Prep-U Stuff for Med Surg (Endocrine Ch 52)

During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and: a) potassium. b) sodium. c) phosphorus. d) magnesium.

c) phosphorus. Explanation: PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation.

A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan? a) "Maintain a moderate exercise program." b) "Rest as much as possible." c) "Lose weight." d) "Jog at least 2 miles per day."

a) "Maintain a moderate exercise program." Explanation: The nurse should instruct the client to maintain a moderate exercise program. Such a program helps strengthen bones and prevents the bone loss that occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise. Because of weakened bones, a rigorous exercise program such as jogging is contraindicated. Weight loss might be beneficial but it isn't as important as developing a moderate exercise program.

A patient with a traumatic brain injury is producing an abnormally large volume of dilute urine. Which alteration to a hormone secreted by the posterior pituitary would the nurse expect to find? a) A deficient production of vasopressin b) An increase in oxytocin c) An increase in antidiuretic hormone d) A deficient amount of somatostatin

a) A deficient production of vasopressin Explanation: The most common disorder related to posterior lobe dysfunction is diabetes insipidus, a condition in which abnormally large volumes of dilute urine are excreted as a result of deficient production of vasopressin. Diabetes insipidus may occur following surgical treatment of a brain tumor, secondary to nonsurgical brain tumors, and traumatic brain injury.

A postpartum client is receiving intravenous oxytocin (Pitocin) after birth. Why will this medication be used for this client after the birth of her child? a) Decreases the postpartum cramping b) Stimulates the contraction of the uterus and prevents bleeding c) Helps treat nausea d) Will prevent lactation for a woman who is bottle feeding her newborn

b) Stimulates the contraction of the uterus and prevents bleeding Explanation: Oxytocin (Pitocin) is released from the pituitary gland and stimulates contraction of pregnant uterus and release of breast milk after childbirth. It will not prevent lactation or help treat nausea. It will increase lactation.

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

b) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) Explanation: 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 female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia? a) Acromegaly b) Type 1 diabetes mellitus c) Deficient growth hormone d) Hypothyroidism

a) Acromegaly Explanation: Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and, commonly, sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism and growth hormone deficiency aren't associated with hyperglycemia.

Margaret Lawson, a 52-year-old grocery clerk, has been experiencing a decrease in serum calcium. She has undergone diagnostics, and her physician proposes her calcium level fluctuation is due to altered parathyroid function. What is the typical number of parathyroid glands? a) Four b) Three c) Two d) One

a) Four Explanation: 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.

The nurse is reviewing a client's history which reveals that the client has had an over secretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? a) Gigantism b) Dwarfism c) Acromegaly d) Simmonds' disease

a) Gigantism Explanation: When over secretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.

A group of students are 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? a) Mineralocorticoids b) Epinephrine c) Glucagon d) Glucocorticoids

b) Epinephrine Explanation: 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 symptoms of thyroid disease is seen in older adults? a) Weight gain b) Atrial fibrillation c) Hyperactivity d) Restlessness

b) Atrial fibrillation Explanation: Symptoms seen in older adults include weight loss, and atrial fibrillation. Older adults may not experience restlessness or hyperactivity.

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: a) folic acid. b) vitamin D. c) iron. d) potassium.

b) vitamin D. Explanation: 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.

When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect: a) a blood pressure of 176/88 mm Hg. b) a blood pressure of 130/70 mm Hg. c) bradycardia. d) a blood glucose level of 130 mg/dl.

a) a blood pressure of 176/88 mm Hg. Explanation: Pheochromocytoma causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with hypotension, hypoglycemia, or bradycardia.

