Evolve: Endo, Endocrine NCLEX, Endocrine Disorder chapter 50 NCLEX Questions, Endocrine NCLEX Practice Questions, Chapter 63 Care of Patients with Problems of the Thyroid Parathyroid Glands, Endocrine NCLEX Questions, NCLEX practice: endocrine, Chapt…

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome?
Glucose level
After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse expects that manifestations of excessive levels of antidiuretic hormone are:
Hyponatremia and decreased urine output
The nurse is caring for a client diagnosed with Cushing syndrome. The nurse expects that the client will exhibit:
Lability of mood
A client is scheduled to have a thyroidectomy for cancer of the thyroid. Preoperative instructions for the postoperative period include teaching the client to:
Support the head with the hands when changing position
Which health problem should the nurse consider is most likely to precipitate acute hypoglycemia in a client?

Liver disease;

Clients with liver disease have a decreased ability to metabolize carbohydrates because of a decreased ability to form glycogen and to form glucose from glycogen. Cushing’s syndrome causes hyperglycemia.

A client is admitted to the hospital for a subtotal thyroidectomy. When discussing postoperative drug therapy with the client, the nurse should teach the client to:
Report palpitations, nervousness, tremors, or loss of weight that may indicate an overdose of thyroid hormone
When taking the blood pressure of a client who had a thyroidectomy, the nurse identifies that the client is pale and has spasms of the hand. The nurse notifies the health care provider. Which should the nurse expect the health care provider to prescribe?
Calcium
A client is diagnosed with diabetic ketoacidosis. Which insulin should the nurse expect the health care provider to prescribe?

Regular insulin (Novolin R)

Regular insulin is rapid-acting and should be used for diabetic coma

On the third postoperative day after a subtotal thyroidectomy for a tumor, a client complains of a “funny, jittery feeling.” On the basis of this statement, the nurse’s best action is to:

Test for Chvostek’s and Trousseau’s signs and notify the health care provider of the complaints.

These symptoms may indicate impending hypocalcemic tetany, a complication after removal of parathyroid tissue during a thyroidectomy. Physical assessment and notification of the health care provider are the priorities.

When assessing a client with Graves disease, the nurse expects to identify:
Weight loss, exophthalmos, and restlessness
A client visits the clinic because of concerns about insomnia and recent weight loss. A tentative diagnosis of hyperthyroidism is made. In addition to these changes, the nurse further assesses this client for:
Fatigue
A client had a thyroidectomy. The nurse monitors for thyrotoxic crisis, which is evidenced by:
An increased temperature and pulse rate
On the first postoperative day following a thyroidectomy, a client tolerates a full-fluid diet. This is changed to a soft diet on the second postoperative day. The client reports having a sore throat when swallowing. What should the nurse do first?

Administer analgesics as prescribed before meals.

Analgesics as prescribed will reduce soreness during meals. Reordering the full-fluid diet is not within the legal role of the nurse. Soreness is to be expected;

A nurse is caring for a client who just had a thyroidectomy. For which client response should the nurse assess the client when concerned about an accidental removal of the parathyroid glands during surgery?

Tetany;

Parathyroid removal eliminates the body’s source of parathyroid hormone (parathormone), which increases the blood calcium level. The resulting low body fluid calcium affects muscles, including the diaphragm, resulting in dyspnea, asphyxia, and death.

The nurse teaches a client with exophthalmos how to reduce discomfort and prevent corneal ulceration. Which plan reported by the client supports the nurse’s conclusion that the teaching was effective?
“Avoid using a sleeping mask at night.
A client is learning alternate site testing (AST) for glucose monitoring. Which client statement indicates to the nurse that additional teaching is necessary?
“The fingertip is preferred for glucose monitoring if hyperglycemia is suspected.”
Propylthiouracil (PTU) is prescribed for a client diagnosed with hyperthyroidism. The client asks the nurse, “Why do I have to take this medication if I am going to get the atomic cocktail?” The nurse explains that the medication is being prescribed because it decreases the:

Production of thyroid hormones.

Propylthiouracil is a thyroid hormone antagonist that inhibits thyroid hormone synthesis by decreasing the use of iodine in the manufacture of these hormones

A nurse is caring for a client who is receiving total parenteral nutrition. Which responses indicate that the client is experiencing hyperglycemia? (Select all that apply.)
Polyuria and Polydipsia
A nurse is providing postoperative care for a client who just had a thyroidectomy. For what response should the nurse assess the client when concerned about the potential risk of thyrotoxic crisis?

Rapid heartbeat and tremors;

Thyrotoxic crisis (thyroid storm) refers to a sudden and excessive release of thyroid hormones, which causes pyrexia, tachycardia, and exaggerated symptoms of thyrotoxicosis; surgery, infection, and ablation therapy can precipitate this life-threatening condition.

A nurse is monitoring for clinical manifestations of infection in a client with a diagnosis of Addison disease. Which body mechanism related to infectious processes does the nurse conclude is impaired as a result of this disease?

Stress response;

Because of diminished glucocorticoid production, there is a decreased response to stress, reducing the ability to fight an infectious process.

A client who is scheduled to have surgery to remove an aldosterone-secreting adenoma asks the nurse what will happen if surgery is not performed. On what information should the nurse base a response?
The tumor must be removed to prevent heart and kidney damage.
Which information from the client’s history does the nurse identify as a risk factor for developing osteoporosis?
1
Receives long-term steroid therapy
2
Has a history of hypoparathyroidism
3
Engages in strenuous physical activity
4
Consumes high doses of the hormone estrogen
1
Receives long-term steroid therapyIncreased levels of steroids will accelerate bone demineralization. Hyperparathyroidism, not hypoparathyroidism, accelerates bone demineralization.

A client is scheduled for an adrenalectomy. The nurse expects that the plan of care will include:
1
Low protein diet
2
Parenteral steroids
3
Preoperative 24-hour urine specimen
4
Withholding all medications 48 hours before surgery
2
Parenteral steroids;Steroid therapy usually is given intravenously or intramuscularly preoperatively and continued intraoperatively to prepare for the acute adrenal insufficiency that follows surgery. The diet must supply ample protein and potassium. A 24-hour urine specimen is unnecessary. Glucocorticoids must be administered preoperatively to prevent adrenal insufficiency during surgery.

When assessing a client with Graves disease (hyperthyroidism) the nurse expects to identify a history of:
1
Diaphoresis
2
Menorrhagia
3
Dry, brittle hair
4
Sensitivity to cold
1
DiaphoresisIncreased basal metabolic rate, increased circulation, and vasodilation result in warm, moist skin. Menorrhagia, dry, brittle hair, and sensitivity to cold are associated with hypothyroidism.

A nurse is caring for a client who just returned from the postanesthesia care unit after having a thyroidectomy. Which action has priority during the first 24 hours after surgery when the nurse is concerned about thyroid storm?
1
Performing range-of-motion exercises
2
Humidifying the room air continuously
3
Assessing for hoarseness every two hours
4
Checking vital signs every two hours after they stabilize
4
Checking vital signs every two hours after they stabilizeChecking vital signs helps detect complications such as thyrotoxic crisis, hemorrhage, and respiratory obstruction that may occur early in the postoperative period.

After a surgical thyroidectomy a client exhibits carpopedal spasm and some tremors. The client complains of tingling in the fingers and around the mouth. What medication should the nurse expect the primary health care provider to prescribe after being notified of the client’s adaptations?
1
Potassium iodide
2
Calcium gluconate
3
Magnesium sulfate
4
Potassium chloride
2
Calcium gluconate;The client is exhibiting signs and symptoms of hypocalcemia, which occurs with accidental removal of the parathyroid glands; calcium gluconate is administered to treat hypocalcemia

A nurse is caring for a client after radioactive iodine is administered for Graves disease. What information about the client’s condition after this therapy should the nurse consider when providing care?
1
Not radioactive and can be handled as any other individual
2
Highly radioactive and should be isolated as much as possible
3
Mildly radioactive but should be treated with routine safety precautions
4
Not radioactive but may still transmit some dangerous radiations and must be treated with precautions
3
Mildly radioactive but should be treated with routine safety precautions;An individual treated for a thyroid problem by intake of radioactive iodine (131I) becomes mildly radioactive, particularly in the region of the thyroid gland, which preferentially absorbs the iodine. Such clients should be treated with routine safety precautions for 48 hours (e.g., avoid prolonged contact or near-contact with others, flush toilet twice after using because radioactive iodine is excreted via the urine, and thoroughly wash hands after toileting). Because radioactive iodine is internalized, the client becomes the source of radioactivity. The amount of radioactive iodine used is not enough to cause high radioactivity.

A client has a thyroidectomy for cancer of the thyroid. To evaluate for nerve injury that may be the result of surgery-related trauma, the nurse assesses the client’s ability to:
1
Speak
2
Swallow
3
Purse the lips
4
Turn the head
1
SpeakThe laryngeal nerve is close to the operative site and can be damaged inadvertently. Loss of the gag reflex occurs with general anesthesia; the ability to swallow signifies its return.

A client is scheduled for an adrenalectomy. Which nursing intervention should the nurse anticipate will be prescribed for this client?
1
Administer intravenous (IV) steroids.
2
Provide a high protein diet.
3
Collect a 24-hour urine specimen.
4
Withhold all medications for 48 hours.
1
Administer intravenous (IV) steroids.Steroid therapy usually is instituted preoperatively and continued intraoperatively to prepare for the acute adrenal insufficiency that follows surgery. The diet must supply ample, not high, protein and potassium; however, it must be low in calories, carbohydrates, and sodium to promote weight loss and reduce fluid retention. A 24-hour urine specimen is unnecessary. Glucocorticoids must be administered preoperatively to prevent adrenal insufficiency during surgery.

Postoperatively a client who had a thyroidectomy complains of tingling and numbness of the fingers and toes, and the nurse observes muscle twitching. Which complication does the nurse suspect the client is experiencing?
1
Hypokalemia
2
Hypocalcemia
3
Thyrotoxic crisis
4
Hypovolemic shock
2
HypocalcemiaThe signs and symptoms presented in the question indicate hypocalcemia. Injury to the parathyroid glands during a thyroidectomy results in a deficiency of parathormone, which decreases calcium levels in the blood.

A client who has just had an adrenalectomy is told about a death in the family and becomes very upset. The nurse notifies the health care provider about the client becoming upset. What is the primary reason the nurse chose to notify the health care provider?
1
With this type of emotion, the dosage of steroids may have to be reduced
2
Despite steroid therapy, the ability to cope with stress will be decreased
3
Mild sedation is needed to assist the client with coping with the loss
4
Feelings of exhaustion with lethargy will occur as a result of stress
2
Despite steroid therapy, the ability to cope with stress will be decreased
The major nursing concern when caring for a client with the diagnosis of hyperthyroidism is:
1
Monitoring for hypoglycemia
2
Protecting visitors and staff from radiation exposure
3
Providing foods to increase appetite
4
Arranging for sufficient rest periods
4
Arranging for sufficient rest periodsPromotion of rest to reduce metabolic demands is a challenging but essential task for a client who has hyperthyroidism . With hyperthyroidism, glucose tolerance is decreased, and the client is hyperglycemic. There is no indication that radioactive iodine has been given; therefore, the client does not emit radiation. The client will have an increased appetite.

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome?
1
Urine output
2
Glucose level
3
Serum potassium
4
Immune response
2
Glucose levelAs a result of increased cortisol levels, glucose metabolism is altered, which may contribute to an increase in blood glucose levels. Increased mineralocorticoids will decrease urine output. Sodium is retained by the kidneys, but potassium is excreted. The immune response is suppressed.

A nurse is providing postoperative care for a client who just had a thyroidectomy. For what response should the nurse assess the client when concerned about the potential risk of thyrotoxic crisis?
1
Elevated serum calcium
2
Sudden drop in pulse rate
3
Hypothermia and dry skin
4
Rapid heartbeat and tremors
4
Rapid heartbeat and tremors
Postoperatively a client who had a thyroidectomy complains of tingling and numbness of the fingers and toes, and the nurse observes muscle twitching. Which complication does the nurse suspect the client is experiencing?

-Hypocalcemia

The signs and symptoms presented in the question indicate hypocalcemia. Injury to the parathyroid glands during a thyroidectomy results in a deficiency of parathormone, which decreases calcium levels in the blood. Hypokalemia is characterized by generalized weakness, a decrease in reflexes, shallow respirations, and cardiac dysrhythmias. Thyrotoxic crisis is characterized by tachycardia, hyperpyrexia, and an exacerbation of hyperthyroid symptoms. Hypovolemic shock is characterized by a weak, thready pulse and hypotension.

A client who is scheduled to have surgery to remove an aldosterone-secreting adenoma asks the nurse what will happen if surgery is not performed. On what information should the nurse base a response?client for:

The tumor must be removed to prevent heart and kidney damage.

Renal and cardiac complications will occur if hypertension caused by the tumor is not arrested. Aldosteronomas are benign tumors; metastasis is not possible.

The major nursing concern when caring for a client with the diagnosis of hyperthyroidism is:

-Arranging for sufficient rest periods

Promotion of rest to reduce metabolic demands is a challenging but essential task for a client who has hyperthyroidism . With hyperthyroidism, glucose tolerance is decreased, and the client is hyperglycemic. There is no indication that radioactive iodine has been given; therefore, the client does not emit radiation. The client will have an increased appetite.

A client who has just had an adrenalectomy is told about a death in the family and becomes very upset. The nurse notifies the health care provider about the client becoming upset. What is the primary reason the nurse chose to notify the health care provider?
-Despite steroid therapy, the ability to cope with stress will be decreased
Hydrocortisone (Cortef) is prescribed for a client with Addison disease. Before discharge, the nurse teaches the client about this medication. What did the nurse include as a therapeutic effect of the drug?

Supports a better response to stress

Hydrocortisone is a glucocorticoid that has anti-inflammatory action and aids in metabolism of carbohydrates, fats, and proteins, causing elevation of the blood glucose level. Thus, it enables the body to adapt to stress.

A nurse is caring for a client with the clinical manifestation of hypotension associated with a diagnosis of Addison disease. Which hormone is impaired in its production as a result of this disease?
-Mineralocorticoids
A client who has had a subtotal thyroidectomy does not understand how hypothyroidism can develop when the problem was initially hyperthyroidism. The nurse bases a response on the fact that:
-There may not be enough thyroid tissue to supply adequate thyroid hormone
A client is hospitalized with a tentative diagnosis of pancreatic cancer. On admission the client asks the nurse, “Do you think I have anything serious, like cancer?” What is the nurse’s best reply?

-“I don’t know if you do; let’s talk about it.”

The nurse has demonstrated recognition of the verbalized concern and a willingness to listen. The client did not state cancer as the diagnosis; this response puts the client on the defensive.

Which information from the client’s history does the nurse identify as a risk factor for developing osteoporosis?

-Receives long-term steroid therapy

Increased levels of steroids will accelerate bone demineralization.

What should the nurse do when collecting a 24-hour urine specimen?

-Check to verify if a preservative is needed.

Depending on the purpose of the collection, a preservative to prevent breakdown of the specimen may be necessary. Weighing the client is not necessary.

A client’s parathyroid glands are removed. What clinical manifestation is indicative of the fluid and electrolyte imbalance associated with this surgery?

-Muscle spasms

Removal of the parathyroids causes hypocalcemia and associated neuromuscular irritability. Constipation is a sign of hypercalcemia. Hypoactive reflexes are signs of hypercalcemia. Increased specific gravity is a sign of fluid volume deficit.

A client is scheduled for an adrenalectomy. Which nursing intervention should the nurse anticipate will be prescribed for this client?
-Administer intravenous (IV) steroids.
The health care provider prescribes propylthiouracil (PTU) for a client with the diagnosis of Graves’ disease. What should the nurse teach the client when discussing the self-administration of this medication?

-Observe for signs of infection

PTU may lower the white blood cell count, making the client prone to infection. Propylthiouracil does not cause hypocalcemia.

On the first day after a thyroidectomy, a client tolerates a full-liquid/fluid diet. When the diet is progressed to a soft diet the next day, the client complains of a sore throat when swallowing. How should the nurse respond?
-Administer prescribed analgesics before meals
A client in thyroid storm tells the nurse, “I know I’m going to die. I’m very sick.” What is the nurse’s best response?
-“You must feel very sick and frightened.”
A nurse is caring for a client who had a hypophysectomy. For which complication specific to this surgery should the nurse assess the client for early clinical manifestations?
-Increased intracranial pressure
After a surgical thyroidectomy a client exhibits carpopedal spasm and some tremors. The client complains of tingling in the fingers and around the mouth. What medication should the nurse expect the primary health care provider to prescribe after being notified of the client’s adaptations?
Calcium gluconate
During a routine examination, an enlarged thyroid gland is discovered in a client, and hyperthyroidism is suspected. What clinical findings should the nurse expect to identify when completing a nursing admission history and physical for this client? (Select all that apply.)
1. Palpitations
2. TachycardiaHyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate and myocardial irritability. Hyperthyroidism increases the metabolic rate and the need for oxygen; this results in an increased heart rate. Thickened skin, An apathetic attitude, and Menstrual disturbances are associated with hypothyroidism and myxedema.

A nurse teaches a client who has had a thyroidectomy for thyroid cancer to observe for signs of surgically induced hypothyroidism. What should be included in the teaching plan? (Select all that apply.)
1. Dry skin
2. Lethargy
5. Sensitivity to cold
A nurse is assessing a client with hypothyroidism. Which clinical manifestations should the nurse expect the client to exhibit? (Select all that apply.)
1. Cool Skin
3. Constipation
4. Periorbital edema
5. Decreased appetite
A client admitted to the emergency department has ketones in the blood and urine. Which situation associated with this physiological finding should be the nurse’s focus when collecting additional data about this client?
1. Starvation
A nurse is caring for a client with a diagnosis of Cushing syndrome. What is the most common cause of Cushing syndrome that the nurse should consider before assessing this client for physiological responses?
Hyperplasia of the adrenal cortex
A nurse is caring for a client who had an adrenalectomy. For what clinical response should the nurse monitor while steroid therapy is being regulated?
Hypotension
A client has been taking levothyroxine (Synthroid) for hypothyroidism for three weeks. The nurse suspects that a decrease in dosage is needed when the client exhibits which clinical manifestations? (Select all that apply.)
1. Tremors
4. Heat intolerance
Which clinical findings should the nurse expect when assessing a client with hyperthyroidism? (Select all that apply.)
2. Tachycardia
5. Exopthalmos
The nurse is assessing a client with hyperthyroidism. Which clinical indicators are consistent with this diagnosis? (Select all that apply.)
1
Emotional lability
2
Dyspnea on exertion
5
Hyperactive deep tendon reflexes
A nurse is caring for a male client with a diagnosis of Cushing syndrome. Which clinical manifestations does the nurse expect to identify? (Select all that apply.)
2. Obese trunk
4. Sleep Disturbance
5. Thin arms and legs
A client who had a subtotal thyroidectomy asks how hypothyroidism may develop when the problem was hyperthyroidism. What should the nurse consider when formulating a response?
Less thyroid tissue is available to supply thyroid hormone after surgery.
A nurse is assessing a client with a diagnosis of diabetes insipidus. For which signs indicative of diabetes insipidus should the nurse assess the client? (Select all that apply.)
1. Excessive Thirst
3. Dry Mucous Membrane
6. Decreased urine specific gravity
A nurse is assessing a malnourished client with a history of cirrhosis. The client is experiencing nausea, ascites, and gastrointestinal bleeding. The primary cause of the client’s ascites is a decrease in:

Plasma protein to maintain adequate capillary-tissue circulation

-Malnutrition and liver damage lead to a reduced serum albumin level and failure of the capillary fluid shift mechanism, resulting in ascites.

A client is diagnosed with hyperthyroidism and is experiencing exophthalmia. Which measures should the nurse include when teaching this client how to manage the discomfort associated with exophthalmia? (Select all that apply.)
1. Use tinted glasses.
3. Elevate the head of the bed 45 degrees.
4. Tape eyelids shut at night if they do not close.
A client with a tentative diagnosis of Cushing syndrome has an increased cortisol level. For what response should the nurse assess this client?
Hypernatremia
A nurse is assessing a female client with Cushing syndrome. Which clinical findings can the nurse expect to identify? (Select all that apply.)
1. Hirsutism
3. Buffalo hump
A client has been diagnosed with hyperthyroidism. The nurse expects the client to exhibit which clinical manifestations? (Select all that apply.)
4. Nervousness
5. Increased appetite
Which clinical indicators can the nurse expect when assessing a client with Cushing syndrome? (Select all that apply.)
1. Lability of mood
2. Slow wound healing
A client with hyperthyroidism refuses radioactive iodine therapy and a subtotal thyroidectomy is scheduled. The nurse reviews the preoperative plan of care and questions which prescription?
Drugs to increase the blood pressure
A client’s laboratory values demonstrate an increased serum calcium level, and further diagnostic tests reveal hyperparathyroidism. For what clinical manifestations should the nurse assess this client? (Select all that apply.)
4
Cardiac dysrhythmias
5
Hypoactive bowel sounds
The health care provider prescribes propylthiouracil (PTU) for a client with hyperthyroidism. The nurse explains that this drug:
Interferes with the synthesis of thyroid hormone
A nurse is assessing a client who is admitted to the hospital with a tentative diagnosis of a pituitary tumor. What signs of Cushing syndrome does the nurse identify?
Retention of sodium and water
When preparing a client for discharge after a thyroidectomy, the nurse teaches the signs of hypothyroidism. The nurse evaluates that the client understands the teaching when the client says, “I should call my health care provider if I develop:
Dry hair and an intolerance to cold.”
A nurse is caring for a client with an underactive thyroid gland. Which responses should the nurse expect the client to exhibit as a result of decreased levels of triiodothyronine (T3 ) and thyroxine (T4 )? (Select all that apply.)
3
Weight gain
4
Cold intolerance
For which client response should the nurse monitor when assessing for complications of hyperparathyroidism?
Bone pain
The nurse is teaching the patient with hyperthyroidism the importance of stress management. She is teaching how to do deep breathing exercises and listens to the patient’s thoughts on coping mechanism and spirituality. The nurse knows this is an important part of this patients plan because:
a) Knowing how to cope with stress will help this patient be able to work through some of the difficult treatments of this disease
b) Every patient needs to know how to cope with stress
c) Extra stress with the patient with hyperthyroidism can lead to life threatening complications
d) Listening to the patients thoughts instead of imposing one’s own thoughts encourages the patient to become self-reliant
Answer: c. Extra stress on the patient with hyperthyroidism can precipitate a life-threatening condition known as thyroid storm. It is important for the nurse to explain procedures to lower patient anxiety to prevent this condition.
You are the nursing student and you are taking care of the patient recently diagnosed with hyperthyroidism. You can visibly see the thryroid gland enlarged. What is the next thing you should assess?
A) Assess for a bruit or a thrill
B) Listen to respiratory rate and look at SpO2
C) Check for peripheral pulses
D) Poke the neck to see if it is soft or hard
Answer: B. Because an enlarged thyroid gland can constrict the neck (often caused by a goiter) it is very important to monitor the patient’s respiratory status. After that a bruit or thrill may be felt for over the distended thyroid gland. Palpating to see if the neck is soft or hard may also be done, as a hard nodule may be indicative thyroid cancer.
The patient diagnosed with SIADH (Syndrome of inappropriate antidiuretic hormone) has a sodium level of 129 mEq/L. He is receiving IV 3% saline at 100 mL/hr. Which of the following is the nurse most concerned about?
A) The patient complains of cramps in his hands
B) There is trace edema in the lower extremities
C) HR 110
D) The patient is suddenly states “Who are you?”
Answer: D. Decreased LOC is a sign of CMP (Central Pontine Myelinlysis) An extremely life-threatening condition that can occur with patient receiving high levels of sodium rich IV fluids. It is a medical emergency and the infusion should be stopped immediately. Cramps in the hands and trace edema are being treated with the infusion of 3% saline solution. HR 110 is also important, but not as emergent as sudden confusion.
Which of the following would the nurse monitor for as signs of thyroid storm? SATA:
A) T 101.5
B) HR 59
C) Constipation
D) Edema
E) Chest pain
Answer: A, D, and E. Thyroid storm is a form of severe hyperthyroidism usually of abrupt onset. S/S are typically characterized by exaggeration of hyperthyroidism. An extreme fever over 101.3 degrees often occurs along with extreme tachycardia (>130) During thyroid storm increased cardiac compromise may occur as evidenced by edema (HF), chest pain, dyspnea, or palpitations.
The nurse is providing preoperative teaching to the patient about to undergo a thyroidectomy. Which statement, if made by the patient, indicates the need for further teaching?
A) I need to eat super healthy before the surgery and should limit my calories to a healthy amount
B) Before the surgery I should practice raising my elbows and placing both hands behind my neck to provide support
C) Well, I will have to quit drinking my coffee and alcohol for now
D) I will be sure increase my intake of protein and carbohydrates
Answer: A. A high calorie diet should be encouraged preoperatively because of the increased metabolic needs of the body. Practicing supporting the neck before the surgery is a good way to remember what to do after the surgery. The patient should avoid consuming any stimulants including tea, coffee, and cola. The patient should increase intake of protein and carbohydrates preoperatively because of increased metabolic needs.
The nurse is counseling the patient with hypoparathyroidism about nutrition choices r/t her disease process. Which of the following trays demonstrates correct understanding of the teaching?
A) Yogurt, cream of chicken soup, and apple sauce with sweet tea
B) Fried salmon, green beans, and a white wheat bread roll
C) Sausage and egg sandwich with whole wheat bread and coffee with creamer
D) Turkey sandwich with lettuce, tomato, fruit cup and a glass of milk
Answer: B. The recommended diet for patients with hypoparathyroidism includes foods that are high in calcium yet low in phosphorous (remember the balancing act) Fish, green beans, and white wheat are recommended foods because they are low in phosphorous. Milk and dairy products, while are high in calcium are also high in phosphorous and are thus restricted. Hypoparathyroidism is as much an issue with too much phosphorus as calcium (although s/s are r/t hypocalcemia) Other restricted foods include eggs and spinach. Other foods encouraged include broccoli, cucumbers, and nondairy creamer.
Uh oh, the patient records got scrambled up. You need to go in and see each of the patients in the clinic to see which problem they have. Which of the following patients does the nurse suspect to be the patient with hyperparathyroidism?
A) The patient with shakiness in his hands and c/o numbness and tingling in fingers and toes
B) The patient c/o back pain and abdominal cramping with nausea
C) The patient with a BP of 167/87 and HR 110 with profuse sweating
D) The patient c/o of fatigue and depression with bronze skin pigmentation
Answer: B. Remember, the patient with hyperparathyroidism is experiencing symptoms r/t too much calcium in the bloodstream. That means they will have issues with Stones (Renal), Bones (bone pain, joint pain, osteoporosis), Moans (GI upset, abdominal cramps), and psychic moans (mental changes). Patient A might be a patient with hypoparathyroidism. Patient C might be a patient with Pheochromocytoma. Patient D might be a patient with Addison’s disease
You the nurse are taking care of the patient with hypoparathyroidism. Based on your knowledge of the disease process. Which of the following do you expect to be your priority in planning care for this patient?
A) Acute Pain
B) Fluid Volume Deficit
C) Ineffective Airway Maintenance
D) Impaired Cerebral Perfusion
Answer: C. Due to bronchospasm that can be caused by decreased calcium levels, it is important for the nurse to assess airway and breathing pattern. Signs associated with hypoparathyroidism are d/t hypocalcemia and the number one sign is tetany.
Which of the following would the nurse most expect to find in the patient with hypoparathyroidism?
A) Hypertension and cramps in extremities
B) Dysphagia and stiffness in hands or feet
C) Positive Trousseau’s sign and profuse sweating
D) Increased Phosphorous levels and tremors
Answer: B. Dysphagia related to laryngeal spasms and stiffness or camping in extremities would be expected signs and symptoms of hypoparathyroidism. Hypertension, profuse sweating, and increased phosphorous levels would not be expected with this condition.
The doctor walks into the patient room and says. “You have pheochromocytoma” and leaves. The patient begins to cry and says, “What does that mean?” What is the best response by the nurse?
A) It is a tumor in your pituitary gland. You are probably going to die.
B) You seem upset. Tell me how you are feeling.
C) Pheochromocytoma is a disorder of the adrenal glands where too little steroids are released into the blood stream
D) This is a caused by a benign tumor in certain glands in your body located above your kidneys
Answer: D.
Which of the following symptoms are expected in the patient with pheochromocytoma? Select all that Apply (SATA):
A) Hypertension
B) HA
C) Hypoglycemia
D) Hypermetabolism
E) Dry skin
Answer: A, B, and D. The five H’s: HA, Hypertension, Hyperhydrosis (sweating), Hypermetabolism and Hyperglycemia.
The patient with Addison’s disease presents to the clinic saying “I’ve gained five pounds in the past week!” You note some edema in both lower extremities. What does the nurse suspect to be the problem?
A) Precipitation of Addisonian Crisis
B) Heart Failure d/t end stage Addison’s disease
C) Excessive hormone replacement dose
D) Adrenocarcinoma development
Answer: C. Signs of too high a corticosteroid dose include edema and weight gain. S/S of an Addisonian crisis include hypotension, tachycardia, cyanosis, pallor, and tachypnea. Heart failure is not associated with Addison’s disease. There is no evidence of a tumor in the adrenal glands based on these symptoms.
You are providing discharge teaching to the client with primary Addison’s disease. Which statement, if made by the patient, indicates the need for further teaching?
A) I will have to take my Florinef and prednisone for the rest of my life
B) During hot weather I will be sure to eat lots of salty foods
C) I should continue to monitor my blood pressure for any drops
D) Because I can’t tolerate the heat I will cancel my trip to the Bahamas but I can still go skiing
Answer: D. Pt. should avoid cold weather in order to prevent precipitation of an Addisonian crisis which can be caused by stress on the body. The patient should be taught that medication will be taken for the rest of the patient’s life. Salt intake should be increased during hot weather d/t hyponatremia. A drop in blood pressure could be a sign of an impending Addisonian crisis
A patient suspected of having acromegaly has an elevated plasma growth hormone level. In acromegaly, the nurse would also expect the patient’s diagnostic results to include
a. hyperinsulinemia
b. a plasma glucose of less than 70
c. decreased growth hormone levels with an oral glucose challenge test
d. a serum sometomedin C (insulin-like growth-factor) of more than 300
d. a serum somatomedin C (Insulin-like-growth-factor) of more than 300
(rationale- a normal response to growth hormone secretion is stimulation of the liver to produce somatomedin C which stimulates growth of bones and soft tissue. The increased levels of somatomedin C normally inhibit growth hormone, but in acromegaly the pituitary gland secretes GH despite elevated somatomedin C levels.)
During assessment of the patient with acromegaly, the nurse would 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 per year
c. undesirable changes in appearance
(Rationale- the increased production of growth hormone in acromegaly causes an increase in thickness and width of bones and enlargement of soft tissues, resulting in marked changes in facial features, oily and coarse skin, and speech difficulties. Height is not increased in adults with growth hormone excess because the epiphyses of the bones are closed, and infertility is not a common finding because growth hormone is usually the only pituitary hormone involved in acromegaly.)
A patient with acromegaly is treated with a transphenoidal hypophysectomy. Postoperatively, the nurse
a. ensures that any clear nasal drainage is tested for glucose
b. maintains the patient flat in bed to prevent cerebrospinal fluid leak
c. assists the patient with toothbrushing Q4H to keep the surgical area clean
d. encourages deep breathing and coughing to prevent respiratory complications
a. ensures that any clear nasal drainage is tested for glucose
(Rationale- a transphenoidal 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. Postoperative clear nasal drainage with glucose content indicates 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, coughing and straining are avoided to prevent increased ICP and CSF leakage, and although mouth care is required Q4H toothbrushing should not be performed for 7-10post sx.)
During care of a patient with syndrome of inappropriate ADH (SIADH), the nurse should
a. monitor neurologic status Q2H or more often if needed
b. keep the head of the bed elevated to prevent ADH release
c. teach the patient receiving treatment with diuretics to restrict sodium intake
d. notify the physician if the patient’s blood pressure decreases more than 20mmHg from baseline
a. monitor neurologic status Q2H or more often if needed
Rationale- the patient with SIADH has marked dilution hyponatremia and should be monitored for decreased neurologic function and convulsions every 2 hours. ADH release is reduced by keeping the head of the bed flat to increase left atrial filling pressure, and sodium intake is supplemented because of hyponatremia and sodium loss caused by diuretics. A reduction in blood pressure indicates a reduction in total fluid volume and is an expected outcome of treatment.)
A patient with SIADH is treated with water restriction and administration of IV fluids. The nurses evaluates that treatment has been effective when the patient experiences
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. increased urine output, increased serum sodium, and decreased urine specific gravity
(rationale- 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 reflected by increased urine output, normalization of serum sodium, and more water in the urine, decreasing the specific gravity.)
In a patient with central diabetes insipidus, administration of aqueous vasopressin during a water deprivation test will result in a
a. decrease in body weight
b. increase in urinary output
c. decrease in blood pressure
d. increase in urine osmolality
d. increase in urine osmolality
(rationale- a patient with DI has a deficiency of ADH with excessive loss of water from the kidney, hypovolemia, hypernatreamia, and dilute urine with a low specific gravity. When vasopressin is administered, the symptoms are reversed, with water retention, decreased urinary output that increases urine osmolality, and an increase in blood pressure.)
A patient with DI is treated with nasal desmopression. The nurse recognize that the drug is not having an adequate therapeutic effect the 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. a urine specific gravity of 1.002
(rationale- normal urine specific gravity is 1.003 to 1.030, and 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. H/A, weight gain, and oral intake greater the urinary output are signs of volume excess that occur with overmedication. Nasal irritation & nausea may also indicate overmedication.)
A patient with Grave’s dz asks the nurse what caused the disorder. The best response by the nurse is
a. “The cause of Grave’s 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 of time.”
c. “Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones”
d. “In genetically susceptible persons antibodies form that attack thyroid tissue and stimulate overproduction of thyroid hormones.”
d. “In genetically susceptible persons antibodies form that attack thyroid tissue and stimulate overproduction of thyroid hormones.”
(rationale- The antibodies present in Graves’ disease that attack thyroid tissue cause hyperplasia of the gland and stimulate TSH receptors on the thyroid and activate the production of thyroid hormones, creating hyperthyroidism. The disease is not directly genetic, but individuals appear to have a genetic susceptibility to become sensitized to develop autoimmune antibodies. Goiter formation from insufficient iodine intake is usually associated with hypothyroidism.)
Preoperative instructions for the patient scheduled for a subtotal thyroidectomy includes teaching the patient
a. how to support the head with the hands when moving
b. that coughing should due avoided to prevent pressure on the incision
c. that the head and neck will need to remain immobile until the incision heals
d. that any tingling around the lips or in the fingers after surgery is expected and temporary
a. how to support the head with the hands when moving
(rationale- to prevent strain on the suture line postoperatively, the head must be manually supported while turning and moving in bed, but range-of-motion exercise for the head and neck are also taught preoperatively to be gradually implemented after surgery. There is no contraindication for coughing and deep breathing, and they should be carrier out postoperatively. Tingling around the lips or fingers is a sign of hypocalcemia, which may occur if the parathyroid glands are inadvertently removed during surgery, and should be reported immediately.)
When providing discharge instructions to a patient following a subtotal thyroidectomy, the nurse advises the patient to
a. never miss a daily dose of thyroid replacement therapy
b. avoid regular exercise until thyroid function is normalized
c. avoid eating foods such as soybeans, turnips, and rutabagas
d. use warm salt water gargles several times a day to relieve throat pain
c. avoid eating foods such as soybeans, turnips, and rutabagas
(Rationale- 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. However, the patient should avoid goitrogens, foods that inhibit thyroid, such as soybeans, turnips, rutabagas, and peanut skins. REgular exercise stimulates the thyroid gland and is encourage. Salt water gargles are used for dryness and irritation of the mouth and throat following radioactive iodine therapy.)
Causes of primary hypothyroidism in adults include
a. malignant or benign thyroid nodules
b. surgical removal or failure of the pituitary gland
c. surgical removal or radiation of thyroid gland
d. autoimmune-induced atrophy of the gland
d. autoimmune-induced atrophy of the gland
(rationale- both Graves disease and Hasimotos thyroiditis are autoimmune disorders that eventually destroy the thyroid gland, leading to primary hypothyroidism. Thyroid tumors most often result in hyperthyroidism. Secondary hypothyroidism occurs as a result of pituitary failure, and iatrogenic hypothyroidism results from thyroidectomy or radiation of the thyroid gland.)
A patient with hypothyroidism is treated with Synthroid. When teaching the patient about the therapy, the nurse
a. explains that caloric intake must be reduced when drug therapy is started
b. provides written instruction for all information related to the medication therapy
c. assures the patient that a return to normal function will occur with replacement therapy
d. informs the patient that medications must be taken until hormone balance is reestablished
b. provides written instruction for all information related to the medication therapy
(rationale- 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. Caloric intake can be increased when drug therapy is started, because of an increased metabolic rate, and replacement therapy must be taken for life. Although most patients return to a normal state with treatment, cardiovascular conditions and psychoses may persist.)
An appropriate nursing intervention for the patient with hyperparathyroidism is to
a. pad side rails as a seizure precaution
b. increase fluid intake to 3000 to 4000ml/day
c. maintain bed rest to prevent pathologic fractures
d. monitor the patient for Trousseau’s phenomenon or Chvostek’s sign
b. increase fluid intake to 3000 to 4000ml/day
(Rationale-A high fluid intake is indicated in hyperparathyroidism to dilute hypercalcemia and flush the kidneys so that calcium stone formation is reduced.)
A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, the nurse would expect to find
a. HTN, 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 hyper pigmentation of the skin
a. HTN, peripheral edema, and petechiae
(rationale- The effects of 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. Clinical manifestations of corticosteroid deficiency include hypotension, dehydration, weight loss, and hyperpigmentation of the skin.)
To prevent complications in the patient with Cushing syndrome, the nurse monitors the patient for
a. hypotension
b. hypoglycemia
c. cardiac arrhythmias
d. decreased cardiac output
c. cardiac arrhythmias
(rationale- electrolyte changes that occur in Cushing syndrome include sodium retention and potassium excretion by the kidney, resulting in hypokalemia, which may lead to cardiac arrhythmias or arrest. Hypotension, hypoglycemia, and decreased cardiac strength and output are characteristic of adrenal insufficiency.)
A patient is scheduled for bilateral adrenalectomy. During the postoperative period, the nurse would expect administration of corticosteroids to be
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 because excessive hormones are released during surgical manipulation of the glands
c. increased to promote an adequate response to the stress of surgery
(rationale- although the patient with Cushing syndrome has excess corticosteroids, removal of the glands and the stress of surgery require that high doses of cortisone be administered postoperatively for several days. The nurse should monitor the patient postoperatively to detect whether large amounts of hormones were released during surgical manipulation and to ensure the healing is satisfactory.)
The nurse determines that the patient in acute adrenal insufficiency is responding favorably to treatment when
a. the patient appears alert and oriented
b. the patient’s urinary output has increased
c. pulmonary edema is reduced as evidenced by clear lung sounds
d. laboratory tests reveal serum elevations of K and glucose and a decrease in sodium
a. the patient appears alert and oriented
(rationale- confusion, irritability, disorientation, or depressioni s often present in the patient with Addison’s dz, and a positive response to therapy would be indicated by a return to alertness and orientation. Other indication of response to therapy would be a decreased urinary output, decreased serum potassium, and increased serum sodium and glucose. The patient with Addison’s would be very dehydrated and volume-depleted and would not have pulmonary edema.)
Which of the following assessment findings characterize thyroid storm?
a) increased body temperature, decreased pulse, and increased blood pressure
b) increased body temperature, increased pulse, and increased blood pressure
c) increased body temperature, decreased pulse, and decreased blood pressure
d) increased body temperature, increased pulse, and decreased blood pressure

