Chapter 19 Nursing Care of Patients with Endocrine Disorders

A patient with an adrenal gland alteration asks why the skin appears tan when no time is spent outdoors in the sun. What should the nurse do to address the patient's concern? 1. Ask if the patient is still taking steroids prescribed for another illness. 2. Ask the patient what time of day he is outdoors. 3. Auscultate the patient's lung sounds. 4. Palpate the patient's thyroid gland.

Answer: 1 Explanation: 1. Addison disease could develop if a patient abruptly stops taking steroids for a chronic health condition. 2. The patient has already reported that no time is spent outdoors in the sun. 3. Auscultation of lung sounds would not help in determining the cause of this skin change. 4. Palpation of the thyroid gland would not help in determining the cause of this skin change. Page Ref: 584

The nurse is planning a teaching session for a patient with a new diagnosis of adrenoleukodystrophy. What topic should the nurse include? 1. Why genetic counseling is included in the plan of care 2. The role of autoimmunity in the development of the disorder 3. The role of anticoagulants in the development of the disorder 4. The surgical site for transsphenoidal entry, using a diagram

Answer: 1 Explanation: 1. Adrenoleukodystrophy is an X-linked disorder characterized by an accumulation of very long chain fatty acids in the adrenal cortex, testes, brain, and spinal cord. 2. Adrenoleukodystrophy is not an autoimmune disorder. 3. Adrenoleukodystrophy is not caused by anticoagulant therapy. 4. Adrenoleukodystrophy is not treated with surgery. Page Ref: 584

A patient with hyperparathyroidism secondary to renal failure is prescribed calcimimetic. What should the nurse instruct the patient about this medication? 1. It increases the sensitivity of the calcium-sensing receptors of the parathyroid gland to serum calcium. 2. It blocks calcium receptors in the nervous and musculoskeletal systems. 3. It decreases resorption of calcium in the distal renal tubule. 4. It binds calcium to bile salts that are then excreted through the GI tract.

Answer: 1 Explanation: 1. Calcimimetic increases the sensitivity of the calcium-sensing receptors of the parathyroid gland to serum calcium. The effect is decreased secretion of PTH and reduced serum calcium and phosphorus. 2. Calcimimetic does not block calcium receptors in the nervous and musculoskeletal systems. 3. Calcimimetic does not decrease the resorption of calcium in the distal renal tubule. 4. Calcimimetic does not bind calcium to bile salts to excrete through the GI tract. Page Ref: 580

A 35-year-old female patient taking oral contraceptives is prescribed steroid therapy. What is a priority teaching point for this patient? 1. "Consider adding another form of contraception while using both medications." 2. "These medications do not interact. No changes need to be made." 3. "Measure your weight daily." 4. "Avoid the use of salt."

Answer: 1 Explanation: 1. Corticosteroids may impair the effectiveness of oral contraceptives. 2. Corticosteroids may impair the effectiveness of oral contraceptives. 3. Daily weights have nothing to do with the interaction of oral contraceptives and steroids. 4. Limiting salt has nothing to do with the interaction of oral contraceptives and steroids. Page Ref: 586

A patient whose thyroid gland produces an insufficient amount of thyroid hormone is concerned about an elevated cholesterol level. What should the nurse explain to this patient? 1. "The thyroid gland malfunction can affect your cholesterol level." 2. "Maybe you don't realize how much fat is in the foods you eat." 3. "Elevated cholesterol is a normal part of aging." 4. "Describe your typical bedtime snack."

Answer: 1 Explanation: 1. Deficient amounts of thyroid hormone can cause abnormalities in lipid metabolism, with elevated serum cholesterol and triglyceride levels. As a result, the patient is at increased risk for atherosclerosis and cardiac disorders. 2. The nurse should not make assumptions about the patient's dietary intake. 3. Comments about aging are not therapeutic. 4. Comments about eating at bedtime are not therapeutic. Page Ref: 573

A patient recovering from a closed head injury has a urine specific gravity of 1.010 g/mL. The previous intake and output totals were 1200 mL intake and 10,000 mL output. Which prescription from the healthcare provider should the nurse question for this patient? 1. Desmopressin (Minirin) 0.2 mg by mouth daily 2. Oral fluid restriction of 800 mL per day 3. 3% normal saline at 100 mL per hour 4. Computed tomography scan of head

Answer: 1 Explanation: 1. Desmopressin is administered intranasally or parenterally and is the treatment of choice for SIADH that cannot be treated by correcting the underlying cause. 2. Strategies for correcting the underlying cause of SIADH include treating the hyponatremia and replacing fluid based on a calculation that adds fluid losses from the prior hour to an hourly base rate of fluid. 3. Strategies for correcting the underlying cause of SIADH include treating the hyponatremia with intravenous hypertonic saline. 4. A CT scan is an appropriate diagnostic tool. Page Ref: 590

