Endocrine

The nurse determines that additional instruction is needed for a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient makes which statement? a."I need to shop for foods low in sodium and avoid adding salt to food." b."I should weigh myself daily and report any sudden weight loss or gain." c."I need to limit my fluid intake to no more than 1 quart of liquids a day." d."I should eat foods high in potassium because diuretics cause potassium loss."

a."I need to shop for foods low in sodium and avoid adding salt to food." Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred.

Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency? a.Increasing serum sodium levels c.Decreasing serum chloride levels b.Decreasing blood glucose levels d.Increasing serum potassium levels

a.Increasing serum sodium levels

The nurse determines that demeclocycline is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patient's a.weight has increased. c.peripheral edema is increased. b.urinary output is increased. d.urine specific gravity is increased.

b .urinary output is increased.

The nurse admits a patient to the hospital in Addisonian crisis. Which patient statement supports the need to plan additional teaching? a."I frequently eat at restaurants, and my food has a lot of added salt." b."I had the flu earlier this week, so I couldn't take the hydrocortisone." c."I always double my dose of hydrocortisone on the days that I go for a long run." d."I take twice as much hydrocortisone in the morning dose as I do in the afternoon."

b."I had the flu earlier this week, so I couldn't take the hydrocortisone."

After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? a.A 31-yr-old female patient with Cushing syndrome and a blood glucose level of 244 mg/dL b.A 70-yr-old female patient taking levothyroxine (Synthroid) who has an irregular pulse of 134 c.A 53-yr-old male patient who has Addison's disease and is due for a prescribed dose of hydrocortisone (Solu-Cortef). d.A 22-yr-old male patient admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L

b.A 70-yr-old female patient taking levothyroxine (Synthroid) who has an irregular pulse of 134

A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next? a.Suction the patient's airway. b.Administer IV calcium gluconate. c.Plan for emergency tracheostomy. d.Prepare for endotracheal intubation.

b.Administer IV calcium gluconate. The patient's clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Endotracheal intubation or tracheostomy may be needed if the calcium does not resolve the stridor. Suctioning will not correct the stridor.

A patient seen in the emergency department for severe headache and acute confusion has a serum sodium level of 118 mEq/L. The nurse will anticipate the need for which diagnostic test? a.Urinary 17-ketosteroids b.Antidiuretic hormone level c.Growth hormone stimulation test d.Adrenocorticotropic hormone level

b.Antidiuretic hormone level

Which intervention will the nurse include in the plan of care for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? a.Encourage fluids to 2 to 3 L/day. b.Monitor for increasing peripheral edema. c.Offer the patient hard candies to suck on. d.Keep head of bed elevated to 30 degrees.

c. Offer the patient hard candies to suck on. Sucking on hard candies decreases thirst for a patient on fluid restriction. Patients with SIADH are on fluid restrictions of 800 to 1000 mL/day. Peripheral edema is not seen with SIADH. The head of the bed is elevated no more than 10 degrees to increase left atrial filling pressure and decrease antidiuretic hormone (ADH) release.

A nurse cares for a client with excessive production of thyrocalcitonin (calcitonin). For which electrolyte imbalance should the nurse assess? a.Potassium b.Sodium c.Calcium d.Magnesium

c.Calcium

A patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the nurse expect during the assessment? a.Chronically low blood pressure c.Purplish streaks on the abdomen b.Bronzed appearance of the skin d.Decreased axillary and pubic hair

c.Purplish streaks on the abdomen

A nurse plans care for a client with Cushing's disease. Which action should the nurse include in this client's plan of care to prevent injury? a.Pad the siderails of the client's bed. b.Assist the client to change positions slowly. c.Use a lift sheet to change the client's position. d.Keep suctioning equipment at the client's bedside.

c.Use a lift sheet to change the client's position. Cushing's syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risk for pathologic bone fracture. Padding the siderails and assisting the client to change position may be effective, but these measures will not protect him or her as much as using a lift sheet. The client should not require suctioning.