b) increased body temperature, increased pulse, and increased blood pressure

Thyroid storm is characterized by SNS activation. Thyroid hormones potentiate effects of cathecolamines (epinephrine/norepinephrine). Therefore, all vital signs will be increased.

The nurse is planning care for a client with hyperthyroidism. Which of the following nursing interventions are appropriate? Select all that apply

a) instill isotonic eye drops as necessary
b) provide several, small, well-balanced meals
c) provide rest periods
d) keep environment warm
e) encourage frequent visitors and conversation
f) weigh the client daily

a, b, c, and f

(a) The client with hyperthyroidism may experience exopthalmos. This requires instillation of eye drops to prevent dryness and ulceration of the cornea.

(b and f) The client experiences weight loss because of hypermetabolism. Several, small, well-balanced meals are given to improve nutritional status of the client and daily weights should be monitored. Weight is the most objective indicator of nutritional status.

(c) The client is usually exhausted due to restlessness and agitation. Frequent rest periods help the client regain energy.

After thyroidectomy, which of the following is the priority assessment to observe laryngeal nerve damage?

a) hoarseness of voice
b) difficulty in swallowing
c) tetany
d) fever

a) hoarseness of voice

Laryngeal nerve damage is manifested by severe hoarseness of voice of “whispery voice”.

When caring for a male client with diabetes insipidus, nurse Juliet expects to administer:
a. vasopressin (Pitressin Synthetic)
b. furosemide (Lasix).
c. regular insulin.
d. 10% dextrose.

a. vasopressin (Pitressin Synthetic)

Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

Nurse Ronn is assessing a client with possible Cushing’s syndrome. In a client with Cushing’s syndrome, the nurse would expect to find:
a. Hypotension.
b. Thick, coarse skin.
c. Deposits of adipose tissue in the trunk and dorsocervical area.
d. Weight gain in arms and legs.

c. Deposits of adipose tissue in the trunk and dorsocervical area

Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek’s sign and Trousseau’s sign because they indicate which of the following?
a. Hypocalcemia
b. Hypercalcemia
c. Hypokalemia
d. Hyperkalemia

a. Hypocalcemia

The client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek’s sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau’s sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren’t present with hypercalcemia, hypokalemia, or hyperkalemia.

An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. 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, nurse Libby prepares to take emergency action to prevent the potential complication of:

a. Thyroid storm.
b. Cretinism.
c. Myxedema coma.
d. Hashimoto’s thyroiditis.

c. Myexedema coma.

Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto’s thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.

In a 29-year-old female client who is being successfully treated for Cushing’s syndrome, nurse Lyzette would expect a decline in:

a. Serum glucose level.
b. Hair loss.
c. Bone mineralization.
d. Menstrual flow.

a. Serum glucose level.

Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing’s syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in Cushing’s syndrome; therefore, with successful treatment, abnormal hair growth also declines. Osteoporosis occurs in Cushing’s syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing’s syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.

Nurse Oliver should expect a client with hypothyroidism to report which health concerns?

a. Increased appetite and weight loss
b. Puffiness of the face and hands
c. Nervousness and tremors
d. Thyroid gland swelling

b. Puffiness of the face and hands

Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves’ disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).

Which nursing diagnosis takes highest priority for a female client with hyperthyroidism?

a. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess

b. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing

c. Body image disturbance related to weight gain and edema

d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis. Options B and C may be appropriate for a client with hypothyroidism, which slows the metabolic rate.

Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

a. Diabetic ketoacidosis
b. Thyroid crisis
c. Hypoglycemia
d. Tetany

b. Thyroid crisis

Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.

Nurse Louie 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?

a. antidiuretic hormone (ADH).
b. thyroid-stimulating hormone (TSH).
c. follicle-stimulating hormone (FSH).
d. luteinizing hormone (LH).

a. antidiuretic hormone (ADH).

ADH is the hormone clients with diabetes insipidus lack. The client’s TSH, FSH, and LH levels won’t be affected.

A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

a. Infusing I.V. fluids rapidly as ordered
b. Encouraging increased oral intake
c. Restricting fluids
d. Administering glucose-containing I.V. fluids as ordered

c. Restricting fluids

To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client’s already heightened fluid load.

Nurse Troy is aware that the most appropriate for a client with Addison’s disease?

a. Risk for infection
b. Excessive fluid volume
c. Urinary retention
d. Hypothermia

a. Risk for infection

Addison’s disease decreases the production of all adrenal hormones, compromising the body’s normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison’s disease include Deficient fluid volume and Hyperthermia. Urinary retention isn’t appropriate because Addison’s disease causes polyuria.

A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug effect?

a. Dysuria
b. Leg cramps
c. Tachycardia
d. Blurred vision

c. Tachycardia

Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse effects of this agent include tachycardia. The other options aren’t associated with levothyroxine.

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

b. Neck vein distention

SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by neck vein distention. This syndrome isn’t associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria).

Which outcome indicates that treatment of a male 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.

a. Fluid intake is less than 2,500 ml/day

Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn’t been effective.

In the administration of a drug such as levothyroxine (Synthroid), the nurse should teach the client:

A) That therapy typically lasts about 6 months.
B) That weekly laboratory tests for T4 levels will be required.
C) To report weight loss, anxiety, insomnia, and palpitations.
D) That the drug may be taken every other day if diarrhea occurs.

C) To report weight loss, anxiety, insomnia, and palpitations.

Weight loss, anxiety, insomnia and palpitations are signs of hyperthyroidism. An adjustment in dose would need to be obtained in order to reach a therapeutic level of levothyroxine (Synthroid) in the patient with hypothyroidism.

A patient with hyperthyroidism is taking propylthiouracil (PTU). The nurse will monitor the patient for:

A) gingival hyperplasia and lycopenemia.
B) dyspnea and a dry cough.
C) blurred vision and nystagmus.
D) fever and sore throat.

D) fever and sore throat.

Fever and sore throat are signs of a serious adverse reaction in PTU and should be reported immediately.

A physician has prescribed propylthiouracil (PTU) for a client with hyperthyroidism and the nurse develops a plan of care for the client. A priority nursing assessment to be included in the plan regarding this medication is to assess for:

a) relief of pain
b) signs of renal toxicity
c) signs and symptoms of hyperglycemia
d) signs and symptoms of hypothyroidism

d) signs and symptoms of hypothyroidism

Excessive dosing with propylthiouracil (PTU) may convert the client from a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required. Propylthiouracil is not used for pain and does not cause hyperglycemia or renal toxicity.

A physician prescribes levothyroxine sodium (Synthroid), 0.15 mg orally daily, for a client with hypothyroidism. The nurse will prepare to administer this medication:

a) in the morning to prevent insomnia
b) only when the client complains of fatigue and cold intolerance
c) at various times during the day to prevent tolerance from occurring
d) three times daily in equal doses of 0.5 mg each to ensure consistent serum drug levels

a) in the morning to prevent insomnia

Levothyroxine (Synthroid) is a synthetic thyroid hormone that increases cellular metabolism. Levothyroxine should be given in the morning in a single dose to prevent insomnia and should be given at the same time each day to maintain an adequate drug level. Therefore, options B, C, and D are incorrect.

Of what precautions should a client receiving radioactive iodine-131 be made aware?

a.) Drink plenty of fluids, especially those high in calcium.

b.) Avoid close contact with children or pregnant women for one week after administration of drug.

c.) Be aware of the symptoms of tachycardia, increased metabolic rate, and anxiety.

d.) Wear a mask if around children or pregnant women.

b.) Avoid close contact with children or pregnant women for one week after administration of drug.

After receiving radioactive iodine-131, you should avoid prolonged, close contact with other people for several days, particularly pregnant women and small children. The majority of the radioactive iodine that has not been absorbed leaves the body during the first two days following the treatment, primarily through the urine. Small amounts will also be excreted in saliva, sweat, tears, vaginal secretions, and feces.

A client presents to the emergency room with a history of Graves’ disease. The client reports having symptoms for a few days, but has not previously sought or received any additional treatment. The client also reports having had a cold a few days back. Which of the following interventions would be appropriate to implement for this client, based on the history and current symptoms? Select all that apply.

a. Administer aspirin
b. Replace intravenous fluids
c. Induce shivering
d. Relieve respiratory distress
e. Administer a cooling blanket

b. Replace intravenous fluids
c. Induce shivering
d. Relieve respiratory distress
e. Administer a cooling blanketRapid treatment of thyroid storm is essential to preserve life. Treatment includes cooling without aspirin (which increases free TH) or inducing shivering, replacing fluids, glucose, and electrolytes, relieving respiratory distress, stabilizing cardiovascular function, and reducing TH synthesis and secretion. #1 is incorrect because cooling happens without the use of aspirin. All of the other choices are correct.

A nursing student is studying for a test on care of the client with endocrine disorders. Which of the following statements demonstrates an understanding of the difference between hyperthyroidism and hypothyroidism?

a. “Deficient amounts of TH cause abnormalities in lipid metabolism, with decreased serum cholesterol and triglyceride levels.”

b. “Graves’ disease is the most common cause of hypothyroidism.”

c. “Decreased renal blood flow and glomerular filtration rate reduces the kidney’s ability to excrete water, which may cause hyponatremia.”

d. “Increased amounts of TH cause a decrease in cardiac output and peripheral blood flow.”

Correct answer:
c. “Decreased renal blood flow and glomerular filtration rate reduces the kidney’s ability to excrete water, which may cause hyponatremia.”Rationale:
a. Is incorrect because deficient amounts of TH cause abnormalities in lipid metabolism with elevated serum cholesterol and triglyceride levels.

b. Is incorrect because Graves’ disease is the most common cause of hyperthyroidism, not hypothyroidism.

d. Is incorrect because increased amounts of TH cause an increase in cardiac output and peripheral blood flow.

A nurse on a general medical-surgical unit is caring for a client with Cushing’s syndrome. Which of the following statements is correct about the medication regimen for Cushing’s syndrome?

a. Mitotane is used to treat metastatic adrenal cancer.

b. Aminogluthimide may be administered to clients with ectopic ACTH-secreting tumors before surgery is performed.

c. Ketoconazole increases cortisol synthesis by the adrenal cortex.

d. Somatostatin analog increases ACTH secretion in some clients.

a. Mitotane is used to treat metastatic adrenal cancer.

Mitotane directly suppresses activity of the adrenal cortex and decreases peripheral metabolism of corticosteroids. It is used to treat metastatic adrenal cancer.

b. Is incorrect because aminogluthimide may be administered to clients with ectopic ACTH-secreting tumors that cannot be surgically removed.

c. Is incorrect because ketoconazole inhibits, not increases, cortisol synthesis by the adrenal cortex.

d. Is incorrect because somatostatin suppresses, not increases, ACTH secretion.

Which of the following nursing implications is most important in a client being medicated for Addison’s disease?

a. Administer oral forms of the drug with food to minimize its ulcerogenic effect.

b. Monitor capillary blood glucose for hypoglycemia in the diabetic client.

c. Instruct the client to never abruptly discontinue the medication.

d. Teach the client to consume a diet that is high in potassium, low in sodium, and high in protein.

c. Instruct the client to never abruptly discontinue the medication.

The primary medical treatment of Addison’s disease is replacement of corticosteroids and mineralcorticoids, accompanied by increased sodium in the diet. The client needs to know the importance of maintaining a diet high is sodium and low in potassium. Medications should never be discontinued abruptly because crisis can ensue. Oral forms of the drug are given with food in Cushing’s disease.

The nurse is caring for a client who is about to undergo an adrenalectomy. Which of the following Preoperative interventions is most appropriate for this client?

a. Maintain careful use of medical and surgical asepsis when providing care and treatments.

b. Teach the client about a diet high in sodium to correct any potential sodium imbalances preoperatively.

c. Explain to the client that electrolytes and glucose levels will be measured postoperatively.

d. Teach the client how to effectively cough and deep breathe once surgery is complete.

a. Maintain careful use of medical and surgical asepsis when providing care and treatments.

Use careful medical and surgical asepsis when providing care and treatments since Cortisol excess increases the risk of infection.

A client newly diagnosed with Addison’s disease is giving a return explanation of teaching done by the primary nurse. Which of the following statements indicates that further teaching is necessary?

a. “I need to increase how much I drink each day.”
b. “I need to weigh myself if I think I am losing or gaining weight.”
c. “I need to maintain a diet high in sodium and low in potassium.”
d. “I need to take my medications each day.”

b. “I need to weigh myself if I think that I am losing or gaining weight.”

The client is at risk for ineffective therapeutic regimen management. Clients with Addison’s disease must learn to provide lifelong self-care that involves varied components: medications, diet, and recognizing and responding to stress. Changes in lifestyle are difficult to maintain permanently. The client needs to take the medications on a daily basis. The client needs to perform daily weights to monitor for signs of dehydration. The client needs to maintain a diet high in sodium and low in potassium, as well as maintain an increased fluid intake.

A patient with SIADH is treated with water restriction and administration of IV fluids. The nurses evaluates that treatment has been effective when the patient experiences

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. increased urine output, increased serum sodium, and decreased urine specific gravity

(rationale- 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 reflected by increased urine output, normalization of serum sodium, and more water in the urine, decreasing the specific gravity.)

Causes of primary hypothyroidism in adults include

a. malignant or benign thyroid nodules
b. surgical removal or failure of the pituitary gland
c. surgical removal or radiation of thyroid gland
d. autoimmune-induced atrophy of the gland

d. autoimmune-induced atrophy of the gland

(rationale- both Graves disease and Hasimotos thyroiditis are autoimmune disorders that eventually destroy the thyroid gland, leading to primary hypothyroidism. Thyroid tumors most often result in hyperthyroidism. Secondary hypothyroidism occurs as a result of pituitary failure, and iatrogenic hypothyroidism results from thyroidectomy or radiation of the thyroid gland.)

A patient with hypothyroidism is treated with Synthroid. When teaching the patient about the therapy, the nurse

a. explains that caloric intake must be reduced when drug therapy is started
b. provides written instruction for all information related to the medication therapy
c. assures the patient that a return to normal function will occur with replacement therapy
d. informs the patient that medications must be taken until hormone balance is reestablished

b. provides written instruction for all information related to the medication therapy

(rationale- 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. Caloric intake can be increased when drug therapy is started, because of an increased metabolic rate, and replacement therapy must be taken for life. Although most patients return to a normal state with treatment, cardiovascular conditions and psychoses may persist.)

A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, the nurse would expect to find

a. HTN, 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 hyper pigmentation of the skin

a. HTN, peripheral edema, and petechiae

(rationale- The effects of 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. Clinical manifestations of corticosteroid deficiency include hypotension, dehydration, weight loss, and hyperpigmentation of the skin.)

A characteristic common to all hormones is that they:
A.circulate in the blood bound to plasma proteins
B. influence cellular activity of specific target tissues
C. accelerate the metabolic processes of all body cells
D. enter a cell to alter the cell’s metabolism or gene expression
Correct answer: b
Rationale: A hormone is a chemical substance synthesized and secreted by a specific organ or tissue. Most hormones have common characteristics, including (1) secretion in small amounts at variable but predictable rates, (2) circulation through the blood, and (3) binding to specific cell receptors in the cell membrane or within the cell.
A patient is receiving radiation therapy for cancer of the kidney. The nurse monitors the patient for signs and symptoms of damage to the
A. pancreas
B. thyroid gland
C. adrenal glands
D. poster pituitary gland
Correct answer: c
Rationale: The adrenal glands are small, paired, highly vascularized glands located on the upper portion of each kidney.
A patient has a serum sodium level of 152 mEq/L. The normal hormonal response to this situation is:
A. release of ADH
B. release of ACTH
C. secretion of aldosterone
D. secretion of corticotropin-releasing hormone
Correct answer: a
Rationale: The most important stimulus of antidiuretic hormone (ADH) secretion is plasma osmolality, which is a measure of solute concentration in circulating blood. Plasma osmolality increases when there is a decrease in extracellular fluid or an increase in solute concentration. The increased plasma osmolality activates osmoreceptors, which are extremely sensitive, specialized neurons in the hypothalamus. These activated osmoreceptors stimulate ADH release. When ADH is released, the renal tubules reabsorb water, which causes urine to be more concentrated.
All cells in the body are believed to have intracellular receptors for:
a. insulin
b. glucagon
c. growth hormone
d. thyroid hormone
Correct answer: d
Rationale: There are two types of receptors: those that are within the cell (e.g., steroid and thyroid hormone receptors) and those that are on the cell membrane (e.g., water-soluble hormone receptors). Thyroid hormone receptors are located inside the cell. Because these hormones are lipid soluble, they pass through the target cell membrane by passive diffusion and bind to receptor sites located in the cytoplasm or nucleus of the target cell.
When obtaining subjective data from a patient during assessment of the endocrine system, the nurse asks specifically about:
a. energy level
b. intake of vitamin C
C. employment history
d. frequency of sexual intercourse
Correct answer: a
Rationale: The nurse should ask about energy levels, particularly in comparison with the patient’s past energy level. Fatigue and hyperactivity are two common problems associated with endocrine problems.
Endocrine disorders often go unrecognized in the older adult because:
a. symptoms are often attributed to aging
b. older adults rarely have identifiable symptoms
c. endocrine disorders are relatively rare in the older adult
d. older adults usually have subclinical endocrine disorders that minimize symptoms
Correct answer: a
Rationale: Assessment of the effects of aging on the endocrine system is difficult because the subtle changes of aging often mimic manifestations of endocrine disorders.
An abnormal finding by the nurse during an endocrine assessment would be: (select all that apply)
a. blood pressure of 100/70 mm Hg
b. excessive facial hair on a woman
c. soft, formed stool every other day
d. 3-lb weight gain over last 6 months
e. hyperpigmented coloration in the lower legs
Correct answers: b, e
Rationale: Hirsutism (i.e., excessive facial hair on women) may indicate Cushing syndrome or prolactinoma, a pituitary tumor. Hyperpigmentation (i.e., darkening of the skin, particularly in creases and skin folds) may indicate Addison’s disease, which is caused by increased secretion of melanocyte-stimulating hormone, or it may indicate acanthosis nigricans.
What regulates the blood level of calcium?
Parathyroid hormone or PTH, is secreted by the parathyroid glands in response to low serum calcium levels. This causes resorption of calcium from the bones, kidneys and GI tract.
What are some functions of cortisol?
Cortisol is necessary to maintain life. Its functions include regulation of blood glucose concentration, inhibition of inflammatory action, and support in response to stress.
What’s the function of aldosterone?
Aldosterone is a potent mineralocorticoid that maintains extracellular fluid volume
When instructing a patient regarding a urine study for free cortisol, what is most important for the nurse to tell the patient?
A. Save the first voided urine in the morning.
B. Maintain a high-sodium diet 3 days before collection.
C. Try to avoid stressful situations during the collection period.
D. Complete at least 30 minutes of exercise before collecting the urine sample.
C. Try to avoid stressful situations during the collection period.
A urine study for free cortisol requires a 24-hour urine collection. The patient should be instructed to avoid stressful situations and excessive physical exercise that could unduly increase cortisol levels. The patient should also maintain a low-sodium diet before and during the urine collection period.
Which assessment parameter is of highest priority when caring for a patient undergoing a water deprivation test?
A. Serum glucose
B. Patient weight
C. Arterial blood gases
D. Patient temperature
B. Patient weight
A patient is at risk for severe dehydration during a water deprivation test. The test should be discontinued and the patient rehydrated if the patient’s weight drops more than 2 kg at any time. The other assessment parameters do not assess fluid balance.
A patient has sought care because of a loss of 25 lb over the past 6 months, during which the patient claims to have made no significant dietary changes. What potential problem should the nurse assess the patient for?
A. Thyroid disorders
B. Diabetes insipidus
C. Pituitary dysfunction
D. Parathyroid dysfunction
A.Thyroid disorders
Hyperthyroidism is associated with weight loss. Alterations in pituitary function, such as diabetes insipidus, and parathyroid dysfunction are not commonly associated with this phenomenon.
The surgeon was unable to save a patient’s parathyroid gland during a radical thyroidectomy. The nurse should consequently pay particular attention to which laboratory value?
A. Calcium levels
B. Potassium levels
C. Blood glucose levels
D. Sodium and chloride levels
A. Calcium levels
The parathyroid gland plays a key role in maintaining calcium levels. Potassium, sodium, glucose, and chloride are not directly influenced by the loss of the parathyroid gland.
A patient’s recent medical history is indicative of diabetes insipidus. The nurse would perform patient teaching related to which diagnostic test?
A. Thyroid scan
B. Fasting glucose test
C. Oral glucose tolerance
D. Water deprivation test
D. Water deprivation test
A water deprivation test is used to diagnose the polyuria that accompanies diabetes insipidus. Glucose tests and thyroid tests are not directly related to the diagnosis of diabetes insipidus.
When the nurse assesses the patient that has pancreatitis, what function may be altered related to the endocrine function of the pancreas?
A. Blood glucose regulation
B. Increased response to stress
C. Fluid and electrolyte regulation
D. Regulates metabolic rate of cells
A. Blood glucose regulation
The endocrine functions of the pancreas are regulated by α cells that produce and secrete glucagon, β cells that produce and secrete insulin and amylin, delta cells that produce and secrete somatostatin, and F cells that secrete pancreatic polypeptide. Glucagon, insulin, and amylin, and somatostatin all affect blood glucose. Pancreatic polypeptide regulates appetite. Increased response to stress occurs from epinephrine secreted by the adrenal medulla. Fluid and electrolyte regulation occurs in response to several hormones (mineralocorticoids, antidiuretic hormone, parathyroid hormone, calcitonin) from several organs (adrenal cortex, posterior pituitary, parathyroid, thyroid). The metabolic rate of cells is regulated by triiodothyronine (T3) from the thyroid.
The hypothalamus secretes releasing hormones and inhibiting hormones. What is the target tissue of these releasing hormones and inhibiting hormones?
A. Pineal
B. Adrenal cortex
C. Posterior pituitary
D. Anterior pituitary
D. Anterior pituitary
The anterior pituitary is the target tissue of the releasing hormones (corticotropin releasing hormone, thyrotropin releasing hormone, growth hormone releasing factor, gonadotropin releasing hormone, prolactin releasing factor) and the inhibiting hormones (somatostatin, prolactin inhibiting factor). These hormones release or inhibit other hormones that affect the thyroid, adrenal cortex, pancreas, reproductive organs, and all body cells. The pineal gland is not directly affected by the releasing and inhibiting hormones from the hypothalamus. The posterior pituitary releases antidiuretic hormone (ADH) in response to plasma osmolality changes that is not directly affected by the hypothalamus hormones.
The patient has been feeling tired lately and has gained weight; reports thickened, dry skin and increased cold sensitivity even though it is now summer. Which endocrine diagnostic test should be done first?
A. Free thyroxine (FT4)
B. Serum growth hormone (GH)
C. Follicle stimulating hormone (FSH)
D. Magnetic resonance imaging (MRI) of the head
A. Free thyroxine (FT4)
The manifestations the patient is experiencing could be related to hypothyroidism. Free thyroxine (FT4) is considered a better indicator of thyroid function than total T4 and could be done to evaluate the patient for hypothyroidism. Growth hormone excess could cause thick, leathery, oily skin but does not demonstrate the other manifestations. FSH is manifest with menstrual irregularity and would be useful in distinguishing primary gonadal problems from pituitary insufficiency. MRI is the examination of choice for radiologic evaluation of the pituitary gland and the hypothalamus but would not be the first diagnostic study to further explore the basis of these manifestations.
The nurse is caring for a group of older patients in a long-term care setting. Which physical changes in the patients should the nurse investigate as signs of possible endocrine dysfunction?
A. Absent reflexes, diarrhea, and hearing loss
B. Hypoglycemia, delirium, and incontinence
C. Fatigue, constipation, and mental impairment
D. Hypotension, heat intolerance, and bradycardia
C. Fatigue, constipation, and mental impairment
Changes of aging often mimic clinical manifestations of endocrine disorders. Clinical manifestations of endocrine dysfunction such as fatigue, constipation, or mental impairment in the older adult are often missed because they are attributed solely to aging.
The nurse performs a physical assessment on a 74-year-old woman with possible endocrine dysfunction. The patient’s weight was 142 pounds 6 months ago compared to a current weight of 125 pounds. What percent weight change will the nurse document in the patient’s health record?
A. 12% weight loss
B. 17% weight loss
C. 25% weight loss
D. 74% weight loss
A. 12% weight loss
142 pounds – 125 pounds = 17 pounds; (17/142) × 100 = 12%. Weight change (%) is calculated by dividing the current body weight change by the usual body weight and multiplying the result by 100. Weight change greater than 5% in 1 month, 7.5% in 3 months, or 10% in 6 months is considered severe.
The nurse interviews a 50-year-old man with a history of type 2 diabetes mellitus, chronic bronchitis, and osteoarthritis who has a fasting blood glucose of 154 mg/dL. Which medications, if taken by the patient, may raise blood glucose levels?
A. Glargine (Lantus)
B. Prednisone (Deltasone)
C. Metformin (Glucophage)
D. Acetaminophen (Tylenol)
B. Prednisone (Deltasone)
Prednisone is a corticosteroid that may cause glucose intolerance in susceptible patients by increasing gluconeogenesis and insulin resistance. Insulin (e.g., glargine) and metformin (an oral hypoglycemic agent) decrease blood glucose levels. Acetaminophen has a glucose-lowering effect.
The nurse is caring for a 36-year-old woman with possible hypoparathyroidism after a thyroidectomy. It is most appropriate for the nurse to assess for which clinical manifestations?
A. Polyuria, polydipsia, and weight loss
B. Cardiac dysrhythmias and hypertension
C. Muscle spasms and hyperactive deep tendon reflexes
D. Hyperpigmentation, skin ulcers, and peripheral edema
C.Muscle spasms and hyperactive deep tendon reflexes
Common assessment abnormalities associated with hypoparathyroidism include tetany (muscle spasms) and increased deep tendon reflexes. Hyperpigmentation is associated with Addison’s disease. Skin ulcers occur in patient with diabetes. Edema is associated with hypothyroidism. Polyuria and polydipsia occur in patients with diabetes mellitus or diabetes insipidus. Weight loss occurs in hyperthyroidism or diabetic ketoacidosis. Hypertension and cardiac dysrhythmias may be caused by hyperthyroidism, hyperparathyroidism, or pheochromocytoma.
An 18-year-old male patient is undergoing a growth hormone stimulation test. The nurse should monitor the patient for
A. hypothermia.
B. hypertension.
C. hyperreflexia.
D. hypoglycemia.
D. hypoglycemia.
Insulin or arginine (agent that stimulates insulin secretion) is administered for a growth hormone stimulation test. The nurse should monitor the patient closely for hypoglycemia. Hypothermia and hypertension are not expected in response to insulin or arginine. Hyperreflexia is an autonomic complication of spinal cord injury.

A 22-year-old patient is being seen in the clinic with increased secretion of the anterior pituitary hormones. The nurse would expect the laboratory results to show

A. Increased urinary cortisol.
B. Decreased serum thyroxine.
C. Elevated serum aldosterone levels.
D. Low urinary catecholamines excretion.

A – Increased secretion of adrenocorticotropic hormone (ACTH) by the anterior pituitary gland will lead to an increase in serum and urinary cortisol levels. An increase, rather than a decrease, in thyroxine level would be expected with increased secretion of thyroid stimulating hormone (TSH) by the anterior pituitary. Aldosterone and catecholamine levels are not controlled by the anterior pituitary.

Which statement by a 50-year-old female patient indicates to the nurse that further assessment of thyroid function may be necessary?

A. “I notice my breasts are tender lately.”
B. “I am so thirsty that I drink all day long.”
C. “I get up several times at night to urinate.”
D. “I feel a lump in my throat when I swallow.”

D – Difficulty in swallowing can occur with a goiter. Nocturia is associated with diseases such as diabetes mellitus, diabetes insipidus, or chronic kidney disease. Breast tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of disease such as diabetes.

A 30-year-old patient seen in the emergency department for severe headache and acute confusion is found to have a serum sodium level of 118 mEq/L. The nurse will anticipate the need for which diagnostic test?

A. Urinary 17-ketosteroids
B. Antidiuretic hormone level
C. Growth hormone stimulation test
D. Adrenocorticotropic hormone level

B – Elevated levels of antidiuretic hormone will cause water retention and decrease serum sodium levels. The other tests would not be helpful in determining possible causes of the patient’s hyponatremia.

Which question will provide the most useful information to a nurse who is interviewing a patient about a possible thyroid disorder?

A. “What methods do you use to help cope with stress?”
B. “Have you experienced any blurring or double vision?”
C. “Have you had a recent unplanned weight gain or loss?”
D. “Do you have to get up at night to empty your bladder?”

