Patho/Pharm Exam 2
As the nurse educating the patient about Grave's Disease, which of the following statements by the patient ensures the patient understood the education about their condition?
"Grave's disease is due to an excessive amount of thyroid hormone in the body"
A patient is being educated on how to take their anti-thyroid medication. Which of the following statements are INCORRECT?
"I will continue taking aspirin daily"
Which of the following patients are most at risk for developing myxedema coma?
75 year old client taking Lithium and reports missing several doses of levothyroxine
A patient is receiving treatment for myxedema coma with IV levothyroxine. Which of the following findings would require nursing intervention for this patient?
A physician order for Fentanyl 0.25 mcg every 2 hours for pain
A male client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which of the following glands?
Adrenal cortex
A female client with Cushing's syndrome is admitted to the med/surg unit. During admission assessment, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem?
Depression
When instructing a client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of which of the following?
Encouraging fluids Helps prevent renal calculi
Common adverse effects of calcitonin include
Flushing of the face an hands
Which condition benefits from antihypercalcemic agents?
Hyperparathyroidism
Which of the following is not a typical sign and symptom of Cushing's syndrome?
Hyperpigmentation of the skin
Which is the most common type of thyroid dysfunction?
Hypothyroidism
A patient recovering from myxedema coma and being discharged tomorrow. What should be included in their discharge teaching?
Importance of taking levothyroxine in the morning without any food
Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications? a. Tetanic contractions b. Neck vein distention c. Weight loss d. Polyuria
Neck vein distention
A female adult client with a history of chronic hyperparathyroidism admits to being non-compliant. 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?
Related to bone demineralization resulting in pathologic fractures
The principle objective of medical management is to
Replace the missing hormone
In a 29 year old client who is being treated for Cushing's syndrome, the nurse would expect a decline in:
Serum glucose level
A nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?
Tetany
Nursing goals for Addison's disease
adequate fluid volume and electrolyte balance optimized nutritional status adequate cardiac output
The nursing care plan for a client receiving epoetin alfa should include careful monitoring for symptoms of
angina, or change in LOC
A patient with Addison's disease should consume which of the following diets?
high protein, carbs, and adequate sodium
In Cushing's disease what secretes too much ACTH that causes the increase in cortisol production?
pituitary gland
Glucocorticoids are hormones that
promote the preservation of energy through increased glucose levels, protein breakdown, and fat formation
The nurse would question the prescription for epoetin alfa in a client with which condition?
uncontrolled hypertension
When caring for a male client with diabetes insipidus, the nurse would expect to administer?
vasopressin
A patient is started on Methimazole for treatment of Grave's disease. Which statement by the patient indicates they understood your teaching about this medication?
"I know it may take a while before I feel relief of symptoms, therefore, I will never abruptly stop taking my medication"
The nurse is assessing a client who has been taking levothyroxine for two months for hypothyroidism. Which client statements should the nurse report? Select all that apply.
"I take my levothyroxine each morning with my coffee or a full glass of grapefruit juice" "Each morning I take levothyroxine, biotin, and a multivitamin"
A patient with Addison's disease is being discharged home on Prednisone. Which of the following statements by the patient warrants you to re-educate the patient?
"I will take this medication as needed when symptoms present"
You are performing discharge teaching with a patient who is going home on Synthroid. Which statement by the patient causes you to re-educate the patient about this medication?
"I will take this medication at bedtime with a snack"
After providing drug education to a client prescribed levothyroxine for a diagnosis of hypothyroidism, which statement indicates to the nurse that additional drug teaching is needed?
"Over-the-counter drugs are not contraindicated with this drug"
A client taking an increased dose of levothyroxine for hypothyroidism reports feelings of sadness and depression. Which response should the nurse make?
"Symptoms are likely related to low levels of hormone and should improve with the change in the amount of the medication"
While providing education to the client diagnosed with hypothyroidism, what priority education point will the registered nurse stress to the client?
