Chapter 52
The nurse recognizes that which of the following agents suppress release of thyroid hormones? Select all that apply.
Sodium iodide Potassium iodide Saturated solution of potassium iodide (SSKI)
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
Parathyroid hormone (PTH) has which effects on the kidney?
Stimulation of calcium reabsorption and phosphate excretion
During an assessment of a client's functional health pattern, which question by the nurse directly addresses the client's thyroid function?
"Do you experience fatigue even if you have slept a long time?"
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."
A nursing student asks the instructor why the pituitary gland is called the "master gland." What is the best response by the instructor?
"It regulates the function of other endocrine glands."
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."
During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement?
"You must avoid hyperextending your neck after surgery."
The nurse is aware that the best time of day for the total large corticosteroid dose is between:
7-8am
The nurse is reviewing a client's laboratory studies and determines that the client has an elevated calcium level. What does the nurse know will occur as a result of the rise in the serum calcium level?
A rise in serum calcium stimulates the release of calcitonin from the thyroid gland.
Which of the following hormones controls secretion of adrenal androgens?
ACTH
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
Before discharge, what should a nurse instruct a client with Addison's disease to do when exposed to periods of stress?
Administer hydrocortisone I.M.
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
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
Which diagnostic test is done to determine suspected pituitary tumor?
CT
Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany?
Calcium gluconate
What interventions can the nurse encourage the client with diabetes insipidus to do in order to control thirst and compensate for urine loss?
Consume adequate amounts of fluid
Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?
Cushing syndrome
A client sustained a head injury when falling off of a ladder. While in the hospital, the client begins voiding large amounts of clear urine and states he is very thirsty. The client states that he feels weak, and he has had an 8-lb weight loss since admission. What should the client be tested for?
DI
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 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
A patient is being evaluated for a diagnosis of pheochromocytoma. He is scheduled for epinephrine and norepinephrine laboratory tests. Which of the following plasma levels is a positive value that is diagnostic for pheochromocytoma?
Epinephrine @ 450 pg/mL
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 adrenal cortex is responsible for producing which substances?
Glucocorticoids and androgens
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
Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease?
Have regular follow up care
The typical triad of manifestations seen in a client diagnosed with pheochromocytoma does not include which of the following?
Hypotension
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
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?
MRI
For a client with Graves' disease, which nursing intervention promotes comfort?
Maintaining room temperature in the low-normal range
When preparing teaching plan for a client with an endocrine disorder, the nurse includes information about hormone regulation. Which of the following would the nurse include?
Most disorders result from over- or underproduction of the hormone.
Which of the following would the nurse need to be alert for in a client with severe hypothyroidism?
Myxedemic coma
A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add?
Related to bone demineralization resulting in pathologic fractures
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
Dilutional hyponatremia occurs in which disorder?
SIADH
Which of the following endocrine disorder causes the patient to have dilutional hyponatremia?
SIADH
A nurse explains to a client with thyroid disease that the thyroid gland normally produces:
T3, thyroxine (T4), and calcitonin.
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?
Temp 102
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.
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
Which group of clients should not receive potassium iodide?
Those who are allergic to seafood
Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis?
Weight gain, decreased appetite, and constipation
A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect?
Weight loss, nervousness, and tachycardia
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.
A 35-year-old female client who complains of weight gain, facial hair, absent menstruation, frequent bruising, and acne is diagnosed with Cushing's syndrome. Cushing's syndrome is most likely caused by:
a corticotropin-secreting pituitary adenoma.
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 nurse is performing an examination and notes that the client exhibits signs of exophthalmos. What has the nurse observed?
abnormal bulging or protrusion of the eyes
A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia?
acromegaly
A nurse understands that for the parathyroid hormone to exert its effect, what must be present?
adequate vitamin d level
A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland?
adrenal cortex
Which type of cell secretes glucagon and promotes gluconeogenesis?
alpha
What is the most common cause of hyperaldosteronism?
an adrenal adenoma
A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?
an irregular apical pulse
During the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently?
assess vital signs
Evaluation of an adult client reveals oversecretion of growth hormone. Which of the following would the nurse expect to find?
bulging forehead
Trousseau sign is elicited
by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff.