The nurse suspects that a patient with chronic hyperfunction of the adrenal cortex has an infection. What did the nurse assess to come to this conclusion? 1. General feeling of malaise 2. Recent weight loss 3. Muscular tremors 4. Sense of nervous energy

Answer: 1 Explanation: 1. Elevated cortisol levels impair the immune response and put the patient with Cushing syndrome at risk for infection. A generalized feeling of malaise may be the primary manifestation of infection. 2. A weight change is not a manifestation of infection in a patient with chronic hyperfunction of the adrenal cortex. 3. Muscle tremors are not a manifestation of infection in a patient with chronic hyperfunction of the adrenal cortex. Patients typically experience muscle weakness and fatigue rather than tremors. 4. Nervous energy is not a manifestation of infection in a patient with chronic hyperfunction of the adrenal cortex. Patients typically experience muscle weakness and fatigue rather than increased energy. Page Ref: 583

The nurse prepares teaching material for a patient with Cushing syndrome. Which statement about the risk for infection should the nurse alter before teaching? 1. "Epidermal hypertrophy restricts macrophage activity." 2. "Cortisol affects protein synthesis." 3. "Cortisol inhibits collagen synthesis." 4. "The resulting edema impairs blood flow to tissues."

Answer: 1 Explanation: 1. Glucocorticoid excess inhibits fibroblasts, resulting in loss of collagen and connective tissue. Thinning of skin, poor wound healing, and frequent skin infections result. Macrophage activity is not a related action. 2. Increased cortisol affects protein synthesis, causing delayed wound healing and further inhibiting resistance to infection. 3. Increased cortisol inhibits collagen formation, which results in epidermal atrophy, further inhibiting resistance to infection. 4. Impaired blood flow to edematous tissue results in altered cellular nutrition, which increases the potential for infection. Page Ref: 581

A patient with hyperparathyroidism is taking digoxin (Lanoxin). For what should the nurse assess this patient? 1. Toxic effects of digoxin (Lanoxin) 2. Evidence the medication dose needs to be increased 3. Onset of polyuria 4. Muscle weakness and atrophy

Answer: 1 Explanation: 1. Hyperparathyroidism increases sensitivity to cardiotonic glycosides such as digoxin. The patient should be assessed for toxic effects of this medication. 2. The medication dose will unlikely need to be increased. 3. Polyuria is a manifestation of hyperparathyroidism. 4. Muscle weakness and atrophy are manifestations of hyperparathyroidism. Page Ref: 580

The nurse is caring for a patient with elevated serum T3 and T4 levels who receives a new prescription for methimazole (Tapazole). Which patient statement indicates that additional teaching is needed about this medication? 1. "This medication will increase my metabolism." 2. "I must contact my physician if I plan to become pregnant." 3. "It may take several weeks for this medication to take effect." 4. "I may take a beta-blocker along with this medication."

Answer: 1 Explanation: 1. Hyperthyroidism is treated by administering methimazole or PTU, medications that reduce TH production, thereby decreasing metabolism. 2. Methimazole crosses the placenta and cannot be taken during pregnancy. 3. Antithyroid medications inhibit thyroid hormone production but have no effect on already-produced and circulating thyroid hormone. It can take several weeks for the patient to experience the effects. 4. To rapidly reduce the cardiovascular symptoms associated with hyperthyroidism, propranolol (Inderal) or esmolol, a rapid-acting parenteral beta-blocker, may be used along with methimazole. Page Ref: 569

The nurse is assessing a patient with Cushing syndrome. Which finding should the nurse report for immediate follow-up? 1. Serum potassium 2.5 mEq/L and blood pressure 150/90 mmHg 2. Serum sodium 145 mEq/L and reports of muscle weakness 3. Serum calcium 11 mg/dL and reports of feelings of depression 4. Serum phosphorus 3 mg/dL and hirsutism

Answer: 1 Explanation: 1. Hypokalemia and hypertension occur with Cushing syndrome as potassium is lost and sodium is retained. 2. These findings do not need to be reported for immediate follow-up. 3. These findings do not need to be reported for immediate follow-up. 4. These findings do not need to be reported for immediate follow-up. Page Ref: 582

The nurse is providing preoperative teaching to a patient scheduled for a subtotal thyroidectomy. What should the nurse include in these instructions? 1. Report sensations of tingling in toes, fingers, or lips. 2. Report signs of constipation. 3. Report the improvement of hoarseness. 4. Take aspirin before the surgery.

