Deck 51: Nursing Management: Endocrine Problems

Question 1

Which of the following effects on the cardiovascular system would a patient with a hypofunction of the parathyroid gland most likely exhibit?

A) Hypertension
B) Increased cardiac output
C) Decreased contractility of heart muscle
D) Dysrhythmias

Answer 1

Decreased contractility of heart muscle

Question 2

A 73-year-old woman is hospitalized with possible SIADH.She is confused and reports a headache,muscle cramps,and twitching.Initially,which of the following laboratory results would the nurse expect to find?

A) Hematocrit of 0.52 (52%)
B) Blood urea nitrogen of 7.9 mmol/L (22 mg/dL)
C) Serum sodium of 124 mmol/L
D) Serum chloride of 111 mmol/L

Answer 2

Serum sodium of 124 mmol/L

Question 3

Which one of the following effects on the integumentary system would a patient with a hyperfunction of the parathyroid gland most likely exhibit?

A) Lack of tooth enamel
B) Hair loss on scalp and body
C) Brittle nails
D) Moist skin

Answer 3

Moist skin

Question 4

While a 68-year-old woman is hospitalized for a fractured femur,she is diagnosed with hypothyroidism.Which of the following medications ordered for the patient at the time of admission does the nurse recognize should not be administered without consulting the physician?

A) A stool softener
B) A sedative
C) An analgesic
D) An antibiotic

Question 5

A patient seeks care at the clinic because of increasing speech difficulties and hoarseness,telling the nurse his tongue has gotten so big that he can hardly talk.The physician suspects acromegaly.During the nursing history,which of the following should the nurse specifically ask the patient whether he has experienced?

A) A recent head injury
B) An increase in shoe size
C) A family history of endocrine problems
D) Symptoms of hypoglycemia,such as hunger and nervousness

Question 6

When teaching a patient newly diagnosed with Graves' disease about the disorder,the nurse explains which of the following?

A) Restriction of iodine intake is needed to reduce thyroid activity.
B) Exercise is contraindicated to avoid increasing the 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 7

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

A) Complaining of level 7 incisional pain on a 10-point scale
B) Cardiac monitor showing a heart rate of 112 beats/min
C) Increasing swelling of the neck
D) A weak,hoarse voice

Question 8

During preoperative teaching for a patient scheduled for transsphenoidal hypophysectomy for treatment of a pituitary adenoma,what should the nurse instruct the patient that she will have to do?

A) Take replacement growth hormone for the rest of her life
B) Not brush her teeth for at least 10 days after the surgery
C) Be expected to cough and breathe deeply every 2 hours postoperatively
D) Be positioned flat in bed with sandbags at her head to prevent head movement

Question 9

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.What intervention would the nurse anticipate?

A) An immediate tracheostomy
B) Administration of intravenous morphine
C) Administration of intravenous calcium gluconate
D) Endotracheal intubation with mechanical ventilation

Question 10

Following a transsphenoidal resection of a pituitary tumour,the nurse suspects that the patient has developed diabetes insipidus on finding which of the following data?

A) A urine specific gravity of 1.001
B) A consistent rise in blood pressure
C) Fluid retention with dependent edema
D) A serum sodium of 130 mmol/L

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 gives which of the following responses?

A) "I need to maintain a sodium-restricted diet at home."
B) "I should weigh myself daily and report a sudden loss or gain."
C) "I need to limit my fluid intake to no more than 950 mL of liquids a day."
D) "I will eat foods high in potassium because the diuretics cause potassium loss."

Question 12

A patient with hyperthyroidism is treated with radioactive iodine at a clinic.Before the patient is discharged,what should the nurse instruct the patient about?

A) Symptoms of hyperthyroidism should be relieved in about a week
B) Radioactive precautions to take with urine,stool,and other body secretions
C) Monitoring for symptoms of hypothyroidism,such as easy bruising and cold intolerance
D) Discontinuing the antithyroid medications and propranolol (Inderal)taken before the radioactive therapy

Question 13

A patient with symptoms of diabetes insipidus is admitted to the hospital for evaluation and treatment of the condition.What is an appropriate nursing diagnosis that the nurse would document for the patient based on an understanding of this condition?

A) Disturbed sleep pattern related to nocturia
B) Risk for impaired skin integrity related to edema
C) Excess fluid volume related to intake greater than output
D) Activity intolerance related to muscle cramps and weakness

Question 14

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.What is an appropriate nursing intervention to prevent this problem?

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 15

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) Has a urinary output of 800 mL/hour
B) Has a urine specific gravity of 1.003
C) Had a recent head injury
D) Is confused and lethargic

Question 16

A patient with an antidiuretic hormone (ADH)-secreting small cell cancer of the lung is treated to control the symptoms of syndrome of inappropriate ADH (SIADH).The nurse determines that treatment is effective on finding which of the following data?

A) The patient's weight is stable.
B) The urine specific gravity is increased.
C) The patient's urinary output is increased.
D) The patient's edema is reduced.

Question 17

During the nursing assessment of a patient with Graves' disease,the nurse notes a bounding,rapid pulse and systolic hypertension.What is an additional manifestation of the disorder that the nurse would expect to find?

A) Chest pain
B) Constipation
C) Decreased appetite
D) Muscle aches

Question 18

Which of the following is the first nursing action indicated when a patient returns to the surgical nursing unit after a thyroidectomy?

A) Check the back of the neck for hemorrhage.
B) Assess respiratory rate and effort.
C) Determine whether the patient can speak normally.
D) Ask the patient whether he or she experiences any tingling in the toes or fingers.

