chapter 46 Pituitary, Thyroid, parathyroid and adrenal Disorders
A patient has just begin taking Calcitriol. Which nursing implication would the nurse do? a. Monitor the patient's weight b. Monitor serum calcium levels Teach side effects of alopecia and petechia d. Instruct the patient to avoid persons with respiratory infections
b
A client with hypothyroidism has been taking 50 mcg by mouth daily for the past 3 weeks. Which finding, if present, would result in the nurse holding the medication? A. Polyuria B. Tachycardia C. Cold extremities D. Pallor
B
A client with severe chronic obstructive pulmonary disease has been taking prednisone for several years. Which assessment findings noted by the nurse would indicate an insufficient dose of prednisone? Select all that apply. A. Hypotension B. Hyponatremia C. Tachycardia D. 2+ pitting edema E. Hyperglycemia
A,B,C
A client has been taking levothyroxine for the past 3 months. The nurse would be concerned about toxicity of the medication if which signs or symptoms were discovered? Select all that apply. A. Tachydysrhythmias B. Constipation C. Hypotension D. Insomnia E. Increased appetite
A,D,E
The nurse identifies which of the following as the drug of choice for the treatment of chronic lymphocytic (Hashimoto) thyroiditis? A.Liothyronine B.Levothyroxine sodium C.Propylthiouracil D. Methimazole
ANS: B Levothyroxine sodium (Synthroid) is used to treat simple goiter and chronic lymphocytic (Hashimoto) thyroiditis.
Which drug would the nurse administer for the treatment of a patient with hyperthyroidism? A.Liothyronine sodium B.Methimazole C.Liotrix D.Thyroid
ANS: B Methimazole (Tapazole) is used for the treatment of hyperthyroidism. The other drugs are used to treat hypothyroidism.
The nurse will teach a patient taking levothyroxine for hypothyroidism to notify the health care provider if he or she experiences A.dizziness. B.nausea. C.palpitations. D.abdominal cramps.
ANS: C Patients taking this drug should report tachycardia or palpitations to the health care provider. The other options are considered to be not necessarily reportable.
A patient has hypoparathyroidism. The nurse anticipates administration of which medication? A.Mitotane B.Fludrocortisone C.Dexamethasone D. Calcitriol
ANS: D Calcitriol is a vitamin D analogue that promotes calcium absorption from the GI tract and secretion of calcium from bone to the bloodstream.
A nurse has been teaching a patient about levothyroxine. Which side effect should the nurse teach the patient to observe for? A.Somnolence B.Bradycardia C.Constipation D.Nervousness
ANS: D Side effects of levothyroxine include nervousness, tremors, diarrhea, and insomnia.
During a diagnostic test for parathyroid function, a patient asks the nurse what the parathyroid gland does. The nurse correctly informs the patient that the parathyroid gland is responsible for • A. regulating the body's metabolism. B. maintaining blood glucose levels. C. controlling the release of glucocorticoids. D. regulating calcium levels.
ANS: D The parathyroid gland regulates calcium levels.
A client arrives to the emergency department with the following signs/symptoms: blood pressure 186/102, heart rate 144 beats/min, temperature 102.8°F (39.3°C), oxygen saturation 99%. The client, who has a history of hypertension and hyperthyroidism reports flu-like symptoms for the past week. Which prescribed order is the priority nursing action based upon these findings? A.Obtain an electrocardiogram. B. Apply oxygen via nasal cannula as needed. C. Administer propylthiouracil (PTU) 200 mg PO. D. Administer propranolol 100 mg PO.
C
A client with Graves disease underwent radioactive iodine therapy 3 months ago. At the most recent clinic visit, the client's thyroid-stimulating hormone (TSH) level was 6.7 μIU/L (6.7 mIU/L) and free thyroxine (T4) was 0.6 ng/dL (7.72 pmol/L). Which treatment will the nurse prepare to administer based on these laboratory data? A. No treatment is indicated; these levels are therapeutic. B. Give methimazole for continued thyroid suppression. C. Give levothyroxine for iatrogenic hypothyroidism. D. Repeat radioactive iodine therapy for subtherapeutic response.
