Endocrine - MEDSURG FINAL: CH 49 - Endocrine System
The nurse determines that additional instruction is needed for a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient makes which statement? a. "I need to shop for foods low in sodium and avoid adding salt to food." b. "I should weigh myself daily and report any sudden weight loss or gain." c. "I need to limit my fluid intake to no more than 1 quart of liquids a day." d. "I should eat foods high in potassium because diuretics cause potassium loss."
a. "I need to shop for foods low in sodium and avoid adding salt to food." RATIONALE: Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred.
Which assessment finding would the nurse expect in a patient who has been taking oral prednisone several weeks and is experiencing sudden withdrawal (select all that apply.)? a. BP 80/50 b. HR 54 c. Glucose 63 mg/dL d. sodium 148 mEq/L e. Potassium 6.3 f. Temperature 101.1
a. BP 80/50 c. Glucose 63 mg/dL e. Potassium 6.3 f. Temperature 101.1 RATIONALE: Sudden cessation of corticosteroid therapy can precipitate life-threatening adrenal insufficiency. During acute adrenal insufficiency, the patient exhibits severe manifestations of glucocorticoid and mineralocorticoid deficiencies, including hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, and confusion.
The nurse is caring for a patient admitted with suspected hyperparathyroidism. Which signs and symptoms would represent the expected electrolyte imbalance (select all that apply.) a. nausea and vomiting b. neurologic irritability c. lethargy and weakness d. increasing urine output e. hyperactive bowel sounds
a. nausea and vomiting c. lethargy and weakness d. increasing urine output RATIONALE: Hyperparathyroidism can cause hypercalcemia. Signs of hypercalcemia include muscle weakness, polyuria, constipation, nausea and vomiting, lethargy, and memory impairment. Neurologic irritability and hyperactive bowel sounds do not occur with hypercalcemia.
The community health nurse visits a client at home. Prednisone 10 mg orally daily, has been prescribed for the client and the nurse teaches the client about the medication. Which statement, if made by the client, indicates that further teaching is necessary? a. I can take aspirin or any antihistamine if I need it b. I need to take the medication every day at the same time c. I need to avoid coffee, tea, cola, and chocolate in my diet d. If I gain more than 5 pounds a week, I will call my HCP.
a. I can take aspirin or any antihistamine if I need it RATIONALE: Aspirin and other OTC medications should not be taken unless the client consults with the HCP. The client needs to take the medication at the same time every day and should be instructed not to stop it. A slight weight gain as a result of an improved appetite is expected, but after the dosage is stabilized, a weight gain of 5 pounds or more weekly should be reported. caffeine-containing foods and fluids need to be avoided because they may contribute to steroid-ulcer development.
Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)? a. Increased thyroxine (T4) level b. Blood pressure 112/62 mm Hg c. Distant and difficult to hear heart sounds d. Elevated thyroid stimulating hormone level
a. Increased thyroxine (T4) level RATIONALE: An increased thyroxine level indicates the levothyroxine dose needs to be decreased. The other data are consistent with hypothyroidism and the nurse should administer the levothyroxine.
Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency? a. Increasing serum sodium levels b. Decreasing blood glucose levels c. Decreasing serum chloride levels d. Increasing serum potassium levels
a. Increasing serum sodium levels RATIONALE: Clinical manifestations of Addison's disease include hyponatremia and an increase in sodium level indicates improvement. The other values indicate that treatment has not been effective
Which finding by the nurse when assessing a patient with Hashimoto's thyroiditis and a goiter will require the most immediate action? a. New-onset changes in the patient's voice b. Elevation in the patient's T3 and T4 levels c. Resting apical pulse rate 112 beats/minute d. Bruit audible bilaterally over the thyroid gland
a. New-onset changes in the patient's voice
The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is most important to report to the health care provider? a. The patient is confused and lethargic. b. The patient reports a recent head injury. c. The patient has a urine output of 400 mL/hr. d. The patient's urine specific gravity is 1.003.
a. The patient is confused and lethargic. RATIONALE: The patient's confusion and lethargy may indicate hypernatremia and should be addressed quickly. In addition, patients with DI compensate for fluid losses by drinking copious amounts of fluids, but a patient who is lethargic will be unable to drink enough fluids and will become hypovolemic. A high urine output, low urine specific gravity, and history of a recent head injury are consistent with diabetes insipidus, but they do not require immediate nursing action to avoid life-threatening complications.
