A nurse is assessing a newly

admitted client with

symptoms of heat
intolerance, insomnia,
palpitations, and increased
sweating. Which of the
following diagnoses may be
the reason for these
symptoms?




Pretibial myxedema

Hyperthroidism

Proptosis

Hypothroidism










A client presents to the emergency room
with a history of Graves disease. The client
reports having symptoms for a few days,
but has not previously sought or received
any additional treatment. The client also
reports having had a cold a few days back.
Which of the following interventions would
be appropriate to implement for this client,
based on the history and current
symptoms? Select all that apply.




Administer aspirin

Replace intravenous fluids

Induce shivering


Relieve respiratory distress

Administer a cooling blanket









A nursing student is studying for a test on
care of the client with endocrine disorders.
Which of the following statements
demonstrates an understanding of the
difference between hyperthyroidism and
hypothyroidism?




Deficient amounts of TH cause abnormalities in
lipid metabolism, with decreased serum
cholesterol and triglyceride levels.

Graves disease is the most common cause of
hypothyroidism.

Decreased renal blood flow and glomerular
filtration rate reduces the kidneys ability to
excrete water, which may cause hyponatremia.

Increased amounts of TH cause a decrease in
cardiac output and peripheral blood flow.









A Clinical Instructor is questioning a
student nurse about disorders of the
parathyroid glands. Which statement by the
nursing student, would indicate the need for
further teaching?




Hyperparathyroidism results in an increased
release of calcium and phosphorus by bones,
with resultant bone decalcification.


Hyperparathyroidism results in deposits in soft
tissues and the formation of renal calculi.

Hypoparathyroidism results in impaired renal
tubular regulation of calcium and phosphate.

Hypoparathyroidism results in decreased
activation of vitamin D which then results in
decreased absorption of calcium by the
pancreas.








A nurse on a general medical-surgical unit
is caring for a client with Cushings
syndrome. Which of the following
statements is correct about the medication
regimen for Cushings syndrome?




Mitotane is used to treat metastatic adrenal
cancer.

Aminogluthimide may be administered to clients
with ectopic ACTH-secreting tumors before
surgery is performed.

Ketoconazole increases cortisol synthesis by the
adrenal cortex.

Somatostatin analog increases ACTH secretion
in some clients.









Which of the following nursing implications
is most important in a client being
medicated for Addisons disease?




Administer oral forms of the drug with food to

minimize its ulcerogenic effect.

Monitor capillary blood glucose for hypoglycemia
in the diabetic client.

Instruct the client to never abruptly discontinue
the medication.

Teach the client to consume a diet that is high in
potassium, low in sodium, and high in protein.








A nurse on a surgical floor is caring for a
post-operative client who has just had a
subtotal thyroidectomy. Which of the
following assessments should be completed
first on the client?




Assess for signs of tetany by checking for
Chvosteks and Trousseaus signs

Assess dressing (if present) and the area under
the clients neck and shoulders for drainage.

Administer analgesic pain medications as
ordered, and monitor their effectiveness.

Assess respiratory rate, rhythm, depth, and
effort.









The nurse is caring for a client who is about
to undergo an adrenalectomy. Which of the
following Preoperative interventions is most
appropriate for this client?




Maintain careful use of medical and surgical
asepsis when providing care and treatments.


Teach the client about a diet high in sodium to
correct any potential sodium imbalances
preoperatively.

Explain to the client that electrolytes and
glucose levels will be measured postoperatively.

Teach the client how to effectively cough and
deep breathe once surgery is complete.








The nurse is caring for a client with
pheochromocytoma. Which of the following
must be included in planning the nursing
care for this client ?




Monitor blood pressure frequently, assessing for
hypertension.

Assess only for physical stressors present.

Collect a random urine sample.

Prepare the client for chemotherapy to shrink
the tumor.









A client newly diagnosed with Addisons
disease is giving a return explanation of
teaching done by the primary nurse. Which
of the following statements indicates that
further teaching is necessary?




I need to increase how much I drink each day.

I need to weigh myself if I think I am losing or
gaining weight.

I need to maintain a diet high in sodium and

low in potassium.

I need to take my medications each day.




1.