When caring for a client with diabetes insipidus, the nurse expects to administer: a) vasopressin (Pitressin). b) regular insulin. c) furosemide (Lasix). d) 10% dextrose.

a) vasopressin (Pitressin). Explanation: Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

Lydia Kranston, a 3-year-old female, is being seen by a healthcare provider in the endocrinology group where you practice nursing. She has a significant height deficit and is to be evaluated for diagnostic purposes. What could be the cause of her disorder? a) Adrenal disorder b) Thyroid disorder c) Pituitary disorder d) Parathyroid disorder

c) Pituitary disorder Explanation: Pituitary disorders usually result from excessive or deficient production and secretion of a specific hormone. Dwarfism occurs when secretion of growth hormone is insufficient during childhood. Dwarfism occurs when secretion of growth hormone from the pituitary gland is insufficient during childhood.

A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering: a) potassium chloride. b) insulin. c) furosemide (Lasix). d) vasopressin (Pitressin).

d) vasopressin (Pitressin). Explanation: Vasopressin is given subcutaneously to manage diabetes insipidus. Insulin is used to manage diabetes mellitus. Furosemide causes diuresis. Potassium chloride is given for hypokalemia.

Cardiac effects of hyperthyroidism include which of the following? a) Palpitations b) Decreased systolic blood pressure c) Decreased pulse pressure d) Bradycardia

a) Palpitations Explanation: Cardiac effects may include sinus tachycardia, increased pulse pressure, and palpitations. Systolic blood pressure is elevated.

During an assessment of a patient's functional health pattern, which question by the nurse directly addresses the patient's thyroid function? a) "Do you experience fatigue even if you have slept a long time?" b) "Have you experienced any headaches or sinus problems?" c) "Do you have to get up at night to empty your bladder?" d) "Can you describe the amount of stress in your life?

a) "Do you experience fatigue even if you have slept a long time?" Explanation: With the diagnosis of hypothyroidism, extreme fatigue makes it difficult for the person to complete a full day's work or participate in usual activities.

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

b) "It regulates the function of other endocrine glands." Explanation: 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.

Which of the following diagnostic tests are done to determine suspected pituitary tumor? a) A radioimmunoassay b) A computed tomography scan c) Radiographs of the abdomen d) Measuring blood hormone levels

b) A computed tomography scan Explanation: A computed tomography or magnetic resonance imaging scan is done to detect a suspected pituitary tumor. Radiographs of the chest or abdomen are taken to detect tumors. Radiographs also determine the size of the organ and their location. However, measuring blood hormone levels helps determine the functioning of endocrine glands. A radioimmunoassay determines the concentration of a substance in plasma.

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? a) Methylprednisolone (Solu-Medrol) b) Calcium gluconate c) Sodium bicarbonate d) Fludrocortisone (Florinef)

b) Calcium gluconate Explanation: Tetany and severe hypoparathyroidismare 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.

The nurse is administering a medication to a client with hyperthyroidism to block the production of thyroid hormone. The client is not a candidate for surgical intervention at this time. What medication should the nurse administer to the client? a) Propranolol (Inderal) b) Propylthiouracil (PTU) c) Spironolactone (Aldactone) d) Levothyroxine (Synthroid)

b) Propylthiouracil (PTU) Explanation: Antithyroid drugs, such as propylthiouracil(PTU) and methimazoleare given to block the production of thyroid hormone preoperatively or for long-term treatment for clients who are not candidates for surgery or radiation treatment. Levothyroxine (Synthroid) would increase the level of thyroid and be contraindicated in this client. Spironolactone (Aldactone) is a diuretic and does not have the action of blocking production of thyroid hormone and neither does propranolol (Inderal), which is a beta-blocker.

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

b) Restricting fluids Explanation: 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 actions of parathyroid hormone (PTH) are increased in the presence of which vitamin? a) B b) D c) C d) E

b) Vitamin D Explanation: The actions of PTH are increased by the presence of vitamin D.

