endocrine system Med surg Exam

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A nurse is caring for a client with Addison disease. Which information should the nurse include in a teaching plan to encourage this client to modify dietary intake?

Extra salt is needed to replace the amount being lost caused by lack of sufficient aldosterone to conserve sodium. Lack of mineralocorticoids (aldosterone) leads to loss of sodium ions in the urine and subsequent hyponatremia. Potassium intake is not encouraged; hyperkalemia is a problem because of insufficient mineralocorticoids. Increasing protein is needed to heal the adrenal tissue and thus cure the disease caused by idiopathic atrophy of the adrenal cortex; tissue repair of the gland is not possible. Vitamins are not directly energy-producing; nor will they help the client gain weight.

Which gland does the nurse state is an exocrine gland?

Exocrine glands are glands with ducts that produce enzymes but not hormones. These glands secrete enzymes into ducts. The salivary gland secreting saliva is an example of an exocrine gland. Endocrine glands are ductless glands that produce hormones that are secreted into the blood. Thyroid, pituitary, and parathyroid glands are examples of endocrine glands.

A client is admitted with a head injury. The nurse identifies that the client’s urinary catheter is draining large amounts of clear, colorless urine. What does the nurse identify as the most likely cause?

Deficient ADH from the posterior pituitary results in diabetes insipidus. This can be caused by head trauma; water is not conserved by the body, and excess amounts of urine are produced. Although increased serum glucose may cause polyuria, it is associated with diabetes mellitus, not diabetes insipidus. Ineffective renal perfusion will cause decreased urine production. While excess amounts of IV fluids may cause dilute urine, it is unlikely that a client with head trauma will be receiving excess fluid because of the danger of increased intracranial pressure.

Which hormonal deficiency would increase the client’s risk for fractures?

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.

When preparing a client for discharge after a thyroidectomy, the nurse teaches the signs of hypothyroidism. When teaching when to call the primary healthcare provider, what statement made by the client shows that teaching was effective?
1 "I should call the primary healthcare provider for dry hair and an intolerance to cold."
2 "I should call the primary healthcare provider for muscle cramping and sluggishness."
3 "I should call the primary healthcare provider for fatigue and an increased pulse rate."
4 "I should call the primary healthcare provider for tachycardia and an increase in weight."

Dry, sparse hair and cold intolerance are characteristic responses to low serum thyroxine. Muscle cramping is associated with hypocalcemia. Low thyroxine levels reduce the metabolic rate, resulting in fatigue, but do not increase the pulse rate. Low thyroxine levels reduce the metabolic rate, resulting in weight gain and bradycardia, not tachycardia.

Which drug would be effective for the treatment of pituitary Cushing’s syndrome?
1 Mitotane
2 Cabergoline
3 Cyproheptadine
4 Bromocriptine mesylate

Cyproheptadine is effective for the treatment of pituitary Cushing’s syndrome. Mitotane is prescribed for the treatment of adrenal Cushing’s syndrome. Cabergoline and bromocriptine mesylate are effective for the treatment of hyperpituitarism.

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Which adverse effect can be seen in a female client with gonadotropin deficiency and undergoing hormone replacement therapy?

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 is admitted with a diagnosis of chronic adrenal insufficiency. Which roommate should be avoided when assigning a room for this client?
1 A young adult client with pneumonia
2 An adolescent client with a fractured leg
3 An older adult client who had a brain attack
4 A middle-aged client who has cholecystitis

Circulatory collapse can be caused by exposure to an infection, cold, or overexertion of a client with chronic adrenocortical insufficiency (Addison disease). Roommates with a fractured leg, a brain attack, or cholecystitis are appropriate room assignments because they do not have communicable infections.

A nurse is caring for a client with Addison’s disease. Upon assessment, which classic sign will the nurse find?

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.

What is a clinical manifestation in a client with hyposecretion of growth hormone?

