Med-Surge. Evolve chapter 47, 48, 49.

After a patient with hypothyroidism is in the hospital for 3 days, her daughter asks what measures will help her mother with constipation. What would be the nurse's best response? (Select all that apply.)

"Add fiber to the diet." Adding fiber to the diet, physical activity, and adequate fluid intake will help with constipation. Patients with hypothyroidism usually gain weight, and caloric intake may be reduced. Increasing dietary iron intake will not improve constipation. "Ensure adequate fluid intake." Adding fiber to the diet, physical activity, and adequate fluid intake will help with constipation. Patients with hypothyroidism usually gain weight, and caloric intake may be reduced. Increasing dietary iron intake will not improve constipation. "Age-appropriate physical activity will help." Adding fiber to the diet, physical activity, and adequate fluid intake will help with constipation. Patients with hypothyroidism usually gain weight, and caloric intake may be reduced. Increasing dietary iron intake will not improve constipation.

The patient is receiving propylthiouracil (PTU). Which statement by the patient indicates understanding of teaching regarding this medication? (Select all that apply.)

"If I become pregnant, I need to notify my health care provider immediately." Rare, but serious, adverse effects of thionamides include agranulocytosis. Without adequate neutrophils the patient is unable to resist infection. Any signs of infection, such as sore throat or fever, should be reported immediately. PTU can cause birth defects, and patients should not take it if they are pregnant. Liver problems can occur with PTU. The patient does not need to take his or her pulse daily. Dyspnea and vertigo are not side effects of PTU. SSKI, not PTU, is administered diluted in juice and sipped through a straw. "Liver problems can occur with this drug, so I need to report jaundice." Rare, but serious, adverse effects of thionamides include agranulocytosis. Without adequate neutrophils the patient is unable to resist infection. Any signs of infection, such as sore throat or fever, should be reported immediately. PTU can cause birth defects, and patients should not take it if they are pregnant. Liver problems can occur with PTU. The patient does not need to take his or her pulse daily. Dyspnea and vertigo are not side effects of PTU. SSKI, not PTU, is administered diluted in juice and sipped through a straw. "I will seek medical attention if I develop a sore throat." Rare, but serious, adverse effects of thionamides include agranulocytosis. Without adequate neutrophils the patient is unable to resist infection. Any signs of infection, such as sore throat or fever, should be reported immediately. PTU can cause birth defects, and patients should not take it if they are pregnant. Liver problems can occur with PTU. The patient does not need to take his or her pulse daily. Dyspnea and vertigo are not side effects of PTU. SSKI, not PTU, is administered diluted in juice and sipped through a straw.

A patient scheduled for a partial thyroidectomy asks the nurse why she is being given an iodine preparation before surgery. Which is the nurse's best response?

"It will decrease the release of thyroid hormones before surgery." Iodine inhibits the synthesis of thyroid hormones and are used to suppress hormone secretion before thyroidectomy. Iodine has nothing to do with sterility of the surgical area. It might decrease the amount of hormone released but will not replace or stimulate the release of hormones.

Endocrine function in older adults usually remains adequate. What age-related changes may be seen in the older adult during times of illness? (Select all that apply.)

-Decline in cortisol secretion. Endocrine changes seen in older adults in times of illness include decline in secretion of aldosterone and plasma renin activity which decrease the efficiency of sodium conservation. There is a decline in cortisol secretion and a decline in GH and IGF-1, resulting in reduced protein synthesis, decreased lean body and bone mass, and reduced immune function. There is a diminished response to ADH so the older person is less able to compensate for inadequate fluid intake. Hypothyroidism is more common, especially among women. -Decline in secretion of aldosterone which decreases efficiency of sodium conservation. Endocrine changes seen in older adults in times of illness include decline in secretion of aldosterone and plasma renin activity which decrease the efficiency of sodium conservation. -Decline in GH and IGF-1, resulting in reduced protein synthesis. Endocrine changes seen in older adults in times of illness include decline in secretion of aldosterone and plasma renin activity which decrease the efficiency of sodium conservation.

The nurse is caring for a patient who is prescribed glucocorticoids for adrenal insufficiency. What side effects does the nurse teach the patient to report? (Select all that apply.)