Answer: 1 Explanation: 1. Hypoparathyroidism may result from manipulation of the parathyroid glands during a subtotal thyroidectomy. The lack of circulating parathyroid hormone (PTH) causes hypocalcemia. Neuromuscular manifestations that result from hypocalcemia include numbness and tingling around the mouth and in the fingertips. 2. Hypoparathyroidism may result from manipulation of the parathyroid glands during a subtotal thyroidectomy. The lack of circulating PTH causes hypocalcemia. Constipation is associated with hypercalcemia, not hypocalcemia. 3. The improvement of hoarseness would be desired. 4. Antiplatelet agents, such as aspirin, should be withheld prior to surgery. Page Ref: 570

A patient with suspected Cushing syndrome is prescribed a 24-hour urine collection. What should the nurse explain to the patient about the reason for this urine collection? 1. It measures the amount of cortisol in the urine over 24 hours. 2. At least 2000 mL of urine is required to perform the test. 3. It identifies urine specific gravity changes over a 24-hour period. 4. The 24-hour timeline reduces unwanted effects of medications excreted in the urine.

Answer: 1 Explanation: 1. If the dexamethasone test is positive, a test for urinary free cortisol is made. This measures the amount of cortisol in the urine over 24 hours. 2. The 24-hour urine collection is not performed because 2 L of urine is needed. 3. The 24-hour urine collection does not measure urine specific gravity changes. 4. The 24-hour urine collection is not performed to ensure medication excretion in the urine. Page Ref: 582

A patient taking steroids for an autoimmune disorder asks when the weight loss in the legs is going to stop. What should the nurse realize the patient is experiencing? 1. Muscle wasting 2. Poor wound healing 3. Risk for compression fractures 4. Increased susceptibility to infections

Answer: 1 Explanation: 1. Long-term use of steroids can place a patient at risk for developing Cushing syndrome. One characteristic of this syndrome is muscle weakness and wasting, particularly in the extremities. 2. Poor wound healing is common in patients who are being treated with steroids. However, this would not manifest as weight loss in the limbs. 3. Risk for compression fractures is common in patients who are being treated with steroids. However, this would not manifest as weight loss in the limbs. 4. Increased susceptibility to infections is common in patients who are being treated with steroids. However, this problem would not manifest as weight loss in the limbs. Page Ref: 581

The nurse is reviewing the laboratory results for a group of patients. Which set of results should the nurse identify as being consistent with primary hypothyroidism? 1. Elevated TSH, depressed T3 and T4 2. Elevated TSH, elevated T3 and T4 3. Depressed TSH, elevated T3 and T4 4. Depressed TSH, depressed T3 and T4

Answer: 1 Explanation: 1. Primary hypothyroidism emanates from the thyroid gland itself. Laboratory analysis will indicate an elevated TSH, as the pituitary attempts to stimulate the thyroid gland to produce thyroid hormone, and the thyroid hormone levels T3 and T4 will be low. 2. Laboratory analysis will indicate an elevated TSH, as the pituitary attempts to stimulate the thyroid gland to produce thyroid hormone. Thyroid hormone levels T3 and T4 will not be elevated. 3. TSH is depressed in hyperthyroidism. 4. TSH is depressed in hyperthyroidism. Page Ref: 569

The nurse is caring for a patient with elevated serum thyroid hormones and new-onset proptosis. Which problem would be a priority for this patient? 1. Change in appearance 2. Altered immunity 3. Weight gain 4. Fluid retention

Answer: 1 Explanation: 1. Proptosis changes the appearance of the eyes. The problem that would be a priority for the patient is a change in appearance. 2. Proptosis does not affect immune function. 3. Proptosis is associated with hyperthyroidism. There is a risk that the patient will lose weight. 4. Proptosis does not affect fluid balance. Page Ref: 566

The nurse is instructing a patient about the symptoms of hyperparathyroidism. Which symptom should the nurse include in this discussion? Select all that apply. 1. Abdominal pain 2. Dysrhythmias 3. Hypertension 4. Diarrhea 5. Reduced urine output

Answer: 1, 2, 3 Explanation: 1. Hyperparathyroidism can cause abdominal pain. 2. Hyperparathyroidism can cause dysrhythmias. 3. Hyperparathyroidism can cause hypertension. 4. Diarrhea is not associated with hyperparathyroidism. 5. Reduced urine output is not associated with hyperparathyroidism. Page Ref: 580

The nurse is providing care to a patient recovering from a bilateral adrenalectomy. What should the nurse do to assess for the onset of adrenal insufficiency? 1. Monitor strict intake and output. 2. Change the dressing using clean technique. 3. Question the order for cortisol administration. 4. Place the patient on fluid restriction.

