Exam I: Endocrine System
The nurse is doing an admission assessment on a new resident to a long-term care facility. The patient's face and shoulders seem to have a lot of fat, but the patient's arms and legs are thin. Which of the patient's routine medications might be involved? 1. Prednisone (Deltasone, a glucocorticoid) 2. Calcitonin 3. Insulin 4. Thyroid hormone (Levothyroixine/Synthroid)
1
A patient hospitalized with hypoparathyroidism is about to order lunch. Which food selection is best for this patient based on their dietary needs at this time? 1. Baked chicken, green beans, and boiled potatoes 2. Broccoli salad, cottage cheese, and peaches 3. Roast beef, carrots, and pinto beans 4. Hamburger, fries, and sorbet
2
A patient is recovering from a thyroidectomy. The patient starts to complain of tingling and numbness in the face, toes, and fingers. Which of the following findings below warrants attention? 1. Ca+ level: 6 mg/dL 2. Na+ level: 145 mg/dL 3. K+ level: 3.5 mg/dL 4. Phosphate level: 4.3 mg/dL
1
A patient with Cushing's syndrome will be undergoing an adrenalectomy. Which of the following will be included in the patient's discharge teaching after the procedure? 1. Glucocorticoid replacement therapy 2. Avoiding avocadoes and pears 3. Declomycin therapy 4. Signs and symptoms of Grave's Disease
1
A patient with hypothyroidism is started on levothyroxine (Synthroid). Which of the following statements shows that the patient understands teaching related to the new medication? 1. "I know I should call my doctor if my heart races." 2. "I understand that I may develop a moon-shaped face." 3. "The sleepiness I experience when I start this medication will subside within 2 weeks." 4. "I'll have to watch my diet to avoid further weight gain while on this medication."
1
Following surgery for thyroidectomy, the nurse watches carefully for which of the following signs and symptoms of tetany? 1. Numb fingers, muscle cramps 2. Weakness, muscle fatigue 3. Hallucinations, delusions 4. Dyspnea and tachycardia
1
A patient arrives to the ER and is unable to give you a health history due to altered mental status. The family reports the patient has gained over 10 lbs in 1 week and says it is mainly "water" weight. In addition, they report the patient hasn't been able to urinate or eat within the past week as well and was recently diagnosed with small cell lung cancer. On assessment, you note the patient's HR is 115 and BP 180/92. Patient sodium level is 90. Which of the following conditions do you suspect the patient is most likely presenting with?* 1. SIADH 2. Diabetes Insipidus 3. Addison's Disease 4. Fluid Volume Deficient
1
Which action by the nurse is most important following a hypophysectomy? 1. Performing a routine neurologic assessment 2. Encouraging the patient to cough and deep breathe 3. Monitoring for tracheal edema 4. Assisting with use of an incentive spirometer
1
Which of the following dietary recommendations will reduce the risk of kidney stones in the patient with hyperparathyroidism? 1. Increase fluids 2. Increase citrus fruits 3. Limit meat products 4. Limit bread products
1
Which of the following instructions should the nurse provide to the patient who is being discharged after a thyroidectomy? 1. "You must take your thyroid replacement every day just as the healthcare provider prescribed." 2. "You must weigh yourself daily and report any gain or loss of more than 1 pound." 3. "You will need to return to the healthcare provider's office for a weekly blood pressure check." 4. "You will need to restrict your sodium and potassium intake."
1
Which of the following statements by the patient with hypothyroidism indicates to the nurse that the plan of care has been effective? 1. "I feel so much better now that my energy is returning." 2. "I'm really glad the diarrhea has stopped." 3. "I'm so glad I won't have to take medication for very long." 4. "My fingers aren't tingling anymore."