A client with hyperthyroidism has been given Methimazole. Which nursing considerations are associated with this medication? SATA. a. administer Methimazole with food b. place the client on a low-calorie, low-protein diet c. assess the client for unexplained bruising or bleeding d. Instruct the client to report side/adverse effects such as sore throat, fever, or headaches e. use special radioactive precautions when handling the client's urine for the first 24 hours following initial administration.
a. administer Methimazole with food c. assess the client for unexplained bruising or bleeding d. Instruct the client to report side/adverse effects such as sore throat, fever, or headaches RATIONALE: Common side effects include N/V and diarrhea. To address these, this medication should be taken with food. Because of the increase in metabolism that occurs in hyperthyroidism, the client should consume a high-calorie diet. Antithyroid medications can cause agranulocytosis with leukopenia and thrombocytopenia. Sore throat, fever, headache, or bleeding may indicate agranulocytosis and the HCP should be notified. Methimazole is not radioactive and should be stopped abruptly, due to the risk of thyroid storm.
The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instruction regarding desmopressin acetate would be most appropriate? a. expect to experience some nasal irritation while using this drug b. monitor for symptoms of hypernatremia as a side effect of this drug c. drink at least 3000 mL of water per day while taking this drug d. report any decrease in urinary elimination to the HCP
a. expect to experience some nasal irritation while using this drug RATIONALE: Desmopressin acetate is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. Diuresis will be decreased and is expected. Inhaled desmopressin can cause nasal irritation, headache, nausea, and other signs of hyponatremia, not hypernatremia. Drinking too much water or other fluids increases the risk of hyponatremia. The patient should follow the provider's directions for limiting fluids and be taught to seek medical attention they experience severe nausea; vomiting; severe headache; muscle weakness, spasms, or cramps; sudden weight gain; unusual tiredness; mental/mood changes; seizures; and slow or shallow breathing.
The nurse is caring for a patient after a parathyroidectomy. The nurse would prepare to administer IV calcium gluconate if the patient exhibits which clinical manifestations? a. facial spasms and laryngospasms b. tingling in the hands and around the mouth c. decreased muscle tone and muscle weakness d. shortened QT interval on the ECG
a. facial spasms and laryngospasms RATIONALE: Nursing care for a patient after a parathyroidectomy includes monitoring for a sudden decrease in serum calcium levels causing tetany, a condition of neuromuscular hyperexcitability. If tetany is severe (e.g., muscular spasms or laryngospasms develop), IV calcium gluconate should be administered. Mild tetany, characterized by unpleasant tingling of the hands and around the mouth, may be present but should decrease over time without treatment. Decreased muscle tone, muscle weakness, and shortened QT interval are clinical manifestations of hyperparathyroidism.
A client has been diagnosed with hyperthyroidism. Which signs and symptoms may indicate thyroid storm, a complication of this disorder? (SATA). a. fever b. nausea c. lethargy d. tremors e. confusion f. bradycardia
a. fever b. nausea d. tremors e. confusion RATIONALE: Thyroid storm is an acute and life-threatening condition that occurs in a client with uncontrollable hyperthyroidism. Symptoms of thyroid storm include fever, nausea, and tremors. In addition, the client becomes confused. The client is restless and anxious and experiences tachycardia.
After a hypophysectomy for acromegaly, immediate postoperative nursing care should focus on a. frequent monitoring of serum and urine osmolarity b. parenteral administration of a GH-receptor antagonist c. keeping the patient in a recumbent position at all times d. patient teaching regarding the need for lifelong hormone therapy
a. frequent monitoring of serum and urine osmolarity RATIONALE: A possible postoperative complication after a hypophysectomy is transient diabetes insipidus (DI). It may occur because of the loss of antidiuretic hormone (ADH), which is stored in the posterior lobe of the pituitary gland, or because of cerebral edema related to manipulation of the pituitary gland during surgery. To assess for DI, urine output and serum and urine osmolarity should be monitored closely.
