Endocrine (no DM) MCQs
A client has a diagnosis of diabetes insipidus (DI). What are appropriate nursing interventions for this client? Select all that apply. 1 Monitor urine for specific gravity. 2 Reduce IV fluids and electrolytes. 3 Administer vasopressin. 4 Monitor for increase in weight gain. 5 Provide a sodium-restricted diet.
1,3,5 One of the characteristics of DI is a decrease in antidiuretic hormone (ADH), which leads to decreased urine output and electrolyte depletion. Urine specific gravity will be low (1.001 to 1.005) and dilute, so it should be monitored. Vasopressin is administered. Because of the excessive urine volume, dehydration occurs, not weight gain. Limiting sodium intake is thought to help decrease the urine output.
The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which initial action? 1.Lower the head of the bed. 2.Test the drainage for glucose. 3.Obtain a culture of the drainage. 4.Continue to observe the drainage.
2 After hypophysectomy, the client should be monitored for rhinorrhea, which could indicate a cerebrospinal fluid leak. If this occurs, the drainage should be collected and tested for the presence of cerebrospinal fluid. Cerebrospinal fluid contains glucose, and if positive, this would indicate that the drainage is cerebrospinal fluid. The head of the bed should remain elevated to prevent increased intracranial pressure.
For a client with Cushing's disease, which finding requires a need to call the provider? 1 Upset stomach 2Rapid weight gain 3 Striae on the abdominal skin 4 Development of a buffalo hump
2 Rapid weight gain, which is a sign of fluid retention, must be reported to the healthcare provider because it may lead to complications such as pulmonary edema, hypertension, and heart failure. Gastric irritation and upset stomach are results of the steroid medication irritating the stomach and can be minimized with food ingestion before taking the medication. Striae are noted in the diagnosis of hypercortisolism because high levels of cortisol degrade collagen, but they do not need to be reported; neither does the buffalo hump.
A client is being treated for Addisonian crisis and 0.9% saline solution is being administered. What nursing observation would indicate this intervention may not be achieving the desired response? 1. Ankle edema 2. Serum potassium of 4.1 mEq/L (4.1 mmol/L) 3. Decreasing blood pressure (BP) 4. Heart rate of 78 beats/min
3 The purpose of the infusion of large volumes of saline is to reverse/prevent hypotension. Decreasing BP may be considered a late sign of cardiac decompensation with decreased atrial and ventricular output. The other S/Sx are not associated with Addisonian crisis.
A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia? A. Acromegaly B. Type 1 diabetes mellitus C. Hypothyroidism D. Deficient growth hormone
A Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain.
The nurse is aware that the best time of day for the total large corticosteroid dose is between: A. 7:00 AM and 8:00 AM B. 8:00 PM and 9:00 PM C. 4:00 AM and 5:00 AM D. 4:00 PM and 6:00 PM
A The best time of day for the total large corticosteroid dose is in the early morning, between 7:00 AM and 8:00 AM, when the adrenal gland is most active. Therefore, dosage at this time of day will result in the maximum suppression of the adrenal gland.
Which of the following is considered a late symptom of hypothyroidism? A. Brittle nails B. Physical sluggishness C. Loss of libido D. Cold intolerance
D Late symptoms of hypothyroidism include cold intolerance & absence of sweating, weight gain, apathy, slow speech, thickening of skin, and constipation. Early symptoms include fatigue (physical sluggishness), loss of libido, amenorrhea, brittle nails, hair loss, dry skin, and apathy. Early= low energy/drive
The nurse is caring for a client with Addison disease. Which findings indicate the development of a complication of this condition? Select all that apply. 1. Back and abdominal pain 2. Hyperglycemia 3. Extreme weakness 4. Temperature of 101° F (38.3° C) 5. Increased BP 6. Confusion
1,3,4,6 Addisonian crisis is an acute episode of adrenal insufficiency, which can be a life-threatening emergency. It is characterized by weakness, often accompanied by pain in the back, abdomen, or legs, along with severe manifestations of glucocorticoid and mineralocorticoid deficiency, including hypotension (particularly postural), tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, hyperpyrexia, and confusion. It is treated by administration of hydrocortisone and fluid replacement.
The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which health care provider prescriptions should the nurse anticipate receiving? Select all that apply. 1.Initiate an infusion of 3% NaCl. 2.Administer intravenous furosemide. 3.Restrict fluids to 800 mL over 24 hours. 4.Elevate the head of the bed to high Fowler's. 5.Administer a vasopressin antagonist as prescribed.
