MED SURG ENDO EXAM

1. After a hypophysectomy for acromegaly, postoperative nursing care should focus on a. frequent monitoring of serum and urine osmolarity. b. parenteral administration of a GH-receptor antagonist. c. keeping the patient in a recumbent position at all times. d. patient teaching regarding the need for lifelong hormone therapy.

1. Correct answer: a Rationale: A possible postoperative complication after a hypophysectomy is transient diabetes insipidus (DI). It may occur because of the loss of antidiuretic hormone (ADH), which is stored in the posterior lobe of the pituitary gland, or because of cerebral edema related to manipulation of the pituitary gland during surgery. To assess for DI, urine output and serum and urine osmolarity should be monitored closely.

1. A patient suspected of having acromegaly has an elevated plasma growth hormone (GH) level. In acromegaly, what would the nurse also expect the patient's diagnostic results to indicate? a. Hyperinsulinemia b. Plasma glucose of <70 mg/dL (3.9 mmol/L) c. Decreased GH levels with an oral glucose challenge test d. Elevated levels of plasma insulin-like growth factor-1 (IGF-1)

1. d. A normal response to growth hormone (GH) secretion is stimulation of the liver to produce somatomedin C, or insulin-like growth factor-1 (IGF-1), which stimulates growth of bones and soft tissues. The increased levels of somatomedin C normally inhibit GH but in acromegaly the pituitary gland secretes GH despite elevated IGF-1 levels. When both GH and IGF-1 levels are increased, overproduction of GH is confirmed. GH also causes elevation of blood glucose and normally GH levels fall during an oral glucose challenge but not in acromegaly.

10. In a patient with central diabetes insipidus, what will the administration of ADH during a water deprivation test result in? a. Decrease in body weight c. Decrease in blood pressure b. Increase in urinary output d. Increase in urine osmolality

10. d. A patient with central diabetes insipidus has a deficiency of ADH with excessive loss of water from the kidney, hypovolemia, hypernatremia, and dilute urine with a low specific gravity. When vasopressin is administered, the symptoms are reversed, with water retention, decreased urinary output that increases urine osmolality, and an increase in BP.

11. A patient with diabetes insipidus is treated with nasal desmopressin acetate (DDAVP). The nurse determines that the drug is not having an adequate therapeutic effect when the patient experiences a. headache and weight gain. c. a urine specific gravity of 1.002. b. nasal irritation and nausea. d. an oral intake greater than urinary output.

11. c. Normal urine specific gravity is 1.005 to 1.025 and urine with a specific gravity of 1.002 is very dilute, indicating that there continues to be excessive loss of water and that treatment of diabetes insipidus is inadequate. Headache, weight gain, and oral intake greater than urinary output are signs of volume excess that occur with overmedication. Nasal irritation and nausea may also indicate overdosage.

12. When caring for a patient with nephrogenic diabetes insipidus, what should the nurse expect the treatment to include? a. Fluid restriction b. Thiazide diuretics c. A high-sodium diet d. Chlorpropamide (Diabinese)

12. b. In nephrogenic diabetes insipidus, the kidney is unable to respond to ADH, so vasopressin or hormone analogs are not effective. Thiazide diuretics slow the glomerular filtration rate (GFR) in the kidney and produce a decrease in urine output. Low-sodium diets (<3 g/day) are also thought to decrease urine output. Fluids are not restricted because the patient could easily become dehydrated.

13. What characteristic is related to Hashimoto's thyroiditis? a. Enlarged thyroid gland b. Viral-induced hyperthyroidism c. Bacterial or fungal infection of thyroid gland d. Chronic autoimmune thyroiditis with antibody destruction of thyroid tissue

13. d. In Hashimoto's thyroiditis, thyroid tissue is destroyed by autoimmune antibodies. An enlarged thyroid gland is a goiter. Viral-induced hyperthyroidism is subacute granulomatous thyroiditis. Acute thyroiditis is caused by bacterial or fungal infection.

14. Which statement accurately describes Graves' disease? a. Exophthalmos occurs in Graves' disease. b. It is an uncommon form of hyperthyroidism. c. Manifestations of hyperthyroidism occur from tissue desensitization to the sympathetic nervous system. d. Diagnostic testing in the patient with Graves' disease will reveal an increased thyroid-stimulating hormone (TSH) level.

14. a. Exophthalmos or protrusion of the eyeballs may occur in Graves' disease from increased fat deposits and fluid in the orbital tissues and ocular muscles, forcing the eyeballs outward. Graves' disease is the most common form of hyperthyroidism. Increased metabolic rate and sensitivity of the sympathetic nervous system lead to the clinical manifestations. Thyroid-stimulating hormone (TSH) level is decreased in Graves' disease.

15. A patient with Graves' disease asks the nurse what caused the disorder. What is the best response by the nurse? a. "The cause of Graves' disease is not known, although it is thought to be genetic." b. "It is usually associated with goiter formation from an iodine deficiency over a long period of time." c. "Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones." d. "In genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion.

15. d. In Graves' disease, antibodies to the TSH receptor are formed, attach to the receptors, and stimulate the thyroid gland to release triiodothyronine (T3), thyroxine (T4), or both, creating hyperthyroidism. The disease is not directly genetic but individuals appear to have a genetic susceptibility to develop autoimmune antibodies. Goiter formation from insufficient iodine intake is usually associated with hypothyroidism.

16. A patient is admitted to the hospital with thyrotoxicosis. On physical assessment of the patient, what should the nurse expect to find? a. Hoarseness and laryngeal stridor b. Bulging eyeballs and dysrhythmias c. Elevated temperature and signs of heart failure d. Lethargy progressing suddenly to impairment of consciousness

16. c. A hyperthyroid crisis results in marked manifestations of hyperthyroidism, with severe tachycardia, heart failure, shock, hyperthermia, restlessness, irritability, abdominal pain, vomiting, diarrhea, delirium, and coma. Although exophthalmos may be present in the patient with Graves' disease, it is not a significant factor in hyperthyroid crisis. Hoarseness and laryngeal stridor are characteristic of the tetany of hypoparathyroidism and lethargy progressing to coma is characteristic of myxedema coma, a complication of hypothyroidism.

17. What medication is used with thyrotoxicosis to block the effects of the sympathetic nervous stimulation of the thyroid hormones? a. Potassium iodide c. Propylthiouracil (PTU) b. Atenolol (Tenormin) d. Radioactive iodine (RAI)

17. b. The β-adrenergic blocker atenolol is used to block the sympathetic nervous system stimulation by thyroid hormones. Potassium iodide is used to prepare the patient for thyroidectomy or for treatment of thyrotoxic crisis to inhibit the synthesis of thyroid hormones. Antithyroid medications inhibit the synthesis of thyroid hormones. Radioactive iodine (RAI) therapy destroys thyroid tissue, which limits thyroid hormone secretion.

18. Which characteristics describe the use of RAI (select all that apply)? a. Often causes hypothyroidism over time b. Decreases release of thyroid hormones c. Blocks peripheral conversion of T4 to T3 d. Treatment of choice in nonpregnant adults e. Decreases thyroid secretion by damaging thyroid gland f. Often used with iodine to produce euthyroid before surgery

18. a, d, e. RAI causes hypothyroidism over time by damaging thyroid tissue and is the treatment of choice for nonpregnant adults. Potassium iodide decreases the release of thyroid hormones and decreases the size of the thyroid gland preoperatively. Propylthiouracil (PTU) blocks peripheral conversion of T4 to T3 and may be used with iodine to produce a euthyroid state before surgery.

19. What preoperative instruction should the nurse give to the patient scheduled for a subtotal thyroidectomy? a. How to support the head with the hands when turning in bed b. Coughing should be avoided to prevent pressure on the incision c. Head and neck will need to remain immobile until the incision heals d. Any tingling around the lips or in the fingers after surgery is expected and temporary

19. a. To prevent strain on the suture line postoperatively, the patient's head must be manually supported while turning and moving in bed but range-of-motion exercises for the head and neck are also taught preoperatively to be gradually implemented after surgery. There is no contraindication for coughing and deep breathing and these should be carried out postoperatively. Tingling around the lips or fingers is a sign of hypocalcemia, which may occur if the parathyroid glands are inadvertently removed during surgery. This sign should be reported immediately.

2. A patient with a head injury develops SIADH. Manifestations the nurse would expect to nd include a. hypernatremia and edema. b. muscle spasticity and hypertension. c. low urine output and hyponatremia. d. weight gain and decreased glomerular ltration rate.

2. Correct answer: c Rationale: Excess ADH increases the permeability of the renal distal tubule and collecting ducts, which leads to the reabsorption of water into the circulation. Consequently, extracellular fluid volume expands, plasma osmolality declines, the glomerular filtration rate increases, and sodium levels decline (i.e., dilutional hyponatremia). Hyponatremia causes muscle cramping, pain, and weakness. Initially, the patient displays thirst, dyspnea on exertion, and fatigue. Patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) experience low urinary output and increased body weight. As the serum sodium level falls (usually to less than 120 mEq/L), manifestations become more severe and include vomiting, abdominal cramps, muscle twitching, and seizures. As plasma osmolality and serum sodium levels continue to decline, cerebral edema may occur, leading to lethargy, anorexia, confusion, headache, seizures, and coma.

