NURS 3 - Mod 13 Endocrine (Med Surg) EAQ's

The nurse is performing discharge education for a patient who was admitted for acute hypothyroidism. The patient is undergoing thyroid hormone therapy for the first time. What statement by the patient to the nurse confirms that discharge teaching was effective? 1 "I should take my levothyroxine every morning before eating my breakfast." 2 "I should only follow up with my doctor if I start having shortness of breath." 3 "I should keep the air conditioning a few degrees colder to help me with sweating." 4 "I should limit the amount of fiber I am eating to help keep me from getting constipated."

1 - "I should take my levothyroxine every morning before eating my breakfast." A patient with a new diagnosis of hypothyroidism should be taught how to manage hypothyroidism, including taking the thyroid hormone in the morning before food. Patients with hypothyroidism need to be taught about the importance of regular follow-up care, not just when they are having abnormal symptoms. Patents with hypothyroidism should be taught to keep the environment warm and comfortable because of cold intolerance. Patients with hypothyroidism should increase the amount of fiber in their diet to prevent constipation; they should not limit the amount of fiber.

The nurse is educating patients about having a screening colonoscopy every three to four years, because they are at risk for developing colon polyps and colorectal cancer. What patient is at greatest risk for this complication? 1 A patient with acromegaly 2 A patient with prolactinomas 3 A patient with hypopituitarism 4 A patient with pituitary infarctions

1 - 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. This condition does not require a screening colonoscopy, because it is not associated with a risk of colon polyps and colorectal cancer.

The nurse is caring for a patient being treated for acute thyrotoxicosis. What are the nursing interventions for this patient exhibiting exophthalmos? Select all that apply. 1 Apply artificial tears. 2 Tape the eyelids lightly for sleeping, if needed. 3 Ask the patient to exercise the intraocular muscles. 4 Place the patient in a supine position. 5 Avoid elevating the patient's head.

1 - Apply artificial tears. 2 - Tape the eyelids lightly for sleeping, if needed. 3 - Ask the patient to exercise the intraocular muscles. Nursing interventions for the patient exhibiting exophthalmos include application of artificial tears to soothe and moisten conjunctival membranes, to relieve eye discomfort, and to prevent corneal ulceration. If the eyelids cannot be closed, the nurse should lightly tape them shut to help the patient sleep. To maintain flexibility, the patient must be taught to exercise the intraocular muscles several times a day by turning the eyes in the complete range of motion. The patient should sit upright as much as possible. The head must be elevated to promote fluid drainage from the periorbital area.

A patient is admitted to the hospital with severe burns. Which hormone level does the nurse expect to be elevated in the patient's laboratory reports? 1 Cortisol 2 Oxytocin 3 Aldosterone 4 Antidiuretic hormone

1 - Cortisol Cortisol is a glucocorticoid that protects the body from stress; it is also called as stress hormone. Cortisol helps to maintain vascular integrity and fluid volume; cortisol levels are increased in patients with burns, infections, fevers, and acute anxiety. The level of oxytocin, aldosterone, and antidiuretic hormone does not increase in response to stress.

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. 1 Do you snore? 2 Do you crave salty foods? 3 Have you experienced a recent weight loss? 4 Have you noticed an increase in your shoe size? 5 Have you experienced unusual thirst or excessive urination? 6 Have you experienced numbness or tingling in your fingers or hands?

1 - Do you snore? 4 - Have you noticed an increase in your shoe size? 5 - Have you experienced unusual thirst or excessive urination? 6 - Have you experienced numbness or tingling in your fingers or hands? 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.

Activity intolerance in a patient with hypothyroidism is related to what? 1 Fatigue 2 Diarrhea 3 Weight loss 4 Nervousness

1 - 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.

