endocrine prepu practice questions

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A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching? "I will avoid friends and family members who are sick." "I will eat lots of chicken and dairy products." "I may stop taking this medication when I feel better." "I will see my ophthalmologist regularly for a check-up."

"I may stop taking this medication when I feel better." The client requires additional teaching because he states that he may stop taking corticosteroids when he feels better. Corticosteroids should be gradually tapered by the physician. Tapering the corticosteroid allows the adrenal gland to gradually resume functioning. Corticosteroids increase the risk of infection and may mask the early signs of infection, so the client should avoid people who are sick. Corticosteroids cause muscle wasting in the extremities, so the client should increase his protein intake by eating foods such as chicken and dairy products. Corticosteroids have been linked to glaucoma and corneal lesions, so the client should visit his ophthalmologist regularly.

A nursing student asks the instructor why the pituitary gland is called the "master gland." What is the best response by the instructor? "The gland does not have any other function other than to cause secretion of the growth hormones." "It is the gland that is responsible for regulating the hypothalamus." "It regulates metabolism." "It regulates the function of other endocrine glands."

"It regulates the function of other endocrine glands." The pituitary gland is called the master gland because it regulates the function of other endocrine glands. The term is somewhat misleading, however, because the hypothalamus influences the pituitary gland. The gland has many other hormones that it secretes.

The nurse is aware that the best time of day for the total large corticosteroid dose is between: 7:00 AM and 8:00 AM 8:00 PM and 9:00 PM 4:00 AM and 5:00 AM 4:00 PM and 6:00 PM

7:00 AM and 8:00 AM The best time of day for the total large corticosteroid dose is in the early morning, between 7:00 AM and 8:00 AM, when the adrenal gland is most active. Therefore, dosage at this time of day will result in the maximum suppression of the adrenal gland.

When high levels of plasma calcium occur, the nurse is aware that the following hormone will be secreted: Calcitonin Thyroxine Phosphorus Parathyroid

Calcitonin Calcitonin, secreted in response to high plasma levels of calcium, reduces the calcium level by increasing its deposition in the bone.

Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy. Magnesium Calcium Potassium Sodium

Calcium Efforts are made to spare parathyroid tissue to reduce the risk of postoperative hypocalcemia with resultant tetany.

Trousseau's sign is elicited by which of the following? Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. A sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery. The patient complains of pain in the calf when his foot is dorsiflexed.

Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. A positive Trousseau's sign is suggestive of latent tetany. A positive Chvostek's sign is demonstrated when a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. A positive Allen's test is demonstrated by the palm remaining blanched with the radial artery occluded. A positive Homans' sign is demonstrated when the patient complains of pain in the calf when his foot is dorsiflexed.

Which diagnostic test is done to determine a suspected pituitary tumor? Measuring blood hormone levels Radioimmunoassay Radiography of the abdomen Computed tomography

Computed tomography CT or magnetic resonance imaging is used to diagnose the presence and extent of pituitary tumors.

The actions of parathyroid hormone (PTH) are increased in the presence of which vitamin? E B C D

D The actions of PTH are increased by the presence of vitamin D.

A patient has been diagnosed with thyroidal hypothyroidism. The nurse knows that this diagnosis is consistent with which of the following? Inadequate secretion of TSH Disorder of the hypothalamus Failure of the pituitary gland Dysfunction of the thyroid gland itself

Dysfunction of the thyroid gland itself Thyroidal hypothyroidism results from thyroid gland dysfunction. The other causes result in central, secondary, or tertiary causes if there is inadequate secretion of TSH.

A group of students is reviewing material about endocrine system function. The students demonstrate understanding of the information when they identify which of the following as secreted by the adrenal medulla? Epinephrine Glucocorticoids Mineralocorticoids Glucagon

Epinephrine The adrenal medulla secretes epinephrine and norepinephrine. The adrenal cortex manufactures and secretes glucocorticoids, mineralocorticoids, and small amounts of androgenic sex hormones. Glucagon is released by the pancreas.

Which of the following would the nurse expect to find in a client with severe hyperthyroidism? Buffalo hump Exophthalmos Striae Tetany

Exophthalmos Exophthalmos that results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball is seen in clients with severe hyperthyroidism. Tetany is the symptom of acute and sudden hypoparathyroidism. Buffalo hump and striae are the symptoms of Cushing's syndrome.

A nurse should perform which intervention for a client with Cushing's syndrome? Offer clothing or bedding that's cool and comfortable. Suggest a high-carbohydrate, low-protein diet. Explain that the client's physical changes are a result of excessive corticosteroids. Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather.

Explain that the client's physical changes are a result of excessive corticosteroids. The nurse should explain to the client that Cushing's syndrome causes physical changes related to excessive corticosteroids. Clients with hyperthyroidism, not Cushing's syndrome, are heat intolerant and must have cool clothing and bedding. Clients with Cushing's syndrome should have a high-protein, not low-protein, diet. Clients with Addison's disease must increase sodium intake and fluid intake in times of stress of prevent hypotension.

