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Flashcards in MS - Endocrine System Deck (62)
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1

A patient suspected of having acromegaly has an elevated plasma growth hormone (GH) level. In acromegaly, what would the nurse also expect the patient's diagnostic results to indicate?

a. Hyperinsulinemia
b. Plasma glucose of

d. Elevated levels of plasma insulin-like growth factor-1 (IGF-1)

A normal response to growth hormone secretion is stimulation of the liver to produce somatomedin C or insulin-like growth factor-1, which stimulates growth of bones and soft tissues.

2

During assessment of the patient with acromegaly, what should the nurse expect the patient to report?

a. Infertility
b. Dry, irritated skin
c. Undesirable changes in appearance
d. An increase in height of 2 to 3 inches a year

c. Undesirable changes in appearance

The increased production of GH in acromegaly causes an increase in thickness and width of bones and enlargement of soft tissues, resulting in marked changes in facial features, oily and coarse skin, and speech difficulties.

3

A patient with acromegaly is treated with a transsphenoidal hypophysectomy. What should the nurse do postoperatively?

a. Ensure that any clear nasal drainage is tested for glucose
b. Maintain the patient flat in bed to prevent cerebrospinal fluid (CSF) leakage.
c. Assist the patient with toothbrushing every 4 hours to keep the surgical area clean
d. Encourage deep breathing, coughing, and turning to prevent respiratory complications

a. Ensure that any clear nasal drainage is tested for glucose

A transsphenoidal hypophysectomy involves entry into the sella turcica through an incision in the upper lip ans gingiva into the floor of the nose and the sphenoid sinuses. Postoperative clear nasal drainage with glucose content indicates CSF leakage from an open connection to the brain, putting the patient at risk for meningitis. After surgery, the patient is positioned with the head elevated to avoid pressure on the sella turcica. Coughing and straining are avoided to prevent increased ICP and CSF leakage. Although mouth care is required every 4 hours, toothbrushing should not be performed because injury to the suture line may occur.

4

What findings are commonly found in a patient with a prolactinoma?

a. Gynecomastia in men
b. Profuse menstruation in women
c. Excess follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
d. Signs of increased intracranial pressure, including headache, nausea, and vomiting

d. Signs of increased intracranial pressure, including headache, nausea, and vomiting

Compression of the optic chiasm can cause visual problems as well as signs of increased ICP, including headache, nausea, and vomiting. About 30% of prolactinomas will have excess prolactin secretion with manifestations of impotence in men galactorrhea or amenorrhea in women without relationship to pregnancy, and decreased libido in both men and women. There is decreased FSH and LH

5

An African American woman with a history of breast cancer has panhypopituitarism from radiation therapy for primary pituitary tumors. Which medications should the nurse teach her about needing for the resto of her life? Select all that apply

a. Cortisol
b. Vasopressin
c. Sex hormones
d. Levothyroxine (Synthroid)
e. Growth hormone (somatropin [Omnitropel])
f. Dopamine agonists (bromocriptine [Parlodel])

a. Cortisol
b. Vasopressin
d. Levothyroxine (Synthroid)
e. Growth hormone (somatropin [Omnitropel])

With panyhypopituitarism, lifetime hormone replacement is needed for cortisol, vasopressin, thyroid, and GH. Sex hormones will not be replaced because of the patient's histroy of breast cancer. Dopamine agonists will not be used because they reduce secretion of GH, which has already been achieved with the radiation.

6

The patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What manifestation should the nurse expect to find?

a. Decreased body weight
b. Decreased urinary output
c. Increased plasma osmolality
d. Increased serum sodium levels

b. Decreased urinary output

With increased antidiuretic hormone (ADH), the permeability of the renal distal tubules is increased, so water is reabsorbed into circulation. Decreased output of concentrated urine with increased urine osmolality and specific gravity occur. In addition, fluid retention with weight gain, serum hypoosmolality, dilutional hyponatremia, and hypochloremia occur.

