Medical Surgical: Endocrine

A nurse is reviewing the laboratory reports of a client and notes an elevated thyroid-stimulating (TSH) level. Which of the following findings should the nurse expect? a. bradycardia b. tremors c. low grade fever d. diaphoresis

a. bradycardia An elevated TSH level indicates hypothyroidism, which is characterized by weight gain, bradycardia, cold intolerance, paresthesia, hearing loss, depression, and many other manifestations.

A nurse is caring for a client who had a thyroidectomy to treat hyperthyroidism caused by an adenoma. Which of the following findings should the nurse report to the provider? (select all that apply)

a. tachycardia and hypertension d. laryngeal stridor and hoarseness

A nurse is monitoring a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following findings should the nurse expect? a. polyuria b. dehydration c. hyponatremia d. hyperthermia

c. hyponatremia A client who has SIADH will have hyponatremia caused by excessive release of antidiuretic hormone (ADH). As a result of the excess ADH, the client retains water, which causes dilution hyponatremia.

A nurse is caring for a client who has diabetes insipidus. For which of the following findings should the nurse monitor? a. proteinuria b. oliguria c. polyuria d. glycosuria

c. polyuria Diabetes insipidus is characterized by increased thirst (polydipsia) and increased urination (polyuria). A client who has diabetes insipidus will excrete large quantities of urine with a very low specific gravity.

A nurse in the emergency department is assessing a client who has pancreatitis. In which of the following laboratory results should the nurse expect to see an elevation? a. amylase b. potassium c. calcium d. hematocrit

a. amylase With pancreatitis, laboratory results typically show elevated amylase within 12 to 24 hours. This level remains elevated for 2 to 3 days.

A nurse is caring for a client who is postoperative following a parathyroidectomy to treat hyperparathyroidism. Which of the following laboratory values should the nurse expect to decrease as a therapeutic effect of the procedure? a. calcium b. sodium c. potassium d. phosphorous

a. calcium Parathyroid hormone regulates calcium, phosphorous, and magnesium balance within the client's blood and bones by maintaining mineral levels. Hyperparathyroidism is associated with hypercalcemia; therefore, a decreased calcium level indicates an improvement in the client's condition.

A nurse is caring for a client who is postoperative following a bilateral adrenalectomy. The nurse should expect to administer glucocorticoids following the procedure to enhance which of the following therapeutic effects? a. compensation for decreased cortisol levels b. inhibition of glucose metabolism c. diuretic action to maintain urine output d. decreased susceptibility to infection

a. compensation for decreased cortisol levels A client who has an adrenalectomy requires glucocorticoids before, during, and after surgery to prevent an adrenal crisis caused by a sudden drop in cortisol levels. The adrenal glands produce several hormones including cortisol, a glucocorticoid. Loss of glucocorticoid secretion leads to a state of altered metabolism and an inability to deal with stressors; if untreated, this can be fatal.

A nurse is assessing a client who has Addison's disease. Which of the following findings should the nurse expect? a. hypotension b. weight gain c. sugar craving d. pale skin tone

a. hypotension The nurse should expect hypotension in a client who has adrenal insufficiency (Addison's disease). The nurse should monitor the client's blood pressure closely. If an Addisonian crisis occurs, the client's hypotension can become severe due to blood volume depletion caused by the loss of aldosterone.

A nurse is caring for a client who is scheduled to receive peritoneal dialysis. Which of the following actions should the nurse take? a. warm the dialysate solution prior to administration b. cleanse the catheter site using a back and forth motion, beginning at the end of the catheter and moving inward c. place the drainage bag at the level of the client's chest d. apply clean gloves and cleanse the client's catheter site with cold water

a. warm the dialysate solution prior to administration The nurse should warm the dialysate solution prior to administration to prevent pain and abdominal cramping.

A nurse is teaching a client who had a vaginal hysterectomy with a bilateral oophorectomy. Which of the following pieces of information should the nurse include in the teaching? a. "Plan to use some type of birth control for up to 6 weeks after surgery." b. "Use a water based lubricant when having sexual intercourse" c. "expect to have an increase in bloody vaginal drainage during the first 10 days after surgery" d. "plan to start some type of aerobic exercise such as swimming within a week after surgery"

b. "use a water based lubricant when having sexual intercourse" Vaginal dryness is a manifestation of menopause after the ovaries are removed. The client may require a water-based lubricant when having sexual intercourse.

