PrepU endocrine
Which outcome indicates that treatment of a client with diabetes insipidus has been effective? Fluid intake is less than 2,500 ml/day. Urine output measures more than 200 ml/hour. Blood pressure is 90/50 mm Hg. Heart rate is 126 beats/minute.
Correct response: Fluid intake is less than 2,500 ml/day. Explanation: Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.
Which nursing diagnosis is most appropriate for a client with Addison's disease? Risk for infection Excessive fluid volume Urinary retention Hypothermia
Correct response: Risk for infection Explanation: Addison's disease decreases the production of all adrenal hormones, compromising the body's normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison's disease include Deficient fluid volume and Hyperthermia. Urinary retention isn't appropriate because Addison's disease causes polyuria.
Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance? Desmopressin (DDAVP) Thiazide diuretics Ibuprofen Diabinese
Correct response: Desmopressin (DDAVP) Explanation: DDAVP is a synthetic vasopressin used to control fluid balance and prevent dehydration. Other medications that are used in the treatment of patients with diabetes insipidus include Diabinese, thiazide diuretics (potentiate action of vasopressin), and/or prostaglandin inhibitors such as ibuprofen and aspirin.
A nurse should perform which intervention for a client with Cushing's syndrome? Offer clothing or bedding that's cool and comfortable. Suggest a high-carbohydrate, low-protein diet. Explain that the client's physical changes are a result of excessive corticosteroids. Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather.
Correct response: Explain that the client's physical changes are a result of excessive corticosteroids. Explanation: The nurse should explain to the client that Cushing's syndrome causes physical changes related to excessive corticosteroids. Clients with hyperthyroidism, not Cushing's syndrome, are heat intolerant and must have cool clothing and bedding. Clients with Cushing's syndrome should have a high-protein, not low-protein, diet. Clients with Addison's disease must increase sodium intake and fluid intake in times of stress of prevent hypotension.
A patient comes to the clinic with complaints of severe thirst. The patient has been drinking up to 10 L of cold water a day, and the patient's urine looks like water. What diagnostic test does the nurse anticipate the physician will order for diagnosis? Complete blood count (CBC) Fluid deprivation test Urine specific gravity TSH test
Correct response: Fluid deprivation test Diabetes insipidus (DI) is the most common disorder of the posterior lobe of the pituitary gland and is characterized by a deficiency of ADH (vasopressin). Excessive thirst (polydipsia) and large volumes of dilute urine are manifestations of the disorder. The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost. The patient is weighed frequently during the test. Plasma and urine osmolality studies are performed at the beginning and end of the test. The inability to increase the specific gravity and osmolality of the urine is characteristic of DI.
A patient is diagnosed with a deficiency in vasopressin, a posterior pituitary hormone. Therefore, a primary nursing responsibility is to assess for: Indicators of dehydration. Glycosuria Serum calcium levels. Indicators of hyponatremia.
Correct response: Indicators of dehydration. Explanation: A deficiency in vasopressin, also known as the antidiuretic hormone, would result in increased urinary output, thirst, and dehydration. No glucose is lost in the urine. Hypernatremia occurs with dehydration.
The nurse knows to assess a patient with hyperthyroidism for the primary indicator of: Fatigue Weight gain Constipation Intolerance to heat
Correct response: Intolerance to heat Explanation: With hypothyroidism, the individual is sensitive to cold because the core body temperature is usually below 98.6°F. Intolerance to heat is seen with hyperthyroidism.
For a client with Graves' disease, which nursing intervention promotes comfort? Restricting intake of oral fluids Placing extra blankets on the client's bed Limiting intake of high-carbohydrate foods Maintaining room temperature in the low-normal range
Correct response: Maintaining room temperature in the low-normal range Explanation: Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss. To reduce heat intolerance and diaphoresis, the nurse should keep the client's room temperature in the low-normal range. To replace fluids lost via diaphoresis, the nurse should encourage, not restrict, intake of oral fluids. Placing extra blankets on the bed of a client with heat intolerance would cause discomfort. To provide needed energy and calories, the nurse should encourage the client to eat high-carbohydrate foods.
Which of the following would the nurse need to be alert for in a client with severe hypothyroidism? Thyroid storm Myxedemic coma Addison's disease Acromegaly
Correct response: Myxedemic coma Explanation: Severe hypothyroidism is called myxedema and if untreated, it can progress to myxedemic coma, a life-threatening event. Thyroid storm is an acute, life-threatening form of hyperthyroidism. Addison's disease refers to primary adrenal insufficiency. Acromegaly refers to an oversecretion of growth hormone by the pituitary gland during adulthood.
Which assessment would a nurse perform on a client with Cushing's syndrome who is at high risk of developing a peptic ulcer? Observe stool color. Monitor bowel patterns. Monitor vital signs every 4 hours. Observe urine output.
