chapter 44

Which finding is a symptom of Cushing's syndrome? 1. Hypoglycemia 2. Vomiting 3. Moon face 4. Diarrhea

Correct Answer: 3 Rationale 1: Hypoglycemia is a symptom of Addison's disease. Rationale 2: Vomiting is a sign of Addison's disease. Rationale 3: A moon face is caused from long-term glucocorticoids. Rationale 4: Diarrhea is a symptom of Addison's disease.

The client has been diagnosed with diabetes insipidus. What will the best plan by the nurse include? 1. Assess for increased urine production. 2. Assess for hyperglycemia. 3. Assess for hyponatremia. 4. Assess for fluid retention.

Correct Answer: 1 Rationale 1: Diabetes insipidus results from decreased ADH (antidiuretic hormone) production, so the client will have increased urine output. Rationale 2: Hyperglycemia is not an effect of diabetes insipidus. Rationale 3: Hypernatremia results from the volume of fluid that is lost; the client will not have hyponatremia. Rationale 4: The client will have increased urine output and fluid volume depletion, not retention.

The client has hyperthyroidism. The nurse teaches the client to avoid which food selections? 1. Soy sauce 2. Milk products 3. High-calorie foods 4. Caffeine-free soda

Correct Answer: 1 Rationale 1: Foods high in iodine, such as soy sauce, can affect the effectiveness of medication therapy for clients who are diagnosed with hyperthyroidism. Rationale 2: Milk products should be included in the diet for the client with hyperthyroidism because they are high in protein and calcium. Rationale 3: High-calorie foods are important for clients with hyperthyroidism in order to meet metabolic demands. Rationale 4: There is no reason to restrict caffeine-free soda.

The client receives hydrocortisone therapy. The nurse will primarily assess for which electrolyte disturbance? 1. Hypernatremia and hyperglycemia 2. Hypernatremia and hyperkalemia 3. Hypercalcemia and hyperkalemia 4. Hypoglycemia and hyponatremia

Correct Answer: 1 Rationale 1: Hypernatremia and hyperglycemia are seen due to the aldosterone effects (mineralocorticoid activity) causing sodium and fluid retention, and elevations of blood glucose due to promotion of gluconeogenesis. Rationale 2: Hypernatremia would be seen, but hypokalemia would be seen, not hyperkalemia. Rationale 3: Hypercalcemia and hypokalemia would be seen with this therapy. Rationale 4: Hypoglycemia and hyponatremia would not be seen with hydrocortisone therapy.

A patient has symptoms of adrenocorticoid insufficiency and is having diagnostic testing with administration of cosyntropin (Cortrosyn). The nurse would evaluate that this test shows secondary adrenocortical insufficiency if which result occurs? 1. The patient's plasma level of cortisol rises after injection. 2. The patient has carpal spasms following injection. 3. The patient's urine cortisol fails to rise after injection. 4. The patient flushes after injection.

Correct Answer: 1 Rationale 1: If the adrenal gland responds by secreting corticosteroids after the cosyntropin injection, the pathology lies at the level of the pituitary or hypothalamus (secondary adrenocortical insufficiency). Rationale 2: Carpal spasms are not related to this test. Rationale 3: The test involves plasma levels of cortisol. Rationale 4: Flushing is not related to this test.

The nurse teaches the client about glucocorticoid therapy. The nurse evaluates that additional teaching is required when the client makes which statement? 1. "I can take the medication at any time as long as I don't forget it." 2. "I will monitor my blood sugar on a regular basis." 3. "I will eat a diet that is high in protein." 4. "I should take my medication after I have eaten."

Correct Answer: 1 Rationale 1: The medication must be taken at the same time of day to maintain serum levels. Rationale 2: It is important for the client to monitor blood glucose levels with glucocorticoid medications. Rationale 3: A high-protein diet is necessary with glucocorticoid medications. Rationale 4: Glucocorticoid medications should be taken after eating.

Vasopressin is used in the treatment of 1. diabetes insipidus. 2. dehydration. 3. electrolyte imbalances. 4. diabetes mellitus.