2. During assessment of the patient with acromegaly, what should the nurse expect the patient to report? a. Infertility c. Undesirable changes in appearance b. Dry, irritated skin d. An increase in height of 2 to 3 inches a year

2. c. The increased production of GH in acromegaly causes an increase in thickness and width of bones and enlargement of soft tissues, resulting in marked changes in facial features, oily and coarse skin, and speech difficulties. Infertility is not a common finding because GH is usually the only pituitary hormone involved in acromegaly. Height is not increased in adults with GH excess because the epiphyses of the bones are closed.

20. As a precaution for vocal cord paralysis from damage to the recurrent laryngeal nerve during thyroidectomy surgery, what equipment should be in the room in case it is needed for this emergency situation? a. Tracheostomy tray c. IV calcium gluconate b. Oxygen equipment d. Paper and pencil for communication

20. a. A tracheostomy tray is in the room to use if vocal cord paralysis occurs from recurrent laryngeal nerve damage or for laryngeal stridor from tetany. The oxygen equipment may be useful but will not improve oxygenation with vocal cord paralysis without a tracheostomy. IV calcium salts will be used if hypocalcemia occurs from parathyroid damage. The paper and pencil for communication may be helpful, especially if a tracheostomy is performed, but will not aid in emergency oxygenation of the patient.

21. When providing discharge instructions to a patient who had a subtotal thyroidectomy for hyperthyroidism, what should the nurse teach the patient? a. Never miss a daily dose of thyroid replacement therapy. b. Avoid regular exercise until thyroid function is normalized. c. Use warm saltwater gargles several times a day to relieve throat pain. d. Substantially reduce caloric intake compared to what was eaten before surgery.

21. d. With the decrease in thyroid hormone postoperatively, calories need to be reduced substantially to prevent weight gain. When a patient has had a subtotal thyroidectomy, thyroid replacement therapy is not given because exogenous hormone inhibits pituitary production of TSH and delays or prevents the restoration of thyroid tissue regeneration. Regular exercise stimulates the thyroid gland and is encouraged. Saltwater gargles are used for dryness and irritation of the mouth and throat following radioactive iodine therapy.

22. What is a cause of primary hypothyroidism in adults? a. Malignant or benign thyroid nodules b. Surgical removal or failure of the pituitary gland c. Surgical removal or radiation of the thyroid gland d. Autoimmune-induced atrophy of the thyroid gland

22. d. Both Graves' disease and Hashimoto's thyroiditis are autoimmune disorders that eventually destroy the thyroid gland, leading to primary hypothyroidism. Thyroid tumors most often result in hyperthyroidism. Secondary hypothyroidism occurs as a result of pituitary failure and iatrogenic hypothyroidism results from thyroidectomy or radiation of the thyroid gland.

23. The nurse has identified the nursing diagnosis of fatigue for a patient who is hypothyroid. What should the nurse do while caring for this patient? a. Monitor for changes in orientation, cognition, and behavior. b. Monitor for vital signs and cardiac rhythm response to activity. c. Monitor bowel movement frequency, consistency, shape, volume, and color. d. Assist in developing well-balanced meal plans consistent with level of energy expenditure.

23. b. Cardiorespiratory response to activity is important to monitor in this patient to determine the effect of activities and plan activity increases. Monitoring changes in orientation, cognition, and behavior are interventions for impaired memory. Monitoring bowels is needed to plan care for the patient with constipation. Assisting with meal planning will help the patient with imbalanced nutrition: more than body requirements to lose weight if needed.

24. Priority Decision: When replacement therapy is started for a patient with long-standing hypothyroidism, what is most important for the nurse to monitor the patient for? a. Insomnia c. Nervousness b. Weight loss d. Dysrhythmi

24. d. All these manifestations may occur with treatment of hypothyroidism. However, as a result of the effects of hypothyroidism on the cardiovascular system, when thyroid replacement therapy is started myocardial oxygen consumption is increased and the resultant oxygen demand may cause angina, cardiac dysrhythmias, and heart failure, so monitoring for dysrhythmias is most important.

25. A patient with hypothyroidism is treated with levothyroxine (Synthroid). What should the nurse include when teaching the patient about this therapy? a. Explain that alternate-day dosage may be used if side effects occur. b. Provide written instruction for all information related to the drug therapy. c. Assure the patient that a return to normal function will occur with replacement therapy. d. Inform the patient that the drug must be taken until the hormone balance is reestablished.

25. b. Because of the mental sluggishness, inattentiveness, and memory loss that occur with hypothyroidism, it is important to provide written instructions and repeat information when teaching the patient. Replacement therapy must be taken for life and alternate-day dosing is not therapeutic. Although most patients return to a normal state with treatment, cardiovascular conditions and psychoses may persist.

26. A patient who recently had a calcium oxalate renal stone had a bone density study, which showed a decrease in her bone density. What endocrine problem could this patient have? a. SIADH c. Cushing syndrome b. Hypothyroidism d. Hyperparathyroidis

26. d. The patient with hyperparathyroidism may have calcium nephrolithiasis, skeletal pain, decreased bone density, psychomotor retardation, or cardiac dysrhythmias. The other endocrine problems would not be related to calcium kidney stones or decreased bone density.

27. What is an appropriate nursing intervention for the patient with hyperparathyroidism? a. Pad side rails as a seizure precaution. b. Increase fluid intake to 3000 to 4000 mL daily. c. Maintain bed rest to prevent pathologic fractures. d. Monitor the patient for Trousseau's and Chvostek's signs.

27. b. A high fluid intake is indicated in hyperparathyroidism to dilute the hypercalcemia and flush the kidneys so that calcium stone formation is reduced. Seizures are not associated with hyperparathyroidism. Impending tetany of hypoparathyroidism after parathyroidectomy can be noted with Trousseau's and Chvostek's signs. The patient with hyperparathyroidism is at risk for pathologic fractures resulting from decreased bone density but mobility is encouraged to promote bone calcification.

28. A patient has been diagnosed with hypoparathyroidism. What manifestations should the nurse expect to observe (select all that apply)? a. Skeletal pain b. Dry, scaly skin c. Personality chang d. Abdominal cramping e. Cardiac dysrhythmias f. Muscle spasms and stiffnes

28. b, c, d, e, f. In hypoparathyroidism the patient has inadequate circulating parathyroid hormone (PTH) that leads to hypocalcemia from the inability to maintain serum calcium levels. With hypocalcemia there is muscle stiffness and spasms, which can lead to cardiac dysrhythmias and abdominal cramps. There can also be personality and visual changes and dry, scaly skin.

29. When the patient with parathyroid disease experiences symptoms of hypocalcemia, what is a measure that can be used to temporarily raise serum calcium levels? a. Administer IV normal saline. c. Administer furosemide (Lasix) as ordered. b. Have patient rebreathe in a paper bag. d. Administer oral phosphorus supplements.

29. b. Rebreathing in a paper bag promotes carbon dioxide retention in the blood, which lowers pH and creates an acidosis. An acidemia enhances the solubility and ionization of calcium, increasing the proportion of total body calcium available in physiologically active form and relieving the symptoms of hypocalcemia. Saline promotes calcium excretion, as does furosemide. Phosphate levels in the blood are reciprocal to calcium and an increase in phosphate promotes calcium excretion.

3. The health care provider prescribes levothyroxine (Synthroid) for a patient with hypothyroidism. A er teaching regarding this drug, the nurse determines that further instruction is needed when the patient says a. "I can expect the medication dose may need to be adjusted." b. "I only need to take this drug until my symptoms are improved." c. "I can expect to return to normal function with the use of this drug." d. "I will report any chest pain or di culty breathing to the doctor right away."

3. Correct answer: b Rationale: Levothyroxine (Synthroid) is the drug of choice to treat hypothyroidism. The need for thyroid replacement therapy is usually lifelong.

3. A patient with acromegaly is treated with a transsphenoidal hypophysectomy. What should the nurse do postoperatively? a. Ensure that any clear nasal drainage is tested for glucose. b. Maintain the patient flat in bed to prevent cerebrospinal fluid (CSF) leakage. c. Assist the patient with toothbrushing every 4 hours to keep the surgical area clean. d. Encourage deep breathing, coughing, and turning to prevent respiratory complications.

3. a. A transsphenoidal hypophysectomy involves entry into the sella turcica through an incision in the upper lip and gingiva into the floor of the nose and the sphenoid sinuses. Postoperative clear nasal drainage with glucose content indicates cerebrospinal fluid (CSF) leakage from an open connection to the brain, putting the patient at risk for meningitis. After surgery, the patient is positioned with the head elevated to avoid pressure on the sella turcica. Coughing and straining are avoided to prevent increased intracranial pressure and CSF leakage. Although mouth care is required every 4 hours, toothbrushing should not be performed because injury to the suture line may occur.

30. A patient with hypoparathyroidism resulting from surgical treatment of hyperparathyroidism is preparing for discharge. What should the nurse teach the patient? a. Milk and milk products should be increased in the diet. b. Parenteral replacement of parathyroid hormone will be required for life. c. Calcium supplements with vitamin D can effectively maintain calcium balance. d. Bran and whole-grain foods should be used to prevent GI effects of replacement therapy.