"Take your thyroid medications exactly as prescribed"
A client with primary diabetes insipidus is ready for discharge on desmopressin. Which instruction should the nurse provide?
"You may not be able to use desmopressin nasally if you have nasal discharge or blockage"
During preoperative teaching for a female client who will undergo subtotal thyroidectomy, the nurse should include which statement?
"You must avoid hyperextending your neck after surgery"
A patient is admitted to the ER. The patient is unconscious on arrival. However, the patient's family is with the patient and reports that before the patient became unconscious she was complaining of severe pain in the abdomen, legs, and back, and has been experiencing worsening confusion. In addition, they also report the patient has not been taking any medications. The patient was recently discharged from the hospital for treatment of low cortisol and aldosterone levels. On assessment, you note the patient's blood pressure is 70/45. What disorder is this patient most likely experiencing and what medication is expected to be started?
Addisonian crisis and IV Solu-Cortef
An older adult client who is diagnosed with hypothyroidism is admitted to the hospital due to acute confusion. The client's current vital signs are as follows: temperature: 95 F (35 C); blood pressure: 88/48 mm Hg; heart rate: 50 beats/min; respirations: 10 breaths/min; and SaO2: 84% on room air (RA). Which is the priority action by the nurse in the provision of care for this client?
Alert respiratory of the need for endotracheal (ET) intubation
A positive diagnosis of Cushing's syndrome is associated with: A. The disappearance of lymphoid tissue. B. A reduction in circulating eosinophils. C. An elevated cortisol level D. All of the above.
All of the above
Clinical manifestations of Cushing's syndrome may be modified with a diet that is: A. high in protein B. low in carbohydrates C. low in sodium D. all of the above
All of the above
What is included in the Cushing's triad? A. buffalo hump B. moonface C. truncal obesity D. all of the above
All of the above
Which of the following patient complaints will alert the nurse for possible aldosterone toxicity? A. muscle weakness and abd fullness B. BP of 80/60 mmHg C. parched skin and dry mucous membranes D. all of the above
All of the above
Which of the following should be monitored closely in patients receiving hypothalamic agents? A. serum sodium levels B. serum potassium levels C. blood sugar level D. all of the above
All of the above
Nursing comfort measures for a patient with hypothyroidism should include: A. Encouraging frequent periods of rest throughout the day. B. Offering the patient additional blankets to help prevent chilling. C. Using a cleansing lotion instead of soap for the skin. D. All of the above.
All of the above.
The nurse is aware that the following is the most common cause of hyperaldosteronism?
An adrenal adenoma
The nurse is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?
Antidiuretic hormone (ADH)
The nurse provides dietary instruction for a client who is newly diagnosed with hyperthyroidism. Which instruction should the nurse include in the client's teaching session? Select all that apply
Avoid caffeine and eating spicy foods Include proteins in 3 meals and snacks daily Consume a diet with 4000-5000 calories/day
Which of the following statements are correct about Grave's disease?
Caused by an autoimmune condition where the body produces an antibody called TSI which acts like TSH on the body
While providing care for a client recently diagnosed with hyperthyroidism, which intervention will the registered nurse implement to provide client comfort? Select all that apply
Change damp bed linens promptly Provide iced water for intake Lower the room temperature
Addison's disease is:
Decreased secretion of aldosterone and cortisol
The nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find
Deposits of adipose tissue in the trunk and dorsocervical area
Signs and Symptoms of myxedema coma include all of the following EXCEPT? Select all that apply
Fever Blood glucose level greater than 350 Goiter
Which outcome indicates that treatment of a client with diabetes insipidus has been effective? a. Fluid intake is less than 2,500 ml/day. b. Urine output measures more than 200 ml/hour. c. Blood pressure is 90/50 mm Hg. d. The heart rate is 126 beats/minute.
Fluid intake is less than 2500 ml/day
The nurse provides care for a client who is prescribed radioactive iodine for the treatment of hyperthyroidism. Which safety instruction should the nurse include when providing education to the child and caregivers? Select all that apply.
