ch52.doc

Osborn chapter 52

Learning Outcomes Number and Title Learning Outcome 1 Describe the anatomic location and function of the endocrine

glands, including the physiological effects of the hormones that each gland produces.

Learning Outcome 2 Compare the common pathophysiological syndromes caused by under- and overproduction of hormones for each of the endocrine glands, including the thyroid, parathyroid, hypothalamus and pituitary, and adrenal glands.

Learning Outcome 3 Identify clinical manifestations, treatment, and nursing interventions for hypo- and hypermetabolic conditions.

Learning Outcome 4 Describe the complex neurological and immunologic effects of common glandular disorders.

Learning Outcome 5 Develop a plan of care for patients with each of the common endocrine gland disorders, including the patient teaching and discharge needs.

Learning Outcome 6 Describe the potential gerontological implications for each glandular disorder.

Learning Outcome 7 Identify implications for nursing research when caring for persons with glandular disorders.

Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for PracticeCopyright 2010 by Pearson Education, Inc.

1. A nurse is obtaining a history of a female client during a routine physical exam. The client indicates a past problem with endocrine gland functioning. The nurse is aware that this condition could involve which of the following organs?

Select all that apply.

1. Thyroid2. Adrenals3. Ovaries4. Pancreas5. Uterus

Correct Answer:1. Thyroid

2. Adrenals

3. Ovaries

4. Pancreas

Rationale: Thyroid. The endocrine glands and organs include the thyroid. Adrenals. The endocrine glands and organs include the adrenals. Ovaries. The endocrine glands and organs include the ovaries. Pancreas. The endocrine glands and organs include the pancreas. Uterus. The uterus is not considered part of the function of the endocrine system.

Cognitive level: ApplicationNursing Process: PlanningClient Need: Physiological IntegrityLO: 1


2. The nurse is caring for a client with dehydration. The client’s blood pressure and blood volume have stabilized after several hours of hypotension. The nurse understands that the condition of the client has stabilized because of the body’s regulation of:

1. Aldosterone.2. Adrenalin.3. Dopamine.4. Thyroxine.

Correct Answer: Aldosterone

Rationale: The adrenal gland and its hormone aldosterone stimulate the reabsorption of sodium and passive reabsorption of water, thus increasing blood pressure. Adrenaline may increase blood pressure, but in response to dehydration, aldosterone will be released by the adrenal gland to cause the kidneys to hold on to sodium and water, and will increase blood pressure and blood volume. Dopamine does not influence changes in blood volume. Thyroxine is a thyroid hormone that does not affect blood pressure and blood volume.

Cognitive Level: ApplicationNursing Process: EvaluationClient Need: Physiological IntegrityLO: 1


3. The nurse is performing an assessment on a client and notes that the client has thin arms and legs, purple striae on the abdomen, upper body obesity, and a round red face. The nurse would suspect the client has a disturbance with the:

1. Adrenal gland. 2. Thyroid gland.3. Parathyroid gland.4. Hypothalamus.

Correct Answer: Adrenal gland.

Rationale: The assessment findings of this client indicate Cushing’s syndrome. Cushing’s syndrome is a hypermetabolic disorder of the adrenal cortex. The assessment findings of the client do not indicate associations with the thyroid gland, parathyroid gland, or hypothalamus.

Cognitive Level: AnalysisNursing Process: AssessmentClient Need: Physiological IntegrityLO: 1


4. The nurse is caring for a client with a diagnosis of hypothyroidism. Which of the following clinical manifestations would the nurse expect during the physical assessment of the client?

Select all that apply.1. Lethargy2. Fatigue3. Dry skin4. Hair loss5. Fever

Correct Answer:1. Lethargy2. Fatigue3. Dry skin4. Hair loss

Rationale: Lethargy. Lethargy is a clinical manifestation that indicates hypothyroidism. Fatigue. Fatigue is a clinical manifestation that indicates hypothyroidism. Dry skin. Dry skin is a clinical manifestation that indicates hypothyroidism. Hair loss. Hair loss is a clinical manifestation that indicates hypothyroidism. Fever. Fever is not associated with hypothyroidism. Clients are sensitive to changes in temperature, but fever is not associated with this condition.

Cognitive Level: ApplicationNursing Process: AssessmentClient Need: Physiological IntegrityLO: 2


5. Which of the following assessment parameters would the nurse implement as the greatest priority for a client with severe hypothyroidism?

