Lewis Ch 47 Practice Questions
The nurse is caring for a 63 y/o w/ a possible pituitary tumor who is scheduled for a CT scan w/ contrast. Which information about the patient is most important to discuss w/ the HCP before the test? a) History of renal insufficiency b) Complains of chronic headache c) Recent bilateral visual field loss d) Blood glucose level of 134 mg/dL
A Because contrast media may cause acute kidney injury in patients w/ poor renal function, the HCP will need to prescribe therapies such as IV fluids to prevent this complication.
A 22 y/o patient is being seen in the clinic w/ increased secretion of the anterior pituitary hormones. The nurse would expect the laboratory results to show a) increased urinary cortisol b) decreased serum thyroxine c) elevated serum aldosterone levels d) low urinary catecholamines excretion
A Increased secretion of ACTH by the anterior pituitary gland will lead to an increased in serum and urinary cortisol levels.
Which statements will the nurse include when teaching a patient who is scheduled for oral glucose tolerance testing in the outpatient clinic (select all that apply)? a) You will need to avoid smoking before the test b) Exercise should be avoided until the testing is complete c) Several blood samples will be obtained during the testing d) You should follow a low-calorie diet the day before the test e) The test requires that you fast for at least 8 hours before testing
A, C, E Smoking may affect the results of oral glucose tolerance tests. Blood samples are obtained at baseline and at 30, 60, and 120 minutes. Accuracy requires that the patient be fasting before the test.
The nurse is caring for a 45 y/o male patient during a water deprivation test. Which finding is most important for the nurse to communicate to the HCP? a) The patient complains of intense thirst b) The patient has a 5lb (2.3 kg) weight loss c) The patient's urine osmolality does not increase d) The patient feel dizzy when sitting on the edge of the bed
B A drop in the weight of more than 2kg indicates severe dehydration, and the test should be discontinued.
A 35 y/o female patient w/ a possible pituitary adenoma is scheduled for CT scan w/ contrast media. Which patient information is most important for the nurse to communicate to the HCP before the test? a) Bilateral poor peripheral vision b) Allergies to iodine and shellfish c) Recent weight loss of 20lbs d) Complaint of ongoing headaches
B Because the usual contrast media is iodine-based, the HCP will need to know about the allergy before the CT scan.
Which information about a 30 y/o patient who is scheduled for an oral glucose tolerance test should be reported to the HCP before starting the test? a) The patient reports having occasional orthostatic dizziness b) The patient takes oral corticosteroids for RA c) The patient has had a 10lb weight gain in the last month d) The patient drank several glasses of water an hour previously
B Corticosteroids can affect blood glucose results.
A 30 y/o patient seen in the ED for severe headache and acute confusion is found to have 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) GH stimulation test d) ACTH level
B Elevated levels of ADH will cause water retention and decrease serum sodium levels.
Which action by a new RN caring for a patient w/ a goiter and possible hyperthyroidism indicates that the charge nurse needs to do more teaching? a) the RN checks the blood pressure on both arms b) The RN palpates the neck thoroughly to check thyroid size c) The RN lowers the thermostat to decrease the temperature in the room d) The RN orders nonmedicated eye drops to lubricate the patient's bulging eyes
B Palpation can cause the release of thyroid hormones in a patient w/ an enlarged thyroid and should be avoided.
A nurse will teach a patient who is schedules to complete a 24hr urine collection for 17-ketosteroids to a) insert and maintain a retention catheter b) keep the specimen refrigerated or on ice c) drink at least 3L of fluid during the 24 hours d) void and save that specimen to start the collection
B The specimen must be kept on ice or refrigerated until the collection is finished.
During the physical examination of a 36 y/o female, the nurse finds that the patient's thyroid gland cannot be palpated. The most appropriate action by the nurse is to a) palpate the patient's neck more deeply b) document that the thyroid was palpable c) notify the HCP immediately d) teach the patient about thyroid hormone testing
B The thyroid is frequently nonpalpable. The nurse should simply document the finding.