1
You are developing a care plan for a patient with SIADH. Which of the following would be a potential nursing diagnosis for this patient? 1. Fluid volume overload 2. Fluid volume deficient 3. Acute pain 4. Impaired skin integrity
1
Fill in the blank regarding the negative feedback loop for thyroid hormone production: The __ produces TRH (Thyrotropin-Releasing Hormone) which causes the anterior pituitary gland to produce __ which in turn causes the thyroid gland to release __ and __. 1. Thalamus, CRH (Corticotropin-releasing hormone) TSH (thyroid-stimulating hormone) and T4 2. Hypothalamus, TSH (thyroid-stimulating hormone), T3 and T4 3. Posterior pituitary gland, TSH (thyroid-stimulating hormone), T3 and T4 4. Hypothalamus, CRH (Corticotropin-releasing hormone), TSH (thyroid- stimulating hormone), T3 and TSH
2
Which hormones are secreted by the posterior pituitary gland? Select all that apply. 1. Antidiuretic hormone 2. Thyroid-stimulating hormone 3. Growth hormone 4. Luteinizing hormone 5. Oxytocin 6. Calcitonin
1, 5
When explaining a thyroid scan to a patient, which of the following statements is correct? 1. "You will take a special pill, and then an ultrasound will be taken of your neck." 2. "You will receive an injection of radioactive material, and then a special camera will take pictures of your thyroid gland." 3. "You will be placed into a special machine, and x-rays will be taken of your neck. It may be noisy." 4. "You will be given a special drink, and then magnetic energy is used to visualize the thyroid area."
2
A 26-year-old patient is hospitalized for radioactive iodine treatment for hyperthyroidism. Which of the following precautions by the nurse is appropriate? 1. Talk with the patient only over the intercom system 2. Wear gloves when emptying the bedside commode 3. Maintain reverse isolation for 3 months 4. No precautions are necessary because the dose is so small
2
A client is admitted to the emergency department, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially? 1. Warm the client 2. Maintain a patent airway 3. Monitor intravenous fluids 4. Administer thyroid medication
2
Which nursing action is appropriate when assisting the health care provider with palpation of the thyroid gland during a routine physical examination? 1. Ask the patient to take a deep breath 2. Give the patient a sip of water 3. Have the patient look up toward the ceiling 4. Help the patient to lie back on a pillow
2
Which of the following nursing diagnoses is most appropriate for the patient admitted in addisonian crisis? 1. Imbalanced Nutrition: More Than Body Requirements 2. Deficient Fluid Volume 3. Disturbed Body Image 4. Acute Pain
2
Which of the following patients are MOST at risk for developing myxedema coma? 1. A 28 year old female who is prescribed Methimazole. 2. A 75 year old female who is taking Lithium and reports missing several doses of Synthroid. 3. A 69 year old male experiencing nausea and vomiting for 4 days. 4. A 55 year old male with a history of diabetes and is insulin dependent.
2
Which of the following patients are MOST at risk for hypoparathyroidism? 1. A 75 year-old female who is diabetic and takes Os-Cal daily. 2. A 59 year-old male with a Mg+ level of 0.9 mg/dL. 3. A 85 year-old female complaining of flank pain and constipation. 4. A 19 year-old male with a Ca+ level of 8.9 mg/dL.
2
Which of the following patients are at risk for developing Cushing's Syndrome? 1. A patient with a tumor on the pituitary gland, which is causing too much ACTH to be secreted. 2. A patient taking glucocorticoids for several weeks. 3. A patient with a tuberculosis infection. 4. A patient who is post-opt from an adrenalectomy.
2
Which of the following regulators of blood pressure is actually secreted by the kidney? 1. Antidiuretic hormone 2. Renin 3. Angiotensin 2 4. Aldosterone
2
The nurse needs to accomplish all the following interventions for a patient who is 24-hours post-thyroidectomy in this order. Place the interventions in the correct order in which they should be completed. 1. Check the surgical site dressing for signs of bleeding 2. Verify that the airway is patent 3. Assess vital signs 4. Administer an analgesic for postoperative pain 5. Teach the patient about levothyroxine (Synthroid) use after discharge 6. Assist with ROM exercises of the neck
2, 3, 1, 4, 6, 5
Which assessment finding should the nurse expect to see in the patient with uncontrolled diabetes insipidus? Select all that apply. 1. Edema 2. Polyuria 3. Heat intolerance 4. Diarrhea 5. Polydipsia 6. Dehydration
2, 5, 6
A 42 year old patient enters an outpatient clinic with symptoms of weight gain and fatigue. Laboratory studies are done, and a diagnosis of primary hypothyroidism is made. The patient asks why the TSH level is elevated. Which of the following is the best response by the nurse? 1. "The thyroid makes more thyroid-stimulating hormone to take the place of the deficient triiodothyronine (T3) and thyroxine (T4)." 2. "The thyroid-stimulating hormone tries to directly raise the metabolic rate when there is not enough triiodothyronine (T3) and thyroxine (T4)." 3. "The pituitary makes more thyroid-stimulating hormone to try to stimulate the underactive thyroid." 4. "The extra fat cells from your weight gain make excess thyroid-stimulating hormone."
