Care of the Patients with Endocrine Disorders

13. Initial treatment for a CSF leak after transphenoidal hypophysectomy would mostly likely involve: A. Repacking the nose. B. Returning the client to surgery. C. Enforcing bed rest with the head of the bed elevated. D. Administering high-dose corticosteroid therapy.

13. Answer: C. Enforcing bed rest with head of the bed elevated may resolve CSF leak via the nose after transphenoidal hypophysectomy. CSF leak beyond 72 hours may require surgery. There may be a need for the surgeon to resuture dura mater.

09. The diabetic client who is taking insulin Lispro (Humalog) injections would be advised to eat: A. Within 10 to 15 minutes after injection. B. 1 hour after injection. C. At any time, because timing of meals with Humalog injections is unnecessary. D. 2 hours before the injection.

9. Answer: A. Lispro (Humalog) is very rapid acting insulin. The onset of action is 5-10 minutes after injection. Therefore, the patient may eat within 10 to 15 minutes after the injection.

1. Propylthiouracil (PTU) is prescribed for a client with Grave's disease to decrease circulating thyroid hormone. The nurse should teach the client to immediately report which of the following signs and symptoms? a. Sore throat b. Painful, excessive menstruation. c. Constipation. d. Increased urine output

1. Answer: A. Agranulocytopenia is a common toxic effect of PTU. This is characterized by fever, skin rash, sore throat

10. A female client with type I DM is experiencing minor illness with the flu. The nurse should instruct the client A. To increase the frequency of blood glucose monitoring. B. That she should try to reduce food intake to diminish nausea. C. That she does not need to take the insulin if she cannot eat. D. To take half of the normal dose of insulin.

10. Answer: A. During illness, stress response is triggered causing release of hormones that elevate blood glucose levels. Therefore, there is a need to increase the frequency of self-monitoring for blood glucose levels

11. During a home visit, a diabetic client cries and says, "I just cannot stand the thought of having to give myself a shot everyday." Which of torbes the following would be the best response by the nurse? A. "If you do not give yourself your insulin shot, you will die." B. "We can teach your daughter to give the shot so you will not have to do it." C. "I can arrange to have a home care nurse give you the shot everyday." D. "What is it about giving yourself the insulin shots that bothers you."

11. Answer: D. Focusing on the client's feelings is therapeutic. Option A is incorrect. The nurse should not threaten the client. Options B and C are incorrect because they don't allow the client to verbalize concerns.

12. Which of the following monitoring activities would be a major focus when planning a nursing care for a client who has undergone transphenoidal hypophysectomy? A. Monitoring for cerebrospinal fluid (CSF) levels. B. Monitoring for fluctuating blood glucose C. Monitoring for Cushing's syndrome. D. Monitoring for cardiac arrest.

12. Answer: A. Monitoring for CSF leak via the nose is a hypophysectomy. This is normal during the first 72 hours. This could be relieved by promoting bed rest and by placing the client in semi- Fowler's position.

14. Which of the following findings would be typical of Addison's disease A. Hypokalemia B. Hypernatremia C. Hypoglycemia D. Decreased blood urea nitrogen (BUN) level.

14. Answer: C. Addison's disease is characterized by hyposecretion of adrenal cortex gland hormones. Hypoglycemia is a manifestation. Hyperkalemia and hyponatremia also occur. These are due to hyposecretion of aldosterone. (Addison's disease: "Everything is a low, Except potassium, calcium and pulse rate").

15. Which of the following statements should the nurse make when teaching the client about taking oral corticoticoids? A. "Take your medication with a full glass of water." B. "Take your medication on an empty stomach." C. "Take your medication at bedtime to increase absorption." D. "Take your medication with meals or with an antacid."

15. Answer: D. Glucocorticoids in general, should be taken with meals or with an antacid to prevent gastrointestinal irritation.

16. A client with Cushing's syndrome needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate? A. Increase calories B. Restrict sodium C. Restrict potassium D. Reduce fat to 10%

16. Answer: B. The client with Cushing's disease should restrict sodium intake. Hypersecretion of aldosterone causes retention of Boma sodium and water.

17. A client who is recovering from a bilateral adrenalectomy has a patient controlled analgesia (PCA) system with morphine sulfate. Which of the following actions is a priority nursing intervention for the client? A. Observing the client at regular intervals for narcotic addiction. B. Encouraging the client to reduce analgesic use and tolerate the pain. C. Evaluating pain control at least every 2 hours. D. Increasing the amount of morphine if the client does not self- administer the medication.

