Endocrine

The nurse is developing a plan of care for a client with Cushing's syndrome. The nurse documents a client problem of excess fluid volume. Which nursing actions should be included in the care plan for this client? Select all that apply. 1. Monitor daily weight. 2. Monitor intake and output. 3. Assess extremities for edema. 4. Maintain a high-sodium diet. 5. Maintain a low-potassium diet.

1. Monitor daily weight. 2. Monitor intake and output. 3. Assess extremities for edema.

The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1. Provide a cool environment for the client. 2. Instruct the client to consume a high-fat diet. 3. Instruct the client about thyroid replacement therapy. 4. Encourage the client to consume fluids and high-fiber foods in the diet. 5. Inform the client that iodine preparations will be prescribed to treat the disorder. 6. Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur.

2. Instruct the client to consume a high-fat diet. 3. Instruct the client about thyroid replacement therapy. 6. Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur.

The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which symptoms are associated with this diagnosis? Select all that apply. 1. Tremors 2. Weight loss 3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face

3. Feeling cold 4. Loss of body hair 5. Persistent lethargy 6. Puffiness of the face

A nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's disease. Which statement by the student indicates an accurate understanding of this disorder? 1. "Cushing's disease results from an oversecretion of insulin." 2. "Cushing's disease results from an undersecretion of corticotropic hormones." 3. "Cushing's disease results from anundersecretion of mineralocoritcoid hormones." 4. "Cushing's disease results from an increased pituitary secretion of adrenocorticotropic hormone."

4 R: Cushing's disease is a metabolic disorder characterized by abnormally increased secretion (endogenous) of cortisol, caused by increased amounts of adrenocorticotropic hormone (ACTH) secreted by the pituitary gland. Addison's disease is characterized by the hyposecretion of adrenal cortex hormones (glucocorticoids and mineralocorticoids) from the adrenal gland, resulting in deficiency of the corticosteroid hormones. Options 1, 2, and 3 are inaccurate regarding Cushing's disease.

3. Following a transsphenoidal resection of a pituitary tumor, an important N assessment is a. monitoring hourly urine output. b. checking the dressings for serous drainage. c. palpating for dependent pitting edema. d. obtaining continuous pulse oximetry.

A R: After pituitary surgery, the pt is at risk for diabetes insipidus caused by cerebral edema and monitoring of urine output and urine specific gravity is essential. There will be no dressing when transsphenoidal approach is used. The pt is at risk for dehydration, not volume overload. The pt is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.

What should be taught to a person with Addison's disease? check all that apply

Adrenal insufficiency=cause (adrenalectomy or coming off steroids too fast), hirsutism (hair distribution changes, avoid stress (infection, rm changes, or arguing), STEROIDS rest of life in am, Diet: Salt and decreased K (no salt substitutes), Immunocompromised.

The nurse is assessing a client who has a diagnosis of goiter. Which should the nurse expect to note during the assessment of the client? 1. An enlarged thyroid gland 2. The presence of heart damage 3. Client complaints of chronic fatigue 4. Client complaints of slow wound healing

An enlarged thyroid gland

The nurse is reviewing the postoperative prescriptions for a client who had a transsphenoidal hypophysectomy. Which health care provider's (HCP) prescriptions, if noted on the record, would indicate the need for clarification? 1. Assess vital signs and neurological status. 2. Instruct the client to avoid blowing his nose. 3. Apply a loose dressing if any clear drainage is noted. 4. Instruct the client about the need for a Medic-Alert bracelet.

Apply a loose dressing if any clear drainage is noted.

After hypophysectomy, a client complains of being thirsty and having to urinate frequently. What is the initial nursing action? 1. Increase fluid intake. 2. Document the complaints. 3. Assess for urinary glucose. 4. Assess urine specific gravity.

Assess urine specific gravity

The nurse is developing a plan of care for a client who is scheduled for a thyroidectomy. The nurse focuses on psychosocial needs, knowing that which is likely to occur in the client? 1. Infertility 2. Gynecomastia 3. Sexual dysfunction 4. Body image changes

Body image changes

What electrolyte levels should you evaluate after thyroidectomy?

Calcium levels. Parathyroids may have been damaged or accidentally removed. Low levels of Calcium could be an EMERGENCY. Have calcium gluconate available.

A client has returned to the nursing unit after a thyroidectomy. The nurse notes that the client is complaining of tingling sensations around the mouth, fingers, and toes. On the basis of these findings, the nurse should next assess the results of which serum laboratory study? 1. Sodium 2. Calcium 3. Potassium 4. Magnesium

Calcium=Chvostek's sign

What sign should you assess for decreased calcium?

Chvosteks (face spasm) or trousseaus (arm spasm).

What is a person with hyperthyroidism (graves disease) at risk for?

Corneal abrasions from exopthalmia (may need artificial tears and cover with tape at night.

A client is diagnosed with Cushing's syndrome. The nurse plans care, knowing that this client has an excess of which substances? 1. Calcium 2. Cortisol 3. Epinephrine 4. Norepinephrine

Cortisol

A registered nurse (RN) is caring for a client with a diagnosis of Cushing's syndrome. A nursing student is working with the RN for the day. Which statement by the student indicates understanding of Cushing's syndrome? 1. "Cushing's syndrome is caused by excessive amounts of cortisol." 2. "Cushing's syndrome is caused by decreased amounts of aldosterone." 3. "Cushing's syndrome is caused by excessive amounts of antidiuretic hormone." 4. "Cushing's syndrome is caused by decreased amounts of parathyroid hormone."

Cushing's syndrome is caused by excessive amounts of cortisol. Cushing's=cortisol

22. A patient with primary hyperparathyroidism has a serum calcium level of 14 mg/dl (3.5 mmol/L), phosphorus of 1.7 mg/dl (0.55 mmol/L), serum creatinine of 2.2 mg/dl (194 mmol/L), and a high urine calcium. While the patient awaits surgery, the nurse should a. institute seizure precautions such as padded siderails. b. assist the patient to perform range-of-motion exercises QID. c. monitor the patient for positive Chvostek's or Trousseau's sign. d. encourage the pt to drink 4000 ml of fluid daily.

