Deck 50: Nursing Management: Endocrine Problems

Question 1

A patient with an antidiuretic hormone (ADH)-secreting small-cell cancer of the lung is treated with demeclocycline (Declomycin) to control the symptoms of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse determines that the demeclocycline is effective upon finding that the

A) patient's daily weight is stable.
B) urine specific gravity is increased.
C) patient's urinary output is increased.
D) peripheral edema is decreased.

Answer 1

patient's urinary output is increased.

Question 2

While hospitalized for a fractured femur, a 68-year-old patient is diagnosed with hypothyroidism. Which of these medications on the original admission orders will the nurse need to consult with the health care provider about before it is administered?

A) Docusate (Colace)
B) Diazepam (Valium)
C) Ibuprofen (Motrin)
D) Cefoxitin (Mefoxin)

Answer 2

Diazepam (Valium)

Question 3

A 72-year-old patient is diagnosed with hypothyroidism, and levothyroxine (Synthroid) is prescribed. During initiation of thyroid replacement for the patient, it is most important for the nurse to assess

A) mental status.
B) nutritional level.
C) cardiac function.
D) fluid balance.

Answer 3

cardiac function.

Question 4

A patient with hyperthyroidism is treated with radioactive iodine (RAI) at a clinic. Before the patient is discharged, the nurse instructs the patient

A) to monitor for symptoms of hypothyroidism, such as easy bruising and cold intolerance.
B) to discontinue the antithyroid medications taken before the radioactive therapy.
C) that symptoms of hyperthyroidism should be relieved in about a week.
D) about radioactive precautions to take with urine, stool, and other body secretions.

Question 5

A patient is hospitalized with possible SIADH. The patient is confused and reports a headache, muscle cramps, and twitching. The nurse would expect the initial laboratory results to include a

A) serum sodium of 125 mEq/L (125 mmol/L).
B) hematocrit of 52%.
C) blood urea nitrogen (BUN) of 22 mg/dl (11.5 mmol/L).
D) serum chloride of 110 mEq/L (110 mmol/L).

Question 6

A patient with Graves' disease is prepared for surgery with drug therapy consisting of 4 weeks of propylthiouracil (PTU) and 10 days of iodine before surgery. When teaching the patient about the drugs, the nurse explains that the drugs are given preoperatively to

A) eliminate the risk for tetany during the postoperative period.
B) decrease the risk of hypometabolism during and after the surgery.
C) normalize metabolism and decrease the size and vascularity of the gland.
D) assist in differentiating the thyroid and parathyroid glands during surgery.

Question 7

A patient seen at the clinic for an upper respiratory infection reports receiving subcutaneous somatotropin (Genotropin) when asked by the nurse about current medications. The nurse questions the patient further about a history of

A) adrenal disease.
B) untreated acromegaly.
C) a pituitary tumor.
D) diabetes insipidus (DI).

Question 8

When teaching a patient newly diagnosed with Graves' disease about the disorder, the nurse explains that

A) restriction of iodine intake is needed to reduce thyroid activity.
B) exercise is contraindicated to avoid increasing metabolic rate.
C) surgery will eventually be required to remove the thyroid gland.
D) antithyroid medications may take several weeks to have an effect.

Question 9

Following a transsphenoidal resection of a pituitary tumor, an important nursing assessment is

A) monitoring hourly urine output.
B) checking the dressings for serous drainage.
C) palpating for dependent pitting edema.
D) obtaining continuous pulse oximetry.

Question 10

A patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask?

A) "Have you had a recent head injury?"
B) "Do you have to wear larger shoes now?"
C) "Is there any family history of acromegaly?"
D) "Are you experiencing tremors or anxiety?"

Question 11

When teaching a patient with chronic SIADH about long-term management of the disorder, the nurse determines that additional instruction is needed when the patient says,

A) "I need to shop for foods that are low in sodium and avoid adding salt to foods."
B) "I should weigh myself daily and report any sudden weight loss or gain."
C) "I need to limit my fluid intake to no more than 1 quart of liquids a day."
D) "I will eat foods high in potassium because the diuretics cause potassium loss."

Question 12

Which information obtained when caring for a patient who has just been admitted for evaluation of diabetes insipidus will be of greatest concern to the nurse?

A) The patient has a urine output of 800 ml/hr.
B) The patient's urine specific gravity is 1.003.
C) The patient had a recent head injury.
D) The patient is confused and lethargic.

Question 13

The first nursing action indicated when a patient returns to the surgical nursing unit following a thyroidectomy is to

A) check the dressing for bleeding.
B) assess respiratory rate and effort.
C) support the patient's head with pillows.
D) take the blood pressure and pulse.

Question 14

During preoperative teaching for a patient scheduled for transsphenoidal hypophysectomy for treatment of a pituitary adenoma, the nurse instructs the patient about the need to

A) remain on bed rest for the first 48 hours after the surgery.
B) avoid brushing the teeth for at least 10 days after the surgery.
C) cough and deep-breathe every 2 hours postoperatively.
D) be positioned flat with sandbags at the head postoperatively.

