Deck 50: Nursing Management: Endocrine Problems

Question 1

During preoperative teaching for a patient scheduled for transsphenoidal hypophysectomy for treatment of a pituitary adenoma, the nurse instructs the patient about the need to

A) cough and deep breathe every 2 hours postoperatively.
B) remain on bed rest for the first 48 hours after the surgery.
C) be positioned flat with sandbags at the head postoperatively.
D) avoid brushing the teeth for at least 10 days after the surgery.

Answer 1

avoid brushing the teeth for at least 10 days after the surgery.

Question 2

A patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask?

A) "Have you had a recent head injury?"
B) "Do you have to wear larger shoes now?"
C) "Are you experiencing tremors or anxiety?"
D) "Is there any family history of acromegaly?"

Answer 2

"Do you have to wear larger shoes now?"

Question 3

A patient is suspected of having a pituitary tumor causing panhypopituitarism. During assessment of the patient, the nurse would expect to find

A) high blood pressure.
B) elevated blood glucose.
C) tachycardia and cardiac palpitations.
D) changes in secondary sex characteristics.

Answer 3

changes in secondary sex characteristics.

Question 4

A patient with symptoms of diabetes insipidus is admitted to the hospital for evaluation and treatment of the condition. An appropriate nursing diagnosis for the patient is

A) insomnia related to frequent waking at night to void.
B) impaired gas exchange related to fluid retention in lungs.
C) excess fluid volume related to intake greater than output.
D) risk for impaired skin integrity related to generalized edema.

Question 5

After radical neck surgery, a patient develops hypoparathyroidism. The nurse should plan to teach the patient about

A) use of bisphosphonates to reduce bone demineralization.
B) including whole grains in the diet to prevent constipation.
C) calcium supplementation to normalize serum calcium levels.
D) having a high fluid intake to decrease risk for nephrolithiasis.

Question 6

A 78-year-old patient in a long-term care facility has these medications prescribed. After the patient is diagnosed with hypothyroidism, the nurse will need to consult with the health care provider before administration of

A) docusate (Colace).
B) diazepam (Valium).
C) ibuprofen (Motrin).
D) cefoxitin (Mefoxin).

Question 7

When teaching a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) about long-term management of the disorder, the nurse determines that additional instruction is needed when the patient says,

A) "I should weigh myself daily and report any sudden weight loss or gain."
B) "I need to limit my fluid intake to no more than 1 quart of liquids a day."
C) "I will eat foods high in potassium because the diuretics cause potassium loss."
D) "I need to shop for foods that are low in sodium and avoid adding salt to foods."

Question 8

A patient with primary hyperparathyroidism has a serum calcium level of 14 mg/dL (3.5 mmol/L) and a phosphorus of 1.7 mg/dL (0.55 mmol/L). Which nursing action should be included in the plan of care?

A) Institute routine seizure precautions.
B) Monitor for positive Chvostek's sign.
C) Encourage the patient to remain on bed rest.
D) Encourage 3000 to 4000 mL of oral fluids daily.

Question 9

Following a parathyroidectomy, a patient develops tingling of the lips and a positive Trousseau's sign. Which action should the nurse take first?

A) Administer the ordered muscle relaxant.
B) Give the ordered oral calcium supplement.
C) Start the PRN oxygen at 2 L/min per cannula.
D) Have the patient rebreathe using a paper bag.

Question 10

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. Which action will the nurse anticipate taking next?

A) Infuse IV calcium gluconate.
B) Suction the patient's airway.
C) Prepare for endotracheal intubation.
D) Assist with emergency tracheostomy.

Question 11

When planning teaching for a patient who was admitted with myxedema coma and diagnosed with hypothyroidism, which strategy will be best for the nurse to use?

A) Delay teaching until patient discharge.
B) Ensure privacy by asking visitors to leave.
C) Provide written handouts of all information.
D) Offer multiple options for management of therapies.

Question 12

Which information will the nurse include when teaching a patient about use of somatropin (Genotropin)?

A) The medication will improve vaginal dryness.
B) Inject the medication subcutaneously every day.
C) Blood glucose levels will decrease when taking the medication.
D) Stop taking the medication if swelling of the hands or feet occurs.

Question 13

A patient with Graves' disease has exophthalmos. Which nursing action will be included in the plan of care?

