Endocrine

Thyroid DisordersThyroid Disorders•HYPERTHYROIDISM HYPERTHYROIDISM

(GRAVE’S DISEASE)(GRAVE’S DISEASE) Result from an excessive output of thyroid hormones caused by abnormal stimulation of thyroid gland by circulating immunoglobulin.

Affects women 8x more frequently than men.

HYPERTHYROIDISM HYPERTHYROIDISM (GRAVE’S (GRAVE’S DISEASE)DISEASE)Signs and Symptoms:Signs and Symptoms:

• irritability and apprehension• palpitation• poor heat tolerance (heat intolerance)• flushed skin (salmon color), warm, soft and moist

skin• dry skin & diffuse pruritus ( in elderly )• increase appetite• muscular fatigue & weakness• increase systolic BP, sinus tachycardia,

dysrrhythmias• exopthalmos

Accumulation of fluids, mucopolysaccharides at the fat-pads behind the eyeballs, pushing the eyeballs forward

Pathophysiology:

Abnormal stimulation of the thyroid gland

Excessive circulating TH

hypermetabolismIncrease cardiac

stimulation

Increase cardiac output, palpitations

Grave’s disease

exopthalmos

Increase appetite, easy

fatigability, weight loss

Increase sensitivity to

catecholamines and

neurotransmitters

Nervousness, hyperexcitability,

irritable and apprehensiveHeart failure

Pharmacotherapy

• Beta – blockers : Propranolol– These drugs are given to control

tachycardia and HPN• Iodides : Lugol’s solution

SSKI (Saturated Solution of Potassium Iodide)– Are given to inhibit release of thyroid

hormone– Mix with fruit juice with ice or glass of water

to improve its palatability– Provide drinking straw to prevent permanent

staining of teeth • Side effects

– Allergic reaction, Increased salivation, colds

Pharmacotherapy

• Thioamides- PTU and MethimazolePTU (Propylthiouracil) & Tapazole (Methimazole)– These are given to inhibit synthesis of thyroid

hormones

• Side effects of PTU– AGRANULOCYTOSIS / NEUTROPENIA

• This is manifested by unexplained Fever, Sore throat, Skin rashes

• The nurse must elicit these symptoms and if present, the physician must be alerted.

Pharmacotherapy• Ca – channel blockers• For fever, Paracetamol is given. • Aspirin must be avoided

– because it can displace the T3/T4 from the albumin in the plasma causing increased manifestations.

• Dexamethasone– Inhibit the action of thyroid hormones. – Steroids are given to prevent the conversion

of T4 to T3 in the peripheral tissues

Radiation therapy

• Radiation therapy (Iodine131) – Isolation for few days; body

secretions are radioactive contaminated.

– This is NOT recommended in pregnant women because of potential teratogenic effects.

– Pregnancy should be delayed for 6 months after therapy.

Surgery

• Subtotal Thyroidectomy – Usually about 5/6 of the gland is removed

Pre-op Care• Promote euthyroid state

– Control of thyroid disturbance– Stable VS

• Administer Iodides as ordered– To reduce the size & vascularity of thyroid gland,

thereby prevent post-op hemorrhage and thyroid crisis• ECG

– Heart failure / cardiac damage results from HPN / tachycardia.

SurgeryPost-op Care• Position : Semi – Fowler’s with head, neck &

shoulder erect• Prevent Hemorrhage

– Ice collar over the neck

• Keep tracheostomy set available for the first 48 hours post-op

• Ask the patient to speak every hour– To assess for recurrent laryngeal nerve damage

• Keep Ca gluconate readily available– Tetany occurs if hypocalcemia is present. – This may be secondary to the removal of the

parathyroid gland.

