TEST 8: The Client with Endocrine Health Problems Flashcards
The Client with Disorders of the Thyroid
- The nurse is completing a health assessment of a 42-year-old female with suspected Graves’
disease. The nurse should assess this client for: - Anorexia.
- Tachycardia.
- Weight gain.
- Cold skin.
The Client with Disorders of the Thyroid
1. 2. Graves’ disease, the most common type of thyrotoxicosis, is a state of hypermetabolism. The
increased metabolic rate generates heat and produces tachycardia and fine muscle tremors. Anorexia
is associated with hypothyroidism. Loss of weight, despite a good appetite and adequate caloric
intake, is a common feature of hyperthyroidism. Cold skin is associated with hypothyroidism.
CN: Physiological adaptation; CL: Analyze
- When conducting a health history with a female client with thyrotoxicosis, the nurse should ask
about which of the following changes in the menstrual cycle? - Dysmenorrhea.
- Metrorrhagia.
- Oligomenorrhea.
- Menorrhagia.
- A change in the menstrual interval, diminished menstrual flow (oligomenorrhea), or even the
absence of menstruation (amenorrhea) may result from the hormonal imbalances of thyrotoxicosis.
Oligomenorrhea in women and decreased libido and impotence in men are common features of
thyrotoxicosis. Dysmenorrhea is painful menstruation. Metrorrhagia, blood loss between menstrual
periods, is a symptom of hypothyroidism. Menorrhagia, excessive bleeding during menstrual periods,
is a symptom of hypothyroidism.
CN: Physiological adaptation; CL: Analyze
- A change in the menstrual interval, diminished menstrual flow (oligomenorrhea), or even the
3. A 34-year-old female is diagnosed with hypothyroidism. The nurse should assess the client for which of the following? Select all that apply. 1. Rapid pulse. 2. Decreased energy and fatigue. 3. Weight gain of 10 lb (4.5 kg). 4. Fine, thin hair with hair loss. 5. Constipation. 6. Menorrhagia.
- 2, 3, 5, 6. Clients with hypothyroidism exhibit symptoms indicating a lack of thyroid hormone.
Bradycardia, decreased energy and lethargy, memory problems, weight gain, coarse hair,
constipation, and menorrhagia are common signs and symptoms of hypothyroidism.
CN: Physiological adaptation; CL: Analyze
- Propylthiouracil (PTU) is prescribed for a client with Graves’ disease. The nurse should teach
the client to immediately report which of the following? - Sore throat.
- Painful, excessive menstruation.
- Constipation.
- Increased urine output.
- The most serious adverse effects of PTU are leukopenia and agranulocytosis, which usually
occur within the first 3 months of treatment. The client should be taught to promptly report to the
health care provider signs and symptoms of infection, such as a sore throat and fever. Clients having a
sore throat and fever should have an immediate white blood cell count and differential performed,
and the drug must be withheld until the results are obtained. Painful menstruation, constipation, and
increased urine output are not associated with PTU therapy.
CN: Pharmacological and parenteral therapies; CL: Synthesize
- The most serious adverse effects of PTU are leukopenia and agranulocytosis, which usually
- A client with thyrotoxicosis says to the nurse, “I am so irritable. I am having problems at work
because I lose my temper very easily.” Which of the following responses by the nurse would give the
client the most accurate explanation of her behavior? - “Your behavior is caused by temporary confusion brought on by your illness.”
- “Your behavior is caused by the excess thyroid hormone in your system.”
- “Your behavior is caused by your worrying about the seriousness of your illness.”
- “Your behavior is caused by the stress of trying to manage a career and cope with illness.”
- A typical sign of thyrotoxicosis is irritability caused by the high levels of circulating thyroid
hormones in the body. This symptom decreases as the client responds to therapy. Thyrotoxicosis does
not cause confusion. The client may be worried about her illness, and stress may influence her mood;
however, irritability is a common symptom of thyrotoxicosis and the client should be informed of that
fact rather than blamed.
CN: Psychosocial integrity; CL: Synthesize
- A typical sign of thyrotoxicosis is irritability caused by the high levels of circulating thyroid
- The nurse is evaluating a client with hyperthyroidism who is taking Propylthiouracil (PTU)
100 mg/day in three divided doses for maintenance therapy. Which of the following statements from
the client indicates the desired outcome of the drug? - “I have excess energy throughout the day.”
