Med-Surg Endocrine Disorders EAQs

Which patient statement indicates the need for further education regarding the management of both cardiac disease and hypothyroidism? 1. "I will use an enema for constipation." 2. "I will use a sedative to treat insomnia." 3. "I should take my thyroid medication in the morning before eating." 4. "I should not switch to another brand of hormone unless I check with my health care provider."

1. "I will use an enema for constipation." (Enemas are contraindicated for patients diagnosed with both cardiac disease and hypothyroidism. Enemas cause vagal stimulation that can lead to fainting. The patient is taught to use laxatives, stool softeners, and to consume a fiber-rich diet to treat constipation, rather than using enemas. Using low-dose sedatives is recommended if the patient is experiencing insomnia. Thyroid medication should be taken in the morning before food. Switching to different brands is not recommended, because bioavailability may differ with different brands.)

Which statement by the patient who is postoperative following a transphenoidal hypophysectomy indicates a need for further education? 1. "It is important that I brush my teeth every day." 2. "I should refrain from vigorous coughing and sneezing." 3. "I should notify the nurse if I develop a severe headache." 4. "I may need to take a stool softener so that I do not strain with having a bowel movement."

1. "It is important that I brush my teeth every day." (Tooth brushing should be avoided for 10 days to protect the suture line. Vigorous coughing and sneezing should be avoided to prevent cerebrospinal leakage. A severe headache may indicate cerebrospinal leakage into the sinuses. Straining with bowel movements may cause cerebrospinal leakage.)

The nurse is caring for a patient diagnosed with nephrogenic diabetes insipidus not responding to primary treatment. Which intervention does the nurse expect to be useful in increasing the renal response to antidiuretic hormone? 1. Administering indomethacin 2. Providing hormonal therapy 3. Administering thiazide diuretics 4. Limiting sodium intake to 3 g/day

1. Administering indomethacin (Indomethacin is a nonsteroidal antiinflammatory drug that helps increase the renal response to antidiuretic hormone. Patients with nephrogenic diabetes insipidus are not responsive to hormonal therapy. Hormonal therapy would not aid in increasing the renal response to antidiuretic hormone. Thiazide diuretics and limiting sodium intake are the primary treatments for nephrogenic diabetes insipidus; the patient has not responded to these treatments.)

Which nursing interventions are appropriate when providing care to a patient that is recovering from a thyroidectomy? Select all that apply. 1. Assessing for tetany 2. Monitoring vital signs 3. Monitoring potassium levels 4. Assessing the patient every two hours on the first postoperative day 5. Placing the patient in a high Fowler's position

1. Assessing for tetany 2. Monitoring vital signs 4. Assessing the patient every two hours on the first postoperative day (Postoperative nursing interventions that are appropriate for a patient after a thyroidectomy include assessing for tetany, monitoring vital signs, and assessing the patient every two hours on the first postoperative day for hemorrhage and tracheal compression. The nurse should monitor calcium levels, not potassium levels. The nurse should place the patient in a semi-Fowler's position to reduce swelling and edema in the neck area. Sandbags or pillows may be used to support the head or neck.)

The nurse expects that which drug will be prescribed for the treatment of a patient diagnosed with hyperthyroidism, asthma, and heart disease? 1. Atenolol 2. Methimazole 3. Lugol's solution 4. Propylthiouracil

1. Atenolol (Atenolol, a β-Adrenergic blocker, is prescribed to control the stimulation of the sympathetic nervous system that often occurs with hyperthyroidism. Atenolol manages tachycardia, nervousness, irritability, and tremors. It is considered the drug of choice for treating a patient diagnosed with hyperthyroidism, asthma, and heart disease. Methimazole is used to treat hyperthyroidism; however, it is not the drug of choice for patients with concurrent diagnoses of asthma and heart disease. Lugol's solution is an antithyroid drug that is used in treatment of thyrotoxicosis. Propylthiouracil, although appropriate for the treatment of hyperthyroidism, is not the drug of choice for a patient with concurrent diagnoses of asthma and heart disease.)

The nurse is caring for a patient who has cerebral edema associated with syndrome of inappropriate antidiuretic hormone (SIADH). What clinical manifestation of severe serum sodium level decline does the nurse assess? Select all that apply. 1. Coma 2. Lethargy 3. Confusion 4. Headache 5. Tachycardia 6. Hypovolemic shock

1. Coma 2. Lethargy 3. Confusion 4. Headache (If the plasma osmolality and serum sodium levels continue to decline below 120 mmol/L, cerebral edema may occur, leading to the manifestations such as coma, lethargy, confusion, and headache. Tachycardia and hypovolemic shock are the complications of diabetes insipidus.)

