CHAPTER 13 - ENDOCRINE SYSTEM

What should be included in the nursing care plan for a client with diabetes insipidus?
1. Blood pressure every hour
2. Strict intake and output
3. Urine for ketone bodies
4. Glucose monitoring four times a day

2. Diabetes insipidus is excessive urine output due to decreased amounts of antidiuretic hormone. Because of the excessive urine output, it is necessary to monitor intake and output.

What must the nurse do when preparing a client for a computed tomography (CT) scan?
1. Administer a laxative prep
2. Encourage fluids
3. Explain the procedure
4. Administer a radioisotope

3. Explanation is all that is necessary. The client is not given a radioisotope. Fluids are not pushed prior to the procedure. The client frequently is given an iodine dye, so the nurse should ask about allergies to shellfish.

Antibiotics are ordered for a client who has had a transsphenoidal hypophysectomy. He asks why he is receiving an antibiotic when he does not have an infection. The primary reason for administering antibiotics to this client is based on which information?

2. A transsphenoidal approach goes through the roof of the mouth, which has many organisms. Meningitis can occur. Answer 1 is a true statement but not the primary reason in this case. Antibiotics do not lower spinal fluid pressure. Answer 4 is a true stat

Twelve hours after a transsphenoidal hypophysectomy, the client keeps clearing his throat and complains of a drip in his mouth. To accurately assess this, the nurse should test the fluid for:
1. sugar.
2. protein.
3. bacteria.
4. blood.

1. Dripping in the back of the throat after a transsphenoidal hypophysectomy may be cerebrospinal fluid (CSF). CSF contains glucose. Saliva and mucus do not.

The client is ready for discharge following an adrenalectomy. Which statement that the client makes indicates the best understanding of the client's condition?
1. "I will continue on a low-sodium, low- potassium diet."
2. "My husband has arranged for a ma

4. The client must take steroid replacements every day for the rest of his/her life. Answer
1 is not an appropriate diet. The client should be on a high-sodium, low-potassium diet. The fights should decrease as mood swings decrease after surgery. The medi

What is the nursing priority when administering care to a client with severe hyperthyroidism?
1. Assess for recent emotional trauma.
2. Provide a calm, nonstimulating environment.
3. Provide diversionary activity.
4. Encourage range-of-motion exercises.

2. A calm environment is important to reduce activity. Hyperthyroidism makes a person hyperactive and easily distractible. There is no reason to assess for emotional trauma. The hyperthyroid client is usually hyperactive, so there would be no need for ran

Which problem is most likely to develop if hyperthyroidism remains untreated?
1. Pulmonary embolism
2. Respiratory acidosis
3. Cerebrovascular accident
4. Heart failure

4. Hyperthyroidism causes tachycardia, which can be severe enough to cause heart failure. Pulse rates can be 100 to 150 per minute.

Which nursing care measure is essential because a client has exophthalmos?
1. Administer artificial tears.
2. Encourage the client to wear her glasses.
3. Promote bed rest.
4. Monitor her pulse rate every four hours.

1. Exophthalmos (protrusion of the eyes) may be so severe that the eyelids cannot close. Artificial tears will keep the eyes moist so that abrasions do not occur. The client who has exophthalmos may or may not have glasses. Bed rest and monitoring pulse r

A client who has just had a thyroidectomy returns to the unit in stable condition. What equipment is it essential for the nurse to have readily available?
1. Tracheostomy set
2. Thoracotomy tray
3. Dressing set
4. Ice collar

1. Swelling in the operative site could cause airway obstruction. The nurse should have a tracheostomy set and oxygen readily available for 48 hours after thyroidectomy. A thoracotomy tray is not indicated. This client is not likely to need intervention i

What is the best way to assess for hemorrhage in a client who has had a thyroidectomy?
1. Check the pulse and blood pressure hourly.
2. Roll the client to the side and check for
evidence of bleeding.
3. Ask the client if he/she feels blood trickling
down

4. Following a thyroidectomy, the client is in semi-sitting position so drainage would go to the back of the neck. Because of the neck incision, the client should not be rolled to the side. The bleeding is unlikely to be inside the throat. Blood trickling