Answer: 1 Explanation: 1. Removal of an adrenal gland, especially a bilateral adrenalectomy, results in adrenal insufficiency. Addisonian crisis and hypovolemic shock may occur. The nurse should monitor intake and output. 2. While care should be taken during dressing changes to avoid infection, this will not prevent adrenal insufficiency. 3. Cortisol is often given on the day of surgery and in the postoperative period to replenish inadequate hormone levels. 4. Intravenous fluids are administered postoperatively. Page Ref: 586

The nurse is reviewing the relationship between thyroid hormone and iodine. Which information should the nurse identify that is least likely to cause iodine deficiency and hypothyroidism? 1. Eating large amounts of shellfish 2. Using prescribed lithium carbonate 3. Eating large amounts of turnips or rutabagas 4. Living in an area where iodine is deficient in the soil

Answer: 1 Explanation: 1. Shellfish contains iodine. 2. Drugs such as lithium carbonate interfere with thyroid hormone synthesis. 3. Foods such as turnips and rutabagas interfere with thyroid hormone synthesis. 4. Living in an area where iodine is deficient in the soil may lead to thyroid deficiency and hypothyroidism. Page Ref: 575

A patient is experiencing manifestations of Addisonian crisis. What should the nurse expect to provide to this patient? 1. Intravenous fluids 2. Warm blankets 3. Thyroid replacement hormone 4. Blood transfusion

Answer: 1 Explanation: 1. The manifestations of Addisonian crisis are high fever, weakness, abdominal pain, severe hypotension, circulatory collapse, shock, and coma. The crisis is treated with rapid intravenous replacement of fluids. 2. The patient in Addisonian crisis may have a high fever, so warm blankets would not promote comfort or therapeutic action. 3. There is no thyroid hormone insufficiency. 4. There are no indications the patient is in need of a blood transfusion. Page Ref: 586 Cognitive Level:

The nurse is screening a group of patients for risk factors related to thyroid cancer. Which patient should the nurse recognize as having the highest risk for developing thyroid cancer? 1. A 75-year-old patient with a history of sinus infections in childhood 2. A 70-year-old patient who refinishes furniture as a hobby 3. An 80-year-old patient whose diet consists largely of red meat 4. An 85-year-old patient who works outdoors without sunscreen

Answer: 1 Explanation: 1. The most consistent risk factor for thyroid cancer is exposure to ionizing radiation to the head and neck during childhood. For example, many adults in their 60s, 70s, and 80s received x-ray treatments for colds, tonsillitis, acne, and sinus infections during childhood. 2. Exposure to products used in refinishing furniture is not a risk factor for thyroid cancer. 3. A diet of red meat is not a risk factor for thyroid cancer. 4. Failing to use sunscreen when working outdoors is not a risk factor for thyroid cancer. Page Ref: 579

The nurse is reviewing postoperative care for a patient scheduled for a thyroidectomy. What information should the nurse include in this teaching? 1. "Avoid the use of iodized salt after your procedure." 2. "Plastic surgery may be required to conceal the surgical scar." 3. "Use iodized salt when preparing foods." 4. "Perform neck flexion and extension exercises twice daily for several weeks postoperatively."

Answer: 1 Explanation: 1. The nurse anticipates that the patient who has a thyroidectomy will require a lifelong prescription for a thyroid preparation. Iodized salt and iodine preparations should not be taken with thyroid preparations. 2. Typically the scar fades to a small line, so plastic surgery is not needed. 3. Iodized salt and iodine preparations should not be taken with thyroid preparations. 4. The patient is instructed to support the neck by placing both hands behind the neck when sitting up in bed, while moving about, and while coughing. Neck extension would place stress on the suture line. Page Ref: 576

The nurse is reviewing health history information for a group of patients. Which patient should the nurse identify as being at the lowest risk of developing Cushing syndrome? 1. The patient who received radioactive iodine treatment for hyperthyroidism 2. The patient receiving treatment for rheumatoid arthritis 3. The patient who has had an organ transplant 4. The patient receiving chemotherapy to treat a brain tumor

Answer: 1 Explanation: 1. The patient who received radioactive iodine treatment for hyperthyroidism is not at increased risk for Cushing syndrome. 2. Patients receiving treatment for rheumatoid arthritis are frequently prescribed corticosteroids, which are a primary risk factor for Cushing syndrome. 3. Patients with organ transplants are frequently prescribed corticosteroids, which are a primary risk factor for Cushing syndrome. 4. Patients receiving chemotherapy are frequently prescribed corticosteroids, which are a primary risk factor for Cushing syndrome. Page Ref: 581

A patient with Cushing syndrome is concerned about having a head cold every few weeks. What should the nurse do to address this patient's concern? 1. Assess for protein and vitamin intake. 2. Plan for frequent rest periods. 3. Encourage daily weights. 4. Review coping strategies.

