Med Surg: Chapter 31: Nursing Management: Patients With Endocrine Disorders: PREPU
The nurse on the telemetry floor is caring for a patient with long-standing hypothyroidism who has been taking synthetic thyroid hormone replacement sporadically. What is a priority that the nurse monitors for in this patient? A Symptoms of acute coronary syndrome B Symptoms of pneumonia C Dietary intake of foods with saturated fats D Heat intolerance
A
Which of the following is a clinical manifestation of hypothyroidism? A A pulse rate below 60 beats/minute. B Systolic murmurs C Exophthalmos D An elevated systolic blood pressure.
A
Patients with hyperthyroidism are characteristically: A Calm B Sensitive to heat C Apathetic and anorexic D Emotionally stable
B
The nurse is teaching a client about the dietary restrictions related to his diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid? A. Hamburger B. Milk C Bananas DChicken livers
B
The nurse practitioner who assesses a patient with hyperthyroidism would expect the patient to report which of the following conditions? A Fatigue B Weight loss C Hair loss D Dyspnea
B
A client with Addison's disease comes to the clinic for a follow-up visit. When assessing this client, the nurse should stay alert for signs and symptoms of: A. sodium and potassium abnormalities. B sodium and chloride abnormalities. C. calcium and phosphorus abnormalities. D chloride and magnesium abnormalities.
A
A nurse in a large university hospital has cared for several patients with endocrine disorders over the past year. For which of the following patients would a nursing diagnosis of disturbed body image be most likely applicable? A. A woman with a longstanding diagnosis of Cushing's syndrome B A man who was treated for Hashimoto's thyroiditis C A man who was diagnosed with hypoparathyroidism after neck surgery D A woman whose diagnosis of Graves' disease required radioactive iodine therapy
A
A nurse is preparing an IV dose of hydrocortisone that is to be administered to an adult patient on an acute medical unit. The endocrine disorder for which this treatment is most clearly indicated is: A Addison's disease B. Cushing's syndrome C. Diabetes insipidus D. Syndrome of inappropriate antidiuretic hormone (SIADH)
A
A patient taking corticosteroids for exacerbation of Crohn's disease comes to the clinic and informs the nurse that he wants to stop taking them because of the increase in acne and moon face. What can the nurse educate the patient regarding these symptoms? A The moon face and acne will resolve when the medication is tapered off. B Those symptoms are not related to the corticosteroid therapy. C The dose of the medication must be too high and should be lowered. D The symptoms are permanent side effects of the corticosteroid therapy.
A
The nurse is closely monitoring the blood work of a patient who has a diagnosis of primary hyperparathyroidism. The nurse should be aware that the fluid and electrolyte disturbances associated with this disease create a significant risk of what problems? A Renal calculi and urinary obstruction B Metabolic acidosis and cardiac ischemia C Fluid volume overload and pruritus D Deep vein thrombosis and pulmonary embolism
A
A client receiving thyroid replacement therapy develops influenza and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication puts the client at risk for developing which life-threatening complication? A Myxedema coma B Thyroid storm C Tibial myxedema D Exophthalmos
A Myxedema coma, severe hypothyroidism, is a life-threatening condition that may develop if thyroid replacement medication isn't taken. Exophthalmos (protrusion of the eyeballs) is seen with hyperthyroidism. Although thyroid storm is life-threatening, it's caused by severe hyperthyroidism.
A client with severe hypoparathyroidism is experiencing tetany. What medication, prescribed by the physician for emergency use, will the nurse administer to correct the deficit? A. Fludrocortisone B. Calcium gluconate C Methylprednisolone D Sodium bicarbonate
B
A nurse is caring for a client with Cushing's syndrome. Which would the nurse not include in this client's plan of care? A. Administer prescribed diuretics. B. Provide a high-sodium diet. C. Report systolic BP that exceeds 139 mm Hg or diastolic BP that exceeds 89 mm Hg. D. examine extremities for pitting edema.
B
A nurse is preparing an IV dose of hydrocortisone that is to be administered to an adult patient on an acute medical unit. The endocrine disorder for which this treatment is most clearly indicated is: A. Cushing's syndrome B Addison's disease C Diabetes insipidus D Syndrome of inappropriate antidiuretic hormone (SIADH)
B
A patient is ordered desmopressin (DDAVP) for the treatment of diabetes insipidus. What therapeutic response does the nurse anticipate the patient will experience? A A decrease in blood pressure B A decrease in urine output C A decrease in appetite D A decrease in blood glucose levels
B
For a client with Graves' disease, which nursing intervention promotes comfort? A. Limiting intake of high-carbohydrate foods B.Maintaining room temperature in the low-normal range C. Restricting intake of oral fluids D. Placing extra blankets on the client's bed
B Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis, excessive thirst and appetite, and weight loss.
A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of: A excessive thirst. B profound neuromuscular irritability. C. acute gastritis. D severe hypotension.
