Medsurge quiz 3 Endocrine (ch 49)
The patient with systemic lupus erythematosus is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What interventions should be included in the plan of care? (Select all that apply.) A. Obtain daily weights. B. Limit fluids to 1000 mL/day. C. Administer diuretics as ordered. D. Monitor for signs of hypernatremia. E. Minimize turning and range of motion. F. Elevate the head of the bed at 10 degrees or less.
A,B,C,F 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.
The nurse is caring for a patient admitted with suspected hyperparathyroidism. Which manifestations 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,C,D 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.
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. Heart rate 54 C. Glucose 63 mg/dL D. Sodium 148 mEq/L E. Potassium 6.3 mEq/L F. Temperature 101.1° F
A,C,E,F 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.
What is a nursing priority when caring for a patient with hypothyroidism? A. Patient teaching related to levothyroxine B. Providing a dark, low-stimulation environment C. Closely monitoring the patient's intake and output D. Initiating precautions related to radioactive iodine therapy
A. A euthyroid state is most often achieved in patients with hypothyroidism by the administration of levothyroxine. It is not necessary to closely monitor intake and output. Low stimulation and radioactive iodine therapy are used to treat hyperthyroidism.
After a hypophysectomy for acromegaly, immediate postoperative nursing care should focus on A. Frequent monitoring of serum and urine osmolarity B. parenteral administration of GH-receptor antagonist C. Keeping the patient in a recumbent position at all times D. Patient teaching about the need for lifelong hormone therapy
A. 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.
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. 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.
To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroid to A. increase calcium intake to 1500 mg/day B. preform glucose monitoring for hypoglycemia C. obtain immunizations due to high risk for infection D. avoid abrupt position changes because of orthostatic hypotension
A. Because patients often receive corticosteroid treatment for prolonged periods (more than 3 months), corticosteroid-induced osteoporosis is an important concern. Therapies to reduce bone resorption may include increased calcium intake, vitamin D supplementation, bisphosphonates (e.g., alendronate), and taking part in a low-impact exercise program
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/min D. Bruit audible bilaterally over the thyroid gland
A. Changes in the patient's voice indicate that the goiter is compressing the laryngeal nerve and may lead to airway compression. The other findings will also be reported but are expected with Hashimoto's thyroiditis and do not require immediate action.
Which finding indicates to the nurse that the current therapies are effective for a patient who has acute adrenal insufficiency? A. Increasing serum sodium levels B. Decreasing blood glucose levels C. Decreasing serum chloride levels D. Increasing serum potassium levels
A. 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.
The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instruction about desmopressin acetate would be most appropriate? A. Expect to have some nasal irritation while using this drug. B. Monitor for symptoms of hypernatremia as a drug side effect. C. Report any decrease in urinary output to the health care provider. D. Drink at least 3000 mL of water per day while taking this medication.
A. 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 if they have 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 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 infuse this medication through an IV." B. "I will inject the medication in the subcutaneous layer of the skin." C. "The medication should decrease the growth hormone production to normal." D. "I will have my growth hormone level measured every 2 weeks for several weeks."
A. 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 K guide drug dosing, and then every 6 months until the desired response is obtained.
The nurse is caring for a patient after a parathyroidectomy. The nurse would prepare to administer IV calcium gluconate if the patient has which manifestations? A. Facial muscle 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 electrocardiogram
A. 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 manifestations of hyperparathyroidism.
The nurse is caring for a patient receiving high-dose oral corticosteroid therapy after a kidney transplant. Which side effect would the nurse monitor for as it presents the greatest risk? A. Infection B. Low blood pressure C. Increased urine output D. Decreased blood glucose
A. Side effects of corticosteroid therapy include increased susceptibility to infection, edema related to sodium and water retention (decreasing urine output), hypertension, and hyperglycemia.
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'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.
Important nursing intervention (s) when caring for a patient with Cushing syndrome include (SATA) A. restricting protein intake B. Monitoring blood glucose levels C. Observing the signs of hypertension D. administering medication in equal doses E. protecting patient from exposure to infection
B,E. 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 risk of infection and delay wound healing.
A 40-year-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. 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.
A 29-year-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. 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.
A patient is admitted with diabetes insipidus. Which action will be appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/VN)? A. Titrate the infusion of 5% dextrose in water. B. Administer prescribed subcutaneous DDAVP. C. Assess the patient's overall hydration status every 8 hours. D. Teach the patient to use desmopressin (DDAVP) nasal spray.
B. Administration of medications is included in LPN/VN education and scope of practice. Assessments, patient teaching, and titrating fluid infusions are more complex skills and should be done by the RN.
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. 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 is assessing a male patient diagnosed with a pituitary tumor causing panhypopituitarism. Which assessment finding is consistent with panhypopituitarism? A. High blood pressure B. Decreased facial hair C. Elevated blood glucose D. Intermittent tachycardia
B. Changes in male secondary sex characteristics such as decreased facial hair, testicular atrophy, diminished spermatogenesis, loss of libido, impotence, and decreased muscle mass are associated with decreases in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Fasting hypoglycemia and hypotension occur in panhypopituitarism because of decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is due to the decrease in thyroid-stimulating hormone (TSH) and thyroid hormones associated with panhypopituitarism.
The nurse receives a phone call from a patient taking cyclophosphamide for treatment of non-Hodgkin's lymphoma. The patient tells the nurse that she has muscle cramps, weakness, and very little urine output. Which response by the nurse is best? A. "Start taking supplemental potassium, calcium, and magnesium." B. "Stop taking the medication now and call your health care provider." C. "These symptoms will decrease with continued use of the medication." D. "Increase your fluid intake to 3000 mL for 24 hours to improve your urine output."
B. Cyclophosphamide may cause syndrome of inappropriate antidiuretic hormone (SIADH). Medications that stimulate the release of ADH should be avoided or discontinued. Treatment may include restriction of fluids to 800 to 1000 mL/day. A loop diuretic such as furosemide (Lasix) is used to promote diuresis, and supplements of potassium, calcium, and magnesium may be needed.