3
A patient is admitted with complaints of palpations, excessive sweating, and unable to tolerate heat. In addition, the patient voices concern about how her appearance has changed over the past year. The patient presents with protruding eyeballs and pretibial myxedema on the legs and feet. Which of the following is the likely cause of the patient's signs and symptoms? 1. Thyroiditis 2. Deficiency of iodine consumption 3. Grave's Disease 4. Hypothyroidism
3
A patient is being discharged home for treatment of hypothyroidism. Which medication is most commonly prescribed for this condition? 1. Tapazole 2. Radioactive Iodine 3. Synthroid 4. Inderal
3
A patient is recovery from a parathyroidectomy. Which of the following findings causes concern and requires nursing intervention? 1. The patient is in Semi-Fowler's position. 2. The patient's calcium level is 8.9 mg/dL. 3. The patient's voice is hoarse. 4. The patient is drowsy but arouses to name.
3
A patient with Syndrome of Inappropriate Antidiuretic Hormone asks the nurse why he has gained 10 pounds. Which response is best? 1. "The syndrome causes an increase in appetite. As soon as you are effectively treated, the weight should drop back to normal for you." 2. "You are retaining a lot of sodium and potassium and that causes you to gain water weight." 3. "You have too much of a hormone in your system that causes you to retain water. The extra 10 pounds is likely water weight." 4. "Your kidneys are not working correctly, so they can't get rid of extra water from your system."
3
All of the following are treatments for myxedema coma EXCEPT? 1. Corticosteroids 2. IV glucose 3. Hypotonic IV solutions 4. IV Synthroid
3
The nurse is caring for a patient after a thyroidectomy and notes that calcium gluconate is prescribed. The nurse determines that this medication has been prescribed for which reason? 1. Treat thyroid storm 2. Prevent cardiac irritability 3. Treat hypocalcemic tetany 4. Stimulate the release of parathyroid hormone
3
What assessment findings should the nurse monitor to detect the onset of thyrotoxicosis in a patient with hyperthyroidism? 1. Peripheral pulses 2. Serum sodium 3. Vital signs 4. Incision site
3
Which assessment finding in a patient who has just returned from having a thyroidectomy should be immediately reported to the healthcare provider? 1. Neck discomfort 2. Sore throat 3. Tingling fingertips 4. Sleepiness
3
Which of the following nursing diagnoses would be most appropriate for a patient with fatigue related to hypothyroidism? 1. Imbalanced nutrition: more than body requirements related to excessive food intake 2. Impaired gas exchange related to weight gain 3. Activity intolerance related to fatigue 4. Ineffective coping related to depression
3
Which of the following signs and symptoms is NOT expected with Diabetes Insipidus? 1. Polyuria 2. Polydipsia 3. Polyphagia 4. Extreme thirst
3
You are providing discharge teaching to a patient who is prescribed calcium supplements with vitamin D for treatment of hypoparathyroidism. Which of the following statements by the patient warrants you to re-educate the patient on how they should take this medication? 1. "I will also make sure I eat foods rich in calcium, such as dairy and green leafy vegetables while I'm taking this medication." 2. "A side effect of this medication is constipation. Therefore, I should drink plenty of fluids." 3. "I will take my calcium supplements in the morning when I take my Synthroid." 4. All the statements above are correctly stated by the patient.
3
A patient has an extremely high T3 and T4 level. Which of the following signs and symptoms DO NOT present with this condition? 1. Weight loss 2. Intolerance to heat 3. Smooth skin 4. Hair loss
4
A patient is started on levothyroxine (Synthroid) to replace thyroxine (T4) for a new diagnosis of hypothyroidism. What effect can the patient expect as the medication begins to work? 1. Increased urination 2. Improved blood sugar 3. Lower blood pressure 4. Increased energy
4
A patient reports they do not eat enough iodine in their diet. What condition are they most susceptible to? 1. Pheochromocytoma 2. Hyperthyroidism 3. Thyroid Storm 4. Hypothyroidism
4
A patient with SIADH is undergoing IV treatment of a hypertonic IV solution of 3% saline and IV Lasix. Which of the following nursing findings requires intervention? 1. Sodium level of 136. 2. Patient reports urinating more frequently. 3. Potassium level of 5.0. 4. Assessment finding of crackles throughout the lung fields.