To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to a. increase calcium intake to 1500 mg/day b. perform glucose monitoring for hypoglycemia c. obtain immunizations due to high risk infections d. avoid abrupt position changes because of orthostatic hypotension
a. increase calcium intake to 1500 mg/day RATIONALE: Because patients often receive corticosteroid treatment for prolonged periods (more than 3 months), corticosteroid-induced osteoporosis is an important concern. Therapies to reduce the resorption of bone may include increased calcium intake, vitamin D supplementation, bisphosphonates (e.g., alendronate), and institution of a low-impact exercise program.
The nurse is monitoring a client receiving Synthroid for hypothyroidism. Which findings indicate the presence of a side effect associated with this medication? Select all that apply. a. insomnia b. weight loss c. bradycardia d. constipation e. mild heat intolerance
a. insomnia b. weight loss e. mild heat intolerance RATIONALE: Insomnia, weight loss, and mild heat intolerance are side effects of Synthroid. Bradycardia and constipation are not side effects, but are associated with hypothyroidism.
The nurse is caring for a postoperative parathyroidectomy client. Which client complaint would indicate that a life-threatening complication may be developing, requiring notification of the HCP immediately? a. laryngeal stridor b. abdominal cramps c. difficulty voiding d. mild to moderate incisional pain
a. laryngeal stridor RATIONALE: during the postoperative period, the nurse carefully observes for signs of hemorrhage, which causes swelling and compression of the adjacent tissue. Laryngeal stridor is a hard, high-pitched sound heard on inspiration and expiration. Leads to respiratory distress.
The nurse providing care for a patient who has an adrenocortical adenoma causing hyperaldosteronism should a. monitor the blood pressure every 4 hours. b. elevate the patient's legs to relieve edema. c. monitor blood glucose level every 4 hours. d. order the patient a potassium-restricted diet.
a. monitor the blood pressure every 4 hours. RATIONALE: Hypertension caused by sodium retention is a common complication of hyperaldosteronism. Hyperaldosteronism does not cause an elevation in blood glucose. The patient will be hypokalemic and require potassium supplementation before surgery. Edema does not usually occur with hyperaldosteronism.
A client is admitted to an ED, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially? a. warm the client b. maintain a patent airway c. administer thyroid hormone d. administer fluid replacement
b. maintain a patent airway
The nurse is teaching a patient with acromegaly from an unresectable benign pituitary tumor about octreotide therapy. The nurse should provide further teaching if the patient makes which statement? a. the provider will infused this medication through an IV b. i will inject it into the subcutaneous layer of the skin c. the medication should decrease the GH production to normal d. i will have my GH level measured every 2 weeks for several weeks
a. the provider will infused this medication through an IV RATIONALE: Drug therapy is an option for patients whose tumors are not surgically resectable. The primary drug used is octreotide, a somatostatin analog. It reduces growth hormone (GH) levels to normal in many patients. Octreotide is given by subcutaneous injection three times a week. GH levels are measured every 2 weeks to guide drug dosing, and then every 6 months until the desired response is obtained.
A 40-yr-old patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask? a. "Have you had a recent head injury?" b. "Do you have to wear larger shoes now?" c. "Is there a family history of acromegaly?" d. "Are you experiencing tremors or anxiety?"
b. "Do you have to wear larger shoes now?" RATIONALE: Acromegaly causes an enlargement of the hands and feet. Head injury and family history are not risk factors for acromegaly. Tremors and anxiety are not clinical manifestations of acromegaly.
The nurse admits a patient to the hospital in Addisonian crisis. Which patient statement supports the need to plan additional teaching? a. "I frequently eat at restaurants, and my food has a lot of added salt." b. "I had the flu earlier this week, so I couldn't take the hydrocortisone." c. "I always double my dose of hydrocortisone on the days that I go for a long run." d. "I take twice as much hydrocortisone in the morning dose as I do in the afternoon."
b. "I had the flu earlier this week, so I couldn't take the hydrocortisone." RATIONALE: The need for hydrocortisone replacement is increased with stressors such as illness, and the patient needs to be taught to call the health care provider because medication and IV fluids and electrolytes may need to be given. The other patient statements indicate appropriate management of the Addison's disease.
