Question 1

A nursing assessment of a patient with Cushing's syndrome reveals that the patient has truncal obesity and thin arms and legs.What is an additional manifestation of Cushing's syndrome that the nurse would expect to find?

Accepted Answer

Purplish red striae on the abdomen are a common manifestation of Cushing's syndrome. Option A is not expected as Cushing's syndrome can cause hypertension. Option B is not expected as Cushing's syndrome can cause excessive hair growth or hirsutism. Option D is a manifestation of another condition called Addison's disease, which is characterized by hyperpigmentation of the skin, but not a symptom of Cushing's syndrome.

Question 2

Following a thyroidectomy,a patient develops generalized muscle cramps and mild tetany.The patients' calcium levels are decreased.Which nursing action is appropriate?

Accepted Answer

Rebreathing into a paper bag can help increase carbon dioxide levels, which can temporarily relieve symptoms of tetany caused by hypocalcemia.

Question 3

Following a thyroidectomy,the patient develops hypoparathyroidism.The nurse teaches the patient that maintenance therapy for the hypoparathyroidism will include which of the following?

Accepted Answer

Hypoparathyroidism is a condition of low parathyroid hormone levels, which causes low levels of calcium in the blood. Therefore, maintenance therapy for hypoparathyroidism will include calcium supplements to maintain the calcium levels in the blood. A diet high in oxalic acid is not recommended because oxalic acid can bind with calcium, leading to decreased absorption of calcium. Phosphorus supplements are not recommended because high levels of phosphorus can lead to decreased calcium absorption. Parenteral parathyroid hormone may be used in severe cases but is not typically used for maintenance therapy.

Question 4

A patient with Cushing's syndrome returns to the surgical unit following an adrenalectomy.During the initial postoperative period,the nurse gives the highest priority to which of the following actions?

Accepted Answer

Following an adrenalectomy, fluid and electrolyte balance is a priority due to the loss of hormonal regulation of sodium and water by the adrenal gland. This should be monitored closely to prevent electrolyte imbalances and hypovolemia. Although monitoring for infection is important, it is not the highest priority in the immediate postoperative period. Protecting the patient's skin and preventing severe emotional disturbances are important, but addressing fluid and electrolyte balance is the highest priority.

Question 5

A patient who uses every-other-day prednisone therapy for rheumatoid arthritis complains of not feeling as well on the nonprednisone days and asks the nurse about taking prednisone daily instead.What is the best response to the patient?

Accepted Answer

The best response is that when prednisone is taken every other day, the effect on normal adrenal function is less. This regimen helps to minimize the suppression of the adrenal glands that can occur with daily steroid use, thereby preserving some of the body's natural ability to produce cortisol.

Question 6

A patient is hospitalized with acute adrenal insufficiency.Which of the following findings assists the nurse to determine that the patient is responding favourably to treatment?

Accepted Answer

Decreasing serum potassium is a sign that a patient with acute adrenal insufficiency is responding favorably to treatment. In adrenal insufficiency, the body cannot produce enough aldosterone, leading to hyperkalemia (high potassium levels). Treatment aims to correct this imbalance, so a decrease in serum potassium indicates improvement.

Question 7

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

Accepted Answer

A hypophysectomy involves removal of the pituitary gland, which produces adrenocorticotropic hormone (ACTH) that stimulates cortisol production in the adrenal gland. After surgery, the patient will need corticosteroids to replace the endogenous cortisol that was previously produced by the adrenal gland. Insulin use, sodium restriction, and chemotherapy are not typically needed after a hypophysectomy.

Question 8

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

Accepted Answer

The 70-year-old patient with an irregular pulse of 134 beats/min after starting levothyroxine indicates a potentially life-threatening situation due to the risk of cardiac arrhythmias, necessitating immediate assessment.

Question 9

When admitting a patient who has just recently fallen and broken his hip,the nurse notes hypertension,muscle wasting,and a large buffalo hump.The nurse knows that these findings are consistent with the patient having which following diagnosis?

Accepted Answer

The symptoms of hypertension, muscle wasting, and a large buffalo hump are indicative of Cushing's syndrome, which is caused by excess cortisol secretion. Patients with Cushing's syndrome are at an increased risk for fractures due to decreased bone density, which may explain the patient's broken hip. Addison's disease is characterized by low cortisol levels and would not be consistent with these symptoms. SIADH is a disorder of inappropriate antidiuretic hormone secretion and would not cause these particular symptoms. Pheochromocytoma is a tumor of the adrenal gland that causes excessive catecholamine secretion, leading to symptoms such as headache, palpitations, and sweating, but would not be consistent with these particular symptoms.

Question 10

A patient with a possible pheochromocytoma is admitted to the hospital for evaluation and diagnostic testing.During an attack,what would the nurse expect the patient to experience?

Accepted Answer

During an attack of a possible pheochromocytoma, the patient may experience severe, pounding headache, tachycardia, and profuse sweating due to excessive secretion of catecholamines. Persistent hypoglycemia, severe bradycardia refractory to drug therapy, and severe hypotension with sympathoadrenal blockade are not commonly associated with pheochromocytoma.