The nurse assesses a patient that presents with eye protrusion. The patient states, "My eyes are dry and irritated." Based on these data, the nurse expects that what diagnosis will be made? 1. Graves' disease 2. Myxedema coma 3. Diabetes insipidus 4. Pheochromocytoma

1. Graves' disease (Eye protrusion is referred to as exophthalmos and this indicates Graves' disease. Exophthalmos results from an increase in fat and fluid in the orbital tissues. The increased pressure due to edema forces the eyeballs outwards, and the upper eye lids retract and become elevated. As a result, the corneal surface is exposed, causing eye dryness and irritation. Myxedema coma presents with generalized edema. Diabetes insipidus is characterized by the large amount of urine excretion (2 to 20 L/day). Pheochromocytoma is characterized by tachycardia, dysrhythmia, and metanephrines in urine.)

The nurse is reviewing a patient's laboratory reports that show increased levels of plasma insulin-like growth factor 1. What does this finding indicate about growth hormone levels? 1. Growth hormone levels are elevated 2. Growth hormone levels are decreased 3. Growth hormone production has stopped 4. Growth hormone levels are unchanged

1. Growth hormone levels are elevated (In acromegaly, the level of insulin-like growth factor 1 is tested to evaluate growth hormone levels. Increases in insulin-like growth hormone indicate increased levels of growth hormone. Insulin-like growth factor 1 is proportional to the growth hormone; therefore, increased levels do not indicate that growth hormone production has stopped or is unchanged.)

Which condition may be linked to Conn's syndrome? 1. Hyperaldosteronism 2. Hypoaldoestronism 3. Hyperparathyroidism 4. Hypoparathyroidism

1. Hyperaldosteronism (Conn's syndrome is associated with the excessive production of aldosterone (hyperaldosteronism) by the adrenal glands. Conn's syndrome is characterized by high blood pressure, headache, poor vision, and various complications. Hypoaldosteronism, hyperparathyroidism, and hypoparathyroidism may not be linked with Conn's syndrome.)

A patient with an endocrine disorder is prescribed corticosteroids. Which parameters should the nurse monitor for early detection of side effects? Select all that apply. 1. Increased risk for ulcers 2. Decreased bone density 3. Increased potassium levels 4. Decreased risk for infections 5. Increased level of blood pressure

2. Decreased bone density 5. Increased level of blood pressure (Decreased bone density due to the prolonged use of corticosteroids may lead to bone weakness; therefore, the patient is advised to take calcium supplements. Corticosteroids may increase the blood pressure by causing a decrease in the level of potassium and promoting retention of sodium. The drug may increase the risk of ulcers but only if taken on an empty stomach. Corticosteroids tend to suppress the immune system, thereby increasing the risk of infections.)

The nurse is caring for a patient who received treatment for hypoparathyroidism and later developed hypocalcemia. Which is the goal of the treatment regimen for this condition? 1. Increasing the pH 2. Decreasing the pH 3. Maintaining the pH 4. Decreasing the calcium ionization level

2. Decreasing the pH (A decreased pH will cause an acidic environment and increase the calcium ionization, which will in turn increase the available calcium in the blood and help the patient to recover from hypocalcemia. An increased pH will decrease calcium ionization, thereby decreasing the calcium level in the blood. If the pH is maintained, then there will be a nullifying effect on the calcium level. If the calcium ionization level is decreased, then the available calcium in the blood will become low.)

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.)

The patient is brought to the emergency department following a car accident and is wearing medical identification that says the patient has Addison's disease. What should the nurse expect to be included in the collaborative care of this patient? 1. Low-sodium diet 2. Increased glucocorticoid replacement 3. Suppression of pituitary adrenocorticotropic hormone (ACTH) synthesis 4. Elimination of mineralocorticoid replacement

2. Increased glucocorticoid replacement (The patient with Addison's disease needs lifelong glucocorticoid and mineralocorticoid replacement and has an increased need with illness, injury, or stress, as this patient is experiencing. The patient with Addison's also may need a high-sodium diet. Suppression of pituitary ACTH synthesis is done for Cushing's syndrome. Elimination of mineralocorticoid replacement cannot be done for Addison's disease.)

