Lippincott Q&A: The Client with
Endocrine Health Problems
1. The nurse is completing a health assessment
of a 42-year-old female with suspected Graves' disease. The nurse should
assess this client for:
■ 1. Anorexia.
■ 2. Tachycardia.
■ 3. Weight gain.
■ 4. Cold skin. - -2. Graves' disease, the most common type
of thyrotoxicosis, is a state of hypermetabolism.
The increased metabolic rate generates heat and
produces tachycardia and fine muscle tremors.
Anorexia is associated with hypothyroidism. Loss of
weight, despite a good appetite and adequate caloric
intake, is a common feature of hyperthyroidism.
Cold skin is associated with hypothyroidism.
CN: Physiological adaptation;
CL: Analyze
- 2. When conducting a health history with a
female client with thyrotoxicosis, the nurse should
ask about which of the following changes in the
menstrual cycle?
■ 1. Dysmenorrhea.
■ 2. Metrorrhagia.
■ 3. Oligomenorrhea.
■ 4. Menorrhagia. - -3. A change in the menstrual interval, diminished
menstrual flow (oligomenorrhea), or even the
absence of menstruation (amenorrhea) may result
from the hormonal imbalances of thyrotoxicosis.
Oligomenorrhea in women and decreased libido and
impotence in men are common features of thyrotoxicosis. Dysmenorrhea
is painful menstruation.
Metrorrhagia, blood loss between menstrual periods, is a symptom of
hypothyroidism. Menorrhagia,
excessive bleeding during menstrual periods, is a
symptom of hypothyroidism.
CN: Physiological adaptation;
CL: Analyze
- 3. A 34-year-old female is diagnosed with hypothyroidism. The nurse
should assess the client for
which of the following? Select all that apply.
■ 1. Rapid pulse.
,■ 2. Decreased energy and fatigue.
■ 3. Weight gain of 10 lb.
■ 4. Fine, thin hair with hair loss.
■ 5. Constipation.
■ 6. Menorrhagia. - -2, 3, 5, 6. Clients with hypothyroidism
exhibit symptoms indicating a lack of thyroid hormone. Bradycardia,
decreased energy and lethargy,
memory problems, weight gain, coarse hair, constipation, and
menorrhagia are common signs and
symptoms of hypothyroidism.
CN: Physiological adaptation;
CL: Analyze
- 4. Propylthiouracil (PTU) is prescribed for a client with Graves' disease.
The nurse should teach the
client to immediately report which of the following?
■ 1. Sore throat.
■ 2. Painful, excessive menstruation.
■ 3. Constipation.
■ 4. Increased urine output. - -1. The most serious adverse effects of PTU
are
leukopenia and agranulocytosis, which usually occur
within the first 3 months of treatment. The client
should be taught to promptly report to the health care
provider signs and symptoms of infection, such as a
sore throat and fever. Clients complaining of a sore
throat and fever should have an immediate white
blood cell count and differential performed, and the
drug must be withheld until the results are obtained.
Painful menstruation, constipation, and increased
urine output are not associated with PTU therapy.
CN: Pharmacological and parenteral
therapies; CL: Synthesize
- 5. 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?
■ 1. "Your behavior is caused by temporary confusion brought on by your
illness."
■ 2. "Your behavior is caused by the excess thyroid hormone in your
system."
■ 3. "Your behavior is caused by your worrying
about the seriousness of your illness."
■ 4. "Your behavior is caused by the stress of trying to manage a career
and cope with illness." - -2. A typical sign of thyrotoxicosis is irritability
caused by the high levels of circulating thyroid
hormones in the body. This symptom decreases
,as the client responds to therapy. Thyrotoxicosis
does not cause confusion. The client may be worried about her illness, and
stress may influence her
mood; however, irritability is a common symptom of
thyrotoxicosis and the client should be informed of
that fact rather than blamed.
CN: Psychosocial adaptation;
CL: Synthesize
- 6. 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?
■ 1. Elevated thyroid hormone concentrations and
normal TSH.
■ 2. Elevated TSH and normal thyroid hormone
concentrations.
■ 3. Decreased thyroid hormone concentrations
and elevated TSH.
■ 4. Elevated thyroid hormone concentrations and
decreased TSH. - -6. 4. Elevated serum concentrations of thyroid
hormones and suppressed serum TSH are the features of thyrotoxicosis.
Decreased or absent serum
TSH is a very accurate indicator of thyrotoxicosis.
Increased levels of circulating thyroid hormones
cause the feedback mechanism to the brain to suppress TSH secretion.
CN: Physiological adaptation;
CL: Analyze
- 7. The nurse should teach the client to prevent
corneal irritation from mild exophthalmos by:
■ 1. Massaging the eyes at regular intervals.
■ 2. Instilling an ophthalmic anesthetic as
ordered.
■ 3. Wearing dark-colored glasses.