A 29-yr-old woman with systemic lupus erythematosus has been prescribed 2 weeks of high-dose prednisone therapy. Which information about the prednisone is most important for the nurse to include? a. "Weigh yourself daily to monitor for weight gain." b. "The prednisone dose should be decreased gradually." c. "A weight-bearing exercise program will help minimize risk for osteoporosis." d. "Call the health care provider if you have mood changes with the prednisone."
b. "The prednisone dose should be decreased gradually." RATIONALE: Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped. Mood alterations and weight gain are possible adverse effects of corticosteroid use, but these are not life-threatening effects. Osteoporosis occurs when patients take corticosteroids for longer periods.
After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? a. A 31-yr-old female patient with Cushing syndrome and a blood glucose level of 244 mg/dL b. A 70-yr-old female patient taking levothyroxine (Synthroid) who has an irregular pulse of 134 c. A 53-yr-old male patient who has Addison's disease and is due for a prescribed dose of hydrocortisone (Solu-Cortef). d. A 22-yr-old male patient admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L
b. A 70-yr-old female patient taking levothyroxine (Synthroid) who has an irregular pulse of 134 RATIONALE: Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The patient's high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for life-threatening complications.
A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next? a. Suction the patient's airway. b. Administer IV calcium gluconate. c. Plan for emergency tracheostomy. d. Prepare for endotracheal intubation.
b. Administer IV calcium gluconate. RATIONALE: The patient's clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Endotracheal intubation or tracheostomy may be needed if the calcium does not resolve the stridor. Suctioning will not correct the stridor.
Which nursing assessment of a 70-yr-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)? a. Fluid balance b. Apical pulse rate c. Nutritional intake d. Orientation and alertness
b. Apical pulse rate
A patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should be included in the plan of care? a. Restrict the patient to bed rest. b. Encourage 4000 mL of fluids daily. c. Institute routine seizure precautions. d. Assess for positive Chvostek's sign.
b. Encourage 4000 mL of fluids daily. RATIONALE: The patient with hypercalcemia is at risk for kidney stones, which may be prevented by a high fluid intake. Seizure precautions and monitoring for Chvostek's or Trousseau's sign are appropriate for hypocalcemic patients. The patient should engage in weight-bearing exercise to decrease calcium loss from bone.
The nurse performs an admission assessment on a client who visits a healthcare clinic for the first time. The client tells the nurse that propylthiouracil (PTU) is taken daily. The nurse continues to collect data from the client, suspecting that the client has a history of which condition? a. Myxedema b. Graves' disease c. Addison's disease d. Cushing's syndrome
b. Graves' disease PTU inhibits thyroid hormone synthesis and is used to treat hyperthyroidism, or Graves'. Myxedema indicates hypothyroidism. Cushing's syndrome and Addison's disease are disorders related to adrenal function.
A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action will provide the patient with rapid relief from the symptoms? a. Administer the prescribed muscle relaxant. b. Have the patient rebreathe from a paper bag. c. Start the PRN O2 at 2 L/min per cannula. d. Stretch the muscles with passive range of motion.
b. Have the patient rebreathe from a paper bag. RATIONALE: The patient's symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the patient breathe into a paper bag, which will raise the PaCO2 and create a more acidic pH. Applying as-needed O2 or range of motion will have no impact on the ionized calcium level. Calcium supplements will be given to normalize calcium levels quickly, but oral supplements will take time to be absorbed.
Which information will the nurse include when teaching a 50-yr-old male patient about somatropin (Genotropin)? a. The medication will be needed for 3 to 6 months. b. Inject the medication subcutaneously every day. c. Blood glucose levels may decrease when taking the medication. d. Stop taking the medication if swelling of the hands or feet occurs.
b. Inject the medication subcutaneously every day. RATIONALE: Somatropin is injected subcutaneously on a daily basis, preferably in the evening. The patient will need to continue on somatropin for life. If swelling or other common adverse effects occur, the health care provider should be notified. Growth hormone will increase blood glucose levels.
The nurse is planning postoperative care for a patient who is being admitted to the surgical unit from the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action should be included? a. Palpate extremities for edema. b. Measure urine volume every hour. c. Check hematocrit every 2 hours for 8 hours. d. Monitor continuous pulse oximetry for 24 hours.
b. Measure urine volume every hour. RATIONALE: After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema. Monitoring of urine output and urine specific gravity is essential. Hemorrhage is not a common problem. There is no need to check the hematocrit hourly. The patient is at risk for dehydration, not volume overload. The patient is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.
