ch 39

  1. Which of the following symptoms would the nurse expect to observe in a patient diagnosed with hypothyroidism?

    a.

    Anxiety and tachycardia

    b.

    Dry skin and slowed heart rate

    c.

    Increase in appetite and diarrhea

    d.

    Tremor and oily skin
    • ANS:     B
    • Symptoms of hypothyroidism are related to the reduced metabolic rate and include fatigue, weight gain, bradycardia, constipation, mental dullness, feeling cold, shortness of breath, decreased sweating, and dry skin and hair. A, C, and D are more common with hyperthyroidism.
  2. A patient is prescribed levothyroxine (Synthroid) for hypothyroidism. Which of the following statements should the nurse include when teaching the patient?

    a.

    “Worsening hypothyroidism can result in a condition called myxedema coma, so it is important to take this medication.”

    b.

    “If you do not take your medication, you will retain water and begin to see swelling in your feet and legs.”

    c.

    “Thyrotoxicosis results from too little thyroid hormone, so you should monitor your temperature every day.”

    d.

    “Cushing’s syndrome is a complication of severe hypothyroidism, so you need to take this medication regularly.”
    ANS:    A

    If a patient does not take medication to correct hypothyroidism, then worsening hypothyroidism will occur, which can lead to myxedema coma. Fluid excess is not directly related to hypothyroidism. Thyrotoxicosis occurs with too much, not too little, thyroid hormone. Cushing’s syndrome is caused by deficient cortisol, not thyroid hormone.
  3. The nurse is caring for a patient with a history of asthma who is newly diagnosed with hyperthyroidism. What assessment finding should the LPN report to the RN immediately?

    a.

    Heart rate 112 beats/min

    b.

    Respiratory rate 20 breaths/min

    c.

    Blood pressure 112/73 mm Hg

    d.

    Temperature 97.2°F (36.2°C)
    ANS:    A

    A heart rate of 112 beats per minute is abnormal. All the other vital signs are normal. The history of asthma complicates the diagnosis, because some treatments for asthma (adrenergic bronchodilators) can also raise the heart rate, although this knowledge is not essential to answer this question.
  4. The nurse is caring for a patient with exophthalmos secondary to Graves’ disease. What nursing interventions are appropriate for this patient?

    a.

    Myotic eyedrops and privacy

    b.

    Television and other diversionary activities

    c.

    Reassurance that the symptoms will resolve when the Graves’ disease is under control

    d.

    An accepting attitude and lubricating eyedrops
    ANS:    D

    Lubricating eyedrops will help keep the eyes moist if the patient is unable to close them. An accepting attitude is important if the patient’s body image is disturbed. Diversion and myotic eyedrops do not address the problem. Symptoms will not resolve with treatment.
  5. The nurse is preparing a patient for a thyroidectomy to treat hyperthyroidism. What statement by the patient indicates to the nurse that the patient understands the preoperative instructions?

    a.

    “I know that I should avoid turning my head after surgery.”

    b.

    “I will need to increase my calorie intake after surgery to avoid weight loss.”

    c.

    “I will probably need thyroid replacement medication after surgery.”

    d.

    “I will avoid taking any thyroid or antithyroid drugs before surgery.”
    ANS:     C

    Most patients require thyroid replacement therapy after thyroidectomy. Patients should be taught range-of-motion exercises, not to avoid turning the head. Calories will need to be reduced, not increased. Antithyroid drugs may be ordered to stabilize thyroid function prior to surgery.
  6. What is the most likely cause of tetany after thyroidectomy?

    a.

    Excess circulating thyroid hormone released during manipulation of the gland during surgery

    b.

    Swelling of the incisional area

    c.

    Overdose of preoperative antithyroid medication

    d.

    Accidental removal of the parathyroids during surgery
    ANS:    D

    Tetany can occur if the parathyroid glands are accidentally removed during thyroid surgery. Because of the proximity of the parathyroid glands to the thyroid, it is sometimes difficult for the surgeon to avoid them. In the absence of parathyroid hormone, serum calcium levels drop, and tetany results. Excess thyroid hormone causes a thyrotoxic crisis. Swelling and antithyroid medication do not cause tetany.
  7. The nurse is caring for a patient who underwent thyroid surgery the day before. The patient reports feeling numb around the mouth and experiencing random muscle twitches. The nurse anticipates the physician will order which of the following intravenous medications?

    a.