1,3,5 Management is directed at correcting the hyponatremia and preventing cerebral edema. Hypertonic saline is prescribed when the hyponatremia is severe, less than 120 mEq/L (120 mmol/L). Hypertonic saline must be infused slowly as prescribed and an infusion pump must be used. Fluid restriction is a useful strategy aimed at correcting dilutional hyponatremia. Vasopressin is an ADH; vasopressin antagonists are used to treat SIADH. Furosemide may be used to treat extravascular volume and dilutional hyponatremia in SIADH, but it is only safe to use if the serum sodium is at least 125 mEq/L (125 mmol/L). When furosemide is used, potassium supplementation should also occur and serum potassium levels should be monitored. To promote venous return, the head of the bed should not be raised more than 10 degrees for the client with SIADH. Maximizing venous return helps to avoid stimulating stretch receptors in the heart that signal to the pituitary that more ADH is needed.
A client is scheduled for transsphenoidal hypophysectomy for treatment of an anterior pituitary tumor. What would be important nursing interventions for this client? Select all that apply. 1 Elevate the head of the bed 30 degrees. 2 Encourage hourly coughing, deep breathing, and incentive spirometry. 3 Monitor for symptoms of increasing intracranial pressure. 4 Monitor urine output for a decrease in volume. 5 Provide frequent oral hygiene with nonirritating solutions; avoid using a toothbrush. 6 Take cortisone, thyroid hormones, and antidiuretic hormone (ADH)-regulating medications.
1,3,5,6 The nurse would elevate the head of the bed 30 degrees, discourage coughing, sneezing, or straining while defecating to prevent cerebrospinal fluid leak, assess for symptoms of increasing intracranial pressure, evaluate urine for excessive increase in volume (more than 200 mL/hr) or specific gravity less than 1.005 (i.e., development of DI), and provide frequent oral hygiene with nonirritating solutions to avoid disruption of the suture line. The client should avoid brushing the teeth for 10-14 days after surgery. The client will require medication to support pituitary target organs involved (e.g., pancreas, thyroid, adrenals, gonads), cortisone and thyroid hormone replacement throughout his or her lifetime, and ADH-regulating medications.
A client in the recovery room after a thyroidectomy is asked frequently by the nurse to speak. What is the rationale for the nurse monitoring the client's speech? 1. Assessing for the continued effects of the anesthesia. 2 Detecting spasms or edema in the area of the vocal cords. 3 Assessing the client's cognitive ability. 4 Assessing for damage to the cricoid process.
2 The nurse would have the client talk to detect possible swelling around the glottis or damage to the recurrent laryngeal nerve. This would not be an effective way to evaluate anesthesia recovery. The cricoid process does not have anything to do with speech. To assess cognitive ability, the nurse would focus on what the client was saying rather than whether the voice was getting hoarser or whether the client could not speak at all.
The nurse is monitoring a client diagnosed with acromegaly who was treated with transsphenoidal hypophysectomy and is recovering in the intensive care unit. Which findings should alert the nurse to the presence of a possible postoperative complication? Select all that apply. 1.Anxiety 2.Leukocytosis 3.Chvostek's sign 4.Urinary output of 800 mL/hour 5.Clear drainage on nasal dripper pad
2,4,5 Acromegaly results from excess secretion of growth hormone, usually caused by a benign tumor on the anterior pituitary gland. Treatment is surgical removal of the tumor, usually with a sublingual transsphenoidal complete or partial hypophysectomy. The sublingual transsphenoidal approach is often through an incision in the inner upper lip at the gum line. Transsphenoidal surgery is a type of brain surgery and infection is a primary concern. Leukocytosis, or an elevated white count, may indicate infection. Diabetes insipidus is a possible complication of transsphenoidal hypophysectomy. In diabetes insipidus there is decreased secretion of antidiuretic hormone and clients excrete large amounts of dilute urine. Following transsphenoidal surgery, the nasal passages are packed and a dripper pad is secured under the nares. Clear drainage on the dripper pad is suggestive of a cerebrospinal fluid leak. The surgeon should be notified and the drainage should be tested for glucose. A cerebrospinal fluid leak increases the postoperative risk of meningitis. Anxiety is a nonspecific finding that is common to many disorders. Chvostek's sign is a test of nerve hyperexcitability associated with hypocalcemia and is seen as grimacing in response to tapping on the facial nerve. Chvostek's sign has no association with complications of sublingual transsphenoidal hypophysectomy.
