Ch. 31 Endocrine disorders PrepU
A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug? Dysuria Leg cramps Tachycardia Blurred vision
*Tachycardia* Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse reactions to this agent include tachycardia. Dysuria, leg cramps, and blurred vision aren't associated with levothyroxine.
A patient has been admitted to an acute medical unit with a diagnosis of diabetes insipidus with a neurogenic etiology. When planning this patient's care, what diagnosis should be the nurse's most likely priority? a. Fluid volume deficit related to increased urine output b. Acute confusion related to alterations in electrolytes c. Altered nutrition: less than body requirements related to decreased intake d. Risk for injury related to decreased level of consciousness
*a. Fluid volume deficit related to increased urine output * The hallmark of diabetes insipidus, and the primary focus of interventions, is the copious urine output that accompanies the condition. Confusion, injury, and impaired nutrition are less likely to result from diabetes insipidus.
A nurse caring for a hospitalized patient with hypoparathyroidism reviews his electrocardiogram (ECG) strip and completes a cardiac assessment. The nurse recognizes the diagnostic sign of: a. Bradycardia. b. Prolonged QT interval. c. First-degree AV heart block. d. Third-degree AV heart block.
*b. Prolonged QT interval.* Hypoparathyroidism is associated with hypocalcemia, which ↓ myocardial contractility and prolongs the QT interval. *Hyper*calcemia causes bradycardia and heart blocks.
What interventions can the nurse encourage the client with diabetes insipidus to do in order to control thirst and compensate for urine loss? a. Come to the clinic for IV fluid therapy daily. b.Limit the fluid intake at night. c. Consume adequate amounts of fluid. d. Weigh daily.
*c. Consume adequate amounts of fluid. * The nurse teaches the client to consume sufficient fluid to control thirst and to compensate for urine loss. The client will not be required to come in daily for IV fluid therapy. The client should not limit fluid intake at night if thirst is present. Weighing daily will not control thirst or compensate for urine loss.
A nurse should perform which intervention for a client with Cushing's syndrome? a. Offer clothing or bedding that's cool and comfortable. b. Suggest a high-carbohydrate, low-protein diet. c. Explain that the client's physical changes are a result of excessive corticosteroids. d. Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather.
*c. Explain that the client's physical changes are a result of excessive corticosteroids. * 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.
An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and periorbital area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: a. thyroid storm. b. cretinism. c. myxedema coma. d. Hashimoto's thyroiditis.
*c. myxedema coma.* Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.
Which intervention is the most critical for a client with myxedema coma? a. Administering an oral dose of levothyroxine (Synthroid) b. Warming the client with a warming blanket c. Measuring and recording accurate intake and output d. Maintaining a patent airway
*d. Maintaining a patent airway* Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. Although myxedema coma is associated with severe hypothermia, a warming blanket shouldn't be used because it may cause vasodilation and shock. Gradual warming with blankets is appropriate. Thyroid replacement is administered I.V., not orally. Although recording intake and output is important, these interventions aren't critical at this time.
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: a. in a few days. b. in 3 to 4 months. c. immediately. d. in 1 to 2 weeks.
*d. in 1 to 2 weeks.* 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).
What should the nurse suspect when hourly assessment of urine output on a postcraniotomy patient exhibits a urine output from a catheter of 1,500 mL for 2 consecutive hours?
Diabetes insipidus Diabetes insipidus is an abrupt onset of extreme polyuria that commonly occurs in patients after brain surgery. Cushing's syndrome is excessive glucocorticoid secretion resulting in sodium and water retention. SIADH is the result of increased secretion of antidiuretic hormone (ADH). The patient becomes volume-overloaded, urine output diminishes, and serum sodium concentration becomes dilute. Adrenal crisis is undersecretion of glucocorticoids resulting in profound hypoglycemia, hypovolemia, and hypotension.
A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: thyroiditis. Graves' disease. Hashimoto's thyroiditis. multinodular goiter.
Graves' disease. Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).
A 42-year-old man with a history of pheochromocytoma is being treated in the intensive care unit after experiencing an acute exacerbation of his condition. This patient will require the nurse to perform which of the following assessments most frequently?
HR and BP Blood pressures exceeding 250/150 mm Hg have been recorded in cases of pheochromocytoma. Such BP elevations are life-threatening and can cause severe complications. Consequently, constant monitoring of BP and heart rate is a priority over other assessments, even though each of the listed assessments is relevant and appropriate.
A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication? Exophthalmos Thyroid storm Myxedema coma Tibial myxedema
Myxedema coma Myxedema coma, severe hypothyroidism, is a life-threatening condition that may develop if thyroid replacement medication isn't taken. Exophthalmos (protrusion of the eyeballs) is seen with hyperthyroidism. Although thyroid storm is life-threatening, it's caused by severe hyperthyroidism. Tibial myxedema (peripheral mucinous edema involving the lower leg) is associated with hypothyroidism but isn't life-threatening.
The nurse is aware that the best time of day for the total large corticosteroid dose is between: a. 7:00 AM and 8:00 AM b. 8:00 PM and 9:00 PM c. 4:00 AM and 5:00 AM d. 4:00 PM and 6:00 PM
a. 7:00 AM and 8:00 AM The best time of day for the total large corticosteroid dose is in the early morning, between 7:00 AM and 8:00 AM, when the adrenal gland is most active. Therefore, dosage at this time of day will result in the maximum suppression of the adrenal gland.