- “I am able to sleep and rest at night.”
- “I have lost weight since taking this medication.”
- “I do perspire throughout the entire day.
- PTU is a prototype of thioamide antithyroid drugs. It inhibits production of thyroid hormonesand peripheral conversion of T4 to the more active T3. A client taking this antithyroid drug should be
able to sleep and rest well at night since the level of thyroid hormones is reduced in the blood.
Excess energy throughout the day, loss of weight and perspiring through the day are symptoms of
hyperthyroidism indicating the drug has not produced its outcome.
CN: Pharmacological and parenteral therapies; CL: Evaluate.
- PTU is a prototype of thioamide antithyroid drugs. It inhibits production of thyroid hormonesand peripheral conversion of T4 to the more active T3. A client taking this antithyroid drug should be
- The nurse should teach the client with Graves’ disease to prevent corneal irritation from mild
exophthalmos by: - Massaging the eyes at regular intervals.
- Instilling an ophthalmic anesthetic as prescribed.
- Wearing dark-colored glasses.
- Covering both eyes with moistened gauze pads.
- Treatment of mild ophthalmopathy that may accompany thyrotoxicosis includes measures
such as wearing sunglasses to protect the eyes from corneal irritation. Treatment of ophthalmopathy
should be performed in consultation with an ophthalmologist. Massaging the eyes will not help to
protect the cornea. An ophthalmic anesthetic is used to examine and possibly treat a painful eye, not
protect the cornea. Covering the eyes with moist gauze pads is not a satisfactory nursing measure to
protect the eyes of a client with exophthalmos because treatment is not focused on moisture to the eye
but rather on protecting the cornea and optic nerve. In exophthalmos, the retrobulbar connective
tissues and extraocular muscle volume are expanded because of fluid retention. The pressure is also
increased.
CN: Reduction of risk potential; CL: Synthesize
- Treatment of mild ophthalmopathy that may accompany thyrotoxicosis includes measures
- A client with Graves’ disease is treated with radioactive iodine (RAI) in the form of sodium
iodide 131 I. Which of the following statements by the nurse will explain to the client how the drug
works? - “The RAI stabilizes the thyroid hormone levels before a thyroidectomy.”
- “The RAI reduces uptake of thyroxine and thereby improves your condition.”
- “The RAI lowers the levels of thyroid hormones by slowing your body’s production of them.”
- “The RAI destroys thyroid tissue so that thyroid hormones are no longer produced.”
- Sodium iodide 131 I destroys the thyroid follicular cells, and thyroid hormones are no longer
produced. RAI is commonly recommended for clients with Graves’ disease, especially the elderly.
The treatment results in a “medical thyroidectomy.” RAI is given in lieu of surgery, not before
surgery. RAI does not reduce uptake of thyroxine. The outcome of giving RAI is the destruction of the
thyroid follicular cells. It is possible to slow the production of thyroid hormones with RAI.
CN: Pharmacological and parenteral therapies; CL: Synthesize
- Sodium iodide 131 I destroys the thyroid follicular cells, and thyroid hormones are no longer
- After treatment with radioactive iodine (RAI) in the form of sodium iodide 131 I, the nurse
teaches the client to: - Monitor for signs and symptoms of hyperthyroidism.
- Rest for 1 week to prevent complications of the medication.
- Take thyroxine replacement for the remainder of the client’s life.
- Assess for hypertension and tachycardia resulting from altered thyroid activity.
- The client needs to be educated about the need for lifelong thyroid hormone replacement.
Permanent hypothyroidism is the major complication of RAI 131 I treatment. Lifelong medical follow-
up and thyroid replacement are warranted. The client needs to monitor for signs and symptoms of
hypothyroidism, not hyperthyroidism. Resting for 1 week is not necessary. Hypertension and
tachycardia are signs of hyperthyroidism, not hypothyroidism.
CN: Pharmacological and parenteral therapies; CL: Synthesize
- The client needs to be educated about the need for lifelong thyroid hormone replacement.
- A client with a large goiter is scheduled for a subtotal thyroidectomy to treat thyrotoxicosis.
Saturated solution of potassium iodide (SSKI) is prescribed preoperatively for the client. The
expected outcome of using this drug is that it helps: - Slow progression of exophthalmos.
- Reduce the vascularity of the thyroid gland.
- Decrease the body’s ability to store thyroxine.
- Increase the body’s ability to excrete thyroxine.
