Deck 51: Assessment and Management of Patients With Endocrine Disorders

Question 1

The nurse is caring for a patient diagnosed with hypothyroidism secondary to Hashimotos thyroiditis. When assessing this patient, what sign or symptom would the nurse expect?

A) Fatigue
B) Bulging eyes
C) Palpitations
D) Flushed skin

Answer 1

Fatigue

Question 2

A patient has been admitted to the post-surgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the patient?

A) Side-lying (lateral) with one pillow under the head
B) Head of the bed elevated 30 degrees and no pillows placed under the head
C) Semi-Fowlers with the head supported on two pillows
D) Supine, with a small roll supporting the neck

Answer 2

Semi-Fowlers with the head supported on two pillows

Question 3

A patient with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the patient should prioritize what question when addressing
Potential complications?

A) Do you feel any muscle twitches or spasms?
B) Do you feel flushed or sweaty?
C) Are you experiencing any dizziness or lightheadedness?
D) Are you having any pain that seems to be radiating from your bones?

Answer 3

Do you feel any muscle twitches or spasms?

Question 4

The nurse is caring for a patient with a diagnosis of Addisons disease. What sign or symptom is most closely associated with this health problem?

A) Truncal obesity
B) Hypertension
C) Muscle weakness
D) Moon face

Question 5

The nurse is caring for a patient with Addisons disease who is scheduled for discharge. When teaching the patient about hormone replacement therapy, the nurse should address what topic?

A) The possibility of precipitous weight gain
B) The need for lifelong steroid replacement
C) The need to match the daily steroid dose to immediate symptoms
D) The importance of monitoring liver function

Question 6

The nurse is teaching a patient that the body needs iodine for the thyroid to function. What food would be the best source of iodine for the body?

A) Eggs
B) Shellfish
C) Table salt
D) Red meat

Question 7

A patient is prescribed corticosteroid therapy. What would be priority information for the nurse to give the patient who is prescribed long-term corticosteroid therapy?

A) The patients diet should be low protein with ample fat.
B) The patient may experience short-term changes in cognition.
C) The patient is at an increased risk for developing infection.
D) The patient is at a decreased risk for development of thrombophlebitis and thromboembolism.

Question 8

A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding?

A) Glucose in the urine
B) Albumin in the urine
C) Highly dilute urine
D) Leukocytes in the urine

Question 9

The nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve?

A) Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3 hours
B) Administration of dexamethasone IV, followed by an $\mathrm{x}$ -ray of the adrenal glands
C) Administration of dexamethasone orally at $11 \mathrm{PM}$ , and a plasma cortisol level at $8 \mathrm{AM}$ the next morning
D) Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after the drug is administered

Question 10

You are developing a care plan for a patient with Cushing syndrome. What nursing diagnosis would have the highest priority in this care plan?

A) Risk for injury related to weakness
B) Ineffective breathing pattern related to muscle weakness
C) Risk for loneliness related to disturbed body image
D) Autonomic dysreflexia related to neurologic changes

Question 11

The nurse is performing a shift assessment of a patient with aldosteronism. What assessments should the nurse include? Select all that apply.

A) Urine output
B) Signs or symptoms of venous thromboembolism
C) Peripheral pulses
D) Blood pressure
E) Skin integrity

Question 12

The home care nurse is conducting patient teaching with a patient on corticosteroid therapy. To achieve consistency with the bodys natural secretion of cortisol, when would the home care nurse instruct the patient to take his or her corticosteroids?

A) In the evening between 4 PM and 6 PM
B) Prior to going to sleep at night
C) At noon every day
D) In the morning between $7 \mathrm{AM}$ and $8 \mathrm{AM}$

Question 13

A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a documented history of adrenal insufficiency. Considering the patients history and current symptoms, the nurse should anticipate that the patient will be instructed to do which of the following?

A) Increase his intake of sodium until the GI symptoms improve.
B) Increase his intake of potassium until the GI symptoms improve.
C) Increase his intake of glucose until the GI symptoms improve.
D) Increase his intake of calcium until the GI symptoms improve.