Which finding indicates to the nurse that demeclocycline is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? A. Weight has increased. B. Urinary output is increased. C. Peripheral edema is increased. D. Urine specific gravity is increased.
B. 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.
The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first? A. Patient with Hashimoto's thyroiditis and a heart rate of 102 B. Patient with tetany who has a new order for IV calcium chloride C. Patient with Cushing syndrome and a blood glucose of 140 mg/dL D. Patient with Addison's disease who takes IV hydrocortisone twice daily
B. Emergency treatment of tetany requires IV administration of calcium; electrocardiographic monitoring will be required because cardiac arrest may occur if high calcium levels result from too-rapid administration. The information about the other patients indicates that they are more stable than the patient with tetany.
What action should the nurse take when providing care for a patient who has an adrenocortical adenoma causing hyperaldosteronism? A. Check blood glucose level every 4 hours. B. Monitor the blood pressure every 4 hours. C. Elevate the patient's legs to relieve edema. D. Order the patient a potassium-restricted diet.
B. 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.
Which nursing assessment of a 70-year-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. In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication also is expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes will not result in potentially life-threatening complications.
After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? A. A 31-year-old female patient with Cushing syndrome and a blood glucose level of 244 mg/dL B. A 70-year-old female patient taking levothyroxine (Synthroid) who has an irregular pulse of 134 C. A 53-year-old male patient who has Addison's disease and is due for a prescribed dose of hydrocortisone (Solu-Cortef). D. A 22-year-old male patient admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L
B. 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.
The health care provider prescribes levothyroxine for a patient with hypothyroidism. After teaching about 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. Levothyroxine is the drug of choice to treat hypothyroidism. The need for thyroid replacement therapy is usually lifelong.
The nurse is caring for a patient recently started on levothyroxine for hypothyroidism. What information reported by the patient requires immediate action? A. Weight gain or weight loss B. Chest pain and palpitations C. Muscle weakness and fatigue D. Decreased appetite and constipation
B. Levothyroxine is used to treat hypothyroidism. With replacement, the patient can be overmedicated, causing hyperthyroidism. Any chest pain, heart palpitations, or heart rate greater than 100 beats/min experienced by a patient starting thyroid replacement should be reported immediately, and electrocardiography and serum cardiac enzyme tests should be performed.
The provider 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.White blood cell levels and signs of infection B. Serum calcium levels and signs of hypocalcemia C. Hemoglobin, hematocrit, and red blood cell levels D. Level of consciousness and signs of acute delirium
B. 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.
Which question will the nurse in the endocrine clinic ask to help determine a patient's risk factors for goiter? A. "How much milk do you drink?" B. "What medications are you taking?" C. "Have you had a recent neck injury?" D. "Are your immunizations up to date?"
B. Medications that contain thyroid-inhibiting substances can cause goiter. Milk intake, neck injury, and immunization history are not risk factors for goiter.
A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. What topic should the nurse plan to teach the patient? A. Bisphosphonates to reduce bone demineralization B. Calcium supplements to normalize serum calcium levels C. Increasing fluid intake to decrease risk for nephrolithiasis D. Including whole grains in the diet to prevent constipation
B. Oral calcium supplements are used to maintain the serum calcium in normal range and prevent the complications of hypocalcemia. Whole grain foods decrease calcium absorption and will not be recommended. Bisphosphonates will lower serum calcium levels further by preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of hypoparathyroidism and low calcium levels.
Which patient statement indicates to the nurse that additional instruction is needed for a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH)? "A. I should weigh myself daily and report sudden weight loss or gain." B. "I need to shop for foods low in sodium and avoid adding salt to food." 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."
B. 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 information will the nurse include when teaching a 50-year-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. Somatropin is injected subcutaneously daily, 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.
What finding should the nurse plan to assess for in a patient diagnosed with a pheochromocytoma? a. Flushing b. Headache c. Bradycardia d. Hypoglycemia
B. 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.
A patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy. Which information about the patient is most important to communicate to the surgeon? A. Difficult to awaken. B. Increasing neck swelling. C. Reports 7/10 incisional pain. D. Cardiac rate 112 beats/min.
B. The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to prevent airway obstruction. The incisional pain should be treated but is not unusual after surgery. A heart rate of 112 beats/min is not unusual in a patient who has been hyperthyroid and has just arrived in the PACU from surgery. Sleepiness in the immediate postoperative period is expected.
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. 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.
Which nursing action will be included in the plan of care for a patient with Graves' disease who has exophthalmos? A. Place cold packs on the eyes to relieve pain and swelling. B. Elevate the head of the patient's bed to reduce periorbital fluid. C. Apply alternating eye patches to protect the corneas from irritation. D. Teach the patient to blink every few seconds to lubricate the corneas.
B. The patient should sit upright as much as possible to promote fluid drainage from the periorbital area. With exophthalmos, the patient is unable to close the eyes completely to blink. Lubrication of the eyes, rather than eye patches, will protect the eyes from developing corneal scarring. The swelling of the eye is not caused by excessive blood flow to the eye, so cold packs will not be helpful.
The patient in the emergency department after a car accident is wearing medical identification listing Addison's disease. What should the nurse expect to be included in the care of this patient? A. Low-sodium diet B. Increased glucocorticoid replacement C. Limiting IV fluid replacement therapy D. Withholding mineralocorticoid replacement
B. The patient with Addison's disease needs lifelong glucocorticoid and mineralocorticoid replacement and has an increased need with illness, injury, or stress, as this patient is experiencing. The patient with Addison's may need large volumes of IV fluid replacement and a high-sodium diet. Withholding mineralocorticoid replacement cannot be done for patients with Addison's disease.
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. 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.
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. Plan for emergency tracheostomy. B. Administer IV calcium gluconate. C. Prepare for endotracheal intubation. D. Begin thyroid hormone replacement.
B. 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. Thyroid hormone replacement may be needed eventually but will not improve the symptoms of hypocalcemia.
