ENDOCRINE
The nurse is assessing a client admitted to the hospital with a tentative diagnosis of an adrenal cortex tumor. When assessing the client, which of these are signs of Cushing disease? Select all that apply. 1. Round face 2. Dependent edema in the feet and ankles 3. Increased fatty deposition in the extremities 4. Thin, translucent skin with bruising 5. Increased fatty deposition in the neck and back
> Changes in fat distribution may result in a round face and fat pads on the neck, back, and shoulders. > There are increased levels of steroids and aldosterone, causing sodium and water retention in clients with Cushing syndrome. > This increased fluid retention results in dependent peripheral edema. > Skin changes result from increased blood vessel fragility and include bruises and thin or translucent skin. > The extremities appear thinner from muscle wasting and weakness, not thicker from fatty deposition. > Hypertension, not hypotension, is expected because of sodium and water retention.
A client has been diagnosed with hyperthyroidism. The nurse expects the client to exhibit which clinical manifestations? Select all that apply. 1. Dry skin 2. Slow pulse 3. Weight gain 4. Nervousness 5. Increased appetite
> Nervousness is associated with hyperthyroidism because of central nervous system irritation. > The appetite increases with hyperthyroidism because of the increased metabolic rate. > Moist skin occurs with hyperthyroidism because of the increase in the metabolic rate. > Dry skin occurs with hypothyroidism because of the decrease in the metabolic rate. > Tachycardia occurs with hyperthyroidism because of the increase in the metabolic rate. > Bradycardia occurs with hypothyroidism because of the decrease in the metabolic rate. > Weight loss occurs with hyperthyroidism because of the increase in the metabolic rate. > Weight gain occurs with hypothyroidism because of the decrease in the metabolic rate.
A nurse, caring for a client with uncontrolled diabetes, suspects that a client is experiencing hypoglycemia in response to insulin administration. What clinical manifestations lead the nurse to this conclusion? Select all that apply. 1. Headache 2. Confusion 3. Extreme thirst 4. Profuse sweating 5. Increased urination
> Neurologic responses occur when there is an insufficient supply of glucose to the brain, thus causing clinical manifestations such as headache and confusion. > Profuse sweating is a classic sign of hypoglycemia. This is triggered by lack of glucose to the nerve cells. > Thirst (polydipsia) is a classic symptom of hyperglycemia. > Increased urination (polyuria) is a classic sign of hyperglycemia.
A client is scheduled for a computed tomography (CT) of the brain with contrast. When reviewing the client's medical record, what significant finding should the nurse report to the primary healthcare provider before the diagnostic procedure? 1. The client takes metformin daily. 2. The client has not been nothing by mouth (NPO). 3. The client reports an allergy to gadolinium. 4. The client was not prescribed a bowel prep.
A CT often requires a contrast agent to be administered. The contrast agent can cause temporary changes in kidney function. This change in kidney function can cause clients on metformin to have an increased risk of developing a serious side effect called lactic acidosis. NPO status is not required for a brain CT; however, clients may be instructed to be NPO for a CT of the abdomen or chest. Magnetic resonance imaging contrast contains gadolinium; contrast for CT scans contains iodine. A bowel prep is not required for this diagnostic procedure.
The nurse caring for a client with diabetic ketoacidosis (DKA) can expect to implement which intervention? 1. Intravenous administration of regular insulin 2. Administer insulin glargine subcutaneously at hour of sleep 3. Maintain nothing prescribed orally (NPO) status 4. Intravenous administration of 10% dextrose
A client admitted with DKA will have a blood glucose value greater than 250 and blood ketones. Intravenous (IV) administration of regular insulin is needed to rid the body of ketones and regulate blood glucose. Administration of insulin glargine is not going to reverse the ketoacidosis. The client will be allowed fluids to maintain hydration. Administration of 10% dextrose IV will increase the client's blood glucose.