A) Apply eye patches to protect the cornea from irritation.
B) Place cold packs on the eyes to relieve pain and swelling.
C) Elevate the head of the patient's bed to reduce periorbital fluid.
D) Teach the patient to blink every few seconds to lubricate the cornea.

Question 14

Which information will the nurse include when teaching a patient who has been newly diagnosed with Graves' disease?

A) Exercise is contraindicated to avoid increasing metabolic rate.
B) Restriction of iodine intake is needed to reduce thyroid activity.
C) Surgery will eventually be required to remove the thyroid gland.
D) Antithyroid medications may take several weeks to have an effect.

Question 15

A patient with hyperthyroidism is treated with radioactive iodine (RAI) at a clinic. Before the patient is discharged, the nurse instructs the patient

A) that symptoms of hyperthyroidism should be relieved in about a week.
B) that symptoms of hypothyroidism may occur as the RAI therapy takes effect.
C) to discontinue the antithyroid medications taken before the radioactive therapy.
D) about radioactive precautions to take with urine, stool, and other body secretions.

Question 16

Which nursing action will be included in the postoperative plan of care for a patient who has had a transsphenoidal resection of a pituitary tumor?

A) Monitor urine output every hour.
B) Palpate extremities for dependent edema.
C) Check hematocrit hourly for first 12 hours.
D) Obtain continuous pulse oximetry for 24 hours.

Question 17

A 72-year-old patient is diagnosed with hypothyroidism and levothyroxine ( Synthroid ) is prescribed. Which assessment is most important for the nurse to make during initiation of thyroid replacement?

A) Apical pulse rate
B) Nutritional intake
C) Intake and output
D) Orientation and alertness

Question 18

A patient is hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The patient is confused and reports a headache, muscle cramps, and twitching. The nurse would expect the initial laboratory results to include

A) an elevated hematocrit.
B) a decreased serum sodium.
C) an increased serum chloride.
D) a low urine specific gravity.

Question 19

A patient is treated with demeclocycline (Declomycin) to control the symptoms of syndrome of inappropriate antidiuretic hormone (SIADH). The nurse determines that the demeclocycline is effective upon finding that the

A) peripheral edema is decreased.
B) patient's weight has increased.
C) urine specific gravity is increased.
D) patient's urinary output is increased.

Question 20

Which assessment finding for a patient who takes levothyroxine ( Synthroid ) to treat hypothyroidism indicates that the nurse should contact the health care provider before administering the medication?

A) Increased thyroxine ( T₄ ) level
B) Blood pressure 102/62 mm Hg
C) Distant and difficult to hear heart sounds
D) Elevated thyroid stimulating hormone level

Question 21

A patient with Cushing syndrome returns to the surgical unit following an adrenalectomy. During the initial postoperative period, the nurse gives the highest priority to

A) monitoring for infection.
B) protecting the patient's skin.
C) maintaining fluid and electrolyte status.
D) preventing severe emotional disturbances.

Question 22

Which assessment finding for a 24-year-old patient admitted with Graves' disease requires the most rapid intervention by the nurse?

A) BP 166/100 mm Hg
B) Bilateral exophthalmos
C) Heart rate 136 beats/minute
D) Temperature 104.8° F ( 40.4° C )

Question 23

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

A) A 31-year-old with Cushing syndrome and a blood glucose level of 244 mg/dL
B) A 22-year-old admitted with syndrome of inappropriate antidiuretic hormone ( SIADH ) who has a serum sodium level of 130 mEq/L
C) A 70-year-old who recently started taking levothyroxine ( Synthroid ) and has an irregular pulse of 134
D) A 53-year-old who has Addison's disease and is due for a scheduled dose of hydrocortisone ( Solu-Cortef ).

Question 24

A patient is admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH). Which information obtained by the nurse is most important to communicate rapidly to the health care provider?

A) The patient complains of dyspnea with activity.
B) The patient has a urine specific gravity of 1.025.
C) The patient has a recent weight gain of 8 lb.
D) The patient has a serum sodium level of 119 mEq/L.

Question 25

When providing postoperative care for a patient who had a bilateral adrenalectomy, which assessment information requires the most rapid action by the nurse?

A) The blood glucose is 176 mg/dL.
B) The lungs have bibasilar crackles.
C) The patient's BP is 88/50 mm Hg.
D) The patient has 5/10 incisional pain.