A 56-year-old patient who is disoriented and reports a headache and muscle cramps is hospitalized with syndrome of inappropriate antidiuretic hormone (SIADH). Which initial laboratory result should the nurse expect? A. Elevated hematocrit B. Decreased serum sodium C. Increased serum chloride D. Low urine specific gravity
B. When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient. The hematocrit will decrease because of the dilution caused by water retention. Urine will be more concentrated with a higher specific gravity. The serum chloride level will usually decrease along with the sodium level.
A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving. Discharge is expected to occur in 2 days. Which teaching strategy is likely to result in effective patient self-management at home? A. Delay teaching until closer to discharge date. B. Provide written reminders of information taught. C. Offer multiple options for management of therapies. D. Ensure privacy for teaching by asking the family to leave.
B. Written instructions will be helpful to the patient because initially the hypothyroid patient may be unable to remember to take medications and other aspects of self-care. Because the treatment regimen is complex, teaching should be started well before discharge. Family members or friends should be included in teaching because the hypothyroid patient is likely to forget some aspects of the treatment plan. A simpler regimen will be easier to understand until the patient is euthyroid.
The nurse is caring for a patient following an adrenalectomy. What is the highest priority in the immediate postoperative period? A. Protecting the patient's skin B. Monitoring for signs of infection C. Balancing fluids and electrolytes D. Preventing emotional disturbances
C. After adrenalectomy, the patient is at risk for circulatory instability caused by fluctuating hormone levels, and the focus of care is to assess and maintain fluid and electrolyte status through the use of IV fluids and corticosteroids. The other goals are also important for the patient but are not as immediately life threatening as the circulatory collapse that can occur with fluid and electrolyte disturbances.
A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first? A. Observe the dressing for bleeding. B. Check the blood pressure and pulse. C. Assess the patient's respiratory effort. D. Support the patient's head with pillows.
C. Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany. The priority nursing action is to assess the airway. The other actions are also part of the standard nursing care postthyroidectomy but are not as high of a priority.
What topic should the nurse teach a patient who had a pituitary adenoma after the hypophysectomy? 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. 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.
An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism is to A. monitor blood glucose levels B. restrict fluid and sodium intake C. administer potassium-sparing diuretics D. advise the patient to make postural changes slowly
C. Before surgery, patients should be treated with potassium-sparing diuretics (spironolactone, eplerenone) to normalize serum potassium levels. Spironolactone and eplerenone block the binding of aldosterone to the mineralocorticoid receptor in the terminal distal tubules and collecting ducts of the kidney. This increases sodium excretion, water excretion, and potassium retention. Oral potassium supplements may be needed.
What should be included in the interprofessional plan of care for a patient with Cushing disease? A. Lab monitoring for hyperkalemia B. Vital sign monitoring for hypotension C. Counseling related to body image changes D. Diet consultation to determine low protein choices
C. Elevated corticosteroid levels can cause body changes, including truncal obesity, moon face, and hirsutism in women and gynecomastia in men. Counseling and support should be offered because of the changes in body image. Hypokalemia and hypertension are consistent with Cushing disease. Sodium restriction and potassium supplementation are indicated. High-protein choices are necessary to counteract catabolic processes and assist with wound healing.
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 glomerular filtration rate
C. Excess ADH increases the permeability of the renal distal tubule and collecting ducts, which leads to the reabsorption of water into the circulation. Thus, 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. At first, the patient has thirst, dyspnea on exertion, and fatigue. Patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) have 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 2 Copyright © 2020 by Elsevier, Inc. All rights reserved. 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.
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. Medications used to block the synthesis of thyroid hormones may take 2 to 3 months before the full effect is seen. Large doses of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large muscle groups is encouraged to decrease the irritability and hyperactivity associated with high levels of thyroid hormones. Radioactive iodine is the most common treatment for Graves' disease, although surgery may be used.
Which problem should the nurse anticipate for a patient admitted to the hospital with diabetes insipidus? A. Generalized edema B. Fluid volume overload C. Disturbed sleep pattern D. Decreased gas exchange
C. Nocturia occurs because of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.
A patient is being admitted with a diagnosis of Cushing syndrome. Which finding will the nurse expect during the assessment? A. Chronically low blood pressure B. Bronzed appearance of the skin C. Purplish streaks on the abdomen D. Decreased axillary and pubic hair
C. Purplish-red striae on the abdomen are a common clinical manifestation of Cushing syndrome. Hypotension and bronzed-appearing skin are manifestations of Addison's disease. Decreased axillary and pubic hair occur with androgen deficiency.
Which intervention will the nurse include in the plan of care for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)? A. Encourage fluids to 2 to 3 L/day. B. Monitor for increasing peripheral edema. C. Offer the patient hard candies to suck on. D. Keep head of bed elevated to 30 degrees.
C. Sucking on hard candies decreases thirst for a patient on fluid restriction. Patients with SIADH are on fluid restrictions of 800 to 1000 mL/day. Peripheral edema is not seen with SIADH. The head of the bed is elevated no more than 10 degrees to increase left atrial filling pressure and decrease antidiuretic hormone (ADH) release.
Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider? A. Patient's blood pressure is 148/94 mm Hg. B. Patient has bilateral 2+ pitting ankle edema. C. Patient stopped taking the medication 2 days ago. D. Patient has not been taking the prescribed vitamin D.
C. Sudden cessation of corticosteroids after taking the medication for a week or more can lead to adrenal insufficiency, with problems such as severe hypotension and hypoglycemia. The patient will need immediate evaluation by the health care provider to prevent or treat adrenal insufficiency. The other information will also be reported but does not require rapid treatment.
A patient who smokes reports having significant stress and has some eye problems. On assessment, the nurse notes exophthalmos. What additional abnormal findings should the nurse assess for? A. Muscle weakness and slow movements B. Puffy face, decreased sweating, and dry hair C. Systolic hypertension and increased heart rate D. Decreased appetite, increased thirst, and pallor
C. The manifestations are consistent with Graves' disease or hyperthyroidism. Systolic hypertension, increased heart rate, and increased thirst are associated with hyperthyroidism. Cigarette smoking places the patient at increased risk for Graves' disease. The inhaled cigarette toxins may absorb via the eye orbits, causing exophthalmos. A puffy face; decreased sweating; dry, coarse hair; muscle weakness and slow movements; decreased appetite; and pallor are all manifestations of hypothyroidism.
