Level 2: Topic 6
The patient has a prescription for levothyroxine 37.5 mcg. Available are 0.075 mg tablets. How many tablets should the nurse administer?
0.5 tablet
A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8 AM. The nurse instructs the patient to fast for what period of time? 1. At least eight hours 2. 4 AM on the day of the test 3. After dinner the evening before the test 4. 7 AM on the day of the test
1. At least eight hours Typically, a patient is prescribed to be nothing by mouth (NPO) for eight hours before determination of the fasting blood glucose level. For this reason, the patient who has a laboratory draw at 8 AM should not have any food or beverages containing any calories after midnight. It is not necessary to fast longer than eight hours; 4 AM and 7 AM would not allow for sufficient time to fast for morning laboratory testing.
The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? 1. Cheese 2. Broccoli 3. Chicken 4. Oranges
1. Cheese Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid macrovascular changes.
What is the clinical manifestation of Addison's disease? 1. Delusions 2. Hypokalemia 3. Hyperglycemia 4. Truncal obesity
1. Delusions Addison's disease occurs due to the hypofunction of adrenal cortex. This hypofunction manifests as delusions, which occur due to decreased levels of glucocorticoids. Hypokalemia, hyperglycemia, and truncal obesity are clinical manifestations of Cushing syndrome that occur due to hyperfunction of the adrenal cortex.
An adult patient is experiencing menopause-related symptoms. Which hormone decline results in an increased risk of atherosclerosis and osteoporosis? 1. Estrogen 2. Epinephrine 3. Progesterone 4. Norepinephrine
1. Estrogen Estrogen is secreted from the woman's ovaries and stimulates the development of secondary sex characteristics. It prepares the uterus for fertilization and stimulates bone growth. Decreased estrogen secretion increases the risk for atherosclerosis and osteoporosis. Progesterone maintains the lining of the uterus for successful pregnancy. Epinephrine and norepinephrine increase in response to stress and enhance the effects of the sympathetic nervous system.
One of the unlicensed assistive personnel (UAP) reports to the nurse that a patient with diabetes is slow to respond, pale, and diaphoretic. What is the nurse's priority intervention? 1. Obtain a bedside glucose reading. 2. Ask patient to drink 4 ounces of orange juice. 3. Ask the unlicensed assistive personnel (UAP) to obtain a set of vital signs. 4. Administer 50 mL of 50% dextrose intravenously.
1. Obtain a bedside glucose reading. The patient with diabetes is exhibiting signs and symptoms of hypoglycemia. The priority intervention at this time is to validate assessment findings with a bedside glucose reading. Although vital signs may add to assessment data findings, they are not as much a priority as validating hypoglycemia and initiating treatment. Because the patient is experiencing a change in level of consciousness, management of the hypoglycemia via oral nourishment is contraindicated. If the patient has an existing intravenous (IV) line, then treatment of documented hypoglycemia with intravenous dextrose may be indicated.
Which assessment parameter is of highest priority when caring for a patient undergoing a water deprivation test? 1. Patient weight 2. Serum glucose 3. Arterial blood gases 4. Patient temperature
1. Patient weight A patient is at risk for severe dehydration during a water deprivation test. The test should be discontinued and the patient rehydrated if the patient's weight drops more than 2 kg at any time. Serum glucose, arterial blood gases, and the patient's temperature are not used to assess fluid balance.
A patient has sought care because of a loss of 25 lb over the past six months during which the patient states that he or she has made no significant dietary changes. For what potential problem should the nurse assess the patient? 1. Thyroid disorders 2. Diabetes insipidus 3. Pituitary dysfunction 4. Parathyroid dysfunction
1. Thyroid disorders Hyperthyroidism is associated with weight loss. Alterations in pituitary function, such as diabetes insipidus, and parathyroid dysfunction commonly are not associated with this phenomenon.
The nurse observes a return demonstration by a patient who is learning how to mix regular insulin and NPH insulin in the same syringe. Which action by the patient indicates the need for further teaching? 1. Withdrawing the NPH insulin first 2. Injecting air into the NPH insulin bottle first 3. Removing air bubbles after drawing up the first insulin 4. Injecting an amount of air equal to the desired dose of insulin
1. Withdrawing the NPH insulin first Regular insulin is always withdrawn first so it will not become contaminated with the NPH insulin. Injecting air into the NPH bottle first, removing air bubbles after drawing up the regular insulin, and injecting air equal to the desired dose of insulin are correct actions in regard to the mixture of regular and NPH insulin.
A patient has just begun long-term corticosteroid therapy. The nurse determines that the patient requires further education when making which statement? 1. "I may need to monitor my blood sugar more frequently." 2. "If I begin to gain weight I should stop taking my medication." 3. "It is important that I stay away from people who have contagious illnesses." 4. "I understand my appearance may change as fat tissue increases in my face and trunk."
2. "If I begin to gain weight I should stop taking my medication." Corticosteroids should be gradually tapered and not stopped suddenly to avoid life-threatening adrenal insufficiency. Corticosteroids may lead to insulin resistance and increased gluconeogenesis by the liver, and therefore the patient may need to monitor for blood sugar increase. Corticosteroids decrease the inflammatory response and delay healing, and therefore the patient is more susceptible to infections. Adipose tissue accumulates in the trunk, face, and cervical spine as a result of corticosteroid therapy.
An unlicensed assistive personnel (UAP) reports to the nurse that a patient's blood glucose level at 0800 before breakfast was 324 mg/dL. The nurse is reviewing the electronic medical record and notices that the patient received a high dose of insulin the previous night before bedtime. The nurse recognizes that the patient's hyperglycemia is most likely due to which problem with insulin therapy? 1. Lipodystrophy 2. Somogyi effect 3. Allergic reaction 4. Dawn phenomenon
2. Somogyi effect The Somogyi effect occurs when a patient receives a high dose of insulin that produces a decline in blood glucose levels during the night. As a result, counterregulatory hormones are released, stimulating lipolysis, gluconeogenesis, and glycogenolysis, which in turn produce rebound hyperglycemia. Lipodystrophy is atrophy or hypertrophy of the subcutaneous tissue. Allergic reactions related to insulin occur as local inflammatory reactions and do not produce hyperglycemia. The dawn phenomenon is characterized by hyperglycemia that is present on awakening; however, it is caused by growth hormone and cortisol excretion during the early morning hours, regardless of the amount of insulin given at nighttime.