• Monitor Body Temperature – Hyperthermia is an initial sign of thyroid crisis

Surgery• Monitor BP (hypertension may be a manifestation

of thyroid storm)• Assess for Trousseau’s sign (hypocalcemia)• Observe for signs and symptoms of potential

complications.– Hemorrhage– Airway obstruction– Tetany– Recurrent laryngeal nerve damage– Thyroid crisis / storm / thyrotoxicosis– Myxedema

Thyroid Crisis or Storm• Uncontrolled and potentially life –

threatening hyperthyroidism• Causes: Stress, Infection and

Unprepared thyroid surgery

AssessmentElevated temperature (initial sign)Tachycardia, dysrhythmiasTremors, apprehension, restlessnessDelirium, psychotic state, comaElevated BP

Collaborative Management

• Monitor temperature, I and O, neurologic status, cardiovascular status every hour

• Administer increasing doses of oral PTU (200 to 300 mg. q 6 hours) as ordered, following a loading dose of 800 to 1,200 mg./ p.o as ordered

• Administer iodide preparation as ordered

• Administer dexamethasone to help inhibit the release of thyroid hormone

Collaborative Management

• Administer propranolol to control hypertension and tachycardia

• Implement measures to lower fever, e.g. cooling devises, cold baths, acetaminophen (avoid aspirin)

• Administer oxygen as needed

• Maintain quiet, calm, cool, private environment until crisis is over

REVIEW QUESTIONS

• 10 items

• The nurse is completing a health assessment of a 42-year-old woman with suspected Graves’ disease. The nurse should assess this client for

A. Anorexia.

B. Tachycardia.

C. Weight gain.

D. Cold skin.

• The nurse is completing a health assessment of a 42-year-old woman with suspected Graves’ disease. The nurse should assess this client for

A. Anorexia.

B. Tachycardia.

C. Weight gain.

D. Cold skin.

• Propylthiouracil (PTU) is prescribed for a client with Graves’ disease to decrease circulating thyroid hormone. The nurse should teach the client to immediately report which of the following signs and symptoms?

A. Sore throat.B. Painful, excessive menstruation.C. Constipation.D. Increased urine output.

• Propylthiouracil (PTU) is prescribed for a client with Graves’ disease to decrease circulating thyroid hormone. The nurse should teach the client to immediately report which of the following signs and symptoms?

A. Sore throat.B. Painful, excessive menstruation.C. Constipation.D. Increased urine output.

• A client with thyrotoxicosis says to the nurse, “I am so irritable. I am having problems at work because I lose my temper very easily.” Which of the following responses by the nurse would give the client the most accurate explanation of her behavior?

A. “Your behavior is caused by temporary confusion brought on by your illness.”

B. “Your behavior is caused by the excess thyroid hormone in your system.”

C. “Your behavior is caused by your worrying about the seriousness of your illness.”

D. “Your behavior is caused by the stress of trying to manage a career and cope with illness.”

• A client with thyrotoxicosis says to the nurse, “I am so irritable. I am having problems at work because I lose my temper very easily.” Which of the following responses by the nurse would give the client the most accurate explanation of her behavior?

A. “Your behavior is caused by temporary confusion brought on by your illness.”

B. “Your behavior is caused by the excess thyroid hormone in your system.”

C. “Your behavior is caused by your worrying about the seriousness of your illness.”

D. “Your behavior is caused by the stress of trying to manage a career and cope with illness.”

• Serum concentrations of thyroid hormones and thyroid-stimulating hormone (TSH) are tests ordered for the client with thyrotoxicosis. Which of the following laboratory values are indicative of thyrotoxicosis?

A. Elevated thyroid hormone concentrations and normal TSH.

B. Elevated TSH and normal thyroid hormone concentrations.

C. Decreased thyroid hormone concentrations and elevated TSH.

D. Elevated thyroid hormone concentrations and decreased TSH.

• Serum concentrations of thyroid hormones and thyroid-stimulating hormone (TSH) are tests ordered for the client with thyrotoxicosis. Which of the following laboratory values are indicative of thyrotoxicosis?

