Quiz: Chapter 36, Care of Patients With Pituitary, Thyroid, Parathyroid, and Adrenal Disorders: EAQ
The nurse is preparing to care for a patient with diabetes insipidus. The nurse anticipates that the patient will have which assessment data? Select all that apply. 1 Heart rate: 110 bpm 2 Coarse breath sounds 3 2+ edema in bilateral ankles 4 Complaints of extreme thirst 5 Blood pressure: 98/66 mm Hg 6 Weight loss of 8 pounds in 3 days
1 Heart rate: 110 bpm 4 Complaints of extreme thirst 5 Blood pressure: 98/66 mm Hg 6 Weight loss of 8 pounds in 3 days The patient with diabetes insipidus will exhibit signs of deficient fluid volume, which include weight loss, extreme thirst, hypotension, and tachycardia. Coarse breath sounds and edema are signs of fluid volume excess.
The patient presents to the clinic with acromegaly, muscle weakness, and osteoporosis. Laboratory results show elevated growth hormone levels. These symptoms, along with computed tomography scan findings, most closely correlate with which disorder? 1 Astrocytoma 2 Craniopharyngioma 3 Benign pituitary adenoma 4 Malignant pituitary adenoma
Benign pituitary adenoma Benign pituitary adenomas are usually the cause of the hypersecretion of growth hormone, which results in acromegaly in the adult, muscle weakness, and osteoporosis. Pituitary adenomas are not generally malignant. Astrocytomas and craniopharyngiomas would not cause the hypersecretion of growth hormone.
he nurse is providing teaching for the patient recently diagnosed with hypothyroidism who has been prescribed levothyroxine. The nurse knows the patient understands the teaching when the patient makes which statement? 1 "I should take this medication with food or with milk." 2 "I should begin losing all this excess weight quickly." 3 "I can stop taking this medication once my symptoms subside." 4 "I will call my health care provider if I notice increased palpitations."
"I will call my health care provider if I notice increased palpitations." Side effects of excess levothyroxine are nervousness, palpitations, sweating, chest pain, and shortness of breath. The patient should notify the health care provider if these occur. The medication should be taken on an empty stomach. Weight loss may occur once the medication is started but may not occur quickly. The patient must take the medication for his or her lifetime, not stop once symptoms subside.
The nurse is providing education to a patient who has been recently diagnosed with hypothyroidism. Which statement(s), if made by the patient, indicate an understanding of the teaching? Select all that apply. Correct1 "I will take my levothyroxine on an empty stomach." 2 "I should only take my pills on days I'm not feeling well." 3 "I will set my alarm for 10 pm to take my levothyroxine each night." 4 "I am so happy I will feel better after the first week of thyroid hormone replacement." 5 "I should expect to have diarrhea, increased urine output, and heart palpitations regularly." 6 "I will alert my provider immediately if I experience dizziness, hypothermia, or difficulty breathing."
"I will take my levothyroxine on an empty stomach." "I will alert my provider immediately if I experience dizziness, hypothermia, or difficulty breathing." Levothyroxine (Synthroid) is lifelong thyroid hormone replacement therapy. The pill should be taken in the morning on an empty stomach every day. It may take 6 to 8 weeks for symptoms to improve. The patient should alert the provider if he or she experiences myxedema coma (dizziness, hypothermia, and respiratory distress) or hyperthyroidism (palpitations, increased urination, and diarrhea).
The nurse receives a call that the patient is ready to return from the post-anesthesia care unit following a thyroidectomy. Which item, if missing from the patient's bedside, would prompt the nurse to request the transfer be postponed until the item is brought to the bedside? A ventilator 2 An oral airway 3 A tracheostomy tray 4 An endotracheal tube
A tracheostomy tray Laryngeal swelling is not uncommon in a patient after a thyroidectomy. A tracheostomy tray should be immediately available. A ventilator is not necessary, and the endotracheal tube will be very difficult, if not impossible, to intubate if edema has already occurred. An oral airway will be of no value, because the edema will be in the trachea.
