Deck 19: Nursing Care of Patients With Endocrine Disorders

Question 1

The nurse is caring for a patient with elevated serum thyroid hormones and new-onset proptosis. Which problem would be a priority for this patient?

A) change in appearance
B) altered immunity
C) weight gain
D) fluid retention

Answer 1

change in appearance

Question 2

The nurse is describing the manifestations of myxedema coma to a patient with hypothyroidism. What should the nurse identify as precipitating factors for this health problem?

A) gastrointestinal bleeding
B) pneumonia
C) excessive use of thyroid replacement medications
D) excessive use of central nervous system stimulants
E) exposure to excessive heat and humidity

Answer 2

gastrointestinal bleeding
pneumonia

Question 3

A patient whose thyroid gland produces an insufficient amount of thyroid hormone is concerned about an elevated cholesterol level. What should the nurse explain to this patient?

A) "The thyroid gland malfunction can affect your cholesterol level."
B) "Maybe you don't realize how much fat is in the foods you eat."
C) "Elevated cholesterol is a normal part of aging."
D) "Describe your typical bedtime snack."

Answer 3

"The thyroid gland malfunction can affect your cholesterol level."

Question 4

The nurse is reviewing orders for a patient in myxedema coma. Which orders should the nurse question before administering to this patient?

A) regular insulin IV at 5 units per hour
B) cooling blanket
C) methimazole (Tapazole) 15 mg PO daily
D) pulse oximetry and vital signs hourly
E) serum TSH level daily

Question 5

A patient taking steroids for an autoimmune disorder asks when the weight loss in the legs is going to stop. What should the nurse realize the patient is experiencing?

A) muscle wasting
B) poor wound healing
C) risk for compression fractures
D) increased susceptibility to infections

Question 6

A 35-year-old female patient taking oral contraceptives is prescribed steroid therapy. What is a priority teaching point for this patient?

A) "Consider adding another form of contraception while using both medications."
B) "These medications do not interact. No changes need to be made."
C) "Measure your weight daily."
D) "Avoid the use of salt."

Question 7

The nurse is caring for a patient with elevated serum T3 and T4 levels who receives a new prescription for methimazole (Tapazole). Which patient statement indicates that additional teaching is needed about this medication?

A) "This medication will increase my metabolism."
B) "I must contact my physician if I plan to become pregnant."
C) "It may take several weeks for this medication to take effect."
D) "I may take a beta-blocker along with this medication."

Question 8

The nurse is assessing a female patient who has an abnormally high level of parathyroid hormone. Which assessment findings would be consistent with this diagnosis?

A) muscle atrophy
B) muscle weakness
C) diarrhea
D) weight gain
E) hypotension

Question 9

While assessing a patient with an alteration in thyroid function, the nurse notes smooth, fine hair and warm, dry skin. Which question should the nurse ask this patient?

A) "Have you experienced any recent weight loss?"
B) "Have you been feeling constipated?"
C) "Have you noticed increased bruising?"
D) "Have you noticed a change in your skin color?"

Question 10

The nurse is reviewing postoperative care for a patient scheduled for a thyroidectomy. What information should the nurse include in this teaching?

A) "Avoid the use of iodized salt after your procedure."
B) "Plastic surgery may be required to conceal the surgical scar."
C) "Use iodized salt when preparing foods."
D) "Perform neck flexion and extension exercises twice daily for several weeks postoperatively."

Question 11

The nurse is reviewing the relationship between thyroid hormone and iodine with a group of nursing students. The nurse knows further teaching is required when a student states that patients may experience iodine deficiency and hypothyroidism if they:

A) eat large amounts of shellfish.
B) use prescribed lithium carbonate.
C) eat large amounts of turnips or rutabagas.
D) live in an area where iodine is deficient in the soil.

Question 12

A patient comes into the emergency department with manifestations of Addisonian crisis. What should the nurse expect to provide to this patient?

A) intravenous fluids
B) warm blankets
C) thyroid replacement hormone
D) blood transfusion

Question 13

The nurse is reviewing the laboratory results for a group of patients. Which set of results should the nurse identify as being consistent with primary hypothyroidism?

