Ch. 50
The nurse is caring for a client who has developed diabetes insipidus. The cause is unknown, and the physician has ordered a diagnostic test to determine if the cause is nephrogenic or neurogenic. What test will the nurse prepare the client for? A) Urine specific gravity B) Fluid deprivation test C) Urine osmolality D) Serum osmolality
Ans: B Feedback: A fluid deprivation test can diagnose DI and differentiate neurogenic DI from nephrogenic DI. The other tests listed are nonspecific tests that help support diagnosis.
A client is receiving a test to determine adrenal function. What medication does the nurse administer as a screening test? A) Cosyntropin (Cortrosyn) B) Sodium bicarbonate C) Fludrocortisone (Florinef) D) Glucagon
Ans: A Feedback: A dose of synthetic ACTH, cosyntropin (Cortrosyn), is administered intramuscularly as a screening test for adrenal function. The other medications are not screening medications to determine adrenal function.
Which of the following would the nurse expect the physician to order for a client with hypothyroidism? A) Levothyroxine sodium B) Methimazole C) Propranolol D) Propylthiouracil
Ans: A Feedback: Hypothyroidism is treated with thyroid replacement therapy, in the form of desiccated thyroid extract or a synthetic product, such as levothyroxine sodium (Synthroid) or liothyronine sodium (Cytomel). Methimazole and propylthiouracil are antithyroid agents used to treat hyperthyroidism. Propranolol is a beta-blocker that can be used to treat hyperthyroidism.
The nurse is caring for a client with hypoparathyroidism. When the nurse taps the client's facial nerve, the client's mouth twitches and the jaw tightens. What is this response documented as related to the low calcium levels? A) Positive Chvostek's sign B) Positive Trousseau's sign C) Positive paresthesias D) Positive Babinski's sign
Ans: A Feedback: If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek's sign. A positive Trousseau's sign is elicited by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Positive Babinski's sign is elicited by stroking the sole of the foot. Paresthesia is not a symptom that can be elicited; it is felt by the client.
The nurse is instructing a client about the use of pegvisomant for the treatment of acromegaly. How will the nurse instruct to take this medication? A) Injected subcutaneously once a day B) Injected intramuscularly once a month C) Administer via an implanted port once a month D) Injected intramuscularly one every 6 months
Ans: A Feedback: Pegvisomant, a GH receptor antagonist, is the newest and most effective drug for treating acromegaly. Injected subcutaneously once a day, it normalizes the IGF-I level in 93% to 97% of cases by blocking the GH stimulation of IGF-1 produced by the liver.
A client with syndrome of inappropriate antidiuretic hormone is severely hyponatremic. What IV fluids would the nurse anticipate administering to this client? A) 3% hypertonic sodium chloride solution B) Lactated Ringer's solution C) 5% dextrose in water D) 0.9% sodium chloride solution
Ans: A Feedback: Severe hyponatremia is treated with IV administration of a 3% hypertonic sodium chloride solution. The other answers will not provide the amount of sodium required to correct the hyponatremia.
A client with diabetes insipidus is extremely dehydrated and is unable to take oral fluids. Fluid therapy is prescribed. Which intervention would be most important for the client? A) Measuring the urine output every 30 minutes B) Monitoring the rate of IV infusions C) Measuring the fluid intake D) Weighing the client daily
Ans: A Feedback: The nurse must measure the urine output every 30 minutes when administering prescribed fluid and drug therapy when the client is acutely ill or extremely dehydrated, fails to take oral fluids, or is beginning to receive medical treatment. Doing so ensures adequate kidney function. Although monitoring the rate of IV infusions, measuring fluid intake, and weighing the client daily are important, measuring the urine output every 30 minutes is the priority.
What statement made by the client indicates he requires further education about taking corticosteroid therapy for adrenal insufficiency? A) "I will take the corticosteroid medication until my adrenal glands begin to work." B) "I will not omit any of the doses of my medication." C) "I will seek medical attention for dosage readjustments whenever I am under stress." D) "I will get plenty of rest and avoid exposure to infection."
Ans: A Feedback: The nurse should explain adrenal insufficiency and the importance of lifetime corticosteroid replacement. The other statements indicate that the client is educated about his medication administration.