4
Addison's Disease is: 1. Increased secretion of cortisol 2. Increased secretion of aldosterone and cortisol 3. Decreased secretion of cortisol 4. Decreased secretion of aldosterone and cortisol
4
Retention of water in SIADH can cause hyponatremia by which of the following mechanisms? 1. The extracellular fluid has a normal volume and a reduced absolute amount of sodium. 2. The intracellular fluid has a larger volume and a reduced absolute amount of sodium. 3. The intracellular fluid has a normal volume and a reduced concentration of sodium. 4. The extracellular fluid has a larger volume and a reduced concentration of sodium.
4
The nurse is collecting data regarding a patient after a thyroidectomy and notes the development of a hoarse and weak voice. Which nursing action is appropriate? 1. Check for signs of bleeding 2. Administer calcium gluconate 3. Notify the registered nurse immediately 4. Reassure the patient that this is usually a temporary condition
4
Which of the following nursing assessments is most important in the patient with hyperthyroidism and risk for thyrotoxic crisis? 1. Intake and output 2. Breath sounds 3. Bowel sounds 4. Vital signs
4
DI is caused by a deficiency of __.
ADH
DI is caused by a deficiency of __. If this is lacking, adequate reabsorption of water is prevented, leading to diuresis. Patients can urinate from 3-15L/day. This leads to dehydration and __ serum osmolality.
ADH; increased
__ is a rare excess of GH that affects adults, usually in their 30s or 40s.
Acromegaly
The most significant sign of __ is hypotension. This is related to the lack of aldosterone. Low cortisol levels cause hypoglycemia, weakness, fatigue, weight loss, confusion, and psychosis. It may cause hyperpigmentation of the skin, resulting in a tanned or bronze appearance. Anorexia, nausea, or vomiting may also occur. There may be reduced body hair and a craving for salt.
Addison disease
The __ secretes three types of steroid hormones: mineralcorticoids, glucocorticoids, and gonadocorticoids.
Adrenal cortex
Adrenocortical insufficiency is the insufficient production of the hormones of the __. Primary AI is called __.
Adrenal cortex; Addison disease
A pheochromocytoma is a rare tumor of the __ that secretes excess catecholamines.
Adrenal medulla
The catecholamines are released by the __.
Adrenal medulla
__ is associated with reduced levels of cortisol, aldosterone, or both. There may also be a deficiency in androgens.
Adrenocortical insufficiency
__ stimulates the adrenal cortex to secrete corticosteroids.
Adrenocorticotropic hormone
In Addison's Disease there is a lack of _________ and ________. In Cushing's disease there is an abundance of ___________.
Aldosterone; cortisol; cortisol
__ decreases the reabsorption of calcium in bone: lowers blood calcium levels.
Calcitonin
__ increases the use of fats and amino acids for energy.
Cortisol
In __, muscle wasting and thin skin with purple striae occur as a result of cortisol's catabolic effect on tissues. Catabolic effects on bone lead to osteoporosis, pathological fractures, and back pain from compression fractures of the vertebrae. There is a high risk of infection. Hyperpigmentation may occur.
Cushing syndrome
Most signs and symptoms of __ are related to excess cortisol levels Weight gain, central obesity with thin arms and legs, fat pads on the upper back (Buffalo hump), and a round, moon-shaped face result from deposits of adipose tissue at these sites. It also causes insulin resistance and stimulates gluconeogenesis, which results in glucose intolerance.
Cushing syndrome
__ is caused by exposure to excess cortisol. This can be because of an adrenal or pituitary gland problem or from treatment with exogenous corticosteroids.
Cushing syndrome
A decrease in ADH activity results in __.
DI
In adults, symptoms of growth hormone __ include fatigue, weakness, excess body fat, decreased muscle and bone mass, sexual dysfunction, high cholesterol, and increased risk for cardiovascular and cerebrovascular disease. Headaches, mental slowness, and psychological disturbances may also occur.
Deficiency
A normally functioning thyroid gland produces a __ state.
Euthyroid
A patient with Syndrome of Inappropriate Antidiuretic Hormone (SIADH) has __ antidiuretic hormone. They will present with fluid retention, weight gain, and concentrated urine.
Excess
__ increases the conversion of glycogen to glucose in the liver between meals.
Glucagon
A food or medication that can cause enlargement of the thyroid gland is called a __.