A. Elevated thyroid hormone concentrations and normal TSH.

B. Elevated TSH and normal thyroid hormone concentrations.

C. Decreased thyroid hormone concentrations and elevated TSH.

D. Elevated thyroid hormone concentrations and decreased TSH.

• A client with Graves’ disease is treated with radioactive iodine (RAI) in the form of sodium iodide. Which of the following statements by the nurse will explain to the client how the drug works?

A. “The radioactive iodine stabilizes the thyroid hormone levels before a thyroidectomy.”

B. “The radioactive iodine reduces uptake of thyroxine and thereby improves your condition.”

C. “The radioactive iodine lowers the levels of thyroid hormones by slowing your body’s production of them.”

D. “The radioactive iodine destroys thyroid tissue so that thyroid hormones are no longer produced.”

• A client with Graves’ disease is treated with radioactive iodine (RAI) in the form of sodium iodide. Which of the following statements by the nurse will explain to the client how the drug works?

A. “The radioactive iodine stabilizes the thyroid hormone levels before a thyroidectomy.”

B. “The radioactive iodine reduces uptake of thyroxine and thereby improves your condition.”

C. “The radioactive iodine lowers the levels of thyroid hormones by slowing your body’s production of them.”

D. “The radioactive iodine destroys thyroid tissue so that thyroid hormones are no longer produced.”

• A client with a large goiter is scheduled for a subtotal thyroidectomy to treat thyrotoxicosis. Saturated solution of potassium iodide (SSKI) is prescribed preoperatively for the client. The primary reason for using this drug is that it helps

A. Slow progression of exophthalmos.

B. Reduce the vascularityof the thyroid gland.

C. Decrease the body’s ability to store thyroxine.

D. Increase the body’s ability to excrete thyroxine.

• A client with a large goiter is scheduled for a subtotal thyroidectomy to treat thyrotoxicosis. Saturated solution of potassium iodide (SSKI) is prescribed preoperatively for the client. The primary reason for using this drug is that it helps

A. Slow progression of exophthalmos.

B. Reduce the vascularityof the thyroid gland.

C. Decrease the body’s ability to store thyroxine.

D. Increase the body’s ability to excrete thyroxine.

• Which of the following measures is most often recommended when preparing SSKI for administration?

A. Pour the solution over ice chips.

B. Mix the solution with an antacid.

C. Dilute the solution with water, milk, or fruit juice and have the client drink it with a straw.

D. Disguise the solution in a pureed fruit or vegetable

• Which of the following measures is most often recommended when preparing SSKI for administration?

A. Pour the solution over ice chips.B. Mix the solution with an antacid.C. Dilute the solution with water, milk, or

fruit juice and have the client drink it with a straw.

D. Disguise the solution in a pureed fruit or vegetable

• The nurse asks the client to state her name as soon as she regains consciousness postoperatively after a subtotal thyroidectomy and at each assessment. The nurse does this primarily to monitor for signs of which of the following?

A. Internal hemorrhage.

B. Decreasing level of consciousness.

C. Laryngeal nerve damage.

D. Upper airway obstruction.

• The nurse asks the client to state her name as soon as she regains consciousness postoperatively after a subtotal thyroidectomy and at each assessment. The nurse does this primarily to monitor for signs of which of the following?

A. Internal hemorrhage.

B. Decreasing level of consciousness.

C. Laryngeal nerve damage.

D. Upper airway obstruction.

• A client who has undergone a subtotal thyroidectomy is subject to complications in the first 48 hours after surgery. The nurse should obtain and keep at the bedside equipment to

A. Begin total parenteral nutrition.B. Start a cutdown infusionC. Administer tube feedings.D. Perform a tracheostomy.

• A client who has undergone a subtotal thyroidectomy is subject to complications in the first 48 hours after surgery. The nurse should obtain and keep at the bedside equipment to

A. Begin total parenteral nutrition.B. Start a cutdown infusionC. Administer tube feedings.D. Perform a tracheostomy.

• Which of the following symptoms might indicate that a client was developing tetany after a subtotal thyroidectomy?