A nurse is caring for a client with an under-active thyroid gland. Which responses should the nurse expect the client to exhibit as a result of decreased levels of triiodothyronine (T3) and thyroxine (T4)? Select all that apply. 1. Irritability 2. Tachycardia 3. Weight gain 4. Cold intolerance 5. Profuse diaphoresis
A decrease in metabolism will result in a gain in weight. Decreased production of thyroid hormones lowers metabolism, which leads to decreased heat production and cold intolerance. Lethargy, rather than irritability, is expected. Decreased metabolism requires less oxygen, so the pulse rate is generally slower. The skin is dry and coarse, not moist
A nurse is caring for a client with a suspected endocrine tumor that presents with hypertension. Which study will the nurse prepare to monitor that best screens for this condition? 1. Thyroglobulin 2. Metanephrine 3. Catecholamine 4. Vanillylmandelic acid
An endocrine tumor that presents with hypertension is pheochromocytoma. Metanephrine is the best study to screen for pheochromocytoma. Thyroglobulin is used to identify thyroid tumor cells. Although catecholamine and vanillylmandelic acid studies are used to screen for pheochromocytoma, metanephrine studies are more accurate.
While reviewing the laboratory reports of a client, the nurse finds that the client has low sodium levels. Which hormonal imbalance should the nurse suspect in the client? 1. Epinephrine 2. Glucagon 3. Calcitonin 4. Cortisol
Cortisol is the glucocorticoid secreted by the adrenal cortex that maintains sodium and water balance. Therefore, reduced sodium levels in the client indicate a cortisol imbalance. Additionally, depleted sodium levels in a client indicate hyponatremia. Epinephrine is a catecholamine, which helps in maintaining homeostasis. Glucagon increases blood glucose levels and does not play a role in maintaining electrolyte balance. Calcitonin helps in regulating serum calcium levels.
Which physiologic responses should a nurse expect when assessing a client with hyperthyroidism? Select all that apply. 1. Bradycardia 2 . Blurred vision 3. Cold intolerance 4. Increased appetite 5. Widened pulse pressure
Blurred vision may occur as a result of exophthalmos. The appetite increases in an attempt to meet the caloric needs of the body. As the systolic pressure increases, it causes a widened pulse pressure (the difference between the systolic and diastolic blood pressures). Tachycardia, not bradycardia, occurs because of the increased metabolic rate. Intolerance to heat, not cold, occurs because of the increased metabolic rate.
A nurse is assessing a client and suspects diabetic ketoacidosis (DKA). What clinical findings support this conclusion? 1. Nervousness and tachycardia 2. Erythema toxicum rash and pruritus 3. Diaphoresis and altered mental state 4. Deep respirations and fruity odor to the breath
Deep respirations and a fruity odor to the breath are classic signs of DKA, because of the respiratory system's attempt to compensate by blowing off excess carbon dioxide, a component of carbonic acid. Nervousness and tachycardia are indicative of an insulin reaction (diabetic hypoglycemia). When the blood glucose level decreases, the sympathetic nervous system is stimulated, resulting in an increase in epinephrine and norepinephrine; this causes clinical findings such as nervousness, tachycardia, palpitations, sweating, tremors, and hunger. Erythema toxicum rash and pruritus are unrelated to diabetes; they indicate a hypersensitivity reaction. Although an altered mental state is associated with both hypoglycemia and DKA, diaphoresis is associated only with hypoglycemia. Diaphoresis occurs when the blood glucose level decreases and stimulates an increase in epinephrine and norepinephrine.