1. Heart rate2. Temperature3. Respiratory rate4. Oxygen saturation

Correct Answer: Heart rate

Rationale: Clients with hypothyroidism have seriously decreased thyroid hormone levels, which causes cardiac problems as evidenced by bradycardia. Temperature is a parameter that may indicate that the client has a cold intolerance, but it is not the priority assessment parameter. Respiratory rate and oxygen saturation are parameters that are not associated with potential problems indicated with hypothyroidism.

Cognitive Level: AnalysisNursing Process: ImplementationClient Need: Physiological IntegrityLO: 2


6. When caring for a client with hypoparathyroidsim, the nurse would expect which laboratory findings?

Select all that apply.1. Low calcium2. High phosphorous3. High calcium4. Low phosphorous5. Low protein

Correct Answer: 1. Low calcium2. High phosphorous

Rationale: Low calcium. When a deficient amount of parathyroid hormone is produced, hypocalcemia results. High phosphorous. When a deficient amount of parathyroid hormone is produced, results include high phosphorous levels. High calcium. When a deficient amount of parathyroid hormone is produced, hypocalcemia results. Low phosphorous. When a deficient amount of parathyroid hormone is produced, results include high phosphorous levels. Low protein. Protein levels are not associated with hypoparathyroidism. Cognitive Level: AnalysisNursing Process: ImplementationClient Need: Physiological IntegrityLO: 2


7. A client is beginning drug treatment for hypothyroidism and asks the nurse “How do I know if the drug is working?” The nurse would respond by stating that:

Select all that apply.1. “You should notice less symptoms of the disorder.”2. “You will need to have your thyroid levels monitored.”3. “You will notice at least a 2-pound weight loss.”4. “You should ask your doctor if the drug is working.”5. “You will periodically notice a burst in your energy level.”

Correct Answers: 1. “You should notice less symptoms of the disorder.”2. “You will need to have your thyroid levels monitored.”

Rationale: “You should notice less symptoms of the disorder.” Symptoms of hypothyroidism gradually fade over a period of 3 to 6 weeks as therapy is initiated. “You will need to have your thyroid levels monitored.” Clients should be instructed to have their blood levels tested 6 to 8 weeks after therapy to determine if hormone levels have stabilized. “You will notice at least a 2-pound weight loss.” The client may not experience a weight loss with this therapy. “You should ask your doctor if the drug is working.” Asking the doctor does not provide the client information on the effectiveness of the drug. “You will periodically notice a burst in your energy level.” The client will not experience bursts of energy; although there may be increases in the energy level in general, periodic bursts are not associated with this therapy.

Cognitive Level: ApplicationNursing Process: ImplementationClient Need: Physiological IntegrityLO: 3


8. The nurse is preparing to administer the synthetic hormone levothyroxine. The nurse understands that to best facilitate absorption, the drug should be administered:

Select all that apply.1. On an empty stomach.2. At least 4 hours before taking antacids.3. With supplemental calcium.4. With meals.5. During the evening hours.

Correct answers 1. On an empty stomach.2. At least 4 hours before taking antacids.

Rationale: On an empty stomach. Because the absorption of the synthetic thyroid hormone levothyroxine is altered by food and selected drugs, herbs, vitamins, and minerals, the nurse should administer the drug while the client’s stomach is empty, usually as a single dose before breakfast, and hold food intake for at least 1 hour. At least 4 hours before taking antacids. The nurse should administer the medication at least 4 hours before taking antacids. With supplemental calcium. The drug will suppress the TSH, which increases the risk of osteoporosis, a side effect that can be avoided by the ingestion of calcium. However, the calcium should not be administered with the drug because it can interfere with the absorption of the drug. Therefore, calcium is incorrect because it should not be administered at the same time as the levothyroxine. With meals. Taking levothyroxine with meals will interfere with the absorption of the drug. During the evening hours. The best time for the administration of the drug is in the early morning while the stomach is empty, not during the evening hours while the stomach is full and its contents will alter absorption of the drug.

Cognitive Level: ApplicationNursing Process: PlanningClient Need: Physiological IntegrityLO: 3


9. Which of the following nursing diagnoses would be incorporated into the plan of care for a client with acute adrenal insufficiency?