Growth hormone deficiency changes tissue growth patterns resulting in increasing bone destructive activity and reduced bone density. A client becomes lethargic and gains weight due to the deficiency of thyroid stimulating hormone. Decreased libido (sexual desire) is seen due to the deficiency of gonadotropins.

The nurse is caring for a client with a diagnosis of diabetic ketoacidosis. Which arterial blood gas results are associated with this diagnosis?
1 pH: 7.28; PCO 2: 28; HCO 3: 18
2 pH: 7.30; PCO 2: 54; HCO 3: 28
3 pH: 7.50; PCO 2: 49; HCO 3: 32
4 pH: 7.52; PCO 2: 26; HCO 3: 20

A low pH and bicarbonate reflect metabolic acidosis; a low PCO 2 indicates compensatory hyperventilation. A low pH and elevated PCO 2 reflect hypoventilation and respiratory acidosis. An elevated pH and bicarbonate reflect metabolic alkalosis; an elevated PCO 2 indicates compensatory hypoventilation. An elevated pH and low PCO 2 reflect hyperventilation and respiratory alkalosis.

Which cells does the nurse identify as producing thyrocalcitonin hormone?

Parafollicular cells produce thyrocalcitonin hormone. This hormone helps in the regulation of serum calcium levels. Islet cells are responsible for the production of hormones such as insulin and glucagon. Adrenal cells are responsible for the production of hormones such as cortisol and aldosterone. Pituitary cells are responsible for the production of growth hormone, prolactin, and adrenocorticotropic hormone. Calcitonin is a 32-amino acid linear polypeptide hormone that is produced in humans primarily by the parafollicular cells of the thyroid gland, and in many other animals in the ultimopharyngeal body. Wikipedia

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What will the nurse expect diagnostic studies of a client with Cushing syndrome to indicate?

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.

A client who is taking an oral hypoglycemic daily for type 2 diabetes develops the flu and is concerned about the need for special care. What should the nurse instruct the client to do?
1 Skip the oral hypoglycemic pill, drink plenty of fluids, and stay in bed.
2 Avoid food, drink clear liquids, take a daily temperature, and stay in bed.
3 Eat as much as possible, increase fluid intake, and call the office again the next day.
4 Take the oral hypoglycemic pill, drink warm fluids, and perform a serum glucose test before meals and at bedtime.

Physiological stress increases gluconeogenesis, requiring continued pharmacological therapy despite an inability to eat; fluids prevent dehydration, and monitoring serum glucose levels permits early intervention if necessary. Skipping the oral hypoglycemic can precipitate hyperglycemia; serum glucose levels must be monitored. Food intake should be attempted to prevent acidosis; oral hypoglycemics should be taken, and serum glucose levels should be monitored. Telling the client to eat as much as possible, increase fluid intake, and call the office again the next day are incomplete instructions; oral hypoglycemics should be taken, and serum glucose levels should be monitored. Eating as much as possible can precipitate hyperglycemia.

Which type of drug-induced hormonal imbalance is likely to be observed in the client undergoing treatment with demeclocycline?

Drug-induced diabetic insipidus is usually caused by demeclocycline, which can interfere with the response of the kidneys to antidiuretic hormone. Demeclocycline does not cause endocrine disorders, such as acromegaly, diabetes mellitus, and Cushing’s syndrome.

Which medical condition could most probably result in clients developing primary diabetes insipidus (DI)?

Diabetes insipidus a disease in which the secretion of or response to the pituitary hormone vasopressin is impaired, resulting in the production of very large quantities of dilute urine, often with dehydration and insatiable thirst. defect in the hypothalamus (thirst center) could be the most probable cause of primary DI. Meningitis or a brain tumor could interfere with the synthesis, transport, or release of antidiuretic hormone (ADH) and cause central DI. Lithium therapy affects the renal response to ADH and results in nephrogenic DI, or drug-related DI.

Which organ has only beta 1-receptors?

The heart has only beta 1 receptors, which increase heart rate and contractility. The liver has only alpha receptors. The bladder and pancreas have both alpha and beta receptors.