A nurse is providing discharge teaching to a patient with a new diagnosis of type I diabetes mellitus who will need to give self-injections of insulin at home. What statement by the patient indicates to the nurse that the discharge teaching was effective? 1. "I can use my lower forearm for insulin injections." 2. "If my intermediate-acting insulin looks cloudy, I should discard the bottle." 3. "I need to rotate sites of injection to allow for better absorption of the insulin." 4. "I should push the plunger all the way down and then remove the needle as soon as possible."
3. "I need to rotate sites of injection to allow for better absorption of the insulin." Teaching the patient to rotate the injection within and between sites is important to allow for better insulin absorption. The lower forearm is not an injection site for subcutaneous insulin administration. The abdomen, arm, thigh, and buttock are the preferred sites. Intermediate-acting insulin is normally cloudy, and the patient should gently roll the bottle between the palms of hands to mix the insulin. The patient should push the plunger all the way down and leave the needle in place for 5 seconds to ensure that all of the insulin has been injected before removing the needle.
The nurse is performing an assessment for a patient who has been admitted to the acute care facility. A "bronze" skin tone is observed during the assessment. What condition does the nurse recognize that this patient may have? 1. Goiter 2. Acromegaly 3. Addison's disease 4. Cushing syndrome
3. Addison's disease Addison's disease is characterized by hyperpigmentation or ''bronzing'' of the skin in parts of the body such as the knuckles, elbows, and knees. A goiter is characterized by the enlargement of the thyroid gland. Acromegaly is characterized by an overgrowth of the bones and soft tissues. Cushing syndrome is characterized by hyperglycemia, hypertension, and weight gain.
Which disease is treated with corticosteroidal hormonal therapy? 1. Thyrotoxicosis 2. Nephrotic syndrome 3. Adrenal insufficiency 4. Rheumatoid arthritis
3. Adrenal insufficiency Adrenal insufficiency is treated with hormonal therapy of corticosteroids. Thyrotoxicosis, nephritic syndrome, and congenital adrenal hyperplasia are treated with corticosteroid drug therapy.
A college student is newly diagnosed with type 1 diabetes. The patient now has a headache, changes in vision, and is anxious, but does not have the portable blood glucose monitor with him or her. Which action should the campus nurse advise the patient to take? 1. Eat a piece of pizza 2. Drink some diet soft drink 3. Eat 15 g of simple carbohydrates 4. Take an extra dose of rapid-acting insulin
3. Eat 15 g of simple carbohydrates When the patient with type 1 diabetes is unsure about the meaning of the symptoms he or she is experiencing, the patient should treat him- or herself for hypoglycemia to prevent seizures and coma from occurring. The patient also should be advised to check the blood glucose as soon as possible. The fat in the pizza and the diet soft drink would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease the blood glucose.
The nurse working in an endocrine clinic knows that Chvostek's sign is a diagnostic tool that is used to assess for which electrolyte disturbance? 1. Hypokalemia 2. Hyperkalemia 3. Hypocalcemia 4. Hypercalcemia
3. Hypocalcemia Chvostek's sign is a diagnostic tool that is used to assess for tetany, a sign of hypocalcemia. This is an important assessment when the nurse is dealing with patients in an endocrine clinic, especially those that may have hypoparathyroidism. A positive Chvostek's sign is specific to hypocalcemic tetany, and therefore would not indicate a state of hypercalcemia, hypokalemia, or hyperkalemia.
Which parameter would indicate the optimal intended effect of therapy with levothyroxine? 1. Blood pressure 120/78 mm Hg 2. Weight loss of 5 pounds 3. Thyroid-stimulating hormone (TSH) of 1.5 mIU/L 4. White blood cell count 8000 mm 3
3. Thyroid-stimulating hormone (TSH) of 1.5 mIU/L Levothyroxine is a thyroid preparation used for hypothyroidism. A normal TSH level (between 0.4 to 4 mIU/L) indicates optimal intended effects of the medication. Weight loss, blood pressure, and a normal white blood cell count are not indicators of effective treatment with levothyroxine.
Which statement is true about pheochromocytoma? 1. The primary treatment is drug therapy. 2. An attack is provoked by antiepileptic medications. 3. Decreased levels of epinephrine and norepinephrine are observed. 4. Severe pounding headaches and profuse sweating are clinical features.
4. Severe pounding headaches and profuse sweating are clinical features. Severe pounding headache and profuse sweating are clinical features of pheochromocytoma. Although drug therapy is administered during preoperative care to reduce complications, the primary treatment is surgery. The attack is provoked by opioids, not antiepileptic medications. Epinephrine and norepinephrine levels rise in patients with pheochromocytoma.
A patient with type 2 diabetes takes oral hypoglycemics and is admitted to the hospital with a urinary tract infection (UTI). The patient asks why insulin injections have been prescribed. What explanation should the nurse provide? 1. Insulin acts synergistically with the antibiotic that was prescribed. 2. Insulin should have been prescribed for the patient to take at home. 3. Oral hypoglycemic medications are contraindicated in patients with UTIs. 4. The infection increases the glucose level, resulting in a need for more insulin.
4. The infection increases the glucose level, resulting in a need for more insulin. When the body is under stress, as in an acute illness, the need for insulin is more than oral hypoglycemics can provide. Insulin injections are usually required until the illness resolves. Insulin does not act synergistically with antibiotics, the patient did not need insulin at home, and oral hypoglycemics are not contraindicated in patients with UTIs.
The nurse is performing discharge education for a patient who was admitted for acute hypothyroidism. The patient is undergoing thyroid hormone therapy for the first time. What statement by the patient to the nurse confirms that discharge teaching was effective? 1. "I should take my levothyroxine every morning before eating my breakfast." 2. "I should only follow up with my doctor if I start having shortness of breath." 3. "I should keep the air conditioning a few degrees colder to help me with sweating." 4. "I should limit the amount of fiber I am eating to help keep me from getting constipated."
1. "I should take my levothyroxine every morning before eating my breakfast." A patient with a new diagnosis of hypothyroidism should be taught how to manage hypothyroidism, including taking the thyroid hormone in the morning before food. Patients with hypothyroidism need to be taught about the importance of regular follow-up care, not just when they are having abnormal symptoms. Patents with hypothyroidism should be taught to keep the environment warm and comfortable because of cold intolerance. Patients with hypothyroidism should increase the amount of fiber in their diet to prevent constipation; they should not limit the amount of fiber.
The nurse is caring for a patient in an outpatient diabetes clinic. Which statement by the patient indicates an understanding of the teaching? 1. "I will be sure to measure my finger stick blood glucose level four times a day, and more frequently when I am ill." 2. "When I am ill, I will eliminate my Lantus insulin and only cover my finger stick blood glucose if it is over 250." 3. "When I am ill, I will continue to take my Lantus insulin only." 4. "When I am ill I will only take my rapid-acting insulin."
