endocrine and oncology
The nurse is preparing to care for a client returning from the operating room after a subtotal thyroidectomy. The nurse antici- pates the need for which item to be placed at the bedside? 1 Hypothermia blanket 2 Emergency tracheostomy kit 3 Magnesium sulfate in a ready-to-inject vial 4 Ampule of saturated solution of potassium iodide (SSKI) (ThyroShield)
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The nurse is admitting a client with a diag- nosis of hypothyroidism to the hospital. What action should the nurse perform to obtain data related to this diagnosis? 1 Inspect facial features 2 Auscultate lung sounds 3 Percuss the thyroid gland 4 Assess the client's ability to ambulate
1 : Inspection of facial features will reveal the characteristic coarse features, presence of edema around the eyes and face, and the blank expression that are characteristic of hypothyroidism. The assessment techniques in options 2, 3, and 4 will not reveal informa- tion related to the diagnosis of hypothyroidism.
The nurse is caring for a client with a diag- nosis of Cushing's syndrome. The nurse should plan which of these measures to prevent complications from this medical condition? 1 Monitoring glucose levels 2 Encouraging daily jogging 3 Monitoring epinephrine levels 4 Encouraging visits from friends
1 Cushing's syndrome is a metabolic disorder resulting from the chronic and excessive production of cortisol by the adrenal cortex or the administration of glucocorticoids in large doses for sev- eral weeks or longer. In the client with Cushing's syndrome, increased levels of glucocorticoids can result in hyperglycemia and signs and symptoms of diabetes mellitus. Clients experience activity intoler- ance related to muscle weakness and fatigue; therefore, option 2 is incorrect. Epinephrine levels are not affected. Visitors should be lim- ited because of the client's impaired immune response.
A client is receiving desmopressin (DDAVP) intranasally for management of diabetes insipidus. Which assessment parameters should the nurse check to determine the effectiveness of this medication? 1 Daily weight 2 Temperature 3 Apical heart rate 4 Pupillary response
1 DDAVP is an analog of vasopressin (antidiuretic hor- mone). It is used in the management of diabetes insipidus. The nurse monitors the client's fluid balance to determine the effectiveness of the medication. Fluid status can be evaluated by noting intake and urine output, daily weight, and the presence of edema. The measure- ments in options 2, 3, and 4 are not related to this medication.
The nurse is caring for a client with multi- ple myeloma who is receiving intravenous hydration at 100mL per hour. Which find- ing indicates a positive response to the treat- ment plan? 1 Creatinine of 1.0 mg/dL 2 Weight increase of 1 kilogram 3 Respirations of 18 breaths per minute 4 White blood cell count of 6000 cells/mm3
1 Multiple myeloma is a malignant proliferation of plasma cells within the bone. Renal failure is a concern in the client with mul- tiple myeloma. In multiple myeloma, hydration is essential to pre- vent renal damage resulting from precipitation of protein in the renal tubules and excessive calcium and uric acid in the blood. Creatinine is the most accurate measure of renal status. Options 3 and 4 are unrelated to the subject of hydration. Weight gain is not a positive sign when concerned with renal status.
The nurse develops a postoperative plan of care for a client scheduled for hypophysec- tomy. Which interventions should be included in the plan of care? Select all that apply. 1 Obtain daily weights. 2 Monitor intake and output. 3 Elevate the head of the bed. 4 Use a soft toothbrush for mouth care. 5 Encourage coughing and deep breathing.
1,2 3 A hypophysectomy is done to remove a pituitary tumor. Because temporary diabetes insipidus or syndrome of inappropriate antidiuretic hormone can develop after this surgery, obtaining daily weights and monitoring intake and output are important interven- tions. The head of the bed is elevated to assist in preventing increased intracranial pressure. Toothbrushing, sneezing, coughing, nose blow- ing, and bending are activities that should be avoided postoperatively in the client who underwent a hypophysectomy because of the risk of increasing intracranial pressure. These activities interfere with the healing of the incision and can disrupt the graft.