C
The client with Addison disease has been prescribed prednisone daily during a period of increased psychological stress. The nurse includes which information with regard to the prescribed prednisone therapy? A. Monitor for signs/symptoms of hypoglycemia while taking this medication. B. Ingest more salt to counteract the hypotension caused by prednisone. C. Taper the medication slowly over 7 to 10 days when discontinued. D. Increase dietary protein to prevent weight loss while taking prednisone.
C
A patient has adrenocortical insufficiency and was taking hydrocortisone 240 mg every 12 h IV. Before discharge the drug was switched to prednisone. Which is appropriate teaching for discharging a patient with oral prednisone? A.Stop the drug when feeling better. B.Prednisone is always given by injection. C.The dose needs to be tapered off over 1 to 2 weeks. D. Hyperkalemia is common
C Glucocorticoids must be tapered off gradually to avoid adrenal crisis. Never stop the drug abruptly. Prednisone is an oral preparation. Prednisone promotes potassium loss and hypokalemia.
The nurse is reviewing the most recent laboratory results with a client diagnosed with hyperthyroidism. Upon review, the nurse instructs the client to withhold the next dose of the medication based upon which laboratory value? A. Platelet count 162,000 × 103/μL (162 × 109/L) B. Thyroid-stimulating hormone (TSH) 2.5 μIU/mL (2.5 mIU/L) C. White blood cell count 5,500/μL (5.5 × 109/L) D. Free thyroxine (T4) 0.2 ng/dL (2.57 pmol/L)
D
A patient is giving corticotropin. The nurse know to monitor the patient for which condition? a. Weight gain b. Hyperkalemia c. Hypoglycemia d. Dehydration
a
A patient is taking levothyroxine. For which adverse effect would the nurse monitor? a. Tachycardia b. Drowsiness c. Constipation d. Weight gain
a
When assessing for potential side effects of fludrocortisone, what is a priority for the nurse to monitor? a. Serum potassium levels for hypokalemia b. Serum sodium levels for potential hyponatremia c. Serum calcium levels for hypercalcemia d. Intake and output for potential fluid volume deficit
a Fludrocortisone has mineralocorticoid properties, resulting in sodium and fluid retention along with potassium excretion.
A patient asks the nurse to explain the action of glucocorticoids. Which statement is the nurse's best response? a. Glucocorticoids stimulate defense mechanisms to produce immunity." b. "Glucocorticoids influence carbohydrate, lipid, and protein metabolism." c. "Glucocorticoids decrease serum sodium and glucose levels." d. "Glucocorticoids are produced in decreased amounts during times of stress."
a Glucocorticoids play a major role in carbohydrate, lipid, and protein metabolism within the body. They are produced in increasing amounts during stress. They increase sodium and glucose levels and suppress the immune system.
The patient is receiving corticotropin for ACTH deficiency. Which statement by the patient indicates a need for additional teaching? a. "When my symptoms are resolved, I can discontinue the drug." b. "The drug may suppress symptoms of infection." c. "I need to eat foods high in potassium." d. "I can administer the drug subcutaneously."
a The patient should not discontinue the drug abruptly; the dose of the drug must be tapered over several days. Hypokalemia is possible, so eating foods high in potassium is correct. The drug can be administered subcutaneously.
What assessment finding indicates to the nurse that vasopressin has been effective? a. Increased urine specific gravity b. Increased serum albumin levels c. Relief of pain d. Decreased adrenocorticotropic hormone levels
a Vasopressin causes decreased water excretion in the renal tubule, thus increasing urine specific gravity. It is used to treat diabetes insipidus, which presents with a low urine specific gravity. This medication does not affect serum albumin, decrease adrenocorticotropic hormone levels, or decrease pain.
