NURS 3 Mod 11 EAQs

When caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH), it is important that the nurse implement which nursing action? A. Initiate seizure precautions B. Elevate the patient to a semi-Fowler's position C. Increase fluid intake to at least 1500 mL/24 hours D. Infuse prescribed hypotonic intravenous (IV) solution, such as 0.45% saline

ANS A. Initiate seizure precautions Rationale: SIADH is a disorder in which there is abnormally high production of antidiuretic hormone (ADH). Dilutional hyponatremia is a characteristic of SIADH and can cause seizures, nausea and vomiting, muscle cramps, and decreased neurologic function. 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 may be administered if the Na level is less than 120 mEq/L

A patient with hyperaldosteronism is prescribed eplerenone. What advice would the nurse give the patient regarding eplerenone? A. "Avoid coffee." B. "Eat more bananas." C. "Avoid grapefruit juice." D. "Eat more sugar, candy, and syrups."

ANS C. "Avoid grapefruit juice." Rationale: Grapefruit juice should be avoided in patients taking eplerenone because the drink leads to increased levels of eplerenone in blood and causes toxicity. Coffee should be avoided because it may interrupt sleep; however, coffee does not affect eplerenone action. Eplerenone may cause hyperkalemia, so bananas should be avoided. Sugar, candy, and syrups are concentrated simple carbohydrates and should be avoided.

A patient's serum potassium level is 3 mEq/L and serum sodium level is 145 mEq/L. Which hormone synthesis does the nurse understand is inhibited by these conditions? A. Oxytocin B. Thyroxine C. Aldosterone D. Progesterone

ANS C. Aldosterone Rationale: Mineralocorticoids are essential maintaining fluid and electrolyte balance. Conditions such as low levels of potassium and high levels of calcium inhibit the synthesis of aldosterone, which leads to fluid and electrolyte imbalance. Oxytocin peptide is synthesized as an inactive precursor protein from an OXT gene, and the synthesis of oxytocin is affected by low levels of vitamin C. Thyroxine and progesterone synthesis are not inhibited by low levels of potassium and high levels of sodium in the blood stream.

Which hormone has both mineralocorticoid and glucocorticoid properties? A. Cortisol B. prednisone C. Aldosterone D. Hydrocortisone

ANS D. 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.

A patient is scheduled for a total thyroidectomy. What information does the nurse include when teaching this patient about recovery after the procedure? A. exercise will be restricted for up to six months B. a low-or no-sodium diet will be prescribed C. Physical therapy will need to be continued D. Life-long hormone replacement will be needed.

ANS D. life-long hormone replacement will be needed. Rationale: 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 condition may be linked to Conn's syndrome? A. Hyperaldosteronism B. Hypoaldosteronism C. Hyperparathyroidism D. Hypothyroidism

ANS A. Hyperaldosteronism Rationale: Conn'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

A patient with hypertension reports a severe pounding headache and profuse sweating. Upon assessment, the patient is found to have tachycardia. What drug should be prescribed by the primary health care provider? A. Metyrosine B. Ketoconazole C. Spironolactone D. Dexamethasone

ANS A. Metyrosine Rationale: Severe pounding headache, profuse sweating, and tachycardia are manifestations of pheochromocytoma; metyrosine can manage these symptoms. Ketoconazole is prescribed to suppress the synthesis and secretion of cortisol from the adrenal gland. Spironolactone is used to treat hyperaldosteronism. Dexamethasone is prescribed for the treatment of adrenal hyperplasia.

A patient has a serum sodium level of 134 mEq/L, an osmolality less than 280 mOsm/kg, and the urine specific gravity is greater than 1.025. Which medication is most beneficial for this patient? A. Tolvaptan B. Propranolol C. Methimazole D. Desmopressin

ANS A. Tolvaptan Rationale: A serum sodium level of 134 mEq/L, an osmolality less than 280 mOsm/kg, and a urine specific gravity greater than 1.025 indicate dilutional hyponatremia. Tolvaptan is an antihyponatremic drug used to treat dilutional hyponatremia by increasing the sodium concentration in the body. Propranolol is a beta blocker that is used to treat pheochromocytoma. Methimazole is used to treat a goiter. Desmopressin is used to treat diabetes insipidus.

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

ANS B. Acromegaly Rationale: 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 is a sign of syndrome inappropriate antidiuretic hormone (SIADH)? A. Decreased ADH B. Excessive urine output C. Increased serum osmolality D. Increased intravascular volume

ANS D. Increased intravascular volume Rationale: 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.

The nurse is caring for a patient who underwent transsphenoidal hypophysectomy to treat acromegaly. Which is the best nursing action to prevent leakage of cerebrospinal fluid? A. Having the patient lie down in the supine position B. Ensuring oral hygiene in the patient by regular brushing C. Informing the primary health care provider about nasal drainage D. Instructing the patient to avoid vigorous coughing, sneezing, and straining at stool.

ANS D. Instructing the patient to avoid vigorous coughing, sneezing, and straining at stool. Rationale: 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.

The patient experiencing thyrotoxicosis asks the nurse why he or she is being given propranolol. What is the most accurate answer to the patient's question? A. To suppress thyroid hormone secretion B. To prevent thyroid hormone induced hypotension C. To decrease thyroid gland vascularity in preparation for surgery D. To block the sympathetic nervous system response to excess thyroid hormone.

ANS D. To block the sympathetic nervous system response to excess thyroid hormone Rationale: Thyrotoxicosis is an acute crisis state of hyperthyroidism often precipitated by a physiologic stressor in the patient with hyperthyroidism. Thyrotoxicosis is an extreme state of hypermetabolism. Excessive amounts of thyroid hormone are present and tissue sensitivity to sympathetic nervous system stimulation is increased, resulting in a number of signs and symptoms, including severe tachycardia leading to heart failure. Propranolol is a beta-adrenergic antagonist that blocks the thyroid-hormone-induced sympathetic nervous system stimulation, resulting in a lowered heart rate and a decreased risk of heart failure. One of the priority treatment goals in the patient with thyrotoxicosis is to decrease thyroid hormone secretion. A decrease in thyroid hormone secretion is primarily accomplished through the use of either methimazole or propylthiourical. Propranolol does not suppress thyroid hormone secretion. In addition to slowing heart rate, propranolol decreases blood pressure; it is not used to prevent hypotension. Nonradioactive strong iodine solution, either in the form of saturated solution of potassium iodine or Lugol's solution, may be used to decrease size and vascularity of the thyroid gland in preparation for surgery. Potassium Iodide or Lugol's solution also may inhibit thyroid hormone synthesis. Propranolol does not decrease size or vascularity of the thyroid gland.

Which hormone is referred to as the "fight or flight" hormone? A. Cortisol B. Estrogen C. Epinephrine D. Aldosterone

ANS C. Epinephrine Rationale: Epinephrine is a catecholamine secreted by the adrenal medulla. It is released during stressful conditions and results in the "fight or flight" response. Cortisol, estrogen, and aldosterone are steroidal hormones secreted by the adrenal cortex.