Which medication instructions should the nurse provide to a client who has been pre- scribed levothyroxine (Synthroid)? Select all that apply. 1 Monitor your own pulse rate. 2 Take the medication in the morning. 3 Take the medication at the same time each day. 4 Notify the health care provider if chest pain occurs. 5 Expect the pulse rate to be greater than 100 beats per min. 6 It may take 1 to 3 weeks for a full ther- apeutic effect to occur.
1,2,3,4,6 : Levothyroxine is a thyroid hormone. The client is instructed to monitor his or her own pulse rate. The client is also instructed to take the medication in the morning before breakfast to prevent insomnia and to take the medication at the same time each day to maintain hor- mone levels. The client is told not to discontinue the medication and that thyroid replacement is lifelong. Additional instructions include contacting the health care provider if the rate is greater than 100 beats per minute and notifying the health care provider if chest pain occurs, or if weight loss, nervousness and tremors, or insomnia develops. The client is also told that full therapeutic effect may take 1 to 3 weeks and that he or she needs to have follow-up thyroid blood studies to moni- tor therapy.
The nurse is assessing a client with Addison's disease for signs of hyper- kalemia. Which sign/symptom should the nurse observe with this electrolyte imbalance? 1 Polyuria 2 Cardiac dysrhythmias 3 Dry mucous membranes 4 Prolonged bleeding time
2 : The inadequate production of aldosterone in clients with Addison's disease causes the inadequate excretion of potassium and results in hyperkalemia. The clinical manifestations of hyperkalemia are the result of altered nerve transmission. The most harmful con- sequence of hyperkalemia is its effect on cardiac function. Options 1, 3, and 4 are not manifestations that are associated with Addison's disease or hyperkalemia.
A client undergoes a subtotal thyroidec- tomy. The nurse ensures that which priority item is at the client's bedside upon arrival from the operating room? 1 An apnea monitor 2 A suction unit and oxygen 3 A blood transfusion warmer 4 An ampule of phytonadione (vitamin K)
2 After thyroidectomy, respiratory distress can occur from tetany, tissue swelling, or hemorrhage. It is important to have oxygen and suction equipment readily available and in working order if such an emergency were to arise. Apnea is not a problem associated with thyroidectomy, unless the client experienced respiratory arrest. Blood transfusions can be administered without a warmer, if necessary. Vitamin K would not be administered for a client who is hemorrhag- ing, unless deficiencies in clotting factors warrant its administration.
. During history taking of a client admitted with newly diagnosed Hodgkin's disease, which symptom should the nurse expect the client to report? 1 Weight gain 2 Night sweats 3 Severe lymph node pain 4 Headache with minor visual changes
2 Assessment of a client with Hodgkin's disease most often reveals night sweats, enlarged, painless lymph nodes, fever, and malaise. Weight loss may be present if metastatic disease occurs. Headache and visual changes may occur if brain metastasis is present.
The nurse provides home care instructions to a client with Cushing's syndrome. The nurse determines that the client under- stands the hospital discharge instructions if the client makes which statement? 1 "I need to eat foods low in potassium." 2 "I need to check the color of my stools." 3 "I need to check the temperature of my legs twice a day." 4 "I need to take aspirin rather than Tylenol for a headache."
2 Cushing's syndrome results in an increased secretion of cortisol. Cortisol stimulates the secretion of gastric acid, and this can result in the development of peptic ulcers and gastrointestinal bleed- ing. The client should be encouraged to eat potassium-rich foods to correct the hypokalemia that occurs with this disorder. Cushing's syn- drome does not affect temperature changes in the lower extremities. Aspirin can increase the risk for gastric bleeding and skin bruising
The nurse is conducting a health history on a client with hyperparathyroidism. Which question asked of the client would elicit information about this condition? "Do you have tremors in your hands?" "Are you experiencing pain in your joints?" "Have you had problems with diarrhea lately?" "Do you notice any swelling in your legs at night?"
