Endocrine

The male client with hypopituitarism asks the nurse how long he will have to take testosterone hormone replacement therapy. Which is the nurse's best answer?

""When your beard thickens and your voice deepens, the dose is decreased, but treatment will continue forever."

A female client has a decrease in all pituitary hormones. Which assessment question by the nurse elicits the best information?

"Do you have any biological children?" Hypofunction of all anterior pituitary hormones is often caused by postpartum hemorrhage of the anterior pituitary gland. This usually occurs immediately after delivery but may be delayed for several years. Asking the client if she has children of her own would let the nurse know of this possibility.

Which client statement alerts the nurse to the possibility of hypothyroidism?

"I am always tired, even with 10 or 12 hours of sleep." Clients with hypothyroidism usually feel tired or weak despite getting many hours of sleep. Thyroid problems are not inherited. Heat intolerance is indicative of hyperthyroidism. Loss of taste is not a manifestation of hyperthyroidism.

Which is the best instruction for the nurse to give a client scheduled for a thyroid scan?

"No special radiation precautions are needed." The radioactive iodine used in thyroid scans is of low intensity and has such a short half-life that the client is not considered to be a radiation hazard. Thus, no radiation precautions are necessary

A client with hypercortisolism has an irregular pulse. Which is the nurse's priority intervention?

Assessing the telemetry reading Hypercortisolism causes potassium imbalances, which can lead to fatal dysrhythmias. With an irregular pulse, the nurse should assess the client's cardiac rhythm. The finding should be documented, but the nurse cannot wait an hour to take further action.

A client just diagnosed with acromegaly is scheduled for a hypophysectomy. Which statement made by the client indicates a need for clarification regarding this treatment?

I hope I can go back to wearing size 8 shoes instead of size 12." Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement are not reversible.

client is brought to the emergency department via rescue squad in acute adrenal crisis. Which action by the nurse is the priority?

Start an IV line if the client does not already have one.

How does a tropic hormone differ from other hormones?

Tropic hormones stimulate other endocrine glands to secrete hormones The target tissues for tropic hormones are other endocrine glands. The effect of these agents is to stimulate another endocrine gland to secrete its hormone. The other statements are inaccurate

Which serum laboratory values alert the nurse to the possibility of hyperaldosteronism

a. Sodium, 150 mEq/L c. Potassium, 2.5 mEq/L e. pH, 7.28 Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis.

The nurse is teaching a client about self-care after menopause. Which teaching topic is the priority?

weight bearing excercise After menopause, the ovaries produce less estrogen. This leads to decreased bone mass. The client should engage in regular weight-bearing exercise to prevent fractures

A client is going home after an endoscopic transnasal hypophysectomy. Which statement by the client indicates an adequate understanding of discharge instructions?

"I will keep food on upper shelves so I do not have to bend over." After this surgery, the client must take care to avoid activities that can increase intracranial pressure. The client should avoid bending from the waist and should not bear down, cough, or lie flat

Which pulse rate finding in a client taking a drug that stimulates beta1 receptors requires immediate action by the nurse?

50bpm Stimulation of beta1 receptor sites in the heart has positive chronotropic and inotropic actions. The nurse expects an increase in heart rate and increased cardiac output. The client with a heart rate of 50 beats/min would be cause for concern because this would indicate that the client was not responding to the medication.

A client has a hormone deficiency. Which deficiency is the highest priority?

A deficiency of thyroid-stimulating hormone (TSH) is the most life-threatening deficiency of the hormones listed. TSH is needed to ensure proper synthesis and secretion of the thyroid hormones, whose functions are essential for life

A client thought to have a problem with the pituitary gland is given a stimulation test using insulin. A short time later, blood analysis reveals elevated levels of growth hormone (GH) and adrenocorticotropic hormone (ACTH). Which is the nurse's interpretation of this finding?