A nurse is planning care for a client who has Cushing's syndrome due to chronic corticosteroid use. Which of the following actions should the nurse include in the plan of care? a. check the client's blood glucose for hypoglycemia b. check the client's urine specific gravity c. weigh the client weekly d. insert an indwelling urinary catheter for the client

b. check the client's urine specific gravity The nurse should check the client's urine specific gravity to assess for fluid volume overload.

A nurse is caring for a client who has been diagnosed with an Addisonian crisis and has a blood pressure of 74/42 mmHg. Which of the following prescriptions should the nurse anticipate? a. desmopressin b. hydrocortisone c. dopamine d. furosemide

b. hydrocortisone The nurse should identify that a client who has Addison's disease and is experiencing an Addisonian crisis will require hydrocortisone to assist with replacing cortisol levels. A client who has Addison's disease has adrenal corticoid insufficiency, which is due to the pituitary's inability to produce cortisol. Illness and stress can require steroids like hydrocortisone to restore hormone levels. An Addisonian crisis can cause sudden destruction of the adrenal gland or pituitary and become life-threatening.

A nurse is monitoring a client following a thyroidectomy for the presence of hypoparathyroidism. Which of the following findings should the nurse expect? a. elevated blood pressure b. involuntary muscle spasms c. cold intolerance d. weight loss

b. involuntary muscle spasms The nurse should identify involuntary muscle spasms as an indication of hypoparathyroidism, which can occur if the parathyroid glands are damaged or removed during a thyroidectomy. Muscle twitching and paresthesias can result due to decreased parathyroid hormone levels and calcium deficiency.

A nurse is assessing a client who is recovering from a thyroidectomy and has a harsh, high-pitched respiratory sound. Which of the following actions should the nurse take? a. hyperextend the client's neck b. prepare for a tracheostomy c. lower the head of the bed d. administer morphine

b. prepare for a tracheostomy The nurse should notify the provider immediately and prepare for a tracheostomy. Laryngeal stridor is a high-pitched, harsh breathing sound that indicates respiratory distress due to swelling, tetany, or laryngeal spasms.

A nurse is planning care for a client who has syndrome of inappropriate antidiuretic hormone secretion (SIADH) with mild manifestations. The nurse should expect the provider to prescribe which of the following medications? a. chlorpropamide b. tolvaptan c. vasopressin d. desmopressin

b. tolvaptan SIADH is a disorder of water intoxication due to the inappropriate continuous secretion of antidiuretic hormone by the posterior pituitary gland, causing hypervolemia and hyponatremia. Treatment of SIADH includes fluid restriction, sodium replacement with small amounts of 0.9% sodium chloride, and a vasopressin antagonist such as tolvaptan. Tolvaptan promotes the excretion of water, which helps correct the fluid imbalance in clients who have SIADH.

A nurse is preparing a 24 hr urine specimen for a client who is suspected to have pheochromocytoma. Which of the following laboratory tests from the 24 hr urine specimen should the nurse use to determine the client's condition? a. creatinine clearance b. vanillylmandelic acid (VMA) c. 17-hydroxycorticosteroids (17-OHCS) d. protein

b. vanillylmandelic acid (VMA) The VMA test is used to determine if the client has pheochromocytoma, which measures the level of catecholamine metabolites in a 24 hour urine sample. Pheochromocytoma is a tumor of the adrenal gland that causes excess release of the catecholamines epinephrine and norepinephrine, which are hormones that regulate blood pressure and heart rate.

A nurse is providing teaching to a client who has Addison's disease about healthy snack foods. Which of the following food choices by the client indicates an understanding of the teaching? a. sliced bananas b. baked potato c. turkey and cheese sandwich d. plain yogurt with peaches

c. Turkey and cheese sandwich A turkey and cheese sandwich is high in protein, carbohydrates, and sodium. A client who has Addison's disease requires a diet low in potassium and high in sodium, carbohydrates, and protein. Addison's disease is a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex). Addison's disease occurs when the adrenal glands do not produce enough cortisol and, in some cases, aldosterone.

A nurse is assessing a client who has Addison's disease. Which of the following skin manifestations should the nurse expect to find? a. purple striae on the chest and abdomen b. butterfly rash across the bridge of the nose c. bronze pigmentation of the skin d. jaundice of the face and sclera

c. bronze pigmentation of the skin A client who has Addison's disease will have a darkening of the skin on both exposed and unexposed parts of the body due to a hormone deficiency caused by damage to the outer layer of the adrenal gland (adrenal cortex).

