Endocrine (Med/Surg)

A female client who is scheduled for a thyroidectomy is concerned that the surgery will interfere with her ability to become pregnant. What is the nurse's best response? "As long as medication is continued, ovulation will occur." "Hyperthyroidism can cause abortions and fetal anomalies." "Pregnancy is not advisable for the client with a thyroidectomy." "Pregnancy affects metabolism and will require decreased thyroid hormone."

"As long as medication is continued, ovulation will occur." Rationale Medication is regulated to maintain the usual blood levels of thyroxine; therefore, ovulation is not affected, and future pregnancy is possible. The client will no longer be hyperthyroid after surgery because the overactive tissue is excised; therefore, pregnancy is not contraindicated. Pregnancy is not contraindicated after a thyroidectomy because the overactive tissue is excised. Pregnancy is not contraindicated; however, thyroid hormone therapy may have to be increased during pregnancy.

The nurse is caring for a client with hypothyroidism. Which instruction is most important to provide to the client to help in managing their condition? "Take medication on time" "Perform regular exercises" "Dress warmly in cold weather" "Take more proteins in your diet"

"Dress warmly in cold weather" Rationale Thyroxin levels decrease during cold temperatures, thus hypothyroidism causes the client to become very sensitive to cold. Clients are advised to dress warmly in cold weather to prevent worsening the situation. A client with any disease condition should be instructed to take the medication on time. Hypothyroidism may cause the client to gain weight due to poor metabolic activity. Therefore, the client should be instructed to perform regular exercises and increase proteins in the diet to meet nutritional requirements.

Which dietary instruction would be most beneficial to a client who has undergone a hypophysectomy and has difficulty passing stools? "Drink plenty of water." "Eat foods rich in protein." "Drink a glass of milk daily." "Eat foods rich in carbohydrates."

"Drink plenty of water." Rationale The client should be instructed to drink plenty of water (roughly 8 to 10 glasses a day) to relieve constipation. Although proteins are required for overall health, proteins will not relieve constipation. Milk may cause constipation in certain individuals. Carbohydrates act as power sources; they do not relieve constipation.

A client with Cushing syndrome asks why a low-sodium, high-potassium diet has been prescribed. What is the best response by the nurse? "The client will gain excessive weight if sodium is not limited." "An inadequate intake of potassium contributed to the disease." "This type of diet increases emotional stability." "Excessive aldosterone and cortisone cause the retention of sodium and loss of potassium."

"Excessive aldosterone and cortisone cause the retention of sodium and loss of potassium." Rationale Clients with Cushing syndrome or those receiving cortical hormones must limit their intake of sodium and increase their intake of potassium, because the kidneys are retaining sodium and excreting potassium. Although sodium retention causes fluid retention and weight gain, the need for increased potassium must be considered as well. An excessive secretion of adrenocortical hormones in Cushing syndrome, not inadequate potassium intake, is the problem. This type of diet has no direct effect on the client's emotional status.

The nurse is assessing a client suspected of having hypersecretion of growth hormone. Which question should the nurse ask the client? "Have you noticed thickening of your lips?" "Do you experience excessive thirst?" "Did you notice increase in frequency of urination?" "Do you experience pain during sexual intercourse?"

"Have you noticed thickening of your lips?" Rationale Excessive secretion of growth hormone results in several skeletal and soft-tissue changes. A common manifestation of increased levels of growth hormone in the body is the thickening of the client's lips. Asking the client about increased thirst and frequency of urination helps assess the status of diabetes insipidus, which is a disorder of water loss. Hypersecretion of prolactin is assessed by asking the client about difficulty during intercourse because excess of prolactin results in difficulties in sexual function.

A nurse teaches a client with type 2 diabetes how to provide self-care to prevent infections of the feet. Which statement made by the client shows that teaching was effective? "I should massage my feet and legs with oil or lotion." "I should apply heat intermittently to my feet and legs." "I should eat foods high in protein and carbohydrate kilocalories." "I should control my blood glucose with diet, exercise, and medication."

"I should control my blood glucose with diet, exercise, and medication." Rationale Controlling the diabetes decreases the risk of infection; this is the best prevention. Oil or lotion that is not completely absorbed may provide a warm, moist environment for bacterial growth. Coexisting neuropathy may result in injury from heat application. Protein, carbohydrates, and fats must be in an appropriate balance; high carbohydrate intake can provide too many calories.

Which instruction given by the nurse ensures good healing in a client recovering after surgical removal of the pituitary gland by endoscopic transnasal approach? "Decrease fluid intake." "Increase high-fiber food intake." "Bend over from the waist to pick up fallen objects." "Brush teeth regularly with a medium-bristle brush."

"Increase high-fiber food intake." Rationale The nurse should instruct the client who is recovering after surgical removal of the pituitary gland to consume high-fiber food. Intracranial pressure is raised if the client strains during defecation. Fibrous foods reduce the risk of constipation and thereby reduce bowel strain. The client should be instructed to drink sufficient water to facilitate easy bowel movements and soften the stools. The nurse should teach the client to bend the knees and then lower the body to pick up fallen objects; bending at the waist increases intracranial pressure. The client should use dental floss and avoid brushing post-operatively for at least 2 weeks to prevent disturbance of the operative site.

Which statement made by a diabetic client shows that dietary teaching by the nurse was effective? "My diet should be rigidly controlled to avoid emergencies." "My diet can be planned around a wide variety of commonly used foods." "My diet is based on nutritional requirements that are the same for all people." "My diet must not include eating any combination dishes and processed foods."

"My diet can be planned around a wide variety of commonly used foods." Rationale Each client should be given an individually devised diet consisting of commonly used foods from the American Diabetic Association (Canadian Diabetes Association) diet; family members should be included in the diet teaching. Rigid diets are difficult to follow; appropriate substitutions are permitted. Nutritional requirements are different for each individual and depend on many factors, such as activity level, degree of compliance, and physical status. Combination dishes and processed foods can be eaten when accounted for in the dietary regimen.

A client diagnosed with adrenal gland hypofunction is receiving fludrocortisone therapy. Which nursing intervention would help the client reduce the risk of complications? Instruct the client to report severe diarrhea Instruct the client to report fever and vomiting Instruct the client to take the drug with meals or snacks Instruct the client to regularly monitor blood pressure

. Instruct the client to regularly monitor blood pressure Rationale Fludrocortisone, prednisone, and cortisone are the drugs prescribed for the treatment of adrenal gland hypofunction. During fludrocortisone therapy, the blood pressure of the client should be regularly monitored because fludrocortisone has a potential to cause hypertension. Reporting of severe diarrhea, fever, and vomiting is required during the administration of prednisone. During the administration of cortisone, the client should take the drug with meals to reduce the risk of gastrointestinal irritation.

After recording the blood pressure of a client, the primary health care provider confirms a diagnosis of pheochromocytoma. What blood pressure may have helped confirm the diagnosis? 90/70 mmHg 80/60 mmHg 120/80 mmHg 190/90 mmHg

190/90 mmHg

After recording the blood pressure of a client, the primary health care provider confirms a diagnosis of pheochromocytoma. What blood pressure may have helped confirm the diagnosis? 90/70 mmHg 80/60 mmHg 120/80 mmHg 190/90 mmHg

190/90 mmHg Rationale Increased blood pressure indicates the presence of pheochromocytoma. The increase in blood pressure could be due to the increased production of catecholamines, indicating endocrine imbalance. Therefore, the client could have a blood pressure of 190/90 mmHg. The blood pressure values of 90/70 mmHg and 80/60 are below normal and indicate hypotension. A blood pressure value of 120/80 mmHg is a normal value.

A client is diagnosed with parathyroid dysfunction. Which serum calcium concentration in the client would support the diagnosis? 7.8 mg/dL 8.9 mg/dL 9.7 mg/dL 10.2 mg/dL

7.8 mg/dL Rationale The normal serum calcium concentration ranges from 8.6 to 10.2 mg/dL. A serum calcium concentration below 8.6 mg/dL indicates hypocalcemia and a serum calcium concentration above 10.2 mg/dL indicates hypercalcemia. Parathyroid hormone maintains calcium balance in the body. Hypocalcemia reflects hypoparathyroidism and hypercalcemia suggests hyperparathyroidism. The serum calcium concentration of 7.8 mg/dL is below the normal range and indicates hypocalcemia. Therefore, the client may have hypoparathyroidism, which is a parathyroid dysfunction. Serum calcium concentrations of 8.9 mg/dL, 9.7 mg/dL, and 10.2 mg/dL are all normal findings.