C – Because thyroid function affects metabolic rate, changes in weight may indicate hyperfunction or hypofunction of the thyroid gland. Nocturia, visual difficulty, and changes in stress level are associated with other endocrine disorders.

A 29-year-old patient in the outpatient clinic will be scheduled for blood cortisol testing. Which instruction will the nurse provide?

A. “Avoid adding any salt to your foods for 24 hours before the test.”
B. “You will need to lie down for 30 minutes before the blood is drawn.”
C. “Come to the laboratory to have the blood drawn early in the morning.”
D. “Do not have anything to eat or drink before the blood test is obtained.”

C – Cortisol levels are usually drawn in the morning, when levels are highest. The other instructions would be given to patients who were having other endocrine testing.

A 61-year-old female patient admitted with pneumonia has a total serum calcium level of 13.3 mg/dL (3.3 mmol/L). The nurse will anticipate the need to teach the patient about testing for _____ levels.

A. Calcitonin
B. Catecholamine
C. Thyroid hormone
D. Parathyroid hormone

D – Parathyroid hormone is the major controller of blood calcium levels. Although calcitonin secretion is a countermechanism to parathyroid hormone, it does not play a major role in calcium balance. Catecholamine and thyroid hormone levels do not affect serum calcium level.

During the physical examination of a 36-year-old female, the nurse finds that the patient’s thyroid gland cannot be palpated. The most appropriate action by the nurse is to

A. Palpate the patient’s neck more deeply.
B. Document that the thyroid was nonpalpable.
C. Notify the health care provider immediately.
D. Teach the patient about thyroid hormone testing.

B – The thyroid is frequently nonpalpable. The nurse should simply document the finding. There is no need to notify the health care provider immediately about a normal finding. There is no indication for thyroid-stimulating hormone (TSH) testing unless there is evidence of thyroid dysfunction. Deep palpation of the neck is not appropriate.

Which laboratory value should the nurse review to determine whether a patient’s hypothyroidism is caused by a problem with the anterior pituitary gland or with the thyroid gland?

A. Thyroxine (T4) level
B. Triiodothyronine (T3) level
C. Thyroid-stimulating hormone (TSH) level
D. Thyrotropin-releasing hormone (TRH) level

C – A low TSH level indicates that the patient’s hypothyroidism is caused by decreased anterior pituitary secretion of TSH. Low T3 and T4 levels are not diagnostic of the primary cause of the hypothyroidism. TRH levels indicate the function of the hypothalamus.

The nurse reviews a patient’s glycosylated hemoglobin (Hb A1C) results to evaluate

A. Fasting preprandial glucose levels.
B. Glucose levels 2 hours after a meal.
C. Glucose control over the past 90 days.
D. Hypoglycemic episodes in the past 3 months.

C – Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose testing before/after a meal or random testing may reveal impaired glucose tolerance and indicate prediabetes, but it is not done on patients who already have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in the past.

A 60-year-old patient is taking spironolactone (Aldactone), a drug that blocks the action of aldosterone on the kidney, for hypertension. The nurse will monitor for

A. Increased serum sodium.
B. Decreased urinary output.
C. Elevated serum potassium.
D. Evidence of fluid overload.

C – Because aldosterone increases the excretion of potassium, a medication that blocks aldosterone will tend to cause hyperkalemia. Aldosterone also promotes the reabsorption of sodium and water in the renal tubules, so spironolactone will tend to cause increased urine output, a decreased or normal serum sodium level, and signs of dehydration.

An 18-year-old male patient with a small stature is scheduled for a growth hormone stimulation test. In preparation for the test, the nurse will obtain

A. Ice in a basin.
B. Glargine insulin.
C. A cardiac monitor.
D. 50% dextrose solution.

D – Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be ready to administer 50% dextrose immediately. Regular insulin is used to induce hypoglycemia (glargine is never given IV). The patient does not require cardiac monitoring during the test. Although blood samples for some tests must be kept on ice, this is not true for the growth hormone stimulation test.

The nurse will teach a patient to plan to minimize physical and emotional stress while the patient is undergoing

A. A water deprivation test.
B. Testing for serum T3 and T4 levels.
C. A 24-hour urine test for free cortisol.
D. A radioactive iodine (I-131) uptake test.

C – Physical and emotional stress can affect the results of the free cortisol test. The other tests are not impacted by stress.

A nurse will teach a patient who is scheduled to complete a 24-hour urine collection for 17-ketosteroids to

A. Insert and maintain a retention catheter.
B. Keep the specimen refrigerated or on ice.
C. Drink at least 3 L of fluid during the 24 hours.
D. Void and save that specimen to start the collection.

B – The specimen must be kept on ice or refrigerated until the collection is finished. Voided or catheterized specimens are acceptable for the test. The initial voided specimen is discarded. There is no fluid intake requirement for the 24-hour collection.

Which additional information will the nurse need to consider when reviewing the laboratory results for a patient’s total calcium level?

A. The blood glucose is elevated.
B. The phosphate level is normal.
C. The serum albumin level is low.
D. The magnesium level is normal.

C – Part of the total calcium is bound to albumin so hypoalbuminemia can lead to misinterpretation of calcium levels. The other laboratory values will not affect total calcium interpretation.

A 44-year-old patient is admitted with tetany. Which laboratory value should the nurse monitor?

A. Total protein
B. Blood glucose
C. Ionized calcium
D. Serum phosphate

C – Tetany is associated with hypocalcemia. The other values would not be useful for this patient.

Which information about a 30-year-old patient who is scheduled for an oral glucose tolerance test should be reported to the health care provider before starting the test?

A. The patient reports having occasional orthostatic dizziness.
B. The patient takes oral corticosteroids for rheumatoid arthritis.
C. The patient has had a 10-pound weight gain in the last month.
D. The patient drank several glasses of water an hour previously.

B – Corticosteroids can affect blood glucose results. The other information will be provided to the health care provider but will not affect the test results.

Corticosteroids can affect blood glucose results. The other information will be provided to the health care provider but will not affect the test results.

A. The RN checks the blood pressure on both arms.
B. The RN palpates the neck thoroughly to check thyroid size.
C. The RN lowers the thermostat to decrease the temperature in the room.
D. The RN orders nonmedicated eye drops to lubricate the patient’s bulging eyes.

B – Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided. The other actions by the new RN are appropriate when caring for a patient with an enlarged thyroid.

The nurse is caring for a 45-year-old male patient during a water deprivation test. Which finding is most important for the nurse to communicate to the health care provider?

A. The patient complains of intense thirst.
B. The patient has a 5-lb (2.3 kg) weight loss.
C. The patient’s urine osmolality does not increase.
D. The patient feels dizzy when sitting on the edge of the bed.

B – A drop in the weight of more than 2 kg indicates severe dehydration, and the test should be discontinued. The other assessment data are not unusual with this test.

A 35-year-old female patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which patient information is most important for the nurse to communicate to the health care provider before the test?

A. Bilateral poor peripheral vision
B. Allergies to iodine and shellfish
C. Recent weight loss of 20 pounds
D. Complaint of ongoing headaches

B – Because the usual contrast media is iodine-based, the health care provider will need to know about the allergy before the CT scan. The other findings are common with any mass in the brain such as a pituitary adenoma.

The nurse is caring for a 63-year-old with a possible pituitary tumor who is scheduled for a computed tomography (CT) scan with contrast. Which information about the patient is most important to discuss with the health care provider before the test?

A. History of renal insufficiency
B. Complains of chronic headache
C. Recent bilateral visual field loss
D, Blood glucose level of 134 mg/dL

A – Because contrast media may cause acute kidney injury in patients with poor renal function, the health care provider will need to prescribe therapies such as IV fluids to prevent this complication. The other findings are consistent with the patient’s diagnosis of a pituitary tumor.

Which statements will the nurse include when teaching a patient who is scheduled for oral glucose tolerance testing in the outpatient clinic (select all that apply)?

A. “You will need to avoid smoking before the test.”
B. “Exercise should be avoided until the testing is complete.”
C. “Several blood samples will be obtained during the testing.”
D. “You should follow a low-calorie diet the day before the test.”
E. “The test requires that you fast for at least 8 hours before testing.”

A, C, E – Smoking may affect the results of oral glucose tolerance tests. Blood samples are obtained at baseline and at 30, 60, and 120 minutes. Accuracy requires that the patient be fasting before the test. The patient should consume at least 1500 calories/day for 3 days before the test. The patient should be ambulatory and active for accurate test results.
The parathyroid glands play a major role in regulating which substances?
A. Calcium and Phosphorus
B. Cholride and potassium
C. Potassium and calcium
D. Sodium and potassium
A. Calcium and Phosphorus
a client is admitted to the hospital with a medical DX of hyperthyroidism. When taking a history which information would be most significant?
A. edema, intolerance to cold, lethargy
b. peri-orbital edema, lethargy mask like face
c. weight loss, intolerance to cold, muscle wasting
d. weight loss, intolerance to heat, exophthalmos
d. weight loss, intolerance to heat, exophthalmos
Which nursing action is most appropriate for a client in ketoacidosis?
a. admin of carbs
b. admin of IV fluids
c. applying cold compress
d. giving glucagon IV
b. admin of IV fluids
The nurse smells a sweet fruity odor on the breath of a client admitted with DM. This odor may be associated with?
a. alcohol intoxication
b. insulin shock
c. ketoacidosis
d. macrovacular complications
c. ketoacidosis
which of the following would be a nursing priority for a client just DX with Addison’s disease?
a. avioding unnecessary activity
b. encouraging client to wear a med alert tag
c. ensuring the client is adequatly hydrated
d. explaining that the client will need life long hormone therapy
c. ensuring the client is adequatly hydrated
A nurse is caring for a client in the late stage of Ketoacidosis. The nurse notices that the clients breath has a characteristic fruity odor. Which of the following substances is responsible for the fruity smell in the breath?
a. iodine
b. acetone
c.alcohol
d. glucose
b. acetone
A nurse is caring for a client with Addison’s disease. Which of the following nursing considerations should be employed when caring for this client?
a. avoid sodium in the clients diet
b. monitor and protect skin integrity
c. document the specific gravity of urine
d. monitor increases in blood pressure
c. document the specific gravity of urine
A nurse is preparing a diet plan for a 50yr with simple goiter. Which of the following should be included in the clients diet to decrease the enlargement of the thyroid gland?
a. iodine
b. sodium
c. potassium
d. calcium
a. iodine
A nurse is caring for a 60yr client affected with hypoparathyroidism. When checking the lab report, the nurse finds tht the clients calcium lvl was very low. Which of the following vitamins regulates the calcium lvl in the body?
a. A
b. D
c. E
d. K
Vitamin D

A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which “related-to” phrase should the nurse add?

A. Related to bone demineralization resulting in pathologic fractures
B. Related to exhaustion secondary to an accelerated metabolic rate
C. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces
D. Related to tetany secondary to a decreased serum calcium level

A. Related to bone demineralization resulting in pathologic fractures

Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury. Hyperparathyroidism doesn’t accelerate the metabolic rate. A decreased thyroid hormone level, not an increased parathyroid hormone level, may cause edema and dry skin secondary to fluid infiltration into the interstitial spaces. Hyperparathyroidism causes hypercalcemia, not hypocalcemia; therefore, it isn’t associated with tetany.

Nurse Oliver should expect a client with hypothyroidism to report which health concerns?

A. Increased appetite and weight loss
B. Puffiness of the face and hands
C. Nervousness and tremors
D. Thyroid gland swelling

B. Puffiness of the face and hands

Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves’ disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter).

A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug effect?

A. Dysuria
B. Leg cramps
C. Tachycardia
D. Blurred vision

C. Tachycardia

Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse effects of this agent include tachycardia. The other options aren’t associated with levothyroxine.

A 67-year-old male 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, nurse Richard would suspect which of the following disorders?

A. Diabetes mellitus
B. Diabetes insipidus
C. Hypoparathyroidism
D. Hyperparathyroidism

D. Hyperparathyroidism

Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercaliuria-causing polyuria. While clients with diabetes mellitus and diabetes insipidus also have polyuria, they don’t have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than polyuria.

When caring for a male client with diabetes insipidus, nurse Juliet expects to administer:

A. vasopressin (Pitressin Synthetic).
B. furosemide (Lasix).
C. regular insulin.
D. 10% dextrose.

A. vasopressin (Pitressin Synthetic).

Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.

The nurse is aware that the following is the most common cause of hyperaldosteronism?

A. Excessive sodium intake
B. A pituitary adenoma
C. Deficient potassium intake
D. An adrenal adenoma

D. An adrenal adenoma

An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake as well as of pituitary stimulation.

Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following?

A. Muscle weakness
B. Tremors
C. Diaphoresis
D. Constipation

A. Muscle weakness

Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren’t seen in hyperkalemia.

Nurse Louie 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?

A. antidiuretic hormone (ADH).
B. thyroid-stimulating hormone (TSH).
C. follicle-stimulating hormone (FSH).
D. luteinizing hormone (LH).

A. antidiuretic hormone (ADH).

ADH is the hormone clients with diabetes insipidus lack. The client’s TSH, FSH, and LH levels won’t be affected.

Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

A. Diabetic ketoacidosis
B. Thyroid crisis
C. Hypoglycemia
D. Tetany

B. Thyroid crisis

Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.

When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, nurse April is most likely to detect:

A. a blood pressure of 130/70 mm Hg.
B. a blood glucose level of 130 mg/dl.
C. bradycardia.
D. a blood pressure of 176/88 mm Hg.

D. a blood pressure of 176/88 mm Hg.

Pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn’t associated with the other options.

A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?

A. Infusing I.V. fluids rapidly as ordered
B. Encouraging increased oral intake
C. Restricting fluids
D. Administering glucose-containing I.V. fluids as ordered

C. Restricting fluids

To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client’s already heightened fluid load.

A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects to assess:

A. Trousseau’s sign.
B. Homans’ sign.
C. Hegar’s sign.
D. Goodell’s sign.

A. Trousseau’s sign.

This client’s serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseau’s sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans’ sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar’s sign (softening of the uterine isthmus) and Goodell’s sign (cervical softening) are probable signs of pregnancy.

Which outcome indicates that treatment of a male 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.

A. Fluid intake is less than 2,500 ml/day.

Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn’t been effective.

Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client’s hyperglycemia?

A. Acromegaly
B. Type 1 diabetes mellitus
C. Hypothyroidism
D. Deficient growth hormone

A. Acromegaly

Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn’t associated with hyperglycemia, nor is growth hormone deficiency.

An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. 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, nurse Libby prepares to take emergency action to prevent the potential complication of:

A. Thyroid storm.
B. Cretinism.
C. myxedema coma.
D. Hashimoto’s thyroiditis.

C. myxedema coma.

Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto’s thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.

When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description?

A. sulfisoxazole (Gantrisin)
B. mexiletine (Mexitil)
C. prednisone (Orasone)
D. lithium carbonate (Lithobid)

A. sulfisoxazole (Gantrisin)

Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesn’t cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia.

After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. Which of the following would the nurse expect the physician to do?

A. Initiate insulin therapy.
B. Switch the client to a different oral antidiabetic agent.
C. Prescribe an additional oral antidiabetic agent.
D. Restrict carbohydrate intake to less than 30% of the total caloric intake.

B. Switch the client to a different oral antidiabetic agent.

Many clients (25% to 60%) with secondary failure respond to a different oral antidiabetic agent. Therefore, it wouldn’t be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the antidiabetic agent.

During preoperative teaching for a female client who will undergo subtotal thyroidectomy, the nurse should include which statement?

A. “The head of your bed must remain flat for 24 hours after surgery.”
B. “You should avoid deep breathing and coughing after surgery.”
C. “You won’t be able to swallow for the first day or two.”
D. “You must avoid hyperextending your neck after surgery.”

D. “You must avoid hyperextending your neck after surgery.”

Nurse Ronn is assessing a client with possible Cushing’s syndrome. In a client with Cushing’s syndrome, the nurse would expect to find:

A. Hypotension.
B. Thick, coarse skin.
C. Deposits of adipose tissue in the trunk and dorsocervical area.
D. Weight gain in arms and legs.

C. Deposits of adipose tissue in the trunk and dorsocervical area.

Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide?

A. “Administer desmopressin while the suspension is cold.”
B. “Your condition isn’t chronic, so you won’t need to wear a medical identification bracelet.”
C. “You may not be able to use desmopressin nasally if you have nasal discharge or blockage.”
D. “You won’t need to monitor your fluid intake and output after you start taking desmopressin.”

C. “You may not be able to use desmopressin nasally if you have nasal discharge or blockage.”

Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and receive adequate fluid replacement.

Nurse Wayne is aware that a positive Chvostek’s sign indicate?

A. Hypocalcemia
B. Hyponatremia
C. Hypokalemia
D. Hypermagnesemia

A. Hypocalcemia

Chvostek’s sign is elicited by tapping the client’s face lightly over the facial nerve, just below the temple. If the client’s facial muscles twitch, it indicates hypocalcemia. Hyponatremia is indicated by weight loss, abdominal cramping, muscle weakness, headache, and postural hypotension. Hypokalemia causes paralytic ileus and muscle weakness. Clients with hypermagnesemia exhibit a loss of deep tendon reflexes, coma, or cardiac arrest.

In a 29-year-old female client who is being successfully treated for Cushing’s syndrome, nurse Lyzette would expect a decline in:

A. Serum glucose level.
B. Hair loss.
C. Bone mineralization.
D. Menstrual flow.

A. Serum glucose level.

Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing’s syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in Cushing’s syndrome; therefore, with successful treatment, abnormal hair growth also declines. Osteoporosis occurs in Cushing’s syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing’s syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.

A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar), 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin?

A. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs.
B. It interacts with plasma membrane receptors to inhibit enzymatic actions.
C. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism.
D. It regulates the threshold for water resorption in the kidneys.

C. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism.

Corticotropin interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. It doesn’t decrease cAMP production. The posterior pituitary hormone, antidiuretic hormone, regulates the threshold for water resorption in the kidneys.

A female client with Cushing’s syndrome is admitted to the medical-surgical unit. During the admission assessment, nurse Tyzz 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?

A. Depression
B. Neuropathy
C. Hypoglycemia
D. Hyperthyroidism

A. Depression

Agitation, irritability, poor memory, loss of appetite, and neglect of one’s appearance may signal depression, which is common in clients with Cushing’s syndrome. Neuropathy affects clients with diabetes mellitus — not Cushing’s syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite.

Nurse Ruth 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?

A. Tetany
B. Hemorrhage
C. Thyroid storm
D. Laryngeal nerve damage

A. Tetany

Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.

After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?

A. Primary hypothyroidism
B. Graves’ disease
C. Thyrotoxicosis
D. Euthyroidism

A. Primary hypothyroidism

Levothyroxine is the preferred agent to treat primary hypothyroidism and cretinism, although it also may be used to treat secondary hypothyroidism. It is contraindicated in Graves’ disease and thyrotoxicosis because these conditions are forms of hyperthyroidism. Euthyroidism, a term used to describe normal thyroid function, wouldn’t require any thyroid preparation.

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

B. Neck vein distention

SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by neck vein distention. This syndrome isn’t associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria).

A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer:

A. phentolamine (Regitine).
B. methyldopa (Aldomet).
C. mannitol (Osmitrol).
D. felodipine (Plendil).

A. phentolamine (Regitine).

Pheochromocytoma causes excessive production of epinephrine and norepinephrine, natural catecholamines that raise the blood pressure. Phentolamine, an alpha-adrenergic blocking agent given by I.V. bolus or drip, antagonizes the body’s response to circulating epinephrine and norepinephrine, reducing blood pressure quickly and effectively. Although methyldopa is an antihypertensive agent available in parenteral form, it isn’t effective in treating hypertensive emergencies. Mannitol, a diuretic, isn’t used to treat hypertensive emergencies. Felodipine, an antihypertensive agent, is available only in extended-release tablets and therefore doesn’t reduce blood pressure quickly enough to correct hypertensive crisis.

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?

A. Adrenal cortex
B. Pancreas
C. Adrenal medulla
D. Parathyroid

A. Adrenal cortex

Excessive secretion of aldosterone in the adrenal cortex is responsible for the client’s hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone.

Nurse Troy is aware that the most appropriate for a client with Addison’s disease?

A. Risk for infection
B. Excessive fluid volume
C. Urinary retention
D. Hypothermia

A. Risk for infection

Addison’s disease decreases the production of all adrenal hormones, compromising the body’s normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with Addison’s disease include Deficient fluid volume and Hyperthermia. Urinary retention isn’t appropriate because Addison’s disease causes polyuria.

A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, nurse Jacob reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize?

A. “You must lie flat for 24 hours after surgery.”
B. “You must avoid coughing, sneezing, and blowing your nose.”
C. “You must restrict your fluid intake.”
D. “You must report ringing in your ears immediately.”

B. “You must avoid coughing, sneezing, and blowing your nose.”

After a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing, and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The head of the bed must be elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24 hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake. Visual, not auditory, changes are a potential complication of hypophysectomy.

For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client?

A. They contain exudate and provide a moist wound environment.
B. They protect the wound from mechanical trauma and promote healing.
C. They debride the wound and promote healing by secondary intention.
D. They prevent the entrance of microorganisms and minimize wound discomfort.

C. They debride the wound and promote healing by secondary intention.

For this client, wet-to-dry dressings are most appropriate because they clean the foot ulcer by debriding exudate and necrotic tissue, thus promoting healing by secondary intention. Moist, transparent dressings contain exudate and provide a moist wound environment. Hydrocolloid dressings prevent the entrance of microorganisms and minimize wound discomfort. Dry sterile dressings protect the wound from mechanical trauma and promote healing.

When instructing the female client diagnosed with hyperparathyroidism about diet, nurse Gina should stress the importance of which of the following?

A. Restricting fluids
B. Restricting sodium
C. Forcing fluids
D. Restricting potassium

C. Forcing fluids

The client should be encouraged to force fluids to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn’t necessary in hyperparathyroidism.

For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for Chvostek’s sign and Trousseau’s sign because they indicate which of the following?

A. Hypocalcemia
B. Hypercalcemia
C. Hypokalemia
D. Hyperkalemia

A. Hypocalcemia

The client who has undergone a thyroidectomy is at risk for developing hypocalcemia from inadvertent removal or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive Chvostek’s sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive Trousseau’s sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren’t present with hypercalcemia, hypokalemia, or hyperkalemia.

