Chapter 31: PrepU - Nursing Management: Patients With Endocrine Disorders
A patient is suspected of having a pheochromocytoma and is having diagnostic tests done in the hospital. What symptoms does the nurse recognize as most significant for a patient with this disorder? 1- Blood pressure varying between 120/86 and 240/130 mm Hg 2- Heart rate of 56-64 bpm 3- Shivering 4- Complaints of nausea
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A patient who is receiving treatment for hyperthyroidism is being monitored closely by the care team. When observing this patient for signs and symptoms of thyroid storm (thyrotoxicosis), the nurse should prioritize which of the following assessments? 1- Temperature and heart rate 2- Deep tendon reflexes and peripheral pulses 3- Pain and level of consciousness (LOC) 4- Assessment for visual and auditory disturbances
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Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects? 1- Sympathetic 2- Parasympathetic 3- Gastrointestinal effects 4- Respiratory effects
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One of the most frequently occurring complications (55% occurrence) of primary hyperparathyroidism is: 1- Kidney stones. 2- Pancreatitis. 3- Pathologic fractures. 4- Peptic ulcer.
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The nurse assesses a patient who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease? 1- Potassium of 6.0 mEq/L 2- Sodium of 140 mEq/L 3- Glucose of 100 mg/dL 4- A blood pressure reading of 135/90 mm Hg
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The nurse is reviewing a client's history which reveals that the client has had an oversecretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following? 1- Gigantism 2- Dwarfism 3- Acromegaly 4- Simmonds' disease
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Trousseau's sign is elicited by which of the following? 1- Carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood pressure cuff. 2- A sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye. 3- After making a clenched fist, the palm remains blanched when pressure is placed over the radial artery. 4- The patient complains of pain in the calf when his foot is dorsiflexed.
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When caring for a client with diabetes insipidus, the nurse expects to administer: 1- vasopressin. 2- furosemide. 3- regular insulin. 4- 10% dextrose.
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When reviewing laboratory results for a patient with a possible diagnosis of hypoparathyroidism, the nurse knows that this condition is characterized by which of the following? 1- Inadequate secretion of parathormone 2- Increase in serum calcium 3- Lowered blood phosphate 4- Increase in the renal excretion of phosphate
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Which feature(s) indicates a carpopedal spasm in a client with hypoparathyroidism? 1- Hand flexing inward 2- Cardiac dysrhythmia 3- Moon face and buffalo hump 4- Bulging forehead
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Which of the following is a clinical manifestation of hypothyroidism? 1- A pulse rate below 60 beats/minute. 2- An elevated systolic blood pressure. 3- Systolic murmurs 4- Exophthalmos
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A nurse in a large university hospital has cared for several patients with endocrine disorders over the past year. For which of the following patients would a nursing diagnosis of disturbed body image be most likely applicable? 1- A man who was treated for Hashimoto's thyroiditis 2- A woman with a longstanding diagnosis of Cushing's syndrome 3- A woman whose diagnosis of Graves' disease required radioactive iodine therapy 4- A man who was diagnosed with hypoparathyroidism after neck surgery
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A nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. The nurse should state that the physician probably will order daily supplements of calcium and: 1- folic acid. 2- vitamin D. 3- potassium. 4- iron.
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A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? 1- Risk for infection 2- Decreased cardiac output 3- Impaired physical mobility 4- Imbalanced nutrition: Less than body requirements
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A patient taking corticosteroids for exacerbation of Crohn's disease comes to the clinic and informs the nurse that he wants to stop taking them because of the increase in acne and moon face. What can the nurse educate the patient regarding these symptoms? 1- The symptoms are permanent side effects of the corticosteroid therapy. 2- The moon face and acne will resolve when the medication is tapered off. 3- Those symptoms are not related to the corticosteroid therapy. 4- The dose of the medication must be too high and should be lowered.
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A patient who is postoperative day 1 following neck dissection surgery has rung his call bell complaining of numb fingers, stiff hands, and a tingling sensation in his lips and around his mouth. The nurse should anticipate that this patient may require the IV administration of: 1- Potassium chloride 2- Calcium gluconate 3- Magnesium sulfate 4- Sodium phosphate
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A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine disorder should the nurse expect the physician to diagnose? 1- Diabetes mellitus 2- Goiter 3- Diabetes insipidus 4- Cushing's syndrome
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An adult patient has undergone extensive testing that has resulted in a diagnosis of a basophilic pituitary tumor. The pathophysiological effects of the patient's tumor include excessive secretion of adrenocorticotropic hormone (ACTH). As a result, this patient is likely to exhibit signs and symptoms that are characteristic of what endocrine disorder? 1- Addison's disease 2- Cushing's disease 3- Hyperthyroidism 4- Diabetes insipidus
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During an assessment of a patient with SIADH, the nurse notes the unexpected result of: 1- Moist mucous membranes. 2- Pitting edema in the lower extremities. 3- A blood pressure reading of 120/85 mm Hg. 4- Normal skin turgor.