A health care provider suspects that a thyroid nodule may be malignant. The nurse knows to prepare information for the patient based on the usual test that will be ordered to establish a diagnosis. What is that test? Serum immunoassay for TSH Fine-needle biopsy of the thyroid gland Free T4 analysis Ultrasound of the thyroid gland

Fine-needle biopsy of the thyroid gland Fine needle biopsy of the thyroid gland is often used to establish the diagnosis of thyroid cancer. The purpose of the biopsy is to differentiate cancerous thyroid nodules from noncancerous nodules and to stage the cancer if detected. The procedure is safe and usually requires only a local anesthetic.

Which outcome indicates that treatment of a client with diabetes insipidus has been effective? Heart rate is 126 beats/minute. Blood pressure is 90/50 mm Hg. Urine output measures more than 200 ml/hour. Fluid intake is less than 2,500 ml/day.

Fluid intake is less than 2,500 ml/day. Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.

A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: Graves' disease. multinodular goiter. Hashimoto's thyroiditis. thyroiditis.

Graves' disease. Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).

Which of the following precautions would be most appropriate when caring for a client being treated with radioactive iodine (RAI) for a thyroid tumor? Handle body fluids carefully. Monitor the respiratory status. Administer prescribed corticosteroids carefully. Administer the prescribed medications at the same time each day.

Handle body fluids carefully. The nurse handles body fluids carefully to prevent spread of contamination. Corticosteroids are not prescribed for thyroid tumor. Monitoring the respiratory status and administering prescribed medicines at the same time each day are unrelated to the care of a client receiving RAI.

Which instruction should be included in the discharge teaching plan for a client after thyroidectomy for Graves' disease? Exercise to improve cardiovascular fitness. Use nasal desmopressin acetate (DDAVP). Keep an accurate record of intake and output. Have regular follow-up care.

Have regular follow-up care. The nurse should instruct the client with Graves' disease to have regular follow-up care because most cases of Graves' disease eventually result in hypothyroidism. Annual thyroid-stimulating hormone tests and the client's ability to recognize signs and symptoms of thyroid dysfunction will help detect thyroid abnormalities early. Recording intake and output is important for clients with fluid and electrolyte imbalances but not thyroid disorders. DDAVP is used to treat diabetes insipidus. Although exercise to improve cardiovascular fitness is important, the importance of regular follow-up is most critical for this client.

A client with a history of Addison's disease and flu-like symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by IV infusion? Hydrocortisone Hypotonic saline Potassium Insulin

Hydrocortisone Emergency treatment for acute adrenal insufficiency (addisonian crisis) is IV infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic — saline solution.

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? Hypercalcemia Hypophosphaturia Hyperphosphatemia Hypocalcemia

Hypercalcemia Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low (hypophosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased.

Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? Hyperphosphatemia Hypercalcemia Hypocalcemia Hypophosphaturia

The nurse is aware that the clinical symptoms of a patient with hypoparathyroidism are the result of the initial physiologic response of: Cardiac arrhythmias. Hypocalcemia. Decreased levels of vitamin D. Increased serum levels of phosphate.

Hypocalcemia. Hypoparathyroidism results in hypocalcemia, which triggers a series of physiologic responses, including the choices presented.

A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize are progressing to myxedema coma? Select all that apply. Hypothermia Hypertension Hypotension Hypoventilation Hyperventilation

Hypothermia Hypotension Hypoventilation Severe hypothyroidism is called myxedema. Advanced, untreated myxedema can progress to myxedemic coma. Signs of this life-threatening event are hypothermia, hypotension, and hypoventilation. Hypertension and hyperventilation indicate increased metabolic responses, which are the opposite of what the client would be experiencing.

The thymus gland secretes thymosin and thymopoietin, which aid in developing T lymphocytes, a type of white blood cell involved in immunity. Which of the following best identifies the location of this gland? Attached to the thalamus in the brain In the upper part of the chest above or near the heart Connected by a stalk to the hypothalamus in the brain Positioned above the kidneys

In the upper part of the chest above or near the heart The thymus gland is located in the upper part of the chest above or near the heart. The pineal gland is attached to the thalamus, and the pituitary gland is connected by a stalk to the hypothalamus in the brain. The adrenal glands are located above the kidneys.

A client is experiencing an increase in blood glucose levels. The nurse understands that which of the following hormones would be important in lowering the client's blood glucose level? Insulin Parathormone Melatonin Calcitonin

Insulin Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises above normal limits. Parathormone increases the level of calcium in the blood when a decrease in serum calcium levels occurs. Melatonin aids in regulating sleep cycles and mood. Calcitonin is a thyroid hormone that inhibits the release of calcium from the bone into the extracellular fluid.

The nurse knows to assess a patient with hyperthyroidism for the primary indicator of: Weight gain Constipation Fatigue Intolerance to heat

Intolerance to heat With hypothyroidism, the individual is sensitive to cold because the core body temperature is usually below 98.6°F. Intolerance to heat is seen with hyperthyroidism.

The nurse assesses a patient who has an obvious goiter. What type of deficiency does the nurse recognize is most likely the cause of this? Iodine Calcitonin Thyroxine Thyrotropin

Iodine Oversecretion of thyroid hormones is usually associated with an enlarged thyroid gland known as a goiter. Goiter also commonly occurs with iodine deficiency.

