Ch 52 Brunner

A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia?

Acromegaly Explanation: Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and, commonly, sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism and growth hormone deficiency aren't associated with hyperglycemia.

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

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.

Parathyroid hormone (PTH) has which effects on the kidney?

Stimulation of calcium reabsorption and phosphate excretion Explanation: PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.

When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect:

a blood pressure of 176/88 mm Hg. Explanation: Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.

When caring for a client with diabetes insipidus, the nurse expects to administer:

vasopressin. Explanation: Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

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 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 with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland?

Adrenal cortex Explanation: Excessive secretion of aldosterone in the adrenal cortex is responsible for the client's hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone.

What is the most common cause of hyperaldosteronism?

An adrenal adenoma Explanation: An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake and pituitary stimulation.

A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?

An irregular apical pulse Explanation: Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.

During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in which of the following?

Detecting evidence of hormone hypersecretion Explanation: The evaluation of body structures helps the nurse detect evidence of hypersecretion or hyposecretion of hormones. This helps in the assessment of findings that are unique to specific endocrine glands. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and its location.

A health care provider suspects that a thyroid nodule may be malignant. The nurse knows to prepare information for the patient based on the usual test that will be ordered to establish a diagnosis. What is that test?

Fine-needle biopsy of the thyroid gland Explanation: Fine needle biopsy of the thyroid gland is often used to establish the diagnosis of thyroid cancer. The purpose of the biopsy is to differentiate cancerous thyroid nodules from noncancerous nodules and to stage the cancer if detected. The procedure is safe and usually requires only a local anesthetic.

Which outcome indicates that treatment of a client with diabetes insipidus has been effective?

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.

A client with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with the client to improve the patient's nutritional intake. What foods should a client with Cushing syndrome eat to optimize health? Select all that apply.

Foods high in vitamin D Foods high in protein Foods high in calcium Explanation: Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and osteoporosis. Referral to a dietitian may assist the client in selecting appropriate foods that are also low in sodium and calories.

A client is having chronic pain from arthritis. What type of hormone is released in response to the stress of this pain that suppresses inflammation and helps the body withstand stress?

Glucocorticoids Explanation: Glucocorticoids, such as cortisol, affect body metabolism, suppress inflammation, and help the body withstand stress. Mineralocorticoids, primarily aldosterone, maintain water and electrolyte balances. The androgenic hormones convert to testosterone and estrogens.

The most common type of goiter is caused by lack of which of the following?

Iodine Explanation: 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.

The preferred preparation for treating hypothyroidism includes which of the following?

Levothyroxine (Synthroid) Explanation: Synthetic levothyroxine (Synthroid or Levothroid) is the preferred preparation for treating hypothyroidism and suppressing nontoxic goiters (enlargements of the thyroid gland). Radioactive iodine is the most common form of treatment for Graves' disease in North America. Both PTU and Tapazole are used for hyperthyroidism.

For a client with Graves' disease, which nursing intervention promotes comfort?

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 are correct statements about the relationship between the hypothalamus and the pituitary gland? Select all that apply.

Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain. Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones. Explanation: Many endocrine glands respond to stimulation from the pituitary gland, which is connected by a stalk to the hypothalamus in the brain. Under the influence of the hypothalamus, the lobes of the pituitary gland secrete various hormones. Even though the pituitary gland is called the 'master gland,' the hypothalamus influences the pituitary gland. The pituitary gland is called the 'master gland' because it regulates the function of other endocrine glands.

Which glands regulate calcium and phosphorous metabolism?

Parathyroid Explanation: Parathormone (parathyroid hormone), the protein hormone produced by the parathyroid glands, regulates calcium and phosphorous metabolism. The thyroid gland controls cellular metabolic activity. The adrenal medulla at the center of the adrenal gland secretes catecholamines, and the outer portion of the gland, the adrenal cortex, secretes steroid hormones. The pituitary gland secretes hormones that control the secretion of additional hormones by other endocrine glands.

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 Furosemide Amphetamine Explanation: 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.

