Endocrine
The nurse is caring for a client who has undergone a hypophysectomy. Which is the nurse’s priority postoperative intervention?
a. Keep the head of the bed flat and the client supine.
b. Instruct the client to cough, turn, and deep breathe hourly.
c. Report clear or yellow drainage from the nose or incision site.
d. Apply petroleum jelly to the client’s lips to avoid mouth dryness.
What is C? A light yellow drainage or a halo effect on the dressing is indicative of a cerebrospinal leak. The client should have the head of the bed elevated after surgery. Although deep breathing is important postoperatively, coughing should be avoided to prevent cerebrospinal leakage. Although application of petroleum jelly to the lips will help with mouth dryness, this instruction is not as important as reporting the yellowish drainage.
Which safety measure is most important for the nurse to institute for a client who has Cushing’s disease?
a. Pad the siderails of the client’s bed.
b. Assist the client to change positions slowly.
c. Use a lift sheet to change the client’s position.
d. Keep suctioning equipment at the client’s bedside.
What is C?
Cushing’s syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risk for pathologic bone fracture. The client should not require suctioning. Padding the siderails and assisting the client to change position may be effective, but these measures will not protect him or her as much as using a lift sheet.
A client has documented acromegaly. During a physical assessment before surgery for a knee replacement, the nurse discovers that she has a moderately enlarged liver. Which is the nurse’s best action?
a. Counsel the client on the health risks of alcoholism.
b. Assess for jaundice of the skin and eyes.
c. Document the finding and monitor the client.
d. Draw blood for liver function studies.
What is C?
Clients with acromegaly or gigantism commonly have organomegaly of the heart and liver. Other than documenting the finding and monitoring the client, these actions would be inappropriate because the finding is commonly associated with acromegaly.
Which client statement indicates the need for clarification regarding the instructions for collecting a 24-hour urine specimen for assessment of endocrine function?
a. “I will continue to take all my prescribed medicine during the test.”
b. “I will add the preservative to the container at the beginning of the test.”
c. “I will start the collection by saving the first urine of the morning.”
d. “At the end of 24 hours, I will urinate and save that last specimen.”
What is C?
The 24-hour urine collection specimen is started when the client first arises and urinates. The first urine specimen is discarded because there is no way to know how long it has been in the bladder, but the time is noted. The client adds all urine voided after that first discarded specimen during the next 24 hours. When the 24-hour mark is reached, the client voids one last time and adds this specimen to the collection. The preservative, if used, must be added to the container at the beginning of the collection. Clients can continue to take all their normal medications during a timed urine collection. They should, however, avoid unnecessary medications.
A client has a deficiency of aldosterone. Which assessment finding does the nurse correlate with this condition?
a. Increased urine output
b. Vasoconstriction
c. Blood glucose, 98 mg/dL
d. Serum sodium, 144 mEq/L
What is A?
Aldosterone, the major mineralocorticoid, maintains extracellular fluid volume. It promotes sodium and water reabsorption and potassium excretion in the kidney tubules. A client with an aldosterone deficiency will have increased urine output. Sodium and potassium levels are normal; in aldosterone deficiency, the client would have hyponatremia and hyperkalemia. Vasoconstriction is not related.
The client with adrenal hyperfunction screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, “I feel like I am going crazy.” Which is the nurse’s best response?
a. “I will ask your doctor to order a psychiatric consult for you.”
b. “You feel this way because of your hormone levels.”
c. “Can I bring you information about support groups?”
d. “I will close the door to your room and restrict visitors.”
What is B?
Hypercortisolism can cause the client to show neurotic or psychotic behavior. The client needs to know that these behavior changes do not reflect a true psychiatric disorder and will resolve when therapy results in lower and steadier blood cortisol levels. The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.
A client with suspected syndrome of inappropriate antidiuretic hormone (SIADH) has a serum sodium of 114 mEq/L. Which action by the nurse is best?
a. Consult with the registered dietitian about increased dietary sodium.
b. Restrict the client’s fluid intake to 900 mL/24 hr.
c. Handle the client gently by using turn sheets for repositioning.
d. Instruct the nursing assistants to measure intake and output.