The nurse will plan to teach a patient to minimize physical and emotional stress while the patient is undergoing a.a water deprivation test. b.testing for serum T3 and T4 levels. c.a 24-hour urine test for free cortisol. d.a radioactive iodine (I-131) uptake test.

c.a 24-hour urine test for free cortisol.

An expected patient problem for a patient admitted to the hospital with symptoms of diabetes insipidus is a.excess fluid volume related to intake greater than output. b.impaired gas exchange related to fluid retention in lungs. c.sleep pattern disturbance related to frequent waking to void. d.risk for impaired skin integrity related to generalized edema.

c.sleep pattern disturbance related to frequent waking to void.

A 62-yr-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient a.about radioactive precautions to take with all body secretions. b.that symptoms of hyperthyroidism should be relieved in about a week. c.that symptoms of hypothyroidism may occur as the RAI therapy takes effect. d.to discontinue the antithyroid medications taken before the radioactive therapy.

c.that symptoms of hypothyroidism may occur as the RAI therapy takes effect.

A nurse prepares to palpate a client's thyroid gland. Which action should the nurse take when performing this assessment? a.Stand in front of the client instead of behind the client. b.Ask the client to swallow after palpating the thyroid. c.Palpate the right lobe with the nurse's left hand. d.Place the client in a sitting position with the chin tucked down.

d.Place the client in a sitting position with the chin tucked down.

Which prescribed medication should the nurse expect will have rapid effects on a patient admitted to the emergency department in thyroid storm? a.Iodine c.Propylthiouracil b.Methimazole d.Propranolol (Inderal)

d.Propranolol (Inderal)

Which assessment finding of a 42-yr-old patient who had a bilateral adrenalectomy requires the most rapid action by the nurse? a.The blood glucose is 192 mg/dL. b.The lungs have bibasilar crackles. c.The patient reports 6/10 incisional pain. d.The blood pressure (BP) is 88/50 mm Hg.

d.The blood pressure (BP) is 88/50 mm Hg.

The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is most important to report to the health care provider? a.The patient is confused and lethargic. b.The patient reports a recent head injury. c.The patient has a urine output of 400 mL/hr. d.The patient's urine specific gravity is 1.003.

a.The patient is confused and lethargic.

The nurse providing care for a patient who has an adrenocortical adenoma causing hyperaldosteronism should a.monitor the blood pressure every 4 hours. b.elevate the patient's legs to relieve edema. c.monitor blood glucose level every 4 hours. d.order the patient a potassium-restricted diet.

a.monitor the blood pressure every 4 hours.

Which nursing assessment of a 70-yr-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)? a.Fluid balance c.Nutritional intake b.Apical pulse rate d.Orientation and alertness

b.Apical pulse rate

The nurse is planning postoperative care for a patient who is being admitted to the surgical unit form the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action should be included? a.Palpate extremities for edema. b.Measure urine volume every hour. c.Check hematocrit every 2 hours for 8 hours. d.Monitor continuous pulse oximetry for 24 hours.

b.Measure urine volume every hour. After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema. Monitoring of urine output and urine specific gravity is essential. Hemorrhage is not a common problem. There is no need to check the hematocrit hourly. The patient is at risk for dehydration, not volume overload. The patient is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.

A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The client's serum sodium level is 114 mEq/L. Which action should the nurse take first? a.Consult with the dietitian about increased dietary sodium. b.Restrict the client's fluid intake to 600 mL/day. c.Handle the client gently by using turn sheets for re-positioning. d.Instruct unlicensed assistive personnel to measure intake and output.

b.Restrict the client's fluid intake to 600 mL/day.

A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. The nurse should plan to teach the patient about a.bisphosphonates to reduce bone demineralization. b.calcium supplements to normalize serum calcium levels. c.increasing fluid intake to decrease risk for nephrolithiasis. d.including whole grains in the diet to prevent constipation.

b.calcium supplements to normalize serum calcium levels.

The nurse will plan to monitor a patient diagnosed with a pheochromocytoma for a.flushing. c.bradycardia. b.headache. d.hypoglycemia.

b.headache.