Deck 46: Caring for the Patient With Glandular and Hormonal Disorders

Question 1

The nurse is caring for a patient who experienced a closed head injury 6 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. Diabetes insipidus DI) has been diagnosed. Which order would the nurse question?

A) Desmopressin Minirin) 0.2 mg IM daily
B) Increased oral fluid intake
C) Serum electrolyte levels every 12 hours
D) Computed tomography scan of head

Answer 1

Desmopressin Minirin) 0.2 mg IM daily

Question 2

Which clinic patient would the nurse monitor for development of Cushing syndrome?

A) A patient who received radioactive iodine treatment for hyperthyroidism
B) A patient receiving steroid treatment for rheumatoid arthritis
C) A patient who has had surgery on the neck
D) A patient receiving radiation for a brain tumor

Answer 2

A patient who received radioactive iodine treatment for hyperthyroidism

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

A patient is scheduled to start taking prednisone Dexasone). The nurse would monitor this patient for which side effects? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: 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) Varicose leg veins
E) Hypotension

Question 5

A patient comes into the emergency department with symptoms of an Addisonian crisis. What 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 6

The nurse assesses a patient who has a diagnosis of Cushing syndrome. 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 7

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 measures should be included in the plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Promote patient ambulation and mobility.
B) Remind the patient to avoid activities that increase the risk for falls or injuries.
C) Teach the patient to increase daily oral intake of fluids.
D) Advise the patient to contact the health care provider if continual thirst is noted.
E) Encourage the use of calcium-based antacids for indigestion.

Question 8

The nurse would monitor for which findings in a patient diagnosed with hypoparathyroidism? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Low protein
B) Low calcium
C) High phosphorous
D) Low potassium
E) High magnesium

Question 9

The nurse is caring for a patient with Cushing syndrome who is scheduled for a surgical procedure to remove an adrenal cortex tumor. The nurse knows patient teaching regarding the procedure has been effective when the patient makes which statement?

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 10

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Muscle weakness
B) Hypercalcemia
C) Diarrhea
D) Weight gain
E) Hypotension

Question 11

Which instruction would be most important for the 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 headache immediately.
C) Herbal remedies are appropriate for use postoperatively.
D) Avoid exposure to crowds for several weeks after surgery.

Question 12

The nurse notes that a patient has thin arms and legs, purple striae on the abdomen, upper body obesity, and a round, red face. The nurse would ask additional assessment questions based on a possible disorder of which structure?

A) Hypothalamus
B) Adrenal gland
C) Parathyroid gland
D) Thyroid gland

Question 13

A patient with chronic hyperfunction of the adrenal cortex is being assessed. The nurse would attribute which finding to the patient's chronic condition?

A) General feeling of malaise
B) Recent weight loss
C) Hypotension
D) Yellowing of the cornea

Question 14

During the assessment of a patient with thyroid dysfunction, the nurse notes hair loss and warm, moist skin. Which question is 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 that you do not tolerate cold as well as you once did?"

Question 15

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 understanding of instructions about this medication?

A) "This medication will increase my metabolism."
B) "As long as I take this medication daily, the time of the dose is not important."
C) "This medication will cure my thyroid problem."
D) "I will need regular blood tests while taking this medication."

Question 16

The patient is being treated for hypothyroidism. Under which circumstances would the nurse monitor this patient for development of myxedema crisis? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) The patient is injured in an automobile accident.
B) The patient develops a urinary tract infection.
C) The patient accidentally doubled the dose of thyroid replacement medications today.
D) The patient must have surgery for a ruptured appendix.
E) The patient's husband just filed for divorce.

Question 17

A patient diagnosed with an adrenal gland alteration tells the nurse, "I am rarely outside in the sun but I'm getting such a tan!" Which nursing intervention 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, particularly for wheezing.
D) Palpate the patient's thyroid gland.

Question 18

A nurse notes that a patient who has hypoparathyroidism has a serum calcium level of 4.2 mg/dL. This finding would help reinforce which nursing diagnosis?

A) Risk for Injury
B) Chronic Confusion
C) Risk for Altered Tissue Perfusion: Renal
D) Impaired Gas Exchange

Question 19

A patient with a diagnosis of acromegaly related to a benign pituitary tumor is scheduled to have surgical removal of the tumor by the transsphenoidal route. Which statement by the patient would indicate that the nurse's teaching regarding the procedure has been effective?

A) "I will clean my teeth and gums with a soft foam sponge after the procedure."
B) "I should choose a wig before my head is shaved."
C) "There may be drainage from my ears for a day or two after surgery."
D) "Surgical placement marks on my head will wash off with soap and water."

Question 20

The nurse is caring for a patient with elevated serum thyroid hormones and new-onset exophthalmos. The nurse establishes which nursing diagnosis?