- SSKI is frequently administered before a thyroidectomy because it helps decrease the
vascularity of the thyroid gland. A highly vascular thyroid gland is very friable, a condition that
presents a hazard during surgery. Preparation of the client for surgery includes depleting the gland of
thyroid hormone and decreasing vascularity. SSKI does not decrease the progression of
exophthalmos, and it does not decrease the body’s ability to store thyroxine or increase the body’s
ability to excrete thyroxine.
CN: Pharmacological and parenteral therapies; CL: Apply
- SSKI is frequently administered before a thyroidectomy because it helps decrease the
- The nurse is administering a saturated solution of potassium iodide (SSKI). The nurse should:
- Pour the solution over ice chips.
- Mix the solution with an antacid.
- Dilute the solution with water, milk, or fruit juice and have the client drink it with a straw.
- Disguise the solution in a pureed fruit or vegetable.
- SSKI should be diluted well in milk, water, juice, or a carbonated beverage before
administration to help disguise the strong, bitter taste. Also, this drug is irritating to mucosa if taken
undiluted. The client should sip the diluted preparation through a drinking straw to help prevent
staining of the teeth. Pouring the solution over ice chips will not sufficiently dilute the SSKI or cover
the taste. Antacids are not used to dilute or cover the taste of SSKI. Mixing in a puree would put the
SSKI in contact with the teeth.
CN: Pharmacological and parenteral therapies; CL: Apply
- SSKI should be diluted well in milk, water, juice, or a carbonated beverage before
- Following a subtotal thyroidectomy, the nurse asks the client to speak immediately upon
regaining consciousness. The nurse does this to monitor for signs of which of the following? - Internal hemorrhage.
- Decreasing level of consciousness.
- Laryngeal nerve damage.
- Upper airway obstruction.
- Laryngeal nerve damage is a potential complication of thyroid surgery because of the
proximity of the thyroid gland to the recurrent laryngeal nerve. Asking the client to speak helps assess
for signs of laryngeal nerve damage. Persistent or worsening hoarseness and weak voice are signs of
laryngeal nerve damage and should be reported to the physician immediately. Internal hemorrhage is
detected by changes in vital signs. The client’s level of consciousness can be partially assessed by
asking her to speak, but that is not the primary reason for doing so in this situation. Upper airway
obstruction is detected by color and respiratory rate and pattern.
CN: Reduction of risk potential; CL: Analyze
- Laryngeal nerve damage is a potential complication of thyroid surgery because of the
- A client who has undergone a subtotal thyroidectomy is subject to complications in the first
48 hours after surgery. The nurse should obtain and keep at the bedside equipment to: - Begin total parenteral nutrition.
- Start a cutdown infusion.
- Administer tube feedings.4. Perform a tracheotomy.
- Equipment for an emergency tracheotomy should be kept in the room, in case tracheal
edema and airway occlusion occur. Laryngeal nerve damage can result in vocal cord spasm and
respiratory obstruction. A tracheostomy set, oxygen and suction equipment, and a suture removal set
(for respiratory distress from hemorrhage) make up the emergency equipment that should be readily
available. Total parenteral nutrition is not anticipated for the client undergoing thyroidectomy.
Intravenous infusion via a cutdown is not an expected possible treatment after thyroidectomy. Tube
feedings are not anticipated emergency care.
CN: Reduction of risk potential; CL: Synthesize
- Equipment for an emergency tracheotomy should be kept in the room, in case tracheal
- One day following a subtotal thyroidectomy, a client begins to have tingling in the fingers and
toes. The nurse should first: - Encourage the client to flex and extend the fingers and toes.
- Notify the physician.
- Assess the client for thrombophlebitis.
- Ask the client to speak.
- Tetany may occur after thyroidectomy if the parathyroid glands are accidentally injured or
removed during surgery. This would cause a disturbance in serum calcium levels. An early sign of
tetany is numbness and tingling of the fingers or toes and in the circumoral region. Tetany may occur
from 1 to 7 days postoperatively. Late signs and symptoms of tetany include seizures, contraction of
the glottis, and respiratory obstruction. The nurse should notify the physician. Exercising the joints in
the fingers and toes will not relieve the tetany. The client is not exhibiting signs of thrombophlebitis.
There is no indication of nerve damage that would cause the client not to be able to speak.