A client has been hospitalized for impaired function of the posterior pituitary gland. The nurse plans to monitor for signs and symptoms of which hormone imbalance? 1.Growth hormone (GH) 2.Luteinizing hormone (LH) 3.Antidiuretic hormone (ADH) 4.Follicle-stimulating hormone (FSH)
3 ADH is secreted by the posterior pituitary gland. The other hormone stored in the posterior pituitary gland is oxytocin. Both ADH and oxytocin are synthesized by the hypothalamus and stored in the posterior pituitary gland.
The nurse has provided dietary instructions to a client with a diagnosis of hypoparathyroidism. The nurse should instruct the client that it is acceptable to include which item in the diet? 1.Fish 2.Cereals 3.Vegetables 4.Meat and poultry
3 The client with hypoparathyroidism is instructed to follow a calcium-rich diet and to restrict the amount of phosphorus in the diet. Vegetables are allowed in the diet. The client should limit meat, poultry, fish, eggs, cheese, and cereals.
The staff nurse is assigned to the following clients. Which client should the nurse assess first? 1. An adult client with type 1 diabetes and fingerstick glucose level of 127 mg/dL (7.1 mmol/L) 2. An older adult with Cushing's syndrome, truncal obesity, and peripheral edema 2+ 3. An adult with a history of Graves' disease and a heart rate of 90 beats/min 4. An older adult with hypothyroidism and a heart rate of 48 beats/min
4 The priority client to see first would be the client with the bradycardia who has hypothyroidism. This low pulse may have cardiac implications and should be evaluated first. Truncal obesity and peripheral edema are common findings with clients who have Cushing's syndrome. Clients who are diagnosed with Graves' disease (hyperthyroidism) usually have a rapid heart rate, but 90 beats/min is within normal limits. The client with type 1 diabetes with a glucometer reading of 127 mg/dL (7.1 mmol/L) may need watching but is not a priority.
Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction experiences: A. heat intolerance and systolic hypertension. B. weight gain and heat intolerance. C. diastolic hypertension and widened pulse pressure. D. anorexia and hyperexcitability.
A An increased metabolic rate in a client with hyperthyroidism caused by excess serum thyroxine leads to systolic hypertension and heat intolerance. Weight loss — not gain — occurs because of the increased metabolic rate. Diastolic blood pressure decreases because of decreased peripheral resistance (Diastolic BP is directly related to total peripheral resistance). Clients with hyperthyroidism experience an increase in appetite — not anorexia.
Which patient is most at risk for developing Syndrome of Inappropriate Anti-diuretic Hormone (SIADH)? A. A patient diagnosed with small cell lung cancer. B. A patient whose kidney tubules are failing to reabsorb water. C. A patient with a tumor on the anterior pituitary gland. D. A patient taking Declomycin.
A SIADH can be a result due to malignant tumor (ex. lung cancer), head injury, stroke, meningitis, and tuberculosis.
A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a history of adrenal insufficiency. Considering the patient's history and current symptoms, what would the nurse instruct the patient? A. Increase his intake of sodium until the gastrointestinal symptoms improve B. Increase his intake of glucose until the gastrointestinal symptoms improve C. Increase his intake of calcium until the gastrointestinal symptoms improve D. Increase his intake of potassium until the gastrointestinal symptoms improve
A The patient will need to supplement his dietary intake with added salt during episodes of gastrointestinal losses of fluid through vomiting and diarrhea to prevent the onset of Addisonian crisis. While the patient may experience the loss of other electrolytes, the major concern is the replacement of lost sodium.
A nurse is caring for a client with diabetes insipidus. The nurse should anticipate administering: A. vasopressin. B. insulin. C. potassium chloride. D. furosemide.
A Vasopressin is given subcutaneously to manage diabetes insipidus. Insulin is used to manage diabetes mellitus. Furosemide causes diuresis. Potassium chloride is given for hypokalemia.