D R: The pt with hypercalcemia is at risk for kidney stones, which may be prevented by a high fluid intake. Seizure precautions and monitoring for Chvostek's or Trousseau's sign are appropriate for hypocalcemic patients. The pt should engage in weight-bearing exercise rather than range-of-motion because weight-bearing decreases calcium loss from bone.

What electrolytes/ values is Addison low in?

Everything except K (Na, H20, BP, and Blood Sugar)

During physical examination of a client, which finding is characteristic of hyperthyroidism? Select all that apply: 1. Periorbital edema 2. Flushed warm skin 3. Hyperactive bowel sounds 4. Heart rate of 120 beats/min

Flushed warm skin, hyperactive bowel sounds, tachycardia

What are the S&S of thyroid storm?

Heart palpitations, anxiety, dyspnea, diaphoretic, tremors, bulging eyes, high fever (104*).

A nurse is caring for a client with a dysfunctional thyroid gland and is concerned that the client will exhibit signs of thyroid storm. Which is an early indicator of this complication? 1. Constipation 2. Bradycardia 3. Hyperreflexia 4. Low-grade temperature

Hyperreflexia

A nurse is caring for a client with a thyrotoxicosis who is at risk for the development of thyroid storm. To detect this complication, the nurse should assess for which sign or symptom? 1. Bradycardia 2. Constipation 3. Hypertension 4. Low-grade temperature

Hypertension

The nurse is caring for a client with a diagnosis of Cushing's syndrome. Which expected signs should the nurse monitor for? Select all that apply. 1. Anorexia 2. Dizziness 3. Hypertension 4. Weight loss 5. Moon face 6. Truncal obesity

Hypertension, moon face, truncal obesity

Which condition on assessment of the client with Addison's disease should the nurse expect to note? 1. Edema 2. Obesity 3. Hirsutism 4. Hypotension

Hypotension

The nurse is caring for a client who has had an adrenalectomy and is monitoring the client for signs of adrenal insufficiency. Which signs and symptoms indicate adrenal insufficiency in this client? 1. Hypotension and fever 2. Mental status changes and hypertension 3. Subnormal temperature and hypotension 4. Complaints of weakness and hypertension

Hypotension and fever

The nurse is instructing a client with Cushing's syndrome on follow-up care. Which of these client statements would indicate a need for further instruction? 1. "I should avoid contact sports." 2. "I should check my ankles for swelling." 3. "I need to avoid foods high in potassium." 4. "I need to check my blood glucose regularly."

I need to avoid foods high in potassium

The home care nurse visits a client with a diagnosis of hyperparathyroidism who is taking furosemide (Lasix) and provides dietary instructions to the client. Which statement by the client indicates a need for additional instruction? 1. "I need to eat foods high in potassium." 2. "I need to drink at least 2 to 3 L of fluid daily." 3. "I need to eat small, frequent meals and snacks if nauseated." 4. "I need to increase my intake of dietary items that are high in calcium."

I need to increase my intake of dietary items that are high in calcium

Can Cushing's patients have steroids?

NO because their blood sugar is already elevated.

A nurse is preparing to provide instructions to a client with Addison's disease regarding diet therapy. The nurse knows that which diet would most likely be prescribed for this client? 1. High fat intake 2. Low protein intake 3. Normal sodium intake 4. Low carbohydrate intake

Normal sodium intake

A client has overactivity of the thyroid gland. The nurse plans care, knowing that the client will experience which effects from this hormonal excess? 1. Weight gain 2. Nutritional deficiencies 3. Low blood glucose levels 4. Increased body fat stores

Nutritional deficiencies

What should you do immediately for someone experiencing thyroid storm?

O2, IV placement for fluids, propythiouracil (dec thyroid), lower body temp wtemp blanket and acetaminophen.

Can Cushing's patients have salt substitutes?

Yes bc they are low in Potassium

Can Addison's pts have steroids?

Yes because they increase Blood Sugar

A pt is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, the nurse would expect to find a. HTN, peripheral edema, and petechiae b. weight loss, buffalo hump, moon face with acne c. abdominal and buttock striae, truncal obesity, and hypotension d. anorexia, signs of dehydration, and hyper pigmentation of the skin

a. HTN, peripheral edema, and petechiae (R- effects of glucocorticoid excess include weight gain from accumulation and redistribution of adipose tissue, Na and water retention, glucose intolerance, protein wasting, loss of bone structure, loss of collagen, capillary fragility. CM of corticosteroid deficiency include hypotension, dehydration, weight loss, hyperpigmentation of skin.)

A patient is admitted to the hospital in thyrotoxic crisis. On physical assessment of the patient, the nurse would expect to find a. hoarseness and laryngeal stridor b. bulging eyeballs and arrhythmias c. elevated temperature and signs of heart failure d. lethargy progressing suddenly to impairment of consciousness

c. elevated temperature and signs of heart failure (R- a hyperthyroid crisis results in marked manifs of hyperthyroidism, w fever tachycardia, heart failure, shock, hyperthermia, agitation, N/V/D, delirium, and coma. Although exophthalmos may be present in pt w Gravs', it is not a signif factor in hyperthyroid crisis. Hoarsness and laryngeal stridor are ch of tetany of hypoparathyroidsm, and lethargy progressing to coma is characteristic of myxedema coma, a complication of hypothyroidism.

A client with Cushing's syndrome verbalizes concern to the nurse regarding the appearance of the buffalo hump that has developed. Which statement should the nurse make to the client? 1. "Don't be concerned; this problem can be covered with clothing." 2. "Usually these physical changes slowly improve following treatment." 3. "This is permanent, but looks are deceiving and are not that important." 4. "Try not to worry about it; there are other things to be concerned about."