A nurse is assessing a newly admitted client
with symptoms of heat intolerance,
insomnia, palpitations, and increased
sweating. Which of the following diagnoses
may be the reason for these symptoms?
Your Answer: Hypothroidism

Correct Answer: Hyperthroidism


Rationale: The client with hyperthyroidism
typically has an increased appetite, yet loses
weight and may have hypermotile bowels
and diarrhea. Additional manifestations
related to hypermetabolism include heat
intolerance, insomnia, palpitations, and
increased sweating. # 1 is incorrect because
pretibial myxedema is a rare characteristic
of Graves disease. It is manifested by
plaques and nodule development bilaterally
over the shins and dorsal surface of the feet.
# 3 is incorrect because proptosis is the
forward displacement of the eye. # 4 is
incorrect because the symptoms in the stem
describe symptoms of hyperthyroidism, and
not hypothyroidism. In hypothyroidism,
clients characteristically have the
manifestations of goiter, fluid retention and
edema, decreased appetite, weight gain,
constipation, dry skin, dyspnea, pallor,
hoarseness, and muscle stiffness.

Nursing Process: Diagnosis

Client Need: Physiological Integrity

Cognitive Level: Analysis

Objective: Apply knowledge of normal
anatomy, physiology, and assessments of
the thyroid, parathyroid, adrenal, and
pituitary glands when providing nursing care
for clients with endocrine disorders.

Strategy: Be able to know the definition and
symptoms associated with each disorder
listed. Compare with the symptoms listed in
the stem in order to choose the correct
answer.

2.

A client presents to the emergency room
with a history of Graves disease. The client
reports having symptoms for a few days, but
has not previously sought or received any
additional treatment. The client also reports
having had a cold a few days back. Which of
the following interventions would be
appropriate to implement for this client,
based on the history and current symptoms?
Select all that apply.
Your Answer: Replace intravenous
fluids

Correct Answers: Replace intravenous
fluids

Induce shivering

Relieve respiratory
distress

Administer a cooling
blanket



Rationale: Thyroid storm (also called thyroid
crisis) is an extreme state of
hyperthyroidism that is rare today because
of improved diagnosis and treatment
methods (Porth, 2005). When it does occur,
those affected are usually people with
untreated hyperthyroidism (most often
Graves disease) and people with
hyperthyroidism who have experienced a
stressor, such as an infection, trauma. The
rapid increase in metabolic rate that results
from the excessive TH causes the
manifestations of thyroid storm. The
manifestations include hyperthermia, with
body temperatures ranging from 102F
(39C) to 106F (41C); tachycardia;
systolic hypertension; and gastrointestinal
symptoms (abdominal pain, vomiting,
diarrhea). Agitation, restlessness, and
tremors are common, progressing to
confusion, psychosis, delirium, and seizures.
The mortality rate is high. Rapid treatment
of thyroid storm is essential to preserve life.
Treatment includes cooling without aspirin
(which increases free TH) or inducing
shivering, replacing fluids, glucose, and
electrolytes, relieving respiratory distress,
stabilizing cardiovascular function, and
reducing TH synthesis and secretion. #1 is
incorrect because cooling happens without
the use of aspirin. All of the other choices
are correct.

Nursing Process: Planning

Client Need: Physiological Integrity

Cognitive Level: Analysis

Objective: Apply knowledge of normal
anatomy, physiology, and assessments of
the thyroid, parathyroid, adrenal, and
pituitary glands when providing nursing care
for clients with endocrine disorders.

Strategy: Gather clues from the stem
regarding client history, and current
symptoms. Make the diagnosis of thyroid
storm and then determine which
interventions are indicated in thyroid storm
to prevent death.



Rationale: Thyroid storm (also called thyroid
crisis) is an extreme state of
hyperthyroidism that is rare today because
of improved diagnosis and treatment
methods (Porth, 2005). When it does occur,
those affected are usually people with
untreated hyperthyroidism (most often
Graves disease) and people with
hyperthyroidism who have experienced a
stressor, such as an infection, trauma. The
rapid increase in metabolic rate that results
from the excessive TH causes the
manifestations of thyroid storm. The
manifestations include hyperthermia, with
body temperatures ranging from 102F
(39C) to 106F (41C); tachycardia;
systolic hypertension; and gastrointestinal
symptoms (abdominal pain, vomiting,
diarrhea). Agitation, restlessness, and
tremors are common, progressing to
confusion, psychosis, delirium, and seizures.
The mortality rate is high. Rapid treatment
of thyroid storm is essential to preserve life.
Treatment includes cooling without aspirin
(which increases free TH) or inducing
shivering, replacing fluids, glucose, and
electrolytes, relieving respiratory distress,
stabilizing cardiovascular function, and
reducing TH synthesis and secretion. #1 is
incorrect because cooling happens without
the use of aspirin. All of the other choices
are correct.