1. Fluid-Volume Deficit2. Hyponatremia3. Risk for Ineffective Therapeutic Regimen4. Knowledge Deficit5. Fluid-Volume Excess

Correct Answer:1. Fluid-Volume Deficit2. Hyponatremia3. Risk for Ineffective Therapeutic Regimen4. Knowledge Deficit

Rationale: Fluid-Volume Deficit. Nurses play a key role in managing fluid replacement and fluid intake and output. Hyponatremia. Hyponatremia is in the plan of care for this client because it develops secondary to adrenal insufficiency. Risk for Ineffective Therapeutic Regimen. A plan for client education and family education must be developed, and clients will be at risk for ineffective therapeutic regimen. Knowledge Deficit. Clients will require instruction on lifetime drug therapy and must adhere to the drug schedule. Clients are also advised to learn how to administer intramuscular injections so that they can self-administer hydrocortisone if unable to take medications by mouth due to nausea and vomiting. Fluid-Volume Excess. Clients are dehydrated during this condition; therefore, fluid-volume excess is incorrect.



10. The nurse is developing a plan of care for a client with a diagnosis of hyperparathyroidism. Nursing interventions for this client would include:


1. Decrease environmental stimuli.2. Promote comfort and rest.3. Eliminate caffeine from the diet.4. Monitor vital signs.5. Liberally apply emollient skin lotion.

Correct Answer: 1. Decrease environmental stimuli.2. Promote comfort and rest.3. Eliminate caffeine from the diet.4. Monitor vital signs.

Rationale: Decrease environmental stimuli. Decrease environmental stimuli because clients experience insomnia and restlessness with this disorder. Promote comfort and rest. Promoting comfort and rest will lessen the anxiety of the client. Eliminate caffeine from the diet. Elimination of caffeine is recommended because caffeine will increase the hand tremors and nervousness that occur with clients with this disorder. Monitor vital signs. Monitoring vital signs is necessary to detect any early complications such as thyroid storm. Should thyroid storm occur, the nurse would expect changes in the vital signs such as tachycardia and hyperpyrexia. Liberally apply emollient skin lotion. Application of skin lotion is not indicated for this client.



11. A client with hypoparathyroidism has a low serum calcium level. In order to test for the clinical manifestation consistent with this laboratory result, the nurse would:

Select all that apply.1. Tap over the facial nerve of the client.2. Place a tourniquet on the client’s arm.3. Have the client open and close both hands.4. Ask the client to count backwards.5. Press lightly on the client’s shoulders.

Correct answers: 1. Tap over the facial nerve of the client.2. Place a tourniquet on the client’s arm.

Rationale: Tap over the facial nerve of the client. Tapping over the facial nerve will cause spasm and twitching of the mouth, indicating hypocalcemia; this is referred to as the Chvostek’s sign. Place a tourniquet on the client’s arm. Placing a tourniquet or BP cuff on the client’s arm to assess for carpopedal spasm can also indicate hypocalcemia. This is referred to as the Trousseau’s sign. Have the client open and close both hands. This is not a test for hypocalcemia. Ask the client to count backwards. This is not a test for hypocalcemia. Press lightly on the client’s shoulders. This is not a test for hypocalcemia.



12. Following surgery for hyperpitutarism, a client complains of a supra-orbital headache. The nurse suspects a possible CSF leak and would:


1. Maintain bed rest.2. Keep HOB elevated 30 degrees.3. Administer antibiotics.4. Medicate for pain.5. Inform the client that headaches are expected.

Correct answers: 1. Maintain bed rest.2. Keep HOB elevated 30 degrees.3. Administer antibiotics.4. Medicate for pain.

Rationale: Maintain bed rest. Postoperative care of clients with a CSK leak should include bed rest. Keep HOB elevated 30 degrees. Postoperative care of clients with a CSK leak should include continued elevation of the head of the bed. Administer antibiotics. Postoperative care of clients with a CSK leak should include being placed on prophylactic antibiotics. Medicate for pain. Mild analgesics will be prescribed for pain. Inform the client that headaches are expected. Headaches are not expected after surgery and are a sign of a CSF leak.



13. The nurse is admitting a client with acute adrenal insufficiency. Which of the following questions would the nurse ask to establish subjective data regarding this disease?

