Chapter 45 Assessment and Management of Patients with Endocrine Disorders

The nurse is caring for a patient at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the patient? Select all that apply. - Epistaxis - Pallor - Rapid respiratory rate - Bounding pulse - Hypotension

Pallor* Rapid respiratory rate* Hypotension Rationale: The patient at risk is monitored for S/S indicative of addisonian crisis, which can include shock; hypotension; rapid, weka pulse; rapid respiratory rate; pallor; and extreme weakness

A patient is undergoing testing for suspected adrenocortical insufficiency. The care team should ensure that the patient has been assessed for the most common cause of adrenocortical insufficiency. What is the most common cause of this health problem? - Therapeutic use of corticosteroids - Pheochromocytoma - Inadequate secretion of ACTH - Adrenal tumor

Therapeutic use of corticosteroids

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? - thyroid disorder - pituitary disorder - adrenal disorder - parathyroid disorder

pituitary disorder Rationale: 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.

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? - Hyperphosphatemia - Hypophosphaturia - Hypercalcemia - Hypocalcemia

Hypercalcemia Rationale: 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.

Following a thyroidectomy, a client exhibits signs of tetany. The nurse anticipates administering which medication? - methimazole - IV calcium gluconate - propylthiouracil - potassium iodide

IV calcium gluconate Rationale: Usually tetany is treated with IV calcium gluconate. Methimazole, propylthiouracil, and potassium iodide are agents used to treat hyperthyroidism.

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? - Closed - Compression - Incomplete - Stress

Incomplete Rationale: A greenstick fracture involves a break through only part of the cross-section of the bone

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: - potassium - sodium - magnesium - phosphorus

phosphorus Rationale: PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.

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? - Details about the size of the organ and its location - The functioning of endocrine glands - The concentration of a substance in plasma - The client's blood sugar level

The functioning of endocrine glands Rationale: 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.

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 glucose level of 130 mg/dl - bradycardia - a blood pressure of 130/70 mm Hg - a blood pressure of 176/88 mm Hg

a blood pressure of 176/88 mm Hg

A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of: - excessive thirst - severe hypotension - profound neuromuscular irritability - acute gastritis

profound neuromuscular irritability Rationale: Hypoparathyroidism may slow bone resorption, reduce the serum calcium level, and cause profound neuromuscular irritability (as evidenced by tetany). Hypoparathyroidism doesn't alter blood pressure or affect the thirst mechanism, which usually is triggered by fluid volume deficit. Gastritis doesn't cause or result from hypoparathyroidism.

A patent who has been taking corticosteroids for several months has been experiencing muscle wasting. The patuent has asked the nurse for suggestions to address this adverse effect. What should the nurse recommend? - Activity limitation to conserve energy - Consumption of a high-protein diet - Use of OTC vitamin D and calcium supplements - Passive range of motion exercises

Consumption of a high-protein diet Rationale: Muscle wasting can be partly addressed through increased protein intake. Passive ROM exercises maintain flexibility, but do not build muscle mass. Vitamin D and calcium supplements do not decrease muscle wasting.

A nurse is completing an assessment of a client with suspected acromegaly. To assist in making the diagnosis, which question should the nurse ask? - Do you experience skin breakouts? - Have you had a recent head injury? - Is there any family history of acromegaly? - Has your shoe size increased recently?

Has your shoe size increased recently? Rationale: 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 patient is diagnosed with Addison's disease, a condition that results in insufficient production of cortisol. Which of the following is the most important function of cortisol that the nurse needs to consider when caring for a patient with Addison's disease? - Helps the body to adjust - Regulates metabolism - Slows the body's response to inflammation - Maintains blood pressure

Helps the body to adjust

A patient has been admitted to the post-surgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the patient? - Side-lying (lateral) with one pillow under the head - Head of the bed elevated 30 degrees and no pillows placed under the head - Semi-fowlers with the head supported on two pillows - Supine, with a small roll supporting the neck

Semi-fowlers with the head supported on two pillows Rationale: When moving and turning the patient, the nurse carefully supports the patents head and avoids tension on the sutures.