What is B?
With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr. The client should be on intake and output (I&O); however, this will monitor only the client’s intake, so it is not the best answer. Reducing intake will help increase the client’s sodium. Adding sodium to the client’s diet will not help if he or she is retaining fluid and diluting the sodium. The client is not at increased risk for fracture, so gentle handling is not an issue.
The male client with hypopituitarism asks the nurse how long he will have to take testosterone hormone replacement therapy. Which is the nurse’s best answer?
a. “When your blood levels of testosterone are normal, the therapy is no longer needed.”
b. “When your beard thickens and your voice deepens, the dose is decreased, but treatment will continue forever.”
c. “When your sperm count is high enough to demonstrate fertility, you will no longer need this therapy.”
d. “When you start to have undesirable side effects, the dose is decreased to the lowest possible level, and treatment is continued until you are 50 years old.”
What is B?
Testosterone therapy is initiated with high-dose testosterone derivatives and is continued until virilization is achieved. The dose is then decreased, but therapy continues throughout life.
A new nurse is palpating a client’s thyroid gland. Which action requires intervention from the nurse’s mentor?
a. The nurse stands behind, instead of in front of, the client.
b. The client is asked to swallow while the nurse finds the thyroid gland.
c. The nurse palpates the right lobe with his or her left hand.
d. The client is placed in a sitting position with the chin tucked down.
What is C?
The client should be in a sitting position with the chin tucked down as the examiner stands behind the client. The nurse feels for the thyroid isthmus while the client swallows and turns the head to the right, and the nurse palpates the right lobe with the right hand. The technique is repeated in the opposite fashion for the left lobe.
A client is taking a drug that blocks a hormone’s receptor site. What is the effect on the client’s hormone response?
a. Greater hormone metabolism
b. Decreased hormone activity
c. Increased hormone activity
d. Unchanged hormone response
What is B?
Hormones cause activity in the target tissues by binding with their specific cellular receptor sites, thereby changing the activity of the cell. When receptor sites are occupied by other substances that block hormone binding, the cell’s response is the same as when the level of the hormone is decreased.
A client has received vasopressin (DDAVP) for diabetes insipidus. Which assessment finding indicates a therapeutic response to this therapy?
a. Urine output is increased; specific gravity is increased.
b. Urine output is increased; specific gravity is decreased.
c. Urine output is decreased; specific gravity is increased.
d. Urine output is decreased; specific gravity is decreased.
What is C?
Diabetes insipidus causes urine output to be greatly increased, with a low urine osmolarity, as evidenced by a low specific gravity. Effective treatment results in decreased urine output that is more concentrated, as evidenced by an increased specific gravity.
A client is going home after an endoscopic transnasal hypophysectomy. Which statement by the client indicates an adequate understanding of discharge instructions?
a. “I will wear dark glasses whenever I am outdoors.”
b. “I will keep food on upper shelves so I do not have to bend over.”
c. “I will wash the incision line every day with peroxide and redress it immediately.”
d. “I will remember to cough and deep breathe every 2 hours while I am awake.”
What is B?
After this surgery, the client must take care to avoid activities that can increase intracranial pressure. The client should avoid bending from the waist and should not bear down, cough, or lie flat. With this approach, there is no incision to clean and dress.
An adult client has been diagnosed with a deficiency of gonadotropin and growth hormone. Which fact reported in the client’s history could have contributed to this problem?
a. Mother with adult-onset diabetes mellitus
b. Experienced head trauma 5 years ago
c. Severe allergy to shellfish and iodine
d. Has used oral contraceptives for 5 years
What is B?
Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction. The other factors do not increase the risk of this condition.
Which situation or condition is likely to result in increased production of thyroid hormones?
a. Starvation
b. Dehydration
c. Adequate sleep
d. Cold environmental temperature
D: Cold environmental temperatures stimulate the hypothalamus to secrete thyrotropin-releasing hormone, which in turn stimulates the anterior pituitary gland to secrete thyroid-stimulating hormone (TSH). TSH then stimulates the thyroid gland to secrete thyroid hormones, which, when bound to target tissues, increase the rate of metabolism to maintain body temperature near normal. The other situations would not lead to an increase in thyroid hormone production.
