Caring for the Adult Unit 3 Study Guide
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Ductless gland that produces an internal secretion discharged into the lymph or bloodstream and circulated to all parts of the body' hormones, the active substances of these glands, cause an effect on certain organs or tissues.
Disease resulting from a deficiency of adrenocorticotropic hormone (ACTH) caused by destruction or dysfunction of the adrenal glands' characterized by increased pigmentation of the skin and mucous membranes, weakness, fatigue, hypotension, nausea, weight loss, and hypoglycemia.
Disease caused by inadequate secretion of antidiuretic hormone (ADH) by the posterior pituitary gland; symptoms include excessive urination, thirst, and dehydration
Disease of middle-aged adults resulting from overproduction of growth hormone (GH) by the anterior pituitary gland' characterized by enlargement of the facial bones, nose, lips, and jaw' also associated with decreased libido, moodiness, fatigue, muscle pains, sweating, and headache.
Type of hormone secreted by the adrenal cortex and involved in the regulation of fluid and electrolyte levels in the body.
Disorder caused by excess antidiuretic hormone production' symptoms include decreased urination, edema, and fluid overload
syndrome of inappropriate antidiuretic hormone (SIADH)
Disorder resulting from excessive glucocorticoids in the body as a result of tumor or hypersecretion of the pituitary' may also be caused by prolonged administration of large doses of exogenous steroids; symptoms include fat deposits in the neck and abdomen, fatigue, weakness, edema, excess hair growth, glucose intolerances, skin discoloration, and mood swings.
Class of adrenocortical hormones that affects protein and carbohydrate metabolism and helps protect the body against stress.
Chemical (dopamine, epinephrine, norepinephrine) released at sympathetic nerve endings in response to stress
Hormones produced by the ovaries, adrenal glands, and fetoplacental unit in females that are responsible for the development and maturation of females
Disease caused by excessive growth hormone in children and young adolescents, resulting in excessive proportional growth
Disease caused by the hypersecretion of glucocorticoids as a result of excessive release of adrenocorticotropic hormone by the pituitary gland
Hormones produced by the adrenal cortex and testes that stimulate the development of male characteristics
Surgical removal of all or part of the pituitary gland
Epinephrine; a powerful vasoactive substance produced by the medulla or adrenal glands in times of stress or danger, allowing the body to react by fighting or fleeing
Often the first symptom of a problem in hyper pituitarism
Radiographic films of the skull of people with hyperpituitarism may show a large sella turcica and increased .
The treatment of choice for patients with a diagnosis of pituitary tumors
A disease that occurs in early childhood or puberty in which the diaphyses of the long bones grows to great lengths stimulated by excess GH.
A disease that appears when adults are in their 30s and 40s in which bones increase in thickness and width after epiphyseal closure.
A syndrome characterized by a water imbalance related to an increase in ADH secretion is called .
Kidneys retain fluid due to the elevation of .
Plasma volume expands when ADH is elevated in SIADH, causing an increased .
When the ADH level is elevated, the patient experiences water intoxication and the body's sodium is diluted, resulting in .
Weight gain without edema is one of the main symptoms of .
The treatment of SIADH promotes the elimination of .
In patients with SIADH, fluids are restricted and patients are given .
Patients with SIADH have fluid volume excess related to excess secretion of .
A test that is necessary for a definitive diagnosis of hypoadrenalism, such as Addison's disease, is .
ACTH stimulation test
The mainstay of treatment of patients with Addison's disease is replacement therapy with mineralocorticoids and .
Potassium excretion is decreased when cortisol is not secreted, resulting in .
Secondary adrenal insufficiency is a result of dysfunction of the hypothalamus or the .
Decreased levels of aldosterone alter the clearance of potassium, water, and .
When sodium and water excretion rates accelerate, resulting problems are hyponatremia and .
Acute adrenal crisis is also called .
Impaired secretion of cortisol results in decreased liver and muscle glycogen and decreased .
Secondary adrenal insufficiency is also called .
Primary adrenal insufficiency is also called .
Decreased supply of available glucose which occurs as a result of impaired secretion of cortisol is called .
Patients with either primary or secondary adrenal insufficiency are at risk for episodes of .
A condition that occurs because hyperkalemia promotes hydrogen ion retention is .