A client visits the clinic to seek treatment for disturbed sleep cycles and depressed mood. Which glands and hormones help to regulate sleep cycles and mood?

Pineal gland, melatonin Explanation: The pineal gland secretes melatonin, which aids in regulating sleep cycles and mood. Melatonin plays a vital role in hypothalamic-pituitary interaction. The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes. The parathyroid glands secrete parathormone, which increases the levels of calcium and phosphorus in the blood. The adrenal cortex secretes corticosteroids hormones, which influence many organs and structures of the body.

Vision and visual fields are altered in disorders of which of the following endocrine glands?

Pituitary Explanation: The pituitary gland is located close to the optic nerves and hence causes pressure on these nerves; thus, changes in the vision and the visual fields may occur.

The nurse is administering a medication to a client with hyperthyroidism to block the production of thyroid hormone. The client is not a candidate for surgical intervention at this time. What medication should the nurse administer to the client?

Propylthiouracil Explanation: Antithyroid drugs, such as propylthiouracil and methimazole are given to block the production of thyroid hormone preoperatively or for long-term treatment for clients who are not candidates for surgery or radiation treatment. Levothyroxine would increase the level of thyroid and be contraindicated in this client. Spironolactone is a diuretic and does not have the action of blocking production of thyroid hormone and neither does propranolol, which is a beta-blocker.

The nurse is reviewing the plan of care for a client with a disorder of the thyroid gland. Which diagnostic test would the nurse expect the physician to order to evaluate thyroid hormones?

Radioimmunoassay Explanation: A radioimmunoassay determines the concentration of a substance in plasma. A T3 determination by radioimmunoassay evaluates thyroid hormone function. A CT or magnetic resonance imaging scan is done to detect a suspected tumor and to determine organ size and placement. Cortisol levels determine adrenal hyperfunction.

A nurse is caring for a female client with hypothyroidism. The client is extremely upset about her altered physical appearance. She doesn't want to take her medication because she doesn't believe it's doing any good. What should the nurse do?

Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency. Explanation: Telling the client that she'll soon experience improvement is supportive and encouraging and offers direction in a way that motivates her to take her medication consistently. Telling the client that she looks fine and that she'll soon feel better discount the feelings she's currently experiencing. Advising the client to accept herself is parental and direct at a time when the client needs support and understanding.

A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?

Tetany Explanation: Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.

Which suggestion would the nurse include for a client who has had a thyroidectomy to reduce tension on the suture line?

Use the hands to support the head when rising from a sitting position. Explanation: After a thyroidectomy, the client should use the hands to support the head while rising from a sitting position. This type of support helps avoid strain to the neck muscles and surgical incision. The client is encouraged to gradually increase his or her activity level as tolerated. Comfort measures, such as analgesics, would be used to manage pain; however they would have no effect on reducing tension on the suture line.

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:

myxedema coma. Explanation: 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.

A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of:

sodium and potassium abnormalities. Explanation: In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes directly.

A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching?

"I may stop taking this medication when I feel better." Explanation: The client requires additional teaching because he states that he may stop taking corticosteroids when he feels better. Corticosteroids should be gradually tapered by the physician. Tapering the corticosteroid allows the adrenal gland to gradually resume functioning. Corticosteroids increase the risk of infection and may mask the early signs of infection, so the client should avoid people who are sick. Corticosteroids cause muscle wasting in the extremities, so the client should increase his protein intake by eating foods such as chicken and dairy products. Corticosteroids have been linked to glaucoma and corneal lesions, so the client should visit his ophthalmologist regularly.

A nurse is caring for a client who was recently diagnosed with hyperparathyroidism. Which statement by the client indicates the need for additional discharge teaching?

"I will increase my fluid and calcium intake." Explanation: The client requires additional teaching if he states that he will increase his calcium intake. Hyperparathyroidism causes extreme increases in serum calcium levels. The client should increase his fluid intake, but he should limit his calcium and vitamin D intake. The client should continue to take pain mediations as scheduled and have regular follow-up visits with his physician. Tingling around the lips is a sign of hypercalcemia and should be reported to the physician immediately.

