Exam 4 - General Endocrine

Question 1

Why does gigantism-giantism occur only in children?

Answer 1

• Occurs before epiphyses close
• Pituitary disorder –> excess secretion of GH
• Benign tumor (IGF-1 in liver)
• Increased growth of bone and tissue

Question 2

What causes acromegaly?

Answer 2

• Excessive GH secretion after closure of epiphyses of long bones
• Often result of benign slow-growing tumor (pituitary adenoma)

Question 3

Graves disease—would you expect the TSH level to be high or low? Physical assessment findings.

Answer 3

• (Hyperthyroidism)
• TSH high
• ** Exophthalmos (bulging of eyes)
• Fatiguability, hypertension, shortness of breath, tachycardia, nervousness, diaphoresis, increased sensitivity to heat

Question 4

Signs of thyroid storm/crisis

Answer 4

• Elevated temperature
• Tachycardia, arrhythmias
• Agitation, tremors, anxiety, restlessness
• Delirium
• Confusion and seizures as condition progresses

Question 5

Clinical manifestations of hypothyroidism (common & less common ones). Be able to select the
correct combination of S/S

Answer 5

• Intolerance to cold
• Weight gain
• Myxedema (facial swelling)
• Constipation & abdominal distention
• Tongue enlarged, voice hoarse/husky
• Carpal tunnel & other entrapment syndromes common
• Weakness, lethargy
• Dry, coarse skin and hair

Question 6

<p>

| Dangerous complication influencing the parathyroid glands after thyroidectomy</p>

Answer 6

<p>
- Check calcium levels and assess for tetany (will happen if calcium is low) because parathyroid may have been damaged or accidentally removed - Permanent hypothyroidism due to damage to parathyroid gland, blood supply, post-surgical swelling or fibrosis</p>

Question 7

Be able to match Cushing disease with its clinical manifestations in a multiple choice question

Answer 7

• Buffalo hump
• Moon face
• Truncal obesity, thin extremities
• Thin skin, purple striae
• Muscle weakness, osteoporosis
• Hyperglycemia, glucose intolerance

Question 8

What are the general s/s of diabetes insipidus?

Answer 8

• Excessive thirst and large amounts of diluted urine most characteristic
• Hypernatremia due to water deficit
• Low urine specific gravity
• Dehyration, dry mucous membranes

Question 9

Neurogenic diabetes insipidus—be able to recognize the clinical manifestations

Answer 9

• Deficiency in ADH secretion related to head trauma, brain surgery, genetics, tumors
• Less ADH than nephrogenic DI

Question 10

Syndrome of inappropriate antidiuretic hormone (SIADH)–effects on solutes & water (retention
or loss?)

Answer 10

• Excessive ADH –> increased water retention

- Solutes low because they are heavily diluted (e.g. hyponatremia)

Question 11

What is the very basic pathophysiology of pheochromocytoma?

Answer 11

• Adrenal medulla secretes catecholamines (norepinephrine & epinephrine)
• Pheochromocytoma is a tumor of chromaffin tissue resulting in excessive production and release of catecholamines

Question 12

What causes adrenocortical insufficiency/Addisonian crisis?

Answer 12

• Failure for Addison’s patient to take medication or increased emotional stress without appropriate hormone replacement
• Exposure to minor illness
• Inadequate levels of glucocorticoids & mineral corticoids in circulation
• May occur with acute withdrawal of corticosteroids
• Cause: destruction of the adrenal gland through idiopathic or autoimmune mechanisms, tuberculosis, trauma or hemorrhage, fungal disease, or neoplasia

Question 13

Which medication will the nurse have available for emergency treatment of tetany in the client who has had a thyroidectomy?

1. Calcium chloride
2. Potassium chloride
3. Magnesium sulfate
4. Propylthiouracil (PTU)

Answer 13

1. Calcium chloride

Calcium chloride or calcium gluconate should be available to treat tetany caused by accidental removal of the parathyroid glands during surgery. The parathyroid glands regulate calcium metabolism. Potassium chloride replaces the electrolyte potassium. Magnesium sulfate is used in the treatment of preeclampsia (pregnancy induced hypertension). Propylthiouracil is an antithyroid medication used to block production of thyroid hormone.

Question 14

When caring for a client in a thyroid crisis, the nurse would question an order for:

1. IV fluids
2. Propanolol (Inderal)
3. Propylthiouracil (PTU)
4. A hyperthermia blanket

Answer 14

4. A hyperthermia blanket

Fever (hyperthermia) is a symptom of thyroid storm. The correct treatment would be a hypothermia blanket to cool the client. All other choices (IV fluids, Inderal, and PTU) are appropriate interventions for this diagnosis.

