chapter 50 52, adult nursing endocrine and biliary disorder
The following clients are scheduled for thyroid testing. Which client would be at greatest risk for inaccurate results?
A client who was given salicylates last month. p 1513 use estrogen, androgen, salicylates, phenytoin., anticoagulation, corticosteroid.Drugs such as salicylates and corticosteroids affect the results of thyroid tests if taken within past 3 months. Therefore, inaccurate thyroid test results will be obtained for the client who was given salicylates last month but not for the client who was administered corticosteroids 4 months ago. Kelp is high in iodine, which affects the thyroid test results. However, this factor will not affect the results of the thyroid test for a client avoiding kelp. A client's history of low blood sugar will not affect thyroid test results.
A 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? You Selected:
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? You Selected:
A client with acromegaly is complaining of severe headaches. What does the nurse suspect is the cause of the headaches that is related to the acromegaly?
A pituitary tumor Explanation: When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica, a bony depression in which the pituitary gland rests, are common. There is actually an increase in the secretion of the growth hormone. The headaches would not be caused by decreases in glucose levels. The client does not have cerebral edema.
Which of the following is the primary hormone for the long-term regulation of sodium balance?
Aldosterone
What is the most common cause of hyperaldosteronism?
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.
What clinical manifestations does the nurse recognize would be associated with a diagnosis of hyperthyroidism? Select all that apply.
An elevated systolic blood pressure Muscular fatigability Weight loss. Explanation: Manifestations of hyperthyroidism include an increased appetite and dietary intake, weight loss, fatigability and weakness (difficulty in climbing stairs and rising from a chair), amenorrhea, and changes in bowel function. Atrial fibrillation occurs in 15% of in older adult patients with new-onset hyperthyroidism (Porth & Matfin, 2009). Cardiac effects may include sinus tachycardia or dysrhythmias, increased pulse pressure, and palpitations. These patients are often emotionally hyperexcitable, irritable, and apprehensive; they cannot sit quietly; they suffer from palpitations; and their pulse is abnormally rapid at rest as well as on exertion. They tolerate heat poorly and perspire unusually freely.
Which symptom of thyroid disease is seen in older adults?
Atrial fibrillation Explanation: Symptoms seen in older adults include weight loss and atrial fibrillation. Older adults may not experience restlessness or hyperactivity.
The primary function of the thyroid gland includes which of the following?
Control of cellular metabolic activity
Hypophysectomy is the treatment of choice for which endocrine disorder?
Cushing syndrome Explanation: Transsphenoidal hypophysectomy is the treatment of choice for clients diagnosed with Cushing syndrome resulting from excessive production of adrenocorticotropic hormone (ACTH) by a tumor of the pituitary gland. Hypophysectomy has an 80% success rate.
Propylthiouracil (PTU), rather than methimazole (MMI), is the treatment of choice during pregnancy for those diagnosed with hyperthyroidism due to the teratogenic effects of MMI.
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. Antidiuretic hormone (ADH) levels determine the presence or absence of ADH and testosterone levels.
Which assessment is done by the nurse when conducting a physical examination?
Examine the shape and color of the nails Explanation: During physical examination, the nurse examines the shape and color of the nails and determines whether they are thin, thick, or brittle. The outstretched hands should be examined for tremors. Repeated palpation of the thyroid gland may have serious implications.
A client with Addison's disease has a blood glucose level above 80 mg/dL 30 minutes after receiving 15 g of carbohydrates for symptoms of hypoglycemia. Which of the following would the nurse do now?
Give the client milk and graham crackers. Explanation: Milk and graham crackers contain forms of carbohydrates that take longer to absorb and tend to maintain the blood glucose level for an extended period. The physician should be informed if the client continues to be symptomatic and the blood glucose level is below 80 mg/dL. Maintaining bed rest protects the client from injuries from a fall but does not address the blood glucose issue. Assessing the client's blood glucose level provides a numeric assessment of the blood glucose level and would be performed in an ongoing fashion.