1. "I will be sure to measure my finger stick blood glucose level four times a day, and more frequently when I am ill." When a patient with diabetes is ill, it is recommended he or she continues checking blood sugar every four hours and more frequently to prevent hyperglycemia and hypoglycemia during illness. The diabetic patient should adhere to the sick day rules, which indicate to continue with your basal dosing of insulin and continue to correct a finger stick blood sugar greater than 200. The patient also should be checking urine ketones for two blood sugars over 250 in a row.
Which patient statement indicates the need for further education regarding the management of both cardiac disease and hypothyroidism? 1. "I will use an enema for constipation." 2. "I will use a sedative to treat insomnia." 3. "I should take my thyroid medication in the morning before eating." 4. "I should not switch to another brand of hormone unless I check with my health care provider."
1. "I will use an enema for constipation." Enemas are contraindicated for patients diagnosed with both cardiac disease and hypothyroidism. Enemas cause vagal stimulation that can lead to fainting. The patient is taught to use laxatives, stool softeners, and to consume a fiber-rich diet to treat constipation, rather than using enemas. Using low-dose sedatives is recommended if the patient is experiencing insomnia. Thyroid medication should be taken in the morning before food. Switching to different brands is not recommended, because bioavailability may differ with different brands.
The nurse provides dietary instructions to a patient with type 1 diabetes mellitus. Which statement made by the patient indicates a need for further teaching? 1. "If I go over my calories, I can just increase my insulin." 2. "I'll need a bedtime snack, because I take an evening dose of NPH insulin." 3. "I can have an occasional low-calorie dessert as long as I include it in my meal plan." 4. "I should eat meals at the scheduled times, even if I'm not hungry, to prevent hypoglycemia."
1. "If I go over my calories, I can just increase my insulin." The goal of dietary therapy for the patient with diabetes mellitus is to attain and maintain an ideal body weight and a stable blood glucose level. Each patient should be prescribed a specific caloric intake and insulin regimen to help him or her achieve this goal. Insulin dosage should not be increased to account for an increased caloric intake. A bedtime snack for people taking evening NPH insulin, planning for an occasional low-calorie dessert, and eating at scheduled times are all part of correct diabetes management.
The nurse provides education to a patient with newly diagnosed type 1 diabetes mellitus. Which statement made by the patient indicates a need for further instruction? 1. "If I skip breakfast, I can hold my insulin until noon." 2. "I'll have some options when it comes to food choices." 3. "If I feel sweaty, shaky, or dizzy, my blood sugar might be low." 4. "If I have to urinate a lot, feel thirsty all of the time, or have blurred vision, my blood sugar might be high."
1. "If I skip breakfast, I can hold my insulin until noon." A diabetic patient should adhere to an American Diabetes Association diet and insulin regimen. These patients should not self-regulate insulin unless directed to do so by their primary health care provider. The statements in the other answer options are all correct in regard to self-management of diabetes at home.
The nurse has taught a patient who was admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse determines that additional teaching is necessary when the patient makes which statement? 1. "Taking a hot bath every day will help with my circulation." 2. "I should avoid walking barefoot at all times." 3. "I should look at the condition of my feet every day." 4. "I need a podiatrist to treat my ingrown toenails."
1. "Taking a hot bath every day will help with my circulation." Hot water may injure tissue related to decreased sensation and should be avoided. Patients with diabetes mellitus should inspect the feet daily for broken areas that are at risk for delayed wound healing, avoid walking barefoot, and have a podiatrist for foot care.
The nurse is evaluating the teaching session on nutrition for the newly diagnosed diabetic patient. Which statement indicates an understanding of the teaching? 1. "When my blood sugar is less than 70 mg/dL, I will take 15 grams of a fast-acting carbohydrate, such as orange juice, and recheck in 15 minutes." 2. "When my blood sugar is less than 70 mg/dL I will drink 8 ounces of milk and recheck in 15 minutes." 3. "I will eat a few hard candies when my blood sugar is less than 70 and recheck in 15 minutes." 4. "When my blood sugar is less than 70 mg/dL, I will take 3 to 4 sugar tablets and recheck in 30 minutes."
1. "When my blood sugar is less than 70 mg/dL, I will take 15 grams of a fast-acting carbohydrate, such as orange juice, and recheck in 15 minutes." The patient understands the need for a fast-acting sugar and the need to recheck in 15 minutes. Milk is not a fast-acting carbohydrate, so it will take longer for the low blood sugar to stabilize. The patient's statement about the hard candies does not indicate that the patient understands the need for 15 to 20 grams of carbohydrates. Rechecking blood sugar in 30 minutes is waiting too long to check blood sugar.
The nurse is assigned to care for a patient with type 2 diabetes. To encourage the patient to become an active participant in his or her care, what action should the nurse take? 1. Assess the patient's understanding of the disease 2. Make a list of food restrictions for proper diabetes management 3. Refer the patient to a nutritionist 4. Set long-term goals to decrease the risk of complications
1. Assess the patient's understanding of the disease For teaching to be effective, the first step is assessing the patient. Teaching can be individualized once the nurse is aware of what a diagnosis of diabetes means to the patient. Food restrictions, nutritionist referral, and setting long-term goals can occur once the nurse is confident the patient understands what it means to have diabetes.
A nurse is caring for a patient with diabetes mellitus who is in an inpatient unit. The primary health care provider has ordered regular insulin. The nurse is preparing the medication for subcutaneous injection. What is the most effective site for subcutaneous injection of insulin? 1. Thigh 2. Abdomen 3. Upper arm 4. Right buttock
2. Abdomen The abdomen is the preferred injection site; it provides the fastest subcutaneous absorption. The thigh, upper arm, and buttock are other sites that may be used for subcutaneous injection, but the abdomen is the best site.
The nurse has been teaching a patient with diabetes mellitus how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? 1. Chooses a puncture site in the center of the finger pad 2. Washes hands with soap and water to cleanse the site to be used 3. Warms the finger before puncturing it to obtain a drop of blood 4. Tells the nurse that the result of 110 mg/dL indicates good control of diabetes
1. Chooses a puncture site in the center of the finger pad The patient should select a site on the sides of the fingertips, not on the center of the finger pad, because this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching.