The nurse is teaching the patient and caregiver about managing hypothyroidism. What instruction should the nurse give the patient? A. Use soap sparingly B. Avoid applying lotions to the skin C. Use an enema if required D. Reduce intake of dietary fiber

AND A. Use soap sparingly Rationale: The nurse should teach the patient and caregiver measures to prevent skin breakdown. The patient should be taught to use soap sparingly and apply lotion frequently to the skin. The patient should be instructed to avoid the use of enemas, because they produce vagal stimulation, which can be hazardous if cardiac disease is present. The patient should be asked to increase the intake of fiber in the diet to minimize constipation.

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

ANS A. "It is important that I brush my teeth every day." Rationale: Tooth brushing should be avoided for 10 days to protect the suture line. Vigorous coughing and sneezing should be avoided to prevent cerebrospinal leakage. A severe headache may indicate cerebrospinal leakage into the sinuses. Straining with bowel movements may cause cerebrospinal leakage.

The nurse teaches a patient about diagnostic tests for ascertaining the presence of Cushing syndrome. Which advice would the nurse tell the patient to do to confirm the diagnosis? Select all that apply. A. "check plasme adrenocorticotropic hormone (ACTH) levels'" B. "Take blood chemistries for sodium, potassium, and calcium." C. "Opt for a complete blood count (CBC) with RBC differential." D. "Collect a 24-hr urine sample for testing free cortisol and 17-ketosteroids." E. "undergo computed tomography (CT) scan or magnetic resonance imaging (MRI)

ANS A. "check plasme adrenocorticotropic hormone (ACTH) levels' D. "Collect a 24-hr urine sample for testing free cortisol and 17-ketosteroids." E. "undergo computed tomography (CT) scan or magnetic resonance imaging (MRI) Rationale: Checking plasma adrenocorticotropic (ACTH) hormone levels will help assess the underlying cause of Cushing syndrome because a high or normal ACTH level indicates Cushing syndrome. A urine cortisol level higher than the normal range of 80 to 120 mcg/24 hr is an indicator of Cushing syndrome. Both a computed tomography (CT) scan and a magnetic resonance imaging (MRI) of the pituitary and adrenal glands are used to detect Cushing syndrome. Blood chemistries for sodium, potassium, and glucose are also a part of the diagnostic tests for Cushing syndrome. A complete blood count (CBC) with WBC, not RBC, differential is usually performed as part of the diagnostic tests for Cushing syndrome.

A patient is instructed to ingest 75 g of glucose orally as a part of an oral glucose tolerance test. In addition, growth hormone measurements are taken consecutively at 30, 60, 90, and 120 minutes. Glucose levels and growth hormone levels are found to be constant during the test. What does the nurse infer from these findings? A. Acromegaly B. Hepatomegaly C. Splenomegaly D. Dactylomegaly

ANS A. Acromegaly Rationale: In addition to the patient history and physical examination, the oral glucose tolerance test is a specific test for acromegaly. As growth hormone secretion is normally inhibited by glucose, measurement of glucose nonsuppresibility is required. Growth hormone concentration normally falls during the oral glucose tolerance test, but in patients with acromegaly, the growth hormone levels do not fall. Hepatomegaly is enlargement of the liver. Splenomegaly is enlargement of the spleen. Dactylomegaly is enlargement of the toes and fingers.

In an inpatient setting, the nurse instructs a patient to maintain a supine position for two hours before a prescribed blood sample is collected. This patient positioning is needed when testing for which hormone? A. Aldosterone B. Cortisol (total) C. Adrenocorticotropic (ACTH) (corticotropin) D. Adrenocorticotropic (ACTH) stimulation with cosyntropin

ANS A. Aldosterone Rationale: Before assessing aldosterone hormone levels, the nurse should instruct the patient to lie in a supine position for at least two hours before obtaining the blood sample. This ensures the assessment of accurate levels of aldosterone. The nurse collects the blood sample in the morning to assess the levels of cortisol. The blood sample is collected between 6 and 8:00 AM to assess adrenocorticotropic hormone (ACTH) (corticotropin). In order to assess ACTH stimulation with cosyntropin, cosyntropin is injected with a plastic syringe and blood samples are collected in plastic heparinized tubes.

A nurse is caring for a patient who has Addison's disease. The nurse should assess the patient for which symptoms? Select all that apply A. weight gain B. hyperpigmentation C. weakness and fatigue D. orthostatic hypotension E. thin skin with ecchymosis

ANS B. Hyperpigmentation C. Weakness and fatigue D. Orthostatic hypotension Rationale: Hyperpigmentation, orthostatic hypotension, and weakness coupled with fatigue are all manifestations of Addison's disease. A patient with Addison's disease will have weight loss, not weight gain. Thin skin with ecchymosis is a manifestation of Cushing syndrome, not Addison's disease.

The nurse is caring for a patient undergoing radioactive iodine therapy in the outpatient setting. What instructions should the nurse provide to this patient? Select all that apply. A. Avoid preparing food for others B. Gargle with warm water before meals C. Launder personal towels, bed linens, and clothes separately at home. D. Avoid being close to pregnant women or children for seven days after therapy E. Discontinue antithyroid drugs after RAI

ANS A. Avoid preparing food for others C. Launder personal towels, bed linens, and clothes separately at home D. Avoid being close to pregnant women or children for seven days after therapy. Rationale: The nurse should instruct the patient receiving RAI therapy to avoid preparing food for others; to launder personal towels, bed linens, and clothes separately at home; and to avoid being close to pregnant women or children for 7 days after therapy. These precautions are to limit radiation exposure to others. The patient is asked to use a salt and soda gargle three or four times per day to provide relief from dryness and irritation of the mouth and throat as a result of the therapy. RAI has a delayed response, and the maximum effect may not be seen for up to 3 months; therefore, the patient is usually treated with antithyroid drugs and propranolol before and for 3 months after the initiation of RAI therapy, until the effects of radiation become apparent.

The nurse is caring for a patient who has cerebral edema associated with syndrome of inappropriate antidiuretic hormone (SIADH). What clinical manifestation of severe serum sodium level decline does the nurse assess? Select all that apply. A. Coma B. Lethargy C. Confusion D. Headache E. Tachycardia F. Hypovolemic shock

ANS A. Coma B. Lethargy C. Confusion D. Headache Rationale: If the plasma osmolality and serum sodium levels continue to decline below 120 mmol/L, cerebral edema may occur, leading to the manifestations such as coma, lethargy, confusion, and headache. Tachycardia and hypovolemic shock are the complications of diabetes insipidus.

A patient with hypertension undergoes testing on his or her serum electrolyte and plasma aldosterone levels. The laboratory findings showed plasma 18-hydroxycorticosterone levels as 60 ng/dL, potassium level as 2.5 mEq/L, and sodium level as 150 mEq/L. What could be the diagnosis? A. Conn's syndrome B. Addison's disease C. Cushing syndrome D. Pheochromocytoma

ANS A. Conn's syndrome Rationale: Conn's syndrome, or hyperaldosteronism, is characterized by increased aldosterone secretion, increased serum sodium levels, and decreased serum potassium levels. The normal level of 18-hydroxycorticosterone in blood is less than 50 ng/dL; 60 ng/dL indicates an increase in aldosterone secretion. The normal range of serum potassium is 3.5 to 5 mEq/L; a value of 2.5 mEq/L indicates hypokalemia. The normal range of serum sodium is 135 to 145 mEq/L; a value of 150 mEq/L indicates hypernatremia. Addison's disease is characterized by abnormal levels of adrenocorticotropic hormone, hyperkalemia, and hyponatremia. Cushing syndrome is characterized by abnormal adrenocorticotropic hormone levels, hyperglycemia, and eosinopenia. Pheochromocytoma is characterized by increased levels of catecholamines such as epinephrine and norepinephrine.