Stimulates the growth and development of bone, muscles, or organs
Controls ovulation or egg release in the female and testosterone production in the male
Controls the release of glucocorticoids and adrenal androgens
Stimulates the development of eggs in the ovary of the female and the production of sperm in the testes of the male.
Another name for the somatotrophic hormone
Stimulates breast milk production in the female
Another name for the lactogenic hormone
Causes the reabsorption of water from the renal tubules of the kidney
Causes contractions of the uterus in labor and the release of breast milk
Another name for vasopressin
Controls the secretory activities of the thyroid gland
Increased plasma osmolarity stimulates the osmoreceptors, which in turn relay information to the cerebral cortex, causing the person to experience .
Massive dehydration leads to severe imbalances.
With ADH deficiency, massive dehydration occurs, which leads to decreased intravascular volume, circulatory collapse, and .
Electrolyte imbalances contribute to circulatory collapse by causing arrhythmias and impaired contractility of the .
Massive diuresis results in increased plasma .
Used to detect diabetes mellitus and hyperpituitarism
glucose tolerance test
Serum levels are measured to detect elevation or deficiencies of pituitary hormones
pituitary hormone serum levels
Given to stimulate release of ADH to detect DI
hypertonic saline test
Measures cortisol, which increases with adrenal hyperplasia and Cushing's syndrome
dexamethasone suppression tests
Detects changes in specific gravity and osmolality after vasopressin is given; used to detect DI
fluid deprivation test
Radiographs taken to study cerebral blood flow and blood vessels
Uses radiographs to create images of internal structures and detect tumors
cerebral computed tomography scan
In the health older person, there may be increased secretion of ADH, which may lead to:
a. fluid imbalance.
The production of excess GH may lead to the development of:
a. atherosclerosis and hyperglycemia.
b. edema and congestive heart failure.
c. dyspnea and pneumonia.
d. oliguria and kidney failure.
GH antagonizes insulin and interferes with its effects, thus leading to:
Because growth hormone mobilizes stored fat for energy, levels of free fatty acids are elevated in the bloodstream, leading to the development of:
b. kidney failure
Visual problems occur in hyperpituitarism due to pressure on the:
a. occipital lobe.
b. optic nerves.
c. frontal lobe.
d. oculomotor nerves.
Patients with gigantism and acromegaly initially present with increased strength, progressing rapidly to complaints of:
a. hypotension and syncope.
b. weakness and fatigue.
c. edema and dry skin.
d. dehydration and bradycardia.
One drug commonly prescribed for patients with acromegaly is:
a. octreotide (Sandostatin).
b. furosemide (Lasix).
c. levothyroxine (Synthroid).
A common nursing diagnosis for patients with hyperpituitarism is:
a. Altered tissue perfusion.
b. Altered skin integrity.
c. High risk for infection.
d. Disturbed body image.
Bromocroptine (Parlodel) inhibits the release of prolactin and GH from:
a. antidiuretic hormone.
b. the thyroid gland.
c. the adrenal gland.
d. the pituitary gland.
Strict documentation of intake and output and measurement of specific gravity are important because postoperative hypophysectomy patients are at risk for:
a. congestive heart failure.
b. kidney failure.
A bedside test can be done with a chemical strip to detect whether drainage in a postoperative hypophysectomy patient is cerebrospinal fluid (CSF), because CSF has a high content of:
c. white blood cells.
d. red blood cells.
Decreased pigmentation of the skin results in:
The patient who has a complete hypophysectomy requires hormone replacement:
b. during the postoperative recovery period.
c. for 6 months to 1 year.
d. for a lifetime.
In patients with hypopituitarism, insufficient thyroid hormone is available for normal metabolism and:
a. visual acuity.
b. muscle tone.
c. heat production.
d. bone growth.
If there is a lack of melanocyte-stimulating hormones, the skin exhibits decreased:
a. sensory perception.
To produce or maintain libido, secondary sexual characteristics, and well-being, males with hypopituitarism should receive:
c. levothyroxine (Synthroid).
d. bromocriptine (Parlodel).
Drug-related DI is often caused by:
a. bromocriptine (Parlodel).
b. lithium carbonate (Eskalith).
c. levothyroxine (Synthroid).
A 24-hour urine output of greater than 4 liters of fluid suggests a diagnosis of:
b. kidney infection.
c. congestive heart failure.
