MS 1 Final Exam Review - Endocrine Flashcards
Which findings would the nurse assess in a patient with Cushing syndrome? Select all that apply.
1 Facial fullness 2 Mask like effect 3 Peri-orbital edema 4 Excessive facial hair 5 Eyeball protrusion from orbits
1 Facial fullness
3 Periorbital edema
4 Excessive facial hair
Cushing syndrome is caused by increased cortisol secretion. Excessive facial hair, periorbital edema, and facial fullness are noted in the patient with Cushing syndrome. Eyeball protrusion from orbits occurs in hyperthyroidism as a result of fluid accumulation in eye and retroorbital tissue. A masklike effect is found in patients with hypothyroidism.
Which laboratory values support the diagnosis of primary hypothyroidism?
1 Low thyroid-stimulating hormone (TSH) level, low thyroxine level
2 High TSH level, low thyroxine level
3 Low TSH level, low basal metabolic rate
4 Low TSH level, high basal metabolic rate
2 High TSH level, low thyroxine level
Primary hypothyroidism is caused by destruction of thyroid tissue or defective hormone synthesis. It is characterized by a high TSH level and a low thyroxine level. A low TSH level and low thyroxine level support secondary hypothyroidism. A low TSH level and a low basal metabolic rate (BMR) support secondary hypothyroidism. A low TSH and high BMR indicate hyperthyroidism.
Which characteristic is seen in syndrome of inappropriate antidiuretic hormone secretion (SIADH)?
1 Polyuria
2 Serum hyperosmolality
3 Dilutional hypernatremia
4 Fluid retention
4 Fluid retention
The posterior pituitary gland secretes an excess of antidiuretic hormone (ADH), which ultimately increases fluid retention and causes decreased serum osmolality. The glomerular filtration rate increases, and sodium levels decline, causing dilutional hyponatremia. SIADH is characterized by fluid retention, serum hypoosmolality, dilutional hyponatremia, and concentrated urine with normal intravascular volume. A patient with SIADH experiences low urine output, not polyuria, and serum hypoosmolality due to fluid retention, not serum hyperosmolality. A patient with SIADH does not experience dilutional hypernatremia because the sodium levels are low due to the expanding fluid volume.
Which potential problem would the nurse assess in a patient who has made no significant dietary changes but still lost 25 lbs over the past six months?
1 Thyroid disorders
2 Diabetes insipidus
3 Pituitary dysfunction
4 Parathyroid dysfunction
1 Thyroid disorders
Hyperthyroidism is associated with weight loss. Alterations in pituitary function, such as diabetes insipidus, and parathyroid dysfunction are not commonly associated with this phenomenon.
The nurse is performing discharge education for a patient newly diagnosed with hypothyroidism and is beginning thyroid hormone therapy. Which statement by the patient to the nurse confirms that discharge teaching was effective?
1 “I should take my levothyroxine every morning before eating my breakfast.”
2 “I should only follow up with my doctor if I start having shortness of breath.”
3 “I should keep the air conditioning a few degrees colder to help me with sweating.”
4 “I should limit the amount of fiber I am eating to help keep me from getting constipated.”
1 “I should take my levothyroxine every morning before eating my breakfast.”
A patient with a new diagnosis of hypothyroidism should be taught how to manage hypothyroidism, including taking the thyroid hormone in the morning before food. Patients with hypothyroidism need to be taught about the importance of regular follow-up care, not just when they are having abnormal symptoms. Patents with hypothyroidism should be taught to keep the environment warm and comfortable because of cold intolerance. Patients with hypothyroidism should increase the amount of fiber in their diet to prevent constipation; they should not limit the amount of fiber.
The nurse would implement which nursing action when caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)?
