Endocrine System Level 1

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A nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. What interventions should the nurse include to decrease the risk of complications? Select all that apply.
A. Examine the feet daily
B. Wear well-fitting shoes
C. Perform regular exercise
D. Powder the feet after showering
E. Visit the primary healthcare provider weekly
F. Test bathwater with the toes before bathing

A. Examine the feet daily B. Wear well-fitting shoes C. Perform regular exercise rational: Clients with diabetes often have peripheral neuropathies and are unaware of discomfort or pain in the feet; the feet should be examined every night for signs of trauma. Well-fitting shoes prevent pressure and rubbing that can cause tissue damage and the development of ulcers. Daily exercise increases the uptake of glucose by the muscles and improves insulin use. Powdering the feet after showering may cause a pastelike residue between the toes that may macerate the skin and promote bacterial and fungal growth. Generally, visiting the primary healthcare provider weekly is unnecessary. Clients with diabetes often have peripheral neuropathy and are unable to accurately evaluate the temperature of bathwater, which can result in burns if the water is too hot.

A nurse is caring for a client with Addison’s disease. Upon assessment, which classic sign will the nurse find?
a. Ecchymosis
b. Hyperreflexia
c. Exophthalmos
d. Hyperpigmentation

D. Hyperpigmentation Rational Hyperpigmentation, or "bronzing," is a classic sign of Addison’s disease. Ecchymosis (bruise) is the discoloration of the skin due to rupture of blood vessels beneath the skin. Hyperreflexia is a sign of hypoparathyroidism. Exophthalmos is the classic sign of hyperthyroidism.

Which laboratory value may indicate hyperfunction of the adrenal gland in a client?
A. Sodium: 143 mEq/L
B. Potassium: 2.9 mEq/L
C. Bicarbonate: 25 mEq/L
D. Total calcium: 10 mg/dL

B. Potassium: 2.9 mEq/L The normal level of potassium is 3.5 to 5.0 mEq/L. The laboratory value of the potassium in the client is 2.9 mEq/L, which is below the normal level. Therefore, it may indicate the presence of adrenal gland hyperfunction in the client. The normal value of sodium is 136 to 145 mEq/L, bicarbonate is 23 to 30 mEq/L, and total calcium is 9 to 10.5 mg/dL. Thus, the laboratory values of sodium (143 mEq/L), bicarbonate (25 mEq/L), and total calcium (10 mg/dL) lie in the normal range, which does not indicate hyperfunction of the adrenal gland in the client.

What will the nurse expect diagnostic studies of a client with Cushing syndrome to indicate?
A. Moderately increased serum potassium levels
B. Increased numbers of eosinophils in the blood
C. High levels of 17-ketosteroids in a 24-hour urine test
D. Normal to low levels of adrenocorticotropic hormone (ACTH)

C. High levels of 17-ketosteroids in a 24-hour urine test High levels of 17-ketosteroids in a 24-hour urine test is a urinary metabolite of steroid hormones that are excreted in large amounts in hyperaldosteronism. With aldosterone hypersecretion, sodium is retained and potassium is excreted, resulting in hypernatremia and hypokalemia. With Cushing syndrome, the eosinophil count is decreased, not increased. ACTH levels usually are high in Cushing syndrome.

Which condition results in elevated serum adrenocorticotropic hormone (ACTH) and urine cortisol levels?
A. Diabetes insipidus
B. Adrenal Cushing’s syndrome
C. Pituitary Cushing’s syndrome
D. Syndrome of inappropriate antidiuretic hormone

C. Pituitary Cushing’s syndrome RATIONAL: In pituitary Cushing’s syndrome, urine cortisol and serum adrenocorticotropic hormone levels are raised. Diabetes insipidus is the result of decreased levels of antidiuretic hormone and is not associated with cortisol and ACTH levels. Adrenal Cushing’s syndrome is caused by chronic steroid use, so the client will have increased urine cortisol and decreased ACTH levels. Syndrome of inappropriate antidiuretic hormone is the result of elevated levels of antidiuretic hormone and is not related with the ACTH and cortisol levels.