Correct response: Observe stool color. Explanation: The nurse should observe the color of each stool and test the stool for occult blood.
The nurse assesses a patient who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease? Potassium of 6.0 mEq/L Sodium of 140 mEq/L Glucose of 100 mg/dL A blood pressure reading of 135/90 mm Hg
Correct response: Potassium of 6.0 mEq/L Explanation: Addison's disease is characterized by hypotension, low blood glucose, low serum sodium, and high serum potassium levels. The normal serum potassium level is 3.5 to 5 mEq/L.
A client with hyperthyroidism is concerned about changes in appearance. How can the nurse convey an understanding of the client's concern and promote effective coping strategies? Reassure the client that their emotional reactions are a result of the disorder and symptoms can be controlled with effective treatment. Encourage the client to participate in outside activities to boost coping strategies. Suggest that the client wear cosmetics to cover any changes in appearance. Refer the client to professional counseling.
Correct response: Reassure the client that their emotional reactions are a result of the disorder and symptoms can be controlled with effective treatment. Explanation: The client with hyperthyroidism needs reassurance that the emotional reactions being experienced are a result of the disorder and that with effective treatment those symptoms can be controlled. It is important to use a calm, unhurried approach with the client. Stressful experiences should be minimized, and a quiet uncluttered environment should be maintained. The nurse encourages relaxing activities that will not overstimulate the client. It is important to balance periods of activity with rest.
Which of the following endocrine disorder causes the patient to have dilutional hyponatremia? Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Diabetes insipidus (DI) Hypothyroidism Hyperthyroidism
Correct response: Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Explanation: Patients diagnosed with SIADH retain water and develop a subsequent sodium deficiency known as dilutional hyponatremia. In DI, there is excessive thirst and large volumes of dilute urine. Patients with DI, hypothyroidism, or hyperthyroidism do not exhibit dilutional hyponatremia
The nurse is caring for a patient with hyperthyroidism who suddenly develops symptoms related to thyroid storm. What symptoms does the nurse recognize that are indicative of this emergency? Heart rate of 62 Blood pressure 90/58 mm Hg Oxygen saturation of 96% Temperature of 102ºF
Correct response: Temperature of 102ºF Explanation: Thyroid storm is characterized by the following: 1) high fever (hyperpyrexia), >38.5°C (>101.3°F); 2) extreme tachycardia (>130 bpm); 3) exaggerated symptoms of hyperthyroidism with disturbances of a major system—for example, gastrointestinal (weight loss, diarrhea, abdominal pain) or cardiovascular (edema, chest pain, dyspnea, palpitations); and 4) altered neurologic or mental state, which frequently appears as delirium psychosis, somnolence, or coma.
The nurse is assisting with the preparation of a teaching plan for a client who is to receive methimazole (Tapazole). Which of the following would be most appropriate to include in this plan? Telling the client to dilute the drug with fruit juice. Advising the client to use a straw when taking the drug. Urging the client to report any fever or sore throat. Telling the client to take largest dose of the drug in the morning.
Correct response: Urging the client to report any fever or sore throat. Explanation: Methimazole (Tapazole) can cause agranulocytosis which occurs most often in the first 2 months of therapy and requires discontinuation of the drug. Thus, the client should be instructed to report sore throat, fever, chills, headache, malaise, weakness, or unusual bleeding or bruising. Diluting the drug with fruit juice or using a straw are appropriate instructions for a client taking iodine solution. Methimazole is given in equal doses every 8 hours around the clock.
A nurse caring for a patient with diabetes insipidus is reviewing the patient's laboratory results. What is an expected urinalysis finding? Glucose in the urine Albumin in the urine Urine specific gravity of 1.001 to 1.005 Leukocytes in the urine
Correct response: Urine specific gravity of 1.001 to 1.005 Explanation: Patients with diabetes insipidus experience profound polyuria. Consequently, the patient's urine will have a water-like specific gravity (close to 1.000). The urine would not contain abnormal substances such as glucose or albumin. Leukocytes in the urine are not related to the condition of diabetes insipidus, but would indicate a urinary tract infection, if present in the urine.
Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction experiences: heat intolerance and systolic hypertension. weight gain and heat intolerance. diastolic hypertension and widened pulse pressure. anorexia and hyperexcitability.
Correct response: heat intolerance and systolic hypertension. Explanation: An increased metabolic rate in a client with hyperthyroidism caused by excess serum thyroxine leads to systolic hypertension and heat intolerance. Weight loss — not gain — occurs because of the increased metabolic rate. Diastolic blood pressure decreases because of decreased peripheral resistance. Heat intolerance and widened pulse pressure can occur but systolic hypertension and diastolic hypertension don't. Clients with hyperthyroidism experience an increase in appetite — not anorexia.