The nurse is teaching the patient and caregiver about managing hypothyroidism. What instruction should the nurse give the patient? 1 "Use soap sparingly." 2 "Use an enema if required." 3 "Reduce your intake of dietary fiber." 4 "Avoid applying lotions to your skin
"Use soap sparingly." The nurse should teach the patient and caregiver measures to prevent skin breakdown. These patients have very rough and dry skin, and they will need to massage with lotions and creams to prevent cracking and peeling of the skin. The patient should be taught to use soap sparingly and apply lotion frequently to the skin. The patient should be instructed to avoid the use of enemas, because they produce vagal stimulation, which can be hazardous if cardiac disease is present. The patient should be asked to increase the intake of fiber in the diet to minimize constipation.
A patient diagnosed with hypothyroidism is prescribed levothyroxine sodium. What instruction does the nurse provide to the patient about this treatment? 1 "This treatment lasts for a year." 2 "A fixed dose is maintained throughout treatment." 3 "You must take the drug exactly as prescribed." 4 "You must be assessed for fever during the initiation of therapy."
"You must take the drug exactly as prescribed." The patient taking levothyroxine must take the drug exactly as prescribed and not change the schedule or dose without consulting the health care provider. The patient must not switch drug brands because response to different brands can vary. The patient with hypothyroidism requires lifelong thyroid hormone replacement. Therapy is started with low doses and is gradually increased over the next few weeks. The final dosage depends upon the blood levels of thyroid-stimulating hormone (TSH) and the patient's physical response. The patient with hypothyroidism generally has decreased blood pressure, bradycardia, and dysrhythmias; therefore the patient must be assessed for chest pain and dyspnea during the initiation of therapy.
The nurse is caring for a patient after thyroidectomy. What are the nursing interventions for this patient? Select all that apply. 1 Check for muscular twitching or tingling 2 Place the patient in low Fowler's position 3 Assess the patient for hemorrhage every shift 4 Monitor vital signs, calcium and phosphorus levels 5 Assess the patient for irregular breathing or neck swelling
1 Check for muscular twitching or tingling 3 Assess the patient for hemorrhage every shift 4 Monitor vital signs, calcium and phosphorus levels 5 Assess the patient for irregular breathing or neck swelling The nurse should monitor the patient's vital signs, calcium, and phosphorus levels. The patient should be assessed for muscular twitching or tingling, which are signs of tetany secondary to hypoparathyroidism. The nurse should assess the patient every 1 hour for 24 hours for signs of hemorrhage or tracheal compression, such as irregular breathing, neck swelling, frequent swallowing, sensations of fullness at the incision site, choking, and blood on the anterior or posterior dressings. The patient should be placed in Fowler's position and the head should be supported with pillows.
The nurse is caring for a patient after a thyroidectomy. Which assessment data indicate that the patient is suffering from a life-threatening complication of this surgery? Select all that apply. 1 Extreme restlessness 2 Temperature of 105.4° F 3 Urine output of 100 mL/hr 4 Heart rate of 52 beats/min 5 Blood pressure of 98/66 mm Hg 6 Respiratory rate of 32 breaths/min
1 Extreme restlessness 2 Temperature of 105.4° F 5 Blood pressure of 98/66 mm Hg 6 Respiratory rate of 32 breaths/min After a thyroidectomy, the patient is at risk for thyroid storm as a result of the manipulation of thyroid tissue before removal. The patient will exhibit extreme hyperthermia, tachycardia, rapid respirations, and restlessness. Urine output is not necessarily affected. The patient is likely to have hypertension rather than hypotension.
The nurse is reviewing the history of a patient suspected of having hyperthyroidism. Which manifestation(s) would be supportive of the diagnosis? Select all that apply. 1 Increased heart rate 2 Increase in appetite t3 Emotional instability 4 Mental sluggishness 5 Hyperactivity with increasing sense of fatigue
1 Increased heart rate 2 Increase in appetite t3 Emotional instability 5 Hyperactivity with increasing sense of fatigue The earliest symptoms of hyperthyroidism may be weight loss (in spite of a good appetite) and nervousness. Symptoms can vary from mild to severe, and may include weakness, insomnia, tremulousness, agitation, tachycardia, palpitations, exertion-related dyspnea, ankle edema, difficulty concentrating, diarrhea, increased thirst and urination, decreased libido, scanty menstruation, and infertility. The condition is sometimes not diagnosed in its early stages because of the vagueness of the symptoms. In some cases, hyperthyroidism is misdiagnosed as a cardiovascular disease, because symptoms for both conditions are similar. Hypothyroidism is associated with mental sluggishness.