A client with acromegaly has been given the option of a surgical approach or a medical approach. The client decides to have a surgical procedure to remove the pituitary gland. What does the nurse understand this surgical procedure is called? A) Hypophysectomy B) Hysteroscopy C) Thyroidectomy D) Ablation
Ans: A Feedback: The treatment of choice is surgical removal of the pituitary gland (transsphenoidal hypophysectomy) through a nasal approach. The surgeon may substitute an endoscopic technique using microsurgical instruments to reduce surgical trauma. A hysteroscopy is a gynecologic procedure. The thyroid gland is not involved for a surgical procedure. Ablation is not a removal of the pituitary gland.
What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking his antithyroid medication? A) Thyrotoxic crisis B) Myxedema coma C) Diabetes insipidus D) Syndrome of inappropriate antidiuretic hormone secretion
Ans: A Feedback: Thyrotoxic crisis, an abrupt and life-threatening form of hyperthyroidism, is thought to be triggered by extreme stress, infection, diabetic ketoacidosis, trauma, toxemia of pregnancy, or manipulation of a hyperactive thyroid gland during surgery or physical examination. Although rare, this condition may occur in clients with undiagnosed or inadequately treated hyperthyroidism. Myxedema coma is the opposite in symptoms that thyrotoxic crisis. DI and SIADH clinical manifestations do not correlate with medication taken for hyperthyroidism.
A client sustained a head injury when falling off of a ladder. While in the hospital, the client begins voiding large amounts of clear urine and states he is very thirsty. The client states that he feels weak and has had an 8-lb weight loss since admission. What should the client be tested for? A) Diabetes insipidus (DI) B) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) C) Pituitary tumor D) Hypothyroidism
Ans: A Feedback: Urine output may be as high as 20 L/24 hours. Urine is dilute, with a specific gravity of 1.002 or less. Limiting fluid intake does not control urine exertion. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weakness, dehydration, and weight loss develop. SIADH will have the opposite clinical manifestations. The client's symptoms are related to the trauma and not a pituitary tumor. The thyroid gland does not exhibit these symptoms.
After teaching a client who is to receive lypressin nasal spray as treatment for neurogenic diabetes insipidus about administration, which client statement indicates the need for additional teaching? A) "I'll inhale fully after spraying the drug." B) "If my nose gets irritated, I'll call my physician." C) "I should hold the spray container upright." D) "While sitting up, I'll place the nozzle in my nostril."
Ans: A Feedback: When administering lypressin nasal spray, the client should not inhale the drug. Calling the physician if he or she experiences nasal irritation, holding the container upright, and placing the nozzle in the nostril while sitting up are appropriate.
The nurse is reviewing a client's history which reveals that the client has had an oversecretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? A) Gigantism B) Dwarfism C) Acromegaly D) Simmonds' disease
Ans: A Feedback: When oversecretion of GH occurs before puberty, gigantism results. Dwarfism occurs when secretion of GH is insufficient during childhood. Oversecretion of GH during adulthood results in acromegaly. An absence of pituitary hormonal activity causes Simmonds' disease.
A client with acromegaly is complaining of severe headaches. What does the nurse suspect is the cause of the headaches that is related to the acromegaly? A) A pituitary tumor B) A decrease in release in the growth hormone C) A decrease in the glucose level D) An increase in cerebral edema
Ans: A Feedback: When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica, a bony depression in which the pituitary gland rests, are common. There is actually an increase in the secretion of the growth hormone. The headaches would not be caused by decreases in glucose levels. The client does not have cerebral edema.
A client is taking methimazole (Tapazole) every 8 hours around the clock for the treatment of severe hyperthyroidism. The client has been taking the medication for 2 months. What should the nurse instruct the client to report immediately? Select all that apply. A) Sore throat B) Unusual bleeding C) Fever D) Pain in the leg E) Cough
Ans: A, B, C Feedback: The most serious adverse effect of antithyroid drugs is agranulocytosis, which occurs most often in the first 2 months of therapy and necessitates discontinuing the drug. Instruct the client to report sore throat, fever, chills, headache, malaise, weakness, or unusual bleeding or bruising.
