Deck 37: Care of Patients With Pituitary, thyroid, parathyroid, and Adrenal Disorders

Question 1

The nurse is caring for a patient who reports abruptly discontinuing his prescribed levothyroxine.Which clinical finding is most consistent with this behavior?

A)Seizures
B)Extreme diarrhea
C)Sudden hypertension
D)Respiratory distress

Answer 1

Respiratory distress

Question 2

A patient who had a hypophysectomy 3 days ago begins to have 3000 mL of urine output every shift and complains of thirst and a dry mouth.The nurse interprets these signs as possible:

A)overreaction to diuretics.
B)diabetes insipidus.
C)diabetes mellitus.
D)glucose intolerance.

Answer 2

diabetes insipidus.

Question 3

The nurse is aware that the patient has central diabetes insipidus because the disease was the result of the patient's having:

A)brain surgery to remove a tumor.
B)a kidney disorder.
C)habitually consumed excessive amounts of water.
D)a thyroid disorder.

Answer 3

brain surgery to remove a tumor.

Question 4

The patient with hyperthyroidism is undergoing ablation therapy with radioactive iodine.The precaution the nurse will employ is to:

A)take radioactive precautions with syringes and bedpans.
B)use Standard Precautions only.
C)enforce isolation for 3 days.
D)wear a mask and eye protectors when caring for patient.

Question 5

The nurse uses a visual aid to demonstrate the effects of a benign pituitary adenoma,which include: (Select all that apply.)

A)gigantism in children.
B)acromegaly in adults.
C)muscle weakness.
D)excessive hair growth.
E)joint pain.

Question 6

The nurse clarifies that a subtotal thyroidectomy,which removes only two thirds of the gland,allows:

A)the patient to take minimum amounts of antithyroid drugs.
B)continued production and release of thyroid hormones from the remainder of the gland.
C)the reduction of exophthalmos.
D)for less postoperative risk than total thyroidectomy.

Question 7

The nurse recognizes a need for instruction when the patient with a simple goiter says:

A)"The lump on my throat is my enlarged thyroid."
B)"Treatment will stop the enlargement of the goiter."
C)"I am aware this goiter could develop into cancer."
D)"I'm glad my treatment will make this thing go away."

Question 8

When a patient who is 8 hours postoperative from a total thyroidectomy shows a positive Chvostek's sign and complains of muscle cramps,the nurse interprets these assessments as indicative of:

A)imminent convulsion.
B)hypoparathyroidism.
C)hyperkalemia.
D)thyroid storm.

Question 9

The physician has prescribed methimazole (Tapazole).When providing education to the patient,which instruction should be included in the teaching?

A)"The medication can be doubled if the previous dose was missed."
B)"The medication should be taken on a strict schedule."
C)"The medication could be replaced by a less expensive generic substitute."
D)"The medication can be safely taken by pregnant women."

Question 10

During the preoperative thyroidectomy instruction to a patient with Graves' disease,the patient bursts into tears and says,"I am so nervous and can't listen to you.Just get out!" The nurse's best action is to:

A)give the patient written preoperative instructions.
B)inform the charge nurse or surgeon of this stressful behavior.
C)remind the patient the preoperative information is important.
D)inform the oncoming shift of this behavior.

Question 11

The nurse is caring for a patient scheduled for a thyroidectomy.Which instruction should be included in the preoperative care?

A)Salt should be avoided during the 2 weeks before surgery.
B)Medications will be administered to increase the vascularity of the gland before surgery.
C)Iodine will be administered in the 2 weeks before surgery to increase the level of thyroid hormone being released into the bloodstream.
D)Medications will be administered in the 2 weeks before surgery to reduce the vascularity of the gland.

Question 12

The patient in addisonian crisis is receiving IV fluids for rehydration.The nursing care is focused on:

A)early assessment of hypotension.
B)monitoring for hyperglycemia.
C)keeping the patient cool with sponge baths.
D)prevention of skin breakdown.

Question 13

The nurse is aware that the severe dehydration associated with diabetes insipidus can lead to the serious electrolyte imbalance of:

A)hypercalcemia.
B)hypernatremia.
C)hypocalcemia.
D)hyperkalemia.

