N136 Week 1 - Lewis Adaptive Quizzing

Which level of urine cortisol in a 24-hour period indicates Cushing syndrome? 50 mcg/24 hr 70 mcg/24 hr 90 mcg/24 hr 110 mcg/24 hr

110 mcg/24 hr Urine cortisol levels higher than 100 mcg/24 hr indicates a high urinary cortisol level, which is observed in Cushing syndrome.

Which complication would the nurse include in the teaching plan when educating a patient about possible postsurgical complications related to a hypophysectomy? Seizures Infertility Cerebral edema Transient diabetes mellitus

Infertility

A patient has a dysfunction of the pituitary gland. Which hormone secretion may be altered in a patient with a dysfunction of the pituitary gland? Prolactin Thyroxine Erythropoietin Parathormone

Prolactin Prolactin is secreted by the pituitary gland. Thyroxine hormone is secreted by the thyroid gland. The kidney secretes erythropoietin. Parathormone is secreted by the parathyroid gland.

Which rationale is accurate when explaining to a patient with hypothyroidism and coronary artery disease (CAD) as to why the use of an enema is contraindicated? Vagus-nerve stimulation Olfactory-nerve stimulation Abducens-nerve stimulation Hypoglossal-nerve stimulation

Vagus-nerve stimulation Constipation is a common problem associated with hypothyroidism. The use of enemas, however, is contraindicated because they result in vagus-nerve stimulation for patients with a history of cardiac disease. Olfactory, abducens, and hypoglossal nerves are not affected by the use of enemas.

Which function do bile salts facilitate in the body? Protein metabolism Vitamin absorption Glucose metabolism Ammonia elimination

Vitamin absorption

Which clinical manifestations would the nurse assess in a patient with hyperthyroidism? Select all that apply. Weight loss Protrusion of the eyeballs Thick, cold, and dry skin Elevated BP Purplish-red marks on the abdomen

Weight loss Protrusion of eye balls Elevated BP Weight loss, protrusion of the eyeballs, and elevated BP are clinical manifestations of hyperthyroidism. Weight loss and hypertension are due to increases in metabolic demands; protrusion of the eyeballs is due in part to accumulation of fluid in the eyes. Thick, cold, and dry skin are symptoms of hypothyroidism. Purplish-red marks on the abdomen are seen in Cushing syndrome.

Which instruction would the nurse teach a patient with Addison's disease about corticosteroid therapy? "Plan a high-carbohydrate diet." "Increase your daily intake of sodium." "Decrease your daily intake of calcium." "Do not stop taking the medication abruptly."

"Do not stop taking the medication abruptly."

The nurse is teaching a student nurse about postoperative care for a patient who has undergone laparoscopic cholecystectomy. Which statements made by the student nurse indicate the need for further teaching? Select all that apply. "I will monitor for bleeding." "I will need to administer narcotics for pain control." "I will encourage the patient to practice deep breathing." "The patient will use a bedside commode for the first 24 hours after surgery." "The patient will need to return to the office in 10 days for removal of stitches."

"I will encourage the patient to practice deep breathing." "I will encourage the patient to practice deep breathing." "The patient will use a bedside commode for the first 24 hours after surgery." "The patient will need to return to the office in 10 days for removal of stitches." With laparoscopic cholecystectomy, there are small incisions that are covered by small adhesive bandages that can be removed in about five days. The stitches dissolve over time. Patients who have undergone laparoscopic cholecystectomy can usually walk to the bathroom, so there is no need for a bedside commode. Postoperative pain can usually be controlled with over-the-counter pain relievers. A cholecystectomy may result in changes in prothrombin time and may cause bleeding. Therefore the nurse should monitor for bleeding. Deep-breathing exercises should be encouraged to prevent postoperative pneumonia and to help relieve the patient's discomfort.

Which statement by the patient who is status post a transsphenoidal hypophysectomy indicates a need for further education? "It is important that I brush my teeth every day." "I should refrain from vigorous coughing and sneezing." "I should notify the nurse if I develop a severe headache." "I may need to take a stool softener so that I do not strain with having a bowel movement."

"It is important that I brush my teeth every day."

A patient diagnosed with acromegaly has developed speech difficulties and asks what is causing the problem. Which response by the nurse is accurate? "You have developed the condition from numbness of the vocal cords." "You have developed the condition due to overgrowth of the tongue." "You have developed the condition from an overgrowth of soft tissue in the neck." 'You have developed the condition related to upper airway narrowing."

"You have developed the condition due to overgrowth of the tongue." Acromegaly most often occurs because of a benign growth hormone (GH)-secreting pituitary adenoma. The excess GH results in an overgrowth of soft tissues and bones in the hands, feet, and face. Overgrowth of the tongue leads to dental and speech difficulties. The voice may deepen due to overgrowth of the vocal cords, but there is not a change in sensation. Soft tissue of the neck may overgrow, leading to difficulties with skin conditions such as acne. Upper airway narrowing can predispose the person with acromegaly to sleep apnea, not speech difficulties.

To promote optimal absorption, the nurse would instruct a patient to take their levothyroxine at which time? 0600 1200 1600 2100

0600 For maximum absorption, levothyroxine should be taken first thing in the morning on an empty stomach 30 minutes before breakfast. 1200, 1600, and 2100 may not result in adequate absorption.

Which diagnostic test would be done for a patient with a severe pounding headache who has been diagnosed with hypertension that is not responding to traditional treatment? Adrenocorticotropic hormone (ACTH) stimulation test A 24-hour urine cortisol Radioactive iodine uptake (RAIU) test A 24-hour urine collection for fractionated metanephrines

A 24-hour urine collection for fractionated metanephrines Pheochromocytoma should be suspected when hypertension does not respond to traditional treatment. The 24-hour urine collection for fractionated metanephrines is simple and reliable, with elevated values in 95% of people with pheochromocytoma. In a patient with pheochromocytoma preoperatively an α-adrenergic receptor blocker is used to reduce blood pressure. Abdominal palpation is avoided to avoid a sudden release of catecholamines and severe hypertension. Potassium-sparing diuretics are not needed; most likely they would be used for hyperaldosteronism, which is another cause of hypertension.