In order to maintain adequate blood volume in patients with DI, two measures that are required include intravenous fluid volume replacement and:
The level of consciousness deteriorates and the patient may have seizures or lapse into a coma when water intoxication affects the:
a. respiratory system.
b. urinary system.
c. cardiovascular system.
d. central nervous system.
In postmenopausal women, the primary source of endogenous estrogen is the:
b. thyroid gland.
c. adrenal cortex.
d. ovarian follicle.
A common skin finding in patients with adrenal dysfunction is:
a. protruding bones.
c. bronze pigmentation.
An age-related change that affects the adrenal glands is that adrenal function:
a. decreases in epinephrine.
b. remains adequate.
c. becomes hyperactive.
d. increases in metabolism.
What is a common sign of DI?
a. Massive diuresis
Which is the most common cause of Cushing's syndrome?
a. Prolonged administration of high doses of corticosteroids.
b. Corticotropin-secreting pituitary tumor
c. Truncal obesity
d. Protein wasting
In the immediate postoperative period of adrenalectomy patients, which medication is needed to maintain blood pressure?
c. Beta blockers
Which are appropriate nursing diagnoses for patients with Cushing's syndrome? (Select all that apply.)
a. Risk for injury (fracture)
b. Risk for impaired skin integrity
c. Disturbed body image
d. Fluid volume deficit
e. Ineffective self health management
f. Disturbed thought processes
g. Risk for infection
a, b, c, e, f, g
Which of the following are age-related changes in the health older person regarding pituitary function? (Select all that apply.)
a. Pituitary function is not adequate.
b. ADH secretion may be increased.
c. Ability to concentrate urine may be decreased.
d. Risk for dehydration decreases
The nurse is monitoring the postoperative hypophysectomy patient for signs and symptoms of infection. Which are signs and symptoms that may be indications of meningitis? (Select all that apply.)
a. Decreased white blood cell (WBC) count
b. Sudden rise in temperature
d. Neck rigidity
b, c, d
Which medications are given as hormone replacement therapy following a complete hypophysectomy? (Select all that apply.)
a. Pituitary hormone suppressants
b. Dopamine receptor antagonists
d. Thyroid medications
The postoperative hypophysectomy patient is instructed to avoid any activities that can cause Valsalva's maneuver. Which activities may create enough intracranial pressure to disrupt the surgical site and cause CSF leakage? (Select all that apply.)
a. Passive range-of-motion exercises
b, c, d
Which are manifestations of acute adrenal crisis (addisonian crisis)? (Select all that apply.)
b, c, d, e, f
Which types of stressors can initiate acute adrenal crisis (addisonian crisis)? (Select all that apply.)
c. Steroid therapy use
a, b, d
Which are diagnostic test results used to determine the presence of Addison's disease? Select all that apply.)
a. Decreased fasting glucose
b. Decreased BUN
d. ECG changes of increased peaked T waves
a, c, d
A patient has been admitted to the hospital with Addison's disease. Which problem would the nurse expect to see in this patient?
a. Excess fluid volume related to excess ADH secretion
b. Risk for infection related to high serum cortisol levels
c. Ineffective tissue perfusion related to electrolyte imbalances
d. Fluid volume deficit related to excessive urine output
Changes in assessment findings following hypophysectomy that may reflect edema due to the manipulation of tissues or bleeding intracranially include:
a. unequal pupil size.
b. decreasing alertness.
c. decreasing blood pressure.
d. rising body temperature.
Following hypophysectomy, the nurse asks the patient to place the chin to the chest to assess for nuchal rigidity, which is associated with:
a. bone density.
b. meningeal irritation.
c. cerebral edema.
d. impaired circulation.
Because CSF leaks sometimes occur un postoperative hypophysectomy patients, the nurse should check:
a. intake and output.
b. pupil reactivity.
c. nasal packing.
d. vital signs.
Deficiency of thyroid-stimulating hormones necessitates thyroid replacement with a drug such as:
a. octreotide acetate (Sandostatin).
b. bromocriptine (Parlodel).
c. levothyroxine (Synthroid).
d. vasopressin (Pitressin Syntheric).
A nursing diagnosis for patients with SIADH is Risk for injury related to confusion associated with:
a. acute adrenal insufficiency.
b. impaired physiologic response to stress.
c. water intoxication.
d. decreased ADH secretion.
