Chapter 45: Endocrine Disorders Flashcards
A client has been admitted to the postsurgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the client?
A. Side-lying with one pillow under the head
B. Head of the bed elevated 30 degrees and no pillows placed under the head
C. Semi-Fowler with the head supported on two pillows
D. Supine, with a small roll supporting the neck
ANS: C
Rationale: When moving and turning the client, the nurse carefully supports the client’s head and avoids tension on the sutures. The most comfortable position is the semi-Fowler position, with the head elevated and supported by pillows.
A client with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the client should prioritize what question when addressing potential complications?
A. “Do you feel any muscle twitches or spasms?”
B. “Do you feel flushed or sweaty?”
C. “Are you experiencing any dizziness or lightheadedness?”
D. “Are you having any pain that seems to be radiating from your bones?”
ANS: A
Rationale: As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This is characteristic of hypoparathyroidism. Flushing, diaphoresis, dizziness, and pain are atypical signs of the resulting hypocalcemia.
The nurse is caring for a client with a diagnosis of Addison disease. What sign or symptom is most closely associated with this health problem?
A. Truncal obesity
B. Hypertension
C. Muscle weakness
D. Moon face
ANS: C
Rationale: Clients with Addison disease demonstrate muscular weakness, anorexia, gastrointestinal symptoms, fatigue, emaciation, dark pigmentation of the skin, and hypotension. Clients with Cushing syndrome demonstrate truncal obesity, “moon” face, acne, abdominal striae, and hypertension.
The nurse is caring for a client with Addison disease who is scheduled for discharge. When teaching the client about hormone replacement therapy, the nurse should address what topic?
A. The possibility of precipitous weight gain
B. The need for lifelong steroid replacement
C. The need to match the daily steroid dose to immediate symptoms
D. The importance of monitoring liver function
ANS: B
Rationale: Because of the need for lifelong replacement of adrenal cortex hormones to prevent addisonian crises, the client and family members receive explicit education about the rationale for replacement therapy and proper dosage. Doses are not adjusted on a short-term basis. Weight gain and hepatotoxicity are not common adverse effects.
A client is prescribed corticosteroid therapy. What would be priority information for the nurse to give the client who is prescribed long-term corticosteroid therapy?
A. The client’s diet should be low protein with ample fat.
B. The client may experience short-term changes in cognition.
C. The client is at an increased risk for developing infection.
D. The client is at a decreased risk for development of thrombophlebitis and thromboembolism.
ANS: C
Rationale: The client is at increased risk of infection and masking of signs of infection. The cardiovascular effects of corticosteroid therapy may result in development of thrombophlebitis or thromboembolism. The diet should be high in protein with limited fat. Changes in appearance usually disappear when therapy is no longer necessary. Cognitive changes are not common adverse effects.
A nurse caring for a client with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding?
A. Glucose in the urine
B. Albumin in the urine
C. Highly dilute urine
D. Leukocytes in the urine
ANS: C
Rationale: Clients with diabetes insipidus produce an enormous daily output of very dilute, water-like urine with a specific gravity of 1.001 to 1.005. The urine contains no abnormal substances such as glucose or albumin. Leukocytes in the urine are not related to the condition of diabetes insipidus, but if present would indicate a urinary tract infection.
The nurse caring for a client with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve?
A. Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3 hours
B. Administration of dexamethasone IV, followed by an x-ray of the adrenal glands
C. Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning
D. Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after the drug is given
ANS: C
Rationale: Dexamethasone (1 mg) is given orally at 11 PM, and a plasma cortisol level is obtained at 8 AM the next morning. This test can be performed on an outpatient basis and is the most widely used and sensitive screening test for diagnosis of pituitary and adrenal causes of Cushing syndrome.
The nurse is developing a care plan for a client with Cushing syndrome. What nursing diagnosis should the nurse prioritize?
A. Risk for injury related to weakness
B. Ineffective breathing pattern related to muscle weakness
C. Risk for loneliness related to disturbed body image
D. Autonomic dysreflexia related to neurologic changes
ANS: A
Rationale: The nursing priority is to decrease the risk of injury by establishing a protective environment. The client who is weak may require assistance from the nurse in ambulating to prevent falls or bumping corners of furniture. The client’s breathing will not be affected, and autonomic dysreflexia is not a plausible risk. Loneliness may or may not be an issue for the client, but safety is a priority.
- The nurse is performing a shift assessment of a client with aldosteronism. What priority assessment(s) should the nurse include that relate to this condition? Select all that apply.