The nurse reviews a patient's medical record and notes assessment findings. Which endocrine hormone level does the nurse expect to be increased in the patient? (Body temperature-104, WBCs-14,000/microliter, fasting blood glucose-65 mg/dL) A. cortisol B. Aldosterone C. Androstenedione D. Dehydroepiandrosterone

ANS A. Cortisol Rationale: Cortisol level increases if a patient has fever, stress, burns, infection, acute anxiety, or hypoglycemia. A body temperature of 104 oF indicates that the patient has fever. The normal white blood cell count is 4500 to 10,000/microliter. A white blood cell count of 14,000/microliter indicates that the patient may have an infection. The normal fasting blood glucose levels of a patient are 70 to 100 mg/dL. Blood glucose levels of 65 mg/dL indicate that the patient has hypoglycemia. Therefore the nurse expects to find high levels of cortisol in the patient. Fever, infection, and hypoglycemia may not enhance the secretion of aldosterone. Androstenedione and dehydroepiandrosterone are adrenal hormones. They are not elevated because of fever, infection, or hypoglycemia.

What is the clinical manifestation of Addison's disease? A. delusions B. hypokalemia C. Hyperglycemia D. truncal obesity

ANS A. 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.

What complications may arise if pheochromocytoma is left untreated? A. Diabetes mellitus B. Graves' disease C. Alzheimer's disease D. Chronic kidney disease

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

A patient is suspected of having acromegaly. When gathering a health history, what questions would be important for the nurse to ask? Select all that apply. A. Do you snore? B. Do you crave salty foods? C. Have you experienced a recent weight loss? D. Have you noticed an increase in your shoe size? E. Have you experienced unusual thirst or excessive urination? F. Have you experienced numbness or tingling in your fingers or hands?

ANS A. Do you snore? D. Have you noticed an increase in your shoe size? E. Have you experienced unusual thirst or excessive urination? F. Have you experienced numbness or tingling in your fingers or hands? Rationale: The patient with acromegaly experiences excess secretion of growth hormone from the anterior pituitary. Growth hormone excess results in enlargement and thickening of bones and soft tissues. Sleep apnea can occur because of narrowing of the airway caused by enlargement of the soft tissues of the upper airway. Increased snoring is suggestive of sleep apnea. Bones and tissues of the face, feet, and hands are particularly susceptible to the effects of excess growth hormone. Patients may notice that their rings no longer fit and that their shoe size is increasing. Because growth hormone antagonizes insulin, patients with acromegaly often experience hyperglycemia. Hyperglycemia causes an osmotic diuresis, resulting in increased thirst and excessive urination. As soft tissues and bony structures enlarge, patients may experience nerve impingement syndromes. Numbness or tingling of the fingers or hands may be caused by carpal tunnel syndrome. There is no association between acromegaly and a craving for salty foods. Acromegaly occurs when there is excess secretion of growth hormone after the epiphyses of the long bones have closed. Although the patient will not gain additional height, thickening of the bones leads to an increase, rather than a decrease, in body weight.

Which interventions does the nurse use when caring for a patient recovering from a transsphenoidal hypophysectomy? Select all that apply. A. Elevate the head of the bed 30 degrees B. Monitor for and report clear nasal drainage C. Encourage hourly coughing and deep breathing D. perform routine pin cares according to agency policy E. Monitor for and report increased urinary output

ANS A. Elevate the head of the bed 30 degrees. B. Monitor for and report clear nasal drainage E. Monitor for and report increased urinary output Rationale: Elevating the head of the bed 30 degrees decreases pressure on the sella turcica in the brain and decreases the patient's risk of headache. Clear nasal drainage may represent a cerebral spinal fluid leak. The primary health care provider should be notified and a sample of the drainage should be sent to the laboratory for analysis. The patient with cerebral spinal fluid leak is at risk for meningitis. Any insult to the posterior lobe of the pituitary gland puts the patient at risk for diabetes insipidus (DI). Transsphenoidal hypophysectomy induced pituitary insult may result in diabetes insipidus, either because of direct manipulation of the gland during surgery or as a result of postoperative edema. When diabetes insipidus occurs, there is a decrease in antidiuretic hormone (ADH), leading to a significant increase in urinary output. The increase in pressure created by vigorous coughing, sneezing, and straining to have a bowel movement can lead to cerebral spinal fluid leak in the patient recovering from transsphenoidal hypophysectomy. Deep breathing exercises are encouraged, but the patient should avoid coughing. Stereotactic radiosurgery may be a treatment option for some patients. Stereotactic radiosurgery is a form of radiation therapy that requires application of a stereotactic head frame to the patient's scalp. Patients with a stereotactic head frame require pin cares. Transphenoidal hypophysectomy is a surgical procedure that is accomplished via an endonasal (through the nose) approach or, less commonly, sublabially (under the lip at the upper gum line). Transsphenoidal hypophysectomy does not require attachment of a head frame and there are no pin cares.

The patient has been feeling tired lately and has gained weight and reports thickened, dry skin, and increased cold sensitivity even though it is now summer. Which endocrine diagnostic test should be done first ? A. Free thyroxine (FT4) B. Serum growth hormone (GH) C. Follicle stimulating hormone (FSH) D. Magnetic resonance imaging (MRI) of the head

ANS A. Free thyroxine (FT4) Rationale: The manifestations the patient is experiencing could be related to hypothyroidism. Free thyroxine (FT4) is considered a better indicator of thyroid function than total T4 and could be done to evaluate the patient for hypothyroidism. Growth hormone excess could cause thick, leathery, oily skin, but does not demonstrate the other manifestations. FSH is manifested with menstrual irregularity and would be useful in distinguishing primary gonadal problems from pituitary insufficiency. MRI is the examination of choice for radiologic evaluation of the pituitary gland and the hypothalamus, but would not be the first diagnostic study to further explore the basis of these manifestations.

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

ANS A. Goiter Rationale: 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.

A patient is just returning to the surgical floor from the recovery room after undergoing a thyroidectomy. What is the nurse's priority nursing intervention? A. Have a tracheostomy try at the bedside B. Closely monitor the patient's emotional state. C. Avoid touching the patient's neck and shoulders D. Maintain hydration status with small sips of water.

ANS A. Have a tracheostomy tray at the bedside Rationale: Postoperative complications for a patient following a thyroidectomy include injury to the recurrent or superior laryngeal nerve, which can lead to vocal cord paralysis. If both cords are paralyzed, spastic airway obstruction will occur, requiring an immediate tracheostomy. Closely monitoring the patient's emotional status is important, especially because the appearance of the incision may be distressing to the patient. However, providing reassurance that the scar will fade in color and eventually look like a normal neck wrinkle is not the priority. Following surgery, patients are nothing by mouth status, and would not be taking small sips of water to maintain hydration. Hydration status is maintained via intravenous fluids. The nurse would not avoid touching the patient's neck and shoulders, because this would impede a thorough assessment.