During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement?

"You must avoid hyperextending your neck after surgery." Explanation: To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesn't affect swallowing.

After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate?

Administer IV calcium gluconate as ordered. Explanation: When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered.

A patient is diagnosed with overactivity of the adrenal medulla. What epinephrine value does the nurse recognize is a positive diagnostic indicator for overactivity of the adrenal medulla?

450 pg/mL Explanation: Normal plasma values of epinephrine are 100 pg/mL (590 pmol/L); normal values of norepinephrine are generally less than 100 to 550 pg/mL (590 to 3,240 pmol/L). Values of epinephrine greater than 400 pg/mL (2,180 pmol/L) or norepinephrine values greater than 2,000 pg/mL (11,800 pmol/L) are considered diagnostic of pheochromocytoma (associated with overactivity of the adrenal medulla). Values that fall between normal levels and those diagnostic of pheochromocytoma indicate the need for further testing.

A client with acromegaly is complaining of severe headaches. What does the nurse suspect is the cause of the headaches that is related to the acromegaly?

A pituitary tumor Explanation: When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica, a bony depression in which the pituitary gland rests, are common. There is actually an increase in the secretion of the growth hormone. The headaches would not be caused by decreases in glucose levels. The client does not have cerebral edema.

Before discharge, what should a nurse instruct a client with Addison's disease to do when exposed to periods of stress?

Administer hydrocortisone I.M. Explanation: Clients with Addison's disease and their family members should know how to administer I.M. hydrocortisone during periods of stress. Although it's important for the client to keep well hydrated during stress, the critical component in this situation is to know how and when to use I.M. hydrocortisone. Capillary blood glucose monitoring isn't indicated in this situation because the client doesn't have diabetes mellitus. Hydrocortisone replacement doesn't cause insulin resistance.

The most common cause of hypothyroidism is which of the following?

Autoimmune thyroiditis Explanation: The most common cause of hypothyroidism is autoimmune thyroiditis (Hashimoto's disease), in which the immune system attacks the thyroid gland. Hypothyroidism can occur in patient with previous hyperthyroidism that has been treated with radioiodine, antithyroid medication treatment, or thyroidectomy.

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:

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.

A client with severe hypoparathyroidism is experiencing tetany. What medication, prescribed by the physician for emergency use, will the nurse administer to correct the deficit?

Calcium gluconate Explanation: Tetany and severe hypoparathyroidism are treated immediately by the administration of an IV calcium salt, such as calcium gluconate. The other medications are not effective for the treatment of calcium deficit.

Trousseau's sign is elicited by which of the following?

Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. Explanation: A positive Trousseau's sign is suggestive of latent tetany. A positive Chvostek's sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. A positive Allen's test is demonstrated by the palm remaining blanched with the radial artery occluded. A positive Homans' sign is demonstrated when the patient complains of pain in the calf when his foot is dorsiflexed.

Which diagnostic test is done to determine a suspected pituitary tumor?

Computed tomography Explanation: CT or magnetic resonance imaging is used to diagnose the presence and extent of pituitary tumors.

What interventions can the nurse encourage the client with diabetes insipidus to do in order to control thirst and compensate for urine loss?

Consume adequate amounts of fluid. Explanation: 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.

The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin?

D Explanation: The actions of PTH are increased by the presence of vitamin D.

A patient is having diagnostic testing for suspected hyperthyroidism. Which of the following diagnostics correlate with this endocrine disorder? Select all that apply.

Decrease in serum thyroid-stimulating hormone (TSH) Increased T3 Increased T4 Increase in radioactive iodine uptake Explanation: Laboratory findings include a decrease in serum TSH (with primary disease), increased Ts and T4, and an increase in radioactive iodine uptake.

Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance?

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 patient has been diagnosed with thyroidal hypothyroidism. The nurse knows that this diagnosis in consistent with which of the following?

Dysfunction of the thyroid gland itself Explanation: Thyroidal hypothyroidism results from thyroid gland dysfunction. The other causes result in central, secondary, or tertiary causes if there is inadequate secretion of TSH.