"Usually these physical changes slowly improve following treatment."

A client is admitted to the hospital with a diagnosis of Addison's disease. The nurse would assess for which problem as a manifestation of this disorder? 1. Edema 2. Obesity 3. Hirsutism 4. Hypotension

Hypotension

What does a cushings syndrome diet look like?

Increased protein & K but decreased calories, carbs, Na.

What are two complication of transphenoidal hypophysectomy?

Meningitis (check for clear fluid from nose, decrease stimulation, seizure precautions) and DIABETES INSIPIDUS (decrease ADH=decreased concentration=decreas SG<1.010).

During physical examination of a client, which finding is characteristic of hypothyroidism? 1. Periorbital edema 2. Flushed warm skin 3. Hyperactive bowel sounds 4. Heart rate of 120 beats/min

Periorbital edema

What if the medical tx for cushings is unsuccessful?

Remove adrenal glands and turn into addisons patient (can control addisons with steroids)

What are the S&S of hypthyroidism (AKA myxedema)?

SLOW AND LOW, LETHARGY, CONSTIPATION, MENSTRUAL DISTURBANCES, DULL-BLANK EXPRESSION, INTOLERANCE TO COLD, RECEDING HAIRLINE, ANOREXIA, BRITTLE HAIR AND NAILS.

A client is admitted to the hospital with a diagnosis of Addison's disease. The nurse would monitor for which problems associated with this disease? Select all that apply. 1. Obesity 2. Syncope 3. Hirsutism 4. Hypotension 5. Muscle weakness

Syncope, hypotension, muscle weakness

What should you have available post thyroidectomy?

Tracheostomy set in case an emergency airway is needed. (tight sutures so possible compromise)

What should you teach the patient about a i131 test?

Used to test thyroid function, can't have an iodine allergy, stop thyroid meds 1 week before test, can't be pregnant, MAKE SURE DONE BEFORE OTHER IODINE TESTS!

The nurse is caring for a client after thyroidectomy. The nurse notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed for which purpose? 1. To treat thyroid storm 2. To prevent cardiac irritability 3. To treat hypocalcemic tetany 4. To stimulate release of parathyroid hormone

To treat hypocalcemic tetany

During routine nursing assessment after hypophysectomy, a client complains of thirst and frequent urination. Knowing the expected complications of this surgery, what should the nurse assess next? 1. Serum glucose 2. Blood pressure 3. Respiratory rate 4. Urine specific gravity

Urine specific gravity

What will need life long replacement following transphenoidal hypophysectomy?

Vasopressin (suppresses pee), Cortisone, Thyroid, and Sex hormones

The nurse is caring for a client scheduled for a transsphenoidal hypophysectomy. The preoperative teaching instructions should include which most important statement? 1. "Your hair will need to be shaved." 2. "You will receive spinal anesthesia." 3. "You will need to ambulate after surgery." 4. "Brushing your teeth will not be permitted for at least 2 weeks after surgery."

"Brushing your teeth will not be permitted for at least 2 weeks after surgery."

The nurse is caring for a client who had a transsphenoidal hypophysectomy. Which statements should the nurse include in the discharge teaching instructions? Select all that apply. 1. "Include adequate fiber and fluids in your diet." 2. "Wear slip on shoes rather than those that need to be tied." 3. "A post-nasal drip may be expected for several weeks after surgery." 4. "Brushing your teeth will not be permitted for at least 2 weeks after surgery." 5. "Contact your health care provider (HCP) immediately if you develop any headache, fever, or neck stiffness."

1. "Include adequate fiber and fluids in your diet." 2. "Wear slip on shoes rather than those that need to be tied." 4. "Brushing your teeth will not be permitted for at least 2 weeks after surgery." 5. "Contact your health care provider (HCP) immediately if you develop any headache, fever, or neck stiffness."

A client has been diagnosed with hyperthyroidism. Which signs and symptoms may indicate thyroid storm, a complication of this disorder? Select all that apply. 1. Fever 2. Nausea 3. Lethargy 4. Tremors 5. Confusion 6. Bradycardia

1. Fever 2. Nausea 4. Tremors 5. Confusion

The nurse is developing a plan of care for a client with Addison's disease. The nurse has identified a problem of risk for deficient fluid volume and identifies nursing interventions that will prevent this occurrence. Which nursing interventions should the nurse include in the plan of care? Select all that apply. 1. Monitor for changes in mentation. 2. Encourage an intake of low-protein foods. 3. Encourage an intake of low-sodium foods. 4. Encourage fluid intake of at least 3000 mL per day. 5. Monitor vital signs, skin turgor, and intake and output.

1. Monitor for changes in mentation. 4. Encourage fluid intake of at least 3000 mL per day. 5. Monitor vital signs, skin turgor, and intake and output.

The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1. Provide a warm environment for the client. 2. Instruct the client to consume a low-fat diet. 3. A thyroid-releasing inhibitor will be prescribed. 4. Encourage the client to consume a well-balanced diet. 5. Instruct the client that thyroid replacement therapy will be needed. 6. Instruct the client that episodes of chest pain are expected to occur.

1. Provide a warm environment for the client. 2. Instruct the client to consume a low-fat diet. 4. Encourage the client to consume a well-balanced diet. 5. Instruct the client that thyroid replacement therapy will be needed.

The nurse is providing home care instructions to the client with a diagnosis of Cushing's syndrome and prepares a list of instructions for the client. Which instructions should be included on the list? Select all that apply. 1. The signs and symptoms of hypoadrenalism 2. The signs and symptoms of hyperadrenalism 3. Instructions to take the medications exactly as prescribed 4. The importance of maintaining regular outpatient follow-up care 5. A reminder to read the labels on over-the-counter medications before purchase

1. The signs and symptoms of hypoadrenalism 2. The signs and symptoms of hyperadrenalism 3. Instructions to take the medications exactly as prescribed 4. The importance of maintaining regular outpatient follow-up care

A client's serum calcium level is high. The nurse plans care knowing that which hormones are directly responsible for maintaining the free or unbound portion of the serum calcium within normal limits? 1. Thyroid hormone 2. Parathyroid hormone 3. Follicle-stimulating hormone 4. Adrenocorticotropic hormone

Parathyroid hormone

A nurse is caring for a client after hypophysectomy. The nurse notices clear nasal drainage from the client's nostril. The initial nursing action would be to: 1. Lower the head of the bed. 2. Test the drainage for glucose. 3. Obtain a culture of the drainage. 4. Continue to observe the drainage.

