Exam #2: Endocrine Quiz

Which of the following pituitary hormones is most commonly affected by hyperpituitarism? 1. Prolactin 2. Growth hormone 3. Corticotropin 4. Gonadotropic hormones

1

Match the following manifestions with either hyperthyroidism (A) or hypothyroidism (B). 1. Anemia 2. Puffy face 3. Increased thirst 4. Decreased metabolism 5. Dysrhythmias 6. Clubbing of fingers 7. Osteoporosis 8. Diminished peripheral blood flow

1. B 2. B 3. A 4. B 5. A 6. A 7. A 8. B

A client is hospitalized to confirm the diagnoses of diabetes insipidus. Which nursing actions are correct for this client? 1. Measure urine specific gravity every shift. 2. Allow unrestricted access to the bathroom. 3. Question orders for the patient to be NPO. 4. Expect to administer IV vasopressin every 4 hours.

4

Parathyroid hormone is released in response to what? 1. Hypopituitarism. 2.Hypercalcemia. 3. Hyperthyroidism. 4. Hypocalcemia.

4

Thyrotoxicosis is a term referring to exaggerated clinical signs and symptoms of what? 1. Myxedema. 2. Hyperparathyroidism. 3. Hypothyroidism. 4. Hyperthyroidism.

4

What structure in the kidney is affected by antidiuretic hormone in diabetes insipidus? 1. Glomerulus. 2. Loop of Henle. 3. Proximal tubule. 4. Collecting duct.

4

The nurse is caring for a client after a hypophysectomy. The nurse notices clear nasal drainage from the client's nostril. The initial nursing action would be to 1) Obtain a culture of the drainage. 2) Lower the head of the bed. 3) Continue to observe the drainage. 4) Test the drainage for glucose.

4 The drainage could be cerebrospinal fluid that is leaking into the nasopharynx. Testing the drainage should reveal glucose if it is CSF, but not if it is just serous drainage from the surgical wound or respiratory secretions. It is important to determine if there is a communication between the central nervous system and tissues in the mouth and nasopharynx because of the possibility of a CNS infection occurring.

In adults excessive secretion of growth hormone results in the disorder?

acromegaly

A nurse is reviewing lab work for a patient who is receiving propylthiouracil. Which of the following lab values would indicate possible toxic effects of this drug? 1. White blood cell count of 4,000/mm. 2. Decreased TSH level. 3. Hemoglobin level of 13 grams. 4. Platelet count of 175,000/ mm.

1

Pituitary hormones include which of the following? 1. Adrenocorticotropic hormone. 2. Thyroxin. 3. Aldosterone. 4. Cortisol.

1

The active form of calcium in terms of neuromuscular functioning is what? 1. Ionized calcium. 2. Protein bound calcium. 3. Calcium citrate. 4. Calcium bicarbonate.

1

The nurse is explaining diabetes insipidus to a patient with the disorder. The nurse should explain that the signs and symptoms are related to inadequate secretion of which hormone? 1) ADH (antidiuretic hormone) 2) FSH (follicle stimulating hormone) 3) HGH (human growth hormone) 4) Oxytocin

1

Which of the following statements best describes the feedback mechanism which normally operates between the anterior pituitary and thyroid glands? 1. An increase in circulating thyroxin inhibits secretion of thyroid releasing hormone (TRH) and thyroid stimulating hormone (TSH) which results in decreased thyroxine. 2. An increase in cellular metabolism stimulates secretion of THS. which decreases thyroxine release, causing a decrease in cellular metabolism. 3. An increase in cellular metabolism stimulates the release of TRH which in turn stimulates the secretion of thyrotropin causing a decrease in cellular metabolism. 4. A decrease in cellular metabolism inhibits the conversion of thyroglobin to thyrotropin which in turn stimulates the release of thyroxin causing an increase in cellular metabolism.

1 Regulation of thyroid hormones is via a feedback mechanism within the hypothalamus, pituitary, and thyroid glands. Thyroid hormones regulate metabolic rate, calorie and oxygen consumption and other important body functions.

