Endocrine Problems Mix T4

13. During the nursing assessment of a patient with Graves' disease, the nurse notes a bounding, rapid pulse and systolic hypertension. Based on these assessment data, which question is important for the nurse to ask the patient?

a. "Do you have any problem with frequent constipation?" b. "Have you noticed any recent decrease in your appetite?" c. "Do you ever have any chest pain?" d. "Have you had recent muscle aches?" Correct C

13. During the nursing assessment of a patient with Graves' disease, the nurse notes a bounding, rapid pulse and systolic hypertension. Based on these assessment data, which question is important for the nurse to ask the patient?

a. "Do you have any problem with frequent constipation?" b. "Have you noticed any recent decrease in your appetite?" c. "Do you ever have any chest pain?" d. "Have you had recent muscle aches?" Correct C

1. A patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask?

a. "Have you had a recent head injury?" b. "Do you have to wear larger shoes now?" c. "Is there any family history of acromegaly?" d. "Are you experiencing tremors or anxiety?" Correct B

35.. A patient with a possible pheochromocytoma is admitted to the hospital for evaluation and diagnostic testing.. During an attack, the nurse will monitor for hypertension and

a. hypoglycemia. b. bradycardia. c. headache. d. flushing. Correct C

27. A patient recovering from DKA asks the nurse how acidosis occurs. The best response by the nurse is that

a. insufficient insulin leads to cellular starvation, and as cells rupture they release organic acids into the blood. b. when an insulin deficit causes hyperglycemia, then proteins are deaminated by the liver, causing acidic by-products. c. excess glucose in the blood is metabolized by the liver into acetone, which is acidic. d. an insulin deficit promotes metabolism of fat stores, which produces large amounts of acidic ketones. Correct D

29.. A patient with Cushing syndrome returns to the surgical unit following an adrenalectomy. During the initial postoperative period, the nurse gives the highest priority to

a. monitoring for infection. b. protecting the patient's skin. c. maintaining fluid and electrolyte status. d. preventing severe emotional disturbances. Correct C

3. Following a transsphenoidal resection of a pituitary tumor, an important nursing assessment is

a. monitoring hourly urine output. b. checking the dressings for serous drainage. c. palpating for dependent pitting edema. d. obtaining continuous pulse oximetry. Correct A

18. A patient with type 2 diabetes that is controlled with diet and metformin (Glucophage) also has severe rheumatoid arthritis (RA). During an acute exacerbation of the patient's arthritis, the health care provider prescribes prednisone (Deltasone) to control inflammation. The nurse will anticipate that the patient may

a. require administration of insulin while taking prednisone. b. develop acute hypoglycemia during the RA exacerbation. c. have rashes caused by metformin-prednisone interactions. d. need a diet higher in calories while receiving prednisone. Correct A

8. A patient is hospitalized with possible SIADH. The patient is confused and reports a headache, muscle cramps, and twitching. The nurse would expect the initial laboratory results to include a

a. serum sodium of 125 mEq/L (125 mmol/L). b. hematocrit of 52%. c. blood urea nitrogen (BUN) of 22 mg/dl (11.5 mmol/L). d. serum chloride of 110 mEq/L (110 mmol/L). Correct A

18. A patient with hyperthyroidism is treated with radioactive iodine (RAI) at a clinic. Before the patient is discharged, the nurse instructs the patient

a. to monitor for symptoms of hypothyroidism, such as easy bruising and cold intolerance. b. to discontinue the antithyroid medications taken before the radioactive therapy. c. that symptoms of hyperthyroidism should be relieved in about a week. d. about radioactive precautions to take with urine, stool, and other body secretions. Correct A

9. A patient with type 1 diabetes has received diet instruction as part of the treatment plan. The nurse determines a need for additional instruction when the patient says,

a. "I may have an occasional alcoholic drink if I include it in my meal plan." b.. "I will need a bedtime snack because I take an evening dose of NPH insulin." c. "I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia." d. "I may eat whatever I want, as long as I use enough insulin to cover the calories." Correct D

27. A patient with Cushing syndrome is admitted to the hospital to have laparoscopic adrenalectomy. During the admission assessment, the patient tells the nurse, "The worst thing about this disease is how terrible I look. I feel awful about it." The best response by the nurse is

a. "Let me show you how to dress so that the changes are not so noticeable." b. "I do not think you look bad. Your appearance is just altered by your disease." c. "Most of the physical and mental changes caused by the disease will gradually improve after surgery." d. "You really should not worry about how you look in the hospital. We see many worse things." Correct C

13. A patient receives a daily injection of 70/30 NPH/regular insulin premix at 7:00 AM. The nurse expects that a hypoglycemic reaction is most likely to occur between

a. 8:00 and 10:00 AM. b. 4:00 and 6:00 PM. c. 7:00 and 9:00 PM. d. 10:00 PM and 12:00 AM. Correct B

20. While hospitalized for a fractured femur, a 68-year-old patient is diagnosed with hypothyroidism. Which of these medications on the original admission orders will the nurse need to consult with the health care provider about before it is administered?

a. Docusate (Colace) b. Diazepam (Valium) c. Ibuprofen (Motrin) d. Cefoxitin (Mefoxin) Correct B

