Chapter 52

A patient with suspected adrenal insufficiency has been ordered an adrenocorticotropic hormone stimulation test. Administration of ACTH caused a marked increase in cortisol levels. How should the nurse interpret this finding?

An adrenal response to the administration of a stimulating hormone suggests inadequate production of the stimulating hormone. In this case, ACTH is produced by the pituitary and, consequently, pituitary hypofunction is suggested.

The nurse is planning the care of a patient with hyperthyroidism. the nurse specify in the patient's meal plan?

A patient with hyperthyroidism has an increased appetite. The patient should be counseled to consume several small, well-balanced meals. High-calorie, high-protein foods are encouraged.

The nurse is caring for a patient at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the patient?

symptoms indicative of addisonian crisis, which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness.

after having a thyroidectomy for thyroid cancer. nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal?

Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of calcium levels hypocalcemia

The physician has ordered a fluid deprivation test for a patient suspected of having diabetes insipidus. During the test, the nurse should prioritize what assessments?

BP and heart rate monitoring are priorities

patient with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal hypophysectomy. important for the nurse to monitor

Before, during, and after this surgery, blood glucose monitoring and assessment of stools for blood are carried out.

The nurse is assessing a patient diagnosed with Graves' disease. What physical characteristics of Graves' disease would the nurse expect to find?

Clinical manifestations of the endocrine disorder Graves' disease include exophthalmos (bulging eyes) and fine tremor in the hands.

A patient has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the patient knows to do which of the following?

Corticosteroid dosages are reduced gradually (tapered) to allow normal adrenal function to return and to prevent steroid-induced adrenal insufficiency.

30 year-old female patient has been diagnosed with Cushing syndrome. the psychosocial nursing diagnosis should nurse prioritize when planning the patient's care?

Cushing syndrome causes characteristic physical changes that are likely to result in disturbed body image.

A patient with hypofunction of the adrenal cortex has been admitted to the medical unit. What would the nurse most likely find when assessing this patient?

Decreased BP

nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. the nurse explain that this test will involve?

Dexamethasone (1 mg) is administered orally at 11 PM, and a plasma cortisol level is obtained at 8 AM the next morning.

patient with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. nurse should prioritize what question?

Do you feel any muscle twitches or spasms?As the blood calcium level falls,hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching.

Following an addisonian crisis, a patient's adrenal function has been gradually regained. nurse should ensure that the patient knows about the need for supplementary glucocorticoid therapy in which of the following circumstances?

During stressful procedures or significant illnesses, additional supplementary therapy with glucocorticoids is required to prevent addisonian crisis.

A nurse works in a walk-in clinic. The nurse recognizes that certain patients are at higher risk for different disorders than other patients. What patient is at a greater risk for the development of hypothyroidism?

Even though osteoporosis is not a risk factor for hypothyroidism, the condition occurs most frequently in older women.

A patient with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with the patient to improve the patient's nutritional intake.

Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and osteoporosis.

patient with pheochromocytoma has been admitted for an adrenalectomy to be performed the following day. To prevent complications, nurse should anticipate preoperative administration of which of the following?

IV administration of corticosteroids may begin on the evening before surgery and continue during the early postoperative period to prevent adrenal insufficiency.

A patient with a recent diagnosis of hypothyroidism is being treated for an unrelated injury. When administering medications to the patient, the nurse should know that the patient's diminished thyroid function may have what effect?

In all patients with hypothyroidism, the effects of analgesic agents, sedatives, and anesthetic agents are prolonged.

To achieve consistency with the body's natural secretion of cortisol, when would the home care nurse instruct the patient to take his or her corticosteroids?

In keeping with the natural secretion of cortisol, the best time of day for the total corticosteroid dose is in the morning from 7 to 8 AM.

While assisting with the surgical removal of an adrenal tumor, the nurse is aware that the patient's vital signs may change upon manipulation of the tumor.

Manipulation of the tumor during surgical excision may cause release of stored epinephrine and norepinephrine, with marked increases in BP and changes in heart rate.

The nurse is caring for a patient with hyperparathyroidism. What level of activity would the nurse expect to promote?

Mobility, with walking or use of a rocking chair for those with limited mobility, is encouraged as much as possible because bones subjected to normal stress give up less calcium.

A patient who has been taking corticosteroids for several months has been experiencing muscle wasting. The patient has asked the nurse for suggestions to address this adverse effect. What should the nurse recommend?