Question 15

A patient is suspected of having a pituitary tumor causing panhypopituitarism. During assessment of the patient, the nurse would expect to find

A) elevated blood glucose.
B) changes in secondary sex characteristics.
C) high blood pressure.
D) tachycardia and cardiac palpitations.

Question 16

A few hours after returning to the surgical nursing unit, a patient who has undergone a subtotal thyroidectomy develops laryngeal stridor and a cramp in the right hand. The nurse anticipates that intervention will include

A) administration of IV morphine.
B) administration of IV calcium gluconate.
C) endotracheal intubation with mechanical ventilation.
D) immediate tracheostomy and manual ventilation.

Question 17

During the nursing assessment of a patient with Graves' disease, the nurse notes a bounding, rapid pulse and systolic hypertension. Based on these assessment data, which question is important for the nurse to ask the patient?

A) "Do you have any problem with frequent constipation?"
B) "Have you noticed any recent decrease in your appetite?"
C) "Do you ever have any chest pain?"
D) "Have you had recent muscle aches?"

Question 18

A patient with symptoms of DI is admitted to the hospital for evaluation and treatment of the condition. An appropriate nursing diagnosis for the patient is

A) insomnia related to waking at night to void.
B) risk for impaired skin integrity related to generalized edema.
C) excess fluid volume related to intake greater than output.
D) activity intolerance related to muscle cramps and weakness.

Question 19

While assessing a patient who has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy, the nurse obtains these data. Which information is most important to communicate to the surgeon?

A) The patient is complaining of 7/10 incisional pain.
B) The patient's cardiac monitor shows a heart rate of 112.
C) The patient has increasing swelling of the neck.
D) The patient's voice is weak and hoarse sounding.

Question 20

The nurse identifies a nursing diagnosis of risk for injury: corneal ulceration related to inability to close the eyelids secondary to exophthalmos for a patient with Graves' disease. An appropriate nursing intervention for this problem is to

A) teach the patient to blink every few seconds to lubricate the cornea.
B) elevate the head of the patient's bed to reduce periorbital fluid.
C) apply eye patches to protect the cornea from irritation.
D) place cold packs on the eyes to relieve pain and swelling.

Question 21

A patient is taking high doses of prednisone to control the symptoms of an acute exacerbation of systemic lupus erythematosus. When teaching the patient about the use of prednisone, which information is most important for the nurse to include?

A) Call the doctor if you experience any mood alterations with the prednisone.
B) Do not stop taking the prednisone suddenly; it should be decreased gradually.
C) Weigh yourself daily to monitor for weight gain caused by water or increased fat.
D) Check your temperature daily because prednisone can hide signs of infection.

Question 22

A patient is hospitalized with acute adrenal insufficiency. The nurse determines that the patient is responding favorably to treatment upon finding

A) decreasing serum sodium.
B) decreasing serum potassium.
C) decreasing blood glucose.
D) increasing urinary output.

Question 23

A patient with hypoparathyroidism receives instructions from the nurse regarding symptoms of hypocalcemia and hypercalcemia. The nurse teaches the patient that if mild symptoms of hypocalcemia occur, the patient should

A) increase the daily fluid intake to twice the usual amount.
B) self-administer IM calcium before calling the doctor.
C) call an ambulance because the symptoms will progress to seizures.
D) rebreathe with a paper bag and then seek medical assistance.

Question 24

A patient with primary hyperparathyroidism has a serum calcium level of 14 mg/dl (3.5 mmol/L), phosphorus of 1.7 mg/dl (0.55 mmol/L), serum creatinine of 2.2 mg/dl (194 mmol/L), and a high urine calcium. While the patient awaits surgery, the nurse should

A) institute seizure precautions such as padded siderails.
B) assist the patient to perform range-of-motion exercises QID.
C) monitor the patient for positive Chvostek's or Trousseau's sign.
D) encourage the patient to drink 4000 ml of fluid daily.

Question 25

Following a thyroidectomy, a patient develops carpal spasm while the nurse is taking a blood pressure on the left arm. Which action by the nurse is appropriate?

A) Administer the ordered muscle relaxant.
B) Have the patient rebreathe using a paper bag.
C) Start oxygen at 2 to 3 L/min per cannula.
D) Give the ordered oral calcium supplement.

Question 26

A patient with Cushing syndrome returns to the surgical unit following an adrenalectomy. During the initial postoperative period, the nurse gives the highest priority to

A) monitoring for infection.
B) protecting the patient's skin.
C) maintaining fluid and electrolyte status.
D) preventing severe emotional disturbances.

Question 27

When developing a plan of care for a patient with SIADH, which interventions will the nurse include?

A) Encourage fluids to 2000 ml/day.
B) Offer patient hard candies to suck on.
C) Monitor for increased peripheral edema.
D) Keep head of bed elevated to 30 degrees.