1 Initiate seizure precautions.
2 Elevate the patient to a semi-Fowler’s position.
3 Increase fluid intake to at least 1500 mL/24 hours.
4 Infuse prescribed hypotonic IV solution, such as 0.45% saline.
1 Initiate seizure precautions.
SIADH is a disorder in which there is abnormally high production of antidiuretic hormone (ADH). Dilutional hyponatremia is a characteristic of SIADH and can cause seizures, nausea and vomiting, muscle cramps, and decreased neurologic function. The patient’s head should be kept flat or elevated no higher than 10 degrees to enhance venous return to the heart and increase left atrial filling pressure, which all help to reduce ADH release. Fluid restrictions of 1000 mL or less need to be maintained. A hypertonic IV solution may be administered if the sodium level is less than 120 mEq/L.
Which instruction is highest priority when the nurse is developing a teaching plan for a patient with Addison’s disease?
1 Avoiding infection
2 Wearing a Medic Alert bracelet
3 Practicing stress-management techniques
4 Managing lifelong corticosteroid replacement
4 Managing lifelong corticosteroid replacement
The patient with Addison’s disease experiences hypofunctioning of the adrenal cortex, resulting in decreased production of glucocorticoids, mineral corticoids, and androgens. Patients with Addison’s disease require lifelong glucocorticoid and mineral corticoid replacement therapy to avoid Addisonian crisis. Addisonian crisis is characterized by profound hypotension, dehydration, fever, tachycardia, hyponatremia, and hyperkalemia. Circulatory collapse may occur if the patient is treated inadequately. Although Addisonian crisis is often triggered by illness-related physiologic stress, and although avoiding infection is important, avoiding infection is of lower priority than managing lifelong corticosteroid replacement. Corticosteroid replacement must be increased during times of stress to prevent Addisonian crisis. Emotional stress may contribute to the need for increased corticosteroid replacement. Stress-management techniques are important. Practicing stress management techniques, however, is of lower priority than managing lifelong corticosteroid replacement. Patients with Addison’s disease should be taught to wear a Medic Alert bracelet, but managing lifelong steroid replacement is a higher priority.
Which hormone is likely to be released when there is a decrease in serum Ca+ levels?
1 Calcitonin 2 Thyroxine (T4) 3 Parathormone (PTH) 4 Triiodothyronine (T3)
3 Parathormone (PTH)
PTH is the principle hormone produced by the parathyroid glands. PTH regulates calcium by enhancing the release of calcium from bone stores, stimulating reabsorption of calcium by the kidneys, and enhancing absorption of calcium in the intestine by increasing the production of activated vitamin D. Imbalance of PTH may cause impaired absorption and a decrease in blood Ca ++ levels. PTH is released in response to decreased calcium levels in the blood. PTH increases bone resorption, gastrointestinal (GI) absorption of calcium, and renal tubule reabsorption of calcium to increase calcium levels in the blood. Calcitonin is released in response to high calcium levels. Calcitonin acts opposite of PTH and decreases calcium levels. Thyroxine, also known as tetraiodothyronine (T4), is a hormone produced by the thyroid gland. Calcitonin is a hormone produced by the parafollicular cells of the thyroid gland that increases calcium storage in bone and decreases serum Ca ++ levels. Triiodothyronine (T3) is a hormone produced by the thyroid gland that increases the rate of metabolism.
The nurse would monitor for increases in which laboratory value in a patient being treated with dexamethasone?
1 Sodium
2 Calcium
3 Potassium
4 Blood glucose
4 Blood glucose
Hyperglycemia, or increased blood glucose level, is an adverse effect of corticosteroid therapy. Sodium, calcium, and potassium levels are not affected directly by dexamethasone.
Which finding would the nurse assess in a patient admitted with Addison’s disease?
1 Goiter
2 Oversized hands and feet
3 “Bronze” skin tone
4 Weight gain
3 “Bronze” skin tone
Addison’s disease is characterized by hyperpigmentation or “bronzing” of the skin in parts of the body such as the knuckles, elbows, and knees. A goiter is characterized by the enlargement of the thyroid gland and is associated with hypo- or hyperthyroidism. Oversized hands and feet are seen in acromegaly, which is characterized by an overgrowth of the bones and soft tissues. Weight gain would be seen in Cushing syndrome, which is characterized by hyperglycemia, hypertension, and weight gain.