Which nursing diagnostic statement is the highest priority for a patient with myxedema? A. Hypothermia B. Excess fluid volume C. Imbalanced nutrition: more than body requirements D. risk for activity intolerance

ANS A. Hypothermia Rationale: People with myxedema are at high risk for hypothermia. In myxedema severe hypothyroidism causes slower metabolism and subnormal body temperature. The nursing diagnoses in the other answer options are appropriate for a patient with myxedema, because edema, weight gain, and activity intolerance are likely a result of hypothyroidism.

The nursing care of a patient who had a parathyroidectomy should include which actions? Select all that apply. A. Monitor intake and output B. monitor for Babinski's sign C. Ensure that intravenous (IV) calcium is available D. Instruct patient to maintain bed rest for 48 hours E. Assess for numbness and tingling of the hands and mouth

ANS A. Monitor intake and output C. Ensure that intravenous (IV) calcium is available E. Assess for numbness and tingling of the hands and mouth Rationale: Intake and output are assessed carefully because of the patient's risk for fluid imbalance. IV calcium gluconate or gluceptate should be readily available for administration because the postoperative parathyroidectomy patient is at risk for hypocalcemia, which can lead to life-threatening tetany. Numbness and tingling of the hands and mouth are signs of mild tetany. Babinski's sign is not assessed in postoperative parathyroidectomy patients. Chvostek's and Trousseau's signs are assessed to monitor for signs of tetany. Mobility should be encouraged to promote bone calcification.

A patient with an endocrine disorder is prescribed corticosteroids. Which parameters should the nurse monitor for early detection of side effects? Select all that apply. A. Increased risk for ulcers B. Decreased bone density C. Increased potassium levels D. Decreased risk for infections E. Increased level of blood pressure

ANS B. Decreased bone density E. Increased level of blood pressure Rationale: Decreased bone density due to the prolonged use of corticosteroids may lead to bone weakness; therefore, the patient is advised to take calcium supplements. Corticosteroids may increase the blood pressure by causing a decrease in the level of potassium and promoting retention of sodium. The drug may increase the risk of ulcers but only if taken on an empty stomach. Corticosteroids tend to suppress the immune system, thereby increasing the risk of infections.

The nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone secretion in the acute care setting. What nursing interventions are important for this patient? Select all that apply. A. Restrict fluid intake to no more than 1000 mL/day B. Elevate the head of the bed to an angle of 30 degrees C. Avoid frequent repositioning of the patient. D. Implement seizure precautions and set the bed alarm. E. Provide the patient with ice chips to decrease thirst

ANS A. Restrict fluid intake to no more than 1000 mL/day D. Implement seizure precautions and set the bed alarm. E. Provide the patient with ice chips to decrease thirst Rationale: In the acute care setting the patient's total fluid intake is restricted to no more than 1000 mL/day, including that taken with medications. The nurse should implement seizure precautions and set the bed alarm to protect the patient from injury, because of the potential for an alteration in mental status. The nurse should provide the patient with frequent oral care and ice chips to decrease discomfort related to thirst from the fluid restrictions. The head of the bed should be flat or elevated no more than 10 degrees to enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of antidiuretic hormone. Frequent turning, positioning, and range-of-motion exercises are important to maintain skin integrity and joint mobility.

A female patient who is on drug therapy for hyperaldosteronism develops menstrual disorders. Which prescribed drug may be the cause of this condition? A. Spironolactone B. Amlodipine C. Dexamethasone D. Aminoglutethimide

ANS A. Spironolactone Rationale: 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.

A patient is diagnosed with central diabetes insipidus and states not knowing how the illness was acquired. What does the nurse recognize as a possible cause of this disorder? A. The presence of a brain tumor B. Renal damage from long-standing hypertension C. Drug therapy with lithium for bipolar disorder D. Structural lesion in the thirst center

ANS A. The presence of a brain tumor Rationale: Brain tumor is one possible cause for central diabetes insipidus, which occurs due to the interference with antidiuretic hormone synthesis, transport, or release. In cases of renal damage and drug therapy with lithium, there would be an inadequate renal response to antidiuretic hormone despite the presence of adequate antidiuretic hormone, which leads to nephrogenic diabetes insipidus. A structural lesion in the thirst center may cause primary diabetes insipidus, which can be a result of excessive water intake.

What is the rationale for checking Trousseau's sign in a patient following a subtotal thyroidectomy? A. To assess for parathyroid gland injury B. To assess for serum hypercalcemia C. To assess for high phosphorus levels D. To assess for an iodine deficiency

ANS A. To assess for parathyroid gland injury Rationale: 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 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 indicate iodine deficiency, phosphorus level, or hypercalcemia.

What is the function of the hormone calcitonin? A. to regulate calcium balance B. to decrease calcium storage in bone C. to allow transfer of calcium from bone to the blood D. to increase renal absorption of calcium and phosphorus

ANS A. to regulate calcium balance Rationale: Calcitonin regulates calcium balance in response to high circulating calcium levels in blood. It increases the calcium storage in the bone and inhibits the transfer of calcium from the bones to the blood. Calcitonin aids in the renal excretion of calcium and phosphorus.

The registered nurse is teaching a nursing student about the drug profile of octreotide. Which statement made by the student indicates the need for further teaching? A. "Octreotide is the primary drug for treating acromegaly." B. "Growth hormone levels are measured every four weeks." C. "Octreotide is administered subcutaneously three times a week." D. "Growth hormone levels are initially measured every two weeks."

ANS B. "Growth hormone levels are measured every four weeks." Rationale: Growth hormone levels are initially measured every two weeks, not every four weeks, to guide drug dosing. Octreotide is administered three times a week. It is the primary drug used in the treatment of acromegaly; it is a somatostatin analog that reduces the growth hormone levels to normal levels in many patients. Growth hormone levels are initially measured every two weeks and then every six months, so that the dose may be adjusted based on the alterations in the growth hormone levels.

A patient with pheochromocytoma is prescribed propranolol during preoperative care. Which instruction provided by the nurse is most appropriate to prevent complications in the patient? A. "Obtain adequate rest." B. "Make postural changes cautiously." C. "Have a blood pressure check frequently." D. "Consult your primary health care provider if you have severe headache."

ANS B. "Make postural changes cautiously." Rationale: Propranolol is a β-adrenergic receptor blocker that is administered during preoperative care to treat tachycardia, dysrhythmias, and high blood pressure, in order to prevent intraoperative hypertensive crisis. Propranolol causes orthostatic hypotension, so postural changes should be made cautiously, to prevent falls. Adequate rest should be taken by the patient, but it is not related to preventing falls. Blood pressure should be monitored regularly to prevent hypertensive crisis. A severe headache should be reported to the primary health care provider for immediate intervention; however, this condition is unconnected to complications of propranolol

A patient with adrenal insufficiency is advised to take corticosteroids for four months. What should be told to the patient about how to prevent osteoporosis? Select all that apply. A. "Eat a protein-rich diet." B. "Take vitamin D tablets." C. "Avoid a calcium-rich diet." D. "Avoid bisphosphonates." E. "Avoid high-impact exercise."