A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize are progressing to myxedema coma? Select all that apply. A) Hypothermia B) Hypertension C) Hypotension D) Hypoventilation E) Hyperventilation
Ans: A, C, D Feedback: Severe hypothyroidism is called myxedema. Advanced, untreated myxedema can progress to myxedemic coma. Signs of this life-threatening event are hypothermia, hypotension, and hypoventilation. Hypertension and hyperventilation indicate increased metabolic responses, which are the opposite of what the client would be experiencing.
A client is suspected of having acromegaly. What definitive diagnostic testing is the most reliable method of confirming acromegaly? A) A serum glucose level B) Glucose tolerance test in combination with a GH measurement C) Growth hormone levels D) Bone radiographs
Ans: B Feedback: A glucose tolerance test in combination with a GH measurement is the most reliable method of confirming acromegaly. Ingestion of a bolus of glucose should lower GH levels, but GH levels remain elevated in persons with acromegaly. Increased blood levels of IGF-1 can also indicate acromegaly in nonpregnant women; they typically have IGF-1 levels two to three times higher than normal in pregnant women. A serum glucose level is not an indicator of acromegaly. Growth hormone levels and bone radiographs may support the diagnosis but are not reliable indicators.
The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with? A) Hypothyroidism B) Hyperthyroidism C) Syndrome of inappropriate antidiuretic hormone secretion (SIADH) D) Diabetes insipidus (DI)
Ans: B Feedback: Clients with hyperthyroidism characteristically are restless despite felling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarged muscle and fatty tissue surrounding the rear and sides of the eyeball. Neck swelling caused by the enlarged thyroid gland often is visible. Hypothyroidism clinical manifestations are the opposite of what is seen as hyperthyroidism. SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client.
A client with Addison's disease has a blood glucose level above 80 mg/dL 30 minutes after receiving 15 g of carbohydrates for symptoms of hypoglycemia. Which of the following would the nurse do now? A) Inform the physician immediately. B) Give the client milk and graham crackers. C) Instruct the client to remain in bed. D) Check the client's blood glucose level before each meal.
Ans: B Feedback: Milk and graham crackers contain forms of carbohydrates that take longer to absorb and tend to maintain the blood glucose level for an extended period. The physician should be informed if the client continues to be symptomatic and the blood glucose level is below 80 mg/dL. Maintaining bed rest protects the client from injuries from a fall but does not address the blood glucose issue. Assessing the client's blood glucose level provides a numeric assessment of the blood glucose level and would be performed in an ongoing fashion.
The nurse is providing education to a client who will be having a hypophysectomy. What should the nurse be sure to include to preventing complications? A) Lay in the supine flat position to avoid an increase in intracranial pressure. B) Avoid drinking from a straw, sneezing, coughing, and bending over. C) When the packing is removed, you may blow your nose to clear the clot. D) Brush teeth with a firm bristle toothbrush.
Ans: B Feedback: Postoperatively, the client undergoes frequent neurologic assessments to detect signs of increased intracranial pressure and meningitis. If the client has nasal packing, the nurse monitors drainage from the nose and postnasal drainage for the presence of cerebrospinal fluid. The nurse modifies oral and facial hygiene to promote cleanliness without contributing to trauma near the operative site. The nurse also reminds the client to avoid drinking from a straw, sneezing, coughing, and bending over to prevent dislodging the graft that seals the operative area between the cranium and nose.
The nurse is caring for a client who has SIADH. The nurse notices that the client has become confused and extremely short of breath, and crackles are heard when lungs are auscultated. What is the first action by the nurse? A) Administer a diuretic. B) Notify the physician. C) Lay the client flat. D) Suction the client.
Ans: B Feedback: The nurse closely monitors fluid intake and output and vital signs. He or she carefully assesses LOC and immediately reports any changes to the physician. The nurse checks closely for signs of fluid overload (confusion, dyspnea, pulmonary congestion, hypertension) and hyponatremia (weakness, muscle cramps, anorexia, nausea, diarrhea, irritability, headache, weight gain without edema). Laying the client flat would increase the shortness of breath and would deoxygenate the client. The nurse cannot administer a diuretic without the physician's order. Suctioning of the client will not clear the airway at this time.