    Sodium bicarbonate

    b.

    Potassium chloride

    c.

    Iodine

    d.

    Calcium gluconate
    ANS:   D

    In the absence of parathyroid hormone, serum calcium levels drop, and tetany results. Intravenous calcium gluconate is given to treat acute tetany. Sodium, potassium, and iodine will not help restore calcium level.
  8. The nurse is caring for a patient following a thyroidectomy. Which postoperative assessment activity is most important in detecting thyrotoxic crisis?

    a.

    Monitor the surgical dressing.

    b.

    Monitor vital signs.

    c.

    Assess hand grips and foot presses.

    d.

    Assess for confusion and delirium.
    ANS:     B

    Symptoms include tachycardia, high fever, hypertension (with eventual heart failure and hypotension), dehydration, restlessness, and delirium or coma; it is important to monitor vital signs to detect symptoms early. Monitoring the dressing and neurological status (C, D) are good routine care but do not help detect thyrotoxic crisis.
  9. The nurse is caring for a patient 6 hours after a thyroidectomy and notes the patient’s temperature is 104°F, pulse is 144 beats per minute, respirations are 24 per minute, and blood pressure is 184/108 mm Hg. Which of the following orders does the nurse anticipate?

    a.

    Beta blockers and a cooling blanket

    b.

    Epinephrine and compression dressings

    c.

    Aspirin and bedrest

    d.

    Diphenhydramine (Benadryl) and Fowler’s position
    ANS:    A

    If thyrotoxic crisis occurs, treatment is first directed toward relieving the life-threatening symptoms. Acetaminophen is given for the fever. Aspirin is avoided because it binds with the same serum protein as T4, freeing additional T4 into the circulation. Intravenous fluids and a cooling blanket may be ordered to cool the patient. A beta-adrenergic blocker, such as propranolol, is given for tachycardia. Epinephrine will make symptoms worse. Compression dressing on the thyroid could impair the airway. Benedryl and Fowler’s position do not address the problem.
  10. The nurse is caring for a patient following a thyroidectomy. What item is most important to have at the bedside?

    a.

    Hemostats

    b.

    Tracheostomy set

    c.

    Gauze dressings

    d.

    Suture removal kit
    ANS:     B

    A tracheostomy set is most essential in case swelling impedes the airway. Hemostats are not necessary. Dressings and a suture removal kit may be needed at some point, but they are not as important as airway maintenance.
  11. A nurse is approached by a neighbor who has a neck growth that appears to be a goiter. What should the nurse do?

    a.

    Palpate the neighbor’s thyroid gland for enlargement or nodules.

    b.

    Advise the neighbor to switch to iodized salt when cooking.

    c.

    Question the neighbor about symptoms of hypothyroidism or hyperthyroidism.

    d.

    Ask if the neighbor has numbness or tingling in the hands or lips.
    ANS:   C

    Further assessment is the first step in deciding what to do. Palpating the gland is inappropriate because the patient might be experiencing hyperthyroidism. Instructing about iodized salt is not appropriate without a definitive diagnosis. Numbness and tingling signify a parathyroid, not a thyroid, problem.
  12. The nurse is doing volunteer health screenings at a local mall. A patient with a large growth on the neck approaches. What finding should alert the nurse to send the patient to the physician immediately?

    a.

    The growth is difficult to conceal with clothing.

    b.

    The patient makes a funny high-pitched sound with each breath.

    c.

    The patient complains of being very tired lately.

    d.

    The patient seems depressed.
    • ANS:     B
    • The patient is exhibiting stridor, which indicates poor airway clearance. Airway problems always take priority. A, C, and D are concerns but are not the first priority.
  13. A patient develops hyperparathyroidism related to a benign tumor. What laboratory result should the nurse expect to see?

    a.