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On assessment of a patient with early-stage hypothyroidism, the nurse practitioner assesses for a vague yet significant sign which is: 1- Bradypnea 2- Paresthesia 3- Hypotension 4- Hypothermia
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The PACU staff have brought a patient to the unit following a thyroidectomy. To promote comfort for this patient, how should the nurse position this patient? 1- Side-lying (lateral) with one pillow under the head 2- Head of the bed elevated 30 degrees and no pillows placed under the head 3- Semi-Fowler's with the head supported on two pillows 4- Flat, with a small roll supporting the neck
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The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with? 1- Hypothyroidism 2- Hyperthyroidism 3- Syndrome of inappropriate antidiuretic hormone secretion (SIADH) 4- Diabetes insipidus (DI)
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The nurse obtains a complete family history of a client with a suspected endocrine disorder based on which rationale? 1- An allergy to iodine is inherited. 2- Endocrine disorders can be inherited. 3- It helps determine the client's general status. 4- Diet and drug histories are related to the family history.
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Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism? 1- Hypocalcemia 2- Hypercalcemia 3- Hyperphosphatemia 4- Hypophosphaturia
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Which of the following would the nurse expect to find in a client with severe hyperthyroidism? 1- Tetany 2- Exophthalmos 3- Buffalo hump 4- Striae
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A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication? 1- Exophthalmos 2- Thyroid storm 3- Myxedema coma 4- Tibial myxedema
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A nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse expects to find: 1- hypotension. 2- thick, coarse skin. 3- deposits of adipose tissue in the trunk and dorsocervical area. 4- weight gain in arms and legs.
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A nurse is teaching a client with adrenal insufficiency about corticosteroids. Which statement by the client indicates a need for additional teaching? 1- "I will avoid friends and family members who are sick." 2- "I will eat lots of chicken and dairy products." 3- "I may stop taking this medication when I feel better." 4- "I will see my ophthalmologist regularly for a check-up."
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An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and periorbital area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: 1- thyroid storm. 2- cretinism. 3- myxedema coma. 4- Hashimoto's thyroiditis.
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Evaluation of an adult client reveals oversecretion of growth hormone. Which of the following would the nurse expect to find? 1- Excessive urine output 2- Weight loss 3- Bulging forehead 4- Constant thirst
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The nurse auscultates a bruit over the thyroid glands. What does the nurse understand is the significance of this finding? 1- The patient may have hypothyroidism. 2- The patient may have thyroiditis. 3- The patient may have hyperthyroidism. 4- The patient may have Cushing disease.
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The nurse is closely monitoring the blood work of a patient who has a diagnosis of primary hyperparathyroidism. The nurse should be aware that the fluid and electrolyte disturbances associated with this disease create a significant risk of what problems? 1- Fluid volume overload and pruritus 2- Metabolic acidosis and cardiac ischemia 3- Renal calculi and urinary obstruction 4- Deep vein thrombosis and pulmonary embolism
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The nurse practitioner who assesses a patient with hyperthyroidism would expect the patient to report which of the following conditions? 1- Fatigue 2- Dyspnea 3- Weight loss 4- Hair loss
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A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add? 1- Related to bone demineralization resulting in pathologic fractures 2- Related to exhaustion secondary to an accelerated metabolic rate 3- Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces 4- Related to tetany secondary to a decreased serum calcium level
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A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? 1- Tetany 2- Hemorrhage 3- Thyroid storm 4- Laryngeal nerve damage
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A nurse is caring for a client with Cushing's syndrome. Which would the nurse not include in this client's plan of care? 1- Provide a high-sodium diet. 2- Examine extremities for pitting edema. 3- Report systolic BP that exceeds 139 mm Hg or diastolic BP that exceeds 89 mm Hg. 4- Administer prescribed diuretics.