The nurse will plan to monitor a patient diagnosed with a pheochromocytoma for a. flushing. b. headache. c. bradycardia d. hypoglycemia.
b. headache. RATIONALE: The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia, severe headache, diaphoresis, and abdominal or chest pain. Elevated blood glucose may also occur because of sympathetic nervous system stimulation. Bradycardia and flushing would not be expected.
The HCP prescribes levothyroxine for a patient with hypothyroidism. After teaching regarding this drug, the nurse determines that further instruction is needed when the patient says a. i can expect the medication dose may need to be adjusted b. i only need to take this drug until my symptoms are improved c. i can expect to return to normal function with the use of this drug d. i will report any chest pain or difficulty breathing to the doctor right away
b. i only need to take this drug until my symptoms are improved
The nurse is providing discharge instructions to a client who has Cushing's syndrome. Which client statement indicates that instructions related to dietary management are understood? a. i will need to limit the amount of protein in my diet. b. i should eat foods that have a lot of potassium in them. c. i am fortunate enough that i can eat all the salty foods i enjoy. d. i am fortunate that i do not need to follow any special diet.
b. i should eat foods that have a lot of potassium in them. RATIONALE: a diet low in carbs and sodium but ample in protein and potassium is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, reduction of edema and hypertension, control of hypokalemia, and rebuilding of wasted tissue.
The patient with systemic lupus erythematosus is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What should be included in the plan of care (select all that apply.)? a. obtain weekly weights b. limit fluids to 1000 mL/day c. monitor for signs of hypernatremia d. administration of diuretics as ordered e. minimize turning and range of motion f. Keep the head of the bed at 10 degrees or less
b. limit fluids to 1000 mL/day d. administration of diuretics as ordered f. Keep the head of the bed at 10 degrees or less RATIONALE: The care for the patient with SIADH will include limiting fluids to 1000 mL/day or less to decrease weight, increase osmolality, and improve symptoms and keeping the head of the bed elevated at 10 degrees or less to enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of ADH. Measure weights daily and maintain accurate intake and output. Monitor for signs of hyponatremia. Frequent turning, positioning, and range-of-motion exercises are important to maintain skin integrity and joint mobility.
Important nursing interventions when caring for a patient with Cushing syndrome include (SATA) a. restricting protein intake b. monitoring BG levels c. observing for signs of hypotension d. administering medication in equal doses e. protecting patient from exposure to infection
b. monitoring BG levels e. protecting patient from exposure to infection RATIONALE: Hyperglycemia occurs with Cushing disease because of glucose intolerance (associated with cortisol-induced insulin resistance) and increased gluconeogenesis by the liver. High levels of corticosteroids increase susceptibility to infection and delay wound healing.
The nurse is completing an assessment on a client who is being admitted for a diagnostic workup for primary hyperparathyroidism. Which client complaint would be characteristic of this disorder? a. diarrhea b. polyuria c. polyphagia d. weight gain
b. polyuria RATIONALE: Hypercalcemia is the hallmark of hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis and thus polyuria. This diuresis leads to dehydration and weight loss. Some GI symptoms include anorexia, N/V, and constipation
The surgeon was unable to spare a patient's parathyroid gland during a thyroidectomy. Which assessments should the nurse prioritize when providing postoperative care for this patient? a. WBC levels and signs of infection b. serum calcium levels and signs of hypocalcemia c. hemoglobin, hematocrit, and red blood cells d. level of consciousness and signs of acute delirium
b. serum calcium levels and signs of hypocalcemia RATIONALE: Loss of the parathyroid gland is associated with hypocalcemia. Whereas infection and anemia are not associated with loss of the parathyroid gland, cognitive changes are less pronounced than the signs and symptoms of hypocalcemia.
The nurse is caring for a client after a hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which initial action? a. lower the head of the bed b. test the drainage for glucose. c. obtain a culture of the drainage. d. continue to observe the drainage.
b. test the drainage for glucose. RATIONALE: after hypophysectomy, the client should be monitore for rhinorrhea, which could indicate a CSF leak. If this occurs, the drainage should be collected and tested. The head of the bed should not be lowered to prevent intracranial pressure.