Correct Answer: 1 Rationale 1: Vasopressin and lypressin are used to treat diabetes insipidus. Rationale 2: Vasopressin is not used to treat dehydration. Rationale 3: Vasopressin is not used to treat electrolyte imbalances. Rationale 4: Vasopressin is not used to treat diabetes mellitus.

A patient has been prescribed long-term corticosteroid therapy. Which preventative information does 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. 1. Avoid carbonated beverages. 2. Participate in regular weight-bearing exercises. 3. Do not take any calcium supplements. 4. Schedule periodic colon studies. 5. Avoid caffeine in the diet.

Correct Answer: 1,2 Rationale 1: The patient on long-term corticosteroid therapy is at risk for osteoporosis and should avoid carbonated beverages. Rationale 2: Regular weight-bearing exercises help to strengthen the bones. Rationale 3: The patient should have a sufficient calcium intake, either from foods or from supplements. Rationale 4: There is no specific reason to schedule colon studies. Rationale 5: There is no reason to avoid caffeine in the diet.

A client will be prescribed an oral corticosteroid for treatment of a rash. The prescriber says, "In order to avoid adverse effects, I am prescribing the smallest amount possible." What other prescribing regimens could the nurse suggest to achieve this same effect? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Give the oral medication every other day. 2. Administer a larger dose for a few days and then gradually decrease the dose until the medication is discontinued. 3. Use a topical application instead of an oral product. 4. Start with a small dose and work up to the desired dose. 5. Administer the doses intramuscularly for the first few days of treatment.

Correct Answer: 1,2,3 Rationale 1: Alternate day administration can limit adrenal atrophy. Rationale 2: There are specific formulations of corticosteroids that are packaged for use of a large dose initially, which is then tapered off until all the medication is gone. Rationale 3: Topical application does not cause as many systemic effects as oral dosage. Rationale 4: Corticosteroid doses are generally started high and worked down to discontinuance. Rationale 5: Using a less systemic approach would lessen effects.

A client has been prescribed propylthiouracil (PTU). What medication education 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. 1. "It may take several days or weeks for you to see effects of this drug." 2. "Take this drug with meals." 3. "Do not become pregnant while taking this medication." 4. "You may experience a rash while taking this drug." 5. "You may continue to breastfeed while taking this drug."

Correct Answer: 1,2,3,4 Rationale 1: The action of this drug may be delayed from several days to as long as 6-12 weeks. Rationale 2: This drug may cause gastric upset, which is decreased if the drug is taken with food. Rationale 3: This is a pregnancy class D drug. Rationale 4: Rash is one of the most frequent adverse effects. Rationale 5: This drug should not be taken while breastfeeding.

The nursing instructor teaches the student nurses about the endocrine system. The nursing instructor evaluates that learning has occurred when the student nurses make which statements? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "The hypothalamus secretes releasing hormones." 2. "Hormones released by the endocrine system influence every organ in the body." 3. "The hypothalamus is considered the master gland." 4. "The pituitary gland secretes TSH (thyroid-stimulating hormone)." 5. "The endocrine system is a major controller of homeostasis."

Correct Answer: 1,2,4,5 Rationale 1: The hypothalamus secretes releasing hormones. Rationale 2: Hormones released by the endocrine system influence every organ in the body. Rationale 3: The pituitary, not the hypothalamus, is often called the master gland; however, the pituitary and hypothalamus are best visualized as an integrated unit. Rationale 4: The pituitary gland secretes TSH (thyroid-stimulating hormone). Rationale 5: The endocrine system is a major controller of homeostasis.

A client has been prescribed levothyroxine (Levothroid). What medication information 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. 1. "It may take a few weeks for you to see the full benefits from this drug." 2. "Be sure to keep all of your follow-up appointments." 3. "Take this medication at whatever time you eat your evening meal." 4. "Do not start a fiber laxative without first discussing it with your health care team." 5. "Take your calcium supplement at least 4 hours after taking this drug."

Correct Answer: 1,2,4,5 Rationale 1: When given orally, it may take up to 3 weeks for the full effect of the drug to be realized. Rationale 2: Serum TSH levels will be drawn frequently as the client begins this therapy and to monitor its effectiveness as therapy continues. Rationale 3: The medication should be taken at the same time every day, not at variable meal times. It should be taken in the morning to decrease insomnia. Rationale 4: Dietary fiber may bind to and decrease the absorption of levothyroxine. Rationale 5: Calcium and iron supplements should be taken at least 4 hours after taking levothyroxine to prevent interference with drug absorption.