Trousseau's sign is elicited a) after making a clenched fist and the palm remains blanched when pressure is placed over the radial artery. b) by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. c) when the foot is dorsiflexed and there is pain in the calf. d) by a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear that causes spasm or twitching of the mouth, nose, and eye.

b) by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. Explanation: A positive Trousseau's sign is suggestive of latent tetany. A positive Chvostek 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. The palm remaining blanched when the radial artery is occluded demonstrates a positive Allen's test. The radial artery should not be used for an arterial puncture. A positive Homans' sign is demonstrated when the patient complains of pain in the calf when his foot is dorsiflexed

A nurse is reviewing the laboratory order for a client suspected of having an endocrine disorder. The lab slip includes obtaining cortisol levels. Which of the following is being tested? a) Thymus functioning b) Parathyroid functioning c) Adrenal functioning d) Thyroid functioning

c) Adrenal functioning Explanation: The adrenal cortex manufactures and secretes glucocorticoids, such as cortisol, which affect body metabolism, suppress inflammation, and help the body withstand stress. The adrenal cortex manufactures and secretes cortisol

Which glands regulate calcium and phosphorous metabolism? a) Pituitary b) Thyroid c) Parathyroid d) Adrenal

c) Parathyroid Explanation: Parathormone (parathyroid hormone), the protein hormone produced by the parathyroid glands, regulates calcium and phosphorous metabolism. The thyroid gland controls cellular metabolic activity. The adrenal medulla at the center of the adrenal gland secretes catecholamines, and the outer portion of the gland, the adrenal cortex, secretes steroid hormones. The pituitary gland secretes hormones that control the secretion of additional hormones by other endocrine glands.

The nurse practitioner who assesses a patient with hyperthyroidism would expect the patient to report which of the following conditions? a) Dyspnea b) Fatigue c) Weight loss d) Hair loss

c) Weight loss Explanation: Weight loss is consistent with a diagnosis of hyperthyroidism. The other conditions are found in hypothyroidism.

A client with acromegaly has been given the option of a surgical approach or a medical approach. The client decides to have a surgical procedure to remove the pituitary gland. What does the nurse understand this surgical procedure is called? a) Thyroidectomy b) Hysteroscopy c) Ablation d) Hypophysectomy

d) Hypophysectomy Explanation: The treatment of choice is surgical removal of the pituitary gland (transsphenoidal hypophysectomy) through a nasal approach. The surgeon may substitute an endoscopic technique using microsurgical instruments to reduce surgical trauma. A hysteroscopy is a gynecologic procedure. The thyroid gland is not involved for a surgical procedure. Ablation is not a removal of the pituitary gland.

Which nursing diagnosis is most appropriate for a client with Addison's disease? a) Risk for infection b) Hypothermia c) Urinary retention d) Excessive fluid volume

a) Risk for infection Explanation: Addison's disease decreases the production of all adrenal hormones, compromising the body's normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison's disease include Deficient fluid volume and Hyperthermia. Urinary retention isn't appropriate because Addison's disease causes polyuria.

During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement? a) "You must avoid hyperextending your neck after surgery." b) "The head of your bed must remain flat for 24 hours after surgery." c) "You should avoid deep breathing and coughing after surgery." d) "You won't be able to swallow for the first day or two."

a) "You must avoid hyperextending your neck after surgery." Explanation: To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesn't affect swallowing.

Which of the following hormones controls secretion of adrenal androgens? a) Adrenocorticotropic hormone (ACTH) b) Parathormone c) Thyroid-stimulating hormone (TSH) d) Calcitonin

a) Adrenocorticotropic hormone (ACTH) Explanation: ACTH controls the secretion of adrenal androgens. When secreted in normal amounts, the adrenal androgens appear to have little effect, but when secreted in excess, as in certain inborn enzyme deficiencies, masculinization may result. The secretion of T3 and T4 by the thyroid gland is controlled by TSH. Parathormone regulates calcium and phosphorous metabolism. Calcitonin reduces the plasma level of calcium by increasing its deposition in bone

Accidental removal of one or both parathyroid glands can occur during a thyroidectomy. Which of the following is used to treat tetany? a) Calcium gluconate b) Synthroid c) Propylthiouracil (PTU) d) Tapazole

a) Calcium gluconate Explanation: Sometimes in thyroid surgery, the parathyroid glands are removed, producing a disturbance in calcium metabolism. Tetany is usually treated with IV calcium gluconate. Synthroid is used in the treatment of hypothyroidism. PTU and Tapazole are used in the treatment of hyperthyroidism.