What assessment is the nurse’s main priority during the early postoperative period after a subtotal thyroidectomy?

Maintaining airway patency is always the priority to permit gas exchange necessary to maintain life. Although important, hemorrhage, thyrotoxic crisis, and hypocalcemic tetany do not exceed patency of the airway in priority.

subtotal thyroidectomy

Subtotal thyroidectomy is a surgical procedure, in which the surgeon leaves a small thyroid remnant in situ (in original positon) to preserve thyroid function, thereby preventing lifelong thyroid hormone supplementation therapy. there is partial thyroid lobectomy, subtotal thryoidectomy, and total thyroidectomy

Thyrotoxic crisis

Thyroid storm or thyrotoxic crisis is a rare but severe and potentially life-threatening complication of hyperthyroidism

A nurse is caring for a client with a diagnosis of type 1 diabetes who has developed diabetic coma. Which element excessively accumulates in the blood to precipitate the signs and symptoms associated with this condition?

Ketones as a result of rapid fat breakdown, causing acidosis Ketones are produced when fat is broken down for energy. Although rarely used, sodium bicarbonate may be administered to correct the acid-base imbalance resulting from ketoacidosis; acidosis is caused by excess acid, not excess base bicarbonate. Diabetes does not interfere with removal of nitrogenous wastes. Carbohydrate metabolism is impaired in the client with diabetes.

Which hormone is released from the posterior pituitary gland?

Oxytocin is released from the posterior pituitary gland, which acts on the uterus and mammary glands. Prolactin, growth hormone, and luteinizing hormone are produced by the anterior pituitary gland.

anterior pituitary

growth hormone TSH adrenocorticotropic hormone follicle stimulating hormone luteinizing hormone prolactin

posterior pituitary

oxytocin vasopressin ADH

Which hormones does the nurse state are released by the hypothalamus? Select all that apply.

http://howmed.net/physiology/hormones-of-pituitary-gland/

hypothalamus

thyrotropin releasing hormone dopamine growth hormone releasing hormoen somatostatin conadotropin releasing hormone corticotropin releasing hormone oxytocin vasopressin Melanocyte-inhibiting hormone (MIH)

What other name can the nurse use for vasopressin?

Antidiuretic hormone is also called vasopressin. Growth hormone can be called somatotropin. Luteinizing hormone is a gonadotropin. Thyroid-stimulating hormone can be called thyrotropin.

A client is diagnosed with hyperthyroidism, and surgery is scheduled because the client refuses ablation therapy. While awaiting the surgical date, what instruction should the nurse teach the client?

Coffee, tea, and cola contain caffeine, which may increase thyroid activity. Hyperactivity is a physiological response; it is not under conscious control. The increased metabolic rate associated with hyperthyroidism will make the client feel warm; a cool environment is needed. Hyperactivity is a problem, and the client should be encouraged to rest.

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A client is admitted for hypertension, and serum electrolyte studies have yielded abnormal results. The scheduled workup includes a scan for an aldosteronoma. What disease will this scan rule out?

An aldosteronoma is an aldosterone-secreting adenoma of the adrenal cortex. An aldosteronoma is not a tumor of the kidney cortex. An aldosteronoma is not a tumor of the thyroid gland. An aldosteronoma is not a tumor of the pituitary gland.

aldosteronoma

The tumor that overproduce aldosterone called aldosteronoma.

A nurse is monitoring a client’s laboratory results for a fasting plasma glucose level. Within which range of a fasting plasma glucose level does the nurse conclude that a client is considered to be diabetic?

Results in the range 126 to 140 mg/dL (7.0 to 7.8 mmol/L) indicate diabetes. Results in the range 40 to 60 mg/dL (2.2 to 3.3 mmol/L) indicate hypoglycemia. Results in the range 80 to 99 mg/dL (4.5 to 5.5 mmol/L) are considered expected (normal). Results in the range 100 to 125 mg/dL (5.6 to 6.9 mmol/L) indicate prediabetes according to the American Diabetes Association. (Results in the range of 6.1 to 6.9 mmol/L indicate prediabetes according to the Canadian Diabetes Association Guidelines.)