7

During the care of the patient with SIADH, what should the nurse do?

a. Monitor neurologic status at least every 2 hours
b. Teach the patient receiving tratment with diuretics to restrict sodium intake
c. Keep the head of the bed elevated to prevent antidiuretic hormone (ADH) release
d. Notify the health care provider if the patient's blood pressure decreases more than 20 mm Hg from baseline

a. Monitor neurologic status at least every 2 hours

The patient with SIADH has marked dilutional hyponatremia nd should be monitored for decreased neurologic function and seizures every 2 hours. Sodium intake is supplemented because of the hyponatremia and sodium loss caused by diuretics. ADH release is reduced by keeping the head of the bed flat to increase left atrial filling pressure A reduction in blood pressure indicates a reduction in total fluid volume and is an expected outcome of treatment.

8

A patient with SIADH is treated with water restriction. What does the patient experience when the nurse determines that treatment has been effective?

a. Increased urine output, decreased serum sodium, and increased urine specific gravity
b. Increased urine output, increased serum sodium, and decreased urine specific gravity
c. Decreased urine output, increased serum sodium, and decreased urine specific gravity
d. Decreased urine output, decreased serum sodium and increased urine specific gravity

b. Increased urine output, increased serum sodium, and decreased urine specific gravity

The patient with SIADH has water retention with hyponatremia, decreased urine output, and concentrated urine with high specific gravity. Improvement in the patient's condition is reflected by increased urine output, normalization of serum sodium, and more water in the urine, thus decreasing the specific gravity.

9

The patient with diabetes insipidus is brought to the emergency department with confusion and dehydration after excretion of a large volume of urine today even thought several liters of fluid were drunk. What is a diagnostic test that the nurse should expect to be done to help make a diagnosis?

a. Blood glucose
b. Serum sodium level
c. Urine specific gravity
d. Computed tomography (CT) of the head

c. Urine specific gravity

Patients with diabetes insipidus excrete large amounts of urine with a specific gravity of less than 1.005. Blood glucose would be tested to diagnose diabetes mellitus. The serum sodium level is expected to be low with DI but it is not a diagnostic. To diagnose central DI a water deprivation test is required. Then a CT of the head may be done to determine the cause. Nephrogenic DI is differentiated from central DI with determination of the level of ADH after an analog of ADH is given.

10

In a patient with central diabetes insipidus, what will the administration of ADH during a water deprivation test result in?

a. Decrease in body weight
b. Increase in urinary output
c. Decrease in blood pressure
d. Increase in urine osmolality

d. Increase in urine osmolality

A patient with central diabetes insipidus has a deficiency of ADH with excessive loss of water from the kidney, hypovolemia, hypernatremia nd dilute urine with a low specific gravity. When vasopressin is administered, the symptoms are reversed, with water retention, decreased urinary output that increases urine osmolality and an increase in BP

11

A patient with diabetes insipidus is treated with nasal desmopressin acetate (DDAVP). The nurse determines that the drug is not having an adequate therapeutic effect when the patient experiences.

a. headache and weight gain
b. nasal irritation and nausea
c. a urine specific gravity of 1.002
d. an oral intake greater than urinary output

c. a urine specific gravity of 1.002

Normal urine specific gravity is 1.005 to 1.025 and urine with a specific gravity of 1.002 is very dilute, indicating that there continues to be excessive loss of water and that treatment of diabetes insipidus is inadequate. Headache, weight gain and oral intake greater than urinary output are signs of volume excess that occur with overmedication. Nasal irritation and nausea may also indicate overdosage.

12

When caring for a patient with nephrogenic diabetes insipidus, what should the nurse expect the treatment to include?

a. fluid restriction
b. thiazide diuretics
c. a high-sodium diet
d. chlorpropamide (Diabinese)

b. thiazide diuretics

In nephrogenic diabetes insipidus, the kidney is unable to respond the ADH, so vasopressin or hormone analogs are not effective. Thiazide diuretics slow the glomerular filtration rate in the kidney and produce a decrease in urine output. Low sodium diets are also thought to decrease urine output. Fluids are not restricted because the patient could easily become dehydrated.