The nurse provides medication instructions to a client who is taking Synthroid and should tell the client to notify the HCP if which problem occurs? a. fatigue b. tremors c. cold intolerance d. excessively dry skin
b. tremors RATIONALE: excessive doses of Synthroid can produce signs and symptoms of hyperthyroidism. These include tachycardia, chest pain, tremors, nervousness, insomnia, hyperthermia, extreme heat intolerance, and sweating.
The nurse determines that demeclocycline is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patient's a. weight has increased. b. urinary output is increased. c. peripheral edema is increased d. urine specific gravity is increased.
b. urinary output is increased. RATIONALE: Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and increases urine output. An increase in weight or an increase in urine specific gravity indicates that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a common clinical manifestation of this disorder.
Which information will the nurse teach a patient who has been newly diagnosed with Graves' disease? a. Exercise is contraindicated to avoid increasing metabolic rate. b. Restriction of iodine intake is needed to reduce thyroid activity. c. Antithyroid medications may take several months for full effect. d. Surgery will eventually be required to remove the thyroid gland.
c. Antithyroid medications may take several months for full effect.
Which assessment finding for a 33-yr-old female patient admitted with Graves' disease requires the most rapid intervention by the nurse? a. Heart rate 136 beats/min b. Severe bilateral exophthalmos c. Temperature 103.8° F (40.4° C) d. Blood pressure 166/100 mm Hg
c. Temperature 103.8° F (40.4° C)
An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism is to a. monitor BG levels b. restrict fluid and sodium intake c. administer potassium-sparing diuretics d. advice the patient to make postural changes slowly
c. administer potassium-sparing diuretics
Prednisone is prescribed for a client with DM who is taking Humulin NPH insulin daily. Which prescription change does the nurse anticipate during therapy with the prednisone? a. an additional dose of prednisone daily b. a decreased amount of daily insulin c. an increased amount of daily insulin d. the addition of an oral hypoglycemic medication daily.
c. an increased amount of daily insulin RATIONALE: Glucocorticoids can elevate BG levels. Clients with DM may need their dosages of insulin or oral hypoglycemia medications increased during glucocorticoids therapy.
A patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. During preoperative teaching, the nurse instructs the patient about the need to a. cough and deep breathe every 2 hours postoperatively. b. remain on bed rest for the first 48 hours after the surgery. c. avoid brushing teeth for at least 10 days after the surgery. d. be positioned flat with sandbags at the head postoperatively.
c. avoid brushing teeth for at least 10 days after the surgery. RATIONALE: To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is discouraged because it may cause leakage of cerebrospinal fluid (CSF) from the suture line. The head of the bed should be elevated 30 degrees to reduce pressure on the sella turcica and decrease the risk for headaches.
An 82-yr-old patient in a long-term care facility is newly diagnosed with hypothyroidism. The nurse will need to consult with the health care provider before administering the prescribed a. docusate (Colace). b. ibuprofen (Motrin). c. diazepam (Valium). d. cefoxitin (Mefoxin).
c. diazepam (Valium). RATIONALE: Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older adults. The nurse should discuss the use of diazepam with the health care provider before administration. The other medications may be given safely to the patient.
A daily dose of Prednisone is prescribed for a client. The nurse provides instructions to the client regarding administration of the medication and should instruct the clinet that which time is best to take this medication? a. at noon b. at bedtime c. early morning d. any time, at the same time, each day.
c. early morning RATIONALE: Glucocorticoids should be administered before 9am. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenal glands each morning.
The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which symptoms are associated with this diagnosis? (SATA). a. tremors b. weight loss c. feeling cold d. loss of body hair e. persistent lethargy f. puffiness of face
c. feeling cold d. loss of body hair e. persistent lethargy f. puffiness of face
A patient with a head injury develops SIADH. Manifestations the nurse would expect to find include a. hypernatremia and edema b. muscle spasticity and hypertension c. low urine output and hyponatremia d. weight gain and decreased GFR
c. low urine output and hyponatremia RATIONALE:Excess ADH increases the permeability of the renal distal tubule and collecting ducts, which leads to the reabsorption of water into the circulation. Consequently, extracellular fluid volume expands, plasma osmolality declines, the glomerular filtration rate increases, and sodium levels decline (i.e., dilutional hyponatremia). Hyponatremia causes muscle cramping, pain, and weakness. Initially, the patient displays thirst, dyspnea on exertion, and fatigue. Patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) experience low urinary output and increased body weight. As the serum sodium level falls (usually to less than 120 mEq/L), manifestations become more severe and include headache, vomiting, abdominal cramps, muscle twitching, and seizures. As plasma osmolality and serum sodium levels continue to decline, cerebral edema may occur, leading to lethargy, anorexia, confusion, seizures, and coma.