The following clients are scheduled for thyroid testing. Which client would be at greatest risk for inaccurate results? A client who was given salicylates last month A client who avoids kelp A client diagnosed with low blood sugar A client who received corticosteroids 4 months ago
Correct response: A client who was given salicylates last month Explanation: Drugs such as salicylates and corticosteroids affect the results of thyroid tests if taken within past 3 months. Therefore, inaccurate thyroid test results will be obtained for the client who was given salicylates last month but not for the client who was administered corticosteroids 4 months ago. Kelp is high in iodine, which affects the thyroid test results. However, this factor will not affect the results of the thyroid test for a client avoiding kelp. A client's history of low blood sugar will not affect thyroid test results.
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? Infusing IV fluids rapidly as ordered Encouraging increased oral intake Restricting fluids Administering glucose-containing I.V. fluids as ordered
Correct response: Restricting fluids Explanation: To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.
Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU). The nurse should expect the client's symptoms to subside: in a few days. in 3 to 4 months. immediately. in 1 to 2 weeks.
Correct response: in 1 to 2 weeks. Explanation: Potassium iodide reduces the vascularity of the thyroid gland and is used to prepare the gland for surgery. Potassium iodide reaches its maximum effect in 1 to 2 weeks. PTU blocks the conversion of thyroxine to triiodothyronine, the more biologically active thyroid hormone. PTU effects are also seen in 1 to 2 weeks. To relieve symptoms of hyperthyroidism in the interim, clients are usually given a beta-adrenergic blocker such as propranolol (Inderal).
A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering: insulin. furosemide. potassium chloride. vasopressin.
Correct response: vasopressin. Explanation: Vasopressin is given subcutaneously to manage diabetes insipidus. Insulin is used to manage diabetes mellitus. Furosemide causes diuresis. Potassium chloride is given for hypokalemia.
A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: exophthalmos and conjunctival redness. flushed, warm, moist skin. systolic murmur at the left sternal border. decreased body temperature and cold intolerance.
Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. Exophthalmos; conjunctival redness; flushed, warm, moist skin; and a systolic murmur at the left sternal border are typical findings in a client with hyperthyroidism.
The nurse is preparing a client for a thyroid test. Which medications that the client is taking should be documented on the laboratory slip as possibly affecting the thyroid test? Phenytoin Metoclopramide Lisinopril Furosemide Amphetamine
If a client has recently taken a drug that contains iodine or has had radiographic contrast studies that used iodine, thyroid test results may be inaccurate. Other drugs also affect the results of thyroid tests. Phenytoin can lower T4 values. Metoclopramide can raise TSH levels. Amphetamine can lower TSH levels. Furosemide can increase T4 level. Be sure to enter on the laboratory request slip all drugs the client is taking or has taken within the past 3 months. The other drugs do not have relevance to the thyroid test.
The most common type of goiter is caused by lack of which of the following? Iodine Calcium Potassium Sodium
The most common type of goiter is often encountered in geographic regions where there is lack of iodine. If too little iodine exists, the level of thyroxine will decrease, causing the stimulation of thyroid-stimulating hormone (TSH) from the anterior pituitary.
calcitonin function
it acts to reduce calcium levels in the blood.
A patient who is postoperative day 1 following neck dissection surgery has rung his call bell complaining of numb fingers, stiff hands, and a tingling sensation in his lips and around his mouth. The nurse should anticipate that this patient may require the IV administration of: Potassium chloride Calcium gluconate Magnesium sulfate Sodium phosphate
Correct response: Calcium gluconate Explanation: Inadvertent removal of the parathyroid may occur during neck dissection surgery, resulting in hypocalcemia. This condition is treated with the IV administration of calcium gluconate.
The nurse is reviewing a client's laboratory studies and determines that the client has an elevated calcium level. What does the nurse know will occur as a result of the rise in the serum calcium level? A rise in serum calcium stimulates the release of T lymphocytes. A rise in serum calcium stimulates the release of erythropoietin. A rise in serum calcium inhibits the release of calcitonin. A rise in serum calcium stimulates the release of calcitonin from the thyroid gland.
Correct response: A rise in serum calcium stimulates the release of calcitonin from the thyroid gland. Explanation: Calcitonin, another thyroid hormone, inhibits the release of calcium from bone into the extracellular fluid. A rise in the serum calcium level stimulates the release of calcitonin from the thyroid gland.
The nurse practitioner who assesses a patient with hyperthyroidism would expect the patient to report which of the following conditions? Fatigue Dyspnea Weight loss Hair loss
Correct response: Weight loss Explanation: Weight loss is consistent with a diagnosis of hyperthyroidism. The other conditions are found in hypothyroidism.