The primary healthcare provider prescribes daily fasting blood glucose levels for a client with diabetes mellitus. What is the goal of treatment with glucose levels for this client? 40 to 65 mg/dL (2.2 to 3.6 mmol/L) of blood 70 to 105 mg/dL (3.9 to 5.8 mmol/L) of blood 110 to 145 mg/dL (6.1 to 8.0 mmol/L) of blood 150 to 175 mg/dL (8.3 to 9.7 mmol/L) of blood

70 to 105 mg/dL (4 to 6 mmol/L) of blood Rationale The range of 70 to 105 mg/dL (4 to 6 mmol/L) of blood is the expected range for blood glucose. The range of 40 to 65 mg/dL (2.2 to 3.6 mmol/L) of blood is indicative of hypoglycemia. The ranges 110 to 145 mg/dL (6.1 to 8.0 mmol/L) of blood and 150 to 175 mg/dL (8.3 to 9.7 mmol/L) of blood are indicative of hypoglycemia.

A client with adrenal insufficiency reports feeling weak and dizzy, especially in the morning. What should the nurse determine is the most probable cause of these symptoms? A lack of potassium Postural hypertension A hypoglycemic reaction Increased extracellular fluid volume

A hypoglycemic reaction Rationale Deficiency of glucocorticoids causes hypoglycemia in the client with Addison disease. Clinical manifestations of hypoglycemia include nervousness; weakness; dizziness; cool, moist skin; hunger; and tremors. Hypokalemia is evidenced by nausea, vomiting, muscle weakness, and dysrhythmias. Weakness with dizziness on arising is postural hypotension, not hypertension. An increased extracellular fluid volume is evidenced by edema, increased blood pressure, and crackles.

The nurse is caring for a client who is diagnosed with hyperpituitarism due to a prolactin-secreting tumor. Which clinical manifestation can help confirm the diagnosis? Hypertrophy of skin Enlargement of liver Hypertrophy of the heart Absence of menstruation

Absence of menstruation Rationale A prolactin-secreting tumor is a common type of pituitary adenoma that results from excessive secretion of prolactin. Therefore, ultimately, there are associated clinical symptoms, such as absence of galactorrhea and menstruation and infertility. Excessive production of growth hormone is manifested by clinical symptoms, such as skin hypertrophy and enlargement of organs (e.g., liver and heart).

Which nursing care should be provided to a client who has undergone unilateral adrenalectomy? Offer a high-sodium diet. Encourage the client to use saliva-inducing agents Instruct the client to wear a medical alert bracelet. Administer temporary glucocorticoid replacement therapy.

Administer temporary glucocorticoid replacement therapy. Rationale Temporary glucocorticoid replacement therapy is needed for a client who has undergone a unilateral adrenalectomy. Spironolactone therapy is used when surgery cannot be performed. A client on spironolactone therapy is advised to increase sodium intake to reduce the risk of hyponatremia. Spironolactone therapy can cause a side effect of dry mouth that can be managed by saliva-inducing agents. A client who has undergone bilateral adrenal gland removal will require lifelong replacement of glucocorticoids and should wear a medical alert bracelet as an indication.

Which nursing intervention is the priority when a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS)? Providing oxygen Encouraging carbohydrates Administering fluid replacement Teaching facts about dietary principles

Administering fluid replacement Rationale As a result of osmotic pressures created by an increased serum glucose level, the cells become dehydrated; the client must receive fluid and then insulin. Oxygen therapy is not necessarily indicated. Carbohydrates will increase the blood glucose level, which is already high. Although dietary instruction may be appropriate later, such instruction is inappropriate during the crisis.

Which action by the nurse while administering human growth hormone ensures effective therapy? Administration at nighttime Administration via oral route Administration along with meals Administration by metered spray

Administration at nighttime Rationale Human growth hormone therapy shows best results when the hormone is administered at nighttime because the body naturally produces growth hormone at night. Therefore the normal body rhythm is being mimicked to ensure effective therapy. Subcutaneous injections of growth hormone yield effective results. Hyperpituitarism is treated by the administration of bromocriptine, which should be taken along with food to reduce side effects. Desmopressin acetate is administered either orally or intranasally with a metered spray to treat diabetes insipidus.

The nurse is caring for a client who had a thyroidectomy. Which symptoms will the client exhibit if having a thyrotoxic crisis? An increased pulse deficit A decreased blood pressure A decreased heart rate and respirations An increased temperature and pulse rate

An increased temperature and pulse rate Rationale Thyrotoxic crisis is severe hyperthyroidism; excessive amounts of thyroxine increase the metabolic rate, thereby raising the pulse and temperature. During crisis there usually is no increase in the difference between the apical and the peripheral pulse rates (pulse deficit). The blood pressure will increase to meet the oxygen demand caused by the increased metabolic rate during crisis. Because of the increased metabolic rate, the pulse and respiratory rates increase to meet the body's oxygen needs.

A client is diagnosed with a pituitary tumor. Which diagnostic test should be prescribed to rule out the probability of an aneurysm prior to surgery for tumor removal? Skull x-ray Angiogram Computed tomography Magnetic resonance imaging

Angiogram Rationale A localized swelling or inflammation in an arterial wall is called an aneurysm. An angiogram is a diagnostic procedure used to visualize blood flow in arteries. Therefore an angiogram should be prescribed to rule out the probability of an aneurysm prior to pituitary tumor removal surgery. A skull x-ray will reveal tumor-induced changes in the bony sella turcica, which houses the pituitary gland. Computed tomography and magnetic resonance imaging are useful to obtain distinct images of bony and soft-tissue lesions.

The nurse is caring for a client immediately after a subtotal thyroidectomy. How will the nurse assess for unilateral injury of the laryngeal nerve? Checking the throat for edema Asking the client to say what the current time is Eliciting spasms of the facial muscles Palpating the neck for seepage of blood

Asking the client to say what the current time is Rationale If the laryngeal nerve is damaged during surgery, the client will be hoarse and have difficulty speaking. Checking the throat for edema does not indicate injury to the laryngeal nerve; this is part of the assessment for a compromised airway. Eliciting the Chvostek sign assesses for hypocalcemia resulting from inadvertent removal of the parathyroid glands. Palpating the neck for seepage of blood assesses for bleeding and possible hemorrhage, not laryngeal nerve injury.

A client with type 1 diabetes receives Humulin R insulin in the morning. Shortly before lunch the nurse identifies that the client is diaphoretic and trembling. What is the nurse's most appropriate action? Administer insulin to the client Give the client lunch immediately Encourage the client to drink fluids Assess the client's blood glucose level

Assess the client's blood glucose level Rationale The client needs glucose, not just fluids. The presence of hypoglycemia should be determined before initiating therapy; Humulin R insulin given in the morning peaks within four hours or just before lunchtime. After hypoglycemia is verified, the client should be given an immediate source of glucose. Administering insulin is contraindicated; the client is experiencing adaptations of hypoglycemia, and administering insulin will decrease further an already low blood glucose level. Giving the client lunch may be done after hypoglycemia is determined.

A client is admitted to the hospital with a diagnosis of cancer of the thyroid gland and a thyroidectomy is performed. What should the nurse do during the first six to eight hours after surgery? Place two pillows behind the client's head. Monitor for the complication of seizures resulting from hypocalcemia. Assess the sides and back of the client's neck for evidence of bleeding. Encourage the client to perform deep-breathing and coughing exercises.

Assess the sides and back of the client's neck for evidence of bleeding. Rationale In a back-lying (supine) position, blood will flow with gravity down the sides of the neck and not be seen. Positioning two pillows behind the client's head flexes the neck excessively and increases tension on the suture line which may inhibit the passage of gases through the oral, pharyngeal, and tracheal areas. A small pillow behind the head keeps the head and neck in functional alignment and limits tension on the suture line. Seizures are a complication of hyponatremia and not a common complication of hypocalcemia. Although deep breathing should be encouraged, coughing should not be encouraged during the first 24 to 48 hours, to limit stress on the suture line.

A client with hyperthyroidism is treated with radioactive iodine to ablate thyroid tissue. What should the nurse instruct the client to do after the procedure? Remain in the house. Avoid holding an infant. Save urine in a lead-lined container. Refrain from using a bathroom used by others.

Avoid holding an infant. Rationale Infants are particularly sensitive to radioactivity; even the small amount emitted after treatment may affect infants. It is not necessary to avoid leaving the house as long as close proximity to others is avoided. Saving urine in a lead-lined container is not necessary; the same bathroom may be used by all members of the family, but the toilet should be flushed twice after use by the client. Refraining from using a bathroom used by others is not necessary.

The laboratory reports of a client who underwent a hypophysectomy show an intracranial pressure (ICP) of 20 mmHg. Which action made by the client is responsible for this condition? Drinking lots of water Eating high-fiber foods Bending over at the waist Bending knees when lowering body

Bending over at the waist Rationale Bending over at the waist should be avoided as this position increases intracranial pressure in clients who underwent hypophysectomy. Drinking lots of water and eating high-fiber foods reduce the risk of constipation, so this should not cause increased intracranial pressure. The client should bend the knees then lowering their body to reduce the risk of intracranial pressure.