-Signs of infection The patient taking glucocorticoids is instructed to report edema, signs of infection even if subtle, muscle weakness and tingling or twitching. Other side effects include hypertension and hyperglycemia -Muscle cramps and weakness The patient taking glucocorticoids is instructed to report edema, signs of infection even if subtle, muscle weakness and tingling or twitching. Other side effects include hypertension and hyperglycemia. -Edema The patient taking glucocorticoids is instructed to report edema, signs of infection even if subtle, muscle weakness and tingling or twitching. Other side effects include hypertension and hyperglycemia

The health care provider has prescribed the patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) to have 1000 mL/day fluid restriction. The nurse notes the patient has an intravenous fluid infusing at 20 mL/hr. How many mL will the nurse allot for the patient's oral intake per day? __ mL (Record your answer using a whole number in numeric characters only.)

520 The patient is receiving 480 mL per day of IV fluid (20 mL × 24 hours). The remaining 520 mL (1000 - 480) would be allotted for oral intake with meals and medications and for thirst sensation.REF: p. 939

The nurse is assessing a patient who is being treated for syndrome of inappropriate antidiuretic hormone (SIADH). Which condition most requires health care provider notification?

A headache with drowsiness A headache, drowsiness, and listlessness are signs of worsening water intoxication and should be communicated to the health care provider immediately. Concentrated urine, increased urine sodium, and blood pressure of 130/90 mm Hg would be a concern but are expected with a diagnosis of SIADH and should be treated and monitored and reported if worsening.

A patient who will be undergoing a transsphenoidal hypophysectomy asks the nurse how the surgeon will close the incision made in the dura. What is the nurse's best response?

A piece of abdominal tissue is used to pack the dura. The incision in the dura is closed by using a piece of adipose tissue from the abdomen to pack the area and prevent cerebrospinal fluid leakage. Nasal packing is then placed to hold the patch in place. Dissolvable sutures are not used because they would not keep the incision line intact. Nasal packing is used but not to heal the incision in the dura. Synthetic mesh is not a choice to close the dura.

Which hormones are secreted by the posterior pituitary gland?

ADH and oxytocin ADH and oxytocin are secreted by the posterior pituitary gland. GH, TSH, and prolactin are secreted by the anterior pituitary gland.

The nurse is caring for a patient who is being treated for acute adrenal crisis. The nurse maintains the hydrocortisone (Solu-Cortef) infusion and educates the family on the need for the infusion after the intravenous (IV) push dose. Which information should the nurse include in the education for the patient and family?

An infusion of hydrocortisone (Solu-Cortef) will maintain blood levels of the drug. An initial dose of hydrocortisone (Solu-Cortef) is given IV push followed by a maintenance infusion to ensure a continuous source of glucocorticoids. The medication given via the IV push and the infusion route are both considered intravenous. The infusion will not be continued for life. The infusion is typically continued for 8 hours until the oral glucocorticoids are started.

Which diagnostic exam is used to determine the presence of vascular anomalies associated with a pituitary disorder?

Angiography Angiography, in which radiopaque dye is injected into the arteries, may reveal the presence of vascular anomalies associated with pituitary or adrenal disorders. Ultrasound is useful in assessing adrenal, thyroid, and parathyroid conditions. CT and MRIs are useful in detecting structural abnormalities.

On the second postoperative day after a subtotal thyroidectomy, the patient tells the nurse that he feels numbness and tingling around his mouth. Which is the nurse's priority intervention?

Attempt to elicit Chvostek sign. Numbness and tingling are signs of hypocalcemia, a common complication after thyroid surgery if the parathyroid glands are accidentally removed. A positive Chvostek sign involves tapping the facial nerve to elicit facial twitching. This is not a normal symptom after surgery. There must be intervention if this occurs. Loosening the dressing or breathing into a paper bag will have no effect.

The nurse is caring for a patient who is having a GH suppression test and the nurse is educating about the process. What does the nurse tell the patient to expect?

Blood glucose levels are measured before and after a dose of glucose solution. A GH suppression test may be done by measuring blood glucose levels before and after a dose of glucose solution. The glucose will suppress GH levels through a negative-feedback process. The blood glucose levels are not measured every morning for 5 days, and they are not measured three times in 1 day.

Medication used to treat a patient with hypoparathyroidism has been prescribed by the health care provider. Which medications would the nurse expect to find in the patient's chart?