2 Hyperparathyroidism causes an oversecretion of para- thyroid hormone (PTH), which causes excessive osteoblast growth and activity within the bones. When bone reabsorption is increased, calcium is released from the bones into the blood, causing hypercal- cemia. The bones suffer demineralization as a result of calcium loss, leading to bone and joint pain and pathological fractures. Options 1 and 3 relate to assessment of hypoparathyroidism. Option 4 is unre- lated to hyperparathyroidism.
A client who was admitted to the hospital for the treatment of thyroid storm (hyper- thyroidism) is preparing for discharge. The client is anxious about his illness and is, at times, emotionally labile. Which interven- tion should the nurse take at this time in caring for this client? 1 Avoid teaching the client anything about the disease until he is emotionally stable. 2 Assist the client with identifying coping skills, support systems, and potential stressors. 3 Reassure the client that everything will be fine after he returns to his home environment. 4 Confront the client and explain that he must control his behavior if he wants to go home.
2 It is normal for clients who experience thyroid storm (hyperthyroidism) to continue to be anxious and emotionally labile at the time of discharge. The best intervention is to help the client cope with these changes in behavior and to anticipate potential stress- ors so that symptoms will not be as severe. Options 1 and 3 block communication by either avoiding the issue or providing false reas- surance. The confrontation described in option 4 will only heighten his anxiety.
A nursing instructor asks a student to iden- tify risk factors for and methods of prevent- ing prostate cancer. Which statement by the student indicates the need for further teaching? 1 "Smoking increases the risk for this type of cancer." 2 "A high-fat diet will assist in preventing this type of cancer." 3 "A history of a sexually transmitted infec- tion is a risk for this disease." 4 "Men more than 50 years old should be monitored with a yearly digital rectal exam"
2 Prostate cancer is a slow-growing malignancy of the pros- tate gland. A high intake of dietary fat is a risk factor for prostate cancer. Options 1, 3, and 4 are accurate statements regarding the risks and prevention measures related to this type of cancer.
The nurse is caring for a client who is scheduled to have a thyroidectomy and provides instruc- tions to the client about the surgical procedure. Which statement by the client would indicate an understanding of the nurse's instructions? 1 "I will definitely have to continue taking antithyroid medication after this surgery." 2 "I need to place my hands behind my neck when I have to cough or change positions." 3 "I need to turn my head and neck front, back, and side to side every hour for the first 12 hours after surgery." 4 "I will immediately report to the emergency room if I experience tingling of my toes, fin- gers, and lips after surgery."
2 The client is taught that following thyroidectomy ten- sion needs to be avoided on the suture line because hemorrhage may develop. One way of reducing incisional tension is to teach the cli- ent how to support the neck when coughing or being repositioned. Likewise, during the postoperative period, the client should avoid any unnecessary movement of the neck; that is why sandbags and pillows are frequently used to support the head and neck. The removal of the thyroid does not mean that the client will be taking antithyroid medi- cations postoperatively. If a client experiences tingling in the fingers, toes, and lips, it is probably a result of injury to the parathyroid gland during surgery, resulting in hypocalcemia. These signs and symptoms need to be reported immediately.
A client is admitted to the hospital with Cushing's disease. The nurse should moni- tor the client's laboratory studies for which finding that occurs in this disorder? Hypokalemia Hyperglycemia Decreased plasma cortisol levels Low white blood cell (WBC) count
2 The client with adrenocorticosteroid excess experiences hyperglycemia, hyperkalemia, elevated plasma cortisol and adreno- corticotropic hormone (ACTH) levels, and an elevated WBC count. These abnormalities are caused by th
The nurse is admitting a client who recently underwent a bilateral adrenalec- tomy. Which intervention is essential for the nurse to include in the client's plan of care? Prevent social isolation. Consider occupational therapy. Discuss changes in body image. Avoid stress-producing situations.
4 Adrenalectomy can lead to adrenal insufficiency. Adrenal hormones are essential to maintaining homeostasis in response to stressors. Options 1, 2, and 3 are not essential interventions specific to this client's problem.
