Chapter 45: Assessment and Management of Patients with Endocrine Disorders
The nurse auscultates a bruit over the thyroid glands. What does the nurse understand is the significance of this finding?
The patient may have hyperthyroidism. -If palpation discloses an enlarged thyroid gland, both lobes are auscultated using the diaphragm of the stethoscope. Auscultation identifies the localized audible vibration of a bruit. This is indicative of increased blood flow through the thyroid gland associated with hyperthyroidism and necessitates referral to a physician.
Which group of clients should not receive potassium iodide?
Those who are allergic to seafood
Dilutional hyponatremia occurs in which disorder?
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) -Clients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.
A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect?
Weight loss, nervousness, and tachycardia -Weight loss, nervousness, and tachycardia are signs of hyperthyroidism. Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea. Weight gain, constipation, lethargy, decreased sweating, and cold intolerance are signs of hypothyroidism.
A client who is postpartum is receiving intravenous oxytocin, and the client asks the nurse about the function of oxytocin in the body. How should the nurse respond?
"It stimulates the contraction of the pregnant uterus before birth and stimulates the release of breast milk after childbirth."
A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder?
Blood pressure varying between 120/86 and 240/130 mm Hg
Evaluation of an adult client reveals oversecretion of growth hormone. Which of the following would the nurse expect to find?
Bulging forehead
A nurse is assigned to care for a patient with increased parathormone secretion. Which of the following serum levels should the nurse monitor for this patient?
Calcium -Increased secretion of parathormone results in bone resorption. Calcium is released into the blood, increasing serum levels
Which diagnostic test is done to determine a suspected pituitary tumor?
Computed tomography -CT or magnetic resonance imaging is used to diagnose the presence and extent of pituitary tumors.
A client with hypofunction of the adrenal cortex has been admitted to the medical unit. What would the nurse most likely find when assessing this client?
Decreased blood pressure -Decreased blood pressure may occur with hypofunction of the adrenal cortex. Decreased function of the adrenal cortex does not affect the client's body temperature, urine output, or skin tone.
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.
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 - 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.
The nurse is caring for a client with diabetes who developed hypoglycemia. What can the nurse administer to the client to raise the blood sugar level?
Glucagon -Glucagon, a hormone released by alpha islet cells, raises blood sugar levels by stimulating glycogenolysis, the breakdown of glycogen into glucose, in the liver. Insulin is released to lower the blood sugar levels. Cortisone and estrogen are not released from the pancreas.
Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease?
Have regular follow-up care.
The nurse is aware that the clinical symptoms of a patient with hypoparathyroidism are the result of the initial physiologic response of:
Hypocalcemia.
A client is admitted to the hospital and will be undergoing tests to determine if an abdominal mass is present. What should the nurse be sure to document when asking about allergies?
If the client is allergic to shellfish -The nurse documents an allergy to iodine, a component of contrast dyes, or shellfish, and informs the physician.
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
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. -The nurse should observe the color of each stool and test the stool for occult blood.
Vision and visual fields are altered in disorders of which of the following endocrine glands?
Pituitary -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 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
A client with a history of diabetes insipidus seeks medical attention for an exacerbation of symptoms. Which laboratory finding indicates to the nurse that the client has been restricting fluids in an attempt to control the symptoms?
Sodium level of 150 mEq/L
Which hormone is secreted by the posterior pituitary?
Vasopressin -Vasopressin causes smooth muscle, particularly blood vessels, to contract. Calcitonin is secreted by the parafollicular cells of the thyroid gland. Corticosteroids are secreted by the adrenal cortex. Somatostatin is released by the anterior lobe of the pituitary.
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 -Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland. In positive feedback, the opposite occurs.
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
After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. Which electrolyte should the nurse anticipate administering?
Calcium gluconate -Immediate treatment for a client who develops hypocalcemia and tetany after thyroidectomy is calcium gluconate. Potassium chloride and sodium bicarbonate aren't indicated. Sodium phosphorus wouldn't be given because phosphorus levels are already elevated.
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. - Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.
Because there is no one cause for Graves' disease, treatment is relegated to the management of symptoms, or in severe cases, surgery to remove the thyroid gland. Which is not a symptom of Graves' disease?
constipation -Clients with Graves' disease commonly experience diarrhea, increased appetite, weight loss, visual changes such as blurred or double vision, and fine tremors of the hands, causing unusual clumsiness.