ANS B. "Take vitamin D tablets." E. "Avoid high-impact exercise." Rationale: Vitamin D tablets should be taken to aid in calcium absorption to prevent osteoporosis. The patient should be advised to do low-impact exercise rather than high-impact exercise, because high-impact exercise may lead to complications. A protein-rich diet should be eaten by patients undergoing corticosteroid therapy; this diet will not lower the risk of osteoporosis. A calcium-rich diet and bisphosphonates help to prevent osteoporosis.

The patient is brought to the emergency department following a car accident and is wearing medical identification that says the patient has Addison's disease. What should the nurse expect to be included in the collaborative care of this patient? A. low-sodium diet B. increased glucocorticoid replacement C. Suppression of pituitary adrenocorticotropic hormone (ACTH) synthesis D. Elimination of mineralocorticoid replacement.

ANS B. Increased glucocorticoid replacement Rationale: The patient with Addison's disease needs lifelong glucocorticoid and mineralocorticoid replacement and has an increased need with illness, injury, or stress, as this patient is experiencing. The patient with Addison's also may need a high-sodium diet. Suppression of pituitary ACTH synthesis is done for Cushing's syndrome. Elimination of mineralocorticoid replacement cannot be done for Addison's disease.

The nurse is caring for a patient who underwent a transsphenoidal hypophysectomy. What is the most important nursing intervention for this patient? A. Place the patient in a supine position at all times B. Monitor pupillary response and speech patterns C. Perform mouth care every 12 hours D. test any clear nasal drainage for potassium

ANS B. Monitor pupillary response and speech patterns. Rationale: The nurse should monitor the pupillary response, speech patterns, and extremity strength to detect neurologic complications. The nurse should ensure the head of the bed is elevated at all times to a 30-degree angle to avoid pressure on the sella turcica and to decrease headaches, a frequent postoperative problem. The nurse must perform mouth care for the patient every four hours to keep the surgical area clean and free of debris. The nurse must notify the surgeon and send any clear nasal fluid to the laboratory to test for glucose

A patient with adrenocortical insufficiency is prescribed hydrocortisone. Which drugs should be avoided in the patient's prescription? A. Oral contraceptives, antiepileptics, and nonsteroidal anti-inflammatory drugs (NSAIDs) B. Oral hypoglycemic, anticoagulants, and nonsteroidal anti-inflammatory drugs (NSAIDs) C. Antihypertensives, oral hypoglycemic, and nonsteroidal anti-inflammatory drugs (NSAIDs) D. Antiepileptics, antihypertensives, and oral hypoglycemics

ANS B. Oral hypoglycemic, anticoagulants, and nonsteroidal anti-inflammatory drugs (NSAIDs) Rationale: Hydrocortisone is a corticosteroid. Oral hypoglycemics, anticoagulants, and nonsteroidal antiinflammatory drugs (NSAIDs) have potential interactions with corticosteroids and should be avoided by a patient taking hydrocortisone. Note that antiepileptics and antihypertensives may or may not interact with corticosteroids.

The nurse is reviewing the results of four diagnostic tests for diabetes insipidus (DI). Which patient's results indicate nephrogenic DI? A. Patient A (Urine volume decreases to 50 mL/hr) B. Patient B (Urine osmolality of 260 mOsm/Kg) C. Patient C (Urine osmolality of 600 mOsm/Kg) D. Patient D (Kidneys respone to ADH (antidiuretic hormone) analog by concentrating urine

ANS B. Patient B (Urine osmolality of 260 mOsm/Kg) Rationale: Patients with nephrogenic diabetes insipidus will not be able to increase urine osmolality to greater than 300 mOsm/kg. Patients with central diabetes insipidus show a significant decrease in urine volume below 200 mL/hr and a dramatic increase in the urine osmolality from 100 to 600 mOsm/kg. When an antidiuretic hormone analog such as desmopressin is administered, if the patient has central diabetes, the kidneys respond by forming concentrated urine.

The nurse sends the clear nasal drainage of a patient who underwent transphenoidal hypophysectomy for testing. The laboratory readings reveal glucose levels at 40 mg/dL. What does the nurse infer from this finding? A. The patient is at in increased risk for stroke. B. The patient is at an increased risk for meningitis C. the patient is at an increased risk for encephalitis D. The patient is at an increased risk for subdural hematoma

ANS B. The patient is at an increased risk for meningitis Rationale: A glucose level greater than 30mg/dL in a patient's nasal discharge after transphenoidal hypophysectomy indicates that the patient has cerebrospinal fluid leakage. Patients with cerebrospinal fluid leakage are at an increased risk of acquiring meningitis. Stroke is not related to the leakage of cerebrospinal fluid. Encephalitis, an inflammation in the brain, is caused by infection or an allergic reaction; CSF leakage is not a risk factor of encephalitis. Subdural hematoma is the collection of blood under the dura matter; it is not related to CSF leakage.

The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instructions regarding desmopressin acetate would be most appropriate? A. The patient can expect to experience weight loss resulting from increased diuresis B. The patient should alternate nostrils during administration to prevent nasal irritation. C. The patient should monitor for symptoms of hypernatremia as a side effect of this drug. D. The patient should report any decrease in urinary elimination to the health care provider

ANS B. The patient should alternate nostrils during administration to prevent nasal irritation. Rationale: Desmopressin acetate is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. Inhaled desmopressin acetate can cause nasal irritation, headache, nausea, and other signs of hyponatremia. Diuresis will be decreased and is expected, and hypernatremia should not occur.

A patient is diagnosed with Cushing syndrome and the cause was found to be a pituitary adenoma. What treatment should be provided to the patient? A. radiation therapy B. transphenoidal resection C. drug therapy with mitotane D. drug therapy with ketoconazole

ANS B. Transphenoidal resection Rationale: A transphenoidal resection is the surgical removal of a pituitary tumor. This surgery is the standard treatment of Cushing syndrome caused by a pituitary adenoma. Radiation and drug therapies may be given if a patient is not an ideal candidate for surgery.

Which signs and symptoms would the nurse expect to assess in a patient who is diagnosed with acromegaly? Select all that apply A. fragile skin B. increased shoe size C. elevated blood glucose D. complaint of headaches E. increased height and weight

ANS B. increased shoe size C. elevated blood glucose D. complaint of headaches Rationale: Acromegaly is a disorder in which there is increased secretion of growth hormone (GH). Enlargement of the feet and hands occurs as a result of overgrowth of bones and tissue. GH antagonizes the action of insulin, and therefore blood glucose is elevated. Headaches also are common if the increased secretion of GH is caused by a pituitary adenoma, which increases pressure on the optic nerve. The skin becomes thick and leathery. The patient's weight may increase, but there is no change in height because acromegaly occurs after epiphyseal closure.

The nurse creates a plan of care for a patient with a pheochromocytoma. What is an appropriate expected outcome for the patient? A. verbalizing coping mechanisms B. Maintaining a normotensive state C. Maintaining a decreased activity level D. Demonstrating compliance with dietary instructions

ANS B. maintaining a normotensive state Rationale: A pheochromocytoma is a benign tumor of the adrenal gland, the major manifestation of which is severe hypertension due to excessive secretion of catecholamines, such as epinephrine. Therefore, the priority goal for this patient would be to maintain a normal blood pressure, or a normotensive state. At least 10% to 30% of patients require antihypertensive medication after the surgery. If the blood pressure returns to a normotensive state, the need to verbalize coping mechanisms, a decreased activity level, and compliance with dietary restrictions do not apply.