A nurse is collecting data regarding a client after a thyroidectomy and notes that the client has developed hoarseness and a weak voice. Which nursing action is appropriate?
1. Check for signs of bleeding.
2. Administer calcium gluconate.
3. Notify the registered nurse immediately.
*4. Reassure the client that this is usually a temporary condition.*
*rationale* Weakness and hoarseness of the voice can occur as a result of trauma of the laryngeal nerve. If this develops, the client should be reassured that the problem will subside in a few days. Unnecessary talking should be discouraged. It is not necessary to notify the registered nurse immediately. These signs do not indicate bleeding or the need to administer calcium gluconate.
A nurse is reviewing discharge teaching with a client who has Cushing’s syndrome. Which statement by the client indicates that the instructions related to dietary management were understood?
*1. “I can eat foods that contain potassium.”*
2. “I will need to limit the amount of protein in my diet.”
3. “I am fortunate that I can eat all the salty foods I enjoy.”
4. “I am fortunate that I do not need to follow any special diet.”
*rationale* A diet that is low in calories, carbohydrates, and sodium but ample in protein and potassium content is encouraged for a client with Cushing’s syndrome. Such a diet promotes weight loss, the reduction of edema and hypertension, the control of hypokalemia, and the rebuilding of wasted tissue.
A nurse is caring for a postoperative parathyroidectomy client. Which of the following would require the nurse’s immediate attention?
1. Incisional pain
*2. Laryngeal stridor*
3. Difficulty voiding
4. Abdominal cramps
*rationale* During the postoperative period, the nurse carefully observes the client for signs of hemorrhage, which cause swelling and the compression of adjacent tissue. Laryngeal stridor is a harsh, high-pitched sound heard on inspiration and expiration that is caused by the compression of the trachea and that leads to respiratory distress. It is an acute emergency situation that requires immediate attention to avoid the complete obstruction of the airway.
A nurse assists in developing a plan of care for a client with hyperparathyroidism receiving calcitonin-human (Cibacalcin). Which outcome has the highest priority regarding this medication?
1. Relief of pain
2. Absence of side effects
*3. Reaching normal serum calcium levels*
4. Verbalization of appropriate medication knowledge
*rationale* Hypercalcemia can occur in clients with hyperparathyroidism, and calcitonin is used to lower plasma calcium level. The highest priority outcome in this client situation would be a reduction in serum calcium level. Option 1 is unrelated to this medication. Although options 2 and 4 are expected outcomes, they are not the highest priority for administering this medication.
A nursing instructor asks a student to describe the pathophysiology that occurs in Cushing’s disease. Which statement by the student indicates an accurate understanding of this disorder?
1. “Cushing’s disease is characterized by an oversecretion of insulin.”
*2. “Cushing’s disease is characterized by an oversecretion of glucocorticoid hormones.”*
3. “Cushing’s disease is characterized by an undersecretion of corticotropic hormones.”
4. “Cushing’s disease is characterized by an undersecretion of glucocorticoid hormones.”
*rationale* Cushing’s syndrome is characterized by an oversecretion of glucocorticoid hormones. Addison’s disease is characterized by the failure of the adrenal cortex to produce and secrete adrenocortical hormones. Options 1 and 4 are inaccurate regarding Cushing’s syndrome.
A nurse would expect to note which interventions in the plan of care for a client with hypothyroidism? *Select all that apply.*
1. Provide a cool environment for the client.
2. Instruct the client to consume a high-fat diet.
*3. Instruct the client about thyroid replacement therapy.*
*4. Encourage the client to consume fluids and high-fiber foods in the diet.*
*5. Instruct the client to contact the health care provider if episodes of chest pain occur.*
6. Inform the client that iodine preparations will be prescribed to treat the disorder.
*rationale* The clinical manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interventions are aimed at replacement of the hormones and providing measures to support the signs and symptoms related to a decreased metabolism. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation. The client often has cold intolerance and requires a warm environment. The client would notify the health care provider if chest pain occurs since it could be an indication of overreplacement of thyroid hormone. Iodine preparations are used to treat hyperthyroidism. These medications decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone.
Which nursing action would be appropriate to implement when a client has a diagnosis of pheochromocytoma?
1. Weigh the client.
2. Test the client’s urine for glucose.
*3. Monitor the client’s blood pressure.*
4. Palpate the client’s skin to determine warmth.
*rationale* Hypertension is the major symptom that is associated with pheochromocytoma. The blood pressure status is monitored by taking the client’s blood pressure. Glycosuria, weight loss, and diaphoresis are also clinical manifestations of pheochromocytoma, but hypertension is the major symptom.
A nurse is caring for a client with pheochromocytoma. The client is scheduled for an adrenalectomy. During the preoperative period, the priority nursing action would be to monitor the:
*1. Vital signs*
2. Intake and output
3. Blood urea nitrogen (BUN) level
4. Urine for glucose and acetone
*rationale* Hypertension is the hallmark of pheochromocytoma. Severe hypertension can precipitate a brain attack (stroke) or sudden blindness. Although all of the options are accurate nursing interventions for the client with pheochromocytoma, the priority nursing action is to monitor the vital signs, particularly the blood pressure.
A nurse is caring for a client with pheochromocytoma. The client asks for a snack and something warm to drink. The appropriate choice for this client to meet nutritional needs would be which of the following?
1. Crackers with cheese and tea
*2. Graham crackers and warm milk*
3. Toast with peanut butter and cocoa
4. Vanilla wafers and coffee with cream and sugar
*rationale* The client with pheochromocytoma needs to be provided with a diet that is high in vitamins, minerals, and calories. Of particular importance is that food or beverages that contain caffeine (e.g., chocolate, coffee, tea, and cola) are prohibited.
A nurse is caring for a client with pheochromocytoma. Which data would indicate a potential complication associated with this disorder?
1. A urinary output of 50 mL/hr
2. A coagulation time of 5 minutes
*3. Congestion heard on auscultation of the lungs*
4. A blood urea nitrogen (BUN) level of 20 mg/dL
*rationale* The complications associated with pheochromocytoma include hypertensive retinopathy and nephropathy, myocarditis, congestive heart failure (CHF), increased platelet aggregation, and stroke. Death can occur from shock, stroke, renal failure, dysrhythmias, or dissecting aortic aneurysm. Congestion heard on auscultation of the lungs is indicative of CHF. A urinary output of 50 mL/hr is an appropriate output; the nurse would become concerned if the output were less than 30 mL/hr. A coagulation time of 5 minutes is normal. A BUN level of 20 mg/dL is a normal finding.
A nurse is caring for a client after thyroidectomy and monitoring for signs of thyroid storm. The nurse understands that which of the following is a manifestation associated with this disorder?
1. Bradycardia
*2. Hypotension*
3. Constipation
4. Hypothermia
*rationale* Clinical manifestations associated with thyroid storm include a fever as high as 106° F (41.1° C), severe tachycardia, profuse diarrhea, extreme vasodilation, hypotension, atrial fibrillation, hyperreflexia, abdominal pain, diarrhea, and dehydration. With this disorder, the client’s condition can rapidly progress to coma and cardiovascular collapse.
When caring for a client who is having clear drainage from his nares after transsphenoidal hypophysectomy, which action by the nurse is appropriate?
1. Lower the head of the bed.
*2. Test the drainage for glucose.*
3. Obtain a culture of the drainage.
4. Continue to observe the drainage.
*rationale* After hypophysectomy, the client should be monitored for rhinorrhea, which could indicate a cerebrospinal fluid (CSF) leak. If this occurs, the drainage should be collected and tested for glucose, indicating the presence of CSF. The head of the bed should not be lowered to prevent increased intracranial pressure. Clear nasal drainage would not indicate the need for a culture. Continuing to observe the drainage without taking action could result in a serious complication.
After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse understands that which symptom is indicative of this disorder?
1. Diarrhea
*2. Polydipsia*
3. Weight gain
4. Blurred vision
*rationale* Polydipsia and polyuria are classic symptoms of diabetes insipidus. The urine is pale in color, and its specific gravity is low. Anorexia and weight loss occur. Diarrhea, weight loss, and blurred vision are not manifestations of the disorder.
Which clinical manifestation should the nurse expect to note when assessing a client with Addison’s disease?
1. Edema
2. Obesity
3. Hirsutism
*4. Hypotension*
*rationale* Common manifestations of Addison’s disease include postural hypotension from fluid loss, syncope, muscle weakness, anorexia, nausea, vomiting, abdominal cramps, weight loss, depression, and irritability. The manifestations in options 1, 2, and 3 are not associated with Addison’s disease.
What would the nurse anticipate being included in the plan of care for a client who has been diagnosed with Graves’ disease?
1. Provide a high-fiber diet.
*2. Provide a restful environment.*
3. Provide three small meals per day.
4. Provide the client with extra blankets.
*rationale* Because of the hypermetabolic state, the client with Graves’ disease needs to be provided with an environment that is restful both physically and mentally. Six full meals a day that are well balanced and high in calories are required, because of the accelerated metabolic rate. Foods that increase peristalsis (e.g., high-fiber foods) need to be avoided. These clients suffer from heat intolerance and require a cool environment.
A licensed practical nurse (LPN) is assisting a high school nurse in conducting a session with female adolescents regarding the menstrual cycle. The LPN tells the adolescents that the normal duration of the menstrual cycle is about:
1. 14 days
*2. 28 days*
3. 30 days
4. 45 days
*rationale* The normal duration of the menstrual cycle is about 28 days, although it may range from 20 to 45 days. The first day of the menstrual period is counted as day 1 of the woman’s cycle. Options 1, 3, and 4 are incorrect.
A maternity nursing instructor asks a nursing student to identify the hormones that are produced by the ovaries. Which of the following, if identified by the student, indicates an understanding of the hormones produced by this endocrine gland?
1. Oxytocin
2. Luteinizing hormone (LH)
*3. Estrogen and progesterone*
4. Follicle-stimulating hormone (FSH)
*rationale* The ovaries are the endocrine glands that produce estrogen and progesterone. Oxytocin is produced by the posterior pituitary gland and stimulates the uterus to produce contractions. LH and FSH are produced by the anterior pituitary gland.
Which statement by the client would cause the nurse to suspect that the thyroid test results drawn on the client this morning may be inaccurate?
*1. “I had a radionuclide test done 3 days ago.”*
2. “When I exercise I sweat more than normal.”
3. “I drank some water before the blood was drawn.”
4. “That hamburger I ate before the test sure tasted good.”
*rationale* Option 1 indicates that a recent radionuclide scan had been performed. Recent radionuclide scans performed before the test can affect thyroid laboratory results. No food, fluid, or activity restrictions are required for this test, so options 2, 3, and 4 are incorrect.
A nurse is preparing to provide instructions to a client with Addison’s disease regarding diet therapy. The nurse understands that which of the following diets would likely be prescribed for this client?
1. Low-protein diet
2. Low-sodium diet
*3. High-sodium diet*
4. Low-carbohydrate diet
*rationale* A high-sodium, high-complex carbohydrate, and high-protein diet will be prescribed for the client with Addison’s disease. To prevent excess fluid and sodium loss, the client is instructed to maintain an adequate salt intake of up to 8 g of sodium daily and to increase salt intake during hot weather, before strenuous exercise, and in response to fever, vomiting, or diarrhea.
Which of the following statements made by the nursing student demonstrates an understanding of the hormone oxytocin?
1. “Production of oxytocin occurs in the ovaries.”
2. “It is produced by the anterior pituitary gland.”
*3. “It causes contractions of the uterus during birth.”*
4. “Release of oxytocin stimulates the pancreas to produce insulin.”
*rationale* Oxytocin is produced by the posterior pituitary, not the anterior pituitary gland, and stimulates the uterus to produce contractions during birth. The ovaries are the endocrine glands that produce estrogen and progesterone. The pancreas produces insulin and other enzymes that aid digestion. Oxytocin does not stimulate the pancreas to produce insulin.
A nurse is caring for a client with a diagnosis of hypoparathyroidism. The nurse reviews the laboratory results drawn on the client and notes that the calcium level is extremely low. The nurse would expect to note which of the following on data collection of the client?
*1. Positive Trousseau’s sign*
2. Negative Chvostek’s sign
3. Unresponsive pupils
4. Hyperactive bowel sounds
*rationale* Hypoparathyroidism is related to a lack of parathyroid hormone secretion or to a decreased effectiveness of parathyroid hormone on target tissues. The end result of this disorder is hypocalcemia. When serum calcium levels are critically low, the client may exhibit positive Chvostek’s and Trousseau’s signs, which indicate potential tetany. Options 2, 3, and 4 are not related to the presence of hypocalcemia.
A nurse caring for a client scheduled for a transsphenoidal hypophysectomy to remove a tumor in the pituitary gland assists to develop a plan of care for the client. The nurse suggests including which specific information in the preoperative teaching plan?
1. Hair will need to be shaved.
2. Deep breathing and coughing will be needed after surgery.
*3. Toothbrushing will not be permitted for at least 2 weeks following surgery.*
4. Spinal anesthesia is used.
*rationale* Based on the location of the surgical procedure, spinal anesthesia would not be used. In addition, the hair would not be shaved. Although coughing and deep breathing are important, specific to this procedure is avoiding toothbrushing to prevent disruption of the surgical site. Also, coughing may disrupt the surgical site.
Following hypophysectomy, a client complains of being very thirsty and having to urinate frequently. The initial nursing action is to:
1. Document the complaints.
2. Increase fluid intake.
*3. Check the urine specific gravity.*
4. Check for urinary glucose.
*rationale* Following hypophysectomy, diabetes insipidus can occur temporarily because of antidiuretic hormone deficiency. This deficiency is related to surgical manipulation. The nurse should check the urine for specific gravity and report the results if they are less than 1.005. Urinary glucose and diabetes mellitus is not a concern here. In this situation, increasing fluid intake would require a health care provider’s prescription. The client’s complaint would be documented but not as an initial action.
A client is brought to the emergency department in an unresponsive state, and a diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is made. The nurse who is assisting to care for the client obtains which of the following immediately in preparation for the treatment of this syndrome?
1. NPH insulin
2. A nasal cannula
3. Intravenous (IV) infusion of sodium bicarbonate
*4. IV infusion of normal saline*
*rationale* The primary goal of treatment is to rehydrate the client to restore fluid volume and to correct electrolyte deficiency. IV fluid replacement is similar to that administered in diabetic ketoacidosis (DKA) and begins with IV infusion of normal saline. Regular insulin, not NPH insulin would be administered. The use of sodium bicarbonate to correct acidosis is avoided because it can precipitate a further drop in serum potassium levels. A nasal cannula for oxygen administration is not necessarily required to treat HHNS.
A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which of the following findings would the nurse expect to note as confirming this diagnosis?
*1. Elevated blood glucose and low plasma bicarbonate*
2. Decreased urine output
3. Increased respirations and an increase in pH
4. Coma
*rationale* In DKA, the arterial pH is less than 7.35, plasma bicarbonate is less than 15 mEq/L, the blood glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine. The client would be experiencing polyuria and Kussmaul’s respirations. Coma may occur if DKA is not treated, but coma would not confirm the diagnosis.
A client is admitted to the hospital with a diagnosis of diabetic ketoacidosis (DKA). The initial serum glucose level was 950 mg/dL. Intravenous (IV) insulin was started along with rehydration with IV normal saline. The serum glucose level is now 240 mg/dL. The nurse who is assisting in caring for the client obtains which of the following items, anticipating a health care provider’s prescription?
*1. IV infusion containing 5% dextrose*
2. NPH insulin and a syringe for subcutaneous injection
3. An ampule of 50% dextrose
4. Phenytoin (Dilantin) for prevention of seizures
*rationale* During management of DKA, when the blood glucose level falls to 300 mg/dL, the infusion rate is reduced and 5% dextrose is added to maintain a blood glucose level of about 250 mg/dL, or until the client recovers from ketosis. NPH insulin is not used to treat DKA; 50% dextrose is used to treat hypoglycemia. Phenytoin is not a normal treatment measure in DKA.
A client with diabetes mellitus is being discharged following treatment for hyperglycemic hyperosmolar nonketotic syndrome (HHNS) precipitated by acute illness. The client states to the nurse, “I will call the doctor next time I can’t eat for more than a day or so.” The nurse plans care, understanding that which of the following accurately reflects this client’s level of knowledge?
*1. The client needs immediate education before discharge.*
2. The client’s statement is accurate, but knowledge should be evaluated further.
3. The client’s statement is inaccurate, and the client should be scheduled for outpatient diabetic counseling.
4. The client requires follow-up teaching regarding the administration of insulin.
*rationale* If the client becomes ill and cannot retain fluids or food for a period of 4 hours, the health care provider should be notified. The client’s statement in this question indicates a need for immediate education to prevent HHNS, a life-threatening emergency situation.
A health care provider has prescribed propylthiouracil (PTU) for a client with hyperthyroidism, and the nurse assists in developing a plan of care for the client. A priority nursing measure to be included in the plan regarding this medication is to monitor the client for:
*1. Signs and symptoms of hypothyroidism*
2. Signs and symptoms of hyperglycemia
3. Relief of pain
4. Signs of renal toxicity
*rationale* Excessive dosing with propylthiouracil may convert the client from a hyperthyroid state to a hypothyroid state. If this occurs, the dosage should be reduced. Temporary administration of thyroid hormone may be required. Propylthiouracil is not used for pain and does not cause hyperglycemia or renal toxicity.
A nurse is assisting in preparing a care plan for a client with diabetes mellitus who has hyperglycemia. The nurse focuses on which potential problem for this client?
*1. Dehydration*
2. The need for knowledge about the causes of hyperglycemia
3. Lack of knowledge about nutrition
4. Inability of family to cope with the client’s diagnosis
*rationale* Increased blood glucose will cause the kidneys to excrete the glucose in the urine. This glucose is accompanied by fluids and electrolytes, causing an osmotic diuresis that leads to dehydration. This fluid loss must be replaced when it becomes severe. Options 2, 3, and 4 may be concerns at some point but are not the priority with hyperglycemia.
A nurse is assigned to care for a client at home who has a diagnosis of type 1 diabetes mellitus. When the nurse arrives to care for the client, the client tells the nurse that she has been vomiting and has diarrhea. Which additional statement by the client indicates a need for further teaching?
*1. “I need to stop my insulin.”*
2. “I need to increase my fluid intake.”
3. “I need to call my health care provider.”
4. “I need to monitor my blood glucose every 4 to 6 hours.”
*rationale* When a client with diabetes is unable to eat normally because of illness, the client should still take the prescribed insulin or oral medication. Additional fluids should be consumed and a call placed to the health care provider. The client should monitor the blood glucose levels every 4 to 6 hours.
A nurse is assigned to assist in caring for a client admitted to the emergency department with diabetic ketoacidosis (DKA). In the acute phase, the priority nursing action is to plan to prepare to:
*1. Administer intravenous (IV) regular insulin.*
2. Administer IV 5% dextrose.
3. Correct the acidosis.
4. Apply an electrocardiogram (ECG) monitor.
*rationale* Lack (absolute or relative) of insulin is the primary cause leading to DKA. Treatment consists of IV fluids (normal saline initially), regular insulin administration, and potassium replacement, followed by correcting the acidosis. An ECG monitor may be applied but is not the priority in this situation.
A client with type 2 diabetes mellitus has a blood glucose of more than 600 mg/dL and is complaining of polydipsia, polyuria, weight loss, and weakness. The nurse reviews the health care provider’s documentation and would expect to note which of the following diagnoses?
1. Diabetic ketoacidosis (DKA)
2. Hypoglycemia
*3. Hyperglycemic hyperosmolar nonketotic syndrome (HHNS)*
4. Pheochromocytoma
*rationale* HHNS is seen primarily in individuals with type 2 diabetes who experience a relative deficiency of insulin. The onset of symptoms may be gradual. The symptoms may include polyuria, polydipsia, dehydration, mental status alterations, weight loss, and weakness. DKA normally occurs in type 1 diabetes mellitus. The clinical manifestations noted in the question are not signs of hypoglycemia. Pheochromocytoma is not related to these clinical manifestations.
A nurse is preparing to administer an injection of regular insulin. The vial of the regular insulin has been refrigerated. On inspection of the vial, the nurse finds that the medication is frozen. The nurse should:
1. Wait for the insulin to thaw at room temperature.
2. Check the temperature settings of the refrigerator.
*3. Discard the insulin and obtain another vial.*
4. Rotate the vial between the hands until the medication becomes liquid.
*rationale* Insulin preparations are stable at room temperature for up to 1 month without significant loss of activity. Insulin should not be frozen. If the insulin is frozen, it should be discarded and the nurse should obtain another vial. Options 1, 2, and 4 are incorrect.
A nurse has collected data on a client with diabetes mellitus. Findings include a fasting blood glucose of 130 mg/dL, temperature 101° F, pulse of 88 beats per minute, respirations of 22 breaths per minute, and a blood pressure of 118/78 mm Hg. Which finding would be of concern to the nurse?
1. Pulse and respirations
2. Blood pressure
3. Blood glucose
*4. Temperature*
*rationale* Elevated temperature may be indicative of infection, which is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) or diabetic ketoacidosis (DKA). Options 1, 2, and 3 are findings that are within a normal range.
A nurse is collecting data from a client newly diagnosed with diabetes mellitus regarding the client’s learning readiness. Which client behavior indicates to the nurse that the client is not ready to learn?
*1. The client complains of fatigue whenever the nurse plans a teaching session.*
2. The client asks if the spouse can attend the classes also.
3. The client asks for written materials about diabetes before class.
4. The client asks appropriate questions about what will be taught.
*rationale* Physical symptoms can interfere with an individual’s ability to learn and can indicate to the teacher that the learner lacks motivation to learn if the symptoms repeatedly recur when teaching is initiated. Options 2, 3, and 4 identify the client as actively seeking information.
A client with diabetes mellitus visits the health care clinic. The client previously had been well controlled with glyburide (Diabeta), but recently, the fasting blood glucose has been running 180 to 200 mg/dL. Which of the following medications, if added to the client’s regimen, may be contributing to the hyperglycemia?
*1. Prednisone*
2. Atenolol (Tenormin)
3. Phenelzine (Nardil)
4. Allopurinol (Zyloprim)
*rationale* Prednisone may decrease the effect of oral hypoglycemics, insulin, diuretics, and potassium supplements. Options 2, a β-blocker, and 3, a monoamine oxidase inhibitor, have their own intrinsic hypoglycemic activity. Option 4 decreases urinary excretion of sulfonylurea agents, causing increased levels of the oral medications, which can lead to hypoglycemia.
A health care provider prescribes a 24-hour urine collection for vanillylmandelic acid (VMA). The nurse instructs the client in the procedure for the collection of the urine. Which statement by the client would indicate a need for further instruction?
1. “I will start the collection in 2 days. I cannot eat or drink any tea, chocolate, vanilla, or fruit until the test is completed.”
2. “When I start the collection, I will urinate and discard that specimen.”
3. “I will pour the urine into the collection bottle each time I urinate and refrigerate the urine.”
*4. “I can take any medications if I need to before the collection.”*
*rationale* Because a 24-hour urine collection is a timed quantitative determination, it is essential that the client start the test with an empty bladder. Therefore the client is instructed to void and discard the first urine and note the time and start the test. The 24-hour urine specimen collection bottle must be kept on ice or refrigerated. In a VMA collection, the client is instructed to avoid tea, chocolate, vanilla, and all fruits for 2 days before urine collection begins. Also clients are reminded not to take certain medications for 2 to 3 days before the test.
A nurse in an outpatient diabetes clinic is assisting in caring for a client on insulin pump therapy. Which statement by the client indicates that a knowledge deficit exists regarding insulin pump therapy?
1. “If my blood sugars are elevated, I can bolus myself with additional insulin as prescribed.”
2. “I’ll need to check my blood sugars before meals in case I need a pre-meal insulin bolus.”
*3. “Now that I have this pump, I don’t have to worry about insulin reactions or ketoacidosis occurring again.”*
4. “I still need to follow an appropriate diet and exercise plan even though I don’t have to inject myself daily anymore.”
*rationale* All of the statements are correct in regard to insulin pump therapy, except the one that mentions insulin reactions and ketoacidosis. Hypoglycemic reactions can occur if there is an error in calculating the insulin dose or if the pump malfunctions. Ketoacidosis can occur if too little insulin is used or if there is an increase in metabolic need. The pump does not have a built-in blood glucose monitoring feedback system, so the client is subject to the usual complications associated with insulin administration without the use of a pump.
A client with Graves’ disease has exophthalmos and is experiencing photophobia. Which intervention would best assist the client with this problem?
1. Administering methimazole (Tapazole) every 8 hours
2. Lubricating the eyes with tap water every 2 to 4 hours
3. Instructing the client to avoid straining or heavy lifting
*4. Obtaining dark glasses for the client*
*rationale* Because photophobia (light intolerance) accompanies this disorder, dark glasses are helpful in alleviating the symptom. Medical therapy for Graves’ disease does not help alleviate the clinical manifestation of exophthalmos. Other interventions may be used to relieve the drying that occurs from not being able to completely close the eyes; however, the question is asking what the nurse can do for photophobia. Tap water, which is hypotonic, could actually cause more swelling to the eye because it could pull fluid into the interstitial space. In addition, the client is at risk for developing an eye infection because the solution is not sterile. There is no need to prevent straining with exophthalmos.
The nurse caring for a client who has had a subtotal thyroidectomy reviews the plan of care and determines which problem is the priority for this client in the immediate postoperative period?
1. Dehydration
2. Infection
3. Urinary retention
*4. Bleeding*
*rationale* Hemorrhage is one of the most severe complications that can occur following thyroidectomy. The nurse must frequently check the neck dressing for bleeding and monitor vital signs to detect early signs of hemorrhage, which could lead to shock. T3 and T4 do not regulate fluid volumes in the body. Infection is a concern for any postoperative client but is not the priority in the immediate postoperative period. Urinary retention can occur in postoperative clients as a result of medication and anesthesia but is not the priority from the options provided.
A comatose client with an admitting diagnosis of diabetic ketoacidosis (DKA) has a blood glucose of 368 mg/dL, arterial pH of 7.2, arterial bicarbonate of 14 mEq/L, and a positive for serum ketones. The diagnosis is supported by which noted data?
1. Hypertension
*2. Fruity breath odor*
3. Slow regular breathing
4. Moist mucous membranes
*rationale* Diabetic ketoacidotic coma is usually identified with a fruity breath odor, dry cracked mucous membranes, hypotension, and rapid deep breathing.
A nurse is collecting data on a client admitted to the hospital with a diagnosis of myxedema. Which data collection technique will provide data necessary to support the admitting diagnosis?
1. Auscultation of lung sounds
*2. Inspection of facial features*
3. Percussion of the thyroid gland
4. Palpation of the adrenal glands
*rationale* Inspection of facial features will reveal the characteristic coarse features, presence of edema around the eyes and face, and a blank expression that are characteristic of myxedema. The techniques in the remaining options will not reveal any data that would support the diagnosis of myxedema.
A client with Cushing’s disease is being admitted to the hospital after a stab wound to the abdomen. The nurse plans care and places highest priority on which potential problem?
1. Nervousness
*2. Infection*
3. Concern about appearance
4. Inability to care for self
*rationale* The client with a stab wound has a break in the body’s first line of defense against infection. The client with Cushing’s disease is at great risk for infection because of excess cortisol secretion and subsequent impaired antibody function and decreased proliferation of lymphocytes. The client may also have a potential for the problems listed in the other options but these are not the highest priority at this time.
A nurse has reinforced instructions about measuring blood glucose levels to a client newly diagnosed with diabetes mellitus. The nurse determines that the client understands the procedure when making which most accurate statement?
1. “I should check my blood glucose level before eating a big meal.”
*2. “I should check my blood glucose level before eating each meal, regardless of how much I eat.”*
3. “I should check my blood glucose level 2 hours after each meal.”
4. “I should check my blood glucose level once a day.”
*rationale* The most effective and accurate measure for testing blood glucose is to test the level before each meal regardless of the amount of food to be eaten. The client should also check the blood glucose level at bedtime. Checking the level after the meal will provide an inaccurate assessment of diabetic control. Checking the level once daily will not provide enough data related to controlling the diabetes mellitus.
A nurse is reinforcing dietary instructions to a client newly diagnosed with diabetes mellitus. The nurse instructs the client that it is best to:
*1. Eat meals at approximately the same time each day.*
2. Adjust mealtimes depending on blood glucose levels.
3. Vary mealtimes if insulin is not administered at the same time every day.
4. Avoid being concerned about the time of meals as long as snacks are taken on time.
*rationale* Mealtimes must be approximately the same time each day to maintain a stable blood glucose level. The client should not be instructed that mealtimes are varied, depending on blood glucose levels or insulin administration. Mealtimes should not be adjusted based on blood glucose levels or snacks.
A client with diabetes mellitus who takes insulin is seen in the health care clinic. The client tells the nurse that after giving the injection, the insulin seems to leak through the skin. The nurse can appropriately determine the problem by asking the client which of the following?
1. “Are you placing an air bubble in the syringe before injection?”
2. “Are you using a 1-inch needle to give the injection?”
3. “Are you aspirating before you inject the insulin?”
*4. “Are you rotating the injection site?”*
*rationale* The client should be instructed that insulin injection sites should be rotated within one anatomical area before moving to another. This rotation process promotes uniform absorption of insulin and reduces the chances of irritation. Options 1, 2, and 3 are not associated with the condition (skin leakage of insulin) presented in the question.
A nurse is reinforcing instructions to a client newly diagnosed with diabetes mellitus regarding insulin administration. The health care provider has prescribed a mixture of NPH and regular insulin. The nurse should stress that the first step is to:
1. Inject air equal to the amount of regular insulin prescribed into the vial of regular insulin.
*2. Inject air equal to the amount of NPH insulin prescribed into the vial of NPH insulin.*
3. Draw up the correct dosage of regular insulin into the syringe.
4. Draw up the correct dosage of NPH insulin into the syringe.
*rationale* The initial step in preparing an injection of insulin that is a mixture of NPH and regular is to inject air into the NPH bottle equal to the amount of insulin prescribed. The client is instructed to next inject an amount of air equal to the amount of prescribed insulin into the regular insulin bottle. The regular insulin should then be withdrawn followed by the NPH insulin. Contamination of regular insulin with NPH insulin will convert part of the regular insulin into a longer-acting form.
A nurse is reviewing the prescriptions of a client diagnosed with diabetes mellitus who was admitted because of an infected foot ulcer. Which health care provider’s prescription supports the treatment of this condition?
1. A decreased amount of NPH daily insulin
*2. An increased amount of NPH daily insulin*
3. An increased-calorie diet
4. A decreased-calorie diet
*rationale* Infection is a physiological stressor that can cause an increase in the level of epinephrine in the body. An increase in epinephrine causes an increase in blood glucose levels. When the client is under stress, such as when an infection exists, the client will require an increase in the dose of insulin to facilitate the transport of excess glucose into the cells. The client does not necessarily need an adjustment in the daily diet.
A nurse is assisting in preparing a plan of care for the client with diabetes mellitus and plans to reinforce the client’s understanding regarding the symptoms of hypoglycemia. Which symptoms will the nurse review?
1. Slow pulse; lethargy; and warm, dry skin
2. Elevated pulse; lethargy; and warm, dry skin
*3. Elevated pulse; shakiness; and cool, clammy skin*
4. Slow pulse, confusion, and increased urine output
*rationale* Symptoms of mild hypoglycemia include tachycardia; shakiness; and cool, clammy skin. Options 1, 2, and 4 are not symptoms of hypoglycemia.
A nurse notes in the medical record that a client with Cushing’s syndrome is experiencing fluid overload. Which interventions should be included in the plan of care? *Select all that apply.*
*1. Monitoring daily weight*
*2. Monitoring intake and output*
3. Maintaining a low-potassium diet
*4. Monitoring extremities for edema*
*5. Maintaining a low-sodium diet*
*rationale* The client with Cushing’s syndrome experiencing fluid overload should be maintained on a high-potassium and low-sodium diet. Decreased sodium intake decreases renal retention of sodium and water. Monitoring weight, intake, output, and extremities for edema are all appropriate interventions for such a nursing diagnosis.
A nursing student notes in the medical record that a client with Cushing’s syndrome is experiencing body image disturbances. The need for additional education regarding this problem is identified when the nursing student suggests which nursing intervention?
1. Encouraging the client’s expression of feelings
2. Evaluating the client’s understanding of the disease process
3. Encouraging family members to share their feelings about the disease process
*4. Evaluating the client’s understanding that the body changes need to be dealt with*
*rationale* Evaluating the client’s understanding that the body changes that occur in this disorder need to be dealt with is an inappropriate nursing intervention. This option does not address the client’s feelings. Options 1, 2, and 3 are appropriate because they address the client and family feelings regarding the disorder.
A nurse is caring for a client following an adrenalectomy and is monitoring for signs of adrenal insufficiency. Which of the following, if noted in the client, indicates signs and symptoms related to adrenal insufficiency? *Select all that apply.*
1. Double vision
*2. Hypotension*
*3. Mental status changes*
*4. Weakness*
*5. Fever*
*rationale* The nurse should be alert to signs and symptoms of adrenal insufficiency in a client following adrenalectomy. These signs and symptoms include weakness, hypotension, fever, and mental status changes. Double vision is generally not associated with this condition.
A nurse is reinforcing home care instructions to a client with a diagnosis of Cushing’s syndrome. Which statement reflects a need for further client education?
1. “Taking my medications exactly as prescribed is essential.”
*2. “I need to read the labels on any over-the-counter medications I purchase.”*
3. “My family needs to be familiar with the signs and symptoms of hypoadrenalism.”
4. “I could experience the signs and symptoms of hyperadrenalism because of Cushing’s.”
*rationale* The client with Cushing’s syndrome should be instructed to take the medications exactly as prescribed. The nurse should emphasize the importance of continuing medications, consulting with the health care provider before purchasing any over-the-counter medications, and maintaining regular follow-up care. The nurse should also instruct the client in the signs and symptoms of both hypoadrenalism and hyperadrenalism.
A nurse is reviewing a plan of care for a client with Addison’s disease. The nurse notes that the client is at risk for dehydration and suggests nursing interventions that will prevent this occurrence. Which nursing intervention is an appropriate component of the plan of care? *Select all that apply.*
*1. Encouraging fluid intake of at least 3000 mL/day*
2. Encouraging an intake of low-protein foods
*3. Monitoring for changes in mental status*
*4. Monitoring intake and output*
5. Maintaining a low-sodium diet
*rationale* The client at risk for deficient fluid volume should be encouraged to eat regular meals and snacks and to increase the intake of sodium, protein, and complex carbohydrates. Oral replacement of sodium losses is necessary, and maintenance of adequate blood glucose levels is required.
A nurse is reviewing the postoperative prescriptions for a client who had a transsphenoidal hypophysectomy. Which health care provider’s prescription, if noted on the record, indicates the need for clarification?
1. Instruct the client about the need for a Medic-Alert bracelet.
*2. Apply a loose dressing if any clear drainage is noted.*
3. Monitor vital signs and neurological status.
4. Instruct the client to avoid blowing the nose.
*rationale* The nurse should observe for clear nasal drainage, constant swallowing, and a severe, persistent, generalized, or frontal headache. These signs and symptoms indicate cerebrospinal fluid leak into the sinuses. If clear drainage is noted following this procedure, the health care provider needs to be notified immediately. Options 1, 3, and 4 indicate appropriate postoperative interventions.
A nurse reviews a plan of care for a postoperative client following a thyroidectomy and notes that the client is at risk for breathing difficulty. Which of the following nursing interventions will the nurse suggest to include in the plan of care?
1. Maintain a supine position.
2. Encourage coughing and deep breathing exercises.
*3. Monitor neck circumference frequently.*
4. Maintain a pressure dressing on the operative site.
*rationale* Following a thyroidectomy, the client should be placed in an upright position to facilitate air exchange. The nurse should assist the client with deep breathing exercises, but coughing is minimized to prevent tissue damage and stress to the incision. A pressure dressing is not placed on the operative site because it could affect breathing. The nurse should monitor the dressing closely and should loosen the dressing if necessary. Neck circumference is monitored at least every 4 hours to assess for postoperative edema.
A nurse is monitoring a client following a thyroidectomy for signs of hypocalcemia. Which of the following signs, if noted in the client, likely indicates the presence of hypocalcemia?
*1. Tingling around the mouth*
2. Negative Chvostek’s sign
3. Flaccid paralysis
4. Bradycardia
*rationale* Following a thyroidectomy, the nurse assesses the client for signs of hypocalcemia and tetany. Early signs include tingling around the mouth and fingertips, muscle twitching or spasms, palpitations or dysrhythmias, and positive Chvostek’s and Trousseau’s signs. Options 2, 3, and 4 are not signs of hypocalcemia.
A nurse is caring for a client following a thyroidectomy. The client tells the nurse that she is concerned because of voice hoarseness. The client asks the nurse whether the hoarseness will subside. The nurse appropriately tells the client that the hoarseness:
1. Indicates nerve damage
2. Is harmless but permanent
3. Will worsen before it subsides
*4. Is normal and will gradually subside*
*rationale* Hoarseness that develops in the postoperative period is usually the result of laryngeal pressure or edema and will resolve within a few days. The client should be reassured that the effects are transitory. Options 1, 2, and 3 are incorrect.
A nurse is monitoring a client with Graves’ disease for signs of thyrotoxic crisis (thyroid storm). Which of the following signs and symptoms, if noted in the client, will alert the nurse to the presence of this crisis? *Select all that apply.*
1. Bradycardia
*2. Fever*
*3. Sweating*
*4. Agitation*
5. Pallor
*rationale* Thyrotoxic crisis (thyroid storm) is an acute, potentially life-threatening state of extreme thyroid activity that represents a breakdown in the body’s tolerance to a chronic excess of thyroid hormones. The clinical manifestations include fever greater than 100° F, severe tachycardia, flushing and sweating, and marked agitation and restlessness. Delirium and coma can occur.
Which of the following clients is at risk for developing thyrotoxicosis?
1. A client with hypothyroidism
*2. A client with Graves’ disease who is having surgery*
3. A client with diabetes mellitus scheduled for debridement of a foot ulcer
4. A client with diabetes insipidus scheduled for an invasive diagnostic test