The laboratory report of a client reveals increased serum cholesterol levels. Which other finding indicates growth hormone deficiency in the client?
A. Scalp alopecia
B. Intolerance to cold
C. Pathological fractures
D.Increased urine output

C. Pathological fractures Growth hormone deficiency results in thinning of bones and increases the risk for pathological fractures. Thyrotropin deficiency results in scalp alopecia and intolerance to cold. Marked increase in the volume of urine output is a sign of diabetes insipidus caused by vasopressin deficiency.

Which neurologic manifestation in a client is associated with hyperthyroidism?
A. Confusion
B. Hearing loss
C. Tremors
D. Slowness of speech

C. Tremors Tremors is a neurologic manifestation in a client associated with hyperthyroidism. Confusion, hearing loss, and slowness of speech are caused by hypothyroidism.

Which hormonal deficiency causes breast atrophy in female clients?
A. Growth hormone
B. Luteinizing hormone
C. Thyroid-stimulating hormone
D. Adrenocorticotropic hormone

B. Luteinizing hormone A luteinizing hormone deficiency causes atrophy of the breasts. A growth hormone deficiency causes decreased bone density and pathologic fractures. A thyroid-stimulating hormone deficiency results in hirsutism, weight gain, and menstrual abnormalities. An adrenocorticotropic hormone deficiency causes postural hypotension, hypoglycemia, and anorexia.

A client with hyperthyroidism asks the nurse about the tests that will be prescribed. Which diagnostic tests should the nurse include in a discussion with this client?
A. Thyroxine (T4) and x-ray films
B. Thyroid-stimulating hormone (TSH) assay and triiodothyronine (T3)
C. Thyroglobulin level and PO2
D. Protein-bound iodine and sequential multichannel autoanalyzer (SMA)

B. Thyroid-stimulating hormone (TSH) assay and triiodothyronine (T3) RATIONAL: A decreased TSH assay together with an elevated T3 level may indicate hyperthyroidism. X-ray results will not indicate thyroid disease, and elevation of T4 level might indicate hyperthyroidism. However, this may be a false reading because of the presence of thyroid-binding globulin (TBG) and is inadequate for diagnosis when used alone. PO2 is not specific to thyroid disease, and the thyroglobulin level is most useful to monitor for recurrence of thyroid carcinoma or response to therapy. The results with the SMA are not specific to thyroid disease; the protein-bound iodine test is not definitive because it is influenced by the intake of exogenous iodine.

A nurse is reviewing several charts. Which condition is an autoimmune disorder?
A. Addison’s disease
B. Cushing’s syndrome
C. Hashimoto’s disease
D. Sheehan’s syndrome

C. Hashimoto’s disease Hashimoto’s disease is an autoimmune disorder, wherein the immune system attacks the thyroid gland. Addison’s disease is caused by adrenal insufficiency. Cushing’s syndrome is caused by increased body levels of cortisol. Sheehan’s syndrome is hemorrhage-associated hypopituitarism after delivery of a child.

Which hormone does the nurse state binds to the receptor site on the surface of a target cell?
A. Estrogen
B. Adrenaline
C. Aldosterone
D. Hydrocortisone

B. Adrenaline Water-soluble hormones have receptors on the surface of a target cell. Adrenaline is a water-soluble hormone. Lipid-soluble hormones have receptors inside the target cell. Estrogen, aldosterone, and hydrocortisone are lipid-soluble hormones.