A) elevated TSH, depressed T3 and T4
B) elevated TSH, elevated T3 and T4
C) depressed TSH, elevated T3 and T4
D) depressed TSH, depressed T3 and T4

Question 14

A patient with an adrenal gland alteration does not understand why his skin is tanning when he does not spend any time outdoors in the sun. What should the nurse do to address the patient's concern?

A) ask if the patient is still taking steroids prescribed for another illness
B) ask the patient what time of day he is outdoors
C) auscultate the patient's lung sounds
D) palpate the patient's thyroid gland

Question 15

The family of an older patient with hypothyroidism is concerned about the open wounds on the patient's legs and arms. How should the nurse respond to the family's questions about bathing?

A) "Use warm water to bathe the patient."
B) "Make sure she has a daily bath."
C) "Use firm, consistent strokes when bathing."
D) "Follow the bath with a rubbing-alcohol massage."

Question 16

A patient with Cushing syndrome is concerned about having a head cold every few weeks. What should the nurse do to address this patient's concern?

A) assess for protein and vitamin intake
B) plan for frequent rest periods
C) encourage daily weights
D) review coping strategies

Question 17

The nurse is providing care to a patient recovering from a bilateral adrenalectomy. What should the nurse do to assess for the onset of adrenal insufficiency?

A) monitor strict intake and output
B) change the dressing using clean technique
C) question the order for cortisol administration
D) place the patient on fluid restriction

Question 18

The nurse is providing preoperative teaching to a patient scheduled for a subtotal thyroidectomy. What should the nurse include in these instructions?

A) Report sensations of tingling in toes, fingers, or lips.
B) Report signs of constipation.
C) Report the improvement of hoarseness.
D) Take aspirin before the surgery.

Question 19

The nurse is caring for a patient with untreated hypothyroidism. For which health problems should the nurse assess this patient?

A) elevated serum cholesterol
B) anemia
C) hyperglycemia
D) hypernatremia
E) decreased serum LDL

Question 20

The nurse is providing care to a patient with a low level of serum parathyroid hormone. What should the nurse expect to assess in this patient?

A) facial grimacing
B) abdominal cramps
C) hair loss
D) dysrhythmias
E) smooth, soft skin

Question 21

The nurse is assessing a patient with hypothyroidism. Which findings should the nurse expect for this patient?

A) change in heart rate from 80 bpm to 60 bpm on auscultation
B) decreased stroke volume from 70 mL/beat to 50 mL/beat per echocardiogram
C) new finding of pericardial effusion per chest x-ray
D) left descending coronary artery narrowing per angiogram
E) increased cardiac output from 3,000 mL/min to 4,000 mL/min per echocardiogram

Question 22

The nurse is preparing to assess a patient with Cushing syndrome. Which findings should the nurse expect to assess in this patient?

A) weight gain
B) auscultatory lung crackles
C) jugular vein distention
D) peripheral edema
E) hypotension

Question 23

A patient with hyperparathyroidism secondary to renal failure is prescribed calcimimetic. What should the nurse instruct the patient about this medication?

A) It increases the sensitivity of the calcium-sensing receptors of the parathyroid gland to serum calcium.
B) It blocks calcium receptors in the nervous and musculoskeletal systems.
C) It decreases resorption of calcium in the distal renal tubule.
D) It binds calcium to bile salts that are then excreted through the GI tract.

Question 24

A patient with suspected Cushing syndrome is prescribed a 24-hour urine collection. What should the nurse explain to the patient about the reason for this urine collection?

A) It measures the amount of cortisol in the urine over 24 hours.
B) At least 2,000 mL of urine is required to perform the test.
C) It identifies urine specific gravity changes over a 24-hour period.
D) The 24-hour timeline reduces unwanted effects of medications excreted in the urine.

Question 25

The nurse is teaching a group of older adults about thyroid hormone replacement. The nurse realizes teaching has been ineffective when one participant states that older adults may be at risk for too much thyroid medication in their blood because of which factor?

A) high blood lipid levels
B) less albumin in the blood to bind to thyroid medication
C) kidney alterations that make the organs less efficient at removing medications from the blood
D) polypharmacy, leading to problems with medication dosing and administration

Question 26

A patient is prescribed prednisone (Dexasone) for a chronic health problem. The nurse instructs the patient to be alert for which signs that Cushing syndrome is developing?