The patient presents to the emergency department with symptoms of syndrome of inappropriate antidiuretic hormone (SIADH). The nurse knows to educate the patient about which test(s) or procedure(s) that will be performed before a diagnosis can be made? Select all that apply. 1 Urine osmolality 2 Serum osmolality 3 Glucose tolerance testing 4 Magnetic resonance imaging (MRI) 5 Radioactive iodine uptake test (RAIU) 6 Complete blood count (CBC) with differential
1 Urine osmolality 2 Serum osmolality SIADH is diagnosed with results that indicate urine osmolality and serum osmolality. Glucose tolerance testing, MRI, and RAIU are not applicable. A CBC with differential will be performed but is not diagnostic for SIADH.
The nurse is preparing to care for a 49-year-old patient who is scheduled for a hypophysectomy. The nurse anticipates that this patient will exhibit which symptom(s) before surgery? Select all that apply. 1 Gigantism 2 Acromegaly 3 Abdominal pain 4 Muscle cramping 5 Hearing difficulties 6 Excessive urine output
2 Acromegaly 3 Abdominal pain A hypophysectomy is performed to correct the hypersecretion of growth hormone, which leads to acromegaly in the adult, abdominal pain, vision changes, and weakness. Gigantism occurs with the hypersecretion of growth hormone before the growth plates close. Hearing difficulties, muscle cramping, and excessive urine output are not symptoms of the hypersecretion of growth hormone.
The nurse is providing emergency care to a patient experiencing thyroid storm. What actions does the nurse take? Select all that apply. 1 Reduce fluid intake 2 Provide a warm blanket for comfort 3 Administer antithyroid drugs as prescribed 4 Monitor continually for cardiac dysrhythmias 5 Maintain a patent airway and adequate ventilation
Administer antithyroid drugs as prescribed 4 Monitor continually for cardiac dysrhythmias 5 Maintain a patent airway and adequate ventilation The nurse must ensure that the patient experiencing thyroid storm has a patent airway and adequate ventilation because the patient is likely to have respiratory distress. Thyroid storm occurs mainly in patients with uncontrolled hyperthyroidism; antithyroid drugs are prescribed to control the manifestations, which include fever, tachycardia, and systolic hypertension. The patient must be monitored continually for cardiac dysrhythmias. Treatment of thyroid crisis must begin immediately after the first symptoms are noticed rather than waiting for laboratory confirmation. Measures are taken to reduce the temperature, cardiac drugs are given to slow the heart rate, and sedatives, such as a barbiturate, are given to reduce restlessness and anxiety.
The nurse is caring for a patient being treated for acute hypoparathyroidism with tetany. What are the nursing interventions for this patient? Select all that apply. 1 Administer diuretics agents 2 Administer infusions of normal saline 3 Administer oral or parenteral calcium salts 4 Administer intravenous (IV) calcium gluconate 5 Instruct the patient to wear a medical alert bracelet
Administer oral or parenteral calcium salts 4 Administer intravenous (IV) calcium gluconate 5 Instruct the patient to wear a medical alert bracelet Nursing interventions for the patient with hypoparathyroidism with tetany include administration of IV calcium gluconate to raise serum calcium levels to normal range; and oral or parenteral administration of calcium salts are used in the acute phase. The nurse must remind the patient that therapy for hypoparathyroidism is lifelong, and advise the patient to wear a medical alert bracelet. Administration of diuretics and infusions of normal saline are nursing interventions for hyperparathyroidism.
A patient with a pituitary tumor will most likely exhibit which symptom? 1 Urticaria 2 Frequent diarrhea 3 Alteration in visual acuity 4 Alterations in blood glucose
Alteration in visual acuity Because of its location in the middle of the skull, adjacent to the optic nerve and brain, pressure on this area can cause an increase in intracranial pressure (ICP). As a pituitary tumor enlarges, ICP continues to increase. Common symptoms of increasing ICP are nausea, headache, vomiting, and decreasing visual acuity. The patient would not likely experience urticaria, diarrhea or alterations in blood glucose.