A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action will provide the patient with rapid temporary relief from the symptoms? A. Start the PRN O2 at 2 L/min per cannula. B. Administer the prescribed muscle relaxant. C. Have the patient rebreathe from a paper bag. D. Stretch the muscles with passive range of motion.
C. 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 assessment finding for an adult 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. The patient's temperature indicates that the patient may have thyrotoxic crisis and that interventions to lower the temperature are needed immediately. The other findings also require intervention but do not indicate potentially life-threatening complications.
A patient who has hyperthyroidism is treated with radioactive iodine (RAI). What information should the nurse include in discharge teaching? A. Take radioactive precautions with all body secretions. B. Symptoms of hyperthyroidism should be relieved in about a week. C. Symptoms of hypothyroidism will occur as the RAI therapy takes effect. D. Discontinue the antithyroid medications that were taken before the RAI therapy.
C. There is a high incidence of post radiation 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.
A patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. What should the nurse include in preoperative teaching? A. Cough and deep breathe every 2 hours postoperatively. B. Remain on bed rest for the first 48 hours postoperatively. C. Avoid brushing teeth for at least 10 days after the surgery. D. You will be positioned flat with a cervical collar after surgery.
C. 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. A cervical collar is not needed.
An 82-year-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. Worsening of mental status and myxedema coma can be precipitated using 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.
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 pounds. 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. 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.
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 may indicate increased intracranial pressure, which will require rapid actions for diagnosis and treatment. Changes in the visual field, elevated blood glucose, and galactorrhea are common with pituitary adenoma, but these do not require rapid action to prevent life-threatening complications.
After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops A. muscle weakness and weight loss B. Hyperthermia and severe tachycardia C. Hypertension and difficulty swallowing D. Laryngospasms and tingling in the hands and feet.
D. Painful tonic spasms of smooth and skeletal muscles can cause laryngospasms that may compromise breathing. These spasms may be related to tetany, which occurs if the parathyroid glands are removed or damaged during surgery, which leads to hypocalcemia.
A patient with a severe pounding headache has been diagnosed with hypertension. However, the hypertension is not responding to traditional treatment. What should the nurse expect as the next step in determining a diagnosis for this patient? A. Administration of β-blocker medications B. Abdominal palpation to search for a tumor C. Administration of potassium-sparing diuretics D. A 24-hour urine collection for fractionated metanephrines
D. Pheochromocytoma should be suspected when hypertension does not respond to traditional treatment. The 24-hour urine collection for fractionated metanephrines is simple and reliable with elevated values in 95% of people with pheochromocytoma. In a patient with pheochromocytoma, an α-adrenergic receptor blocker is used preoperatively to reduce blood pressure. Abdominal palpation is avoided to avoid a sudden release of catecholamines and severe hypertension. Potassium-sparing diuretics are not needed. Most likely they would be used for hyperaldosteronism, which is another cause of hypertension.
Which assessment finding in a 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 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.
A 44-year-old female patient with Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be helpful for the patient problem of disturbed body image related to changes in appearance? A. Reassure the patient that the physical changes are very common in patients with Cushing syndrome. B. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome. C. Teach the patient that the metabolic impact of Cushing syndrome is of more importance than appearance. D.Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery.
D. The most reassuring and accurate communication to the patient is that the physical and emotional changes caused by the Cushing syndrome will resolve after hormone levels return to normal postoperatively. Reassurance that the physical changes are expected or that there are more serious physiologic problems associated with Cushing syndrome minimize the patient's concerns. The patient's physiological changes are caused by the high hormone levels, not by the patient's diet or exercise choices.
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. 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.
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. β-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.
A black woman with a history of breast cancer has panhypopituitarism from radiation therapy for a primary pituitary tumor. Which medications should the nurse teach her about needing for the rest of her life (select all that apply)? a. Cortisol b. Vasopressin c. Sex hormones d. Levothyroxine (Synthroid) e. Growth hormone (somatropin [Omnitrope]) f. Dopamine agonists (bromocriptine [Parlodel])
a, b, d, e. With panhypopituitarism, lifetime hormone replacement is needed for cortisol, vasopressin, thyroid, and GH. Sex hormones will not be replaced. Her GH will be monitored closely because of the patient's history of breast cancer. Dopamine agonists will not be used because they reduce secretion of GH, which has already been achieved with the radiation.
A patient has been diagnosed with hypoparathyroidism. What manifestations should the nurse expect to observe (select all that apply)? a. Skeletal pain b. Dysrhythmias c. Dry, scaly skin d. Personality changes e. Abdominal cramping f. Muscle spasms and stiffness
a, c, d, e, f. In hypoparathyroidism, the patient has inadequate circulating parathyroid hormone (PTH) that leads to hypocalcemia from the inability to maintain serum calcium levels. With hypocalcemia, there is muscle stiffness and spasms, which can lead to dysrhythmias and abdominal cramps. There can be personality and visual changes and dry, scaly skin.
As a precaution for vocal cord paralysis from damage to the superior laryngeal nerve during thyroidectomy surgery, what is the most important equipment to have in the room in case it is needed for this emergency situation? a. Tracheostomy tray b. Oxygen equipment c. IV calcium gluconate d. Paper and pencil for communication
a. A tracheostomy tray must be in the room to use if the emergency situation of vocal cord paralysis occurs from recurrent or superior laryngeal nerve damage or for laryngeal stridor from tetany. The oxygen equipment may be useful but will not improve oxygenation with vocal cord paralysis without a tracheostomy. IV calcium salts will be used if hypocalcemia occurs from parathyroid damage. The paper and pencil for communication may be helpful, especially if a tracheostomy is done, but will not aid in emergency oxygenation of the patient.