    Decreased serum potassium

    b.

    Elevated serum potassium

    c.

    Decreased serum calcium

    d.

    Elevated serum calcium
    ANS:    D

    Overactivity of one or more of the parathyroid glands causes an increase in parathyroid hormone (PTH), with a subsequent increase in the serum calcium level (hypercalcemia). This is achieved through movement of calcium out of the bones and into the blood, absorption in the small intestine, and reabsorption by the kidneys. Potassium level is not affected.
  14. A patient with hyperparathyroidism asks why ambulation three times per day is necessary because it is so difficult to do so. Which response by the nurse is best?

    a.

    “Walking is important for preventing cardiovascular disease.”

    b.

    “Walking is good for you; I walk three times a day.”

    c.

    “Walking will keep the calcium where it belongs—in your bones.”

    d.

    “Walking is important to maintaining adequate serum calcium levels.”
    ANS:     C

    Walking and weight-bearing exercises help keep calcium in the bones. Exercise helps prevent cardiovascular disease, but this is not the reason it is recommended. The nurse should not give advice based on his or her own habits. Walking keeps calcium in the bones, not the blood.
  15. The nurse is caring for a patient who is newly diagnosed with acromegaly. Which treatment does the nurse anticipate?

    a.

    Adrenalectomy

    b.

    Administration of intravenous beta blockers

    c.

    Irradiation or removal of the pituitary gland

    d.

    Irradiation of the thyroid gland
    ANS:     C

    Treatment of acromegaly includes irradiation or removal of the pituitary to reduce growth hormone levels. Adrenalectomy, beta blockers, and thyroid irradiation do not address the problem, which is in the pituitary.
  16. For which nursing diagnosis should the nurse assess in a patient with newly diagnosed acromegaly?

    a.

    Imbalanced Nutrition

    b.

    Ineffective Airway Clearance

    c.

    Body Image Disturbance

    d.

    Risk for Complications related to fluid imbalance
    ANS:     C

    Body image disturbance is likely due to changes in physical appearance. Airway clearance, nutrition, and fluid balance are not directly affected.
  17. What data would best help the nurse to monitor a patient with diabetes insipidus?

    a.

    Bowel sounds and abdominal girth

    b.

    Intake and output and daily weight

    c.

    Blood glucose before meals and at bedtime

    d.

    Pupil responses and hand grasps
    ANS:     B

    Fluid balance is best monitored with daily weights; intake and output may also be helpful. Bowel sounds, abdominal girth, and blood glucose are not affected. Neurological symptoms would occur only late in the disorder if the patient does not receive care.
  18. A patient is newly diagnosed with diabetes insipidus. Which of the following medications should the nurse anticipate for long-term patient management?

    a.

    Inderal (propranolol)

    b.

    Calcium and vitamin D

    c.

    Desmopressin acetate

    d.

    Mithramycin
    ANS:     C

    In patients who require long-term therapy, synthetic antidiuretic hormone (ADH) (desmopressin, or DDAVP) in the form of a nasal spray is used, usually twice a day. Inderal, calcium, and mithramycin will not affect fluid balance.
  19. While caring for a patient with diabetes insipidus, the nurse recognizes that treatment is effective when normal results are noted for which of the following laboratory values?

    a.

    Fasting blood glucose

    b.

    Serum potassium

    c.

    Urine specific gravity

    d.

    Urine ketones
    ANS:     C

    Urine specific gravity is a good measure of urine concentration and antidiuretic hormone (ADH) function. Diabetes insipidus does not directly affect potassium level. Blood glucose and urine ketones are monitored in diabetes mellitus, not diabetes insipidus.
  20. The nurse is caring for a patient with lung cancer who develops syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Which assessment findings does the nurse expect?

    a.

    Weight gain and concentrated urine

    b.

    Poor skin turgor and polyuria

    c.

    Truncal obesity and thin extremities

    d.