Question 19

After 5 years of experiencing depression,fatigue,and lethargy,an older adult woman 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 which of the following functions?

A) Mental status
B) Nutritional status
C) Cardiovascular function
D) Fluid and electrolyte balance

Question 20

A patient is suspected of having a pituitary tumour causing panhypopituitarism.During assessment of the patient,the nurse would expect to find which of the following changes?

A) Elevated plasma glucose levels and dyslipidemia
B) Changes in secondary sex characteristics and loss of libido
C) Hypertension resulting from increased water reabsorption in the kidney
D) Evidence of hypofunction of the adrenal,thyroid,and parathyroid glands

Question 21

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

A) Hypotension
B) Decreased axillary and pubic hair
C) Purplish red striae on the abdomen
D) Bronzed hyperpigmentation of the skin

Question 22

Following a thyroidectomy,a patient develops generalized muscle cramps and mild tetany.The patients' calcium levels are decreased.Which nursing action 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 23

Following a thyroidectomy,the patient develops hypoparathyroidism.The nurse teaches the patient that maintenance therapy for the hypoparathyroidism will include which of the following?

A) Calcium supplements
B) A diet high in oxalic acid
C) Phosphorus supplements
D) Parenteral parathyroid hormone

Question 24

A patient with Cushing's syndrome returns to the surgical unit following an adrenalectomy.During the initial postoperative period,the nurse gives the highest priority to which of the following actions?

A) Monitoring for infection
B) Protecting the patient's skin
C) Monitoring fluid and electrolyte status
D) Preventing severe emotional disturbances

Question 25

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

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) When prednisone is taken every other day,the effect on normal adrenal function is less.

Question 26

A patient is hospitalized with acute adrenal insufficiency.Which of the following findings assists the nurse to determine that the patient is responding favourably to treatment?

A) Decreasing blood glucose
B) Increasing urinary output
C) Decreasing serum sodium
D) Decreasing serum potassium

Question 27

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

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 recurrence of the tumour

Question 28

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

A) A 22-year-old patient admitted with SIADH who has a serum sodium level of 130 mmol/L
B) A 31-year-old patient who has iatrogenic Cushing's syndrome with a capillary blood glucose level of 13.6 mmol/L (244 mg/dL)
C) A 53-year-old patient who has Addison's disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef)
D) A 70-year-old patient who recently started levothyroxine to treat hypothyroidism and has an irregular pulse of 134 beats/min

Question 29

When admitting a patient who has just recently fallen and broken his hip,the nurse notes hypertension,muscle wasting,and a large buffalo hump.The nurse knows that these findings are consistent with the patient having which following diagnosis?

A) Addison's disease
B) SIADH
C) Cushing's syndrome
D) Pheochromocytoma

Question 30

A patient with a possible pheochromocytoma is admitted to the hospital for evaluation and diagnostic testing.During an attack,what would the nurse expect the patient to experience?

A) Persistent hypoglycemia
B) Severe bradycardia refractory to drug therapy
C) Severe hypotension with sympathoadrenal blockade
D) Severe,pounding headache,tachycardia,and profuse sweating

Question 31

Which type of diabetes insipidus results from excessive water intake?

A) Central
B) Neurogenic
C) Nephrogenic
D) Primary

Question 32

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 33

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

A) Complains of a severe headache
B) Complains of severe thirst
C) Has a urine specific gravity of 1.025
D) Has a serum sodium level of 119 mmol/L

Question 34

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

A) The blood glucose is 8 mmol/L.
B) The patient's blood pressure is 102/50 mm Hg.
C) The patient has level 6 incisional pain on a 10-point scale.
D) The lungs have bibasilar crackles.

Question 35

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

A) Schedule daily home visits by home care nurses to repeat the necessary instructions.
B) Delay teaching about the condition until the patient has responded to replacement therapy.
C) Provide written handouts of all instructions for continued reference as the patient improves.
D) Designate a family member to teach the patient about the condition when forgetfulness has improved.

Question 36

A patient has an adenoma of the adrenal zona glomerulosa causing hyperaldosteronism and is scheduled for surgery to remove the affected gland.During care before surgery,the nurse should do which of the following?

A) Limit fluids to 1000 mL/day.
B) Provide a potassium-restricted diet.
C) Monitor the blood pressure every 4 hours.
D) Elevate the patient's extremities to relieve edema.

Question 37

A patient is admitted to the hospital in addisonian crisis 1 month following a diagnosis of Addison's disease.The nurse documents the nursing diagnosis of ineffective therapeutic regimen management related to lack of knowledge of management of condition when the patient gives which of the following responses?

A) "I double my dose of hydrocortisone if I am experiencing moderate stress."
B) "I had the stomach flu earlier this week and couldn't take the hydrocortisone."
C) "I frequently eat at restaurants,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 38

A patient with Cushing's syndrome is admitted to the hospital in preparation for surgery to remove an adrenal tumour.During the admission assessment,the patient tells the nurse that she looks so awful she does not want anyone to be around her.What is the best response to the patient?

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) "You really should not worry about how you look in the hospital.We see many worse things."
D) "Most of the physical and mental changes caused by the disease will gradually improve after surgery."

Question 39

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

A) Increase the daily fluid intake to twice the usual amount.
B) Self-administer intramuscular calcium before calling the doctor.
C) Call an ambulance because the symptoms will progress to seizures.
D) Breathe in and out of a paper bag to temporarily relieve the symptoms,and then seek medical assistance.