The nurse provides instructions to a client who is taking Synthroid. The nurse should tell the client to take the medication at which time? a. with food b. at lunchtime c. on an empty stomach d. at bedtime with a snack
c. on an empty stomach RATIONALE: oral doses should be taken on an empty stomach to enhance absorption. Dosing should be done in the morning before breakfast.
The nurse teaches the patient that the best time to take corticosteroids for replacement purposes is a. once a day at bedtime b. every other day on awakening c. on arising and in the late afternoon d. at consistent invervals every 6-8 hours
c. on arising and in the late afternoon RATIONALE: As replacement therapy, glucocorticoids are usually administered in divided doses: two thirds in the morning and one third in the afternoon. This dosage schedule reflects normal circadian rhythm in endogenous hormone secretion and decreases the side effects associated with corticosteroid replacement therapy.
After a patient with a pituitary adenoma has had a hypophysectomy, the nurse will teach about the need for a. sodium restriction to prevent fluid retention. b. insulin to maintain normal blood glucose levels. c. oral corticosteroids to replace endogenous cortisol. d. chemotherapy to prevent malignant tumor recurrence.
c. oral corticosteroids to replace endogenous cortisol. RATIONALE: Antidiuretic hormone (ADH), cortisol, and thyroid hormone replacement will be needed for life after hypophysectomy. Without the effects of adrenocorticotropic hormone (ACTH) and cortisol, the blood glucose and serum sodium will be low unless cortisol is replaced. An adenoma is a benign tumor, and chemotherapy will not be needed.
After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse performs an assessment on the client, knowing that which symptom is most indicative of this disorder? a. fatigue b. diarrhea c. polydipsia d. weight gain
c. polydipsia RATIONALE: DI is characerized by hyposecretion of antidiuretic hormone, and the kidney tubules fail to reabsorb water. Polydipsia and polyuria are classic symptoms of DI. The urine is pale, and the specific gravity is low. Anorexia and weight loss occur.
A client has just been admitted to the nursing unit following thyroidectomy. Which assessment is the priority for this client? a. hypoglycemia b. level of hoarseness c. respiratory distress d. edema at the surgical site
c. respiratory distress RATIONALE: Thyroidectomy is the removal of the thyroid glad, which is located in the anterior neck. It is very important to monitor airway status as any swelling to the surgical site could cause respiratory distress. Although all the options are important for the nurse to monitor, the priority action is to monitor the airway.
The nurse is instructing a client regarding intranasal desmopressin (DDAVP). The nurse should tell the client that which occurrence is a side effect of the medication? a. headache b. vulval pain c. runny nose d. flushed skin
c. runny nose RATIONALE: Desmopressin administered by the instranasal route can cause runny or stuffy nose. The other options are side effects if the medication is administered intravenously.
An expected patient problem for a patient admitted to the hospital with symptoms of diabetes insipidus is a. excess fluid volume related to intake greater than output. b. impaired gas exchange related to fluid retention in lungs. c. sleep pattern disturbance related to frequent waking to void. d. risk for impaired skin integrity related to generalized edema.
c. sleep pattern disturbance related to frequent waking to void. RATIONALE: Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.
A 62-yr-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient a. about radioactive precautions to take with all body secretions. b. that symptoms of hyperthyroidism should be relieved in about a week. c. that symptoms of hypothyroidism may occur as the RAI therapy takes effect. d. to discontinue the antithyroid medications taken before the radioactive therapy.
c. that symptoms of hypothyroidism may occur as the RAI therapy takes effect. RATIONALE: There is a high incidence of postradiation hypothyroidism after RAI, and the patient should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum effect not seen for 2 to 3 months, and the patient will continue to take antithyroid medications during this time. The therapeutic dose of radioactive iodine is low enough that no radiation safety precautions are needed.