    Fatigue and weakness
    ANS:    A

    Excess antidiuretic hormone (ADH) causes water retention, with weight gain and concentrated urine. Poor skin turgor and polyuria are associated with diabetes insipidus, not SIADH. Truncal obesity and thin extremities are signs of Cushing’s syndrome. Fatigue and weakness are nonspecific.
  21. What disorder places the patient at risk for compression fractures?

    a.

    Hyperparathyroidism

    b.

    Hypoparathyroidism

    c.

    Hyperthyroidism

    d.

    Hypothyroidism
    ANS:    A

    Hyperparathryroidism causes calcium to move from bone to blood, increasing risk of fracture. Hypoparathyroidism does not pull calcium from bone. Thyroid problems do not affect calcium movement.
  22. A patient with chronic obstructive pulmonary disease who is placed on corticosteroid therapy asks the nurse what the medication does. Which of the following responses by the nurse is best?

    a.

    “The medication causes your airways to dilate.”

    b.

    “The medication is an expectorant that helps you cough up secretions.”

    c.

    “It is an anti-infective and helps kill bacteria.”

    d.

    “It is an anti-inflammatory agent that reduces the swelling in your airways.”
    ANS:    D

    Corticosteroids are potent anti-inflammatory agents. Whereas patients with lung disease may need medications for bronchodilation, anti-infective, and expectorant actions, corticosteroids are given for inflammation.
  23. A patient with chronic obstructive pulmonary disease develops Cushing’s syndrome related to long-term steroid use. The physician writes an order to discontinue the steroids. Which action by the nurse is most appropriate?

    a.

    Monitor the patient’s blood glucose level.

    b.

    Monitor the patient’s weight daily.

    c.

    Instruct the patient to report worsening respiratory symptoms.

    d.

    Question the order.
    • ANS:    D
    • Steroids should always be tapered, never stopped abruptly, to prevent adrenal crisis. A, B, and C are appropriate for patients on high-dose steroids, but abrupt cessation of the drug is life threatening.
  24. The nurse develops a nursing diagnosis of “fluid volume excess related to sodium retention secondary to steroid therapy as evidenced by weight gain of 12 pounds in 2 weeks and edema of lower extremities.” Which goal is most appropriate?

    a.

    Patient will verbalize importance of low-sodium diet.

    b.

    Patient will have improved fluid balance as evidenced by weight returning to baseline.

    c.

    Patient’s fluid volume will decrease as evidenced by discontinuing steroids.

    d.

    Ankle circumference will be measured for edema daily.
    ANS:     B

    B addresses the problem. A and D are not goals, they are actions. C. Discontinuing steroids is not evidence of improved fluid volume.
  25. Which intervention by the nurse is most important for a patient with symptoms of a pheochromocytoma?

    a.

    Offer distraction such as television or music.

    b.

    Encourage frequent intake of fluids.

    c.

    Provide a calm, quiet environment.

    d.

    Assist with ambulation at least three times a day.
    ANS:     C

    The patient with a pheochromocytoma is in a fight-or-flight state and needs a calm, quiet environment. Distraction and ambulation will stimulate the patient. Fluids do not address the problem.
  26. A patient enters the emergency department in an addisonian crisis. Vital signs are blood pressure 85/52 mm Hg and pulse 88 beats/min. The patient is lethargic. Which event in the patient’s week most likely precipitated this crisis?

    a.

    Taking Tylenol for a headache

    b.

    Maintaining usual exercise of walking each night

    c.

    Eating a high-fat diet

    d.

    Being laid off from a job
    ANS:    D

    Stress causes a need for an increase in cortisol, the body’s stress hormone. Being laid off is a stressor. Tylenol, walking, and a high-fat diet are not unusually stressful.
  27. The nurse is assisting with discharge of a patient with Addison’s disease following an addisonian crisis. Which instruction is most important for the nurse to reinforce?

    a.

    The importance of taking steroid replacements as prescribed

    b.

    How to monitor blood glucose levels

    c.

    The need for a well-balanced diet

    d.