Which nursing action would the nurse include when caring for a client with endemic goiter and experiencing respiratory symptoms?

Elevating the head of the bed. Explanation: The nurse should monitor the respiratory status and elevate the head of the bed to relieve respiratory symptoms. A high-iodine diet does not relieve respiratory distress. Although proper air circulation in the room and avoiding physical exertion may be important, these actions do not address the respiratory symptoms.

A nurse is preparing to palpate a client's thyroid gland. Which action by the nurse is appropriate?

Encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. Explanation: When palpating the thyroid gland, the nurse should encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. As the client swallows, the gland is palpated for enlargement as the tissue rises and falls. Having the client flex his neck wouldn't allow for palpation. Massaging the area or checking during inhalation doesn't allow for the movement of tissue that swallowing provides.

A group of students is reviewing material about endocrine system function. The students demonstrate understanding of the information when they identify which of the following as secreted by the adrenal medulla?

Epinephrine Explanation: The adrenal medulla secretes epinephrine and norepinephrine. The adrenal cortex manufactures and secretes glucocorticoids, mineralocorticoids, and small amounts of androgenic sex hormones. Glucagon is released by the pancreas.

A client is being seen in the clinic to receive the results of the lab work to determine thyroid levels. The nurse observes the client's eyes appear to be bulging, and there is swelling around the eyes. What does the nurse know that the correct documentation of this finding is?

Exophthalmos Explanation: Exophthalmos is an abnormal bulging or protrusion of the eyes and periorbital swelling. These findings are not consistent with retinal detachment.

The nurse is caring for a client who has developed diabetes insipidus. The cause is unknown, and the physician has ordered a diagnostic test to determine if the cause is nephrogenic or neurogenic. What test will the nurse prepare the client for?

Fluid deprivation test Explanation: A fluid deprivation test can diagnose diabetes insipidus (DI) and differentiate neurogenic DI from nephrogenic DI. The other tests listed are nonspecific tests that help support diagnosis.

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?

Fluid deprivation test Explanation: 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 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?

Fluid volume deficit related to increased urine output Explanation: 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.

Which feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism?

Hand flexing inward Explanation: Carpopedal spasm is evidenced by the hand flexing inward. Cardiac dysrhythmia is a symptom of hyperparathyroidism. Moon face and buffalo hump are the symptoms of Cushing syndrome. A bulging forehead is a symptom of acromegaly.

Which of the following precautions would be most appropriate when caring for a client being treated with radioactive iodine (RAI) for a thyroid tumor?

Handle body fluids carefully. Explanation: The nurse handles body fluids carefully to prevent spread of contamination. Corticosteroids are not prescribed for thyroid tumor. Monitoring the respiratory status and administering prescribed medicines at the same time each day are unrelated to the care of a client receiving RAI.

Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease?

Have regular follow-up care. Explanation: The nurse should instruct the client with Graves' disease to have regular follow-up care because most cases of Graves' disease eventually result in hypothyroidism. Annual thyroid-stimulating hormone tests and the client's ability to recognize signs and symptoms of thyroid dysfunction will help detect thyroid abnormalities early. Recording intake and output is important for clients with fluid and electrolyte imbalances but not thyroid disorders. DDAVP is used to treat diabetes insipidus. Although exercise to improve cardiovascular fitness is important, the importance of regular follow-up is most critical for this client.

Thyroid storm is a severe form of hyperthyroidism that can be fatal if not treated. Medical management includes pharmacotherapy. Which of the following drugs have proved helpful? Select all that apply.

Hydrocortisone Acetaminophen Methimazole Iodine Explanation: Salicylates (i.e., aspirin) are contradicted because they displace thyroid hormone from binding to proteins and make hypermetabolism worse.

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism?

Hypercalcemia Explanation: Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low (hypophosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased.

On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery?