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

Stimulation of calcium reabsorption and phosphate excretion

A client is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by altered thyroid function? - sleep/wake cycle - fluid/electrolyte balance - growth - metabolic rate

metabolic rate Rationale: The thyroid concentrates iodine from food and uses it to synthesize thyroxine (T4) and triiodothyronine (T3). These two hormones regulate the body's metabolic rate.

Cardiac effects of hyperthyroidism include - decreased pulse pressure - palpitations - decreased systolic BP - bradycardia

palpitations Rationale: Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic BP is elevated.

The nurse is planning the care of a patient with hyperthyroidism. What should the nurse specify in the patients meal plan? - A clear liquid diet, high in nutrients - Small, frequent meals, high in protein and calories - Three large, bland meals a day - A diet high in fiber and plant-sourced fat

Small, frequent meals, high in protein and calories Rationale: A patient with hyperthyroidism has an increased appetite. The patient should be counseled to consume several small, well-balanced meals. High calorie, high-protein foods are encouraged. A clear liquid diet would not satisfy the patiebts caloric or hunger needs. A diet rich in fiber and fat should be avoided becasue these foods may lead to GI upset or increase peristalsis.

Kayexalate

- sodium polystyrene sulfonate (SPS) - Make sure to assess bowel sounds before giving

The adrenal cortex is responsible for producing which substances? - Catecholamines and epinephrine - Mineralocorticoids and catecholamines - Glucocorticoids and androgens - Norepinephrine and epinephrine

Glucocorticoids and androgens Rationale: The adrenal glands have two divisions, the cortex and medulla. The cortex produces three types of hormones: glucocorticoids, mineralocorticoids, and androgens. The medulla produces catecholamines — epinephrine and norepinephrine.

A patient with pheochromocytoma has been admitted for an adrenalectomy to be performed the following day. To prevent complications, the nurse should anticipate administration of which of the following? - IV antibiotics - Oral antihypertensives - Parenteral nutrition - IV corticosteroids

IV corticosteroids Rationale: IV administration of corticosteroids may begin on the evening before surgery and continue during the early postoperative period to prevent adrenal insufficiency.

Diabetic Ketoacidosis (DKA)

Shortage of insulin resulting in hyperglycemia and production of ketones Most important electrolyte is K+ Treatment: IV regular insulin bolus- (0.1-0.15 units/kg) then IV continuous infusion of 0.1 unit/kg/hr.

The physician has ordered a fluid deprivation test for a patent suspected of having diabetes insipidus. During the test, the nurse should prioritize what assessments? - Temperature and oxygen saturation - Heart rate and BP - Breath sounds and bowel sounds - Color, warmth, movement, and sensation of extremities

Heart rate and BP Rationale: 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 patients condition needs to be monitored frequently during the test, and the test is terminated if tachycardia, excessive weight loss, or hypotension develops. Consequently, BP and heart rate monitoring are priorities.

During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted? - hormonal underproduction - hormonal overproduction - decrease in hormone levels - increase in hormone levels

decrease in hormone levels Rationale: 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 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 - I will eat lots of chicken and dairy products - I will avoid friends and family members who are sick - I will see my ophthalmologist regularly for a check-up

I may stop taking this medication when I feel better Rationale: 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 patient with a recent diagnosis of hypothyroidism is being treated for an unrelated injury. When administering medications to the patient, the nurse should know that the patients diminished thyroid function may have what effect? - Anaphylaxis - Nausea and vomiting - Increased risk of drug interactions - Prolonged duration of effect

Prolonged duration of effect Rationale: In all patients with hypothyroidism, the effects of analgesic agents, sedatives, and anesthetic agents are prolonged.

The physician has ordered an outpatient dexamethasone suppression test to diagnose the cause of Cushing syndrome in a client who works at night, from 11:00 PM to 7:00 AM, and normally sleeps from 8:00 AM to 4:00 PM. The client has been given the dexamethasone. To ensure the most reliable test results, the nurse arranges for the plasma cortisol concentration to be tested at which time? - 8:00 PM - 12:00 PM - 8:00 AM - 5:00 PM

5:00 PM Rationale: A dexamethasone suppression test is used to diagnose pituitary and adrenal causes of Cushing syndrome. It can be performed on an outpatient basis. Dexamethasone is administered orally at bedtime, and a plasma cortisol concentration is measured when the client awakens the next day. Often, therefore, the medication is administered late in the evening and the measurement taken around 8:00 AM. However, for this client who sleeps during the day, the medication would be given before the 8:00 AM bedtime, and the plasma concentration would be measured soon after awakening in the late afternoon.