CN: Physiological adaptation; CL: Synthesize
- Tetany may occur after thyroidectomy if the parathyroid glands are accidentally injured or
- Which of the following medications should be available to provide emergency treatment if a
client develops tetany after a subtotal thyroidectomy? - Sodium phosphate.
- Calcium gluconate.
- Echothiophate iodide.
- Sodium bicarbonate.
- The client with tetany is suffering from hypocalcemia, which is treated by administering an
IV preparation of calcium, such as calcium gluconate or calcium chloride. Oral calcium is then
necessary until normal parathyroid function returns. Sodium phosphate is a laxative. Echothiophate
iodide is an eye preparation used as a miotic for an antiglaucoma effect. Sodium bicarbonate is a
potent systemic antacid.
CN: Pharmacological and parenteral therapies; CL: Apply
- The client with tetany is suffering from hypocalcemia, which is treated by administering an
16. A 60-year-old female is diagnosed with hypothyroidism. The nurse should assess the client for which of the following? 1. Tachycardia. 2. Weight gain. 3. Diarrhea. 4. Nausea.
- Typical signs and symptoms of hypothyroidism include weight gain, fatigue, decreased
energy, apathy, brittle nails, dry skin, cold intolerance, hair loss, constipation, and numbness and
tingling in the fingers. Tachycardia is a sign of hyperthyroidism, not hypothyroidism. Diarrhea and
nausea are not symptoms of hypothyroidism.
CN: Physiological adaptation; CL: Analyze
- Typical signs and symptoms of hypothyroidism include weight gain, fatigue, decreased
- The nurse should assess a client with hypothyroidism for which of the following?
- Corneal abrasion due to inability to close the eyelids.
- Weight loss due to hypermetabolism.
- Fluid loss due to diarrhea.
- Decreased activity due to fatigue
- A major problem for the person with hypothyroidism is fatigue. Other signs and symptoms
include lethargy, personality changes, generalized edema, impaired memory, slowed speech, cold
intolerance, dry skin, muscle weakness, constipation, weight gain, and hair loss. Incomplete closure
of the eyelids, hypermetabolism, and diarrhea are associated with hyperthyroidism.
CN: Basic care and comfort; CL: Analyze
- A major problem for the person with hypothyroidism is fatigue. Other signs and symptoms
- When discussing recent onset of feelings of sadness and depression in a client with
hypothyroidism, the nurse should inform the client that these feelings are: - The effects of thyroid hormone replacement therapy and will diminish over time.
- Related to thyroid hormone replacement therapy and will not diminish over time.
- A normal part of having a chronic illness.
- Most likely related to low thyroid hormone levels and will improve with treatment.
- Hypothyroidism may contribute to sadness and depression. It is good practice for clientswith newly diagnosed depression to be monitored for hypothyroidism by checking serum thyroid
hormone and thyroid-stimulating hormone levels. This client needs to know that these feelings may be
related to her low thyroid hormone levels and may improve with treatment. Replacement therapy does
not cause depression. Depression may accompany chronic illness, but it is not “normal.”
CN: Psychosocial integrity; CL: Analyze
- Hypothyroidism may contribute to sadness and depression. It is good practice for clientswith newly diagnosed depression to be monitored for hypothyroidism by checking serum thyroid
- The nurse is instructing the client with hypothyroidism who takes levothyroxine (Synthroid)
100 mcg, digoxin (Lanoxin) and simvastatin (Zocor). Teaching regarding medications is effective if
the client will take: - The Synthroid with breakfast and the other medications after breakfast.
- The Synthroid before breakfast and the other medications 4 hours later.
- All medications together 1 hour after eating breakfast.
- All medications before going to bed.
- Synthroid (levothyroxine) must be given at the same time each day on an empty stomach,
preferably 1/2 to 1 hour before breakfast. Other medications may impair the action of levothyroxine
(Synthroid) absorption; the client should separate doses of other medications by 4 to 5 hours.
CN: Pharmacological and parenteral therapies; CL: Evaluate
- Synthroid (levothyroxine) must be given at the same time each day on an empty stomach,
The Client with Diabetes Mellitus
20. The nurse is teaching a diabetic client using an empowerment approach. The nurse should
initiate teaching by asking which of the following?
1. “How much does your family need to be involved in learning about your condition?”
2. “What is required for your family to manage your symptoms?”
3. “What activities are most important for you to be able to maintain control of your diabetes?”
4. “What do you know about your medications and condition?”