    The importance of 30 minutes of exercise each day
    ANS:    A

    Steroid replacements are essential because the patient with Addison’s disease does not have adequate steroid hormones. Blood glucose levels are monitored if a patient is on high-dose steroids, not for replacement steroids. Diet and exercise are important but are not immediately life threatening if not carried out.
  28. The LPN is caring for a patient with diabetes insipidus and obtains a urine specific gravity reading of 1.002. Which response by the LPN is most important?

    a.

    Document the results

    b.

    Report the reading to the RN because therapy is ineffective

    c.

    Report the reading to the RN because the patient may be receiving too much medication

    d.

    Advise the patient to drink less water
    ANS:     B

    Normal urine specific gravity is 1.010 to 1.025. 1.002 is too low, meaning therapy is not effective. Results should be documented, but it is most important to assure the patient is treated. It is unlikely the patient is receiving too much medication. The patient needs to drink to replace water lost in urine.
  29. In addition to monitoring vital signs, which physical or laboratory result assessment is important for the nurse to monitor for a patient being given fludrocortisone for an adrenal disorder?

    a.

    Serum calcium levels

    b.

    Serum potassium levels

    c.

    Serum magnesium levels

    d.

    Thyroid hormone levels
    ANS:     B

    Fludrocortisone is a mineral corticoid replacement, so it will cause sodium and water retention and potassium loss. Potassium should be monitored. It will not directly affect calcium, magnesium, or thyroid hormone levels.
  30. What is the most common cause of hyperthyroidism?

    a.

    Multinodular goiter

    b.

    Radiation exposure

    c.

    Graves’ disease

    d.

    Excess thyrotropin-releasing hormone (TRH) from the hypothalamus
    ANS:     C

    A variety of disorders can cause hyperthyroidism. Graves’ disease is the most common cause; it is thought to be an autoimmune disorder, because thyroid-stimulating antibodies are present in the blood of these patients. Multinodular goiter, radiation, and excess TRH are less commonly the cause.
  31. A patient is being discharged after a hypophysectomy, which was performed because of a tumor that resulted in acromegaly. What is important for the nurse to include in discharge teaching?

    a.

    “Be sure to take your prescribed bromocriptine (Parlodel) every day.”

    b.

    “You must learn to accept the enlargement of soft tissues that occurred before surgery.”

    c.

    “Be sure to take the thyroid hormone, corticosteroids, and sex hormones that have been prescribed for you.”

    d.

    “Visual changes you experienced before surgery will begin to reverse within 6 months.”
    ANS:     C

    If the pituitary is removed, lifelong replacement of thyroid hormone, corticosteroids, and sex hormones is important to maintain homeostasis. Bromocriptine reduces growth hormone release. Soft tissue will reduce in size some; telling the patient to learn to accept it is not therapeutic. Visual changes may not reverse.
  32. The nurse is caring for a patient with diabetes insipidus. What type of intravenous fluid would the nurse expect to be ordered for fluid replacement?

    a.

    Isotonic

    b.

    Hypotonic

    c.

    Hypertonic
    ANS:     B

    Hypotonic IV fluids such as 0.45% saline may be ordered to replace intravascular volume without adding excessive sodium. IV fluids are especially important if the patient is unable to take oral fluids. Isotonic and hypertonic fluids will add sodium.
  33. The nurse working in a primary care physician office recognizes which of the following individuals is at highest risk for iodine deficiency?

    a.

    A 52-year-old vegan with dietary sodium restrictions

    b.

    A 44-year-old lacto-vegetarian with a 40 pack-year smoking history

    c.

    A 49-year-old with celiac disease who takes digoxin (Lanoxin)

    d.

    A 28-year-old with lactose intolerance and a history of Graves’ disease
    ANS:    A

    At higher risk of iodine deficiency are strict vegetarians who consume sea salt, which contains virtually no iodine.
  34. The LPN is assisting in the care of a 51-year-old woman recovering from a hypophysectomy. Which of the following, if noted by the nurse, would require immediate intervention?

    a.

    Complaints of pain at a 5 on a scale of 0 to 10

    b.

    Urinary output of 800 mL in 4 hours

    c.

    Hemoglobin level of 13.2 g/dL

    d.

