-1. What medication will the nurse prepare to administer to the patient?

Pegvisomant - growth hormone antagonist, which reduces the effect of growth hormone in the body by blocking the hepatic production of insulin-like growth factor-1. Lanreotide is a long-acting somatostatin analog, which is administered intramuscularly every four weeks in the treatment of acromegaly. Cabergoline may be administered alone or along with somatostatin analogs; it acts by reducing the secretions of growth hormone from the tumor. Bromocriptine is a dopamine antagonist that helps reduce the secretion of growth hormone from the tumor.

The nurse is administering intravenous glucose solution to a patient who is suffering from diabetes insipidus. What parameters would the nurse monitor for the management of osmotic diuresis?

Serum glucose levels. If intravenous glucose solutions are administered, the serum glucose levels of the patient should be monitored, because hyperglycemia and glycosuria can occur, which can lead to osmotic dieresis and an increase in fluid volume deficit.

A patient is diagnosed with adrenocortical insufficiency. What would the nurse anticipate the patient's laboratory findings to look like?

Serum potassium: 6.5 mEq/L Blood glucose levels: 80 mg/dL Electrocardiogram (ECG): Peaked T waves

A female patient who is on drug therapy for hyperaldosteronism develops menstrual disorders. Which prescribed drug may be the cause of this condition?

Spironolactone

The nurse anticipates that which interventions will be prescribed for a patient that is admitted to the intensive care unit (ICU) with myxedema coma?

Strict input and output Low-pressure mattress Continuous cardiac monitoring

Which parameter would indicate the optimal intended effect of therapy with levothyroxine?

Thyroid-stimulating hormone (TSH) of 1.5 mIU/L

What is the rationale for checking Trousseau's sign in a patient following a subtotal thyroidectomy?

To assess for parathyroid gland injury

The patient experiencing thyrotoxicosis asks the nurse why he or she is being given propranolol. What is the most accurate answer to the patient's question?

To block the sympathetic nervous system response to excess thyroid hormone

A patient with aldosteronism who has undergone unilateral adrenalectomy is advised to monitor blood pressure (BP) frequently. What is the most appropriate reason behind monitoring BP?

To continue health supervision To assess the success of surgery To check for hypotension after surgery Correct. To check whether the blood pressure is controlled or not after surgery

What does the nurse include in the teaching plan for the client who is receiving radioactive iodine?

Towels that are used by the patient should not be used by other family members.

Which test is more reliable to diagnose pheochromocytoma?

Urinary creatinine

A patient who is diagnosed with hypothyroidism and coronary artery disease (CAD) states to the nurse, "I am constipated. My spouse wants me to try an enema to help relieve my discomfort." The nurse educates the patient that using enemas is contraindicated due to the diagnosis. Which is the rationale for this contraindication?

Vagus nerve stimulation

The nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) who has muscle twitching, vomiting, severe abdominal cramps, and begins to have seizures. The nurse assesses a serum sodium level of 116 mEq/L. What is the priority nursing action for this patient?

administer hypertonic saline solution slowly.

A 35-year-woman who has undergone hypophysectomy develops deficiency of follicle-stimulating hormone and luteinizing hormone. What consequence of this complication should the nurse monitor in the patient?

decreased fertility rate

A patient with endogenous Cushing syndrome shows a persistent rise in blood glucose levels. What drug would be administered to control glucose levels?

mifepristone is used to control hyperglycemia. Prednisone and hydrocortisone are used to suppress the symptoms of Cushing syndrome. Aminoglutethimide is used to treat pituitary adenoma by suppressing the synthesis and secretion of cortisol from the adrenal gland.