What complications may arise if pheochromocytoma is left untreated? 1. Diabetes mellitus 2. Graves' disease 3. Alzheimer's disease 4. Chronic kidney disease
1. Diabetes mellitus Diabetes mellitus may occur if pheochromocytoma is left untreated. Graves' disease, Alzheimer's disease, and chronic kidney disease are not complications of pheochromocytoma.
Activity intolerance in a patient with hypothyroidism is related to what? 1. Fatigue 2. Diarrhea 3. Weight loss 4. Nervousness
1. Fatigue Activity intolerance in a patient with hypothyroidism is related to weakness and fatigue. Patients with hyperthyroidism, not hypothyroidism, experience weight loss, diarrhea, and nervousness.
A nurse completes an assessment and notes that a patient's thyroid gland is enlarged. With which condition is 1. Goiter 2. Fibroma 3. Thyrotoxicosis 4. Hyperthyroidism
1. Goiter Thyroid abnormalities consist of three basic forms: goiter (enlarged thyroid gland), hypothyroidism, and hyperthyroidism. Goiter may be present in hyper- or hypofunction of the gland. A fibroma is a fibrous encapsulated connective tissue tumor not usually occurring in the thyroid gland. Thyrotoxicosis results from extreme hyperthyroidism or increased secretion of T3 and T4. Thyrotoxicosis is also known as thyroid storm or thyroid crisis. Hyperthyroidism is a condition resulting from an increase in production of T3 and T4.
The nurse assesses a patient that presents with eye protrusion. The patient states, "My eyes are dry and irritated." Based on these data, the nurse expects that what diagnosis will be made? 1. Graves' disease 2. Myxedema coma 3. Diabetes insipidus 4. Pheochromocytoma
1. Graves' disease Eye protrusion is referred to as exophthalmos and this indicates Graves' disease. Exophthalmos results from an increase in fat and fluid in the orbital tissues. The increased pressure due to edema forces the eyeballs outwards, and the upper eye lids retract and become elevated. As a result, the corneal surface is exposed, causing eye dryness and irritation. Myxedema coma presents with generalized edema. Diabetes insipidus is characterized by the large amount of urine excretion (2 to 20 L/day). Pheochromocytoma is characterized by tachycardia, dysrhythmia, and metanephrines in urine.
A patient is just returning to the surgical floor from the recovery room after undergoing a thyroidectomy. What is the nurse's priority nursing intervention? 1. Have a tracheostomy tray at the bedside. 2. Closely monitor the patient's emotional state. 3. Avoid touching the patient's neck and shoulders. 4. Maintain hydration status with small sips of water.
1. Have a tracheostomy tray at the bedside. Postoperative complications for a patient following a thyroidectomy include injury to the recurrent or superior laryngeal nerve, which can lead to vocal cord paralysis. If both cords are paralyzed, spastic airway obstruction will occur, requiring an immediate tracheostomy. Closely monitoring the patient's emotional status is important, especially because the appearance of the incision may be distressing to the patient. However, providing reassurance that the scar will fade in color and eventually look like a normal neck wrinkle is not the priority. Following surgery, patients are nothing by mouth status, and would not be taking small sips of water to maintain hydration. Hydration status is maintained via intravenous fluids. The nurse would not avoid touching the patient's neck and shoulders, because this would impede a thorough assessment.
The nurse is caring for a patient who underwent removal of the thyroid gland (thyroidectomy) three days ago. The patient's serum chemistries reveal calcium of 3.2 mg/dL, potassium of 3.9 mEq/L, and phosphorus of 4.0 mg/dL. What condition do these findings indicate? 1. Hypocalcemia 2. Hypercalcemia 3. Hyperkalemia 4. Hypophosphatemia
1. Hypocalcemia Hypocalcemia is a low serum calcium level. Surgical removal of the thyroid gland may also include removal of the parathyroid gland. This results in a deficiency of parathyroid hormone, which controls serum calcium by regulating absorption of calcium from the gastrointestinal tract, mobilizing calcium in bones, and excreting calcium in breast milk, feces, sweat, and urine. The normal serum calcium level ranges from 9.0 to 11.5 mg/dL. Potassium is within normal limits (3.5 to 5 mEq/L), and phosphorus is also within normal limits (2.8 to 4.5 mg/dL).
A patient who is diagnosed with hypothyroidism and coronary artery disease (CAD) states to the nurse, "I am constipated. My spouse wants me to try an enema to help relieve my discomfort." The nurse educates the patient that using enemas is contraindicated due to the diagnosis. Which is the rationale for this contraindication? 1. Vagus nerve stimulation 2. Olfactory nerve stimulation 3. Abducens nerve stimulation 4. Hypoglossal nerve stimulation
1. Vagus nerve stimulation Constipation is a common problem associated with hypothyroidism. The use of enemas, however, is contraindicated because they result in vagus nerve stimulation for patients with a history of cardiac disease. Olfactory, abducens, and hypoglossal nerves are not affected by the use of enemas.
A patient with type 2 diabetes who takes metformin daily to manage blood sugar is scheduled for an intravenous pyelogram (IVP). Which question by the nurse is most important to ask the patient when preparing for the procedure? 1. "Have you ever skipped a dose of metformin?" 2. "When was the last time you took your metformin?" 3. "How many times a day do you take your metformin?" 4. "How long have you been taking metformin for diabetes?
2. "When was the last time you took your metformin?" During an IVP, contrast dye is injected so that the urinary system can be visualized. To reduce risk of kidney injury, metformin should be discontinued a day or two before the procedure and for 48 hours following the procedure. Medication administration adherence, dosage, and history are important to assess, but will not affect the interaction.
Which syndrome would be suspected in a patient who has Addison's disease along with other endocrine conditions? 1. Hashimoto's thyroiditis 2. Autoimmune polyglandular syndrome 3. Multiple endocrine neoplasia 4. Syndrome of Inappropriate antidiuretic hormone (SIADH)
2. Autoimmune polyglandular syndrome Addison's disease is an autoimmune disorder caused by the destruction of adrenal tissue by antibodies. When it occurs along with other endocrine disorders, Addison's disease is called autoimmune polyglandular syndrome. Hashimoto's thyroiditis, multiple endocrine neoplasia syndrome, and syndrome of Inappropriate antidiuretic hormone (SIADH) are not associated with these conditions.
An older adult patient who has a history of coronary artery disease (CAD) is diagnosed with hypothyroidism. What is appropriate for the nurse to include in the patient's education? Select all that apply. 1. Eat a low-fiber diet. 2. Avoid using enemas. 3. Avoid using sedatives. 4. Take the prescribed medication before breakfast. 5. Alternate between the trade and generic brands of the medication.