A normal pituitary response to insulin Some tests for pituitary function involve administering agents that are known to stimulate the secretion of specific pituitary hormones and then measuring the response. Such tests are termed stimulation tests. For example, the presence of insulin in those with normal pituitary function causes increased release of GH and ACTH. The stimulation test for GH or ACTH assessment involves injecting the client with regular insulin (0.05 to 1 U/kg of body weight) and checking circulating levels of GH and ACTH.

18. The nursing assistant reports that while pouring urine into a 24-hour urine container, some urine splashed the nursing assistant's hand. Which action by the nurse is best?

Ask the assistant if he or she washed the hands afterward. For safety, the nurse should find out if the assistant washed his or her hands. The nursing assistant should do this for two reasons. First, it is part of Standard Precautions to wash hands after client care. Second, if the container did have preservative in it, this would wash it away. The preservative may be caustic to the skin. The nurse can call the laboratory while the assistant is washing hands if needed. The nursing assistant would then need to fill out an incident or exposure report and may or may not need to go to Employee Health. The nursing assistant also needs further education on Standard Precautions, which include wearing gloves.

A female client is beginning treatment with bromocriptine (Parlodel). The nurse has initiated teaching sessions about potential side effects. Which is the most important point of instruction?

Be sure to eat 20 to 30 grams of fiber daily Constipation is an expected side effect of treatment with bromocriptine, so the client should be taught ways to prevent and/or manage it. Eating plenty of fiber and drinking fluids is a good plan.

Which is the expected clinical manifestation for a client who has excessive production of melanocyte-stimulating hormone?

Darkening of the skin Melanocyte-stimulating hormone increases the size of melanocytes in the skin and increases the amount of pigment (melanin) that they produce. The other actions do not occur as the result of excessive melanocyte-stimulating hormone function

A client presents with elevations in triiodothyronine (T3) and thyroxine (T4) and with normal thyroid-stimulating hormone (TSH) levels. Which is the nurse's priority intervention?

Monitor the apical pulse The client's laboratory findings suggest that the client is experiencing hyperthyroidism. The increased metabolic rate can cause an increase in the client's heart rate, and the client should be monitored for the development of dysrhythmias. Placing the client on a telemetry monitor might also be a precaution. Synthroid is given for hypothyroidism. Propranolol is a beta blocker often used to lower sympathetic nervous system activity in hyperthyroidism. Trousseau's sign is a test for hypocalcemia.

An older client is being admitted to the hospital for pneumonia. The client has no other health problems. Which action by the nurse is best?

Offer the client fluids every hour or two. A normal age-related endocrine change is decreased antidiuretic hormone (ADH) production. This results in a more dilute urine output, which can lead to dehydration. If no contraindications are known, the nurse should offer (or delegate) the client something to drink at least every 2 hours

Twelve hours after a total thyroidectomy, the client develops stridor. Which is the nurse's priority intervention

Prepare for emergency tracheostomy and call the health care provider. Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. One emergency measure is to remove the surgical clips to relieve the pressure. This might be a physician function. The nurse should prepare to assist with emergency intubation or tracheostomy while notifying the provider or the Rapid Response Team. The other choices do not address the emergency situation.

A client has a condition of excessive catecholamine release. Which assessment finding does the nurse correlate with this condition?

incr pulse rate Catecholamines are responsible for the "fight-or-flight" stress response. Activation of the sympathetic nervous system can be correlated with *tachycardia*

A client asks why a 24-hour urine collection is necessary to measure excreted hormones instead of a random voided specimen. Which response by the nurse is most accurate?

"We are testing for a hormone secreted on a circadian rhythm."

A male client reports fluid secretion from his breasts. What does the nurse assess next in this client?

anterior pituitary hormones Breast fluid and milk production are induced by the presence of prolactin, secreted from the anterior pituitary gland.

A client has cortisol deficiency and is being treated with prednisone (Deltasone). Which instruction by the nurse is most appropriate?