The nurse assesses a patient who has an obvious goiter. What type of deficiency does the nurse recognize is most likely the cause of this? Thyrotropin Iodine Thyroxine Calcitonin

Iodine Oversecretion of thyroid hormones is usually associated with an enlarged thyroid gland known as a goiter. Goiter also commonly occurs with iodine deficiency.

One of the most frequently occurring complications (55% occurrence) of primary hyperparathyroidism is: Pathologic fractures. Peptic ulcer. Kidney stones. Pancreatitis.

Kidney stones. Kidney stones occur in 55% of patients with primary hyperparathyroidism. They are caused by renal damage from the precipitation of calcium phosphate in the renal pelvis and parenchyma.

The nurse is teaching a client about the dietary restrictions related to his diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid? Bananas Milk Chicken livers Hamburger

Milk Clients with hyperparathyroidism should use a low-calcium diet (fewer dairy products) and drink at least 3 to 4 L of fluid daily to dilute the urine and prevent renal stones from forming. It is especially important that the client drink fluids before going to bed and periodically throughout the night to avoid concentrated urine. Bananas, chicken livers, and hamburgers do not require avoidance. Milk is the highest in calcium content.

A patient experiences a life-threatening hypercalcemic crisis. The provider orders a cytotoxic agent. Which of the following is most likely the drug that is prescribed? Mithramycin Didronel Aredia Calcitonin

Mithramycin Mitramycin is a cytotoxic agent commonly used in a hypercalcemic crisis. Didronel and Aredia are bisphosphonates that decrease serum calcium levels. Calcitonin can be ordered but it is not a cytotoxic agent.

A client has a decreased level of thyroid hormone being excreted. What will the feedback loop do to maintain the level of thyroid hormone required to maintain homeostatic stability? Produce a new hormone to try and regulate the thyroid function Stimulate more hormones using the positive feedback system Be unable to perform in response to low levels of thyroid hormone. Stimulate more hormones using the negative feedback system

Stimulate more hormones using the negative feedback system Feedback can be either negative or positive. Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland.

A client has a decreased level of thyroid hormone being excreted. What will the feedback loop do to maintain the level of thyroid hormone required to maintain homeostatic stability? Stimulate more hormones using the negative feedback system Stimulate more hormones using the positive feedback system Produce a new hormone to try and regulate the thyroid function Be unable to perform in response to low levels of thyroid hormone.

Parathyroid hormone (PTH) has which effects on the kidney? Increased absorption of vitamin D and excretion of vitamin E Stimulation of phosphate reabsorption and calcium excretion Increased absorption of vitamin E and excretion of vitamin D Stimulation of calcium reabsorption and phosphate excretion

Stimulation of calcium reabsorption and phosphate excretion PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E.

Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects? Respiratory effects Sympathetic Gastrointestinal effects Parasympathetic

Sympathetic Beta-adrenergic blocking agents are important in controlling the sympathetic nervous system effects of hyperthyroidism. For example, propranolol is used to control nervousness, tachycardia, tremor, anxiety, and heat intolerance.

A nurse is caring for a female client with hypothyroidism. The client is extremely upset about her altered physical appearance. She doesn't want to take her medication because she doesn't believe it's doing any good. What should the nurse do? Tell the client she needs to learn to accept herself as she is and be compliant during treatment. Tell the client that she looks fine and offer to help her with makeup. Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency. Tell the client she'll feel better if she consistently takes the thyroid replacement medication.

Tell the client she'll soon experience improvement in her looks as the medication corrects her hormone deficiency. Telling the client that she'll soon experience improvement is supportive and encouraging and offers direction in a way that motivates her to take her medication consistently. Telling the client that she looks fine and that she'll soon feel better discount the feelings she's currently experiencing. Advising the client to accept herself is parental and direct at a time when the client needs support and understanding.

A client is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following? The concentration of a substance in plasma The client's blood sugar level The functioning of endocrine glands Details about the size of the organ and its location

The functioning of endocrine glands Measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma. The measurement of blood hormone levels will not reveal a client's blood sugar level. Radiographs of the chest or abdomen determine the size of the organ and its location.

When describing the difference between endocrine and exocrine glands, which of the following would the instructor include as characteristic of endocrine glands? The glands play a minor role in maintaining homeostasis. The glands contain ducts that produce the hormones. The secretions are released directly into the blood stream. The secreted hormones act like target cells.

The secretions are released directly into the blood stream. The endocrine glands secrete hormones, chemicals that accelerate or slow physiologic processes, directly into the bloodstream. This characteristic distinguishes endocrine glands from exocrine glands, which release secretions into a duct. Hormones circulate in the blood until they reach receptors in target cells or other endocrine glands. They play a vital role in regulating homeostatic processes.

What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking the prescribed antithyroid medication? Thyrotoxic crisis Myxedema coma Diabetes insipidus Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Thyrotoxic crisis Antithyroid medication is given to treat hyperthyroidism. Although rare, this condition may occur in clients with undiagnosed or inadequately treated hyperthyroidism. Therefore, this client is at risk for thyrotoxic crisis, an abrupt and life-threatening form of hyperthyroidism. Myxedema coma results from severe hypothyroidism. Diabetes insipidus (DI) and SIADH do not correlate with hyperthyroidism or the medication taken for hyperthyroidism.

Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis? Weight loss, increased urination, and increased thirst Weight gain, decreased appetite, and constipation Weight loss, increased appetite, and hyperdefecation Weight gain, increased urination, and purplish-red striae

Weight gain, decreased appetite, and constipation Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of hypothyroidism. It's seen most frequently in women older than age 40. Signs and symptoms include weight gain, decreased appetite; constipation; lethargy; dry cool skin; brittle nails; coarse hair; muscle cramps; weakness; and sleep apnea. Weight loss, increased appetite, and hyperdefecation are characteristic of hyperthyroidism. Weight loss, increased urination, and increased thirst are characteristic of uncontrolled diabetes mellitus. Weight gain, increased urination, and purplish-red striae are characteristic of hypercortisolism.

A client with severe hypoparathyroidism is experiencing tetany. What medication, prescribed by the physician for emergency use, will the nurse administer to correct the deficit? Sodium bicarbonate Fludrocortisone Calcium gluconate Methylprednisolone

calcium gluconate Tetany and severe hypoparathyroidism are treated immediately by the administration of an IV calcium salt, such as calcium gluconate. The other medications are not effective for the treatment of calcium deficit.

For the first 72 hours after thyroidectomy surgery, a nurse should assess a client for Chvostek's sign and Trousseau's sign because they indicate: hypocalcemia. hypercalcemia. hypokalemia. hyperkalemia.

hypocalcemia A client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal of or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek's sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau's sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren't present with hypercalcemia, hypokalemia, or hyperkalemia.

A client has been experiencing a decrease in serum calcium. After diagnostics, the physician believes the calcium level fluctuation is due to altered parathyroid function. What is the role of parathormone? increase serum calcium level promote urinary secretion of calcium decrease serum calcium level inhibit release of calcium into extracellular fluid

increase serum calcium level The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level.

A client is undergoing diagnostics for an alteration in thyroid function. What physiologic function is affected by altered thyroid function? growth sleep/wake cycles fluid/electrolyte balance metabolic rate

metabolic rate The thyroid concentrates iodine from food and uses it to synthesize thyroxine (T4) and triiodothyronine (T3). These two hormones regulate the body's metabolic rate.

A patient is diagnosed with overactivity of the adrenal medulla. What epinephrine value does the nurse recognize is a positive diagnostic indicator for overactivity of the adrenal medulla? 450 pg/mL 100 to 300 pg/mL 100 pg/mL 50 pg/mL

450 pg/mL Normal plasma values of epinephrine are 100 pg/mL (590 pmol/L); normal values of norepinephrine are generally less than 100 to 550 pg/mL (590 to 3,240 pmol/L). Values of epinephrine greater than 400 pg/mL (2,180 pmol/L) or norepinephrine values greater than 2,000 pg/mL (11,800 pmol/L) are considered diagnostic of pheochromocytoma (associated with overactivity of the adrenal medulla). Values that fall between normal levels and those diagnostic of pheochromocytoma indicate the need for further testing.

A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience? A decrease in blood glucose levels A decrease in urine output A decrease in appetite A decrease in blood pressure

A decrease in urine output Desmopressin (DDAVP), a synthetic vasopressin without the vascular effects of natural ADH, is particularly valuable because it has a longer duration of action and fewer adverse effects than other preparations previously used to treat the disease. DDAVP and lypressin (Diapid) reduce urine output to 2 to 3 L/24 hours. It is administered intranasally; the patient sprays the solution into the nose through a flexible calibrated plastic tube. One or two administrations daily (i.e., every 12 to 24 hours) usually control the symptoms (Papadakis, McPhee, & Rabow, 2013). Vasopressin causes vasoconstriction; thus, it must be used cautiously in patients with coronary artery disease.

After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate? Administer a sedative as ordered. Start administering oxygen at 2 L/min via a cannula. Administer an oral calcium supplement as ordered. Administer IV calcium gluconate as ordered.

Administer IV calcium gluconate as ordered. When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered.

A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland? Pancreas Adrenal cortex Parathyroid Adrenal medulla

Adrenal cortex Excessive secretion of aldosterone in the adrenal cortex is responsible for the client's hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone.

A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? Pitting edema of the legs Frequent urination An irregular apical pulse Dry mucous membranes

An irregular apical pulse Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.

A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder? Complaints of nausea Blood pressure varying between 120/86 and 240/130 mm Hg Shivering Heart rate of 56-64 bpm

Blood pressure varying between 120/86 and 240/130 mm Hg Hypertension associated with pheochromocytoma may be intermittent or persistent. Blood pressures exceeding 250/150 mm Hg have been recorded. Such blood pressure elevations are life threatening and can cause severe complications, such as cardiac dysrhythmias, dissecting aneurysm, stroke, and acute kidney failure.