Nursing Process: Planning

Client Need: Physiological Integrity

Cognitive Level: Analysis

Objective: Apply knowledge of normal
anatomy, physiology, and assessments of
the thyroid, parathyroid, adrenal, and
pituitary glands when providing nursing care
for clients with endocrine disorders.

Strategy: Gather clues from the stem
regarding client history, and current
symptoms. Make the diagnosis of thyroid
storm and then determine which
interventions are indicated in thyroid storm
to prevent death.

3.

A nursing student is studying for a test on
care of the client with endocrine disorders.
Which of the following statements
demonstrates an understanding of the
difference between hyperthyroidism and
hypothyroidism?
Your Answer: (blank)

4.

A Clinical Instructor is questioning a student
nurse about disorders of the parathyroid
glands. Which statement by the nursing
student, would indicate the need for further
teaching?
Your Answer: Hypoparathyroidism results
in decreased activation of
vitamin D which then results
in decreased absorption of
calcium by the pancreas.

Rationale: Choices 1, 2, and 3 are all correct
statements. # 4 demonstrates a need for
further teaching because
hypoparathyroidism results in decreased
activation of vitamin D which then results in
decreased absorption of calcium by the
intestines, not the pancreas.

Nursing Process: Diagnosis

Client Need: Physiological Integrity

Cognitive Level: Application

Objective: Compare and contrast the
manifestations of disorders that result from
hyperfunction and hypofunction of the
thyroid, parathyroid, adrenal, and pituitary
glands.

Strategy: Read each statement to identify
true statements. Choose as the answer an
incorrect statement because the stem says
to identify a statement which indicates the
need for further teaching. Further teaching
is needed when the student makes an
incorrect statement.

5.

A nurse on a general medical-surgical unit is
caring for a client with Cushings syndrome.
Which of the following statements is correct
about the medication regimen for Cushings
syndrome?
Your Answer: Aminogluthimide may be
administered to clients
with ectopic ACTH-
secreting tumors before
surgery is performed.

Correct Answer: Mitotane is used to treat
metastatic adrenal
cancer.



Rationale: Mitotane directly suppresses
activity of the adrenal cortex and decreases
peripheral metabolism of corticosteroids. It
is used to treat metastatic adrenal cancer. #
2 is incorrect because aminogluthimide may
be administered to clients with ectopic
ACTH-secreting tumors that cannot be
surgically removed. # 3 is incorrect because
ketoconazole inhibits, not increases, cortisol
synthesis by the adrenal cortex. # 4 is
incorrect because somatostatin suppresses,
not increases, ACTH secretion.

Nursing Process: Planning

Client Need: Physiological Integrity

Cognitive Level: Application

Objective: Explain the nursing implications
for medications prescribed to treat disorders
of the thyroid and adrenal glands.

Strategy: Review each statement about the
medications for Cushings syndrome.
Determine if each statement is correct or
not. Select the correct statement as the
answer.

6.

Which of the following nursing implications is
most important in a client being medicated
for Addisons disease?
Your Answer: (blank)

7.

A nurse on a surgical floor is caring for a
post-operative client who has just had a
subtotal thyroidectomy. Which of the
following assessments should be completed
first on the client?
Your Answer: Assess for signs of tetany
by checking for
Chvosteks and
Trousseaus signs

Correct Answer: Assess respiratory rate,
rhythm, depth, and
effort.



Rationale: All of the above assessments
have importance, but airway and breathing
in a client should always be addressed first
when prioritizing care. Assess for signs of
latent tetany due to calcium deficiency,
including tingling of toes, fingers, and lips;
muscular twitches; positive Chvosteks and
Trousseaus signs; and decreased serum
calcium levels. However, tetany may occur
in 1 to 7 days after thyroidectomy so # 1 is
not the highest priority. Assessing for
hemorrhage is always important, but the
danger of hemorrhage is greatest in the first
12 to 24 hours after surgery, and as this
client is immediately post operative it is not
the main concern at this time. Pain
medication is important but according to
Maslow, pain is a psychosocial need to be
addressed after a physiologic need.

Nursing Process: Assessment

Client Need: Physiological Integrity

Cognitive Level: Application

Objective: Provide appropriate nursing care
for the client before and after a subtotal
thyroidectomy and an adrenalectomy.

Strategy: Read each nursing action in order
to determine if it is the most important
action. Select the action with the most
importance. All of the answers here are
appropriate, but the question is asking for
the highest priority.

