Endocrine
A nurse is assessing a client admitted to the hospital with a tentative diagnosis of a pituitary tumor. What signs of Cushing syndrome does the nurse identify? 1 Retention of sodium and water 2 Hypotension and a rapid, thready pulse 3 Increased fatty deposition in the extremities 4 Hypoglycemic episodes in the early morning
1 1. Retention of sodium and water Increased levels of steroids and aldosterone cause sodium and water retention in clients with Cushing syndrome. Hypertension, not hypotension, is expected because of sodium and water retention. The extremities will be thin; subcutaneous fat deposits occur in the upper trunk, especially the back between the scapulae. Hyperglycemia, not hypoglycemia, occurs because of increased secretion of glucocorticoids. Hyperglycemia is sustained and not restricted to the morning hours.
A client is diagnosed with hyperthyroidism and is experiencing exophthalmia. Which measures should the nurse include when teaching this client how to manage the discomfort associated with exophthalmia? Select all that apply. 1 Use tinted glasses. 2 Use warm, moist compresses. 3 Elevate the head of the bed 45 degrees. 4 Tape eyelids shut at night if they do not close. 5 Apply a petroleum-based jelly along the lower eyelid.
1, 3, 4 1. Use tinted glasses 3. Elevate the HOB 45 degrees 4. Tape eyelids shut at night if they do not close. Use warm, moist compresses. → cool moist compresses are used to relieve irritation - warm compresses cause vasodilation which may aggrevate tissue congestion. Apply a petroleum-based jelly along the lower eyelid → Artificial tears are used to moisten the eyes not petroleum based jelly Tinted glasses decrease light impacting on the eyes and protect eyes that are photosensitive. Elevating the head of the bed 45 degrees will promote a decrease in periorbital fluid. Taping the eyelids shut at night if they do not close reduces the risk of corneal dryness, which can lead to infection or injury. Cool, moist compresses are used to relieve irritation; warm compresses cause vasodilation, which may aggravate tissue congestion. Artificial tears are used to moisten the eyes, not a petroleum-based jelly.
A client with small cell carcinoma of the lung develops the syndrome of inappropriate antidiuretic hormone (SIADH). What signs should the nurse expect to observe? Select all that apply. 1 Oliguria 2 Seizures 3 Vomiting 4 Polydipsia 5 Polyphagia
1,2,3 1. Oliguria 2. Seizures 3. Vomiting Cancerous cells of small cell lung cancer can produce antidiuretic hormone, which causes fluid retention, resulting in increased blood volume and decreased urine volume. Fluid retention associated with SIADH can cause cerebral edema, resulting in confusion and seizures. Fluid retention resulting in hyponatremia causes nausea and vomiting. The client will have nausea and vomiting, resulting in a decreased oral fluid and food intake.
The nurse is providing care for a client with small-cell carcinoma of the lung who develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). What clinical findings correspond with the secretion of antidiuretic hormone (ADH)? Select all that apply. 1 Edema 2 Polyuria 3 Bradycardia 4 Hypotension 5 Hyponatremia
1,5 Edema, Hyponatremia Polyuria → oliguria Bradycardia → tachycardia Hypotension → Hypertension Edema results as fluid is retained because of the increased secretion of antidiuretic hormone. ADH causes water retention, which dilutes serum electrolytes such as sodium, with a resultant hyponatremia. A decreased urine output occurs with SIADH because ADH causes reabsorption of fluid in the kidney glomeruli. The increased fluid volume associated with SIADH results in tachycardia, tachypnea, and crackles. The increased fluid volume associated with SIADH results in hypertension, not hypotension.
A client has a history of hypothyroidism. Which skin condition should the nurse expect when performing a physical assessment? 1 Dry 2 Moist 3 Flushed 4 Smooth
1. Dry 1 Dry 2 Moist 3 Flushed 4 Smooth Dry skin is caused by decreased function of sebaceous glands; a paucity of thyroid hormones T3 and T4, which control the basal metabolic rate, can alter the function of almost every body system. The skin will not be flushed; the client will appear pale. Moist, smooth skin occurs with hyperfunction of the thyroid and an increase in the basal metabolic rate.