A nurse is reviewing the diagnostic blood tests of a client with a diagnosis of type 1 diabetes. Which laboratory results support the nurse's suspicion that the client is experiencing ketoacidosis? Blood glucose of 40 mg/100 mL (2.2 mmol/L), blood pH of 7.37 Blood glucose of 130 mg/100 mL (7.2 mmol/L), blood pH of 7.35 Blood glucose of 650 mg/100 mL (36.1 mmol/L), blood pH of 7.42 Blood glucose of 300 mg/100 mL (16.7 mmol/L), blood pH of 7.20

Blood glucose of 300 mg/100 mL (16.7 mmol/L), blood pH of 7.20 Rationale The blood glucose level of 300 mg/100 mL (16.7 mmol/L) is above the expected range of individuals with type 1 diabetes, indicating hyperglycemia. The normal serum pH is 7.35 to 7.45; therefore, 7.20 indicates acidosis. The blood glucose level of 40 mg/100 mL (2.2 mmol/L) is below the expected range for all individuals, indicating hypoglycemia; the serum pH of 7.37 is within the expected range for pH. The blood glucose level of 130 mg/100 mL (7.2 mmol/L) is within the expected range for individuals with type 1 diabetes, and the pH of 7.35 is within the expected range for pH. The blood glucose level of 650 mg/100 mL (36.1 mmol/L) indicates hyperglycemia, but the serum pH is within the expected range for pH.

During a follow-up visit, the nurse finds increased intracranial pressure in a client who has undergone nasal hypophysectomy for hyperpituitarism. Which action taken by the client is responsible for this condition? Using stool softeners Blowing the nose and sneezing Performing deep-breathing exercises Bending the knees and lowering the body to pick up objects

Blowing the nose and sneezing Rationale A client who underwent hypophysectomy should be taught to perform activities that reduce intracranial pressure. Blowing the nose and sneezing can increase intracranial pressure. Constipation may result in increased intracranial pressure. Therefore, the client should be advised to take stool softeners and change to a high-fiber diet to prevent the risk of increased intracranial pressure. Performing deep breathing exercises can reduce intracranial pressure. Bending the knees and lowering the body to pick up objects reduces the risk of intracranial pressure.

A nurse is caring for a client who has a 20-year history of type 2 diabetes. The nurse should assess for what physiologic changes associated with a long history of diabetes? Blurry, spotty, or hazy vision Arthritic changes in the hands Hyperactive knee and ankle jerk reflexes Dependent pallor of the feet and lower legs

Blurry, spotty, or hazy vision Rationale Blurry, spotty, or hazy vision; floaters or cobwebs in the visual field; and cataracts or complete blindness can occur as a result of diabetes. Diabetic retinopathy is characterized by abnormal growth of new blood vessels in the retina (neovascularization). More than 60% of clients with type 2 diabetes have some degree of retinopathy after 20 years. Arthritic changes of the hands are not a usual complication associated with diabetes mellitus. Clients who are diabetic have peripheral neuropathy, which is characterized by hypoactive, not hyperactive, reflexes. Peripheral vascular disease is indicated by dependent rubor with pallor on elevation, not dependent pallor.

A urine specimen is needed to test for the presence of ketones in a diabetic client. What should the nurse do when collecting this specimen from a urinary catheter? Disconnect the catheter, and drain the urine into a clean container. Clean the drainage valve, and remove the urine from the catheter bag. Wipe the catheter with alcohol, and drain the urine into a sterile test tube. Clamp the catheter, cleanse the port, and use a sterile syringe to remove urine.

Clamp the catheter, cleanse the port, and use a sterile syringe to remove urine. Rationale The urinary catheter and drainage bag should always remain a closed, sterile system; urine should be drawn only from the catheter port, not the collection bag. Cleaning the drainage valve and removing the urine from the catheter bag will not yield a fresh specimen indicating present acetone levels. The system should remain closed so that fewer microorganisms enter the urinary tract.

The nurse is assisting the primary healthcare provider, who is examining the client's skull radiograph. An abnormality in the endocrine gland situated in a depression of the sphenoid bone is suspected. Which hormone release is most probably affected? Glucagon Cortisol Aldosterone Corticotropin

Corticotropin Rationale The pituitary gland is the endocrine gland that is situated in a bony depression of the sphenoid bone. Corticotropin or adrenocorticotropic hormones are secreted by the anterior pituitary and could be affected by an abnormality in the pituitary. Glucagon is a hormone that is secreted by the pancreas. Cortisol and aldosterone are hormones secreted by the adrenal cortex. There is less likelihood that the release of glucagon, cortisol, or aldosterone might be affected by a suspected abnormality in the pituitary gland.

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? Epinephrine Glucagon Calcitonin Cortisol

Cortisol Rationale 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.

A client complains of weight gain and purplish-blue striae on the abdomen. Which condition does the nurse anticipate in the client? Hypothyroidism Addison's disease Cushing's syndrome Pheochromocytoma

Cushing's syndrome Rationale Cushing's syndrome occurs because of chronic exposure to excess corticosteroids. Weight gain and purplish-blue striae are the clinical manifestations of Cushing's syndrome. Anemia, weight gain, and cold dry skin are the common manifestations of hypothyroidism. Weight loss and fatigue are the manifestations observed in Addison's disease. Severe, pounding headache, tachycardia, and profuse sweating are the clinical manifestations observed in pheochromocytoma.

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? Decreased glucose tolerance Decreased general metabolism Decreased ovarian production of estrogen Decreased antidiuretic hormone production

Decreased antidiuretic hormone production Rationale 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.

What expected effect of increased serum cortisone levels does a nurse consider when caring for clients with multiple physical and emotional problems? Accelerated wound healing Blocked gluconeogenesis in the liver Decreased pituitary secretion of adrenocorticotropic hormone (ACTH) Impaired tolerance of stressful situations

Decreased pituitary secretion of adrenocorticotropic hormone (ACTH) Rationale Cortisone and ACTH work together via a feedback loop. ACTH is released in response to decreased blood levels of cortisone. ACTH then stimulates release of additional adrenocortical hormone. Cortisone has anti-inflammatory properties that delay wound healing. As a glucocorticoid, cortisone increases gluconeogenesis in the liver. Cortisone assists the body in responding to stress.

A client feeling increasingly tired seeks medical care. Type 1 diabetes is diagnosed. What causes increased fatigue with type 1 diabetes? Increased metabolism at the cellular level Increased glucose absorption from the intestine Decreased production of insulin by the pancreas Decreased glucose secretion into the renal tubules

Decreased production of insulin by the pancreas Rationale Insulin facilitates transport of glucose across the cell membrane to meet metabolic needs and prevent fatigue. With diabetes there is decreased cellular metabolism because of the decrease in glucose entering the cells. Glucose is not absorbed from the intestinal tract by the cells; fatigue is caused by decreased, not increased, cellular levels of glucose. Filtration and excretion of glucose by the kidneys do not regulate energy levels; if insulin production is adequate, glucose does not spill into the urine.

The primary healthcare provider prescribed carbamazepine to a client with central diabetes insipidus. The serum osmolarity is 600 mOsm (mmol)/kg. Which will be an effective outcome of the drug? Decreased thirst Decreased seizures Decreased urine output Increased serum calcium levels

Decreased thirst Rationale Carbamazepine helps to decrease thirst associated with central diabetes insipidus (DI). While carbamazepine is an antiseizure medication, when given to clients with central DI, it decreases thirst. Urine output is decreased by hormone replacement therapy. Carbamazepine does not affect serum calcium levels.

A nurse is assessing a client and suspects diabetic ketoacidosis (DKA). What clinical findings support this conclusion? Nervousness and tachycardia Erythema toxicum rash and pruritus Diaphoresis and altered mental state Deep respirations and fruity odor to the breath

Deep respirations and fruity odor to the breath Rationale 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.

Which drug can cause diabetes insipidus? Cabergoline Metyrapone Demeclocycline Aminoglutethimide

Demeclocycline Rationale Prolonged administration of demeclocycline may cause diabetes insipidus, as this drug decreases the production of antidiuretic hormone by the kidneys. Cabergoline inhibits the release of growth hormone and prolactin by stimulating dopamine receptors in the brain. Metyrapone and aminoglutethimide decrease cortisol production.

When assessing a client with Graves disease (hyperthyroidism), what would the nurse expect to find in the client's history? Diaphoresis Menorrhagia Dry, brittle hair Sensitivity to cold

Diaphoresis Rationale 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.

Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? Select all that apply. Diarrhea Listlessness Weight loss Bradycardia Decreased appetite

Diarrhea Weight Loss Rationale Excessive thyroid hormones increase the metabolic rate, causing an increase in intestinal peristalsis. Excessive thyroid hormones increase the metabolic rate, causing weight loss. Listlessness occurs with hypothyroidism because of a decreased metabolic rate. A slow pulse rate accompanies hypothyroidism, not hyperthyroidism, because of a decreased metabolic rate. Appetite increases (polyphagia) with hyperthyroidism in an effort to meet metabolic needs.

Which clinical manifestations in a client indicate hyperfunctional thyroid gland? Select all that apply. Anemia Diarrhea Weight loss Decreased appetite Distant heart sounds

Diarrhea Weight loss Rationale Diarrhea and weight loss are the characteristic manifestations of a hyperfunctional thyroid gland. Anemia is seen in a client with a hypofunctional thyroid and decreased levels of thyroid hormone. Decreased appetite and distant heart sounds are symptoms of a hypofunctional thyroid gland.

While assessing the health of a female client, the nurse suspects endocrine dysfunction. Which findings support the nurse's suspicion? Select all that apply. Diminished pubic hair Yellow-colored urine Pulse of 74 beats/min Protrusion of eyeballs Blood pressure of 172/80 mm Hg

Diminished pubic hair Protrusion of eyeballs Blood pressure of 172/80 mm Hg Rationale Diminished axillary and pubic hair, protruding eyeballs, and elevated blood pressure are signs of endocrine dysfunction. Yellow urine is a normal finding. The normal pulse rate ranges from 60 to 100 beats/min.

While assessing a client with adrenal gland hypofunction 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? Dose adjustment of cortisone Dose adjustment of prednisone Dose adjustment of hydrocortisone Dose adjustment of fludrocortisones

Dose adjustment of hydrocortisone Rationale 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 nurse is caring for a client with hypothyroidism. Which clinical manifestations should the nurse anticipate when assessing this client? Select all that apply. Dry skin Brittle hair Weight loss Resting tremors Heat intolerance

Dry skin Brittle hair Rationale Dry skin results from a decrease in the metabolic rate, which is associated with hypothyroidism. Dry, brittle hair results from a decrease in the metabolic rate, which is associated with hypothyroidism. Weight loss is associated with hyperthyroidism because of an increase in body metabolism. Resting tremors are not associated with hypothyroidism; they are associated with Parkinson's disease. Heat intolerance is associated with hyperthyroidism, not hypothyroidism, because of the increase in body metabolism.

The nurse develops a teaching plan for a client with diabetes who has been diagnosed with lower extremity arterial disease (LEAD). What measures should the nurse include to increase arterial blood flow to the extremities? Exercises that promote muscular activity Meticulous care of minor skin breakdown Elevation of the legs above the level of the heart Soaking the feet in hot water each day

Exercises that promote muscular activity Rationale Arterial blood flow is improved with exercise by fostering the development of collateral circulation. Meticulous care of minor skin breakdown is important for the person with diabetes, but it does not improve arterial blood flow. Elevating the legs above the heart reduces arterial blood flow; the legs should be kept dependent to facilitate tissue perfusion. Soaking the feet in hot water is contraindicated because it can burn the skin or cause drying; also, individuals with diabetes may have neuropathies, which alter the perception of temperature.

A client is diagnosed with hyperthyroidism and is treated with 131I. Before discharge the nurse teaches the client to observe for signs and symptoms of therapy-induced hypothyroidism. Which signs and symptoms should be included in the teaching? Select all that apply. Fatigue Dry skin Insomnia Intolerance to heat Progressive weight gain

Fatigue Dry skin Progressive weight gain Rationale Fatigue is caused by a decreased metabolic rate associated with hypothyroidism. Dry skin most likely is caused by decreased glandular function associated with hypothyroidism. Progressive weight gain is associated with hypothyroidism in response to a decrease in the metabolic rate because of insufficient thyroid hormone. Insomnia is associated with hyperthyroidism, not hypothyroidism, in response to an increase in the metabolic rate because of excessive thyroid hormone. Intolerance to heat is associated with hyperthyroidism, not hypothyroidism, in response to an increase in the metabolic rate because of excessive thyroid hormone.

A client is admitted to the hospital with diabetic ketoacidosis. The nurse concludes that the client's elevated ketone level is caused by incomplete oxidation of which nutrient? Fats Protein Potassium Carbohydrates

Fats Rationale Incomplete oxidation of fat results in fatty acids that further break down to ketones. Protein metabolism produces nitrogenous waste, causing elevated blood urea nitrogen (BUN), not ketones. Potassium is not oxidized; potassium is not directly associated with ketones. Carbohydrates do not contain fatty acids that are broken down into ketones.

A nurse identifies that the client is experiencing a hypoglycemic reaction. Which intervention should the nurse implement to relieve the symptoms associated with this reaction? Giving 4 oz (120 mL) of fruit juice Administering 5% dextrose solution intravenously (IV) Withholding a subsequent dose of insulin Providing a snack of cheese and dry crackers

Giving 4 oz (120 mL) of fruit juice Rationale Liquids containing simple carbohydrates are most readily absorbed and thus increase the blood glucose level quickly. Although a solution of 50% dextrose may be given if the client is comatose, 5% dextrose does not supply sufficient carbohydrates. Withholding a subsequent dose of insulin will not alter the current situation. Complex carbohydrates and protein take longer to increase the blood glucose level, so they should be administered after a simple carbohydrate.

A nurse is caring for a newly admitted client with a diagnosis of Cushing syndrome. Why should the nurse monitor this client for clinical indicators of diabetes mellitus? Cortical hormones stimulate rapid weight loss. Tissue catabolism results in a negative nitrogen balance. Glucocorticoids accelerate the process of gluconeogenesis. Excessive adrenocorticotropic hormone (ACTH) secretion damages pancreatic tissue.

Glucocorticoids accelerate the process of gluconeogenesis. Rationale Excess glucocorticoids cause hyperglycemia, and signs of diabetes mellitus may develop ACTH, which causes sodium retention and subsequent weight gain. Although muscle wasting is associated with excessive corticoid production, this will not cause diabetes mellitus. ACTH affects the adrenal cortex, not the pancreas.

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome? Urine output Glucose level Serum potassium Immune response

Glucose level Rationale As a result of increased cortisol levels, glucose metabolism is altered, which may contribute to an increase in blood glucose levels. Increased mineralocorticoids will decrease urine output. Sodium is retained by the kidneys, but potassium is excreted. The immune response is suppressed.

A client reports enlargement of the hands and feet, thickened lips, and joint pains. The client's blood glucose is 250 mg/dL (13.89 mmol/L) and x-ray reports reveal increased size of the lungs. Which hormonal change does the nurse suspect in the client? Prolactin Thyrotropin Growth hormone Adrenocorticotropic hormone

Growth hormone Rationale 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 nurse is caring for a client with a history of hyperthyroidism who is now experiencing thyroid crisis (thyroid storm). What does the nurse consider to be the most likely precipitating factor in the client's current health problem? Increased iodine in the blood Removal of the parathyroid glands High levels of the hormone triiodothyronine Rebound increase in metabolism following anesthesia

High levels of the hormone triiodothyronine Rationale Thyroid trauma, thyroid surgery, or physiological stress in a client with hyperthyroidism may lead to a release of abnormally high levels of thyroid hormones. High levels of the hormone triiodothyronine intensify all the signs and symptoms of hyperthyroidism (thyroid storm or crisis), such as increased temperature, pulse, and respirations, restlessness, vomiting, and often death. Iodine binds with thyroxine, thus decreasing the potential for crisis. Tetany, not thyroid crisis, occurs from surgical excision of the parathyroid glands. Anesthesia will depress metabolism, not increase it.

A nurse is caring for a newly admitted client with a diagnosis of Graves disease. In preparing a teaching plan, the nurse anticipates which diet will be prescribed for this client? High-calorie diet Low-sodium diet High-roughage diet Mechanical-soft diet

High-calorie diet Rationale Because of the individual's increased metabolic rate, a high-calorie diet is needed to meet the energy demands of the body and prevent weight loss. Sodium is not restricted because clients with hyperthyroidism perspire heavily and lose sodium. Gastrointestinal motility is increased and does not require the additional stimulus of increased roughage. Modification of dietary consistency is unnecessary.

A female client is undergoing treatment for infertility. After therapy with clomiphene the client comes for follow-up visits and no results are seen. What further treatment does the nurse anticipate administering? Estrogen Progesterone Human growth hormone Human chorionic gonadotropin

Human chorionic gonadotropin Rationale Clomiphene is used to induce pregnancy by triggering ovulation. If the desired result is not obtained, the second alternative is to administer human chorionic gonadotropin and gonadotropin-releasing hormone to stimulate ovulation. A combination of estrogen and progesterone is generally administered to treat female clients who have a gonadotropin deficiency. Human growth hormone injections are administered to treat adults with growth hormone deficiency.