Hypocalcemia Explanation: Hypocalcemia may follow thyroid surgery if the parathyroid glands were removed accidentally. Signs and symptoms of hypocalcemia may be delayed for up to 7 days after surgery. Thyroid surgery doesn't directly cause serum sodium, potassium, or magnesium abnormalities. Hyponatremia may occur if the client inadvertently received too much fluid; however, this can happen to any surgical client receiving I.V. fluid therapy, not just one recovering from thyroid surgery. Hyperkalemia and hypermagnesemia usually are associated with reduced renal excretion of potassium and magnesium, not thyroid surgery.

Which condition may occur during the postoperative period in a client who underwent adrenalectomy because of sudden withdraw of excessive amounts of catecholamines?

Hypoglycemia Explanation: Hypotension and hypoglycemia may occur in the postoperative period because of the sudden withdrawal of excessive amounts of catecholamines. Hypertension and hyporeflexia are not related to the sudden withdraw of excessive amounts of catecholamines.

A client with acromegaly has been given the option of a surgical approach or a medical approach. The client decides to have a surgical procedure to remove the pituitary gland. What does the nurse understand this surgical procedure is called?

Hypophysectomy Explanation: The treatment of choice is surgical removal of the pituitary gland (transsphenoidal hypophysectomy) through a nasal approach. The surgeon may substitute an endoscopic technique using microsurgical instruments to reduce surgical trauma. A hysteroscopy is a gynecologic procedure. The thyroid gland is not involved for a surgical procedure. Ablation is not a removal of the pituitary gland.

A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize are progressing to myxedema coma? Select all that apply.

Hypothermia Hypotension Hypoventilation Explanation: Severe hypothyroidism is called myxedema. Advanced, untreated myxedema can progress to myxedemic coma. Signs of this life-threatening event are hypothermia, hypotension, and hypoventilation. Hypertension and hyperventilation indicate increased metabolic responses, which are the opposite of what the client would be experiencing.

The nurse knows to assess a patient with hyperthyroidism for the primary indicator of:

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.

The nurse assesses a patient who has an obvious goiter. What type of deficiency does the nurse recognize is most likely the cause of this?

Iodine Explanation: Oversecretion of thyroid hormones is usually associated with an enlarged thyroid gland known as a goiter. Goiter also commonly occurs with iodine deficiency.

A client is scheduled for a thyroid panel. The nurse understands that this test would involve which of the following?

Measurement of blood hormone levels Explanation: A thyroid panel measures the blood hormone levels of TSH, T3, and T4. It is a blood test, not a radiograph (x-ray). A radioactive iodine uptake test is a radionuclide study that determines thyroid function. A thyroid scan would involve the use of a radioactive substance to visualize the thyroid gland or its activity.

The nurse is teaching a client about the dietary restrictions related to his diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid?

Milk Explanation: Clients with hyperparathyroidism should use a low-calcium diet (fewer dairy products) and drink at least 3 to 4 L of fluid daily to dilute the urine and prevent renal stones from forming. It is especially important that the client drink fluids before going to bed and periodically throughout the night to avoid concentrated urine. Bananas, chicken livers, and hamburgers do not require avoidance. Milk is the highest in calcium content.

A patient with a history of hypothyroidism is admitted to the intensive care unit unconscious and with a temperature of 95.2ºF. A family member informs the nurse that the patient has not taken thyroid medication in over 2 months. What does the nurse suspect that these findings indicate?

Myxedema coma Explanation: Myxedema coma is a rare life-threatening condition. It is the decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious (Ross, 2012a). This condition may develop with undiagnosed hypothyroidism and may be precipitated by infection or other systemic disease or by use of sedatives or opioid analgesic agents. Patients may also experience myxedema coma if they forget to take their thyroid replacement medication.

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?

Myxedema coma Explanation: 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.

Which of the following would the nurse need to be alert for in a client with severe hypothyroidism?

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 of the following assessments should the nurse perform to determine the development of peptic ulcers when caring for a patient with Cushing's syndrome?

Observe the color of stool. Explanation: The nurse should observe the color of each stool and test the stool for occult blood. Bowel patterns, vital signs, and urine output do not help in determining the development of peptic ulcers.