Question 14

The nurse planning the hypophysectomy postoperative instructions that will be given to the patient before surgery will include: (Select all that apply.)

A)presence of drip pad under nose.
B)postponing brushing teeth.
C)presence of nasal packing for several days.
D)need to cough and deep breathe.
E)avoiding bending over.

Question 15

The nurse administering potassium iodide for the treatment of goiter will:

A)pour the solution over ice to make it more palatable.
B)give the well-diluted solution through a straw.
C)give the solution on an empty stomach.
D)mix the solution with an antacid to reduce gastric irritation.

Question 16

The husband of a patient with Graves' disease confides that he is frustrated with his wife's emotional outbursts and wide mood swings.The nurse's most helpful response would be:

A)"I know what you mean! She can be quite a handful!"
B)"Her antithyroid drugs will smooth the behavior out in a few weeks."
C)"I'm afraid this behavior will continue. How are you coping with it now?"
D)"If I were you, I'd tell her how you feel."

Question 17

The nurse is preparing a patient to undergo a dexamethasone suppression test.Which action is most appropriate?

A)Instruct the patient to be NPO 6 hours before the test.
B)Instruct the patient that urine levels will be assessed after a 24-hour collection period.
C)Administer a steroid the morning of the test.
D)Instruct the patient that a blood specimen will be collected in the morning.

Question 18

Although benign,the pituitary adenoma antagonizes insulin,which would cause:

A)hyperinsulinism.
B)hyperglycemia.
C)hypopituitarism.
D)hypoglycemia.

Question 19

A patient with Addison's disease is taking daily doses of corticosteroids to control the symptoms of this disease.The nurse explains that corticosteroids should be:

A)taken every day.
B)taken on an empty stomach.
C)stopped if gastrointestinal symptoms appear.
D)doubled in the event of stress.

Question 20

The nurse is reviewing the health history of a patient.Which finding is most linked to the probability of developing Graves' disease?

A)Smoking
B)Long-term use of birth control pills
C)Habitual excessive alcohol consumption
D)Use of herbal remedies, such as St. John's wort

Question 21

Matching
The nurse associates the pathophysiology to the signs of the condition it causes in the adult.Match the hormonal change to the symptom it would produce.

Weight gain,fatigue,and lethargy

A)Decreased growth hormone
B)Increased thyroid hormone
C)Decreased follicle-stimulating hormone
D)Decreased thyroid hormone
E)Increased antidiuretic hormone

Question 22

Matching
The nurse associates the pathophysiology to the signs of the condition it causes in the adult.Match the hormonal change to the symptom it would produce.

Menstrual irregularities

A)Decreased growth hormone
B)Increased thyroid hormone
C)Decreased follicle-stimulating hormone
D)Decreased thyroid hormone
E)Increased antidiuretic hormone

Question 23

The immediate postoperative care of a person who had a total thyroidectomy will include: (Select all that apply.)

A)placing the patient in a prone position.
B)supporting the head with sandbags.
C)assessing for vital signs every hour.
D)assessing ability to swallow.
E)assessing for bleeding.

Question 24

The nurse traces the closed loop of thyroid secretion.Place the events in appropriate order.

Step: 5

A)Hypothalamus is activated.
B)Pituitary releases thyroid-stimulating hormone (TSH).
C)Drop in norepinephrine level.
D)Thyroid releases thyroid hormone.
E)Satisfaction of norepinephrine level signals hypothalamus in negative feedback.
F)Thyrotropin-releasing hormone (TRH) is secreted.

Question 25

The nurse lists the classic signs and symptoms of hyperthyroidism,which are: (Select all that apply.)

A)tremulousness.
B)bradycardia.
C)exertional dyspnea.
D)scanty menstruation.
E)increased thirst and urination.

Question 26

Matching
The nurse associates the pathophysiology to the signs of the condition it causes in the adult.Match the hormonal change to the symptom it would produce.

Hyponatremia,edema

A)Decreased growth hormone
B)Increased thyroid hormone
C)Decreased follicle-stimulating hormone
D)Decreased thyroid hormone
E)Increased antidiuretic hormone

Question 27

The nurse traces the closed loop of thyroid secretion.Place the events in appropriate order.