A patient is diagnosed with adrenocortical insufficiency. Which laboratory findings would be consistent with this diagnosis? Select all that apply. A. serum sodium: 140 mEq/L B. serum potassium: 6.5 mEq/L C. blood glucose levels: 80 mg/dL D. blood urea nitrogen (BUN): 30 mg/dL E. electrocardiogram (ECG): peaked T waves

ANS B. serum potassium: 6.5 mEq/L D. blood urea nitrogen (BUN): 30 mg/dL E. electrocardiogram (ECG): peaked T waves Rationale: Adrenocortical insufficiency leads to hyperkalemia and the resulting peaked T waves in an electrocardiogram (ECG), as well as an elevated blood urea nitrogen (BUN) level. Normal serum electrolyte ranges include sodium from 135 to 145 mEq/L, potassium from 3.5 to 5 mEq/L, glucose from 70 to 99 mg/dL, and blood urea nitrogen from 6 to 20 mg/dL. A serum potassium level of 6.5 mEq/L shows hyperkalemia, which promotes peaked T waves in an ECG. A blood urea nitrogen level of 30 mg/dL shows an increased level.

The nurse determines that the patient who is receiving radioactive iodine (RAI) therapy for the treatment of hyperthyroidism needs additional instructions when the patient makes which statement? A. "I will need to flush the toilet after I use it." B. "I should launder my clothes separately form those in my household. C. "I will need to take anti-thyroid drugs for 6-9 months after I begin RAI therapy." D. "If I develop a dry mouth I may gargle with salt and soda mixture for relief."

ANS C. "I will need to take anti-thyroid drugs for 6-9 months after I begin RAI therapy." Rationale: The maximum effect of RAI therapy may not occur for up to 3 months, and therefore the patient usually continues to be treated with anti-thyroid drugs for 3 months, not 6 to 9 months, after the initiation of radioactive iodine therapy. Flushing the toilet twice and laundering clothes separately will help to limit radiation exposure to household members. Radiation parotiditis may cause dryness and irritation of the mouth, and a salt and soda gargle may provide relief.

A patient diagnosed with hyperthyroidism received radioactive iodine one week ago. The patient tells the nurse, "I don't think the medication is working, I don't feel any different." What is the best response by the nurse? A. "You should notify your primary health care provider immediately." B. "You may need to have your thyroid removed sooner than anticipated." C. "It may take several weeks to see the full benefits of the treatment." D. "You don't feel any different? Would you like to sit down and talk about it?"

ANS C. "It may take several weeks to see the full benefits of the treatment." Rationale: Radioactive iodine has a delayed response, and the maximum effect may not be seen for up to three months. For this reason, it would not be necessary to contact the primary health care provider immediately, or for the patient to have the thyroid gland removed sooner. Asking the patient to sit and talk about it demonstrates that the nurse is being responsive to psychosocial/emotional needs, but is not the best nursing response at this time.

A patient scheduled for a thyroidectomy is placed on potassium iodine. When the patient's family asks the nurse why this medication is needed, what is the nurse's best response? A. "This medication will promote thyroid synthesis." B. "This medication will enhance healing following surgery." C. "This medication will decrease the vascularity of the thyroid gland." D. "This medication will inhibit the production of parathyroid hormone."

ANS C. "This medication will decrease the vascularity of the thyroid gland." Rationale: When a patient is to undergo a thyroidectomy, before surgery antithyroid drugs, iodine, and adrenergic blockers may be administered to achieve a euthyroid state. Iodine reduces vascularization of the thyroid gland, reducing the risk of hemorrhage. Potassium iodide does not promote thyroid hormone synthesis, inhibit the production of parathyroid hormone, or enhance healing and electrolyte balance postoperatively.

The nurse is preparing a patient for a water deprivation test for central diabetes insipidus in the hospital. What intervention is required for this patient? A. Deprive the patient of water for six hours. B. Administer intravenous hypotonic saline or dextrose 5% in water. C. Administer desmopressin acetate (DDAVP) subcutaneously D. Provide the patient with a diluted solution of sodium

ANS C. Administer desmopressin acetate (DDAVP) subcutaneously Rationale: The patient is given DDAVP subcutaneously or nasally. The patient is deprived of water for 8 to 12 hours before administration of DDAVP. In acute diabetes insipidus, intravenous hypotonic saline or dextrose 5% in water is given and titrated to replace urine output. The patient with chronic syndrome of inappropriate antidiuretic hormone is given a diluted solution of sodium electrolyte to prevent gastrointestinal irritation or damage.

Which type of adrenal disorder is illustrated? Thinning hair, red cheeks, buffalo hump, supraclavicular fat pad, acne, moon face, increased body and facial hair, weight gain, purple striae, pendulous abdomen, thin extremities with muscle atrophy, ecchymosis resulting from easy bruising, thin skin and subcutaneous tissue, slow wound healing. A. Conn syndrome B. Addison's disease C. Cushing syndrome D. Pheochromocytoma

ANS C. Cushing syndrome Rationale: The image illustrates a patient with symptoms of Cushing syndrome, which is characterized by overexposure to corticosteroid hormones. Addison's disease is a disorder of adrenocortical insufficiency. Conn syndrome is a disorder of hyperaldosteronism. Pheochromocytoma is a tumor of the adrenal medulla.

What does the nurse infer about the clinical condition of the patient? A. Conn's syndrome B. Addison's disease C. Cushing syndrome D. Pheochromocytoma

ANS C. Cushing syndrome Rationale: The image is of a rounded face (moon face) with thin and reddened skin, which is a characteristic feature of Cushing syndrome. Conn's syndrome, Addison's disease, and pheochromocytoma do not show a characteristic feature of a rounded face.

Which parameter is assessed for corticosteroid imbalance after surgery in a patient with Cushing syndrome? A. Plantar B. Infection C. Fluid intake D. Oxygen saturation

ANS C. Fluid intake Rationale: Fluid intake should be monitored because there may be a chance of corticosteroid imbalance after surgery, which can cause dehydration. Plantar and oxygen saturation monitoring are not necessary, because corticosteroid imbalance may not have an effect on these parameters. Infections should be monitored during surgery.

A patient suffering from pheochromocytoma is scheduled for surgery. Before the procedure, the patient develops dysrhythmias. What is the appropriate treatment for this patient? A. Atenolol B. Metyrosine C. Propranolol D. Phenoxybenzamine

ANS C. Propranolol Rationale: Propranolol is an adrenergic receptor blocker used to treat dysrhythmias in a patient with pheochromocytoma. Atenolol is used to treat hypertension. Metyrosine is used to decrease catecholamine production when surgery is not an option. Phenoxybenzamine is used to reduce blood pressure and symptoms of excess catecholamines.