A nurse is caring for a client with Addison's disease. Upon assessment, which classic sign will the nurse find? 1 Ecchymosis 2 Hyperreflexia 3 Exophthalmos 4 Hyperpigmentation
4. Hyperpigmentation Hyperpigmentation, or "bronzing," is a classic sign of Addison's disease. Ecchymosis (bruise) is the discoloration of the skin due to rupture of blood vessels beneath the skin. Hyperreflexia is a sign of hypoparathyroidism. Exophthalmos is the classic sign of hyperthyroidism.
What clinical indicators should a nurse assess when caring for a client with hyperthyroidism? Select all that apply. 1 Dry skin 2 Weight loss 3 Tachycardia 4 Restlessness 5 Constipation 6 Exophthalmos
2,3,4,6 2. weight loss 3. tachycardia 4. restlessness 6. exophtalmos Weight loss is associated with hyperthyroidism because of the increase in the metabolic rate. Muscle weakness and wasting also occur. Tachycardia, palpitations, increased systolic blood pressure, and dysrhythmias occur with hyperthyroidism because of the increased metabolic rate. Restlessness and insomnia are also associated with hyperthyroidism because of the increased metabolic rate. Protrusion of the eyeballs occurs with hyperthyroidism because of peribulbar edema. Dry, coarse, scaly skin occurs with hypothyroidism, not hyperthyroidism, because of decreased glandular function. Smooth, warm, moist skin occurs with hyperthyroidism. Constipation is associated with hypothyroidism. Increased stools and diarrhea are associated with hyperthyroidism.
Which metabolic manifestations are likely to be observed in a client with hypothyroidism? Select all that apply. 1 Impaired memory Correct2 Intolerance to cold 3 Difficulty breathing 4 Decreased blood pressure Correct5 Decreased body temperature
Cold intolerance and decreased body temperature are the metabolic manifestations observed in a client with hypothyroidism. Impaired memory is the neuromuscular manifestation of hypothyroidism. Difficulty in breathing is the pulmonary manifestation observed in the client with hypothyroidism. Decreased blood pressure is the cardiovascular manifestation observed in the client with hypothyroidism.
A client has been taking levothyroxine for hypothyroidism for 3 months. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? Select all that apply. Correct1 Tremors 2 Bradycardia 3 Somnolence Correct4 Heat intolerance 5 Decreased blood pressure
Excessive levothyroxine produces adaptations similar to hyperthyroidism, including tremors, tachycardia, hypertension, heat intolerance, and insomnia. These adaptations are related to the increase in the metabolic rate associated with hyperthyroidism. Bradycardia is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Somnolence is a sign of hypothyroidism and a need to increase the dose of levothyroxine. Hypotension is a sign of hypothyroidism and a need to increase the dose of levothyroxine.
What interventions should the nurse implement in caring for a client with diabetes insipidus (DI) following a head injury? Select all that apply. 1 Providing adequate fluids within easy reach 2 Reporting an increasing urine specific gravity 3 Administering prescribed erythromycin 4 Assessing for and reporting changes in neurological status 5 Monitoring for constipation, weight loss, hypotension, and tachycardia
1, 4, 5 1. Providing adequate fluids within easy reach 4. Assessing for and reporting changes in neurological status 5. Monitoring for constipation, weight loss, hypotension, and tachycardia Diabetes insipidus is a condition resulting in underproduction of antidiuretic hormone. The focus of care is on maintaining fluids and electrolytes. Oral fluids must be easily accessible at the bedside to balance urinary losses and prevent severe dehydration. The nurse monitors for, and reports, changes in neurological status associated with hypernatremia and high serum osmolality. Constipation and weight loss indicate fluid volume deficit and must be reported. Hypotension and tachycardia are signs of impending shock. Massive polyuria results in dilute urine. Decreasing urine specific gravity must be reported. There is no indication that an antibiotic is required; therefore erythromycin would not be prescribed. The primary pharmacologic treatment for diabetes insipidus, then, is replacement of antidiuretic hormone (ADH) with an exogenous vasopressin, such as desmopressin acetate (DDAVP).