Which finding would be the greatest cause
for concern to the nurse during the early postoperative period following a thyroidectomy?
1. Temperature of 100�F
2. A sore throat
3. Carpal spasm when the blood pressure is taken
4. Complaints of pain in the area

3. Carpal spasm is a sign of tetany and is known as Chvostek's sign. Tetany may occur if the parathyroids have been inadvertently removed or damaged. The parathyroids regulate calcium phosphorus balance. Hypocalcemia causes tetany. Most clients who have b

An adult is admitted to the hospital with a diagnosis of hypothyroidism. Which findings would the nurse most likely elicit during the nursing assessment?
1. Elevated blood pressure and temperature
2. Tachycardia and weight gain
3. Hypothermia and constipa

3. Hypothyroidism causes decreased metabolic rate, which will cause lowered body temperature and pulse and decreased digestion of food. The skin is dry, and the hair thins.

Which diet does the nurse expect will be ordered for the client with hypothyroidism?
1. High protein, high calorie
2. Restricted fluids, low protein
3. High roughage, low calorie
4. High carbohydrate, low roughage

3. Hypothyroidism causes constipation and obesity. A diet high in roughage and low in calories is appropriate. The client should not be given a high-calorie diet. There is no need for fluid restriction or alteration in protein.

An adult with myxedema is started on thyroid replacement therapy and is discharged. The client returns to the doctor's office one week later. Which statement that the client makes is most indicative of an adverse reaction to the medication?
1. "My chest h

1. Chest pain on exertion suggests angina. In addition to a slow heart rate, the client with hypothyroidism frequently has atherosclerosis. Thyroxine will increase the heart rate, and the heart will require more oxygen. Angina is a likely and serious comp

The nurse's next door neighbor calls. He says he cannot awaken his 21-year-old wife. The nurse notes that the client is unconscious and is having deep respirations. Her breath has a fruity smell to it. The husband says that his wife has been eating and dr

2. Her symptoms suggest ketoacidosis. She must receive medical treatment at once. Coffee will not help her and is contraindicated because she is unresponsive. Sweetened orange juice is not indicated for ketoacidosis. It would be appropriate for hypoglycem

A client is diagnosed as having insulin-dependent diabetes mellitus (Type 1 diabetes). She received regular insulin at 7:30 A.M. When is she most apt to develop a hypoglycemic reaction?
1. Mid-morning
2. Mid-afternoon
3. Early evening
4. During the night

1. Hypoglycemic reactions occur at peak action time. Peak action time for regular insulin is two to four hours after injection, which would be mid- morning.

The nurse is teaching a client to self-administer insulin. The instructions should include teaching the client to:
1. inject the needle at a 90-degree angle into the muscle.
2. vigorously massage the area after injecting the insulin.
3. rotate injection s

3. Injection sites should be rotated to prevent tissue damage. Insulin is injected at a 90-degree angle into the deep subcutaneous tissue, not the muscle. Insulin does not need to be refrigerated. The open vial should be kept in the box to protect it from

An adolescent with Type 1 diabetes is learning about a diabetic diet. He asks the nurse if he will ever be able to go out to eat with his friends again. What is the most appropriate answer for the
nurse to give?
1. "You can go out with them, but you shoul

2. Eating out with friends is very important to an adolescent. Snacks will be allowed on his diet. He should be taught how to use the exchange lists in managing his diet.

At 10 A.M., a client with Type 1 diabetes becomes very irritable and starts to yell at the nurse. Which initial nursing assessment should take priority?
1. Blood pressure and pulse
2. Color and temperature of skin
3. Reflexes and muscle tone
4. Serum elec

2. The nurse should immediately assess the
skin. Behavior change and irritability suggest hypoglycemia. The nurse could also do a finger stick and check the glucose level. If the client is hypoglycemic, the client will have pale, cold, clammy skin and wil

An elderly woman has been recently diagnosed
as having Type 2 diabetes. Which of the following complaints that she has is most likely to be related to the diagnosis of diabetes mellitus?
1. Pruritus vulvae
2. Cough
3. Eructation
4. Singultus

1. Pruritus vulvae (itching of the vulva) frequently accompanies diabetes. Monilial infections are common due to the change in pH. Eructation is belching or burping, and singultus is hiccups. Neither of these is particularly related to diabetes.