A. Pains in the joints of the hands and feet.

B. Tingling in the fingers.

C. Bleeding on the back of the dressing.

D. Tension on the suture line.

• Which of the following symptoms might indicate that a client was developing tetany after a subtotal thyroidectomy?

A. Pains in the joints of the hands and feet.

B. Tingling in the fingers.

C. Bleeding on the back of the dressing.

D. Tension on the suture line.

Thyroid DisordersThyroid Disorders•HYPOTHYROIDISMHYPOTHYROIDISM

(MYXEDEMA )(MYXEDEMA )Results from suboptimal levels of thyroid hormoneCommonly caused by auto immune thyroiditis (Hashimoto’s disease) in adults.Commonly occur in patient with previous hyperthyroidism who have been treated with radio iodine or anti thyroid medications or who had surgery.Known as CRETINISM when is present at birth.

HypothyroidismFailure of thyroid cells to produce

sufficient levels of thyroid hormones

Functioning cells inadequate ingestion

of substances to make TH (iodine and

tyrosine)

Damaged cell no longer functioning

TH TSH

Metabolic rate

Cellular energy

metabolites

CHONS and sugar (GAGS)

Cellular edema

mucous and water

SSx of Hypothyroidism

HYPOTHYROIDISMHYPOTHYROIDISM

Signs and Symptoms:Signs and Symptoms:• extreme fatigue• hail loss, brittle nails• dry skin• numbness, tingling sensation of the

fingers• husky voice, hoarseness• amenorrhea• hypothermia

TreatmentTreatment

Thyroid hormone replacement

Synthetic levothyroxine (Synthyroid)

Supportive therapy.

Avoid application of external heat (heating pads)

Corticosteroid therapy (for associated adrenocorticosteroid insufficiency)

Nursing InterventionsNursing Interventions Modifying activity

encourage patient to participate in activities within established

tolerance level

Monitor physical status Promote physical comfort

provide extra clothing and blankets

Provide emotional support

Nursing InterventionsNursing InterventionsPromote home and community – based care.

provide dietary instructionassess patient’s and family’s understanding of the importance of prescribed long term medication therapyreport signs and symptoms indicating inadequate or excessive thyroxine hormone.

REVIEW QUESTIONS

• 3 items

• A 60-year-old woman is diagnosed with hypothyroidism. Signs and symptoms of hypothyroidism include

A. Tachycardia.

B. Weight gain.

C. Diarrhea.

D. Nausea.

• A 60-year-old woman is diagnosed with hypothyroidism. Signs and symptoms of hypothyroidism include

A. Tachycardia.

B. Weight gain.

C. Diarrhea.

D. Nausea.

• Appropriate nursing diagnoses for a client with hypothyroidism would probably include which of the following?

A. Risk for Injury (corneal abrasion) related to incomplete closure of eyelid.

B. Imbalanced Nutrition: Less Than Body Requirements related to hypermetabolism.

C. Deficient Fluid Volume related to diarrhea.D. Activity Intolerance related to fatigue

associated with the disorder.

• Appropriate nursing diagnoses for a client with hypothyroidism would probably include which of the following?

A. Risk for Injury (corneal abrasion) related to incomplete closure of eyelid.

B. Imbalanced Nutrition: Less Than Body Requirements related to hypermetabolism.

C. Deficient Fluid Volume related to diarrhea.D. Activity Intolerance related to fatigue

associated with the disorder.

• When discussing recent onset of feelings of sadness and depression in a client with hypothyroidism, the nurse should inform the client that these feelings are

A. The effects of thyroid hormone replacement therapy and will diminish over time.

B. Related to the thyroid hormone replacement therapy and will not diminish over time.

C. A normal part of having a chronic illness.D. Most likely related to low thyroid hormone levels

and will improve with treatment.

