Deck 19: Nursing Care of Patients with Endocrine Disorders

Question 1

A patient says to the nurse, "I didn't realize this steroid medicine would make me lose weight in my legs." The nurse realizes that this patient is reporting signs of which of the following?

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

Answer 1

muscle wasting

Question 2

Which of these explanations regarding the postoperative period is the priority for a nurse to give to a patient who is scheduled to have a thyroidectomy?

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."

Answer 2

"Avoid the use of iodized salt after your procedure."

Question 3

The nurse is reviewing the laboratory findings for a group of patients. The nurse knows that which set of diagnostic results is consistent with a diagnosis of 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

Answer 3

elevated TSH, depressed T3 and T4

Question 4

The nurse is providing care to a patient who is in the postoperative period following a bilateral adrenalectomy. Which of the following interventions would be helpful to assess for the onset of adrenal insufficiency?

A)Monitor strict intake and output.
B)Change dressing using clean technique.
C)Question the order for cortisol administration.
D)Place on fluid restriction.

Question 5

A nurse should recognize that a patient with untreated hypothyroidism is at risk for developing which of the following? Select all that apply.

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

Question 6

The nurse receives the following orders for a hospitalized patient with a history of long-standing, untreated hypothyroidism diagnosed as myxedema coma. The nurse seeks follow up with the primary healthcare provider for which of the following orders? Select all that apply.

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 7

A patient with Cushing's syndrome tells the nurse, "I seem to catch a cold every couple of weeks." Which of the following nursing interventions is most appropriate in addressing the 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 8

The nurse is caring for a patient with elevated serum T3 and T4 levels who receives a new prescription for methimazole (Tapazole). Which of these patient statements indicates the patient needs further instruction regarding 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 9

The nurse is teaching a class for a group of nursing students regarding myxedema coma. The nurse knows the students understand teaching when they identify which of the following as possible precipitating factors for myxedema coma? Select all that apply.

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

Question 10

The nurse is caring for a patient with elevated serum thyroid hormones and new onset proptosis. The nurse establishes a nursing diagnosis of which of the following?

A)Disturbed Body Image
B)Risk for Infection
C)Imbalanced Nutrition: More than Body Requirements
D)Fluid Volume Excess

Question 11

Which of these explanations would be most important for a nurse to give to a patient who is scheduled to have a subtotal thyroidectomy?

A)Report sensations of tingling in toes, fingers, or lips.
B)Report signs of constipation.
C)Report any occurrence of hoarse voice.
D)Administer aspirin as prescribed.

Question 12

A patient whose thyroid gland produces an insufficient amount of thyroid hormone tells the nurse, "I watch what I eat but my cholesterol continues to go up." An appropriate response for the nurse to make to this patient is which of the following?

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

Question 13

The nurse is teaching a group of nursing students about the relationship between thyroid hormone and iodine. The nurse knows further teaching is required when the students state, "Patients may experience iodine deficiency and hypothyroidism if they

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

Question 14

A patient diagnosed with an adrenal gland alteration tells the nurse, "I am rarely outside in the sun and I'm getting such a tan!" Which of the following nursing interventions is a priority in addressing the patient's concern?

A)Ask if the patient is still taking the prescribed steroid for Addison's disease.
B)Ask the patient what time of day he or she is outdoors.
C)Auscultate the patient's lung sounds.
D)Palpate the patient's thyroid gland.

Question 15

A patient comes into the emergency department with symptoms of an Addisonian crisis. Which of the following should the nurse be prepared to administer to assist this patient?

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

Question 16

The family of an elderly patient with hypothyroidism says, "I try to keep her clean but she has all of these open areas on her legs and arms." Which of the following statements is appropriate for the nurse to make to this family?

A)"Use warm water."
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 17

The nurse is providing care to a patient with a low level of serum parathyroid hormone. Which of the following assessment findings would be consistent with this diagnosis? Select all that apply.

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

Question 18

During the assessment of a patient with an alteration in thyroid function the nurse notes smooth fine hair, and warm dry skin. Which of these questions would be most important for the nurse to 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 19

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

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

Question 20

A 35-year-old female patient with a prescription for oral contraceptives is prescribed steroid therapy. Which of the following 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)"Weigh yourself daily."
D)"Avoid the use of salt."

Question 21

A nurse assesses a patient who has a diagnosis of Cushing's syndrome and notes the following findings. Which set of findings should the nurse follow-up immediately?