The nurse is caring for a 70-year-old client who presents with dilute urine even when fluid intake is low. What could be the possible cause of the client's condition? 1. Decreased glucose tolerance 2. Decreased general metabolism 3. Decreased ovarian production of estrogen 4. Decreased antidiuretic hormone production
Dilute urine with decreased fluid intake indicates a decrease in antidiuretic hormone production. Decreased glucose tolerance causes elevated fasting and random blood glucose levels. The clinical manifestations of decreased general metabolism are decreased heart rate and blood pressure, decreased appetite, and decreased tolerance to cold. Decreased ovarian production of estrogen may result in decreased bone density and thin and dry skin.
x-ray reports reveal increased size of the lungs. Which hormonal change does the nurse suspect in the client? 1. Prolactin 2. Thyrotropin 3. Growth hormone 4. Adrenocorticotropic hormone
Enlargement of the hands and feet, thickened lips, sleep apnea, pain in the joints, hyperglycemia, and enlargement of the liver, lungs, and heart are clinical manifestations of acromegaly; this is caused by the increased production of growth hormone. Increased levels of prolactin cause galactorrhea, increased body fat, and hypogonadism. Increased levels of thyrotropin cause tachycardia, fine tremors, and weight loss. Increased levels of adrenocorticotropic hormone cause hyperglycemia, hypertension, weight gain, and moon face.
A client visits the clinic because of concerns about insomnia and recent weight loss. A tentative diagnosis of hyperthyroidism is made. What symptom might the nurse identify when assessing this client? 1. Fatigue 2. Dry skin 3. Anorexia 4. Bradycardia
Excessive metabolic activity associated with hyperthyroidism causes fatigue. Warm, moist skin is expected because of increased peripheral perfusion associated with increased metabolism. Increased appetite is expected because of the increased metabolism associated with hyperthyroidism. Tachycardia is expected because of the increased metabolism associated with hyperthyroidism.
When assessing a client with Graves disease (hyperthyroidism), what would the nurse expect to find in the client's history? 1. Diaphoresis 2. Menorrhagia 3. Dry, brittle hair 4. Sensitivity to cold
Increased basal metabolic rate, increased circulation, and vasodilation result in warm, moist skin. Menorrhagia, sensitivity to cold, and dry, brittle hair are associated with hypothyroidism.
A nurse is caring for a client who is experiencing an underproduction of thyroxine (T4). Which client response is associated with an underproduction of thyroxine? 1. Myxedema 2. Acromegaly 3. Graves disease 4. Cushing disease
MYEXEDEMA: Myxedema is the severest form of hypothyroidism. Decreased thyroid gland activity means reduced production of thyroid hormones. Acromegaly results from excess growth hormone in adults once the epiphyses are closed. Graves disease results from an excess, not a deficiency, of thyroid hormones. Cushing disease results from excess glucocorticoids.
During the progressive stage of shock, anaerobic metabolism occurs. Which complication should the nurse anticipate in this client? 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
Metabolic acidosis occurs during the progressive stage of shock as a result of accumulated lactic acid. Metabolic alkalosis cannot occur with the buildup of lactic acid associated with the progressive stage of shock. Respiratory acidosis can result from decreased respiratory function in late shock, further compounding metabolic acidosis. Respiratory alkalosis occurs as a result of hyperventilation during early shock.
While assessing a client with adrenal gland hypo-function receiving drug therapy, the nurse finds that the client has a round face, rapid weight gain, and swelling in the body. Which medication change should the nurse expect the primary healthcare provider to make? 1. Dose adjustment of cortisone 2. Dose adjustment of prednisone 3. Dose adjustment of hydrocortisone 4. Dose adjustment of fludrocortisones
The administration of hydrocortisone can result in "round face," rapid weight gain, and swelling in the body, which are the symptoms of Cushing's syndrome. These symptoms should be immediately reported to the primary healthcare provider for dose adjustment. The administration of cortisone may cause gastrointestinal irritation when not taken with meals or snacks. Prednisone administration may cause severe diarrhea, fever, and vomiting, and fludrocortisone administration may cause hypertension and sodium-related fluid retention.