The nurse is caring for a patient with hyperparathyroidism. What level of activity would the nurse expect to promote? - Complete bed rest - Bed rest with bathroom privileges - Out of bed to the chair twice a day - Ambulation and activity as tolerated

Ambulation and activity as tolerated Rationale: Mobility with walking or use of a rocking chair for those with limited mobility, is encouraged as much as possible because bones subjected to normal stress give up less calcium. Bed rest should be discouraged because it increases calcium excretion and the risk of renal calculi. Limiting the patient to getting out of bed only a few times a day also increases calcium excretion and the associated risks.

What is the most common cause of hyperaldosteronism? - Deficient potassium intake - An adrenal adenoma - A pituitary adenoma - Excessive sodium intake

An adrenal adenoma Rationale: 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? - Pitting edema of the legs - Frequent urination - An irregular apical pulse - Dry mucous membranes

An irregular apical pulse Rationale: 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.

Evaluation of an adult client reveals over-secretion of growth hormone. Which of the following would the nurse expect to find? - Constant thirst - Bulging forehead - Weight loss - Excessive urine output

Bulging forehead Rationale: 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.

A nurse is preparing to palpate a client's thyroid gland. Which action by the nurse is appropriate? - Place her hands around the client's neck, with the thumbs in the front of the neck, and gently massage the anterior neck - Have the client flex his neck onto his chest and cough while she palpates the anterior neck with her fingertips - Have the client hyperextend his neck and take slow, seep inhalations while she palpates his neck with her fingertips - Encircle the client's neck with both hands, have the client slightly extend his neck and ask him to swallow

Encircle the client's neck with both hands, have the client slightly extend his neck and ask him to swallow Rationale: 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.

Following an addisonian crisis, a patients adrenal function has been gradually regained. The nurse should ensure that the patient knows about the need for supplementary glucocorticoid therapy in which of the following circumstances? - Episodes of high psychosocial stress - Periods of dehydration - Episodes of physical exertion - Administration of a vaccine

Episodes of high psychosocial stress Rationale: During stressful procedures or significant illnesses, additional supplementary therapy wit glucocorticoids is required to prevent addisonian crisis.

A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on the critical care unit. The priority nursing diagnosis for a patient with this condition is what? - Risk for peripheral neurovascular dysfunction - Excess fluid volume - Hypothermia - Ineffective airway clearance

Excess fluid volume Rationale: as the patient retains fluids and develops a sodium deficiency. Restricting fluid intake is a typical intervention for managing this syndrome.

A nurse should perform which intervention for a client with Cushing's syndrome? - Suggest a high-carbohydrate, low-protein diet - Offer clothing or bedding that's cool and comfortable - Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather - Explain that the client's physical changes are a result of excessive corticosteroids

Explain that the client's physical changes are a result of excessive corticosteroids Rationale: 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.

The nurse is caring for a patient diagnosed with hypothyroidism secondary to Hashimoto thyroiditis. When assessing this patient, what sign or symptom would the nurse expect? - Fatigue - Bulging eyes - Palpitations - Flushed skin

Fatigue Rationale: Symptoms of hypothyroidism include extreme fatigue, hair loss, brittle nails, dry skin, voice huskiness or hoarseness, menstrual disturbance, and numbness and tingling of the fingers. Bulging eyes, palpitations, and flushed skin would be signs and symptoms of hyperthyroidism.

A patient with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with the patient to improve the patients nutritional intake. What foods should a patient with Cushing syndrome eat to optimize health? Select all that apply. - Foods high in vitamin D - Foods high in calories - Foods high in protein - Foods high in calcium - Foods high in sodium

Foods high in vitamin D* Foods high in protein* Foods high in calcium Rationale: are recommended to minimize muscle wasting and osteoporosis.