Which information would the nurse provide to the patient after a laparoscopic cholecystectomy? Do not return to work or normal activities for three weeks. Bile-colored drainage probably will drain from the incision. A diet lower in fat may be better tolerated for several weeks. Keep the bandages on and the puncture site dry until it heals.

A diet lower in fat may be better tolerated for several weeks. Although the usual diet can be resumed, a low-fat diet usually is better tolerated for several weeks following surgery. Normal activities can be resumed gradually as the patient tolerates. Bile-colored drainage or pus, redness, swelling, severe pain, and fever may all indicate infection. The bandage may be removed the day after surgery, and the patient can shower.

What patient is at greatest risk for developing colon polyps and colorectal cancer and should have a screening colonoscopy every three to four years? A patient with acromegaly A patient with prolactinomas A patient with hypopituitarism A patient with pituitary infarctions

A patient with acromegaly Patients with acromegaly are at higher risk for colon polyps and colorectal cancer and should have a screening colonoscopy performed every three to four years. Prolactinomas are the most common type of pituitary adenomas; these types of adenomas do not require colonoscopy. Hypopituitarism is a rare disorder that involves a decrease in one or more pituitary hormones; it does not require a screening colonoscopy. Pituitary infarctions are also called Sheehan syndrome; it involves the death of areas of tissue in the pituitary gland.

Which clinical manifestations would the nurse assess in a patient with hyperthyroidism? Select all that apply. Enlarged, scaly tongue A positive bruit upon auscultation of the thyroid gland Dry, thick, inelastic, and cold skin A goiter Clubbing of the fingers

A positive bruit upon auscultation of the thyroid gland A goiter Clubbing of the fingers In a patient with hyperthyroidism, auscultation of the thyroid gland reveals bruits and palpation of the thyroid gland reveals goiter, and the nurse may observe the acropachy (clubbing of the digits). Enlarged, scaly tongue and dry, thick, inelastic, and cold skin are observed in patients with hypothyroidism.

Which finding would the nurse expect in a patient who has cholecystitis? Spider angioma Flapping tremors Abdominal rigidity Grey Turner's sign

Abdominal rigidity Physical findings in patients with cholecystitis are abdominal rigidity and tenderness in the right upper quadrant. A spider angioma is a manifestation of liver cirrhosis wherein the patient has a small, dilated blood vessel with a red center and branching of the blood vessel. Flapping tremors are seen in patients with hepatic encephalopathy, which is characterized by rapid flexion and extension movements when asked to stretch the hand. Grey Turner's sign is a manifestation of acute pancreatitis characterized by bluish discoloration of the flanks.

Which condition can result if hypersecretion of growth hormone (GH) occurs after epiphyseal plate closure? Dwarfism Acromegaly Gigantism Cretinism

Acromegaly Excess GH after closure of the epiphyseal plates results in acromegaly. When there is excess GH before the epiphyseal plates close, then gigantism can result. Dwarfism is associated with a deficiency, not an excess of GH and cretinism can result as an effect of congenital hypothyroidism.

Which condition is associated with the symptoms of numbness and a "pins and needles" sensation in the thumb, middle, and index finger, especially at night? Acromegaly Hypopituitarism Hyperthyroidism Diabetes insipidus

Acromegaly In acromegaly, carpal tunnel syndrome may exist, which is characterized by feelings of numbness and discomfort in the thumb and fingers. Hypopituitarism leads to visual changes, loss of smell, and nausea and vomiting. Hyperthyroidism can be easily diagnosed by palpating the thyroid gland. Diabetes insipidus is mostly manifested by excessive thirst caused by frequent urination.

A patient who has 20-year history of hypothyroidism was admitted to the intensive care unit (ICU) with a decreased level of consciousness and a temperature of 96 degrees F. Which interventions would be included in the plan of care for this patient? Select all that apply. Performing radiotherapy Using a high-pressure mattress Providing oxygen therapy Administering thyroid hormone IV Monitoring cardiovascular status continuously

Administering thyroid hormone IV Monitoring cardiovascular status continuously

Which factor may be the cause of iatrogenic Addison's disease? Infarction Tuberculosis Fungal infections Adrenal hemorrhage

Adrenal hemorrhage Iatrogenic Addison's disease may be caused by an adrenal hemorrhage, which is related to anticoagulant therapy, chemotherapy, or ketoconazole therapy for acquired immunodeficiency syndrome (AIDS). Infarction, tuberculosis, and fungal infections may lead to Addison's disease.

The nurse would plan to teach a patient with Addison's disease about the need for which primary treatment? Blood transfusions Ablation of the thyroid Oral calcium supplementation Adrenocorticosteroid replacement therapy

Adrenocorticosteroid replacement therapy Because Addison's disease results from a deficiency of adrenocorticosteroid hormones, steroid therapy is the primary treatment. Blood transfusions, thyroid ablation, and oral calcium supplements are not primary treatments for Addison's disease.

Adrenocortical insufficiency develops secondary to inadequate secretion of which pituitary hormone? Antidiuretic hormone (ADH) Follicle-stimulating hormone (FSH) Thyroid-stimulating hormone (TSH) Adrenocorticotropic hormone (ACTH)

Adrenocorticotropic hormone (ACTH) Adrenocorticotropic hormone (ACTH) Adrenocortical insufficiency occurs as a result of an inadequate amount of serum cortisol, which occurs as a result of undersecretion of ACTH by the anterior pituitary. ADH and FSH are both secreted by the posterior pituitary, not the anterior pituitary. TSH is secreted by the anterior pituitary, but it acts on the thyroid gland to secrete thyroid hormones.

Which hormone plays a key role in the regulation of water balance and osmolarity? Oxytocin Growth hormone Arginine vasopressin Adrenocorticotropic hormone

Arginine vasopressin The hormones secreted by the posterior pituitary gland are antidiuretic hormone and oxytocin. They are produced in the hypothalamus and transported and stored in the posterior pituitary gland. Antidiuretic hormone (ADH) is also referred to as arginine vasopressin, which plays a major role in the regulation of water balance and osmolarity.