Question 26

When caring for a patient who has an adrenocortical adenoma, causing hyperaldosteronism, the nurse should

A) provide a potassium-restricted diet.
B) monitor the blood pressure every 4 hours.
C) monitor blood glucose level every 4 hours.
D) relieve edema by elevating the extremities.

Question 27

Which information obtained by the nurse when caring for a patient who has diabetes insipidus (DI) is most important to report to the health care provider?

A) The patient had a recent head injury.
B) The patient is confused and lethargic.
C) The patient has a urine output of 400 mL/hr.
D) The patient's urine specific gravity is 1.003.

Question 28

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

A) oral corticosteroids to replace endogenous cortisol.
B) chemotherapy to prevent reoccurrence of the tumor.
C) insulin use to maintain blood glucose at normal levels.
D) sodium restriction to prevent fluid retention and hypertension.

Question 29

Which of these nursing actions in the plan of care for a patient who has diabetes insipidus will be most appropriate for the RN to delegate to an experienced LPN/LVN?

A) Titrate the infusion of 5% dextrose in water.
B) Teach patient how to use DDAVP nasal spray.
C) Assess patient's hydration status every 8 hours.
D) Administer subcutaneous desmopressin (DDAVP).

Question 30

When a patient is hospitalized with acute adrenal insufficiency, which assessment finding by the nurse indicates that the prescribed therapies are effective?

A) Increasing serum sodium levels
B) Decreasing blood glucose levels
C) Decreasing serum chloride levels
D) Increasing serum potassium levels

Question 31

A patient with Graves' disease is admitted to the emergency department with thyroid storm. Which of these prescribed medications should the nurse administer first?

A) propranolol (Inderal)
B) propylthiouracil (PTU)
C) methimazole (Tapazole)
D) iodine (Lugol's solution)

Question 32

When caring for a patient with a diagnosis of Cushing syndrome, which data will the nurse expect to find during the admission assessment?

A) Chronically low blood pressure
B) Bronzed appearance of the skin
C) Decreased axillary and pubic hair
D) Purplish red streaks on the abdomen

Question 33

When developing a plan of care for a patient with syndrome of inappropriate antidiuretic hormone (SIADH), which interventions will the nurse include?

A) Encourage fluids to 2000 mL/day.
B) Offer patient hard candies to suck on.
C) Monitor for increased peripheral edema.
D) Keep head of bed elevated to 30 degrees.

Question 34

A patient is admitted to the hospital in Addisonian crisis. Which patient statement supports the nursing diagnosis of ineffective self-health management related to lack of knowledge about management of Addison's disease?

A) "I double my dose of hydrocortisone on the days that I go for a run."
B) "I frequently eat at restaurants, and so my food has a lot of added salt."
C) "I had the stomach flu earlier this week and couldn't take the hydrocortisone."
D) "I take twice as much hydrocortisone in the morning as I do in the afternoon."

Question 35

A patient with Cushing syndrome who is admitted for adrenalectomy has a nursing diagnosis of disturbed body image related to changes in appearance caused by the effects of the disease. Which intervention by the nurse will be most helpful?

A) Reassure the patient that the physical changes are very common in patients with Cushing syndrome.
B) Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome.
C) Teach the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.
D) Remind the patient that the metabolic impact of Cushing syndrome is of more importance than appearance.

Question 36

A patient admitted to the hospital with hypertension is diagnosed with a pheochromocytoma. The nurse will plan to monitor the patient for

A) flushing.
B) headache.
C) bradycardia.
D) hypoglycemia.

Question 37

Which action should the nurse take first when caring for a patient who has just arrived on the unit after a thyroidectomy?

A) Check the dressing for bleeding.
B) Assess respiratory rate and effort.
C) Take the blood pressure and pulse.
D) Support the patient's head with pillows.

Question 38

A patient with systemic lupus erythematosus has a prescription for 2 weeks of high-dose prednisone therapy. When teaching the patient about the 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) A weight-bearing exercise program will help minimize the risk for osteoporosis.
D) Weigh yourself daily to monitor for weight gain caused by water or increased fat.

Question 39

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

A) The patient is sleepy and hard to arouse.
B) The patient has increasing swelling of the neck.
C) The patient is complaining of 7/10 incisional pain.
D) The patient's cardiac monitor shows a heart rate of 112.