An instructor is preparing a teaching plan for a class on the various pituitary hormones. Which hormone would the instructor include as being released by the posterior pituitary gland?

Oxytocin Explanation: The posterior pituitary gland released oxytocin and antidiuretic hormone. Somatotropin, prolactin, and adrenocorticotropic hormone are released by the anterior pituitary gland.

The nurse is caring for a client at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the client? Select all that apply.

Pallor Rapid respiratory rate Hypotension Explanation: The client at risk is monitored for signs and symptoms indicative of addisonian crisis, which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness. Epistaxis and a bounding pulse are not symptoms or signs of an addisonian crisis.

The nurse is caring for a client with hypoparathyroidism. When the nurse taps the client's facial nerve, the client's mouth twitches and the jaw tightens. What is this response documented as related to the low calcium levels?

Positive Chvostek's sign Explanation: If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek's sign. A positive Trousseau's sign is elicited by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Positive Babinski's sign is elicited by stroking the sole of the foot. Paresthesia is not a symptom that can be elicited; it is felt by the client.

ADH is secreted by which gland?

Posterior pituitary Explanation: Antidiuretic hormone (vasopressin) is secreted by the posterior pituitary gland. The anterior pituitary secretes growth hormone. The adrenal gland secretes glucocorticoids and mineralocorticoids. The thyroid gland secretes T3 and T4.

A client has been assessed for aldosteronism and has recently begun treatment. What are priority areas for assessment that the nurse should frequently address? Select all that apply.

Potassium level Blood pressure Explanation: Clients with aldosteronism exhibit a profound decline in the serum levels of potassium, and hypertension is the most prominent and almost universal sign of aldosteronism. Pupillary response, peripheral pulses, and renal function are not directly affected.

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 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.

Patients with hyperthyroidism are characteristically:

Sensitive to heat Explanation: Those with hyperthyroidism tolerate heat poorly and may perspire unusually freely. Their condition is characterized by symptoms of nervousness, hyperexcitability, irritability, and apprehension.

A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease?

Serum potassium level of 5.8 mEq/L Explanation: Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level.

Which of the following agents suppress release of thyroid hormones? Select all that apply.

Sodium iodide Potassium iodide Dexamethasone Saturated solution of potassium iodide (SSKI) Explanation: Sodium iodide, potassium iodide, dexamethasone, and SSKI suppress the release of thyroid hormones. Methimazole blocks the synthesis of thyroid hormone.

A client has a decreased level of thyroid hormone being excreted. What will the feedback loop do to maintain the level of thyroid hormone required to maintain homeostatic stability?

Stimulate more hormones using the negative feedback system Explanation: Feedback can be either negative or positive. Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland.

Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects?

Sympathetic Explanation: Beta-adrenergic blocking agents are important in controlling the sympathetic nervous system effects of hyperthyroidism. For example, propranolol is used to control nervousness, tachycardia, tremor, anxiety, and heat intolerance.

Dilutional hyponatremia occurs in which disorder?

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Explanation: Clients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.

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?

Tachycardia Explanation: 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 client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following?

The functioning of endocrine glands Explanation: Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma. The measurement of blood hormone levels will not reveal a client's blood sugar level. Radiographs of the chest or abdomen determine the size of the organ and its location.

A patient taking corticosteroids for exacerbation of Crohn's disease comes to the clinic and informs the nurse that he wants to stop taking them because of the increase in acne and moon face. What can the nurse educate the patient regarding these symptoms?

The moon face and acne will resolve when the medication is tapered off. Explanation: Cushing syndrome is commonly caused by the use of corticosteroid medications and is infrequently the result of excessive corticosteroid production secondary to hyperplasia of the adrenal cortex. The patient develops a "moon-faced" appearance and may experience increased oiliness of the skin and acne. If Cushing syndrome is a result of the administration of corticosteroids, an attempt is made to reduce or taper the medication to the minimum dosage needed to treat the underlying disease process (e.g., autoimmune or allergic disease, rejection of a transplanted organ).

When describing the difference between endocrine and exocrine glands, which of the following would the instructor include as characteristic of endocrine glands?