Question 14

The nurse is caring for a patient with hyperparathyroidism. What level of activity would the nurse expect to promote?

A) Complete bed rest
B) Bed rest with bathroom privileges
C) Out of bed (OOB) to the chair twice a day
D) Ambulation and activity as tolerated

Question 15

While assisting with the surgical removal of an adrenal tumor, the OR nurse is aware that the patients vital signs may change upon manipulation of the tumor. What vital sign changes would the nurse expect to see?

A) Hyperthermia and tachypnea
B) Hypertension and heart rate changes
C) Hypotension and hypothermia
D) Hyperthermia and bradycardia

Question 16

A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal?

A) Hyponatremia
B) Hypophosphatemia
C) Hypocalcemia
D) Hypokalemia

Question 17

The nurse is planning the care of a patient with hyperthyroidism. What should the nurse specify in the patients meal plan?

A) A clear liquid diet, high in nutrients
B) Small, frequent meals, high in protein and calories
C) Three large, bland meals a day
D) A diet high in fiber and plant-sourced fat

Question 18

A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on the critical care unit. The priority nursing diagnosis for a patient with this condition is what?

A) Risk for peripheral neurovascular dysfunction
B) Excess fluid volume
C) Hypothermia
D) Ineffective airway clearance

Question 19

A patient with hypofunction of the adrenal cortex has been admitted to the medical unit. What would the nurse most likely find when assessing this patient?

A) Increased body temperature
B) Jaundice
C) Copious urine output
D) Decreased BP

Question 20

The nurse is assessing a patient diagnosed with Graves disease. What physical characteristics of Graves disease would the nurse expect to find?

A) Hair loss
B) Moon face
C) Bulging eyes
D) Fatigue

Question 21

A patient with suspected adrenal insufficiency has been ordered an adrenocorticotropic hormone
(ACTH) stimulation test. Administration of ACTH caused a marked increase in cortisol levels. How should the nurse interpret this finding?

A) The patients pituitary function is compromised.
B) The patients adrenal insufficiency is not treatable.
C) The patient has insufficient hypothalamic function.
D) The patient would benefit from surgery.

Question 22

The physician has ordered a fluid deprivation test for a patient suspected of having diabetes insipidus. During the test, the nurse should prioritize what assessments?

A) Temperature and oxygen saturation
B) Heart rate and BP
C) Breath sounds and bowel sounds
D) Color, warmth, movement, and sensation of extremities

Question 23

A nurse works in a walk-in clinic. The nurse recognizes that certain patients are at higher risk for different disorders than other patients. What patient is at a greater risk for the development of hypothyroidism?

A) A 75-year-old female patient with osteoporosis
B) A 50-year-old male patient who is obese
C) A 45-year-old female patient who used oral contraceptives
D) A 25-year-old male patient who uses recreational drugs

Question 24

A patient with a recent diagnosis of hypothyroidism is being treated for an unrelated injury. When administering medications to the patient, the nurse should know that the patients diminished thyroid function may have what effect?

A) Anaphylaxis
B) Nausea and vomiting
C) Increased risk of drug interactions
D) Prolonged duration of effect

Question 25

A patient has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this patients immediate care? Select all that apply.

A) Administering diuretics to prevent fluid overload
B) Administering beta blockers to reduce heart rate
C) Administering insulin to reduce blood glucose levels
D) Applying interventions to reduce the patients temperature
E) Administering corticosteroids

Question 26

The nurses assessment of a patient with thyroidectomy suggests tetany and a review of the most recent blood work corroborate this finding. The nurse should prepare to administer what intervention?

A) Oral calcium chloride and vitamin D
B) IV calcium gluconate
C) STAT levothyroxine
D) Administration of parathyroid hormone (PTH)

Question 27

A patient has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the patient knows to do which of the following?

A) Take the drug concurrent with levothyroxine (Synthroid).
B) Take each dose of prednisone with a dose of calcium chloride.
C) Gradually replace the prednisone with an OTC alternative.
D) Slowly taper down the dose of prednisone, as ordered.

