Chapter 49
A patient is to receive methylprednisolone (Solu-Medrol) 100 mg. The label on the medication states: methylprednisolone 125 mg in 2 mL. How many milliliters will the nurse administer?
1.6
Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)? a. Increased thyroxine (T4) level b. Blood pressure 112/62 mm Hg c. Distant and difficult to hear heart sounds d. Elevated thyroid stimulating hormone level
A An increased thyroxine level indicates the levothyroxine dose needs to be decreased. The other data are consistent with hypothyroidism and the nurse should administer the levothyroxine. DIF: Cognitive Level: Apply (application) REF: 1169 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
Which finding by the nurse when assessing a patient with Hashimoto's thyroiditis and a goiter will require the most immediate action? a. New-onset changes in the patient's voice b. Elevation in the patient's T3 and T4 levels c. Resting apical pulse rate 112 beats/minute d. Bruit audible bilaterally over the thyroid gland
A Changes in the patient's voice indicate that the goiter is compressing the laryngeal nerve and may lead to airway compression. The other findings will also be reported but are expected with Hashimoto's thyroiditis and do not require immediate action. DIF: Cognitive Level: Analyze (analysis) REF: 1163 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency? a. Increasing serum sodium levels b. Decreasing blood glucose levels c. Decreasing serum chloride levels d. Increasing serum potassium levels
A Clinical manifestations of Addison's disease include hyponatremia and an increase in sodium level indicates improvement. The other values indicate that treatment has not been effective. DIF: Cognitive Level: Apply (application) REF: 1178 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrit
The nurse providing care for a patient who has an adrenocortical adenoma causing hyperaldosteronism should a. monitor the blood pressure every 4 hours. b. elevate the patient's legs to relieve edema. c. monitor blood glucose level every 4 hours. d. order the patient a potassium-restricted diet.
A Hypertension caused by sodium retention is a common complication of hyperaldosteronism. Hyperaldosteronism does not cause an elevation in blood glucose. The patient will be hypokalemic and require potassium supplementation before surgery. Edema does not usually occur with hyperaldosteronism. DIF: Cognitive Level: Apply (application) REF: 1180 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. The nurse should plan to teach the patient about a. bisphosphonates to reduce bone demineralization. b. calcium supplements to normalize serum calcium levels. c. increasing fluid intake to decrease risk for nephrolithiasis. d. including whole grains in the diet to prevent constipation.
B 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 levels further by preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of hypoparathyroidism and low calcium levels. DIF: Cognitive Level: Apply (application) REF: 1174 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving. Discharge is expected to occur in 2 days. Which teaching strategy is likely to result in effective patient self-management at home? a. Delay teaching until closer to discharge date. b. Provide written reminders of information taught. c. Offer multiple options for management of therapies. d. Ensure privacy for teaching by asking the family to leave.
B Written instructions will be helpful to the patient because initially the hypothyroid patient may be unable to remember to take medications and other aspects of self-care. Because the treatment regimen is somewhat complex, teaching should be initiated well before discharge. Family members or friends should be included in teaching because the hypothyroid patient is likely to forget some aspects of the treatment plan. A simpler regimen will be easier to understand until the patient is euthyroid. DIF: Cognitive Level: Apply (application) REF: 1170 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
A 29-yr-old woman with systemic lupus erythematosus has been prescribed 2 weeks of high-dose prednisone therapy. Which information about the prednisone is most important for the nurse to include? a. "Weigh yourself daily to monitor for weight gain." b. "The prednisone dose should be decreased gradually." c. "A weight-bearing exercise program will help minimize risk for osteoporosis." d. "Call the health care provider if you have mood changes with the prednisone."
B Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped. Mood alterations and weight gain are possible adverse effects of corticosteroid use, but these are not life-threatening effects. Osteoporosis occurs when patients take corticosteroids for longer periods. DIF: Cognitive Level: Analyze (analysis) REF: 1177 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first? a. Patient with Hashimoto's thyroiditis and a heart rate of 102 b. Patient with tetany who has a new order for IV calcium chloride c. Patient with Cushing syndrome and a blood glucose of 140 mg/dL d. Patient with Addison's disease who takes hydrocortisone twice daily
B Emergency treatment of tetany requires IV administration of calcium; electrocardiographic monitoring will be required because cardiac arrest may occur if high calcium levels result from too-rapid administration. The information about the other patients indicates that they are more stable than the patient with tetany. DIF: Cognitive Level: Analyze (analysis) REF: 1168 OBJ: Special Questions: Multiple Patients | Special Questions: Prioritization TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment
Which nursing assessment of a 70-yr-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)? a. Fluid balance c. Nutritional intake b. Apical pulse rate d. Orientation and alertness
B In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication also is expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes will not result in potentially life-threatening complications. DIF: Cognitive Level: Analyze (analysis) REF: 1169 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? a. A 31-yr-old female patient with Cushing syndrome and a blood glucose level of 244 mg/dL b. A 70-yr-old female patient taking levothyroxine (Synthroid) who has an irregular pulse of 134 c. A 53-yr-old male patient who has Addison's disease and is due for a prescribed dose of hydrocortisone (Solu-Cortef). d. A 22-yr-old male patient admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L
B Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The patient's high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for life-threatening complications. DIF: Cognitive Level: Analyze (analysis) REF: 1169 OBJ: Special Questions: Prioritization | Special Questions: Multiple Patients TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment
Which question will the nurse in the endocrine clinic ask to help determine a patient's risk factors for goiter? a. "How much milk do you drink?" b. "What medications are you taking?" c. "Are your immunizations up to date?" d. "Have you had any recent neck injuries?"
