Chapter 56Endocrine Dysfunction: Nursing Management My Nursing Test Banks

Chapter 56Endocrine Dysfunction: Nursing Management

MULTIPLE CHOICE

1.A male client is diagnosed with hyperprolactinemia. The nurse realizes that which of the following clinical manifestations occurs less frequently in men?

1.

A decrease in testosterone

2.

Erectile dysfunction

3.

Gynecomastia

4.

Infertility

ANS: 3

In men, hyperprolactinemia causes a decrease in testosterone secondary to an inhibition of gonadotropin secretion, leading to decreased facial and body hair, erectile dysfunction, decreased libido, small testicles, and infertility. Gynecomastia occurs less frequently in men.

PTS:1DIF:Analyze

REF:Hyperprolactinemia: Assessment with Clinical Manifestations

2.A female client is admitted with hyperprolactinemia. Which of the following would not be a clinical manifestation of the disorder in this client?

1.

Excessive estrogen

2.

Hirsutism

3.

Osteoporosis

4.

Weight gain

ANS: 1

Hyperprolactinemia is associated with a decrease in estrogen, resulting in symptoms of vaginal dryness, hot flashes, osteopenia, and osteoporosis. The patient may also experience weight gain, irritability, hirsutism, anxiety, and depression.

PTS:1DIF:Analyze

REF:Hyperprolactinemia: Assessment with Clinical Manifestations

3.A client has been instructed regarding a prolactin level to be drawn the next day. Which of the following statements indicate that the client will need further instruction?

1.

I will be on time, in the afternoon.

2.

I will be relaxed.

3.

I will make sure not to take my antihistamine.

4.

I will practice another method of birth control rather than the pill.

ANS: 1

Certain medications (e.g., antihistamines and oral contraceptives) and fear can increase the prolactin level. The prolactin level is drawn in the morning.

PTS: 1 DIF: Analyze REF: Box 56-1 Prolactin Levels

4.An adult client is complaining of vision changes and difficulty speaking because the tongue is larger. The client also states that his shoes no longer fit. Based on these symptoms, the client is most likely to be diagnosed with:

1.

acromegaly.

2.

cretinism.

3.

gigantism.

4.

Graves disease.

ANS: 1

Acromegaly is caused by a hypersecretion of the pituitary growth hormone over a long period. This hypersecretion causes a coarsening of the features, including soft tissue overgrowth such as the tongue. Shoes and rings may no longer fit due to tissue and bone overgrowth. In children, hypersecretion of growth hormone causes gigantism. Cretinism and Graves disease are caused by a thyroid hormone imbalance.

PTS:1DIF:Analyze

REF: Acromegaly (Gigantism): Assessment with Clinical Manifestations

5.A client is prescribed medication after recovering from surgery to treat acromegaly. Which of the following medications would the nurse expect to see prescribed?

1.

None

2.

Cabergoline (Dostinex) 1 mg PO twice a week

3.

Cortisone acetate (Cortone) 100 mg PO three times a day

4.

Octreotide (Sandostatin) 20 mg IM every 4 weeks

ANS: 4

Sandostatin is used for residual growth hormone hypersecretion following surgery. Cortone is used to treat adrenocorticotropic dysfunction, and Dostinex is used to treat hyperprolactinemia.

PTS: 1 DIF: Analyze REF: Acromegaly (Gigantism): Pharmacology

6.A client, complaining of weight gain, has thin extremities, a buffalo hump, and a protruding abdomen. The nurse realizes that this client is most likely to be diagnosed with which disease process?

1.

Addisons disease

2.

Cretinism

3.

Cushings syndrome

4.

Obesity

ANS: 3

Even though the client has gained weight (obesity), the distribution of that weight is characteristic for the disease process of Cushings syndrome. Cretinism and Addisons disease do not exhibit those symptoms.

PTS:1DIF:Analyze

REF: Cushings Disease (Hypercortisolism): Assessment with Clinical Manifestations

7.The nurse is providing instructions to a client receiving treatment for Cushings syndrome. Which of the following instructions would not be appropriate for this client?

1.

Monitor glucose levels.

2.

Implement safety precautions.

3.