The adrenal cortex is responsible for producing which substances?
Glucocorticoids and androgens
A number of pharmacologic agents are used to treat hyperthyroidism. Which of the following drugs is one of the most commonly prescribed and acts by blocking synthesis of the thyroid hormones?
Methimazole Explanation: Propylthiouracil (PTU) and methimazole are commonly used. They both act by blocking the synthesis of hormones. The other choices suppress the release of the thyroid hormones, except for propranolol which is a beta-adrenergic blocking agent.
The nurse is caring for a client who has an excess amount of potassium being excreted and has a serum level of 6.2 mEq/L. What group of adrenal hormones is likely to be impacting the laboratory result?
Mineralocorticoids Explanation: Mineralocorticoids, primarily aldosterone, maintain water and electrolyte balances. The androgenic hormones convert to testosterone and estrogens. Glucocorticoids, such as cortisol, affect body metabolism, suppress inflammation, and help the body withstand stress.
A nurse is reviewing a laboratory order for a client who is scheduled to be tested for a suspected endocrine disorder. The client was recently seen in the office for bronchitis, and you note that he is still taking cough medication. The nurse explains to the client that he will not be able to get his lab testing done today. Why has the testing been postponed?
The client is being tested for a thyroid disorder
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.
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.
The most common cause of hypothyroidism is which of the following?
The most common cause of hypothyroidism is which of the following?
A nurse working in the ED at a level 1 trauma center is notified that casualties from a multivehicle car accident are currently in transit. The nurse's heart is pounding and mouth is dry. What gland is responsible for this nurse's physiologic response?
adrenal medulla Explanation: The adrenal medulla secretes epinephrine and norepinephrine. These two hormones are released in response to stress or threat to life. They facilitate what has been referred to as the fight-or-flight response.
A nurse is caring for a client with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which finding would indicate that the client has developed fluid overload?
dyspnea and hypertension Explanation: Signs of fluid overload would include confusion, dyspnea, pulmonary congestion, and hypertension. Muscle cramps, diarrhea, and weight gain without edema would be indicative of hyponatremia.
A nurse is caring for a client with suspected diabetes insipidus. Which test does the nurse anticipate the physician will order to confirm the diagnosis?
Fluid deprivation test Explanation: The fluid deprivation test involves withholding water for 4 to 18 hours and periodically checking urine and plasma osmolarity. A client with diabetes insipidus will have an increased serum osmolarity of less than 300 mOsm/kg. Urine osmolarity won't increase. The capillary blood glucose test rapidly measures glucose level in whole blood. The serum ketone test is used to diagnose diabetic ketoacidosis. The urine glucose test monitors glucose levels in urine; however, diabetes insipidus doesn't affect urine glucose levels, so this test isn't appropriate.
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 adjust to stress Explanation: Cortisol, a glucocorticoid, affects almost every organ in the body, helping it respond to a variety of stressors. Its most important function is helping the body adjust to stress.
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 Explanation: 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 patient has been placed on corticosteroid therapy for an Addison's disease. The nurse should be aware of which of the following side effects with this type of therapy? Select all that apply.
Hypertension Alterations in glucose metabolism Poor wound healing Explanation: Side effects of corticosteroid therapy include hypertension, alterations in glucose metabolism, weight gain, and poor wound healing.
A client has had a thyroidectomy. Which of the following would lead the nurse to suspect that the client is developing thyrotoxic crisis?
Hyperthermia Explanation: Thyrotoxic crisis is manifested by hyperthermia (temperature possibly as high as 106oF (41Co). The pulse is rapid and cardiac dysrhythmias are common. The client may experience persistent vomiting, extreme restlessness with delirium, chest pain, and dypsnea. Hoarseness may be noted due to trauma to the vocal cords during surgery. Tetany indicating hypocalcemia would be manifested if the parathyroid glands are accidentally removed. Reference:
Which of the following clinical signs are associated with diabetes insipidus?
Hypotension Explanation: Diabetes insipidus, which causes profound polyuria, may cause clinical signs of volume depletion such as tachycardia and hypotension.