A client with a parathyroid disorder reports nausea, vomiting, weight loss, and epigastric pain. Which electrolyte disturbance would be responsible for the client's clinical manifestations? Hypercalcemia Hypernatremia Hypermagnesemia Hyperphosphatemia

Hypercalcemia Rationale High levels of calcium in the serum cause nausea, vomiting, weight loss, and epigastric pain (pain in the upper abdomen). Therefore the client may have hypercalcemia. Hypernatremia is manifested as altered cerebral functioning. Hypermagnesemia is manifested as bradycardia, peripheral vasodilation, and hypotension. Hyperphosphatemia is manifested as hypocalcemia that results when serum phosphorus levels increase.

After a surgical procedure for cancer of the pancreas with removal of the stomach, the head of the pancreas, the distal end of the duodenum, and the spleen, what symptom exhibited by the client requires immediate attention by the nurse? Jaundice Indigestion Weight loss Hyperglycemia

Hyperglycemia Rationale When the head of the pancreas is removed, the client has a greatly reduced number of insulin-producing cells, and hyperglycemia will occur; immediate treatment is necessary. Jaundice, indigestion, and weight loss are not immediately life threatening and will take time to develop.

Which clinical indicator should the nurse identify as expected for a client with type 2 diabetes? Ketones in the blood but not in the urine Glucose in the urine but not hyperglycemia Hyperglycemia and urine negative for ketones Blood and urine positive for both glucose and ketones

Hyperglycemia and urine negative for ketones Rationale In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia. Ketones in the blood but not in the urine does not occur with either type. In type 2 diabetes, there is sufficient insulin production to prevent fat breakdown that leads to ketones, but insulin resistance leads to hyperglycemia and diabetes mellitus. Glucose in the urine but not hyperglycemia is impossible; if glycosuria is present, the level of glucose in blood first must exceed the renal threshold of 160 to 180 mg/dL (8.9 to 10 mmol/L). Blood and urine positive for both glucose and ketones is expected in uncontrolled type 1 diabetes.

The nurse is performing an assessment and notes that the client has exophthalmos and complains of double vision. These assessment findings are found with which condition? Glaucoma Hypertension Hyperthyroidism Sinus infection

Hyperthyroidism Rationale Visual changes such as blurring or double vision, as well as tiring of the eyes, may be among the earliest problems for a client with hyperthyroidism. Exophthalmos, or protruding eyes, is also seen with hyperthyroidism. Glaucoma, hypertension, and sinus infection are not characteristic of the other conditions listed.

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? Hypokalemia Hypocalcemia Thyrotoxic crisis Hypovolemic shock

Hypocalcemia Rationale 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 client with diabetic ketoacidosis who is receiving intravenous fluids and insulin reports tingling and numbness of the fingers and toes, and shortness of breath. The nurse identifies a U wave on the cardiac monitor. What should the nurse conclude is causing these clinical findings? Hypokalemia Hyponatremia Hyperglycemia Hypercalcemia

Hypokalemia Rationale These are classic signs of hypokalemia that occur when potassium levels are reduced as potassium reenters cells with glucose. Clinical manifestations of hyponatremia include nausea, malaise, and changes in mental status. Clinical manifestations of hyperglycemia include weakness, dry skin, flushing, polyuria, and thirst. Clinical manifestations of hypercalcemia include lethargy, nausea, vomiting, paresthesias, and personality changes.

A client is admitted to the hospital with a potential diagnosis of excess antidiuretic hormone. Which clinical indicator should the nurse identify when assessing this client? Polyuria Dehydration Hyponatremia Hyperglycemia

Hyponatremia Rationale Antidiuretic hormone (ADH) causes increased resorption of water by renal tubules, which dilutes sodium levels, causing hyponatremia. ADH will decrease urine volume. ADH causes fluid retention. ADH does not alter glucose metabolism.

The nurse is assessing the client admitted with diabetic ketoacidosis. Which statement made by the client indicates a need for further education on sick day management? I will stop taking my insulin when I am ill because I am not eating. I will check my urine for ketones when my blood sugar is over 250. I will alternate drinking Gatorade and water throughout the day while ill. I will continue all my insulin including my glargine when I am sick.

I will stop taking my insulin when I am ill because I am not eating. Rationale The diabetic client's metabolic needs will require the same amount of insulin and sometimes more when in a stressed state, including illness. The client checking the urine for ketones when blood sugar is over 250, alternating water and Gatorade intake, and continuing insulin indicate that the client has an understanding of the basic sick day rules. Alternating the intake of water and Gatorade throughout the day provides noncarbohydrate water and fluids containing glucose and electrolytes while reducing the risk of consuming too much sugar.

What is the effect of parathyroid hormone on bones? Select all that apply. <p>What is the effect of parathyroid hormone on bones? <b>Select all that apply</b>.</p> Increased bone breakdown Increased serum calcium levels Increased sodium and phosphorus excretion Increased absorption of calcium and phosphorus Increased net release of calcium and phosphorus

Increased bone breakdown Increased serum calcium levels Increased net release of calcium and phosphorus Rationale Parathyroid hormone increases bone breakdown, which increases serum calcium levels. Parathyroid hormone increases net release of calcium and phosphorus from bone into the extracellular fluid. It increases sodium and phosphorus excretion by the kidneys, not in the bone and increases absorption of calcium and phosphorus in the gastrointestinal tract by using activated vitamin D. However, this increased absorption of calcium and phosphorus is not related to the bone.

Which clinical feature is indicative when a client has hypercortisolism? Loss of weight Thickening of skin Enhanced density of bones Increased pigmentation

Increased pigmentation Rationale Hypercortisolism causes such skin manifestations as increased pigmentation. Weight gain is a characteristic finding in hypercortisolism. The skin becomes thin due to increased fragility of the blood vessels. Loss of bone density is seen in clients with hypercortisolism.

A nurse provides post-operative care to a client who has undergone a hypophysectomy. Which action should the nurse take if there is a yellowish discharge at the dressing site? Change the dressing Wipe the discharge off with alcohol Inform the primary healthcare provider Tighten the dressing in order to avoid leakage

Inform the primary healthcare provider Rationale In order to reduce the risk of further complications, the nurse should inform the primary healthcare provider. Leakage of cerebrospinal fluid (CSF) may occur due to hypophysectomy. A yellowish discharge at the dressing site indicates the leakage of CSF. Changing the dressing, cleaning the wound with alcohol, and tightening the dressing may complicate the condition.

The nurse caring for a client with diabetic ketoacidosis (DKA) can expect to implement which intervention? Intravenous administration of regular insulin Administer insulin glargine subcutaneously at hour of sleep Maintain nothing prescribed orally (NPO) status Intravenous administration of 10% dextrose

Intravenous administration of regular insulin Rationale 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 client is admitted to the hospital with a possible diagnosis of Addison disease. What is an important nursing responsibility during a 24-hour urine collection for this client? Keeping the client quiet and reducing stress Assessing the client for signs and symptoms of edema Monitoring the client for an elevation in blood pressure Restricting the client's fluid intake during the day of the test

Keeping the client quiet and reducing stress Rationale Stress and activity increase the secretion of adrenocorticotropic hormone (ACTH) and adrenocortical hormones, elevating the urine values for the by-products of these hormones, thus invalidating the test results. Clients with Addison disease chronically are dehydrated and do not have edema. Because of fluid deficits, the client will be hypovolemic, and the blood pressure will be decreased. Adequate fluid intake is necessary for urine production; Addison disease involves salt wasting and dehydration, which necessitates an increased fluid intake, not a restriction of fluid intake.

A client with untreated type 1 diabetes mellitus may lapse into a coma because of acidosis. Which component is increased in the blood and a direct cause of acidosis? Ketones Glucose Lactic acid Glutamic acid

Ketones Rationale The ketones produced excessively in diabetes are a by-product of the breakdown of body fats and proteins for energy; this occurs when insulin is not secreted or is unable to be used to transport glucose across the cell membrane into the cells. The major ketone, acetoacetic acid, is an alpha-ketoacid that lowers the blood pH, resulting in acidosis. Glucose does not change the pH. Lactic acid is produced as a result of muscle contraction; it is not unique to diabetes. Glutamic acid is a product of protein metabolism.

A client complains of fatigue, hair loss, and weight gain. On assessment, the client is found to have anemia. Which therapy does the nurse anticipate in the client's prescription? Iodine Methimazole Levothyroxine Propylthiouracil

Levothyroxine Rationale Fatigue, hair loss, weight gain, and anemia are the clinical manifestations of hypothyroidism, which occurs due to deficiency of thyroid hormones. Treatment includes restoration of euthyroid state by hormone therapy, such as levothyroxine. Iodine is used to prepare the client for thyroidectomy to treat thyrotoxicosis. Methimazole and propylthiouracil inhibit the synthesis of thyroid hormones and are used to treat hyperthyroidism.