Question 11

Which type of diabetes insipidus results from excessive water intake?

Accepted Answer

Primary diabetes insipidus, also known as primary polydipsia or psychogenic polydipsia, results from excessive water intake. This condition is characterized by an individual drinking excessive amounts of water, which can dilute the body's electrolytes, particularly sodium, and can mimic the symptoms of diabetes insipidus. Unlike the other types of diabetes insipidus (central/neurogenic and nephrogenic), which are caused by the body's inability to properly manage water balance due to issues with antidiuretic hormone (ADH) production or response, primary diabetes insipidus is a behavioral disorder.

Question 12

A patient is taking high doses of prednisone to control the symptoms of an acute exacerbation of systemic lupus erythematosus.When teaching the patient about the use of prednisone,which information is most important for the nurse to include?

Accepted Answer

The most important information for the nurse to include when teaching a patient about the use of prednisone is to not stop taking it suddenly and to decrease the dose gradually. Abruptly stopping prednisone can lead to adrenal insufficiency and a potentially life-threatening adrenal crisis. The other options are also important considerations when taking prednisone, but not as critical as the importance of gradually tapering off the medication.

Question 13

A patient is admitted with possible SIADH.Which information obtained by the nurse is most important to communicate rapidly to the physician?

Accepted Answer

A serum sodium level of 119 mmol/L is a critical finding in a patient with possible SIADH. It indicates severe hyponatremia, which can lead to seizures, coma, and death if left untreated. Therefore, it is important to communicate this information rapidly to the physician to initiate appropriate treatment. Complains of a severe headache and severe thirst are common symptoms of SIADH, and a urine specific gravity of 1.025 is within the normal range.

Question 14

When providing postoperative care for a patient who has had a bilateral adrenalectomy,which assessment information obtained by the nurse is most important to communicate to the physician?

Accepted Answer

The patient's blood pressure of 102/50 mm Hg is most important to communicate to the physician because after a bilateral adrenalectomy, the patient is at risk for hypotension due to the sudden decrease in corticosteroids and catecholamines, which can affect blood pressure regulation.

Question 15

When teaching a patient with newly diagnosed hypothyroidism about management of the condition,the nurse should do which of the following?

Accepted Answer

Providing written instructions allows the patient to review and refer back to the information as needed, which is a helpful strategy for managing hypothyroidism. Daily home visits (A) may not be necessary and may place a burden on both the patient and the healthcare system. Delaying teaching (B) may cause the patient to miss important information and hinder their ability to manage their condition. Designating a family member to teach the patient (D) may not ensure that the patient receives accurate and complete information.

Question 16

A patient has an adenoma of the adrenal zona glomerulosa causing hyperaldosteronism and is scheduled for surgery to remove the affected gland.During care before surgery,the nurse should do which of the following?

Accepted Answer

Monitoring blood pressure every 4 hours is important because hyperaldosteronism can cause hypertension. Limiting fluids or providing a potassium-restricted diet may not be necessary, as they are not directly related to the patient's condition. Elevating the patient's extremities may not necessarily relieve edema caused by hyperaldosteronism.

Question 17

A patient is admitted to the hospital in addisonian crisis 1 month following a diagnosis of Addison's disease.The nurse documents the nursing diagnosis of ineffective therapeutic regimen management related to lack of knowledge of management of condition when the patient gives which of the following responses?

Accepted Answer

Ineffective therapeutic regimen management is related to lack of knowledge of management of condition. Skipping medication during illness leads to Addisonian crisis. So, option B is incorrect. Option A is correct as doubling the dose of hydrocortisone during moderate stress is the correct approach. Option C is incorrect as patients with Addison's disease need to increase salt intake, not reduce it. Option D is irrelevant to the management of Addison's disease.

Question 18

A patient with Cushing's syndrome is admitted to the hospital in preparation for surgery to remove an adrenal tumour.During the admission assessment,the patient tells the nurse that she looks so awful she does not want anyone to be around her.What is the best response to the patient?

Accepted Answer

This response addresses the patient's concerns by providing information about the expected outcomes of the surgery. It offers reassurance that the changes in appearance and mental state caused by Cushing's syndrome are temporary and will improve after surgery. This response also implies that the nurse recognizes the patient's feelings of discomfort in her altered appearance, but offers hope that things will get better.

Question 19

A patient with hypoparathyroidism receives instructions from the nurse regarding symptoms of hypo- and hypercalcemia.The nurse teaches the patient that if mild symptoms of hypocalcemia occur,the patient should do which of the following?

Accepted Answer

Breathe in and out of a paper bag can temporarily relieve symptoms of hypocalcemia by increasing carbon dioxide levels in the blood which can help reduce muscle spasms and tetany. However, seeking medical assistance is still necessary. Increasing fluid intake is not the appropriate treatment for hypocalcemia, and self-administering intramuscular calcium should only be done under medical supervision. Severe hypocalcemia can lead to seizures, but mild symptoms can be managed with breathing exercise and medical attention.

Quiz 51: Nursing Management: Endocrine Problems