2. Avoid using enemas. 3. Avoid using sedatives. 4. Take the prescribed medication before breakfast. An older adult patient diagnosed with both hypothyroidism and CAD should be taught to avoid enemas due to the risk of vagal stimulation, to avoid the use of sedatives for insomnia, and to take medication in the morning before breakfast. A high-fiber diet is recommended to avoid constipation. Different brands of hormones may have different bioavailability, and should be avoided.
A patient reports excessive thirst, increased urine output, and weight loss. Upon reviewing the laboratory reports of the patient, the nurse finds increased blood glucose levels. The nurse suspects that the patient has which condition? 1. Acromegaly 2. Diabetes mellitus 3. Addison's disease 4. Cushing syndrome
2. Diabetes mellitus Diabetes mellitus (DM) is characterized by polyuria (increased urine output), polydipsia (excessive thirst), and polyphagia (excessive hunger). Other signs and symptoms of DM include weakness, fatigue, hyperglycemia, irritability, and weight loss. Acromegaly occurs due to hypersecretion of growth hormone and is characterized by the elongation of facial bones and extremities. Addison's disease is caused by hyposecretion of adrenal gland hormones and is characterized by hyperpigmentation of the skin, weakness, and irritability. Cushing syndrome results from hypersecretion of cortisol and is characterized by periorbital edema, easy bruising, moon face, and elevated blood pressure.
A patient is referred for a magnetic resonance imaging (MRI) scan for radiologic evaluation of the pituitary gland. Which interventions should the nurse perform for the patient? Select all that apply. 1. Ensure the patient is fasting. 2. Explain that the test is noninvasive. 3. Assess renal function before the test. 4. Assure the patient that the test is painless. 5. Inform the patient of the need to lie still during the procedure.
2. Explain that the test is noninvasive. 4. Assure the patient that the test is painless. 5. Inform the patient of the need to lie still during the procedure. The nurse should inform the patient to lie as still as possible. The patient should be assured that the test is noninvasive and painless. Renal function is assessed in the patient preparing for computed tomography (CT) scan. The patient does not need to fast for an MRI test.
Which finding is consistent with a diagnosis of hyperaldosteronism? 1. Edema 2. Hypernatremia 3. Low blood pressure 4. Potassium retention
2. Hypernatremia In hyperaldosteronism, elevated levels of aldosterone are associated with sodium retention, which leads to hypernatremia. Edema and low blood pressure are not caused by an increase in sodium excretion. Elevated levels of aldosterone lead to potassium excretion.
Which is a clinical manifestation of Cushing syndrome? 1. Hypovolemia 2. Hypokalemia 3. Hyperkalemia 4. Hyponatremia
2. Hypokalemia Hypokalemia is a sign of Cushing syndrome because of the hyperfunctioning of the adrenal cortex. Hypovolemia, hyperkalemia, and hyponatremia are clinical manifestations of Addison's disease because of the hypofunctioning of the adrenal cortex.
Which effect may be observed if large amounts of endogenous corticosteroids are released into systemic circulation during surgery on a patient with Cushing syndrome? 1. Fatigue 2. Infections 3. Delusions 4. Hypotension
2. Infections A patient may become susceptible to infections if the endogenous corticosteroid levels are high during surgery. Fatigue and delusions may not occur due to elevated corticosteroids. Hypertension, not hypotension, is observed due to increased levels of corticosteroids.
The nurse is caring for a female patient with abnormal development of breasts. What does the nurse expect to find in the patient's diagnostic reports? 1. Low levels of insulin 2. Low levels of estrogen 3. Low levels of testosterone 4. Low levels of corticosteroids
2. Low levels of estrogen Estrogen helps in developing secondary sexual characteristics, such as breast development, in females. Therefore low levels of estrogen may lead to abnormal development of breasts in the female patient. Low levels of insulin may lead to decreased glucose levels in the blood. Low levels of testosterone may lead to decreased spermatogenesis (in men). Low levels of corticosteroids may lead to decreased lipid metabolism.
A patient with diabetes mellitus is scheduled for a fasting blood glucose level at 8:00 AM. The nurse instructs the patient to only drink water after what time? 1. 6:00 PM on the evening before the test 2. Midnight before the test 3. 4:00 AM on the day of the test 4. 7:00 AM on the day of the test
2. Midnight before the test Typically, a patient is prescribed to be nothing by mouth (NPO) for eight hours before a fasting blood glucose level. For this reason, the patient who has a laboratory draw at 8:00 AM should not have any food or beverages containing any calories after midnight.
After a teaching session with the registered nurse, the newly diagnosed patient with type 1 diabetes mellitus is correct when he or she makes which statement? 1. "If I lose weight, I will be able to stop taking insulin." 2. "My pancreas will produce more insulin as I recover." 3. "I will need to be medicated with insulin for the rest of my life." 4. "I will be able to take insulin pills once my blood sugar is stabilized.
3. "I will need to be medicated with insulin for the rest of my life." Type 1 diabetes is caused by destruction of pancreatic β-cells, which causes permanent insulin insufficiency and eventual absence. Weight loss and recovery will not affect insulin production. Exogenous insulin is not absorbed in the GI system and therefore must be given parenterally.
A patient diagnosed with hyperthyroidism received radioactive iodine one week ago. The patient tells the nurse, "I don't think the medication is working, I don't feel any different." What is the best response by the nurse? 1. "You should notify your primary health care provider immediately." 2. "You may need to have your thyroid removed sooner than anticipated." 3. "It may take several weeks to see the full benefits of the treatment." 4. "You don't feel any different? Would you like to sit down and talk about it?"
3. "It may take several weeks to see the full benefits of the treatment." Radioactive iodine has a delayed response, and the maximum effect may not be seen for up to three months. For this reason, it would not be necessary to contact the primary health care provider immediately, or for the patient to have the thyroid gland removed sooner. Asking the patient to sit and talk about it demonstrates that the nurse is being responsive to psychosocial/emotional needs, but is not the best nursing response at this time.
The nurse assesses a patient with darkening of the skin on the knuckles, elbows, knees, genitals, and palmar creases. What endocrine disorder does the nurse suspect these clinical manifestations indicate? 1. Hypothyroidism 2. Hyperthyroidism 3. Addison's disease 4. Cushing syndrome
3. Addison's disease Hyperpigmentation or darkening of the skin at skin folds, such as at the knuckles, elbows, knees, and genitalia, are manifestations of Addison's disease. Changes in skin texture are observed with hypothyroidism and hyperthyroidism. Purplish red marks below the skin surface seen on the abdomen, breasts, and buttocks are observed in Cushing syndrome.