The clinical findings of a client with diabetes mellitus show decreased glucose tolerance. Which complication is anticipated in the client?

Decreased glucose tolerance may cause frequent yeast infections, but it is not associated with the risk of cystitis, thin and dry skin, and decreased bone density. The risk of cystitis, thin and dry skin, and decreased bone density are due to decreased ovarian production of estrogen.

decreased glucose tolerance

clinical findings: – weight becomes greater than ideal along with – elevated fasting blood glucose levels – elevated random blood glucose levle – slow wound healing – freuqent yeast infecitons – polydipsia – polyuria

Which hormonal deficiency reduces the growth of axillae and pubic hair in female clients?

An adrenocorticotropic hormone deficiency causes a reduced growth of axial and pubic hair in women. A growth hormone deficiency causes decreased muscle strength and decreased bone density. An antidiuretic hormone deficiency causes excessive urine output and a low urine specific gravity. A thyroid-stimulating hormone deficiency results in hirsutism and menstrual abnormalities.

Which gland secretes melatonin?

pineal gland

pheochromocytoma

a small vascular tumor of the adrenal medulla, causing irregular secretion of epinephrine and norepinephrine, leading to attacks of raised blood pressure, palpitations, and headache.

A 24-hour urine test is prescribed for a client who has a tentative diagnosis of pheochromocytoma. What should the nurse do first?

The first voiding is discarded because that urine was in the bladder before the test began and should not be included. The last voiding should be placed in the specimen container because the urine was produced during the 24-hour time frame of the test. Discarding the last void in the 24-hour time period for the test is not necessary; voided specimens are acceptable. Straining the urine following each voiding before adding the urine to the container is not necessary; this is done for clients with renal calculi.

A client, visiting the health center, reports feeling nervous, irritable, and extremely tired. The client says to the nurse, "Although I eat a lot of food, I have frequent bouts of diarrhea and am losing weight." The nurse observes a fine hand tremor, an exaggerated reaction to external stimuli, and a wide-eyed expression. What laboratory tests may be prescribed to determine the cause of these signs and symptoms?

T 3, T 4, and thyroid-stimulating hormone (TSH) T 3, T 4, and TSH provide a measure of thyroid hormone production; an increase is associated with the client’s signs and symptoms. PT and PTT assess blood coagulation. The VDRL test is for syphilis; the CBC assesses the hematopoietic system. ACTH stimulates the synthesis and secretion of adrenal cortical hormones. ADH increases water reabsorption by the kidney. CRF triggers the release of ACTH.

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Which glands secrete hormones that regulate metabolism of carbohydrates, proteins, and fats? Select all that apply.

The pancreas secretes insulin and glucagon, which affects the body’s metabolism of carbohydrates, proteins, and fats. The thyroid gland secretes thyroid hormones T 3 and T 4 that regulate carbohydrates, proteins, and fat metabolism. Cortisol is a glucocorticoid secreted by the adrenal cortex that affects carbohydrates, proteins, and fat metabolism. Adrenal medulla secretes catecholamines, which do not affect metabolism of carbohydrates, proteins, and fats. Hormones secreted by the parathyroid gland mainly regulate calcium and phosphorus metabolism.

Which hormone overproduction is associated with carpel tunnel syndrome in clients?

Overproduction of growth hormone is associated with carpel tunnel syndrome. Overproduction of aldosterone hormone is associated with Conn’s syndrome. Antidiuretic hormone overproduction can result in syndrome of inappropriate antidiuretic hormone. Overproduction of parathyroid hormone results in hyperparathyroidism.

Which condition results in elevated serum adrenocorticotropic hormone (ACTH) and urine cortisol levels?

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.

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 decreased TSH assay together with an elevated T 3 level may indicate hyperthyroidism. X-ray results will not indicate thyroid disease, and elevation of T 4 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. PO 2 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.

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