Which nursing intervention is a priority for a patient recovering from hypophysectomy? Maintaining patent IV access Monitoring the patient for increased temperature Offering the bedpan or urinal at least every two to three hours Assessing for signs of increased intracranial pressure (ICP)

Assessing for signs of increased intracranial pressure (ICP)

Which syndrome would be suspected in a patient who has Addison's disease along with other endocrine conditions? Hashimoto's thyroiditis Autoimmune polyglandular syndrome Multiple endocrine neoplasia Syndrome of inappropriate antidiuretic hormone (SIADH)

Autoimmune polyglandular syndrome Addison's disease is an autoimmune disorder caused by the destruction of adrenal tissue by antibodies. When it occurs along with other endocrine disorders, Addison's disease is called autoimmune polyglandular syndrome. Hashimoto's thyroiditis, multiple endocrine neoplasia syndrome, and SIADH are not associated with these conditions.

Which instructions would the nurse include in a teaching plan for a patient who has a history of coronary artery disease (CAD) and is newly diagnosed with hypothyroidism? Select all that apply. Eat a low-fiber diet. Avoid using enemas. Avoid using sedatives. Take the prescribed medication before breakfast. Alternate between the trade and generic brands of the medication

Avoid using enemas. Avoid using sedatives. Take the prescribed medication before breakfast.

The nurse would monitor for increases in which laboratory value in a patient being treated with dexamethasone? Sodium Calcium Potassium Blood glucose

Blood glucose Hyperglycemia, or increased blood glucose level, is an adverse effect of corticosteroid therapy. Sodium, calcium, and potassium levels are not affected directly by dexamethasone.

Which substance is involved in the development of cholelithiasis? Sodium Calcium Albumin Globulin

Calcium

A nurse caring for a patient with hyperparathyroidism would monitor the patient for which complication? Seizures Cataracts Dry, scaly skin Cardiac dysrhythmias

Cardiac dysrhythmias

Which food item would be included on a list of foods that fall under the category of goitrogens? Carrot Tomato Cauliflower Bell peppers

Cauliflower

The nurse notes that a patient is scheduled for a gallbladder removal. Which name for the procedure will be on the consent form? Splenectomy Cholecystectomy Cholecystojejunostomy Pancreaticoduodenectomy

Cholecystectomy

Which term is used for the formation of stones in the gallbladder? Biliary colic Cholangitis Cholecystitis Cholelithiasis

Cholelithiasis

A patient with cholelithiasis is experiencing severe itching. Laboratory findings reveal a 2.1 mg/dL bilirubin level. Which medication is likely to be prescribed? Nadolol Lactulose Vasopressin Cholestyramine

Cholestyramine Rationale: Bilirubin levels in a healthy individual are between 0.3 and 1.9 mg/dL. The patient's laboratory reports indicate hyperbilirubinemia, which results in jaundice. Moreover, the patient has severe itching, which is a sign of pruritus. Pruritus that is accompanied by jaundice is treated with cholestyramine.

Which instructions would the nurse include in a dietary teaching plan provided to a patient who is diagnosed with hyperthyroidism? Select all that apply. Eat a high-fiber diet. Consume a high-calorie diet. Eat snacks high in protein. Avoid caffeinated beverages. Decrease the intake of carbohydrates.

Consume a high-calorie diet. Eat snacks high in protein. Avoid caffeinated beverages.

Arrange the events in the order they occur in a patient who has developed diabetes insipidus. Increase in serum osmolality Decrease in antidiuretic hormone Decrease in water reabsorption Decrease in intravascular fluid volume

Decrease in antidiuretic hormone Decrease in water reabsorption Decrease in intravascular fluid volume Increase in serum osmolality Diabetes insipidus is caused by abnormalities in antidiuretic hormone levels. In patients with diabetes insipidus, the level of antidiuretic hormone is reduced; this leads to decreased reabsorption of water, increasing the urine output, which reduces the intravascular fluid volume and elevates the osmolality in the blood.

For which complication would a 35-year-woman who had a hypophysectomy and who developed a deficiency of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) be at risk? Slowed speech Impaired memory Increase in weight Decreased fertility rate

Decreased fertility rate When a hypophysectomy is performed on the pituitary gland, it may result in damage to the pituitary gland, which affects the release of TSH and LH associated with reproduction and development of eggs in women. Therefore decrease fertility rate is a side effect of the surgery .Memory impairment, increased weight gain, and slowed speech are manifestations of hypothyroidism.

Which finding is of most concern when the nurse review laboratory values for a patient who underwent thyroidectomy 48 hours ago? Increased thyroxine Decreased phosphorus Increased serum calcium Decreased serum calcium

Decreased serum calcium

Which condition is the goal for treating hypocalcemia? Increasing the pH Decreasing the pH Maintaining the pH Decreasing the calcium ionization level

Decreasing the pH A decreased pH will cause an acidic environment and increase the calcium ionization, which will in turn increase the available calcium in the blood and help the patient to recover from hypocalcemia. An increased pH will decrease calcium ionization, thereby decreasing the calcium level in the blood. If the pH is maintained, then there will be a nullifying effect on the calcium level. If the calcium ionization level is decreased, then the available calcium in the blood will become low.

Which clinical manifestation is seen with Addison's disease? Delusions Hypokalemia Hyperglycemia Truncal obesity

Delusions Rationale: Addison's disease occurs due to the hypofunction of adrenal cortex. This hypofunction manifests as delusions, which occur due to decreased levels of glucocorticoids. Hypokalemia, hyperglycemia, and truncal obesity are clinical manifestations of Cushing syndrome that occur due to hyperfunction of the adrenal cortex.

Which factor explains why patients with cholelithiasis experience pruritis? Solubility of bilirubin in urine Deposition of bile salts in tissues Decreased absorption of vitamin K Bile not flowing into the duodenum

Deposition of bile salts in tissues Pruritus is manifested by itching and is caused by deposition of bile salts in skin tissues. Solubility of bilirubin in the urine results in amber-colored urine that foams on shaking; it does not result in pruritus. When bile does not flow into the duodenum, it accumulates in the systemic circulation and results in obstructive jaundice, not pruritus. Vitamin K is an important element in the clotting pathway. Its decreased absorption may cause clotting problems, resulting in bleeding.