A nurse is completing an assessment of a client with suspected acromegaly. To assist in making the diagnosis, which question should the nurse ask?
"Has your shoe size increased recently?" -Excessive skeletal growth occurs only in the feet, the hands, the superciliary ridge, the molar eminences, the nose, and the chin, giving rise to the clinical condition of acromegaly.
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." -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.
A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan?
"Maintain a moderate exercise program."
Antithyroid medications are contraindicated in late pregnancy due to the fact that which of the following may occur? Select all that apply.
- Fetal hypothyroidism - Fetal bradycardia - Goiter - Cretinism
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
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
A nurse is reviewing the laboratory test results of a client diagnosed with SIADH. Which result would the nurse identify as reflecting this condition? Select all that apply.
- Serum osmolality 260 mOsm/Kg - Urine sodium 28 mEq/L - Uric acid 2.5 mg/dL (148.7 µmol/L)
A patient has been taking tricyclic antidepressants for many years for the treatment of depression. The patient has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this patient? Select all that apply.
- Strict intake and output - Neurologic function - Urine and blood chemistry
A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience?
A decrease in urine output
A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience?
A decrease in urine output -Desmopressin (DDAVP), a synthetic vasopressin without the vascular effects of natural ADH, is particularly valuable because it has a longer duration of action and fewer adverse effects than other preparations previously used to treat the disease. DDAVP and lypressin (Diapid) reduce urine output to 2 to 3 L/24 hours. It is administered intranasally; the patient sprays the solution into the nose through a flexible calibrated plastic tube. One or two administrations daily (i.e., every 12 to 24 hours) usually control the symptoms (Papadakis, McPhee, & Rabow, 2013). Vasopressin causes vasoconstriction; thus, it must be used cautiously in patients with coronary artery disease.
Which of the following is a clinical manifestation of hypothyroidism?
A pulse rate below 60 beats/minute.
What is the most common cause of hyperaldosteronism?
An adrenal adenoma -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 -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 the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently?
Assess vital signs.
A client with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse's suspicion of diabetes insipidus?
Below-normal urine osmolality level, above-normal serum osmolality level -In diabetes insipidus, excessive polyuria causes dilute urine, resulting in a below-normal urine osmolality level. At the same time, polyuria depletes the body of water, causing dehydration that leads to an above-normal serum osmolality level. For the same reasons, diabetes insipidus doesn't cause above-normal urine osmolality or below-normal serum osmolality levels.
When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted:
Calcitonin -Calcitonin, secreted in response to high plasma levels of calcium, reduces the calcium level by increasing its deposition in the bone.
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. -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.
The primary function of the thyroid gland includes which of the following?
Control of cellular metabolic activity -The primary function of the thyroid hormone is to control cellular metabolic activity. Oxytocin facilitates milk ejection during lactation and increases the force of uterine contraction during labor and delivery. Antidiuretic hormone (ADH) release results in reabsorption of water into the bloodstream rather than excretion by the kidneys. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone.
Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance?
Desmopressin (DDAVP) -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.
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 -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.
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.
A client sustained a head injury when falling from a ladder. While in the hospital, the client begins voiding large amounts of clear urine and reports being very thirsty. The client states feeling weak and having experienced an 8-pound weight loss since admission. What condition does the nurse expect the client to be tested for?
Diabetes insipidus (DI) -With diabetes insipidus, urine output may be as high as 20 L/24 hours. Urine is dilute, with a specific gravity of 1.002 or less. Limiting fluid intake does not control urine excretion. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weakness, dehydration, and weight loss develop. SIADH will have the opposite clinical manifestations. The client's symptoms are related to the trauma and not to a pituitary tumor. The thyroid gland does not exhibit these symptoms.
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
A nurse should perform which intervention for a client with Cushing's syndrome?
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.
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 -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. -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.
The nurse is reviewing a client's history which reveals that the client has had an oversecretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following?
Gigantism -When oversecretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.
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 -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.
Antithyroid medications are not generally recommended for elderly patients because of which side effect?
Granulocytopenia -Antithyroid medications are not generally recommended for elderly clients because of the increased incidence of side effects such as granulocytopenia and the need for frequent monitoring.
A client has been diagnosed with nephrogenic diabetes insipidus (DI), and the physician is initiating treatment. What medication does the nurse prepare to administer for this client?