A. Urine output
B. Signs or symptoms of venous thromboembolism
C. Peripheral pulses
D. Blood pressure
E. Skin integrity
ANS: A, D
Rationale: The principal action of aldosterone is to conserve body sodium. Alterations in aldosterone levels consequently affect urine output and blood pressure (BP). Hypertension is the most prominent and almost universal sign of primary aldosteronism. The client’s peripheral pulses, risk of venous thromboembolism (VTE), and skin integrity are not typically affected by aldosteronism.
The home care nurse is conducting client teaching with a client on corticosteroid therapy. To achieve consistency with the body’s natural secretion of cortisol, when should the home care nurse instruct the client to take the corticosteroids?
A. In the evening between 4 PM and 6 PM
B. Prior to going to sleep at night
C. At noon every day
D. In the morning between 7 AM and 8 AM
ANS: D
Rationale: In keeping with the natural secretion of cortisol, the best time of day for the total corticosteroid dose is in the morning from 7 to 8 AM. Large-dose therapy at 8 AM, when the adrenal gland is most active, produces maximal suppression of the gland. Also, a large 8 AM dose is more physiologic because it allows the body to escape effects of the steroids from 4 PM to 6 AM, when serum levels are normally low, thus minimizing cushingoid effects.
A client presents at the walk-in clinic reporting diarrhea and vomiting. The client has a documented history of adrenal insufficiency. Considering the client’s history and current symptoms, the nurse should anticipate that the client will be instructed to increase intake of:
A. sodium.
B. potassium.
C. simple carbohydrates.
D. calcium.
ANS: A
Rationale: The client will need to supplement dietary intake with added salt during episodes of GI losses of fluid through vomiting and diarrhea to prevent the onset of addisonian crisis. While the client may experience the loss of other electrolytes, the major concern is the replacement of lost sodium.
The nurse is caring for a client with hyperparathyroidism. What level of activity would the nurse expect to promote?
A. Complete bed rest
B. Bed rest with bathroom privileges
C. Out of bed (OOB) to the chair twice a day
D. Ambulation and activity as tolerated
ANS: D
Rationale: Mobility, through walking or use of a rocking chair for those with limited mobility, is encouraged as much as possible because bones subjected to normal stress give up less calcium. Bed rest should be discouraged because it increases calcium excretion and the risk of renal calculi. Limiting the client to getting out of bed only a few times a day also increases calcium excretion and the associated risks.
A client has returned to the floor after having a thyroidectomy for thyroid cancer. What laboratory finding may be an early indication of parathyroid gland injury or removal?
A. Hyponatremia
B. Hypophosphatemia
C. Hypocalcemia
D. Hypokalemia
ANS: C
Rationale: Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as tetany and must be reported to the health care provider immediately because laryngospasm may occur and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not expected responses to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may lead to hyperphosphatemia.
The nurse is planning the care of a client with hyperthyroidism. What should the nurse specify in the client’s meal plan?
A. A reduced calorie diet, high in nutrients
B. Small, frequent meals, high in protein and calories
C. Three large, bland meals a day
D. A diet high in fiber and plant-sourced fat
ANS: B
Rationale: A client with hyperthyroidism has an increased appetite. The client should be counseled to consume several small, well-balanced meals. High-calorie, high-protein foods are encouraged. A clear liquid diet would not satisfy the client’s caloric or hunger needs. A diet rich in fiber and fat should be avoided because these foods may lead to GI upset or increase peristalsis.
A client with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on the critical care unit. What is the priority nursing diagnosis for a client with this condition?
A. Risk for peripheral neurovascular dysfunction
B. Excess fluid volume
C. Hypothermia
D. Ineffective airway clearance
ANS: B
Rationale: The priority nursing diagnosis for a client with SIADH is excess fluid volume, as the client retains fluids and develops a sodium deficiency. Restricting fluid intake is a typical intervention for managing this syndrome. Temperature imbalances are not associated with SIADH. The client is not at risk for neurovascular dysfunction or a compromised airway.
A client with suspected adrenal insufficiency has been ordered an adrenocorticotropic hormone (ACTH) stimulation test. Administration of ACTH caused a marked increase in the client’s cortisol levels. How should the nurse interpret this finding?
A. The client’s pituitary function is compromised.
B. The client’s adrenal insufficiency is not treatable.
C. The client has insufficient hypothalamic function.
D. The client would benefit from surgery.
ANS: A
Rationale: An adrenal response to the administration of a stimulating hormone suggests inadequate production of the stimulating hormone. In this case, ACTH is produced by the pituitary and, consequently, pituitary hypofunction is suggested. Hypothalamic function is not relevant to the physiology of this problem. Treatment exists, although surgery is not likely indicated.
The health care provider has ordered a fluid deprivation test for a client suspected of having diabetes insipidus. During the test, the nurse should prioritize what assessments?