A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine condition should the nurse expect the health care provider to diagnose? A. Goiter B. Diabetes insipidus C. Diabetes mellitus D. Cushing's syndrome
A **Weird question because goiter is simply a presence of enlarged thyroid gland (not necessarily hypo or hyper) A goiter can result from inadequate dietary intake of iodine associated with changes in foods or malnutrition. It can be caused by insufficient thyroid gland production and depletion of glandular iodine. Enlarged thyroid gland can result in dizziness when raising the arms above the head, dysphagia, and if the compression of the airway is severe, respiratory distress.
Upon evaluation of the patient's laboratory data and clinical signs and symptoms, the nurse suspects that the patient may have pheochromocytoma. Which of the following is directly related with pheochromocytoma? Select all that apply. A. Severe headache; pain score of 9 out of 10 B. Perspiration C. Blood pressure 80/90 mm Hg D. Pallor E. Lethargy
A,B Severe headache, perspiration, are indicative ofpheochromocytoma. High, not low, blood pressure is strongly associated withpheochromocytoma. The massive release of catecholamines is associated with tremor, and nervousness, not lethargy. Palpitations may also be seen.
A nurse is planning care for a client who has Cushing's disease. The nurse should identify that clients who have Cushing's disease are at increased risk for which of the following? (Select all that apply). A. Infection B. Gastric ulcer C. Renal calculi D. Bone fractures E. Dysphagia
A,B,D Infection: suppression of the immune system due to overproduction of cortisol Gastric ulcer: Overproduction of cortisol inhibits production of protective mucus lining in stomach Bone fracture: Overproduction of cortisol is related to decreased calcium absorption, risk of bone fracture.
The nursing management of a patient who underwent transsphenoidal removal of a pituitary tumor yesterday includes which of the following actions? Select all that apply. A. Maintaining oral care B. Removing nasal pack to check for bleeding and CSF leak C. Giving fluid after nausea ceases, and then slowly progressing to normal diet D. Raising the head of the bed to promote drainage E. Brush teeth to prevent bacterial overgrowth with hard toothbrush
A,C,D Nasal packs are not removed until the third or fourth postoperative day. Removing the nasal pack the day after surgery may exacerbate bleeding. If a sublabial approach is used, the patient is advised not to brush his or her teeth until the incision above the teeth has been healed. Usually fluids are provided after nausea ceases, after which the patient may be able to progress to a regular diet.
A patient is diagnosed with a deficiency in vasopressin, a posterior pituitary hormone. Therefore, a primary nursing responsibility is to assess for: A. Indicators of hyponatremia. B. Indicators of dehydration. C. Glycosuria D. Serum calcium levels.
B A deficiency in vasopressin, also known as the antidiuretic hormone, would result in increased urinary output, thirst, and dehydration.
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? A. Imbalanced nutrition: Less than body requirements B. Decreased cardiac output C. Risk for infection D. Impaired physical mobility
B An acute addisonian crisis is a life-threatening event, caused by deficiencies of cortisol and aldosterone. Glucocorticoid insufficiency causes a decrease in cardiac output and vascular tone, leading to hypovolemia. The client becomes tachycardic and hypotensive and may develop shock and circulatory collapse.
A client with hyperparathyroidism declines surgery and chooses to monitor their calcium levels. Which instruction is most important for the nurse to include in the client's teaching plan? A. "Rest as much as possible." B. "Maintain a moderate exercise program." C. "Jog at least 2 miles per day."
B Client is at risk of decrease bone density due to excess parathyroid hormone and will benefit from an exercise program that helps strengthen bones and prevents bone loss, such as moderate exercise program. Walking or swimming provides the most beneficial exercise. Immobility could worsen the issue. Because of weakened bones, a rigorous exercise program such as jogging a long distance is contraindicated.
Because there is no one cause for Graves disease, treatment is relegated to the management of symptoms, or in severe cases, surgery to remove the thyroid gland. Which is not a symptom of Graves disease? A. fine hand tremors B. constipation C. increased appetite D. blurred vision
B Clients with Graves disease (primary hyperthyroidism) commonly experience diarrhea, increased appetite, weight loss, visual changes such as blurred or double vision, and fine tremors of the hands, causing unusual clumsiness.
For a client who has SIADH, what drug do you anticipate the patient will be started on per doctor's order? A. Desmopressin (DDAVP) IV B. Declomycin C. Chlorpropamide
B Declomycin is a tetracycline Abx, but it is used for SIADH by stimulating urinary flow (unalbeled use). Important to monitor for S/Sx of yeast infection. Other drugs that can be used are vasopressin antagnoists (tolvaptan, conivaptan).
Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy. A. Sodium B. Calcium C. Potassium D. Magnesium
B Efforts are made to spare parathyroid tissue to reduce the risk of postoperative hypocalcemia with resultant tetany.
A female client is being successfully treated for Cushing's syndrome. The nurse should expect a decline in: A. hair loss. B. serum glucose level. C. bone mineralization. D. menstrual flow.
B Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline.
When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of: A. restricting sodium. B. encouraging fluids. C. restricting potassium. D. restricting fluids.
B Hyperparathyroidism results in elevated serum calcium levels, which could increase the risk of renal calculi formation. The nurse should encourage fluid intake to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine.
Which condition may occur during the postoperative period in a client who underwent adrenalectomy because of sudden withdraw of excessive amounts of catecholamines? A. Hypertension B. Hypoglycemia C. Hyporeflexia D. Hyperglycemia
B Hypotension and hypoglycemia may occur in the postoperative period because of the sudden withdrawal of excessive amounts of catecholamines (epinephrine and norepinephrine).
A patient who is postoperative day 1 following neck dissection surgery has rung his call bell complaining of numb fingers, stiff hands, and a tingling sensation in his lips and around his mouth. The nurse should anticipate that this patient may require the IV administration of: A. Potassium chloride B. Calcium gluconate C. Magnesium sulfate D. Sodium phosphate
B Inadvertent removal of the parathyroid may occur during neck dissection surgery, resulting in hypocalcemia. This condition is treated with the IV administration of calcium gluconate.
After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate? A. Administer a sedative as ordered. B. Administer IV calcium gluconate as ordered. C. Start administering oxygen at 2 L/min via a cannula. D. Administer an oral calcium supplement as ordered.
B When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered.
A client sustained a head injury when falling from a ladder. While in the hospital, the client begins voiding large amounts of clear urine and reports being very thirsty. The client states feeling weak and having experienced an 8-pound weight loss since admission. What condition does the nurse expect the client to be tested for? A. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) B. Diabetes insipidus (DI) C. Pituitary tumor D. Hypothyroidism
B With diabetes insipidus, urine output may be as high as 20 L/day. Urine is dilute, with a specific gravity of 1.002 or less. Limiting fluid intake does not control urine excretion. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weakness, dehydration, and weight loss develop.
A 55-year-old female presents to the clinic with complaints of fatigue and tiredness. The nurse notices that the patient's skin is thin, fragile, and easily traumatized. Ecchymosis and purple striae are noted over the thighs and abdomen. She presents with a slight kyphosis and a protruding abdomen. Which of the following methods of management might be appropriate for her? A. Increase dose of corticosteroids B. Unilateral or bilateral adrenalectomy C. Increase dose of Spironolactone D. Diet that is high in carbohydrates and low in protein
B,C Adrenalectomy is the treatment of choice for patients with primary adrenal hypertrophy. Spironolactone might be prescribed if high BP and hypokalemia. It is a drug that treats fluid retention and maintains potassium levels in the body. Corticosteroids should be reduced or tapered rather than increased. Diet high in carbohydrate and high in protein should be encouraged.
A nurse is providing medication teaching for a client who has Addison's disease and is taking hydrocortisone. Which of the following instructions should the nurse include? (Select all that apply) A. Take the medication on an empty stomach. B. Notify the provider of any illness or stress. C. Report any manifestations of weakness or dizziness. D. Do not discontinue the medication suddenly. E. Eat a low-sodium diet
B,C,D For a client who is on corticosteroid therapy, they should never abruptly discontinue the medication. Also, in case of illness or extreme stress, the client may require additional dose of hydrocortisone, so contacting the provider is important. Client should also be advised to report mainfestations of Addisonian crisis, such as weakness or diziness (sudden drop in blood pressure). Finally, low-sodium diet is NOT advised in Addison's disease because they are in hyponatremic state; the client might require sodium supplementation, especially if experiencing diaphoresis or vomiting.
A nurse is admitting a client who has acute adrenal insufficiency. Which of the following prescriptions should the nurse expect? (Select all that apply) A. IV 0.45% Sodium chloride B. Regular insulin C. Hydrocortisone D. Sodium polystyrene sulfonate E. Furosemide
B,C,D,E During acute adrenal insufficiency, isotonic (ex. 0.9% NaCl) saline should be administrated for rapid vascular volume restoration for hypotension. Also, they may exhibit hyperkalemia, and insulin (w/ dextrose) and SDS are used to get rid of excess potassium. Finally, loop diuretics (ex. furosemide) helps excrete potassium via urine.