What are the characteristic signs and symptoms of hyperparathyroidism? Select all that apply. 1 Fractures 2 Tachycardia 3 Hypotension 4 Osteoporosis 5 Nephrolithiasis

1 - Fractures 4 - Osteoporosis 5 - Nephrolithiasis Fractures may be seen due to increase in parathyroid hormone secretion. It decreases bone density because it has an effect on osteoclastic and osteoblastic activity. Osteoporosis may occur due to deformation of bones. Nephrolithiasis can occur due to an increase in calcium levels in the urine. Tachycardia may be present in some patients but it is not a characteristic symptom. Hypotension is not associated with hyperparathyroidism.

The nurse receives primary care provider orders for a patient with syndrome of inappropriate antidiuretic hormone (SIADH). Which medication order should the nurse question? 1 Vinblastine 2 Cabergoline 3 Bromocriptine 4 Lysine vasopressin

1 - Vinblastine Chemotherapeutic agents such as vinblastine are contraindicated for SIADH, because these drugs induce the release of antidiuretic hormone (ADH). Cabergoline and bromocriptine do not induce the release of ADH, so these drugs are not contraindicated in patients with SIADH. Lysine vasopressin does not induce the release of ADH; therefore, it is not contraindicated in patients with SIADH.

A patient has just begun long-term corticosteroid therapy. The nurse determines that the patient requires further education when making which statement? 1 "I may need to monitor my blood sugar more frequently." 2 "If I begin to gain weight I should stop taking my medication." 3 "It is important that I stay away from people who have contagious illnesses." 4 "I understand my appearance may change as fat tissue increases in my face and trunk."

2 - "If I begin to gain weight I should stop taking my medication." Corticosteroids should be gradually tapered and not stopped suddenly to avoid life-threatening adrenal insufficiency. Corticosteroids may lead to insulin resistance and increased gluconeogenesis by the liver, and therefore the patient may need to monitor for blood sugar increase. Corticosteroids decrease the inflammatory response and delay healing, and therefore the patient is more susceptible to infections. Adipose tissue accumulates in the trunk, face, and cervical spine as a result of corticosteroid therapy.

Which condition can result if hypersecretion of growth hormone (GH) occurs after epiphyseal plate closure? 1 Dwarfism 2 Acromegaly 3 Gigantism 4 Cretinism

2 - 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.

What should the nurse include in dietary instructions provided to a patient who is diagnosed with hyperthyroidism? Select all that apply. 1 Eat a high-fiber diet. 2 Consume a high-calorie diet. 3 Eat snacks high in protein. 4 Avoid caffeinated beverages. 5 Decrease the intake of carbohydrates.

2 - Consume a high-calorie diet. 3 - Eat snacks high in protein. 4 - Avoid caffeinated beverages. A diet high in calories and protein is encouraged. Caffeinated beverages should be avoided. High-fiber foods should be avoided, not encouraged, because they can further stimulate the already hyperactive gastrointestinal tract. The patient should increase intake of carbohydrate-rich foods to compensate for the increased metabolism. This provides energy and decreases the use of body-stored protein.

A nurse is caring for a patient who underwent subtotal thyroidectomy because of the overproduction and release of thyroid hormone. Postoperative nursing interventions are important to prevent complications after surgery. Which nursing interventions should the nurse implement for safe, effective care? Select all that apply. 1 Monitor vital signs and potassium levels. 2 Control postoperative pain by administering medication. 3 Place the patient supine and support the head with pillows. 4 Assess for signs of tetany secondary to hypoparathyroidism. 5 Assess the patient every two hours for signs of bleeding or tracheal compression.

2 - Control postoperative pain by administering medication. 4 - Assess for signs of tetany secondary to hypoparathyroidism. 5 - Assess the patient every two hours for signs of bleeding or tracheal compression. Nursing interventions after a thyroidectomy are important to prevent complications, such as airway obstruction. These interventions include controlling pain with medication; assessing for signs of tetany (i.e., tingling in toes, fingers, and around the mouth, Trousseau sign, and Chvostek sign); and assessing the patient every two hours for signs of bleeding and tracheal compression. Monitoring vital signs is important, but monitoring potassium levels is not; the calcium levels should be monitored. The patient should be placed in a semi-Fowler's position, not supine, with the head supported with pillows.