13

What characteristic is related to Hashimoto's thyroiditis?

a. Enlarged thyroid gland
b. Viral-induced hyperthyroidism
c. Bacterial or fungal infection of thyroid gland
d. Chronic autoimmune thyroiditis with antibody destruction of thyroid tissue

d. Chronic autoimmune thyroiditis with antibody destruction of thyroid tissue

In Hashimoto's thyroiditis, thyroid tissue is destroyed by autoimmune antibodies. An enlarged thyroid gland is a goiter. Viral-induced hyperthyroidism is subacute granulomatous thyroiditis. Acute thyroiditis is caused by bacterial or fungal infection

14

Which statement accurately describes Graves' disease?

a. Exopthalmos occurs in Graves disease
b. It is an uncommon form of hyperthyroidism
c. Manifestations of hyperthyroidism occur from tissue desensitization to the sympathetic nervous system
d. Diagnostic testing in the patient with Graves' disease will reveal an increased thyroid-stimulating hormone (TSH) level.

a. Exopthalmos occurs in Graves disease

Exopthalmos or protrusion of the eyeballs may occur in Graves' disease from increased fat deposits and fluid in the orbital tissues and ocular muscles, forcing the eyeballs outward. Graves' disease is the most common form of hyperthyroidism. Increased metabolic rate and sensitivity of the sympathetic nervous system lead to the clinical manifestations. TSH level is decreased in Graves' disease

15

A patient with Graves' disease asks the nurse what caused the disorder. What is the best response by the nurse?

a. "The cause of Graves' disease is not known, although it is thought to be genetic."
b. "It is usually associated with goiter formation from an iodine deficiency over long period of time."
c. "Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones."
d. "In genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion."

d. "In genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion."

In Graves' disease, antibodies to the TSH receptor are formed, attach to the receptors, and stimulate the thyroid gland to release T3 and T4, or both, creating hyperthyroidism. The disease is not directly genetic but individuals appear to have a genetic susceptiblity to develop autoimmune antibodies. Goiter formation from insufficient iodine intake is usually associated with hypothyroidism.

16

A patient is admitted to the hospital with thyrotoxicosis. On physical assessment of the patient, what should the nurse expect to find?

a. Hoarseness and laryngeal stridor
b. Bulging eyeballs and dysrhythmias
c. Elevated temperature and signs of heart failure
d. Lethargy progressing suddenly to impairment of consciousness

c. Elevated temperature and signs of heart failure

A hyperthyroid crisis results in marked manifestations of hyperthyroidism, with sever tachycardia, heart failure, shock, hyperthermia, restlessness, irritability, abdominal pain, vomiting, diarrhea, delirium, and coma. Although exopthalamos may be present in the patient with Graves' disease, it is not a significant factor in hyperthyroid crisis. Hoarseness and laryngeal stridor are characteristic of the tetany of hypoparathyroidism and lethargy progressing to coma is characteristic of myxedema coma, a complication of hypothyroidism

17

What medication is used with thyrotoxicosis to block the effects of the sympathetic nervous stimulation of the thyroid hormones?

a. Potassium iodide
b. Atenolol (Tenormin)
c. Propylthiouracil (PTU)
d. Radioactive iodine (RAI)

b. Atenolol (Tenormin)

The B-adrenergic blocker atenolol is used to block the sympathetic nervous system stimulation by thyroid hormones. Potassium iodide is used to prepare the patient for thyroidectomy or for treatment of thyrotoxic crisis to inhibit the synthesis of thyroid hormones. Antithyroid medications inhibit the synthesis of thyroid hormones. RAI destroys thyroid tissue, which limits thyroid hormone secretion

18

Which characteristics describe the use of RAI? (select all that apply)

a. Often causes hypothyroidism over time
b. Decreases release of thyroid hormones
c. Blocks peripheral conversion of T4 to T3
d. Treatment of choice in nonpregnant adults
e. Decreases thyroid secretion by damaging thyroid gland
f. Often used with iodine to produce euthyroid before surgery

a. Often causes hypothyroidism over time
d. Treatment of choice in nonpregnant adults
e. Decreases thyroid secretion by damaging thyroid gland

RAI causes hypothyroidism over time by damaging thyroid tissue and is the treatment of choice for nonpregnant adults. Potassium iodide decreases the release of thyroid hormones and decreases the size of the thyroid gland preoperatively. Propylthiouracil (PTU) blocks peripheral conversion of T4 to T3 and may be used with iodine to produce a euthyroid state before surgery.