The nurse is caring for a client with cancer of the lung who is receiving chemotherapy. The nurse reviews the laboratory results and notes that the platelet count is 18,000 cells/mm3. Based on this laboratory result, which should the nurse implement? 1 Contact precautions 2 Bleeding precautions 3 Respiratory precautions 4 Neutropenic precautions
2 When the platelet count is less than 20,000 cells/mm3, the client is at risk for bleeding, and the nurse should institute bleed- ing precautions. Contact precautions are initiated in a client who has drainage from wounds that may be infectious. Respiratory precau- tions are instituted for a client with a respiratory infection that is transmitted by the airborne route. Neutropenic precautions would be instituted for a client with a low neutrophil count.
A client is diagnosed with hypothyroidism. The nurse performs an assessment on the client, expecting to note which findings? Select all that apply. 1. Weight loss 2. Bradycardia 3. Hypotension 4. Dry, scaly skin 5. Heat intolerance 6. Decreased body temperature
2,3,4,6 The manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormones. Some of these manifestations are bradycardia; hypotension; cool, dry, scaly skin; decreased body temperature; dry, coarse, brittle hair; decreased hair growth; cold intolerance; slowing of intellectual functioning; lethargy; weight gain; and constipation.
While a client with myxedema is being admit- ted to the hospital, the client reports having experienced a lack of energy, cold intolerance, and puffiness around the eyes and face. The nurse plans care knowing that these clinical manifestations are caused by a lack of pro- duction of which hormones? 1Luteinizing hormone (LH) 2Adrenocorticotropic hormone (ACTH) 3 Triiodothyronine (T3) and thyroxine (T4) 4 Prolactin (PRL) and growth hormone (GH)
3 Although all of these hormones originate from the ante- rior pituitary, only T3 and T4 are associated with the client's symptoms. Myxedema results from inadequate thyroid hormone levels (T3 and T4). Low levels of thyroid hormone result in an overall decrease in the basal metabolic rate, affecting virtually every body system and leading to weakness, fatigue, and a decrease in heat production. A decrease in LH results in the loss of secondary sex characteristics. A decrease in ACTH is seen in Addison's disease. PRL stimulates breast milk pro- duction by the mammary glands, and GH affects bone and soft tissue by promoting growth through protein anabolism and lipolysis.
A client with the diagnosis of hyperpara- thyroidism says to the nurse, "I can't stay on this diet. It is too difficult for me." How should the nurse best respond when inter- vening in this situation? 1. "Why do you think you find this diet plan difficult to adhere to?" 2. "It really isn't difficult to stick to this diet. Just avoid milk products." 3."You are having a difficult time staying on this plan. Let's discuss this." 4. "It is very important that you stay on this diet to avoid forming renal calculi."
3 By paraphrasing the client's statement, the nurse can encourage the client to verbalize emotions. The nurse also sends feed- back to the client that the message was understood. An open-ended statement or question such as this prompts a thorough response from the client. Option 1 requests information that the client may not be able to express. Option 2 devalues the client's feelings. Option 4 gives advice, which blocks communication.
The nurse assesses the client with a diagno- sis of thyroid storm. Which manifestations associated with thyroid storm indicate the need for immediate nursing intervention? 1 Polyuria, nausea, and severe headaches 2 Hypotension, translucent skin, and obesity 3 Fever, tachycardia, and systolic hypertension 4 Profuse diaphoresis, flushing, and consti- pation
3 The excessive amounts of thyroid hormone cause a rapid increase in the metabolic rate, thereby causing the manifestations of thyroid storm such as fever, tachycardia, and hypertension. When these signs present themselves, the nurse must take quick action to prevent deterioration of the client's health because death can ensue. Priority interventions include maintaining a patent airway and stabi- lizing the hemodynamic status. Options 1, 2, and 4 do not indicate the need for immediate nursing intervention.
Vasopressin (Pitressin) is prescribed for a client with diabetes insipidus, and the cli- ent asks the nurse about the purpose of the medication. The nurse responds, know- ing that this medication promotes which action? 1 Vasodilation 2 Decrease in peristalsis 3 Decrease in urinary output 4 Inhibit smooth muscle contraction
3 Vasopressin is a vasopressor and an antidiuretic. It directly stimulates contraction of smooth muscle, causes vasoconstriction, stimulates peristalsis, and increases reabsorption of water by the renal tubules, resulting in decreased urinary output.Priority Nursing Tip: Diabetes insipidus is characterized by polyuria of 4 to 24 liters per day. Therefore, monitor the client for signs of dehydration.