The nurse is caring for a patient with a tumor on the parathyroid. The nurse would anticipate the patient to have a disturbance in which electrolyte? 1 Sodium 2 Calcium 3 Potassium 4 Magnesium
Calcium Parathyroid hormone (PTH) regulates serum calcium levels. Therefore, a tumor on the parathyroid gland would result in hyperparathyroidism and disturbance in calcium levels. Sodium, potassium, and magnesium are not regulated by the parathyroid.
A patient has been admitted for management of hypoparathyroidism. The nurse should anticipate an order for administration of which electrolyte? 1 Iron 2 Calcium 3 Potassium 4 Magnesium
Calcium The parathyroid is responsible for calcium and phosphorus absorption. Patients with hypoparathyroidism develop hypocalcemia and will require calcium supplementation. Iron, potassium, and magnesium may be necessary, but this depends on the patient's electrolyte status.
The nurse is caring for a patient with diabetes insipidus after a traumatic brain injury. The nurse knows that it is vital to correct the cause of diabetes insipidus to prevent which life-threatening complication of the disease? 1 Coma 2 Incontinence 3 Cardiac dysrhythmias 4 Extrapyramidal symptoms
Coma If untreated, diabetes insipidus can result in coma and death as a result of severe dehydration. Although Incontinence may occur with diabetes insipidus, this is not a life-threatening complication. Cardiac dysrhythmias do not occur as a result of hyponatremia. Extrapyramidal symptoms occur with some antipsychotics.
The patient presents to the clinic complaining of easy bruising, facial changes, excess body hair growth, purple markings on her belly, and weight gain. Upon assessment, the nurse notes a "buffalo hump," a moon-shaped face, and hypertension. These symptoms are most consistent with which disorder? 1 Graves' disease 2 Addison's disease 3 Cushing's syndrome 4 Hashimoto's disease
Cushing's syndrome The patient is exhibiting signs of Cushing's syndrome, which involves an excess of corticosteroid hormones. Graves' and Hashimoto's diseases are disturbances that involve the thyroid hormones. Addison's disease is a deficiency of corticosteroid hormones.
The patient presents to the clinic with excessive thirst and urine output and is diagnosed with diabetes insipidus. The nurse knows this is caused by which imbalance? 1 Increased atrial natriuretic peptide release 2 Increased antidiuretic hormone production 3 Decreased atrial natriuretic peptide release 4 Decreased antidiuretic hormone production
Decreased antidiuretic hormone production Diabetes insipidus is caused by the decreased production of antidiuretic hormone. It is not caused by changes in atrial natriuretic peptide release.
An adult patient has growth hormone (GH) deficiency. What risk does the nurse anticipate for this patient? 1 Double vision 2 Decreased height 3 Growth retardation 4 Decreased bone strength
Decreased bone strength Deficiency in GH in an adult leads to decreased bone strength following an increased rate of destructive activity of the bone. This increases the risk for fracture in the patient. A decrease in GH in children leads to growth retardation resulting in short stature or decreased height. Diplopia or double vision is a neurologic manifestation of hypopituitarism as a result of tumor growth.
The nurse is supervising the care of a patient with syndrome of inappropriate antidiuretic hormone (SIADH) by unlicensed assistive personnel (UAP). Which action by the UAP would prompt the nurse to intervene immediately? 1 Providing frequent oral care 2 Encouraging the patient to drink plenty of fluids 3 Reminding the patient to use the incentive spirometer 4 Weighing the patient in the early morning
Encouraging the patient to drink plenty of fluids The patient with SIADH is severely fluid restricted; the UAP should not encourage the patient to drink fluids. The UAP would be correct to provide frequent oral care, to remind the patient to use the incentive spirometer, and to weigh the patient in the early morning with the patient wearing similar clothing.
The nurse is caring for a patient after a hypophysectomy for the treatment of the hypersecretion of growth hormone. Which assessment finding(s) would indicate the presence of a life-threatening complication of this procedure? Select all that apply. 1 Tetany 2 Bradycardia 3 Hyperglycemia 4 Excessive thirst 5 Excessive hunger 6 Excessive urination
Excessive thirst Excessive urination After a hypophysectomy, the patient is at risk for diabetes insipidus, which presents with excessive thirst and urine output. The patient is not at risk for hypocalcemia (tetany), excessive hunger, or bradycardia. Hyperglycemia may occur as a result of the stress response of surgery, but it is not necessarily representative of a life-threatening complication.
