Question 1

The patient with Addison disease is receiving IV fluids for rehydration.The nurse should carefully monitor the patient for which potential problem?

Accepted Answer

The patient with Addison disease is at risk for an addisonian crisis.During an addisonian crisis,decreased levels of cortisol result in decreased sensitivity of the blood vessels to sympathetic stimulation.It is the sympathetic stimulation that maintains vascular tone.Lack of vascular tone causes vasodilation,producing hypotension.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 2

The nurse is caring for a patient with a goiter.The nurse correctly uses which technique to administer potassium iodide solution?

Accepted Answer

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

Question 3

A nurse is teaching a patient with Addison disease who has a prescription for corticosteroids.Which statement is most important for the nurse to include in the teaching plan?

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 4

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 5

The nurse is caring for patient who is 8 hours postoperative after a total thyroidectomy.The patient complains of muscle cramps,and the nurse assesses a positive Chvostek sign.The nurse correctly interprets that these findings indicate which complication?

Accepted Answer

Hypoparathyroidism results when the parathyroid glands are removed during a total thyroidectomy.Chvostek sign (muscle irritability when the facial nerve is gently tapped)is consistent with hypocalcemia that occurs secondary to the removal of the parathyroid glands.

Question 6

The nurse is educating a patient who has a new prescription for methimazole (Tapazole).Which instruction is most important for the nurse to include?

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 risk for fetal damage.

Question 7

The husband of a patient with Grave disease confides that he is frustrated with his wife's emotional outbursts and wide mood swings.How should the nurse respond?

Accepted Answer

Reassurance that the signs and symptoms will improve with medication is helpful.The nurse may or may not understand how the patient feels,and this dismisses the husband's concern.The behavior may or may not continue,and asking how the husband is coping or if he has shared his feelings are examples of nontherapeutic communication.

Question 8

The nurse is caring for a patient who reports abruptly discontinuing his prescribed levothyroxine.The nurse should carefully monitor the patient for which complication?

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.Discontinuation of levothyroxine should not cause seizures,diarrhea,or sudden hypertension.

Question 9

A patient with central diabetes insipidus (DI)likely has which occurrence as part of his health history?

Accepted Answer

Central DI is caused by insult to the pituitary that results from a brain injury or invasive brain surgery.Kidney disorders,water addiction,and thyroid disorders do not cause central DI.

Question 10

Which statement accurately describes a subtotal thyroidectomy?

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 11

The patient with hyperthyroidism is undergoing ablation therapy with radioactive iodine.Which precaution is most important for the nurse to employ?

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 12

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.Which problem does the nurse suspect?

Accepted Answer

DI 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 13

Pituitary adenoma antagonizes insulin.This benign tumor results in which imbalance?

Accepted Answer

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

Question 14

The nurse planning the postoperative instructions for the patient who will undergo a hypophysectomy.Which information is most important for the nurse to include?

Accepted Answer

Removal of the pituitary gland is most often done microsurgically.The usual approach is transsphenoidal via the nose or at the junction of the gums and upper lip,and a nasal drip pad is placed.After surgery it is important that the patient not brush his teeth,cough,sneeze,blow his nose,or bend forward,as these may interfere with the healing process.The patient is allowed to raise his arms above his head.

Question 15

The nurse is performing preoperative thyroidectomy instruction for a patient with Graves' disease.The patient begins to cry and says,"I am so nervous and can't listen to you.Just get out!" What should the nurse do next?

Accepted Answer

Informing the charge nurse or surgeon will alert them to possible ineffective control of the thyroid,which can cause thyroid crisis postoperatively.The patient is not ready to read or listen to any instructions at this time,and instruction should not be deferred to a family member.

Question 16

Which manifestations occur with a benign pituitary adenoma?

Accepted Answer

A benign pituitary adenoma may cause gigantism in children,acromegaly in adults,muscle weakness,and joint pain.A benign pituitary adenoma does not cause excessive hair growth (hirsutism).

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 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

The nurse is educating a patient with a simple goiter.Which statement indicates that the patient needs additional instruction?

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 19

The nurse is reviewing the health history of a patient.Which behavior is linked to increased probability of developing Grave disease?

Accepted Answer

Primary hyperthyroidism is also known as Grave 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.

Question 20

The nurse is aware that the severe dehydration associated with diabetes insipidus (DI)can lead which serious electrolyte imbalance?

Accepted Answer

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

Quiz 36: Care of Patients with Pituitary, Thyroid, Parathyroid, and Adrenal Disorders