HESI Prep: Endocrine System

A client is worried about what to expect after having a pancreatoduodenectomy (Whipple procedure) for cancer of the pancreas. In helping this client plan for the future, which concept would the nurse need to understand?

The stage and grade of the client's cancer - The stage and grade of the client's cancer are the best predictors of the outcome of therapy. Any history of alcohol or tobacco use is not helpful in understanding the likelihood of additional problems associated with the current cancer. Information about any previous exposure to known carcinogens is not helpful in understanding the likelihood of additional problems associated with the current cancer. The survival rate for individuals with pancreatic cancer is useful, but it is not specific for this client.

Which clinical findings would the nurse expect to see when assessing a client with a primary brain tumor who has developed syndrome of inappropriate secretion of antidiuretic hormone (SIADH)? Select all that apply. One, some, or all responses may be correct.

Vomiting, increased weight, decreased serum sodium + decreased level of consciousness - Water retention and decreased urinary output occur because of excess secretion of antidiuretic hormone (ADH). Early manifestations are related to water retention and may include gastrointestinal (GI) disturbances such as loss of appetite, nausea, and vomiting. Weight gain occurs because of the water retention. Serum sodium levels are decreased because of fluid retention and sodium loss. Central nervous system changes include headaches, lethargy, and decreased level of consciousness, progressing to coma and seizures. Hypothermia also occurs because of central nervous system disturbance. The pulse is full and bounding because of the increased fluid volume.

Which dietary instruction would be beneficial to a client who has undergone a hypophysectomy and has difficulty passing stools?

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

A client is diagnosed with a pituitary tumor. Before surgery for tumor removal, the probability of an aneurysm must be determined. The nurse anticipates that which diagnostic test will be prescribed?

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

In preparing a teaching plan, the nurse anticipates which diet will be prescribed for this client?

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

The nurse is caring for a client with nephrogenic diabetes insipidus who is prescribed a low-sodium diet and chlorothiazide therapy. Which alternative treatment would the nurse be prepared to administer if the client fails to respond to the therapy?

Indomethacin - When a low-sodium diet and thiazide medications such as chlorothiazide are ineffective in a client with nephrogenic diabetes insipidus (DI), indomethacin is prescribed. This medication helps increase the renal responsiveness to antidiuretic hormone. Furosemide is not recommended for nephrogenic DI. Chlorpropamide helps decrease thirst seen in clients with central DI. Lysine vasopressin is also prescribed to clients with central DI. Because the kidney is unable to respond to antidiuretic hormone in nephrogenic DI, hormone therapy has little effect.

Which clinical manifestation is indicative of the fluid and electrolyte imbalance associated with a parathyroidectomy?

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

Which laboratory value may indicate hyperfunction of the adrenal gland in a client?

Potassium: 2.9 mEq/L - The normal level of potassium is 3.5 to 5.0 mEq/L. The laboratory value of the potassium in the client is 2.9 mEq/L, which is less than the normal level. It may indicate the presence of adrenal gland hyperfunction in the client. The normal value of sodium is 136 to 145 mEq/L, bicarbonate is 23 to 30 mEq/L, and total calcium is 9 to 10.5 mg/dL. Thus the laboratory values of sodium (143 mEq/L), bicarbonate (25 mEq/L), and total calcium (10 mg/dL) lie in the normal range, which does not indicate hyperfunction of the adrenal gland in the client.

While hospitalized, a client with diabetes is observed picking at calluses on the feet. Which intervention would the nurse implement immediately?

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

Which complication would the nurse be concerned about if there is removal of the parathyroid glands during a thyroidectomy?

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

Which medication will the nurse administer to trigger ovulation?

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

When evaluating for nerve injury after a thyroidectomy, which action would the client be asked to do?

Speak - The laryngeal nerve is close to the operative site and can be damaged inadvertently. Loss of the gag reflex occurs with general anesthesia; the ability to swallow signifies its return. The ability to purse the lips tests the seventh cranial (facial) nerve, which is not affected in thyroid surgery. The nerves involved in turning the head are not near the thyroid gland.

A client is diagnosed with parathyroid dysfunction. Which serum calcium concentration supports the diagnosis?

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

The laboratory reports of a client reveal selective hypopituitarism related to growth hormone (GH). Which other findings would the nurse anticipate in the client? Select all that apply. One, some, or all responses may be correct.

Decreased muscle strength + Increased serum cholesterol - The deficiency of GH results in a decrease in the body's muscle strength because GH regulates bone and muscle growth. GH deficiency also results in an increase in serum cholesterol levels because GH also plays a role in lipid metabolism. Hyposecretion of gonadotropins results in decreased body hair. The serum cortisol levels decrease when there is deficiency of adrenocorticotropic hormone, which regulates cortisol secretion. Thyroid-stimulating hormone (TSH) regulates thyroid hormones secretions, which are involved in thermoregulation. Hyposecretion of TSH results in decreased tolerance to cold.

The nurse reviews the serum laboratory values of a client. The nurse suspects hypofunctioning of the adrenal gland based on which results? Select all that apply. One, some, or all responses may be correct.