Question 15

What is the nurse’s priority concern for a client admitted to the hospital with a diagnosis of diabetes insipidus?

1. Sleep disturbance caused by nocturia
2. Decreased physical mobility due to muscular cramping
3. Fluid volume excess caused by water retention
4. Skin breakdown caused by generalized edema

Answer 15

1. Sleep disturbance caused by nocturia

Diabetes insipidus (DI) is associated with a decrease (or deficiency) in the secretion of antidiuretic hormone (ADH). Lack of ADH leads to increased urinary output (as much as 5 to 20 L/day). Clients with DI become very fatigued from nocturia. Fluid volume deficit can occur due to the excess urine output. There is no edema or muscle cramping.

Question 16

A nurse assessing a client with syndrome of inappropriate antidiuretic hormone (SIADH) would expect to find which laboratory values?

1. Serum sodium = 150 mEq/L and low urine osmolality
2. Serum potassium = 5 mEq/L and low serium osmolality
3. Serum sodium = 120 mEq/L and low serum osmolality
4. Serum potassium = 3 mEq/L and high serum osmolality

Answer 16

3. Serum sodium = 120 mEq/L and low serum osmolality

SIADH occurs when excessive antidiuretic hormone (ADH) is released, even when the plasma (serum) osmolality is normal. The excess ADH increases the permeability of the renal tubules, causing reaborption of water into the circulation. As a result of extracellular fluid expansion, serum osmolality decreases. Also, sodium levels decline (as a result of being diluted), leading to hyponatremia.

Question 17

The nurse is performing an assessment on a client who has been receiving long-term steroid therapy. What would the nurse expect to find during the assessment?

1. Jaundice
2. Flank pain
3. Bulging eyes
4. Central obesity

Answer 17

4. Central obesity

Cushing’s syndrome develops because an excess of cortisol, in this case from prolonged exogenous steroid administration. This syndrome may be characterized by truncal (central) obesity, hypertension, weakness, hirsutism, abdominal striae, edema, and hypokalemia. Flank pain is associated with kidney problems. Bulging eyes are found in hyperthyroidism. Jaundice is associated with liver and gallbladder problems.

Question 18

A client has been receiving inhalation desmopressin (DDAVP) therapy for hypothalamic diabetes insipidus. What will the nurse evaluate to determine the therapeutic response to this medication?

1. Urine specific gravity
2. Blood glucose
3. Vital signs
4. Oxygen saturation levels

Answer 18

1. Urine specific gravity

Demopressin (DDAVP) alleviates polyuria by acting as antidiuretic hormone (ADH). In the case of diabetes insipidus, urine specific gravity should return to a normal level of 1.010 to 1.030. There is no effect on blood glucose or oxygen saturation levels. One adverse effect (not considered therapeutic for demopressin) is the possibility of a change in vital signs related to peripheral vascular resistance (vasoconstriction). Another reason the vital signs may be affected is water intoxication, which is also a side effect of demopressin.

Question 19

The nurse is caring for a client who has exophthalmos associated with thyroid disease. What is the cause of exophthalmos?

1. Impaired vision, which causes the client to squint in order to focus
2. Fluid in the retro-orbital tissues that increases pressure behind the eyes
3. Increased intraocular pressure from an increase in circulating thyroid hormone
4. Decrease in extraocular eye movements, which results in the “thyroid stare”

Answer 19

2. Fluid in the retro-orbital tissues that increases pressure behind the eyes

Impaired venous drainage from the orbit of the eye causes fluid and fat accumulation in the areas behind (retro-orbital) the eyeballs, which forces the eyes forward and out of their sockets. It is the increased pressure in the area that causes the eyeballs to be forced outward and protrude. There is no decrease the extraocular eye movements. The upper lids are usually retracted and elevated, giving a “thyroid stare” appearance. Vision is not impaired, and it is possible that the exophthalmos could lead to increased intraocular pressure.

Question 20

The nurse is caring for a client postoperative thyroidectomy. What would be an important nursing intervention?

1. Have the client speak every 5 to 10 minutes if hoarseness is present.
2. Provide a low-calcium diet to prevent hypercalcemia.
3. Check the dressing at the back of the neck for bleeding.
4. Apply a soft cervical collar to restrict neck movement.

Answer 20

3. Check the dressing at the back of the neck for bleeding.

If bleeding occurs, the blood will drain posteriorly or behind the client’s neck. Serum levels of calcium are important to monitor because of possible damage to the parathyroids during surgery. Oral intake of calcium is not immediately significant. The client is often hoarse; it is important to monitor for increasing hoarseness that would be indicative of edema but not every 5 to 10 minutes. A cervical collar is not indicated.