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 - Hypotonic saline - Potassium - Insulin

Hydrocortisone Rationale: 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.

While assisting with the surgical removal of an adrenal tumor, the OR nurse is aware that the patients vital signs change upon manipulation of the tumor. What vital sign changes would the nurse expect to see? - Hyperthermia and tachypnea - Hypertension and heart rate changes - Hypotension and hypothermia - Hyperthermia and bradycardia

Hypertension and heart rate changes Rationale: 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 aware that the clinical symptoms of a patient with hypoparathyroidism are the result of the initial physiologic response of: - Hypocalcemia - Decreased levels of vitamin D - Increased serum levels of phosphate - Cardiac arrhythmias

Hypocalcemia Rationale: Hypoparathyroidism results in hypocalcemia, which triggers a series of physiologic responses, including the choices presented.

A client with Cushing syndrome is admitted to the hospital. During the initial assessment, the client tells the nurse, "The worst thing about this disease is how awful I look. I want to cry every time I look in the mirror." Which statements by the nurse is the best response? - I can refer you to a support group. Talking to someone may help you feel better - If treated successfully, the major physical changes will disappear with time - I do not think you look bad and I am sure your family loves you very much - I can show you how to change your style of dress so that the changes are not so noticeable

If treated successfully, the major physical changes will disappear with time Rationale: If treated successfully, the major physical changes associated with Cushing syndrome disappear with time. The client may benefit from discussion of the effect the changes have had on his or her self-concept and relationships with others. Weight gain and edema may be modified by a low-carbohydrate, low-sodium diet, and a high protein intake may reduce some of the other bothersome symptoms.

A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a documented history of adrenal insufficiency. Considering the patient history and current symptoms, the nurse should anticipate that the patient will be instructed to do which of the following? - Increase his intake of sodium until the GI symptoms improve - Increase his intake of potassium until the GI symptoms improve - Increase his intake of glucose until the GI symptoms improve - Increase his intake of calcium until the GI symptoms improve

Increase his intake of sodium until the GI symptoms improve Rationale: The patient will need to supplemnet dietary intake with added salt during episodes of GI losses of fluid through vomiting and diarrhea to prevent the onset of addisonian crisis. While the patient may experience the loss of other elctrolytes, the major concern is the replacemnt of lost sodium.

Which intervention is the most critical for a client with myxedema coma? - Maintaining a patent airway - Administering an oral dose of levothyroxine (Synthroid) - Warming the client with a warming blanket - Measuring and recording accurate intake and output

Maintaining a patent airway Rationale: 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.

The nurse is caring for a patient with a diagnosis of Addisons disease. What sign or symptom is most closely associated with this health problem? - Truncal obesity - Hypertension - Muscle weakness - Moon face

Muscle weakness Rationale: Patients with Addisons disease demonstrate muscular weakness, anorexia, GI symptoms, fatigue, emaciation, dark pigmentation of the skin and hypotension. Patients with Cushing syndrome demonstrate truncal obesity, moon face, acne, abdominal striae, and hypertension

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? - Thyroid storm - Myxedema coma - Syndrome of inappropriate antidiuretic hormone (SIADH) - Diabetes insipidus

Myxedema coma Rationale: 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.

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 urine output - Monitor bowel patterns - Observe the color of stool - Monitor vital signs every 4 hours

Observe the color of stool Rationale: 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.

A patient 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. - Pupillary response - Creatinine and BUN levels - Potassium level - Peripheral pulses - BP

Potassium level* BP Rationale: The principal action of aldosterone is to conserve body sodium. Patients with aldosteronism exhibit a profound decline in the serum levels of potassium, and hypertension is the most prominent and almost universal sign of aldosteronism.

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? - Retinal detachment - Glaucoma - Pressure on the optic nerve - Corneal abrasions

Pressure on the optic nerve Rationale: 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.

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? - Magnetic resonance imaging - Cortisol level determination - Radioimmunoassay - Computed tomography

Radioimmunoassay Rationale: 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.

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 - Inability to tolerate cold - Thick hard nails - Complaints of sleepiness

Reports of increased appetite Rationale: 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.