Which signs and symptoms would the nurse expect to assess in a patient who is diagnosed with acromegaly? Select all that apply. 1. Fragile skin 2. Increased show size 3. Elevated blood glucose 4. Complaint of headaches 5. Increased height and weight

2. Increased show size 3. Elevated blood glucose 4. Complaint of headaches (Acromegaly is a disorder in which there is increased secretion of growth hormone (GH). Enlargement of the feet and hands occurs as a result of overgrowth of bones and tissue. GH antagonizes the action of insulin, and therefore blood glucose is elevated. Headaches also are common if the increased secretion of GH is caused by a pituitary adenoma, which increases pressure on the optic nerve. The skin becomes thick and leathery. The patient's weight may increase, but there is no change in height because acromegaly occurs after epiphyseal closure.)

Which effect may be observed if large amounts of endogenous corticosteroids are released into systemic circulation during surgery on a patient with Cushing syndrome? 1. Fatigue 2. Infections 3. Delusions 4. Hypotension

2. Infections (A patient may become susceptible to infections if the endogenous corticosteroid levels are high during surgery. Fatigue and delusions may not occur due to elevated corticosteroids. Hypertension, not hypotension, is observed due to increased levels of corticosteroids.)

The nurse is educating family members about postsurgical complications for a patient who is undergoing hypophysectomy. Which complication should the nurse include in the teaching? 1. Seizures 2. Infertility 3. Cerebral edema 4. Transient diabetes mellitus

2. Infertility (Hypophysectomy may result in permanent loss or deficiencies of follicle-stimulating hormone, luteinizing hormone, and thyroid hormones resulting in decreased fertility or infertility. Seizures and cerebral edema are possible complications for patients undergoing stereotactic radio surgery, not hypophysectomy. Transient diabetes insipidus, not diabetes mellitus, may occur following hypophysectomy.)

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

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.)

The nurse is instructing a patient regarding self-management of syndrome of inappropriate antidiuretic hormone (SIADH). The patient has gastric ulceration as a comorbid condition. Which statement by the patient needs correction? 1. "I should tale demeclocylcline as prescribed." 2. "I should chew sugarless gum and ice chips." 3. "I should drink the electrolyte solution after meals." 4. "I should dilute the electrolyte solution before administration."

3. "I should drink the electrolyte solution after meals." (Electrolyte solutions should be taken during meals, because it dilutes the solution by allowing it to mix with the food, which prevents irritation and damage to the gastrointestinal tract. Administration of demeclocycline blocks the effect of antidiuretic hormone on the renal tubules, resulting in more dilute urine. Chewing sugarless gum and ice chips decreases thirst. Diluting the electrolyte solution before administration prevents gastrointestinal damage.)

A patient diagnosed with hyperthyroidism received radioactive iodine one week ago. The patient tells the nurse, "I don't think the medication is working, I don't feel any different." What is the best response by the nurse? 1. "You should notify your primary health care provider immediately." 2. "You may need to have your thyroid removed sooner than anticipated." 3. "It may take several weeks to see the full benefits of the treatment." 4. "You don't feel any different? Would you like to sit down and talk about it?"

3. "It may take several weeks to see the full benefits of the treatment." (Radioactive iodine has a delayed response, and the maximum effect may not be seen for up to three months. For this reason, it would not be necessary to contact the primary health care provider immediately, or for the patient to have the thyroid gland removed sooner. Asking the patient to sit and talk about it demonstrates that the nurse is being responsive to psychosocial/emotional needs, but is not the best nursing response at this time.)

The nurse is preparing a patient for a water deprivation test for central diabetes insipidus in the hospital. What intervention is required for this patient? 1. Deprive the patient of water for six hours 2. Administer intravenous hypotonic saline or dextrose 5% in water 3. Administer desmopressin acetate (DDAVP) subcutaneously 4. Provide the patient with a diluted solution of sodium

3. Administer desmopressin acetate (DDAVP) subcutaneously (The patient is given DDAVP subcutaneously or nasally. The patient is deprived of water for 8 to 12 hours before administration of DDAVP. In acute diabetes insipidus, intravenous hypotonic saline or dextrose 5% in water is given and titrated to replace urine output. The patient with chronic syndrome of inappropriate antidiuretic hormone is given a diluted solution of sodium electrolyte to prevent gastrointestinal irritation or damage.)