Answer: 1 Explanation: 1. The patient with Cushing syndrome is at risk for infection due to the overproduction of glucocorticoids. The nurse should assess for protein and vitamins C and A intake which are all needed to support and repair body tissues. 2. Rest periods are recommended in the care of a patient with Cushing but would not address the problem of frequent infections. 3. Daily weights are recommended in the care of a patient with Cushing but would not address the problem of frequent infections. 4. There is no indication of a need to review or change coping strategies. Page Ref: 583

While assessing a patient with an alteration in thyroid function, the nurse notes smooth, fine hair and warm, dry skin. Which question should the nurse ask this patient? 1. "Have you experienced any recent weight loss?" 2. "Have you been feeling constipated?" 3. "Have you noticed increased bruising?" 4. "Have you noticed a change in your skin color?"

Answer: 1 Explanation: 1. The patient with hyperthyroidism can present with dry, warm skin, and the hair may become fine. Weight loss is another symptom of hyperthyroidism. 2. Constipation is a symptom of hypothyroidism or hyperparathyroidism. Dry, warm skin and hair that becomes fine are associated with another disorder. 3. Increased bruising is a sign of Cushing syndrome. Dry, warm skin and hair that becomes fine are associated with another disorder. 4. A change in skin color is a sign of Addison disease. Dry, warm skin and hair that becomes fine are associated with another disorder. Page Ref: 566

The nurse notes that a patient who has hypoparathyroidism has a serum calcium level of 6.8 mg/dL. What would be a priority problem when planning care for this patient? 1. Potential for injury 2. Safety concerns because of confusion 3. Changes in renal function 4. Problems with oxygenation

Answer: 1 Explanation: 1. The patient with hypocalcemia has a potential for injury because of the effects of the low calcium level on bone structure. Calcium is also needed for muscle and nerve function. 2. Confusion is not a manifestation of hypoparathyroidism and low calcium level. 3. Renal function changes are not a manifestation of hypoparathyroidism and low calcium level. 4. Problems with oxygenation are not a manifestation of hypoparathyroidism and low calcium level. Page Ref: 580

The family of an older patient with hypothyroidism is concerned about the open wounds on the patient's legs and arms. How should the nurse respond to the family's questions about bathing? 1. "Use warm water to bathe the patient." 2. "Make sure bathing occurs daily." 3. "Use firm, consistent strokes when bathing." 4. "Follow the bath with a rubbing-alcohol massage."

Answer: 1 Explanation: 1. The patient with hypothyroidism has dry skin and edema, which increase the risk of skin breakdown. Hot water, rough massage, and the use of alcohol-based products increase skin dryness. The patient should only bathe when necessary, with warm, not hot, water. 2. The patient should bathe only when necessary. 3. Gentle motions should be used. 4. Alcohol-free oils and lotions should be used. Page Ref: 577

A patient with a non-ACTH-producing adrenal cortex tumor is scheduled for a surgical procedure to remove the tumor. Which statement by the patient indicates that teaching about the procedure has been effective? 1. "The adrenal gland with the tumor will be removed." 2. "I will need to take adrenal hormones for the rest of my life." 3. "The tumor will be removed by the transsphenoidal route." 4. "I will receive IV cortisol in preparation for the surgery."

Answer: 1 Explanation: 1. When Cushing syndrome is caused by a non-ACTH-producing adrenal cortex tumor, an adrenalectomy may be performed to remove the tumor and the affected adrenal gland. 2. Only one adrenal gland is usually involved. As there is a remaining adrenal gland, patients do not need lifetime adrenal hormone replacement. 3. Adrenal glands are not removed via the transsphenoidal route. 4. The patient with Cushing syndrome is already experiencing elevated cortisol levels; IV cortisol is not indicated prior to adrenalectomy. Page Ref: 582

The nurse is teaching a patient who has a diagnosis of hypothyroidism about the importance of dietary fiber. Which statement by the patient indicates that teaching has been effective? Select all that apply. 1. "I will drink a full glass of water with my fiber pill each morning." 2. "I will snack on fruit rather than potato chips." 3. "I will take an over-the-counter fiber pill each morning with my levothyroxine." 4. "I will increase my intake of protein sources such as meat and eggs." 5. "I will read the nutrition labels and choose foods with high carbohydrate content."

Answer: 1, 2 Explanation: 1. A full glass of water should be taken with fiber tablets to reduce the risk of intestinal blockage. 2. Fruit is a high-fiber food and an appropriate choice for a patient who needs a high-fiber diet. 3. The patient should not ingest a high-fiber source at the same time as thyroid replacement medications, as the fiber will interfere with absorption of the medication. 4. Meat and eggs are not good sources of fiber. 5. This patient should look for fiber content rather than carbohydrate content on labels. Page Ref: 576

A patient with Addison disease is experiencing weakness and abdominal pain and has an oral temperature of 102°F and blood pressure of 70/35 mmHg. Which patient information should the nurse identify as potentially causing these manifestations? Select all that apply. 1. "I had my tonsils out last week." 2. "I have a pressure ulcer from sleeping in my recliner." 3. "I have been using a tanning bed." 4. "I take my prednisone (Deltasone) every day." 5. "I have been increasing my intake of calcium-rich foods."