A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder? Heart rate of 56-64 bpm Shivering Complaints of nausea Blood pressure varying between 120/86 and 240/130 mm Hg

After undergoing a thyroidectomy, a client develops hypocalcemia and tetany. Which electrolyte should the nurse anticipate administering? Sodium bicarbonate Sodium phosphorus Calcium gluconate Potassium chloride

Calcium gluconate Immediate treatment for a client who develops hypocalcemia and tetany after thyroidectomy is calcium gluconate. Potassium chloride and sodium bicarbonate aren't indicated. Sodium phosphorus wouldn't be given because phosphorus levels are already elevated.

A patient who is postoperative day 1 following neck dissection surgery has rung his call bell complaining of numb fingers, stiff hands, and a tingling sensation in his lips and around his mouth. The nurse should anticipate that this patient may require the IV administration of: Potassium chloride Calcium gluconate Magnesium sulfate Sodium phosphate

Calcium gluconate Inadvertent removal of the parathyroid may occur during neck dissection surgery, resulting in hypocalcemia. This condition is treated with the IV administration of calcium gluconate.

An 84-year-old client who is experiencing cognitive decline is scheduled for a diagnostic test. Which action by the nurse reflects best practice when recording the client's drug history before the diagnostic test? Consulting with the institution's procedure manual for specific instructions. Consulting with the client's family or caregiver to confirm the information. Giving printed directions to the client about participation in the test. Offering assurance about the diagnostic test.

Consulting with the client's family or caregiver to confirm the information. Obtaining a drug history is essential before a diagnostic examination for an older adult because side effects or interactions may contribute to changes in endocrine function. If the older adult is cognitively impaired, a family member or the caregiver should provide information regarding medications and dosage history. Giving printed instructions would be an effective teaching strategy once the drug history is confirmed. Offering assurance about the test would be helpful in alleviating the client's and family's anxiety. Consulting the institution's procedure manual provides information about preparation for the test. It is unrelated to the client's drug history.

An 84-year-old client who is experiencing cognitive decline is scheduled for a diagnostic test. Which action by the nurse reflects best practice when recording the client's drug history before the diagnostic test? Giving printed directions to the client about participation in the test. Consulting with the client's family or caregiver to confirm the information. Offering assurance about the diagnostic test. Consulting with the institution's procedure manual for specific instructions.

Dilutional hyponatremia occurs in which disorder? Pheochromocytoma Addison disease Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Diabetes insipidus (DI)

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Clients diagnosed with SIADH exhibit dilutional hyponatremia. They retain fluids and develop a sodium deficiency.

During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in which of the following? Detecting evidence of hormone hypersecretion Detecting information about possible tumor growth Determining the presence or absence of testosterone levels Determining the size of the organs and location

Detecting evidence of hormone hypersecretion The evaluation of body structures helps the nurse detect evidence of hypersecretion or hyposecretion of hormones. This helps in the assessment of findings that are unique to specific endocrine glands. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and its location.

During physical examination of a client with a suspected endocrine disorder, the nurse assesses the body structures. The nurse gathers this data based on the understanding that it is an important aid in which of the following? Detecting evidence of hormone hypersecretion Determining the presence or absence of testosterone levels Detecting information about possible tumor growth Determining the size of the organs and location

While the nurse is recording the health history of a client who is scheduled for a thyroid test, the client informs the nurse about an allergy to seafood. What is the nurse's most appropriate response? Palpate the thyroid gland Inquire about frequent urination Consult the institution's procedure manual Document the allergy and inform the physician

Document the allergy and inform the physician Recording the health history is an important step in the diagnosis of endocrine disorders. The nurse documents an allergy to iodine, a component of contrast dyes and seafood, and informs the physician. Repeated or forceful palpation of the thyroid in the case of thyroid hyperactivity can result in a sudden release of thyroid hormones, which may have serious implications. Consulting the institution's procedure manual and inquiring about frequent urination are not immediate follow-up actions.

A nurse is preparing to palpate a client's thyroid gland. Which action by the nurse is appropriate? Have the client hyperextend his neck and take slow, deep inhalations while she palpates his neck with her fingertips. Place her hands around the client's neck, with the thumbs in the front of the neck, and gently massage the anterior neck. Encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. Have the client flex his neck onto his chest and cough while she palpates the anterior neck with her fingertips.

Encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. When palpating the thyroid gland, the nurse should encircle the client's neck with both hands, have the client slightly extend his neck, and ask him to swallow. As the client swallows, the gland is palpated for enlargement as the tissue rises and falls. Having the client flex his neck wouldn't allow for palpation. Massaging the area or checking during inhalation doesn't allow for the movement of tissue that swallowing provides.

A group of students is reviewing material about endocrine system function. The students demonstrate understanding of the information when they identify which of the following as secreted by the adrenal medulla? Glucocorticoids Epinephrine Mineralocorticoids Glucagon

Which of the following would the nurse expect to find in a client with severe hyperthyroidism? Striae Tetany Exophthalmos Buffalo hump

During the physical examination of a client with a suspected endocrine disorder, the nurse observes an abnormal bulging of the eyes. The nurse documents this finding as which of the following? Exophthalmos Thyroid enlargement Hypopigmentation Tremor

Exophthalmos The nurse would document the finding of abnormal bulging of the eyes as exophthalmos. Palpation of the thyroid would reveal thyroid enlargement. Hypopigmentation would suggest a loss of color to an area. Tremor would be used to denote shaking or quivering.