A patient with acromegaly is treated with a transsphenoidal hypophysectomy. What should the nurse do postoperatively? a. Ensure that any clear nasal drainage is tested for glucose and protein. b. Maintain the patient flat in bed to prevent cerebrospinal fluid (CSF) leakage. c. Aid the patient with tooth brushing every 4 hours to keep the surgical area clean. d. Encourage deep breathing, coughing, and turning to prevent respiratory complications.
a. A transsphenoidal hypophysectomy involves entry into the sella turcica through an incision in the upper lip and gingiva into the floor of the nose and the sphenoid sinuses. Clear nasal drainage with glucose and protein content indicates cerebrospinal fluid (CSF) leakage from an open connection to the brain, putting the patient at risk for meningitis. After surgery, the patient is positioned with the head elevated to avoid pressure on the sella turcica. Although mouth care is required every 4 hours, toothbrushing should not be done because injury to the suture line may occur. Coughing and straining are avoided to prevent increased intracranial pressure and CSF leakage.
Which statement accurately describes Graves' disease? a. Exophthalmos occurs in Graves' disease. b. It is an uncommon form of hyperthyroidism. c. Manifestations of hyperthyroidism occur from tissue desensitization to the sympathetic nervous system. d. Diagnostic testing in the patient with Graves' disease will reveal an increased thyroid-stimulating hormone (TSH) level.
a. Exophthalmos or protrusion of the eyeballs may occur in Graves' disease from increased fat deposits and fluid in the orbital tissues and ocular muscles, forcing the eyeballs outward. Graves' disease is the most common form of hyperthyroidism. Increased metabolic rate and sensitivity of the sympathetic nervous system lead to the manifestations. Thyroid-stimulating hormone (TSH) level is decreased in Graves' disease.
A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, what should the nurse expect to find? a. Hypertension, peripheral edema, and petechiae b. Weight loss, buffalo hump, and moon face with acne c. Abdominal and buttock striae, truncal obesity, and hypotension d. Anorexia, signs of dehydration, and hyperpigmentation of the skin
a. The effects of adrenocorticotropic hormone (ACTH) excess, especially glucocorticoid excess, include weight gain from accumulation and redistribution of adipose tissue, sodium and water retention, glucose intolerance, protein wasting, loss of bone structure, loss of collagen, and capillary fragility leading to petechiae. Manifestations of adrenocortical hormone deficiency include hypotension, dehydration, weight loss, and hyperpigmentation of the skin.
During care of the patient with SIADH, what should the nurse do? a. Monitor neurologic status at least every 2 hours. b. Teach the patient receiving diuretic therapy to restrict sodium intake. c. Keep the head of the bed elevated to prevent antidiuretic hormone (ADH) release. d. Notify the health care provider (HCP) if the patient's BP decreases more than 20 mm Hg from baseline.
a. The patient with syndrome of inappropriate antidiuretic hormone (SIADH) has marked dilutional hyponatremia and should be monitored for decreased neurologic function and seizures every 2 hours. Sodium intake is supplemented because of the hyponatremia and sodium loss caused by diuretics. ADH release is reduced by keeping the head of the bed flat to increase left atrial filling pressure. A reduction in BP indicates a reduction in total fluid volume and is an expected outcome of treatment.
What preoperative instruction should the nurse give to the patient scheduled for a subtotal thyroidectomy? a. How to support the head with the hands when turning in bed b. Coughing should be avoided to prevent pressure on the incision c. Head and neck will have to remain immobile until the incision heals d. Any tingling around the lips or in the fingers after surgery is expected and temporary
a. To prevent strain on the suture line after surgery, the patient's head must be manually supported while turning and moving in bed. Range-of- motion exercises for the head and neck are taught preoperatively to be gradually implemented after surgery. There is no contraindication for coughing and deep breathing. These should be carried out after surgery. Tingling around the lips or fingers is a sign of hypocalcemia, which may occur if the parathyroid glands were inadvertently removed during surgery. This sign should be reported at once.
Which characteristics most accurately describe the use of RAI (select all that apply)? a. Decreases release of thyroid hormones b. Often causes hypothyroidism over time c. Blocks peripheral conversion of T4 to T3 d. Treatment of choice in nonpregnant adults e. Often used with iodine to produce euthyroid before surgery f. Decreases thyroid hormone secretion by damaging thyroid gland
b, d, f. RAI causes hypothyroidism over time by damaging thyroid tissue. This decreases thyroid hormone secretion and is the treatment of choice for nonpregnant adults. Potassium iodine decreases the release of thyroid hormones and the size of the thyroid gland before surgery. Propylthiouracil blocks peripheral conversion of T4 to T3 and may be used with iodine to produce a euthyroid state before surgery.
What is an appropriate nursing intervention for the patient with hyperparathyroidism? a. Pad side rails as a seizure precaution. b. Increase fluid intake to 3000 to 4000 mL daily. c. Maintain bed rest to prevent pathologic fractures. d. Monitor the patient for Trousseau's and Chvostek's signs.
b. A high fluid intake is indicated in hyperparathyroidism to dilute the hypercalcemia and flush the kidneys so that calcium stone formation is reduced. Seizures are not associated with hyperparathyroidism. The patient with hyperparathyroidism is at risk for pathologic fractures resulting from decreased bone density, but mobility is encouraged to promote bone calcification. Impending tetany of hypoparathyroidism after parathyroidectomy can be noted with Trousseau's and Chvostek's signs.
During discharge teaching for the patient with Addison's disease, which patient statement indicates the need for further teaching? a. "I should always call the doctor if I develop vomiting or diarrhea." b. "If my weight goes down, my dosage of steroid is probably too high." c. "I should double or triple my steroid dose if I undergo rigorous physical exercise." d. "I need to carry an emergency kit with injectable hydrocortisone in case I can't take my medication by mouth."
b. A weight reduction in the patient with Addison's disease may indicate a fluid loss and a dose of replacement therapy that is too low rather than too high. Because vomiting and diarrhea are early signs of crisis and because fluid and electrolytes must be replaced, patients should notify their HCP if these symptoms occur. Patients with Addison's disease are taught to take 2 to 3 times their usual dose of steroids if they become ill, have teeth extracted, or engage in rigorous physical activity and should always have injectable hydrocortisone available if oral doses cannot be taken.