B Hypoparathyroidism may slow bone resorption, reduce the serum calcium level, and cause profound neuromuscular irritability (as evidenced by tetany).
During an assessment of a patient with SIADH, the nurse notes the unexpected result of: A. A blood pressure reading of 120/85 mm Hg. B Pitting edema in the lower extremities. C Moist mucous membranes. D Normal skin turgor.
B In SIADH, the patient does not appear to retain fluids because reabsorbed water is intracellular rather than interstitial
A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add? A Related to exhaustion secondary to an accelerated metabolic rate B. Related to bone demineralization resulting in pathologic fractures C. Related to tetany secondary to a decreased serum calcium level D Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces
B. Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This increase, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury
A client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: A. systolic murmur at the left sternal border. B. exophthalmos and conjunctival redness. . C decreased body temperature and cold intolerance. D. flushed, warm, moist skin.
C
Beta-blockers are used in the treatment of hyperthyroidism to counteract which of the following effects? A Parasympathetic B Gastrointestinal effects C Sympathetic D Respiratory effects
C
Surgical removal of the thyroid gland is the treatment of choice for thyroid cancer. During the immediate postoperative period, the nurse knows to evaluate serum levels of __________ to assess for a serious and primary postoperative complication of thyroidectomy. A. Potassium B. Magnesium C Calcium D Sodium
C
The nurse is reviewing the history and physical examination of a client diagnosed with hyperthyroidism. Which of the following would the nurse expect to find? A. Inability to tolerate cold B Thick hard nails C Reports of increased appetite D Complaints of sleepiness
C
The preferred preparation for treating hypothyroidism includes which of the following? A. Methimazole (Tapazole) B. Propylthiouracil (PTU) C. Levothyroxine (Synthroid) D. Radioactive iodine
C
What is the most common cause of hyperaldosteronism? A. A pituitary adenoma B. Deficient potassium intake C. An adrenal adenoma D. Excessive sodium intake
C
What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking his antithyroid medication? A Diabetes insipidus B Syndrome of inappropriate antidiuretic hormone secretion C Thyrotoxic crisis DMyxedema coma
C
Which outcome indicates that treatment of a client with diabetes insipidus has been effective? A. Urine output measures more than 200 ml/hour. B Heart rate is 126 beats/minute. C Fluid intake is less than 2,500 ml/day. D Blood pressure is 90/50 mm Hg.
C
While assessing a client with hypoparathyroidism, the nurse taps the client's facial nerve and observes twitching of the mouth and tightening of the jaw. The nurse would document this finding as which of the following? A Positive Trousseau's sign B Tetany C Positive Chvostek's sign D Hyperactive deep tendon reflex
C
After a thyroidectomy, the client develops a carpopedal spasm while the nurse is taking a BP reading on the left arm. Which action by the nurse is appropriate? A. Administer a sedative as ordered. B. Administer an oral calcium supplement as ordered. C Administer IV calcium gluconate as ordered. D Start administering oxygen at 2 L/min via a cannula.
C When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium gluconate. If this does not immediately decrease neuromuscular irritability and seizure activity, sedative agents such as pentobarbital may be administered
A nurse is planning care for a client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority? A Risk for infection B Imbalanced nutrition: Less than body requirements C Impaired physical mobility D Decreased cardiac output
D
An adult patient has undergone extensive testing that has resulted in a diagnosis of a basophilic pituitary tumor. The pathophysiological effects of the patient's tumor include excessive secretion of adrenocorticotropic hormone (ACTH). As a result, this patient is likely to exhibit signs and symptoms that are characteristic of what endocrine disorder? A. Addison's disease B. Hyperthyroidism C. Diabetes insipidus D. Cushing's disease
D
The nurse is closely monitoring the blood work of a patient who has a diagnosis of primary hyperparathyroidism. The nurse should be aware that the fluid and electrolyte disturbances associated with this disease create a significant risk of what problems? A. Metabolic acidosis and cardiac ischemia B Fluid volume overload and pruritus C Deep vein thrombosis and pulmonary embolism D. Renal calculi and urinary obstructio
D
Which nursing diagnosis takes highest priority for a client with hyperthyroidism? A. Disturbed body image related to weight gain and edema B. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess C. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing D. imbalanced nutrition: Less than body requirements related to thyroid hormone excess
D
A nurse should expect a client with hypothyroidism to report: A. thyroid gland swelling. B. nervousness and tremors. C. increased appetite and weight loss. D puffiness of the face and hands.
D Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).
Which of the following endocrine disorder causes the patient to have dilutional hyponatremia? A Diabetes insipidus (DI) B Hyperthyroidism C Hypothyroidism D Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
D Patients diagnosed with SIADH retain water and develop a subsequent sodium deficiency known as dilutional hyponatremia. In DI, there is excessive thirst and large volumes of dilute urine. Patients with DI, hypothyroidism, or hyperthyroidism do not exhibit dilutional hyponatremia