A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? a) Decreased cardiac output b) Risk for infection c) Imbalanced nutrition: Less than body requirements d) Impaired physical mobility

a) Decreased cardiac output Explanation: An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse. The client with Addison's disease is at risk for infection; however, reducing infection isn't a priority during an addisonian crisis. Impaired physical mobility and Imbalanced nutrition: Less than body requirements are appropriate nursing diagnoses for the client with Addison's disease, but they aren't priorities in a crisis.

A patient is diagnosed with Addison's disease, a condition that results in insufficient production of cortisol. Which of the following is the most important function of cortisol that the nurse needs to consider when caring for a patient with Addison's disease? a) Helps the body adjust to stress b) Regulates metabolism c) Maintains blood pressure d) Slows the body's response to inflammation

a) Helps the body adjust to stress Explanation: Cortisol, a glucocorticoid, affects almost every organ in the body, helping it respond to a variety of stressors. Its most important function is helping the body adjust to stress.

The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with? a) Hyperthyroidism b) Diabetes insipidus (DI) c) Hypothyroidism d) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)

a) Hyperthyroidism Explanation: Clients with hyperthyroidism characteristically are restless despite felling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball. Neck swelling caused by the enlarged thyroid gland often is visible. Hypothyroidism clinical manifestations are the opposite of what is seen as hyperthyroidism.SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client

A patient with a history of hypothyroidism is admitted to the intensive care unit unconscious and with a temperature of 95.2ºF. A family member informs the nurse that the patient has not taken thyroid medication in over 2 months. What does the nurse suspect that these findings indicate? a) Myxedema coma b) Diabetes insipidus c) Syndrome of inappropriate antidiuretic hormone (SIADH) d) Thyroid storm

a) Myxedema coma Explanation: Myxedema coma is a rare life-threatening condition. It is the decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious (Ross, 2012a). This condition may develop with undiagnosed hypothyroidism and may be precipitated by infection or other systemic disease or by use of sedatives or opioid analgesic agents. Patients may also experience myxedema coma if they forget to take their thyroid replacement medication.

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

a) Myxedemic coma Explanation: 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.

A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? a) Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. b) Monitor laboratory values daily for elevated thyroid-stimulating hormone. c) Evaluate the quality of the client's voice postoperatively, noting any drastic changes. d) Observe for swelling of the neck, tracheal deviation, and severe pain.

a) Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes. Explanation: Muscle twitching and numbness or tingling of the lips, fingers, and toes are signs of hyperirritability of the nervous system due to hypocalcemia. The other options describe complications for which the nurse should also be observing; however, tetany and neurologic alterations are primary indications of hypocalcemia.

The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find? a) Reports of increased appetite b) Complaints of sleepiness c) Inability to tolerate cold d) Thick hard nails

a) Reports of increased appetite Explanation: Signs and symptoms of hyperthyroidism reflect the increased metabolic rate and would include reports of increased appetite, weight loss, and intolerance to heat. Sleepiness, thick hard nails, and intolerance to cold are associated with hypothyroidism.

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

a) Stimulation of calcium reabsorption and phosphate excretion Explanation: 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

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? a) Tachycardia b) Blurred vision c) Leg cramps d) Dysuria

a) Tachycardia Explanation: 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.

A nurse is caring for a client with a kidney disorder. What role might the kidneys have in causing the client to have fluctuations in blood pressure? a) The kidneys release renin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. b) The kidneys release gastrin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume c) The kidneys release cholecystokinin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume d) The kidneys release erythropoietin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume

a) The kidneys release renin, a hormone that initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. Explanation: Renin is released from the kidneys and initiates the production of angiotensin and aldosterone to increase blood pressure and blood volume. The kidneys secrete erythropoietin, a substance that promotes the maturation of red blood cells. Cholecystokinin released from cells in the small intestine stimulates contraction of the gallbladder to release bile when dietary fat is ingested. Gastrin is released within the stomach to increase the production of hydrochloric acid.