A client has been hospitalized with myxedema. Which of the following actions will the nurse take to care for this client?
Measure the client's arterial blood gases Monitor the client's oxygen saturation levels Turn and reposition the client at regular intervals Give fluids to the client with caution Explanation: Myxedema requires nursing management measures to maintain the client's vital functions. Oxygen saturation levels and arterial blood gases should be monitored and measured to determine the need for assited ventilation. Caution should be used when giving fluids because of the risk of water intoxication. The client should be turned and positionsed to minimize risks associated with immobility. Active warming should be avoided to prevent the client's oxygen demands from increasing and to prevent hypotension. Instead passive warming with a blanked is recommended.
A client is undergoing a diagnostic workup for suspected thyroid cancer. What is the most common form of thyroid cancer in adults?
Papillary carcinoma Explanation: Papillary carcinoma accounts for about 70% of thyroid cancer cases in adults. Follicular carcinoma accounts for roughly 15%; anaplastic carcinoma, about 5%; and medullary carcinoma, about 5%.
Which medication is the treatment of choice for pregnant women diagnosed with hyperthyroidism?
Propylthiouracil (PTU), rather than methimazole (MMI), is the treatment of choice during pregnancy for those diagnosed with hyperthyroidism due to the teratogenic effects of MMI.
A client is transferred to a rehabilitation center after being treated in the hospital for a stroke. Because the client has a history of Cushing's syndrome (hypercortisolism) and chronic obstructive pulmonary disease, the nurse formulates a nursing diagnosis of:
Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. Explanation: Cushing's syndrome causes tissue catabolism, resulting in thinning skin and connective tissue loss; along with immobility related to stroke, these factors increase this client's risk for impaired skin integrity. The exaggerated glucocorticoid activity in Cushing's syndrome causes sodium and water retention which, in turn, leads to edema and hypertension. Therefore, Risk for imbalanced fluid volume and Decreased cardiac output are inappropriate nursing diagnoses. Increased glucocorticoid activity also causes persistent hyperglycemia, eliminating Ineffective health maintenance related to frequent hypoglycemic episodes as an appropriate nursing diagnosis.
Which nursing diagnosis is most appropriate for a client with Addison's disease?
Risk for infection
Mineralocorticoids Explanation: Mineralocorticoids, primarily aldosterone, maintain water and electrolyte balances. The androgenic hormones convert to testosterone and estrogens. Glucocorticoids, such as cortisol, affect body metabolism, suppress inflammation, and help the body withstand stress.
Self-care deficit related to weakness, fatigue, muscle wasting, and altered sleep patterns Explanation: The major goals for the client include decreased risk of injury, decreased risk of infection, increased ability to perform self-care activities, improved skin integrity, improved body image, improved mental function, and absence of complications. The other nursing diagnoses do not apply in Cushing syndrome.
Which laboratory test results should a nurse expect to find in a client diagnosed with Hashimoto's thyroiditis?
T4, 2 µg/dl; T3, 35 ng/dl; TSH 45 mIU/ml Explanation: Normal thyroid function tests are as follows: T4, 5 to 12 µg/dl; T3, 65 to 195 ng/dl; TSH 0.3 to 5.4 mIU/ml. With Hashimoto's thyroiditis, T4 and T3 levels are typically subnormal and TSH is elevated. With primary hyperthyroidism, T4 and T3 levels are elevated and TSH is subnormal. With hypothyroidism, T4 is subnormal and T3 and TSH levels are elevated.
When teaching a client diagnosed with hypothyroidism about medical intervention, which is important for the nurse to communicate?
TH may increase the effect of digitalis preparation. Explanation: Thyroid hormones may increase the pharmacologic effects of digitalis glycosides, anticoagulant agents, and indomethacin, necessitating careful observation and assessment by the nurse for side effects. Reference:
Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis?
Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis?
Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction experiences:
heat intolerance and systolic hypertension.
Risk for infection
serum glucose level.