Flush the toilet twice after each use It is important to stay away from pregnant women It is important to not share washcloths and towels with others Limit time in the car with others to no more than one hour Do not sleep in a room with others
A patient with Cushing's syndrome will be undergoing an adrenalectomy. Which of the following will be included in the patient's discharge teaching after the procedure?
Glucocorticoid replacement therapy
A patient is admitted with complaints of palpations, excessive sweating, and unable to tolerate heat. In addition, the patient voices concern about how her appearance has changed over the past year. The patient presents with protruding eyeballs and pretibial myxedema on the legs and feet. Which of the following is the likely cause of the patient's signs and symptoms?
Grave's disease
A patient has an extremely high T3 and T4 level. Which of the following signs and symptoms DO NOT present with this condition?
Hair loss
The nurse is teaching a client newly diagnosed with hypothyroidism about potential side effects of levothyroxine. Which side effects with the nurse include in the teaching? Select all that apply
Heat sensitivity Anxiety Tachycardia
A 67-year-old female client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse would suspect which of the following disorders?
Hyperparathyroidism
For the first 72 hours after thyroidectomy surgery, the nurse would assess the female client for Chvostek's sign and Trousseau's sign because they indicate which of the following?
Hypocalcemia
All of the following are treatments for myxedema coma EXCEPT?
Hypotonic IV solutions
Which nursing diagnosis takes highest priority for a female client with hyperthyroidism?
Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
The nurse is evaluating lab results of a client who reports excessive fatigue for the past month. Labs are as follows: thyroid-stimulating hormone (TSH) is 8 U/L (Reference range: 0.4 to 4.2); total triiodothyronine (T3) is 30 ng/dL (Reference range: 70 to 204) free thyroxine (T4) is 0.2 ng/dL (Reference range: 0.8 to 2.7). Which additional clinical manifestation should the nurse anticipate for this client? Select all that apply.
Inability to tolerate cold Difficulty having regular bowel movements Fragile, dry skin Hypotension
he thyroid hormones, T3 and T4, play many roles in the human body. Which of the following functions are performed by T3 and T4? Select all that apply
Increasing the heart rate Stimulating the sympathetic nervous system Regulating TSH produced by the pituitary gland
Which of the following are NOT a cause of myxedema coma?
Iodine toxicity
A male client has recently undergone surgical removal of a pituitary tumor. The doctor prescribes corticotropin 20 units IM QID as a replacement therapy. What is the mechanism of action of corticotropin?
It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism.
Which hyperthyroid medication should be avoided in the first trimester of pregnancy?
Methimazole
A client with newly diagnosed Grave's disease meets with the health care provider to discuss treatment options. Which treatment option should be discussed and considered before a thyroidectomy? Select all that apply
Methimazole Propylthiouracil Radioactive iodine
A patient is being treated for Grave's Disease. They have a health history of type 1 diabetes, breast cancer, eczema, and hypertension. The physician orders Propanolol. What important information will you include in their discharge teaching about this medication?
Monitor blood glucose levels closely because this medication can mask the signs and symptoms of hypoglycemia
Following a unilateral adrenalectomy, the nurse would assess for hyperkalemia shown by which of the following?
Muscle weakness
An incoherent female client with a history of hypothyroidism is brought to the emergency department. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of:
Myxedema coma
A patient is receiving radioactive iodine as treatment for Grave's Disease. Which of the following are common side effects of the treatment? Select all that apply
Nausea Taste changes Swollen salivary glands
After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. The doctor prescribes levothyroxine 25 mcg PO daily. For which condition is levothyroxine the preferred agent?
Primary hypothyroidism
The antithyroid agent of choice for pregnant women is?
Propylthiouracil
The nurse should expect a client with hypothyroidism to report which health concerns?
Puffiness of face and hands
Which teaching will promote understanding of hypothyroidism and enhance adherence to the treatment of the condition?