Which drug acts as an abortifacient in female clients? Mifepristone Metyrapone Cyproheptadine Aminoglutethimide

Mifepristone Rationale Mifepristone is an antiprogesterone that blocks the progesterone receptors and acts as an abortifacient. Metyrapone, cyproheptadine, and aminoglutethimide are used to treat hyperfunctioning of the adrenal glands (Cushing's disease/syndrome).

A client's parathyroid glands are removed. What clinical manifestation is indicative of the fluid and electrolyte imbalance associated with this surgery? Constipation Muscle spasms Hypoactive reflexes Increased specific gravity

Muscle spasms Rationale Removal of the parathyroids causes hypocalcemia and associated neuromuscular irritability. Constipation is a sign of hypercalcemia. Hypoactive reflexes are signs of hypercalcemia. Increased specific gravity is a sign of fluid volume deficit.

A client complains of joint pain with deformities. On assessing the client, the nurse suspects that the client has acromegaly. Which medication is beneficial to the client? Octreotide Carbamazepine Chlorpropamide Cyclophosphamide

Octreotide Rationale Joint pain with deformities are the clinical manifestations of acromegaly. The primary medication used for the treatment of acromegaly is octreotide. It is given by subcutaneous injection three times a week. Carbamazepine, chlorpropamide, and cyclophosphamide are the medications used in the treatment of syndrome of inappropriate antidiuretic hormone secretion.

The nurse is caring for a client who is going to undergo surgery for pheochromocytoma. Which action of the nurse needs correction to ensure client safety? Palpating the abdomen Providing fluids before surgery Administering phenoxybenzamine Initiating an intravenous bolus of alpha-adrenergic blockers

Palpating the abdomen Rationale The nurse should not palpate the abdomen of a client with pheochromocytoma. Abdominal palpation can cause sudden release of catecholamines and induce hypertension in the client. Hydration before surgery can reduce the risk of hypotension due to decreased blood volume. Phenoxybenzamine is an adrenergic blocking agent that is administered for a week prior to surgery to stabilize the client's blood pressure. Anesthetic agents can induce the release of catecholamines; therefore intravenous bolus of short-acting alpha-adrenergic blockers are administered to the client.

Which carcinoma is the most common type of thyroid cancer and is most often found in younger women? Papillary carcinoma Follicular carcinoma Medullary carcinoma Anaplastic carcinoma

Papillary carcinoma Rationale Papillary carcinoma is the most common type of thyroid cancer; it is most often seen in younger women. Follicular carcinoma occurs most often in older adults. Medullary carcinoma is seen mostly in clients older than 50 years. Anaplastic carcinoma is a rapid-growing, aggressive tumor.

Blood studies are being performed on a client with the potential diagnosis of hyperparathyroidism. What serum blood level should the nurse expect to be decreased when reviewing this client's hematologic studies? Calcium Chloride Phosphorus Parathormone

Phosphorus Rationale Because of its inverse relationship with calcium, when serum calcium levels increase, serum phosphorus levels decrease (greater than 3 mg/dL; greater than 0.17 mmol/L). Serum calcium levels will increase because of the action of elevated levels of serum parathormone; serum calcium levels usually exceed 10 mg/dL (2.50 mmol/L). Serum chloride levels will increase, not decrease, with hyperparathyroidism. Parathormone, produced in the parathyroid gland, will increase with hyperparathyroidism.

In anticipation of a client returning to their room following a subtotal thyroidectomy, what intervention would be highest priority for the nurse to perform? Have sterile dressing supplies in the room. Place a tracheostomy set at the bedside. Lock the client's bed in a supine position until surgeon orders a different position. Have pencil and paper in the room so the client can communicate their needs in writing.

Place a tracheostomy set at the bedside. Rationale Thyroid surgery sometimes results in accidental removal of the parathyroid glands. A resultant hypocalcemia may lead to contraction of the glottis, causing airway obstruction; edema around the operative site also may cause an airway obstruction. Although not common, airway obstruction after thyroid surgery is an emergency situation.Oxygen, suction equipment, and a tracheostomy tray should be readily available in the patient's room. A patent airway takes priority over incision inspection. Speaking is important to determine the status of the laryngeal nerve. The semi-Fowler position is indicated to maximize respiratory excursion.

Which hormones are secreted by the client's hypothalamus? Select all that apply. Growth hormone Follicle-stimulating hormone Prolactin-inhibiting hormone Corticotropin-releasing hormone Melanocyte-stimulating hormone

Prolactin-inhibiting hormone Corticotropin-releasing hormone Rationale The hormones that are secreted by the hypothalamus include prolactin-inhibiting hormone and corticotropin-releasing hormone. Growth hormone, follicle-stimulating hormone, and melanocyte-stimulating hormone are hormones secreted by the anterior pituitary gland.

Upon assessing a female client, the nurse discovers an abnormal endocrine finding. Which finding in the client supports the nurse's conclusion? Facial hair Protruding eyes Pulse of 90 beats/min Blood pressure of 120/80 mmHg

Protruding eyes Rationale Protruding eyes are a clinical manifestation of hyperthyroidism, wherein the fluid accumulates in the eye and retro-orbital tissue. Hyperthyroidism is a problem of the endocrine system. Therefore, protrusion of the eyes in the client helped the nurse in arriving at this conclusion. Presence of facial hair is common in women. However, an increase suggests an endocrine abnormality. A heartbeat of 90 beats/minute is a normal finding. A blood pressure value of 120/80 mmHg is normal.

While assessing a postpartum client who is suspected of having a thyroid disorder, the nurse suspects that the client has autoimmune thyroiditis. Which diagnostic studies are most suitable for confirming the diagnosis? Radioactive iodine uptake Computed tomography scan Magnetic resonance imaging Thyroid-stimulating hormone

Radioactive iodine uptake Rationale The postpartum client may have silent, painless thyroiditis. Radioactive iodine uptake is suppressed in silent thyroiditis, so this test would be beneficial in diagnosing the thyroiditis. A computed tomography scan is used to detect thyroid nodules. Magnetic resonance imaging is also used in evaluating thyroid nodules. A blood test for thyroid-stimulating hormone is used to evaluate thyroid function.

A nurse is providing postoperative care for a client who has begun taking levothyroxine after undergoing a thyroidectomy. Which findings in the client may indicate potential thyrotoxic crisis? Elevated serum calcium Sudden drop in pulse rate Hypothermia and dry skin Rapid heartbeat and tremors

Rapid heartbeat and tremors Rationale Thyrotoxic crisis (thyroid storm) refers to a sudden and excessive release of thyroid hormones, which causes pyrexia, tachycardia, and exaggerated symptoms of thyrotoxicosis; surgery, infection, and ablation therapy can precipitate this life-threatening condition. Hypercalcemia is not related to thyrotoxic crisis; hypocalcemia results from accidental removal of the parathyroid glands. Tachycardia is an increased, not decreased, heart rate, which occurs with thyrotoxic crisis because of the sudden release of thyroid hormones; thyroid hormones increase the basal metabolic rate. Fever, not hypothermia, and diaphoresis, not dry skin, occur with thyrotoxic crisis because of the sudden release of thyroid hormones, which increase the basal metabolic rate.

Which drug will the nurse administer to trigger ovulation? Tolvaptan Clomiphene Conivaptan Metyrapone

Rationale Clomiphene is used to trigger ovulation for women with gonadotropin deficiency. Tolvaptan and conivaptan are used to treat syndrome of inappropriate antidiuretic hormone. Metyrapone is used to treat Cushing's syndrome.

Which hormone levels peak during the client's sleep? Select all that apply. Cortisol Calcitonin Thyrotropin Progesterone Growth hormone

Rationale Cortisol, thyrotropin, and growth hormone levels peak during sleep. Calcitonin and progesterone hormone levels are not altered during sleep.

Which parameter monitoring should be the nurse's priority while caring for a client with hypothyroidism? Pulse rate Blood pressure Respiratory rate Body temperature

Rationale Hypothyroidism is associated with a decreased respiratory rate. Therefore monitoring the client's respiratory rate should be the nurse's top priority. While hypotension, hypothermia, and pulse rate are important, they are not the priority.

A nurse is assessing a client with a suspected pituitary tumor. Which assessment finding is consistent with a pituitary tumor? Tetany Seizures Lethargy Hyperreflexia

Rationale Seizures are common in clients who have pituitary tumors. Tetany is associated with severe hypocalcemia; that condition can be caused by hypoparathyroidism. Lethargy is found in clients with hypothyroidism. Hyperreflexia is observed in clients with hyperthyroidism and hypoparathyroidism.