Preoperative instructions for the patient scheduled for a subtotal thyroidectomy include teaching the patient what? 1) Ways to support the head with the hands when moving. 2) Coughing should be avoided to prevent pressure on the incision. 3) The head and neck will need to remain immobile until the incision heals. 4) Tingling around the lips or in the fingers after surgery is expected and temporary.

1 The head needs to be supported so that sutures are not disrupted as the neck is flexed, extended or moved side to side. Usually the patient is taught to stabilize the head with their own hands as they change position - especially when rising from bed. Total immobilization of the head and neck is not necessary. Coughing should not be avoided since it is a necessary intervention to prevent lung complications after surgery. Very vigorous coughing should not be encouraged. Respiratory system must be assessed frequently. Tingling is not expected and could be a sign of hypoparathyroidism and should be reported immediately.

Post-thyroidectomy patients are especially prone to which of the following complications? Choose all that apply. 1. Increased intracranial pressure. 2. Hemorrhage. 3. Respiratory obstruction. 4. Tetany. 5. Laryngeal stridor. 6. Stroke.

1 and 6

Select the correct statements regarding chronic syndrome of inappropriate antidiuretic hormone. Choose all that apply. 1. Gastrointestinal disturbances are common. 2. Confusion is often present. 3. Oral Lasix (furosemide) is often prescribed. 4. Dietary sodium should be increased. 5. Signs of dehydration are present. 6. Weight is usually decreased. 7. Hypotension is common.

1, 2, 3, and 4

A nurse is caring for a patient with hyperthyroidism and is reviewing a list of his medications. Which medications are commonly used to treat hyperthyroidism? Choose all that apply. 1. Lugol's solution. 2. Potassium iodide (SSKI). 3. Levothyroxin (Synthroid) 4. Atenolol (Tenormin) 5. Liotrix.

1, 2, and 4

Which of the following is characteristic of a malignant thyroid nodule? More than one choice may be selected. 1. The nodule is hard on palpation. 2. There is associated satellite lymphadenopathy. 3. The mass is multinodular. 4. The nodule is fixed to overlying tissue.

1, 2, and 4

Nutritional treatment for a patient with hyperthyroidism includes a diet consisting of which of the following? Choose all that apply. 1. Increased vitamin A and thiamine 2. Increased protein. 3. Increased high-fiber foods 4. Decreased iodine. 5. Increased vitamins B and C. 6. Decreased carbohydrates. 7.Coffee and tea at least three times daily. 8. No concentrated sweets.

1, 2, and 5

Signs and symptoms of water deficit in a patient with a pituitary abnormality include which of the following? Choose all that apply. 1. Increased specific gravity 2. Decreased thirst 3. Dry tongue 4. Thick speech 5. Increased skin turgor 6. Bradycardia 7. Increased blood pressure 8. Tachycardia

1, 3, 4, and 8

Which of the following statements regarding hypersecretion of growth hormone is true? Choose all that apply. 1. Glucose intolerance can occur. 2. All changes can be reversed if detected early. 3. Is usually caused by somatotrophic tumors. 4. Headaches often occur frequently.

1, 3, and 4

If a client develops syndrome of inappropriate antidiuretic hormone (SIADH), it will be necessary for the nurse to do what? 1. Monitor the serum sodium levels carefully. 2. Force oral fluids. 3. Restrict fluid intake. 4. Restrict sodium in the diet. 5. Maintain accurate I&O. 6. Administer corticosteroids. 7. Monitor glucose every 2 hours.

1, 3, and 5

A patient will have a hypophysectomy for treatment of a pituitary tumor. The nurse will need to teach the patient about hormone replacement post-operatively. Which hormone replacements will need to be taken? Select all that apply. 1) Antidiuretic hormone 2) Insulin 3) Erythropoietin 4) Cortisol 5) Aldosterone 6) Thyroid hormones 7) Calcitonin

1, 4, and 6 The key to this question is to know that a hypophysectomy is removal of the pituitary gland. And it is important to know which hormones are under the control of the pituitary and which ones are controlled by other substances or conditions. Thyroid hormone, ADH and corticosteroids will need to be replaced after this surgery. The stimulating hormones are not replaced. Insulin and erythropoietin secretion are not affected by this surgery.