Answer: 1, 2 Explanation: 1. Addisonian crisis is a life-threatening response to acute adrenal insufficiency. Surgery is one trigger. 2. Addisonian crisis is a life-threatening response to acute adrenal insufficiency. One trigger is acute systemic illness such as sepsis from a pressure ulcer. 3. The use of tanning beds is not associated with Addisonian crisis. 4. Patients are prescribed prednisone or related glucocorticoids to treat Addison disease; this is not a cause of Addisonian crisis. 5. Intake of calcium-rich foods is not associated with Addisonian crisis. Page Ref: 585

The nurse is assessing a patient who has an abnormally high level of parathyroid hormone. Which assessment finding would be consistent with this diagnosis? Select all that apply. 1. Muscle atrophy 2. Muscle weakness 3. Diarrhea 4. Weight gain 5. Hypotension

Answer: 1, 2 Explanation: 1. Manifestations of hyperparathyroidism are related to hypercalcemia. Elevated calcium levels alter neural and muscular activity, leading to muscle atrophy. 2. Manifestations of hyperparathyroidism are related to hypercalcemia. Elevated calcium levels alter neural and muscular activity, leading to muscle weakness. 3. Diarrhea is not a manifestation of hyperparathyroidism. 4. Weight gain is not a manifestation of hyperparathyroidism. 5. Hypotension is not a manifestation of hyperparathyroidism. Page Ref: 580

The nurse is describing the manifestations of myxedema coma to a patient with hypothyroidism. What should the nurse identify as precipitating factors for this health problem? Select all that apply. 1. Stroke 2. Pneumonia 3. Excessive use of thyroid replacement medications 4. Excessive use of central nervous system stimulants 5. Exposure to excessive heat and humidity

Answer: 1, 2 Explanation: 1. Myxedema coma may be precipitated by a stroke. 2. Myxedema coma may be precipitated by an infection such as pneumonia. 3. Excessive use of thyroid replacement medications would not precipitate myxedema coma. 4. Excessive use of central nervous system stimulants would not precipitate myxedema coma. 5. Exposure to heat and humidity would not precipitate myxedema coma. Page Ref: 575

The nurse is caring for a patient with untreated hypothyroidism. For which health problem should the nurse assess this patient? Select all that apply. 1. Elevated serum cholesterol 2. Anemia 3. Hyperglycemia 4. Hypernatremia 5. Decreased serum LDL

Answer: 1, 2 Explanation: 1. Untreated hypothyroidism increases the risk for abnormalities in lipid metabolism. 2. Anemia is common in untreated hypothyroidism. 3. Hyperglycemia is not associated with untreated hypothyroidism. 4. Hypernatremia is not associated with untreated hypothyroidism. 5. Untreated hypothyroidism increases the risk for abnormal lipid metabolism. Page Ref: 573

The nurse is reviewing orders for a patient in myxedema coma. Which prescription should the nurse question before administering to this patient? Select all that apply. 1. Regular insulin IV at 5 units per hour 2. Cooling blanket 3. Methimazole (Tapazole) 15 mg PO daily 4. Pulse oximetry and vital signs hourly 5. Serum TSH level daily

Answer: 1, 2, 3 Explanation: 1. Myxedema coma is characterized by hypoglycemia. There is no evidence that IV insulin is indicated, and administering it would likely be harmful to an already hypoglycemic patient. 2. Patients with myxedema are often hypothermic, and a cooling blanket would be harmful. 3. Methimazole (Tapazole) interferes with thyroid hormone and would be contraindicated for a patient in myxedema coma. 4. Hourly vital signs with oximetry are appropriate for this patient. 5. Daily serum TSH monitoring is appropriate for this patient. Page Ref: 576

A patient is prescribed prednisone (Dexasone) for a chronic health problem. Which sign of Cushing syndrome should the nurse instruct this patient to report to the healthcare provider? Select all that apply. 1. Fat deposits in the abdominal and clavicle regions 2. Muscle weakness and wasting in the extremities 3. Delayed wound healing 4. Development of varicose leg veins 5. Hypotension

Answer: 1, 2, 3 Explanation: 1. Symptoms of Cushing syndrome include obesity and a redistribution of body fat to the abdominal region (central obesity), the upper back, and under the clavicle. 2. Changes in protein metabolism cause muscle weakness and wasting, especially in the extremities. 3. Poor wound healing is common. 4. Varicose veins are not a manifestation of Cushing syndrome. 5. Hypotension is not a manifestation of Cushing syndrome. Page Ref: 581