    Urine specific gravity of 1.19
    ANS:     B

    Tumors, trauma, or other problems in the hypothalamus or pituitary gland can lead to decreased production or release of antidiuretic hormone (ADH), causing diabetes insipidus and resulting in excess urinary output. The listed hemoglobin and urine specific gravity are within normal limits for the patient. Pain is not the highest priority in this scenario.
  35. The LPN admits a well-known patient to the clinic and notes that the patient’s face and features seem broader and more coarse. Which of the following laboratory tests would the nurse expect to be ordered?

    a.

    Cortisol

    b.

    Vanillylmandelic acid (VMA)

    c.

    Growth hormone

    d.

    Glucose tolerance test
    ANS:     C

    Growth hormone is elevated in individuals with acromegaly (giantism).
  36. A patient is admitted to the hospital with new-onset diabetes insipidus. Which of the following nursing diagnoses should the nurse include in the plan of care? (Select all that apply.)

    a.

    Risk for Injury related to hypertension

    b.

    Risk for Injury related to fractures

    c.

    Risk for Deficient Fluid Volume

    d.

    Impaired Gas Exchange related to decreased oxygenation

    e.

    Knowledge Deficit related to disease process
    ANS: C, E

    Diabetes insipidus causes excessive urination and fluid loss. Hypotension, not hypertension, would more likely be related to fluid loss. Bone fracture and impaired gas exchange are not related to diabetes insipidus.
  37. A patient is being discharged with treatment for long-term hypoparathyroidism. What should the nurse include in discharge teaching? (Select all that apply.)

    a.

    Eat a diet high in calcium.

    b.

    Have regular eye examinations.

    c.

    Eat a diet high in phosphates.

    d.

    Follow up with regular laboratory tests.

    e.

    Take oral calcium and vitamin D supplements as prescribed.

    f.

    Add iron-rich foods to your diet.
    ANS: A, B, D, E

    A high calcium diet with calcium supplements is necessary to maintain serum calcium levels. Eye examinations are important because calcifications can occur in the eyes, and cataracts can develop. A high-phosphate diet may lower serum calcium. Follow-up laboratory tests are important to be sure the calcium level is normal. Hypoparathyroidism will not alter iron stores; increased intake of iron-rich foods is not necessary.
  38. What are signs/symptoms of dilutional hyponatremia? (Select all that apply.)

    a.

    Weak, slow pulse

    b.

    Muscle weakness

    c.

    Nausea

    d.

    Constipation

    e.

    Headache

    f.

    Elevated blood pressure
    ANS: B, C, E, F

    Manifestations of dilutional hyponatremia include bounding pulse, elevated blood pressure, muscle weakness, headache, personality changes, nausea, diarrhea, convulsions, and coma.
  39. The LPN is caring for a patient with suspected hyperthyroidism who is scheduled for a radioactive iodine uptake test. What are symptoms of hyperthyroidism that the nurse should note on the medical record? (Select all that apply.)

    a.

    Weight loss

    b.

    Fatigue

    c.

    Cold intolerance

    d.

    Constipation

    e.

    Tremor

    f.

    Buffalo hump
    ANS: A, D

    Milk products and canned fish are high in calcium. Meats, potatoes, and grains are not as high.
  40. The LPN is caring for a patient with suspected hyperthyroidism who is scheduled for a radioactive iodine uptake test. What are symptoms of hyperthyroidism that the nurse should note on the medical record? (Select all that apply.)

    a.

    Weight loss

    b.

    Fatigue

    c.

    Cold intolerance

    d.

    Constipation

    e.

    Tremor

    f.

    Buffalo hump
    ANS: A, B, E

    Weight loss, fatigue, heat intolerance, tremor, increased pulse and blood pressure, and agitation or nervousness may be seen with hyperthyroidism. Cold intolerance and constipation are seen with hypothyroidism. Dehydration is seen in Addison’s disease. Buffalo hump is seen in Cushing’s syndrome.
Author
mayjher
ID
344145
Card Set
ch 39
Description
nursing care of pt with endocrine disorders
Updated