A patient's T3 and T4 levels are decreased, and the TSH (thyroid-stimulating hormone) level is increased. The nurse suspects what condition? 1 Hypoparathyroidism 2 Hypothyroidism 3 Hyperthyroidism 4 Hyperparathyroidism

2 - Hypothyroidism A decrease in the level of thyroid hormone, evidenced by below-normal T3 and T4 levels and increased TSH, indicates hypothyroidism. TSH increases as the body attempts to compensate for decreased thyroid production by trying to stimulate more T3 and T4 production. Hypoparathyroidism is a decrease in parathormone that in turn causes a decrease in serum calcium. In hyperthyroidism T3 and T4 production are increased and TSH is decreased. Hyperparathyroidism is an increase in parathormone that causes an increase in serum calcium.

A nurse on an inpatient unit is caring for a patient who underwent a hypophysectomy. While performing the adult ongoing assessment at the beginning of the shift, the nurse notices the moustache dressing is saturated with clear drainage. After notifying the primary healthcare provider, the nurse sends a specimen to the laboratory to assess for a cerebrospinal fluid (CSF) leak. The glucose level is 50 mg/dL. Considering this result, for which complication is the patient most at risk? 1 Diabetes 2 Meningitis 3 Hypoglycemia 4 Visual deterioration

2 - Meningitis A hypophysectomy is usually performed through the sphenoid sinuses, and the physician packs the sphenoid sinus with gauze. When a specimen is tested for a CSF leak, a glucose level greater than 30 mg/dL indicates a CSF leak from an open connection with the brain. If this happens, the patient has an increased risk of meningitis. Diabetes is not a complication of a CSF leak from hypophysectomy. Hypoglycemia is not a complication of a CSF leak from hypophysectomy. Visual deterioration after hypophysectomy would be evidenced by changes in extraocular movements, peripheral vision changes, and changes in visual acuity.

The nurse is caring for a patient who underwent a transsphenoidal hypophysectomy. What is the most important nursing intervention for this patient? 1 Place the patient in a supine position at all times. 2 Monitor pupillary response and speech patterns. 3 Perform mouth care every 12 hours. 4 Test any clear nasal drainage for potassium.

2 - Monitor pupillary response and speech patterns. 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.

The nurse is assessing a patient for hyperthyroidism. What are the manifestations of hyperthyroidism? Select all that apply. 1 Enlarged scaly tongue 2 Presence of bruits upon auscultation of the thyroid gland 3 Presence of dry, thick, inelastic, and cold skin 4 Presence of goiter detected on palpation of the thyroid gland 5 Presence of clubbed and swollen fingers In

2 - Presence of bruits upon auscultation of the thyroid gland 4 - Presence of goiter detected on palpation of the thyroid gland 5 - Presence of clubbed and swollen fingers In a patient with hyperthyroidism, auscultation of the thyroid gland reveals bruits, palpation of the thyroid gland reveals goiter, and the nurse would observe the patient's clubbed and swollen fingers. Enlarged scaly tongue and dry, thick, inelastic, and cold skin are observed in patients with hypothyroidism.

Which type of health education should a nurse provide to a patient who is on corticosteroid therapy? Select all that apply. 1 Co-administer opioids. 2 Restrict sodium intake. 3 Reduce physical exercise. 4 Maintain a high-protein diet. 5 Ensure adequate rest and sleep.

2 - Restrict sodium intake. 4 - Maintain a high-protein diet. 5 - 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 anticipates that which interventions will be prescribed for a patient that is admitted to the intensive care unit (ICU) with myxedema coma? Select all that apply. 1 Oxygen therapy 2 Strict input and output 3 Low-pressure mattress 4 Oral thyroid medication 5 Continuous cardiac monitoring

2 - Strict input and output 3 - Low-pressure mattress 5 - Continuous cardiac monitoring A patient admitted with myxedema coma requires acute nursing care in the ICU. Interventions for this patient will most likely include strict input and output, a lower-pressure mattress, and continuous cardiac monitoring. Mechanical ventilation, not oxygen therapy, is also expected. All medications would be administered by intravenous (IV) delivery, not by mouth.