The patient presents to the clinic complaining of weight loss and nervousness. The nurse notes that the patient's eyes protrude and that the whites above and below the irises can be seen. The nurse would use which term to chart this assessment? 1 Myopia 2 Cataract 3 Astigmatism 4 Exophthalmos
Exophthalmos Protruding eyeballs are called exophthalmos and are a sign of hyperthyroidism. Myopia, cataracts, and astigmatism are not associated with hyperthyroidism.
The postoperative period, the LPN/LVN should observe a patient who has had a thyroidectomy for which signs of thyroid crisis? 1 Depression and fatigue, mental slowness 2 Respiratory distress and vocal hoarseness 3 Twitching of muscles and severe convulsions 4 Extreme temperature elevation and rapid pulse rate
Extreme temperature elevation and rapid pulse rate Thyroid storm (TS), also known as thyroid crisis or thyrotoxicosis, is another complication following a thyroidectomy. In the postoperative setting, the condition is caused by a sudden increase in the output of thyroxine caused by manipulation of the thyroid as it is being removed. Another cause of TS may be improper reduction of thyroid secretions before surgery. The symptoms of TS are produced by a sudden and extreme elevation of all body processes. The temperature may rise to 106° F (41.1° C) or more, the pulse increases to as much as 200 beats per minute, respirations become rapid, and the patient exhibits marked apprehension and restlessness. Unless the condition is relieved, the patient quickly passes from delirium to coma to death from heart failure. Respiratory distress is a complication of thyroidectomy if the edema affects the airway, but it is not a sign of thyroid storm. Muscle twitching and convulsions are a sign of hypocalcemia from hyperparathyroidism. Hoarseness is an expected finding following thyroidectomy. Depression and fatigue may result from hypothyroidism.
Immediately after a patient has a thyroidectomy, the patient should be placed in which position? 1 Supine 2 Fowler's 3 Trendelenburg 4 Sims' left lateral
Fowler's After a thyroidectomy, the patient is placed in the Fowler's position (sitting upright to at least 90 degrees) to facilitate breathing and reduce swelling of the operative area. The head may be supported with sandbags on either side to relieve tension on the sutures. Supine, Trendelenburg, and Sims' left lateral positions would increase the chances of swelling in the airway.
A patient has undergone a hypophysectomy. What postoperative interventions does the nurse perform for this patient? 1 Have the patient lie flat after surgery 2 Monitor neurologic status every 4 hours 3 Have the patient avoid brushing the teeth after surgery 4 Discard and replace the nasal drip pad at regular intervals
Have the patient avoid brushing the teeth after surgery The patient should be instructed to avoid brushing the teeth after surgery until the incision sufficiently heals. Frequent mouth care with mouthwash and daily flossing provide adequate oral hygiene. The patient must use a mirror to check the gums for bleeding; reduced sensation in the mouth increases the risk for injury. The nurse monitors the patient's neurologic status every hour for the first 24 hours and then every 4 hours. The nasal drip pad is assessed for quantity and quality of drainage before it is discarded; a light yellow color at the edge of clear drainage on the dressing is indicative of cerebrospinal fluid leak. The head of the bed is elevated after surgery to prevent edema.
A 42-year-old patient complains that she has been losing a lot of hair, is fatigued, and is cold all the time. The LPN/LVN recognizes that these symptoms are closely associated with which disorder? 1 Hypothyroidism 2 Hyperthyroidism 3 Hypoparathyroidism 4 Hyperparathyroidism
Hypothyroidism Hypothyroidism can be caused by inflammation of the thyroid gland (thyroiditis) or by treatment of hyperthyroidism that results in destroying too many thyroid cells and a resultant deficit of thyroid hormone. The patient is not exhibiting signs of hyperthyroidism or parathyroid dysfunction.
A patient with Cushing's disease should be given which instruction, due to use of steroid therapy? 1 Avoid alcoholic beverages 2 Increase intake of potassium 3 Limit the amount of dietary protein 4 Increase servings of dark green leafy vegetables
Increase intake of potassium A patient with Cushing's disease who is taking steroids should be educated in use of foods high in potassium. Alcohol in moderation is allowed. There is no need to increase consumption of green leafy vegetables or protein.