The nurse is developing a plan of care for a patient with hyperparathyroidism and a serum calcium level of 12.0 mg/dL. What should be included in the plan? Select all that apply. 1. Promoting ambulation and mobility 2. Discussing a change from ordered thiazide diuretics to another type of diuretic with healthcare provider 3. Teaching to increase daily oral intake of fluids 4. Encouraging supplementation of fat-soluble vitamins 5. Encouraging use of calcium-based antacids for indigestion

Answer: 1, 2, 3 Explanation: 1. Treatment of hyperparathyroidism focuses on reducing elevated serum calcium levels. Patients with mild hypercalcemia are urged to keep active and avoid immobilization. 2. Patients with mild hypercalcemia are urged to avoid thiazide diuretics. 3. Patients with mild hypercalcemia are urged to increase fluid intake. 4. Patients with mild hypercalcemia are urged to avoid large doses of vitamins A and D. 5. Patients with mild hypercalcemia are urged to avoid antacids containing calcium. Page Ref: 580

The nurse is providing care to a patient with a low level of serum parathyroid hormone. What should the nurse expect to assess in this patient? Select all that apply. 1. Brittle nails 2. Abdominal cramps 3. Hair loss 4. Dysrhythmias 5. Smooth, soft skin

Answer: 1, 2, 3, 4 Explanation: 1. Brittle nails is an integumentary manifestation of hypoparathyroidism. 2. Abdominal cramps are a gastrointestinal manifestation of hypoparathyroidism. 3. Hair loss is an integumentary manifestation of hypoparathyroidism. 4. Dysrhythmias are a cardiovascular manifestation of hypoparathyroidism. 5. Smooth, soft skin is not a common finding in the patient with hypoparathyroidism. Page Ref: 580

The nurse is reviewing the manifestations of hyperparathyroidism with a patient. Which statement by the patient indicates that teaching has been effective? Select all that apply. 1. "Hyperparathyroidism can cause the kidneys to keep calcium and excrete phosphorus." 2. "Calcium and phosphorus leave the bones and make them weak." 3. "Calcium is deposited in soft tissues." 4. "Kidney stones can develop." 5. "The kidneys work to raise blood pH and retain potassium."

Answer: 1, 2, 3, 4 Explanation: 1. Hyperparathyroidism is characterized by increased resorption of calcium and excretion of phosphate by the kidneys, which increases the risk of hypercalcemia and hypophosphatemia. 2. Hyperparathyroidism increases the release of calcium and phosphorus by the bones, with resultant bone decalcification. 3. The increase in PTH affects the kidneys and bones, leading to the deposit of calcium in soft tissues. 4. Renal calculi can form. 5. Hyperparathyroidism causes the kidneys to lower blood pH and excrete potassium. Page Ref: 579

The nurse is preparing to assess a patient with Cushing syndrome. Which finding should the nurse expect to assess in this patient? Select all that apply. 1. Weight gain 2. Auscultatory lung crackles 3. Jugular vein distention 4. Peripheral edema 5. Hypotension

Answer: 1, 2, 3, 4 Explanation: 1. The excess cortisol secretion associated with Cushing syndrome results in sodium and water resorption, causing symptoms of fluid volume excess such as weight gain. 2. The nurse may note crackles and wheezes on lung auscultation. 3. The nurse may note jugular vein distention. 4. The excess cortisol secretion associated with Cushing syndrome results in sodium and water resorption, causing symptoms of fluid volume excess and edema. 5. Hypotension is not an expected assessment finding in the patient with Cushing syndrome. Page Ref: 583

A patient with hyperthyroidism is experiencing vision changes. What teaching should the nurse provide to preserve this patient's sight? Select all that apply. 1. Apply eye shields. 2. Instill artificial tears. 3. Wear eyeglasses with tinted lenses. 4. Apply warm compresses to the eyes every 4 hours. 5. Notify the healthcare provider about vision changes.

Answer: 1, 2, 3, 5 Explanation: 1. Measures to protect the eyes from injury and maintain visual acuity include applying eye shields. 2. Measures to protect the eyes from injury and maintain visual acuity include instilling artificial tears to moisten the eyes. 3. Measures to protect the eyes from injury and maintain visual acuity include using tinted glasses. 4. The application of warm compresses would not help preserve this patient's visual acuity. 5. Measures to protect the eyes from injury and maintain visual acuity include notifying the healthcare provider about vision changes. Page Ref: 571

The nurse is caring for a patient with hypoparathyroidism. What action should the nurse expect to perform to help this patient with a low calcium level? Select all that apply. 1. Administering calcium tablets as prescribed 2. Arranging for a dietary consult regarding foods high in calcium 3. Restricting fluids 4. Administering intravenous IV calcium gluconate 5. Administering calcimimetic