*rationale* Thyrotoxicosis is usually seen in clients with Graves’ disease with the symptoms precipitated by a major stressor. This complication typically occurs during periods of severe physiological or psychological stress such as trauma, sepsis, the birth process, or major surgery. It also must be recognized as a potential complication following a thyroidectomy.
A nurse is caring for a client diagnosed with hyperparathyroidism who is prescribed furosemide (Lasix). The nurse reinforces dietary instructions to the client. Which of the following is an appropriate instruction?
1. Increase dietary intake of calcium.
*2. Drink at least 2 to 3 L of fluid daily.*
3. Eat sparely when experiencing nausea.
4. Decrease dietary intake of potassium.
*rationale* The aim of treatment in the client with hyperparathyroidism is to increase the renal excretion of calcium and decrease gastrointestinal absorption and bone resorption. This is aided by the sufficient intake of fluids. Dietary restriction of calcium may be used as a component of therapy. The parathyroid is responsible for calcium production, and the term, “hyperparathyroidism” can be indicative of an increase in calcium. The client should eat foods high in potassium, especially if the client is taking furosemide. Limiting nutrients is not advisable.
A nurse has reinforced instructions to the client with hyperparathyroidism regarding home care measures related to exercise. Which statement by the client indicates a need for further instruction? *Select all that apply.*
1. “I enjoy exercising but I need to be careful.”
2. “I need to pace my activities throughout the day.”
*3. “I need to limit playing football to only the weekends.”*
4. “I should gauge my activity level by my energy level.”
*5. “I should exercise in the evening to encourage a good sleep pattern.”*
*rationale* The client should be instructed to avoid high-impact activity or contact sports such as football. Exercising late in the evening may interfere with restful sleep. The client with hyperparathyroidism should pace activities throughout the day and plan for periods of uninterrupted rest. The client should plan for at least 30 minutes of walking each day to support calcium movement into the bones. The client should be instructed to use energy level as a guide to activity.
A nurse has reinforced dietary instructions to a client with a diagnosis of hypoparathyroidism. The nurse instructs the client to include which of the following items in the diet?
*1. Vegetables*
2. Meat
3. Fish
4. Cereals
*rationale* The client with hypoparathyroidism is instructed to follow a calcium-rich diet and to restrict the amount of phosphorus in the diet. The client should limit meat, poultry, fish, eggs, cheese, and cereals. Vegetables are allowed in the diet.
A nurse has reinforced home care measures to a client diagnosed with diabetes mellitus regarding exercise and insulin administration. Which statement by the client indicates a need for further instruction?
*1. “I should perform my exercise at peak insulin time.”*
2. “I should always carry a quick-acting carbohydrate when I exercise.”
3. “I should always wear a Medic-Alert bracelet especially when I exercise.”
4. “I should avoid exercising at times when a hypoglycemic reaction is likely to occur.”
*rationale* The client should be instructed to avoid exercise at peak insulin time because this is when a hypoglycemic reaction is likely to occur. If exercise is performed at this time, the client should be instructed to eat an hour before the exercise and drink a carbohydrate liquid. Options 2, 3, and 4 are correct statements regarding exercise, insulin, and diabetic control.
A nurse is caring for a client newly diagnosed with diabetes mellitus. The client asks the nurse whether eating at a restaurant will affect the diabetic control and whether this is allowed. Which nursing response is appropriate?
1. “You really should not eat in restaurants.”
2. “If you plan to eat in a restaurant, you need to avoid carbohydrates.”
*3. “You should order a half-portion meal and have fresh fruit for dessert.”*
4. “You should increase your daily dose of insulin by half on the day you plan to eat out.”
*rationale* Clients with diabetes mellitus are instructed to make adjustments in their total daily intake to plan for meals at restaurants or parties. Some useful strategies include ordering half portions, salads with dressing on the side, fresh fruit for dessert, and baked or steamed entrées. Clients are not instructed to avoid any food group or to increase their prescribed insulin dosage.
A client who is managing diabetes mellitus with insulin injections asks the nurse for information about any necessary changes in her diet to avoid hyperinsulinism. Which of the following diets would be appropriate for the client?
1. Low-fiber, high-fat diet
2. Limit carbohydrate intake to three meals per day
3. Large amounts of carbohydrates between low protein meals
*4. Small frequent meals with protein, fat, and carbohydrates at each meal*
*rationale* The definition of hyperinsulinism is an excessive insulin secretion in response to carbohydrate-rich foods leading to hypoglycemia. It is often treated with a diet that provides for limited stimulation of the pancreas. Carbohydrates can produce a rapid rise in blood glucose levels. However, carbohydrates are necessary in the diet. Proteins do not stimulate insulin secretion. Fats are needed in the diet to provide calories. The best diet for hyperinsulinism will contain proteins and fats whenever carbohydrates are consumed and delivered in frequent but portion-controlled meals. Diets high in soluble fiber may be beneficial.
A client has an endocrine system dysfunction of the pancreas. The nurse anticipates that the client will exhibit impaired secretion of which of the following substances?
1. Amylase
2. Lipase
3. Trypsin
*4. Insulin*
*rationale* The pancreas produces both endocrine and exocrine secretions as part of its normal function. The organ secretes insulin as a key endocrine hormone to regulate the blood glucose level. Other pancreatic endocrine hormones are glucagon and somatostatin. The exocrine pancreas produces digestive enzymes such as amylase, lipase, and trypsin.
An adult client just admitted to the hospital with heart failure also has a history of diabetes mellitus. The nurse calls the health care provider to verify a prescription for which medication that the client was taking before admission?
1. NPH insulin
2. Regular insulin
3. Acarbose (Precose)
*4. Chlorpropamide*
*rationale* Chlorpropamide is an oral hypoglycemic agent that exerts an antidiuretic effect and should be administered cautiously or avoided in the client with cardiac impairment or fluid retention. It is a first-generation sulfonylurea. Insulin does not cause or aggravate fluid retention. Acarbose is a miscellaneous oral hypoglycemic agent.
A nurse is providing discharge instructions to a client who had a unilateral adrenalectomy. Which of the following will be a component of the instructions?
1. The reason for maintaining a diabetic diet
*2. Instructions about early signs of a wound infection*
3. Teaching regarding proper application of an ostomy pouch
4. The need for lifelong replacement of all adrenal hormones
*rationale* A client who is undergoing a unilateral adrenalectomy will be placed on corticosteroids temporarily to avoid a cortisol deficiency. These medications will be gradually weaned in the postoperative period until they are discontinued. Because of the anti-inflammatory properties of corticosteroids, clients who undergo an adrenalectomy are at increased risk for developing wound infections. Because of this increased risk for infection, it is important for the client to know measures to prevent infection, early signs of infection, and what to do if an infection is present. Options 1, 3, and 4 are incorrect instructions.
A nurse is caring for a client experiencing thyroid storm. Which of the following would be a priority concern for this client?
1. Inability to cope with the treatment plan
2. Lack of sexual drive
3. Self-consciousness about body appearance
*4. Potential for cardiac disturbances*
*rationale* Clients in thyroid storm are experiencing a life-threatening event, which is associated with uncontrolled hyperthyroidism. It is characterized by high fever, severe tachycardia, delirium, dehydration, and extreme irritability. The signs and symptoms of the disorder develop quickly, and therefore emergency measures must be taken to prevent death. These measures include maintaining hemodynamic status and patency of airway as well as providing adequate ventilation. Options 1, 2, and 3 are not a priority in the care of the client in thyroid storm.
A nurse is collecting data on a client with hyperparathyroidism. Which of the following questions would elicit the accurate information about this condition from the client?
1. “Do you have tremors in your hands?”
*2. “Are you experiencing pain in your joints?”*
3. “Have you had problems with diarrhea lately?”
4. “Do you notice swelling in your legs at night?”
*rationale* Hyperparathyroidism causes an oversecretion of parathyroid hormone (PTH), which causes excessive osteoblast growth and activity within the bones. When bone reabsorption is increased, calcium is released from the bones into the blood, causing hypercalcemia. The bones suffer demineralization as a result of calcium loss, leading to bone and joint pain, and pathological fractures.
A client is in metabolic acidosis caused by diabetic ketoacidosis (DKA). The nurse prepares for the administration of which of the following medications as a primary treatment for this problem?
1. Potassium
*2. Regular insulin*
3. Sodium bicarbonate
4. Calcium gluconate
*rationale* The primary treatment for any acid-base imbalance is treatment of the underlying disorder that caused the problem. In this case, the underlying cause of the metabolic acidosis is anaerobic metabolism as a result of the lack of ability to use circulating glucose. Administration of regular insulin corrects this problem.
A nurse is caring for a postoperative adrenalectomy client. Which of the following does the nurse specifically monitor for in this client?
1. Peripheral edema
2. Bilateral exophthalmos
3. Signs and symptoms of hypocalcemia
*4. Signs and symptoms of hypovolemia*
*rationale* Following adrenalectomy, the client is at risk for hypovolemia. Aldosterone, secreted by the adrenal cortex, plays a major role in fluid volume balance by retaining sodium and water. A deficiency of adrenocortical hormones does not cause the clinical manifestations noted in options 1, 2, and 3.
A nurse is caring for a client with a diagnosis of myasthenia gravis. The health care provider plans to perform an Enlon test on the client to determine the presence of cholinergic crisis. In addition to planning care for the client during this testing, which of the following will the nurse ensure is at the bedside?
1. Cardiac monitor
*2. Oxygen equipment*
3. Vial of protamine sulfate and a syringe
4. Potassium injection and a liter of normal saline solution
*rationale* An Enlon test is performed to distinguish between myasthenic and cholinergic crisis. Following administration of Enlon, if symptoms intensify, the crisis is cholinergic. Because the symptoms of cholinergic crisis will worsen with the administration of Enlon, atropine sulfate and oxygen should be immediately available whenever Enlon is used.
A client with myxedema has changes in intellectual function such as impaired memory, decreased attention span, and lethargy. The client’s husband is upset and shares his concerns with the nurse. Which statement by the nurse is helpful to the client’s husband?
1. “Would you like me to ask the health care provider for a prescription for a stimulant?”
2. “Give it time. I’ve seen dozens of clients with this problem that fully recover.”
3. “I don’t blame you for being frustrated, because the symptoms will only get worse.”
*4. “It’s obvious that you are concerned about your wife’s condition, but the symptoms may improve with continued therapy.”*
*rationale* Using therapeutic communication techniques, the nurse acknowledges the husband’s concerns and conveys that the client’s symptoms are common with myxedema. With thyroid hormone therapy, these symptoms should decrease, and cognitive function often returns to normal. Option 1 is not helpful, and it blocks further communication. Option 3 is pessimistic and untrue. Option 2 is not appropriate and offers false reassurance.
A client with hypoparathyroidism has hypocalcemia. The nurse avoids giving the client the prescribed vitamin and calcium supplement with which of the following liquids?
*1. Milk*
2. Water
3. Iced tea
4. Fruit juice
*rationale* Milk products are high in phosphates, which should be avoided by a client with hypoparathyroidism. Otherwise, calcium products are best absorbed with milk because the vitamin D in the milk promotes calcium absorption.
A client is diagnosed with hyperparathyroidism. The nurse teaching the client about dietary alterations to manage the disorder tells the client to limit which of the following foods in the diet?
1. Bananas
2. Oatmeal
*3. Ice cream*
4. Chicken breast
*rationale* The client with hyperparathyroidism is likely to have elevated calcium levels. This client should reduce intake of dairy products such as milk, cheese, ice cream, or yogurt. Apples, bananas, chicken, oatmeal, and pasta are low-calcium foods.
A nurse participating in a free health screening at the local mall obtains a random blood glucose level of 200 mg/dL on an otherwise healthy client. The nurse tells the client to do which of the following as a next step?
1. Seek treatment for diabetes mellitus.
2. Ask the pharmacist about starting insulin therapy.
3. Begin blood glucose monitoring three times a day.
*4. Call the health care provider to have the value rechecked as soon as possible.*
*rationale* Adult diabetes mellitus can be diagnosed either by symptoms (polydipsia, polyuria, polyphagia) or by laboratory values. Diabetes is also diagnosed by an abnormal glucose tolerance test, when random plasma glucose levels are greater than 200 mg/dL, or fasting plasma glucose levels are greater than 140 mg/dL on two separate occasions. Further confirmation of this result is needed to ensure appropriate diagnosis and therapy.
A client with Addison’s disease asks the nurse how a newly prescribed medication, fludrocortisone acetate (Florinef), will improve the condition. When formulating a response, the nurse should incorporate that a key action of this medication is to:
*1. Help restore electrolyte balance.*
2. Make the body produce more cortisol.
3. Replace insufficient circulating estrogens.
4. Alter the body’s immune system functioning.
*rationale* Fludrocortisone acetate is a long-acting oral medication with mineralocorticoid and moderate glucocorticoid activity. It is prescribed for the long-term management of Addison’s disease. Mineralocorticoids cause renal reabsorption of sodium and chloride ions and the excretion of potassium and hydrogen ions. These actions help restore electrolyte balance in the body. The other options are incorrect.
A nurse reviews the nursing care plan of an older client with diabetic neuropathy of the lower extremities as a result of type 2 diabetes mellitus. The nurse plans care, knowing that which problem has the highest priority for this client?
1. Pain as a result of intermittent claudication
2. Lack of self-confidence as a result of impaired ability to walk
3. Lack of self-esteem as a result of perceived loss of abilities
*4. The possibility of injury as a result of decreased sensation in the legs and feet*
*rationale* The client with diabetic neuropathy of the lower extremities has diminished ability to feel sensations in the legs and feet. This client is at risk for tissue injury and for falls as a result of this nervous system impairment. Thus the highest priority problem is option 4, which can be determined using Maslow’s Hierarchy of Needs theory. Options 2 and 3 represent problems that are more psychosocial in nature, and as such are secondary needs using Maslow’s theory. Option 1 is incorrect because intermittent claudication is not directly associated with diabetic neuropathy.
An older client with a history of hyperparathyroidism and severe osteoporosis is hospitalized. The nurse caring for the client plans first to address which problem?
*1. The possibility of injury*
2. Constipation
3. Urinary retention
4. Need for teaching about the disorder
*rationale* The client with severe osteoporosis as a result of hyperparathyroidism is at risk for injury as a result of pathological fractures that can occur from bone demineralization. The client may also have a risk for constipation from the disease process but this is a lesser priority than client safety. The client may or may not have urinary elimination problems, depending on other factors in the client’s history. There is no information in the question to support whether the client needs teaching.
A client has been diagnosed with hypoparathyroidism. The nurse teaches the client to include foods in the diet that are:
1. High in phosphorus and low in calcium
2. Low in phosphorus and low in calcium
*3. Low in phosphorus and high in calcium*
4. High in phosphorus and high in calcium
*rationale* Hypoparathyroidism results in hypocalcemia. A therapeutic diet for this disorder is one that is high in calcium but low in phosphorus because these two electrolytes have inverse proportions in the body. All of the other options are unrelated to this disorder and are incorrect.
A hospitalized client is newly diagnosed with diabetes mellitus. The client must take both NPH and Regular insulin for glucose control. The nurse develops a teaching plan to help the client meet which outcome as a first step in managing the disease?
1. Avoid all strenuous exercise.
2. Maintain health at an optimum level.
3. Lose 40 pounds to achieve ideal body weight.
*4. Adjust insulin according to capillary blood glucose levels.*
*rationale* There are many learning goals for the client who is newly diagnosed with diabetes mellitus. The client must learn dietary control, medication management, and proper exercise in order to control the disease. As a first step, the client learns to adjust medication (insulin) according to blood glucose results as prescribed by the health care provider. The client should then focus on long-term dietary control and weight loss, which will often lead to a decreased need for insulin. At the same time that diet is being controlled, the client should begin a regular exercise program to aid in weight loss.
A client newly diagnosed with diabetes mellitus takes NPH insulin every day at 7:00 ᴀᴍ. The nurse has taught the client how to recognize the signs of hypoglycemia. The nurse determines that the client understands the information presented if the client watches for which of the following signs in the late afternoon?
1. Nausea and vomiting, and abdominal pain
*2. Hunger; shakiness; and cool, clammy skin*
3. Drowsiness; red, dry skin; and fruity breath odor
4. Increased urination; thirst; and rapid, deep breathing
*rationale* The client taking NPH insulin obtains peak medication effects approximately 6 to 12 hours after administration. At the time that the medication peaks, the client is at risk of hypoglycemia if food intake is insufficient. The nurse should teach the client to watch for signs and symptoms of hypoglycemia including anxiety, confusion, difficulty concentrating, blurred vision, cold sweating, headache, increased pulse, shakiness, and hunger. The other options list various signs and symptoms of hyperglycemia.
A client newly diagnosed with diabetes mellitus is having difficulty learning the technique of blood glucose measurement. The nurse should teach the client to do which of the following to perform the procedure properly?
1. Wash the hands first using cold water.
2. Puncture the center of the finger pad.
3. Puncture the finger as deeply as possible.
*4. Let the arm hang dependently and milk the digit.*
*rationale* Before doing a fingerstick for blood glucose measurement, the client should first wash the hands. Warm water should be used to stimulate the circulation to the area. The finger is punctured near the side, not the center, because there are fewer nerve endings along the side of the finger. The puncture is only deep enough to obtain an adequately sized drop of blood; excessively deep punctures may lead to pain and bruising. The arm should be allowed to hang dependently, and the finger may be milked to promote obtaining a good-size blood drop.
A nurse is planning to instruct a client with diabetes mellitus who has hypertension about “sick day management.” Which of the following does the nurse avoid putting on a list of easily consumed carbohydrate-containing beverages for use when the client cannot tolerate food orally?
1. Cola
2. Ginger ale
3. Apple juice
*4. Mineral water*
*rationale* Diabetic clients should take in approximately 15 g of carbohydrate every 1 to 2 hours when unable to tolerate food because of illness. Each of the beverages listed in options 1, 2, and 3 provides approximately 13 to 15 g of carbohydrate in a half-cup serving. Mineral water is incorrect for two reasons. First, it contains sodium and should not be used by the client with hypertension. Second, it is not a source of carbohydrates.
A nurse is monitoring the results of periodic serum laboratory studies drawn on a client with diabetic ketoacidosis (DKA) receiving an insulin infusion. The nurse determines that which of the following values needs to be reported?
*1. Potassium 3.1 mEq/L*
2. Calcium 9.2 mg/dL
3. Sodium 137 mEq/L
4. Serum osmolality 288 mOsm/kg H2O
*rationale* The client with DKA initially becomes hyperkalemic as potassium leaves the cells in response to lowered pH. Once fluid replacement and insulin therapy are started, the potassium level drops quickly. This occurs because potassium is carried into the cells along with glucose and insulin and because potassium is excreted in the urine once rehydration has occurred. Thus the nurse carefully monitors the results of serum potassium levels and reports hypokalemia (option 1) promptly. The other laboratory values are within the normal ranges.
The wife of a client with diabetes mellitus who takes insulin calls the nurse in a health care provider’s office about her husband. She states that her husband is sleepy and that his skin is warm and flushed. She adds that his breathing is faster than normal and his pulse rate seems fast. Which of the following should the nurse tell the woman to do first?
1. Call an ambulance.
2. Take his temperature.
*3. Check his blood glucose level.*
4. Drive him to the health care provider’s office.
*rationale* The client’s signs and symptoms are consistent with hyperglycemia. The wife should first obtain a blood glucose reading, which the nurse would then report to the health care provider. Option 1 or 4 may be done at a later time if required. Option 2 is unrelated to the client’s immediate problem.
A male client recently diagnosed with diabetes mellitus requiring insulin tells the clinic nurse that he is traveling by air throughout the next week. The client asks the nurse for any suggestions about managing the disorder while traveling. The nurse tells the client to:
1. Obtain referrals to health care providers in the destination cities.
2. Check the blood glucose every 2 hours during the flight.
*3. Keep snacks in carry-on luggage to prevent hypoglycemia during the flight.*
4. Pad the insulin and syringes against breakage and place in a suitcase to be stowed.
*rationale* A frequent concern of diabetics during air travel is the availability of food at times that correspond with the timing and peak action of the client’s insulin. For this reason, the nurse may suggest that the client have carbohydrate snacks on hand. Insulin equipment and supplies should always be placed in carry-on luggage (not stowed). This provides ready access to treat hyperglycemia, if needed, and prevents loss of equipment if luggage is lost. Options 1 and 2 are unnecessary.
A client scheduled for a thyroidectomy says to the nurse, “I am so scared to get cut in my neck.” Based on the client’s statement, the nurse determines that the client is experiencing which problem?
1. Inadequate knowledge about the surgical procedure
*2. Fear about impending surgery*
3. Embarrassment about the changes in personal appearance
4. Lack of support related to the surgical procedure
*rationale* The client is having a difficult time coping with the scheduled surgery. The client is able to express fears but is scared. No data in the question support options 1, 3, and 4.
A nurse is caring for a client with Addison’s disease. The nurse checks the vital signs and determines that the client has orthostatic hypotension. The nurse determines that this finding relates to which of the following?
1. A decrease in cortisol release
*2. A decreased secretion of aldosterone*
3. An increase in epinephrine secretion
4. Increased levels of androgens
*rationale* A decreased secretion of aldosterone results in a limited reabsorption of sodium and water; therefore the client experiences fluid volume deficit. A decrease in cortisol, an increase in epinephrine, and an increase in androgen secretion do not result in orthostatic hypotension.
Which nursing measure would be effective in preventing complications in a client with Addison’s disease?
1. Restricting fluid intake
2. Offering foods high in potassium
3. Checking family support systems
*4. Monitoring the blood glucose*
*rationale* The decrease in cortisol secretion that characterizes Addison’s disease can result in hypoglycemia. Therefore monitoring the blood glucose would detect the presence of hypoglycemia so that it can be treated early to prevent complications. Fluid intake should be encouraged to compensate for dehydration. Potassium intake should be restricted because of hyperkalemia. Option 3 is not a priority for this client.
A nurse is collecting data on a client with a diagnosis of hypothyroidism. Which of these behaviors, if present in the client’s history, would the nurse determine as being likely related to the manifestations of this disorder?
*1. Depression*
2. Nervousness
3. Irritability
4. Anxiety
*rationale* Hypothyroid clients experience a slow metabolic rate, and its manifestation includes apathy, fatigue, sleepiness, and depression. Options 2, 3, and 4 identify the clinical manifestations of hyperthyroidism.
While collecting data on a client being prepared for an adrenalectomy, the nurse obtains a temperature reading of 100.8° F. The nurse analyzes this temperature reading as:
1. Within normal limits
*2. A finding that needs to be reported immediately*
3. An expected finding caused by the operative stress response
4. Slightly abnormal but an insignificant finding
*rationale* An adrenalectomy is performed because of excess adrenal gland function. Excess cortisol production impairs the immune response, which puts the client at risk for infection. Because of this, the client needs to be protected from infection, and minor variations in normal vital sign values must be reported so that infections are detected early, before they become overwhelming. In addition, the surgeon may elect to postpone surgery in the event of a fever because it can be indicative of infection. Options 1, 3, and 4 are not correct interpretations.
The anticipated intended effect of fludrocortisone acetate (Florinef) for the treatment of Addison’s disease is to:
1. Stimulate the immune response.
*2. Promote electrolyte balance.*
3. Stimulate thyroid production.
4. Stimulate thyrotropin production.
*rationale* Florinef is a long-acting oral medication with mineralocorticoid and moderate glucocorticoid activity used for long-term management of Addison’s disease. Mineralocorticoids act on the renal distal tubules to enhance the reabsorption of sodium and chloride ions and the excretion of potassium and hydrogen ions. In small doses, fludrocortisone acetate causes sodium retention and increased urinary potassium excretion. The client rapidly can develop hypotension and fluid and electrolyte imbalance if the medication is discontinued abruptly. Options 1, 3, and 4 are not associated with the effects of this medication.
A nurse is caring for a client with hypothyroidism who is overweight. Which food items would the nurse suggest to include in the plan?
1. Peanut butter, avocado, and red meat
*2. Skim milk, apples, whole-grain bread, and cereal*
3. Organ meat, carrots, and skim milk
4. Seafood, spinach, and cream cheese
*rationale* Clients with hypothyroidism may have a problem with being over-weight because of their decreased metabolic need. They should consume foods from all food groups, which will provide them with the necessary nutrients; however, the foods should be low in calories. Option 2 is the only option that identifies food items that are low in calories.
A client has a blood glucose level drawn for suspected hyperglycemia. After interviewing the client, the nurse determines that the client ate lunch approximately 2 hours before the blood specimen was drawn. The laboratory reports that the blood glucose to be 180 mg/dL, and the nurse analyzes this result to be:
1. Normal
2. Lower than the normal value
*3. Elevated from the normal value*
4. A dangerously high value requiring immediate health care provider notification
*rationale* Normal fasting blood glucose values range from 70 to 120 mg/dL. A 2-hour postprandial blood glucose level should be less than 140 mg/dL. In this situation, the blood glucose value was 180 mg/dL 2 hours after the client ate, which is an elevated value as compared to normal. Although the result may be reported to the health care provider, it is not a dangerously high one.
In planning nutrition for the client with hypoparathyroidism, which diet would be appropriate?
*1. High in calcium and low phosphorous*
2. Low in vitamins A, D, E, and K
3. High in sodium with no fluid restriction
4. Low in water and insoluble fiber
*rationale* Hypocalcemia is the end result of hypoparathyroidism resulting from either a lack of parathyroid hormone (PTH) secretion or ineffective PTH influence on tissue. Calcium is the major controlling factor of PTH secretion. Because of this, the diet needs to be high in calcium but low in phosphorus because these two electrolytes must exist in inverse proportions in the body. The other options are not dietary interventions with hypoparathyroidism.
A nurse is caring for a client with type 1 diabetes mellitus who is hyperglycemic. Which problem would the nurse consider first, when planning care for this client?
1. The need for knowledge about the diagnosis
2. Insomnia
3. Lack of appetite
*4. Signs of dehydration*
*rationale* Hyperglycemia can develop into ketoacidosis in the client with type 1 diabetes mellitus. Polyuria develops as the body attempts to get rid of the excess glucose, and the client will lose large amounts of fluid. Because glucose is hyperosmotic, fluid is pulled from the tissue. Nausea and vomiting can occur as a result of hyperglycemia and can lead to a loss of sodium and water. Water also is lost from the lungs in an attempt to get rid of excess carbon dioxide. The severe dehydration that occurs can lead to hypovolemic shock. Of the problems listed, dehydration is considered first.
A preoperative client is scheduled for adrenalectomy to remove a pheochromocytoma. The nurse would most closely monitor which of the following items in the preoperative period?
1. Intake and output
2. Blood urea nitrogen (BUN)
*3. Vital signs*
4. Urine glucose and ketones
*rationale* Hypertension is the hallmark of pheochromocytoma. Severe hypertension can precipitate a stroke or sudden blindness. Although all the items are appropriate nursing assessments for the client with pheochromocytoma, the priority is to monitor the vital signs, especially the blood pressure.
A nurse working on an endocrine nursing unit understands that which correct concept is used in planning care?
1. Clients with Cushing’s syndrome are likely to experience episodic hypotension.
2. Clients with hyperthyroidism must be monitored for weight gain.
3. Clients who have diabetes insipidus should be assessed for fluid excess.
*4. Clients who have hyperparathyroidism should be protected against falls.*
*rationale* Hyperparathyroidism is a disease that involves excess secretion of parathyroid hormone (PTH). Elevation of PTH causes excess calcium to be removed from the bones. There is a decline in bone mass, which may cause a fracture if a fall occurs. Cushing’s syndrome is likely to cause hypertension. Clients with hypothyroidism must be monitored for weight gain and clients with hyperthyroidism must be monitored for weight loss. Clients who have diabetes insipidus should be assessed for fluid deficit.
Glucagon hydrochloride injection would most likely be prescribed for which disorder?
1. Thyroid crisis
*2. Type 1 diabetes mellitus*
3. Hypoadrenalism
4. Excess growth hormone secretion
*rationale* Glucagon hydrochloride is a medication that can be administered subcutaneously or intramuscularly. It is prescribed to stimulate the liver to release glucose when a client is experiencing hypoglycemia and unable to take oral glucose replacement. It is important to teach a person other than the client how to administer the medication because the client’s symptoms may prevent self-injection. Therefore options 1, 3, and 4 are incorrect.
When caring for a client diagnosed with pheochromocytoma, what information should the nurse know when assisting with planning care?
1. Profound hypotension may occur.
*2. Excessive catecholamines are released.*
3. The condition is not curable and is treated symptomatically.
4. Hypoglycemia is the primary presenting symptom.
*rationale* Pheochromocytoma is a catecholamine-producing tumor of the adrenal gland and causes secretion of excessive amounts of epinephrine and norepinephrine. Hypertension is the principal manifestation, and the client has episodes of a high blood pressure accompanied by pounding headaches. The excessive release of catecholamine also results in excessive conversion of glycogen into glucose in the liver. Consequently, hyperglycemia and glucosuria occur during attacks. Pheochromocytoma is curable. The primary treatment is surgical removal of one or both of the adrenal glands, depending on whether the tumor is unilateral or bilateral.
A client with pheochromocytoma is scheduled for surgery and says to the nurse, “I’m not sure that surgery is the best thing to do.” What response by the nurse is appropriate?
1. “I think you are making the right decision to have the surgery.”
2. “You are very ill. Your health care provider has made the correct decision.”
3. “There is no reason to worry. Your health care provider is a wonderful surgeon.”
*4. “You have concerns about the surgical treatment for your condition.”*
*rationale* Paraphrasing is restating the client’s message in the nurse’s own words. Option 4 addresses the therapeutic communication technique of paraphrasing. The client is reaching out for understanding. In option 3, the nurse is offering a false reassurance, and this type of response will block communication. Option 2 also represents a communication block because it reflects a lack of the client’s right to an opinion. In option 1, the nurse is expressing approval, which can be harmful to a nurse-client relationship.
A client with Cushing’s syndrome verbalizes concern to the nurse regarding the appearance of the buffalo hump that has developed. Which response by the nurse is appropriate?
1. “Don’t be concerned, this problem can be covered with clothing.”
2. “This is permanent, but looks are deceiving and not that important.”
*3. “Usually, these physical changes slowly improve following treatment.”*
4. “Try not to worry about it. There are other things to be concerned about.”
*rationale* The client with Cushing’s syndrome should be reassured that most physical changes resolve with treatment. Options 1, 2, and 4 are not therapeutic responses.
A client with diabetes mellitus demonstrates acute anxiety when admitted to the hospital for the treatment of hyperglycemia. The appropriate intervention to decrease the client’s anxiety would be to:
1. Administer a sedative.
*2. Convey empathy, trust, and respect toward the client.*
3. Ignore the signs and symptoms of anxiety so that they will soon disappear.
4. Make sure the client knows all the correct medical terms so that he or she can understand what is happening.
*rationale* The appropriate intervention is to address the client’s feelings related to the anxiety and to convey empathy, trust, and respect toward the client. Administering a sedative is not the most appropriate intervention. The nurse should not ignore the client’s anxious feelings. A client will not relate to medical terms, particularly when anxiety exists.
A nurse is collecting data from a client with type 2 diabetes mellitus. Which statement by the client indicates an understanding of the medication regimen?
1. “I should take my metformin (Glucophage) only if my blood glucose is elevated.”
2. “By taking these medications, I am able to eat more.”
3. “When I become ill, I need to increase the number of pills I take.”
*4. “The medication that I am taking helps release the insulin I already make.”*
*rationale* Clients with type 2 diabetes mellitus have decreased or impaired insulin secretion. Oral hypoglycemic agents are given to these clients to facilitate glucose use and need to be taken on a regular schedule as prescribed. To maintain normal blood glucose levels throughout the day, oral hypoglycemic agents such as metformin are not taken on an as-needed basis depending on the blood glucose levels. Insulin injections may be given during times of stress-induced hyperglycemia. Oral insulin is not available or effective because of the breakdown of the insulin by digestion.
A nurse is collecting data from a client who is being admitted to the hospital for a diagnostic workup for primary hyperparathyroidism. The nurse understands that which client complaint would be characteristic of this disorder?
1. Diarrhea
*2. Polyuria*
3. Polyphagia
4. Weight gain
*rationale* Hypercalcemia is the hallmark of hyperparathyroidism. Elevated serum calcium levels produce osmotic diuresis (polyuria). This diuresis leads to dehydration and the client would lose weight. Options 1, 3, and 4 are gastrointestinal (GI) symptoms but are not associated with the common GI symptoms typical of hyperparathyroidism (nausea, vomiting, anorexia, constipation).
A nurse is preparing to discharge a client who has had a parathyroidectomy. When teaching the client about the prescribed oral calcium supplement, what information should the nurse include?
*1. Take the calcium 30 to 60 minutes following a meal.*
2. Avoid sunlight because it can cause skin color change.
3. Store the calcium in the refrigerator to maintain potency.
4. Check the pulse daily and hold the dosage if it is below 60 beats per minute.
*rationale* Oral calcium supplements can be taken 30 to 60 minutes after meals to enhance their absorption and decrease gastrointestinal irritation. All the other options are unrelated to oral calcium therapy.
A client is brought to the emergency department with suspected diabetic ketoacidosis (DKA). Which of the following findings would the nurse note as being consistent with this diagnosis?
1. High serum glucose level and an increase in pH
2. Low serum potassium and high serum bicarbonate level
*3. High serum glucose level and low serum bicarbonate level*
4. Decreased urine output and Kussmaul’s respirations
*rationale* In DKA the blood glucose level is higher than 250 mg/dL, and ketones are present in the blood and urine. The arterial pH is low, less than 7.35. The plasma bicarbonate is also low. The client would exhibit polyuria and Kussmaul’s respirations. The potassium level usually is elevated as a result of dehydration.
A client is admitted with a diagnosis of pheochromocytoma. The nurse would monitor which of the following to detect the most common sign of pheochromocytoma?
1. Skin temperature
*2. Blood pressure*
3. Urine ketones
4. Weight
*rationale* Hypertension is the major symptom associated with pheochromocytoma and is monitored by taking the client’s blood pressure. Glycosuria, weight loss, and diaphoresis are other clinical manifestations of pheochromocytoma; however, hypertension is the most common sign.
During routine postoperative assessment of a client who has undergone hypophysectomy, the client complains of thirst and frequent urination. Knowing the expected complications of this surgery, the nurse would next check the:
*1. Urine specific gravity*
2. Serum glucose
3. Respiratory rate
4. Blood pressure
*rationale* Following hypophysectomy, diabetes insipidus can occur temporarily because of antidiuretic hormone (ADH) deficiency. This deficiency is related to surgical manipulation. The nurse should assess specific gravity and notify the registered nurse if the results are less than 1.005. Although options 2, 3, and 4 may be components of the assessment, the nurse would next check urine specific gravity.
A client with diabetes mellitus is scheduled to have a fasting blood glucose level determined in the morning. The nurse tells the client not to eat or drink after midnight. When the client asks for further information, the nurse clarifies by stating that which of the following would be acceptable to take before the test?
*1. Water*
2. Coffee without any milk
3. Tea without any sugar
4. Clear liquids such as apple juice
*rationale* When a client is scheduled for a fasting blood glucose level, the client should not eat or drink anything except water after midnight. This is needed to ensure accurate test results, which form the basis for adjustments or continuance of treatment. Options 2, 3, and 4 are inaccurate, and the client should not consume these items before the test.
A client with a pituitary tumor will undergo transsphenoidal hypophysectomy. The nurse includes which priority item in the preoperative teaching plan for the client?
1. Brushing the teeth vigorously and frequently is important to minimize bacteria in the mouth.
*2. Blowing the nose following surgery is prohibited.*
3. A small area will be shaved at the base of the neck.
4. It will be necessary to cough and deep breathe following the surgery.
*rationale* The approach used for this surgery is the oronasal route, specifically where the upper lip meets the gum. The surgeon then uses a route through the sphenoid sinus to get to the pituitary gland. The client is not allowed to blow the nose, sneeze, or cough vigorously because these activities could raise intracranial pressure. The client also is not allowed to brush the teeth, to avoid disrupting the surgical site. Alternate methods for performing mouth care are used.
A client who returned to the nursing unit 8 hours ago after hypophysectomy has clear drainage saturating the nasal dressing. The nurse should take which action first?
1. Continue to observe for further drainage.
*2. Test the drainage for glucose.*
3. Put the head of the bed flat.
4. Test the drainage for occult blood.
*rationale* Following hypophysectomy the client should be monitored for rhinorrhea (clear nasal drainage), which could indicate a cerebrospinal fluid (CSF) leak. If this occurs, the drainage should be collected and tested for the presence of CSF by testing it for glucose. CSF tests positive for glucose, whereas true nasal secretions would not. It is not necessary to test drainage that is clear for occult blood. The head of the bed should not be lowered, to prevent a rise in intracranial pressure. Continuing to observe the drainage without taking action could put the client at risk for developing a serious complication.
A client with newly diagnosed Cushing’s syndrome expresses concern about personal appearance, specifically about the “buffalo hump” that has developed at the base of the neck. When counseling the client about this manifestation, the nurse should incorporate the knowledge that:
1. This is a permanent feature.
2. It can be minimized by wearing tight clothing.
*3. It may slowly improve with treatment of the disorder.*
4. It will quickly disappear once medication therapy is started.
*rationale* The client with Cushing’s syndrome should be reassured that most physical changes resolve over time with treatment. The other options are incorrect.
A client has just been admitted with a diagnosis of myxedema coma. If all of the following interventions were prescribed, the nurse would place highest priority on completing which of the following first?
*1. Administering oxygen*
2. Administering thyroid hormone
3. Warming the client
4. Giving fluid replacement
*rationale* As part of maintaining a patent airway, oxygen would be administered first. This would be quickly followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones.