Question 21

A nurse knows the clinical manifestations of a client with Addison’s disease include which of the following? Select all that apply.

1. Nausea
2. Hypothermia
3. Hypertension
4. Hyperpigmentation
5. Hypotension
6. Hypernatremia

Answer 21

1, 4, 5 (Nausea, hyperpigmentation, hypotension)

Addison’s disease is due to a hypofunctioning of the adrenal cortex. The clinical manifestations have a very slow onset, and skin hyperpigmentation (melanosis) is a classic sign. This bronze coloring of the skin is seen primarily in those areas exposed to the sun, pressure points, joints, and in skin creases (especially on the palms, knuckles, and elbows). Fatigue, nausea, weight loss, hypotension, hyponatremia, and hyperkalemia are other findings associated with the condition.

Question 22

A client admitted with a pheochromocytoma returns from the operating room after adrenalectomy. The nurse should carefully assess this client for:

1. Hypoglycemia
2. Hypokalemia
3. Changes in blood pressure
4. Increased sodium and water retention

Answer 22

3. Changes in blood pressure

Pheochromocytoma is a tumor in the adrenal medulla that produces excess catecholamines (epinephrine and norepinephrine). An excess of these catecholamines can cause severe hypertension. Surgery (an adrenalectomy) alleviates the elevated blood pressure most of the time. In 10% to 30% of clients, hypertension remains and must be monitored and treated. Electrolytes imbalances and blood sugar are not typically affected.

Question 23

A client is brought in to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome is made. The nurse would immediately prepare to initiate which of the following anticipated physician’s prescriptions?

1. Endotracheal intubation
2. 100 units of NPH insulin
3. Intravenous infusion of normal saline
4. Intravenous infusion of sodium bicarbonate

Answer 23

3. Intravenous infusion of normal saline

571

Question 24

After several diagnostic tests, a client is diagnosed with diabetes insipidus. A nurse performs an assessment on the client, knowing that which symptom is most indicative of this disorder?

1. Fatigue
2. Diarrhea
3. Polydipsia
4. Weight gain

Answer 24

3. Polydipsia

582

Question 25

A client is admitted to an 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. Administer thyroid hormone.
4. Administer fluid replacement.

Answer 25

2. Maintain a patent airway

The initial nursing action would be to maintain a patent airway. Oxygen would be administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones by the intravenous route.

Question 26

A nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder?

1. Diarrhea
2. Polyuria
3. Polyphagia
4. Weight gain

Answer 26

2. Polyuria

586

Question 27

A client is diagnosed with pheochromocytoma. A nurse prepares a plan of care for the client; while planning, the nurse understands that pheochromocytoma is a condition that:

1. Causes profound hypotension
2. Is manifested by severe hypoglycemia
3. Is not curable and is treated symptomatically
4. Causes the release of excessive amounts of catecholamines

Answer 27

4. Causes the release of excessive amounts of catecholamines

588

Question 28

A nurse is caring for a client with pheochromocytoma who is scheduled for adrenalectomy. In the preoperative period, the priority nursing action would be to monitor:

1. Vital signs
2. Intake and output
3. Blood urea nitrogen results
4. Urine for glucose and ketones

Answer 28

1. Vital signs

589

Question 29

A nurse is performing an assessment on a client with pheochromocytoma. Which of the following assessment data would indicate a potential complication associated with this disorder?

1. A coagulation time of 5 minutes
2. A urinary output of 50 mL per hour
3. A blood urea nitrogen level of 20 mg/dL
4. A heart rate that is 90 beats/min and irregular

Answer 29

4. A heart rate that is 90 beats/min and irregular

590

Question 30

A nursing instructor asks a student to describe the pathophysiology that occurs in Cushing’s disease. Which statement by the student indicates an accurate understanding of this disorder?

1. “Cushing’s disease results from an oversecretion of insulin.”
2. “Cushing’s disease results from an undersecretion of corticotropic hormones.”
3. “Cushing’s disease results from an undersecretion of mineralcorticoid hormones.”
4. “Cushing’s disease results from an increased pituitary secretion of adrenocorticotropic hormone.”

Answer 30

4. “Cushing’s disease results from an increased pituitary secretion of adrenocorticotropic hormone.”

591

Question 31

A nurse is providing discharge instructions to a client who has Cushing’s syndrome. Which client statement indicates that instructions related to dietary management are understood?

1. “I can eat foods that have a lot of potassium in them.”
2. “I will need to limit the amount of protein in my diet.”
3. “I am fortunate that I can eat all the salty foods I enjoy.”
4. “I am fortunate that I do not need to follow any special diet.”

Answer 31

1. “I can eat foods that have a lot of potassium in them.”

594