A client has a transsphenoidal hypophysectomy to remove a pituitary tumor. When the client returns to the nursing unit following surgery, the head of the bed is elevated 30 degrees. What is the primary purpose for placing the client in this position?
1. T

2. Slight head elevation will reduce pressure on the sella turcica, where the pituitary gland is located, and edema formation in the area. This position may help promote respiratory effort; however, that is not the primary reason in this client. This posi

The nurse is discussing discharge plans
with a client who had a transsphenoidal hypophysectomy. Which statement made by the client indicates a need for more teaching?
1. "I won't brush my teeth until the doctor removes the stitches."
2. "I will wear loafe

4. Because the pituitary or master gland was removed, the client will need to take life-long medications, not just until the client feels better. All of the other actions are appropriate. The client should not bend over to tie shoes because this increases

A woman with a tumor of the adrenal cortex says to the nurse, "Will I always look this ugly? I hate having a beard." What is the best response for the nurse to make?
1. "After surgery, you will not develop any more symptoms, but the changes you have now w

3. A gradual return to normal will occur after adrenalectomy when there are no longer abnormal amounts of steroids being produced.

A client develops hypoparathyroidism after a total thyroidectomy. What treatment should the nurse anticipate?
1. Emergency tracheostomy
2. Administration of calcium
3. Oxygen administration
4. Administration of potassium

2. Hypoparathyroidism causes a decrease in calcium, which is manifested by tetany.

A woman with newly diagnosed Type 1 diabetes mellitus says she wants to have children. She asks if she will be able to have children and if they will be normal. What is the best answer for the nurse to give?
1. "Women with diabetes should not get pregnant

3. Most diabetic women can safely have babies if they receive good medical supervision during pregnancy. There is a slightly higher incidence of fetal loss and malformations in babies of diabetic mothers but not enough to preclude the chance of a normal b

A client is admitted to the hospital with recently diagnosed Type 1 diabetes mellitus and is to
have fasting blood work drawn this morning. At 7:00 A.M., the lab has not arrived to draw the blood. The client's dose of regular insulin is scheduled for 7:30

2. The onset of regular insulin is within 30 minutes. It should not be given until the client can eat within 15 to 30 minutes so that he will not develop hypoglycemia.

An adolescent with newly diagnosed Type 1 diabetes mellitus asks the nurse if he can continue to play football. What is the best answer for the nurse to give?
1. "Now that you have diabetes, you should not play football because you may get a cut that will

2. Diabetes is not a contraindication for sports. Changes in activity level will alter the utilization of glucose, so he will need to work closely with his physician to regulate exercise, insulin, and diet control.

The client is a 62-year-old woman who is 30 pounds overweight. She comes to the doctor's office complaining of headaches, frequent hunger, excessive thirst, and urination. The presenting complaints suggest that the nurse should assess
for other signs of w

4. The symptoms are the cardinal symptoms of diabetes mellitus: polydipsia, polyphagia, and polyuria. The client with hypothyroidism would have fatigue and weight gain and would complain of being cold all the time. The person with acute pyelonephritis wou

An elderly client with Type 2 diabetes mellitus develops an ingrown toenail. What is the best action for the nurse to take?
1. Put cotton under the nail and clip the nail straight across
2. Elevate the foot immediately
3. Apply warm, moist soaks
4. Notify

4. An ingrown toenail may cause infection, which can be very serious for the diabetic client. The physician should be notified. It is not appropriate for the practical nurse to initiate treatment.

A woman with hypothyroidism asks the nurse why the doctor told her she cannot have a sedative. The nurse's response is based on which of the following facts?
1. Sedatives potentiate thyroid replacement medication.
2. Clients with hypothyroidism have incre

2. In hypothyroidism, the metabolic rate is decreased. This causes an increased susceptibility to sedative drugs.