The patient presents to the emergency department after a head injury with excessive urine output and thirst. The nurse anticipates which laboratory results? Select all that apply. 1 Increased serum osmolality 2 Decreased urine osmolality 3 Increased serum sodium levels 4 Decreased urine specific gravity 5 Decreased serum potassium levels 6 Abundant polymorphic neutrophils
Increased serum osmolality 2 Decreased urine osmolality 3 Increased serum sodium levels 4 Decreased urine specific gravity The patient is exhibiting signs of diabetes insipidus: decreased urine osmolality, decreased urine specific gravity, increased serum osmolality, and hypernatremia. This disorder does not cause decreased serum potassium levels. Abundant polymorphic neutrophils are present with an infectious process.
A patient is diagnosed as having Addison's disease. This condition is the result of which disturbance? 1 A secreting tumor of the adrenal cortex 2 Overfunctioning of the pituitary and hypothalamus 3 Excessive secretion of adrenocorticotropic hormone 4 Insufficiencies of the mineralocorticoids and glucocorticoids
Insufficiencies of the mineralocorticoids and glucocorticoids Addison's disease is characterized by decreased function of the adrenal cortex resulting in a deficit of all three hormones secreted by the adrenal cortex. The major problems are related to insufficiencies of the mineralocorticoids and the glucocorticoids. It is not caused by a secreting adrenal cortex tumor, overfunctioning pituitary or hypothalamus, or excessive secretion of the adrenocorticotropic hormone.
The patient presents to the clinic with a gross enlargement of the anterior neck. The nurse knows that this is most likely caused by a deficiency in which substance? 1 Iodine 2 Sodium 3 Calcium 4 Vitamin D
Iodine A gross enlargement of the thyroid gland in the anterior neck is likely a goiter caused by iodine deficiency. The patient's symptoms are not caused by sodium, calcium, or vitamin D deficiencies.
A patient with acromegaly will most likely exhibit which symptom? 1 Fatigue 2 Joint pain 3 Weight loss 4 Frequent infections
Joint pain Acromegaly results from increased secretion of growth hormone, causing elongation and expansion of the bones. Muscle weakness may occur with acromegaly, and osteoporosis and joint pain are common. Infection and weight loss are not directly associated with this disorder. Although the disease process causes patients to become fatigued, the best answer is joint pain.
A patient who has hyperthyroidism exhibits symptoms of anxiety, nervousness, and agitation. Which intervention should be included in the patient's care? 1 Keeping environmental stimuli to a minimum 2 Encouraging questions about options for treatment 3 Stressing the importance of complying with treatment regimen 4 Maintaining the temperature of the room slightly above normal
Keeping environmental stimuli to a minimum The patient with hyperthyroidism may experience nervousness and irritability. The patient will benefit from having the environmental stimuli kept to a minimum. Although encouraging questions and stressing treatment compliance are appropriate interventions for this patient, they are not the most appropriate for the anxiety symptoms the patient is experiencing. The patient will be more comfortable with a room temperature slightly below normal.
The nurse is caring for a patient admitted with suspected hyperparathyroidism. Because of the potential effects of this disease on electrolyte balance, the nurse should assess this patient for what manifestation? 1 Neurologic irritability 2 Declining urine output 3 Lethargy and confusion 4 Hyperactive bowel sounds
Lethargy and confusion Hyperparathyroidism can cause hypercalcemia. Signs of hypercalcemia include muscle weakness, polyuria, constipation, nausea and vomiting, lethargy, and confusion. Neurologic irritability, declining urine output, and hyperactive bowel sounds do not occur with hypercalcemia.
The patient presents to the clinic with complaints of muscle weakness, vague abdominal pain, and fatigue. The nurse notes that the patient's jaw is heavier, the forehead has a bulge that was not present before, and the patient's hands are enlarged. The nurse anticipates that which test(s) will be ordered to diagnose this patient's condition? Select all that apply. 1 Skeletal series x-ray 2 Glucose tolerance testing 3 Radioactive iodine uptake (RAIU) 4 Magnetic resonance imaging (MRI) 5 Performance-enhancing drug testing 6 Computed tomography (CT) with contrast media
Magnetic resonance imaging (MRI) Computed tomography (CT) with contrast media The patient is exhibiting signs of the hypersecretion of growth hormone caused by a pituitary adenoma, which would be diagnosed with a CT with contrast and MRI. A skeletal series x-ray may be ordered to determine the extent of bone changes, but this is not diagnostic. Glucose tolerance testing, RAIU, and performance-enhancing drug testing are not necessary.