A)serum potassium 2.5 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 22

A nurse is teaching a patient about alterations of the parathyroid glands. Which of these patient comments is a reliable indicator that the patient has the correct understanding of the effect of hyperparathyroidism on the patient's body? Select all that apply. Select all that apply.

A)"Hyperparathyroidism can cause the kidneys to keep calcium and excrete phosphorus."
B)calcium and phosphorus to leave the bones and make bones weak."
C)calcium to be deposited in soft tissues."
D)development of kidney stones."
E)the kidneys to raise blood pH and retain potassium."

Question 23

A nurse should recognize that a patient who has a diagnosis of Cushing's syndrome is at risk for developing which of the following? Select all that apply.

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

Question 24

The nurse is teaching a patient who has a diagnosis of hypothyroidism about the importance of dietary fiber. The nurse realizes the patient understands teaching when the patient states which of the following? Select all that apply. Select all that apply.

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 25

The nurse is assessing a patient's understanding of teaching regarding the diagnosis of hyperparathyroidism. The nurse knows further teaching is needed when the patient states, "The primary healthcare provider can determine I have hyperparathyroidism when

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

Question 26

The nurse is teaching a group of nursing students about risk factors for Cushing's syndrome. The nurse knows further teaching is required when the students identify which of the following patients as being at risk for Cushing's syndrome? The patient who

A)received radioactive iodine treatment for hyperthyroidism.
B)is receiving treatment for rheumatoid arthritis.
C)has an organ transplant.
D)has been receiving chemotherapy to treat a brain tumor.

Question 27

A nurse is conducting an educational class for older adults regarding the use of thyroid hormone replacement. The nurse knows further teaching is needed when the participants state, "Older adults may be at risk for too much thyroid medication in their blood because they

A)may have too many lipids in their blood that can displace the medication from serum albumin."
B)may have less albumin in the blood to bind to thyroid medication."
C)may have kidney alterations that make the organs less efficient at removing medications from the blood."
D)may be at greater risk for polypharmacy, leading to problems with medication dosing and administration."

Question 28

The nurse is screening a group of patients for risk factors related to thyroid cancer. The nurse realizes that which of the following patients is at 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 who diet consists largely of red meat
D)an 85-year-old patient who works outdoors without sunscreen

Question 29

A patient is scheduled to start taking prednisone (Dexasone). A nurse should teach the patient to observe for side effects that include which of the following? Select all that apply.

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 30

Which of these measures, if included in the care plan for a patient who has hypoparathyroidism, would be most effective in addressing the most prevalent electrolyte abnormality associated with this health alteration? Select all that apply.

A)Administer calcium tablets with a full glass of water.
B)Monitor electrocardiogram (ECG) if giving IV calcium when patient taking digitalis.
C)Administer calcium salts with meals.
D)Administer IV calcium with bicarbonate.
E)Administer calcium subcutaneously if IV access is unavailable.

Question 31

The nurse is teaching a patient diagnosed with hyperparathyroidism secondary to renal failure about the patient's new prescription for cinacalcet (Sensipar). The nurse knows the patient understands teaching regarding the medication when the patient states, "This medication works by

A)increasing the sensitivity of the calcium-sensing receptors of the parathyroid gland to serum calcium."
B)blocking calcium receptors in the nervous system and musculoskeletal system."
C)decreasing reabsorption of calcium in the distal renal tubule."
D)binding calcium to bile salts that are then excreted through the GI tract."

Question 32

A nurse notes that a patient who has hypoparathyroidism has a serum calcium level of 6.8 mg/dL. This finding would help substantiate a nursing diagnosis of which of the following?

A)Risk for Injury
B)Chronic Confusion
C)Risk for Ineffective Renal Perfusion
D)Impaired Gas Exchange

Question 33

The nurse is assessing a patient with hyperparathyroidism who recently received a new prescription for Lanoxin (digoxin). Which of these manifestations would indicate the patient is experiencing an adverse effect related to the use of this medication?

A)disturbed color vision
B)agitation
C)metallic taste in mouth
D)seizure activity

Question 34

When assessing a patient who has chronic hyperfunction of the adrenal cortex the nurse should determine whether the patient has which of these manifestations?

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

Question 35

The nurse is assessing a patient and reviewing the patient's diagnostic data. The nurse understands that which of the following data are likely associated with the diagnosis of hypothyroidism? Select all that apply.