A patient who had surgery for the treatment of acromegaly asked about the possibility of becoming pregnant. When responding to the patient, from what knowledge should the nurse base the rationale? 1 There will be a decrease in thyroid hormone. 2 There will be a permanent loss of hormones. 3 There is a loss of antidiuretic hormone (ADH). 4 There will be increased levels of corticosteroids.

2 - There will be a permanent loss of hormones. Surgery for acromegaly may result in permanent loss or deficiencies in follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which leads to decreased fertility. Hypothyroidism occurs when a patient is deficient in thyroid-stimulating hormone (TSH) and is generally observed in radiation therapy. Loss of antidiuretic hormone is seen in patients with transient diabetes insipidus. Cushing syndrome results from increased levels of corticosteroids.

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? 1 Radiation therapy 2 Transphenoidal resection 3 Drug therapy with mitotane 4 Drug therapy with ketoconazole

2 - Transphenoidal resection 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.

The nurse assesses a patient with diabetes insipidus. The most important assessment finding is an increase in: 1 Temperature 2 Urine output 3 Serum glucose 4 Blood pressure

2 - 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.

The nurse is teaching a patient with Cushing syndrome about home care. Which statement made by the patient indicates effective learning? 1 "I don't require a home health nurse." 2 "I will take acetaminophen if I have fever." 3 "I will wear a Medic Alert bracelet all the time." 4 "I can't take corticosteroid therapy for lifetime."

3 - "I will wear a Medic Alert bracelet all the time." Wearing a Medic Alert bracelet would indicate that the patient has Cushing syndrome and will help to provide an appropriate therapy in case of emergency. A home nurse should be provided to an elderly patient for assistance in daily activities. If any side effects occur, the patient should consult the primary health care provider immediately. Corticosteroid therapy should be taken for the patient's lifetime.

A patient who underwent thyroid surgery develops neck swelling. What is the first action that the nurse should take? 1 Monitor calcium levels 2 Evaluate difficulty in speaking 3 Assess the patient for signs of hemorrhage 4 Place the patient in a semi-Fowler's position

3 - Assess the patient for signs of hemorrhage The patient who undergoes thyroid surgery is at risk for hemorrhage. Swelling is a clinical manifestation of hemorrhage. The first nursing action is to assess the patient. Monitoring calcium levels and evaluating difficulty in speaking helps in assessing the signs of hypoparathyroidism. Placing the patient in a semi-Fowler's position helps in avoiding flexion of the neck and tension on the suture lines.

The nurse is caring for a patient who is postoperative following a thyroidectomy. A priority of the patient's nursing care includes which action? 1 Assessment of hoarseness 2 Assessment of Babinski's reflex 3 Assessment of Chvostek's sign 4 Assessment of neck full range of motion

3 - Assessment of Chvostek's sign A positive Chvostek's sign is a sign of life-threatening tetany, which could be caused by hypocalcemia because of accidental removal of the parathyroid glands. Hoarseness for three to four weeks postoperatively is an expected outcome of a thyroidectomy. A Babinski's reflex is not related to thyroid removal. Although it is advisable that the postoperative thyroidectomy patient exercise the neck muscles, neck flexion is contraindicated because it places tension on the suture line.

The nurse is caring for a patient with central diabetes insipidus (DI). What does the nurse recognize is a priority focus of care? 1 Pacing activities and minimizing fatigue 2 Preventing treatment-related hypoglycemia 3 Avoiding dehydration and fluid volume deficit 4 Decreasing renal responsiveness to antidiuretic hormone (ADH)

3 - Avoiding dehydration and fluid volume deficit 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? 1 Indomethacin 2 Thiazide diuretics 3 Desmopressin acetate (DDAVP) 4 Fluid restrictions, oral and intravenous

3 - Desmopressin acetate (DDAVP) 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.

