Endocrine
The client with Cushings 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?
TOO MUCH CORTISOL 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.
Which safety measure is most important for the nurse to institute for a client who has Cushing’s?
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 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 patient with Addison's disease has a blood glucose level of 70 mg/dL 30 minutes after receiving 15grams of carbohydrates for symptoms of hypoglycemia. Which of the following would the nurse do now?
A. Inform the physician immediately
B. Give the patient milk and graham crackers
C. Instruct the patient to remain in bed
D. Check the patient's blood glucose level again in one hour
Answer: B
Milk and graham crackers contain forms of carbs that take longer to absorb and tend to maintain the blood glucose level for an extended period. The physician should be informed if the patient continues to be symptomatic and the blood glucose level is below 70 mg/dL. Maintaining bed rest protects the patient from injuries from a fall but does not address the blood glucose issue. Assessing the client's blood glucose level in one hour is too long to wait.
The nurse is reviewing the laboratory and diagnostic test findings of a patient diagnosed with Syndrome of Inappropriate AntiDiuretic Hormone (SIADH). Which of the following would the nurse expect to find?
A. Elevated serum sodium levels
B. Decreased serum osmolarity
C. Decreased urine sodium levels
D. Elevated urine calcium levels
Answer: B
Serum Sodium = Decreased
Urine Sodium = High
Calcium NOT involved with SIADH
Which of the following woud the nurse expct the physician to order for a patient with hypothyroidism?
A. Levothyroxine
B. Methimazole
C. Propranolol
D. Propylthiouracil
Answer: A
Levothyroxine is thyroid replacement therapy
B & D = Antithyroid agents
C = Beta Blocker, can be used to Tx hyperthyroid
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 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.
A patient with diabetes insipidus is extremely dehydrated and is unable to take oral fluids. Fluid therapy is prescribed. Which intervention would be MOST important for the patient?
A. Measuring the urine output every hour
B. Monitoring the rate of IV infusions
C. Measuring the fluid intake
D. Weighing the patient
Answer: A
Monitoring the urine output when patient is EXTREMELY dehydrated ensures adequate kidney function. Answers B, C, D are important but measuring urine output is the PRIORITY!
A patient sustained a head injury when falling off a ladder. While in the hospital, the patient begins voiding large amounts of clear urine and states he is very thirsty. The patient states that he feelsweak and has had an 8lb. weight loss since admission. What should the patient be tested for?
A. Diabetes Insipidus
B. SIADH
C. Pituitary Tumor
D. Hypothyroidism
Answer: A
UO may be as high as 20L/24 hours. Urine is DILUTE with a specific gravity of 1.002 or less
SIADH presents the opposite
Patient Sxs r/t TRAUMA and NOT pituitary tumor
Hypothyroid doesn't exhibit these Sxs
What interventions mcan the nurse encourage the paitnet with diabetes insipdis to do in order to control thirst and compensate for urine loss?
A. Come to the clinic for IVF therapy daily
B. Limit the fluid intake at night
C. Consume adequate amounts of fluid
D. Weigh daily
Answer: C
This is to compensate for the urine loss.
Weighing the patient does NOT control thirst
Which teaching will promote understanding of hypothyroidism and enhance adherence to the treatment of the condition? Select all that apply.
A. Take levothyroxine each evening before bedtime
B. Taper the dosage of levothyroxine when discontinuing
C. Levothyroxine should not be taken during pregnancy
D. Report symptoms of restlessness and insomnia
Answer: D
This answer is correct because clients should be instructed to report symptoms of hyperthyroidism since this could indicate the dosage is too high. Hyperthyroidism symptoms include jitteriness, anxiety, tachycardia, diarrhea, excessive sweating, and heat intolerance.
While providing care for the client diagnosed with hypothyroidism who is experiencing memory deficit, poor attention span, and difficulty communicating, which statement made by the client’s spouse requires information and emotional support by the registered nurse (RN)?
A. “I am working on asking our son to help us once we can be discharged home.”
B. “I am trying to reorient my spouse to date and time throughout the day.”
C. “I have set a goal to watch for any memory changes that may occur each day.”
D. “There is no way I can handle these memory issues for the rest of our lives together.”
Answer: D
This answer is correct because the statement “there is no way I can handle these memory issues for the rest of our lives together” is the statement that requires the RN to provide further information and emotional support. The RN will reinforce to the spouse that the memory changes will improve after the client has been on thyroid hormone replacement therapy for 2 weeks. The RN will allow the spouse time to verbalize fears, concerns, and feelings without judgment.