Step: 6

A)Hypothalamus is activated.
B)Pituitary releases thyroid-stimulating hormone (TSH).
C)Drop in norepinephrine level.
D)Thyroid releases thyroid hormone.
E)Satisfaction of norepinephrine level signals hypothalamus in negative feedback.
F)Thyrotropin-releasing hormone (TRH) is secreted.

Question 28

The nurse traces the closed loop of thyroid secretion.Place the events in appropriate order.

Step: 3

A)Hypothalamus is activated.
B)Pituitary releases thyroid-stimulating hormone (TSH).
C)Drop in norepinephrine level.
D)Thyroid releases thyroid hormone.
E)Satisfaction of norepinephrine level signals hypothalamus in negative feedback.
F)Thyrotropin-releasing hormone (TRH) is secreted.

Question 29

The nurse's major contribution to the care of a patient with Cushing's syndrome is that of __________ and __________.

Question 30

The nurse planning care for a patient with diabetes insipidus will include: (Select all that apply.)

A)maintaining fluid therapy.
B)conserving energy.
C)supporting dietary choices to reduce diarrhea.
D)assessing for bradycardia.
E)encouraging exercise to reduce weight.

Question 31

The nurse traces the closed loop of thyroid secretion.Place the events in appropriate order.

Step: 1

A)Hypothalamus is activated.
B)Pituitary releases thyroid-stimulating hormone (TSH).
C)Drop in norepinephrine level.
D)Thyroid releases thyroid hormone.
E)Satisfaction of norepinephrine level signals hypothalamus in negative feedback.
F)Thyrotropin-releasing hormone (TRH) is secreted.

Question 32

Matching
The nurse associates the pathophysiology to the signs of the condition it causes in the adult.Match the hormonal change to the symptom it would produce.

Pathologic fractures

A)Decreased growth hormone
B)Increased thyroid hormone
C)Decreased follicle-stimulating hormone
D)Decreased thyroid hormone
E)Increased antidiuretic hormone

Question 33

Matching
The nurse associates the pathophysiology to the signs of the condition it causes in the adult.Match the hormonal change to the symptom it would produce.

High metabolism rate

A)Decreased growth hormone
B)Increased thyroid hormone
C)Decreased follicle-stimulating hormone
D)Decreased thyroid hormone
E)Increased antidiuretic hormone

Question 34

A tumor of the pituitary has caused the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).The nurse plans interventions for: (Select all that apply.)

A)assisting with activities of daily living because of weakness.
B)recording accurate urine output because of oliguria.
C)weighing daily to assess edema.
D)assessing for changes in level of conscious because of confusion and seizures.
E)assessing stool for occult blood.

Question 35

On the first postoperative day following a total thyroidectomy,the nurse assesses signs that indicate a developing "thyroid storm," which are: (Select all that apply.)

A)rising temperature (over 101° F).
B)pulse dropping below 60.
C)brief attention span.
D)apprehension and restlessness.
E)respirations below 14.

Question 36

The nurse traces the closed loop of thyroid secretion.Place the events in appropriate order.

Step: 4

A)Hypothalamus is activated.
B)Pituitary releases thyroid-stimulating hormone (TSH).
C)Drop in norepinephrine level.
D)Thyroid releases thyroid hormone.
E)Satisfaction of norepinephrine level signals hypothalamus in negative feedback.
F)Thyrotropin-releasing hormone (TRH) is secreted.

Question 37

The nurse is evaluating the laboratory results of a patient suspected of having hyperparathyroidism.Which finding(s)would be consistent with this condition? (Select all that apply.)

A)Decreased serum calcium levels
B)Decreased serum phosphate levels
C)Increased calcium levels in the urine
D)Decreased phosphate levels in the urine
E)Increased serum calcium levels

Question 38

The nurse traces the closed loop of thyroid secretion.Place the events in appropriate order.

Step: 2

A)Hypothalamus is activated.
B)Pituitary releases thyroid-stimulating hormone (TSH).
C)Drop in norepinephrine level.
D)Thyroid releases thyroid hormone.
E)Satisfaction of norepinephrine level signals hypothalamus in negative feedback.
F)Thyrotropin-releasing hormone (TRH) is secreted.