2. R: After hypophysectomy, the client should be monitored for rhinorrhea, which could indicate a cerebrospinal fluid leak. If this occurs, the drainage should be collected and tested fir the presence of cerebrospinal fluid. The head of the bed should not be lowered to prevent increased intracranial pressure. Clear nasal drainage would not indicate the need for a culture. Continuing to observe the drainage without taking action could result in a serious complication.

A nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? 1. Diarrhea 2. Polyuria 3. Polyphagia 4. Weight gain

2. R: Hypercalcemia is the hallmark of hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis and thus polyuria. This diruesis leads to dehydration (weight loss rather than weight gain). Options 1, 3, and 4 are gastrointestinal symptoms and are not associated with the common gastrointestinal symptoms typical of hyperparathyroidism (nausea, vomiting, anorexia, constipation).

A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially? 1. Warm the client. 2. Maintain a patent airway. 3. Administer thyroid hormone. 4. Administer fluid replacement.

2. R: The initial nursing action would be to maintain a patent airway. Oxygen would be administered, followed by fluid replacement, keeping the client warm, monitoring VS, and administering thyroid hormones by the intravenous route.

What are the S&S of Addisons?

Bronze pigmentation of skin, changes in distribution of body hair (hirsutism), weakness, weight loss, hypoglycemia, hypotension.

A nurse is providing home care instructions to a client with a diagnosis of Addison's disease. Which statement by the client indicates a need for further instruction? 1. "I need to wear a Medic-Alert bracelet." 2. "I need to purchase a travel kit that contains cortisone." 3. "I will need to take daily medications until my symptoms decrease." 4. "I need an increased dose of glucocorticoid medication during stressful minor illnesses."

I will need to take my daily medications until my symptoms decrease.

The nurse is caring for a client after thyroidectomy. The client expresses concern about the postoperative voice hoarseness she is experiencing and asks if the hoarseness will subside. The nurse should provide the client with which information? 1. The hoarseness is permanent. 2. It indicates nerve damage. 3. It is normal during this time and will subside. 4. It will worsen before it subsides, which may take 6 months.

It is normal during this time and will subside

36. RN observes a nursing assistant (NA) caring for a patient after a hypophysectomy. Which action by the NA requires that the RN intervene? a. The NA lowers the HOB to the flat position. b. The NA cautions the patient to avoid coughing. c. The NA cleans the patient's mouth with a swab. d. NA collects a urine specimen for specific gravity

A R: HOB should be elevated about 30 degrees to decrease pressure on the sella turcica and avoid headaches. The other actions by the NA are appropriate after this surgery. (Cognitive Level: Application Text : p. 1293 NProcess: Implementation NCLEX: Safe and Effective Care Enviro)

24. After neck surgery, a patient develops hypoparathyroidism. The nurse should plan to teach the patient about a. calcium supplementation to normalize serum calcium levels. b. including whole grains in the diet to prevent constipation. c. use of bisphosphonates to reduce bone demineralization. d. having a high fluid intake to decrease risk for nephrolithiasis.

A R: Oral calcium supplements are used to maintain the serum calcium in normal range and prevent the complications of hypocalcemia. Whole-grain foods decrease calcium absorption and will not be recommended. Bisphosphonates will lower serum calcium level further by preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of hypoparathyroidism and low calcium levels.

18. A patient with hyperthyroidism is treated with radioactive iodine (RAI) at a clinic. Before the patient is discharged, the nurse instructs the pt a. to monitor for symptoms of hypothyroidism, such as easy bruising and cold intolerance. b. to discontinue the antithyroid medications taken before the radioactive therapy. c. that symptoms of hyperthyroidism should be relieved in about a week. d. about radioactive precautions to take with urine, stool, and other body secretions.

A R: There is a high incidence of post-radiation hypothyroidism after RAI, and the pt should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with maximum effect not seen for 2-3 months, and pt will continue to take antithyroid medications during this time. The therapeutic dose of radioactive iodine is low enough that no radiation safety precautions are needed.

The nursing instructor asks a nursing student to identify the risk factors associated with the development of thyrotoxicosis. The student demonstrates understanding of the risk factors by identifying an increased risk for thyrotoxicosis in which client? 1. A client with hypothyroidism 2. A client with Graves' disease who is having surgery 3. A client with diabetes mellitus scheduled for a diagnostic test 4. A client with diabetes mellitus scheduled for débridement of a foot ulcer

A client with Graves' disease who is having surgery

A client with hypovolemia experiences activation of the renin-angiotensin system to maintain blood pressure. The nurse plans care, understanding that, as part of this response, the endocrine system will increase production and secretion of which mineralocorticoid? 1. Cortisol 2. Glucagon 3. Aldosterone 4. Adrenocorticotropic hormone

Aldosterone

A 33-year-old female client is admitted to the hospital with a tentative diagnosis of Graves' disease. Which symptom related to the menstrual cycle would the client be most likely to report during the initial assessment? 1. Amenorrhea 2. Menorrhagia 3. Metrorrhagia 4. Dysmenorrhea

Amenorrhea

17. The first nursing action indicated when a patient returns to the surgical nursing unit following a thyroidectomy is to a. check the dressing for bleeding. b. assess respiratory rate and effort. c. support the patient's head with pillows. d. take the blood pressure and pulse.