Which outcome indicates that treatment of a client with diabetes insipidus has been effective? Urine output measures more than 200 ml/hour. Heart rate is 126 beats/minute. Fluid intake is less than 2,500 ml/day. Blood pressure is 90/50 mm Hg.

The adrenal cortex is responsible for producing which substances? Mineralocorticoids and catecholamines Catecholamines and epinephrine Glucocorticoids and androgens Norepinephrine and epinephrine

Glucocorticoids and androgens The adrenal glands have two divisions, the cortex and medulla. The cortex produces three types of hormones: glucocorticoids, mineralocorticoids, and androgens. The medulla produces catecholamines — epinephrine and norepinephrine.

Which nursing diagnosis takes highest priority for a client with hyperthyroidism? Disturbed body image related to weight gain and edema Imbalanced nutrition: Less than body requirements related to thyroid hormone excess Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess

Imbalanced nutrition: Less than body requirements related to thyroid hormone excess In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. These changes put the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements related to thyroid hormone excess the most important nursing diagnosis. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing and Disturbed body image related to weight gain and edema may be appropriate for a client with hypothyroidism, which slows the metabolic rate.

Which intervention is the most critical for a client with myxedema coma? Measuring and recording accurate intake and output Administering an oral dose of levothyroxine (Synthroid) Warming the client with a warming blanket Maintaining a patent airway

Maintaining a patent airway Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical nursing intervention. Ventilatory support is usually needed. Although myxedema coma is associated with severe hypothermia, a warming blanket shouldn't be used because it may cause vasodilation and shock. Gradual warming with blankets is appropriate. Thyroid replacement is administered I.V., not orally. Although recording intake and output is important, these interventions aren't critical at this time.

For a client with Graves' disease, which nursing intervention promotes comfort? Maintaining room temperature in the low-normal range Limiting intake of high-carbohydrate foods Placing extra blankets on the client's bed Restricting intake of oral fluids

Maintaining room temperature in the low-normal range Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss. To reduce heat intolerance and diaphoresis, the nurse should keep the client's room temperature in the low-normal range. To replace fluids lost via diaphoresis, the nurse should encourage, not restrict, intake of oral fluids. Placing extra blankets on the bed of a client with heat intolerance would cause discomfort. To provide needed energy and calories, the nurse should encourage the client to eat high-carbohydrate foods.

A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit? Pale thick skin Moon face Weight loss Hypotension

Moon face Clients who are receiving long-term high-dose corticosteroid therapy often develop a cushingoid appearance, manifested by facial fullness and the characteristic moon face. They also may exhibit weight gain, peripheral edema, and hypertension due to sodium and water retention. The skin is usually thin, and ruddy.

A client is receiving long-term treatment with high-dose corticosteroids. Which of the following would the nurse expect the client to exhibit? Weight loss Pale thick skin Moon face Hypotension

When preparing teaching plan for a client with an endocrine disorder, the nurse includes information about hormone regulation. Which of the following would the nurse include? The gland becomes enlarged leading to a deficiency of the hormone. Most disorders result from over- or underproduction of the hormone. The gland slows hormone secretion when the hormone level decreases. Hormone secretion occurs as a straight-line continuous process.

Most disorders result from over- or underproduction of the hormone. Most endocrine disorders result from an overproduction or underproduction of specific hormones. A negative feedback loop controls hormone levels, such that a decrease in levels stimulates the releasing gland. Glandular enlargement is not involved with hormonal regulation.

A patient who has had a total parathyroidectomy has returned to the unit from PACU. The nurse caring for the patient knows to assess for what complication following this surgery? Hemorrhage Hypercalcemia Muscle twitching Fatigue

Muscle twitching Loss of parathyroid function can result in complaints of paresthesias (perioral, extremities) and fasciculations (muscle twitching), therefore the nurse asks the patient about neuromuscular manifestations. Hemorrhage, fatigue, and hypercalcemia are not associated with the loss of the parathyroid gland. *think hypocalcemia

A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication? Thyroid storm Exophthalmos Myxedema coma Tibial myxedema

Myxedema coma Myxedema coma, severe hypothyroidism, is a life-threatening condition that may develop if thyroid replacement medication isn't taken. Exophthalmos (protrusion of the eyeballs) is seen with hyperthyroidism. Although thyroid storm is life-threatening, it's caused by severe hyperthyroidism. Tibial myxedema (peripheral mucinous edema involving the lower leg) is associated with hypothyroidism but isn't life-threatening.

Which of the following would the nurse need to be alert for in a client with severe hypothyroidism? Myxedemic coma Addison's disease Acromegaly Thyroid storm

Myxedemic coma Severe hypothyroidism is called myxedema and if untreated, it can progress to myxedemic coma, a life-threatening event. Thyroid storm is an acute, life-threatening form of hyperthyroidism. Addison's disease refers to primary adrenal insufficiency. Acromegaly refers to an oversecretion of growth hormone by the pituitary gland during adulthood.

Which of the following assessments should the nurse perform to determine the development of peptic ulcers when caring for a patient with Cushing's syndrome? Observe the color of stool. Monitor vital signs every 4 hours. Monitor bowel patterns. Observe urine output.