30. c. The hypocalcemia that results from PTH deficiency is controlled with calcium and vitamin D supplementation and possibly oral phosphate binders. Replacement with PTH is not used because of antibody formation to PTH, the need for parenteral administration, and cost. Milk products, although good sources of calcium, also have high levels of phosphate, which reduce calcium absorption. Whole grains and foods containing oxalic acid also impair calcium absorption.

31. A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, what should the nurse expect to find? a. Hypertension, peripheral edema, and petechiae b. Weight loss, buffalo hump, and moon face with acne c. Abdominal and buttock striae, truncal obesity, and hypotension d. Anorexia, signs of dehydration, and hyperpigmentation of the skin

31. a. The effects of adrenocortical hormone excess, especially glucocorticoid excess, include weight gain from accumulation and redistribution of adipose tissue, sodium and water retention, glucose intolerance, protein wasting, loss of bone structure, loss of collagen, and capillary fragility leading to petechiae. Clinical manifestations of adrenocortical hormone deficiency include hypotension, dehydration, weight loss, and hyperpigmentation of the skin.

32. A patient is scheduled for a bilateral adrenalectomy. During the postoperative period, what should the nurse expect related to the administration of corticosteroids? a. Reduced to promote wound healing b. Withheld until symptoms of hypocortisolism appear c. Increased to promote an adequate response to the stress of surgery d. Reduced because excessive hormones are released during surgical manipulation of adrenal glands

32. c. Although the patient with Cushing syndrome has excess corticosteroids, removal of the glands and the stress of surgery require that high doses of corticosteroids (cortisone) be administered postoperatively for several days before weaning the dose. The nurse should monitor the patient's vital signs postoperatively to detect whether large amounts of hormones were released during surgical manipulation, obtain morning urine specimens for cortisol measurement to evaluate the effectiveness of the surgery, and provide dressing changes with aseptic technique to avoid infection as usual inflammatory responses are suppressed.

33. A patient with Addison's disease comes to the emergency department with complaints of nausea, vomiting, diarrhea, and fever. What collaborative care should the nurse expect? a. IV administration of vasopressors b. IV administration of hydrocortisone c. IV administration of D5W with 20 mEq KCl d. Parenteral injections of adrenocorticotropic hormone (ACT

33. b. Vomiting and diarrhea are early indicators of Addisonian crisis and fever indicates an infection, which is causing additional stress for the patient. Treatment of a crisis requires immediate glucocorticoid replacement and IV hydrocortisone, fluids, sodium, and glucose are necessary for 24 hours. Addison's disease is a primary insufficiency of the adrenal gland and adrenocorticotropic hormone (ACTH) is not effective, nor would vasopressors be effective with the fluid deficiency of Addison's disease. Potassium levels are increased in Addison's disease and KCl would be contraindicated.

34. During discharge teaching for the patient with Addison's disease, which statement by the patient indicates that the nurse needs to do additional teaching? a. "I should always call the doctor if I develop vomiting or diarrhea." b. "If my weight goes down, my dosage of steroid is probably too high." c. "I should double or triple my steroid dose if I undergo rigorous physical exercise." d. "I need to carry an emergency kit with injectable hydrocortisone in case I can't take my medication by mouth."

34. b. A weight reduction in the patient with Addison's disease may indicate a fluid loss and a dose of replacement therapy that is too low rather than too high. Because vomiting and diarrhea are early signs of crisis and because fluid and electrolytes must be replaced, patients should notify their health care provider if these symptoms occur. Patients with Addison's disease are taught to take two to three times their usual dose of steroids if they become ill, have teeth extracted, or engage in rigorous physical activity and should always have injectable hydrocortisone available if oral doses cannot be taken.

35. A patient who is on corticosteroid therapy for treatment of an autoimmune disorder has the following additional drugs ordered. Which one is used to prevent corticosteroid-induced osteoporosis? a. Potassium c. Alendronate (Fosamax) b. Furosemide (Lasix) d. Pantoprazole (Protonix)

35. c. Alendronate (Fosamax) is used to prevent corticosteroid- induced osteoporosis. Potassium is used to prevent the mineralocorticoid effect of hypokalemia. Furosemide (Lasix) is used to decrease sodium and fluid retention from the mineralocorticoid effect. Pantoprazole (Protonix) is used to prevent gastrointestinal (GI) irritation from an increase in secretion of pepsin and hydrochloric acid.

36. A patient with mild iatrogenic Cushing syndrome is on an alternate-day regimen of corticosteroid therapy. What does the nurse explain to the patient about this regimen? a. It maintains normal adrenal hormone balance. b. It prevents ACTH release from the pituitary gland. c. It minimizes hypothalamic-pituitary-adrenal suppression. d. It provides a more effective therapeutic effect of the drug.

36. c. Taking corticosteroids on an alternate-day schedule for pharmacologic purposes is less likely to suppress ACTH production from the pituitary and prevent adrenal atrophy. Normal adrenal hormone balance is not maintained during glucocorticoid therapy because excessive exogenous hormone is used.

37. When caring for a patient with primary hyperaldosteronism, the nurse would question a health care provider's prescription for which drug? a. Furosemide (Lasix) c. Spironolactone (Aldactone) b. Amiloride (Midamor) d. Aminoglutethimide (Cytadren)

37. a. Hyperaldosteronism is an excess of aldosterone, which is manifested by sodium and water retention and potassium excretion. Furosemide is a potassium-wasting diuretic that would increase the potassium deficiency. Aminoglutethimide blocks aldosterone synthesis. Spironolactone and amiloride are potassium-sparing diuretics.

38. Priority Decision: What is the priority nursing intervention during the management of the patient with pheochromocytoma? a. Administering IV fluids c. Administering β-adrenergic blockers b. Monitoring blood pressure d. Monitoring intake and output and daily weights

38. b. Pheochromocytoma is a catecholamine-producing tumor of the adrenal medulla, which may cause severe, episodic hypertension; severe, pounding headache; and profuse sweating. Monitoring for a dangerously high BP before surgery is critical, as is monitoring for BP fluctuations during medical and surgical treatment.

4. After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops a. muscle weakness and weight loss. b. hyperthermia and severe tachycardia. c. hypertension and di culty swallowing. d. laryngospasms and tingling in the hands and feet.

4. Correct answer: d Rationale: Painful tonic spasms of smooth and skeletal muscles can cause laryngospasms that may compromise breathing. These spasms may be related to tetany, which occurs if the parathyroid glands are removed or damaged during surgery, which leads to hypocalcemia.

4. What findings are commonly found in a patient with a prolactinoma? a. Gynecomastia in men b. Profuse menstruation in women c. Excess follicle-stimulating hormone (FSH) and luteinizing hormone (LH) d. Signs of increased intracranial pressure, including headache, nausea, and vomiting

4. d. Compression of the optic chiasm can cause visual problems as well as signs of increased intracranial pressure, including headache, nausea, and vomiting. About 30% of prolactinomas will have excess prolactin secretion with manifestations of impotence in men, galactorrhea or amenorrhea in women without relationship to pregnancy, and decreased libido in both men and women. There is decreased follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

5. Important nursing intervention(s) when caring for a patient with Cushing syndrome include (select all that apply) a. restricting protein intake. b. monitoring blood glucose levels. c. observing for signs of hypotension. d. administering medication in equal doses. e. protecting patient from exposure to infection.

5. Correct answers: b, e Rationale: Hyperglycemia occurs with Cushing disease because of glucose intolerance (associated with cortisol-induced insulin resistance) and increased gluconeogenesis by the liver. High levels of corticosteroids increase susceptibility to infection and delay wound healing.

5. An African American woman with a history of breast cancer has panhypopituitarism from radiation therapy for primary pituitary tumors. Which medications should the nurse teach her about needing for the rest of her life (select all that apply)? a. Cortisol b. Vasopressin c. Sex hormones d. Levothyroxine e. GH (somatropin) f. Dopamine agonist (bromocriptine)

5. a, b, d, e. With panhypopituitarism, lifetime hormone replacement is needed for cortisol, vasopressin, thyroid, and GH. Sex hormones will not be replaced because of the patient's history of breast cancer. Dopamine agonists will not be used because they reduce secretion of GH, which has already been achieved with the radiation.

6. An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism is to a. monitor blood glucose levels. b. restrict uid and sodium intake. c. administer potassium-sparing diuretics. d. advise the patient to make postural changes slowly.

6. Correct answer: c Rationale: Before surgery, patients should be treated with potassium-sparing diuretics (spironolactone [Aldactone], eplerenone [Inspra]) to normalize serum potassium levels. Spironolactone and eplerenone block the binding of aldosterone to the mineralocorticoid receptor in the terminal distal tubules and collecting ducts of the kidney, thus increasing sodium excretion, water excretion, and potassium retention. Oral potassium supplements may also be necessary.

6. The patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What manifestation should the nurse expect to find? a. Decreased body weight c. Increased plasma osmolality b. Decreased urinary output d. Increased serum sodium levels

6. b. With increased antidiuretic hormone (ADH), the permeability of the renal distal tubules is increased, so water is reabsorbed into circulation. Decreased output of concentrated urine with increased urine osmolality and specific gravity occur. In addition, fluid retention with weight gain, serum hypoosmolality, dilutional hyponatremia, and hypochloremia occur.