The secretions are released directly into the blood stream. Explanation: The endocrine glands secrete hormones, chemicals that accelerate or slow physiologic processes, directly into the bloodstream. This characteristic distinguishes endocrine glands from exocrine glands, which release secretions into a duct. Hormones circulate in the blood until they reach receptors in target cells or other endocrine glands. They play a vital role in regulating homeostatic processes.

What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking the prescribed antithyroid medication?

Thyrotoxic crisis Explanation: Antithyroid medication is given to treat hyperthyroidism. Although rare, this condition may occur in clients with undiagnosed or inadequately treated hyperthyroidism. Therefore, this client is at risk for thyrotoxic crisis, an abrupt and life-threatening form of hyperthyroidism. Myxedema coma results from severe hypothyroidism. Diabetes insipidus (DI) and SIADH do not correlate with hyperthyroidism or the medication taken for hyperthyroidism.

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?

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.

The nurse is performing a shift assessment of a client with aldosteronism. What assessments should the nurse include? Select all that apply.

Urine output Blood pressure Explanation: The principal action of aldosterone is to conserve body sodium. Alterations in aldosterone levels consequently affect urine output and BP. The client's peripheral pulses, risk of VTE, and skin integrity are not typically affected by aldosteronism.

A nurse caring for a patient with diabetes insipidus is reviewing the patient's laboratory results. What is an expected urinalysis finding?

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.

The nurse practitioner who assesses a patient with hyperthyroidism would expect the patient to report which of the following conditions?

Weight loss Explanation: Weight loss is consistent with a diagnosis of hyperthyroidism. The other conditions are found in hypothyroidism.

A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. What is being tested?

adrenal function Explanation: The adrenal cortex manufactures and secretes glucocorticoids, such as cortisol, which affect body metabolism, suppress inflammation, and help the body withstand stress.

Trousseau sign is elicited

by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. Explanation: A positive Trousseau sign is suggestive of latent tetany. A positive Chvostek sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes the mouth, nose, and eye to spasm or twitch. The palm remaining blanched when the radial artery is occluded demonstrates a positive Allen test. The radial artery should not be used for an arterial puncture. A positive Homans sign is demonstrated when the client reports pain in the calf when the foot is dorsiflexed.

Which diagnostic test is done to determine suspected pituitary tumor?

computed tomography scan Explanation: A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and their location. Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma.

During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted?

decrease in hormonal levels Explanation: Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland. In positive feedback, the opposite occurs.

A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which finding would indicate that the client has developed fluid overload?

dyspnea and hypertension Explanation: Signs of fluid overload would include confusion, dyspnea, pulmonary congestion, and hypertension. Muscle cramps, diarrhea, and weight gain without edema would be indicative of hyponatremia.

A client has been experiencing a decrease in serum calcium. After diagnostics, the physician proposes the calcium level fluctuation is due to altered parathyroid function. What is the typical number of parathyroid glands?

four Explanation: The parathyroid glands are four (some people have more than four) small, bean-shaped bodies, each surrounded by a capsule of connective tissue and embedded within the lateral lobes of the thyroid.

A client presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What is the most reliable method of confirming the client's condition?

glucose tolerance test + GH measurement Explanation: A glucose tolerance test in combination with a growth hormone measurement is the most reliable method of confirming acromegaly.

A young client has a significant height deficit and is to be evaluated for diagnostic purposes. What could be the cause of this client's disorder?

pituitary disorder Explanation: Pituitary disorders usually result from excessive or deficient production and secretion of a specific hormone. Dwarfism occurs when secretion of growth hormone is insufficient during childhood.

A nurse is caring for a client with a kidney disorder. What hormone released by the kidneys initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume?

renin Explanation: Renin is released from the kidneys and initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys secrete erythropoietin, a substance that promotes the maturation of red blood cells. Cholecystokinin released from cells in the small intestine stimulates contraction of the gallbladder to release bile when dietary fat is ingested. Gastrin is released within the stomach to increase the production of hydrochloric acid.