One week after beginning antithyroid medication for the treatment of hyperthyroidism, a client reports diarrhea, abdominal pain, and a fever. The client is admitted with a diagnosis of thyrotoxic crisis. What is the most important intervention to implement for this client? Limiting fluid intake Reducing body temperature and heart rate Observing for an exaggerated response to sedatives Treating the associated hyperglycemia and ketoacidosis

Reducing body temperature and heart rate Rationale Immediate treatment in this emergency focuses on reduction of oxygen demands and thus cardiac workload to prevent cardiac decompensation. The need is for an increase, not decrease, in fluid intake to compensate for that loss because of the high metabolic rate. A response to sedatives is not likely because drugs are metabolized more rapidly with thyrotoxic crisis; there is a danger of exaggerated effects of the drug with hypothyroidism. Clients with thyrotoxic crisis are more apt to develop hypoglycemia from the high metabolic rate.

The primary health care provider prescribes fludrocortisone to a client with adrenal gland hypofunction. What does the nurse instruct the client about this medication? "Report symptoms of diarrhea." "Regularly monitor blood pressure." "Monitor temperature every 5 hours." "Report signs of changes in facial features."

Regularly monitor blood pressure Rationale Fludrocortisone may cause hypertension and sodium-related fluid retention. Therefore, the nurse should instruct the client to monitor blood pressure regularly. Diarrhea and fever are the main side effects of prednisone and may not be seen in a client taking fludrocortisone. The client taking hydrocortisone is instructed to report signs of "round face" and fluid retention, which may cause Cushing's syndrome.

The nurse is assessing a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which finding in the client is consistent with the diagnosis? Preservation of salt Retention of water Decrease of vasopressin Presence of pedal edema

Retention of water Rationale SIADH is manifested in the form of retention of free water. This is because of excessive secretion of vasopressin causing reabsorption of water in renal tubules. There is hyponatremia and dilution of serum sodium in SIADH. Decreased vasopressin is seen in diabetes insipidus. Generally pedal (dependent) edema is not seen in SIADH despite the water retention.

The nurse is caring for a client newly diagnosed with diabetes. When preparing the teaching plan about the importance of yearly eye examinations, the nurse should instruct the client on which eye problem most associated with diabetes? Cataracts Glaucoma Retinopathy Astigmatism

Retinopathy Rationale Diabetic retinopathy is a leading cause of blindness in diabetics. Glaucoma and cataracts also are associated with diabetes, but retinopathy is the most common eye problem. Astigmatism is not associated with diabetes.

A primary healthcare provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. Two months after being started on the antithyroid medication, the client calls the nurse and complains of feeling tired and looking pale. What should the nurse do? Advise the client to get more rest. Schedule the client for an appointment. Instruct the client to skip one dose daily. Tell the client to increase the medication.

Schedule the client for an appointment. Rationale The client should be examined by the primary healthcare provider, and blood tests should be prescribed; anemia may result from the bone marrow depressant effect of PTU. Advising the client to get more rest is unsafe; a physical examination and blood tests are necessary to determine the cause of the client's fatigue and paleness. It is unsafe to skip one dose of PTU daily without a primary healthcare provider's prescription; advising the client to alter the dosage of a drug is not within the legal role of the nurse. It is unsafe to increase the dose of PTU without a primary healthcare provider's prescription; advising the client to alter the dosage of a drug is not within the legal role of the nurse.

A client is admitted to the hospital for a thyroidectomy. In which position should the nurse maintain the client after surgery? Prone Supine Left Sims Semi-Fowler

Semi-Fowler Rationale The semi-Fowler position limits edema in the operative area via gravity and promotes respirations by facilitating thoracic expansion. The prone, supine, and Sims position will promote edema in the operative area, which can compromise respirations.

The primary healthcare provider prescribed a diagnostic study with contrast medium for an older adult who has an endocrine disorder. Which assessment result should the nurse check before the study? Urinary pH Serum creatinine Urinary creatinine Creatinine clearance

Serum creatinine Rationale If a contrast medium is used in older adults with an elevated serum creatinine, it may cause renal failure. Thus, the nurse should assess the client's renal function prior to the diagnostic by checking the serum creatinine to assess for renal failure. Urinary pH may not help a nurse assess the client's risk of renal failure. Urinary creatinine helps to assess the degree of renal failure but usually takes 24 hours and is not routinely done before contrast medium tests. Creatinine clearance helps to assess the glomerular filtration rate.

Which electrolyte concentration has the potential to precipitate dysrhythmias and cardiac arrest in a client? Serum sodium of 139 mEq/L (139 mmol/L) Serum chloride of 100 mEq/L (100 mmol/L) Serum calcium of 10.2 mg/dL (2.55 mmol/L) Serum potassium of 7.2 mEq/L (7.2 mmol/L)

Serum potassium of 7.2 mEq/L (7.2 mmol/L) Rationale Hyperkalemia causes dysrhythmias and cardiac arrest. The normal serum potassium concentration ranges between 3.5 and 5.0 mEq/L (3.5-5.0 mmol/L). A concentration of 7.2 mEq/L (7.2 mmol/L) indicates hyperkalemia. The normal concentration of sodium in the serum ranges between 135 and 145 mEq/L (135-145 mmol/L). The normal chloride concentration ranges between 96 and 106 mEq/L (96-106 mmol/L). The normal serum calcium level ranges between 9 and 10.5 mg/dL (2.25-2.625 mmol/L).

Which laboratory finding is a characteristic feature in a client with hypercortisolism? Serum sodium of 150 mEq/L (150 mmol/L) Serum chloride of 100 mEq/L (100 mmol/L) Serum potassium of 4.1 mEq/L (4.1 mmol/L) Serum bicarbonate of 25 mEq/L (25 mmol/L)

Serum sodium of 150 mEq/L (150 mmol/L) Rationale Hypercortisolism manifests as hypernatremia, or an elevated sodium level. The normal concentration of sodium in the serum ranges between 135 and 145 mEq/L (135-145 mmol/L). Therefore, a serum sodium concentration of 150 mEq/L (150 mmol/L) is an abnormal finding that supports hypercortisolism. The normal chloride ranges between 96 and 106 mEq/L (96-106 mmol/L). The normal serum potassium concentration ranges between 3.5 and 5.0 mEq/L (3.5-5 mmol/L). The normal serum bicarbonate concentration ranges between 22 and 26 mEq/L (22-26 mmol/L). Decreased serum calcium level occurs in hypercortisolism.

A client admitted to the emergency department has ketones in the blood and urine. Which situation associated with this physiologic finding should be the nurse's focus when collecting additional data about this client? Starvation Alcoholism Bone healing Positive nitrogen balance

Starvation Rationale In starvation there are inadequate carbohydrates available for immediate energy, and stored fats are used in excessive amounts, producing ketones. There is no fat in alcohol; fat oxidation does not occur. Bone healing does not require the use of great amounts of fat; calcium is deposited to form callus. A positive nitrogen balance does not require the use of great amounts of fat.

While caring for a client receiving hydrocortisone therapy, the nurse anticipates a dose adjustment in the client's prescription. Which observation in the client supports this anticipation? Three episodes of vomiting Passage of loose stools Body temperature of 37.2°C (99°F) Sudden weight gain of 8 kg

Sudden weight gain of 8 kg Rationale Excessive hydrocortisone therapy causes rapid weight gain, fluid retention, and a round face. Thus a sudden weight gain of 8 kg (17.637 lbs.) indicates excessive hydrocortisone levels and indicates the need for dose adjustment. Vomiting, diarrhea, and fever are seen in excessive prednisone therapy.

A client is scheduled to have a thyroidectomy for thyroid cancer. What specific instruction about postoperative care should the nurse provide the client during preoperative teaching? Cough and deep breathe every hour. Perform range-of-motion exercises of the head and neck. Support the head with the hands when changing position. Apply gentle pressure against the incision when swallowing.

Support the head with the hands when changing position. Rationale Supporting the head with the hands when changing position relieves tension on the incision and limits the risk of dehiscence. Coughing should be avoided during the early postoperative period to prevent trauma to the operative site. Performing range-of-motion exercises of the head and neck should be avoided until advised by the primary healthcare provider, usually after sutures or skin clips have been removed. Pressure against the operative area is not necessary to promote integrity of the incision, and it may inhibit swallowing.