Hydrochlorothiazide -The physician prescribes a thiazide diuretic, such as hydrochlorothiazide. The thiazide acts at the proximal convoluted tubule, leaving less fluid for excretion in the distal convoluted tubules, the portion affected by nephrogenic diabetes insipidus (DI). Consequently, the client excretes water, but the total volume is less than in an untreated state. The other diuretics listed do not work on the proximal convoluted tubule and would not be effective in treatment.
A client with a history of Addison's disease and flu-like symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by IV infusion?
Hydrocortisone -Emergency treatment for acute adrenal insufficiency (addisonian crisis) is IV infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic — saline solution.
Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism?
Hypercalcemia
An older adult female client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse should suspect which disorder?
Hyperparathyroidism -Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone. Clients also exhibit hypercalciuria-causing polyuria. Although clients with diabetes mellitus and diabetes insipidus have polyuria, they don't have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than by polyuria
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 -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.
The typical triad of manifestations seen in a client diagnosed with pheochromocytoma does notinclude which of the following?
Hypotension -The typical triad of symptoms seen in clients diagnosed with pheochromocytoma comprises headache, diaphoresis, and palpitations.
When reviewing laboratory results for a patient with a possible diagnosis of hypoparathyroidism, the nurse knows that this condition is characterized by which of the following?
Inadequate secretion of parathormone
A nurse is assigned to support a patient while a cast is being applied to treat a greenstick fracture. The nurse documents that this fracture is classified as what type of fracture?
Incomplete -A greenstick fracture involves a break through only part of the cross-section of the bone.
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. -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:
Intolerance to heat -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 -Oversecretion of thyroid hormones is usually associated with an enlarged thyroid gland known as a goiter. Goiter also commonly occurs with iodine deficiency.
The nurse is teaching a client that the body needs iodine for the thyroid to function. What food would be the best source of iodine for the body?
Iodized table salt -The major use of iodine in the body is by the thyroid. Iodized table salt is the best source of iodine.
The preferred preparation for treating hypothyroidism includes which of the following?
Levothyroxine (Synthroid) -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.
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
Which of the following would the nurse need to be alert for in a client with severe hypothyroidism?
Myxedemic coma -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.
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 -The posterior pituitary gland released oxytocin and antidiuretic hormone. Somatotropin, prolactin, and adrenocorticotropic hormone are released by the anterior pituitary gland.
A client has a dysfunction in one of his glands that is causing a decrease in the level of calcium in the blood. What gland should be evaluated for dysfunction?
Parathyroid gland -The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level. The thyroid, thymus, and adrenal gland do not secrete calcium.
On assessment of a patient with early-stage hypothyroidism, the nurse practitioner assesses for a vague yet significant sign which is:
Paresthesia -Paresthesia refers to numbness and tingling of the fingers. It is a vague sign that is frequently ignored, yet it is linked with hypothyroidism.
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
A client who is being tested for syndrome of inappropriate antidiuretic hormone secretion asks the nurse to explain the diagnosis. While explaining, the nurse states that excessive antidiuretic hormone is secreted from which gland?
Posterior pituitary
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 -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 acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client?
Pressure on the optic nerve - Partial blindness may result from pressure on the optic nerve. Glaucoma does not occur suddenly, and the client did not report injury to suspect corneal abrasions or retinal detachment.
A nurse is caring for a client with suspected hyperparathyroidism. Which condition may contribute to hyperparathyroidism?
Renal failure -Kidney damage can result from the precipitation of calcium phosphate in the renal pelvis and parenchyma, which causes renal calculi (kidney stones), obstruction, pyelonephritis, and kidney injury. Parathyroid hormone release increases, causing hyperparathyroidism. Serum calcium level may rise as a result of hyperparathyroidism. Thyroidectomy may lead to hypoparathyroidism if the parathyroid is also removed during surgery. Steroid use causes calcium to leave bone, suppressing parathyroid hormone.
The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find?
Reports of increased appetite -Signs and symptoms of hyperthyroidism reflect the increased metabolic rate and would include reports of increased appetite, weight loss, and intolerance to heat. Sleepiness, thick hard nails, and intolerance to cold are associated with hypothyroidism.
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
Restricting fluids -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.
Which nursing diagnosis is most appropriate for a client with Addison's disease?