7. To control the side e ects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to a. increase calcium intake to 1500 mg/day. b. perform glucose monitoring for hypoglycemia. c. obtain immunizations due to high risk of infections. d. avoid abrupt position changes because of orthostatic hypoten- sion.

7. Correct answer: a Rationale: Because patients often receive corticosteroid treatment for prolonged periods (more than 3 months), corticosteroid-induced osteoporosis is an important concern. Therapies to reduce the resorption of bone may include increased calcium intake, vitamin D supplementation, bisphosphonates (e.g., alendronate [Fosamax]), and institution of a low-impact exercise program.

7. During care of the patient with SIADH, what should the nurse do? a. Monitor neurologic status at least every 2 hours. b. Teach the patient receiving treatment with diuretics to restrict sodium intake. c. Keep the head of the bed elevated to prevent antidiuretic hormone (ADH) release. d. Notify the health care provider if the patient's blood pressure decreases more than 20 mm Hg from baseline.

7. a. The patient with syndrome of inappropriate antidiuretic hormone (SIADH) has marked dilutional hyponatremia and should be monitored for decreased neurologic function and seizures every 2 hours. Sodium intake is supplemented because of the hyponatremia and sodium loss caused by diuretics. ADH release is reduced by keeping the head of the bed flat to increase left atrial filling pressure. A reduction in blood pressure (BP) indicates a reduction in total fluid volume and is an expected outcome of treatment.

8. The nurse teaches the patient that the best time to take corticosteroids for replacement purposes is a. once a day at bedtime. b. every other day on awakening. c. on arising and in the late a ernoon. d. at consistent intervals every 6 to 8 hours.

8. Correct answer: c Rationale: As replacement therapy, glucocorticoids are usually administered in divided doses: two thirds in the morning and one third in the afternoon. This dosage schedule reflects normal circadian rhythm in endogenous hormone secretion and decreases the side effects associated with corticosteroid replacement therapy.

8. A patient with SIADH is treated with water restriction. What does the patient experience when the nurse determines that treatment has been effective? a. Increased urine output, decreased serum sodium, and increased urine specific gravity b. Increased urine output, increased serum sodium, and decreased urine specific gravity c. Decreased urine output, increased serum sodium, and decreased urine specific gravity d. Decreased urine output, decreased serum sodium, and increased urine specific gravity

8. b. The patient with SIADH has water retention with hyponatremia, decreased urine output, and concentrated urine with high specific gravity. Improvement in the patient's condition is reflected by increased urine output, normalization of serum sodium, and more water in the urine, thus decreasing the specific gravity.

9. The patient with diabetes insipidus is brought to the emergency department with confusion and dehydration after excretion of a large volume of urine today even though several liters of fluid were drunk. What is a diagnostic test that the nurse should expect to be done to help make a diagnosis? a. Blood glucose c. Urine specific gravity b. Serum sodium level d. Computed tomography (CT) of the head

9. c. Patients with diabetes insipidus (DI) excrete large amounts of urine with a specific gravity of less than 1.005. Blood glucose would be tested to diagnose diabetes mellitus. The serum sodium level is expected to be low with DI but is not diagnostic. To diagnose central DI a water deprivation test is required. Then a CT of the head may be done to determine the cause. Nephrogenic DI is differentiated from central DI with determination of the level of ADH after an analog of ADH is given.

8. What is a nursing priority in the care of a patient with hypothyroidism? A Patient teaching related to levothyroxine B Providing a dark, low-stimulation environment C Closely monitoring the patient's intake and output D Initiating precautions related to radioactive iodine therapy

A A euthyroid state is most often achieved in patients with hypothyroidism by the administration of levothyroxine. It is not necessary to closely monitor intake and output. Low stimulation and radioactive iodine therapy are used to treat hyperthyroidism.

15. A severely hypertensive patient presents with the classic triad of headache, tachycardia, and diaphoresis, and laboratory tests show excessive circulating catecholamine levels. Which rare, but treatable, disorder is suspected? A Pheochromocytoma B Adrenal cortical hypertension C Hypertrophy of the adrenal gland D Hyperplasia of the adrenal gland

A A pheochromocytoma is a catecholamine-secreting tumor that is usually located in the adrenal medulla and presents a classic triad of symptoms (headache, tachycardia, and diaphoresis) that result from effects of the massive circulating catecholamine levels on the sympathetic nervous system. Adrenal cortical hypertension and hypertrophy or hypotrophy of the adrenal gland do not present with these symptoms.

8. The posterior pituitary gland secretes: A antidiuretic hormone (ADH). B prolactin-releasing factor (PRF). C thyrotropin-releasing hormone (TRH). D gonadotropin-releasing hormone (GnRH).

A ADH is secreted by the posterior pituitary gland. The hypothalamus secretes the remaining substances.

7. Medication used to treat thyrotoxic crisis includes: A iodine. B epinephrine. C thyroid hormone. D synthroid.

A Beta blockers, PTU (propylthiouracil), iodine, and supportive care are used to treat thyrotoxic crisis. The remaining options would not be considered therapeutic for this condition.

5. CRH (corticotropin-releasing hormone) influences the immune system through: A its release from peripheral inflammatory sites. B vasoconstriction. C decreased vascular permeability. D targeting red blood cells at peripheral targets.

A CRH is released from the hypothalamus and peripherally at inflammatory sites. Because this hormone is proinflammatory, it causes vasodilation and increased vascular permeability. The primary target of peripheral CRH is the mast cell.

5. Children who have midline craniocerebral defects, nystagmus, retinal abnormalities, and other midline or midfacial abnormalities (e.g., cleft lip or palate) should be evaluated for deficiencies in A Growth hormone B T3 and T4 hormones C Parathyroid hormone D Corticosteroid hormones

A Deficiencies in growth hormone can lead to congenital malformations of cranial development. T3 and T4 hormone, parathyroid hormone, and corticosteroid hormone deficiencies are not currently connected with congenital malformations of the cranium.

7. The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instruction regarding desmopressin acetate would be most appropriate? A Expect to experience some nasal irritation while using this drug. B Monitor for symptoms of hypernatremia as a side effect of this drug. C Drink at least 3000 mL of water per day while taking this medication. D Report any decrease in urinary elimination to the health care provider.

A Desmopressin acetate is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. Diuresis will be decreased and is expected. Inhaled desmopressin can cause nasal irritation, headache, nausea, and other signs of hyponatremia, not hypernatremia. Drinking too much water or other fluids increases the risk of hyponatremia. The patient should follow the provider's directions for limiting fluids and be taught to seek medical attention they experience severe nausea; vomiting; severe headache; muscle weakness, spasms, or cramps; sudden weight gain; unusual tiredness; mental/mood changes; seizures; and slow or shallow breathing.

1. The nurse is teaching a patient with acromegaly from an unresectable benign pituitary tumor about octreotide therapy. The nurse should provide further teaching if the patient makes which statement? A "The provider will infuse this medication through an IV." B "I will inject the medication in the subcutaneous layer of the skin." C "The medication should decrease the growth hormone production to normal." D "I will have my growth hormone level measured every 2 weeks for several weeks."

A Drug therapy is an option for patients whose tumors are not surgically resectable. The primary drug used is octreotide, a somatostatin analog. It reduces growth hormone (GH) levels to normal in many patients. Octreotide is given by subcutaneous injection three times a week. GH levels are measured every 2 weeks to guide drug dosing, and then every 6 months until the desired response is obtained.

1. The nurse instructs a 28-year-old man with acromegaly resulting from an unresectable benign pituitary tumor about octreotide (Sandostatin). The nurse should intervene if the patient makes which statement? A "I will come in to receive this medication IV every 2 to 4 weeks." B "I will inject the medication in the subcutaneous layer of the skin." C "The medication will decrease the growth hormone production to normal." D "If radiation treatment is not effective, I may need to take the medication."

A Drugs are most commonly used in patients who have had an inadequate response to or cannot be treated with surgery and/or radiation therapy. The most common drug used for acromegaly is octreotide (Sandostatin), a somatostatin analog that reduces growth hormone levels to within the normal range in many patients. Octreotide is given by subcutaneous injection three times a week. Two long-acting analogs, octreotide (Sandostatin LAR) and lanreotide SR (Somatuline Depot), are available as intramuscular (IM) injections given every 2 to 4 weeks.

6. A symptom of a prolactinoma includes: A galactorrhea. B alopecia. C excessive menses. D pregnancy.

A Galactorrhea is the spontaneous flow of milk from the breast, unassociated with childbirth or nursing. Amenorrhea (absence of menses), hirsutism (excessive body hair), and osteopenia can all be caused by a prolactinoma. Pregnancy is a normal cause of galactorrhea.

2. The conditions of pituitary gigantism in children and acromegaly in adults are produced by excessive levels of A Growth hormone B Thyroid hormone C Antidiuretic hormone D Corticosteroid hormone

A Growth hormone excess in children, before skeletal epiphyses close, leads to rapid growth, resulting in "pituitary gigantism." In adults, excessive growth hormone causes bony growth that occurs at the short bones, such as the hands and feet, the brow, and the mandible. The thyroid hormone, antidiuretic hormone, and corticosteroid are not related to either gigantism or acromegaly.