Wear medical identification.

4.

Volunteer at the hospital to prevent depression.

ANS: 4

A client diagnosed with Cushings syndrome is predisposed to falls, injury, and increased glucose levels. The client should wear an identification bracelet indicating her disease process. The client should avoid crowds and persons with infections.

PTS:1DIF:Apply

REF: Cushings Disease (Hypercortisolism): Planning and Implementation

8.The nurse is assessing a client diagnosed with hyperaldosteronism. Which of the following would take the least priority during this period?

1.

Assessment of breath sounds

2.

Cardiac monitoring

3.

Assistance with activities of daily living (ADLs)

4.

Review of electrolyte levels

ANS: 3

The first priority for the nurse is to monitor cardiac and respiratory status. Cardiac status can be impaired because of changes in potassium levels, and fluid balance can be impaired because of sodium, affecting the respiratory status. After the client is stabilized, the nurse can assist the client with activities of daily living.

PTS:1DIF:Analyze

REF: Hypersecretion of the Adrenal Gland (Hyperaldosteronism): Assessment with Clinical Manifestations

9.A client is diagnosed with primary adrenal insufficiency. The nurse realizes that this disorder affects which of the following glands?

1.

Adrenal cortex

2.

Adrenal medulla

3.

Thyroid

4.

Pituitary

ANS: 1

Mineralocorticoids, glucocorticoids, and androgens are produced in the adrenal cortex. The principal mineralocorticoid is aldosterone. The adrenal medulla secretes the catecholamines. The thyroid and pituitary do not secrete aldosterone.

PTS:1DIF:Analyze

REF: Hyposecretion of the Adrenal Gland: Pathophysiology

10.A client tells the nurse that he is so thirsty that he has already consumed four pitchers of water. The clients urine output is 3500 mL in an 8-hour period. The client is recovering from surgery on the pituitary gland. What endocrine disorder is the client most likely experiencing?

1.

Diabetes insipidus

2.

Diabetes mellitus

3.

Myxedema

4.

Syndrome of inappropriate antidiuretic hormone secretion

ANS: 1

Diabetes insipidus and diabetes mellitus both cause increased urine output, but diabetes insipidus is related to a problem with antidiuretic hormone; diabetes mellitus is a problem with glucose. Myxedema is caused by a thyroid hormone imbalance. Syndrome of inappropriate antidiuretic hormone secretion causes fluid retention.

PTS:1DIF:Analyze

REFiabetes Insipidus: Assessment with Clinical Manifestations

11.The nurse is planning care for a client diagnosed with Graves disease. Which of the following nursing interventions would be appropriate for this clients care?

1.

Administer a stool softener.

2.

Provide extra blankets.

3.

Provide frequent meals.

4.

Restrict the caloric intake.

ANS: 3

Nursing interventions for Graves disease (hyperthyroidism) include offering frequent, high-calorie meals; medicating for diarrhea; providing a fan or decreasing the temperature on the air conditioner; and taking daily weight measurements. The client does not need a stool softener. The client does not need extra blankets. The clients metabolic rate is increased, and she should not have a restriction on caloric intake.

PTS:1DIF:Apply

REF: Hypersecretion of the Thyroid Gland: Planning and Implementation

12.A client is hospitalized with an ongoing fever. The nurse learns that the client has had a recent infection. Currently the client is restless, diaphoretic, and agitated with the following vital signs: temperature 106F, pulse 114, blood pressure 180/80 mmHg. Which of the following disorders is the client most likely experiencing?

1.

Addisonian crisis

2.

Goiter

3.

Myxedema

4.

Thyroid crisis

ANS: 4

Thyroid crisis is a serious form of hyperthyroidism that is life threatening. It is most likely to occur in persons who have been inadequately treated or undiagnosed. Infection, stress or emotional trauma, pregnancy, and medications may precipitate the event. Myxedema and addisonian crisis would not produce a severe increase in blood pressure. Goiter tends to interfere with swallowing and breathing.

PTS: 1 DIF: Analyze REF: Thyroid Crisis (Thyroid Storm)

13.A pregnant client is receiving treatment for hyperthyroidism. Which of the following medications would the nurse expect to see?