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

b) An irregular apical pulse Explanation: 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 nurse is providing postoperative care to a client recovering from a hypophysectomy. Which of the following would be included in the care plan? Select all that apply. a) Encourage deep breathing and coughing. b) Assess for neurologic changes. c) Offer a straw when drinking liquids. d) Closely monitor nasal packing and postnasal drainage.

b) Assess for neurologic changes. d) Closely monitor nasal packing and postnasal drainage. Explanation: The client undergoes frequent neurologic assessments to detect signs of increased intracranial pressure and meningitis. The nurse monitors drainage from the nose and postnasal drainage for the presence of cerebrospinal fluid. The client is advised to avoid drinking from a straw, sneezing, coughing, and bending over to prevent dislodging the graft that seals the operative area between the cranium and nose

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: a) Hashimoto's thyroiditis. b) Graves' disease. c) thyroiditis. d) multinodular goiter.

b) Graves' disease. Explanation: 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 intervention is the most critical for a client with myxedema coma? a) Warming the client with a warming blanket b) Maintaining a patent airway c) Administering an oral dose of levothyroxine (Synthroid) d) Measuring and recording accurate intake and output

b) Maintaining a patent airway Explanation: 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.

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

c) "I may stop taking this medication when I feel better." Explanation: 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 nurse is assigned to care for a patient with increased parathormone secretion. Which of the following serum levels should the nurse monitor for this patient? a) Glucose b) Sodium c) Calcium d) Potassium

c) Calcium Explanation: Increased secretion of parathormone results in bone resorption. Calcium is released into the blood, increasing serum levels.

What interventions can the nurse encourage the client to do in order to control thirst and compensate for urine loss? a) Come to the clinic for IV fluid therapy daily. b) Limit the fluid intake at night. c) Consume adequate amounts of fluid. d) Weigh daily.

c) Consume adequate amounts of fluid. Explanation: The nurse teaches the client to consume sufficient fluid to control thirst and to compensate for urine loss. The client will not be required to come in daily for IV fluid therapy. The client should not limit fluid intake at night if thirst is present. Weighing daily will not control thirst or compensate for urine loss.

Which of the following disorders is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? a) Addison's disease b) Graves' disease c) Cushing syndrome d) Hashimoto's disease

c) Cushing syndrome Explanation: The patient with Cushing syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. Regardless of the cause, the normal feedback mechanisms that control the function of the adrenal cortex become ineffective, and the usual diurnal pattern of cortisol is lost. The signs and symptoms of Cushing syndrome are primarily a result of the oversecretion of glucocorticoids and androgens, although mineralocorticoid secretion also may be affected.

A patient is being evaluated for a diagnosis of pheochromocytoma. He is scheduled for epinephrine and norepinephrine laboratory tests. Which of the following plasma levels is a positive value that is diagnostic for pheochromocytoma? a) Norepinephrine @ 550 pg/mL b) Epinephrine @ 100 pg/mL c) Epinephrine @ 550 pg/mL d) Norepinephrine @ 200 pg/mL

c) Epinephrine @ 550 pg/mL Explanation: A plasma level of epinephrine that is more than 400 pg/mL is diagnostic of a pheochromocytoma. Refer to Table 31-4 in the text.

Which hormone would be responsible for increasing blood glucose levels by stimulating glycogenolysis? a) Cholecystokinin b) Insulin c) Glucagon d) Somatostatin

c) Glucagon Explanation: Glucagon is a hormone released by the alpha islet cells of the pancreas that raises blood glucose levels by stimulating glycogenolysis (the breakdown of glycogen into glucose in the liver). Somatostatin is a hormone secreted by the delta islet cells that helps to maintain a relatively constant level of blood glucose by inhibiting the release of insulin and glucagons. Insulin is a hormone released by the beta islet cells that lowers the level of blood glucose when it rises beyond normal limits. Cholecystokinin is released from the cells of the small intestine that stimulates contraction of the gall bladder to release bile when dietary fat is ingested

The preferred preparation for treating hypothyroidism includes which of the following? a) Radioactive iodine b) Propylthiouracil (PTU) c) Levothyroxine (Synthroid) d) Methimazole (Tapazole)

c) Levothyroxine (Synthroid) Explanation: Synthetic levothyroxine (Synthroid or Levothroid) is the preferred preparation for treating hypothyroidism and suppressing nontoxic goiters (enlargements of the thyroid gland). Radioactive iodine is the most common form of treatment for Graves' disease in North America. Both PTU and Tapazole are used for hyperthyroidism.