A patient who lives alone has been admitted with myxedema coma. What is the nurse's priority intervention? 1 Promote nutrition with a high-calorie diet. 2 Monitor for tachycardia and hypertension. 3 Prevent skin breakdown by turning every 2 hours. 4 Monitor for hypothermia, hypotension, and respiratory failure.
Monitor for hypothermia, hypotension, and respiratory failure. The main signs of myxedema coma are hypothermia, hypotension, and respiratory failure. The patient should be monitored for these manifestations. Tachycardia and hypertension are signs of hyperthyroidism. Nutrition and skin breakdown are not the priority interventions for this patient.
The nurse is assessing a patient diagnosed with Addison's disease. What would the nurse expect to find in this patient? 1 Hypertension 2 Loss of muscle mass 3 Swelling in the facial area 4 Muscle weakness and pain
Muscle weakness and pain In the patient with Addison's disease, the nurse would expect to find muscle weakness and pain; generalized malaise; orthostatic hypotension; and vulnerability to cardiac dysrhythmias. The patient with Cushing's disease will have swelling in the face (moon face), loss of muscle mass (weakness due to abnormal protein catabolism), and hypertension.
The nurse is supervising the care of a patient by unlicensed assistive personnel (UAP) after hypophysectomy. Which action by the UAP would prompt the nurse to intervene immediately? 1 Encouraging the patient to drink water regularly 2 Providing the patient with tissues to blow her nose 3 Assisting the patient to the toilet while remaining upright 4 Reminding the patient to wear sequential compression devices while in bed
Providing the patient with tissues to blow her nose After a hypophysectomy, it is vital that the patient not cough, blow her nose, or bend forward due to the risk of causing cerebrospinal fluid to leak. Encouraging fluid intake, helping the patient to remain upright while transferring her to the toilet, and reminding the patient to wear sequential compression devices while in bed are appropriate interventions by the UAP.
The patient with an adrenal hyperplasia is being admitted to the outpatient surgical preparation area for laparoscopic adrenalectomy surgery this morning. The nurse should be prepared to treat which possible concern? 1 Vomiting 2 Infection 3 Thromboembolism 4 Rapid blood pressure changes
Rapid blood pressure changes Before surgery, the patient may be experiencing a hypertensive crisis and require intravenous medication. The patient should also be monitored for orthostatic hypotension.
The nurse assigns unlicensed assistive personnel (UAP) to monitor the temperature of a patient with Graves' disease. What does the nurse instruct the UAP to do? 1 Monitor the patient's temperature every 6 hours 2 Document the findings and report at the end of the shift 3 Report even a 1-degree Fahrenheit increase in temperature immediately 4 Nothing, because it is normal for the patient to have an elevated temperature
Report even a 1-degree Fahrenheit increase in temperature immediately The nurse should instruct the UAP to report even a 1-degree Fahrenheit increase in temperature immediately, because any increase in temperature may indicate a rapid worsening of the patient's condition and the onset of a thyroid storm. The patient's temperature should be measured at least every 4 hours, documented, and reported to the nurse as soon as it is obtained. The patient with Graves' disease experiences diaphoresis and has heat intolerance, so an elevated temperature must be reported to the nurse immediately.
A patient has been diagnosed with syndrome of inappropriate antidiuretic hormone. The nurse would anticipate which abnormal laboratory value(s) as a result of the syndrome? Select all that apply. 1 Serum sodium 2 Serum potassium 3 Decreased hemoglobin 4 Decreased urine sodium 5 Increased urine osmolality 6 Decreased serum osmolality
Serum sodium Decreased hemoglobin Increased urine osmolality Decreased serum osmolality Severely decreased urine sodium, decreased hemoglobin, decreased serum osmolality, increased urine sodium, and increased urine osmolality are all expected laboratory values for a patient with syndrome of inappropriate antidiuretic hormone.