You are developing a care plan for a patient with Cushing syndrome. What nursing diagnosis would have the highest priority in this care plan? - Risk for injury related to weakness - Ineffective breathing pattern related to muscle weakness - Risk for loneliness related to disturbed body image - Autonomic dysreflexia related to neurologic changes

Risk for injury related to weakness Rationale: The nursing priority is to decrease the risk of injury by establishing a protective environment. The patient who is weak may require assistance from the nurse in ambulating to prevent falls or bumping corners or furniture. The patients breathing will not be affected and autonomic dysreflexia is not a plausible risk. Loneliness may or may not be an issue for the patient, but safety is a priority

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? - Blood glucose level of 90 mg/dl - Serum sodium level of 134 mEq/L - Blood urea nitrogen (BUN) level of 12 mg/dl - Serum potassium level of 5.8 mEq/L

Serum potassium level of 5.8 mEq/L Rationale: 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.

A nurse explains to a client with thyroid disease that the thyroid gland normally produces: - T3, thyroxine (T4), and calcitonin - TSH, triiodothyroxine, and calcitonin - thyrotropin- releasing hormone (TRH) and TSH - iodine and thyroid-stimulating hormone (TSH)

T3, thyroxine (T4), and calcitonin Rationale: 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.

A patient taking corticosteroids for exacerbation of Cushing'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 - The symptoms are permanent side effects of the corticosteroid therapy - Those symptoms are not related to the corticosteroid therapy - The dose of the medication must be too high and should be lowered

The moon face and acne will resolve when the medication is tapered off Rationale: 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).

A patient is prescribed corticosteroid therapy. What would be riority information for the nurse to give the patient who is prescribed long-term corticosteroid therapy? - The patents diet should be low protein with ample fat - The patient may experience short-term changes in cognition - The patient is at an increased risk for developing infection - The patient is at a decreased risk for development of thrombophlebitis and thromboembolism

The patient is at an increased risk for developing infection Rationale: The patient is at increased risk of infection and masking signs of infection. The cardiovascular effects of therapy may result in development of thrombophlebitis or thromboembolism. Diet should be high in protein with limited fat. Changes in appearance usually disappear when therapy is no longer necessary. Cognitive changes are not common adverse effects.

A patient with suspected adrenal insufficiency has been ordered an adrenocorticotrophic (ACTH) hormone stimulation test. Administration of ACTH caused a marked increase in cortisol levels. How should the nurse interpret this finding? - The patient's pituitary function is compromised - The patient's adrenal insufficiency is not treatable - The patient has insufficient hypothalamic function - The patient would benefit from surgery

The patient's pituitary function is compromised Rationale: An adrenal response to the administration of a stimulating hormone suggests inadequate production of the stimulating hormone. In this case, ACTH is produced by the pituitary gland and, consequently, pituitary hypofunction is suggested. Hypothalamic function is not relevant to the physiology of this problem.

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 glands play a minor role in maintaining homeostasis - The secreted hormones act like target cells - The glands contain ducts that produce the hormones

The secretions are released directly into the blood stream Rationale: 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.

Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis? - Weight loss, increased urination, and increased thirst - Weight gain, decreased appetite, and constipation - Weight loss, increased appetite, and hyperdefecation - Weight gain, increased urination, and purplish-red striae

Weight gain, decreased appetite, and constipation Rationale: Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of hypothyroidism. It's seen most frequently in women older than age 40. Signs and symptoms include weight gain, decreased appetite; constipation; lethargy; dry cool skin; brittle nails; coarse hair; muscle cramps; weakness; and sleep apnea. Weight loss, increased appetite, and hyperdefecation are characteristic of hyperthyroidism. Weight loss, increased urination, and increased thirst are characteristic of uncontrolled diabetes mellitus. Weight gain, increased urination, and purplish-red striae are characteristic of hypercortisolism.

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 blood glucose levels - a decrease in blood pressure - a decrease in appetite - a decrease in urine output

a decrease in urine output Rationale: 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.