A client is suspected to have a pituitary tumor due to signs of diabetes insipidus. What initial test does the nurse assist the client with preparing for? a) Radioactive iodine uptake test b) A nuclear scan c) Magnetic resonance imaging (MRI) d) Radioimmunoassay

c) Magnetic resonance imaging (MRI) Explanation: A computed tomography (CT) or magnetic resonance imaging (MRI) scan is performed to detect a suspected pituitary tumor or to identify calcifications or tumors of the parathyroid glands. A radioactive iodine uptake test would be useful for a thyroid tumor. Radioimmunoassay determines the concentration of a substance in plasma.

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

c) Moon face Explanation: 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.

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? a) Monitor bowel patterns. b) Monitor vital signs every 4 hours. c) Observe the color of stool. d) Observe urine output.

c) Observe the color of stool. Explanation: 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

Which action would be most appropriate when evaluating a client's neck for thyroid enlargement? a) Inspect changes in pigmentation in the neck. b) Perform repeated palpation of the thyroid gland. c) Palpate the thyroid gland gently. d) Examine the skin of the neck for excessive oiliness.

c) Palpate the thyroid gland gently. Explanation: The nurse should inspect the neck for thyroid enlargement and gently palpate the thyroid gland. Repeated palpation of the thyroid in case of thyroid hyperactivity can result in a sudden release of a large amount of thyroid hormones, which may have serious implications.

A client has a dysfunction in one of his glands that is causing a decrease in the level of calcium in the blood. What gland should be evaluated for dysfunction? a) Thyroid gland b) Thymus gland c) Parathyroid gland d) Adrenal gland

c) Parathyroid gland Explanation: The parathyroids secrete parathormone, which increases the level of calcium in the blood when there is a decrease in the serum level. The thyroid, thymus, and adrenal gland do not secrete calcium.

A patient with a history of hypothyroidism is admitted to the intensive care unit unconscious and with a temperature of 95.2ºF. A family member informs the nurse that the patient has not taken thyroid medication in over 2 months. What does the nurse suspect that these findings indicate? a) Syndrome of inappropriate antidiuretic hormone (SIADH) b) Thyroid storm c) Diabetes insipidus d) Myxedema coma

d) Myxedema coma Explanation: Myxedema coma is a rare life-threatening condition. It is the decompensated state of severe hypothyroidism in which the patient is hypothermic and unconscious (Ross, 2012a). This condition may develop with undiagnosed hypothyroidism and may be precipitated by infection or other systemic disease or by use of sedatives or opioid analgesic agents. Patients may also experience myxedema coma if they forget to take their thyroid replacement medication.

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? a) Positive Trousseau's sign b) Tetany c) Positive Chvostek's sign d) Hyperactive deep tendon reflex

c) Positive Chvostek's sign Explanation: 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 client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of: a) severe hypotension. b) excessive thirst. c) profound neuromuscular irritability. d) acute gastritis.

c) profound neuromuscular irritability. Explanation: Hypoparathyroidism may slow bone resorption, reduce the serum calcium level, and cause profound neuromuscular irritability (as evidenced by tetany). Hypoparathyroidism doesn't alter blood pressure or affect the thirst mechanism, which usually is triggered by fluid volume deficit. Gastritis doesn't cause or result from hypoparathyroidism.