B R: Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany, and priority nursing action is to assess airway. The other actions are also part of the standard nursing care post-thyroidectomy but are not as high in priority.

30. A pt is hospitalized with acute adrenal insufficiency. The nurse determines that the pt is responding favorably to treatment upon finding a. decreasing serum sodium. b. decreasing serum potassium. c. decreasing blood glucose. d. increasing urinary output.

B R: CMs of Addison's disease include hyperkalemia and a decrease in potassium level indicates improvement. Decreasing serum sodium and decreasing blood glucose indicate that treatment has not been effective. Changes in urinary output are not an effective way of monitoring treatment for Addison's disease.

23. Following a thyroidectomy, a patient develops carpal spasm while the nurse is taking a blood pressure on the left arm. Which action by the nurse is appropriate? a. Administer the ordered muscle relaxant. b. Have the patient rebreathe using a paper bag. c. Start oxygen at 2 to 3 L/min per cannula. d. Give the ordered oral calcium supplement.

B R: Carpal spasm after a thyroidectomy suggests that pt has hypocalcaemia caused by damage to the parathyroid glands. The symptoms of hypocalcemia will be temporarily reduced by having the patient breath into a paper bag, which will raise the PaCO2 and create a more acidic pH. The muscle relaxant will not impact on ionized calcium level. There is no indication that the patient is experiencing laryngeal stridor or needs oxygen. IV calcium supplements will be given to normalize calcium level quickly.

28. When providing postoperative care for a patient who has had bilateral adrenalectomy, which assessment information obtained by the nurse is most important to communicate to HCP? a. The blood glucose is 156 mg/dl. b. The patient's blood pressure is 102/50. c. The patient has 5/10 incisional pain. d. The lungs have bibasilar crackles.

B R: During immediate postoperative period, marked fluctuation in cortisol levels may occur and the nurse must be alert for signs of acute adrenal insufficiency such as hypotension. nurse should also address elevated glucose, incisional pain, and crackles with appropriate collaborative or nursing actions, but prevention and treatment of acute adrenal insufficiency is the priority after adrenalectomy.

31. A pt is admitted to the hospital in addisonian crisis 1 month after a diagnosis of Addison's disease. The nurse identifies the nursing diagnosis of ineffective therapeutic regimen management related to lack of knowledge of management of condition when the patient says, a. "I double my dose of hydrocortisone on the days that I go for a run." b. "I had the stomach flu earlier this week and couldn't take the hydrocortisone." c. "I frequently eat at restaurants, and so my food has a lot of added salt." d. "I do yoga exercises almost every day to help me reduce stress and relax."

B R: The need for hydrocortisone replacement is increased with stressors such as illness, and the patient needs to be taught to call the health care provider because medication and IV fluids and electrolytes may need to be given. The other patient statements indicate appropriate management of the Addison's disease.

16. The nurse identifies a nursing dx of risk for injury: corneal ulceration related to inability to close the eyelids secondary to exophthalmos for a patient with Graves' disease. An appropriate nursing intervention for this problem is to a. teach the patient to blink every few seconds to lubricate the cornea. b. elevate the head of the patient's bed to reduce periorbital fluid. c. apply eye patches to protect the cornea from irritation. d. place cold packs on the eyes to relieve pain and swelling.

B R: The patient should sit upright as much as possible to promote fluid drainage from the periorbital area. With exophthalmos, the pt is unable to close eyes completely. Lubrication of the eyes, rather than eye patches, will protect the eyes from developing corneal scarring. The swelling of the eye is not caused by excessive blood flow to the eye, so cold packs will not be helpful.

15. A few hours after returning to the surgical nursing unit, a patient who has undergone a subtotal thyroidectomy develops laryngeal stridor and a cramp in the right hand. The nurse anticipates that intervention will include a. administration of IV morphine. b. administration of IV calcium gluconate. c. endotracheal intubation with mechanical ventilation. d. immediate tracheostomy and manual ventilation.

B R: The pt's CMs are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Tracheostomy may be needed if the calcium does not resolve the stridor. There is no indication that morphine is needed. Endotracheal intubation may be done, but only if calcium is not effective in correcting stridor

2. During preoperative teaching for a patient scheduled for transsphenoidal hypophysectomy for treatment of a pituitary adenoma, the nurse instructs the patient about the need to a. remain on bed rest for the first 48 hours after the surgery. b. avoid brushing the teeth for at least 10 days after the surgery. c. cough and deep-breathe every 2 hrs postoperatively. d. be positioned flat with sandbags at the head postoperatively.

B R: To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is discouraged because it may cause leakage of cerebrospinal fluid (CSF) from the suture line. The head of the bed should be elevated 30 degrees to reduce pressure on the sella turcica and decrease the risk for headaches. (Cognitive Level: Application Text Reference: p. 1293 NProcess: Implementation NCLEX: Physiological Integrity)

4. A pt is suspected of having a pituitary tumor causing panhypopituitarism. During assessment of the pt, the nurse would expect to find a. elevated blood glucose. b. changes in secondary sex characteristics. c. high blood pressure. d. tachycardia and cardiac palpitations.

B Rationale: Changes in secondary sex characteristics are associated with decreases in FSH and LH. Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of decreases in ACTH and cortisol. Bradycardia is likely due to the decrease in TSH and thyroid hormones associated with panhypopituitarism. (Cognitive Level: Application Text Reference: p. 1294 NProcess: Assessment NCLEX: Physiological Integrity)

37. After a patient with a pituitary adenoma has had a hypophysectomy, the nurse will plan to do discharge teaching about the need for a. insulin use to maintain blood glucose at normal levels. b. Na restriction to prevent fluid retention and hypertension. c. oral corticosteroids to replace endogenous cortisol. d. chemotherapy to prevent reoccurrence of tumor

C R: ADH, cortisol, and thyroid hormone replacement will be needed for life after hypophysectomy. Without the effects of ACTH and cortisol, the blood glucose and serum sodium will be low unless cortisol is replaced. An adenoma is a benign tumor, and chemotherapy will not be needed. (Cognitive Level: Application Text Reference: p. 1293 NProcess: Planning NCLEX: Physiological Integrity)

29. A patient with Cushing syndrome returns to the surgical unit following an adrenalectomy. During the initial postoperative period, the nurse gives the highest priority to a. monitoring for infection. b. protecting the patient's skin. c. maintaining fluid and electrolyte status. d. preventing severe emotional disturbances.