To prevent progressive cerebral edema in patients with SIADH, patients are placed in which position in bed?
The response to sodium restriction and position changes is less efficient in older adults because of declines in the secretion of plasma renin and:
Signs and symptoms of hyperkalemia that should be reported to the physician by patients with Addison's disease include:
a. dyspnea and coughing.
b. oliguria and flank pain.
c. constipation and fatty stools.
d. weakness and paresthesia.
Which substance may be used liberally in the diet of patients with Addison's disease?
c. Saturated fats
What is a priority nursing diagnosis specific to the patient who has had an adrenalectomy?
a. Ineffective tissue perfusion related to fluid volume deficit
b. Risk for injury related to acute adrenal insufficiency
c. Fatigue related to fluid and electrolyte imbalance
d. Risk for injury related to infection
Which are appropriate nursing interventions for patients with Cushing's syndrome? (Select all that apply.)
a. Avoid exposure to infections
b. Report minor signs, such as low-grade fever, sore throat, or aches to the physician
c. Seek a psychiatric referral if mood swings continue to be a problem
d. Assist patient to change positions at least every 2 hours
e. Protect patient from falls or trauma
f. Discuss bruises, abnormal fat distribution, and hirsutism with the patient if they cause embarrassment
g. Teach patient about the importance of continuing drug therapy
a, b, c, d, e, f, g
Facial edema that develops with severe, long-term hypothyroidism; sometimes used as a synonym for hypothyroidism.
Enlargement of the thyroid gland, causing ht neck to appear swollen
Steady muscle contraction caused by hypocalcemia
Small mass of tissue that can be palpated
Spasmodic closure of the larynx
Permanent mental and physical retardation caused by congenital deficiency of thyroid hormones
Excessive metabolic stimulation caused by elevated thyroid hormone level
Inflammation of the parotid (salivary) gland
Inflammation of the thyroid gland
Substance that suppresses thyroid function
Protrusion of the eyeballs associated with hyperthyroidism
Which are signs and symptoms of poor oxygenation due to airway obstruction that may occur after thyroidectomy? (Select all that apply.)
b. Increased pulse
c. Increased temperature
f. Cold intolerance
a, b, e
Which are signs of laryngeal nerve damage that may occur after thyroidectomy? (Select all that apply.)
c. Inability to speak
Which are signs of sever hyperthyroidism that may occur after thyroidectomy? (Select all that apply.)
b, c, d
Which are true statements about complications following thyroidectomy? (Select all that apply.)
a. A complication involving injury to parathyroid glands results in tetany.
b. Symptoms of infection that should be reported after thyroidectomy include fever, wound swelling, and foul discharge.
c. The most serious side effect of hypocalcemia is dyspnea.
d. Laryngospasm can be prevented by preoperative treatment with parathyroid drugs.
Which is secreted when serum calcium levels are high to limit the shift of calcium from the bones into the blood?
Hyperthyroid patients often experience sleep disturbances and:
Poor tolerance of heat and excessive perspiration are symptoms of:
If untreated, hyperthyroidism may lead to:
a. thyrotoxicosis (thyroid storm).
d. decreased metabolism.
Signs of iodine toxicity include:
a. bradycardia and hypotension.
b. urinary retention and oliguria.
c. esophageal ulcers and pyloric sphincter spasms.
d. swelling and irritation of mucous membranes and increased salivation.
Elevated thyroid hormones result in:
a. Decreased pulse and blood pressure.
b. Increased pulse and blood pressure.
c. decreased temperature and susceptibility to infection.
d. increased temperature and susceptibility to infection.
An important nursing diagnosis for the patient with exophthalmos is:
a. Risk for infection.
b. Knowledge deficit (of disease process).
c. Decreased cardiac output.
d. Disturbed body image.
A complication of thyroidectomies includes injury to the parathyroid glands, which results in:
Results of two tests that are indicative of hypocalcemia are:
a. positive Chvostek's and Trousseau's signs.
b. increased blood urea nitrogen and potassium levels.
c. increased WBC and decreased RBC levels.
d. increased phosphorus and decreased iodine levels.
An early symptom of tetany is:
a. flank pain with hematuria.
b. difficulty breathing.
c. a tingling sensation around the mouth, fingers, and toes.
d. muscle cramps in leg and arm muscles.