Calcium salts Intravenous calcium salts are used to correct calcium deficiency caused by hypoparathyroidism. Ibuprofen is an analgesic, anti-inflammatory, and antipyretic. Calcitonin is used to treat hypercalcemia caused by hyperparathyroidism. Potassium iodide reduces the size and vascularity of the thyroid gland in hyperthyroidism. It is used alone or in combination with other drugs to treat hyperthyroidism.

Oxytocin is a hormone that is secreted by the posterior pituitary gland and responsible for which of these actions?

Causes contractions of the uterus in labor. Oxytocin is a hormone secreted by the posterior pituitary gland which causes contractions of the uterus in labor and stimulates the release of breast milk. FSH stimulates development of eggs in the ovaries. GH stimulates growth and development of the bones, muscles, and organs. ADH causes reabsorption of water from the renal tubules of the kidney.

The nurse is caring for a patient after intracranial surgery. The patient develops a sudden onset of polyuria accompanied by extreme thirst, dilute urine, and hypotension. The nurse suspects the patient has which disorder?

Diabetes insipidus Hallmark symptoms of diabetes insipidus after intracranial surgery include sudden-onset polyuria, thirst, dilute urine, hypotension, tachycardia, and other symptoms of dehydration. The syndrome of inappropriate antidiuretic hormone secretion is characterized by concentrated urine, oliguria, and fluid retention. Addison disease is characterized by fluid loss with accompanying sodium loss and potassium increase. Cushing disease symptoms are fluid retention, hypokalemia, and protein wasting.

The nurse is helping a patient with Addison disease select a diet for the following morning's breakfast. Which selections would be the best choice for this patient?

Eggs, bacon, and toast Patients with Addison disease need a high-protein, low-carbohydrate, low-potassium diet with unrestricted salt intake. Eggs, bacon, and toast would provide the most protein. The other choices offer no protein and are higher in potassium.

The nurse is caring for a patient who has been diagnosed with diabetes insipidus. Which patient problem should have the highest priority?

Fluid volume deficit Although the nurse would assess the patient's knowledge deficit, body image, and ability to manage the diagnosis of diabetes insipidus, the priority is maintaining the patient's fluid balance to prevent hypovolemia, orthostatic hypotension, and electrolyte disturbances.

The overall mission of the endocrine system is what?

Maintain homeostasis. The overall mission of the endocrine system is to maintain homeostasis. Hormones are responsible for important functions related to reproduction and growth and development. The exocrine glands pass secretions through ducts or tubes that empty outside the body.

The nurse is caring for a patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which symptoms should the nurse expect to assess? (Select all that apply.)

Muscle cramps and weakness The patient with SIADH would have concentrated urine because of the decrease in antidiuretic hormone (causing the body to conserve fluid and concentrate urine) and muscle cramps and weakness because of hyponatremia. The patient with SIADH would have weight gain without edema (the excess fluid is not in the tissue) and low serum sodium because of dilution. Concentrated urine The patient with SIADH would have concentrated urine because of the decrease in antidiuretic hormone (causing the body to conserve fluid and concentrate urine) and muscle cramps and weakness because of hyponatremia. The patient with SIADH would have weight gain without edema (the excess fluid is not in the tissue) and low serum sodium because of dilution.

The nurse is caring for a patient postoperatively after a hypophysectomy for hyperpituitarism. The nurse knows to inspect drainage at which site?

Nasal After a hypophysectomy, an absorbent dressing is used to pack the nasal passages, and an external nasal dressing is applied to keep the dressing in place. The nurse should inspect this dressing for drainage. The drainage would not be located on the scalp, the neck, or the roof of the mouth.

Twelve hours after a total thyroidectomy, the patient develops dyspnea and respiratory distress. Which is the nurse's priority intervention?

Prepare for an emergency tracheotomy. Because of the location of the thyroidectomy incision, edema or bleeding can cause pressure on the trachea, resulting in respiratory distress. Without prompt intervention, the patient can die. An emergency tracheotomy may need to be performed because of the edema, and the nurse needs to prepare to assist with this. Hyperextending the patient's neck will increase the pressure on the trachea and cause more distress. The head of the bed should be elevated immediately after surgery to decrease edema, and only elevating the head alone will not help with this type of respiratory distress. Documenting the finding does not address the emerging problem.

The nurse is teaching the patient about an upcoming thyroid scan. What will the patient ingest prior to the scan?