A nurse is assessing a client who has Grave's disease. Which of the following findings should the nurse expect the client to display? a. constipation b. cold intolerance c. difficulty sleeping d. anorexia

c. difficulty sleeping A client who has Graves' disease can have difficulty sleeping and anxiety due to the overproduction of thyroid hormone

A nurse is caring for a client with Addison's disease who has been admitted with muscle weakness, dehydration, and nausea and vomiting for the past 2 days. Which of the following prescribed medications should the nurse plan to administer? a. rifampin b. loperamide c. hydrocortisone d. spironolactone

c. hydrocortisone The nurse should identify that a client who has Addison's disease will require hydrocortisone to assist with replacing cortisol levels. A client who has Addison's disease has adrenal corticoid insufficiency, which is the inability of the pituitary to produce cortisol. Illness and stress can require steroids like hydrocortisone to restore hormone levels.

A nurse is teaching a client who has hyperthyroidism about managing this disorder. Which of the following recommendations should the nurse include? a. reduce total hours of sleep b. keep the immediate environment warm c. increase caloric intake with meals d. gradually increase activity

c. increase caloric intake with meals Clients whose thyroid hormone levels are high have increased protein, lipid, and carbohydrate metabolism, resulting in the loss of protein stores and a negative nitrogen balance. Even with an increased appetite, meeting energy demands is often difficult, and weight loss is common. Muscle weakness and wasting can develop without adequate caloric and protein intake.

A nurse in the emergency department is caring for a client who has Addison's disease and reports nausea, vomiting, diarrhea, and abdominal pain. To prevent an Addisonian crisis, the nurse should prepare to administer which of the following medications? a. calcium b. potassium c. iodine d. hydrocortisone

d. hydrocortisone Addison's disease causes adrenal gland hypo function and inadequate production of glucocorticoids. Acute adrenal insufficiency is life-threatening and can lead to severe fluid and electrolyte imbalances. Without treatment, sodium falls, and potassium levels increase. Rapid infusion of IV fluids such as 0.9% sodium chloride and IV administration of high dose corticosteroids such as hydrocortisone are vital to correct the glucocorticoid deficiency.

A nurse is monitoring a client who has Graves' disease for the development of thyroid storm. The nurse should report which of the following findings to the provider? a. constipation b. headache c. bradycardia d. hypertension

d. hypertension A client who is experiencing a thyroid storm will have an exaggerated condition of hyperthyroidism associated with the development of a fever, hypertension, abdominal pain, and tachycardia. Graves' disease is a common cause of hyperthyroidism, which is an imbalance of metabolism caused by overproduction of thyroid hormone.

A nurse is assessing a client who has manifestations of acromegaly. Which of the following findings should the nurse expect? a. thinning of skeletal bone structure b. concave chest wall c. high-pitched voice d. increased head size

d. increased head size A client who has acromegaly will present with an enlarged head size due to the excessive production of growth hormones after closing of the epiphyses (the "growth plate" at the ends of the long bones) by the pituitary gland. This results in the gradual enlargement of the client's body tissues such as the bones of the face, jaw, hands, feet, and skull.

A nurse is caring for a client who has urolithiasis and requires further diagnostic testing after an initial test indicated hypercalcemia. Which of the following structures controls calcium concentration? a. pancreas b. thyroid gland c. anterior pituitary gland d. parathyroid gland

d. parathyroid gland The parathyroid gland secretes parathyroid hormones, which are substances that help the kidneys reabsorb calcium and increase calcium absorption from the gastrointestinal tract.

A nurse is accepting a transfer from the post anesthesia care unit (PACU) of a client who has had a subtotal thyroidectomy. Which of the following pieces of equipment should the nurse have available at the bedside for the client. a. cardiac monitor b. defibrillator c. thoracotomy tray d. tracheostomy tray

d. tracheostomy tray Because of the laryngeal edema that is common after a thyroidectomy, respiratory distress could result in airway obstruction. Emergency intubation can be difficult due to laryngeal swelling, and endotracheal intubation can increase the risk of hemorrhage by increasing tension on the incision during insertion. The nurse should have a tracheostomy tray available for this client.