Graves' disease (toxic diffuse goiter) is characterized by:
a. increased secretion of thyroid hormones.
b. a decreased metabolic rate.
c. intolerance to cold.
Which drug stains the teeth and should be sipped through a straw?
b. Saturated solution of potassium iodide (SSKI)
c. Levothyroxine (Synthroid)
In patients with toxic diffuse goiter, there is a risk for injury related to:
a. increased metabolic energy production.
c. increased thyroid hormone stimulation.
d. intolerance to heat.
Lack of iodine is associated with:
Thyroxine (T4), triiodothyronine (T3), and calcitonin are hormones produced by the:
a. adrenal gland.
b. thymus gland.
c. thyroid gland.
d. parathyroid gland.
Which drug is used to treat hypothyroidism?
c. Methimazole (Tapazole)
d. Lugol's solution
If thyroid enlargement is mild and thyroid hormone production is normal, what treatment is required?
a. No treatment
b. Radioactive iodine
c. Antithyroid medication
d. Thyroid replacement therapy
Which statements are true about hyperparathyroidism? (Select all that apply.)
a. PTH plays a critical role in regulating sodium.
b. The most notable effect of hyperparathyroidism is hypercalcemia.
c. People who undergo kidney transplantation after being on dialysis for a long time may experience hyperparathyroidism.
d. When the serum calcium level falls, PTH is secreted.
e. A spasm of the facial muscle when the face is tapped over the facial nerve is Chvostek's sign.
f. A carpopedal spasm that occurs when a blood pressure cuff is inflated beyond a patient's systolic blood pressure and is left in place for several minutes is Trousseau's sign.
b, c, d, f
Which are manifestations of hyperparathyroidism? (Select all that apply.)
b. Poor muscle tone
c. Bone pain
b, c, d, e, f
Which two things should be placed at the bedside before the patient who is having a thyroidectomy returns from surgery? (Select two that apply.)
a. Thromboembolic stockings
b. Suction equipment
c. Emergency tracheotomy tray
What are two reasons that respiratory distress can result following thyroidectomy? (Select two that apply.)
a. Compression of the trachea
b. Aspiration leading to atelectasis
c. Spasms of the larynx due to nerve damage or hypocalcemia
Following thyroidectomy surgery, where should the nurse check for bleeding? (Select all that apply.)
a. Inspect the dressing on the front of the neck.
b. Check behind the neck.
c. Check in the midclavicular area.
A patient has had thyroidectomy surgery and asks why the surgery will be followed with radioactive iodine treatment. The nurse should respond that the purpose of this treatment is to:
a. stimulate the thyroid gland to produce thyroxine.
b. inhibit the thyroid-stimulating hormone produced by the pituitary gland.
c. decrease the activity of the thyroid gland and decrease the thyroid hormones.
d. destroy any remaining tissue that might contain malignant cells
Which statements are true about hyperthyroidism? (Select all that apply.)
a. Symptoms of thyrotoxicosis include tachycardia, heart failure, and hyperthermia.
b. The two classes of drugs commonly used as antithyroid drugs are iodides and thyroid hormones.
c. When a patient is taking drugs that interfere with thyroxine secretion, the nurse should monitor for edema, weight gain, and cold intolerance.
d. Examples of antithyroid thioamides are methimazole (Tapazole) and propylthiouriacil (PTU).
e. One main disadvantage of the thiomides is that they can cause agranulocytosis.
a, c, d, e
Which patient problems are seen in patients with hyperthyroidism? (Select all that apply.)
a. Hyperthermia related to increased metabolic energy production
b. Ineffective airway clearance related to laryngeal spasm
c. Risk for impaired skin integrity related to dryness and edema
d. Risk for injury related to hypocalcemia
e. Risk for injury related to weakness and decreased bone mass
f. Risk for injury related to exophthalmos
g. Decreased cardiac output related to excessive thyroid hormone stimulation
a, f, g
Which patient problems are seen in patients who have had a thyroidectomy? (Select all that apply.)
a. Hypothermia related to cold intolerance
b. Impaired urinary elimination related to urinary calculi
c. Decreased cardiac output related to dysrhythmias and heart failure secondary to hypocalcemia
d. Decreased cardiac output related to blood loss
e. Ineffective airway clearance related to laryngeal spasm
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