304 - endocrine socrative

Which trends in serum electrolyte values will the nurse expect to find in a client who has untreated hypoparathyroidism? A - Below normal calcium levels; above normal phosphorus levels B - Below normal calcium levels; below normal phosphorus levels C - Above normal calcium levels; above normal phosphorus levels D - Above normal calcium levels; below normal phosphorus levels

A - low calcium high phosphorus With hypoparathyroidism, the lack of parathyroid hormone (PTH) decreases serum calcium levels by increasing kidney calcium excretion and inhibiting calcium absorption from the GI tract. Low levels of calcium cause a corresponding increase in serum phosphorus levels because calcium and phosphorus exist in a balanced reciprocal relationship in which a decrease in one always causes an increase in the other.

Which statement made by the client alerts the nurse to the possibility of hypothyroidism? A - "I seem to feel the heat more than other people." B - "I am always tired, even when I get 10 or 12 hours of sleep." C - "Food just doesn't taste good without a lot of salt." D - "My grandmother had thyroid problems."

B - "I am always tired, even when I get 10 or 12 hours of sleep."

Which precaution will the nurse include when providing instructions to the female client with hypothyroidism who is prescribed to take thyroid hormone replacement therapy (HRT)? A - "Increase the amount of fiber in your diet to prevent the side effect of constipation." B - "Stop this drug immediately if you discover you are pregnant." C - "Avoid over-the-counter medications unless prescribed by your primary health care provider." D - "If you miss a dose, double your next day's dose."

B - "Stop this drug immediately if you discover you are pregnant." (levothyroxine)

With which client will the nurse be aware of an increased risk for hypoparathyroidism? A - A 28-year-old woman with pregnancy-induced hypertension B - A 35-year-old woman who had radiation therapy for Graves disease C - A 50-year-old man starting on insulin therapy for type 2 diabetes mellitus D - A 55-year-old man with moderate heart failure after myocardial infarction

B - Hypoparathyroidism is a relatively rare disorder. It is most often caused by treatment for hyperthyroidism that resulted in injury to the parathyroid glands. None of the other client health problems increase the risk for development of hypoparathyroidism.

Which assessment finding in a client who had a parathyroidectomy yesterday indicates to the nurse that immediate action is needed? A - Hypoactive bowel sounds B - Apical pulse of 92 beats/min C - Bilateral leg muscle twitching D - Dry mouth

C

Which action immediately after a hypophysectomy will the nurse instruct a client to avoid to prevent harm? (Select all that apply.) A - Bending at the waist B - Talking C - Deep breathing D - Coughing E - Wearing makeup F - Using dental floss

Coughing Bending at the waist also brushing teeth

For which assessment finding in a client who had a transsphenoidal hypophysectomy yesterday will the nurse notify the primary health care provider immediately? A - Dry lips and oral mucosa on examination B - Nasal drainage that tests negative for glucose C - Urine specific gravity of 1.016 D - Client report of a headache and stiff neck

D - Client report of a headache and stiff neck Headache and stiff neck (nuchal rigidity) are symptoms of meningitis that have immediate implications for the client's care. The finding requires the nurse to immediately notify the primary health care provider. Dry lips and mouth are not unusual after surgery. Nasal drainage that tests negative for glucose is normal, expected, and not significant. A urine specific gravity of 1.016 is within normal limits.

For which new-onset symptom or behavior will the nurse teach a client taking thyroid hormone replacement therapy (HRT) to report immediately to the primary health care provider? A - Calf muscle cramping B - Runny nose C - Anorexia D - Hand tremors

D - hand tremors Hand tremors are an indication of HRT toxicity with increased central nervous system stimulation. The dose must be decreased to prevent more serious neurologic and cardiac toxicities. Anorexia, runny nose, and muscle cramping are neither side effects of the drug nor indications of toxicity.

Which type of drug therapy will the nurse prepare to teach about to a client who has mild hyperparathyroidism? A - Antipyretics B - Opioid analgesics C - Furosemide diuretics D - Calcium supplements

Diuretics High ceiling or loop diuretics, such as furosemide increase calcium excretion and are used to manage calcium levels in clients who have mild hyperparathyroidism. Antipyretics are not routinely prescribed because fever is not associated with the disorder. Opioid analgesics are used only when a problem causing acute pain is present and not for typical management of mild hyperparathyroidism. Calcium supplements are contraindicated because hyperparathyroidism results in chronic hypercalcemia.

After transsphenoidal hypophysectomy, what is something that the patient CAN'T do?

Lean over! (increases intracranial pressure) After this surgery, the client must take care to avoid activities that can increase intracranial pressure. They should avoid bending from the waste and should not bear down, cough, or lay flat. Wearing dark glasses while outside is not necessary to prevent complications from the surgery.

Which signs, symptoms, or behaviors will the nurse expect to find when assessing a client who has just been diagnosed with hypothyroidism? (Select all that apply.) A - Nonpitting edema of hands and feet B - Warm, moist skin C - Decreased deep tendon reflexes D- Agitation and inability to sleep E - Pulse rate below 60 beats/min

Pulse rate below 60 beats/min Decreased deep tendon reflexes Nonpitting edema of hands and feet Hypothyroidism slows the metabolism and function of all systems and the ones that are usually first noticed and can lead to life-threatening complications are the cardiac and central nervous systems. Thus, the heart rate is usually slower than 60 beats/min, and the deep tendon reflexes are decreased. Metabolites that are compounds of proteins and sugars called glycosaminoglycans (GAGs) build up inside cells, which increase the mucus and water, forming cellular edema that is nonpitting. The onset is so slow and insidious that clients may not even notice them until severe changes are present.

Which statement made by a client about thyroid hormone replacement therapy (HRT) indicates to the nurse that further teaching is needed? A - "If I continue to lose weight, I may need an increased dose." B - "I will have more energy with this medication." C - "If I often am constipated and feel tired, I may need an increased dose."

bc with hypothyroid they should be losing weight, if they lose too much you would DECREASE the dose The statement, "If I continue to lose weight, I may need an increased dose," indicates a need for further teaching. Weight loss indicates a need for a decreased dose, not an increased dose. One of the symptoms of hypothyroidism is lack of energy. Thyroid replacement therapy would cause the client to have more energy. The correct time to take thyroid replacement therapy is in the morning. Frequent constipation and continuing to feel tired are indications that the dose may need to be increased.

transsphenoidal hypophysectomy

endoscopic procedure to surgically remove a pituitary tumor through an incision in the sphenoid sinus without disturbing brain tissue

Which action is most important for the nurse to take first after finding a client who has severe hypothyroidism to be unresponsive to attempts to waken her and have a heart rate of 46 beats/min? A - Increasing the IV infusion rate B - Initiating the Rapid Response Team C - Assessing temperature D - Applying oxygen by mask

oxygen mask The most common cause of death with severe hypothyroidism is respiratory failure with decreased gas exchange. The nurse would apply oxygen first and then initiate the Rapid Response Team. Although a decreased body temperature would support the findings that a client with severe hypothyroidism is worsening, assessing it would not be helpful in this situation. Increasing the IV flow rate may not even improve cardiac output because the slow heart rate is not related to a volume deficit but to reduced myocardial contractility.