Which finding by the nurse when assessing a patient with a large pituitary adenoma is most important to report to the health care provider? a. Changes in visual field b. Milk leaking from breasts c. Blood glucose 150 mg/dL d. Nausea and projectile vomiting
d. Nausea and projectile vomiting
Which prescribed medication should the nurse expect will have rapid effects on a patient admitted to the emergency department in thyroid storm? a. Iodine b. Methimazole c. Propylthiouracil d. Propranolol (Inderal)
d. Propranolol (Inderal) RATIONALE: b-Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function.
Which assessment finding of a 42-yr-old patient who had a bilateral adrenalectomy requires the most rapid action by the nurse? a. The blood glucose is 192 mg/dL. b. The lungs have bibasilar crackles. c. The patient reports 6/10 incisional pain. d. The blood pressure (BP) is 88/50 mm Hg.
d. The blood pressure (BP) is 88/50 mm Hg. RATIONALE: The decreased BP indicates possible adrenal insufficiency. The nurse should immediately notify the health care provider so that corticosteroid medications can be administered. The nurse should also address the elevated glucose, incisional pain, and crackles with appropriate collaborative or nursing actions, but prevention and treatment of acute adrenal insufficiency are the priorities after adrenalectomy.
Which information is most important for the nurse to communicate rapidly to the health care provider about a patient admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH)? a. The patient has a recent weight gain of 9 lb. b. The patient complains of dyspnea with activity. c. The patient has a urine specific gravity of 1.025. d. The patient has a serum sodium level of 118 mEq/L.
d. The patient has a serum sodium level of 118 mEq/L. RATIONALE: A serum sodium of less than 120 mEq/L increases the risk for complications such as seizures and needs rapid correction. The other data are not unusual for a patient with SIADH and do not indicate the need for rapid action.
THe nurse is performing an assessment on a client with pheochromocytoma. Which assessment data would indicate a potential complication associated with this disorder? a. a coagulation time of 5 minutes b. a urinary output of 50 mL/hour c. a BUN of 20 mg/dL d. a HR that is 90 beats/minute and irregular
d. a HR that is 90 beats/minute and irregular RATIONALE: The complicates include hypertensive retinopathy and nephropathy, myocarditis, increased platelet aggregation, and stroke. Death can occur from stroke, shock, kidney failure, dysrhythmias, or dissecting aortic aneurysm
A client is diagnosed with pheochromocytoma. The nurse understands that pheochromocytoma is a condition that has which characteristic? a. causes profound hypotension b. is manifested by severe hypoglycemia c. is not curable and is treated symptomatically d. causes the release of excessive amounts of catecholamines
d. causes the release of excessive amounts of catecholamines RATIONALE: Pheochromocytoma is a catecholamine-producing tumor and causes secretion of excessive amounts of epinephrine and norepinephrine. Hypertension is the principal manifestation, and the client has episodes of high BP accompanied by pounding headaches. The excess release of catecholamine also results in excessive conversion of glycogen into glucose in the liver. Hyperglycemia and glucosuria occur. The primary treatment is surgical removal of one or both of the adrenal glands.
The nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's disease. Which statement by the student indicates an accurate understanding of this disorder? a. it results from an oversecretion of insulin b. it results from an undersecretion of corticotropic hormones c. it results from an undersecretion of mineralcorticoid hormones d. it results from an increased pituitary secretion of adrenocorticotropic hormone
d. it results from an increased pituitary secretion of adrenocorticotropic hormone
The patient with an adrenal hyperplasia is returning from surgery after an adrenalectomy. The nurse should monitor the patient for what immediate postoperative complication? a. vomiting b. infection c. thromboembolism d. rapid blood pressure changes
d. rapid blood pressure changes RATIONALE: The risk of hemorrhage is increased with surgery on the adrenal glands as well as large amounts of hormones being released in the circulation, which may produce hypertension and cause fluid and electrolyte imbalances to occur for the first 24 to 48 hours after surgery. Vomiting, infection, and thromboembolism may occur postoperatively with any surgery.
After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops a. muscle weakness and weight loss b. hypernatremia and severe tachycardia c. hyperthermia and severe tachycardia d. hypertension and difficulty swallowing e. laryngospasms and tingling in the hands and feet
e. laryngospasms and tingling in the hands and feet
