Endocrine

A client has an adrenal tumor and is scheduled for a bilateral adrenalectomy. During preoperative teaching, the nurse instructs the client how to do deep-breathing exercises after surgery by telling the client to: 1. Sit in an upright position, and take a deep breath 2. Hold your abdomen firmly with a pillow, and take several deep breaths 3. Tighten your stomach muscles as you inhale, and breathe normally 4. Raise your shoulders to expand your chest

2 to effectively splint the incision site

A 60 year old female is diagnosed with hypothyroidism. The nurse should assess for: 1. Tachycardia 2. Weight gain 3. Diarrhea 4. Nausea

2

After stabilization of Addison's disease, the nurse teaches the client about stress management. The nurse should instruct the client to: 1. Remove all sources of stress from daily life 2. Use relaxation techniques such as music 3. Take anti anxiety drugs daily 4. Avoid discussing stressful experiences

2

Which is an expected finding in a client with adrenal crisis(Addisonian crisis)? 1. Fluid retention 2. Pain 3. Peripheral edema 4. Hunger

2

A client with Addison's disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effects of corticosteroids? Select all that apply. 1. Hyperkalemia 2. Skeletal muscle weakness 3. Mood changes 4. Hypocalcemia 5. Increased susceptibility to infection 6. Hypotension

2,3,4,5

A 34 year old female is diagnosed with hypothyroidism. What should the nurse assess the client for? Select all that apply 1. Rapid pulse 2. Decreased energy and fatigue 3. Weight gain of 10lb 4. Fine, thin hair with hair loss 5. Constipation 6. Menorrhagia

2,3,5,6

Which goal is the PRIORITY for a client in addisonian crisis? 1. Controlling hypertension 2. Preventing irreversible shock 3. Preventing infection 4. Relieving anxiety

2- Addison's disease is caused by a deficiency of adrenal corticosteroids and can result in severe hypotension and shock due to uncontrolled loss of sodium in the urine

The nurse is instructing the client with hypothyroidism who takes levothyroxine 100mcg, digoxin, and simvastatin. Teaching regarding the use of these medications is effective if the client will take: 1. The levothyroxine with breakfast and the other medications after breakfast 2. The levothyroxine before breakfast and the other medications 4 hours later 3. All medications together 1 hour after eating breakfast 4. All medications before going to bed

2- levothyroxine must be given at the same time every day on an empty stomach. Other medications may impact absorption

The nurse should monitor the client with Cushing's disease for which finding? 1. Postprandial hypoglycemia 2. Hypokalemic 3. Hyponatremia 4. Decreased urine calcium level

2- sodium retention is usually accompanied by potassium depletion

The nurse is completing a health assessment of a 42 year old female with suspected Graves' disease. The nurse should assess this client for: 1. Anorexia 2. Tachycardia 3. Weight gain 4. Cold skin

2. The increased metabolic rate generates heat and produces tachycardia and fine muscle tremors

The nurse should assess the client with Addison's disease for: 1. weight gain 2. Hunger 3. Lethargy 4. Muscle spasms

3

When teaching a client newly diagnosed with Addison's disease, the nurse should explain that the disease results from: 1. Insufficient secretion of growth hormone 2. Dysfunction of the hypothalamic pituitary 3. Idiopathic atrophy of the adrenal gland 4. Over secretion of the adrenal medulla

3

After treatment with radioactive iodine, the nurse should teach the client to: 1. Monitor for signs and symptoms of hyperthyroidism 2. Test for 1 week to prevent complications of the medication 3. Take thyroxine replacement for the remainder of the clients life 4. Assess for hypertension and tachycardia resulting from altered thyroid activity

3. The client needs to be educated on lifelong hormone replacement

Which indicator is BEST for determining whether a client with Addison's disease is receiving the correct amount of glucocorticoid replacement? 1. Skin turgor 2. Temperature 3. Thirst 4. Daily weight

4- daily weight is a reliable, objective way to measure fluid balance

A client reports that she has gained weight and that her face and body are "rounder," while her legs and arms have become thinner. A tentative diagnosis of Cushing's disease is made. The nurse should further assess the client for: 1. Orthostatic hypotension 2. Muscle hypertrophy in the extremities 3. Bruised areas on the skin 4. Decreased body hair

3- skin bruising from increased skin and blood vessel fragility is a classic sign of Cushing's disease

A client with Addison's disease has fluid and electrolyte loss due to inadequate fluid intake and fluid loss secondary to inadequate adrenal hormone secretion. As the clients oral intake increases, which fluids would be the MOST appropriate? 1. Milk and diet soda 2. Water and eggnog 3. Chicken broth and juice 4. Coffee and milkshakes

3-electrolyte imbalances associated with Addison's disease include hypoglycemia, hyponatremia

The nurse is instructing a college student with Addison's disease how to adjust the dose of glucocorticoids. The nurse should explain that the client may need an increased dosage of glucocorticoids in which situation? 1. Completing the spring semester of school 2. Gaining 4 lb 3. Becoming engaged 4. Having wisdom teeth extracted

4. Adrenal crisis can occur with physical stress such as surgery, dental work, infection, flu, trauma, or pregnancy

The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be MOST appropriate? 1. Increase calories 2. Restrict sodium 3. Restrict potassium 4. Reduce fat to 10%

2- to reduce fluid retention

On day following a subtotal thyroidectomy, a client begins to have tingling in the fingers and toes. The nurse should FIRST: 1. Encourage the client to flex and extend the fingers and toes 2. Notify the HCP 3. Assess the client for thrombophlebitis 4. Ask the client to speak

2. Tetany can occur after a thyroidectomy if the parathyroid glands are accidentally injured. The nurse should notify the HCP

A priority in the first 24 hours after a bilateral adrenalectomy is: 1. Beginning oral nutrition 2. Promoting self-care activities 3. Preventing adrenal crisis 4. Ambulatory in the hallway

3- the priority in the first 24 hours is to identify and prevent adrenal crisis

When teaching a client about taking oral glucocorticoids, how should the nurse instruct the client to take the medication? 1. With a full glass of water 2. On an empty stomach 3. At bedtime to increase absorption 4. With meals or with an antacid

4- oral steroids can cause gastric irritation

Bone resorption is a possible complication of Cushing's disease. To help the client prevent this complication, the nurse should recommend that the client: 1. Increase the amount of potassium in the diet 2. Maintain a regular program of weight bearing exercise 3. Limit dietary vitamin D intake 4. Perform isometric exercises

2- osteoporosis is a serious outcome of prolonged cortisol excess , weight bearing helps build bones

The client with Addison's disease should anticipate the need for increased glucocorticoid supplementation when: 1. Returning to work after a weekend 2. Going on vacation 3. Having oral surgery 4. Having a routine medical check up

3- illness or surgery places tremendous stress on the body

A client with hyperthyroidism is hospitalized to have a thyroidectomy. The HCP has prescribed propranolol. In reviewing the client's history, the nurse notes the client has asthma. The nurse should NEXT: 1. Take the clients pulse and withhold the propranolol if the pulse is <100bpm 1. Count the clients respiration's and withhold the propranolol if the respiration's are less <20 breaths per minute 3. Contact the HCP and discuss the prescription for propranolol because of the clients history of having asthma 4. Instruct the client to make position changes slowly

3- propranolol is a non selective beta blocker of both cardiac and bronchial adrenoreceptors. A contraindication of propranolol is bronchial asthma