• When discussing recent onset of feelings of sadness and depression in a client with hypothyroidism, the nurse should inform the client that these feelings are

A. The effects of thyroid hormone replacement therapy and will diminish over time.

B. Related to the thyroid hormone replacement therapy and will not diminish over time.

C. A normal part of having a chronic illness.D. Most likely related to low thyroid hormone

levels and will improve with treatment.

Addison’s diseaseAddison’s disease

 Primary adrenocortical insufficiency Hypofunction of the adrenal cortex

causes decreased secretion of the mineralocorticoids, glucocorticoids, and sex hormones.  

Addison’s diseaseAddison’s disease

Primary Adrenal Insufficiency

• Results from loss of both cortisol and aldosterone secretion due to:– Near total or total

destruction of both adrenal glands

Secondary Adrenal Insufficiency

• ACTH is deficient not enough cortisol will be produced, although aldosterone may remain adequate

Addison’s diseaseAddison’s disease

 It is a relatively rare disease caused by:

Idiopathic atrophy of the adrenal cortex possibly due to an autoimmune process

Destruction of the gland secondary to tuberculosis or fungal infection

PathophysiologyPathophysiology

Addison’s diseaseAddison’s disease

PathophysiologyPathophysiology

Atrophy of adrenal gland

Adrenocotical insufficiency

Decrease steroid

hormone

hypoglycemia hyperkalemia Cannot adapt to stress

hyponatremia

Assessment findings

• Fatigue, muscle weakness

• Anorexia, nausea, vomiting, abdominal pain, weight loss

• History of frequent hypoglycemic reactions

• Hypotension, weak pulse

• Bronze-like pigmentation of the skin

• Decreased capacity to deal with stress

Diagnostic tests:

• Low cortisol levels

• Hyponatremia

• Hyperkalemia

• Hypoglycemia

Nursing interventions• Administer hormone replacement

therapy as ordered.– Glucocorticoids (cortisone,

hydrocortisone): to simulate diurnal rhythm of cortisol release

– Mineralocorticoids: fludrocortisone acetate

• Monitor vital signs.• Decrease stress in the environment.• Prevent exposure to infection.

Nursing interventions

• Provide rest periods; prevent fatigue.

• Monitor intake and output

• Weigh daily.

• Provide small, frequent feedings of diet high in carbohydrates, sodium, and protein to prevent hypoglycemia and hyponatremia and provide proper nutrition.

Nursing interventions

• Provide client teaching and discharge planning concerning

Disease process; signs of adrenal insufficiencyUse of prescribed medications for lifelong replacement therapy; never omit medicationsNeed to avoid stress, trauma, and infections, and to notify physician if these occur as medication dosage may need to be adjusted

Nursing interventions• Provide client teaching and discharge

planning concerningStress management techniques

Diet modification (high in protein, carbohydrates, and sodium)

Use of salt tablets (if prescribed) or ingestion of salty foods (potato chips) if experiencing increased sweating

Importance of alternating regular exercise with rest periods

Avoidance of strenuous exercise especially in hot weather

REVIEW QUESTIONS

• 7 items

When teaching a client newly diagnosed with primary Addison’s disease, the nurse should explain that the disease results from

A. Insufficient secretion of growth hormone (GH).

B. Dysfunction of the hypothalamic pituitary.

C. Idiopathic atrophy of the adrenal gland.

D. Oversecretion of the adrenal medulla.

When teaching a client newly diagnosed with primary Addison’s disease, the nurse should explain that the disease results from

A. Insufficient secretion of growth hormone (GH).

B. Dysfunction of the hypothalamic pituitary.

C. Idiopathic atrophy of the adrenal gland.

D. Oversecretion of the adrenal medulla.

• Which of the following findings would be typical of Addison’s disease?