A nurse is teaching a patient with hypothyroidism about diet. Which diet would be most appropriate for this patient? Choose all that apply. 1. High fiber 2. Low fiber 3. High fat 4. Low fat 5. Increased salt 6. Low salt 7. Increased calories 8. Decreased calories

1, 4, and 8

A nurse is teaching a class on hormone disorders. The nurse includes in the teaching plan that which of the following hormones is secreted from the adrenal cortex? 1. Epinephrine. 2. Aldosterone. 3. Adrenocorticotropic hormone. 4. Antidiuretic hormone.

2

Calcitonin is released in response to: 1. hypopituitarism. 2. hypercalcemia. 3. hyperphosphatemia. 4. hypocalcemia.

2

In the newborn nursery you observe a newborn baby boy who is very lethargic. He has dry jaundiced skin, noisy respirations and a hoarse cry. These manifestations indicate which of the following thyroid dysfunctions? 1. Hyperthyroidism. 2. Cretinism. 3. Hashimoto's thyroiditis. 4. Toxic goiter.

2

The treatment of choice for thyroid cancer is what? 1. Subtotal thyroidectomy. 2. Total thyroidectomy. 3. Chemotherapy without surgery. 4. Iodine replacement therapy without surgery.

2

Patients at risk for Cushing syndrome include those who have which of the following? 1) Increased secretion of mineralocorticoids. 2) A history of receiving corticosteroids. 3) Bilateral adrenal atrophy. 4) A reduced quantity of cortisol in the hypothalamus.

2 Exogenous corticosteroids can be a cause of Cushing syndrome - (or increase in adrenal corticosteroid hormones). If the dosage of corticosteroids is too high, we could see the signs of Cushing syndrome. Patients need to be taught to watch for these signs and report immediately so the prescribed hormones can be adjusted. Also remember that people who have been on steroids for a long time can actually develop adrenal insufficiency (Addison's disease also) if the exogenous form of the hormone is stopped suddenly. The body has stopped producing the adrenal hormones because of the negative feedback mechanism. And so if the exogenous form is suddenly withdrawn, deficiency can occur with all the signs and symptoms of Addison's disease. As far as the other answers go - adrenal atrophy would not give an increase in steroids that result in Cushing syndrome - rather a decrease in steroids would occur. Increased secretion of mineralocorticoids does not relate to Cushing syndrome directly - we are dealing with increased glucocorticoids when we see Cushing manifestations. Cortisol is not in the hypothalmus. Hope you didn't choose that one!

Which nursing diagnosis is most likely for a client with an acute episode of diabetes insipidus? 1) Altered metabolism. 2) Fluid volume deficit. 3) Impaired gas exchange. 4) Altered tissue perfusion.

2 Fluid balance is affected by DI. Not enough antidiurectic hormone is available to help maintain fluid balance. Fluid is lost from the body through excessive urination. So fluid volume deficit is the best nursing diagnosis for this disorder.

The function of thyroid hormones can best be described in terms of what? 1. Mineral metabolism. 2. Anabolic activities. 3. Metabolism of all body cells. 4. Bone growth.

3

The nurse knows that which hormone is responsible for increasing metabolic rate? 1. Calcitonin. 2. Thyrocalcitonin. 3. Thyroxin. 4. Parathyroid hormone.

3

Vasopressin (Pitressin) is prescribed for a client with diabetes insipidus. A nurse is particularly cautious in monitoring the client receiving this medication if the client has which of the following preexisting conditions? 1) Depression 2) Endometiosis 3) Coronary artery disease 4) Pheochromocytosis

3 Because vasopressin replaces antidiuretic hormone (ADH) in cases of DI and it causes fluid retention (like ADH), patients with coronary artery disease (CAD)have to be monitored. Fluid retention causes an increase in the workload of the heart which is not a good thing for the person with CAD. The other conditions are not affected by the action of vasopressin.