"If you work outside when it's hot, you may need another drug." Steroid dosage adjustment may be needed and might be difficult, especially in hot weather, when the client is sweating a great deal more than normal.

A client scheduled for a partial thyroidectomy asks the nurse why she is being given an iodine preparation before surgery. Which is the nurse's best response?

"It will prevent excessive bleeding during surgery." Iodine preparations decrease the size and vascularity of the thyroid gland, reducing the risk for hemorrhage and the potential for thyroid storm during surgery. The other answers are not accurate.

A client who has been taking high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition, which has now resolved, asks the nurse why she needs to continue taking corticosteroids. Which is the nurse's best response?

"Once you start corticosteroids, you have to be weaned off them." One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone (ACTH) and adrenal production of cortisol.

A client with hyperaldosteronism is being treated with spironolactone (Aldactone) before surgery. Which precautions does the nurse teach this client

"Read the label before using salt substitutes." Spironolactone is a potassium-sparing diuretic used to control potassium levels. Its use can lead to hyperkalemia. Although the goal is to increase the client's potassium, unknowingly adding potassium can cause complications. Some salt substitutes are composed of potassium chloride and should be avoided by clients on spironolactone therapy

On the second postoperative day after a subtotal thyroidectomy, the client tells the nurse that he feels numbness and tingling around his mouth. Which is the nurse's priority intervention?

Assess Chvostek's sign. Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which could progress to cause tetany and seizure activity. The nurse should assess the client further by testing for Chvostek's sign and Trousseau's sign. Then the nurse should notify the provider

A client has documented acromegaly. During a physical assessment before surgery for a knee replacement, the nurse discovers that she has a moderately enlarged liver. Which is the nurse's best action?

Document the finding and monitor the client. Clients with acromegaly or gigantism commonly have organomegaly of the heart and liver. Other

A client has hypothyroidism and has been started on levothyroxine (Synthroid). Which assessment finding leads the nurse to conclude that the treatment is effective?

Heart rate is 70 beats/min and regular. Hypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and constipation. If a client's heart rate is bradycardic while on thyroid hormone replacement, this is an indicator that the replacement may not be adequate. Conversely, a heart rate above 100 beats/min may indicate that the client is receiving too much of the thyroid hormone. The other assessment findings do not give any indication as to whether treatment is successful.

13. Which client statement indicates the need for clarification regarding the instructions for collecting a 24-hour urine specimen for assessment of endocrine function?

I will start the collection by saving the first urine of the morning." The 24-hour urine collection specimen is started when the client first arises and urinates. The first urine specimen is discarded because there is no way to know how long it has been in the bladder, but the time is noted. The client adds all urine voided after that first discarded specimen during the next 24 hours. When the 24-hour mark is reached, the client voids one last time and adds this specimen to the collection. The preservative, if used, must be added to the container at the beginning of the collection. Clients can continue to take all their normal medications during a timed urine collection

Which dietary modification does the nurse provide for a client with hyperthyroidism?

Increased calories, proteins, and carbohydrates The client is hypermetabolic and has an increased need for calories, carbohydrates, and proteins. Proteins are especially important

A client has a deficiency of aldosterone. Which assessment finding does the nurse correlate with this condition?

Increased urine output Aldosterone, the major mineralocorticoid, maintains extracellular fluid volume. It promotes sodium and water reabsorption and potassium excretion in the kidney tubules. A client with an aldosterone deficiency will have increased urine output. Sodium and potassium levels are normal; in aldosterone deficiency, the client would have hyponatremia and hyperkalemia.

A client has been diagnosed with hypothyroidism. Which medication is the nurse prepared to administer to treat the client's bradycardia?

Levothyroxine sodium (Synthroid) The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine sodium. If the heart rate were so slow that it became an emergency, then atropine or epinephrine might be an option for short-term management. Inderal is a beta blocker and would be contraindicated for a client with bradycardia.

Which physical characteristics are indicative of anterior pituitary hyperfunction?