A patient who underwent thyroid surgery develops neck swelling. What is the first action that the nurse should take? 1. Monitor calcium levels 2. Evaluate difficulty in speaking 3. Assess the patient for signs of hemorrhage 4. Place the patient in a semi-Fowler's position
3. Assess the patient for signs of hemorrhage The patient who undergoes thyroid surgery is at risk for hemorrhage. Swelling is a clinical manifestation of hemorrhage. The first nursing action is to assess the patient. Monitoring calcium levels and evaluating difficulty in speaking helps in assessing the signs of hypoparathyroidism. Placing the patient in a semi-Fowler's position helps in avoiding flexion of the neck and tension on the suture lines.
The nurse, providing care to a patient with Cushing's syndrome, understands that the disorder is primarily related to: 1. Liver dysfunction 2. Chronic renal failure 3. Excessive secretion of adrenocorticosteroid hormones 4. Decreased secretion of adrenocorticosteroid hormones
3. Excessive secretion of adrenocorticosteroid hormones Cushing's syndrome results from excessive secretion of adrenocorticosteroid hormones, usually caused by pituitary gland tumors or carcinoma of the adrenal glands. It is also the result of excessive steroid intake for other medical conditions or nonmedical use (e.g., sports). Cushing's syndrome is not directly related to liver function or renal failure. It is caused by excessive, not decreased, amounts of adrenocorticosteroid hormones.
Which clinical manifestation is a classic finding in Graves' disease? 1. Gingivitis 2. Cretinism 3. Exophthalmos 4. Muscular dystrophy
3. Exophthalmos Exophthalmos is the protrusion of eyeballs from the orbits; it results from increased fat deposits and fluid in orbital tissues. It is a classic clinical manifestation in Graves' disease. Gingivitis, cretinism, and muscular dystrophy are not classic clinical manifestations associated with Graves' disease.
Which parameter is assessed for corticosteroid imbalance after surgery in a patient with Cushing syndrome? 1. Plantar 2. Infection 3. Fluid intake 4. Oxygen saturation
3. Fluid intake Fluid intake should be monitored because there may be a chance of corticosteroid imbalance after surgery, which can cause dehydration. Plantar and oxygen saturation monitoring are not necessary, because corticosteroid imbalance may not have an effect on these parameters. Infections should be monitored during surgery.
To determine how well a patient's diabetes mellitus has been controlled over the past two to three months, what assessment parameter should the nurse review? 1. Fasting blood glucose 2. Oral glucose tolerance 3. Glycosylated hemoglobin 4. Random fingerstick blood glucose
3. Glycosylated hemoglobin When the glucose level is increased, glucose molecules attach to hemoglobin in the red blood cells (RBCs). This attachment lasts for the life of the RBC, two to three months. Monitoring the numbers of these attachments makes it possible to assess the average blood glucose for the previous two to three months. Fasting blood glucose, oral glucose tolerance, and random fingerstick blood glucose tests are used to measure the current blood glucose level, which is different from the glycosylated hemoglobin level.
Which condition shows a clinical presentation of purplish red striae? 1. Hypofunction of androgens 2. Hyperfunction of androgens 3. Hypofunction of glucocorticoids 4. Hyperfunction of glucocorticoids
3. Hypofunction of glucocorticoids Purplish red striae are seen in Cushing syndrome, which occurs due to the hypofunctioning of adrenal cortex. Purplish red striae are observed in a patient with Cushing syndrome due to the hypofunction of glucocorticoids. Hypofunctioning of androgens may result in hirsutism and hyperpigmentation. Hyperfunctioning of androgens may result in decreased axillary and pubic hair in women. Hyperfunctioning of glucocorticoids may result in bronzed skin or hyperpigmentation of face, neck, and hands.
A patient presents at the outpatient unit for a cortisol (total) blood test. Which intervention should the nurse perform? 1. Keep the sample on ice. 2. Use a plastic heparinized tube. 3. Mark the time of blood draw on the slip. 4. Instruct the patient to restrict food, fluid, or medication before test.
3. Mark the time of blood draw on the slip. Cortisol has diurnal variation; levels are higher in the morning than in evening. The nurse should mark the time of the blood draw on the slip. A fasting blood sample is collected and kept on ice for parathyroid hormone blood studies but is not necessary for cortisol tests. The test measures the amount of cortisol in serum; hence heparinized tubes are not required to collect a blood sample.
The health care provider was unable to spare a patient's parathyroid gland during a thyroidectomy. Which assessments should the nurse prioritize when providing postoperative care for this patient? 1. Assessing the patient's white blood cell levels and assessing for infection 2. Monitoring the patient's hemoglobin, hematocrit, and red blood cell levels 3. Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia 4. Monitoring the patient's level of consciousness and assessing for acute delirium or agitation
3. Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia Loss of the parathyroid gland is associated with hypocalcemia. Infection and anemia are not associated with loss of the parathyroid gland, whereas cognitive changes are less pronounced than the signs and symptoms of hypocalcemia.
A patient's laboratory reports indicate an abnormal decrease in blood Ca+ levels. Which hormone imbalance would cause this decrease? 1. Calcitonin (CT) 2. Thyroxine (T4) 3. Parathormone (PTH) 4. Triiodothyronine (T3)
3. Parathormone (PTH) Parathormone (PTH) is the principle hormone produced by the parathyroid glands. PTH regulates calcium by enhancing the release of calcium from bone stores, stimulating reabsorption of calcium by the kidneys and enhancing absorption of calcium in the intestine by increasing the production of activated vitamin D. Imbalance of PTH may cause impaired absorption and a decrease in blood Ca++ levels. Thyroxine, also known as tetraiodothyronine (T4), is a hormone produced by the thyroid gland. Calcitonin is a hormone produced by the parafollicular cells of the thyroid gland that increases calcium storage in bone and decreases serum Ca++ levels. Triiodothyronine (T3) is a hormone produced by the thyroid gland that increases the rate of metabolism.