Question 28

A patient has an adrenocortical adenoma causing hyperaldosteronism and is scheduled for laparoscopic surgery to remove the tumor. During care before surgery, the nurse should

A) monitor blood glucose level every 4 hours.
B) provide a potassium-restricted diet.
C) monitor the blood pressure every 4 hours.
D) relieve edema by elevating the extremities.

Question 29

A patient who uses every-other-day prednisone therapy for rheumatoid arthritis complains of not feeling as well on the non-prednisone days and asks the nurse about taking prednisone daily instead. The best response to the patient is that

A) an every-other-day schedule mimics the normal pattern of cortisol secretion from the adrenal gland.
B) glucocorticoids are taken on a daily basis only when they are being used for replacement therapy.
C) if it improves the symptoms, it would be acceptable to take half the usual dose every day.
D) there is less effect on normal adrenal function when prednisone is taken every other day.

Question 30

RN observes a nursing assistant (NA) caring for a patient after a hypophysectomy. Which action by the NA requires that the RN intervene?

A) The NA lowers the head of the bed to the flat position.
B) The NA cautions the patient to avoid coughing.
C) The NA cleans the patient's mouth with a swab.
D) The NA collects a urine specimen for specific gravity.

Question 31

After receiving change-of-shift report about these four patients, which patient should the nurse assess first?

A) A 22-year-old admitted with SIADH who has a serum sodium level of 130 mEq/L.
B) A 31-year-old who has iatrogenic Cushing's syndrome with a capillary blood glucose level of 244 mg/dl.
C) A 53-year-old who has Addison's disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef).
D) A 70-year-old who recently started levothyroxine (Synthroid) to treat hypothyroidism and has an irregular pulse of 134.

Question 32

A patient is admitted with possible SIADH. Which information obtained by the nurse is most important to communicate rapidly to the health care provider?

A) The patient complains of a severe headache.
B) The patient complains of severe thirst.
C) The patient has a urine specific gravity of 1.025.
D) The patient has a serum sodium level of 119 mEq/L.

Question 33

After neck surgery, a patient develops hypoparathyroidism. The nurse should plan to teach the patient about

A) calcium supplementation to normalize serum calcium levels.
B) including whole grains in the diet to prevent constipation.
C) use of bisphosphonates to reduce bone demineralization.
D) having a high fluid intake to decrease risk for nephrolithiasis.

Question 34

When providing postoperative care for a patient who has had bilateral adrenalectomy, which assessment information obtained by the nurse is most important to communicate to the health care provider?

A) The blood glucose is 156 mg/dl.
B) The patient's blood pressure is 102/50.
C) The patient has 5/10 incisional pain.
D) The lungs have bibasilar crackles.

Question 35

After a patient with a pituitary adenoma has had a hypophysectomy, the nurse will plan to do discharge teaching about the need for

A) insulin use to maintain blood glucose at normal levels.
B) sodium restriction to prevent fluid retention and hypertension.
C) oral corticosteroids to replace endogenous cortisol.
D) chemotherapy to prevent reoccurrence of the tumor.

Question 36

A nursing assessment of a patient with Cushing syndrome reveals that the patient has truncal obesity and thin arms and legs. An additional manifestation of Cushing syndrome that the nurse would expect to find is

A) chronically low blood pressure.
B) decreased axillary and pubic hair.
C) purplish red streaks on the abdomen.
D) bronzed appearance of the skin.

Question 37

A patient with a possible pheochromocytoma is admitted to the hospital for evaluation and diagnostic testing. During an attack, the nurse will monitor for hypertension and

A) hypoglycemia.
B) bradycardia.
C) headache.
D) flushing.

Question 38

When teaching a patient with newly diagnosed hypothyroidism about management of the condition, the nurse should

A) delay teaching about the condition until the patient has responded to replacement therapy.
B) provide written handouts of all instructions for continued reference as the patient improves.
C) have a family member teach the patient about the condition when the patient is more alert.
D) arrange for daily home visits by home health nurses to repeat the necessary instructions.

Question 39

A patient is admitted to the hospital in addisonian crisis 1 month after a diagnosis of Addison's disease. The nurse identifies the nursing diagnosis of ineffective therapeutic regimen management related to lack of knowledge of management of condition when the patient says,

A) "I double my dose of hydrocortisone on the days that I go for a run."
B) "I had the stomach flu earlier this week and couldn't take the hydrocortisone."
C) "I frequently eat at restaurants, and so my food has a lot of added salt."
D) "I do yoga exercises almost every day to help me reduce stress and relax."

Question 40

A patient with Cushing syndrome is admitted to the hospital to have laparoscopic adrenalectomy. During the admission assessment, the patient tells the nurse, "The worst thing about this disease is how terrible I look. I feel awful about it." The best response by the nurse is

A) "Let me show you how to dress so that the changes are not so noticeable."
B) "I do not think you look bad. Your appearance is just altered by your disease."
C) "Most of the physical and mental changes caused by the disease will gradually improve after surgery."
D) "You really should not worry about how you look in the hospital. We see many worse things."