Protrusion of the lower jaw c. Enlarged hands and feet d. Kyphosis e. Barrel-shaped chest f. Excessive sweating

A client is admitted to the hospital with exacerbation of heart failure, which had been stable for several years. Which finding does the nurse associate with the client's current condition

Recent prescription for thyroid hormone replacement medication Thyroid hormones regulate metabolism. Starting on thyroid replacement therapy can lead to an increase in heart rate and tissue oxygen use, which can lead to an exacerbation of heart failure if the client's heart is not able to meet these increased demands.

A client has a hypofunctioning anterior pituitary gland. Which hormones does the nurse expect to be affected by this?

Thyroid-stimulating hormone Follicle-stimulating hormone growth hormone Thyroid-stimulating hormone, follicle-stimulating hormone, and growth hormone all are secreted by the anterior pituitary gland. Vasopressin is secreted from the posterior pituitary gland. Calcitonin is secreted from the thyroid gland

The client with adrenal hyperfunction screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, "I feel like I am going crazy." Which is the nurse's best response?

You feel this way because of your hormone levels." Hypercortisolism can cause the client to show neurotic or psychotic behavior. The client needs to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and steadier blood cortisol levels

A client on medication after a bilateral adrenalectomy calls the clinic asking to be seen for "stomach flu" with nausea and vomiting. Which response by the nurse is best?

"You need to go to the nearest emergency department today." The client with bilateral adrenalectomy is on lifelong cortisol replacement therapy. The client cannot skip any doses of his or her medication. If the client has nausea and vomiting for longer than 24 hours and cannot give himself or herself an injection of hydrocortisone, the client must go to the nearest emergency department to get it

Which are common key features of hormones

-Hormones may travel long distances to get to their target tissues. -Continued hormone activity requires continued production and secretion. -Control of hormone activity is caused by negative feedback mechanisms. Hormones are secreted by endocrine glands and travel through the body to reach their target tissues. Hormone activity can increase or decrease according to the body's needs, and continued hormone activity requires continued production and secretion. Control is maintained via negative feedback

Which dietary alterations does the nurse make for a client with Cushing's disease?

Low carbohydrate, low sodium The client with Cushing's disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of total calories and carbohydrates to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately

The nurse is caring for a client who has undergone a hypophysectomy. Which is the nurse's priority postoperative intervention?

Report clear or yellow drainage from the nose or incision site A light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal leak. The client should have the head of the bed elevated after surgery. Although deep breathing is important postoperatively, coughing should be avoided to prevent cerebrospinal leakage.

A client who had a trans-sphenoidal hypophysectomy 2 days ago now has nuchal rigidity. Which is the nurse's priority action?

Take the client's temperature and other vital signs. Nuchal rigidity is a major manifestation of meningitis, a potential postoperative complication associated with this surgery. Meningitis is an infection; usually the client will also have a fever and tachycardia. Range-of-motion exercises are inappropriate because meningitis is a possibility. Although pain medication may be a palliative measure, it is not the most appropriate initial action.

Which conditions may cause hypopituitarism?

a. Benign pituitary tumors c. Anorexia nervosa d. Hypotension e. Shock

When performing personal care on a middle-aged woman, the nurse observes that the client has very little pubic and axillary hair. Which is the nurse's best action?

Ask the client if she has less pubic hair now than 5 years ago. Although pubic hair thickness varies from person to person, loss of pubic hair is associated with gonadotropin deficiency. The nurse needs to determine whether this manifestation is normal for this client.

A client has bilateral patchy areas of skin depigmentation on the arms and the face. Which action by the nurse is best?

Assess the client's mucous membranes Vitiligo, patchy areas of depigmentation of the skin, is associated with primary hypofunction of the adrenal glands. Other assessment findings in this condition include uneven pigmentation on the mucous membranes. The other assessments are not related to vitiligo.

The new nurse is assessing a client with suspected pheochromocytoma. Which action by the nurse requires the precepting nurse to intervene?