B Medications that contain thyroid-inhibiting substances can cause goiter. Milk intake, neck injury, and immunization history are not risk factors for goiter. DIF: Cognitive Level: Understand (comprehension) REF: 1162 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
The nurse admits a patient to the hospital in Addisonian crisis. Which patient statement supports the need to plan additional teaching? a. "I frequently eat at restaurants, and my food has a lot of added salt." b. "I had the flu earlier this week, so I couldn't take the hydrocortisone." c. "I always double my dose of hydrocortisone on the days that I go for a long run." d. "I take twice as much hydrocortisone in the morning dose as I do in the afternoon."
B 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. DIF: Cognitive Level: Apply (application) REF: 1179 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 25. A 29-yr-old woman with systemic lupus erythematosus has been prescribed 2 weeks
The nurse will plan to monitor a patient diagnosed with a pheochromocytoma for a. flushing. c. bradycardia. b. headache. d. hypoglycemia.
B The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia, severe headache, diaphoresis, and abdominal or chest pain. Elevated blood glucose may also occur because of sympathetic nervous system stimulation. Bradycardia and flushing would not be expected. DIF: Cognitive Level: Apply (application) REF: 1181 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
A 37-yr-old patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy. Which information about the patient is most important to communicate to the surgeon? a. Difficult to awaken. c. Reports 7/10 incisional pain. b. Increasing neck swelling. d. Cardiac rate 112 beats/minute.
B 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 beats/min is not unusual in a patient who has been hyperthyroid and has just arrived in the PACU from surgery. Sleepiness in the immediate postoperative period is expected. DIF: Cognitive Level: Analyze (analysis) REF: 1168 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
Which nursing action will be included in the plan of care for a patient with Graves' disease who has exophthalmos? a. Place cold packs on the eyes to relieve pain and swelling. b. Elevate the head of the patient's bed to reduce periorbital fluid. c. Apply alternating eye patches to protect the corneas from irritation. d. Teach the patient to blink every few seconds to lubricate the corneas.
B The patient should sit upright as much as possible to promote fluid drainage from the periorbital area. With exophthalmos, the patient is unable to close the eyes completely to blink. 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. DIF: Cognitive Level: Apply (application) REF: 1167 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next? a. Suction the patient's airway. b. Administer IV calcium gluconate. c. Plan for emergency tracheostomy. d. Prepare for endotracheal intubation.
B The patient's clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Endotracheal intubation or tracheostomy may be needed if the calcium does not resolve the stridor. Suctioning will not correct the stridor. DIF: Cognitive Level: Apply (application) REF: 1168 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action will provide the patient with rapid relief from the symptoms? a. Administer the prescribed muscle relaxant. b. Have the patient rebreathe from a paper bag. c. Start the PRN O2 at 2 L/min per cannula. d. Stretch the muscles with passive range of motion.
B The patient's symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the patient breathe into a paper bag, which will raise the PaCO2 and create a more acidic pH. Applying as-needed O2 or range of motion will have no impact on the ionized calcium level. Calcium supplements will be given to normalize calcium levels quickly, but oral supplements will take time to be absorbed. DIF: Cognitive Level: Apply (application) REF: 1174 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
The nurse is caring for a patient following an adrenalectomy. The highest priority in the immediate postoperative period is to a. protect the patient's skin. c. balance fluids and electrolytes. b. monitor for signs of infection. d. prevent emotional disturbances.
C After adrenalectomy, the patient 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. The other goals are also important for the patient but are not as immediately life threatening as the circulatory collapse that can occur with fluid and electrolyte disturbances. DIF: Cognitive Level: Analyze (analysis) REF: 1177 OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first? a. Observe the dressing for bleeding. b. Check the blood pressure and pulse. c. Assess the patient's respiratory effort. d. Support the patient's head with pillows.
C Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany. The priority nursing action is to assess the airway. The other actions are also part of the standard nursing care postthyroidectomy but are not as high of a priority. DIF: Cognitive Level: Analyze (analysis) REF: 1168 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
Which information will the nurse teach a patient who has been newly diagnosed with Graves' disease? a. Exercise is contraindicated to avoid increasing metabolic rate. b. Restriction of iodine intake is needed to reduce thyroid activity. c. Antithyroid medications may take several months for full effect. d. Surgery will eventually be required to remove the thyroid gland.