A patient with hypothyroidism is treated with levothyroxine (Synthroid). What should the nurse include when teaching the patient about this therapy? a. Explain that alternate-day dosage may be used if side effects occur. b. Provide written instruction for all information related to the drug therapy. c. Tell the patient that the drug must be taken until the hormone balance is reestablished. d. Assure the patient that a return to normal function will occur with replacement therapy.
b. Because of the mental sluggishness, inattentiveness, and memory loss that occur with hypothyroidism, it is important to provide written instructions and repeat information when teaching the patient. Replacement therapy must be taken for life and alternate-day dosing is not therapeutic. Although most patients return to a normal state with treatment, cardiovascular conditions and psychoses may persist.
The nurse has identified the nursing diagnosis of fatigue for a patient with hypothyroidism. What should the nurse do while caring for this patient? a. Assess for changes in orientation, cognition, and behavior. b. Monitor for vital signs and cardiac rhythm response to activity. c. Monitor bowel movement frequency, consistency, shape, volume, and color. d. Help in developing well-balanced meal plans consistent with energy expenditure level.
b. Cardiorespiratory response to activity is important to monitor in this patient to determine the effect of activities and plan activity increases. Monitoring changes in orientation, cognition, and behavior are interventions for impaired memory. Monitoring bowels is needed to plan care for the patient with constipation. Assisting with meal planning will help the patient lose weight if needed.
When caring for a patient with primary hyperaldosteronism, the nurse would question an HCP's prescription for which drug? a. Ketoconazole b. Furosemide (Lasix) c. Eplerenone (Inspra) d. Spironolactone (Aldactone)
b. Hyperaldosteronism is an excess of aldosterone, which is manifested by sodium and water retention and potassium excretion. Furosemide is a potassium-wasting diuretic that would increase the potassium deficiency. Ketoconazole decreases adrenal corticosteroid secretion. Eplerenone and spironolactone are potassium-sparing diuretics.
When caring for a patient with nephrogenic diabetes insipidus, what should the nurse expect the treatment to include? a. Fluid restriction b. Thiazide diuretics c. A high-sodium diet d. Metformin (Glucophage)
b. In nephrogenic DI, the kidney is unable to respond to ADH, so vasopressin or hormone analogs are not effective. Thiazide diuretics may reduce flow to the ADH-sensitive distal nephrons and produce a decrease in urine output. Fluids are not restricted because the patient could easily become dehydrated. Low-sodium diets (< 3 g/day) are also thought to decrease urine output. An antidiabetic drug is not needed.
What is the priority nursing intervention during the management of the patient with pheochromocytoma? a. Administering IV fluids b. Monitoring BP c. Administering β-adrenergic blockers d. Monitoring intake and output and daily weights
b. Pheochromocytoma is a catecholamine-producing tumor of the adrenal medulla, which may cause severe, episodic hypertension and severe, pounding headache; tachycardia; and profuse sweating. Monitoring for a dangerously high BP before and after surgery is critical, as is monitoring for BP fluctuations during medical and surgical treatment.
When the patient with parathyroid disease has symptoms of hypocalcemia, what is a measure that can be used to temporarily raise serum calcium levels? a. Administer IV normal saline. b. Have patient rebreathe in a paper bag. c. Administer oral phosphorus supplements. d. Administer furosemide (Lasix) as ordered.
b. Rebreathing in a paper bag promotes carbon dioxide retention in the blood, which lowers pH and creates an acidosis. An acidemia enhances the solubility and ionization of calcium, increasing the proportion of total body calcium available in physiologically active form and relieving the symptoms of hypocalcemia. Saline promotes calcium excretion, as does furosemide. Phosphate levels in the blood are reciprocal to calcium and an increase in phosphate promotes calcium excretion.
A patient with SIADH is treated with water restriction. Which findings would indicate that treatment has been effective? a. Increased urine output, decreased serum sodium, and increased urine specific gravity b. Increased urine output, increased serum sodium, and decreased urine specific gravity c. Decreased urine output, increased serum sodium, and decreased urine specific gravity d. Decreased urine output, decreased serum sodium, and increased urine specific gravity
b. The patient with SIADH has water retention with hyponatremia, decreased urine output, and concentrated urine with high specific gravity. Improvement in the patient's condition is reflected by increased urine output, normalization of serum sodium, and more water in the urine, thus decreasing the specific gravity.
A patient with Addison's disease comes to the ED with reports of nausea, vomiting, diarrhea, and fever. What interprofessional care should the nurse expect? a. IV administration of vasopressors b. IV administration of hydrocortisone c. IV administration of D5W with 20 mEq KCl d. Parenteral injections of adrenocorticotropic hormone (ACTH)
b. Vomiting and diarrhea are early indicators of Addisonian crisis. Fever indicates an infection, which is causing added stress for the patient. Treatment of a crisis requires immediate IV hydrocortisone replacement. Large volumes of 0.9% saline and 5% dextrose fluids are given to reverse hypotension and electrolyte imbalances until BP returns to normal. Addison's disease is a primary insufficiency of the adrenal gland and ACTH is not effective, nor would vasopressors be effective with the fluid deficiency of Addison's disease. Potassium levels are increased in Addison's disease and KCl would be contraindicated.
The patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What manifestation should the nurse expect to find? a. Decreased body weight b. Decreased urinary output c. Increased plasma osmolality d. Increased serum sodium levels
b. With increased antidiuretic hormone (ADH), the permeability of the renal distal tubules is increased, so water is reabsorbed into circulation. Decreased output of concentrated urine with increased urine osmolality and specific gravity occur. In addition, fluid retention with weight gain, serum hypoosmolality, dilutional hyponatremia, and hypochloremia occur.
