Endocrine Disorders PREPU
tachycardia
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?
Glucose tolerance test in combination with a GH measurement
A client is suspected of having acromegaly. What definitive diagnostic testing is the most reliable method of confirming acromegaly?
pineal gland; melatonin
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?
"Do you feel any muscle twitches or spasms?"
A client with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the client should prioritize what question when addressing potential complications?
Foods high in vitamin D Foods high in protein Foods high in calcium Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and osteoporosis. Referral to a dietitian may assist the client in selecting appropriate foods that are also low in sodium and calories.
A client with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with the client to improve the patient's nutritional intake. What foods should a client with Cushing syndrome eat to optimize health? Select all that apply
a corticotropin secreting pituitary adenoma
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:
Administering beta blockers to reduce heart rate Applying interventions to reduce the client's temperature
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.
Semi-Fowler with the head supported on two pillows
A client has been admitted to the postsurgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the client?
profound neuromuscular irritability.
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:
Weight loss, nervousness, and tachycardia
A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect? You Selected:
deposits of adipose tissue in the trunk and dorsocervical area.
A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find:
Urine specific gravity of 1.001 Serum osmolality of 310 mOsm/kg Serum sodium level of 149 mEq/L All are indicative of diabetes insipidus, except for B and D, which are normal results. Refer to Table 31-1.
A nurse is aware that several laboratory results are present in a patient diagnosed with diabetes insipidus. Select all that apply.
Administer IV calcium gluconate as ordered.
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?
myxedema coma.
An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and periorbital area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of:
"You must avoid hyperextending your neck after surgery."
During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement?
Maintaining room temperature in the low-normal range
For a client with Graves' disease, which nursing intervention promotes comfort?
hypocalcemia.
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:
T3, T4, and calcitonin
Name three hormomes produced by the thyroid
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?
regulates serum calcium levels
Parathormone
Propylthiouracil Antithyroid drugs, such as propylthiouracil and methimazole are given to block the production of thyroid hormone preoperatively or for long-term treatment for clients who are not candidates for surgery or radiation treatment. Levothyroxine would increase the level of thyroid and be contraindicated in this client. Spironolactone is a diuretic and does not have the action of blocking production of thyroid hormone and neither does propranolol, which is a beta-blocker.
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?
Administration of calcitonin Intravenous isotonic saline solution in large quantities Monitoring the patient for fluid overload
The nurse is caring for a patient with hyperparathyroidism and observes a calcium level of 16.2 mg/dL. What interventions does the nurse prepare to provide to reduce the calcium level? Select all that apply
5:00pm An overnight 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 late in the evening or at bedtime, and a plasma cortisol concentration is measured at 8 AM the next day. However, in a client who sleeps during the day, the medication would be given before bed and the plasma concentration would be measured soon after awakening in the late afternoon.
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?
vasopressin and oxytocin
The two major hormones secreted by the posterior pituitary
by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff.
Trousseau sign is elicited
An elevated systolic blood pressure Muscular fatigability Weight loss. 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.
What clinical manifestations does the nurse recognize would be associated with a diagnosis of hyperthyroidism? Select all that apply.
An adrenal adenoma
What is the most common cause of hyperaldosteronism?
vasopressin
When caring for a client with diabetes insipidus, the nurse expects to administer:
promotes glycogenolysis
glucagon
Milk
he 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?
lowers blood sugar
insulin
helps with sleep wake cycle
melatonin
FSH, ATH, ACTH
name three hormones secreted by the anterior pituitary:
increases the force of uterine contractions during parturition
oxytocin
promotes secretion of milk
prolactin
influences metabolism that is essential for growth
somatrotropin
controls excretion of water by the kidneys
vasopressin
Acromegaly
Which disorder results from excessive secretion of somatotropin (growth hormone)?
Glucagon
Which hormone would be responsible for increasing blood glucose levels by stimulating glycogenolysis?
Have regular follow-up care.
Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease?
Excessive thirst
Which is a clinical manifestation of diabetes insipidus?
Gigantism
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?
Most disorders result from over- or underproduction of the hormone.
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?
hypercalcemia
Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism?
stimulates reabsorption of sodium and elimination of potassium
aldosterone
inhibits bone reabsorption
calcitonin
Hypothermia Hypotension Hypoventilation 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.
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.
Serum potassium level of 5.8 mEq/L 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 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?
Assess for neurologic changes. Closely monitor nasal packing and postnasal drainage. 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 nurse is caring for a client recovering from a hypophysectomy. What would be included in the client's care plan? Select all that apply.
Encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow.
A nurse is preparing to palpate a client's thyroid gland. Which action by the nurse is appropriate?
adrenal function
A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. What is being tested?
Levothyroxine (Synthroid) Levothyroxine is the agent of choice for thyroid hormone replacement therapy because its standard hormone content provides predictable results. Methimazole is an antithyroid medication used to treat hyperthyroidism. Thyroid USP desiccated and liothyronine are no longer used for thyroid hormone replacement therapy because they may cause fluctuating plasma drug levels, increasing the risk of adverse effects.
A nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy?
"Buffalo hump" Thin extremities "Moon face" Truncal obesity Purple striae
A patient has been diagnosed with Cushing's syndrome. The nurse would expect which of the following features to be present upon physical examination?
Hypertension Alterations in glucose metabolism Poor wound healing side effects of corticosteroid therapy include hypertension, alterations in glucose metabolism, weight gain, and poor wound healing.
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.
A decrease in urine output
A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience?
The moon face and acne will resolve when the medication is tapered off.
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?
Galactorrhea All choices are indicators of a pituitary tumor, but the most common form is indicated by the spontaneous and inappropriate flow of milk from the male or female breast in the absence of pregnancy or breastfeeding. A normal prolactin level is less than 20 ng/mL
A patient whose laboratory studies indicates a prolactin level of 200 ng/mL is assessed for a pituitary tumor. During the physical exam, the nurse practitioner notices a number of signs and/or symptoms suggestive of this condition. Which of the following is the most common indicator of a pituitary tumor?
No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test
A physician orders laboratory tests to confirm hyperthyroidism in a client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis?
Goiter
A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine disorder should the nurse expect the physician to diagnose?