The nurse is assessing a client who has been taking levothyroxine for two months for hypothyroidism. Which client statements should the nurse report? Select all that apply.
A. “I take my levothyroxine each morning with my coffee or a full glass of grapefruit juice.”
B. “I eat breakfast approximately 30-60 minutes after taking levothyroxine each morning.”
C. “I will notify my health care provider immediately if I develop a sore throat and/or fever.”
D. The extreme fatigue I was experiencing seems to be improving.”
E. “Each morning, I take levothyroxine, biotin, and a multivitamin.”
Answer: B, E
This answer is correct because this statement should be reported by the nurse. Coffee and grapefruit juice inhibit the absorption of levothyroxine. Clients can still drink coffee as well as grapefruit juice, but should wait at least 60 minutes after taking the dose of levothyroxine to avoid affecting absorption. Levothyroxine should be taken at the same time each morning, with a full glass of water, and on an empty stomach.
This answer is correct because this is a statement that should be reported by the nurse. Multivitamins, when taken concurrently with levothyroxine, inhibit the absorption of levothyroxine. Multivitamins, biotin, calcium carbonate, phosphate binders, and antacids should be administered at least 4 hours apart from levothyroxine so absorption is not affected.
The nurse is evaluating lab results of a client who reports excessive fatigue for the past month. Labs are as follows: thyroid-stimulating hormone (TSH) is 8 U/L (Reference range: 0.4 to 4.2); total triiodothyronine (T3) is 30 ng/dL (Reference range: 70 to 204; and free thyroxine (T4) is 0.2 ng/dL (Reference range: 0.8 to 2.7). Which additional clinical manifestation should the nurse anticipate for this client? Select all that apply.
A. Inability to tolerate cold
B. Difficulty having regular bowel movements
C. Fragile, dry skin
D. Hypotension
E. Tachycardia
F. Weight loss
Answer:A, B, C, D
The client’s laboratory data is indicative of hypothyroidism; therefore, cold intolerance is expected and occurs due to decreased metabolic function throughout the body.
The current data indicates the client is experiencing hypothyroidism and constipation is an anticipated due to decreased metabolic function throughout the body.
The client’s symptoms and laboratory data are indicative of hypothyroidism, which causes decrease metabolic function throughout the body; therefore, a decreased blood pressure, or hypotension, is anticipated.
An older adult client who is diagnosed with hypothyroidism is admitted to the hospital due to acute confusion. The client’s current vital signs are as follows: temperature: 95 F (35 C); blood pressure: 88/48 mm Hg; heart rate: 50 beats/min; respirations: 10 breaths/min; and SaO2: 84% on room air (RA). Which is the priority action by the nurse in the provision of care for this client?
A. Apply a convection temperature management system to the client.
B. Give one dose of intravenous (IV) levothyroxine now and in 30 minutes.
C. Draw labs for serum TSH, triiodothyronine, and thyroxine.
D. Alert respiratory of the need for endotracheal (ET) intubation.
Answer: D
Low oxygen saturation indicate respiratory compromise which requires emergency intubation and the initiation of mechanical ventilation. The nurse provides support to the client’s bradypnea by initiating bag-valve-mask (BVM) ventilation in preparation for intubation.
A client who is diagnosed with Addison disease is hospitalized for a broken left femur. Which client data is most critical for the nurse to report to the client’s healthcare provider (HCP)?
A. A systolic blood pressure decline of 25 mm Hg.
B. Bronchovesicular breath sounds auscultated throughout the lung fields.
C. Electrocardiogram (ECG) shows occasional premature ventricular contractions (PVCs).
D. Report of stabbing pain of 8 in the left femur on a numeric scale of 1-10.
Answer: A
This client also has a history of Addison disease; therefore, physiologic stress (e.g., femur fracture) increases the risk for Addisonian crisis. An Addisonian crisis may be life-threatening as it can lead to shock; therefore, the nurse reports the drop in systolic blood pressure (a manifestation of Addisonian crisis) to the HCP for further investigation and treatment.
Which clinical manifestation should the nurse anticipate when providing care for a client who is diagnosed with Cushing syndrome? Select all that apply.
A. Easy bruising
B. Increased blood glucose
C. Increased blood pressure
D. Increased potassium
E. Increased abdominal girth
F. Decreased weight
Answer: A, B, C, E
easy bruising due to the lack of collagen
hyperglycemia caused by the hypersecretion of cortisol which causes gluconeogenesis
truncal obesity
A client who is diagnosed with Addison disease presents to the emergency department (ED) with abdominal pain. The client experiences a decline in systolic blood pressure of 30 mm Hg, has a heart rate increase from 75 to 100 beats/minute, and develops new onset confusion. Which action should the nurse implement based on the current data? Select all that apply.