C R: After adrenalectomy, the pt is at risk for circulatory instability caused by fluctuating hormone levels, and the focus of care is to assess and maintain fluid and electrolyte status through the use of IV fluids and corticosteroids. other goals are also important for pt but arent as immediately life-threatening as circulatory collapse

13. During the nursing assessment of a patient with Graves' disease, the nurse notes a bounding, rapid pulse and systolic hypertension. Based on these assessment data, which question is important for the nurse to ask the patient? a. "Do you have any problem with frequent constipation?" b. "Have you noticed any recent decrease in your appetite?" c. "Do you ever have any chest pain?" d. "Have you had recent muscle aches?"

C R: Angina is a possible complication of Graves' disease, especially for a patient with tachycardia and hypertension. The other CMs are associated with hypothyroidism.

12. A patient with Graves' disease is prepared for surgery with drug therapy consisting of 4 weeks of propylthiouracil (PTU) and 10 days of iodine before surgery. When teaching the patient about the drugs, the nurse explains that the drugs are given preoperatively to a. eliminate the risk for tetany during the postoperative period. b. decrease the risk of hypometabolism during and after the surgery. c. normalize metabolism and decrease the size and vascularity of the gland. d. assist in differentiating the thyroid and parathyroid glands during surgery.

C R: Antithyroid drugs and iodine decrease the levels of thyroid hormone and the vascularity of the thyroid gland prior to surgery and lower the risk for postoperative thyrotoxicosis and hemorrhage. Postoperative tetany might be caused by removal of the parathyroid gland during thyroidectomy. The medications will tend to decrease metabolic rate. The medications will not help in differentiating the tissues of the thyroid and parathyroid glands.

6. A patient with an antidiuretic hormone (ADH)-secreting small-cell cancer of the lung is treated with demeclocycline (Declomycin) to control the symptoms of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse determines that the demeclocycline is effective upon finding that the a. patient's daily weight is stable. b. urine specific gravity is increased. c. patient's urinary output is increased. d. peripheral edema is decreased.

C R: Demeclocycline blocks the action of ADH on the renal tubules and increases urine output. A stable body weight and an increase in urine specific gravity indicate that the SIADH is not corrected. Peripheral edema does not occur with SIADH; a sudden weight gain without edema is a common clinical manifestation of this disorder.

34. A patient has an adrenocortical adenoma causing hyperaldosteronism and is scheduled for laparoscopic surgery to remove the tumor. During care before surgery, the nurse should a. monitor blood glucose level every 4 hours. b. provide a potassium-restricted diet. c. monitor the blood pressure every 4 hours. d. relieve edema by elevating the extremities.

C R: HTN caused by Na retention is a common complication of hyperaldosteronism. Hyperaldosteronism does not cause elevation in blood glucose. pt will be hypokalemic and require potassium supplementation prior to surgery. Edema does not usually occur with hyperaldosteronism. (Cognitive Level: Application Text : pp. 1319-1320 NProcess: Implementation NCLEX: Physiological Integrity)

14. While assessing a patient who has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy, the nurse obtains these data. Which information is most important to communicate to the surgeon? a. The pt is complaining of 7/10 incisional pain. b. The pt's cardiac monitor shows a HR of 112. c. The patient has increasing swelling of the neck. d. The pat's voice is weak and hoarse sounding.

C R: The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to prevent airway obstruction. The incisional pain should be treated but is not unusual after surgery. A heart rate of 112 is not unusual in a pt who has been hyperthyroid and has just arrived in the PACU from surgery. Vocal hoarseness is expected after surgery due to edema.

26. A nursing assessment of a patient with Cushing syndrome reveals that the patient has truncal obesity and thin arms and legs. An additional manifestation of Cushing syndrome that the nurse would expect to find is a. chronically low blood pressure. b. decreased axillary and pubic hair. c. purplish red streaks on the abdomen. d. bronzed appearance of the skin.

C Rationale: Purplish-red striae on the abdomen are a common clinical manifestation of Cushing syndrome. Hypotension and bronzed-appearing skin are manifestations of Addison's disease. Decreased axillary and pubic hair occur with androgen deficiency.

27. A pt with Cushing syndrome is admitted to the hospital to have laparoscopic adrenalectomy. During the admission assessment, the patient tells the nurse, "The worst thing about this disease is how terrible I look. I feel awful about it." best response by the nurse is a. "Let me show you how to dress so that the changes are not so noticeable." b. "I do not think you look bad. Your appearance is just altered by your disease." c. "Most of the physical and mental changes caused by the disease will gradually improve after surgery." d. "You really should not worry about how you look in the hospital. We see many worse things."

C Rationale: The most reassuring communication to the patient is that the physical and emotional changes caused by the Cushing syndrome will resolve after hormone levels return to normal postoperatively. The response beginning "Let me show you how to dress" indicates that the changes are permanent and that the patient's appearance needs disguising. The response beginning, "I do not think you look bad" does not acknowledge the patient's feelings and also fails to communicate that the changes will be resolved after surgery. And the response beginning "You really should not worry about how you look in the hospital" implies that the pt's appearance is not good.

11. When teaching a patient newly diagnosed with Graves' disease about the disorder, the nurse explains that a. restriction of iodine intake is needed to reduce thyroid activity. b. exercise is contraindicated to avoid increasing metabolic rate. c. surgery will eventually be required to remove the thyroid gland. d. antithyroid medications may take several weeks to have an effect.