Which of the following precautions would be most appropriate when caring for a client being treated with radioactive iodine (RAI) for a thyroid tumor? A) Administer prescribed corticosteroids carefully. B) Handle body fluids carefully. C) Monitor the respiratory status. D) Administer the prescribed medications at the same time each day.
Ans: B Feedback: The nurse handles body fluids carefully to prevent spread of contamination. Corticosteroids are not prescribed for thyroid tumor. Monitoring the respiratory status and administering prescribed medicines at the same time each day are unrelated to the care of a client receiving RAI.
The nurse is reviewing the laboratory and diagnostic test findings of a client diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following would the nurse expect to find? A) Elevated serum sodium levels B) Decreased serum osmolarity C) Decreased urine sodium levels D) Elevated urine calcium levels
Ans: B Feedback: With SIADH, serum sodium levels and serum osmolarity are decreased. Urine sodium levels and osmolarity are high. Calcium levels are not involved with this disorder.
. A client is scheduled for a hypophysectomy for the management of a pituitary tumor. What are the nurse's priorities in caring for this client? Select all that apply. A) Assure the client that he will make it through the surgery without any difficulty. B) Help the client cope with changes in physical appearance. C) Pace activities to accommodate the client's fatigue. D) Relieve discomfort from headaches, abdominal distention, and skeletal pain. E) Instruct the client on how to cough and deep breath postoperatively.
Ans: B, C, D Feedback: Until the client has surgery or receives radiation treatment, nursing priorities include helping the client cope with changes in physical appearance; pacing activities to accommodate the client's fatigue; and relieving discomfort from headaches, abdominal distention resulting from organ enlargement, and skeletal pain.
The nurse is administering a medication to a client with hyperthyroidism to block the production of thyroid hormone. The client is not a candidate for surgical intervention at this time. What medication should the nurse administer to the client? A) Levothyroxine (Synthroid) B) Spironolactone (Aldactone) C) Propylthiouracil (PTU) D) Propranolol (Inderal)
Ans: C Feedback: Antithyroid drugs, such as propylthiouracil (PTU) and methimazole are given to block the production of thyroid hormone preoperatively or for long-term treatment for clients who are not candidates for surgery or radiation treatment. Levothyroxine (Synthroid) would increase the level of thyroid and be contraindicated in this client. Spironolactone (Aldactone) is a diuretic and does not have the action of blocking production of thyroid hormone and neither does propranolol (Inderal), which is a beta-blocker.
A client with severe hypoparathyroidism is experiencing tetany. What medication, prescribed by the physician for emergency use, will the nurse administer to correct the deficit? A) Sodium bicarbonate B) Fludrocortisone (Florinef) C) Calcium gluconate D) Methylprednisolone (Solu-Medrol)
Ans: C Feedback: Tetany and severe hypoparathyroidism are treated immediately by the administration of an IV calcium salt, such as calcium gluconate. The other medications are not effective for the treatment of calcium deficit.
An adult client has been diagnosed with a rare disorder, Simmonds' disease (panhypopituitarism) and placed on hormone replacements. What is important for the nurse to educate the client regarding about the medication? A) The medication must be taken as ordered until surgery is scheduled to remove the tumor. B) Thyroid medication will be administered for the duration of the client's life. C) Adhere to the medication schedule and never omit a dose. D) The client must take growth hormone for the duration of his life.
Ans: C Feedback: The nurse administers all hormone replacements as prescribed. Teaching the client to adhere to the medication schedule and never to omit a dose is important. The client will have destruction of the pituitary gland so removal will be unnecessary. More than just thyroid medication will be taken. Growth hormone is only administered to children, not adult clients.
A client with pheochromocytoma is scheduled for an adrenalectomy. Which of the following would the nurse perform preoperatively? A) Begin administering prescribed corticosteroid. B) Initiate intravenous access for fluid therapy. C) Monitor blood pressure (BP) frequently. D) Check for the signs of adrenal insufficiency.