A. Give the prescribed hydrocortisone, 100 mg by intravenous push (IVP).
B. Administer the prescribed morphine 2 mg by intravenous push (IVP) every 2 hours for pain.
C. Begin potassium 40 mEq PO every 12 hours as prescribed.
D. Start an intravenous (IV) infusion of normal saline (NS) with 5% dextrose, as prescribed.
E. Give 12.5 mg of promethazine every 4 hours as needed for nausea via intravenous push (IVP).
Answer: A, D
Emergency management for an Addisonian crisis includes the administration of the prescribed high-dose hydrocortisone medication by intravenous push (IVP)
Interventions necessary for the treatment of an Addisonian crisis include shock management with fluid resuscitation using 0.9% normal saline (NS) and 5% dextrose, administered to treat potential hypoglycemia caused by decreased cortisol levels
The nurse provides care for a client who is diagnosed with Addison disease. Which clinical manifestation does the nurse anticipate for this client due to primary adrenocortical insufficiency? Select all that apply.
A. Skin color that is tanned in appearance.
B. Anorexia and weight loss.
C. Increased body or facial hair.
D. Orthostatic hypotension.
E. Purple or red striae on the abdomen.
Answer: A, B, D
Tanned pigmentation of the skin is expected for the client diagnosed with primary adrenocortical insufficiency. This manifestation is caused by an increase in adrenocorticotropic hormone (ACTH)
hypotension is an expected clinical manifestation for this client as a result of hypofunction of the adrenal gland. Decreased levels of mineralocorticoids impacts fluid volume and, therefore, blood pressure.
A client diagnosed with Addison’s disease has been prescribed hydrocortisone, a glucocorticosteroid. Which information should the nurse include in the teaching? Select all that apply.
A. Hydrocortisone should be taken on an empty stomach
B. Periods of stress may require an increase in steroid replacement
C. The medication can be stopped as soon as you begin to feel better
D. glucose levels should be routinely monitored
E. Clients being treated with hydrocortisone should not receive live virus vaccines
Answer: B, D, E
clients with Addison’s disease cannot produce cortisol to help the body cope with increased stressful situations and any resultant increased strain on the body.
This answer is correct because clients taking large doses of glucocorticosteroids may become immunosuppressed as this therapy inhibits the inflammatory process, decreasing inflammation, suppressing lymphocyte activity, and delaying the healing process. Because of this, live virus vaccinations are contraindicated in those receiving hydrocortisone therapy. Live virus vaccinations include FluMist intranasal spray, measles, mumps, and rubella (MMR) vaccines, rotavirus vaccines, and chickenpox (varicella) vaccines.
The nurse is caring for a patient with SIADH. The nurse notices that the patient has become confused and extremely short of breath, and crackles are heard when lungs are auscultated. what is the FIRST action by the nurse?
A. Administer a diuretic
B. Notify the physician
C. Lay the patient flat
D. Suction the patient
Answer: B
Nurse CANNOT administer diuretic w/o MD order
Laying flat would INCREASE SOB
Suctioning will NOT clear airway
The nurse is assessing a patient in the clinic who appears restless, excitable, and agitated. The nurse observes that the patient has exopthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with?
A. Hypothyroidism
B. Hyperthyroidism
C. SIADH
D. DI
Answer: B
Hypothyroid are opposite
SIADH and DI do NOT correlate with Sxs
The nurse is administering a medication to a patient with hyperthyroidism to block the production of thyroid hormone. The patient is not a candidate for surgical intervention at this time. What medication should the nurse administer to the patient?
A. Levothyroxine
B. Spironolactone
C. Propylthiouracil
D. Propranolol
Answer: C
This is an antithyroid drug
The nurse is caring for a patient with hypoprathyroidism. When the nurse taps the patient's facial nerve, the patient'ss mouth twitches and the jaw tightens. What is this response documented as related to the low calium levels?
A. Positive Chvostek's sign
B. Positive Trousseau's sign
C. Positive paresthesias
D. Positive Babinski's sign
Answer: A
Trousseau - placing BP cuff on upper arm and after inflating patient's hand spasms
Paresthesis - NOT a Sx that can be elicited
Babinski - stroking sole of foot
A patient with severe hypoparathyroidism is experiencing tetany. What medication, prescribed by the physician for emergency use, will the nurse administer to correct the deficit?
A. Sodium bicarbonate
B. Fludrocortisone
C. Calcium gluconate
D. Methylprednisolone
Answer: C