While hospitalized, a client with diabetes is observed picking at calluses on the feet. Which intervention should the nurse implement immediately? Warn the client of the danger of infection Suggest that the client wear white cotton socks Teach the client the importance of effective foot care Check the client's shoes for their fit in the area of the calluses

Teach the client the importance of effective foot care Rationale Inadequate foot care can lead to skin breakdown, poor healing, and subsequent infection. Warning the client of the danger of infection can increase anxiety and reduce the client's ability to learn. Suggesting that the client wear white cotton socks is only one aspect of effective foot care; synthetic fibers that wick moisture are preferred. Although important, checking the client's shoes for their fit in the area of the calluses is not comprehensive foot care.

A nurse is caring for a client who had a thyroidectomy. Which client response should the nurse assess when concerned about an accidental removal of the parathyroid glands during surgery? Tetany Myxedema Hypovolemic shock Adrenocortical stimulation

Tetany Rationale Parathyroid removal eliminates the body's source of parathyroid hormone (parathormone), which increases the blood calcium level. The resulting low body fluid calcium affects muscles, including the diaphragm, resulting in dyspnea, asphyxia, and death. Loss of the thyroid gland will upset thyroid hormone balance and may cause myxedema. The parathyroids are not involved in regulating plasma volume; the pituitary and adrenal glands are responsible. The parathyroids do not regulate the adrenal glands.

During thyroid surgery, a client's parathyroid glands have become damaged. Which condition does the nurse expect the client to develop? Goiter Tetany Globe lag Photophobia

Tetany Rationale The parathyroid gland maintains calcium and phosphate levels in the body. When there is any damage to parathyroid glands, there would be improper functioning of these glands, which may cause conditions such as tetany. Tetany is a condition in which there is hyperexcitabilty of nerves and muscles that occurs due to low calcium in the body (hypocalcemia). A goiter is caused byan enlarged thyroid gland. Globe lag is a condition in which the upper eyelid pulls back faster than the eyeball; this occurs in hyperthyroidism. Photophobia is a visual problem that may be seen in clients with Graves' disease.

The primary healthcare provider instructs the client to increase their intake of seafood and protein in the diet. What could be the reason for this instruction? The client has vitiligo. The client has hypothyroidism. The client has diabetes mellitus. The client has a urinary infection.

The client has hypothyroidism. Rationale Nutritional deficiencies due to inadequate diet, especially decreases in protein and iodine intake, may be a cause for certain endocrine disorders, such as hypothyroidism. Therefore, to meet nutritional requirements clients with hypothyroidism are instructed to increase the intake of seafood and proteins to 60 mg/day. Because of hypofunction of the adrenal gland, clients with skin pigmentation conditions, such as vitiligo, are mainly instructed to consume more water. To improve metabolism, clients with diabetes mellitus are advised to add high-fiber food to their diet. A client with a urinary infection may not be advised to add seafood and proteins to their diet.

A client is injured in a motor vehicle accident and is admitted to the critical care unit. Twelve hours later the client complains of increased abdominal pain in the left upper quadrant. A ruptured spleen is diagnosed, and an emergency splenectomy is scheduled. What should the nurse emphasize when preparing the client for surgery? The poor prognosis associated with a splenectomy The expectation that postoperative bleeding will occur The high risk associated with the procedure in light of the client's other injuries The presence of abdominal drains for several days after the surgery

The presence of abdominal drains for several days after the surgery Rationale Drains usually are inserted into the splenic bed to facilitate removal of fluid that may lead to abscess formation. Splenectomy has a low mortality rate (5%) except when multiple injuries are present (15% to 40%). Bleeding occurs more commonly with splenic repair than with removal. Educating the client about the risks associated with surgery is the responsibility of the primary healthcare provider. There is no need to frighten the client unnecessarily.

A client who is scheduled to have surgery to remove an aldosterone-secreting adenoma asks the nurse what will happen if surgery is not performed. On what information should the nurse base a response? The tumor must be removed to prevent heart and kidney damage. Surgery will prevent the tumor from metastasizing to other organs. Radiation therapy can be just as effective as surgery if the tumor is small. Chemotherapy is as reliable as surgery for the treatment of adenomas of this type in some people.

The tumor must be removed to prevent heart and kidney damage. Rationale Renal and cardiac complications will occur if hypertension caused by the tumor is not arrested. Aldosteronomas are benign tumors; metastasis is not possible. Radiation is not used to treat this type of adenoma. Chemotherapy is not recommended treatment for this particular adenoma.

The nurse is assessing a client with a suspected thyroid disorder. Which diagnostic studies will be most appropriate to confirm that the thyroid disorder is autoimmune in origin? Select all that apply. Free thyroxine Thyroglobulin antibody Thyroid peroxidase antibody Thyroid-stimulating antibody Thyroid-stimulating hormone

Thyroglobulin antibody Thyroid peroxidase antibody Thyroid-stimulating antibody Rationale Thyroglobulin, thyroid peroxidase, and thyroid-stimulating antibodies are assessed in a thyroid antibody test. This test helps to differentiate other forms of thyroiditis from autoimmune thyroid disease. An active component of total T 4 is measured by free thyroxine but cannot differentiate the origin. Thyroid-stimulating hormone levels are used to evaluate a thyroid dysfunction but cannot differentiate the origin.

A client with a family history of goiter is experiencing changes in voice and breathing. Which diagnostic study does the nurse consider to be beneficial in confirming a diagnosis? Thyroglobulin Thyroid antibodies Thyroxine (free T 4), total Thyroid-stimulating hormone (TSH)

Thyroid antibodies Rationale Changes in voice and breathing can be seen in Hashimoto's thyroiditis if the thyroid gland enlarges rapidly and constricts the trachea and laryngeal nerves. Clients with a family history of goiter may have this condition. A thyroid antibody test is used diagnose Hashimoto's thyroiditis by differentiating thyroid dysfunction from thyroiditis. Thyroglobulin is used to detect thyroid cancer. Thyroxine (free T 4), total and TSH are used to evaluate thyroid function.

A client newly diagnosed with type 1 diabetes is taught to exercise on a regular basis. What is the primary reason for instruction on exercise? To decrease insulin sensitivity To stimulate glucagon production To improve the cellular uptake of glucose To reduce metabolic requirements for glucose

To improve the cellular uptake of glucose Rationale Exercise increases the metabolic rate, and glucose is needed for cellular metabolism; therefore, excess glucose is consumed during exercise. Regular vigorous exercise increases cell sensitivity to insulin. Glucagon action raises blood glucose but does not affect cell uptake or use of glucose. Cellular requirements for glucose increase with exercise.

After a head injury, a client develops a deficiency of antidiuretic hormone (ADH). What should the nurse consider before assessing the patient about the response to secretion of ADH? Serum osmolarity increases Urine concentration decreases Glomerular filtration decreases Tubular reabsorption of water increases

Tubular reabsorption of water increases Rationale Reabsorption of sodium and water in the kidney tubules decreases urinary output and retains body fluids. There is no effect on filtration with ADH; ADH increases reabsorption in the tubules. The opposite is true of serum osmolarity increase, urine concentration decrease, and tubular reabsorption of water increase.

Which intervention should the nurse provide while caring for an older adult client who is reported to have decreased estrogen production? Use minimal tape on client's skin. Cover the client with warm clothing. Perform blood glucose test for the client Monitor for bradycardia.

Use minimal tape on client's skin. Rationale Decreased estrogen production associated with aging affects skin texture and makes the skin dry and thin. Therefore the nurse should refrain from using tape on the client's skin to prevent skin injury. Warm clothing and monitoring heart rate are needed for older adult clients with decreased general metabolism or hypothyroidism but are not relevant with estrogen deficiency. A client exhibiting signs of decreased glucose tolerance, such as slow wound healing and recurrent yeast infections, should be tested for blood glucose levels.

Which clinical manifestation occurs in a client with adrenal insufficiency? Vitiligo Moon face Hypertension Truncal obesity

Vitiligo Rationale Adrenal insufficiency is clinically manifested as patchy white areas on the skin (vitiligo). Moon face, hypertension, and truncal obesity are clinical manifestations of Cushing's syndrome.

A nurse is caring for a client with an underactive thyroid gland. Which responses should the nurse expect the client to exhibit as a result of decreased levels of triiodothyronine (T 3) and thyroxine (T 4)? Select all that apply. Irritability Tachycardia Weight gain Cold intolerance Profuse diaphoresis

Weight gain Cold intolerance Rationale 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.

When obtaining the history of a client recently diagnosed with type 1 diabetes, what will the nurse expect to discover? Edema Anorexia Weight loss Hypoglycemic episodes

Weight loss Rationale Protein and lipid catabolism occur because carbohydrates cannot be used by the cells; this results in weight loss and muscle wasting. Dehydration, not edema, is more likely to occur because of the polyuria associated with hyperglycemia. Polyphagia, not anorexia, occurs with diabetes as the client attempts to meet metabolic needs. Hyperglycemia, not hypoglycemia, is present in both type 1 and type 2 diabetes.