Auscultating, palpating, and percussing the client's abdomen Pheochromocytomas are found on the adrenal glands or in the abdomen. Palpation of a pheochromocytoma can cause intense release of catecholamines and can precipitate a hypertensive crisis. The experienced nurse should intervene if the new nurse attempts this.

A client is taking a drug that blocks a hormone's receptor site. What is the effect on the client's hormone response?

Decreased hormone activity Hormones cause activity in the target tissues by binding with their specific cellular receptor sites, thereby changing the activity of the cell. When receptor sites are occupied by other substances that block hormone binding, the cell's response is the same as when the level of the hormone is decreased.

An adult client has been diagnosed with a deficiency of gonadotropin and growth hormone. Which fact reported in the client's history could have contributed to this problem?

Experienced head trauma 5 years ago Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction

A female client with an endocrine problem has hirsutism. Which question or statement by the nurse is most appropriate?

I'm interested in knowing how you feel about yourself." Hirsutism, excessive hair growth on the face and body, can result from endocrine disorders. This may cause a disruption in body image, especially for female clients. The nurse should gently inquire into the client's body image and self-perception. Asking about the client's financial status sounds judgmental.

A client with hyperthyroidism is taking lithium carbonate. Which finding indicates that the client is having side effects of this therapy?

Increased thirst and urination Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus

A client with suspected syndrome of inappropriate antidiuretic hormone (SIADH) has a serum sodium of 114 mEq/L. Which action by the nurse is best?

Restrict the client's fluid intake to 900 mL/24 hr. With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. The client should be on intake and output (I&O); however, this will monitor only the client's intake, so it is not the best answer. Reducing intake will help increase the client's sodium.

A new nurse is palpating a client's thyroid gland. Which action requires intervention from the nurse's mentor?

The nurse palpates the right lobe with his or her left hand. The client should be in a sitting position with the chin tucked down as the examiner stands behind the client. The nurse feels for the thyroid isthmus while the client swallows and turns the head to the right, and the nurse palpates the right lobe with the right hand. The technique is repeated in the opposite fashion for the left lobe.

A client has abnormal calcium levels. Which hormone does the nurse anticipate testing for?

Thyrocalcitonin (calcitonin) Parafollicular cells produce thyrocalcitonin (calcitonin [TCT]), which helps regulate serum calcium levels.

A client has received vasopressin (DDAVP) for diabetes insipidus. Which assessment finding indicates a therapeutic response to this therapy

Urine output is decreased; specific gravity is increased. Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolarity, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity.

Which safety measure is most important for the nurse to institute for a cliCushing's syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risk for pathologic bone fractureent who has Cushing's disease?

Use a lift sheet to change the client's position. Cushing's syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risk for pathologic bone fracture

Which safety measure does the nurse use for the adult client who has growth hormone deficiency?

Use a lift sheet to reposition the client. In adults, growth hormone is necessary to maintain bone density and strength. Adults with growth hormone deficiency have thin, fragile bones

The client has chronic hypercortisolism. Which intervention is the highest priority for the nurse?

Wash the hands when entering the room. Excess cortisol reduces the number of circulating lymphocytes, inhibits maturation of macrophages, reduces antibody synthesis, and inhibits production of cytokines and inflammatory chemicals. As a result, these clients are at greater risk of infection and may not have the expected inflammatory manifestations when an infection is present. The nurse needs to take precautions to decrease the client's risk

A client has hypothyroidism. Which problem does the nurse address as a priority for this client?

depression and withdrawel Hypothyroidism causes many problems in psychosocial functioning. Depression is the most common reason for seeking medical attention. Memory and attention span may be impaired. The client's family may have great difficulty accepting and dealing with these changes. The client is often unmotivated to participate in self-care. Lapses in memory and attention require the nurse to ensure that the client's environment is safe. Heat intolerance is seen in hyperthyroidism. Body image problems and weight issues do not take priority over mental status and safety.