17. Answer: C. PCA allows the client to self-administer narcotic analgesic to have adequate pain relief. Pain control should be evaluated every 2 hours, for effectiveness of the treatment

18. After bilateral adrenalectomy for Cushing's syndrome, the client is told by the physician that she needs periodic testosterone injections. She asks the nurse, "What is that for? Did he forget I'm a woman' What would be the nurse's best response? A. Testosterone is needed to balance the reproductive cycle. B. Testosterone is needed to restore to body's sodium and potassium balance. C. Testosterone is given to stimulate protein anabolism. D. Testosterone is given to stabilize mood swings.

18. Answer: C. Testosterone is given after bilateral adrenalectomy to stimulate protein anabolism. This prevents muscle wasting.

19. The primary feature of pheochromocytoma's effect on blood pressure is? A. Systolic hypertension. B. Diastolic hypertension. C. Hypertension that is resistant to treatment with drugs. D. Widening pulse pressure.

19. Answer: C. Pheochromocytoma is a tumor in the adrenal medulla that stimulates increased secretion of cathcholamines. This is primarily characterized by hypertension that is resistant to treatment with drugs. This requires surgery - adrenalectomy.

2. The nurse should teach the client to prevent corneal irritation from mild exophthalmos by: a. Massaging the eye at regular intervals. b. Instilling an ophthalmic anesthetic as ordered. do c. Wearing dark-colored, glasses. d. Covering both eyes with moistened gauze pads.

2. Answer: C. Prevention of corneal irritation from mild exophthalmos can be done by wearing dark colored glasses when going out under the sun.

20. The client with pheochromocytoma should be instructed to avoid activities that precipitate hypertensive crisis or paroxysms, such as: A. Jogging B. Valsalva maneuver C. Anxiety D. Hypoglycemia

20. Answer: B. Valsalva maneuver increases cardiac workload and precipitate hypertensive crisis. This should be avoided by the client then in with pheochromocytoma.

3. A client with a large goiter is scheduled for a subtotal thyroidectomy to treat thyrotoxicosis. Saturated solution of potassium iodide (SSKI) is prescribed preoperatively for the client The primary reason for using this drug is that it helps a. Slow progression of exophthalmos. b. Reduce the vascularity of the thyroid gland. c. Decrease the body's ability to store thyroxine. d. Increase the body's ability to excrete thyroxine.

3. Answer: B. Iodide is administered to the client before thyroid surgery to reduce the size and vascularity of the thyroid gland. This prevents postop hemorrhage and thyroid crisis.

4. The nurse asks the client to state her name as soon as she regains consciousness postoperatively after a subtotal thyroidectomy and at each assessment. The nurse does this primarily to monitor for signs of which of the following? a. Internal hemorrhage. b. Decreasing level of consciousness. c. Laryngeal nerve damage. d. Upper airway obstruction.

4. Answer: C. To assess for laryngeal nerve damage after subtotal thyroidectomy, the patient should be asked to speak every hour. Severe hoarseness of voice of "whispery voice" indicates laryngeal nerve damage.

5. A client who has undergone a subtotal thyroidectomy is subject to complications in the first 48 hours after surgery. The nurse should obtain and keep at the bedside equipment to a. Begin total parenteral nutrition. b. Start a cutdown infusion. c. Administer tube feeding. d. Perform a tracheostomy.

5. Answer: D. Parathyroid glands may be damaged during thyroid surgery. This leads to hypocalcemia which causes laryngospasm and airway obstruction. Tracheostomy set should be made available for emergency purposes.

6. Appropriate nursing diagnosis for a client with hypothyroidism would probably include which of the following A. Risk for injury (corneal abrasion) related to incomplete closure of eyelids B. Imbalanced nutrition: less than body requirements related to hypermetabolism. C. Deficient fluid volume related to diarrhea. D. Activity intolerance related to fatigue associated with the disorder.

6. Answer: D. Activity intolerance related to fatigue iss a common problem associated with hypothyroidism. Options A, B, and C are nursing diagnosis for hyperthyroidism

7. A client with DM asks the nurse to recommend something to remove corns from his toes. The nurse should advise him to: A. Apply a high-quality corn plaster to the area. B. Consult his physician or podiatrist about removing the corn. C. Apply iodine to the corn before peeling them off. D. Soak his feet to borax solution to peel of the corn.

7. Answer: B. The diabetic client should consult the podiatrist for removal of corns from his toes. This is to prevent trauma that may lead to gangrene formation.

8. The client with type 1 DM is taught to take isophane insulin NPH (Humulin N) at 5pm each day. The client should be instructed that the greatest risk for hypoglycemia will occur at what time? A. 11AM, shortly before lunch B. 1PM, shortly after lunch C. 6PM, shortly after dinner D. 1AM, while sleeping

8. Answer: D. Humulin N is an intermediate - acting insulin. The greatest risk for hypoglycemia will occur at its peak of action which is an average of 6 to 8 hours.