Report symptoms of restlessness and insomnia
A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?
Restricting fluids
The nurse is aware that the most appropriate nursing diagnosis for a patient with Addison's disease is which of the following?
Risk for infection
A patient taking calcitriol is also prescribed with a magnesium-containing antacid. Which of the following should be included in the nurse's monitoring?
Serum electrolyte level (concurrent use can result in hypermagnesemia )
A female client with myxedema is receiving levothyroxine 25mg PO daily. Which finding would the nurse recognize as an adverse medication effect?
Tachycardia
A patient is post-opt from a thyroidectomy for treatment of Grave's Disease. When you walk into the patient's room to perform an assessment, which of the following findings causes the MOST concern and needs nursing intervention?
The patient is positioned in supine position.
The patient had a subtotal thyroidectomy. During the assessment the patient has nausea, a temperature of 105°F, tachycardia, and extreme restlessness. What is the most likely cause of these signs?
Thyroid crisis
Which of the following are treatment options for hyperthyroidism? Select all that apply
Thyroidectomy Methimazole Radioactive iodine
A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess:
Trousseau's sign (carpopedal spasm induced by inflating BP cuff above systolic pressure)
Nursing care for a patient with hypothyroidism includes assessing for clinical manifestations associated with hypothyroidism. A manifestation not consistent with her diagnosis is a
Weight loss of 10 lbs over a 2 week period
Which of the following patients are at risk for developing Cushing's syndrome?
a patient taking glucocorticoids for several weeks
All of the following should be included in the nursing interventions for patients taking thyroid hormones, except: A. consistent admin before breakfast B. monitor cardiac response C. advise patient to frequently exercise to develop the core. D. provide for temperature control and safety precautions
advise patient to frequently exercise to develop the core. (should be provided for rest periods)
A patient on aldosterone can eat all of the following except
bagels, salad with dressing, cottage cheese
Which of the following history data will possibly render strong iodine products contraindicated for the patient? A. 35 years old B. history of blood-tinged sputum for the past three weeks C. intake of oral anticoagulants D. both B and C
both B and C
Glucocorticoids can reduce inflammation and suppress the immune system by:
forming complex reactions needed to reduce inflammation
Which of the following are signs and symptoms of Grave's disease
heat intolerance goiter pretibial myxedema ophthalmopathy changes fast heart rate
Nursing priorities for patients with Addison's disease
hormone replacement monitor electrolytes monitor adrenal function
The client receiving filgrastim should be monitored for common adverse effects which include
hypertension and skeletal pain
A positive Chvostek's sign indicates?
hypocalcemia
Thyroid hormones can:
increase oxygen consumption
In Cushing's disease, there are
increased cortisol production
The preferred medication for treating hypothyroidism is
levothyroxine (synthroid)
Confirmatory diagnosis of Cushing's syndrome is made through
low-dose dexamethasone suppression test
Nursing interventions appropriate for a patient with Cushing's syndrome include: A. monitoring fluid intake and output B. administering foods rich in sodium C. stopping corticosteroid intake once symptoms have diminished D. all of the above
monitoring fluid intake and output (patient with Cushing's syndrome retain sodium and water)
The client with a diagnosis of cancer is receiving epoetin alfa as part of the treatment regimen. The nurse evaluates the effectiveness of this drug by
monitoring hematocrit and hemoglobin level
A clinical manifestation usually associated with hypothyroidism is
muscular fatigue
A patient was recently discharged home for treatment of hypothyroidism and was ordered to take Levothyroxine for treatment. The patient is re-admitted with signs and symptoms of the following: heart rate 42, blood pressure 70/56, blood glucose 55, and body temperature of 96.8 'F. The patient is very fatigued and drowsy. The family reports the patient has not been taking Synthroid since being discharged home from the hospital. Which of the following conditions is this patient most likely experiencing?
myxedema coma
The nurse administers filgrastim to the client. The nurse explains to the client that this drug is used in the treatment of
neutropenia