A) fat deposits in the abdominal and clavicle regions
B) muscle weakness and wasting in the extremities
C) delayed wound healing
D) development of varicose leg veins
E) hypotension

Question 27

The nurse is assessing a patient's understanding of hyperparathyroidism. The nurse knows further teaching is needed when the patient states that the primary health care provider can determine the patient has hyperparathyroidism when:

A) the patient has experienced at least two episodes of severe abdominal pain.
B) all other causes of high blood calcium levels have been ruled out.
C) the patient has had the symptoms of hyperparathyroidism for at least 6 months.
D) the patient's blood tests show high calcium and high parathyroid hormone levels.

Question 28

The nurse is reviewing health history information for a group of patients. Which patient should the nurse identify as being at the lowest risk of developing Cushing syndrome?

A) The patient who received radioactive iodine treatment for hyperthyroidism
B) The patient receiving treatment for rheumatoid arthritis
C) The patient who has had an organ transplant
D) The patient receiving chemotherapy to treat a brain tumor

Question 29

The nurse is assessing a patient with Cushing syndrome. Which findings should the nurse report for immediate follow-up?

A) serum potassium 2.5 mEq/L and blood pressure 150/90
B) serum sodium 145 mEq/L and reports of muscle weakness
C) serum calcium 11 mg/dL and reports of feelings of depression
D) serum phosphorus 3 mg/dL and hirsutism

Question 30

The nurse is screening a group of patients for risk factors related to thyroid cancer. Which patient should the nurse recognize as having the highest risk for developing thyroid cancer?

A) a 75-year-old patient with a history of sinus infections in childhood
B) a 70-year-old patient who refinishes furniture as a hobby
C) an 80-year-old patient whose diet consists largely of red meat
D) an 85-year-old patient who works outdoors without sunscreen

Question 31

The nurse is teaching a patient who has a diagnosis of hypothyroidism about the importance of dietary fiber. Which statements by the patient indicate that teaching has been effective?

A) "I will drink a full glass of water with my fiber pill each morning."
B) "I will snack on popcorn rather than potato chips."
C) "I will take an over-the-counter fiber pill each morning with my levothyroxine."
D) "I will increase my intake of protein sources such as meat and eggs."
E) "I will read the nutrition labels and choose foods with high carbohydrate content."

Question 32

The nurse is caring for a patient with hypoparathyroidism. What actions should the nurse expect to perform to help this patient with a low calcium level?

A) administering calcium tablets as prescribed
B) arranging for a dietary consult regarding foods high in calcium
C) restricting fluids
D) administering intravenous IV calcium gluconate
E) administering calcimimetic

Question 33

The nurse is instructing a patient about the symptoms of hyperparathyroidism. Which symptoms should the nurse include in this discussion?

A) abdominal pain
B) dysrhythmias
C) hypertension
D) diarrhea
E) reduced urine output

Question 34

The nurse notes that a patient who has hypoparathyroidism has a serum calcium level of 6.8 mg/dL. What would be a priority problem when planning care for this patient?

A) potential for injury
B) safety concerns because of confusion
C) changes in renal function
D) problems with oxygenation

Question 35

The nurse suspects that a patient with chronic hyperfunction of the adrenal cortex has an infection. What did the nurse assess to come to this conclusion?

A) general feeling of malaise
B) recent weight loss
C) muscular tremors
D) sense of nervous energy

Question 36

A patient with a non-ACTH-producing adrenal cortex tumor is scheduled for a surgical procedure to remove the tumor. Which statement by the patient indicates that teaching about the procedure has been effective?

A) "The adrenal gland with the tumor will be removed."
B) "I will need to take adrenal hormones for the rest of my life."
C) "The tumor will be removed by the transsphenoidal route."
D) "I will receive IV cortisol in preparation for the surgery."

Question 37

The nurse is assessing a patient with hyperparathyroidism who is taking digoxin (Lanoxin). For what should the nurse assess this patient?

A) toxic effects of digoxin (Lanoxin)
B) evidence the medication dose needs to be increased
C) onset of polyuria
D) muscle weakness and atrophy

Question 38

The manager observes a staff nurse instruct a patient with Cushing syndrome about the risk for infection. For which statement should the manager correct the nurse?