In developing a teaching plan for the patient with exophthalmos, the nurse understands that the highest priority is placed on 1. Avoiding eyestrain 2. Improving self-esteem 3. Preventing corneal injury 4. Minimizing the risk of nerve damage
3. Preventing corneal injury The patient with exophthalmos may not be able to close the eyelids completely. This puts the patient at risk for dry eyes, for overexposure to environmental irritants, and for corneal injury. Lubricating eye drops can be used to combat drying, and dark glasses are encouraged to decrease exposure to environmental irritants. Preventing corneal injury is the priority for the patient with exophthalmos. Exophthalmos may create a function limitation in extraocular movements because of forward protrusion of the globe of the eye. The patient with exophthalmos is encouraged to move the eyes through the six cardinal fields of gaze several times a day to maintain ocular muscle flexibility. Avoiding eyestrain is not a priority for the patient with exophthalmos. Patients may suffer from decreased self-esteem because of the physical changes associated with exophthalmos. Good grooming is encouraged as a strategy to improve self-esteem. Improving self-esteem is of lower priority than preventing corneal injury. Exophthalmos is not associated with ocular nerve damage.
A patient has been ordered to undergo a diagnostic procedure to determine the severity of thyroid dysfunction. For what test should the nurse prepare the patient? 1. X-ray 2. Computed tomography (CT) scan 3. Radioactive iodine uptake (RAIU) 4. Magnetic resonance imaging (MRI)
3. Radioactive iodine uptake (RAIU) Radioactive iodine uptake (RAIU) measures the thyroid functioning in terms of its activity. X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) are radiographic tests that are best used for identifying tumors.
An older adult patient is seen in the endocrine clinic. Upon assessment, the nurse is able to palpate the thyroid gland. What does this finding indicate? 1. The onset of hypertension. 2. The onset of diabetes mellitus. 3. This is a normal finding in the elderly. 4. An explanation for reduced urine output.
3. This is a normal finding in the elderly. Gerontologic changes that occur to the thyroid gland include increase in nodularity and an increased incidence of hypothyroidism, both of which would make the gland more easily palpated. The thyroid gland does not have any effect on the development of hypertension, diabetes mellitus, or reduced urine output. Test-Taking Tip: Choose the best answer for questions asking for a single answer. More than one answer may be correct, but one answer may contain more information or more important information than another answer.
Which test is more reliable to diagnose pheochromocytoma? 1. Urinary cortisol 2. Urine osmolality 3. Urinary creatinine 4. Urinary aldosterone
3. Urinary creatinine Pheochromocytoma is a disorder of the adrenal medulla; urinary creatinine is used to diagnose this disorder. Urinary cortisol, urine osmolality, and urinary aldosterone are used to diagnose Addison's disease.
A patient's recent medical history is indicative of diabetes insipidus. The nurse would perform patient teaching related to which diagnostic test? 1. Thyroid scan 2. Fasting glucose test 3. Water deprivation test 4. Oral glucose tolerance
3. Water deprivation test A water deprivation test is used to diagnose the polyuria that accompanies diabetes insipidus. Glucose tests and thyroid tests are not related directly to the diagnosis of diabetes insipidus.
A nurse is providing education for a patient with a new diagnosis of type I diabetes mellitus. Therapy for the patient will require subcutaneous insulin injections several times per day. When teaching the patient how to administer subcutaneous insulin, what education is the most accurate? 1. "You must use an alcohol swab on the site before self-injection." 2. "If you are planning on going jogging, you should use the thigh injection site to administer insulin." 3. "You should use one site for insulin injections so you get used to the process of administering insulin." 4. "Avoid injecting insulin intramuscularly, because rapid and unpredictable absorption could result in hypoglycemia."
4. "Avoid injecting insulin intramuscularly, because rapid and unpredictable absorption could result in hypoglycemia." Patient education for administration of insulin for diabetes should include teaching the patient to avoid intramuscular injections because of the rapid and unpredictable absorption that could result in hypoglycemia. The use of an alcohol swab on the site before self-injection is no longer recommended. Routine hygiene such as washing with soap and water is adequate. Patients should be taught to avoid injection sites that will be exercised, because doing so could increase body heat and circulation, increase the rate of insulin absorption, and speeding up the onset of action, resulting in hypoglycemia. Patients should be taught to rotate the injection within and between sites, not to use one site, to allow for better insulin absorption.
The nurse is teaching a patient with type 2 diabetes about exercise as a method to control blood glucose levels. The nurse knows the patient understands when the patient elicits which exercise plan? 1. "I want to go fishing for 30 minutes each day. I will drink fluids and wear sunscreen." 2. "I will go running each day when my blood sugar is too high to bring it back to normal." 3. "I will plan to keep my job as a teacher because I get a lot of exercise every school day." 4. "I will take a brisk 30-minute walk five days per week and do resistance training three times a week."
4. "I will take a brisk 30-minute walk five days per week and do resistance training three times a week." The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity five days per week and resistance training three times a week. Brisk walking is moderate activity. Fishing and teaching are light activity and running is considered vigorous activity.
The nurse is reviewing diabetic self-care management with a patient newly diagnosed with diabetes. The patient is in need of further education when stating to the nurse: 1. "I am going to check my feet for pressure areas every morning before I take a bath." 2. "I need to be careful on how I cut my toenails. I should not cut down the corners of the nail." 3. "I have scheduled an eye examination with an ophthalmologist for next week. I will need to have an annual eye exam." 4. "To toughen my skin so I do not get pressure sores, I should rub my feet down with rubbing alcohol after my bath."
4. "To toughen my skin so I do not get pressure sores, I should rub my feet down with rubbing alcohol after my bath." Patients with diabetes are at great risk for skin breakdown because of peripheral vascular problems and peripheral neuropathy. Patients should avoid using rubbing alcohol on skin to prevent tissue damage. The best way to prevent foot ulcers is prevention and early detection. Inspecting the feet every day for cuts, abrasions, pressure areas, or sores is a good practice. Toenails should be cut with the rounded contour of the nail and not cut down the corners of the nail. Another complication of diabetes is retinopathy. Patients with a history of diabetes should have an eye examination annually by an ophthalmologist.
What level of urine cortisol indicates Cushing syndrome? 1. 100 mcg/24 hr 2. 110 mcg/24 hr 3. 120 mcg/24 hr 4. 130 mcg/24 hr
4. 130 mcg/24 hr The normal range of urine cortisol levels lies between 80 and 120 mcg/24 hr. A value of 130 mcg/24 hr indicates a high urinary cortisol level, which is observed in Cushing syndrome.
What may be the cause of iatrogenic Addison's disease? 1. Infarction 2. Tuberculosis 3. Fungal infections 4. Adrenal hemorrhage
4. Adrenal hemorrhage Iatrogenic Addison's disease may be caused by an adrenal hemorrhage, which is related to anticoagulant therapy, chemotherapy, or ketoconazole therapy for acquired immunodeficiency syndrome (AIDS). Infarction, tuberculosis, and fungal infections may lead to Addison's disease.