A 40 y/o male patient has been newly diagnosed w/ type 2 DM. Which information about the patient will be most useful to the nurse who is helping the patient develop strategies for successful adaptation to this disease? a) Ideal weight b) Value system c) Activity level d) Visual changes
B When dealing w/ a patient w/ a chronic condition such as diabetes, identification of the patient's values and beliefs can assists the healthcare team in choosing strategies for successful lifestyle changes.
Which laboratory value should the nurse review to determine whether a patient's hypothyroidism is caused by a problem w/ the anterior pituitary gland or w/ the thyroid gland? a) T4 level b) T3 level c) TSH level d) TRH level
C A low TSH level indicates that the patient's hypothyroidism is cased by decreased anterior pituitary secretion of TSH.
A 60 y/o patient is taking spironolactone (Aldactone), a drug that blocks the action of aldosterone on the kidney for hypertension. The nurse will monitor for a) increased serum sodium d) decreased urinary output c) elevated serum potassium d) evidence of fluid overload
C Because aldosterone increases the excretion of potassium, a medication that blocks aldosterone will tend to cause hyperkalemia.
Which question will provide the most useful information to a nurse who is interviewing a patient about a possible thyroid disorder? a) What methods do you use to help cope w/ stress? b) Have you experienced any blurring or double vision? c) Have you had a recent unplanned weight gain or loss? d) Do you get up at night to empty your bladder?
C Because thyroid function affects metabolic rate, changes in weight may indicate hyperfunction or hypofunction of the thyroid glands.
A 29 y/o patient in the outpatient clinic will be scheduled for blood cortisol testing. Which instruction will the nurse provide? a) Avoid adding salt to your foods for 24hrs before the test b) You will need to lie down for 30 minutes before the blood is drawn c) Come to the lab to have the blood drawn early in the morning d) Do not have anything to eat or drink before the blood test is obtained
C Cortisol levels are usually drawn in the morning, when levels are highest.
The nurse reviews a patient's Hb A1C results to evaluate a) fasting preprandial glucose levels b) glucose levels 2 hours after a meal c) glucose control over the past 90 days d) hypoglycemic episodes in the past 3 months
C Hb A1C testing measures glucose control over the last 3 months.
Which additional information will the nurse need to consider when reviewing the laboratory results for a patient's total calcium level? a) The blood glucose level is elevated b) The phosphate level is normal c) The serum albumin level is low d) The magnesium level is normal
C Part of the total calcium is bound to albumin so hypoalbuminemia can lead to misinterpretation of calcium levels.
The nurse will teach a patient to plan 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 24hr urine test for free cortisol d) a radioactive iodine uptake test
C Physical and emotional stress can affect the results of the free cortisol test.
A 44 y/o patient is admitted w/ tetany. Which laboratory value should the nurse monitor? a) Total protein b) Blood glucose c) Ionized calcium d) Serum phosphate
C Tetany is associated w/ hypocalcemia
Which statement by a 50 y/o female patient indicates to the nurse that further assessment of thyroid function may be necessary? a) I notice my breasts are tender lately b) I am so thirsty that I drink all day long c) I get several times at night to urinate d) I feel a lump in my throat when I swallow
D Difficulty in swallowing can occur w/ a goiter.
A 61 y/o female patient admitted w/ pneumonia has a total serum calcium level of 13.3 mg/dL. The nurse will anticipate the need to teach the patient about testing for _________ levels? a) calcitonin b) catecholamine c) thyroid hormone d) parathyroid hormone
D Parathyroid hormone is the major controller of blood calcium levels.
An 18 y/o male patient w/ a small stature is scheduled for a GH stimulation test. In preparation for the test, the nurse will obtain a) ice in a basin b) glargine insulin c) a cardiac monitor d) 50% dextrose solution
D Hypoglycemia is induced during the GH stimulation test, and the nurse should be ready to administer 50% dextrose immediately.