A client is scheduled for a subtotal thyroidectomy. Iodine solution (Lugol solution, potassium iodide solution) is prescribed. A nurse prepares to administer the medication, knowing that the therapeutic effect of this medication is to 1) Replace thyroid hormone. 2) Increase thyroid hormone production. 3) Supress thyroid hormone production. 4) Prevent the oxidation of iodide.

3 Iodine is given to patients scheduled for thyroidectomy to help prepare the patient and for thyrotoxicosis. Large doses of iodine interfere with the production of thyroid hormone. In addition it decreases the vacularity of the thyroid before surgery to help prevent complications from bleeding. However, iodine is not effective in long-term treatment of hyperthyroidism because the peak effect of the drug takes place approximately 2 weeks after initiation of treatment. Of course iodine is necessary for the production of thyroid hormone - it is just that large amounts suppress hormone production. So the key point to remember about iodine is that just the correct amount is needed in order for the thyroid to function properly. Too much interferes and too little interferes.

A client is admitted to an emergency room, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially? 1) Warm the client. 2) Administer fluid replacement. 3) Maintain the airway. 4) Administer thyroid hormone.

3 People, always go for ABC's. That is almost always the correct answer of what to do first. Why? Because if the person is not breathing and circulating it won't matter about medication (except for epinephrine) - but even then, you have to have an airway in order for that drug to do its job. The rest of these interventions are correct interventions - fluid replacement only if the person needed it - but they are done after airway, breathing and circulation are established.

A patient with Graves' disease asks the nurse what caused the disorder. The best response by the nurse is 1) "The cause of Graves' disease is not known, although it is thought to be genetic." 2) "It is usually associated with goiter formation from an iodine deficiency over a long period of time." 3) "Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones." 4) "In genetically susceptible persons antibodies form that attack thyroid tissue and stimulate overproduction of thyroid hormones."

4 The answer is the best choice because it provides a more thorough and complete description of the disease. And your understanding of the disease is critical to have before you teach patients about it. Even though you could make a case for the answer that included the fact that the exact cause is unknown and there is a genetic component (as there are in most diseases), the more complete description with discussion of antibodies that attack thyroid tissue and cause overproduction of thyroid hormones is better. Graves' disease is the most common type of hyperthyroidism and research shows that it seems to have a strong autoimmune component. Goiter formation with iodine deficiency is not a cause of hyperthyroidism. There may be a goiter with hyperthyroidism but it is caused by overproduction and stimulation of the thyroid gland rather than by iodine deficiency as seen in hypothyroidism. In fact, interestingly, goiter can be a manifestation of both hyper-and hypothyroidism.

A client with thyroid cancer undergoes a thyroidectomy. After surgery, the client develops peripheral numbness and tingling and muscle twitching and spasms. The nurse should expect to administer what? 1) Thyroid supplements. 2) Antispasmodics. 3) Barbiturates. 4) IV calcium.

4 These signs could mean that the parathyroid glands were accidentally removed along with thyroid tissue. That would cause hypoparathyroid symptoms, like the ones we see here. Remember that decreased calcium causes cells to be overexcited and there is tingling, muscle twitching, tetany. These signs need to be reported immediately. IV calcium is the treatment here.

Postoperative care of the client after thyroidectomy includes which of the following actions? 1) Keep the head of the bed flat to prevent neck flexion. 2) Minimize coughing and deep breathing to prevent injury to the suture line. 3) Restrict ambulation until the suture line is healed. 4) Check the back of the neck and upper part of the back for bleeding when assessing the dressing.

4 Well, why would you check the back, you ask - the incision is in front. But the thyroid area is quite vascular and if the incision is bleeding, the blood might not show up right away on the front - rather it could drip by gravity to the back of the neck. If you neglected to look back there, you might miss some pretty significant bleeding. Same thing goes for an abdominal wound. Don't forget to check the back.

The normal range of total serum calcium in an adult is (in mg/dL):________

8.6-10.2 mg/dL

What is the reason for the increased incidence of angina pectoris/myocardial infarction as a response to therapy for myxedema?

With therapy, metabolic rate is increased and blood supply to the heart cannot meet the increased demand.