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
A patient has been diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following manifestations would be expected in this patient?
concentrated urine
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
What dietary modifications should be recommended to a client with hyperthyroidism?
consume a high protein diet
Undersecretion of thyroid hormone during fetal and neonatal development can cause which of the following?
cretinism
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority?
decreased cardiac output
A client with a traumatic brain injury is producing an abnormally large volume of dilute urine. Which alteration to a hormone secreted by the posterior pituitary would the nurse expect to find?
deficient production of vasopressin
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.
Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance?
desmopressin
A patient has been diagnosed with thyroidal hypothyroidism. The nurse knows that this diagnosis in consistent with which of the following?
dysfunction of the thyroid itself
When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of:
encouraging fluids
The nurse obtains a complete family history of a client with a suspected endocrine disorder based on which rationale?
endocrine disorders can be inherited
Which of the following would the nurse expect to find in a client with severe hyperthyroidism?
exophthalmos
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
Which outcome indicates that treatment of a client with diabetes insipidus has been effective?
fluid intake is less than 2,500
When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of:
fresh fruits
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
Which feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism?
hand flexing inward
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?
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
Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism?
hypercalcemia
The nurse auscultates a bruit over the thyroid glands. What does the nurse understand is the significance of this finding?
hyperthyroidism
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
On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery?
hypocalcemia
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 with adrenal insufficiency is gravely ill and presents with nausea, vomiting, diarrhea, abdominal pain, profound weakness, and headache. The client's family reports that the client has been doing strenuous yard work all day and was sweating profusely. Nursing management of this client would include observation for signs of
hyponatremia and hyperkalemia.
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
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 nurse knows to assess a patient with hyperthyroidism for the primary indicator of:
intolerance to heat
The most common type of goiter is caused by lack of which of the following?
iodine
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
One of the most frequently occurring complications (55% occurrence) of primary hyperparathyroidism is:
kidney stones
After teaching a class about the endocrine system, the instructor determines that the students need additional instruction when they identify which of the following as an endocrine gland?
kidneys
The nurse is attempting to locate the thyroid gland in order to determine if it is enlarged. Where should the nurse palpate the thyroid gland?
lower neck anterior to the trachea
Which intervention is the most critical for a client with myxedema coma?
maintaining a patent airway
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
A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit?
moon face
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
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
A nursing coordinator calls the intensive care unit (ICU) to inform the department that a client with a suspected pheochromocytoma will be admitted from the emergency department. The ICU nurse should prepare to administer which drug to the client?
nitroprusside
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
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
Cardiac effects of hyperthyroidism include
palpitations
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
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
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
During an assessment of a patient with SIADH, the nurse notes the unexpected result of:
pitting edema in the lower extremities
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
Nursing care for a client in addisonian crisis should include which intervention?
placing the client in a private room
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
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
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:
profound neuromuscular irritability.
A nurse educator is teaching a chapter on "The Function of the Endocrine System." Which hormone would not be included as one of the six hypothalamic hormones?
prolactin
A nurse is caring for a client with Cushing's syndrome. Which would the nurse not include in this client's plan of care?
provide a high sodium diet
A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
restricting fluids
Patients with hyperthyroidism are characteristically:
sensitive to heat
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
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
Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects?
sympathetic
A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug?
tachycardia
Which of the following hormones would the nurse identify as being secreted by the thyroid gland?
thyroxine
A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering:
vasopressin
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:
vitamin d
A client has suffered from several autoimmune disorders over the last 25 years, and lately has developed a new set of symptoms. The client's healthcare provider suspects Addison's disease. Which symptom would the nurse not expect to see?
weight gain
A client has had a thyroidectomy. Which of the following would lead the nurse to suspect that the client is developing thyrotoxic crisis?
hyperthermia
Which of the following glands is considered the master gland?
pituitary
Which hormone is secreted by the posterior pituitary?
vasopressin
Which medication is the treatment of choice for pregnant women diagnosed with hyperthyroidism?
PTU
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?
Potassium 5.8
The nurse is administering a medication to a client with hyperthyroidism to block the production of thyroid hormone. The client is not a candidate for surgical intervention at this time. What medication should the nurse administer to the client?
Propylthiouracil
When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted:
calcitonin
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
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
A nurse should expect a client with hypothyroidism to report:
puffiness of the face and hands