Which clinical manifestation is a classic finding in Graves' disease? 1. Gingivitis 2. Cretinism 3. Exophthalmos 4. Muscular dystrophy

3. Exophthalmos (Exophthalmos is the protrusion of eyeballs from the orbits; it results from increased fat deposits and fluid in orbital tissues. It is a classic clinical manifestation in Graves' disease. Gingivitis, cretinism, and muscular dystrophy are not classic clinical manifestations associated with Graves' disease.)

A patient suffering from pheochromocytoma is scheduled for surgery. Before the procedure, the patient develops dysrhythmias. What is the appropriate treatment for this patient? 1. Atenolol 2. Metyrosine 3. Propranolol 4. Phenoxybenzamine

3. Propranolol (Propranolol is an adrenergic receptor blocker used to treat dysrhythmias in a patient with pheochromocytoma. Atenolol is used to treat hypertension. Metyrosine is used to decrease catecholamine production when surgery is not an option. Phenoxybenzamine is used to reduce blood pressure and symptoms of excess catecholamines.)

A patient with a severe pounding headache has been diagnosed with hypertension that is not responding to traditional treatment. What should the nurse expect as the next step in management of this patient? 1. Administration of B-blocker medications 2. Abdominal palpation to search for a tumor 3. Administration of potassium-sparing diuretics 4. A 24-hour urine collection for fractionated metanephrines

4. A 24-hour urine collection for fractionated metanephrines (Pheochromocytoma should be suspected when hypertension does not respond to traditional treatment. The 24-hour urine collection for fractionated metanephrines is simple and reliable, with elevated values in 95% of people with pheochromocytoma. In a patient with pheochromocytoma preoperatively an α-adrenergic receptor blocker is used to reduce blood pressure. Abdominal palpation is avoided to avoid a sudden release of catecholamines and severe hypertension. Potassium-sparing diuretics are not needed; most likely they would be used for hyperaldosteronism, which is another cause of hypertension.)

A nurse creating a plan of care for a patient with Addison's disease expects that primary treatment will include: 1. Blood transfusions 2. Ablation of the thyroid 3. Oral calcium supplementation 4. Adrenocorticosteroid replacement therapy

4. Adrenocorticosteroid replacement therapy (Because Addison's disease results from a deficiency of adrenocorticosteroid hormones, steroid therapy is the primary treatment. Blood transfusions, thyroid ablation, and oral calcium supplements are not primary treatments for Addison's disease.)

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 of signs of increased intracranial pressure (ICP)

4. Assessing of 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.)

The nurse reviews lab values for a patient who underwent thyroidectomy 48 hours ago. Which finding is of most concern? 1. Increased thyroxine 2. Decreased thyroxine 3. Increased serum calcium 4. Decreased serum calcium

4. Decreased serum calcium (During thyroid surgery the parathyroid glands are often unavoidably removed. The result is an inability to regulate serum calcium, stemming from a lack of parathyroid hormone. In hypoparathyroidism there is a decrease in parathyroid hormone, which results in decreased serum calcium and increased phosphorus levels. An increase in thyroxine is not seen after thyroidectomy; the thyroxine level may actually drop below normal. Decreased phosphorus and increased serum calcium levels may occur initially after a thyroidectomy because of manipulation of the thyroid gland during surgery. This causes a surge of parathormone, but the level does decrease if the parathyroid glands are removed.)

Which condition shows a clinical presentation of purplish red striae? 1. Hypofunction of androgens 2. Hyperfunction of androgens 3. Hypofunction of glucocorticoids 4. Hyperfunction of glucocorticoids

4. Hyperfunction of glucocorticoids (Purplish red striae are seen in Cushing syndrome, which occurs due to excess corticosteroids, particularly glucocorticoids. In Addison's disease, all three classes of adrenal corticosteroids (glucocorticoids, mineralocorticoids, and androgens) are reduced. A striking integumentary sign of Addison's disease is bronze-colored skin hyperpigmentation, not purplish red striae.)

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.)

In developing a teaching plan for the patient with Addison's disease, what is the nurse's highest priority? 1. Avoiding infection 2. Following 3. Practicing stress management techniques 4. Managing lifelong corticosteroid replacement

4. Managing lifelong corticosteroid replacement (The patient with Addison's disease experiences hypofunctioning of the adrenal cortex, resulting in decreased production of glucocorticoids, mineral corticoids, and androgens. Patients with Addison's disease require lifelong glucocorticoid and mineral corticoid replacement therapy to avoid Addisonian crisis. Addisonian crisis is characterized by profound hypotension, dehydration, fever, tachycardia, hyponatremia, and hyperkalemia. Circulatory collapse may occur if the patient is treated inadequately. Although Addisonian crisis often is triggered by illness-related physiologic stress, and although avoiding infection is important, avoiding infection is of lower priority than managing lifelong corticosteroid replacement. Corticosteroid replacement must be increased during times of stress to prevent Addisonian crisis. Patients taking a mineralocorticoid should increase their salt intake. Emotional stress may contribute to the need for increased corticosteroid replacement. Stress management techniques are important. Practicing stress management techniques, however, is of lower priority than managing lifelong corticosteroid replacement.)