The nurse, providing care to a patient with Cushing's syndrome, understands that the disorder is primarily related to: 1 Liver dysfunction 2 Chronic renal failure 3 Excessive secretion of adrenocorticosteroid hormones 4 Decreased secretion of adrenocorticosteroid hormones

3 - Excessive secretion of adrenocorticosteroid hormones Cushing's syndrome results from excessive secretion of adrenocorticosteroid hormones, usually caused by pituitary gland tumors or carcinoma of the adrenal glands. It is also the result of excessive steroid intake for other medical conditions or nonmedical use (e.g., sports). Cushing's syndrome is not directly related to liver function or renal failure. It is caused by excessive, not decreased, amounts of adrenocorticosteroid hormones.

A patient has recently undergone transsphenoidal hypophysectomy and reports a severe supraorbital headache. The nurse maintains the patient's head in an elevated position and requests the patient stay on bed rest for four days. Which finding in the laboratory report is the reason for this nursing action? 1 Glucose level 15 mg/dL in the urine sample 2 Glucose level 70 mg/dL in the blood sample 3 Glucose level 40 mg/dL in the nasal drainage 4 Glucose level 60 mg/dL in the cerebrospinal fluid

3 - Glucose level 40 mg/dL in the nasal drainage A glucose level greater than 30 mg/dL in the nasal drainage indicates cerebrospinal leakage from an open connection to the brain. Supraorbital headache in a patient who has undergone transsphenoidal hypophysectomy is caused by cerebrospinal fluid (CSF) leakage into the sinuses. It can be resolved by placing the patient's head in an elevated position and asking him or her to take bed rest for 72 hours. Glucose levels in urine and blood are measured to know the diabetic condition of the patient; they do not indicate CSF leakage. Glucose levels in the cerebrospinal fluid (CSF) are used to monitor infections, tumors, and inflammation in the central nervous system, not postoperative leakage of CSF.

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? 1 Prevention of hypothyroidism 2 Prevention of diabetes insipidus 3 Prevention of adrenal insufficiency 4 Prevention of cardiovascular complications

3 - 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.

A patient with a pituitary tumor has developed excessive height, and increased hat size and shoe size. Which hormone does the nurse determine is secreting excessively? 1 Cortisol 2 Thyroxine 3 Somatotropin 4 Triiodothyronine

3 - Somatotropin Somatotropin is also called growth hormone (GH). Excessive secretion of GH results in overgrowth of soft tissues and bones resulting in acromegaly. Cortisol produces a number of physiologic effects, such as increasing blood glucose levels, potentiating the action of catecholamines on blood vessels, and inhibiting the inflammatory response. Thyroxine acts as a precursor to triiodothyronine, which regulates metabolic rate of all cells and processes of cell growth and tissue differentiation. Excessive secretion of cortisol, thyroxine, and triiodothyronine do not result in acromegaly.

A patient with adrenocortical insufficiency develops Addisonian crisis. What should be the immediate nursing action? 1 Administer fludrocortisone daily. 2 Advise an increased intake of salt. 3 Decrease the glucocorticoid dosage. 4 Administer large volumes of saline and dextrose.

4 - Administer large volumes of saline and dextrose. 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 nursing intervention is a priority for a patient recovering from removal of a pituitary gland tumor? 1 Maintaining patent IV access 2 Monitoring the patient for increased temperature 3 Offering the bedpan or urinal at least every two to three hours 4 Assessing for signs of increased intracranial pressure (ICP)

4 - Assessing for signs of increased intracranial pressure (ICP) 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 patient has developed Cushing syndrome due to the prolonged administration of corticosteroid hormonal therapy. What course of action should be taken to treat the patient? 1 Withholding therapy for few days 2 Conversion to an alternate-day regimen 3 Abrupt discontinuance of corticosteroids 4 Gradual discontinuance of corticosteroids

4 - 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.