A. Hypokalemia.

B. Hypernatremia.

C. Hypoglycemia.

D. Decreased blood urea nitrogen (BUN) level.

• Which of the following findings would be typical of Addison’s disease?

A. Hypokalemia.

B. Hypernatremia.

C. Hypoglycemia.

D. Decreased blood urea nitrogen (BUN) level.

• Which statement should the nurse make when teaching the client about taking oral glucocorticoids?

A. “Take your medication with a full glass of water.”

B. “Take your medication on an empty stomach.”

C. “Take your medication at bedtime to increase absorption.”

D. “Take your medication with meals or with an antacid,”

• Which statement should the nurse make when teaching the client about taking oral glucocorticoids?

A. “Take your medication with a full glass of water.”

B. “Take your medication on an empty stomach.”

C. “Take your medication at bedtime to increase absorption.”

D. “Take your medication with meals or with an antacid”

• Which of the following signs and symptoms would probably indicate that the client with Addison’s disease is receiving too much glucocorticoid replacement?

A. Anorexia.

B. Dizziness.

C. Rapid weight gain.

D. Poor skin turgor.

• Which of the following signs and symptoms would probably indicate that the client with Addison’s disease is receiving too much glucocorticoid replacement?

A. Anorexia.

B. Dizziness.

C. Rapid weight gain.

D. Poor skin turgor.

• Which of the following is a priority outcome for the client with Addison’s disease?

A. Maintenance of medication compliance.

B. Avoidance of normal activities with stress.

C. Adherence to a 2-g sodium diet.

D. Prevention of hypertensive episodes.

• Which of the following is a priority outcome for the client with Addison’s disease?

A. Maintenance of medication compliance.

B. Avoidance of normal activities with stress.

C. Adherence to a 2-g sodium diet.

D. Prevention of hypertensive episodes.

• The client with Addison’s disease should anticipate the need for increased glucocorticoid supplementation in which of the following situations?

A. Returning to work after a weekend.

B. Going on vacation.

C. Having oral surgery.

D. Having a routine medical checkup.

• The client with Addison’s disease should anticipate the need for increased glucocorticoid supplementation in which of the following situations?

A. Returning to work after a weekend.

B. Going on vacation.

C. Having oral surgery.

D. Having a routine medical checkup.

• The nurse should teach the client with Addison’s disease that the side effect of bronze – colored skin is thought to be caused by which of the following?

A. Hypersensitivity to sun exposureB. Increased serum bilirubin levelC. Side effects of the glucocorticoid therapyD. Increased secretion of adrenocorticotropic

hormone (ACTH)

• The nurse should teach the client with Addison’s disease that the side effect of bronze – colored skin is thought to be caused by which of the following?

A. Hypersensitivity to sun exposureB. Increased serum bilirubin levelC. Side effects of the glucocorticoid therapyD. Increased secretion of

adrenocorticotropic hormone (ACTH)

CUSHING’S SYNDROMECUSHING’S SYNDROME• This is a condition resulting from excessive secretion

of corticosteroids, particularly the glucocorticoid cortisol.

• It occurs most frequently in females between ages 30—60.

• Primary Cushing’s syndrome caused by adrenocortical tumors or hyperplasia.

• Secondary Cushing’s syndrome (also called Cushing’s disease): caused by functioning pituitary or nonpituitary neoplasm secreting ACTH, causing increased secretion of glucocorticoids.

• The latrogenic: caused by prolonged use of corticosteroids

PathophysiologyPathophysiologyAbnormal stimulation of the

pituitary gland

Increase ACTH

Stimulate adrenal gland

Increase steroid

hormone

hyperglycemia hypernatremia hypokalemia

Assessment findings• Muscle weakness, fatigue, obese trunk

with thin arms and legs, muscle wasting• Irritability, depression, frequent mood

swings• Moon face, buffalo hump, pendulous

abdomen• Purple striae on trunk, acne, thin skin• Signs of masculinization in women;

menstrual dysfunction, decreased libido• Osteoporosis, decreased resist to infection• Hypertension, edema• ↑ skin and blood vessel friability

Diagnostic tests:

• Cortisol levels increased

• Slight hypernatremia

• Hypokalemia

• Hyperglycemia

Nursing interventions• Maintain muscle tone.