A client has been taking propylthiouracil (PTU) for several weeks. Which client statements would the nurse interpret as indicating that the drug is having its desired effects? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I am sleeping so much better." 2. "I can't seem to gain any weight no matter how much I eat." 3. "I don't feel as anxious as I once did." 4. "My heart doesn't seem to be racing anymore." 5. "My skin in not bruising as much."

Correct Answer: 1,3,4 Rationale 1: A reduction in insomnia is a desired effect of this drug. Rationale 2: A desired effect of this drug is that the client will gain weight. Rationale 3: Reduction of anxiety is a desired effect of this drug. Rationale 4: A slower pulse rate is a desired effect of this drug. Rationale 5: Skin bruising is not an effect of hyperthyroidism, so this effect would not be expected.

The client receives glucocorticoid therapy. The nurse would prioritize assessment for which finding? 1. Hypothermia 2. Hypotension 3. Hypertension 4. Weight loss

Correct Answer: 3 Rationale 1: Hypothermia would not be seen; temperature regulation is not related to glucocorticoid therapy. Rationale 2: Hypotension would not be expected related to the increased production of angiotensin II. Rationale 3: Hypertension would be expected related to the increased production of angiotensin II. Rationale 4: Weight loss would not be seen; weight gain is more likely with glucocorticoid therapy.

A client diagnosed with an inoperable tumor of the adrenal gland is prescribed mitotane (Lysodren). The nurse would attribute which assessment finding as indicating an adverse reaction to the drug? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The client reports that food is not appealing. 2. The client reports joint pain. 3. The client reports ringing of the ears. 4. The client reports increasing depression. 5. The client reports dizziness.

Correct Answer: 1,4,5 Rationale 1: About 80% of clients started on this drug will report anorexia. Rationale 2: Joint pain is not an expected adverse effect of this drug. Rationale 3: This is not an expected effect of this drug. Rationale 4: About 40% of people taking this drug will experience depression. Rationale 5: About 40% of the people taking this drug report dizziness.

A patient was admitted with Addison's disease. Assessment now reveals nausea, vomiting, and confusion. The nurse anticipates which urgent intervention? 1. Placement of a nasogastric tube. 2. Administration of intravenous hydrocortisone. 3. Administration of intravenous diuretic. 4. Immediate endotracheal intubation.

Correct Answer: 2 Rationale 1: A nasogastric tube may be necessary but is not the priority. Rationale 2: Acute adrenal insufficiency requires immediate treatment with intravenous hydrocortisone. Rationale 3: A diuretic may or may not be necessary but is not the priority. Rationale 4: Intubation may or may not be necessary but is not the priority.

Which finding is a sign or symptom of hypothyroidism? 1. Anxiety 2. Bradycardia 3. Tachycardia 4. Weight loss

Correct Answer: 2 Rationale 1: Anxiety is a symptom of hyperthyroidism. Rationale 2: Bradycardia can be a more severe symptom of hypothyroidism. Rationale 3: Tachycardia is symptom of hyperthyroidism. Rationale 4: Weight loss is a sign of hyperthyroidism.

A patient has been prescribed corticosteroid therapy for the treatment of severe osteoarthritis. The nurse evaluates that teaching about this drug is understood if the patient makes which statement? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "If I get sick and cannot take my medicine for more than 3 days, I will contact my health care provider." 2. "I will take my medication at the same time every day." 3. "I will take my medication with food or a meal." 4. "I will avoid dairy products while taking this medication." 5. "If I notice my vision is changing, I will contact my health care provider."

Correct Answer: 2,3,5 Rationale 1: The patient should not stop the corticosteroid abruptly and should contact the health care provider if unable to take the medication for over 1 day. Rationale 2: The patient should take this medication regularly and at the same time every day. Rationale 3: Taking the medication with food or a meal will help to reduce gastric upset. Rationale 4: There is no reason to avoid dairy products when taking this medication. Rationale 5: Corticosteroids may cause increased intraocular pressure and an increased risks of glaucoma and may cause cataracts.