Increased calcium, Decreased cortisol, Decreased sodium - Hypofunctioning of the adrenal gland is manifested by increased serum calcium, decreased serum cortisol, and decreased serum sodium levels. Decreased serum potassium and decreased serum bicarbonate levels are associated with hyperfunctioning of the adrenal gland. Normal to increased serum glucose is associated with hyperfunctioning of the adrenal gland.

Which action would the nurse do when collecting a 24-hour urine specimen?

Check to verify whether a preservative is needed. - Depending on the purpose of the collection, a preservative to prevent breakdown of the specimen may be necessary. Weighing the client is not necessary. The last specimen should be collected as close as possible to the end of the 24-hour period and added to the urine collected. Collecting urine for the next 24 hours, not checking the intake and output for the previous 24 hours, is important.

Which signs would the nurse expect to observe in a client with small cell carcinoma of the lung who develops syndrome of inappropriate antidiuretic hormone (SIADH)? Select all that apply. One, some, or all responses may be correct.

Oliguria, seizures + vomiting - Cancerous cells of small cell lung cancer can produce antidiuretic hormone, which causes fluid retention, resulting in increased blood volume and decreased urine volume. Fluid retention associated with SIADH can cause cerebral edema, resulting in confusion and seizures. Fluid retention resulting in hyponatremia causes nausea and vomiting. The client will have nausea and vomiting, resulting in a decreased oral fluid and food intake.

The nurse is caring for a client hospitalized with syndrome of inappropriate antidiuretic hormone (SIADH). Which action performed by the nurse may result in a positive outcome of the treatment?

Changing the position of the client frequently - Changing the position of the client frequently helps in maintaining skin integrity and joint mobility. The head of the bed should not be elevated more than 10 degrees to enhance venous return to the heart. The client's weight should be obtained daily to help assess fluid retention. In acute care settings, the client's fluid intake should be no more than 800 to 1000 mL/day. Fluid intake is restricted to 500 mL/day in severe hyponatremia cases.

Which clinical manifestations would the nurse expect a client to exhibit with a diagnosis of Cushing syndrome? Select all that apply. One, some, or all responses may be correct.

Weakness, Hypertension, Truncal obesity - Weakness occurs in response to the excessive catabolism of proteins and resulting loss of muscle mass. Hypertension occurs in response to excessive cortisol that causes an increase in circulating volume or an arteriole response to circulating catecholamines. Truncal obesity is caused by abnormal fat metabolism and deposition of fat in the mesenteric bed. Emaciation is associated with Addison disease. Intermittent tonic spasms of the extremities are associated with tetany, a neuromuscular manifestation, because of a decrease in ionized calcium occurring in hypoparathyroidism, not Cushing syndrome.

Which effect does the parathyroid hormone have on bones? Select all that apply. One, some, or all responses may be correct.

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

An increase in which blood component is responsible for the acidosis related to untreated diabetes mellitus?

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

Which assessment findings are associated with Cushing disease? Select all that apply. One, some, or all responses may be correct.

Round face, Dependent edema in the feet and ankles, Thin, translucent skin with bruising, Increased fatty deposition in the neck and back - Changes in fat distribution may result in a round face and fat pads on the neck, back, and shoulders. There are increased levels of steroids and aldosterone, causing sodium and water retention in clients with Cushing syndrome. This increased fluid retention results in dependent peripheral edema. Skin changes result from increased blood vessel fragility and include bruises and thin or translucent skin. The extremities appear thinner from muscle wasting and weakness, not thicker from fatty deposition.

Which finding supports the diagnosis of a hyperfunctioning of the adrenal glands?

Serum potassium of 2.8 mEq/L (2.8 mmol/L) - The hyperfunctioning of the adrenal gland is manifested as decreased serum potassium levels. Normal levels of serum potassium lie between 3.5 and 5 mEq/L (3.5-5 mmol/L). A serum potassium concentration of 2.8 mEq/L (2.8 mmol/L) is abnormal and supports the diagnosis. The normal serum sodium concentration ranges from 135 to 145 mEq/L (135-145 mmol/L); although 130 mEq/L (135 mmol/L) is low, hypernatremia occurs in hyperfunctioning of the adrenal glands. The normal serum bicarbonate concentration ranges from 22 to 26 mEq/L (22-26 mmol/L). The normal levels of blood urea nitrogen range from 7 to 20 mg/dL (2.5-7.14 mmol/L).

A client is diagnosed with growth hormone deficiency. In addition to increased serum cholesterol levels, the nurse expects which assessment finding?

Pathological fractures - Growth hormone deficiency results in thinning of bones and increases the risk for pathological fractures. Thyrotropin deficiency results in scalp alopecia and intolerance to cold. Marked increase in the volume of urine output is a sign of diabetes insipidus caused by vasopressin deficiency.

The nurse is caring for a client with hyperpituitarism. Which diagnostic test helps identify the abnormalities of the sella turcica associated with the condition?

Skull x-ray - An imaging assessment such as skull x-ray imaging is helpful in the identification of problems related to the sella turcica. Angiography would be helpful in ruling out any aneurysms or vascular abnormalities. Computer tomography and magnetic resonance imaging are helpful in defining soft tissue lesions.