Observe the color of stool. The nurse should observe the color of each stool and test the stool for occult blood. Bowel patterns, vital signs, and urine output do not help in determining the development of peptic ulcers.

While assessing a client with hypoparathyroidism, the nurse taps the client's facial nerve and observes twitching of the mouth and tightening of the jaw. The nurse would document this finding as which of the following? Positive Trousseau's sign Positive Chvostek's sign Tetany Hyperactive deep tendon reflex

Positive Chvostek's sign If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek's sign. The nurse may elicit a positive Trousseau's sign by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Deep tendon reflexes include the biceps, brachioradialis, triceps, and patellar reflexes. Tetany would be manifested by reports of numbness and tingling in the fingers or toes or around the lips, voluntary movement that may be followed by an involuntary, jerking spasm, and muscle cramping. Tonic (continuous contraction) flexion of an arm or a finger may occur.

A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question? Normal saline solution Potassium chloride Fludrocortisone (Florinef) Hydrocortisone (Cortef)

Potassium chloride The nurse should question an order for potassium chloride because addisonian crisis results in hyperkalemia. Administering potassium chloride is contraindicated. Because the client is hyponatremic, an order for normal saline solution is appropriate. Hydrocortisone and fludrocortisone are used to replace deficient adrenal cortex hormones.

A client with acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client? Glaucoma Retinal detachment Corneal abrasions Pressure on the optic nerve

Pressure on the optic nerve Partial blindness may result from pressure on the optic nerve. Glaucoma does not occur suddenly, and the client did not report injury to suspect corneal abrasions or retinal detachment.

In planning the care of a patient who has hyperthyroidism, the nurse has identified the nursing diagnosis of altered nutrition: less than body requirements. What intervention is the best response to this diagnosis? Arrange for the patient to be assessed for the possible use of enteral nutrition. Provide several small meals each day for the patient. Teach the patient to eat each meal slowly and methodically. Provide the patient with a low-fat, high-protein diet.

Provide several small meals each day for the patient. Hyperthyroidism affects all body systems, including the gastrointestinal system. The appetite is increased but may be satisfied by several well-balanced meals of small size, up to six meals a day. Enteral nutrition is unnecessary, and a low-fat, low-protein diet is not indicated. Encouraging the patient to eat slowly is unlikely to improve nutritional status.

A client with hyperthyroidism is concerned about changes in appearance. How can the nurse convey an understanding of the client's concern and promote effective coping strategies? Refer the client to professional counseling. Encourage the client to participate in outside activities to boost coping strategies. Suggest that the client wear cosmetics to cover any changes in appearance. Reassure the client that their emotional reactions are a result of the disorder and symptoms can be controlled with effective treatment.

Reassure the client that their emotional reactions are a result of the disorder and symptoms can be controlled with effective treatment. The client with hyperthyroidism needs reassurance that the emotional reactions being experienced are a result of the disorder and that with effective treatment those symptoms can be controlled. It is important to use a calm, unhurried approach with the client. Stressful experiences should be minimized, and a quiet uncluttered environment should be maintained. The nurse encourages relaxing activities that will not overstimulate the client. It is important to balance periods of activity with rest.

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? Infusing IV fluids rapidly as ordered Administering glucose-containing I.V. fluids as ordered Encouraging increased oral intake Restricting fluids

Restricting fluids To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.

The nurse recognizes that which of the following agents suppress release of thyroid hormones? Select all that apply. Saturated solution of potassium iodide (SSKI) Sodium iodide Potassium iodide Methimazole Propylthiouracil (PTU)

Saturated solution of potassium iodide (SSKI) Sodium iodide Potassium iodide Sodium iodide, potassium iodide, and SSKI suppress the release of thyroid hormones. Methimazole inhibits the synthesis of thyroid hormone. Propylthiouracil blocks the synthesis of hormones.

Which of the following endocrine disorder causes the patient to have dilutional hyponatremia? Hyperthyroidism Diabetes insipidus (DI) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Hypothyroidism

Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Patients diagnosed with SIADH retain water and develop a subsequent sodium deficiency known as dilutional hyponatremia. In DI, there is excessive thirst and large volumes of dilute urine. Patients with DI, hypothyroidism, or hyperthyroidism do not exhibit dilutional hyponatremia

A nurse explains to a client with thyroid disease that the thyroid gland normally produces: iodine and thyroid-stimulating hormone (TSH). thyrotropin-releasing hormone (TRH) and TSH. TSH, triiodothyronine (T3), and calcitonin. T3, thyroxine (T4), and calcitonin.

T3, thyroxine (T4), and calcitonin. The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.

A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug? Tachycardia Blurred vision Leg cramps Dysuria

Tachycardia Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse reactions to this agent include tachycardia. Dysuria, leg cramps, and blurred vision aren't associated with levothyroxine.

The nurse is assisting with the preparation of a teaching plan for a client who is to receive methimazole (Tapazole). Which of the following would be most appropriate to include in this plan? Telling the client to take largest dose of the drug in the morning. Urging the client to report any fever or sore throat. Telling the client to dilute the drug with fruit juice. Advising the client to use a straw when taking the drug.