The nurse is preparing to administer levothyroxine to a patient newly diagnosed with hypothyroidism. The patient's resting heart rate is 110. Which initial action should the nurse take? 1. Administer the medication 2. Notify the health care provider 4. Obtain a blood pressure measurement 5. Administer all other scheduled medications except levothyroxine

4. Obtain a blood pressure measurement (When thyroid hormone therapy is initiated, patients must be monitored carefully for increased pulse and blood pressure, because increased pulse and blood pressure may lead to angina and cardiac dysrhythmias. The nurse should first obtain a blood pressure measurement and assess for other signs of increased thyroid levels, such as chest pain, nervousness, and tremors. Thyroid hormone medication should not be administered until the health care provider is notified. The health care provider should be notified after the nurse collects the appropriate assessment data. Other scheduled medications can be given, but blood pressure assessment is the initial action.)

The patient experiencing thyrotoxicosis asks the nurse why he or she is being given propranolol. What is the most accurate answer to the patient's question? 1. To suppress thyroid hormone secretion 2. To prevent thyroid hormone induced hypotension 3. To decrease thyroid gland vascularity in preparation for surgery 4. To block sympathetic nervous system response to excess thyroid hormone

4. To block sympathetic nervous system response to excess thyroid hormone (Thyrotoxicosis is an acute crisis state of hyperthyroidism often precipitated by a physiologic stressor in the patient with hyperthyroidism. Thyrotoxicosis is an extreme state of hypermetabolism. Excessive amounts of thyroid hormone are present and tissue sensitivity to sympathetic nervous system stimulation is increased, resulting in a number of signs and symptoms, including severe tachycardia leading to heart failure. Propranolol is a beta-adrenergic antagonist that blocks the thyroid-hormone-induced sympathetic nervous system stimulation, resulting in a lowered heart rate and a decreased risk of heart failure. One of the priority treatment goals in the patient with thyrotoxicosis is to decrease thyroid hormone secretion. A decrease in thyroid hormone secretion is primarily accomplished through the use of either methimazole or propylthiourical. Propranolol does not suppress thyroid hormone secretion. In addition to slowing heart rate, propranolol decreases blood pressure; it is not used to prevent hypotension. Nonradioactive strong iodine solution, either in the form of saturated solution of potassium iodine or Lugol's solution, may be used to decrease size and vascularity of the thyroid gland in preparation for surgery. Potassium Iodide or Lugol's solution also may inhibit thyroid hormone synthesis. Propranolol does not decrease size or vascularity of the thyroid gland.)

What is the clinical manifestation of Addison's disease? 1. Delusions 2. Hypokalemia 3. Hyperglycemia 4. Truncal obesity

1. Delusions (Addison's disease occurs due to the hypofunction of adrenal cortex. This hypofunction manifests as delusions, which occur due to decreased levels of glucocorticoids. Hypokalemia, hyperglycemia, and truncal obesity are clinical manifestations of Cushing syndrome that occur due to hyperfunction of the adrenal cortex.)

Which disease is treated with corticosteroidal hormonal therapy? 1. Thyrotoxicosis 2. Nephrotic syndrome 3. Adrenal insufficiency 4. Rheumatoid arthritis

3. Adrenal insufficiency (Adrenal insufficiency is treated with hormonal therapy of corticosteroids. Thyrotoxicosis, nephritic syndrome, and congenital adrenal hyperplasia are treated with corticosteroid drug therapy.)