Question 28

Following an addisonian crisis, a patients adrenal function has been gradually regained. The nurse should ensure that the patient knows about the need for supplementary glucocorticoid therapy in which of the following circumstances?

A) Episodes of high psychosocial stress
B) Periods of dehydration
C) Episodes of physical exertion
D) Administration of a vaccine

Question 29

A 30 year-old female patient has been diagnosed with Cushing syndrome. What psychosocial nursing diagnosis should the nurse most likely prioritize when planning the patients care?

A) Decisional conflict related to treatment options
B) Spiritual distress related to changes in cognitive function
C) Disturbed body image related to changes in physical appearance
D) Powerlessness related to disease progression

Question 30

A patient with pheochromocytoma has been admitted for an adrenalectomy to be performed the following day. To prevent complications, the nurse should anticipate preoperative administration of
Which of the following?

A) IV antibiotics
B) Oral antihypertensives
C) Parenteral nutrition
D) IV corticosteroids

Question 31

A patient is undergoing testing for suspected adrenocortical insufficiency. The care team should ensure that the patient has been assessed for the most common cause of adrenocortical insufficiency. What is the most common cause of this health problem?

A) Therapeutic use of corticosteroids
B) Pheochromocytoma
C) Inadequate secretion of ACTH
D) Adrenal tumor

Question 32

The nurse providing care for a patient with Cushing syndrome has identified the nursing diagnosis of risk for injury related to weakness. How should the nurse best reduce this risk?

A) Establish falls prevention measures.
B) Encourage bed rest whenever possible.
C) Encourage the use of assistive devices.
D) Provide constant supervision.

Question 33

A patient with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with the patient to improve the patients nutritional intake. What foods should a patient with Cushing syndrome eat to optimize health? Select all that apply.

A) Foods high in vitamin D
B) Foods high in calories
C) Foods high in protein
D) Foods high in calcium
E) Foods high in sodium

Question 34

A patient on corticosteroid therapy needs to be taught that a course of corticosteroids of 2 weeks duration can suppress the adrenal cortex for how long?

A) Up to 4 weeks
B) Up to 3 months
C) Up to 9 months
D) Up to 1 year

Question 35

A patient with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal hypophysectomy. What would be most important for the nurse to monitor before, during, and after surgery?

A) Blood glucose
B) Assessment of urine for blood
C) Weight
D) Oral temperature

Question 36

What should the nurse teach a patient on corticosteroid therapy in order to reduce the patients risk of adrenal insufficiency?

A) Take the medication late in the day to mimic the bodys natural rhythms.
B) Always have enough medication on hand to avoid running out.
C) Skip up to 2 doses in cases of illness involving nausea.
D) Take up to 1 extra dose per day during times of stress.

Question 37

The nurse is caring for a patient at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the patient? Select all that apply.

A) Epistaxis
B) Pallor
C) Rapid respiratory rate
D) Bounding pulse
E) Hypotension

Question 38

A patient has been assessed for aldosteronism and has recently begun treatment. What are priority areas for assessment that the nurse should frequently address? Select all that apply.

A) Pupillary response
B) Creatinine and BUN levels
C) Potassium level
D) Peripheral pulses
E) BP

Question 39

A patient who has been taking corticosteroids for several months has been experiencing muscle wasting. The patient has asked the nurse for suggestions to address this adverse effect. What should the nurse recommend?

A) Activity limitation to conserve energy
B) Consumption of a high-protein diet
C) Use of OTC vitamin D and calcium supplements
D) Passive range-of-motion exercises

Question 40

The nurse is providing care for an older adult patient whose current medication regimen includes levothyroxine (Synthroid). As a result, the nurse should be aware of the heightened risk of adverse effects when administering an IV dose of what medication?

A) A fluoroquinalone antibiotic
B) A loop diuretic
C) A proton pump inhibitor (PPI)
D) A benzodiazepine