A client is diagnosed with diabetes insipi- dus. The nurse performs an assessment on the client and expects to note which mani- festations? Select all that apply. 1. Bradycardia 2 Hypertension 3 Poor skin turgor 4 Increased urinary output 5 Dry mucous membranes 6 Decreased pulse pressure
3,4,5,6 Diabetes insipidus is a water metabolism problem caused by an antidiuretic hormone (ADH) deficiency (either a decrease in ADH synthesis or an inability of the kidneys to respond to ADH). Clinical manifestations include poor skin turgor, increased urinary output, dry mucous membranes, decreased pulse pressure, tachycar- dia, hypotension, weak peripheral pulses, and increased thirst.
The nurse has provided instructions to a client who is receiving external radiation therapy. Which statement by the client indi- cates a need for further teaching regarding self-care related to the radiation therapy? 1 "I need to eat a high-protein diet." 2 "I need to avoid exposure to sunlight." 3 "I need to wash my skin with a mild soap and pat it dry." 4 "I need to apply pressure on the irritated area to prevent bleeding."
4 : The client receiving external radiation therapy should avoid pressure on the irritated area and wear loose-fitting cloth- ing. Specific health care provider instructions would be necessary to obtain if an alteration in skin integrity occurred as a result of the radiation therapy. Options 1, 2, and 3 are accurate measures regard- ing radiation therapy.
The nurse is caring for a client with Hodgkin's disease who will be receiving radiation and chemotherapy. Which statement by the cli- ent indicates a positive coping mechanism to be used during these treatments? 1 "I won't leave the house bald." 2 "Losing my hair won't bother me." 3 "I will be one of the few who doesn't lose my hair." 4 "I have selected a wig, even though I will miss my own hair."
4 A combination of radiation and chemotherapy often causes alopecia. To make use of positive coping mechanisms, the client must identify personal feelings and positive interventions to deal with side effects. Options 1, 2, and 3 are not positive coping mechanisms.
The nurse is caring for a client who is sched- uled for an adrenalectomy. The nurse plans to administer which medication in the preoperative period to prevent Addisonian crisis? Prednisone orally Fludrocortisone (Florinef) orally Spironolactone (Aldactone) intramuscularly Methylprednisolone sodium succinate (Solu- medrol) intravenously
4 A glucocorticoid preparation will be administered intrave- nously or intramuscularly in the immediate preoperative period to a client scheduled for an adrenalectomy. Methylprednisolone sodium succinate protects the client from developing acute adrenal insuffi- ciency (Addisonian crisis) that can occur as a result of the adrenal- ectomy. Prednisone is an oral corticosteroid. Fludrocortisone is a mineralocorticoid. Aldactone is a potassium-sparing diuretic.
A client is admitted to the hospital for a thyroidectomy. While preparing the client for surgery, the nurse assesses the client for psychosocial problems that may cause preoperative anxiety and determines which client fear is a realistic source of anxiety? 1 Sexual dysfunction and infertility 2 Imposed dietary restrictions after discharge 3 Developing gynecomastia and hirsutism postoperatively 4 Changes in body image secondary to the location of the incision
4 Because the incision is in the neck area, the client may be fearful of having a large scar postoperatively. Sexual dysfunction and infertility could possibly occur if the entire thyroid gland is removed, and the client is not placed on thyroid replacement medications. The client will not have specific dietary restrictions after discharge. Having all or part of the thyroid gland removed will not cause gynecomastia or hirsutism.