When teaching a client with Cushing's syndrome about dietary changes, the nurse should instruct the client to increase intake of: A. cereals and grains. B. processed meats. C. orange and watermelon D. cheese
C Cushing's syndrome causes sodium retention and potassium loss. Therefore, the nurse should advise the client to increase the intake of potassium-rich foods, such as orange and watermelons.
A client with a history of diabetes insipidus seeks medical attention for an exacerbation of symptoms. Which laboratory finding indicates to the nurse that the client has been restricting fluids in an attempt to control the symptoms? A. Phosphate level of 5.0 mg/dL B. Potassium level of 2.9 mmol/L C. Sodium level of 150 mEq/L D. Blood glucose level of 60 mg/dl
C Diabetes insipidus (DI) invovles deficiency of ADH (vasopressin) that results in excretion of large volumes of dilute urine and extreme thirst. Due to the intense thirst, the client tends to drink 2 to 20 L (!) of fluid daily and craves cold water. The disease cannot be controlled by limiting fluid intake because the high-volume loss of urine continues even without fluid replacement. Attempts to restrict fluids cause the client to experience an insatiable craving for fluid and to develop hypernatremia and severe dehydration. DI does not affect the glucose, potassium, or phosphate levels.
All of the following are treatments for myxedema coma EXCEPT? A. Corticosteroids B. IV glucose C. Hypotonic IV solutions D. IV Synthroid
C Myxedema coma is a life-threatening condition that occurs when hypothyroidism is untreated, or when a stressor affects a client with hypothyroidism. Fluid replacement should be done using isotonic (ex. 0.9% NaCl), not hypotonic IV solutions. In addition, client will need thyroid replacement, IV glucose (for hypoglycemia), and corticosteriods (to prevent adrenal insufficiency that could co-occur in times of extreme stress).
The nurse on the telemetry floor is caring for a patient with long-standing hypothyroidism who has been taking synthetic thyroid hormone replacement sporadically. What is a priority that the nurse monitors for in this patient? A. Heat intolerance B. Dietary intake of foods with saturated fats C. Symptoms of acute coronary syndrome D. Symptoms of pneumonia
C The nurse must monitor for signs and symptoms of acute coronary syndrome (ACS), which can occur in response to therapy (synthetic thyroid) in patients with severe, long-standing hypothyroidism or myxedema coma, especially during the early phase of treatment. ACS must be aggressively treated at once to avoid morbid complications (e.g., myocardial infarction).
Which of the following assessments should the nurse perform to determine the development of peptic ulcers when caring for a patient with Cushing's syndrome? A. Observe urine output. B. Monitor bowel patterns. C. Observe the color of stool. D. Monitor vital signs every 4 hours.
C The nurse should observe the color of each stool and test the stool for occult blood. Bowel patterns, vital signs, and urine output do not help in determining the development of peptic ulcers.
The PACU staff have brought a patient to the unit following a thyroidectomy. To promote comfort for this patient, how should the nurse position this patient? A. Side-lying (lateral) with one pillow under the head B. Head of the bed elevated 30 degrees and no pillows placed under the head C. Semi-Fowler's with the head supported on two pillows D. Flat, with a small roll supporting the neck
C When moving and turning the patient, the nurse carefully supports the patient's head and avoids tension on the sutures. The most comfortable position is the semi-Fowler's position, with the head elevated and supported by pillows.
A client seeks medical attention for new onset of weight loss and heat intolerance. Which additional statements indicate to the nurse that the client is experiencing hyperthyroidism? Select all that apply. A. "I always carry an extra sweater with me since I'm always cold no matter the temperature outside." B. "I use lotion on my skin 2 to 3 times a day since my skin is so dry and itchy." C. "I switched from knitting to glue projects since I have developed tremors in my hands." D. "Even sitting still, sometimes it feels like my heart is racing." E. "My children tell me that my eyes appear to be bigger, almost buldging, particularly when I tell them to do the dishes."
C,D,E Clients with hyperthyroidism exhibit a characteristic group of signs and symptoms. Clinical manifestations are related to the increase in metabolic rate and increased oxygen consumption and include tremors, tachycardia, and exophthalmos (bulging eyes).