A patient is admitted to the hospital with acute thyrotoxicosis. On physical assessment of the patient, what should the nurse expect to find? a. Hoarseness and laryngeal stridor b. Bulging eyeballs and dysrhythmias c. Increased temperature and signs of heart failure d. Lethargy progressing suddenly to impaired consciousness
c. A thyroid storm results in marked manifestations of hyperthyroidism. Severe tachycardia, heart failure, shock, hyperthermia, agitation delirium, seizures, abdominal pain, vomiting, diarrhea, and coma occur. Although exophthalmos may be present in the patient with Graves' disease, it is not a significant factor in thyrotoxic crisis. Hoarseness and laryngeal stridor are characteristic of the tetany of hypoparathyroidism and lethargy progressing to coma is characteristic of myxedema coma, a complication of hypothyroidism.
A patient who is on corticosteroid therapy for treatment of an autoimmune disorder has the following drugs ordered. Which one is used to prevent corticosteroid-induced osteoporosis? a. Potassium b. Furosemide (Lasix) c. Alendronate (Fosamax) d. Pantoprazole (Protonix)
c. Alendronate (Fosamax) is used to prevent corticosteroid-induced osteoporosis. Potassium is used to prevent the mineralocorticoid effect of hypokalemia. Furosemide (Lasix) is used to decrease sodium and fluid retention from the mineralocorticoid effect. Pantoprazole (Protonix) is used to prevent gastrointestinal (GI) irritation from an increase in secretion of pepsin and hydrochloric acid. 36. c. Taking corticosteroids on an alternate-day schedule for pharmacologic purposes is less likely to suppress ACTH production from the pituitary and prevent adrenal atrophy. This method is not used when corticosteroids are given as hormone therapy. Normal adrenal hormone balance is not maintained nor is it more effective.
A patient is scheduled for a bilateral adrenalectomy. During the postoperative period, what should the nurse expect related to the administration of corticosteroids? a. Reduced to promote wound healing b. Withheld until symptoms of hypocortisolism appear c. Increased to promote an adequate response to the stress of surgery d. Reduced with excessive hormone release during surgical manipulation of adrenal glands
c. Although the patient with Cushing syndrome has excess corticosteroids, removing the glands and the stress of surgery require that high doses of corticosteroids (cortisone) be given after surgery for several days before weaning the dose. The nurse should monitor the patient's vital signs to detect whether large amounts of hormones were released during surgical manipulation, obtain morning urine specimens for cortisol measurement to evaluate the effectiveness of the surgery, and provide dressing changes with aseptic technique to avoid infection as usual inflammatory responses are suppressed.
A patient with diabetes insipidus is treated with nasal desmopressin acetate (DDAVP). The nurse determines that the drug is not having an adequate therapeutic effect when the patient experiences a. headache and weight gain. b. nasal irritation and nausea. c. a urine specific gravity of 1.002. d. an oral intake greater than urinary output.
c. Normal urine specific gravity is 1.005 to 1.030. A urine with a specific gravity of 1.002 is very dilute, indicating that there continues to be excessive loss of water and that treatment of DI is inadequate. Headache, weight gain, and oral intake greater than urinary output are signs of volume excess that occur with overmedication. Nasal irritation and nausea may also indicate overdosage.
A patient with mild iatrogenic Cushing syndrome is on an alternate-day regimen of corticosteroid therapy. What does the nurse explain to the patient about this regimen? a. It maintains normal adrenal hormone balance. b. It prevents ACTH release from the pituitary gland. c. It minimizes hypothalamic-pituitary-adrenal suppression. d. It provides a more effective therapeutic effect of the drug.
c. Taking corticosteroids on an alternate-day schedule for pharmacologic purposes is less likely to suppress ACTH production from the pituitary and prevent adrenal atrophy. This method is not used when corticosteroids are given as hormone therapy. Normal adrenal hormone balance is not maintained nor is it more effective.
A patient with hypoparathyroidism from surgical treatment of hyperparathyroidism is preparing for discharge. What should the nurse teach the patient? a. Milk and milk products should be increased in the diet. b. Parenteral replacement of parathyroid hormone will be needed for life. c. Calcium supplements with vitamin D can effectively maintain calcium balance. d. Bran and whole-grain foods should be used to prevent gastrointestinal (GI) effects of replacement therapy
c. The hypocalcemia that results from PTH deficiency is controlled with calcium and vitamin D supplementation and possibly oral phosphate binders. Replacement with PTH is not used because of antibody formation to PTH, the need for parenteral administration, and cost. Milk products, although good sources of calcium, have high levels of phosphate, which reduce calcium absorption. Whole grains and foods containing oxalic acid impair calcium absorption.
During assessment of the patient with acromegaly, what should the nurse expect the patient to report? a. Infertility b. Dry, irritated skin c. Undesirable changes in appearance d. An increase in height of 2 to 3 inches a year
c. The increased production of GH in acromegaly causes an increase in thickness and width of bones and enlargement of soft tissues, resulting in marked changes in facial features, feet, and head; oily and coarse skin; and speech difficulties. Infertility is not a common finding because GH is usually the only pituitary hormone involved in acromegaly. Height is not increased in adults with GH excess because the epiphyses of the bones are closed.
What medication is given in thyrotoxicosis to block the effects of the sympathetic nervous stimulation of the thyroid hormones? a. Potassium iodine b. Propylthiouracil c. Propranolol (Inderal) d. Radioactive iodine (RAI)
c. The β-adrenergic blocker propranolol is usually used to block the sympathetic nervous system stimulation by thyroid hormones. Atenolol would be used with asthma or heart disease. Potassium iodine is used to prepare the patient for thyroidectomy or for treatment of thyrotoxic crisis to inhibit the synthesis of thyroid hormones. Propylthiouracil, an antithyroid medication, inhibits the synthesis of thyroid hormones. Radioactive iodine (RAI) therapy destroys thyroid tissue, which limits thyroid hormone secretion.