About which treatment would the nurse plan to teach a patient who is newly diagnosed with central diabetes insipidus (DI)? Indomethacin Thiazide diuretics Desmopressin acetate (DDVAP) Fluid restrictions

Desmopressin acetate (DDVAP) DDAVP, an analog of antidiuretic hormone, is the hormone replacement choice for central DI. Thiazide diuretics are used with nephrogenic DI because it does not respond to hormone therapy. Indomethacin is given for nephrogenic DI after a low-sodium diet and when thiazide drugs are not effective. Fluid is not restricted; a patient with DI will need fluid-replacement therapy due to severe dehydration.

Which condition is associated with acalculous cholecystitis? Cholangitis Choledolithiasis Diabetes mellitus Acute pancreatitis

Diabetes mellitus Acalculous cholecystitis is an inflammatory process that occurs in the absence of obstruction and is associated with diabetes mellitus. Cholangitis and choledolithiasis are complications of cholelithiasis, not acalculous cholecystitis. Perforation of the gallbladder commonly occurs in acalculous cholecystitis as one of the complications, a type of which is biliary-enteric fistula.

Which complication may arise if pheochromocytoma is left untreated? Diabetes mellitus Graves' disease Alzheimer's disease Chronic kidney disease

Diabetes mellitus Diabetes mellitus may occur if pheochromocytoma is left untreated. Graves' disease, Alzheimer's disease, and chronic kidney disease are not complications of pheochromocytoma.

Which clinical manifestations would the nurse assess in a hospitalized patient diagnosed with Graves' disease? Select all that apply. Bradycardia Dysrhythmias Systolic murmurs Distant heart sounds Systolic hypertension

Dysrhythmias Systolic murmurs Systolic hypertension Graves' disease is a term used to describe hyperthyroidism. Clinical manifestations associated with this disease process include tachycardia, dysrhythmia, systolic murmurs, and systolic hypertension. Hypothyroidism is associated with anemia and distant heart sounds.

Which endocrine problem is more common in men than in women? Grave's disease Thyroid nodules Hyperaldosteronism Ectopic adrenocorticotropic hormone production

Ectopic adrenocorticotropic hormone production Ectopic adrenocorticotropic hormone production is more common in men. Graves' disease affects four to eight times more women than men. Thyroid nodules affect up to four times more women than men. Hyperaldosteronism affects two times as many women as men.

Which laboratory results would confirm overt hyperthyroidism? Select all that apply. Elevated thyroid-stimulating hormone (TSH) level Elevated triiodothyronine (T3) level Low free thyroxine (T4) level Elevated free T4 level Low TSH level

Elevated triiodothyronine (T3) level Elevated free T4 level Low TSH level The primary laboratory findings to confirm the diagnosis of hyperthyroidism are low or undetectable TSH levels and elevated free thyroxine levels and T3 levels. Low free T4 levels and elevated TSH levels are found with hypothyroidism.

Which clinical manifestation is a classic finding in Graves' disease? Gingivitis Cretinism Exophthalmos Muscular dystrophy

Exophthalmos Exophthalmos is the protrusion of eyeballs from the orbits; it results from increased fat deposits and fluid in orbital tissues. It is a classic clinical manifestation in Graves' disease. Gingivitis, cretinism, and muscular dystrophy are not classic clinical manifestations associated with Graves' disease. p. 1150

A patient tells the nurse, "Gallstones were removed by passing shock waves into my gallbladder." Which procedure is the patient referring to? Cholecystojejunostomy Pancreaticoduodenectomy Balloon sphincteroplasty Extracorporeal shock-wave lithotripsy (ESWL)

Extracorporeal shock-wave lithotripsy (ESWL)

Which dietary substance would the nurse recommend limiting for a patient with acute cholecystitis? Fat Protein Calcium Carbohydrates

Fat

Activity intolerance in a patient with hypothyroidism is related to which side effect? Fatigue Diarrhea Weight loss Nervousness

Fatigue Activity intolerance in a patient with hypothyroidism is related to weakness and fatigue. Patients with hyperthyroidism, not hypothyroidism, experience weight loss, diarrhea, and nervousness.

Which parameter is monitored that would indicate a corticosteroid imbalance after surgery in a patient with Cushing syndrome? Temperature Infection Fluid intake Oxygen saturation

Fluid intake Rationale: Fluid intake should be monitored because there may be a chance of corticosteroid imbalance after surgery, which can cause dehydration. Temperature and oxygen saturation monitoring are not related to corticosteroid imbalance. Infections should be monitored during surgery.

Which characteristic is seen in syndrome of inappropriate antidiuretic hormone secretion (SIADH)? Polyuria Serum hyperosmolality Dilutional hypernatremia Fluid retention

Fluid retention The posterior pituitary gland secretes an excess of antidiuretic hormone (ADH), which ultimately increases fluid retention and causes decreased dilutional hyponatremia. SIADH is characterized by fluid retention, serum hypoosmolality, dilutional hyponatremia, and concentrated urine with normal intravascular volume. A patient with SIADH experiences low urine output, not polyuria, and serum hypoosmolality due to fluid retention, not serum hyperosmolality. A patient with SIADH does not experience dilutional hypernatremia because the sodium levels are low due to the expanding fluid volume.

A nurse completes an assessment and notes that a patient's thyroid gland is enlarged. With which condition is this finding consistent? Goiter Fibroma Thyrotoxicosis Hyperthyroidism

Goiter Thyroid abnormalities consist of three basic forms: goiter (enlarged thyroid gland), hypothyroidism, and hyperthyroidism. Goiter may be present in hyper- or hypofunction of the gland. A fibroma is a fibrous encapsulated connective tissue tumor not usually occurring in the thyroid gland. Thyrotoxicosis results from extreme hyperthyroidism or increased secretion of T3 and T4. Thyrotoxicosis is also known as thyroid storm or thyroid crisis. Hyperthyroidism is a condition resulting from an increase in production of T3 and T4. p. 1149

Which course of action would be taken if a patient has developed Cushing syndrome due to the prolonged administration of corticosteroid hormonal therapy? Withholding therapy for a few days Conversion to an alternate-week regimen Abrupt discontinuance of corticosteroids Gradual discontinuance of corticosteroids

Gradual discontinuance of corticosteroids Corticosteroid hormone doses should be decreased gradually until the discontinuation of therapy if the therapy leads to Cushing syndrome. The therapy should not be withheld for a few days. Alternate-day regimen cannot be applied for hormonal therapy. Discontinuing the therapy suddenly might lead to adrenal insufficiency, which is life threatening.