A. Temperature and oxygen saturation
B. Heart rate and blood pressure
C. Breath sounds and bowel sounds
D. Color, warmth, movement, and sensation of extremities
ANS: B
Rationale: The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost. The client’s condition needs to be monitored frequently during the test, and the test is terminated if tachycardia, excessive weight loss, or hypotension develops. Consequently, blood pressure and heart rate monitoring are priorities over the other listed assessments.
The nurse is assessing a diverse group of clients. What client is at a greater risk for the development of hypothyroidism?
A. A 75-year-old female client with osteoporosis
B. A 50-year-old male client who is obese
C. A 45-year-old female client who uses oral contraceptives
D. A 25-year-old male client who uses recreational drugs
ANS: A
Rationale: Even though osteoporosis is not a risk factor for hypothyroidism, the condition occurs most frequently in older women. Younger men and women generally face a lower risk.
A client is admitted to a surgical unit after a thyroidectomy. The nurse takes and maintains the inflated blood pressure cuff on the client and observes a carpopedal spasm. What does this result indicate?
A. Chvostek sign and hypocalcemia
B. Thyroid storm and elevated triiodothyronine
C. Homans sign and deep vein thrombosis
D. Trousseau sign and overt tetany
ANS: D
Rationale: The Trousseau sign is positive when carpopedal spasm (spasms of the hand or, less commonly, the feet) is induced by occluding the blood flow to the arm for 3 minutes and indicates tetany. Chvostek sign is positive when a sharp tapping over the facial nerve causes spasm, or twitching of the mouth, nose and eye. Chvostek sign also indicates tetany (neuronal excitability), which is usually associated with hypocalcemia. This result is not the product of a thyroid storm, which involves the excessive release of thyroid hormones given the client’s surgery. Although blood pressure can be acquired on the leg; this is not the test for the Homans sign. A positive Homans sign is pain in the calf of the leg upon dorsiflexion of the foot and would suggest a deep vein thrombosis (DVT).
The nurse’s assessment of a client with thyroidectomy suggests tetany, and a review of the most recent blood work corroborates this finding. The nurse should prepare to administer what intervention?
A. Oral calcium chloride and vitamin D
B. IV calcium gluconate
C. STAT levothyroxine
D. Administration of parathyroid hormone (PTH)
ANS: B
Rationale: When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. This has a much faster therapeutic effect than PO calcium or vitamin D supplements. PTH and levothyroxine are not used to treat this complication.
A client has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the client knows to take what action?
A. Take the drug concurrent with levothyroxine.
B. Take each dose of prednisone with a dose of calcium chloride.
C. Gradually replace the prednisone with an over-the-counter (OTC) alternative.
D. Slowly taper down the dose of prednisone, as prescribed.
ANS: D
Rationale: Corticosteroid dosages are reduced gradually (tapered) to allow normal adrenal function to return and to prevent steroid-induced adrenal insufficiency. There are no over-the-counter (OTC) substitutes for prednisone, and neither calcium chloride nor levothyroxine addresses the risk of adrenal insufficiency.
Following an addisonian crisis, a client’s adrenal function has been gradually regained. The nurse should ensure that the client knows about the need for supplementary corticosteroid therapy in which circumstance?
A. A significant illness
B. Periods of dehydration
C. Episodes of physical exertion
D. Administration of a vaccine
ANS: A
Rationale: During stressful procedures, significant illnesses, or for clients in the third trimester of pregnancy, additional supplementary therapy with corticosteroids is required to prevent addisonian crisis. Physical activity, dehydration, and vaccine administration would not normally add significant stress and would not require supplemental therapy.
A 30-year-old female client has been diagnosed with Cushing syndrome. What psychosocial nursing diagnosis should the nurse prioritize when planning the client’s care?
A. Decisional conflict related to treatment options
B. Spiritual distress related to changes in cognitive function
C. Disturbed body image related to changes in physical appearance
D. Powerlessness related to disease progression
ANS: C
Rationale: Cushing syndrome causes characteristic physical changes that are likely to result in disturbed body image. Decisional conflict and powerlessness may exist, but disturbed body image is more likely to be present. Cognitive changes take place in clients with Cushing syndrome, but these may or may not cause spiritual distress.
A client with pheochromocytoma has been admitted for an adrenalectomy to be performed the following day. To prevent complications, the nurse should anticipate preoperative administration of which of the following?
A. IV antibiotics
B. Oral antihypertensives
C. Parenteral nutrition
D. IV corticosteroids
ANS: D
Rationale: IV administration of corticosteroids (methylprednisolone sodium succinate may begin on the evening before surgery and continue during the early postoperative period to prevent adrenal insufficiency. Antibiotics, antihypertensives, and parenteral nutrition do not prevent adrenal insufficiency or other common complications of adrenalectomy.