Risk for infection - 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 retentionisn't appropriate because Addison's disease causes polyuria.
Patients with hyperthyroidism are characteristically:
Sensitive to heat -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 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 -Feedback can be either negative or positive. Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland.
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 -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.
The nurse palpates the thyroid gland of a patient suspected of having hyperthyroidism. The nurse documents the positive finding of a gland that is:
Soft with poorly defined borders. -in hyperthyroidism, the thyroid gland is soft to the touch, may pulsate, and sometimes is not clearly defined on ultrasound. This appears due to increased blood flow through the gland.
Parathyroid hormone (PTH) has which effects on the kidney?
Stimulation of calcium reabsorption and phosphate excretion -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.
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.
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?
Temperature of 102ºF - 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.
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
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. -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).
Which of the following hormones would the nurse identify as being secreted by the thyroid gland?
Thyroxine -The thyroid gland secretes thyroxine (T4 or tetraiodothyronine), triiodothyronine (T3), and calcitonin. Parathormone is secreted by the parathyroid glands. Thymosin is secreted by the thymus gland. Somatotropin is secreted by the anterior pituitary gland.
A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside?
Tracheostomy set -After a subtotal thyroidectomy, swelling of the surgical site (the tracheal area) may obstruct the airway. Therefore, the nurse should keep a tracheostomy set at the client's bedside in case of a respiratory emergency. Although an indwelling urinary catheter and a cardiac monitor may be used for a client after a thyroidectomy, the tracheostomy set is more important. A humidifier isn't indicated for this client.
A client with thyroiditis has undergone surgery and is concerned about the barely visible scar. Which suggestion should the nurse give the client to cope with the condition?
Wear clothing that covers the neck -The nurse may suggest that the client wear clothing that covers the neck and assure the client that the scar is almost invisible. Application of medicines, skin graft, and cosmetic surgery are not appropriate suggestions.
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 -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.
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. -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 caring for a client with diabetes insipidus. The nurse should anticipate administering:
vasopressin -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 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 -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.
Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy.
Calcium
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. -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.
Evaluation of an adult client reveals oversecretion of growth hormone. Which of the following would the nurse expect to find?
Bulging forehead -Oversecretion of growth hormone in an adult results in acromegaly, manifested by coarse features, a huge lower jaw, thick lips, thickened tongue, a bulging forehead, bulbous nose, and large hands and feet. Excessive urine output, weight loss, and constant thirst are associated with diabetes insipidus
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany?
Calcium gluconate
Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?
Cushing syndrome -The client with Cushing syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. Regardless of the cause, the normal feedback mechanisms that control the function of the adrenal cortex become ineffective, and the usual diurnal pattern of cortisol is lost. The signs and symptoms of Cushing syndrome are primarily a result of the oversecretion of glucocorticoids and androgens, although mineralocorticoid secretion also may be affected.
The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin?
D -The actions of PTH are increased by the presence of vitamin D.
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority?
Decreased cardiac output -An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse. The client with Addison's disease is at risk for infection; however, reducing infection isn't a priority during an addisonian crisis. Impaired physical mobility and Imbalanced nutrition: Less than body requirements are appropriate nursing diagnoses for the client with Addison's disease, but they aren't priorities in a crisis.
A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine condition should the nurse expect the health care provider to diagnose?
Goiter
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:
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%).
Which feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism?
Hand flexing inward -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. -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.
While assisting with the surgical removal of an adrenal tumor, the OR nurse is aware that the client's vital signs may change upon manipulation of the tumor. What vital sign changes would the nurse expect to see?
Hypertension and heart rate changes -Manipulation of the tumor during surgical excision may cause release of stored epinephrine and norepinephrine, with marked increases in BP and changes in heart rate. The use of sodium nitroprusside and alpha-adrenergic blocking agents may be required during and after surgery. While other vital sign changes may occur related to surgical complications, the most common changes are related to hypertension and changes in the heart rate.
The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with?
Hyperthyroidism - Clients with hyperthyroidism characteristically are restless despite feeling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball. Neck swelling caused by the enlarged thyroid gland often is visible. Hypothyroidism clinical manifestations are the opposite of what is seen as hyperthyroidism. SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client
What does a positive Chvostek's sign indicate?