28. Intramuscular glucagon is administered to an unresponsive patient for treatment of hypoglycemia. Which action should the nurse take after the patient regains consciousness?

a. Give the patient a snack of cheese and crackers. b. Have the patient drink a glass of orange juice or nonfat milk. c. Administer a continuous infusion of 5% dextrose for 24 hours. d. Assess the patient for symptoms of hyperglycemia. Correct A

28. When providing postoperative care for a patient who has had bilateral adrenalectomy, which assessment information obtained by the nurse is most important to communicate to the health care provider?

a. The blood glucose is 156 mg/dl. b. The patient's blood pressure is 102/50. c. The patient has 5/10 incisional pain. d. The lungs have bibasilar crackles. Correct B

10. Which information obtained when caring for a patient who has just been admitted for evaluation of diabetes insipidus will be of greatest concern to the nurse?

a. The patient has a urine output of 800 ml/hr. b. The patient's urine specific gravity is 1.003. c. The patient had a recent head injury. d. The patient is confused and lethargic. Correct D

7. A patient who has just been diagnosed with type 2 diabetes is 5 ft 4 in (160 cm) tall and weighs 182 pounds (82 kg). A nursing diagnosis of imbalanced nutrition: more than body requirements is developed. Which patient outcome is most important for this patient?

a. The patient will have a diet and exercise plan that results in weight loss. b. The patient will state the reasons for eliminating simple sugars in the diet. c. The patient will have a glycosylated hemoglobin level of less than 7%. d. The patient will choose a diet that distributes calories throughout the day. Correct C

24. A diagnosis of hyperglycemic hyperosmolar nonketotic coma (HHNC) is made for a patient with type 2 diabetes who is brought to the emergency department in an unresponsive state. The nurse will anticipate the need to

a. administer glargine (Lantus) insulin. b. initiate oxygen by nasal cannula. c. insert a large-bore IV catheter. d. give 50% dextrose as a bolus. Correct C

15. A few hours after returning to the surgical nursing unit, a patient who has undergone a subtotal thyroidectomy develops laryngeal stridor and a cramp in the right hand. The nurse anticipates that intervention will include

a. administration of IV morphine. b. administration of IV calcium gluconate. c. endotracheal intubation with mechanical ventilation. d. immediate tracheostomy and manual ventilation. Correct B

32. A patient who uses every-other-day prednisone therapy for rheumatoid arthritis complains of not feeling as well on the non-prednisone days and asks the nurse about taking prednisone daily instead. The best response to the patient is that

a. an every-other-day schedule mimics the normal pattern of cortisol secretion from the adrenal gland. b. glucocorticoids are taken on a daily basis only when they are being used for replacement therapy. c. if it improves the symptoms, it would be acceptable to take half the usual dose every day. d. there is less effect on normal adrenal function when prednisone is taken every other day.. Correct D

17. The first nursing action indicated when a patient returns to the surgical nursing unit following a thyroidectomy is to

a. check the dressing for bleeding. b. assess respiratory rate and effort. c.. support the patient's head with pillows. d. take the blood pressure and pulse. correct B

8.During a physical examination, the nurse finds that a patient's thyroid gland cannot be palpated. The most appropriate action by the nurse is to

a. document that the thyroid was nonpalpable. b. notify the health care provider about the finding. c. teach the patient about the purpose of thyroid-stimulating hormone (TSH) testing. d. palpate the patient's neck more deeply. Correct A

22. Cardiac monitoring is initiated for a patient in diabetic ketoacidosis (DKA). The nurse recognizes that this measure is important to identify

a. electrocardiographic (ECG) changes and dysrhythmias related to hypokalemia. b. fluid overload resulting from aggressive fluid replacement. c. the presence of hypovolemic shock related to osmotic diuresis. d. cardiovascular collapse resulting from the effects of hyperglycemia. Correct A

12. A patient with Graves' disease is prepared for surgery with drug therapy consisting of 4 weeks of propylthiouracil (PTU) and 10 days of iodine before surgery. When teaching the patient about the drugs, the nurse explains that the drugs are given preoperatively to

a. eliminate the risk for tetany during the postoperative period. b. decrease the risk of hypometabolism during and after the surgery. c. normalize metabolism and decrease the size and vascularity of the gland. d. assist in differentiating the thyroid and parathyroid glands during surgery. Correct C

25. A patient with type 1 diabetes who uses glargine (Lantus) and lispro (Humalog) insulin develops a sore throat, cough, and fever. When the patient calls the clinic to report the symptoms and a blood glucose level of 210 mg/dl, the nurse advises the patient to

a. use only the lispro insulin until the symptoms of infection are resolved. b. monitor blood glucose every 4 hours and notify the clinic if it continues to rise. c. decrease intake of carbohydrates until glycosylated hemoglobin is less than 7%. d. limit intake to non-calorie-containing liquids until the glucose is within the usual range. Correct B

40. After receiving change-of-shift report about these four patients, which patient should the nurse assess first?

a.. A 22-year-old admitted with SIADH who has a serum sodium level of 130 mEq/L. b. A 31-year-old who has iatrogenic Cushing's syndrome with a capillary blood glucose level of 244 mg/dl. c. A 53-year-old who has Addison's disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef). d. A 70-year-old who recently started levothyroxine (Synthroid) to treat hypothyroidism and has an irregular pulse of 134. Correct D