A client suspected to have hyperpituitarism is sent by the primary healthcare provider to undergo a suppression test. Which laboratory value would indicate a positive result?
A.3 ng/mL
B.4 ng/mL
C.5 ng/mL
D.6 ng/mL

D.6 ng/mL RATIONAL: When the growth hormone level in a suppression test is above 5 ng/mL, this indicates a positive result, which means the client is suffering from hyperpituitarism. Therefore, 6 ng/mL indicates a positive suppression test. When growth hormone level falls below 5 ng/mL, this indicates a negative result, which means the client is not suffering with hyperpituitarism. Therefore, 3 ng/mL, 4 ng/mL, and 5 ng/mL indicate negative results, and the client does not have hyperpituitarism.

Which hormonal deficiency would increase the client’s risk for fractures?
A. Growth hormone
B. Follicle-stimulating hormone
C. Thyroid-stimulating hormone
D. Adrenocorticotropic hormone

A. Growth hormone RATIONAL: Growth hormone deficiency causes decrease in bone density, thereby increasing the risk of fractures. Follicle-stimulating hormone deficiency causes amenorrhea, decreased libido, and infertility in women and impotence in men. Thyroid-stimulating hormone deficiency causes menstrual abnormalities and hirsutism. Adrenocorticotropic hormone deficiency causes hypoglycemia and hyponatremia.

Which adverse effect can be seen in a female client with gonadotropin deficiency and undergoing hormone replacement therapy?
A. Thrombosis
B. Hypotension
C. Dehydration
D. Increased thirst

A. Thrombosis RATIONAL: A female client with gonadotropin deficiency is treated by replacement therapy of combined hormones, namely estrogen and progesterone. The side effect of this therapy is the increased risk of thrombosis or formation of blood clots in deep veins. Hypertension is a side effect of estrogen-progesterone therapy. Dehydration and increased thirst could indicate vasopressin deficiency.

A client presents with chief complaints of unexplained weight gain and back pain from a compression fracture of the vertebrae. On assessment, there is truncal obesity with excessively thin extremities, a moon-shaped face, a buffalo hump, thin hair, and adult acne. The symptoms described are suggestive of what disease?
a. Addison disease
b. Cushing disease
c. Multiple sclerosis
d. Kaposi sarcoma

b. Cushing disease Common symptoms of Cushing disease are weight gain, truncal obesity, buffalo hump, and moon face because of deposits of adipose tissue. The condition is caused by excess cortisol secretion caused by hypersecretion of adrenocorticotropic hormone (ACTH). Other characteristics are diabetes mellitus, muscle wasting, osteoporosis, ecchymosis, and slow healing of wounds. Addison disease is adrenal insufficiency. Symptoms of Addison disease include hypotension, dehydration, hypoglycemia, and hyperpigmentation of the skin. Multiple sclerosis is a progressive disease involving destruction of the myelin sheath, leading to nerve damage. Kaposi sarcoma is a cancer associated with acquired immunodeficiency syndrome (AIDS).

What is the most probable cause for Conn’s syndrome in an adult client?
a. Genetic cause
b. Adrenal adenoma
c. High level of angiotensin II
d. Elevated level of plasma rennin

b. Adrenal adenoma Conn’s syndrome is primary hyperaldosteronism. Excessive secretion of aldosterone by the adrenal glands due to an adrenal adenoma results in Conn’s syndrome. Certain types of hyperaldosteronism that are diagnosed in childhood have genetic causes. High levels of angiotensin II that are stimulated by high levels of plasma rennin are a cause for secondary hyperaldosteronism.

The nurse is providing care to a client being treated for bacterial cystitis. What is the goal before discharge for this client?
a. Understand the need to drink 4 L of water per day, an essential measure to prevent dehydration
b. Be able to identify dietary restrictions and plan menus
c. Achieve relief of symptoms and maintain kidney function
d. Recognize signs of bleeding, a complication associated with this type of procedure

c. Achieve relief of symptoms and maintain kidney function Relief of symptoms and continued urine output are measurable responses to therapy and are the desired outcomes. Four liters of water per day is too much fluid; 2 to 3 liters a day is recommended to flush the bladder and urethra. Dietary restrictions are not necessary with cystitis. Bleeding is not a complication associated with this procedure.

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