A nurse has just supervised a newly diagnosed diabetes mellitus client self-inject NPH insulin at 7:30 ᴀᴍ. The nurse reviews the time frames for peak insulin action with the client, telling the client to be especially watchful for a hypoglycemic reaction between:
1. 7:30 ᴀᴍ and 9:30 ᴀᴍ
*2. 1:30 ᴘᴍ and 7:30 ᴘᴍ*
3. 8:30 ᴘᴍ and 12:00 ᴀᴍ
4. 2:30 ᴀᴍ and 4:30 ᴀᴍ
*rationale* NPH is an intermediate-acting insulin. It begins to work in 1 to 2 hours (onset), peaks in 6 to 12 hours, and lasts for 18 to 24 hours (duration). Hypoglycemic reactions most likely occur during peak time, which in this case is option 2.
A nurse is discussing foot care with a diabetic client and spouse. The nurse includes which of the following during this informational session?
1. There is decreased risk of infection when feet are soaked in hot water.
2. Lanolin should be applied to dry feet, especially the heels and between the toes.
*3. The toenails should be cut straight across.*
4. Strong soap should be used to decrease skin bacteria.
*rationale* The client should be instructed to cut the toenails straight across. The client should not soak the feet in hot water, to prevent burns. The client should be instructed to wash the feet daily using a mild soap. Moisturizing lotion can be applied to the feet but should not be placed between the toes.
1. A pt 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 any family history of acromegaly?”
d. “Are you experiencing tremors or anxiety?”
B
Rationale: Acromegaly causes an enlargement of the hands and feet. Head injury and family history are not risk factors for acromegaly. Tremors and anxiety are not clinical manifestations of acromegaly.
(Cognitive Level: Application Text Reference: p. 1291
NProcess: Assessment NCLEX: Physiological Integrity)
2. During preoperative teaching for a patient scheduled for transsphenoidal hypophysectomy for treatment of a pituitary adenoma, the nurse instructs the patient about the need to
a. remain on bed rest for the first 48 hours after the surgery.
b. avoid brushing the teeth for at least 10 days after the surgery.
c. cough and deep-breathe every 2 hrs postoperatively.
d. be positioned flat with sandbags at the head postoperatively.
B
R: 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.
(Cognitive Level: Application Text Reference: p. 1293
NProcess: Implementation NCLEX: Physiological Integrity)
3. Following a transsphenoidal resection of a pituitary tumor, an important N assessment is
a. monitoring hourly urine output.
b. checking the dressings for serous drainage.
c. palpating for dependent pitting edema.
d. obtaining continuous pulse oximetry.
A
R: After pituitary surgery, the pt is at risk for diabetes insipidus caused by cerebral edema and monitoring of urine output and urine specific gravity is essential. There will be no dressing when transsphenoidal approach is used. The pt is at risk for dehydration, not volume overload. The pt is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.
4. A pt is suspected of having a pituitary tumor causing panhypopituitarism. During assessment of the pt, the nurse would expect to find
a. elevated blood glucose.
b. changes in secondary sex characteristics.
c. high blood pressure.
d. tachycardia and cardiac palpitations.
B
Rationale: Changes in secondary sex characteristics are associated with decreases in FSH and LH. Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of decreases in ACTH and cortisol. Bradycardia is likely due to the decrease in TSH and thyroid hormones associated with panhypopituitarism.
(Cognitive Level: Application Text Reference: p. 1294
NProcess: Assessment NCLEX: Physiological Integrity)
5. A pt seen at clinic for an upper respiratory infection reports receiving subcutaneous somatotropin (Genotropin) when asked by the nurse about current medications. The nurse questions the pt further about a hx of
a. adrenal disease.
b. untreated acromegaly.
c. a pituitary tumor.
d. diabetes insipidus (DI).
C
R: Somatotropin is a recombinant growth hormone product used for adults with growth hormone deficiency, such as that caused by a pituitary tumor. The med is not used in adrenal disease or DI. The patient with untreated acromegaly will have an excess of growth hormone.
6. A patient with an antidiuretic hormone (ADH)-secreting small-cell cancer of the lung is treated with demeclocycline (Declomycin) to control the symptoms of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse determines that the demeclocycline is effective upon finding that the
a. patient’s daily weight is stable.
b. urine specific gravity is increased.
c. patient’s urinary output is increased.
d. peripheral edema is decreased.
C
R: Demeclocycline blocks the action of ADH on the renal tubules and increases urine output. A stable body weight and an increase in urine specific gravity indicate 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.
7. When teaching a patient with chronic SIADH about long-term management of the disorder, the nurse determines that additional instruction is needed when the patient says,
a. “I need to shop for foods that are low in sodium and avoid adding salt to foods.”
b. “I should weigh myself daily and report any sudden weight loss or gain.”
c. “I need to limit my fluid intake to no more than 1 quart of liquids a day.”
d. “I will eat foods high in potassium because the diuretics cause potassium loss.”
A
Rationale: Pts with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other pt statements are correct and indicate successful teaching has occurred.
8. A patient is hospitalized with possible SIADH. The patient is confused and reports a headache, muscle cramps, and twitching. The nurse would expect the initial laboratory results to include a
a. serum sodium of 125 mEq/L (125 mmol/L).
b. hematocrit of 52%.
c. blood urea nitrogen (BUN) of 22 mg/dl (11.5 mmol/L).
d. serum chloride of 110 mEq/L (110 mmol/L).
A
R: When water is retained, the serum sodium level will drop below normal, causing the CMs reported by the patient. The hematocrit will decrease because of the dilution caused by water retention. The BUN is not helpful in diagnosis of SIADH and this BUN value is increased. The serum chloride level will usually decrease along with the sodium level. This chloride value is elevated.
9. A patient with symptoms of DI is admitted to the hospital for evaluation and treatment of the condition. An appropriate nursing diagnosis for the patient is
a. insomnia related to waking at night to void.
b. risk for impaired skin integrity related to generalized edema.
c. excess fluid volume related to intake greater than output.
d. activity intolerance related to muscle cramps and weakness.
A
R: Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema will not be expected because dehydration is a concern with polyuria. The pt drinks large amnts of fluid to compensate for losses experienced from diuresis. The pt’s fluid and electrolyte status remain normal as long as the patient’s oral intake can keep up w fluid losses, muscle cramps and weakness arent concerns.
10. Which information obtained when caring for a pt who has just been admitted for evaluation of DI will be of greatest concern to the nurse?
a. The patient has a urine output of 800 ml/hr.
b. The patient’s urine specific gravity is 1.003.
c. The patient had a recent head injury.
d. The patient is confused and lethargic.
D
R: Pts with diabetes insipidus 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 DI, but they do not require immediate nursing action to avoid life-threatening complications.
11. When teaching a patient newly diagnosed with Graves’ disease about the disorder, the nurse explains that
a. restriction of iodine intake is needed to reduce thyroid activity.
b. exercise is contraindicated to avoid increasing metabolic rate.
c. surgery will eventually be required to remove the thyroid gland.
d. antithyroid medications may take several weeks to have an effect.
D
R: Improvement usually begins in 1-2 wks w good results at 4-6 weeks. Large doses of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large muscle groups is encouraged to decrease irritability and hyperactivity associated with high levels of thyroid hormones. Radioactive iodine is the most common trtmt for Graves’ disease, although surgery may be used.
12. A patient with Graves’ disease is prepared for surgery with drug therapy consisting of 4 weeks of propylthiouracil (PTU) and 10 days of iodine before surgery. When teaching the patient about the drugs, the nurse explains that the drugs are given preoperatively to
a. eliminate the risk for tetany during the postoperative period.
b. decrease the risk of hypometabolism during and after the surgery.
c. normalize metabolism and decrease the size and vascularity of the gland.
d. assist in differentiating the thyroid and parathyroid glands during surgery.
C
R: Antithyroid drugs and iodine decrease the levels of thyroid hormone and the vascularity of the thyroid gland prior to surgery and lower the risk for postoperative thyrotoxicosis and hemorrhage. Postoperative tetany might be caused by removal of the parathyroid gland during thyroidectomy. The medications will tend to decrease metabolic rate. The medications will not help in differentiating the tissues of the thyroid and parathyroid glands.
13. During the nursing assessment of a patient with Graves’ disease, the nurse notes a bounding, rapid pulse and systolic hypertension. Based on these assessment data, which question is important for the nurse to ask the patient?
a. “Do you have any problem with frequent constipation?”
b. “Have you noticed any recent decrease in your appetite?”
c. “Do you ever have any chest pain?”
d. “Have you had recent muscle aches?”
C
R: Angina is a possible complication of Graves’ disease, especially for a patient with tachycardia and hypertension. The other CMs are associated with hypothyroidism.
14. While assessing a patient who has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy, the nurse obtains these data. Which information is most important to communicate to the surgeon?
a. The pt is complaining of 7/10 incisional pain.
b. The pt’s cardiac monitor shows a HR of 112.
c. The patient has increasing swelling of the neck.
d. The pat’s voice is weak and hoarse sounding.
C
R: 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 is not unusual in a pt who has been hyperthyroid and has just arrived in the PACU from surgery. Vocal hoarseness is expected after surgery due to edema.
15. A few hours after returning to the surgical nursing unit, a patient who has undergone a subtotal thyroidectomy develops laryngeal stridor and a cramp in the right hand. The nurse anticipates that intervention will include
a. administration of IV morphine.
b. administration of IV calcium gluconate.
c. endotracheal intubation with mechanical ventilation.
d. immediate tracheostomy and manual ventilation.
B
R: The pt’s CMs are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Tracheostomy may be needed if the calcium does not resolve the stridor. There is no indication that morphine is needed. Endotracheal intubation may be done, but only if calcium is not effective in correcting stridor
16. The nurse identifies a nursing dx of risk for injury: corneal ulceration related to inability to close the eyelids secondary to exophthalmos for a patient with Graves’ disease. An appropriate nursing intervention for this problem is to
a. teach the patient to blink every few seconds to lubricate the cornea.
b. elevate the head of the patient’s bed to reduce periorbital fluid.
c. apply eye patches to protect the cornea from irritation.
d. place cold packs on the eyes to relieve pain and swelling.
B
R: The patient should sit upright as much as possible to promote fluid drainage from the periorbital area. With exophthalmos, the pt is unable to close eyes completely. 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.
17. The first nursing action indicated when a patient returns to the surgical nursing unit following a thyroidectomy is to
a. check the dressing for bleeding.
b. assess respiratory rate and effort.
c. support the patient’s head with pillows.
d. take the blood pressure and pulse.
B
R: Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany, and priority nursing action is to assess airway. The other actions are also part of the standard nursing care post-thyroidectomy but are not as high in priority.
18. A patient with hyperthyroidism is treated with radioactive iodine (RAI) at a clinic. Before the patient is discharged, the nurse instructs the pt
a. to monitor for symptoms of hypothyroidism, such as easy bruising and cold intolerance.
b. to discontinue the antithyroid medications taken before the radioactive therapy.
c. that symptoms of hyperthyroidism should be relieved in about a week.
d. about radioactive precautions to take with urine, stool, and other body secretions.
A
R: There is a high incidence of post-radiation hypothyroidism after RAI, and the pt should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with maximum effect not seen for 2-3 months, and pt 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.
19. A 72-year-old patient is diagnosed with hypothyroidism, and levothyroxine (Synthroid) is prescribed. During initiation of thyroid replacement for the patient, it is most important for the nurse to assess
a. mental status.
b. nutritional level.
c. cardiac function.
d. fluid balance.
C
R: In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication is also expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes do not indicate a need to change the therapy.
20. While hospitalized for a fractured femur, a 68-year-old pt is diagnosed with hypothyroidism. Which of these medications on the original admission orders will the nurse need to consult with the HCP about before it is administered?
a. Docusate (Colace)
b. Diazepam (Valium)
c. Ibuprofen (Motrin)
d. Cefoxitin (Mefoxin)
B
R: Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older adults. The nurse should discuss the diazepam with the health care provider before administration. The other medications may safely be given to the pt.
21. When teaching a patient with newly diagnosed hypothyroidism about management of the condition, the nurse should
a. delay teaching about the condition until the patient has responded to replacement therapy.
b. provide written handouts of all instructions for continued reference as the patient improves.
c. have a family member teach the patient about the condition when the patient is more alert.
d. arrange for daily home visits by home health nurses to repeat the necessary instructions.
B
R: 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. Teaching should not be delayed, but family members or friends should be included in teaching to assist the patient. The nurse, not a family member, is responsible for patient teaching. Because thyroid replacement does not begin to improve alertness immediately, it is not appropriate to schedule daily home health visits for teaching.
22. A patient with primary hyperparathyroidism has a serum calcium level of 14 mg/dl (3.5 mmol/L), phosphorus of 1.7 mg/dl (0.55 mmol/L), serum creatinine of 2.2 mg/dl (194 mmol/L), and a high urine calcium. While the patient awaits surgery, the nurse should
a. institute seizure precautions such as padded siderails.
b. assist the patient to perform range-of-motion exercises QID.
c. monitor the patient for positive Chvostek’s or Trousseau’s sign.
d. encourage the pt to drink 4000 ml of fluid daily.
D
R: The pt 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 pt should engage in weight-bearing exercise rather than range-of-motion because weight-bearing decreases calcium loss from bone.
23. Following a thyroidectomy, a patient develops carpal spasm while the nurse is taking a blood pressure on the left arm. Which action by the nurse is appropriate?
a. Administer the ordered muscle relaxant.
b. Have the patient rebreathe using a paper bag.
c. Start oxygen at 2 to 3 L/min per cannula.
d. Give the ordered oral calcium supplement.
B
R: Carpal spasm after a thyroidectomy suggests that pt has hypocalcaemia caused by damage to the parathyroid glands. The symptoms of hypocalcemia will be temporarily reduced by having the patient breath into a paper bag, which will raise the PaCO2 and create a more acidic pH. The muscle relaxant will not impact on ionized calcium level. There is no indication that the patient is experiencing laryngeal stridor or needs oxygen. IV calcium supplements will be given to normalize calcium level quickly.
24. After neck surgery, a patient develops hypoparathyroidism. The nurse should plan to teach the patient about
a. calcium supplementation to normalize serum calcium levels.
b. including whole grains in the diet to prevent constipation.
c. use of bisphosphonates to reduce bone demineralization.
d. having a high fluid intake to decrease risk for nephrolithiasis.
A
R: 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 level further by preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of hypoparathyroidism and low calcium levels.
25. A patient with hypoparathyroidism receives instructions from the nurse regarding symptoms of hypocalcemia and hypercalcemia. The nurse teaches the patient that if mild symptoms of hypocalcemia occur, the patient should
a. increase daily fluid intake to twice usual amount
b. self-administer IM calcium before calling doctor.
c. call an ambulance because the symptoms will progress to seizures.
d. rebreathe with a paper bag and then seek medical assistance.
D
R: Rebreathing may help alleviate mild sx, but it will only temporarily increase ionized calcium level, so the pt should call HCP. There is no need to increase fluid intake. Calcium is not given IM but given slowly through IV route. Mild hypocalcemia is unlikely to progress to seizures.
26. A nursing assessment of a patient with Cushing syndrome reveals that the patient has truncal obesity and thin arms and legs. An additional manifestation of Cushing syndrome that the nurse would expect to find is
a. chronically low blood pressure.
b. decreased axillary and pubic hair.
c. purplish red streaks on the abdomen.
d. bronzed appearance of the skin.
C
Rationale: 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.
27. A pt with Cushing syndrome is admitted to the hospital to have laparoscopic adrenalectomy. During the admission assessment, the patient tells the nurse, “The worst thing about this disease is how terrible I look. I feel awful about it.” best response by the nurse is
a. “Let me show you how to dress so that the changes are not so noticeable.”
b. “I do not think you look bad. Your appearance is just altered by your disease.”
c. “Most of the physical and mental changes caused by the disease will gradually improve after surgery.”
d. “You really should not worry about how you look in the hospital. We see many worse things.”
C
Rationale: The most reassuring 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. The response beginning “Let me show you how to dress” indicates that the changes are permanent and that the patient’s appearance needs disguising. The response beginning, “I do not think you look bad” does not acknowledge the patient’s feelings and also fails to communicate that the changes will be resolved after surgery. And the response beginning “You really should not worry about how you look in the hospital” implies that the pt’s appearance is not good.
28. When providing postoperative care for a patient who has had bilateral adrenalectomy, which assessment information obtained by the nurse is most important to communicate to HCP?
a. The blood glucose is 156 mg/dl.
b. The patient’s blood pressure is 102/50.
c. The patient has 5/10 incisional pain.
d. The lungs have bibasilar crackles.
B
R: During immediate postoperative period, marked fluctuation in cortisol levels may occur and the nurse must be alert for signs of acute adrenal insufficiency such as hypotension. nurse should also address elevated glucose, incisional pain, and crackles with appropriate collaborative or nursing actions, but prevention and treatment of acute adrenal insufficiency is the priority after adrenalectomy.
29. A patient with Cushing syndrome returns to the surgical unit following an adrenalectomy. During the initial postoperative period, the nurse gives the highest priority to
a. monitoring for infection.
b. protecting the patient’s skin.
c. maintaining fluid and electrolyte status.
d. preventing severe emotional disturbances.
C
R: After adrenalectomy, the pt 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. other goals are also important for pt but arent as immediately life-threatening as circulatory collapse
30. A pt is hospitalized with acute adrenal insufficiency. The nurse determines that the pt is responding favorably to treatment upon finding
a. decreasing serum sodium.
b. decreasing serum potassium.
c. decreasing blood glucose.
d. increasing urinary output.
B
R: CMs of Addison’s disease include hyperkalemia and a decrease in potassium level indicates improvement. Decreasing serum sodium and decreasing blood glucose indicate that treatment has not been effective. Changes in urinary output are not an effective way of monitoring treatment for Addison’s disease.
31. A pt is admitted to the hospital in addisonian crisis 1 month after a diagnosis of Addison’s disease. The nurse identifies the nursing diagnosis of ineffective therapeutic regimen management related to lack of knowledge of management of condition when the patient says,
a. “I double my dose of hydrocortisone on the days that I go for a run.”
b. “I had the stomach flu earlier this week and couldn’t take the hydrocortisone.”
c. “I frequently eat at restaurants, and so my food has a lot of added salt.”
d. “I do yoga exercises almost every day to help me reduce stress and relax.”
B
R: 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.
32. A pt who uses every-other-day prednisone therapy for rheumatoid arthritis complains of not feeling as well on the non-prednisone days and asks nurse about taking prednisone daily instead. The best response to the pt is that
a. an every-other-day schedule mimics the normal pattern of cortisol secretion from the adrenal gland.
b. glucocorticoids are taken on a daily basis only when theyre being used for replacement therapy.
c. if it improves the symptoms, it would be acceptable to take half the usual dose every day.
d. there is less effect on normal adrenal function when prednisone is taken every other day.
D
R: An alternate-day regimen is given to minimize the impact of exogenous glucocorticoids on adrenal gland function. The normal pattern of cortisol secretion is diurnal. Glucocorticoids are taken daily when being used for replacement therapy, but this is not the only indication for daily use. Taking half the usual dose would not achieve the goal of minimizing adrenal gland suppression.
33. A pt is taking high doses of prednisone to control the symptoms of an acute exacerbation of systemic lupus erythematosus. When teaching the pt about use of prednisone, which information is most important for the nurse to include?
a. Call the doctor if you experience any mood alterations with the prednisone.
b. Do not stop taking the prednisone suddenly; it should be decreased gradually.
c. Weigh yourself daily to monitor for weight gain caused by water or increased fat.
d. Check your temperature daily because prednisone can hide signs of infection.
B
R: Acute adrenal insufficiency may occur if exogenous glucocorticoids are suddenly stopped. Mood alterations and weight gain are possible adverse effects of glucocorticoid use, but these are not life-threatening effects. Glucocorticoids do mask the signs of infection, but temperature elevation tends to be suppressed, so other signs of infection should be monitored.
(Cognitive Level: Application Text Reference: p. 1314
NProcess: Implementation NCLEX: Physiological Integrity)
34. A patient has an adrenocortical adenoma causing hyperaldosteronism and is scheduled for laparoscopic surgery to remove the tumor. During care before surgery, the nurse should
a. monitor blood glucose level every 4 hours.
b. provide a potassium-restricted diet.
c. monitor the blood pressure every 4 hours.
d. relieve edema by elevating the extremities.
C
R: HTN caused by Na retention is a common complication of hyperaldosteronism. Hyperaldosteronism does not cause elevation in blood glucose. pt will be hypokalemic and require potassium supplementation prior to surgery. Edema does not usually occur with hyperaldosteronism.
(Cognitive Level: Application Text : pp. 1319-1320 NProcess: Implementation NCLEX: Physiological Integrity)
35. A pt with a possible pheochromocytoma is admitted to the hospital for evaluation and diagnostic testing. During an attack, the nurse will monitor for hypertension and
a. hypoglycemia.
b. bradycardia.
c. headache.
d. flushing.
C
R: The classic CMs of pheochromocytoma are hypertension, tachycardia, severe headache, diaphoresis, and abdominal or chest pain. Elevated blood glucose may also occur due to sympathetic nervous system stimulation. Bradycardia and flushing would not be expected.
(Cognitive Level: Application Text Reference: p. 1320
NProcess: Assessment NCLEX: Physiological Integrity)
36. RN observes a nursing assistant (NA) caring for a patient after a hypophysectomy. Which action by the NA requires that the RN intervene?
a. The NA lowers the HOB to the flat position.
b. The NA cautions the patient to avoid coughing.
c. The NA cleans the patient’s mouth with a swab.
d. NA collects a urine specimen for specific gravity
A
R: HOB should be elevated about 30 degrees to decrease pressure on the sella turcica and avoid headaches. The other actions by the NA are appropriate after this surgery.
(Cognitive Level: Application Text : p. 1293 NProcess: Implementation NCLEX: Safe and Effective Care Enviro)
37. After a patient with a pituitary adenoma has had a hypophysectomy, the nurse will plan to do discharge teaching about the need for
a. insulin use to maintain blood glucose at normal levels.
b. Na restriction to prevent fluid retention and hypertension.
c. oral corticosteroids to replace endogenous cortisol.
d. chemotherapy to prevent reoccurrence of tumor
C
R: ADH, cortisol, and thyroid hormone replacement will be needed for life after hypophysectomy. Without the effects of 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.
(Cognitive Level: Application Text Reference: p. 1293
NProcess: Planning NCLEX: Physiological Integrity)
38. A pt is admitted with possible SIADH. Which information obtained by nurse is most important to communicate rapidly to health care provider?
a. The patient complains of a severe headache.
b. The patient complains of severe thirst.
c. The patient has a urine specific gravity of 1.025.
d. The pt has a serum sodium level of 119 mEq/L.
D
R: A serum sodium of less than 120 mEq/L increases risk for complications such as seizures and needs rapid correction. The other data are not unusual for a pt with SIADH and do not indicate the need for rapid action.
(Cognitive Level: Application Text Reference: p. 1295
NProcess: Assessment NCLEX: Physiological Integrity)
39. When developing a plan of care for a pt with SIADH, which interventions will the nurse include?
a. Encourage fluids to 2000 ml/day.
b. Offer patient hard candies to suck on.
c. Monitor for increased peripheral edema.
d. Keep head of bed elevated to 30 degrees.
B
R: Sucking on hard candies decreases thirst for patient on a fluid restriction. Pts with SIADH are on fluid restrictions of 800-1000 ml/day. Peripheral edema isnt seen w SIADH. HOB is elevated no more than 10 degrees to increase left atrial filling pressure and decrease ADH release.
(Cognitive Level: Application Text Reference: p. 1296
NProcess: Planning NCLEX: Physiological Integrity)
40. After receiving change-of-shift report about these pts, which patient should nurse assess first?
a. A 22-year-old admitted with SIADH who has a serum sodium level of 130 mEq/L.
b. A 31-year-old who has iatrogenic Cushing’s syndrome with a capillary blood glucose level of 244 mg/dl.
c. A 53-year-old who has Addison’s disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef).
d. A 70-year-old who recently started levothyroxine (Synthroid) to treat hypothyroidism and has an irregular pulse of 134.
D
R: Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The pt’s high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other pts also require nursing assessment and/or actions but are not at risk for life-threatening complications.
(Cognitive Level: Application Text Reference: p. 1306
Nursing Process: Planning NCLEX: Physiological Integrity)
A pt suspected of having acromegaly has an elevated plasma growth hormone level. In acromegaly, the nurse would also expect the pt’s diagnostic results to include
a. hyperinsulinemia
b. a plasma glucose of less than 70
c. decreased growth hormone levels with an oral glucose challenge test
d. a serum sometomedin C (insulin-like growth-factor) of more than 300
d. a serum somatomedin C (Insulin-like-growth-factor) of more than 300
(R- a normal response to growth hormone secretion is stimulation of the liver to produce somatomedin C which stimulates growth of bones and soft tissue. The increased levels of somatomedin C normally inhibit growth hormone, but in acromegaly the pituitary gland secretes GH despite elevated somatomedin C levels.)
During assessment of the pt with acromegaly, the nurse would 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 per year
c. undesirable changes in appearance
(R- 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, oily and coarse skin, and speech difficulties. Height is not increased in adults w GH excess bc the epiphyses of the bones are closed, and infertility is not a common finding because growth hormone is usually the only pituitary hormone involved in acromegaly.)
pt with acromegaly is treated w a transphenoidal hypophysectomy. Postoperatively, the nurse
a. ensures that any clear nasal drainage is tested for glucose
b. maintains the patient flat in bed to prevent cerebrospinal fluid leak
c. assists the patient with toothbrushing Q4H to keep the surgical area clean
d. encourages deep breathing and coughing to prevent respiratory complications
a. ensures any clear nasal drainage is tested for glucose
(R- a transphenoidal 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. Postoperative clear nasal drainage with glucose content indicates CSF leakage from an open connection to the brain, putting the pt at risk for meningitis. After surgery, the pt is positioned with head elevated to avoid pressure on the sella turcica, coughing and straining are avoided to prevent increased ICP and CSF leakage, and although mouth care is required Q4H toothbrushing should not be performed for 7-10post sx.)
During care of a patient with syndrome of inappropriate ADH (SIADH), the nurse should
a. monitor neurologic status Q2H or more often if needed
b. keep the HOB elevated to prevent ADH release
c. teach the patient receiving treatment with diuretics to restrict sodium intake
d. notify the physician if the p’s blood pressure decreases more than 20mmHg from baseline
a. monitor neurologic status Q2H or more often if needed
R- the pt with SIADH has marked dilution hyponatremia and should be monitored for decreased neurologic function and convulsions every 2 hours. ADH release is reduced by keeping the HOB flat to increase left atrial filling pressure, and sodium intake is supplemented because of hyponatremia and sodium loss caused by diuretics. A reduction in BP indicates a reduction in total fluid vo and is an expected outcome of treatment.)
A patient with SIADH is treated with water restriction and administration of IV fluids. The nurses evaluates that treatment has been effective when the patient experiences
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. increased urine output, increased serum sodium, and decreased urine specific gravity
(rationale- 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 reflected by increased urine output, normalization of serum sodium, and more water in the urine, decreasing the specific gravity.)
In a patient with central diabetes insipidus, administration of aqueous vasopressin during a water deprivation test will result in a
a. decrease in body weight
b. increase in urinary output
c. decrease in blood pressure
d. increase in urine osmolality
d. increase in urine osmolality
(R- pt with DI has a deficiency of ADH with excessive loss of water from the kidney, hypovolemia, hypernatreamia, and dilute urine with a low specific gravity. When vasopressin is administered, the symptoms are reversed, with water retention, decreased urinary output that increases urine osmolality, and an increase in BP.)
A patient with DI is treated with nasal desmopression. The nurse recognize that the drug is not having an adequate therapeutic effect the 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. a urine specific gravity of 1.002
(rationale- normal urine specific gravity is 1.003 to 1.030, and 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. H/A, weight gain, and oral intake greater the urinary output are signs of volume excess that occur with overmedication. Nasal irritation & nausea may also indicate overmedication.)
When caring for a patient with nephrogenic DI, the nurse would expect treatment to include
a. fluid restriction
b. thiazide diuretics
c. a high-sodium diet
d. chlorpropamide (DIabinese)
b. thiazide diuretics
(Rationale- in nephrogenic Di the kidney is unable to respond to ADH, so vasopressin or hormone analogs are not effective. Thiazide diuretics slow the glomerular filtration rate in the kidney and produce a decrease in urine output. Low-sodium diets are also thought to decrease urine output. Fluids are not restricted, because the patient could become easily dehydrated.)
A pt with Grave’s dz asks the nurse what caused the disorder. The best response by the nurse is
a. “The cause of Grave’s 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 of time.”
c. “Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones”
d. “In genetically susceptible persons antibodies form that attack thyroid tissue and stimulate overproduction of thyroid hormones.”
d. “In genetically susceptible persons antibodies form that attack thyroid tissue and stimulate overproduction of thyroid hormones.”
(R- The antibodies present in Graves’ disease that attack thyroid tissue cause hyperplasia of the gland and stimulate TSH receptors on the thyroid and activate the production of thyroid hormones, creating hyperthyroidism. disease is not directly genetic, but individuals appear to have a genetic susceptibility to become sensitized to develop autoimmune antibodies. Goiter formation from insufficient iodine intake is usually associated with hypothyroidism.)
A patient is admitted to the hospital in thyrotoxic crisis. On physical assessment of the patient, the nurse would expect to find
a. hoarseness and laryngeal stridor
b. bulging eyeballs and arrhythmias
c. elevated temperature and signs of heart failure
d. lethargy progressing suddenly to impairment of consciousness
c. elevated temperature and signs of heart failure
(R- a hyperthyroid crisis results in marked manifs of hyperthyroidism, w fever tachycardia, heart failure, shock, hyperthermia, agitation, N/V/D, delirium, and coma. Although exophthalmos may be present in pt w Gravs’, it is not a signif factor in hyperthyroid crisis. Hoarsness and laryngeal stridor are ch of tetany of hypoparathyroidsm, and lethargy progressing to coma is characteristic of myxedema coma, a complication of hypothyroidism.
Preoperative instructions for the patient scheduled for a subtotal thyroidectomy includes teaching the patient
a. how to support the head w hands when moving
b. that coughing should due avoided to prevent pressure on the incision
c. that the head and neck will need to remain immobile until the incision heals
d. that any tingling around the lips or in the fingers after surgery is expected and temporary
a. how to support the head with the hands when moving
(R- to prevent strain on suture line postoperatively, head must be manually supported while turning and moving in bed, but range-of-motion exercise for the head and neck are also taught preoperatively to be gradually implemented after surgery. There is no contraindication for coughing and deep breathing, and they should be carrier out postoperatively. Tingling around the lips or fingers is a sign of hypocalcemia, which may occur if the parathyroid glands are inadvertently removed during surgery, and should be reported immediately.)
Physical changes of hypothyroidism that must be monitored when replacement therapy is started include
a. achlorhydria and constipation
b. slowed mental processes and lethargy
c. anemia and increased capillary fragility
d. decreased cardiac contractility and coronary atherosclerosis
d. decreased cardiac contractility and coronary atherosclerosis
(R- hypothyroidism affects the heart in many ways, causing cardiomyopathy, coronary atherosclerosis, bradycardia, pericardial effusions, and weakened cardiac contractility. when thyroid replacement therapy is started, myocardial oxygen consumption is increased and resultant oxygen demand may cause angina, cardiac arrhythmias, and HFs. It is important to monitor pts with compromised cardiac status when starting replacement therapy.)
A pt with hypothyroidism is treated h Synthroid. When teaching the pt about the therapy, the nurse
a. explains that caloric intake must be reduced when drug therapy is started
b. provides written instruction for all information related to the medication therapy
c. assures the patient that a return to normal function will occur with replacement therapy
d. informs the patient that medications must be taken until hormone balance is reestablished
b. provides written instruction for all information related to the medication therapy
(R- bc of mental sluggishness, inattentiveness, and memory loss that occur with hypothyroidism, it is important to provide written instructions and repeat information when teaching pt. Caloric intake can be increased when drug therapy is started, because of an increased metabolic rate, and replacement therapy must be taken for life. Although most pts return to a normal state w treatment, cardiovascular conditions and psychoses may persist.)
An appropriate nursing intervention for the patient with hyperparathyroidism is to
a. pad side rails as a seizure precaution
b. increase fluid intake to 3000 to 4000ml/day
c. maintain bed rest to prevent pathologic frxturs
d. monitor the patient for Trousseau’s phenomenon or Chvostek’s sign
b. increase fluid intake to 3000 to 4000ml/day
(R-high fluid intake is indicated in hyperparathyroidism to dilute hypercalcemia and flush the kidneys so that calcium stone formation is reduced.)
When the patient with parathyroid disease experiences symptoms of hypocalcemia, a measure that can be used to temporarily raise serum calcium levels is to
a. administer IV normal saline
b. have the patient rebreathe in a paper bag
c. administer Lasix as ordered
d. administer oral phosphorous supplements
b. have the patient rebreathe in a paper bag
(R- rebreathing in a paper bag promotes CO2 retention in blood, which lowers pH and creates an acidosis. An academia enhances solubility and ionization of calcium, increasing the proportion of total body Ca available in physiologically active form and relieving the sx of hypocalcemia. Saline promotes calcium excretion, as does Lasix. Phosphate levels in blood are reciprocal to calcium and an increase in phosphate promotes calcium excretion.)
A pt is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, the nurse would expect to find
a. HTN, peripheral edema, and petechiae
b. weight loss, buffalo hump, moon face with acne
c. abdominal and buttock striae, truncal obesity, and hypotension
d. anorexia, signs of dehydration, and hyper pigmentation of the skin
a. HTN, peripheral edema, and petechiae
(R- effects of glucocorticoid excess include weight gain from accumulation and redistribution of adipose tissue, Na and water retention, glucose intolerance, protein wasting, loss of bone structure, loss of collagen, capillary fragility. CM of corticosteroid deficiency include hypotension, dehydration, weight loss, hyperpigmentation of skin.)
To prevent complications in the patient with Cushing syndrome, the nurse monitors the pt for
a. hypotension
b. hypoglycemia
c. cardiac arrhythmias
d. decreased cardiac output
c. cardiac arrhythmias
(R- electrolyte changes that occur in Cushing syndrome include Na retention and K excretion by kidney, resulting in hypokalemia, -may lead to cardiac arrhythmias/ arrest. Hypotension, hypoglycemia, decreased cardiac strength and output are characteristic of adrenal insufficiency.)
A patient is scheduled for bilateral adrenalectomy. During the postoperative period, the nurse would expect administration of corticosteroids to be
a. reduced to promote wound healing
b. withheld until sx of hypocortisolism appear
c. increased to promote an adequate response to the stress of surgery
d. reduced bc excessive hormones are released during surgical manipulation of the glands
c. increased to promote an adequate response to the stress of surgery
(R- although pt with Cushing syndrome has excess corticosteroids, removal of the glands and the stress of surgery require that high doses of cortisone be administered postoperatively for several days. The nurse should monitor the pt postoperatively to detect whether large amounts of hormones were released during surgical manipulation and to ensure the healing is satisfactory.)
A patient with Addison’s disease comes to the emergency department with complaints of N/V/D, and fever. The nurse would expect collaborative care to include
a. parenteral injections of ACTH
b. IV administration of vasopressors
c. IV administration of hydrocortisone
d. IV administration of D5W with 20mEq of KCl
c. IV administration of hydrocortisone
(R- vom and dia are early indicators of addisonian crisis and fever indicates an infection, which s causing additional stress for pt. trtmt of crisis requires immediate glucocorticoid replacement, and IV hydrocortisone, fluids, Na and glucose are necessary for 24hours. Addison’s disease is a primary insufficiency of adrenal gland, and ACTH is not effective, nor would vasopressors be effective w fluid deficiency of Addison’s. Potassium levels are incd in Addison’s dz, and KCl would be contraindicated.)
The nurse determines that the pt in acute adrenal insufficiency is responding favorably to trtmt when
a. the patient appears alert and oriented
b. the patient’s urinary output has increased
c. pulmonary edema is reduced as evidenced by clear lung sounds
d. laboratory tests reveal serum elevations of K and glucose and a decrease in sodium
a. the patient appears alert and oriented
(R- confusion, irritability, disorientation, or depressioni s often present in pt with Addison’s dz, and a (+) response to therapy would be indicated by a return to alertness and orientation. Other indication of response to therapy would be a decreased urinary output, decreased serum potassium, and increased serum sodium and glucose. The pt with Addison’s would be very dehydrated and volume-depleted and would not have pulmonary edema.)
The most important nursing intervention during the medical and surgical treatment of the patient with a pheochromocytoma is
a. administering IV fluids
b. monitoring blood pressure
c. monitoring I&O and daily weights
d. administering B-adrenergic blocking agents
b. monitoring blood pressure38
(R- a pheochromocytoma is a catecholamine-producing tumor of the adrenal medulla, which may cause severe, episodic HTN; severe, pounding headache; and profuse sweating. Monitoring for dangerously high BP before surgery is critical, as is monitoring for BP fluctuation during medical and surgical tx.)
When caring for a patient with primary hyperaldosteronism, the nurse would question a physician’s order for the use of
a. Lasix
b. amiloride (midamor)
c. spironolactone (aldactone)
d. aminoglutethimide (cytadren)
a. Lasix37
(R- hyperaldosteronism is an excess of aldosterone, which is manifested by sodium and water retention and potassium excretion. Lasix is a potassium-wasting diuretic that would increase the potassium deficiency. Aminoglutethimide blocks aldosterone synthesis; amiloride is apotassium-sparing diuretic; and spironolactone blocks mineralocorticoid receptors in the kidney, increasing secretion of sodium and water and retention of potassium.)
1. A nurse assesses a client with hyperthyroidism who is prescribed lithium carbonate. Which assessment finding should alert the nurse to a side effect of this therapy?
a. Blurred and double vision
b. Increased thirst and urination
c. Profuse nausea and diarrhea
d. Decreased attention and insomnia