A client has been taking thyroid hormone replacement for several years. On today's clinic visit, the nurse remarks that the client has lost 20 pounds. The client states, "I was getting fat, so I started taking an extra thyroid pill every day or so." How should the nurse respond? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Well, it certainly is working for you." 2. "You should follow the dosage instructions for your thyroid medication exactly as written." 3. "I'll ask your physician to increase the number of refills on your prescription." 4. "That could be dangerous to your health." 5. "I may ask the doctor to write a prescription for me."

Correct Answer: 2,4 Rationale 1: Thyroid medications should not be used in this manner. Rationale 2: Thyroid medications are of various strengths and should be taken as prescribed. Rationale 3: The nurse should not provide additional medication to this client. Rationale 4: Taking excess thyroid medication is dangerous. Rationale 5: The nurse should not encourage the misuse of prescription medications.

The nurse is reviewing the steps of the negative feedback regulation of thyroid hormone. The nurse would place these steps in which sequence? 1. Blood levels of thyroid hormone rise. 2. Hypothalamus secretes thyroid-releasing hormone (TRH). 3. Secretion of TSH and TRH are suppressed. 4. T3 and T4 are secreted. 5. The anterior pituitary secretes thyroid-stimulating hormone (TSH).

Correct Answer: 2,5,4,1,3

The client is very distraught that her 12-year-old son is of very short stature. What is the best plan by the nurse? 1. Tell the client that treatment with growth hormone might result in acromegaly. 2. Tell the client that treatment for short stature is too expensive for many to afford. 3. Tell the client that treatment with growth hormone might help and refer her to an endocrinologist. 4. Tell the client that treatment with growth hormone can add 6 inches of height to her son.

Correct Answer: 3 Rationale 1: Acromegaly is the result of too much growth hormone in adults. Rationale 2: Treatment with growth hormone is very expensive, but it is up to the client to decide whether or not to pursue treatment. Rationale 3: Clients should be referred to endocrinologists to discuss the uses of this hormone. Rationale 4: In order to achieve this much additional growth, treatment would have to be started very early in life, not at age 12.

A client has diabetes insipidus and receives desmopressin (DDAVP). The nurse completes medication education and evaluates that learning has occurred when the client makes which statement? 1. "This medication is a potent vasodilator; my blood pressure can fall." 2. "This medication promotes diuresis in my body; my blood pressure can fall." 3. "This medication increases water reabsorption in my kidneys." 4. "This medication suppresses hormone secretion from my posterior pituitary gland."

Correct Answer: 3 Rationale 1: Desmopressin is a potent vasoconstrictor, not a vasodilator, and can cause blood pressure to rise, not fall. Rationale 2: Desmopressin promotes water retention; blood pressure can rise, not fall. Rationale 3: Desmopressin is the same as ADH (antidiuretic hormone) and acts on the collecting ducts in the kidney to increase water reabsorption. Rationale 4: Desmopressin does not suppress hormone secretion from the posterior pituitary gland.

The client has been diagnosed with Cushing's syndrome. What will the nurse's assessment likely reveal? 1. Low blood pressure and hypoglycemia 2. Well-healed scars on the upper body 3. Upper body obesity 4. Thin, gaunt appearance of the face

Correct Answer: 3 Rationale 1: Hypertension and hyperglycemia are commonly seen. Rationale 2: Delayed wound healing is a sign of Cushing's disease. Rationale 3: Primary symptoms of Cushing's syndrome include upper body obesity. Rationale 4: A redistribution of fat around the face results in a "moon face" appearance.

The primary goal of pharmacotherapy in hyperthyroidism (Graves' disease) is to 1. increase metabolism. 2. increase synthesis of corticosteroid. 3. lower the activity of the thyroid hormone. 4. increase the activity of the thyroid hormone.

Correct Answer: 3 Rationale 1: Increased metabolism is a sign of hyperthyroidism. Rationale 2: Adrenal drugs increase synthesis of corticosteroids. Rationale 3: The goal is to lower the activity of the thyroid hormone. Rationale 4: Increased activity of the thyroid hormone is a physiological mechanism of hyperthyroidism.