The nurse is caring for a patient who underwent removal of the thyroid gland (thyroidectomy) three days ago. The patient's serum chemistries reveal calcium of 3.2 mg/dL, potassium of 3.9 mEq/L, and phosphorus of 4.0 mg/dL. What condition do these findings indicate? 1. Hypocalcemia 2. Hypercalcemia 3. Hyperkalemia 4. Hypophosphatemia

1. Hypocalcemia (Hypocalcemia is a low serum calcium level. Surgical removal of the thyroid gland may also include removal of the parathyroid gland. This results in a deficiency of parathyroid hormone, which controls serum calcium by regulating absorption of calcium from the gastrointestinal tract, mobilizing calcium in bones, and excreting calcium in breast milk, feces, sweat, and urine. The normal serum calcium level ranges from 9.0 to 11.5 mg/dL. Potassium is within normal limits (3.5 to 5 mEq/L), and phosphorus is also within normal limits (2.8 to 4.5 mg/dL))

Which test is more reliable to diagnose pheochromocytoma? 1. Urinary cortisol 2. Urine osmolality 3. Urinary creatinine 4. Urinary aldosterone

3. Urinary creatinine (Pheochromocytoma is a disorder of the adrenal medulla; urinary creatinine is used to diagnose this disorder. Urinary cortisol, urine osmolality, and urinary aldosterone are used to diagnose Addison's disease.)

Which syndrome would be suspected in a patient who has Addison's disease along with other endocrine conditions? 1. Hashimoto's thyroiditis 2. Autoimmune polyglandular syndrome 3. Multiple endocrine neoplasia 4. Syndrome of Inappropriate antidiuretic hormone (SIADH)

2. Autoimmune polyglandular syndrome (Addison's disease is an autoimmune disorder caused by the destruction of adrenal tissue by antibodies. When it occurs along with other endocrine disorders, Addison's disease is called autoimmune polyglandular syndrome. Hashimoto's thyroiditis, multiple endocrine neoplasia syndrome, and syndrome of Inappropriate antidiuretic hormone (SIADH) are not associated with these conditions.)

A patient with hyperaldosteronism is prescribed eplerenone. What advice would the nurse give the patient regarding eplerenone? 1. "Avoid coffee." 2. "Eat more bananas." 3. "Avoid grapefruit juice." 4. "Eat more sugar, candy, and syrup."

3. "Avoid grapefruit juice." Grapefruit juice should be avoided in patients taking eplerenone because the drink leads to increased levels of eplerenone in blood and causes toxicity. Coffee should be avoided because it may interrupt sleep; however, coffee does not affect eplerenone action. Eplerenone may cause hyperkalemia, so bananas should be avoided. Sugar, candy, and syrups are concentrated simple carbohydrates and should be avoided.

The nurse should monitor for increases in which laboratory value in a patient being treated with dexamethasone? 1. Sodium 2. Calcium 3. Potassium 4. Blood glucose

4. Blood glucose (Hyperglycemia, or increased blood glucose level, is an adverse effect of corticosteroid therapy. Sodium, calcium, and potassium levels are not affected directly by dexamethasone.)

A patient is prescribed levothyroxine. To promote optimal absorption, the nurse should instruct the patient to take the medication at which time? 1. 0600 2. 1200 3. 1600 4. 2100

1. 0600 (For maximum absorption, levothyroxine should be taken first thing in the morning on an empty stomach 30 minutes before breakfast. 1200, 1600, and 2100 may not result in adequate absorption.)

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.)

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.)

Which statement is true about pheochromocytoma? 1. The primary treatment is drug therapy 2. An attack is provoked by anti-epileptic medications 3. Decreased levels of epinephrine and norepinephrine are observed 4. Severe pounding headaches and profuse sweating are clinical features

4. Severe pounding headaches and profuse sweating are clinical features (Severe pounding headache and profuse sweating are clinical features of pheochromocytoma. Although drug therapy is administered during preoperative care to reduce complications, the primary treatment is surgery. The attack is provoked by opioids, not antiepileptic medications. Epinephrine and norepinephrine levels rise in patients with pheochromocytoma.)

The nurse recalls that excessive secretion of the hormone vasopressin characterizes: 1. Thyrotoxicosis 2. Diabetes insipidus 3. Hyperosmolar hyperglycemic nonketotic syndrome 4. Syndrome of inappropriate antidiuretic hormone secretion

4. Syndrome of inappropriate antidiuretic hormone secretion (Another term for antidiuretic hormone (ADH) is vasopressin. Syndrome of inappropriate antidiuretic hormone secretion is characterized by excessive release of ADH from the posterior pituitary gland, resulting in the inability of the kidneys to dilute urine. The patient retains water and experiences increased extracellular fluid volume and hyponatremia. The disorder can cause cardiopulmonary overload and neurological problems as a result of water intoxication. Thyrotoxicosis, also known as thyroid storm or thyroid crisis, results from an abrupt increase in T3 and T4 thyroid hormones. Diabetes insipidus results from a decrease in ADH. Hyperosmolar hyperglycemic nonketotic syndrome results from hyperglycemia in type 2 non-insulin-dependent diabetes mellitus.)