3. The uncontrolled hormone production in acromegaly and gigantism is most often the result of A Benign somatotropic tumor in the pituitary gland B Pituitary response to excessive calcium intake C Asymptomatic hypercalcemia D Hyperparathyroidism

A Growth hormone excess is nearly always caused by uncontrolled production of the hormone by a benign somatotropic tumor in the pituitary gland. Growth hormone stimulates the liver to produce insulin-like growth factor (IGF)-1, and these two hormones act in concert to cause unregulated growth of soft and bony tissues. The uncontrolled hormone production in acromegaly and gigantism is not most often the result of pituitary response to excessive calcium intake, asymptomatic hypercalcemia, or hyperparathyroidism.

4. A patient diagnosed with melanoma is most likely: A experiencing a lesion on the back of the legs. B of Asian descent. C able to tan well. D experiencing a high mortality risk factor.

A Melanoma is often found on the trunk and back of the legs. The mortality rate is 2-3%. Whites suffer from melanoma 10 times as often as blacks, Hispanics, or Asians. Those affected are often fair skinned and unable to tan. They develop nevi easily or freckle.

20. The role of iodine in proper thyroid gland function relates to which of the following? (Select all that apply.) A Oxidation to iodide B Coupling to molecular tyrosine C Retention of iodide in renal tubules D Trapping of dietary iodine in thyroid cells E The ability of iodine to neutralize dietary salt

A B D Follicular cells of the thyroid gland trap dietary iodine, oxidize it to iodide, and couple it to molecules of the amino acid, tyrosine. These iodotyrosines are then combined to form T4 and T3. The role of iodine in proper thyroid gland function does not involve retention of iodide in renal tubules or the ability of iodine to neutralize dietary salt

4. The nurse is caring for a patient after a parathyroidectomy. The nurse would prepare to administer IV calcium gluconate if the patient exhibits which clinical manifestations? A Facial muscle spasms and laryngospasms B Tingling in the hands and around the mouth C Decreased muscle tone and muscle weakness D Shortened QT interval on the electrocardiogram

A Nursing care for a patient after a parathyroidectomy includes monitoring for a sudden decrease in serum calcium levels causing tetany, a condition of neuromuscular hyperexcitability. If tetany is severe (e.g., muscular spasms or laryngospasms develop), IV calcium gluconate should be administered. Mild tetany, characterized by unpleasant tingling of the hands and around the mouth, may be present but should decrease over time without treatment. Decreased muscle tone, muscle weakness, and shortened QT interval are clinical manifestations of hyperparathyroidism.

4. The nurse is caring for a 68-year-old woman after a parathyroidectomy related to hyperparathyroidism. The nurse should administer IV calcium gluconate if the patient exhibits which clinical manifestations? A Facial muscle spasms or laryngospasms B Decreased muscle tone or muscle weakness C Tingling in the hands and around the mouth D Shortened QT interval on the electrocardiogram

A Nursing care for the patient following a parathyroidectomy includes monitoring for a sudden decrease in serum calcium levels causing tetany, a condition of neuromuscular hyperexcitability. If tetany is severe (e.g., muscular spasms or laryngospasms develop), IV calcium gluconate should be administered. Mild tetany, characterized by unpleasant tingling of the hands and around the mouth, may be present but should decrease over time without treatment. Decreased muscle tone, muscle weakness, and shortened QT interval are clinical manifestations of hyperparathyroidism.

3. Which hormone is secreted by the posterior pituitary? A Oxytocin B Calcitonin C Thyroid-stimulating (TSH) D Parathyroid (PTH)

A Oxytocin is secreted by the posterior pituitary. Calcitonin is secreted by the thyroid gland. TSH is secreted by the anterior pituitary. PTH is secreted by the parathyroid glands.

5. The nurse is caring for a 56-year-old man receiving high-dose oral corticosteroid therapy to prevent organ rejection after a kidney transplant. What is most important for the nurse to observe related to this medication? A Signs of infection B Low blood pressure C Increased urine output D Decreased blood glucose

A Side effects of corticosteroid therapy include increased susceptibility to infection, edema related to sodium and water retention (decreased urine output), hypertension, and hyperglycemia. Other side effects are listed in Table 50-19.

5. The nurse is caring for a patient receiving high-dose oral corticosteroid therapy after a kidney transplant. Which potential side effect presents the greatest risk? A Infection B Low blood pressure C Increased urine output D Decreased blood glucose

A Side effects of corticosteroid therapy include increased susceptibility to infection, edema related to sodium and water retention (decreasing urine output), hypertension, and hyperglycemia.

7. The most significant regulator of antidiuretic hormone (ADH) release is A Osmotic pressure of plasma B Body mass index C serum pH D Rate pressure product

A Specialized neurons called osmoreceptors, found in the hypothalamus, respond to changes in osmotic pressure by means of a set point. When body fluids become too concentrated, ADH is released and more water is reabsorbed in the kidneys. Body mass index is not a significant regulator of ADH release. Rate pressure product is not a significant regulator of ADH, but rather an indicator of the oxygen requirements of the heart. Serum pH is not a significant regulator of ADH release.

1. A symptom of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is: A hyponatremia (dilutional). B hypernatremia (concentration). C hyperosmolality (serum). D hypoosmolality (urine).

A The cardinal features of SIADH are symptoms of water intoxication. These include hyponatremia (low serum sodium), serum hypoosmolality, and urine that is inappropriately concentrated (hyperosmolar) with respect to serum osmolality.

1. The pituitary gland produces a hormone that is a potent anabolic agent that causes the development of all tissues of the body that are capable of responding to it. This hormone is called A Growth hormone (GH) B Luteinizing hormone (LH) C Follicle-stimulating hormone (FSH) D Thyroid-stimulating hormone (TSH)

A The hormones produced by the anterior pituitary gland have direct actions on other endocrine glands in the body, with the exception of GH. GH promotes increased mitosis and cellular growth, increases the rate of protein synthesis, decreases protein catabolism, slows the rate of carbohydrate utilization, and mobilizes fats for energy use. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are involved with female reproduction. Thyroid-stimulating hormone (TSH) is not involved in the process described in the question.

10. When a patient is diagnosed with thyroid carcinoma, patient education concerning the disease should include the information that: A thyroid carcinoma is the most common endocrine malignancy. B Americans frequently have thyroid carcinoma as a diagnosis. C heredity is the most common risk factor for thyroid carcinoma. D most thyroid carcinoma tumors are undifferentiated.

A Thyroid carcinoma is relatively rare, but is the most common type of endocrine malignancy. The most common risk factor is exposure to ionizing radiation, not heredity or American birth. Most tumors are differentiated.

2. It is TRUE that ultraviolet light: A induces the tumor necrosis factor. B damage is not affected by wavelength. C causes the formation of sarcomas. D exposure has little effect on ozone depletion.

A Ultraviolet light induces tumor necrosis factor. The duration, intensity, and wavelength content all affect exposure. It can cause the formation of basal cell and squamous cell carcinomas. Ozone depletion is increasing the intensity of exposure.

18. A patient diagnosed with hormonal resistance can present with which assessment datum? (Select all that apply.) A No response to exogenous hormone replacement B Lack of normal hormonal action C Normal hormone levels D Elevated hormone levels E Decreased hormone levels

A B C D The absence of response to exogenous hormone replacement and a lack of normal hormonal action is characteristic of hormone resistance. Diminished hormonal action in the presence of normal or high hormonal levels is most likely to have genetic or acquired hormone resistance. Decreased hormone levels are not characteristic of hormonal resistance.

19. The secretion of the appropriate amount of free thyroid hormones in circulating body fluid is regulated by the feedback interaction between which hormone sources? A Pituitary B Hypothalamus C Adrenal medulla D Thyroid E Parathyroid

A B D Secretion of thyroid hormone is regulated by the hypothalamic-pituitary-thyroid feedback system. The adrenal medulla and the parathyroid are not involved.

14. The nurse is caring for a patient admitted with suspected hyperparathyroidism. Which signs and symptoms would represent the expected electrolyte imbalance (select all that apply.)? A Nausea and vomiting B Neurologic irritability C Lethargy and weakness D Increasing urine output E Hyperactive bowel sounds

A C D Hyperparathyroidism can cause hypercalcemia. Signs of hypercalcemia include muscle weakness, polyuria, constipation, nausea and vomiting, lethargy, and memory impairment. Neurologic irritability and hyperactive bowel sounds do not occur with hypercalcemia.

15. Which assessment finding would the nurse expect in a patient who has been taking oral prednisone several weeks and is experiencing sudden withdrawal (select all that apply.)? A BP 80/50 B Heart rate 54 C Glucose 63 mg/dL D Sodium 148 mEq/L E Potassium 6.3 mEq/L F Temperature 101.1° F

A C E F Sudden cessation of corticosteroid therapy can precipitate life-threatening adrenal insufficiency. During acute adrenal insufficiency, the patient exhibits severe manifestations of glucocorticoid and mineralocorticoid deficiencies, including hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, and confusion.

5. Which is true regarding acromegaly? It: A occurs due to excessive levels of ACTH. B is the result of a GH-secreting pituitary adenoma. C occurs more frequently in men. D is a relatively common condition.