1.

Levothyroxine

2.

Methimazole

3.

Propylthiouracil

4.

Radioactive iodine

ANS: 3

Propylthiouracil (PTU) is the drug of choice for treating hyperthyroidism in a pregnant or breastfeeding client. Radioactive iodine and methimazole are treatments for nonpregnant clients with hyperthyroidism. Levothyroxine is used to treat hypothyroidism.

PTS:1DIF:Analyze

REF: Hypersecretion of the Thyroid Gland: Pharmacology

14.A client is diagnosed with chronic lymphocytic thyroiditis. The nurse should instruct the client regarding signs and symptoms of which of the following?

1.

Type 2 diabetes mellitus

2.

Heart failure

3.

Hypothyroidism

4.

Renal failure

ANS: 3

The client diagnosed with chronic lymphocytic thyroiditis will most often progress to hypothyroidism, which is permanent 95% of the time. The nurse should instruct the client regarding signs and symptoms of hypothyroidism. Chronic lymphocytic thyroiditis will not cause type 2 diabetes mellitus, heart failure, or renal failure.

PTS: 1 DIF: Apply REF: Thyroiditis

MULTIPLE RESPONSE

1.Which of the following symptoms would suggest to the nurse that a client is experiencing symptoms of pheochromocytoma? (Select all that apply.)

1.

Severe headache

2.

Decreased urine output

3.

Palpitations

4.

Diarrhea

5.

Profuse sweating

6.

Weight gain

ANS: 1, 3, 5

Severe headache, palpitations, and profuse sweating are the most common symptoms of pheochromocytoma. Decreased urine output, diarrhea, and weight gain are not associated with this disorder.

PTS:1DIF:Analyze

REFheochromocytoma: Assessment with Clinical Manifestations

2.A client is receiving diagnostic tests to determine the presence of a malignant thyroid lesion. Which of the following are symptoms that are usually associated with a malignant thyroid? (Select all that apply.)

1.

Hoarseness

2.

Onset of dysphagia

3.

Age 20; male gender

4.

Thyroid scan revealing a cold nodule

5.

Soft nodules

6.

Presence of a single firm nodule

ANS: 1, 2, 3, 4, 6

Assessment findings consistent with a malignant thyroid lesion include hoarseness, dysphagia, young adult male; thyroid scan revealing a cold nodule; and the presence of a single firm nodule. Multiple soft nodules are indicative of benign thyroid lesions.

PTS:1DIF:Analyze

REF:Table 56-5 Comparison of Benign and Malignant Thyroid Lesions

3.The nurse suspects a client is experiencing the early signs of myxedema coma when which of the following is assessed? (Select all that apply.)

1.

Reduced level of consciousness

2.

Hypothermia

3.

Hypoventilation

4.

Hypotension

5.

Bradycardia

6.

Reduced urine output

ANS: 1, 2, 3, 4, 5

Myxedema is a medical emergency. The client will present with a diminished level of consciousness, hypothermia, hypoventilation, hypotension, and bradycardia. Prior to the coma, the client may be depressed, confused, paranoid, or even manic. Reduced urine output is not associated with this disorder.

PTS:1DIF:AnalyzeREF:Myxedema Coma

4.The nurse is planning care for a client diagnosed with hypercalcemia caused by hyperparathyroidism. Which of the following should the nurse add as interventions to this clients care plan? (Select all that apply.)

1.

Administer high volume intravenous fluids as prescribed.

2.

Monitor arterial blood gases.

3.

Calculate sodium chloride intake to achieve 400 mEq each day.

4.

Provide low rates of intravenous fluids.

5.

Provide thyroid replacement medication orally.

6.

Monitor body temperature.

ANS: 1, 3

Management of fluid and electrolytes is the priority for a client diagnosed with hypercalcemia caused by hyperparathyroidism. The client needs intensive hydration with intravenous normal saline. The nurse also needs to ensure that the client receives greater than 400 mEq of sodium chloride each day. The other answer choices are interventions appropriate for a client diagnosed with myxedema.

PTS:1DIF:Apply

REF: Hyperparathyroidism: Planning and Implementation

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