The Client with Diabetes Mellitus
20. 3. Empowerment is an approach to clinical practice that emphasizes helping people discover
and use their innate abilities to gain mastery over their own condition. Empowerment means that
individuals with a health problem have the tools, such as knowledge, control, resources, and
experience, to implement and evaluate their self-management practices. Involvement of others, such
as asking the client about family involvement, implies that the others will provide the direct care
needed rather than the client. Asking the client what the client needs to know implies that the nurse
will be the one to provide the information. Telling the client what is required does not provide the
client with options or lead to empowerment.
CN: Health promotion and maintenance; CL: Synthesize
- The nurse is obtaining a health history from a client with diabetes mellitus who has been
taking insulin for many years. Currently the client reports having periods of hypoglycemia followed
by periods of hyperglycemia. The nurse should specifically ask if the client is - Eating snacks between meals.
- Initiating the use of the insulin pump.
- Injecting insulin at a site of lipodystrophy.
- Adjusting insulin according to blood glucose levels.
- Lipodystrophy, specifically lipohypertrophy, involves swelling of the fat at the site of
repeated injections, which can interfere with the absorption of insulin, resulting in erratic blood
glucose levels. Because the client has been receiving insulin for many years, this is the most likely
cause of poor control. Eating snacks between meals causes hyperglycemia. Adjusting insulin
according to blood glucose levels would not cause hypoglycemia but normal levels. Initiating an
insulin pump would not, of itself, cause the periods of hyperglycemia.
CN: Physiological Integrity; CL: Analyze
- Lipodystrophy, specifically lipohypertrophy, involves swelling of the fat at the site of
- A nurse is participating in a diabetes screening program. Who of the following is (are) at risk
for developing type 2 diabetes? Select all that apply. - A 32-year-old female who delivered a 91⁄2-lb (4,309-g) infant.
- A 44-year-old Native American (First Nations) who has a body mass index (BMI) of 32.
- An 18-year-old immigrant from Mexico who jogs four times a week.
- A 55-year-old Asian who has hypertension and two siblings with type 2 diabetes.
- A 12-year-old who is overweight.
- 1, 2, 4, 5. The risk factors for developing type 2 diabetes include giving birth to an infant
weighing more than 9 lb (4,082 g); obesity (BMI over 30); ethnicity of Asian, African, Native
American, or First Nations; age greater than 45 years; hypertension; and family history in parents or
siblings. Childhood obesity is also a risk factor for type 2 diabetes. Maintaining an ideal weight,
eating a low-fat diet, and exercising regularly decrease the risk of type 2 diabetes.
CN: Reduction of risk potential; CL: Analyze
- An adult with type 2 diabetes mellitus has been NPO since 10 PM in preparation for having a
nephrectomy the next day. At 6 AM on the day of surgery, the nurse reviews the client’s chart and
laboratory results. Which finding should the nurse report to the physician? - Urine output of 350 mL in 8 hours.
- Urine specific gravity of 1.015.
- Potassium of 4.0 mEq (4 mmol/L).
- Blood glucose of 140 mg/dL (7.8 mmol/L).
- The client’s blood glucose level is elevated, beyond levels accepted for fasting; normal
blood glucose range is 70 to 120 mg/dL (3.9 to 6.7 mmol/L). The specific gravity is within normal
range (1.001 to 1.030). Urine output should be 30 to 50 mL/h; thus, 350 mL is a normal urinary output
over 8 hours. The potassium level is normal.
CN: Reduction of risk potential; CL: Synthesize
- The client’s blood glucose level is elevated, beyond levels accepted for fasting; normal
24. The nurse is checking the laboratory results of an adult client with type 1 diabetes (see chart). BLOOD GLUCOSE 192 MG/DL TOTAL CHOLESTEROL 250 MG / DL HEMOGLOBIN 12.3 MG / DL LDL 125 MG /DL
What laboratory result indicates a problem that should be managed?
- Blood glucose.
- Total cholesterol.
- Hemoglobin.
- Low-density lipoprotein (LDL) cholesterol.
- The elevated blood glucose level indicates hyperglycemia. The hemoglobin is normal. The
client’s cholesterol and LDL levels are both normal. The nurse should determine if there are standing
orders for the hyperglycemia or notify the physician.CN: Reduction of risk potential; CL: Analyze
- The elevated blood glucose level indicates hyperglycemia. The hemoglobin is normal. The