Provide ROM exercises.Assist with ambulation.

• Prevent accidents or falls and provide adequate rest,

• Protect client from exposure to infection

• Maintain skin integrity.Provide meticulous skin care.Prevent tearing of skin: use paper tape if necessary.

Nursing interventions• Minimize stress in the environment.

• Monitor vital signs; observe for hypertension, edema.

• Measure intake and output and daily weights.

• Provide diet low in calories and sodium and high in protein, potassium, calcium, and vitamin supplements.

• Monitor urine for glucose and acetone; administer insulin if ordered.

• Provide psychological support and acceptance.

Nursing interventions• Prepare client for hypophysectomy or radiation

if condition is caused by a pituitary tumor.• Prepare client for an adrenalectomy if

condition is caused by an adrenal tumor or hyperplasia.

• Provide client teaching and discharge planning concerning:– Diet modifications– Importance of adequate rest– Need to avoid stress and infection– Change in medication regimen (alternate day

therapy or reduced dosage) if cause of the condition is prolonged corticosteroid therapy

REVIEW QUESTIONS

• 11 ITEMS

• A 42 year old female client reports that she has gained weight and that her face and body are “rounder,” while her legs and arms have become thinner. A tentative diagnosis of Cushing’s disease is made. When examining this client, the nurse would expect to find

A. Postural hypotension.

B. Muscle hypertrophy in the extremities.

C. Bruised areas on the skin.

D. Decreased body hair.

• A 42 year old female client reports that she has gained weight and that her face and body are “rounder,” while her legs and arms have become thinner. A tentative diagnosis of Cushing’s disease is made. When examining this client, the nurse would expect to find

A. Postural hypotension.

B. Muscle hypertrophy in the extremities.

C. Bruised areas on the skin.

D. Decreased body hair.

• Signs and symptoms of Cushing’s disease include

A. Weight loss.

B. Thin, fragile skin.

C. Hypotension.

D. Abdominal pain.

• Signs and symptoms of Cushing’s disease include

A. Weight loss.

B. Thin, fragile skin.

C. Hypotension.

D. Abdominal pain.

• Cushing’s disease is manifested by the excessive secretion of corticosteroids. The hormones involved are

A. Glucocorticoids and aldosterone.

B. Adrenocorticotropic hormone (ACTH).

C. Glucocorticoids, aldosteronre, and androgens.

D. catecholamines

• Cushing’s disease is manifested by the excessive secretion of corticosteroids. The hormones involved are

A. Glucocorticoids and aldosterone.

B. Adrenocorticotropic hormone (ACTH).

C. Glucocorticoids, aldosteronre, and androgens.

D. catecholamines

• Which of the following test results would be consistent with a diagnosis of Cushing’s disease?

A. Postprandial hypoglycemia.

B. Hypokalemia.

C. Hyponatremia.

D. Decreased urinary calcium level.

• Which of the following test results would be consistent with a diagnosis of Cushing’s disease?

A. Postprandial hypoglycemia.

B. Hypokalemia.

C. Hyponatremia.

D. Decreased urinary calcium level.

• The client with Cushing’s disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate?

A. Increase calories.

B. Restrict sodium.

C. Restrict potassium.

D. Reduce fat to 10%

• The client with Cushing’s disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate?