19

What preoperative instruction should the nurse give to the patient scheduled for a subtotal thyroidectomy?

a. How to support the head with the hands when turning in bed
b. Coughing should be avoided to prevent pressure on the the incision
c. Head and neck will need to remain immobile until the incision heals
d. Any tingling around the lips or in the fingers after surgery is expected and temporary

a. How to support the head with the hands when turning in bed

To prevent strain on the suture line postoperatively, the patient's head must be manually supported while turning and moving in bed but range-of-motion exercises for the head and neck are also taught preoperatively to be gradually implemented after surgery. There is no contraindication for coughing and deep breathing and these should be carried out postoperatively. Tingling around the lips or fingers is a sign of hypocalcemia, which may occur if the parathyroid glands are inadvertently removed during surgery. This sign should be reported immediately.

20

After a hypophysectomy for acromegaly, postoperative nursing care should focus on

a) frequently monitoring of serum and urine osmolarity
b) parenteral administration of a GH-receptor antagonist
c) keeping the patient in a recumbant position at all times
d) patient teaching regarding the need for lifelong hormone therapy

a) frequently monitoring of serum and urine osmolarity

A possible postoperative complication after a hypophysectomy is transient diabetes insipidus (DI). It may occur because of the loss of antidiuretic hormone (ADH), which is stored in the posterior lobe of the pituitary gland, or because of cerebral edema related to manipulation of the pituitary gland during surgery. To assess for DI, urine output and serum and urine osmolarity should be monitored closely.

21

A patient with a head injury develops SIADH. Manifestations the nurse would expect to find would include.

a) hypernatremia and edema
b) muscle spasticity and hypertension
c) low urine output and hyponatremia
d) weight gain and decreased glomerular filtration rate

c) low urine output and hyponatremia

Excess ADH increases the permeability of the renal distal tubule and collecting ducts, which leads to the reabsorption of water into the circulation. Consequently, extracellular fluid volume expands, plasma osmolality declines, the glomerular filtration rate increases, and sodium levels decline (i.e., dilutional hyponatremia). Hyponatremia causes muscle cramping, pain, and weakness. Initially, the patient displays thirst, dyspnea on exertion, and fatigue. Patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) experience low urinary output and increased body weight. As the serum sodium level falls (usually to less than 120 mEq/L), manifestations become more severe and include vomiting, abdominal cramps, muscle twitching, and seizures. As plasma osmolality and serum sodium levels continue to decline, cerebral edema may occur, leading to lethargy, anorexia, confusion, headache, seizures, and coma.

22

The health care provider prescribe levothyroxine (Synthroid) for a patient with hypothyroidism . After teaching regarding this drug, the nurse determines that further instruction is needed when the patient says

a) "I can expect the medication dose may need to be adjusted"
b) "I only need to take this drug until my symptoms are improved"
c) "I can expect to return to normla function with the use of this drug"
d) "I will report any chest pain or difficulty breathing tot he Dr. right away"

b) "I only need to take this drug until my symptoms are improved"

Levothyroxine (Synthroid) is the drug of choice to treat hypothyroidism. The need for thyroid replacement therapy is usually lifelong

23

After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops

a) muscle weakness and weight loss
b) hyperthermia and sever tachycardia
c) hypertension and difficulty swallowing
d) laryngospasms and tingling in hands and feet

d) laryngospasms and tingling in hands and feet

Painful tonic spasms of smooth and skeletal muscles can cause laryngospasms that may compromise breathing. These spasms may be related to tetany, which occurs if the parathyroid glands are removed or damaged during surgery, which leads to hypocalcemia.

24

Important nursing interventions when caring for a patient with Cushing syndrome include

a) restricting protein intake
b) monitoring blood glucose levels
c) observing for signs of hypotension
d) administering medication in equal doses
e) protecting patient from exposure to infection

b) monitoring blood glucose levels
e) protecting patient from exposure to infection

Hyperglycemia occurs with Cushing disease because of glucose intolerance (associated with cortisol-induced insulin resistance) and increased gluconeogenesis by the liver. High levels of corticosteroids increase susceptibility to infection and delay wound healing.