Which is a clinical manifestation of Cushing syndrome? 1. hypovolemia 2. Hypokalemia 3. Hyperkalemia 4. Hyponatremia

2. Hypokalemia (Hypokalemia is a sign of Cushing syndrome because of the hyperfunctioning of the adrenal cortex. Hypovolemia, hyperkalemia, and hyponatremia are clinical manifestations of Addison's disease because of the hypofunctioning of the adrenal cortex.)

A patient who is diagnosed with hypothyroidism and coronary artery disease (CAD) states to the nurse, "I am constipated. My spouse wants me to try an enema to help relieve my discomfort." The nurse educates the patient that using enemas is contraindicated due to the diagnosis. Which is the rationale for this contraindication? 1. Vagus nerve stimulation 2. Olfactory nerve stimulation 3. Abducens nerve stimulation 4. Hypoglossal nerve stimulation

1. Vagus nerve stimulation (Constipation is a common problem associated with hypothyroidism. The use of enemas, however, is contraindicated because they result in vagus nerve stimulation for patients with a history of cardiac disease. Olfactory, abducens, and hypoglossal nerves are not affected by the use of enemas.)

Which clinical manifestations does the nurse expect to assess in a patient that is diagnosed with hyperthyroidism? Select all that apply. 1. Weight loss 2. Protrusion of the eye balls 3. Thick cold, and dry skin 4. Elevated blood pressure 5. Purplish red marks on abdomen

1. Weight loss 2. Protrusion of the eye balls 4. Elevated blood pressure (Weight loss, protrusion of the eyeballs, and elevated blood pressure are clinical manifestations of hyperthyroidism. Weight loss and hypertension are due to increases in metabolic demands; protrusion of the eyeballs is due in part to accumulation of fluid in the eyes. Thick, cold, and dry skin are symptoms of hypothyroidism. Purplish red marks on the abdomen are seen in Cushing syndrome.)

A patient with pheochromocytoma is prescribed propranolol during preoperative care. Which instruction provided by the nurse is most appropriate to prevent complications in the patient? 1. "Obtain adequate rest." 2. "Make postural changes cautiously." 3. "Have a blood pressure check frequently." 4. "Consult your primary health care provider if you have severe headache."

2. "Make postural changes cautiously." (Propranolol is a β-adrenergic receptor blocker that is administered during preoperative care to treat tachycardia, dysrhythmias, and high blood pressure, in order to prevent intraoperative hypertensive crisis. Propranolol causes orthostatic hypotension, so postural changes should be made cautiously, to prevent falls. Adequate rest should be taken by the patient, but it is not related to preventing falls. Blood pressure should be monitored regularly to prevent hypertensive crisis. A severe headache should be reported to the primary health care provider for immediate intervention; however, this condition is unconnected to complications of propranolol.)

An older adult patient who has a history of coronary artery disease (CAD) is diagnosed with hypothyroidism. What is appropriate for the nurse to include in the patient's education? Select all that apply. 1. Eat a low-fiber diet 2. Avoid using enemas 3. Avoid using sedatives 4. Take the prescribed medication before breakfast 5. Alternate between the trade and generic brands of the medication

2. Avoid using enemas 3. Avoid using sedatives 4. Take the prescribed medication before breakfast (An older adult patient diagnosed with both hypothyroidism and CAD should be taught to avoid enemas due to the risk of vagal stimulation, to avoid the use of sedatives for insomnia, and to take medication in the morning before breakfast. A high-fiber diet is recommended to avoid constipation. Different brands of hormones may have different bioavailability, and should be avoided.)

A patient has undergone surgery for acromegaly. After surgery, the patient is experiencing severe headache. What action should be taken to provide relief from the headache? 1. The bed should be placed parallel to the floor 2. The head of the bed should be elevated to 30-degree angle 3. The glucose level of the patient should be maintained 4. The patient should be told to avoid coughing and sneezing

2. The head of the bed should be elevated to 30-degree angle (Elevating the head of the bed to a 30-degree angle alleviates pressure on the sella turcica and thereby relieves the headache. Placing the bed parallel to the floor does not alleviate pressure on the sella turcica. Glucose levels are used to check cerebrospinal fluid leakage. Vigorous coughing and sneezing should be avoided to prevent cerebrospinal fluid leakage.)