B Acromegaly is a condition caused by excess of GH, not ACTH, as a result of a GH-secreting pituitary adenoma. It occurs more commonly in women and is a relatively uncommon condition occurring in about 40 per 1 million individuals.

2. The nurse receives a phone call from a 36-year-old woman taking cyclophosphamide (Cytoxan) for treatment of non-Hodgkin's lymphoma. The patient tells the nurse that she has muscle cramps and weakness and very little urine output. Which response by the nurse is best? A "Start taking supplemental potassium, calcium, and magnesium." B "Stop taking the medication now and call your health care provider." C "These symptoms will decrease with continued use of the medication." D "Increase fluids to 3000 mL per 24 hours to improve your urine output."

B Cyclophosphamide may cause syndrome of inappropriate antidiuretic hormone (SIADH). Medications that stimulate the release of ADH should be avoided or discontinued. Treatment may include restriction of fluids to 800 to 1000 mL per day. If a loop diuretic such as furosemide (Lasix) is used to promote diuresis, supplements of potassium, calcium, and magnesium may be needed.

2. The nurse receives a phone call from a patient taking cyclophosphamide for treatment of non-Hodgkin's lymphoma. The patient tells the nurse that she has muscle cramps, weakness, and very little urine output. Which response by the nurse is best? A "Start taking supplemental potassium, calcium, and magnesium." B "Stop taking the medication now and call your health care provider." C "These symptoms will decrease with continued use of the medication." D "Increase your fluid intake to 3000 mL for 24 hours to improve your urine output."

B Cyclophosphamide may cause syndrome of inappropriate antidiuretic hormone (SIADH). Medications that stimulate the release of ADH should be avoided or discontinued. Treatment may include restriction of fluids to 800 to 1000 mL/day. A loop diuretic such as furosemide (Lasix) is used to promote diuresis, and supplements of potassium, calcium, and magnesium may be needed.

3. The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instructions regarding desmopressin acetate (DDAVP) would be most appropriate? A The patient can expect to experience weight loss resulting from increased diuresis. B The patient should alternate nostrils during administration to prevent nasal irritation. C The patient should monitor for symptoms of hypernatremia as a side effect of this drug. D The patient should report any decrease in urinary elimination to the health care provider.

B DDAVP is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. Inhaled DDAVP can cause nasal irritation, headache, nausea, and other signs of hyponatremia. Diuresis will be decreased and is expected, and hypernatremia should not occur.

8. Two siblings are diagnosed with a thyroid disorder due to destruction of thyroid tissue by lymphocytes and circulating thyroid autoantibodies. This pathology is likely the result of: A subacute thyroiditis. B Hashimoto disease. C painless thyroiditis. D postpartum thyroiditis.

B Hashimoto disease is also called autoimmune thyroiditis. It results in the gradual destruction of thyroid tissue by infiltration or lymphocytes and circulating thyroid autoantibodies. This disorder is linked with several genetic risk factors. Painless thyroiditis has a similar course to subacute thyroiditis, but is pathologically identical to Hashimoto disease. Subacute thyroiditis is a nonbacterial inflammation of thyroid often preceded by a viral infection. Postpartum thyroiditis generally occurs within 6 months of delivery and occurs in up to 7% of all women.

11. An enlarged thyroid gland produces a colloid goiter when A Lack of iodine prevents formation of thyroid-stimulating hormone without stopping T4 and T3 production B Lack of iodine prevents T4 and T3 but without stopping thyroglobulin formation C Excessive iodine suppresses thyroid-stimulating hormone, T4, and T3 formation D Dietary iodine is insufficient and replaced with iodized salt

B Lack of iodine prevents production of both T4 and T3 but does not stop the formation of thyroglobulin. Insufficient T4 and T3 allow excessive quantities of thyroid-stimulating hormone to be secreted, and this in turn causes the thyroid cells to secrete tremendous amounts of thyroglobulin (colloid) into the follicles, producing a goiter. A colloid goiter is not the result of a lack of iodine preventing the formation of thyroid-stimulating hormone without stopping T4 and T3 production; excessive iodine suppressing thyroid-stimulating hormone, T4, and T3 formation; or insufficient dietary iodine being replaced with iodized salt.

3. The nurse is caring for a 40-year-old man who has begun taking levothyroxine (Synthroid) for recently diagnosed hypothyroidism. What information reported by the patient is most important for the nurse to further assess? A Weight gain or weight loss B Chest pain and palpitations C Muscle weakness and fatigue D Decreased appetite and constipation

B Levothyroxine (Synthroid) is used to treat hypothyroidism. Any chest pain or heart palpitations or heart rate greater than 100 beats/minute experienced by a patient starting thyroid replacement should be reported immediately, and an electrocardiogram (ECG) and serum cardiac enzyme tests should be performed.

3. The nurse is caring for a patient recently started on levothyroxine for hypothyroidism. What information reported by the patient requires immediate action? A Weight gain or weight loss B Chest pain and palpitations C Muscle weakness and fatigue D Decreased appetite and constipation

B Levothyroxine is used to treat hypothyroidism. With replacement, the patient can be overmedicated, causing hyperthyroidism. Any chest pain, heart palpitations, or heart rate greater than 100 beats/min experienced by a patient starting thyroid replacement should be reported immediately, and electrocardiography and serum cardiac enzyme tests should be performed.

9. The surgeon was unable to spare a patient's parathyroid gland during a thyroidectomy. Which assessments should the nurse prioritize when providing postoperative care for this patient? A White blood cell levels and signs of infection B Serum calcium levels and signs of hypocalcemia C Hemoglobin, hematocrit, and red blood cell levels D Level of consciousness and signs of acute delirium

B Loss of the parathyroid gland is associated with hypocalcemia. Whereas infection and anemia are not associated with loss of the parathyroid gland, cognitive changes are less pronounced than the signs and symptoms of hypocalcemia.

4. Which hormone is secreted by the anterior pituitary? A Androgen B Prolactin C Thyroid D Oxytocin

B Prolactin is secreted by the anterior pituitary. Androgen is secreted by the adrenal glands and gonads. Thyroid hormone is secreted by the thyroid gland. Oxytocin is secreted by the posterior pituitary.

1. The anatomic center of coordination and communication between nervous system and endocrine system is the A Adrenal cortex B Hypothalamus C Thyroid gland D Adrenal medulla

B The nervous and endocrine systems are closely coupled, sharing several chemical messengers, and are coordinated at the level of the hypothalamus. The adrenal cortex and thyroid glands produces chemicals that trigger responses that are coordinated and communicated by the brain. The medulla oblongata is a portion of the hindbrain that controls autonomic functions such as breathing, digestion, heart and blood vessel function, and swallowing.

7. If the outer two layers of the adrenal cortex are removed, the patient will experience: A hypernatremia. B hyperkalemia. C hyperglycemia. D decreased epinephrine.

B The outer two layers of the adrenal cortex produce aldosterone and glucocorticoids. Aldosterone deficiency would cause hyponatremia and hyperkalemia. A deficiency in glucocorticoids would result in hypoglycemia. Epinephrine would only decrease if the adrenal medulla was damaged or removed.

11. The patient is brought to the ED following a car accident and is wearing medical identification that says she has Addison's disease. What should the nurse expect to be included in the collaborative care of this patient? A Low sodium diet B Increased glucocorticoid replacement C Suppression of pituitary ACTH synthesis D Elimination of mineralocorticoid replacement

B 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 may also need a high sodium diet. Suppression of pituitary ACTH synthesis is done for Cushing syndrome. Elimination of mineralocorticoid replacement cannot be done for Addison's disease

13. The patient in the emergency department after a car accident is wearing medical identification listing Addison's disease. What should the nurse expect to be included in the care of this patient? A Low-sodium diet B Increased glucocorticoid replacement C Limiting IV fluid replacement therapy D Withholding mineralocorticoid replacement

B 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 may need large volumes of IV fluid replacement and a high-sodium diet. Withholding mineralocorticoid replacement cannot be done for patients with Addison's disease.

2. A patient experiences nausea, vomiting, loss of body hair, fatigue, weakness, and hypoglycemia. The hormone deficiency the patient is most likely experiencing is that of: A TSH (thyroid-stimulating hormone). B ACTH (adrenocorticotropic hormone). C FSH (follicle-stimulating hormone). D LH (luteinizing hormone).

B Within 2 weeks of complete absence of ACTH, symptoms of nausea, vomiting, anorexia, fatigue, and weakness develop. With absence of TSH, there is cold intolerance, dry skin, mild myxedema, lethargy, and decreased metabolic rate. FSH and LH deficiencies are associated with amenorrhea, atrophic vagina, uterus, breasts, decrease in body hair, and diminished libido.

17. Syndrome of inappropriate antidiuretic hormone (SIAHD) secretion can be attributed to which of the following? (Select all that apply.) A Renal disorders B Malignant lung disorders C An overactive adrenal cortex D Nonmalignant lung disorders E A hyperactive posterior pituitary gland

B D Ectopic production of antidiuretic hormone has been noted in association with several types of tumors, the most common of which are primary lung malignancies, although nonmalignant lung disorders are also capable of ADH synthesis. Ectopic production of antidiuretic hormone has not been noted in association with renal disorders, an overactive adrenal cortex, or a hyperactive posterior pituitary gland.