A) "Epidermal hypertrophy restricts macrophage activity."
B) "Cortisol affects protein synthesis."
C) "Cortisol inhibits collagen synthesis."
D) "The resulting edema impairs blood flow to tissues."

Question 39

The nurse is reviewing the manifestations of hyperparathyroidism with a patient. Which statements by the patient indicate that teaching has been effective?

A) "Hyperparathyroidism can cause the kidneys to keep calcium and excrete phosphorus."
B) "Calcium and phosphorus leave the bones and make them weak."
C) "Calcium is deposited in soft tissues."
D) "Kidney stones can develop."
E) "The kidneys work to raise blood pH and retain potassium."

Question 40

The nurse is developing a plan of care for a patient with hyperparathyroidism and a serum calcium level of 12.0 mg/dL. What should be included in the plan?

A) promoting ambulation and mobility
B) discussing a change from ordered thiazide diuretics to another type of diuretic with health care provider
C) teaching to increase daily oral intake of fluids
D) encouraging supplementation of fat-soluble vitamins
E) encouraging use of calcium-based antacids for indigestion

Question 41

Type: MCMA A patient with hyperthyroidism is experiencing vision changes. What teaching should the nurse provide to preserve this patient's sight?

A) Apply eye shields.
B) Instill artificial tears.
C) Wear eyeglasses with tinted lenses.
D) Apply warm compresses to the eyes every 4 hours.
E) Notify the health care provider about vision changes.

Question 42

A patient recovering from a closed head injury has a urine specific gravity of 1.010 g/mL. The previous intake and output totals were 1,200 mL intake and 10,000 mL output. Which order from the health care provider should the nurse question for this patient?

A) desmopressin (Minirin) 0.2 mg by mouth daily
B) oral fluid restriction of 800 mL per day
C) 3% normal saline at 100 mL per hour
D) computed tomography scan of head

Question 43

The nurse in the postanesthesia care area is concerned that a patient recovering from a subtotal thyroidectomy is experiencing postoperative complications. What findings led the nurse to come to this conclusion?

A) hoarse voice
B) restlessness and irritability
C) blood pressure 92/56 mmHg
D) heart rate 116 beats per minute
E) high-pitched, squeaky sound with breathing

Question 44

A patient with hypothyroidism is prescribed levothyroxine sodium (Synthroid). What dietary adjustments should the nurse instruct the patient to make?

A) Avoid eating walnuts.
B) Avoid all grapefruit or citrus fruits.
C) Restrict the intake of foods high in fiber.
D) Reduce the intake of green leafy vegetables.
E) Take the medication 30 minutes before eating breakfast in the morning.

Question 45

The nurse is planning a teaching session for a patient with a new diagnosis of adrenoleukodystrophy. What topic should the nurse include?

A) why genetic counseling is included in the plan of care
B) the role of autoimmunity in the development of the disorder
C) the role of anticoagulants in the development of the disorder
D) the surgical site for transsphenoidal entry, using a diagram

Question 46

The nurse is reviewing information in the medical record of a patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of these manifestations should the nurse investigate first when assessing this patient? Laboratory report: Serum sodium 115 mEq/L
History and physical: Patient reports fell from bicycle and struck head 5 days ago
Pulse: 100
Blood pressure: 140/95
Previous 24-hour intake and output: 3,500 mL in, 1,500 mL out

A) The patient is lethargic and difficult to wake.
B) The patient states, "I feel thirsty."
C) The patient states, "I have a headache."
D) The patient's urine is dark amber in color.

Question 47

A patient with Addison disease is experiencing problems with fluid balance. What actions should the nurse take to help this patient?

A) teach to sit and stand slowly
B) monitor cardiac monitor rhythm
C) turn and reposition every 2 hours while awake
D) weigh the patient daily at the same time and in the same clothing
E) encourage oral fluid intake of 3000 mL/day and increased salt intake

Question 48

During an assessment, the nurse determines that a patient with Cushing syndrome requires interventions to support an alteration in carbohydrate metabolism. What manifestations did the patient demonstrate for the nurse to determine this need?

A) striae over the abdomen
B) fat pads on the upper back
C) urine output in one hour 250 mL
D) 2 L of water ingested in 90 minutes
E) fasting blood glucose level 185 mg/dL