Goitrogen
__ stimulates mitosis and protein synthesis.
Growth hormone
Differentiate between hyperthyroidism and hypothyroidism. Increased appetite with weight loss, increased BMs, nervousness, tremor, tachycardia, palpitations, restlessness, diaphoresis
Hyperthyroidism
Patient education following a __ includes: Expect a small amount of bloody or mucous drainage from your nose. If you must blow your nose, do so very gently. Blowing can injure the surgical site and cause bleeding or spinal fluid leakage. Take stool softeners PRN to prevent straining for BMs. Take cough suppressants as directed to prevent coughing. If an upper lip incision was used, wait until the incision line is healed to use a toothbrush. Take all meds as prescribed. You will be on lifelong hormone therapy. Call immediately if you develop a fever, have more than a small amount of blood drainage from the incision site, have clear drainage, feel very thirsty, or urinate more than usual.
Hypophysectomy
Removal of the pituitary gland is known as __.
Hypophysectomy
__ is often done using minimally invasive endoscopic surgery via the nose or a small incision just under the upper lip.
Hypophysectomy
The __ connects the nervous system by way of the pituitary gland or __.
Hypothalamus; hypophysis
Differentiate between hyperthyroidism and hypothyroidism. Fatigue, weight gain, bradycardia, constipation, mental dullness, feeling cold, shortness of breath, reduced sweating, dry skin/hair
Hypothyroidism
A patient with diabetes insipidus has __ antidiuretic hormone. They will present with polyuria, polydipsia, dehydration, and dilute urine.
Insufficient
__ increases glucose uptake by cells and glycogen storage in the liver.
Insulin
The anti-diuretic hormone is __________ in Diabetes Insipidus and _________ in SIADH.
Low; high
__ stimulates secretion of testosterone in males.
Luteinizing hormone
Untreated hypothyroidism can lead to __.
Myxedema coma
__ causes contraction of the myometrium during labor.
Oxytocin
__ increases the reabsorption of calcium and phosphate from bone to blood.
Parathyroid hormone
A __ is a tumor of the adrenal medulla.
Pheochromocytoma
Manifestations of __ include hypertension, tachycardia, palpitations, tremor, diaphoresis, apprehension, and a severe pounding headache. Treatment is the surgical removal of one or both adrenal glands.
Pheochromocytoma
If the thyroid gland is diseased and causing hypothyroidism, it would be considered a __ problem.
Primary
In __ adrenocortical insufficiency, adrenocorticotropic hormone (ACTH) levels from the pituitary gland can be elevated in an attempt to stimulate the adrenal cortex to synthesize more hormones.
Primary
__ hypothyroidism occurs when the thyroid gland fails to produce enough TH even though enough thyroid-stimulating hormone is being secreted by the pituitary gland.
Primary
A __ disorder is a problem within the gland that is out of balance. __ disorders are caused by problems outside the gland, such as an imbalance in a tropic hormone, certain drugs, trauma, surgery, or a problem in the feedback mechanism.
Primary; Secondary
__ initiates milk production in the mammary glands.
Prolactin
In __ adrenocortical insufficiency, deficient adrenocorticotropic hormone (ACTH) fails to stimulate adrenal steroid synthesis. This may be caused by dysfunction of the pituitary gland or hypothalamus.
Secondary
Sometimes, hypothyroidism is caused by a lack of thyroid-stimulating hormone from the pituitary gland, even though the thyroid gland is healthy. This would be considered a __ problem.
Secondary
__ hypothyroidism is caused by low levels of TSH, which fail to stimulate release of TH.
Secondary
Growth hormone, also called __, is responsible for normal growth of bones, cartilage, and soft tissue. GH is synthesized and secreted by the __ pituitary gland.
Somatotropin; anterior
An increase in ADH activity is called __ or SIADH.
Syndrome of Inappropriate Antidiuretic Hormone
__ hypothyroidism results from inadequate release of thyrotropin-releasing hormone, secreted by the hypothalamus.
Tertiary
Muscle spasms and tingling around the mouth are symptoms of __.
Tetany
The __ is the only palpable endocrine gland. The nurse may assist the provider to palpate it by helping to position the patient, instructing the patient to sip water.
Thyroid gland
The __ produces three hormones: triiodothyronine (T3), thyroxine (T4), and calcitonin.
Thyroid gland
__ stimulates growth and secretions of the thyroid gland.
Thyroid-stimulating hormone
__ increases energy production for a normal metabolic rate.
Thyroxine
True or False Most tumors of the pituitary gland are benign.
True