What dietary modifications should be recommended to a client with hyperthyroidism? A. Limit intake of nutritionally dense foods such as milk products, eggs, and cheese. B. Increase calorie intake by 70%. C. Restrict calorie intake. D. Consume a high-protein diet.
D A high protein intake helps replenish losses from muscle catabolism. Metabolism is increased with hyperthyroidism. Calorie needs increase between 10% and 50% above normal to replenish glycogen stores and correct weight loss. Encourage frequent meals and the intake of nutritionally dense foods (fortified milkshakes, foods fortified with skim milk powder, eggs, cheese, butter, or milk).
A nurse is caring for a client in acute addisonian crisis. Which test result does the nurse expect to see? A. Blood urea nitrogen (BUN) level of 2.3 mg/dl B. Serum sodium level of 156 mEq/L C. Serum glucose level of 236 mg/dl D. Serum potassium level of 6.8 mEq/L
D A serum potassium level of 6.8 mEq/L indicates hyperkalemia, which can occur in adrenal insufficiency as a result of reduced aldosterone secretion.
Which outcome indicates that treatment of a client with diabetes insipidus has been effective? A. Blood pressure is 90/50 mm Hg. B. Heart rate is 126 beats/minute. C. Urine output measures more than 200 ml/hour. D. Fluid intake is less than 2,500 ml/day.
D Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.
For a client with Graves' disease, which nursing intervention promotes comfort? A. Restricting intake of oral fluids B. Placing extra blankets on the client's bed C. Limiting intake of high-carbohydrate foods D. Maintaining room temperature in the low-normal range
D Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss. To reduce heat intolerance and diaphoresis, the nurse should keep the client's room temperature in the low-normal range. To replace fluids lost via diaphoresis, the nurse should encourage, not restrict, intake of oral fluids. Placing extra blankets on the bed of a client with heat intolerance would cause discomfort. To provide needed energy and calories, the nurse should encourage the client to eat high-carbohydrate foods.
Which nursing diagnosis takes highest priority for a client with hyperthyroidism? A. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess B. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing C. Disturbed body image related to weight gain and edema D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
D In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. These changes put the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements related to thyroid hormone excess the most important nursing diagnosis. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing and Disturbed body image related to weight gain and edema may be appropriate for a client with hypothyroidism, which slows the metabolic rate.
A 42-year-old man with a history of pheochromocytoma is being treated in the intensive care unit after experiencing an acute exacerbation of his condition. This patient will require the nurse to perform which of the following assessments most frequently? A. Motor and sensory function B. Orientation and cognition C. Urine testing for osmolality D. Blood pressure (BP) and heart rate
D Pheochromocytoma results in increase secretion of catecholamines (epineprhine and norepinephrine) Blood pressures exceeding 250/150 mm Hg have been recorded in cases of pheochromocytoma. Such BP elevations are life-threatening and can cause severe complications. Consequently, constant monitoring of BP and heart rate is a priority over other assessments, even though each of the listed assessments is relevant and appropriate.
A patient with a diagnosis of primary adrenal hypertrophy is postoperative day 1 following a unilateral adrenalectomy. The nurse's astute assessment of the patient has revealed the presence of signs and symptoms that are typically associated with adrenal insufficiency. How should the nurse follow-up these assessment findings? A. Administer a p.r.n. dose of IV calcium gluconate. B. Reassure the patient that these changes are a normal, temporary response to the removal of the adrenal glands. C. Document the assessment findings and reassess in 1 to 2 hours. D. Contact the care provider because steroid replacement therapy may be temporarily needed.
D Postoperatively, symptoms of adrenal insufficiency may begin to appear 12 to 48 hours after surgery because of the reduction of high levels of circulating adrenal hormones. Temporary replacement therapy with hydrocortisone (corticosteroid) may be necessary for several months, until the adrenal glands begin to respond normally to the body's needs. Calcium gluconate is not a relevant intervention.
A patient is recovering from myxedema coma and will be discharged tomorrow. What will you include in their discharge teaching? A. Avoiding green leafy vegetables. B. Importance of taking Tapazole exactly as prescribed at the same time every day. C. Limiting foods with Iodine such as kelp, dairy, and eggs. D. Importance of taking Synthroid in the morning without any food.
D Synthroid should be taken in the morning without food so absorption is not affected. All the other options are incorrect discharge education.
