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?

Accepted Answer

Abruptly stopping hormone replacement can cause the patient to go into myxedema coma.Signs and symptoms of myxedema coma include dizziness,respiratory distress,low blood sugar,or hypothermia.

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:

Accepted Answer

Diabetes insipidus is a complication of a hypophysectomy.The posterior lobe of the pituitary gland controls urinary output;when this portion of the pituitary is removed or damaged,there is no secretion of antidiuretic hormone to stop excessive urine output.

Question 3

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

Accepted Answer

Central diabetes insipidus is caused by insult to the pituitary by brain injury or invasive surgery.

Question 4

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

Accepted Answer

Radioactive iodine (¹³¹I)circulates in the blood and is excreted by the kidneys,so radioactive precautions should be taken with any equipment contaminated with blood or urine.

Question 5

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

Accepted Answer

There is no hirsutism with a pituitary tumor.

Question 6

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

Accepted Answer

Patients who do not respond well to antithyroid drug therapy,who are unable to take radioactive iodine,or who have greatly enlarged thyroid glands are candidates for a subtotal thyroidectomy.In the subtotal procedure,two thirds of the glandular mass is removed.The remaining portion of the gland is left intact so production and release of thyroid hormone can continue.There is no need for antithyroid drugs,and the operative risks are the same.

Question 7

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

Accepted Answer

Treatment usually arrests the growth of the goiter but usually does not diminish the size of the growth unless diagnosis is made early in the disease before growth has become excessive.

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:

Accepted Answer

Hypoparathyroidism results when the parathyroid glands are accidentally removed during a total thyroidectomy.Chvostek's sign is consistent with the removal of the parathyroid glands.Chvostek sign manifests as muscle irritability when the facial nerve is gently tapped.

Question 9

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

Accepted Answer

All replacement hormone drugs should be taken on a strict schedule.Doubling up and taking a substitute drug interfere with the effectiveness of the therapy.Pregnant women should not take this drug because of fetal damage.

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:

Accepted Answer

Informing the charge nurse or surgeon will alert them to possible ineffective control of the thyroid,which can cause thyroid crisis postoperatively.

Question 11

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

Accepted Answer

Iodine preparations may be given for a period of 10 to 14 days before surgery of the thyroid to reduce the vascularity of the gland,minimizing the danger of releasing large amounts of thyroid hormone into the bloodstream during surgery,and to decrease the risk of hemorrhage.

Question 12

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

Accepted Answer

The patient with Addison's disease is at risk for an addisonian crisis.Addisonian crisis requires immediate fluid replacement therapy in order to prevent irreversible shock.Intravenous hydrocortisone is given along with sodium,fluids,and dextrose until blood pressure becomes stable.The hydrocortisone is then tapered off slowly.Hyperkalemia must also be addressed with insulin,Kayexalate,and loop diuretics,and by monitoring arrhythmias and the patient's intake and output.Hypoglycemia is treated with IV glucose and with glucagon as needed;blood glucose is monitored every hour.

Question 13

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

Accepted Answer

The loss of potassium in the large volume of urine depletes the compensatory mechanisms and hypernatremia results.

Question 14

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

Accepted Answer

Patient should not cough,sneeze,or blow nose as this could lead to a cerebrospinal fluid leak.

Question 15

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

Accepted Answer

The solution should be diluted and drunk through a straw to avoid staining of teeth.

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:

Accepted Answer

Reassurance that the signs and symptoms will improve with medication is helpful.Responses of "she can be quite a handful," "I'm afraid this behavior will continue," and "I'd tell her how you feel" are inaccurate and nontherapeutic communication.

Question 17

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

Accepted Answer

When assessing for Cushing's disease cortisol levels are evaluated.If elevated cortisol levels are noted,a dexamethasone suppression test should be ordered.In preparation for the test,the patient is given a steroid at night,and blood and urine cortisol levels are then measured in the morning.

Question 18

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

Accepted Answer

The tumor interferes with the effectiveness of insulin,resulting in hyperglycemia.

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:

Accepted Answer

Corticosteroids should be taken every day.Corticosteroids should be administered with food.The medications should not be abruptly discontinued.To provide appropriate serum medication levels,they are not to be doubled or altered without physician consultation.

Question 20

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

Accepted Answer

Primary hyperthyroidism is also known as Graves' disease or toxic goiter.Medications containing iodine,such as amiodarone (an antidysrhythmic heart medication),can predispose to hyperthyroidism.In addition,it has been discovered recently that people who smoke have nearly twice the risk of developing hyperthyroidism when compared with nonsmokers.

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