Select all that apply.1. “Have you been able to maintain your daily activities?”2. “Have you noticed any food cravings lately?”3. “Have you been sleeping well?” 4. “Have you experienced any stress or trauma recently?”5. “Have experienced any numbness in your extremities?”

Correct Answer:1. “Have you been able to maintain your daily activities?”2. “Have you noticed any food cravings lately?”3. “Have you been sleeping well?” 4. “Have you experienced any stress or trauma recently?”

Rationale: “Have you been able to maintain your daily activities?” Clients with this condition may not be mentally alert, and therefore may have difficulty in maintaining activities of daily living. “Have you noticed any food cravings lately?” Clients with this condition will experience food cravings. “Have you been sleeping well?” Clients with this disorder may have sleep disturbances. “Have you experienced any stress or trauma recently?” Stress and trauma can cause adrenal insufficiency to progress into adrenal crisis. “Have you experienced any numbness in your extremities?”These symptoms are not associated with adrenal insufficiency or crisis.



14. A nurse is providing discharge instructions to a newly diagnosed client with hyperthyroidism. The nurse would instruct the client to avoid:


1. Stress.2. Infections.3. Crowds.4. Contact sports.5. Driving.

Correct Answer: 1. Stress.2. Infections.

Rationale: Stress. Clients should be instructed to avoid additional stress, which can lead to complications of the disease. This should be done until the disease is under control. Infections. Clients should be instructed to avoid infections, which can lead to complications of the disease. This should be done until the disease is under control. Crowds. Avoiding crowds is not necessary with hyperthyroid disorders. Contact sports. Avoiding contact sports is not necessary with hyperthyroid disorders. Driving. Avoiding driving is not necessary with hyperthyroid disorders.



15. Which of the following nursing diagnoses would the nurse include as the highest priority in the discharge teaching for a client with hypoparathyroidism?

1. Risk for Injury2. Altered Nutrition3. Impaired Mobility4. Risk for Infection

Correct Answer: Risk for Injury

Rationale: Discharge priorities for patients with parathyroid disease are focused on safety related to falls and fracture prevention. Follow-up home visits are warranted to assess how the client has modified the environment to enhance safety. Altered nutrition is included because the client will need to be instructed on the intake of vitamin D in the diet, but it is not the priority. Mobility is not affected with this disorder unless the client develops bone fractures related to the low levels of calcium; the question does not imply that the client has bone fractures. Risk for infection is not the priority for these clients.

Cognitive Level: AnalysisNursing Process: PlanningClient Need: Physiological IntegrityLO: 5


16. An elderly client has a decline in the function of the endocrine system. The nurse would alert the client to notify the health care provider under which conditions?


1. Infection2. Trauma3. Surgery4. Stress5. Slowed metabolism

Correct answers:1. Infection2. Trauma3. Surgery4. Stress

Rationale: Infection. The elderly client should notify the health care provider of infection because this condition may quickly destabilize older clients; the aging body is less capable of responding to either internal or external stressors. Trauma. The elderly client should notify the health care provider of trauma because this condition may quickly destabilize older clients; the aging body is less capable of responding to either internal or external stressors. Surgery. The elderly client should notify the health care provider of surgery because this condition may quickly destabilize older clients; the aging body is less capable of responding to either internal or external stressors. Stress. The elderly client should notify the health care provider of stress because this condition may quickly destabilize older clients; the aging body is less capable of responding to either internal or external stressors. Slowed metabolism. The elderly client may not be able to determine if metabolism has slowed, and elderly clients already have a slower metabolism.



17. An elderly client has been diagnosed with a pituitary tumor that cannot be entirely surgically removed. The nurse would:


1. Provide clear instructions on the medications and side effects.2. Refer the client to the local support group for pituitary tumors.3. Refer the client to the hospital chaplain.4. Provide emotional support for the concerns of the client.5. Ask the family if the client has advance directives.

Correct Answer: 1. Provide clear instructions on the medications and side effects.2. Refer the client to the local support group for pituitary tumors.3. Refer the client to the hospital chaplain.4. Provide emotional support for the concerns of the client.