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A nurse is caring for a client with hypoparathyroidism. During assessment, the nurse elicits a positive Trousseau's sign. What does the nurse observe to verify this finding? 1- hand flexing inward 2- cardiac dysrhythmia 3- moon face and buffalo hump 4- bulging forehead
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A patient has been admitted to an acute medical unit with a diagnosis of diabetes insipidus with a neurogenic etiology. When planning this patient's care, what diagnosis should be the nurse's most likely priority? 1- Fluid volume deficit related to increased urine output 2- Acute confusion related to alterations in electrolytes 3- Altered nutrition: less than body requirements related to decreased intake 4- Risk for injury related to decreased level of consciousness
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A 42-year-old man with a history of pheochromocytoma is being treated in the intensive care unit after experiencing an acute exacerbation of his condition. This patient will require the nurse to perform which of the following assessments most frequently? 1- Motor and sensory function 2- Orientation and cognition 3- Urine testing for osmolality 4- Blood pressure (BP) and heart rate
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A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? 1- Blood urea nitrogen (BUN) level of 12 mg/dl 2- Blood glucose level of 90 mg/dl 3- Serum sodium level of 134 mEq/L 4- Serum potassium level of 5.8 mEq/L
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A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: 1- exophthalmos and conjunctival redness. 2- flushed, warm, moist skin. 3- systolic murmur at the left sternal border. 4- decreased body temperature and cold intolerance.
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A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do? 1- Monitor laboratory values daily for elevated thyroid-stimulating hormone. 2- Observe for swelling of the neck, tracheal deviation, and severe pain. 3- Evaluate the quality of the client's voice postoperatively, noting any drastic changes. 4- Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.
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A patient is diagnosed with overactivity of the adrenal medulla. What epinephrine value does the nurse recognize is a positive diagnostic indicator for overactivity of the adrenal medulla? 1- 50 pg/mL 2- 100 pg/mL 3- 100 to 300 pg/mL 4- 450 pg/mL
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During preoperative teaching for a client who will undergo subtotal thyroidectomy, the nurse should include which statement? 1- "The head of your bed must remain flat for 24 hours after surgery." 2- "You should avoid deep breathing and coughing after surgery." 3- "You won't be able to swallow for the first day or two." 4- "You must avoid hyperextending your neck after surgery."
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The nurse is caring for a patient with hyperthyroidism who suddenly develops symptoms related to thyroid storm. What symptoms does the nurse recognize that are indicative of this emergency? 1- Heart rate of 62 2- Blood pressure 90/58 mm Hg 3- Oxygen saturation of 96% 4- Temperature of 102ºF
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The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find? 1- Complaints of sleepiness 2- Thick hard nails 3- Inability to tolerate cold 4- Reports of increased appetite
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Which nursing diagnosis takes highest priority for a client with hyperthyroidism? 1- Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess 2- Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing 3- Disturbed body image related to weight gain and edema 4- Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
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A client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which gland? 1- Adrenal cortex 2- Pancreas 3- Adrenal medulla 4- Parathyroid
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A client is returned to his room after a subtotal thyroidectomy. Which piece of equipment is most important for the nurse to keep at the client's bedside? 1- Indwelling urinary catheter kit 2- Tracheostomy set 3- Cardiac monitor 4- Humidifier
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Which of the following medications is used in the treatment of diabetes insipidus to control fluid balance? 1- Desmopressin (DDAVP) 2- Thiazide diuretics 3- Ibuprofen 4- Diabinese
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Which outcome indicates that treatment of a client with diabetes insipidus has been effective? 1- Fluid intake is less than 2,500 ml/day. 2- Urine output measures more than 200 ml/hour. 3- Blood pressure is 90/50 mm Hg. 4- Heart rate is 126 beats/minute.
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A client has suffered from several autoimmune disorders over the last 25 years, and lately has developed a new set of symptoms. The client's healthcare provider suspects Addison's disease. Which symptom would the nurse not expect to see? 1- weight gain 2- hypoglycemia 3- depression 4- hypotension
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A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia? 1- Acromegaly 2- Type 1 diabetes mellitus 3- Hypothyroidism 4- Deficient growth hormone
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In planning the care of a patient who has hyperthyroidism, the nurse has identified the nursing diagnosis of altered nutrition: less than body requirements. What intervention is the best response to this diagnosis? 1- Arrange for the patient to be assessed for the possible use of enteral nutrition. 2- Provide the patient with a low-fat, high-protein diet. 3- Provide several small meals each day for the patient. 4- Teach the patient to eat each meal slowly and methodically.
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Cardiac effects of hyperthyroidism include 1- decreased pulse pressure. 2- decreased systolic blood pressure. 3- bradycardia. 4- palpitations.
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