Which hormone has both mineralocorticoid and glucocorticoid properties? Cortisol Prednisone Aldosterone Hydrocortisone

Hydrocortisone Rationale: Hydrocortisone is an exogenous hormone that has both mineralocorticoid and glucocorticoid properties and is used to treat adrenal insufficiency. Cortisol is the primary glucocorticoid secreted by the adrenal cortex. Prednisone is an exogenous corticosteroid that is used to treat Cushing syndrome. Aldosterone is the primary mineralocorticoid secreted by the adrenal cortex.

Which condition may be linked to Conn's syndrome? Hyperaldosteronism Hypoaldosteronism Hyperparathyroidism Hypoparathyroidism

HyperaldosteronismConn's syndrome is associated with the excessive production of aldosterone (hyperaldosteronism) by the adrenal glands. Conn's syndrome is characterized by high blood pressure, headache, poor vision, and various complications. Hypoaldosteronism, hyperparathyroidism, and hypoparathyroidism may not be linked with Conn's syndrome.

Which condition shows a clinical presentation of purplish red striae? Hypofunction of androgens Hyperfunction of androgens Hypofunction of glucocorticoids Hyperfunction of glucocorticoids

Hyperfunction of glucocorticoids Purplish red striae are seen in Cushing syndrome, which occurs due to excess corticosteroids, particularly glucocorticoids. In Addison's disease, all three classes of adrenal corticosteroids (glucocorticoids, mineralocorticoids, and androgens) are reduced. A striking integumentary sign of Addison's disease is bronze-colored skin hyperpigmentation, not purplish red striae.

Which finding is consistent with a diagnosis of hyperaldosteronism? Edema Hypernatremia Low BP Potassium retention

Hypernatremia In hyperaldosteronism, elevated levels of aldosterone are associated with sodium retention, which leads to hypernatremia. Edema and low blood pressure are not caused by an increase in sodium excretion. Elevated levels of aldosterone lead to potassium excretion.

Which is a clinical manifestation of Cushing syndrome? Hypovolemia Hypokalemia Hyperkalemia Hyponatremia

Hypokalemia Hypokalemia is a sign of Cushing syndrome because of the hyperfunctioning of the adrenal cortex. Hypovolemia, hyperkalemia, and hyponatremia are clinical manifestations of Addison's disease because of the hypofunctioning of the adrenal cortex.

Which condition is associated with decreased triiodothyronine (T3) and thyroxine (T4) levels and an increased TSH (thyroid-stimulating hormone) level? Hypoparathyroidism Hypothyroidism Hyperthyroidism Hyperparathyroidism

Hypothyroidism

Which dietary recommendation would the nurse give to a patient with chronic gallbladder disease? Include dairy products. Maintain a low-protein diet. Include fat-soluble vitamins. Increase the intake of refined cereals.

Include fat-soluble vitamins. Patients with chronic gallbladder diseases have a deficiency of fat-soluble vitamins. Therefore the nurse should include fat-soluble vitamins in the patient's diet plan. Dairy products are rich in saturated fats, which are contraindicated for patients with gallbladder disease because dairy stimulates the gallbladder, causing pain. A low-protein diet is given to patients with kidney disease because improper functioning of the kidneys reduces the ability to excrete the nitrogenous waste. As a result, these substances accumulate in the brain, leading to neurologic complications. Refined cereals have less fiber content. However, patients with gallbladder disease require a diet high in fiber because fiber is known to reduce the risk of developing gallstones, thereby preventing complications.

Which factor would be seen in syndrome of inappropriate antidiuretic hormone secretion (SIADH)? Decreased antidiuretic hormone (ADH) Excessive urine output Increased serum osmolality Increased intravascular volume

Increased intravascular volume SIADH is characterized by an increase in antidiuretic hormone (ADH) levels in the body. As a result, the patient will have an increased intravascular volume. Decreased ADH, excessive urine output, and increased serum osmolality are features of diabetes insipidus.

Which condition correlates with syndrome of inappropriate antidiuretic hormone secretion (SIADH) after a head injury? Decreased antidiuretic hormone (ADH) Excessive urine output Increased serum osmolality Increased intravascular volume

Increased intravascular volume The syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by inappropriate secretion of ADH, which disrupts the fluid and electrolyte balance. Increased intravascular volume is one of the characteristic features of SIADH. Decreased ADH, excessive urine output, and increased serum osmolality are the features of diabetes insipidus.

Which clinical manifestations would the nurse document that correlate with the development of diabetes mellitus in a patient with a history of acromegaly? Select all that apply. Increased thirst Dysrhythmias Constipation Increased urination Tingling sensation of the hands

Increased thirst Increased urination Since growth hormone (GH) antagonizes the action of insulin leading to hyperglycemia, glucose intolerance and manifestations of diabetes mellitus might occur including polydipsia (increased thirst) and polyuria (increased urine output).

Which effect may be observed if large amounts of endogenous corticosteroids are released into systemic circulation during surgery on a patient with Cushing syndrome? Fatigue Infections Delusions Hypotension

Infections A patient may become susceptible to infections if the endogenous corticosteroid levels are high during surgery. Fatigue and delusions may not occur due to elevated corticosteroids. Hypertension, not hypotension, is observed due to increased levels of corticosteroids.

The nurse would implement which nursing action when caring for a patient with SIADH? Initiate seizure precautions. Elevate the patient to a semi-Fowler's position. Increase fluid intake to at least 1500 mL/24 hours. Infuse prescribed hypotonic IV solution, such as 0.45% saline.

Initiate seizure precautions. SIADH is a disorder in which there is abnormally high production of ADH. Dilutional hyponatremia is a characteristic of SIADH and can cause seizures, NV, muscle cramps, and decreased neurologic functioning. The patient's head should be kept flat or elevated no higher than 10 degrees to enhance venous return to the heart and increase left atrial filling pressure, which all help to reduce ADH release. Fluid restrictions of 1000 mL or less need to be maintained. A hypertonic IV solution maybe administered if the sodium level is less than 120 mEq/L.