b. Increased thirst and urination

ANS: B
Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. This manifests with increased thirst and urination. Lithium has no effect on vision, gastric upset, or level of consciousness.

A nurse assesses a client who is recovering from a total thyroidectomy and notes the development of stridor. Which action should the nurse take first?
a. Reassure the client that the voice change is temporary.
b. Document the finding and assess the client hourly.
c. Place the client in high-Fowler’s position and apply oxygen.
d. Contact the provider and prepare for intubation.
d. Contact the provider and prepare for intubation.
ANS: D
Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. One emergency measure is to remove the surgical clips to relieve the pressure. This might be a physician function. The nurse should prepare to assist with emergency intubation or tracheostomy while notifying the provider or the Rapid Response Team. Stridor is an emergency situation; therefore, reassuring the client, documenting, and reassessing in an hour do not address the urgency of the situation. Oxygen should be applied, but this action will not keep the airway open
A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the second postoperative day the client states, “I feel numbness and tingling around my mouth.” What action should the nurse take?
a. Offer mouth care.
b. Loosen the dressing.
c. Assess for Chvostek’s sign.
d. Ask the client orientation questions

c. Assess for Chvostek’s sign.

ANS: C
Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which could progress to cause tetany and seizure activity. The nurse should assess the client further by testing for Chvostek’s sign and Trousseau’s sign. Then the nurse should notify the provider. Mouth care, loosening the dressing, and orientation questions do not provide important information to prevent complications of low calcium levels.

A nurse assesses a client on the medical-surgical unit. Which statement made by the client should alert the nurse to the possibility of hypothyroidism?
a. “My sister has thyroid problems.”
b. “I seem to feel the heat more than other people.”
c. “Food just doesn’t taste good without a lot of salt.”
d. “I am always tired, even with 12 hours of sleep.”
d. “I am always tired, even with 12 hours of sleep.”
ANS: D
Clients with hypothyroidism usually feel tired or weak despite getting many hours of sleep. Thyroid problems are not inherited. Heat intolerance is indicative of hyperthyroidism. Loss of taste is not a manifestation of hypothyroidism.
A nurse cares for a client who presents with bradycardia secondary to hypothyroidism. Which medication should the nurse anticipate being prescribed to the client?
a. Atropine sulfate
b. Levothyroxine sodium (Synthroid)
c. Propranolol (Inderal)
d. Epinephrine (Adrenalin)

b. Levothyroxine sodium (Synthroid)

ANS: B
The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine sodium. If the heart rate were so slow that it became an emergency, then atropine or epinephrine might be an option for short-term management. Propranolol is a beta blocker and would be contraindicated for a client with bradycardia

A nurse plans care for a client with hypothyroidism. Which priority problem should the nurse plan to address first for this client?
a. Heat intolerance
b. Body image problems
c. Depression and withdrawal
d. Obesity and water retention
ANS: C c. Depression and withdrawal
Hypothyroidism causes many problems in psychosocial functioning. Depression is the most common reason for seeking medical attention. Memory and attention span may be impaired. The client’s family may have great difficulty accepting and dealing with these changes. The client is often unmotivated to participate in self-care. Lapses in memory and attention require the nurse to ensure that the client’s environment is safe. Heat intolerance is seen in hyperthyroidism. Body image problems and weight issues do not take priority over mental status and safety.
A nurse assesses a client who is prescribed levothyroxine (Synthroid) for hypothyroidism. Which assessment finding should alert the nurse that the medication therapy is effective?
a. Thirst is recognized and fluid intake is appropriate.
b. Weight has been the same for 3 weeks.
c. Total white blood cell count is 6000 cells/mm3.
d. Heart rate is 70 beats/min and regular.
ANS: D
d. Heart rate is 70 beats/min and regular.Hypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and constipation. If a client’s heart rate is bradycardic while on thyroid hormone replacement, this is an indicator that the replacement may not be adequate. Conversely, a heart rate above 100 beats/min may indicate that the client is receiving too much of the thyroid hormone. Thirst, fluid intake, weight, and white blood cell count do not represent a therapeutic response to this medication.

A nurse cares for a client who has hypothyroidism as a result of Hashimoto’s thyroiditis. The client asks, “How long will I need to take this thyroid medication?” How should the nurse respond?
a. “You will need to take the thyroid medication until the goiter is completely gone.”
b. “Thyroiditis is cured with antibiotics. Then you won’t need thyroid medication.”
c. “You’ll need thyroid pills for life because your thyroid won’t start working again.”
d. “When blood tests indicate normal thyroid function, you can stop the medication.”
ANS: C
c. “You’ll need thyroid pills for life because your thyroid won’t start working again.”Hashimoto’s thyroiditis results in a permanent loss of thyroid function. The client will need lifelong thyroid replacement therapy. The client will not be able to stop taking the medication.

A nurse assesses clients for potential endocrine disorders. Which client is at greatest risk for hyperparathyroidism?
a. A 29-year-old female with pregnancy-induced hypertension
b. A 41-year-old male receiving dialysis for end-stage kidney disease
c. A 66-year-old female with moderate heart failure
d. A 72-year-old male who is prescribed home oxygen therapy

b. A 41-year-old male receiving dialysis for end-stage kidney disease

ANS: B
Clients who have chronic kidney disease do not completely activate vitamin D and poorly absorb calcium from the GI tract. They are chronically hypocalcemic, and this triggers overstimulation of the parathyroid glands. Pregnancy-induced hypertension, moderate heart failure, and home oxygen therapy do not place a client at higher risk for hyperparathyroidism.

A nurse plans care for a client with hyperparathyroidism. Which intervention should the nurse include in this client’s plan of care?
a. Ask the client to ambulate in the hallway twice a day.
b. Use a lift sheet to assist the client with position changes.
c. Provide the client with a soft-bristled toothbrush for oral care.
d. Instruct the unlicensed assistive personnel to strain the client’s urine for stones.
ANS: B
b. Use a lift sheet to assist the client with position changes.Hyperparathyroidism causes increased resorption of calcium from the bones, increasing the risk for pathologic fractures. Using a lift sheet when moving or positioning the client, instead of pulling on the client, reduces the risk of bone injury. Hyperparathyroidism can cause kidney stones, but not every client will need to have urine strained. The priority is preventing injury. Ambulating in the hall and using a soft toothbrush are not specific interventions for this client

A nurse cares for a client who is recovering from a parathyroidectomy. When taking the client’s blood pressure, the nurse notes that the client’s hand has gone into flexion contractions. Which laboratory result does the nurse correlate with this condition?
a. Serum potassium: 2.9 mEq/L
b. Serum magnesium: 1.7 mEq/L
c. Serum sodium: 122 mEq/L
d. Serum calcium: 6.9 mg/dL

d. Serum calcium: 6.9 mg/dL

ANS: D
Hypocalcemia destabilizes excitable membranes and can lead to muscle twitches, spasms, and tetany. This effect of hypocalcemia is enhanced in the presence of tissue hypoxia. The flexion contractions (Trousseau’s sign) that occur during blood pressure measurement are indicative of hypocalcemia, not the other electrolyte imbalances, which include hypokalemia, hyponatremia, and hypomagnesemia.

A nurse cares for a client newly diagnosed with Graves’ disease. The client’s mother asks, “I have diabetes mellitus. Am I responsible for my daughter’s disease?” How should the nurse respond?
a. “The fact that you have diabetes did not cause your daughter to have Graves’ disease. No connection is known between Graves’ disease and diabetes.”
b. “An association has been noted between Graves’ disease and diabetes, but the fact that you have diabetes did not cause your daughter to have Graves’ disease.”
c. “Graves’ disease is associated with autoimmune diseases such as rheumatoid arthritis, but not with a disease such as diabetes mellitus.”
d. “Unfortunately, Graves’ disease is associated with diabetes, and your diabetes could have led to your daughter having Graves’ disease.”

b. “An association has been noted between Graves’ disease and diabetes, but the fact that you have diabetes did not cause your daughter to have Graves’ disease.”

ANS: B
An association between autoimmune diseases such as rheumatoid arthritis and diabetes mellitus has been noted. The predisposition is probably polygenic, and the mother’s diabetes did not cause her daughter’s Graves’ disease. The other statements are inaccurate.

While assessing a client with Graves’ disease, the nurse notes that the client’s temperature has risen 1° F. Which action should the nurse take first?
a. Turn the lights down and shut the client’s door.
b. Call for an immediate electrocardiogram (ECG).
c. Calculate the client’s apical-radial pulse deficit.
d. Administer a dose of acetaminophen (Tylenol).

a. Turn the lights down and shut the client’s door.

ANS: A
A temperature increase of 1° F may indicate the development of thyroid storm, and the provider needs to be notified. But before notifying the provider, the nurse should take measures to reduce environmental stimuli that increase the risk of cardiac complications. The nurse can then call for an ECG. The apical-radial pulse deficit would not be necessary, and Tylenol is not needed because the temperature increase is due to thyroid activity.

After teaching a client who is recovering from a complete thyroidectomy, the nurse assesses the client’s understanding. Which statement made by the client indicates a need for additional instruction?
a. “I may need calcium replacement after surgery.”
b. “After surgery, I won’t need to take thyroid medication.”
c. “I’ll need to take thyroid hormones for the rest of my life.”
d. “I can receive pain medication if I feel that I need it.”

b. “After surgery, I won’t need to take thyroid medication.”

ANS: B
After the client undergoes a thyroidectomy, the client must be given thyroid replacement medication for life. He or she may also need calcium if the parathyroid is damaged during surgery, and can receive pain medication postoperatively.

A nurse plans care for a client who has hypothyroidism and is admitted for pneumonia. Which priority intervention should the nurse include in this client’s plan of care?
a. Monitor the client’s intravenous site every shift.
b. Administer acetaminophen (Tylenol) for fever.
c. Ensure that working suction equipment is in the room.
d. Assess the client’s vital signs every 4 hours.

c. Ensure that working suction equipment is in the room.

ANS: C
A client with hypothyroidism who develops another illness is at risk for myxedema coma. In this emergency situation, maintaining an airway is a priority. The nurse should ensure that suction equipment is available in the client’s room because it may be needed if myxedema coma develops. The other interventions are necessary for any client with pneumonia, but having suction available is a safety feature for this client.

MULTIPLE RESPONSE
1. A nurse evaluates the following laboratory results for a client who has hypoparathyroidism:
Calcium 7.2 mg/dL
Sodium 144 mEq/L
Magnesium 1.2 mEq/L
Potassium 5.7 mEq/L
Based on these results, which medications should the nurse anticipate administering? (Select all that apply.)
a. Oral potassium chloride
b. Intravenous calcium chloride
c. 3% normal saline IV solution
d. 50% magnesium sulfate
e. Oral calcitriol (Rocaltrol
b. Intravenous calcium chloride
d. 50% magnesium sulfateANS: B, D
The client has hypocalcemia (treated with calcium chloride) and hypomagnesemia (treated with magnesium sulfate). The potassium level is high, so replacement is not needed. The client’s sodium level is normal, so hypertonic IV solution is not needed. No information about a vitamin D deficiency is evident, so calcitriol is not needed.

A nurse cares for a client with elevated triiodothyronine and thyroxine, and normal thyroid-stimulating hormone levels. Which actions should the nurse take? (Select all that apply.)
a. Administer levothyroxine (Synthroid).
b. Administer propranolol (Inderal).
c. Monitor the apical pulse.
d. Assess for Trousseau’s sign.
e. Initiate telemetry monitoring.
c. Monitor the apical pulse
d. Initiate telemetry monitoringANS: C, E
The client’s laboratory findings suggest that the client is experiencing hyperthyroidism. The increased metabolic rate can cause an increase in the client’s heart rate, and the client should be monitored for the development of dysrhythmias. Placing the client on a telemetry monitor might also be a precaution. Levothyroxine is given for hypothyroidism. Propranolol is a beta blocker often used to lower sympathetic nervous system activity in hyperthyroidism. Trousseau’s sign is a test for hypocalcemia

A nurse teaches a client with hyperthyroidism. Which dietary modifications should the nurse include in this client’s teaching? (Select all that apply.)
a. Increased carbohydrates
b. Decreased fats
c. Increased calorie intake
d. Supplemental vitamins
e. Increased proteins
a. Increased carbohydrates
c. Increased calorie intake
e. Increased proteinsANS: A, C, E
The client is hypermetabolic and has an increased need for carbohydrates, calories, and proteins. Proteins are especially important because the client is at risk for a negative nitrogen balance. There is no need to decrease fat intake or take supplemental vitamins.

A nurse assesses a client with hypothyroidism who is admitted with acute appendicitis. The nurse notes that the client’s level of consciousness has decreased. Which actions should the nurse take? (Select all that apply.)
a. Infuse intravenous fluids.
b. Cover the client with warm blankets.
c. Monitor blood pressure every 4 hours.
d. Maintain a patent airway.
e. Administer oral glucose as prescribed.
a. Infuse intravenous fluids.
b. Cover the client with warm blankets.
d. Maintain a patent airway.ANS: A, B, D
A client with hypothyroidism and an acute illness is at risk for myxedema coma. A decrease in level of consciousness is a symptom of myxedema. The nurse should infuse IV fluids, cover the client with warm blankets, monitor blood pressure every hour, maintain a patent airway, and administer glucose intravenously as prescribed.

A nurse teaches a client who is prescribed an unsealed radioactive isotope. Which statements should the nurse include in this client’s education? (Select all that apply.)
a. “Do not share utensils, plates, and cups with anyone else.”
b. “You can play with your grandchildren for 1 hour each day.”
c. “Eat foods high in vitamins such as apples, pears, and oranges.”
d. “Wash your clothing separate from others in the household.”
e. “Take a laxative 2 days after therapy to excrete the radiation.”
ANS: A, D, E
A client who is prescribed an unsealed radioactive isotope should be taught to not share utensils, plates, and cups with anyone else; to avoid contact with pregnant women and children; to avoid eating foods with cores or bones, which will leave contaminated remnants; to wash clothing separate from others in the household and run an empty cycle before washing other people’s clothing; and to take a laxative on days 2 and 3 after receiving treatment to help excrete the contaminated stool faster.

The nurse caring for a patient who recently underwent removal of a pituitary adenoma via the transphenoidal approach knows that which of the following routine post-operative interventions will be contraindicated for this patient:

A.Turn every 2 hours
B.Cough and deep breath
C.Ambulation
D.HOB 30 degrees

Answer: B

The nurse caring for a patient who recently underwent removal of a pituitary adenoma via the transphenoidal approach knows that a common complication with this surgery is a headache. In order to prevent this complication the nurse will:

A.Provide pain medication routinely
B.Keep the patient in the supine position
C.Assess VS every 2 hours
D.Keep the patient’s HOB at 30 degrees

Answer. D

The nurse caring for a patient admitted with an ADH secreting lung cancer would anticipate which lab finding:

A. Serum sodium 150
B. Serum osmolality elevated
C. Urine specific gravity 1.002
D. Serum sodium 125

D

Common nonspecific manifestations that may alert the nurse to endocrine dysfunction include:

A. Goiter and alopecia
B. Exophthalmos and tremors
C. Weight loss, fatigue, depression
D. Polyuria, polydipsia, and polyphagia

C

A patient with diabetes insipidus is treated with 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 (1.003-1.030)
D. Oral intake greater than urinary output

Answer: C

The nurse caring for a patient admitted with SIADH can anticipate which of the following physician orders:

A.0.45% NS at 100 ml/hr
B.D5W at 100 ml/hr
C.Fluid restriction of 1000 ml/day
D.DDAVP IVP

Answer: C

A nurse is caring for a patient after hypophysectomy. The nurse notices clear nasal drainage from the patient’s nostril. The initial nursing action would be to:

A. Lower the head of the bed
B. Test the drainage for glucose
C. Obtain a culture of the drainage
D. Continue to observe the drainage

Answer: B

When obtaining subjective data from a patient during assessment of the endocrine system, the nurse asks specifically about:

A. Energy level
B. Intake of vitamin C
C. Employment history
D. Frequency of sexual intercourse

Answer: A

A potential adverse effect of palpating the thyroid gland is:

A. Carotid artery obstruction
B. Damage to the cricoid cartilage
C. Release of excessive thyroid hormone
D. Hoarseness from pressure on the laryngeal nerve

Answer: C

The normal response to increased serum osmolality is the release of:

A. Aldosterone from the adrenal cortex, which stimulates
sodium excretion by the kidney.
B. ADH from the posterior pituitary gland, which stimulates the kidney to reabsorb water.
C. Mineralocorticoids from the adrenal gland, which stimulates
the kidney to excrete potassium.
D. Calcitonin from the thyroid gland, which increases bone
resorption and decreases serum calcium levels.

Answer: B

Following a hypophysectomy for acromegaly, postoperative nursing care should focus on:

A. Frequent monitoring of serum and urine osmolarity
B. Parenteral administration of a GH-receptor antagonist
C. Keeping the patient in a recumbent position at all times
D. Patient education regarding the need for lifelong ACTH, TSH,
FSH, LH hormone replacement

A
The health care provider prescribes Levothyroxine for a patient with
hypothyroidism. Following teaching regarding this medication, the nurse determines that further teaching is needed when the patient says:A. “I can expect the medication dose may need to be increased”
B. “I can expect to return to normal function with the use of this drug”
C. “I will only need to take this medication until my symptoms are
improved”
D. I will report any chest pain or difficulty breathing to the doctor
right away”

Answer: C

Following 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. Laryngeal stridor and tingling in the hands and feet

Answer: D

Manifestations of endocrine problems in the older adult that are commonly attributed to the aging process are: (Select all that apply)

A. tremors
B. fatigue
C. fluid retention
D. mental impairment

Answer: B and D

The nurse is caring for a patient with Grave’s disease and assessment reveals exophthalmos. Which of the following interventions are indicated to prevent injury to the eye: (Select all that apply)

A. Elevate HOB
B. Apply eye patches during sleep
C. Have patient blink frequently
D. Lubricating eyedrops

A and D

Important Nursing interventions when caring for a patient with Cushing syndrome include (select all that apply)

A. restricting protein intake.
B. monitoring blood glucose levels.
C. administering medication in equal doses.
D. protecting patient from exposure to infection.

B and D

The nurse teaches the patient that the best time to take corticosteroids for replacement purposes is

A. once a day at bedtime.
B. every other day on awakening.
C. on arising and in the late afternoon.
D. at consistent intervals every 6-8 hours.

C
While a client with myxedema is being admitted to the hospital, the client reports having experienced a lack of energy, cold intolerance, and puffiness around the eyes and face. The nurse plans care knowing that these clinical manifestations are caused by a lack of production of which hormones?
a.ACTH
b. T3 and T4
c.prolactin
d.LH

b. T3 and T4

rationale:

Although all of these hormones originate from the anterior pituitary, only T3 and T4 are associated with the client’s symptoms. Myxedema results from inadequate thyroid hormone levels (T3 and T4). Low levels of thyroid hormone result in an overall decrease in the basal metabolic rate, affecting virtually every body system and leading to weakness, fatigue, and a decrease in heat production. A decrease in LH results in the loss of secondary sex characteristics. A decrease in ACTH is seen in Addison’s disease. PRL stimulates breast milk production by the mammary glands, and GH affects bone and soft tissue by promoting growth through protein anabolism and lipolysis.

A client is admitted to the hospital with a suspected diagnosis of Graves’ disease. On assessment, which manifestation related to the client’s menstrual cycle should the nurse expect the client to most likely report?
a.Amenorrhea
Rationale:Amenorrhea or a decreased menstrual flow is common in the client with Graves’ disease.

The nurse is caring for a client with a diagnosis of Cushing’s syndrome. The nurse should plan which of these measures to prevent complications from this medical condition?
a. monitoring glucose levels
b.encouraging jogging
c.monitoring epinephrine levels
d.encouraging visits from friends
a. Monitoring glucose levels
Rationale: Cushing’s syndrome is a metabolic disorder resulting from the chronic and excessive production of cortisol by the adrenal cortex or the administration of glucocorticoids in large doses for several weeks or longer. In the client with Cushing’s syndrome, increased levels of glucocorticoids can result in hyperglycemia and signs and symptoms of diabetes mellitus. Clients experience activity intolerance related to muscle weakness and fatigue; therefore, option 2 is incorrect. Epinephrine levels are not affected. Visitors should be limited because of the client’s impaired immune response.
A client is admitted to the hospital with a diagnosis of Cushing’s syndrome. The nurse monitors the client for which problem that is likely to occur with this diagnosis?
a.hpovolemia
b.hypoglycemia
c.Mood disturbances
d.deficient fluid volume

c.) Mood disturbances

Rationale:
Cushing’s syndrome is a metabolic disorder resulting from the chronic and excessive production of cortisol. When Cushing’s syndrome develops, the normal function of the glucocorticoids becomes exaggerated and the classic picture of the syndrome emerges. This exaggerated physiological action can cause mood disturbances, including memory loss, poor concentration and cognition, euphoria, and depression. It can also cause persistent hyperglycemia along with sodium and water retention (hypernatremia), producing edema (hypervolemia; fluid volume excess) and hypertension.

The nurse is caring for a client scheduled for a bilateral adrenalectomy for treatment of an adrenal tumor that is producing excessive aldosterone (primary hyperaldosteronism). What should the nurse tell the client about the surgery?
a.)”You will need to wear an abdominal binder after surgery.”b.)”You will most likely need to undergo chemotherapy after surgery.”

c.)”You will not require any special long-term treatment after surgery.”

d.)”You will need to take hormone replacements for the rest of your life.”

Answer: D.

Rationale:
The major cause of primary hyperaldosteronism is an aldosterone-secreting tumor called an aldosteronoma. Surgery is the treatment of choice. Clients undergoing a bilateral adrenalectomy require permanent replacement of adrenal hormones. Options 1, 2, and 3 are inaccurate.

The nurse is admitting a client with a diagnosis of hypothyroidism to the hospital. What action should the nurse perform to obtain data related to this diagnosis?
a.) Inspect facial feautures
b.) ascultate lung sounds
3.) percuss the thyroid gland
d.) asess the pts ability to ambulate
Answer: a.) inspect facial features
Rationale:
Inspection of facial features will reveal the characteristic coarse features, presence of edema around the eyes and face, and the blank expression that are characteristic of hypothyroidism. The assessment techniques in options 2, 3, and 4 will not reveal information related to the diagnosis of hypothyroidism.
The nurse is developing a discharge plan for a postoperative client who had one adrenal gland removed. What should the nurse include in the plan?
a.)Teaching client to maintain a diabetic diest
b.)teaching client proper application of an ostomy pouch
c.)Providing a list of the early signs of a wound infection
d.)Explaining the need for lifelong replacement therapy
Answer: C
A client who had a unilateral adrenalectomy will be placed on corticosteroids temporarily to avoid a cortisol deficiency; lifelong replacement is not necessary. Corticosteroids will be gradually weaned in the postoperative period until they are discontinued. Also, because of the anti-inflammatory properties of corticosteroids produced by the adrenals, clients who undergo an adrenalectomy are at increased risk of developing wound infections. Because of this increased risk of infection, it is important for the client to know measures to prevent infection, early signs of infection, and what to do if an infection seems to be present. The client does not need to maintain a diabetic diet, and the client will not have an ostomy after this surgery.
The nurse develops a postoperative plan of care for a client scheduled for hypophysectomy. Which interventions should be included in the plan of care? SELECT ALL THAT APPLY
a.) Obtain daily weights
b.) Monitor I&O’s
c.) Elevate the head of the bed
d.)) Use a soft toothbrush
e.) Encourage coughing and deep breathing

a.,b., c.

Rationale:
A hypophysectomy is done to remove a pituitary tumor. Because temporary diabetes insipidus or syndrome of inappropriate antidiuretic hormone can develop after this surgery, obtaining daily weights and monitoring intake and output are important interventions. The head of the bed is elevated to assist in preventing increased intracranial pressure. Toothbrushing, sneezing, coughing, nose blowing, and bending are activities that should be avoided postoperatively in the client who underwent a hypophysectomy because of the risk of increasing intracranial pressure. These activities interfere with the healing of the incision and can disrupt the graft.

A client is diagnosed with hypothyroidism. The nurse performs an assessment on the client, expecting to note which findings? Select all that apply.
a.)weight loss
b.bradycardia
c. hypotension
d. dry, scaly skin
e.Heat tolerance
f. Decreased body temperature
B,C,D,F
Rationale:
The manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormones. Some of these manifestations are bradycardia; hypotension; cool, dry, scaly skin; decreased body temperature; dry, coarse, brittle hair; decreased hair growth; cold intolerance; slowing of intellectual functioning; lethargy; weight gain; and constipation.
A client undergoes a subtotal thyroidectomy. The nurse ensures that which priority item is at the client’s bedside upon arrival from the operating room?
a. an apnea monitor
b. a suction unit and oxygen
c. a blood transfusion warmer
d. An ampule of phytonadione (Vitamin K)
B
Rationale:
After thyroidectomy, respiratory distress can occur from tetany, tissue swelling, or hemorrhage. It is important to have oxygen and suction equipment readily available and in working order if such an emergency were to arise. Apnea is not a problem associated with thyroidectomy, unless the client experienced respiratory arrest. Blood transfusions can be administered without a warmer, if necessary. Vitamin K would not be administered for a client who is hemorrhaging, unless deficiencies in clotting factors warrant its administration.
The nurse is preparing the bedside for a postoperative parathyroidectomy client who is expected to return to the nursing unit from the recovery room in 1 hour. The nurse should ensure that which specific item is at the client’s bedside?
a. cardiac monitor
b. Tracheotomy set
c. Intermittent gastric suction
d. Underwater seal chest drainage system
B
Rationale:
Respiratory distress caused by hemorrhage and swelling and compression of the trachea is a primary concern for the nurse managing the care of a postoperative parathyroidectomy client. An emergency tracheotomy set is always routinely placed at the bedside of the client with this type of surgery, in anticipation of this potential complication. Although a cardiac monitor may be attached to the client in the postoperative period, it is not specific to this type of surgery. Options 3 and 4 also are not specifically needed with the surgical procedure.Level of Cognitive Ability: Applying
Client Needs: Safe and Effective Care Environment
Integrated Process: Nursing Process: Planning
Content Area: Adult Health: Endocrine
Strategy(ies): Subject
Priority Concepts: Clinical Judgment, Safety