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? 1 Decreased antidiuretic hormone (ADH) 2 Excessive urine output 3 Increased serum osmolality 4 Increased intravascular volume

4 - 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.

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? 1 Having the patient lie down in the supine position 2 Ensuring oral hygiene in the patient by regular brushing 3 Informing the primary health care provider about nasal drainage 4 Instructing the patient to avoid vigorous coughing, sneezing, and straining at stool

4 - 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.

A patient is scheduled for a total thyroidectomy. What information does the nurse include when teaching this patient about recovery after the procedure? 1 Exercise will be restricted for up to six months. 2 A low- or no-sodium diet will be prescribed. 3 Physical therapy will need to be continued. 4 Life-long hormone replacement will be needed.

4 - Life-long 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.

A patient is scheduled for a bilateral adrenalectomy. What does the nurse include in the discharge teaching for this patient? 1 No replacement therapy will be needed. 2 Weekly adrenocorticotropic hormone (ACTH) injections will be needed. 3 Cortisol will be required if the patient has stress. 4 Lifelong replacement of corticosteroids will be required.

4 - 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.

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? 1 Diabetes insipidus 2 Cushing syndrome 3 Primary hyperparathyroidism 4 Syndrome of inappropriate antidiuretic hormone (SIADH)

4 - Syndrome of inappropriate antidiuretic hormone (SIADH) 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.

The nurse creates a plan of care for a patient with Graves' disease. What is an appropriate expected outcome? 1 The patient will be free of infection. 2 The patient will remain awake, alert, and oriented. 3 The patient will be compliant with fluid restrictions. 4 The patient will demonstrate maintenance of his weight.

4 - The patient will demonstrate maintenance of his weight. Graves' disease, which results from hyperthyroidism, causes an increase in metabolism. Untreated, it may cause unexplained weight loss. It is important for the nurse to plan care to support an expected outcome to maintain or gain weight. Risk for infection and fluid overload are not direct issues related to hyperthyroidism. Because of the increased secretion of thyroid hormone, these patients will be hyperalert and anxious and may have difficulty sleeping. Therefore, the goal of remaining awake, alert, and oriented is not a priority.

While assessing a patient with suspected Cushing's syndrome, of what most prominent clinical manifestation is the nurse aware? 1 Dehydration and hypotension 2 "Bulking up" of skeletal muscle 3 Hypoglycemia with intense hunger 4 Weight gain, including truncal obesity

4 - Weight gain, including truncal obesity The most prominent clinical manifestation in Cushing's syndrome is weight gain leading to truncal obesity, with a characteristic rounded "moon face" and fat deposits in the neck and upper back, also known as a "buffalo hump." Cushing's syndrome's results from an overproduction of adrenocorticosteroids or large doses of steroid medication. Dehydration and hypotension, bulking of skeletal muscle, and hypoglycemia with intense hunger are not directly associated with Cushing's syndrome.

The patient has a prescription to receive 45 mg of prednisone by mouth daily. Available are 10 mg tablets. How many tablets should the nurse prepare to give? Fill in the blank using one decimal place. ________ tablet(s)

4.5 45 mg ÷ 10 mg = 4.5 tablets

4 - Fludrocortisone 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 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 Tolvaptan 2 Octreotide 3 Bromocriptine 4 Fludrocortisone

2 - B Label B represents the parathyroid gland. It produces parathyroid hormone, which regulates the level of calcium in blood. Label A represents the larynx, which holds the vocal cords. Label C represents the thyroid gland, which secretes hormones that play a role in carbohydrate and lipid metabolism, brain function, growth and development, and other nervous system activities. Label D represents the trachea, which allows for the passage of air into the lungs.

Which structure indicated in the picture helps regulate the level of calcium in blood? 1 A 2 B 3 C 4 D