Which parameter would indicate the optimal intended effect of therapy with levothyroxine? A. Blood pressure 120/78 mm Hg B. Weight loss of 5 pounds C. Thyroid-stimulating hormone (TSH) of 1.5 mIU/L D. White blood cell count 8000 mm^3

ANS C. Thyroid-stimulating hormone (TSH) of 1.5 mIU/L Rationale: Levothyroxine is a thyroid preparation used for hypothyroidism. A normal TSH level (between 0.4 to 4 mIU/L) indicates optimal intended effects of the medication. Weight loss, blood pressure, and a normal white blood cell count are not indicators of effective treatment with levothyroxine.

The nurse informs a patient that has had a hypophysectomy for removal of a pituitary tumor to avoid vigorous coughing and sneezing. What explanation does the nurse give the patient for these instructions? A. To avoid seizures B. To avoid headache C. To prevent cerebrospinal fluid leakage D. To monitor pupillary and speech responses

ANS C. To prevent cerebrospinal fluid leakage Rationale: Vigorous coughing and sneezing causes leakage of the cerebrospinal fluid, which increases the risk of developing meningitis. Seizures are changes in the brain's electrical activity; they are not triggered by vigorous coughing and sneezing. Postoperative headache can be avoided by raising the head of the patient's bed to a 30-degree angle. Pupillary and speech responses are monitored to detect neurologic complications.

Which test is more reliable to diagnose pheochromocytoma? A. urinary cortisol B. Urine osmolality C. urinary creatinine D. Urinary aldosterone

ANS C. Urinary creatinine Rationale: 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.

A patient's recent medical history is indicative of diabetes insipidus. The nurse would perform patient teaching related to which diagnostic test? A. Thyroid scan B. Fasting glucose test C. Water deprivation test D. Oral glucose tolerance

ANS C. Water deprivation test Rationale: A water deprivation test is used to diagnose the polyuria that accompanies diabetes insipidus. Glucose tests and thyroid tests are not related directly to the diagnosis of diabetes insipidus.

The nurse is caring for a patient with central diabetes insipidus (DI). What does the nurse recognize is a priority focus of care? A. Pacing activities and minimizing fatigue B. Preventing treatment-related hypoglycemia C. Avoiding dehydration and fluid volume deficit D. Decreasing renal responsiveness to antidiuretic hormone (ADH)

ANS C. avoiding dehydrations and fluid volume deficit Rationale: The patient with diabetes insipidus may experience massive diuresis of up to 20 L per day. Severe dehydration and hypovolemic shock may occur if the patient does not consume or receive sufficient fluids to address the urinary losses. The patient may experience nocturia-related weakness and fatigue, but this is of lower priority than preventing dehydration and fluid volume deficit. Diabetes insipidus is a condition of too little ADH. Glucose-lowering agents are not used to treat diabetes insipidus. Whereas diabetes insipidus and diabetes mellitus both result in polydipsia and polyphagia, the mechanism driving these symptoms is entirely different between the two disorders, and treatment is not the same. Diabetes insipidus is a disorder of too little antidiuretic hormone. Decreasing renal responsiveness to a hormone that is already insufficiently present would be deleterious.

A 70-year-old man was admitted to an inpatient unit for a closed head injury after falling down a flight of stairs. The patient has been calling for the nurse every half hour requesting more water to drink and to use the urinal. The unlicensed assistive person (UAP) recorded urine output every hour for the past five hours as 500, 400, 600, 250, and 300 mL. Along with the urine output, the urinalysis revealed a specific gravity of 1.000 on each specimen. Because the patient had a head injury, the primary healthcare provider determines that the patient has central diabetes insipidus (DI). What does the nurse expect the primary healthcare provider will order for the patient? A. Indomethacin B. Thiazide diuretics C. Desmopressin acetate (DDAVP) D. Fluid restrictions, oral and intravenous

ANS C. desmopressin acetate (DDAVP) Rationale: 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.

A patient has been taking oral prednisone for the past several weeks after having an exacerbation of asthma. The nurse has explained the procedure for gradual reduction rather than sudden cessation of the drug. What is the rationale for this approach to drug administration? A. Prevention of hypothyroidism B. Prevention of diabetes insipidus C. Prevention of adrenal insufficiency D. prevention of cardiovascular complications

ANS C. prevention of adrenal insufficiency Rationale: 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.

The nurse is teaching a patient with Addison's disease about corticosteroid therapy. The nurse should prioritize which of these teaching points? A. "Plan a high-carbohydrate diet." B. "Increase your daily intake of sodium." C. "Decrease your daily intake of calcium." D. "Do not stop taking the medication abruptly."

ANS D. "do not stop taking the medication abruptly." Rationale: The patient should be instructed to not stop the medication abruptly because this can cause adverse side effects. Patients taking corticosteroids should not consume a high-carbohydrate diet, because corticosteroids increase blood sugar. Patients should also increase their daily intake of calcium to prevent bone loss due to the side effects of corticosteroids. Patients should also decrease, not increase, their daily intake of sodium to avoid fluid retention.

The nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) who has muscle twitching, vomiting, severe abdominal cramps, and begins to have seizures. The nurse assesses a serum sodium level of 116 mEq/L. What is the priority nursing action for this patient? A. Administer lorazepam IV slowly B. Administer carbamazepine by mouth C. Administer furosemide 40 mg IV push D. Administer hypertonic saline solution slowly

ANS D. Administer hypertonic saline solution slowly. Rationale: A patient with a serum sodium level of 116 mEq/L is severely hyponatremic and needs replacement with a hypertonic saline solution (at least 3 to 5 percent) slowly to correct the neurologic effects of the severe hyponatremia. Lorazepam and carbamazepine are used for seizures but would not be indicated in this case since the only way the seizures will cease are with correction of the hyponatremia. Lasix should not be given to a patient with a serum sodium level under 125 mEq/L, because it will cause further loss of sodium.

A patient with adrenocortical insufficiency develops Addisonian crisis. What should be the immediate nursing action? A. Administer fludrocortisone daily B. Advise an increased intake of salt C. Decrease the glucocorticoid dosage D. Administer large volumes of saline and dextrose

ANS D. Administer large volumes of saline and dextrose Rationale: Addisonian crisis is a life-threatening emergency in which the patient has low levels of adrenal hormones, leading to a loss of water and sodium. The first course of action is to reverse hypotension by administering large volumes of saline and dextrose. Administration of fludrocortisone can be administered once hypotension is corrected. Increasing the salt in the diet would not have an immediate effect during the Addisonian crisis. Glucocorticoids are given as a long-term therapy.

Which hormone deficiency may lead to a life-threatening condition? A. Prolactin B. Oxytocin C. Follicle-stimulating hormone (FSH) D. Adrenocorticotropic hormone (ACTH)

ANS D. Adrenocorticotropic hormone (ACTH) Rationale: Adrenocorticotropic hormone (ACTH) may lead to acute adrenal insufficiency and shock. This may result in a life-threatening situation because of sodium and water depletion. Prolactin plays a role in lactation. Oxytocin is a hormone that is particularly functional during and after childbirth. Follicle-stimulating hormone (FSH) is associated with reproduction and is responsible for the development of eggs in females and sperm in males. The absence of these other hormones are not life threatening.