A nurse is caring for a client recovering from a hypophysectomy. What would be included in the client's care plan? Select all that apply. a) Assess for neurologic changes b) Offer the client a straw when drinking liquids c) Encourage deep breathing and coughing d) Closely monitor nasal packing and postnasal drainage

a) Assess for neurologic changes d) Closely monitor nasal packing and postnasal drainage Rationale: The client undergoes frequent neurologic assessments to detect signs of increased intracranial pressure and meningitis. The nurse monitors drainage from the nose and postnasal drainage for the presence of cerebrospinal fluid. The client is advised to avoid drinking from a straw, sneezing, coughing, and bending over to prevent dislodging the graft that seals the operative area between the cranium and nose.

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. a) Hypothermia b) Hypotension c) Hypertension d) Hyperventilation e) Hypoventilation

a) Hypothermia* b) Hypotension* e) Hypoventilation Rationale: 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 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? a) Oxygen saturation of 96% b) Temperature of 102ºF c) Blood pressure 90/58 mm Hg d) Heart rate of 62

b) Temperature of 102ºF Rationale: 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 nurse understands that for the parathyroid hormone to exert its effect, what must be present? a) Decreased phosphate level b) Increased calcium level c) Adequate vitamin D level d) Functioning thyroid gland

c) Adequate vitamin D level Rationale: Adequate vitamin D must be present for parathyroid hormone to help regulate calcium metabolism. Vitamin D promotes calcium absorption from the intestines.

The nurse is reviewing a client's history which reveals that the client has had an over-secretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? a) Simmonds' disease b) Acromegaly c) Gigantism d) Dwarfism

c) Gigantism Rationale: 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 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? a) Humidifier b) Indwelling urinary catheter kit c) Cardiac monitor d) Tracheostomy set

d) Tracheostomy set Rationale: 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 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 - thick, coarse skin - weight gain in arms and legs - hypotension

deposits of adipose tissue in the trunk & dorsocervical area Rationale: 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: - restricting potassium - restricting sodium - encouraging fluids - restricting fluids

encouraging fluids Rationale: 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 believes the calcium level fluctuation is due to altered parathyroid function. What is the role of parathormone? - increase serum calcium level - promote urinary secretion of calcium - inhibit release of calcium into extracellular fluid - decrease serum calcium level

increase serum calcium level

A patient has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this patients immediate care? Select all that apply - Administering diuretics to prevent fluid overload - Administering beta blockers to reduce heart rate - Administering insulin to reduce blood glucose levels - Applying interventions to reduce the patients temperature - Administering corticosteroids

- Administering beta blockers to reduce heart rate - Applying interventions to reduce the patients temperature

A patient has been diagnosed with Cushing's syndrome. The nurse would expect which of the following features to be present upon physical examination? Select all that apply. - Thin extremities - Purple striae - Buffalo hump - Truncal obesity - Moon face

*Thin extremities* Purple striae*Buffalo hump* Truncal obesity* Moon face Rationale: Manifestations of Cushing's syndrome (excessive adrenocortical hormones may cause "moon face," "buffalo hump," thinning of the skin, obesity of the trunk and thinness of the extremities, and purple striae.

A client has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this client's immediate care? Select all that apply. - Applying interventions to reduce the client's temperature - Administering insulin to reduce blood glucose levels - Administering corticosteroids - Administering beta blockers to reduce heart rate - Administering diuretics to prevent fluid overload

- Applying interventions to reduce the client's temperature - Administering beta blockers to reduce heart rate Rationale: Thyroid storm necessitates interventions to reduce heart rate and temperature. Diuretics, insulin, and steroids are not indicated to address the manifestations of this health problem.

A nurse works in a walk-in clinic. The nurse recognizes that certain patients are at higher risk for different disorders than other patients. What patient is at a greater risk for the development of hypothyroidism? - A 75-year-old female patient with osteoporosis - A 50-year-old male patent who is obese - A 45-year-old female patient who used oral contraceptives - A 25-year-old male patient who uses recreational drugs

A 75-year-old female patient with osteoporosis Rationale: Even though osteoporosis is not a risk factor for hypothyroidism, the condition occurs most frequently in older women.