■ 4. Covering both eyes with moistened gauze
pads. - -7. 3. Treatment of mild ophthalmopathy that
may accompany thyrotoxicosis includes measures
such as wearing sunglasses to protect the eyes from
corneal irritation. Treatment of ophthalmopathy
should be performed in consultation with an ophthalmologist. Massaging
the eyes will not help to
protect the cornea. An ophthalmic anesthetic is
used to examine and possibly treat a painful eye,
not protect the cornea. Covering the eyes with moist
gauze pads is not a satisfactory nursing measure
to protect the eyes of a client with exophthalmos
because treatment is not focused on moisture to the
, eye but rather on protecting the cornea and optic
nerve. In exophthalmos, the retrobulbar connective tissues and
extraocular muscle volume are
expanded because of fluid retention. The pressure is
also increased.
CN: Reduction of risk potential;
CL: Synthesize
- 8. A client with Graves' disease is treated with
radioactive iodine (RAI) in the form of sodium
iodide 131I. Which of the following statements by the
nurse will explain to the client how the drug works?
■ 1. "The radioactive iodine stabilizes the thyroid
hormone levels before a thyroidectomy."
■ 2. "The radioactive iodine reduces uptake of
thyroxine and thereby improves your condition."
■ 3. "The radioactive iodine lowers the levels of
thyroid hormones by slowing your body's
production of them."
■ 4. "The radioactive iodine destroys thyroid tissue so that thyroid
hormones are no longer
produced." - -8. 4. Sodium iodide 131I destroys the thyroid
follicular cells, and thyroid hormones are no longer
produced. RAI is commonly recommended for clients with Graves' disease,
especially the elderly. The
treatment results in a "medical thyroidectomy." RAI
is given in lieu of surgery, not before surgery. RAI
does not reduce uptake of thyroxine. The outcome
of giving RAI is the destruction of the thyroid follicular cells. It is possible
to slow the production of
thyroid hormones with RAI.
CN: Pharmacological and parenteral
therapies; CL: Synthesize
- 9. After treatment with radioactive iodine (RAI)
in the form of sodium iodide 131I, the nurse teaches
the client to:
■ 1. Monitor for signs and symptoms of hyperthyroidism.
■ 2. Rest for 1 week to prevent complications of
the medication.
■ 3. Take thyroxine replacement for the remainder
of the client's life.
■ 4. Assess for hypertension and tachycardia
resulting from altered thyroid activity - -9. 3. The client needs to be
educated about the
need for lifelong thyroid hormone replacement. Permanent
hypothyroidism is the major complication
of RAI 131I treatment. Lifelong medical follow-up
and thyroid replacement are warranted. The client
Endocrine Health Problems
1. The nurse is completing a health assessment
of a 42-year-old female with suspected Graves' disease. The nurse should
assess this client for:
■ 1. Anorexia.
■ 2. Tachycardia.
■ 3. Weight gain.
■ 4. Cold skin. - -2. Graves' disease, the most common type
of thyrotoxicosis, is a state of hypermetabolism.
The increased metabolic rate generates heat and
produces tachycardia and fine muscle tremors.
Anorexia is associated with hypothyroidism. Loss of
weight, despite a good appetite and adequate caloric
intake, is a common feature of hyperthyroidism.
Cold skin is associated with hypothyroidism.
CN: Physiological adaptation;
CL: Analyze
- 2. When conducting a health history with a
female client with thyrotoxicosis, the nurse should
ask about which of the following changes in the
menstrual cycle?
■ 1. Dysmenorrhea.
■ 2. Metrorrhagia.
■ 3. Oligomenorrhea.
■ 4. Menorrhagia. - -3. A change in the menstrual interval, diminished
menstrual flow (oligomenorrhea), or even the
absence of menstruation (amenorrhea) may result
from the hormonal imbalances of thyrotoxicosis.
Oligomenorrhea in women and decreased libido and
impotence in men are common features of thyrotoxicosis. Dysmenorrhea
is painful menstruation.
Metrorrhagia, blood loss between menstrual periods, is a symptom of
hypothyroidism. Menorrhagia,
excessive bleeding during menstrual periods, is a
symptom of hypothyroidism.
CN: Physiological adaptation;
CL: Analyze
- 3. A 34-year-old female is diagnosed with hypothyroidism. The nurse
should assess the client for
which of the following? Select all that apply.
■ 1. Rapid pulse.
,■ 2. Decreased energy and fatigue.
■ 3. Weight gain of 10 lb.
■ 4. Fine, thin hair with hair loss.
■ 5. Constipation.
■ 6. Menorrhagia. - -2, 3, 5, 6. Clients with hypothyroidism
exhibit symptoms indicating a lack of thyroid hormone. Bradycardia,
decreased energy and lethargy,
memory problems, weight gain, coarse hair, constipation, and
menorrhagia are common signs and
symptoms of hypothyroidism.
CN: Physiological adaptation;
CL: Analyze
- 4. Propylthiouracil (PTU) is prescribed for a client with Graves' disease.
The nurse should teach the
client to immediately report which of the following?
■ 1. Sore throat.