Which nursing action would prevent the leakage of cerebrospinal fluid (CSF) after a transsphenoidal hypophysectomy? Having the patient lie down in the supine position Ensuring oral hygiene in the patient by regular brushing Informing the health care provider about nasal drainage Instructing the patient to avoid vigorous coughing, sneezing, and straining at stool

Instructing the patient to avoid vigorous coughing, sneezing, and straining at stool Vigorous coughing, sneezing, and straining at stool may result in cerebrospinal fluid (CSF) leakage after transsphenoidal hypophysectomy. The patient should lie in an elevated position, with the head of the bed at a 30-degree angle, as opposed to lying in the supine position. Tooth brushing should be avoided for a minimum of 10 days to protect the suture line. Reporting clear nasal discharge to the surgeon is important, because elevated glucose levels in the discharge indicate CSF leakage; however, this intervention does not prevent the leakage of CSF.

Which clinical manifestation would the nurse assess in a patient admitted with hyperparathyroidism? Tremor Urinary incontinence Lethargy and weakness Hyperactive bowel sounds

Lethargy and weakness Hyperparathyroidism can cause hypercalcemia. Signs of hypercalcemia include muscle weakness, polyuria, constipation, nausea and vomiting, lethargy, and memory impairment. Tremor and urinary incontinence are seen with hypoparathyroidism. Hyperparathyroidism is associated with constipation, so the nurse would assess hypoactive bowel sounds, not hyperactive.

Which information would the nurse include in the teaching plan for a patient scheduled for a total thyroidectomy about recovery after the procedure? Exercise will be restricted for up to six months. A low- or no-sodium diet will be prescribed. Physical therapy will need to be continued. Lifelong hormone replacement will be needed.

Lifelong hormone replacement will be needed. This patient will need life-long thyroid hormone replacement with levothyroxine because the entire thyroid gland will be missing after surgery. Exercise will not be restricted for six months. Lengthy exercise restriction or physical therapy generally is not indicated following a thyroidectomy. A sodium-restricted diet would not ordinarily be necessary.

Which instruction would the nurse include in the discharge teaching for a patient who had a bilateral adrenalectomy? No replacement therapy will be needed. Weekly adrenocorticotropic hormone (ACTH) injections will be needed. Cortisol will be required if the patient has stress. Lifelong replacement of corticosteroids will be required.

Lifelong replacement of corticosteroids will be required. Discharge instructions are based on the patient's lack of endogenous corticosteroids and resulting inability to physiologically react to stressors. Patients undergoing a bilateral adrenalectomy will require lifetime replacement therapy. ACTH injections are not an option, because both adrenal glands were removed during surgery. Exogenous cortisol is required at all times, and the dose needs to be increased dramatically if the patient experiences stress.

Which drug would be administered to control glucose levels in a patient with endogenous Cushing syndrome and who has a history of type 2 diabetes? Prednisone Mifepristone Hydrocortisone Aminoglutethimide

Mifepristone Korlym (mifepristone) was approved by the FDA in 2012 as a treatment to control hyperglycemia in adults with endogenous Cushing syndrome who have type 2 diabetes or glucose intolerance and are not candidates for surgery, or who have not successfully responded to surgery.

Which nursing inventions would be included in the plan of care for a patient who had a parathyroidectomy? Select all that apply. Monitor intake and output. Monitor for Babinski's sign. Ensure that IV calcium is available. Instruct the patient to maintain bed rest for 48 hours. Assess for numbness and tingling of the hands and mouth.

Monitor intake and output. Ensure that IV calcium is available. Assess for numbness and tingling of the hands and mouth.

Which medication blocks the hepatic production of insulin-like growth factor-1 in a patient with acromegaly? Lanreotide Cabergoline Pegvisomant Bromocriptine

Pegvisomant Pegvisomant is a growth hormone antagonist, which reduces the effect of growth hormone in the body by blocking the hepatic production of insulin-like growth factor-1. Lanreotide is a long-acting somatostatin analog, which is administered IM every four weeks in the treatment of acromegaly. Cabergoline may be administered alone or along with somatostatin analogs; it acts by reducing the secretions of growth hormone from the tumor. Bromocriptine is a dopamine antagonist that helps reduce the secretion of growth hormone from the tumor.

A patient with gallbladder disease has frequent episodes of severe vomiting. Which interventions would the nurse include in the patient's plan of care? Select all that apply. Monitor vital signs. Rinse the mouth daily. Perform gastric decompression. Place the patient on a low-fat diet. Administer prescribed antiemetics.

Monitor vital signs. Perform gastric decompression. Place the patient on a low-fat diet. The nurse should monitor for the patient's vital signs to reduce the risk of any complications. It may be necessary to insert a nasogastric tube and use gastric decompression for patients with severe nausea and vomiting. Because the patient is vomiting frequently, the nurse should rinse the patient's mouth every two hours to provide comfort. Consuming fat may stimulate the gallbladder; the patient should be placed on a low-fat diet. Water high in salt content is an emetic and may provoke vomiting. Therefore the nurse should not instruct the patient to gargle with salt water.

Which nursing intervention is most important for a patient with diabetes insipidus? Providing dietary education Monitoring fluid intake and output Assessing for constipation every day Obtaining a finger-stick blood glucose level

Monitoring fluid intake and output

Which actions would the nurse take when caring for a patient status post a transsphenoidal hypophysectomy? Select all that apply. Monitoring the pupillary response Elevating the head of the patient's bed Observing the patient for any signs of bleeding Advising the patient to brush his or her teeth twice daily Monitoring extremity strength to detect neurologic complications

Monitoring the pupillary response Elevating the head of the patient's bed Observing the patient for any signs of bleeding Monitoring extremity strength to detect neurologic complications Monitoring the pupillary response helps to rule out any visual changes after the transsphenoidal hypophysectomy. Observing the patient for signs of bleeding is of the utmost importance, as hemorrhage can cause complications. The strength of the extremities is monitored to rule out postoperative neurologic complications, such as ataxia. Elevating the head of the patient's bed to a 30-degree angle alleviates pressure on the sella turcica and decreases headaches, which are a frequent postoperative problem. Avoiding tooth brushing for at least 10 days helps to protect the suture line.