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 3000 mL/min to 4000 mL/min per echocardiogram

Question 36

A nurse hears a colleague including all of the following statements when providing teaching to a patient with Cushing's syndrome regarding increased risk for infection. Which one would require the nurse to intervene? "Cushing's syndrome increases the risk of infection because

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

Question 37

The nurse has given the patient instructions regarding the symptoms of hyperparathyroidism. Which of these statements if made by the patient would indicate that the patient has the correct understanding of instructions? "I need to tell my healthcare provider if I experience Select all that apply.

A)abdominal pain."
B)palpitations."
C)morning headaches."
D)diarrhea."
E)twitching muscles."

Question 38

The nurse is developing a plan of care for a home care patient who has hyperparathyroidism and a serum calcium level of 12.0 mg/dL. Which of the following measures should be included in the plan? Select all that apply.

A)Promote patient ambulation and mobility.
B)Discuss change from ordered thiazide diuretics to another type of diuretic with healthcare provider.
C)Teach patient to increase daily oral intake of fluids.
D)Encourage supplementation of fat soluble vitamins.
E)Encourage use of calcium-based antacids for indigestion.

Question 39

The nurse is caring for a patient with a potential diagnosis of Cushing's syndrome and a prescription for a 24-hour urine collection. The patient asks the nurse why a 24-hour collection is needed rather than a one-time urine collection. The nurse correctly answers that 24-hour urine tests are more accurate in this situation because of which of the following?

A)Cortisol levels fluctuate through the day.
B)At least 2000 mL of urine is required to perform the test.
C)Predetermined urine specific gravity changes occur in the 24-hour period.
D)The 24-hour timeline reduces unwanted effects of medications excreted in the urine.

Question 40

The nurse is caring for a patient with a non-ACTH-producing adrenal cortex tumor who is scheduled for a surgical procedure to remove the tumor. The nurse knows patient teaching regarding the procedure has been effective when the patient states,

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 41

The nurse is caring for a patient who experienced a closed head injury six days ago. The patient's urine output over the previous 24 hours was 10,000 mL. Total intake for the same period was 1,200 mL. Urine specific gravity is 1.010 g/mL. The patient receives the following prescriptions. Which order will the nurse clarify with the primary healthcare provider?

A)desmopressin (Minirin) 0.2 mg IM 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 42

The nurse is providing teaching to a patient with a diagnosis of acromegaly related to a benign pituitary tumor who is scheduled to have surgical removal of the tumor by the transsphenoidal route. Which statement, if made by the patient, would indicate that teaching regarding the procedure has been effective? "I will

A)clean my gums with a soft foam sponge after the procedure."
B)choose a wig prior to needing to shave my head."
C)check for any drainage from my ears while in the hospital."
D)wash the marks on my head with lukewarm water only."

Question 43

The nurse is reviewing findings from a patient's chart. Which of these manifestations should a nurse investigate first when assessing this patient? Exhibit 1: Laboratory Report: Serum sodium 115 mEq/L
Exhibit 2: History and Physical: Patient reports fell from bicycle and struck head five days ago.
Exhibit 3: Graphics Record: Pulse 100. Blood Pressure 140/9

A)Patient is lethargic and difficult to wake .
B)Patient states, "I feel thirsty."
C)Patient states, "I have a headache."
D)Patient's urine is dark amber in color
E)Previous 24-hour intake and output - 3,500 mL in.1,500 mL out.

Question 44

The nurse working in the emergency department is caring for a patient with Addison's disease who has an oral temperature of 102° F and blood pressure of 70/35. The patient is reporting weakness and abdominal pain. The nurse recognizes that which of the following patient statements is likely related to the patient's current manifestations?

A)"I had my tonsils out last week."
B)"I have a pressure ulcer from sleeping in my recliner."
C)"I have been using a tanning bed."
D)"I take my prednisone (Deltasone) every day."
E)The patient is reporting weakness and abdominal pain.The nurse recognizes that which of the following patient statements is likely related to the patient's current manifestations? Select all that apply.

Question 45

The nurse is planning a teaching session for a patient with a new diagnosis of adrenoleukodystrophy. Which of these outcomes should receive priority in the plan? The patient will

A)explain why genetic counseling is included in the plan of care.
B)discuss the role of autoimmunity in the development of the disorder.
C)identify the role of anticoagulants in the development of the disorder.
D)identify the surgical site for transsphenoidal entry on a diagram.