Which nursing intervention is a priority for a patient recovering from removal of a pituitary gland tumor? A. Maintaining patent IV access B. Monitoring the patient for increased temperature C. Offering the bedpan or urinal at least every two or three hours D. Assessing for signs of increased intracranial pressure (ICP)

ANS D. Assessing for signs of increased intracranial pressure (ICP) Rationale: Because removal of a pituitary tumor involves entering the cranium, increased ICP is always a risk, especially in the immediate postoperative period. With this knowledge, assessment for increased ICP is a priority for the nurse. Maintaining patent IV access, monitoring the patient for increased temperature, and offering the bedpan frequently are all appropriate but secondary to assessing the patient for increased ICP.

A nurse caring for a patient with hyperparathyroidism should monitor the patient for which complication? A. Seizures B. Cataracts C. Constipation D. Cardiac dysrhythmias

ANS D. Cardiac Dysrhythmias Rationale: Cardiac dysrhythmias may result because of the increased serum calcium level in hyperparathyroidism. Seizures and cataracts are complications seen in hypoparathyroidism. Constipation is not directly associated with parathyroid disorders

The nurse is caring for a hospitalized patient with bronze-colored skin and signs of hyperpigmentation, especially in a sun-exposed area. The clinical findings are as follows. Which drug should be prescribed by the primary health care provider in this case? 1. Cortisol level: urine 112μg/24 hr, serum: 20μg/dL (afternoon) 2. ECG findings: Low voltage and peaked T-waves 3. Level of elements in blood: Potassium: 6.2 mEq/L, Chloride: 90 mEq/L, Sodium: 130 mEq/L, Glucose: Fasting-120mg/dL, Fed-110mg/dL 4. RBC: size smaller than normal and color paler than normal. 5. Hemoglobin: 10g/dL, blood urea nitrogen value: 22 mg/dL A. tolvaptan B. Octreotide C. Bromocriptine D. Fludrocortisone

ANS D. Fludrocortisone Rationale: Bronze-colored skin with hyperpigmentation in sun-exposed areas along with the other clinical findings indicates Addison's disease. The drug prescribed in this case should be fludrocortisone. Tolvaptan is used to treat euvolemia hyponatremia. Octreotide and bromocriptine are prescribed for acromegaly.

The nurse is caring for a patient with hyperaldosteronism. Which intervention will the nurse prioritize for this patient? A. Increase in fluid intake B. Administration of furosemide C. Decrease in dietary potassium D. Frequent blood pressure monitoring

ANS D. Frequent blood pressure monitoring Rationale: The priority intervention is for the nurse to frequently monitor the patient's blood pressure since hyperaldosteronism can cause abnormal blood pressure levels. Because patients with hyperaldosteronism will have sodium retention and potassium excretion, a fluid intake increase can contribute to increasing blood pressure. The patient would need to increase his or her daily intake of potassium, not decrease it. The patient would not be given furosemide because this medication will cause a further loss of potassium.

A patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) after a head injury. What condition does the nurse suspect that correlates with this disorder? A. Decreased antidiuretic hormone (ADH) B. Excessive urine output C. Increased serum osmolality D. Increased intravascular volume

ANS D. Increased intravascular volume Rationale: 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.

A patient is scheduled for a bilateral adrenalectomy. What does the nurse include in the discharge teaching for this patient? A. No replacement therapy will be needed B. Weekly adrenocorticotropic hormone (ACTH) injections will be needed. C. Cortisol will be required if the patient has stress. D. Lifelong replacement of corticosteroids will be required

ANS D. Lifelong replacement of corticosteroids will be required Rationale: 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.

The laboratory findings of a patient indicate decreased urine output. What condition does the nurse suspect? A. Hypothyroidism B. Diabetes mellitus C. Addison's disease D. Syndrome of inappropriate antidiuretic hormone

ANS D. Syndrome of inappropriate antidiuretic hormone Rationale: Syndrome of inappropriate antidiuretic hormone is associated with a decrease in antidiuretic hormone, resulting in reduced reabsorption of water from the kidney tubules and low urine output. Hypothyroidism is associated with reduced metabolic process, which leads to cold insensitivity. Diabetes mellitus is a metabolic disorder associated with excessive urine output. Addison's disease is a chronic renal insufficiency in which the patient has excessive thirst and high urine output.

A nurse has just received a report from the emergency department on a patient admitted with a closed head injury after falling down a flight of stairs. The nurse is reviewing the lab results in the patient's electronic record and discovers a sodium level of 128 mEq/L, serum osmolality of 271 mOsm/kg, and a urine specific gravity of 1.030. After reviewing these results, about which disorder is the nurse most concerned? A. Diabetes insipidus B. Cushing syndrome C. Primary hyperparathyroidism D. Syndrome of inappropriate antidiuretic hormone (SIADH)

ANS D. Syndrome of inappropriate antidiuretic hormone (SIADH) Rationale: The characteristics of SIADH include a decreased serum sodium level, serum osmolality less than 280 mOsm/kg, and an increased urine specific gravity above 1.025. Diabetes insipidus is marked by decreased production of antidiuretic hormone with increased urine output and increased plasma osmolality. Cushing syndrome occurs when levels of cortisol are too high. Primary hyperparathyroidism is a result of an increased production of parathyroid hormone and affects calcium and phosphate levels.

A patient reports "eye problems". On assessment of this patient, the nurse notes exophthalmos. What other abnormal assessments should the nurse expect to find in this patient? A. puffy face, decreased sweating, and dry hair B. muscle aches and pains and slow movements C. decreased appetite and increased thirst and pallor D. Systolic hypertension and increased heart rate

ANS D. Systolic hypertension and increased heart rate Rationale: The patient's symptoms point to Graves' disease, or hyperthyroidism; its symptoms would also include systolic hypertension, increased heart rate, and increased thirst. Puffy face, decreased sweating, dry, coarse hair, muscle aches and pains, slow movements, decreased appetite, and pallor are all manifestations of hypothyroidism.

Which laboratory findings can be observed in a patient with hair loss and decreased skin pigmentation? A. Cortisol level of 2 mcg/dL B. Somatomedin C level of 250 ng/mL C. Parathyroid hormone (PTH) level of 60 pg/mL D. Thyroid stimulating (TSH) level of 7 μU/mL

ANS D. Thyroid stimulating (TSH) level of 7 μU/mL Rationale: Hair loss and decreased skin pigmentation are clinical manifestations of hypothyroidism. The normal levels of thyroid stimulating hormone (TSH) in the body are 0.4 to 4.2 μU/mL. The THS levels are governed by a negative feedback mechanism. Therefore an increase in TSH levels to compensate for low T 3 and T 4 indicates hypothyroidism in the patient. The normal level of cortisol in the morning is 5 to 23 mcg/dL and in the evening it is 3 to 16 mcg/dL. Therefore a cortisol level of 2 mcg/dL indicates hypocortisolism in the patient. Hypocortisolism results in increased skin pigmentation, not decreased skin pigmentation. Hypopituitarism results in hair loss and decreased skin pigmentation in the patient. Somatomedin C is an insulin-like growth factor that is released by the pituitary gland. A somatomedin C level of 250 ng/mL indicates normal levels in the body, but not hypopituitarism. Parathyroid levels are considered normal in range of 50 to 330 pg/mL. Therefore the patient has normal parathyroid levels.