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

Question 21

A patient has been prescribed the synthetic hormone levothyroxine. What medication instructions should the nurse provide? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "Take the medication with juice or milk for best absorption."
B) "You may need a stool softener when taking this medication."
C) "Do not switch brands of levothyroxine without first discussing the change with your health care provider."
D) "Plan to take this medication every day for the rest of your life."
E) "Take your medication at least 4 hours before taking antacids containing calcium."

Question 22

Which interventions would the nurse plan to address the nursing diagnosis Risk for Impaired Skin Integrity for a patient with hypothyroidism? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Wash daily with antibacterial soap.
B) Apply emollient skin lotion liberally at least twice daily.
C) Use astringent wipes to reduce itching.
D) Assess the need for an alternating air mattress daily.
E) Clean areas between skin folds with alcohol to prevent a yeast infection.

Question 23

A patient with Graves' disease is brought to the emergency department by her husband. He says that the couple have both had the flu and that she "has not been able to keep anything down for about 3 days." The patient has a temperature of 103ºF, heart rate is 124bpm, respiratory rate 20, and blood pressure 150/88 mmHg. She complains of severe nausea and is very agitated. Which actions should the nurse take? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Have both the patient and the husband put on isolations masks.
B) Notify the physician that another patient with possible influenza has been admitted to the ED.
C) Place the patient on a cardiac monitor.
D) Start an intravenous access device according to emergency protocol.
E) Stay with the patient while another nurse notifies the physician of the patient's condition.

Question 24

During a routine physical, a 30-year-old patient remarks, "I had to buy all new shoes because my feet are growing again." How should the nurse reply?

A) "Have you noticed any changes in your hands?"
B) "That is not too bad a problem to have."
C) "We should measure your height."
D) "Have you noticed your heart beating faster?"

Question 25

A patient who is beginning drug treatment for hypothyroidism asks the nurse, "How do I know if the drug is working?" How should the nurse reply? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) "You will begin losing weight."
B) "You will probably start feeling like your old self pretty quickly once treatment begins."
C) "You will have to check with your doctor to see if the drug is working."
D) "You should gradually begin to have more energy."
E) "You will probably notice your concentration improving."

Question 26

An older adult is diagnosed with apathetic thyrotoxicosis. Which nursing diagnosis would the nurse prioritize in this patient's care plan?

A) Anxiety
B) Depression
C) Risk for Injury: Falls
D) Decreased Tissue Perfusion: Peripheral 5.

Question 27

The nurse notifies the health care provider that a patient is experiencing signs of myxedema. What assessment parameters has the nurse noted? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Facial swelling
B) Anuria
C) Macroglossia
D) Fever
E) Bradycardia

Question 28

A patient has been admitted for treatment of syndrome of inappropriate antiduretic hormone secretion SIADH). The nurse expects continued diagnostic tests for which disorder?

A) Heart failure
B) Small cell carcinoma of the lung
C) Hypertension
D) Pleural effusion

Question 29

A 70-year-old patient is prescribed levothyroxine for treatment of hypothyroidism. The nurse would expect which age-related adjustment in dosage?

A) The dosage will be higher than for younger patients.
B) The dose will be divided into two or three doses each day.
C) The dose will be the same as for younger adults, but greater than that for children.
D) The initial dose will be significantly lower for the older adult.

Question 30

The nurse is planning to present a community education session on advances in the diagnosis and treatment of endocrine disorders. Which topics should be included in this presentation? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) More sensitive technology for hormonal assays
B) Development of new synthetic hormones
C) Standardized methods to prevent endocrine disorders
D) New diagnostic imaging technologies
E) Improvements in surgical techniques

Question 31

The nurse would consider incorporating which nursing diagnoses into the plan of care for a patient with acute adrenal insufficiency? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Risk of Ineffective Therapeutic Regimen Management
B) Hyponatremia
C) Fluid Volume Excess
D) Risk for Injury
E) Imbalanced Nutrition: Less than Body Requirements

Question 32

When measuring the blood pressure of a patient with hypoparathyroidism, the nurse notes spasms of the patient's hand. How should the nurse document this finding?

A) Trousseau's sign
B) Chvostek's sign
C) Turner's sign
D) Cullen's sign

Question 33

Following surgery for hypersecretion of growth hormone, a patient complains of a supraorbital headache. The nurse suspects a possible CSF leak and would take which actions? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Test any nasal drainage for glucose.
B) Maintain bed rest.
C) Inform the patient that headaches are expected.
D) Keep the head of the bed HOB) elevated 30 degrees.
E) Administer antibiotics as ordered.

Question 34

A patient with hypoparathyroidism has a low serum calcium level. How would the nurse test for the clinical manifestation consistent with this laboratory result? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.

A) Have the patient open and close both hands.
B) Place a blood pressure cuff on the patient's arm.
C) Tap over the patient's facial nerve.
D) Press lightly on the patient's shoulders.
E) Ask the patient to count backwards.