C Medications used to block the synthesis of thyroid hormones may take 2 to 3 months before the full effect is seen. Large doses of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large muscle groups is encouraged to decrease the irritability and hyperactivity associated with high levels of thyroid hormones. Radioactive iodine is the most common treatment for Graves' disease, although surgery may be used. DIF: Cognitive Level: Apply (application) REF: 1165 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
A patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the nurse expect during the assessment? a. Chronically low blood pressure c. Purplish streaks on the abdomen b. Bronzed appearance of the skin d. Decreased axillary and pubic hair
C 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. DIF: Cognitive Level: Understand (comprehension) REF: 1175 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider? a. Patient's blood pressure is 148/94 mm Hg. b. Patient has bilateral 2+ pitting ankle edema. c. Patient stopped taking the medication 2 days ago. d. Patient has not been taking the prescribed vitamin D.
C Sudden cessation of corticosteroids after taking the medication for a week or more can lead to adrenal insufficiency, with problems such as severe hypotension and hypoglycemia. The patient will need immediate evaluation by the health care provider to prevent or treat adrenal insufficiency. The other information will also be reported but does not require rapid treatment. DIF: Cognitive Level: Analyze (analysis) REF: 1176 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
After obtaining the information shown in the accompanying figure regarding a patient with Addison's disease, which prescribed action will the nurse take first? a. Give 4 oz of fruit juice orally. b. Recheck the blood glucose level. c. Infuse 5% dextrose and 0.9% saline. d. Administer O2 therapy as needed.
C The patient's poor skin turgor, hypotension, and hyponatremia indicate an Addisonian crisis. Immediate correction of the hypovolemia and hyponatremia is needed. The other actions may also be needed but are not the initial action for the patient. DIF: Cognitive Level: Analyze (analysis) REF: 1179 OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
Which assessment finding for a 33-yr-old female patient admitted with Graves' disease requires the most rapid intervention by the nurse? a. Heart rate 136 beats/min c. Temperature 103.8° F (40.4° C) b. Severe bilateral exophthalmos d. Blood pressure 166/100 mm Hg
C The patient's temperature indicates that the patient may have thyrotoxic crisis and that interventions to lower the temperature are needed immediately. The other findings also require intervention but do not indicate potentially life-threatening complications. DIF: Cognitive Level: Analyze (analysis) REF: 1165 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
A 62-yr-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient a. about radioactive precautions to take with all body secretions. b. that symptoms of hyperthyroidism should be relieved in about a week. c. that symptoms of hypothyroidism may occur as the RAI therapy takes effect. d. to discontinue the antithyroid medications taken before the radioactive therapy.
C There is a high incidence of postradiation hypothyroidism after RAI, and the patient should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum effect not seen for 2 to 3 months, and the patient 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. DIF: Cognitive Level: Apply (application) REF: 1166 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
An 82-yr-old patient in a long-term care facility is newly diagnosed with hypothyroidism. The nurse will need to consult with the health care provider before administering the prescribed a. docusate (Colace). c. diazepam (Valium). b. ibuprofen (Motrin). d. cefoxitin (Mefoxin).
C Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older adults. The nurse should discuss the use of diazepam with the health care provider before administration. The other medications may be given safely to the patient. DIF: Cognitive Level: Apply (application) REF: 1169 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
A 44-yr-old female patient with Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be most helpful for the patient problem of disturbed body image related to changes in appearance? a. Reassure the patient that the physical changes are very common in patients with Cushing syndrome. b. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome. c. Teach the patient that the metabolic impact of Cushing syndrome is of more importance than appearance. d. Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.
D The most reassuring and accurate 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. Reassurance that the physical changes are expected or that there are more serious physiologic problems associated with Cushing syndrome are not therapeutic responses. The patient's physiological changes are caused by the high hormone levels, not by the patient's diet or exercise choices. DIF: Cognitive Level: Apply (application) REF: 1177 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
Which assessment finding of a 42-yr-old patient who had a bilateral adrenalectomy requires the most rapid action by the nurse? a. The blood glucose is 192 mg/dL. b. The lungs have bibasilar crackles. c. The patient reports 6/10 incisional pain. d. The blood pressure (BP) is 88/50 mm Hg.
D The decreased BP indicates possible adrenal insufficiency. The nurse should immediately notify the health care provider so that corticosteroid medications can be administered. The nurse should also address the elevated glucose, incisional pain, and crackles with appropriate collaborative or nursing actions, but prevention and treatment of acute adrenal insufficiency are the priorities after adrenalectomy. DIF: Cognitive Level: Analyze (analysis) REF: 1176 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
Which prescribed medication should the nurse expect will have rapid effects on a patient admitted to the emergency department in thyroid storm? a. Iodine c. Propylthiouracil b. Methimazole d. Propranolol (Inderal)
D b-Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function. DIF: Cognitive Level: Apply (application) REF: 1165 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