A client has a thyroidectomy for cancer of the thyroid. When evaluating for nerve injury, what should the client be asked to do? 1. Speak 2. Swallow 3. Purse the lips 4. Turn the head
The laryngeal nerve is close to the operative site and can be damaged inadvertently. Loss of the gag reflex occurs with general anesthesia; the ability to swallow signifies its return. The ability to purse the lips tests the seventh cranial (facial) nerve, which is not affected in thyroid surgery. The nerves involved in turning the head are not near the thyroid gland.
The nurse is caring for a client with diabetes mellitus. What is the primary fluid shift that occurs with this condition? 1. Intravascular to interstitial because of glycosuria 2. Interstitial to extracellular because of hypoproteinemia 3. Intracellular to intravascular because of hyperosmolarity 4. Intercellular to intravascular because of increased hydrostatic pressure
The osmotic effect of hyperglycemia pulls fluid from the intracellular and interstitial compartments, resulting in dehydration. Hyperglycemia pulls fluid from the interstitial to the intravascular compartment, eventually spilling into the urine. Interstitial fluid is part of the extracellular compartment; the osmotic pull of glucose exceeds other osmotic forces. An increase in hydrostatic pressure results in an intravascular to interstitial shift
A client who had a subtotal thyroidectomy returns to the unit from the postanesthesia care unit. What is the priority nursing action at this time? 1. Monitor for hypoglycemia. 2. Observe for signs of tetany. 3. Place a sandbag under the neck. 4. Teach the need to support the head.
The parathyroids may be excised accidentally during surgery; because they regulate calcium, lowered blood levels of calcium may induce tetany. There is no danger of hypoglycemia at this time. A sandbag under the neck can cause hyperextension and strain on the suture line. Teaching the need to support the head is not the priority at this time, although it is important to prevent tension on the suture line.
Postoperatively, a client who had a thyroidectomy complains of tingling and numbness of the fingers and toes, and the nurse observes muscle twitching. Which complication does the nurse suspect the client is experiencing? 1. Hypokalemia 2. Hypocalcemia 3.Thyrotoxic crisis 4. Hypovolemic shock
The signs and symptoms presented in the question indicate hypocalcemia. Injury to the parathyroid glands during a thyroidectomy commonly results in a parathormone deficiency and decreased serum calcium levels. Hypokalemia is characterized by generalized weakness, diminished reflexes, shallow respirations, and cardiac dysrhythmias. Thyrotoxic crisis is characterized by tachycardia, hyperpyrexia, and an exacerbation of hyperthyroid symptoms. Hypovolemic shock is characterized by a weak, thready pulse and hypotension.
A nurse is caring for a client after a thyroidectomy. Which symptoms indicating thyroid storm should the nurse monitor the client for? Select all that apply. 1. Increased heart rate 2 . Increased temperature 3. Decreased respirations 4. Increased pulse deficit 5. Decreased blood pressure
Thyroid storm is severe hyperthyroidism; excessive amounts of thyroxine increase the metabolic rate, thereby causing an increased heart rate (tachycardia). Because of the increased metabolic rate associated with thyroid storm, body temperature will increase. Because of the increased metabolic rate associated with thyroid storm, the respiratory rate increases (tachypnea) to meet the body's oxygen needs. Pulse deficit, the difference between apical and peripheral pulse rates, is not indicative of thyroid storm. The blood pressure will increase to meet the oxygen demand caused by the increased metabolic rate during thyroid storm.
A registered nurse is teaching the student nurse the precautions to follow when blood samples are collected. Which statement made by the student nurse indicates effective learning? 1. "I can place the specimen with other samples." 2. "I can use a single-lumen line to obtain samples." 3. "I should not reveal the test procedure to the client." 4. "I should not place the blood samples collected for adrenaline on ice."
Usage of double- or triple-lumen lines for obtaining samples may contaminate the sample. > Therefore, only single-lumen lines should be used. > The samples should be stored separately to avoid contamination. > The procedure of testing should be discussed with the client to obtain proper results. > Blood samples drawn for catecholamines must be placed on ice and taken to the laboratory immediately.