The nurse sends the clear nasal drainage of a patient who underwent transphenoidal hypophysectomy for testing. The laboratory readings reveal glucose levels at 40 mg/dL. What does the nurse infer from this finding? 1. The patient is at an increased risk for stroke 2. The patient is at an increased risk for meningitis 3. The patient is at an increased risk for encephalitis 4. The patient is at an increased risk for subdural hematoma

2. The patient is at an increased risk for meningitis (A glucose level greater than 30mg/dL in a patient's nasal discharge after transphenoidal hypophysectomy indicates that the patient has cerebrospinal fluid leakage. Patients with cerebrospinal fluid leakage are at an increased risk of acquiring meningitis. Stroke is not related to the leakage of cerebrospinal fluid. Encephalitis, an inflammation in the brain, is caused by infection or an allergic reaction; CSF leakage is not a risk factor of encephalitis. Subdural hematoma is the collection of blood under the dura matter; it is not related to CSF leakage.)

The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instructions regarding desmopressin acetate would be most appropriate? 1. The patient can expect to experience weight loss resulting from increased diuresis 2. The patient should alternate nostrils during administration to prevent nasal irritation 3. The patient should monitor for symptoms of hypernatremia as a side effect of this drug 4. The patient should report any decrease in urinary elimination to the health care provider

2. The patient should alternate nostrils during administration to prevent nasal irritation (Desmopressin acetate is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. Inhaled desmopressin acetate can cause nasal irritation, headache, nausea, and other signs of hyponatremia. Diuresis will be decreased and is expected, and hypernatremia should not occur.)

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 teaching the patient with adrenocortical insufficiency and the caregiver about management of corticosteroid therapy. What should the nurse tell the patient and the caregiver? 1. Assess for cataracts every two years 2. Decrease the dose of corticosteroids when stressed 3. Recognize edema and ways to restrict sodium intake 4. Plan a diet high in concentrated simple carbohydrates

3. Recognize edema and ways to restrict sodium intake (The nurse should teach the patient to recognize edema and ways to restrict sodium intake to less than 2000 mg/day if edema occurs. The nurse should ask the patient to see an eye specialist yearly to assess for cataracts. The patient should recognize the need for an increased dose of corticosteroids when stressed. The nurse should teach the patient and caregiver to plan a diet high in protein, calcium, and potassium but low in fat and concentrated simple carbohydrates such as sugar, honey, syrups, and candy.)

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.)

What does the nurse include in the teaching plan for the client who is receiving radioactive iodine? 1. Private bathroom facilities are not necessary unless the patient is incontinent 2. Radioactive iodine therapy is contraindicated in women of childbearing age 3. Towels that are used by the patient should not be used by other family members 4. The patient should avoid being around pregnant women and children for 48 hours after treatment

3. Towels that are used by the patient should not be used by other family members (To decrease risk of radiation exposure to household contacts, towels and bed linens used by the patient should not be handled by other members of the household and should be washed daily, separate from other household laundry. The patient who has been treated with radioactive iodine should use separate bathroom facilities and should flush two to three times after each use. Radioactive iodine may not be given to a pregnant woman. A pregnancy test must be administered to women of childbearing age to rule out pregnancy, before initiation of therapy. The patient who has received radioactive iodine should avoid close proximity to pregnant woman or children for seven days following treatment.)

The nurse is teaching a patient with Addison's disease about corticosteroid therapy. The nurse should prioritize which of these teaching points? 1. "Plan a high-carbohydrate diet." 2. "Increase your daily intake of sodium." 3. "Decrease your daily intake of calcium." 4. "Do not stop taking the medication abruptly."

4. "Do not stop taking the medication abruptly." (The patient should be instructed to not stop the medication abruptly because this can cause adverse side effects. Patients taking corticosteroids should not consume a high-carbohydrate diet, because corticosteroids increase blood sugar. Patients should also increase their daily intake of calcium to prevent bone loss due to the side effects of corticosteroids. Patients should also decrease, not increase, their daily intake of sodium to avoid fluid retention.)

What level of urine cortisol indicates Cushing syndrome? 1. 100 mcg/ 24 hr 2. 110 mcg/ 24 hr 3. 120 mcg/ 24 hr 4. 130 mcg/ 24 hr

4. 130 mcg/ 24 hr (The normal range of urine cortisol levels lies between 80 and 120 mcg/24 hr. A value of 130 mcg/24 hr indicates a high urinary cortisol level, which is observed in Cushing syndrome.)

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.)