D R: Improvement usually begins in 1-2 wks w good results at 4-6 weeks. Large doses of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large muscle groups is encouraged to decrease irritability and hyperactivity associated with high levels of thyroid hormones. Radioactive iodine is the most common trtmt for Graves' disease, although surgery may be used.

40. After receiving change-of-shift report about these pts, which patient should nurse assess first? a. A 22-year-old admitted with SIADH who has a serum sodium level of 130 mEq/L. b. A 31-year-old who has iatrogenic Cushing's syndrome with a capillary blood glucose level of 244 mg/dl. c. A 53-year-old who has Addison's disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef). d. A 70-year-old who recently started levothyroxine (Synthroid) to treat hypothyroidism and has an irregular pulse of 134.

D R: Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The pt's high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other pts also require nursing assessment and/or actions but are not at risk for life-threatening complications. (Cognitive Level: Application Text Reference: p. 1306 Nursing Process: Planning NCLEX: Physiological Integrity)

25. A patient with hypoparathyroidism receives instructions from the nurse regarding symptoms of hypocalcemia and hypercalcemia. The nurse teaches the patient that if mild symptoms of hypocalcemia occur, the patient should a. increase daily fluid intake to twice usual amount b. self-administer IM calcium before calling doctor. c. call an ambulance because the symptoms will progress to seizures. d. rebreathe with a paper bag and then seek medical assistance.

D R: Rebreathing may help alleviate mild sx, but it will only temporarily increase ionized calcium level, so the pt should call HCP. There is no need to increase fluid intake. Calcium is not given IM but given slowly through IV route. Mild hypocalcemia is unlikely to progress to seizures.

A nurse is caring for a client who had a thyroidectomy 1 day ago. Which client laboratory data should the nurse identify as a possible thyroid surgery complication? 1. Increased serum sodium level 2. Increased serum glucose level 3. Decreased serum calcium level 4. Decreased serum albumin level

Decreased serum calcium level

What is the treatment for hyperthyroidism (graves disease)?

Diet: 6-8000 cal/day, propylthiaracil (blocks thyroid hormone), if propythiaracil doesn't work take i131 test (destroys gland so become myxedema pt on synthroid).

The nurse has documented the problem of body image distortion for a client with a diagnosis of Cushing's syndrome. The nurse identifies nursing interventions related to this problem and includes these interventions in the plan of care. Which nursing intervention is inappropriate? 1. Encourage client's expression of feelings. 2. Assess the client's understanding of the disease process. 3. Encourage family members to share their feelings about the disease process. 4. Encourage the client to recognize that the body changes need to be dealt with.

Encourage the client to recognize that the body changes need to be dealt with

What are the S&S of hyperthyroidism (Graves disease)?

FAST AND HIGH, intolerance to heat, fine straight hair, facial flushing, tachycardia, weight loss, diarrhea, finger clubbing, amenorrhea, BULGING EYES, localized edema.

The nurse is monitoring a client with Graves' disease for signs of thyrotoxic crisis (thyroid storm). Which signs or symptoms, if noted in the client, will alert the nurse to the presence of this crisis? 1. Fever and tachycardia 2. Pallor and tachycardia 3. Agitation and bradycardia 4. Restlessness and bradycardia

Fever and tachycardia

A nurse is reviewing the assessment findings and laboratory data for a client with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse understands that which symptoms are associated characteristics of this disorder? Select all that apply. 1. Hypernatremia 2. Signs of water deficit 3. High urine osmolality 4. Low serum osmolality 5. Hypotonicity of body fluids 6. Continued release of antidiuretic hormone

High urine osmolality Low serum osmolality Hypotonicity of body fluids Continued release of ADH

The nurse is caring for a client who is scheduled to have a thyroidectomy and provides instructions to the client about the surgical procedure. Which client statement indicates an understanding of the nurse's instructions? 1. "I expect to experience some tingling of my toes, fingers, and lips after surgery." 2. "I will definitely have to continue taking antithyroid medications after this surgery." 3. "I need to place my hands behind my neck when I have to cough or change positions." 4. "I need to turn my head and neck front, back, and laterally every hour for the first 12 hours after surgery."

I need to place my hands behind my neck when I have to cough or change positions

What values are Cushing's pts low in?

K only everything else is high (Na, H20, BP, BS)

The nurse has developed a postoperative plan of care for a client who had a thyroidectomy and documents that the client is at risk for developing an ineffective breathing pattern. Which nursing intervention should the nurse include in the plan of care? 1. Maintain a supine position. 2. Monitor neck circumference every 4 hours. 3. Maintain a pressure dressing on the operative site. 4. Encourage deep breathing exercises and vigorous coughing exercises.

Monitor neck circumference every 4 hours

What are the S&S of cushings syndrome? select all that apply

Moon face, hyperglycemia, purple striae, buffalo hump, GI distress, Na and fluid retention, everything increased except K (can have salt substitutes), and osteoporosis.

Can Addison's pts have salt substitutes?

NO because they are straight potassium.

A client with Graves' disease has exophthalmos and is experiencing photophobia. Which nursing action would best assist the client with these manifestations? 1. Obtain dark glasses for the client. 2. Lubricate the eyes with tap water every 2 to 4 hours. 3. Administer methimazole (Tapazole) every 8 hours around the clock. 4. Instruct the client to avoid straining or heavy lifting because this effort can increase eye pressure.

Obtain dark glasses for the client

A nurse is performing an assessment on a client after a thyroidectomy and notes that the client has developed hoarseness and a weak voice. Which nursing action is appropriate? 1. Check for signs of bleeding. 2. Administer calcium gluconate. 3. Notify the health care provider (HCP) immediately. 4. Reassure the client that this is usually a temporary condition.

Reassure the client that this is usually a temporary condition

What is a transphenoidal hypophysectomy?

Removal of pituitary gland by approach through the nose.