Ans: C Feedback: The nurse should monitor BP frequently before surgery when a client has a pheochromocytoma. When bilateral adrenalectomy is scheduled, the nurse may start IV administration of a solution containing a corticosteroid preparation the morning of surgery. Some surgeons prefer to initiate corticosteroid administration during removal of the adrenals. The nurse monitors for signs of adrenal insufficiency after the surgery.
What interventions can the nurse encourage the client to do in order to control thirst and compensate for urine loss? A) Come to the clinic for IV fluid therapy daily. B) Limit the fluid intake at night. C) Consume adequate amounts of fluid. D) Weigh daily.
Ans: C Feedback: The nurse teaches the client to consume sufficient fluid to control thirst and to compensate for urine loss. The client will not be required to come in daily for IV fluid therapy. The client should not limit fluid intake at night if thirst is present. Weighing daily will not control thirst or compensate for urine loss.
A client with Addison's disease is being discharged from the hospital and is being instructed about the dietary regimen. What type of diet should the nurse provide written and verbal instructions about? A) Low-carbohydrate, low-protein diet B) Low-fat, high-protein diet C) Low-protein, high-carbohydrate diet D) High-protein, moderate-carbohydrate diet
Ans: D Feedback: A high-protein, moderate-carbohydrate diet that is low in refined carbohydrates is recommended to reduce the risk of hypoglycemia from excess insulin secretion. The risk of hypoglycemia is also lessened by consuming frequent meals and snacks, especially a substantial bedtime snack. The other dietary regimens are not effective in the treatment of Addison's disease.
The nurse is teaching a client about the dietary restrictions related to his diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid? A) Bananas B) Chicken livers C) Hamburger D) Milk
Ans: D Feedback: Clients with hyperparathyroidism should use a low-calcium diet (fewer dairy products) and drink at least 3 to 4 L of fluid daily to dilute the urine and prevent renal stones from forming. It is especially important that the client drink fluids before going to bed and periodically throughout the night to avoid concentrated urine. Bananas, chicken livers, and hamburgers do not require avoidance. Milk is the highest in calcium content.
After teaching a group of students about Simmonds' disease, the instructor determines that additional instruction is necessary when the students identify which hormone as being involved? A) Growth hormone B) Luteinizing hormone C) Adrenocorticotropic hormone D) Oxytocin
Ans: D Feedback: Oxytocin is a hormone of the posterior pituitary gland and would not be involved. Simmonds' disease affects all hormones of the anterior pituitary: GH (bones and muscles), adrenocorticotropic hormone (ACTH; adrenals), thyroid-stimulating hormone (TSH; thyroid), follicle-stimulating hormone (FSH; ovaries and testes), luteinizing hormone (LH; ovaries), interstitial cell-stimulating hormone (ICSH [LH]; testes), and prolactin (breasts).
A client with acromegaly is admitted to the hospital with complaints of partial blindness that began suddenly. What does the nurse suspect is occurring with this client? A) Glaucoma B) Corneal abrasions C) Retinal detachment D) Pressure on the optic nerve
Ans: D Feedback: Partial blindness may result from pressure on the optic nerve. Glaucoma does not occur suddenly, and the client did not report injury to suspect corneal abrasions or retinal detachment.
Which group of clients should not receive potassium iodide? A) Those who are allergic to corticosteroids B) Those who are pregnant C) Those taking medications such as cough medicines D) Those who are allergic to seafood
Ans: D Feedback: Potassium iodide should not be administered to anyone who is allergic to seafood, which is also high in iodine. Clients who take corticosteroids or cough medicines and those who are pregnant would be appropriate candidates for potassium iodide therapy.
A client has been diagnosed with nephrogenic DI, and the physician is initiating treatment. What medication does the nurse prepare to administer for this client? A) Metolazone (Zaroxolyn) B) Bumetanide (Bumex) C) Furosemide (Lasix) D) Hydrochlorothiazide (HydroDIURIL)
Ans: D Feedback: The physician prescribes a thiazide diuretic, such as hydrochlorothiazide (HydroDIURIL). The thiazide acts at the proximal convoluted tubule, leaving less fluid for excretion in the distal convoluted tubules, the portion affected by nephrogenic DI. Consequently, the client excretes water, but the total volume is less than in an untreated state.he other diuretics listed do not work on the proximal convoluted tubule and would not be effective in treatment.