Radioactive iodine Patients undergoing a thyroid scan will ingest radioactive iodine; then a specialized instrument is used to scan the area of the thyroid gland. The patient does not ingest barium, glucose, or magnesium citrate for a thyroid scan.

Several hours after a thyroidectomy, a patient is transferred from a stretcher to a bed. After checking the bandage, the nurse would place the patient in which position?

Semi-Fowler The head of the bed is elevated to decrease edema. The patient is placed in the semi-Fowler position with pillows used to support the head and decrease stress on the suture line. In the Trendelenburg position, the head is lower than the legs, resulting in stress on the suture line. Allowing the patient to lie flat will cause the wound to drain to the back of the throat and could cause airway obstruction. The lithotomy position, which involves lying flat with the legs in stirrups, will not decrease edema or stress on the suture line.

The nurse is caring for a patient on oral drugs for diabetes mellitus. For the patient prescribed glipizide (Glucotrol), what does the nurse teach the patient about when to take the medication?

Take in the morning before breakfast. The patient prescribed glipizide (Glucotrol) should be educated to take the medication in the morning before breakfast. Glipizide (Glucotrol) is not taken after breakfast, before the evening meal, or before bed.

The nurse is educating a middle-aged patient with a new diagnosis of acromegaly. The patient asks the nurse if this diagnosis will cause the patient to grow to "as tall as a giant." What should the nurse understand about acromegaly?

The patient will experience an increase in bone thickness and width but not in length. Acromegaly is a result of increased growth hormone (GH) after the epiphyses of the long bones close at puberty and prevent longitudinal growth of bones. Instead, the bones increase in thickness and width. The degree of pituitary function will affect the width and thickness of the bone after puberty, not the length (height). Excess GH after puberty will not increase the patient's height but will increase the thickness and width of bones. Acromegaly is an increase, not a decrease, in GH.

What gland is located in the lower portion of the anterior neck and consists of two lobes on each side of the trachea?

Thyroid The thyroid gland is located in the lower portion of the anterior neck. It consists of two lobes, one on each side of the trachea. The parathyroid glands are small glands usually located on the back of the thyroid gland. Occasionally some glands are found in the mediastinum. The pituitary gland is located at the base of the brain and the adrenal glands are in the retroperitoneal cavity.

A patient with a history of hyperthyroidism returns to the unit 12 hours after a thyroidectomy. The nurse notes tachycardia, cardiac dysrhythmias, vomiting, and fever. What does the nurse suspect the patient is experiencing based on these findings?

Thyroid storm Thyroid crisis or thyroid storm can develop when large amounts of thyroid hormone enter the bloodstream during surgery. It can also occur in patients with severe hyperthyroidism who develop severe illness or infection. There is no indication of seizure activity. Headache, dizziness, hunger, diaphoresis, and clammy and pale skin are indicators of hypoglycemia and are not present in hyperthyroidism. Blood pressure is usually elevated in the patient in thyroid storm.

Which classification of drugs could precipitate a potentially fatal myxedema (hypothyroidism) coma in a person with severe hypothyroidism? (Select all that apply.)

Tranquilizers Patients with hypothyroidism have an altered metabolism; therefore, opioid, sedative, and tranquilizers can precipitate a potentially fatal myxedema coma in severe hypothyroidism. Antipyretics can be used with caution. Stool softeners do not have a direct correlation with severe hypothyroidism. Sedatives Patients with hypothyroidism have an altered metabolism; therefore, opioid, sedative, and tranquilizers can precipitate a potentially fatal myxedema coma in severe hypothyroidism. Antipyretics can be used with caution. Stool softeners do not have a direct correlation with severe hypothyroidism. Opioids Patients with hypothyroidism have an altered metabolism; therefore, opioid, sedative, and tranquilizers can precipitate a potentially fatal myxedema coma in severe hypothyroidism. Antipyretics can be used with caution. Stool softeners do not have a direct correlation with severe hypothyroidism.

A patient has been admitted to an acute care hospital with a diagnosis of hypoparathyroidism. Upon assisting with data collection on the patient, which finding would the nurse most likely elicit?

itching of facial muscles Facial twitching is a sign of tetany, which occurs in hypoparathyroidism caused by low calcium levels. Weight loss is most commonly associated with hyperthyroidism, but it can occur with any illness. Bulging eyeballs or exophthalmos is a classic sign of hyperthyroidism. An enlarged thyroid occurs with hypothyroidism or hyperthyroidism.