A patient suspected of having acromegaly has an increased plasma growth hormone (GH) level. In acromegaly, what would the nurse expect the patient's diagnostic results to show? a. Hyperinsulinemia b. Plasma glucose of less than 70 mg/dL (3.9 mmol/L) c. Decreased GH levels with an oral glucose challenge test d. Increased levels of plasma insulin-like growth factor-1 (IGF-1)
d. A normal response to growth hormone (GH) secretion is stimulation of the liver to produce insulin-like growth factor-1 (IGF-1). In acromegaly, there are increased levels of IGF-1. When both GH and IGF- 1 levels are increased, overproduction of GH is confirmed. GH also causes elevation of blood glucose and normally GH levels fall during an oral glucose challenge but not in acromegaly.
10. In a patient with central diabetes insipidus, what is the expected outcome of administering ADH during a water deprivation test? a. Decrease in body weight b. Increase in urinary output c. Decrease in blood pressure d. Increase in urine osmolality
d. A patient with central DI has a deficiency of ADH with excessive loss of water from the kidney, hypovolemia, hypernatremia, and dilute urine with a low specific gravity. When desmopressin acetate (DDAVP) is administered, the symptoms are reversed, with water retention, decreased urinary output that increases urine osmolality, and an increase in BP.
When replacement therapy is started for a patient with long- standing hypothyroidism, what is most important for the nurse to monitor for in the patient? a. Insomnia b. Weight loss c. Nervousness d. Dysrhythmias
d. All these manifestations may occur with treatment of hypothyroidism. However, because of the effects of hypothyroidism on the cardiovascular system, when thyroid replacement therapy is started, myocardial oxygen consumption is increased, and the resultant oxygen demand may cause angina, dysrhythmias, and heart failure. So, monitoring for dysrhythmias is most important.
What assessment findings are common in a patient with a prolactinoma? a. Gynecomastia in men b. Profuse menstruation in women c. Excess follicle-stimulating hormone (FSH) and luteinizing hormone (LH) d. Signs of increased intracranial pressure, including headache, nausea, and vomiting
d. Compression of the optic chiasm can cause visual problems as well as signs of increased intracranial pressure, including headache, nausea, and vomiting. About 30% of prolactinomas will have excess prolactin secretion with manifestations of impotence in men, galactorrhea or amenorrhea in women without relationship to pregnancy, and decreased libido in both men and women. There is decreased follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
What is a cause of primary hypothyroidism in adults? a. Malignant or benign thyroid nodules b. Surgical removal or failure of the pituitary gland c. Surgical removal or radiation of the thyroid gland d. Autoimmune-induced atrophy of the thyroid gland
d. In America, atrophy from Graves' disease or Hashimoto's thyroiditis are autoimmune disorders that eventually destroy the thyroid gland, leading to primary hypothyroidism. Worldwide, iodine deficiency is the most common cause. Thyroid tumors most often result in hyperthyroidism. Secondary hypothyroidism occurs because of pituitary failure. Iatrogenic hypothyroidism results from thyroidectomy or radiation of the thyroid gland.
A patient with Graves' disease asks the nurse what caused the disorder. What is the best response by the nurse? a. "The cause of Graves' disease is not known, although it is thought to be genetic." b. "It is usually associated with goiter formation from an iodine deficiency over a long period." c. "Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones." d. "In genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion."
d. In Graves' disease, antibodies to the TSH receptor are formed, attach to the receptors, and stimulate the thyroid gland to release triiodothyronine (T3), thyroxine (T4), or both, creating hyperthyroidism. The disease is not directly genetic, but persons appear to have a genetic susceptibility to develop autoimmune antibodies. Goiter formation from insufficient iodine intake is usually associated with hypothyroidism.
What characteristic is related to Hashimoto's thyroiditis? a. Enlarged thyroid gland b. Viral-induced hyperthyroidism c. Bacterial or fungal infection of thyroid gland d. Chronic autoimmune thyroiditis with antibody destruction of thyroid tissue
d. In Hashimoto's thyroiditis, thyroid tissue is destroyed by autoimmune antibodies. An enlarged thyroid gland is a goiter. Viral- induced hyperthyroidism is subacute granulomatous thyroiditis. Acute thyroiditis is caused by bacterial or fungal infection.
The patient with diabetes insipidus is brought to the emergency department (ED) with confusion and dehydration after excretion of a large volume of urine today even though several liters of fluid were consumed. What is a diagnostic test that the nurse should expect to be done first to help make a diagnosis? a. Blood glucose b. Serum sodium level c. CT scan of the head d. Water deprivation test
d. Patients with diabetes insipidus (DI) excrete large amounts of urine with a specific gravity of <1.005. A blood glucose may be tested if acetone breath is present to diagnose diabetes, but that is not mentioned in this situation. The serum sodium level is expected to be low with DI but is not diagnostic. To diagnose central DI, a water deprivation test is needed.
A patient who recently had a calcium oxalate renal stone had a bone density study, which showed a decrease in her bone density. What endocrine problem could this patient have? a. SIADH b. Hypothyroidism c. Cushing syndrome d. Hyperparathyroidism
d. The patient with hyperparathyroidism may have calcium stones, skeletal pain, decreased bone density, psychomotor retardation, or dysrhythmias among other manifestations. The other endocrine problems would not be related to calcium kidney stones or decreased bone density.
When providing discharge instructions to a patient who had a subtotal thyroidectomy for hyperthyroidism, what should the nurse teach the patient? a. Never miss a daily dose of thyroid replacement therapy. b. Avoid regular exercise until thyroid function is normalized. c. Use warm saltwater gargles several times a day to relieve throat pain. d. Substantially reduce caloric intake compared to what was eaten before surgery.
d. With the decrease in thyroid hormone after surgery, calories must be reduced to prevent weight gain. When a patient has had a subtotal thyroidectomy, thyroid replacement therapy is not given because exogenous hormone inhibits pituitary production of TSH and delays or prevents the restoration of thyroid tissue regeneration. Regular exercise stimulates the thyroid gland and is encouraged. Saltwater gargles are used for dryness and irritation of the mouth and throat after radioactive iodine therapy.