A nurse creating a plan of care for a patient with Addison's disease expects that primary treatment will include: 1. Blood transfusions 2. Ablation of the thyroid 3. Oral calcium supplementation 4. Adrenocorticosteroid replacement therapy
4. Adrenocorticosteroid replacement therapy Because Addison's disease results from a deficiency of adrenocorticosteroid hormones, steroid therapy is the primary treatment. Blood transfusions, thyroid ablation, and oral calcium supplements are not primary treatments for Addison's disease.
Which hormone deficiency may lead to a life-threatening condition? 1. Prolactin 2. Oxytocin 3. Follicle-stimulating hormone (FSH) 4. Adrenocorticotropic hormone (ACTH)
4. Adrenocorticotropic hormone (ACTH) Adrenocorticotropic hormone (ACTH) may lead to acute adrenal insufficiency and shock. This may result in a life-threatening situation because of sodium and water depletion. Prolactin plays a role in lactation. Oxytocin is a hormone that is particularly functional during and after childbirth. Follicle-stimulating hormone (FSH) is associated with reproduction and is responsible for the development of eggs in females and sperm in males. The absence of these other hormones are not life threatening.
Who can serve as a health care proxy? 1. A blood relative 2. A family member 3. A domestic partner 4. Anyone the patient chooses
4. Anyone the patient chooses The patient may choose anyone to serve as a health care proxy. Proxies do not have to be a domestic partner, family member, or blood relative.
A nurse caring for a patient with hyperparathyroidism should monitor the patient for which complication? 1. Seizures 2. Cataracts 3. Constipation 4. Cardiac dysrhythmias
4. Cardiac dysrhythmias Cardiac dysrhythmias may result because of the increased serum calcium level in hyperparathyroidism. Seizures and cataracts are complications seen in hypoparathyroidism. Constipation is not directly associated with parathyroid disorders.
The nurse is assessing a patient diagnosed with Addison's disease. What would the nurse expect to find in this patient? 1. Patchy areas of light skin 2. Warm, smooth, moist skin 3. Purplish red marks on the abdomen 4. Darkened skin on the knuckles, elbows, and palmar creases
4. Darkened skin on the knuckles, elbows, and palmar creases Hyperpigmentation, or "bronzing" of the skin, particularly on the knuckles, elbows, knees, genitalia, and palmar creases, is found in Addison's disease. Patchy areas of light skin may indicate autoimmune endocrine disorders. Warm, smooth, moist skin may indicate hyperthyroidism. Purplish red marks on the abdomen are seen in patients with Cushing syndrome.
The nurse is performing an assessment for a patient with hypoparathyroidism. Which assessment finding does the nurse document that correlates with this condition? 1. Cold intolerance 2. Difficulty swallowing 3. Frequent defecation 4. Decreased skin pigmentation
4. Decreased skin pigmentation Decreased skin pigmentation is observed in patients with hypoparathyroidism. Cold intolerance is seen in patients with hypothyroidism. Frequent defecation may indicate hyperthyroidism or autonomic neuropathy of diabetes mellitus. Difficulty swallowing is associated with an enlarged thyroid gland.
Which hormone has both mineralocorticoid and glucocorticoid properties? 1. Cortisol 2. Prednisone 3. Aldosterone 4. Hydrocortisone
4. Hydrocortisone Hydrocortisone is an exogenous hormone that has both mineralocorticoid and glucocorticoid properties and is used to treat adrenal insufficiency. Cortisol is the primary glucocorticoid secreted by the adrenal cortex. Prednisone is an exogenous corticosteroid that is used to treat Cushing syndrome. Aldosterone is the primary mineralocorticoid secreted by the adrenal cortex.
The nurse working in an endocrine clinic knows that Trousseau's sign is an important diagnostic tool. Which statement best describes how to conduct the test for Trousseau's sign? 1. Depress the skin over the sternum for one minute 2. Observe for circumoral twitches following speaking 3. Tap two fingers anterior to the front of the patient's ear 4. Inflate a blood pressure cuff above the antecubital space
4. Inflate a blood pressure cuff above the antecubital space Trousseau's sign is a diagnostic tool that is used to assess for tetany, a sign of hypocalcemia. This is an important assessment when the nurse is dealing with patients in an endocrine clinic, especially those that may have hypoparathyroidism. Trousseau's sign is performed by inflating a blood pressure cuff above the antecubital space for three to five minutes. Tapping a finger in front of the ear describes testing for Chvostek's sign. Depressing the skin over the sternum and observing for circumoral twitches are not techniques associated with Trousseau's sign.
The nurse is educating a patient about an ultrasound of the thyroid gland to observe for any nodules. What should the nurse teach the patient? 1. Instruct the patient to fast. 2. Inform the patient that sedation may be required. 3. Inform the patient that the test will last approximately 30 minutes. 4. Inform the patient that a gel and transducer will be used over the neck.
4. Inform the patient that a gel and transducer will be used over the neck. The nurse preparing the patient for an ultrasound to evaluate thyroid nodules should inform the patient that a gel and transducer will be used over the neck. The patient is not required to fast, and sedation is not required. The test will last 15 minutes.
A patient is scheduled for a total thyroidectomy. What information does the nurse include when teaching this patient about recovery after the procedure? 1. Exercise will be restricted for up to six months. 2. A low- or no-sodium diet will be prescribed. 3. Physical therapy will need to be continued. 4. Life-long hormone replacement will be needed.
4. Life-long hormone replacement will be needed. This patient will need life-long thyroid hormone replacement with levothyroxine because the entire thyroid gland will be missing after surgery. Exercise will not be restricted for six months. Lengthy exercise restriction or physical therapy generally is not indicated following a thyroidectomy. A sodium-restricted diet would not ordinarily be necessary.
A patient is scheduled for a bilateral adrenalectomy. What does the nurse include in the discharge teaching for this patient? 1. No replacement therapy will be needed. 2. Weekly adrenocorticotropic hormone (ACTH) injections will be needed. 3. Cortisol will be required if the patient has stress. 4. Lifelong replacement of corticosteroids will be required.
4. Lifelong replacement of corticosteroids will be required. Discharge instructions are based on the patient's lack of endogenous corticosteroids and resulting inability to physiologically react to stressors. Patients undergoing a bilateral adrenalectomy will require lifetime replacement therapy. ACTH injections are not an option, because both adrenal glands were removed during surgery. Exogenous cortisol is required at all times, and the dose needs to be increased dramatically if the patient experiences stress.