Ross Babcock, a 42-year-old firefighter, is being seen by an endocrinologist at the endocrinology group where you practice nursing. At this visit, he will receive results of previously ordered diagnostics. During your client education session, you describe the mechanism of hormone level maintenance. What causes most hormones to be secreted? a) Hormonal underproduction b) Increase in hormonal levels c) Hormonal overproduction d) Decrease in hormonal levels

d) Decrease in hormonal levels Explanation: Most hormones are secreted in response to negative feedback, a decrease in levels stimulates the releasing gland; in positive feedback, the opposite occurs.

A client sustained a head injury when falling off of a ladder. While in the hospital, the client begins voiding large amounts of clear urine and states he is very thirsty. The client states that he feels weak and has had an 8-lb weight loss since admission. What should the client be tested for? a) Hypothyroidism b) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) c) Pituitary tumor d) Diabetes insipidus (DI)

d) Diabetes insipidus (DI) Explanation: Urine output may be as high as 20 L/24 hours. Urine is dilute, with a specific gravity of 1.002 or less. Limiting fluid intake does not control urine exertion. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weakness, dehydration, and weight loss develop. SIADH will have the opposite clinical manifestations. The client's symptoms are related to the trauma and not a pituitary tumor. The thyroid gland does not exhibit these symptoms.

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

d) Exophthalmos Explanation: 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.

Wallace Guterman, a 36-year-old construction manager, is being seen by a healthcare provider in the primary care group where you practice nursing. He presents with a huge lower jaw, bulging forehead, large hands and feet, and frequent headaches. What could be causing his symptoms? a) Panhypopituitarism b) Hypopituitarism c) Panhyperpituitarism d) Hyperpituitarism

d) Hyperpituitarism Explanation: Acromegaly (hyperpituitarism) is a condition in which growth hormone is oversecreted after the epiphyses of the long bones have sealed. A client with acromegaly has coarse features, a huge lower jaw, thick lips, a thickened tongue, a bulging forehead, a bulbous nose, and large hands and feet. When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica are common.

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? a) Produce a new hormone to try and regulate the thyroid function b) The feedback loop will be unable to perform in response to low levels of thyroid hormone. c) Stimulate more hormones using the positive feedback system d) Stimulate more hormones using the negative feedback system

d) Stimulate more hormones using the negative feedback system Explanation: 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 nurse explains to a client with thyroid disease that the thyroid gland normally produces: a) TSH, triiodothyronine (T3), and calcitonin. b) iodine and thyroid-stimulating hormone (TSH). c) thyrotropin-releasing hormone (TRH) and TSH. d) T3, thyroxine (T4), and calcitonin.

d) T3, thyroxine (T4), and calcitonin. Explanation: 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 is scheduled for a diagnostic test to measure blood hormone levels. The nurse expects that this test will determine which of the following? a) Details about the size of the organ and its location b) The concentration of a substance in plasma c) The client's blood sugar level d) The functioning of endocrine glands

d) The functioning of endocrine glands Explanation: 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? a) The secreted hormones act like target cells. b) The glands play a minor role in maintaining homeostasis. c) The glands contain ducts that produce the hormones. d) The secretions are released directly into the blood stream.

d) The secretions are released directly into the blood stream. Explanation: 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.

For a client with hyperthyroidism, treatment is most likely to include: a) emollient lotions. b) a synthetic thyroid hormone. c) thyroid extract. d) a thyroid hormone antagonist.

d) a thyroid hormone antagonist. Explanation: Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism.

A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: a) flushed, warm, moist skin. b) systolic murmur at the left sternal border. c) exophthalmos and conjunctival redness. d) decreased body temperature and cold intolerance.

d) decreased body temperature and cold Explanation: Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. Exophthalmos; conjunctival redness; flushed, warm, moist skin; and a systolic murmur at the left sternal border are typical findings in a client with hyperthyroidism.

A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering: a) insulin. b) potassium chloride. c) furosemide (Lasix). d) vasopressin (Pitressin).

d) vasopressin (Pitressin). Explanation: Vasopressin is given subcutaneously to manage diabetes insipidus. Insulin is used to manage diabetes mellitus. Furosemide causes diuresis. Potassium chloride is given for hypokalemia