Urging the client to report any fever or sore throat. Methimazole (Tapazole) can cause agranulocytosis which occurs most often in the first 2 months of therapy and requires discontinuation of the drug. Thus, the client should be instructed to report sore throat, fever, chills, headache, malaise, weakness, or unusual bleeding or bruising. Diluting the drug with fruit juice or using a straw are appropriate instructions for a client taking iodine solution. Methimazole is given in equal doses every 8 hours around the clock.

The nurse is assisting with the preparation of a teaching plan for a client who is to receive methimazole (Tapazole). Which of the following would be most appropriate to include in this plan? Urging the client to report any fever or sore throat. Telling the client to dilute the drug with fruit juice. Telling the client to take largest dose of the drug in the morning. Advising the client to use a straw when taking the drug.

A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect? Weight gain, constipation, and lethargy Diaphoresis, fever, and decreased sweating Exophthalmos, diarrhea, and cold intolerance Weight loss, nervousness, and tachycardia

Weight loss, nervousness, and tachycardia Weight loss, nervousness, and tachycardia are signs of hyperthyroidism. Other signs of hyperthyroidism include exophthalmos, diaphoresis, fever, and diarrhea. Weight gain, constipation, lethargy, decreased sweating, and cold intolerance are signs of hypothyroidism.

During a client education session, the nurse describes the mechanism of hormone level maintenance. What causes most hormones to be secreted? increase in hormonal levels hormonal overproduction decrease in hormonal levels hormonal underproduction

decrease in hormonal levels Most hormones are secreted in response to negative feedback; a decrease in levels stimulates the releasing gland. In positive feedback, the opposite occurs.

A nurse explains the role of the ovaries. Which hormones would be included in that discussion? estrogen and progesterone estrogen and progestin testosterone and progesterone estrogen and testosterone

estrogen and progesterone The ovaries produce estrogen and progesterone. Progestin is a synthetic compound. Testosterone is involved with the development and maintenance of male secondary sex characteristics, such as facial hair and a deep voice.

A nurse explains the role of the ovaries. Which hormones would be included in that discussion? estrogen and testosterone testosterone and progesterone estrogen and progesterone estrogen and progestin

A nurse explains the role of the ovaries. Which hormones would be included in that discussion? testosterone and progesterone estrogen and progesterone estrogen and progestin estrogen and testosterone

A client has been experiencing a decrease in serum calcium. After diagnostics, the physician proposes the calcium level fluctuation is due to altered parathyroid function. What is the typical number of parathyroid glands? four three two one

four The parathyroid glands are four (some people have more than four) small, bean-shaped bodies, each surrounded by a capsule of connective tissue and embedded within the lateral lobes of the thyroid.

A client has been experiencing a decrease in serum calcium. After diagnostics, the physician believes the calcium level fluctuation is due to altered parathyroid function. What is the role of parathormone? promote urinary secretion of calcium inhibit release of calcium into extracellular fluid increase serum calcium level decrease serum calcium level

increase serum calcium level The parathyroid glands secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level.

Although not designated as endocrine glands, several organs within the body secrete hormones as part of their normal function. Which organ secretes hormones involved in increasing blood pressure and volume and maturation of red blood cells? cardiac atria brain kidneys liver

kidneys The kidneys release renin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys also secrete erythropoietin, a substance that promotes the maturation of red blood cells.

A client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, the nurse expects to administer: phentolamine (Regitine). mannitol (Osmitrol). felodipine (Plendil). methyldopa (Aldomet).

phentolamine (Regitine). Pheochromocytoma causes excessive production of epinephrine and norepinephrine, natural catecholamines that raise the blood pressure. Phentolamine, an alpha-adrenergic given by I.V. bolus or drip, antagonizes the body's response to circulating epinephrine and norepinephrine, reducing blood pressure quickly and effectively. Although methyldopa is an antihypertensive agent available in parenteral form, it isn't effective in treating hypertensive emergencies. Mannitol, a diuretic, isn't used to treat hypertensive emergencies. Felodipine, an antihypertensive agent, is available only in extended-release tablets and therefore doesn't reduce blood pressure quickly enough to correct hypertensive crisis.

A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of: chloride and magnesium abnormalities. sodium and chloride abnormalities. sodium and potassium abnormalities. calcium and phosphorus abnormalities.

sodium and potassium abnormalities. In Addison's disease, a form of adrenocortical hypofunction, aldosterone secretion is reduced. Aldosterone promotes sodium conservation and potassium excretion. Therefore, aldosterone deficiency increases sodium excretion, predisposing the client to hyponatremia, and inhibits potassium excretion, predisposing the client to hyperkalemia. Because aldosterone doesn't regulate calcium, phosphorus, chloride, or magnesium, an aldosterone deficiency doesn't affect levels of these electrolytes directly.

A nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will order daily supplements of calcium and: potassium. iron. folic acid. vitamin D.

vitamin D. Typically, clients with hypoparathyroidism are ordered daily supplements of vitamin D along with calcium because calcium absorption from the small intestine depends on vitamin D. Hypoparathyroidism doesn't cause a deficiency of folic acid, potassium, or iron. Therefore, the client doesn't require daily supplements of these substances to maintain a normal serum calcium level.

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