Answer: 1, 2, 4 Explanation: 1. Treatment of hypoparathyroidism focuses on increasing calcium levels. Long-term therapy includes supplemental calcium. 2. Treatment of hypoparathyroidism focuses on increasing calcium levels. Long-term therapy includes increased dietary calcium. 3. Fluids are not restricted in the treatment of hypoparathyroidism. 4. Treatment of hypoparathyroidism focuses on increasing calcium levels. Intravenous calcium gluconate is given immediately to reduce tetany. 5. Treatment of hypoparathyroidism focuses on increasing calcium levels. Calcimimetic would reduce the amount of calcium in the body. Page Ref: 580

A patient with Addison disease is experiencing problems with fluid balance. What actions should the nurse take to help this patient? Select all that apply. 1. Teach to sit and stand slowly. 2. Monitor cardiac monitor rhythm. 3. Turn and reposition every 2 hours while awake. 4. Weigh the patient daily at the same time and in the same clothing. 5. Encourage oral fluid intake of 3000 mL/day and increased salt intake.

Answer: 1, 2, 4, 5 Explanation: 1. The nurse should teach the patient to sit and stand slowly, and provide assistance as necessary. Extracellular fluid volume deficit causes orthostatic hypotension, dizziness, and possible loss of consciousness. These manifestations increase the risk of injury from falls. 2. A drop in aldosterone levels can reduce renal excretion of potassium, leading to increased blood levels and the potential for cardiac dysrhythmias. 3. Turning and repositioning would be beneficial to maintain skin integrity, not to address a fluid imbalance. 4. The nurse should weigh the patient daily at the same time and in the same clothing because dehydration is manifested by weight loss. 5. The nurse should encourage an oral fluid intake of 3000 mL/day and an increased salt intake. Cortisol deficiency increases fluid loss, leading to extracellular fluid volume depletion. Oral fluid replacement is necessary to balance this loss. An increase in dietary sodium can reduce the hyponatremia characteristic of adrenal insufficiency. Page Ref: 586-587

A patient recovering from a head injury is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). Which should the nurse expect to be prescribed for this patient? Select all that apply. 1. Restrict fluids. 2. Increase oral fluids. 3. Provide a loop diuretic. 4. Administer Conivaptan. 5. Administer demeclocycline.

Answer: 1, 3, 4, 5 Explanation: 1. Fluid intake is restricted to gradually reduce total body water. 2. Increasing fluids will exacerbate hyponatremia in SIADH. 3. Loop diuretics such as furosemide are used to decrease fluid volume. 4. Vasopressin receptor antagonist, such as Conivaptan, is used to correct hyponatremia. 5. Demeclocycline is a tetracycline antibiotic that suppresses ADH activity, resulting in increased urine production. Page Ref: 590

A patient with hypothyroidism is prescribed levothyroxine sodium (Synthroid). What dietary adjustment should the nurse instruct the patient to make? Select all that apply. 1. Avoid eating walnuts. 2. Avoid all grapefruit or citrus fruits. 3. Restrict the intake of foods high in fiber. 4. Reduce the intake of green leafy vegetables. 5. Take the medication 30 minutes before eating breakfast in the morning.

Answer: 1, 3, 5 Explanation: 1. The patient should be instructed to avoid excessive intake of foods that are known to inhibit thyroid hormone utilization, such as walnuts. 2. There is no reason for the patient to avoid grapefruit or other citrus fruits. 3. The patient should be instructed to avoid excessive intake of foods that are known to inhibit thyroid hormone utilization, such as high-fiber foods. 4. There is no reason for the patient to limit the intake of green leafy vegetables. 5. The patient should be instructed to take the thyroid preparation in the morning 30 minutes before eating to reduce the possibility of insomnia. Page Ref: 576

The nurse in the postanesthesia care area is concerned that a patient recovering from a subtotal thyroidectomy is experiencing postoperative complications. What finding led the nurse to come to this conclusion? Select all that apply. 1. Hoarse voice 2. Restlessness and irritability 3. Blood pressure 92/56 mmHg 4. Heart rate 116 beats per minute 5. High-pitched, squeaky sound with breathing

Answer: 3, 4, 5 Explanation: 1. Hoarseness is expected immediately after a subtotal thyroidectomy. It is too soon to suspect laryngeal nerve damage in this patient. 2. Restlessness and irritability are vague symptoms that could result from the anesthesia, the surgical procedure, or recovery. This is not considered a postoperative complication. 3. A postoperative complication is hemorrhage, which can manifest as a dropping blood pressure. 4. A postoperative complication is hemorrhage, which can manifest as a rapid heart rate. 5. Stridor, a high-pitched, squeaky sound, is heard in acute airway obstructions. Page Ref: 570