The nurse is caring for a patient who had a thyroidectomy. What nursing interventions would be included in the patient's post-operative care? Select all that apply. Correct1 Take vital signs continuously until stable 2 Take vital signs every 4 hours and as needed 3 Watch for difficulty swallowing or breathing 4 Place patient in Fowler's position after surgery 5 Place patient in a supine position after surgery
Take vital signs continuously until stable Watch for difficulty swallowing or breathing Place patient in Fowler's position after surgery Nursing interventions after a thyroidectomy would include placing the patient in a Fowler's position after surgery to facilitate breathing and reduce swelling of the operative site. Vital signs should be taken continuously until stable and then every hour, noting any rise in temperature, pulse, or respirations because it may indicate a high level of thyroxine in the blood. Difficulty in swallowing or breathing also should be reported immediately, because it may indicate internal edema and pressure on the esophagus and trachea.
The nurse is assessing the elimination patterns of a patient. Which finding needs further evaluation to rule out the possibility of diabetes insipidus (DI)? 1 The urine is very dark and concentrated. 2 The first morning sample of urine is pale yellow and clear. 3 The patient reports excessive thirst and increased frequency of urination. 4 The total urine output is slightly less than the total fluid intake in 24 hours.
The patient reports excessive thirst and increased frequency of urination. The patient who reports excessive thirst and increased frequency of urination must be evaluated for DI. The patient with increased urination frequency will wake up frequently at night to urinate. Normal urine is pale yellow and clear. A patient with DI will record a total urine output that is more than the total fluid intake in 24 hours. The amount of urine may vary from 4 L to 30 L per day, often leading to dehydration. The urine is dilute, not dark and concentrated.
The patient with a simple goiter caused by iodine deficiency will begin iodine replacement therapy. The nurse should be sure to give the patient which instruction regarding iodine preparations? 1 Use a straw when taking this medication. 2 Do not take this medication with milk or dairy products. 3 This product must be taken without food on an empty stomach. 4 Take this medication in the morning with a glass of grapefruit juice.
Use a straw when taking this medication. Iodine preparations can stain teeth, so they should be well diluted and taken through a straw. It is not necessary to avoid dairy products, to take the medication on an empty stomach, or to take the medication with a glass of grapefruit juice.
A patient has hyperparathyroidism. Which priority intervention would the nurse add to this patient's plan of care? 1 Teaching the patient to support the neck when moving 2 Instructing the patient to use a soft-bristled toothbrush 3 Using a lift sheet to assist the patient with position changes 4 Straining all urine and sending any stones to the laboratory for analysis
Using a lift sheet to assist the patient with position changes Patients with hyperparathyroidism are at increased risk for pathologic fractures due to high parathormone causing calcium to shift from the bones into the bloodstream. Using a lift sheet will protect the patient and reduce the risk for bone injury. Supporting the neck and using a soft-bristled toothbrush are not necessary for this patient. Patients may have urinary stones, but this is not the priority intervention.
A patient has been prescribed radioactive iodine (RAI) therapy for hyperthyroidism. What does the nurse teach the patient about this therapy? 1 "You will receive RAI in the form of oral131I." 2 "This treatment is done on an inpatient basis." 3 "The radiation dose will be eliminated within a week." 4 "You will have complete relief from symptoms in 1 week."
You will receive RAI in the form of oral131I. RAI is provided in the form of oral131I. The dosage depends on the size of the thyroid gland and its sensitivity to radiation. Some of the cells that produce thyroid hormone are destroyed. However, the thyroid gland also stores thyroid hormones to an extent. Therefore, the patient may not have complete relief of symptoms until 6 to 8 weeks after RAI therapy. Radioactivity is present in the patient's body fluids and stool for a few weeks even after the therapy is complete. The patient must take radiation precautions to prevent exposure to family members and other people. RAI treatment is done on an outpatient basis; most patients require only one sitting, whereas some may require two or three sittings.
The patient has hypothyroidism. The nurse knows which organ(s) are involved in this condition? Select all that apply. 1 Thyroid 2 Thymus 3 Pituitary 4 Adrenals 5 Hypothalamus
thyroid pituitary hypothalamus The thyroid, pituitary, and hypothalamus regulate the secretion of thyroid hormones. The thymus and adrenals are not involved in hypothyroidism.