The nurse is caring for a child with kidney disease and is analyzing the child's labora- tory results. The nurse notes a sodium level of 148 mEq/L. On the basis of this finding, which clinical manifestation should the nurse expect to note in the child? 1 Lethargy 2 Diaphoresis 3 Cold, wet skin 4 Dry, sticky mucous membranes
4 Hypernatremia occurs when the sodium level is more than 145mEq/L. Clinical manifestations include intense thirst, oli- guria, agitation, restlessness, flushed skin, peripheral and pulmonary edema, dry and sticky mucous membranes, nausea, and vomiting. Options 1, 2, and 3 are not associated with the clinical manifestations of hypernatremia.
The nurse reviews the record of a client who is receiving external radiation therapy and notes documentation of a skin finding as moist desquamation. Which finding on assessment of the client should the nurse expect to observe? 1 A rash 2 Dermatitis 3 Reddened skin 4 Weeping of the skin
4 Moist desquamation occurs when the basal cells of the skin are destroyed. The dermal level is exposed, which results in the leakage of serum. A rash, dermatitis, and reddened skin may occur with external radiation, but these conditions are not described as moist desquamation.
A client has developed oral mucositis as a result of radiation to the head and neck. Which measure should the nurse teach the client to incorporate in a daily home care routine? 1 Oral hygiene should be performed in the morning and evening. 2 A glass of wine per day will not pose any fur- ther harm to the oral cavity. 3 High-protein foods such as peanut butter should be incorporated in the diet. 4 A combination of frequent teeth cleaning and rinsing with a weak saline and water solution before and after each meal.
4 Oral mucositis (irritation, inflammation, and/or ulcer- ation of the mucosa) also known as stomatitis, commonly occurs in clients receiving radiation to the head and neck. Measures need to be taken to soothe the mucosa and provide effective cleansing of the oral cavity. A combination of a weak saline and water solution is an effective cleansing agent. Oral hygiene should be performed more frequently than in the morning and evening. Alcohol would dry and irritate the mucosa. Peanut butter has a thick consistency and will stick to the irritated mucosa.
A client undergoes a thyroidectomy, and the nurse monitors the client for signs of dam- age to the parathyroid glands postopera- tively. Which findings indicate damage to the parathyroid glands? 1 Fever 2 Neck pain 3 Hoarseness 4 Tingling around the mouth
4 The parathyroid glands can be damaged or their blood supply impaired during thyroid surgery. Hypocalcemia and tetany result when parathyroid hormone (PTH) levels decrease. The nurse monitors for complaints of tingling around the mouth or of the toes or fingers and muscular twitching because these are signs of calcium deficiency. Additional later signs of hypocalcemia are posi- tive Chvostek's and Trousseau's signs. Fever may be expected in the immediate postoperative period but is not an indication of damage to the parathyroid glands. However, if a fever persists the health care provider is notified. Neck pain and hoarseness are expected findings postoperatively.
A client is admitted to the hospital with a diagnosis of Cushing's syndrome. The nurse monitors the client for which problem that is likely to occur with this diagnosis? Hypovolemia Hypoglycemia Mood disturbances Deficient fluid volume
Mood disturbances Cushing's syndrome is a metabolic disorder result- ing from the chronic and excessive production of cortisol. When Cushing's syndrome develops, the normal function of the glucocor- ticoids becomes exaggerated and the classic picture of the syndrome emerges. This exaggerated physiological action can cause mood dis- turbances, including memory loss, poor concentration and cognition, euphoria, and depression. It can also cause persistent hyperglycemia along with sodium and water retention (hypernatremia), producing edema (hypervolemia; fluid volume excess) and hypertension.
The nurse is preparing the bedside for a postoperative parathyroidectomy client who is expected to return to the nursing unit from the recovery room in 1 hour. The nurse should ensure that which specific item is at the client's bedside? Cardiac monitor Tracheotomy set Intermittent gastric suction Underwater seal chest drainage system
Tracheotomy set Respiratory distress caused by hemorrhage and swelling and compression of the trachea is a primary concern for the nurse managing the care of a postoperative parathyroidectomy client. An emergency tracheotomy set is always routinely placed at the bedside of the client with this type of surgery, in anticipation of this potential complication. Although a cardiac monitor may be attached to the client in the postoperative period, it is not specific to this type of surgery. Options 3 and 4 also are not specifically needed with the surgical procedure.