A patient with hyperthyroidism presented with thyroid storm and high temperature. The nurse evaluates that measures to lower the temperature should be changed when which assessment is made? 1. The patient has received a second dose of propylthiouracil. 2. The patient develops crackles in both lung bases. 3. The patient begins to shiver. 4. The patient's blood glucose increases.

Correct Answer: 3 Rationale 1: The amount of medication given is not a determinant of when to alter temperature regulation measures. Rationale 2: The development of crackles is not a determinant of need to alter temperature regulation measures. Rationale 3: The goal is to reduce body temperature but to avoid shivering, which increases metabolic stress. Rationale 4: Glucose level is not a determinant of need to alter temperature regulation measures.

The client receives treatment with radioactive iodine (Iodine-131) therapy. What will the best evaluation by the nurse reveal? 1. The client will only temporarily accomplish the euthyroid state. 2. The client could safely become pregnant while receiving this treatment. 3. The client will most likely require thyroid replacement therapy. 4. The client does not have to distance herself from others.

Correct Answer: 3 Rationale 1: Treatment with radioactive iodine (Iodine-131) usually results in a permanent euthyroid state. Rationale 2: This therapy is contraindicated in pregnant clients. Rationale 3: Clients treated with radioactive iodine (Iodine-131) therapy often end up with hypothyroidism and require replacement therapy. Rationale 4: Physical distancing is necessary for others to prevent exposure to radiation.

The client has hypothyroidism and is treated with levothyroxine (Synthroid). The nurse plans to do medication education. What will the best plan by the nurse include? 1. Monitor daily temperature 2. Assess for decreased appetite. 3. Assess weekly serum blood levels. 4. Assess for altered sleep patterns.

Correct Answer: 4 Rationale 1: Daily temperatures are not necessary when taking levothyroxine (Synthroid). Rationale 2: The appetite tends to increase, not decrease, with clients receiving levothyroxine (Synthroid). Rationale 3: Serum blood levels are not required on a weekly basis with clients receiving levothyroxine (Synthroid). Rationale 4: Insomnia is an adverse effect of levothyroxine (Synthroid); altered sleep patterns must be assessed.

An older adult client has hypothyroidism. Which assessment finding would the nurse report to the physician immediately? 1. Dry skin 2. Generalized weakness 3. Muscle cramps 4. Slurred speech

Correct Answer: 4 Rationale 1: Dry skin is an early sign of hypothyroidism and is not an emergent situation. Rationale 2: Generalized weakness is an early sign of hypothyroidism and is likely the reason the client sought treatment. It is not emergent. Rationale 3: Muscle cramps are an early sign of hypothyroidism and are not emergent. Rationale 4: Slurring of the speech in an older adult client may be related to one of the more severe symptoms of hypothyroidism or may be related to a neurological condition such as a CVA. This finding should be reported.

The function of the thyroid gland is to 1. stimulate growth. 2. control pituitary gland secretion. 3. conserve water in the body. 4. control basal metabolism.

Correct Answer: 4 Rationale 1: Growth hormone stimulates growth. Rationale 2: The thyroid gland does not control the pituitary. Rationale 3: Antidiuretic hormone conserves water in the body. Rationale 4: The function of the thyroid gland is to control basal metabolism and affect every cell in the body.

The nurse plans to administer intranasal desmopressin (DDAVP) to the client. What will the best plan by the nurse include? 1. Instruct the client to blow his nose following administration. 2. Be sure to have fresh water at the bedside. 3. Withhold other medications so absorption of desmopressin (DDAVP) will not be affected. 4. Direct the spray high into the nasal cavity.

Correct Answer: 4 Rationale 1: Intranasal sprays of desmopressin (DDAVP) should be alternately rotated between nares. There is no need for the client to blow his nose following administration of intranasal desmopressin (DDAVP). Rationale 2: Fresh water is a good idea but not necessary with intranasal desmopressin (DDAVP). Rationale 3: There is no need to withhold other medications when a client receives intranasal desmopressin (DDAVP). Rationale 4: The spray should be directed high into the nasal cavity, not into the nasopharynx.