For a patient who presents with an enlarged thyroid gland but has normal thyroid levels, which type of goiter would be documented in the patient's medical record? Nodular Nontoxic Toxic nodular Multinodular

Nontoxic A nontoxic goiter is an enlargement of the thyroid gland without any malignancy or other inflammatory process. Normal levels of thyroid hormone are associated with a nontoxic goiter. A nodular goiter is a thyroid hormone secreting nodule that functions independently of TSH stimulation. A toxic nodular goiter results from hyperthyroidism, which is not indicated by the thyroid studies. A multinodular goiter is the same as a nodular goiter, but it presents with multiple goiters.

Which item reported in a patient's history increases the risk of developing cholelithiasis? Antibiotic use Vasodilator therapy Anticholinergic therapy Oral contraceptive use

Oral contraceptive use Oral contraceptives affect cholesterol production, thereby resulting in gallbladder cholesterol saturation, which causes gallbladder diseases such as cholelithiasis. Antibiotics, vasodilators, and anticholinergics do not affect cholesterol production and metabolism.

Which nursing intervention would be included in the plan of care for a patient with a diagnosis of hypothyroidism? Providing a dark, low-stimulation environment Closely monitoring the patient's intake and output Patient teaching related to levothyroxine Patient teaching related to radioactive iodine therapy

Patient teaching related to levothyroxine

A patient who is receiving treatment for cholelithiasis experiences severe nausea and six episodes of vomiting. Which intervention would the nurse plan for the patient? Administering lactulose Administering rifaximin Performing gastric decompression Performing endotracheal intubation

Performing gastric decompression Gastric decompression is performed to remove the gastric contents via a nasogastric tube to prevent aspiration of food contents and reduce the incidence of nausea and vomiting. Lactulose is a laxative and is used to treat constipation. Rifaximin is an antibiotic prescribed for patients with hepatic encephalopathy. Endotracheal intubation is a means of providing ventilation to the patient

Which treatment is given to a patient with pheochromocytoma to control high BP before surgery? Carvedilol Metyrosine Propranolol Phenoxybenzamine

Phenoxybenzamine Phenoxybenzamine is an α-adrenergic blocker that is used to control BP 10 to 14 days before surgery in a patient with pheochromocytoma. Carvedilol is an α-antagonist and β-blocker used to treat hypertension. Metyrosine decreases catecholamine production; it is prescribed to patients who are not ideal candidates for surgery. Propranolol is a β-adrenergic blocker that is used to treat dysrhythmias and tachycardia during preoperative care of a patient with pheochromocytoma.

A transsphenoidal hypophysectomy involves surgical resection of which gland? Thyroid Adrenal Pituitary Parathyroid

Pituitary Transsphenoidal hypophysectomy is the surgical removal of the pituitary gland. The surgical approach to the pituitary gland is made through an incision through the upper gum and nare into the base of the skull. Transsphenoidal hypophysectomy does not involve removal of the thyroid, adrenal, or parathyroid gland.

Which rationale is accurate regarding the need for a long-term corticosteroid to be gradually reduced? Prevention of hypothyroidism Prevention of diabetes insipidus Prevention of adrenal insufficiency Prevention of cardiovascular complications

Prevention of adrenal insufficiency Sudden cessation of corticosteroid therapy can precipitate life-threatening adrenal insufficiency. Diabetes insipidus, hypothyroidism, and cardiovascular complications are not common consequences of suddenly stopping corticosteroid therapy.

Which instruction would the nurse give the patient with adrenocortical insufficiency and the caregiver regarding management of corticosteroid therapy? Get assessed for cataracts every two years. Decrease the dose of corticosteroids when stressed. Recognize edema and ways to restrict sodium intake. Plan a diet high in concentrated simple carbohydrates.

Recognize edema and ways to restrict sodium intake.

The nurse is providing discharge instructions to a patient who has undergone a laparoscopic cholecystectomy. Which information would the nurse include in the teaching? Select all that apply. Eat foods rich in fatty acids. Report development of jaundice. You can shower the day after surgery. You can return to work the day of surgery. Eat several small meals and snacks each day.

Report development of jaundice. You can shower the day after surgery Eat several small meals and snacks each day. Teach the patient signs and symptoms of obstruction to report (e.g., stool and urine changes, jaundice, itching). The patient may remove the bandages on the puncture sites the day after surgery and shower. It is helpful to eat three small meals and two or three snacks daily rather than three large meals to help reduce the flow of bile after the surgery. Eating fat-rich foods will stimulate the release of bile, so the patient should consider eating lighter meals. Return to work is generally permitted in one week; it would be dangerous to return the same day of surgery after general anesthesia.

Which types of health education would a nurse provide to a patient who is on corticosteroid therapy? Select all that apply. Take on an empty stomach Restrict sodium intake. Reduce physical exercise. Maintain a high-protein diet. Ensure adequate rest and sleep.

Restrict sodium intake. Maintain a high-protein diet. Ensure adequate rest and sleep. High sodium intake may cause edema and should be avoided. Patients on corticosteroid therapy should adhere to a high-protein diet to promote healing and reduce inflammation. Adequate rest and sleep help facilitate a quick recovery. Opioid therapy should be avoided, because it may have adverse effects when co-administered with corticosteroids. Reduction in exercise may promote bone density loss.

The nurse is providing discharge instructions to a patient and caregiver following a laparoscopic cholecystectomy. Which measures will be included in the discharge teaching? Select all that apply. Resume normal activities gradually within one week. Eat a low-fat diet for several weeks after the surgery. Keep the bandages on the puncture sites for three days. Report any bile-colored drainage or pus from any incision. Empty and measure the contents of the bile bag from the T-tube every day.

Resume normal activities gradually within one week. Eat a low-fat diet for several weeks after the surgery. Report any bile-colored drainage or pus from any incision.

Which food in the patient's diet would likely facilitate improvement in the condition of cholelithiasis? Butter Yogurt Cheese Skim milk

Skim milk Skim milk is rich in calcium and low in fat. Patients with cholelithiasis should consume a diet rich in calcium and fiber and low in fat. Butter, yogurt, and cheese are rich in fats. Fat-rich foods should not be consumed by patients with biliary tract disease such as cholelithiasis or cholecystitis.