The nurse is providing care for an older adult patient whose current medication regimen includes levothyroxine (Synthroid). As a result, the nurse should be aware of the heightened risk of adverse effects when administering an IV dose of what medication? - A fluoroquinolone antibiotic - A loop diuretic - A proton pump inhibitor (PPI) - A benzodiazepine

A benzodiazepine Rationale: Oral thyroid hormones interact with many other medications. Even in small IV doses, hypnotic and sedative agents may induce profound somnolence, lasting fat longer than anticipated and leading to narcosis (stupor like condition). Furthermore, they are likely to cause respiratory depression, which can easily be fatal because of decreased respiratory reserve and alveolar hypoventilation.

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? - Deficient growth hormone - Type 1 diabetes mellitus - Hypothyroidism - Acromegaly

Acromegaly Rationale: 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.

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 - Administer an oral calcium supplement as ordered - Administer a sedative as ordered - Start administering oxygen at 2L/min via a cannula

Administer IV calcium gluconate as ordered Rationale: 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 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? - Parathyroid - Adrenal cortex - Pancreas - Adrenal medulla

Adrenal cortex Rationale: 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 should the nurse teach a patient on corticosteroid therapy in order to reduce the patients risk of adrenal insufficiency? - Take the medication late in the day to mimic the body natural rhythm - Always have enough medication on hand to avoid running out - Skip up to 2 doses in cases of illness involving nausea - Take up to 1 extra dose per day during times of stress

Always have enough medication on hand to avoid running out Rationale: The patient and family should be informed that acute adrenal insufficiency and underlying symptoms will recur if corticosteroid therapy is stopped abruptly without medical supervision.

During the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently? - Weigh the client - Administer oral hydrocortisone - Assess vital signs - Test urine for ketones

Assess vital signs Rationale: Because the client in addisonian crisis is unstable, vital signs and fluid and electrolyte balance should be assessed every 30 minutes until he's stable. Daily weights are sufficient when assessing the client's condition. The client shouldn't have ketones in his urine, so there is no need to assess the urine for their presence. Oral hydrocortisone isn't administered during the first 24 hours in severe adrenal insufficiency.

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? - Shivering - Heart rate of 56-64 bpm - Complaints of nausea - Blood pressure varying between 120/86 and 240/130 mm Hg

Blood pressure varying between 120/86 & 240/130 mm Hg Rationale: Hypertension associated with pheochromocytoma may be intermittent or persistent. Blood pressures exceeding 250/150 mm Hg have been recorded. Such blood pressure elevations are life threatening and can cause severe complications, such as cardiac dysrhythmias, dissecting aneurysm, stroke, and acute kidney failure.

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 - Thyroxine - Thyrotropin - Calcitonin

Iodine

When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted: - Thyroxine - Parathyroid - Calcitonin - Phosphorus

Calcitonin Rationale: 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? - 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 - Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff - The patient complains of pain in the calf when his foot is dorsiflexed - After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery

Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff Rationale: 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.

What interventions can the nurse encourage the client with diabetes insipidus to do in order to control thirst and compensate for urine loss? - Limit the fluid intake at night - Consume adequate amounts of fluid - Weigh daily - Come to the clinic for IV fluid therapy daily

Consume adequate amounts of fluid Rationale: 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.

Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? - Graves disease - Hashimoto disease - Cushing syndrome - Addison disease

Cushing syndrome Rationale: 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.

A patient with hypofunction of the adrenal cortex has been admitted to the medical unit. What would the nurse most likely find when assessing this patient? - Increased body temperature - Jaundice - Copious urine output - Decreased BP

Decreased BP

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? - Determining the presence or absence of testosterone levels - Detecting information about possible tumor growth - Determining the size of the organs and location - Detecting evidence of hormone hyper-secretion

Detecting evidence of hormone hyper-secretion Rationale: 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. Antidiuretic hormone (ADH) levels determine the presence or absence of ADH and testosterone levels.