The nurse provides home care instructions to a client with Cushing’s syndrome. The nurse determines that the client understands the hospital discharge instructions if the client makes which statement?
a. “I need to eat foods low in potassium”
b. “I need to check the color of my stool”
c.” I need to check the temperature of my legs twice a day”
d. “I need to take Aspirin rather than Tylenol for a HA”
B
Cushing’s syndrome results in an increased secretion of cortisol. Cortisol stimulates the secretion of gastric acid, and this can result in the development of peptic ulcers and gastrointestinal bleeding. The client should be encouraged to eat potassium-rich foods to correct the hypokalemia that occurs with this disorder. Cushing’s syndrome does not affect temperature changes in the lower extremities. Aspirin can increase the risk for gastric bleeding and skin bruising.
The nurse is caring for a client who is scheduled to have a thyroidectomy and provides instructions to the client about the surgical procedure. Which statement by the client would indicate an understanding of the nurse’s instructions?
a. “I will have to take antithyroid medication after this surgery”
b. “I need to put my hands behind my neck when I have to cough or change postions”
c. I need to turn my head and neck front, back and side to side every hour for 12 hrs after surgery”
d. “I will immediately report to the emergency room if I experience tingling of the toes, fingers, and lips after surgery.
Answer: B
Rationale:
The client is taught that following thyroidectomy tension needs to be avoided on the suture line because hemorrhage may develop. One way of reducing incisional tension is to teach the client how to support the neck when coughing or being repositioned. Likewise, during the postoperative period, the client should avoid any unnecessary movement of the neck; that is why sandbags and pillows are frequently used to support the head and neck. The removal of the thyroid does not mean that the client will be taking antithyroid medications postoperatively. If a client experiences tingling in the fingers, toes, and lips, it is probably a result of injury to the parathyroid gland during surgery, resulting in hypocalcemia. These signs and symptoms need to be reported immediately.
A client with the diagnosis of hyperparathyroidism says to the nurse, “I can’t stay on this diet. It is too difficult for me.” How should the nurse best respond when intervening in this situation?
a. “why do you thing you are having a difficult time with this diet?”
b. “It really isn’t difficult to stick to this diet. Just avoid milk prodcts”
c. “You are having a difficult time staying on this plan. Let’s discuss this”
d. “It is very important that you stay on this diet to avoid forming renal calculi”
Answer: C.
Rationale:
By paraphrasing the client’s statement, the nurse can encourage the client to verbalize emotions. The nurse also sends feedback to the client that the message was understood. An open-ended statement or question such as this prompts a thorough response from the client. Option 1 requests information that the client may not be able to express. Option 2 devalues the client’s feelings. Option 4 gives advice, which blocks communication.
Priority Nursing Tip:
After the nurse determines the cause of a client’s difficulty in adhering to a prescribed diet, the nurse can develop a plan of care and refer the client to appropriate community support programs, such as nutritional programs.
Which glands are part of the endocrine system? (SATA)
a. Thyroid
b. Occipital
c. Parathyroid
d. Adrenal
e. Pituitary
Acde
What is the name of the substance secreted by the endocrine glands?
a. Vasoactive amines
b. Chemotaxins
c. Hormones
d. Cytotoxins
c
Which mechanism is used to transport the substance produced by the endocrine glands to their target tissue?
a. Lymph system
b. Bloodstream
c. Direct seeding
d. Gastrointestinal system
b
Which hormones are secreted by the posterior pituitary gland? (SATA)
a. Testosterone
b. Oxytocin
c. Growth hormone (GH)
d. Antidiuretic hormone (ADH)
e Cortisol
Bd
Which hormones are secreted by the thyroid gland? (SATA)
a Calcitonin
b. Somatostatin
c. Glucagon
d. Thyroxine (T₄)
e Aldosterone
f. Triiodothyronine (T₃)
adf
A patient has a low serum cortisol level. Which hormone would the nurse expect to be secreted to correct this?
a. Thyroid-stimulating hormone (TSH)
b. Adrenocorticotropic hormone
c. Parathyroid hormone
d. Antidiuretic hormone
b
The target tissue for ADH is which organ?
a. Hypothalamus
b. Thyroid
c. Ovary
d. Kidney
d
Which statements about hormones and the endocrine system are accurate? (SATA)
a. There are specific normal blood levels of each hormone.
b. Hormones exert their effects on specific target issues.
c. Each hormone can bind with multiple receptor sites.
d. The endocrine system works independently to regulate homeostasis
e. More than one hormone can be stimulated before the target tissue is affected.
abe
The binding of a hormone to a specific receptor site is an example of which endocrine process?
a. “Lock and key” manner
b. Negative feedback mechanism
c. Neuroendocrine regulation
d. “fight-or-flight” response.
a
What are tropic hormones?
a. Hormones that trigger female and male sex characteristics
b. Hormones that have a direct effect on final target tissues
c. Hormones produced by the anterior pituitary gland that stimulate other endocrine glands.
d. Hormones that are synthesized in the hypothalamus and stored in the posterior pituitary gland.
c
Which hormone is directly suppressed when circulating levels of cortisol are above normal?
a. Corticotropin-releasing hormone (CRH)
b. ADH
c. Adrenocorticotropic hormone (ACTH)
d. Growth hormone-releasing hormone (GH-RH)
a
The maintenance of internal body temperature at approximately 98.6 F ( 37 C) is an example of which endocrine process?
a. “Lock and key” manner
b. Neuroendocrine regulation
c. Positive feedback mechanism
d. Stimulus-response theory
b
Which statements about the pituitary glands are correct? (SATA)
a. The main role of the anterior pituitary is to secrete tropic hormones.
b. The posterior pituitary gland stores hormones produced by the hypothalamus
c. The anterior pituitary is connected to the thalamus gland.
d The anterior pituitary releases stored hormones produced by the hypothalamus.
e. The anterior pituitary gland secretes gonadotropins
abe
The anterior pituitary gland secretes tropic hormones in response to which hormones from the hypothalamus?
a. Releasing hormones
b. Target tissue hormones
c. Growth hormones
d. Demand hormones
a
Which statement about pituitary hormones is correct?
a. ACTH acts on the adrenal medulla
b. Follicle-stimulating hormone (FSH) stimulates sperm production in men.
c. Growth hormone promotes protein catabolism
d. Vasopressin decreases systolic blood pressure.
b
Which statement about the gonads is correct?
a. Gonads are reproductive glands found in males only.
b. The function of the hormones begins at birth in low, undetectable levels.
c. The placenta secretes testosterone for the development of male external genitalia
d. External genitalia maturation is stimulated by gonadotropins during puberty
d
Which statements about the adrenal glands are correct? (SATA)
a. The cortex secretes androgens in men and women.
b. Catecholamines are secreted from the cortex.
c. Glucocorticoids are secreted by the medulla
d .The medulla secretes hormones essential for life
e. The cortex secretes aldosterone that maintains extracellular fluid volume.
ae
Which is the major function of the hormones produced by the adrenal cortex?
a. “Fight-or-flight” response
b. Control of potassium, sodium, and water
c. Regulation of cell growth
d. Calcium and stress regulation
b
Which statements about the hormone cortisol being secreted by the adrenal cortex are accurate? (SATA)
a. Cortisol peaks occur late in the day, with lowest points 12 hours after each peak.
b. Cortisol has an effect on the body’s immune function.
c. Stress causes an increase in the production of cortisol
d. Blood levels of cortisol have no effect on its secretion.
e. Cortisol affects carbohydrate, protein, and fat metabolism
bce
Which assessment findings does the nurse monitor in response to catecholamines released by the adrenal medulla? (SATA)
a. Increased heart rate related to vasoconstriction
b. Increased blood pressure related to vasoconstriction
c. Increased perspiration
d. constriction of pupils
e. Increased blood glucose in response to glycogenolysis
abce
Which statements about the thyroid gland and its hormones are correct? (SATA)
a. The gland is located in the posterior neck below the cricoid cartilage.
b. The gland has two lobes joined by a thin tissue called the isthmus
c. T₄ and T₃ are to thyroid hormones
d. Thyroid hormones increase red blood cell production
e. Thyroid hormone production depends on dietary intake of iodine and potassium
bcd
Which hormone responds to a low serum calcium blood level by increasing bone resorption?
a. Parathyroid hormone (PTH)
b. T₄
c. T₃
d. Calcitonin
a
Which hormone responds to elevated serum calcium blood level by decreasing bone resorption?
a. PTH
b. T₄
c. T₃
d. Calcitonin
d
Which statements about T₃ and T₄ hormones are correct? (SATA)
a. The basal metabolic rate is affected
b. Hypothalamus is stimulated by cold and stress to secrete thyrotropin-releasing hormone (TRH)
c. These hormones need intake or protein and iodine for production
d. Circulating hormone in the blood directly affects the production of TSH
e. T₃ and T₄ increase oxygen use in tissues
abce
Which are the target organs of PTH in the regulation of calcium and phosphorus? (SATA)
a. Stomach
b. Kidney
c. Bone
d. Gastrointestinal tract
e. Thyroid gland
bcd
Which endocrine tissues are most commonly found to have reduced function as a result of aging? (SATA)
a. Hypothalamus
b. Ovaries
c. Testes
d. Pancreas
e. Thyroid gland
bcde
Which statement about age-related changes in older adults and the endocrine system is true?
a. All hormone levels are elevated
b. Thyroid hormone levels decrease
c. Adrenal glands enlarge
d. They thyroid gland enlarges
b
In the older adult female, which physiologic changes occur as a result of decreased function?
a. Decreased bone density, decreased production of estrogen
b. Decreased sensitivity fo peripheral tissues to the effects of insulin
c. Decreased urine-concentrating ability of the kidneys
d. Decreased metabolic rate
a
An older adult reports a lack of energy and not being able to do the usual daily activities without several naps during the day. Which problem may these symptoms indicate that is often seen in the older adult?
a. Hypothyroidism
b. Hyperparathyroidism
c. Overproduction of cortisol
d. underproduction of glucagon
a
The nurse is performing a physical assessment of a patient’s endocrine system. Which gland can be palpated?
a. Pancrase
b. Thyroid
c. Adrenal glands
d. Parathyroids
b
Which statement about performing a physical assessment of the thyroid gland is correct?
a The thyroid gland is easily palpated in all patients
b. The patient is instructed to swallow sips of water to aid palpation
c. The anterior approach is preferred fro thyroid palpation
d. The thumbs are used to palpate the thyroid lobes
b
Which are diagnostic methods to measure patient hormone levels? (SATA)
a. Stimulation testing
b. Suppression testing
c. 24-hour urine testing
d. Chromatographic assay
e. Needle biopsy
abcd
What is the correct nursing action before beginning a 24-hour urine collection for endocrine studies?
a. Place each voided specimen in a separate collection container
b. Check whether any preservatives are needed in the collection container
c. Start the collection with the first voided urine
d. Weigh the patient before beginning the collection
b
Which instructions are included when teaching a patient about urine collection for endocrine studies? (SATA)
a. Fast before starting the urine collection
b. Measure the urine in mL rather than ounces
c. Empty the bladder completely, and then start timing
d. Time the test for exactly the instructed number of hours
e. Avoid taking any unnecessary drugs during endocrine testing
f. Empty the bladder at the end of the time period and keep that specimen
cdef
Which are the types of radiographic test that may be used for an endocrine assessment? (SATA)
a. Ultrasonography
b. Skull x-ray
c. Chest x-ray
d. MRI
e. CT
abde
A patient is suspected of having a pituitary tumor. Which radiographic test aids in determining this diagnosis?
a. Skull x-rays
b. MRI/CT
c. Angiography
d. Ultrasound
b
After an ultrasound of the thyroid gland, which diagnostic test determines the need for surgical intervention for thyroid nodules?
a. CT scan
b. MRI
c. Angiography
d. Needle biopsy
d
A patient is at risk for falling related to the effect of pathologic fractures as a result of bone demineralization. Which endocrine problem is this pertinent to?
a. Underproduction of PTH
b. Overproduction of PTH
c. Underproduction of thyroid hormone
d. Overproduction of thyroid hormone
b
Problems in the hypothalamus that change the function of the anterior pituitary gland result in which condition?
A. adenohypophysis
b. Panhypopituitarism
c. Primary pituitary dysfunction
d. Secondary pituitary dysfunction
d
A malfunctioning posterior pituitary gland can result in which disorders? (SATA)
a. hypothyroidism
b. Altered sexual function
c. DI
d. Growth retardation
e. SIADH
ce
A malfunctioning anterior pituitary gland can result in which disorders? (SATA)
a. Pituitary hypofunction
b. Pituitary hyperfunction
c. DI d. Hypothyroidism
e. Osteoporosis
abde
The assessment findings of a male patient with anterior pituitary tumor include reports of change sin secondary sex characteristics, such as episode of impotence and decreased libido. the nurse explains to the patient that these findings are a result of overproduction of which hormone?
a. Gonadotropins inhibiting prolactin (PRL)
b. Thyroid hormone inhibits PRL
PRL inhibiting secretion fo gonadotropins
d. Steroids inhibiting production of sex hormones
c
A patient with a PRL-secreting tumor is likely to be treated with which medication?
A. dopamine agonists
b. vasopressin
c. steroids
d. Growth hormone
a
A patient is prescribed bromocriptine mesylate (Parlodel) Which information does the nurse teach the patient? (SATA) a. Get up slowly from a lying position
b. Take medication on an empty stomach
c. Take daily for purposes of raising GH levels to reduce symptoms of acromegaly.
D. Begin therapy with a maintenance level dose.
E. Report watery nasal discharge to the health care provider immediately
ae
Patients diagnosed with an anterior pituitary tumor can have symptoms of acromegaly or gigantism. These symptoms are a result of overproduction of which hormone?
A. ACTH
b. PRL
c. Gonadotropins
d. GH
d
The nurse is performing an assessment of an adult patient with new-onset acromegaly. What does the nurse expect to find?
A. Extremely long arms and legs
b. Thickened lips
c. Changes in menses with infertility
d. Rough, extremely dry skin
b
When analyzing laboratory values, the nurse expects to find which value as a direct result of overproduction of GH?
A. Hyperglycemia
b. Hyperphosphatemia
c. Hypocalcemia
d. Hypercalcemia
a
In caring for a patient with Hyperpituitarism, which symptoms does the nurse expect the patient to report? (SATA)
a. Join pain
b. Visual disturbances
c. Changes in menstruation
d. Increased libido
e. Headache
f. Fatigue
abcef
A deficiency of which anterior pituitary hormones is considered life-threatening? (SATA)
a. GH
b. Melanocyte-stimulating hormone (MSH)
c. PRL
d. Thyroid-stimulating hormone (TSH)
e. ACTH
de
Which statements about the etiology of hypopituitarism are correct? (SATA)
a. Dysfunction can result from radiation treatment to the head or brain
b. Dysfunction can result from infection or brain tumor.
C. infarction following systemic shock can result in hypopituitarism
d. Severe malnutriotn and body fat depletion can depress pituitary gland function
e. there is always an underlying cause of hypopituitarism
abcd
Which statement about hormone replacement therapy for hypopituitarism is correct?
A. Once manifestations of hypofunction are corrected, treatment is no longer needed
b. The most effective route of androgen replacement is the oral route
c. Testosterone replacement therapy is contraindicated in men with prostate cancer
d. Clomiphene citrate (Clomid) is used to suppress ovulation in women
c
A female patient has been prescribed hormone replacement therapy. What does the nurse instruct the patient to do regarding this therapy?
A. Report any recurrence of symptoms, such as decreased libido, between injections
b. Monitor blood pressure at least weekly for potential hypotension
c. Treat leg pain, especially in the valve, with gentle muscle stretching
d. Take measures to reduce risk for hypertension and thrombosis
d
A patient requires 100 g of oral glucose for suppression testing and GH levels are measured serially for 120 minutes. The results of the suppression testing are abnormal. The nurse assesses for the signs and symptoms of which endocrine disorder?
A. adrenal insufficiency
b. DI
c. Hyperpituitarism
d. Hypothyroidism
c
A patient is recovering from a Transsphenoidal hypophysectomy. What postoperative nursing interventions apply to this patient? (SATA)
a. Encouraging the patient to perform deep-breathing exercises.
B. Vigorous coughing and deep-breathing exercises
c. Instruction on the use of a soft-bristled toothbrush for brushing the teeth
d. Strict monitor of fluid balance
e. Hourly neurologic checks for first 24 hours
f. Instructing the patient to alert the nurse regarding postnasal drip
adef
Following a hypophysectomy, the patient requires instruction on hormone replacement for which hormones? (SATA)
a. Cortisol
b. Thyroid
c. Gonadal
d. Vasopressin
e. PRL
abcd
After a hypophysectomy, home care monitoring by the nurse includes assessing which factors? (SATA)
a. hypoglycemia
b. Bowel habits
c. Possible leakage of CSF.
D. 24-hour intake of fluids and urine output
e. 24-hour diet recall f. activity level
bcdef
Postoperative care for a patient who has had a Transsphenoidal hypophysectomy includes which intervention?
A. Encouraging coughing and deep-breathing to decrease pulmonary complications
b. Testing nasal drainage for glucose to determine whether it contains CSF
c. Keeping the bed flat to decrease central CSF leakage
d. Assisting the patient with brushing the teeth to reduce risk of infection
b
While caring for a postoperative patient following a Transsphenoidal hypophysectomy, the nurse observes nasal drainage that is clear with yellow color at the edge. This “halo sign” is indicative of which condition?
A. Worsening neurologic status of the patient
b. Drainage of CSF from the patient nose
c. Onset of postoperative infection
d. An expected finding following this surgery
b
A patient with a hypophysectomy can postoperatively experience transient DI. Which manifestation alerts the nurse to this problem?
A. Output much greater than intake
b. Change in mental status indicating confusion
c. Laboratory results indicating hyponatremia
d. Nonpitting edema
a
The action of ADH influences normal kidney function by stimulating which mechanism?
A. Glomerulus to control the filtration rate
b. Proximal nephron tubules to reabsorb water
c. Distal nephron tubules and collecting ducts to reabsorb water
d. Constriction of glomerular capillaries to prevent loss of protein in urine
c
What is the disorder that results from a deficiency of ADH form the posterior pituitary gland called?
A. SIADH
b. DI
c. Cushing’s syndrome
d. Addison’s disease
b
Which statements about DI are accurate? (SATA)
a. It is caused by ADH deficiency
b. It is characterized by a decrease in urination
c. Urine output of greater than 4/24 hours is the first diagnostic indication
d. The water loss increases plasma osmolarity
e. Nephrogenic DI can be caused by lithium (Eskalith)
acd
What does the nurse instruct patients with permanent DI to do? (SATA)
a. Continue vasopressin therapy until symptoms disappear
b. Monitor for recurrence of polydipsia and polyuria
c. Monitor and record weight daily
d. Check urine specific gravity three times a week
e. Wear a medical alert bracelet
bce
A hospitalized patient is prescribed desmopressin acetate metered dose spray as a replacement hormone for ADH. Which is an indication for another does? (SATA)
a. Excessive urination
b. Specific gravity of 1.003
c. Dark, concentrated urine
d. Edema in the legs
e. Decreased urination
ab
The nurse is caring for a patient with DI. What is the priority goal of collaborative care?
A. Correct the water metabolism problem
b. Control blood sugar and blood pH
c. Measure urine output, specific gravity, and osmolality hourly
d. Monitor closely for respiratory distress
a
Which medication is used to treat DI?
A. Desmopressin acetate (DDAVP)
b. Lithium (Eskalith)
c. Vasopressin (Pitressin)
d. Demeclocycline (Declomycin)
a
Which patient’s history puts him or her at risk for developing SIADH?
A. 27-year-old patient on high-dose steroids
b. 47-year-old hospitalized adult patient with acute renal failure
c. 58-year-old with metastatic lung or breast cancer
d. Older adult with history of a stroke within the last year
c
Which statement about eh pathophysiology of SIADH is correct?
A. ADH secretion is inhibited in the presence follow plasma osmolality
b. Water retention results in dilutional hyponatremia nd expanded extracellular fluid (ECF) volume
c. The glomerulus is unable to increase its filtration rate to reduce the excess plasma volume
d Renin and aldosterone are released and help decrease the loss of urinary sodium
b
The effect of increased ADH in the blood results in which effect on the kidney?
A. Urine concentration tends to decrease
b. Glomerular filtration tends to decrease
c. Tubular reabsorption of water increased
d. Tubular reabsorption of sodium increases
c
In SIADH, as a result of water retention from excess ADH, which laboratory value does the nurse expect to find? (SATA)
a. Increased sodium in urine
b. Elevated serum sodium level
c. Increased specific gravity (concentrated urine)
d. Decreased serum osmolarity
e. Decreased urine specific gravity
acd
Which nursing intervention is the priority for a patient with SIADH?
A. Restrict fluid intake
b. Monitor neurologic status at least every 2 hours
c. Offer ice chips frequently to ease discomfort of dry mouth
d. Monitor urine tests for decreased sodium levels and low specific gravity
a
Which type of IV fluid does the nurse use to treat a patient with SIADH when the serum sodium level is very low?
A D51/2 normal saline
b. D5w
c. 3% normal saline
d. Normal saline
c
In addition to IV fluids, a patient with SIADH is on a fluid restriction as low as 500 to 600 mL/24 hours. Which serum and urine results demonstrate effectiveness of this treatment? (SATA)
a. Decreased urine specific gravity
b. Decreased serum sodium
c. Increased urine output
d. Increased urine specific gravity
e. Increased serum sodium
f. Decreased urine output
ace
Which medications are used in SIADH to promote water excretion without causing sodium loss? (SATA)
a. Tolvaptan (Samsca)
b. Demeclocycline (Declomycin)
c. Furosemide (Lasix)
d. Conivaptan (Vaprisol)
e. Spironolactone (Aldactone)
ad
Which statement about pheochromocytomatous is correct?
A. It is most often malignant
b. It is a catecholamine-producing tumor
c. It is found only in the adrenal medulla
d. it is manifested by hypotension
b
A patient in the emergency department is diagnosed with possible pheochromocytomatous. What is the priority nursing intervention for this patient?
A. Monitor the patient’s intake and output and urine specific gravity
b. Monitor blood pressure for severe hypertension
c. Monitor blood pressure for severe hypotension
d. Administer medication to increase cardiac output
b
The nurse expects to perform which diagnostic test for pheochromocytoma?
A. 24-hour urine collection for sodium, potassium, and glucose
b. Catecholamine-stimulation test
c. Administration of beta-adrenergic blocking agent and monitor results
d. 24-hour urine collection for fractionated metanephrine and catecholamine levels
d
Which intervention applies to a patient with pheochromocytoma?
A. Assist to sit in a chair for blood pressure monitoring
b Instruct not to smoke, drink coffee, or change positions suddenly.
C Encourage to maintain an active exercise schedule including activity such as running
d. Encourage one glass of red wine nightly to promote rest
b
Which intervention is contraindicated for a patient with pheochromocytoma?
A. Monitoring blood pressure
b. Palpating the abdomen
c. Collecting 24-hour urine specimens
d. Instructing the patient to limit activity
b
Which diuretic is ordered by the health care provider to treat hyperaldosteronism?
A. Furosemide (Lasix)
b. Ethacrynic acid (Edecrin)
c. Bumetanide (Bumex)
d. Spironolactone (Aldactone)
d
Which statement about hyperaldosteronism is correct?
A. Painful “charley horses” are common from hyperkalemia
b. it occurs more often in men than in women
c. it is a common cause of hypertension in the population
d. Hypokalemia and hypertension are the main issues
d
When diagnosed with Cushing’s syndrome, the manifestations are most likely related to an excess production of which hormone?
A. Insulin from the pancreas
b. ADH from posterior pituitary gland
c. PRL from anterior pituitary gland
d. Cortisol from the adrenal cortex
d
What is the most common cause of endogenous hypercortisolism, or Cushing’s disease?
A. Pituitary hypoplasia
b. Insufficient ACTH production
c. Adrenocortical hormone deficiency
d. Hyperplasia of the adrenal cortex
d
Which are physical findings of Cushing’s disease? (SATA)
a. “Mood-faced” appearance
b. Decreased amount of body hair
c. Truncal obesity
d. Coarse facial features
e. Thin, easily damaged skin
f. Extremity muscle wasting
acef
Which laboratory findings does the nurse expect to find with Cushing’s syndrome? (SATA)
a. Decreased serum sodium
b. Increased serum glucose
c. Increased serum sodium
d. Increased serum potassium
e. Decreased serum calcium
bce
The nurse determines a priority patient problem of altered self-concept in a female patient with Cushing’s syndrome who expresses concern about the change in her general appearance. What is the expected outcome for this patient?
A. To verbalize an understanding that treatment will reverse many of the problems
b to ventilate about the frustration of these lifelong physical changes
c. To verbalize ways to cope with the changes such as joining a support group or changing style of dress
d. to achieve a persona l desired level of sexual functioning
a
Which drug is an adrenal cytotoxic agent used for inoperable adrenal tumors?
A. mitotane (Lysodren)
b. Aminoglutethimide (Cytadren)
c. Cyproheptadine (Periactin)
d. Fludrocortisone (Florinef)
a
Which drug decreases cortisol production?
A. Mitotane (Lysodren)
b. Aminoglutethimide (Cytadren)
c. Cyproheptadine (Periactin)
d. Hydrocortisone (Cortef)
b
A patient is scheduled for bilateral adrenalectomy. Before surgery, steroids are to be given. Which is the reasoning behind the administration of this drug?
A. To promote glycogen storage by the liver for body energy reserves
b. To compensate for sudden lack of adrenal hormones following surgery
c. To increase the body’s inflammatory response to promote scar formation
d. To enhance urinary excretion of salt and water following surgery
b
The nurse is teaching a patient being discharged after bilateral adrenalectomy. What medication information does the nurse emphasize in the teaching plan?
A. The dosage of steroid replacement drugs will be consistent throughout the patient’s lifetime.
B. The steroid drugs should be taken in the evening so as not to interfere with sleep
c. The patient should take the drugs on an empty stomach.
D. The patient should learn how to give himself an intramuscular injection of hydrocortisone
d
Which statement about a patient with hyperaldosteronism after a successful unilateral adrenalectomy is correct?
A. The low-sodium diet must be continued postoperatively
b. Glucocorticoid replacement therapy is temporary
c. Spironolactone (Aldactone) must be taken for life
d. Additional measures are needed to control hypertension
b
Which patient is at risk for developing secondary adrenal insufficiency?
A. Patient who suddenly stops taking high-dose steroid therapy
b. pIatent who tapers the dosages of steroid therapy
c. Patient deficient in ADH
d. Patient with an adrenal tumor causing excessive secretion of ACTH
A
An ACTH stimulation test is the most definitive test for which disorder?
A. Adrenal insufficiency
b. Cushing’s syndrome
c. Pheochromocytoma
d. Acromegaly
a
Which interventions are necessary for a patient with acute adrenal insufficiency (Addisonian crisis)? (SATA)
a. IV infusion of normal saline
b. IV infusion of 3% saline
c. Hourly glucose monitoring
d. Insulin administration
e. IV potassium therapy
Acd
A patient in the ED who reports lethargy, muscle weakness, nausea, vomiting, and weight loss over the past week sis diagnosed with Addisonian crisis (acute adrenal insufficiency). Which drug(s) does the nurse expect to administer to this patient?
A. Beta blocker to control the hypertension and dysrhythmias
b. Solu-Cortef IV along with IM injections of hydrocortisone
c. IV fluids of D5NS with KCl added for dehydration
d. Spironolactone (Aldactone) to promote diuresis
B
The nurse determines that the administration of hydrocortisone for Addisonian crisis is effete when which assessment is made?
A. Increased urine output
b. No signs of pitting edema
c. Weight gain
d. Lethargy improving; patient alert and oriented
D
Which nursing intervention is a preventive measure for adrenocortical insufficiency?
A. Maintaining diuretic therapy
b. Instructing the patient on salt restriction
c. Reducing high-dose glucocorticoid therapy quickly
d. Reducing high-dose glucocorticoid doses gradually
D
The nurse should instruct a patient who is taking hydrocortisone to report which symptoms to the health care provider for possible dose adjustment? (SATA)
a. Rapid weight gain.
B. Round face
c. Fluid retention
d. Gastrointestinal irritation
e. Urinary incontinence
abc
The nurse is performing a physical examination of a patient’s thyroid gland. Precautions are takin in performing the correct technique because palpation can result in which occurrence?
A. Damage to the esophagus causing gastric reflux
b. Obstruction of the carotid arteries causing a stroke
c. Pressure on the trachea and laryngeal nerve causing hoarseness
d. Exacerbation of symptoms by releasing additional thyroid hormone
d
Which assessment findings indicate hyperthyroidism? (SATA)
a. Weight loss with increased appetite
b. Constipation
c. Increased heart rate
d. Insomnia
e. Decreased libido
f. Heat intolerance
Acdf
The nurse assesses a patient in the ED and finds the following; constipation, fatigue with increased sleeping time impaired memory, facial puffiness, and weight gain. Which deficiency does the nurse recognize?
A. Hyperthyroidism
b. Hypothyroidism
c. Hyperparathyroidism
d. Hypoparathyroidism
B
Which factor is a hallmark assessment finding that signifies hyperthyroidism?
A. Weight loss
b. Increased libido
c. Heat intolerance
d. Diarrhea
C
Which factor is a main assessment finding that signifies hypothyroidism?
A. Irritability
b. Cold intolerance
c. Diarrhea
d. Fatigue
B
Which sign/symptoms is one of the first indicators of hyperthyroidism that is often noticed by the patient?
A. Eyelid or globe leg
b. Vision changes or tiring of the eyes
c. Protruding eyes
d. Photophobia
B
Which laboratory result is consistent with a diagnosis of hyperthyroidism?
A. Decreased serum T3 and T4 levels
b. Elevated serum TRH level
c. Decreased radioactive iodine uptake
d. Increased serum T3 and T4
D
The laboratory results for a 53-year-old patient indicate a low T3 level and elevated TSH. What do these results indicate?
A. Hyperthyroidism
b. Hypothyroidism
c. Malfunctioning pituitary gland
d. Normal laboratory values for this age
B
The clinical manifestations of hyperthyroidism are known as which condition?
A thyrotoxicosis.
B. Euthyroid function
c. Graves’ disease
d. Hypermetabolism
a
What is the most common cause of hyperthyroidism?
A. Radiation to thyroid
b. Graves’ disease
c. Thyroid cancer
d. Thyroiditis
b
The nurse assessing a patient palpates enlargement of the thyroid gland, along with noticeable swelling of the neck. How does the nurse interpret this finding?
A. globe lag
b. Myxedema
c. Exophthalmos
d. Goiter
d
The nurse is assessing a patient diagnosed with hyperthyroidism and observes dry, waxy swelling of the front surfaces of the lower legs. How does the nurse interpret this finding?
A. Globe lag
b. Pretibial myxedema
c. Exophthalmos
d. Goiter
b
Which statement best describes globe lag in a patient with hyperthyroidism?
A. Abnormal protrusion of the eyes
b. Upper eyelid fails to descend when the patient gazes downward
c. Upper eyelid pulls back faster than the eyeball when the patient gazes upward
d. Inability of both eyes to focus on an object simultaneously
c
The nurse is assessing a patient with Graves’ disease and observes an abnormal protrusion of both eyeballs. How does the nurse document this assessment finding?
A. Globe lag
b. Pretibial myxedema
c. Exophthalmos
d. Goiter
c
Which statements about hyperthyroidism are accurate? (SATA)
a. It is most commonly caused by Graves’ disease
b. It can be caused by overuse of thyroid replacement medication
c. It occurs more often in med between the ages of 20-40
d. Weight gain is a common manifestation
e. Serum T3 and T4 results will be elevated
abe
The nurse is providing instructions to a patient taking levothyroxine (Synthroid). When does the nurse tell the patient to take this medication?
A. With breakfast in the morning
b. At lunchtime immediately after eating
c. In the morning on an empty stomach
d. at dinnertime within 15 minutes after eating
c
The nurse is providing instructions to a patient who is taking the antithyroid medication propylthiouracil (PTU). The nurse instructs the patient to notify the health care provider immediately if which sign/symptom occurs?
A. Weight gain
b. Dark-colored urine
c. Cold intolerance
d. Headache
b
The patient who is prescribed methimazole (Tapazole) 4 mg orally every 8 hours tells the nurse that his heart rate is slow (60/minute), he has gained 7 pounds, and he wears a sweater even on warm days. What does the nurse suspect?
A. Indications of hypothyroidism will require a lower dosage
b. Indications of hypothyroidism will require a higher dosage
c. Indications of hyperthyroidism will require a lower dosage
d. Indications of hyperthyroidism will require a higher dosage
a
A patient who has been diagnosed with Graves’ disease is going to receive radioactive iodine (RAI) in the oral form of 131I. what does the nurse teach the patient about how this drug works?
A. It destroys the hormones T3 and T4
b. It destroys the tissue that produces thyroid hormones
c. IT blocks thyroid hormone production
d. It prevents T4 from being converted to T3
b
A patient who has been diagnosed with Graves disease is to receive RAI in the oral form of 131I as a treatment. What instructions does the nurse include in the teaching plan about preventing radiation exposure to others? (SATA)
a. Do not share a toilet with others for 2 weeks after treatment
b. Flush the toilet three times after each use
c. Wash clothing separately from other in the household
d. Limit contact with pregnant women, infants, and children
e. Do not use a laxative within 2 weeks of having the treatment
abcd
Which statements about hypothyroidism are accurate? (SATA)
a. It occurs more often in women
b. It can be caused by iodine deficiency
c. Weight loss is a common manifestation
d. It can be caused by autoimmune thyroid destruction
e. Myxedema coma is a rare but serious complication
abde
The nurse is assessing a patient with a diagnosis of Hashimoto’s disease. What are the primary manifestation of this disease? (SATA)
a. Dysphagia
b. Painless enlargement of the thyroid gland
c. Painful enlargement of the thyroid gland
d. Weight loss e. Intolerance to heat
ab
Laboratory findings of elevated T# and T4, decreased TSH, and high thyrotropin receptor antibody titer indicate which condition?
A. Multinodular goiter
b. Hyperthyroidism related to overmedication
c. Pituitary tumor suppressing TSH
d. Graves’ disease
d
The patient has multiple thyroid nodules resulting in thyroid hyperfunction. What is the most likely cause of this hyperthyroidism?
A. Thyroid carcinoma
b. Graves’ disease
c. Toxic multinodular goiter
d. Pituitary hyperthyroidism
c
After a visit to the health care provider’s office, a patient is diagnosed with general thyroid enlargement and elevate thyroid hormone level. Which condition do these findings indicate?
A. Hyperthyroidism and goiter
b. Hypothyroidism and goiter
c. Nodules on the parathyroid gland
d. Thyroid or parathyroid cancer
a
Which condition is a life-threatening emergency and serious complication of untreated or poorly treated hypothyroidism?
A. Endemic goiter
b. Myxedema coma
c. Toxic multinodular goiter
d. Thyroiditis
B
A patient with exophthalmos from hyperthyroidism reports dry eyes, especially in the morning. The nurse teaches the patient to perform which intervention to help correct this problem?
A. Wear sunglasses at all times when outside in the bright sun
b. Use cool compresses to the eye four times a day
c. Tape the eyes closed with nonallergenic tape
d. There is nothing that can be done to relieve this problem.
C
Which factors are considered to be triggers for thyroid storm? (SATA)
a. Infection
b. Cold temperatures
c. Vigorous palpation of a goiter
d. Diabetic ketoacidosis
e. Extremely warm temperatures
Acd
A patient has the following assessment findings: elevated TSH level, low T3 and T4 levels, difficulty with memory, lethargy, and muscle stiffness. There are clinical manifestations of which disorder?
A. Hypothyroidism
b. Hyperthyroidism
c. Hypoparathyroidism
d. Hyperparathyroidism
A
A patient has been prescribed thyroid hormone for treatment of hypothyroidism. Within what time frame does the patient expect improvement in mental awareness with this treatment?
A. A few days
b. 2 weeks
c. 1 month
d. 3 months
b
Which signs and symptoms are assessment findings indicative of thyroid storm? (SATA)
a. Abdominal pain and nausea
b. Hypothermia
c. Elevated temperature
d. Tachycardia
e. Elevated systolic blood pressure
f. Bradycardia
acde
Management of the patient with hyperthyroidism focuses on which goals? (SATA)
a. Blocking the effects of excessive thyroid secretion
b. Treating the signs and symptoms the patient experiences
c. Establishing euthyroid function
d. Preventing spread of the disease
e. Maintaining an environment of reduced stimulation
abce
Which are preoperative instructions for a patient having thyroid surgery? (SATA)
a. Teach postoperative restrictions such as no coughing and deep-breathing exercises to prevent strain on the suture line
b. Teach the moving and turning technique of manually supporting the head and avoiding neck extension to minimize strain on the suture line
c. Inform the patient that hoarseness for a few days after surgery is usually the result of a breathing tube (endotracheal tube) used during surgery
d. Humidification of air may be helpful to promote expectoration of secretions. Suctioning may also be used
e. Clarify any questions regarding placement of incision, complications, and postoperative care
f. A supine position and lying flat will be maintained postoperatively to avoid strain on suture line
bcde
The nurse is preparing for a patient to return from thyroid surgery. What priority equipment does the nurse ensure is immediately available? (SATA)
a. Tracheostomy equipment
b. Calcium gluconate or calcium chloride for IV administration
c. Mechanical ventilator
d. Humidified oxygen
e. Suction equipment
f. Pillow
abdef
After a thyroidectomy, a patient reports tingling around the mouth and muscle twitching. Which complication do these assessment findings indicate to the nurse?
A. hemorrhage
b. Respiratory distress
c. Thyroid storm
d. hypocalcemia
d
The nurse assesses a patient postthyroidectomy for laryngeal nerve damage. Which findings indicate this complication? (SATA)
a. Dyspnea
b. Sore throat
c. Hoarseness
d. Weak voice
e. Dry cough
cd
The nurse is assessing a patient after thyroid surgery and discovers harsh, high-pitched respiratory sounds. What is the nurses best first action?
A. Administer oxygen at 5L via nasal cannula
b. Administer IV calcium chloride
c. Notify the Rapid Response Team
D. Suction the patient for oral secretions
c
After hospitalization for myxedema, a patient is prescribed thyroid replacement medication. Which statement by the patient demonstrates a correct understanding of this therapy?
A. “I’ll be taking this medication until my symptoms are completely resolved.”
B. “I’ll be taking thyroid medication for the rest of my life.”
C. “Now that I’m feeling better, no changes in my medication will be necessary.”
D. “I’m taking this medication to prevent symptoms of an overactive thyroid gland.”
b
Which statement about thyroiditis are accurate? (SATA)
a. It is an inflammation of the thyroid gland
b. Hashimoto’s disease is the most common type
c. IT always resolves with antibiotic therapy
d. There are three types: acute, subacute, and chronic.
E. The patient must take thyroid hormones
abde
Which statements about acute thyroiditis are accurate? (SATA)
a. It is caused by a bacterial infection of the thyroid gland
b. It is treated with antibiotic therapy
c. It results from a viral infection of the thyroid gland
d. Subtotal thyroidectomy is a form of treatment
e. Manifestations include neck tenderness, fever, and dysphagia
abe
What is the hallmark of thyroid cancer?
A. aggressive tumors
b. Elevated serum thyroglobulin level
c. Metastasis to other organs
d. Invasion of blood vessels
b
Serum calcium levels are maintained by which hormone?
A. Cortisol
b. Luteinizing hormone
c. ADH
d. Parathyroid hormone (PTH)
d
Production of which hormones causes lower levels of calcium?
A. Calcitonin
b. PTH
c. T4
d. TSH
a
Bone changes in the older adult are often seen with endocrine dysfunction and increased secretion of which substance?
A. PTH
b. Calcitonin
c. Insulin
d. Testosterone
a
In addition to regulation of calcium levels, PTH and calcitonin regulate the circulating blood levels of which substance?
A. Potassium
b. Sodium
c. Phosphate
d. Chloride
c
A patient has positive Trousseau’s and Chvostek’s signs resulting from hypoparathyroidism. What condition does this assessment finding indicate?
A. Hypercalcemia
b. Hypocalcemia
c. Hyperphosphatemia
d. Hypophosphatemia
B
Which foods will the nurse instruct a patient with hypoparathyroidism to avoid? (SATA)
a. Canned vegetables
b. yogurt
c. Fresh fruit
d. Red meat
e. Milk
f. Processed cheese
bef
A patient with continuous spasm of the muscle is diagnosed with hypoparathyroidism. The muscle spasms are a clinical manifestation of which condition?
A. Nerve damage
b. Seizures
c. Tetany
d. Decreased potassium
c
Which disorders/conditions can cause hyperparathyroidism? (SATA)
a. Chronic kidney diseases
b. Neck trauma
c. Thyroidectomy
d. Vitamin D deficiency
e. Parathyroidectomy
abd
A patient has hyperparathyroidism and high levels of serum calcium. Which initial treatment does the nurse prepare to administer to the patient?
a. Furosemide with IV saline
b. Calcitonin
c. Oral phosphates
d Mithramycin
a
Which assessment finings of hypocalcemia? (SATA)
a. Numbness and tingling around the mouth
b. muscle cramping
c. Bone fractures
d. fever
e. Tachycardia
ab
Which medication therapies does the nurse expect patients with hypoparathyroidism to receive? (SATA)
a. Calcium chloride
b. Calcium gluconate
c. Calcitriol
d. Propranolol
e. Ergocalciferol
abce
Discharge planning for a patient with chronic hypoparathyroidism includes which instructions? (SATA)
a. Prescribed medications must be taken for the patient entire life
b. Eat foods low in vitamin D and high in phosphorous
c. Eat foods high in calcium, but low in phosphorous
d. After several weeks, medications can be discontinued
e. Kidney stones are no longer a risk to the patient
ac
In older adults, assessment findings of fatigue, altered thought process, dry skin, and constipation are often mistaken for signs of aging rather than assessment findings for which endocrine disorder?
A. Hyperthyroidism
b. Hypothyroidism
c. Hyperparathyroidism
d. Hypoparathyroidism
b
What is the most common cause of death from myxedema coma?
A myocardial infarction
b. Acute kidney failure
c. High serum level of iodide
d. Respiratory failure
d
Which conditions may precipitate myxedema coma? (SATA)
a. Rapid withdrawal of thyroid medication
b. Vitamin D deficiency
c. Untreated hypothyroidism
d. Surgery
e. Excessive exposure to iodine
acd

“1. A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what “”type 2″” means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs from type 1 diabetes primarily in that with …

1) A nurse is caring for a client with hyperparathyroidism and notes that the client’s serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client? 1. Calcium chloride 2. Calcium gluconate …

Nurse Berlinda is assigned to a 41-year-old client who has a diagnosis of chronic pancreatitis. The nurse reviews the laboratory result, anticipating a laboratory report that indicates a serum amylase level of: a. 45 units/L b. 100 units/L c. 300 …

A client asks the nurse why the provider bases his medication regimen on his HbA1C instead of his log of morning fasting blood glucose results. Which of the following is an appropriate response by the nurse? A. HB A1C measures …

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