Hypocalcemia - Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. If the client's facial muscles twitch, it indicates hypocalcemia. Hyponatremia is indicated by weight loss, abdominal cramping, muscle weakness, headache, and postural hypotension. Hypokalemia causes paralytic ileus and muscle weakness. Clients with hypermagnesemia exhibit a loss of deep tendon reflexes, coma, or cardiac arrest.
A client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse help to prepare the client for?
Magnetic resonance imaging (MRI) -A computed tomography (CT) or magnetic resonance imaging (MRI) scan is performed to detect a suspected pituitary tumor or to identify calcifications or tumors of the parathyroid glands. A radioactive iodine uptake test would be useful for a thyroid tumor. Radioimmunoassay determines the concentration of a substance in plasma.
Which intervention is the most critical for a client with myxedema coma?
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
For a client with Graves' disease, which nursing intervention promotes comfort?
Maintaining room temperature in the low-normal range -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
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 -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 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 -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.
Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects?
Sympathetic -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
The nurse on the telemetry floor is caring for a patient with long-standing hypothyroidism who has been taking synthetic thyroid hormone replacement sporadically. What is a priority that the nurse monitors for in this patient?
Symptoms of acute coronary syndrome -The nurse must monitor for signs and symptoms of acute coronary syndrome (ACS), which can occur in response to therapy in patients with severe, long-standing hypothyroidism or myxedema coma, especially during the early phase of treatment. ACS must be aggressively treated at once to avoid morbid complications (e.g., myocardial infarction).
Which of the following endocrine disorder causes the patient to have dilutional hyponatremia?
Syndrome of inappropriate antidiuretic hormone secretion (SIADH) -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
A nurse explains to a client with thyroid disease that the thyroid gland normally produces:
T3, thyroxine (T4), and calcitonin. -The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.
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. -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.
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 -The adrenal cortex manufactures and secretes glucocorticoids, such as cortisol, which affect body metabolism, suppress inflammation, and help the body withstand stress.
A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find:
deposits of adipose tissue in the trunk and dorsocervical area. -Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moon face), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.
When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of:
encouraging fluids. -The nurse should encourage fluid intake to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn't necessary in hyperparathyroidism.
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 -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.
When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of:
fresh fruits. -Cushing's syndrome causes sodium retention, which increases urinary potassium loss. Therefore, the nurse should advise the client to increase the intake of potassium-rich foods, such as fresh fruit. The client should restrict the consumption of dairy products, processed meats, cereals, and grains because they contain significant amounts of sodium. Although the client should consume foods high in calcium and protein, the client should find these nutrients in low-sodium foods.
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 -A glucose tolerance test in combination with a growth hormone measurement is the most reliable method of confirming acromegaly.
A client presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What could be causing this client's symptoms?
hyperpituitarism -Acromegaly (hyperpituitarism) is a condition in which growth hormone is oversecreted after the epiphyses of the long bones have sealed. A client with acromegaly has coarse features, a huge lower jaw, thick lips, a thickened tongue, a bulging forehead, a bulbous nose, and large hands and feet. When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica are common.
For the first 72 hours after thyroidectomy surgery, a nurse should assess a client for Chvostek's sign and Trousseau's sign because they indicate:
hypocalcemia. -A client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal of or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek's sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau's sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren't present with hypercalcemia, hypokalemia, or hyperkalemia.
A client is suspected of having central diabetes insipidus and is scheduled to undergo a vasopressin challenge test. When preparing the client for this test, the nurse anticipates that the test would be done:
in the morning after fasting.
A client has been experiencing a decrease in serum calcium. After diagnostics, the physician believes the calcium level fluctuation is due to altered parathyroid function. What is the role of parathormone?
increase serum calcium level -The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level.
Although not designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones involved in increasing blood pressure and volume and maturation of red blood cells?
kidneys -The kidneys release renin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys also secrete erythropoietin, a substance that promotes the maturation of red blood cells.
The nurse is completing discharge teaching with a client with hyperthyroidism who has been treated with radioactive iodine at an outpatient clinic. The nurse instructs the client to
monitor for symptoms of hypothyroidism. -Symptoms of hyperthyroidism may be followed later by those of hypothyroidism and myxedema. Hypothyroidism also commonly occurs in clients with previous hyperthyroidism who have been treated with radioiodine or antithyroid medications or thyroidectomy (surgical removal of all or part of the thyroid gland).
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.
During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and:
phosphorus. -PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.