A 30 year-old female patient has been diagnosed with Cushing syndrome. What psychosocial nursing diagnosis should the nurse most likely prioritize when planning the patients care? - Decisional conflict related to treatment options - Spiritual distress related to changes in cognitive function - Disturbed body image related to changes in physical appearance - Powerlessness related to disease progression

Disturbed body image related to changes in physical appearance

A patient has been diagnosed with thyroidal hypothyroidism. The nurse knows that this diagnosis is consistent with which of the following? - Inadequate secretion of TSH - Failure of the pituitary gland - Dysfunction of the thyroid gland itself - Disorder of the hypothalamus

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

The nurse knows to advise the patient with hyperparathyroidism that he or she should be aware of signs of the common complication of: - Heart palpitations - Kidney stones - Gastric esophageal reflex - Bone fractures

Kidney stones Rationale: The formation of stones in one or both kidneys is caused by the increased urinary excretion of calcium and phosphorus. It occurs in more than 50% of patients with primary hyperparathyroidism. Renal damage causes the kidney stones.

Which of the following would the nurse expect the physician to order for a client with hypothyroidism? - Methimazole - Levothyroxine sodium - Propanolol - Propylthiouracil

Levothyroxine sodium Rationale: Hypothyroidism is treated with thyroid replacement therapy, in the form of desiccated thyroid extract or a synthetic product, such as levothyroxine sodium (Synthroid) or liothyronine sodium (Cytomel). Methimazole and propylthiouracil are antithyroid agents used to treat hyperthyroidism. Propranolol is a beta blocker that can be used to treat hyperthyroidism.

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? - Jog at least 2 miles per day - Maintain a moderate exercise program - Lose weight - Rest as much as possible

Maintain a moderate exercise program Rationale: The nurse should instruct the client to maintain a moderate exercise program. Such a program helps strengthen bones and prevents the bone loss that occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise. Because of weakened bones, a rigorous exercise program such as jogging is contraindicated. Weight loss might be beneficial but it isn't as important as developing a moderate exercise program.

Hypocalcemia is associated with which of the following manifestations? - Muscle twitching - Fatigue - Polyuria - Bowel hypomotility

Muscle twitching Rationale: Clinical manifestations of hypocalcemia include paresthesias and fasciculations (muscle twitching). Bowel hypomotility, fatigue, and polyuria are not associated with hypocalcemia.

Vision and visual fields are altered in disorders of which of the following endocrine glands? - Pancreas - Pituitary - Thyroid - Parathyroid

Pituitary Rationale: 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.

Dilutional hyponatremia occurs in which disorder? - Addison disease - Syndrome of inappropriate antidiuretic hormone (SIADH) Diabetes insipidus (DI) - Pheochromocytoma

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

The nurse is performing a shift assessment of a patient with aldosteronism. What assessments should the nurse include? Select all that apply. - Urine output - Signs o symptoms of venous thromboembolism - Peripheral pulses - Blood pressure - Skin integrity

Urine output* Blood pressure Rationale: The principal action of aldosterone is to conserve body sodium. Alterations in aldosterone levels consequently affect urine output and BP.

A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect? - Diaphoresis, fever, and decreased sweating - Weight gain, constipation, and lethargy - Weight loss, nervousness, and tachycardia - Exophthalmos, diarrhea, and cold intolerance

Weight loss, nervousness, and tachycardia Rationale: 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.

When caring for a client with diabetes insipidus, the nurse expects to administer: - regular insulin - furosemide - 10% dextrose - vasopressin

vasopressin Rationale: 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.

A nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will order daily supplements of calcium and: - iron - folic acid - vitamin D - potassium

vitamin D Rationale: Typically, clients with hypoparathyroidism are ordered daily supplements of vitamin D along with calcium because calcium absorption from the small intestine depends on vitamin D. Hypoparathyroidism doesn't cause a deficiency of folic acid, potassium, or iron. Therefore, the client doesn't require daily supplements of these substances to maintain a normal serum calcium level.

A female client is being successfully treated for Cushing's syndrome. The nurse should expect a decline in: - hair loss - menstrual flow - bone mineralization - serum glucose level

serum glucose level Rationale: Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism, not hair loss, is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth declines. Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.

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: - calcium and phosphorus abnormalities - sodium and potassium abnormalites - sodium and chloride abnormalities - chloride and magnesium abnormalities

sodium and potassium abnormalities Rationale: 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.