16. The patient with systemic lupus erythematosus is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What should be included in the plan of care (select all that apply.)? A Obtain weekly weights. B Limit fluids to 1000 mL/day. C Monitor for signs of hypernatremia. D Administration of diuretics as ordered. E Minimize turning and range of motion. F Keep the head of the bed at 10 degrees or less elevation.

B D F The care for the patient with SIADH will include limiting fluids to 1000 mL/day or less to decrease weight, increase osmolality, and improve symptoms and keeping the head of the bed elevated at 10 degrees or less to enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of ADH. Measure weights daily and maintain accurate intake and output. Monitor for signs of hyponatremia. Frequent turning, positioning, and range-of-motion exercises are important to maintain skin integrity and joint mobility.

7. The patient with systemic lupus erythematosus had been diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What should the nurse expect to include in this patient's plan of care (select all that apply)? A Obtain weekly weights. B Limit fluids to 1000 mL per day.* C Monitor for signs of hypernatremia. D Minimize turning and range of motion. E Keep the head of the bed at 10 degrees or less elevation.

B E The care for the patient with SIADH will include limiting fluids to 1000 mL per day or less to decrease weight, increase osmolality, and improve symptoms; and keeping the head of the bed elevated at 10 degrees or less to enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of ADH. The weights should be done daily along with intake and output. Signs of hyponatremia should be monitored, and frequent turning, positioning, and range-of-motion exercises are important to maintain skin integrity and joint mobility.

4. What is a nursing priority in the care of a patient with a diagnosis of hypothyroidism? A Providing a dark, low-stimulation environment B Closely monitoring the patient's intake and output C Patient teaching related to levothyroxine (Synthroid) D Patient teaching related to radioactive iodine therapy

C A euthyroid state is most often achieved in patients with hypothyroidism by the administration of levothyroxine (Synthroid). It is not necessary to carefully monitor intake and output, and low stimulation and radioactive iodine therapy are indicated in the treatment of hyperthyroidism.

8. When damage occurs to the antidiuretic hormone (ADH)-producing cells in the hypothalamus from head trauma, intracranial tumors, or neurosurgery, what disorder is suggested by a large diuresis of very dilute urine? A Kidney damage B Diabetes mellitus C Diabetes insipidus D Adrenogenital syndrome

C ADH acts directly on the renal collecting ducts and distal tubules, increasing membrane permeability to water that is characteristic of diabetes insipidus. Kidney damage would not likely result from causes described in the question nor would it result in a large diuresis of very dilute urine. Diabetes mellitus is related to insufficient insulin not ADH disfunction. Adrenogenital syndrome is a group of disorders caused by adrenocortical hyperplasia or malignant tumors, resulting in abnormal secretion of adrenocortical hormones and characterized by masculinization of women, feminization of men, or precocious sexual development in children.

6. Which is a characteristic of cachexia? A Increased appetite B Weight gain C Early satiety D Least common causes of death

C Cachexia includes anorexia, early satiety, weight loss, anemia, asthenia, taste alterations, and altered metabolism.

3. When ACTH activates the release of cortisol, then: A plasma is bound to corticotropin. B gluconeogenesis is halted. C cortisol increases blood glucose. D cortisol decreases protein synthesis.

C Cortisol has many actions that include the stimulation of gluconeogenesis, resulting in the increase of glucose production. Plasma will bind to a protein called transcortin, and protein synthesis is increased.

13. Cushing syndrome differs from Cushing disease in that the term Cushing syndrome is used only to describe A Hypercortisolism caused by prolonged use of corticosteroid drugs B Hypercortisolism caused by ectopic nonpituitary tumors C Hypercortisolism manifestations, regardless of cause D Hypercortisolism that is pituitary dependent

C Cushing syndrome is used to describe the clinical features of hypercortisolism, regardless of cause, whereas Cushing disease is the diagnosis reserved for pituitary-dependent conditions. Cushing syndrome is used to describe the clinical features of hypercortisolism not a specific cause.

6. What should be included in the interprofessional plan of care for a patient with Cushing disease? A Lab monitoring for hyperkalemia B Vital sign monitoring for hypotension C Counseling related to body image changes D Diet consultation to determine low protein choices

C Elevated corticosteroid levels can cause body changes, including truncal obesity, moon face, and hirsutism in women and gynecomastia in men. Counseling and support should be offered because of the changes in body image. Hypokalemia and hypertension are consistent with Cushing disease. Sodium restriction and potassium supplementation are indicated. High protein choices are necessary to counteract catabolic processes and assist with wound healing

1. 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? A Neurologic irritability B Declining urine output C Lethargy and weakness D Hyperactive bowel sounds

C Hyperparathyroidism can cause hypercalcemia. Signs of hypercalcemia include muscle weakness, polyuria, constipation, nausea and vomiting, lethargy, and memory impairment. Neurologic irritability, declining urine output, and hyperactive bowel sounds do not occur with hypercalcemia.

6. The surgeon was unable to spare a patient's parathyroid gland during a thyroidectomy. Which assessments should the nurse prioritize when providing postoperative care for this patient? A Assessing the patient's white blood cell levels and assessing for infection B Monitoring the patient's hemoglobin, hematocrit, and red blood cell levels C Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia D Monitoring the patient's level of consciousness and assessing for acute delirium or agitation

C Loss of the parathyroid gland is associated with hypocalcemia. Infection and anemia are not associated with loss of the parathyroid gland, whereas cognitive changes are less pronounced than the signs and symptoms of hypocalcemia.

9. Myxedema coma is generally associated with: A hyperthyroidism. B hyperthermia. C lactic acidosis. D hyperglycemia.

C Myxedema coma is a medical emergency involving lactic acidosis. It is associated with a diminished level of consciousness due to severe hypothyroidism. Signs and symptoms include hypothermia, hypoventilation, hypotension, hypoglycemia, and lactic acidosis.

9. The pathology of syndrome of inappropriate antidiuretic hormone (SIADH) secretion, leading to dilution of serum and an excess of water relative to solute, produces A Shrinking of cells and neuron tissue B Hypokalemia and cardiac dysrhythmias C Hemoconcentration and falsely high hemoglobin D Hyponatremia and swelling of cells and neural compression

C SIADH leads to hyponatremia when free water is inappropriately conserved and "dilutes" the serum to a sodium concentration below the normal range. When an excess of water is present, relative to solute, cells swell, causing profound effects of cellular swelling on neurons. The pathology of syndrome of inappropriate antidiuretic hormone (SIADH) secretion does not result in the shrinking of cells and neuron tissue, hypokalemia and cardiac dysrhythmias, or hyponatremia and neural compression.

5. A patient has been taking oral prednisone for the past several weeks after having a severe reaction to poison ivy. The nurse has explained the procedure for gradual reduction rather than sudden cessation of the drug. What is the rationale for this approach to drug administration? A Prevention of hypothyroidism B Prevention of diabetes insipidus C Prevention of adrenal insufficiency D Prevention of cardiovascular complications

C Sudden cessation of corticosteroid therapy can precipitate life-threatening adrenal insufficiency. Diabetes insipidus, hypothyroidism, and cardiovascular complications are not common consequences of suddenly stopping corticosteroid therapy.

12. In adrenocortical insufficiency, such as Addison disease, the most severe manifestations are the result of A An insufficient amount of T4 and T3 B Deficiencies in the renin-angiotensin system C An insufficient amount of circulating cortisol D Decreased levels of all the adrenocortical hormones

C The most severe clinical manifestations of adrenocortical insufficiency occur because of inadequate levels of circulating cortisol. Addison disease is not significantly related to amounts of T4 and T3 or to the renin-angiotensin system. Hyposecretion of all the adrenocortical hormones may occur in Addison disease, but that is not a cause of the most severe manifestations of Addison disease.

10. A patient who smokes reports having significant stress and is experiencing eye problems. On assessment, the nurse notes exophthalmos. What additional abnormal findings should the nurse assess for? A Muscle weakness and slow movements B Puffy face, decreased sweating, and dry hair C Systolic hypertension and increased heart rate D Decreased appetite, increased thirst, and pallor

C The patient's manifestations are consistent with Graves' disease or hyperthyroidism. Systolic hypertension, increased heart rate, and increased thirst are associated with hyperthyroidism. Cigarette smoking places the patient at increased risk of developing Graves' disease. The inhaled cigarette toxins may absorb via the eye orbits, causing exophthalmos. A puffy face; decreased sweating; dry, coarse hair; muscle weakness and slow movements; decreased appetite; and pallor are all manifestations of hypothyroidism.

3. A characteristic of pituitary adenomas would include that they: A will experience rapid growth. B are generally metastatic. C arise from the anterior pituitary. D have a pathogenesis due to infarction

C They arise from the anterior pituitary, are benign, and are usually slow growing in nature. The pathogenesis is not a result of infarction.