The nurse is caring for a client with a diagnosis of Addison's disease. The nurse is monitoring the client for signs of Addisonian crisis. The nurse should assess the client for which manifestation that would be associated with this crisis? 1. Agitation 2. Diaphoresis 3. Restlessness 4. Severe abdominal pain

Severe abdominal pain

A client with an endocrine disorder complains of weight loss and diarrhea, and says that he can "feel his heart beating in his chest." The nurse interprets that which gland is most likely responsible for these symptoms? 1. Thyroid 2. Pituitary 3. Parathyroid 4. Adrenal cortex

Thyroid=hyperthyroidism

The nurse is monitoring a client for signs of hypocalcemia after thyroidectomy. Which sign/symptom, if noted in the client, wouldmost likely indicate the presence of hypocalcemia? 1. Bradycardia 2. Flaccid paralysis 3. Tingling around the mouth 4. Absence of Chvostek's sign

Tingling around the mouth (Positive Chvostek's sign)

When caring for a patient with primary hyperaldosteronism, the nurse would question a physician's order for the use of a. Lasix b. amiloride (midamor) c. spironolactone (aldactone) d. aminoglutethimide (cytadren)

a. Lasix37 (R- hyperaldosteronism is an excess of aldosterone, which is manifested by sodium and water retention and potassium excretion. Lasix is a potassium-wasting diuretic that would increase the potassium deficiency. Aminoglutethimide blocks aldosterone synthesis; amiloride is apotassium-sparing diuretic; and spironolactone blocks mineralocorticoid receptors in the kidney, increasing secretion of sodium and water and retention of potassium.)

Preoperative instructions for the patient scheduled for a subtotal thyroidectomy includes teaching the patient a. how to support the head w hands when moving b. that coughing should due avoided to prevent pressure on the incision c. that the head and neck will need to remain immobile until the incision heals d. that any tingling around the lips or in the fingers after surgery is expected and temporary

a. how to support the head with the hands when moving (R- to prevent strain on suture line postoperatively, head must be manually supported while turning and moving in bed, but range-of-motion exercise for the head and neck are also taught preoperatively to be gradually implemented after surgery. There is no contraindication for coughing and deep breathing, and they should be carrier out postoperatively. Tingling around the lips or fingers is a sign of hypocalcemia, which may occur if the parathyroid glands are inadvertently removed during surgery, and should be reported immediately.)

When the patient with parathyroid disease experiences symptoms of hypocalcemia, a measure that can be used to temporarily raise serum calcium levels is to a. administer IV normal saline b. have the patient rebreathe in a paper bag c. administer Lasix as ordered d. administer oral phosphorous supplements

b. have the patient rebreathe in a paper bag (R- rebreathing in a paper bag promotes CO2 retention in blood, which lowers pH and creates an acidosis. An academia enhances solubility and ionization of calcium, increasing the proportion of total body Ca available in physiologically active form and relieving the sx of hypocalcemia. Saline promotes calcium excretion, as does Lasix. Phosphate levels in blood are reciprocal to calcium and an increase in phosphate promotes calcium excretion.)

A patient with Addison's disease comes to the emergency department with complaints of N/V/D, and fever. The nurse would expect collaborative care to include a. parenteral injections of ACTH b. IV administration of vasopressors c. IV administration of hydrocortisone d. IV administration of D5W with 20mEq of KCl

c. IV administration of hydrocortisone (R- vom and dia are early indicators of addisonian crisis and fever indicates an infection, which s causing additional stress for pt. trtmt of crisis requires immediate glucocorticoid replacement, and IV hydrocortisone, fluids, Na and glucose are necessary for 24hours. Addison's disease is a primary insufficiency of adrenal gland, and ACTH is not effective, nor would vasopressors be effective w fluid deficiency of Addison's. Potassium levels are incd in Addison's dz, and KCl would be contraindicated.)

When providing discharge instructions to a pt following a subtotal thyroidectomy, the nurse advises the patient to a. never miss a daily dose of thyroid replacement therapy b. avoid regular exercise until thyroid function is normalized c. avoid eating foods such as soybeans, turnips, and rutabagas d. use warm salt water gargles several times a day to relieve throat pain

c. avoid eating foods such as soybeans, turnips, and rutabagas (when pt has subtotal thyroidectomy, thyroid replacement therapy is not given, because exogenous hormone inhibits pituitary production of TSH and delays or prevents the restoration of thyroid tissue regeneration. However, pt should avoid goitrogens, foods that inhibit thyroid, such as soybeans, turnips, rutabagas, and peanut skins. REgular exercise stimulates thyroid gland and is encourage. Salt water gargles are used for dryness and irritation of mouth and throat following radioactive iodine therapy.)

To prevent complications in the patient with Cushing syndrome, the nurse monitors the pt for a. hypotension b. hypoglycemia c. cardiac arrhythmias d. decreased cardiac output

c. cardiac arrhythmias (R- electrolyte changes that occur in Cushing syndrome include Na retention and K excretion by kidney, resulting in hypokalemia, -may lead to cardiac arrhythmias/ arrest. Hypotension, hypoglycemia, decreased cardiac strength and output are characteristic of adrenal insufficiency.)

A pt with Grave's dz asks the nurse what caused the disorder. The best response by the nurse is a. "The cause of Grave's disease is not known, although it is thought to be genetic." b. "It is usually associated with goiter formation from an iodine deficiency over a long period of time." c. "Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones" d. "In genetically susceptible persons antibodies form that attack thyroid tissue and stimulate overproduction of thyroid hormones."

d. "In genetically susceptible persons antibodies form that attack thyroid tissue and stimulate overproduction of thyroid hormones." (R- The antibodies present in Graves' disease that attack thyroid tissue cause hyperplasia of the gland and stimulate TSH receptors on the thyroid and activate the production of thyroid hormones, creating hyperthyroidism. disease is not directly genetic, but individuals appear to have a genetic susceptibility to become sensitized to develop autoimmune antibodies. Goiter formation from insufficient iodine intake is usually associated with hypothyroidism.)