Muscle wasting can be partly addressed through increased protein intake.

The nurse is caring for a patient with a diagnosis of Addison's disease. What sign or symptom is most closely associated with this health problem?

Patients with Addison's disease demonstrate muscular weakness, anorexia, gastrointestinal symptoms, fatigue, emaciation, dark pigmentation of the skin, and hypotension.

A patient has been assessed for aldosteronism and has recently begun treatment. What are priority areas for assessment that the nurse should frequently address?

Patients with aldosteronism exhibit a decline in the serum levels of potassium, and hypertension is the most prominent and almost universal sign of aldosteronism.

A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding?

Patients with diabetes insipidus produce an enormous daily output of very dilute, water-like urine with a specific gravity of 1.001 to 1.005.

A patient on corticosteroid therapy needs to be taught that a course of corticosteroids of 2 weeks' duration can suppress the adrenal cortex for how long?

Suppression of the adrenal cortex may persist up to 1 year after a course of corticosteroids of only 2 weeks' duration.

nurse is caring for a patient diagnosed with hypothyroidism secondary to Hashimoto's thyroiditis. When assessing this patient, what sign or symptom would the nurse expect?

Symptoms of hypothyroidism include extreme fatigue, hair loss, brittle nails, dry skin, voice huskiness or hoarseness, menstrual disturbance, and numbness and tingling of the fingers.

The nurse is teaching a patient that the body needs iodine for the thyroid to function. What food would be the best source of iodine for the body?

The major use of iodine in the body is by the thyroid. Iodized table salt is the best source of iodine.

A patient has been admitted to the post-surgical unit following a thyroidectomy. To promote comfort and safety, how should the nurse best position the patient?

The most comfortable position is the semi-Fowler's position, with the head elevated and supported by pillows.

nurse providing care for a patient with Cushing syndrome has identified the nursing diagnosis of risk for injury related to weakness. the nurse best reduce this risk?

The nurse should take action to prevent the patient's risk for falls.

You are developing a care plan for a patient with Cushing syndrome. What nursing diagnosis would have the highest priority in this care plan?

The nursing priority is to decrease the risk of injury by establishing a protective environment.

A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a documented history of adrenal insufficiency. Considering the patient's history and current symptoms, the nurse should anticipate that the patient will be instructed to do which of the following?

The patient will need to supplement dietary intake with added salt during episodes of GI losses of fluid through vomiting and diarrhea to prevent the onset of addisonian crisis.

The nurse is performing a shift assessment of a patient with aldosteronism. What assessments should the nurse include?

The principal action of aldosterone is to conserve body sodium. Alterations in aldosterone levels consequently affect urine output and BP.

patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion is being cared for on the critical care unit. priority nursing diagnosis for patient with this condition is what?

The priority nursing diagnosis for a patient with SIADH is excess fluid volume, as the patient retains fluids and develops a sodium deficiency.

A patient is undergoing testing for suspected adrenocortical insufficiency. The care team should ensure that the patient has been assessed for the most common cause of adrenocortical insufficiency.

Therapeutic use of corticosteroids is the most common cause of adrenocortical insufficiency. The other options also cause adrenocortical insufficiency, but they are not the most common causes.

Urinary anti-infectives are used only to treat urinary tract infections (UTIs). What causes urinary anti-infectives to be so effective in treating UTIs?

They act specifically within the urinary tract.

A patient has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this patient's immediate care?

Thyroid storm necessitates interventions to reduce heart rate and temperature.

nurse's assessment of a patient with thyroidectomy suggests tetany and a review of the most recent blood work corroborate this finding. nurse should prepare to administer what intervention?

When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate.

nurse is caring for a patient with Addison's disease who is scheduled for discharge. When teaching the patient about hormone replacement therapy?

nurse should address the need for lifelong replacement of adrenal cortex hormones to prevent addisonian crises,

A patient is prescribed corticosteroid therapy. What would be priority information for the nurse to give the patient who is prescribed long-term corticosteroid therapy?

patient is at increased risk of infection and masking of signs of infection. cardiovascular effects of corticosteroid therapy may result in development of thrombophlebitis or thromboembolism.

nurse is providing care for an older adult whose current medication regimen includes levothyroxine . nurse should be aware of the heightened risk of adverse effects when administering an IV dose of what medication?

thyroid hormones interact with many other medications. small IV doses, hypnotic and sedative agents may induce profound somnolence,