■ 2. Painful, excessive menstruation.
■ 3. Constipation.
■ 4. Increased urine output. - -1. The most serious adverse effects of PTU
are
leukopenia and agranulocytosis, which usually occur
within the first 3 months of treatment. The client
should be taught to promptly report to the health care
provider signs and symptoms of infection, such as a
sore throat and fever. Clients complaining of a sore
throat and fever should have an immediate white
blood cell count and differential performed, and the
drug must be withheld until the results are obtained.
Painful menstruation, constipation, and increased
urine output are not associated with PTU therapy.
CN: Pharmacological and parenteral
therapies; CL: Synthesize
- 5. 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?
■ 1. "Your behavior is caused by temporary confusion brought on by your
illness."
■ 2. "Your behavior is caused by the excess thyroid hormone in your
system."
■ 3. "Your behavior is caused by your worrying
about the seriousness of your illness."
■ 4. "Your behavior is caused by the stress of trying to manage a career
and cope with illness." - -2. A typical sign of thyrotoxicosis is irritability
caused by the high levels of circulating thyroid
hormones in the body. This symptom decreases
,as the client responds to therapy. Thyrotoxicosis
does not cause confusion. The client may be worried about her illness, and
stress may influence her
mood; however, irritability is a common symptom of
thyrotoxicosis and the client should be informed of
that fact rather than blamed.
CN: Psychosocial adaptation;
CL: Synthesize
- 6. 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?
■ 1. Elevated thyroid hormone concentrations and
normal TSH.
■ 2. Elevated TSH and normal thyroid hormone
concentrations.
■ 3. Decreased thyroid hormone concentrations
and elevated TSH.
■ 4. Elevated thyroid hormone concentrations and
decreased TSH. - -6. 4. Elevated serum concentrations of thyroid
hormones and suppressed serum TSH are the features of thyrotoxicosis.
Decreased or absent serum
TSH is a very accurate indicator of thyrotoxicosis.
Increased levels of circulating thyroid hormones
cause the feedback mechanism to the brain to suppress TSH secretion.
CN: Physiological adaptation;
CL: Analyze
- 7. The nurse should teach the client to prevent
corneal irritation from mild exophthalmos by:
■ 1. Massaging the eyes at regular intervals.
■ 2. Instilling an ophthalmic anesthetic as
ordered.
■ 3. Wearing dark-colored glasses.
■ 4. Covering both eyes with moistened gauze
pads. - -7. 3. Treatment of mild ophthalmopathy that
may accompany thyrotoxicosis includes measures
such as wearing sunglasses to protect the eyes from
corneal irritation. Treatment of ophthalmopathy
should be performed in consultation with an ophthalmologist. Massaging
the eyes will not help to
protect the cornea. An ophthalmic anesthetic is
used to examine and possibly treat a painful eye,
not protect the cornea. Covering the eyes with moist
gauze pads is not a satisfactory nursing measure
to protect the eyes of a client with exophthalmos
because treatment is not focused on moisture to the
, eye but rather on protecting the cornea and optic
nerve. In exophthalmos, the retrobulbar connective tissues and
extraocular muscle volume are
expanded because of fluid retention. The pressure is
also increased.
CN: Reduction of risk potential;
CL: Synthesize
- 8. A client with Graves' disease is treated with
radioactive iodine (RAI) in the form of sodium
iodide 131I. Which of the following statements by the
nurse will explain to the client how the drug works?
■ 1. "The radioactive iodine stabilizes the thyroid
hormone levels before a thyroidectomy."
■ 2. "The radioactive iodine reduces uptake of
thyroxine and thereby improves your condition."
■ 3. "The radioactive iodine lowers the levels of
thyroid hormones by slowing your body's
production of them."
■ 4. "The radioactive iodine destroys thyroid tissue so that thyroid
hormones are no longer
produced." - -8. 4. Sodium iodide 131I destroys the thyroid
follicular cells, and thyroid hormones are no longer
produced. RAI is commonly recommended for clients with Graves' disease,
especially the elderly. The
treatment results in a "medical thyroidectomy." RAI
is given in lieu of surgery, not before surgery. RAI
does not reduce uptake of thyroxine. The outcome
of giving RAI is the destruction of the thyroid follicular cells. It is possible
to slow the production of
thyroid hormones with RAI.
CN: Pharmacological and parenteral
therapies; CL: Synthesize
- 9. After treatment with radioactive iodine (RAI)
in the form of sodium iodide 131I, the nurse teaches
the client to:
■ 1. Monitor for signs and symptoms of hyperthyroidism.
■ 2. Rest for 1 week to prevent complications of
the medication.
■ 3. Take thyroxine replacement for the remainder
of the client's life.
■ 4. Assess for hypertension and tachycardia
resulting from altered thyroid activity - -9. 3. The client needs to be
educated about the
need for lifelong thyroid hormone replacement. Permanent
hypothyroidism is the major complication
of RAI 131I treatment. Lifelong medical follow-up
and thyroid replacement are warranted. The client