Rationale: Provide clear instructions on the medications and side effects. Medication will have to be used when a pituitary tumor cannot be entirely removed. Older patients will need simple but clear instructions on medications that they will be receiving along with the potential side effects. Refer the client to the local support group for pituitary tumors. Referring the client to a support group is appropriate for this condition. Refer the client to the hospital chaplain. The client may need emotional/religious support. Provide emotional support for the concerns of the client. The nurse should provide emotional support to the client. Ask the family if the client has advance directives. The nurse should ask the client rather than the family about advance directives. This is something that should be asked when the client is admitted to the hospital, not after the client has been informed of his condition.



18. Which of following nursing diagnoses would the nurse include in the plan of care for an elderly client with a pituitary adenoma?


1. Knowledge Deficit2. Ineffective Coping3. Risk for Injury4. Disturbed Body Image5. Ineffective Breathing Patterns

Correct Answer:1. Knowledge Deficit2. Ineffective Coping3. Risk for Injury4. Disturbed Body Image

Rationale: Knowledge Deficit. Clients will need instructions on the medications that may have to be used to inhibit hormone production. Older patients may need simple but clear instructions on the medications and the side effects. Ineffective Coping. Ineffective coping is appropriate because the client may have a change in physical appearance that may be disheartening for the client and lead to depression. Risk for Injury. Patients may experience difficulty with vision, which places them at risk for injury. Disturbed Body Image. Clients may have a disturbed body image because of the changes in physical appearance with this disorder. Ineffective Breathing Patterns. Ineffective breathing patterns are not associated with this disorder.



19. A client is concerned about passing on her endocrine disorder to her children. The nurse responds by discussing which of the following significant promises for the future in endocrinology?


1. Genetic etiology2. Genetic counseling3. Gene therapy4. Genetic screening of infants5. Immunizations

Correct Answer: 1. Genetic etiology2. Genetic counseling3. Gene therapy4. Genetic screening of infants

Rationale: Genetic etiology. The field of genetics holds significant promise in endocrinology in the future. Genetic counseling. The field of genetic counseling holds significant promise in endocrinology in the future. Gene therapy. The field of gene therapy holds significant promise in endocrinology in the future. Genetic screening of infants. The field of genetic screening of infants holds significant promise in endocrinology in the future. Immunizations. Immunizations have not been an aspect considered in the research on this topic.



20. The nurse is aware that advances have been made in the diagnosis and treatment of endocrine disorders in recent years due to the development of:


1. New diagnostic imaging technologies.2. An immunoassay test of hormones.3. Improved laboratory techniques for genetic studies.4. New synthetic hormones.5. Hormone agonists.

Correct Answer: 1. New diagnostic imaging technologies.2. An immunoassay test of hormones.3. Improved laboratory techniques for genetic studies.4. New synthetic hormones.5. Hormone agonists.

Rationale: New diagnostic imaging technologies. Significant advances have been made in research in the diagnosis and treatment of endocrine disorders in recent years due to the development of new diagnostic imaging technologies. An immunoassay test of hormones. Significant advances have been made in research in the diagnosis and treatment of endocrine disorders in recent years due to the development of an immunoassay test of hormones. Improved laboratory techniques for genetic studies. Significant advances have been made in research in the diagnosis and treatment of endocrine disorders in recent years due to improved laboratory techniques for genetic studies. New synthetic hormones. Significant advances have been made in research in the diagnosis and treatment of endocrine disorders in recent years due to the development of new synthetic hormones and hormone agonists. Hormone agonists. Significant advances have been made in research in the diagnosis and treatment of endocrine disorders in recent years due to the development of new synthetic hormones and hormone agonists.



21. Which of the following advances offer hope for a cure in patient with endocrine problems?


1. Biochemistry2. Technology3. Genetics4. Pharmacology5. Diet therapy

Correct Answer: 1. Biochemistry2. Technology3. Genetics4. Pharmacology

Rationale: Biochemistry. Advances in biochemistry offer hope in the search for cures and care of the patient with endocrine problems. Technology. Advances in technology offer hope in the search for cures and care of the patient with endocrine problems. Genetics. Advances in genetics offer hope in the search for cures and care of the patient with endocrine problems. Pharmacology. Advances in pharmacology offer hope in the search for cures and care of the patient with endocrine problems. Diet therapy. Diet therapy has not been associated with a cure in this area.



ch52.doc

Documents

endocrine glands

blood volume

endocrine gland functioning

adrenal glands

parathyroid gland

title learning outcome

female client

endocrine system