A. Increase calories.

B. Restrict sodium.

C. Restrict potassium.

D. Reduce fat to 10%

• A priority in the first 24 hours after a bilateral adrenalcotomy is

A. Beginning oral nutrition.

B. Promoting self-care activities.

C. Preventing adrenal crisis.

D. Ambulating in the hallway.

• A priority in the first 24 hours after a bilateral adrenalcotomy is

A. Beginning oral nutrition.

B. Promoting self-care activities.

C. Preventing adrenal crisis.

D. Ambulating in the hallway.

• Adrenal function is affected by the drug ketoconazole (Nizoral), an antifungal agent used to treat severe fungal infections. How is this effect manifested?

A. Ketoconazole suppresses adrenal steroid secretion.

B. Ketoconazole destroys adrenocortical cells, resulting in a “medical” adrenalectomy.

C. Ketoconazole increases ACTH-induced corticosteroid serum levels.

D. Ketoconazole decreases duration of adrenal suppression when administered with corticosteroids.

• Adrenal function is affected by the drug ketoconazole (Nizoral), an antifungal agent used to treat severe fungal infections. How is this effect manifested?

A. Ketoconazole suppresses adrenal steroid secretion.

B. Ketoconazole destroys adrenocortical cells, resulting in a “medical” adrenalectomy.

C. Ketoconazole increases ACTH-induced corticosteroid serum levels.

D. Ketoconazole decreases duration of adrenal suppression when administered with corticosteroids.

• In the early postoperative period after a bilateral adrenalectomy, the nurse should recognize that the most probable cause of temperature elevation is

A. Dehydration.

B. Poor lung expansion.

C. Wound infection.

D. Urinary tract infection

• In the early postoperative period after a bilateral adrenalectomy, the nurse should recognize that the most probable cause of temperature elevation is

A. Dehydration.

B. Poor lung expansion.

C. Wound infection.

D. Urinary tract infection

• Because of steroid excess, the client who has undergone a bilateral adrenalectomy is at an increased risk for

A. Postoperative confusion.

B. Delayed wound healing.

C. Emboli.

D. Malnutrition.

• Because of steroid excess, the client who has undergone a bilateral adrenalectomy is at an increased risk for

A. Postoperative confusion.

B. Delayed wound healing. (collagen matrix)

C. Emboli.

D. Malnutrition.

• The client who has undergone a bilateral adrenalectomy is ready to return home. She tells the nurse that she is concerned about persistent body changes and the fact that her moods are still so unpredictable. She says, “I thought surgery was supposed to fix all that.” The nurse should base her teaching about recovery on which of the following concepts?

A. The body changes are permanent and she will not be the same as before this condition.

B. The body and mood will gradually return to normal.C. The physical changes are permanent, but the mood

swings will disappear.D. The physical changes are temporary, but the mood

swings are permanent.

• The client who has undergone a bilateral adrenalectomy is ready to return home. She tells the nurse that she is concerned about persistent body changes and the fact that her moods are still so unpredictable. She says, “I thought surgery was supposed to fix all that.” The nurse should base her teaching about recovery on which of the following concepts?

A. The body changes are permanent and she will not be the same as before this condition.

B. The body and mood will gradually return to normal.

C. The physical changes are permanent, but the mood swings will disappear.

D. The physical changes are temporary, but the mood swings are permanent.

• Which of the following should the nurse include in the teaching plan of a female client with bilateral adrenalectomy?

A. Emphasizing that the client will need steroid replacement for the rest of her life.

B. Instructing the client about the importance of tapering steroid medication carefully to prevent crisis.

C. Informing the client that steroids will be required only until her body can manufacture sufficient quantities.

D. Emphasizing that the client will need to take steroids whenever her life involves physical or emotional stress.

• Which of the following should the nurse include in the teaching plan of a female client with bilateral adrenalectomy?

A. Emphasizing that the client will need steroid replacement for the rest of her life.

B. Instructing the client about the importance of tapering steroid medication carefully to prevent crisis.

C. Informing the client that steroids will be required only until her body can manufacture sufficient quantities.

D. Emphasizing that the client will need to take steroids whenever her life involves physical or emotional stress.

END