25

An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism is to

a) monitor blood glucose levels
b) restrict fluid and sodium intake
c) administer potassium sparing diuretics
d) advise the patient to make postural changes slowly

c) administer K sparing diuretics

Before surgery, patients should be treated with potassium-sparing diuretics (spironolactone [Aldactone], eplerenone [Inspra]) to normalize serum potassium levels. Spironolactone and eplerenone block the binding of aldosterone to the mineralocorticoid receptor in the terminal distal tubules and collecting ducts of the kidney, thus increasing sodium excretion, water excretion, and potassium retention. Oral potassium supplements may also be necessary.

26

To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to

a) increase calcium intake to 1500 mg/day
b) perform glucose monitoring for hypoglycemia
c) obtain immunizations due to high risk of infections
d) avoid abrupt position changes because of orthostatic hypotension

a) increase calcium intake to 1500 mg/day

Because patients often receive corticosteroid treatment for prolonged periods (more than 3 months), corticosteroid-induced osteoporosis is an important concern. Therapies to reduce the resorption of bone may include increased calcium intake, vitamin D supplementation, bisphosphonates (e.g., alendronate [Fosamax]), and institution of a low-impact exercise program.

27

The nurse teaches the patient that the best time to take corticosteroids for replacement purposes is

a) once a day at bedtime
b) every other day on awakening
c) on arising and in the late afternoon
d) at consistent intervals every 6-8 hours

c) on arising and in the late afternoon

As replacement therapy, glucocorticoids are usually administered in divided doses: two thirds in the morning and one third in the afternoon. This dosage schedule reflects normal circadian rhythm in endogenous hormone secretion and decreases the side effects associated with corticosteroid replacement therapy.

28

The nurse instructs a 28-year-old man with acromegaly resulting from an unresectable benign pituitary tumor about octreotide (Sandostatin). The nurse should intervene if the patient makes which statement?

a) “I will come in to receive this medication IV every 2 to 4 weeks.”
b)“I will inject the medication in the subcutaneous layer of the skin.”
c) “The medication will decrease the growth hormone production to normal.”
d) “If radiation treatment is not effective, I may need to take the medication.”


a) “I will come in to receive this medication IV every 2 to 4 weeks.”

Drugs are most commonly used in patients who have had an inadequate response to or cannot be treated with surgery and/or radiation therapy. The most common drug used for acromegaly is octreotide (Sandostatin), a somatostatin analog that reduces growth hormone levels to within the normal range in many patients. Octreotide is given by subcutaneous injection three times a week. Two long-acting analogs, octreotide (Sandostatin LAR) and lanreotide SR (Somatuline Depot), are available as intramuscular (IM) injections given every 2 to 4 weeks.

29

The nurse receives a phone call from a 36-year-old woman taking cyclophosphamide (Cytoxan) for treatment of non-Hodgkin’s lymphoma. The patient tells the nurse that she has muscle cramps and weakness and very little urine output. Which response by the nurse is best?

a) “Start taking supplemental potassium, calcium, and magnesium.”
b) “Stop taking the medication now and call your health care provider.”
c) “These symptoms will decrease with continued use of the medication.”
d) “Increase fluids to 3000 mL per 24 hours to improve your urine output.”

b) “Stop taking the medication now and call your health care provider."

Cyclophosphamide may cause syndrome of inappropriate antidiuretic hormone (SIADH). Medications that stimulate the release of ADH should be avoided or discontinued. Treatment may include restriction of fluids to 800 to 1000 mL per day. If a loop diuretic such as furosemide (Lasix) is used to promote diuresis, supplements of potassium, calcium, and magnesium may be needed.

30

The nurse is caring for a 40-year-old man who has begun taking levothyroxine (Synthroid) for recently diagnosed hypothyroidism. What information reported by the patient is most important for the nurse to further assess?

a) Weight gain or weight loss
b) Chest pain and palpitations
c) Muscle weakness and fatigue
d) Decreased appetite and constipation

b) Chest pain and palpitations

Levothyroxine (Synthroid) is used to treat hypothyroidism. Any chest pain or heart palpitations or heart rate greater than 100 beats/minute experienced by a patient starting thyroid replacement should be reported immediately, and an electrocardiogram (ECG) and serum cardiac enzyme tests should be performed.