8.

The nurse is caring for a client who is about
to undergo an adrenalectomy. Which of the
following Preoperative interventions is most
appropriate for this client?
Your Answer: Maintain careful use of
medical and surgical asepsis
when providing care and
treatments.

Rationale: Use careful medical and surgical
asepsis when providing care and treatments
since Cortisol excess increases the risk of
infection. # 2 is incorrect. Nutrition should
be addressed preoperatively. Request a
dietary consultation to discuss with the
client about a diet high in vitamins and
proteins. If hypokalemia exists, include
foods high in potassium. Glucocorticoid
excess increases catabolism. Vitamins and
proteins are necessary for tissue repair and
wound healing following surgery. # 3 is
incorrect. Monitor the results of laboratory
tests of electrolytes and glucose levels.
Electrolyte and glucose imbalances are
corrected before the client has surgery. # 4
is incorrect. Teach the client to turn, cough,
and perform deep-breathing exercises.
Although they are important for all surgical
clients, these activities are even more
important for the client who is at risk for
infection. Having the client practice and
demonstrate the activities increases
postoperative compliance.

Nursing Process: Planning

Client Need: Physiological Integrity

Cognitive Level: Analysis

Objective: Provide appropriate nursing care
for the client before and after a subtotal
thyroidectomy and an adrenalectomy.

Strategy: Read each intervention and then
determine if it an appropriate action to do in
the preoperative adrenalectomy client.

9.

The nurse is caring for a client with
pheochromocytoma. Which of the following
must be included in planning the nursing
care for this client ?
Your Answer: Monitor blood pressure
frequently, assessing for
hypertension.

Rationale: Pheochromocytomas are tumors
of chromaffin tissues in the adrenal medulla.
These tumors which are usually benign
produce catecholamines (epinephrine or
norepinephrine) that stimulate the
sympathetic nervous system. Although
many organs are affected, the most
dangerous effects are peripheral
vasoconstriction and increased cardiac rate
and contractility with resultant paroxysmal
hypertension. Systolic blood pressure may
rise to 200 to 300 mmHg, the diastolic to
150 to 175 mmHg. # 1 is correct because
the careful monitoring of blood pressure is
essential. Attacks are often precipitated by
physical, emotional, or environmental
stimuli, so # 2 is incorrect because more
than physical stressors are considered. This
condition is life threatening and is usually
treated with surgery as the preferred
treatment. # 3 is incorrect because it is a
random sample and not a 24 hour urine
collection. Because catecholamine secretion
is episodic, a 24-hour urine is a better
surveillance method than serum
catecholamines. (Pagana & Pagana, 2002).
Surgical removal of the tumor(s) by
adrenalectomy is the treatment of choice. #
4 is incorrect because surgery would be the
treatment usually completed.

Nursing Process: Implementation

Client Need: Physiological Integrity

Cognitive Level: Application

Objective: Use the nursing process as a
framework for providing individualized care
to clients with disorders of the thyroid,
parathyroid, adrenal, and pituitary glands.

Strategy: Determine which nursing action is
most appropriate in the care of the client
with pheochromocytoma.

10.

A client newly diagnosed with Addisons
disease is giving a return explanation of
teaching done by the primary nurse. Which
of the following statements indicates that
further teaching is necessary?
Your Answer: I need to increase how
much I drink each day.

Correct Answer: I need to weigh myself if
I think I am losing or
gaining weight.



Rationale: The client is at risk for ineffective
therapeutic regimen management. Clients
with Addisons disease must learn to provide
lifelong self-care that involves varied
components: medications, diet, and
recognizing and responding to stress.
Changes in lifestyle are difficult to maintain
permanently. The client needs to take the
medications on a daily basis. The client
needs to perform daily weights to monitor
for signs of dehydration. The client needs to
maintain a diet high in sodium and low in
potassium, as well as maintain an increased
fluid intake. # 2 is incorrect because daily
weights need to be performed instead of
weighing when a problem is suspected.

Nursing Process: Assessment

Client Need: Physiological Integrity

Cognitive Level: Analysis

Objective: Use the nursing process as a
framework for providing individualized care
to clients with disorders of the thyroid,
parathyroid, adrenal, and pituitary glands.

Strategy: Read each statement to identify
true statements. Choose as the answer an
incorrect statement because the stem says
to identify a statement which indicates the
need for further teaching. Further teaching
is needed when the client makes an
incorrect statement.