The nurse is administering vasopressin to a patient. Which nursing interventions are indicated when administering vasopressin? (Select all that apply) a. Record urinary output b. Observe the patient's weight and note edema c. Monitor the patient for decreased blood pressure d. Closely monitor the patient's blood glucose levels e. Monitor the patient's pulse for increased heart rate f. Record the patient's daily calcium levels
a, b, c, e
After administering corticotropin, what assessments are priorities for the nurse? (Select all that apply.) a. Serum sodium levels b. Intake and output c. Acid and alkaline phosphatase levels d. C-reactive protein levels e. Changes in vision f. Glucose levels
a,b,e,f Corticotropin can cause cataracts and glaucoma, so the nurse needs to monitor for changes in vision. Corticotropin stimulates the release of adrenal hormones, which can lead to sodium and fluid retention as well as hyperglycemia. Corticotropin can cause sodium and fluid retention, so that intake and output should be monitored. Serum sodium levels should be monitored, as sodium retention can be a result of corticotropin administration. C-reactive protein, acid and alkaline phosphatase levels are not indicated for monitoring.
The nurse is caring for several patients who will be receiving glucocorticoid therapy. Which patient should be assessed first based on clinical diagnosis? a. Recovering from septic shock b. Uncontrolled diabetes mellitus c. Chronic rheumatoid arthritis d. Exacerbation of asthma controlled using oxygen therapy.
b A common side effect of steroid therapy is hyperglycemia. The patient with uncontrolled diabetes mellitus could suffer a severe hyperglycemic episode. The other clinical diagnoses presented do not required immediate action.
What nursing diagnosis is a priority for a patient receiving desmopressin (DDAVP)? a. Risk for injury b. Fluid volume excess c. Knowledge deficit d. Alteration in comfort
b Desmopressin (DDAVP) is a form of antidiuretic hormone, which increases sodium and water retention, leading to an alteration in fluid volume. Although the other nursing diagnoses may be appropriate, they are not a priority using Maslow hierarchy of needs.
The nurse is administering prednisone to a newly admitted patient who is taking multiple other drugs. The nurse consider which drug interactions with prednisone? (Select all that apply) a. Cardiac and central nervous system actions are increased when drug is taking with adrenergic agent. b. Potassium-wasting diuretics increased potassium loss, resulting in hypokalemia c. Risk for gastrointestinal bleeding and ulceration increases when drug is taken with aspirin or other NSAIDs d. The action of prednisone is decreased when taking with phenytoin because phenytoin increases glucocorticoid metabolism. e. Risk for dysrhythmias and digitalis toxicity increased when drug is taking with cardiac glycosides. f. Dosage of anti-diabetic agent may need to be decreased when taken concurrently with glucocorticoids
b, c, d, e
A patient is giving desmopressin acetate. The nurse knows that this drug is used to treat which condition? a. Gigantism b. Diabetes mellitus c. Diabetes insipidus d. Adrenal insufficiency
c
A patient is receiving the drug somatropin. Which drug action will the nurse anticipate? a. Act as an anti-inflammatory agent b. increase metabolic rate and oxygen consumption c. Stimulate grow ion long bones at epiphyseal plates d. promote water reabsorption from the renal tubes
c
A nurse is providing discharge teaching for a patient receiving glucocorticoids. Which medication should the nurse expect to be included for pain management? a. Aspirin b. Ibuprofen c. Acetaminophen d. Naproxen sodium
c Acetaminophen does not cause gastric distress as do aspirin, ibuprofen, naproxen sodium, and glucocorticoids.
The nurse is caring for a patient who has just started taking levothyroxine. What assessment finding is a priority for the nurse to address? a. Heart rate 55 beats/min b. Weight gain of 3 pounds in the last week c. Irritability d. Intolerance to cold
c Irritability is a symptom of hyperthyroidism. This could be a sign that the medication dose is too high. A lowered heart rate, weight gain, and intolerance to cold could be symptoms of hypothyroidism and are expected in this patient, who just began medication therapy.