Which prescribed drug may be the cause of menstrual disorders in a female patient who is on drug therapy for hyperaldosteronism? Spironolactone Amlodipine Dexamethasone Eplerenone

Spironolactone Spironolactone is a potassium-sparing diuretic given to patients with hyperaldosteronism to treat hyperkalemia. This drug can cause menstrual disorders in women. Amlodipine and dexamethasone both control high blood pressure. Aminoglutethimide is given to decrease aldosterone synthesis.

Which disorder is characterized by excessive secretion of the hormone vasopressin? Thyrotoxicosis Diabetes insipidus Hyperosmolar hyperglycemic nonketotic syndrome Syndrome of inappropriate antidiuretic hormone secretion

Syndrome of inappropriate antidiuretic hormone secretion Another term for antidiuretic hormone (ADH) is vasopressin. Syndrome of inappropriate antidiuretic hormone secretion is characterized by excessive release of ADH from the posterior pituitary gland, resulting in the inability of the kidneys to dilute urine. The patient retains water and experiences increased extracellular fluid volume and hyponatremia. The disorder can cause cardiopulmonary overload and neurologic problems as a result of water intoxication. Thyrotoxicosis, also known as thyroid storm or thyroid crisis, results from an abrupt increase in T3 and T4 thyroid hormones. Diabetes insipidus results from a decrease in ADH. Hyperosmolar hyperglycemic nonketotic syndrome results from hyperglycemia in type 2 non-insulin-dependent diabetes mellitus.

Which clinical manifestations would the nurse assess in a hospitalized patient experiencing exophthalmos? Select all that apply. Tachypnea Increased appetite Slurred speech Distended abdomen Bounding, rapid pulse

Tachypnea Increased appetite Bounding, rapid pulse Exophthalmos is a classic finding in Grave's disease, which is caused by hyperthyroidism. Clinical manifestations assessed by the nurse would include tachypnea, increased appetite, and a bounding, rapid pulse. These manifestations are related to the effect of excess circulating thyroid hormone. It directly increases metabolism and tissue sensitivity to sympathetic nervous system stimulation. Clinical symptoms such as slurred speech and distended abdomen are associated with hypothyroidism. pp. 1150-1151

A patient is advised to undergo laparoscopic cholecystectomy. The patient asks the nurse what exactly this procedure means. Which points will the nurse include in an explanation? Select all that apply. The gallbladder is removed through one to four small punctures on the abdominal wall. The procedure is done under anesthesia, using a laparoscope and grasping forceps. The gallbladder is removed through an incision made on the right subcostal region. A tube will be inserted during surgery and will be left in place to drain bile fluids. The patient can be discharged on the day of operation or the next day and resume work in a week.

The gallbladder is removed through one to four small punctures on the abdominal wall. The gallbladder is removed through an incision made on the right subcostal region. A tube will be inserted during surgery and will be left in place to drain bile fluids. Laparoscopic cholecystectomy involves making 1-4 punctures on the abdominal wall, and the gall bladder is removed using laparoscope and grasping forceps. This procedure is done under anesthesia. The patient can be discharged in a day or two, as the recovery is fast. This procedure does not involve incisions.

Which expected outcome would be included in the plan of care for a patient with Graves' disease? The patient will be free of infection. The patient will remain awake, alert, and oriented. The patient will be compliant with fluid restrictions. The patient will demonstrate maintenance of weight.

The patient will demonstrate maintenance of weight.

Which cause is associated with central diabetes insipidus? The presence of a brain tumor Renal damage from long-standing hypertension Drug therapy with lithium for bipolar disorder Structural lesion in the thirst center

The presence of a brain tumor

A patient with a history of hypoparathyroidism would be assessed for which condition? Hypertension Thyroidectomy Use of cocaine Hypermagnesemia

Thyroidectomy Because of the location of the parathyroid glands within the thyroid gland, a thyroidectomy sometimes results in the accidental surgical removal of one or more of the parathyroid glands, which in turn causes hypoparathyroidism. Hypertension and cocaine use are important items to note in a medical history, but they are not directly related to hypoparathyroidism. Hypomagnesemia, not hypermagnesemia, can lead to suppression of parathyroid hormone secretion.

Which rationale is accurate for checking Trousseau's sign in a patient following a subtotal thyroidectomy? To assess for parathyroid gland injury To assess for serum hypercalcemia To assess for high phosphorus levels To assess for an iodine deficiency

To assess for parathyroid gland injury In a patient following a subtotal thyroidectomy, there is a risk of hypocalcemia as a result of inadvertent manipulation or removal of the parathyroid glands. This results in hypoparathyroidism, which causes a serum hypocalcemia. The nurse checks Trousseau's sign and Chvostek's sign to assess for tetany, which is a sign of hypocalcemia. Trousseau's sign does not assess iodine deficiency, phosphorus level, or hypercalcemia. Text Reference - p. 1201

Which surgical instrument is used preoperatively in a patient who will be undergoing an open cholecystectomy? Biliary stent Laparascope Catheter with wire basket Transhepatic biliary catheter

Transhepatic biliary catheter

Which test is more reliable to diagnose pheochromocytoma? Urinary cortisol Urine osmolality Urinary creatinine Urinary aldosterone

Urinary creatinine Pheochromocytoma is a disorder of the adrenal medulla; urinary creatinine is used to diagnose this disorder. Urinary cortisol, urine osmolality, and urinary aldosterone are used to diagnose Addison's disease.

Which assessment finding would be increased in a patient with diabetes insipidus? Temperature Urine output Serum glucose BP

Urine output Diabetes insipidus is a disorder of the posterior pituitary gland that results in a deficiency of antidiuretic hormone, which in turn causes the kidneys to be unable to reabsorb water. This deficiency leads to increased urine output as a primary clinical manifestation of the disorder. Without treatment, an affected individual can become severely dehydrated and experience hypovolemic shock. As diabetes insipidus progresses, the individual may experience hypotension; however, temperature and serum glucose level are usually not affected.

Which instruction would the nurse give the patient and caregiver about managing hypothyroidism? Use soap sparingly. Avoid applying lotions to the skin. Use an enema if constipated. Reduce intake of dietary fiber.

Use soap sparingly.