A client who has been taking high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition, which has now resolved, asks the nurse why she needs to continue taking corticosteroids. Which is the nurse’s best response?
a. “It is possible for the inflammation to recur if you stop the drugs.”
b. “Once you start corticosteroids, you have to be weaned off them.”
c. “You must decrease the dose slowly so your hormones will begin to work again.”
d. “The drug suppresses your immune system, which needs to be built back up.”
What is B?
One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone (ACTH) and adrenal production of cortisol.
A client who had a trans-sphenoidal hypophysectomy 2 days ago now has nuchal rigidity. Which is the nurse’s priority action?
a. Have the client do active range-of-motion exercises for the neck.
b. Document the finding and monitor the client.
c. Take the client’s temperature and other vital signs.
d. Assess using a pain scale and administer pain medication.
C: Nuchal rigidity is a major manifestation of meningitis, a potential postoperative complication associated with this surgery. Meningitis is an infection; usually the client will also have a fever and tachycardia. Range-of-motion exercises are inappropriate because meningitis is a possibility. Although pain medication may be a palliative measure, it is not the most appropriate initial action. Documentation should be done after all assessments are completed and should not be the only action.
A client has a hormone deficiency. Which deficiency is the highest priority?
a. Growth hormone
b. Luteinizing hormone
c. Thyroid-stimulating hormone
d. Follicle-stimulating hormone
What is C?
A deficiency of thyroid-stimulating hormone (TSH) is the most life-threatening deficiency of the hormones listed in this question. TSH is needed to ensure proper synthesis and secretion of the thyroid hormones, whose functions are essential for life.
Which is the expected clinical manifestation for a client who has excessive production of melanocyte-stimulating hormone?
a. Hypoglycemia and hyperkalemia
b. Irritability and insomnia
c. Increased urine output
d. Darkening of the skin
What is D?
Melanocyte-stimulating hormone increases the size of melanocytes in the skin and increases the amount of pigment (melanin) that they produce. The other actions do not occur as the result of excessive melanocyte-stimulating hormone function.
Which dietary alterations does the nurse make for a client with Cushing’s disease?
a. High carbohydrate, low potassium
b. Low carbohydrate, low sodium
c. Low protein, low calcium
d. High carbohydrate, low potassium
What is B?
The client with Cushing’s disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary modifications need to include reduction of total calories and carbohydrates to prevent or reduce the degree of hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium.
A client just diagnosed with acromegaly is scheduled for a hypophysectomy. Which statement made by the client indicates a need for clarification regarding this treatment?
a. “I will drink whenever I feel thirsty after surgery.”
b. “I’m glad no visible incision will result from this surgery.”
c. “I hope I can go back to wearing size 8 shoes instead of size 12.”
d. “I will wear slip-on shoes after surgery so I don’t have to bend over.”
What is C?
Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement are not reversible. It will be appropriate for the client to drink as needed postoperatively and avoid bending over, reassured that the incision will not be visible.
A female client with an endocrine problem has hirsutism. Which question or statement by the nurse is most appropriate?
a. “Do you have the money to pay for treatment?”
b. “I’m interested in knowing how you feel about yourself.”
c. “Many treatment options are available for this problem.”
d. “What can you do to prevent this from happening?”
What is B?
Hirsutism, excessive hair growth on the face and body, can result from endocrine disorders. This may cause a disruption in body image, especially for female clients. The nurse should gently inquire into the client’s body image and self-perception. Asking about the client’s financial status sounds judgmental. Simply stating that treatment options are available minimizes the client’s concerns. The client is not doing anything to herself to cause the problem, so the last question is inappropriate.
A male client reports fluid secretion from his breasts. What does the nurse assess next in this client?
a. Posterior pituitary hormones
b. Adrenal medulla functioning
c. Anterior pituitary hormones
d. Parathyroid functioning
What is C?
Breast fluid and milk production are induced by the presence of prolactin, secreted from the anterior pituitary gland. The other hormones do not influence this process.