The nurse admitting a patient with acromegaly anticipates administering which medication? a. Somatropin b. Desmopressin c. Octreotide d. Corticotropin
c Octreotide suppresses growth hormone that causes acromegaly.
A patient receiving propylthiouracil (PTU) asks the nurse how this medication will help relieve symptoms. Which statement is the nurse's best response? a. PTU inactivates any circulating thyroid hormone, thus decreasing signs and symptoms of hyperthyroidism." b. "PTU helps the thyroid gland use iodine and synthesize hormones better." c. "This medication inhibits the formation of new thyroid hormone, thus gradually returning your metabolism to normal." d. "This medication stimulates the pituitary gland to secrete thyroid-stimulating hormone, which inhibits the production of hormones by the thyroid gland."
c Propylthiouracil (PTU) is an antithyroid medication used to treat hyperthyroidism. It works by inhibiting the synthesis of new thyroid hormone. It does not inactivate hormone already present.
Which patient should the nurse expect to be most likely to be treated with somatropin? a. An 8-year-old with Prader-Willi syndrome b. A 17-year-old who is 5 feet tall c. A 10-year-old of short stature who has severe asthma d. A 7-year-old diagnosed with growth hormone deficiency
d For this medication to be used, the patient has to be diagnosed with a growth hormone deficiency, and the epiphyses must not be fused, so the child needs to be young. Severe respiratory conditions, Prader-Willi syndrome, and age of 17 years are contraindications to this medication.
What should the nurse include in the plan of care for the patient beginning prednisone therapy? a. Administer the medication early evening to coincide with the natural secretion pattern of the adrenal cortex. b. Take the medication only every other day to decrease the risk of adrenal hyperplasia. c. Plan to keep a strict, unchanging schedule to prevent adverse reactions. d. Take the medication with food to diminish the risk of gastric irritation.
d Glucocorticoids can cause gastric distress and should be administered with food. The normal circadian secretion of the adrenal cortex is early morning to wake the person up, not early evening. These medications should be tapered off slowly to prevent adrenal crisis. The patient takes the medication daily.
The nurse is caring for a patient who is taking levothyroxine and warfarin. Which intervention is a priority for the nurse? a. Weigh patient daily for excessive weight loss. b. Assess peripheral pulses and Homans sign daily. c. Monitor the patient for cardiac dysrhythmias. d. Monitor the patient for increased risk of bleeding.
d Levothyroxine can compete with protein-binding sites of warfarin (Coumadin), allowing more warfarin to be unbound or free, thus increasing the effects of warfarin and the risk of bleeding. This combination does not place the patient at an increased risk of dysrhythmias, weight loss, or deep vein thrombosis.
Which patient statement demonstrates understanding of the nurse's teaching for levothyroxine? a. "I can expect to see relief of my symptoms within 1 week." b. "It is best to take the medication with food to prevent gastrointestinal upset." c. "I will double my dose if I gain more than 1 pound/day." d. "I will take this medication first thing in the morning."
d Levothyroxine increases basal metabolism and thus wakefulness. It should be taken first thing in the morning. The patient should not increase the dose. The medication is absorbed best on an empty stomach. Depending on the symptoms, some symptoms may take weeks to improve.
The patient is taking an antithyroid medication. Which foods should the nurse teach the patient to avoid eating? a. Ham and cheese omelet, rye toast with butter, orange juice b. Chicken salad sandwich with mayonnaise, vegetable soup, milk c. Hamburger on sesame roll, salad with French dressing, milk d. Shrimp cocktail, boiled lobster, spinach salad without dressing, water
d Seafood contains high amounts of iodine. The other choices do not. The nurse instructs a patient taking an antithyroid medication to avoid foods high in iodine.