14. If the cause of hypercortisolism is an adrenal tumor, which option is indicated? A Adrenalin administration B Bilateral removal of adrenal glands C Unilateral removal of the affected gland D Glucocorticoid, but not mineralocorticoid, hormone replacement

C Unilateral adrenalectomy is indicated if hypercortisolism is caused by an adrenal tumor. Adrenalin administration would exacerbate the problem. Bilateral removal of adrenal glands is rarely performed today because it requires lifelong glucocorticoid and mineralocorticoid replacement. Glucocorticoid, but not mineralocorticoid, hormone replacement would not be appropriate therapy.

16. The origin of congenital adrenal hyperplasia occurs when circulating cortisol levels A are normal but ACTH levels are high. B are high and stimulate ACTH activity. C and ACTH levels are normal but adrenal glands proliferate. D are insufficient to provide negative feedback to the anterior pituitary gland.

D Adrenal hyperplasia occurs when enzymes needed for cortisol production are lacking and cannot produce adequate cortisol levels to provide negative feedback to the anterior pituitary gland. Adrenocorticotropic hormone (ACTH) secretion continues uncontrolled and results in adrenal hypertrophy and androgen overproduction. Normal cortisol levels would not be characteristic of congenital adrenal hyperplasia. High cortisol levels that stimulate ACTH activity would not be characteristic of congenital adrenal hyperplasia. Adrenal glands proliferate with normal ACTH levels would not be characteristic of congenital adrenal hyperplasia.

5. Long-term exposure to asbestos is most likely to result in development of cancer of the: A bladder. B kidney. C stomach. D lung.

D Asbestos may cause mesothelioma or lung cancer. Research has not shown a strong link between asbestos exposure and the remaining cancers.

3. When a patient has been diagnosed with a basal cell carcinoma, it is correct to assume that the: A lesion is most likely found on the client's trunk. B patient is likely dark skinned and brown eyed. C patient has rarely experienced sunburns. D lesion is most likely found on the arms and legs.

D Basal cell carcinoma is typically found on sun-exposed areas in those with fair complexions. The patients often have light hair and eyes, and they tend to sunburn vs. tan.

2. When experiencing stress, the effects of the epinephrine circulating in body will result in: A bradycardia. B decreased heart contractility. C increased skeletal muscle blood supply. D hyperglycemia.

D Epinephrine will cause transient hyperglycemia. The epinephrine will increase heart rate and contractility. There will be increased venous return to the heart and, thus, increased cardiac output and blood pressure. Epinephrine dilates blood vessels of the muscles.

2. The nurse should monitor for increases in which laboratory value for the patient as a result of being treated with dexamethasone (Decadron)? A Sodium B Calcium C Potassium D Blood glucose

D Hyperglycemia or increased blood glucose level is an adverse effect of corticosteroid therapy. Sodium, calcium, and potassium levels are not directly affected by dexamethasone.

10. Changes in urine osmolality seen in syndrome of inappropriate antidiuretic hormone (SIADH) secretion cause A Increased serum osmolality B Peripheral and central edema C Increased water retention with sodium D Uncreased water retention without sodium

D Increased water reabsorption in renal tubules raises urine osmolality but dilutes serum, causing serum osmolality to fall. Changes in urine osmolality do not result in an increase in serum osmolality. With this pathology, despite increased water retention, the patient does not become edematous. Changes in urine osmolality do not result in an increase in water retention with sodium.

6. If annual development assessment shows a child to have growth hormone deficiencies, treatment alternatives include A Parathyroid preparations B Surgical removal of the tumor C Palliative care because no treatment is known D Pharmacologic agents that affect growth hormone secretion

D Many pharmacologic agents are available that stimulate growth hormone secretion in children; these include insulin, arginine, levodopa, and clonidine. Childhood growth deficiencies are not treated with parathyroid preparations, are not always related to tumors, and are not generally terminal in nature.

7. A description of the feedback mechanism implemented by the thyroid gland would state that A Positive feed-forward occurs when excessive levels of thyroid-stimulating hormone shut down thyroid gland release of hormones but provides similar hormonal action B Positive feedback occurs when falling levels of the circulating thyroid hormones stimulate the release of thyroid-stimulating hormone from the pituitary gland that then inhibits thyroid hormone secretion. C Negative feedback occurs when falling levels of thyroid-stimulating hormone from the pituitary gland stimulate release of the hormone from the thyroid that then inhibits thyroid-stimulating hormone release. D Negative feedback occurs when low levels of circulating T3 and T4 trigger thyrotropin-releasing hormone to stimulate release of pituitary thyroid-stimulating hormone that then stimulates thyroid secretion of T3 and T4, resulting in rising levels that inhibit thyroid-stimulating hormone release

D Negative feedback characterizes the process of thyroid hormone regulation. Falling T3 and T4 levels are sensed by the hypothalamus and trigger release of thyrotropin-releasing hormone (TRH). TRH, in turn, stimulates pituitary release of thyroid-stimulating hormone (TSH), and TSH then stimulates release of the thyroid hormones T3 and T4 from the thyroid follicle. As TSH stimulates release of the thyroid hormones T3 and T4, circulating levels rise, which inhibits TSH and, to some extent, TRH release. The other options do not describe the thyroid feedback mechanism.

5. Which is a characteristic of the parathyroid gland? It: A is made up of at least 6-10 pairs of glands. B is large and makes up the majority of the thyroid gland. C influences the production of thyroid hormone. D secretes the most important factor in Ca++ regulation.

D PTH is the most important regulator of Ca++. While there are two pairs of parathyroid glands normally present, there may be two to six. They are small and located behind the thyroid gland. Thyroid hormone is produced by the thyroid gland and is unaffected by the parathyroid gland.

9. A patient with a severe pounding headache has been diagnosed with hypertension. However, the hypertension is not responding to traditional treatment. What should the nurse expect as the next step in management of this patient? A Administration of β-blocker medications B Abdominal palpation to search for a tumor C Administration of potassium-sparing diuretics D A 24-hour urine collection for fractionated metanephrines

D Pheochromocytoma should be suspected when hypertension does not respond to traditional treatment. The 24-hour urine collection for fractionated metanephrines is simple and reliable with elevated values in 95% of people with pheochromocytoma. In a patient with pheochromocytoma preoperatively an α-adrenergic receptor blocker is used to reduce BP. 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.

11. A patient with a severe pounding headache has been diagnosed with hypertension. However, the hypertension is not responding to traditional treatment. What should the nurse expect as the next step in determining a diagnosis for this patient? A Administration of β-blocker medications B Abdominal palpation to search for a tumor C Administration of potassium-sparing diuretics D A 24-hour urine collection for fractionated metanephrines

D Pheochromocytoma should be suspected when hypertension does not respond to traditional treatment. The 24-hour urine collection for fractionated metanephrines is simple and reliable with elevated values in 95% of people with pheochromocytoma. In a patient with pheochromocytoma, an α-adrenergic receptor blocker is used preoperatively 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.

4. Low serum levels of which hormone is helpful in differentiating between primary or secondary causes of hypothyroidism? A T3 B T4 C Thyroxine D Thyroid-stimulating hormone (TSH)

D TSH levels are helpful in differentiating between primary (high TSH) and secondary (low TSH) causes of hypothyroidism. Low serum T3 or T4 levels do not confirm the diagnosis of hypothyroidism. Medically speaking, hypothyroidism refers to a deficiency of the thyroid hormone thyroxine.

8. A 50-year-old female patient smokes, is getting a divorce, and is reporting eye problems. On assessment of this patient, the nurse notes exophthalmos. What other abnormal assessments should the nurse expect to find in this patient? A Puffy face, decreased sweating, and dry hair B Muscle aches and pains and slow movements C Decreased appetite, increased thirst, and pallor D Systolic hypertension and increased heart rate

D The patient's manifestations point to Graves' disease or hyperthyroidism, which would also include systolic hypertension and increased heart rate and increased thirst. Puffy face, decreased sweating; dry, coarse hair; muscle aches and pains and slow movements; decreased appetite and pallor are all manifestations of hypothyroid

10. The patient with an adrenal hyperplasia is returning from surgery for an adrenalectomy. For what immediate postoperative risk should the nurse plan to monitor the patient? A Vomiting B Infection C Thomboembolism D Rapid BP changes

D The risk of hemorrhage is increased with surgery on the adrenal glands as well as large amounts of hormones being released in the circulation, which may produce hypertension and cause fluid and electrolyte imbalances to occur for the first 24 to 48 hours after surgery. Vomiting, infection, and thromboembolism may occur postoperatively with any surgery.

12. The patient with an adrenal hyperplasia is returning from surgery after an adrenalectomy. The nurse should monitor the patient for what immediate postoperative complication? A Vomiting B Infection C Thromboembolism D Rapid blood pressure changes

D The risk of hemorrhage is increased with surgery on the adrenal glands as well as large amounts of hormones being released in the circulation, which may produce hypertension and cause fluid and electrolyte imbalances to occur for the first 24 to 48 hours after surgery. Vomiting, infection, and thromboembolism may occur postoperatively with any surgery.

4. A patient with visual changes beginning in one eye and then progress to the second eye could be experiencing: A pituitary infarct. B ACTH insufficiency. C Growth hormone (GH) insufficiency. D pituitary adenoma.

D With a pituitary adenoma, there can be increased pressure on the optic chiasm, and growth of the tumor can cause visual changes in both eyes. The other conditions do not present with optic nerve involvement.