Chapter 14: Other Endocrine Problems Flashcards
The nurse is caring for a 25-year-old patient admitted to the acute care unit with an extra strong thirst, and dilute, excessive straw-colored urine output (up to 15 L/day). What does the nurse suspect?
- Type 2 diabetes
- Diabetes insipidus (DI)
- Cushing disease
- Addison disease
Ans: 2
DI is a disorder of the posterior pituitary gland in which water loss is caused by either an antidiuretic hormone (ADH) deficiency or an inability of the kidneys to respond to ADH. The result of DI is the excretion of large volumes of dilute urine because the distal kidney tubules and collecting ducts do not reabsorb water; this leads to polyuria. Dehydration from massive water loss increases plasma osmolarity, which stimulates the sensation of thirst. Thirst promotes increased fluid intake and aids in maintaining hydration. Focus: Prioritization.
The nurse is providing care for a male patient with hypogonadotropin who is receiving sex steroid replacement therapy with testosterone. Which changes indicate to the nurse that therapy is successful? Select all that apply.
- Decreased facial hair
- Increased libido
- Decreased bone size
- Increased muscle mass
- Increased axillary hair growth
- Increased breast tissue
Ans: 2, 4, 5
Therapy for gonadotropin deficiency begins with high-dose testosterone and is continued until virilization (presence of male secondary sex characteristics) is achieved, with responses that include increases in penis size, libido, muscle mass, bone size, and bone strength. Chest, facial, pubic, and axillary hair growth also increase. Patients usually report improved body image after therapy is initiated. Side effects of therapy include gynecomastia (male breast tissue development), acne, baldness, and prostate enlargement. Focus: Prioritization.
A patient is admitted to the medical unit with possible Graves disease (hyperthyroidism). Which assessment finding by the nurse supports this diagnosis?
- Periorbital edema
- Bradycardia
- Exophthalmos
- Hoarse voice
Ans: 3
Exophthalmos (abnormal protrusion of the eyes) is characteristic of patients with hyperthyroidism caused by Graves disease. Periorbital edema, bradycardia, and a hoarse voice are all characteristics of patients with hypothyroidism. Focus: Prioritization.
Which change in vital signs would the nurse instruct the unlicensed assistive personnel to report immediately for a patient with hyperthyroidism?
- Rapid heart rate
- Decreased systolic blood pressure
- Increased respiratory rate
- Decreased oral temperature
Ans: 1
The cardiac problems associated with hyperthyroidism include tachycardia, increased systolic blood pressure, and decreased diastolic blood pressure. Patients with hyperthyroidism also may have increased body temperature related to increased metabolic rate. Respiratory changes are usually not symptomatic of this condition. Focus: Delegation, Supervision.
For a patient with hyperthyroidism, which task should the nurse delegate to an experienced unlicensed assistive personnel (UAP)?
- Instructing the patient to report any occurrence of palpitations, dyspnea, vertigo, or chest pain
- Monitoring the apical pulse, blood pressure, and temperature every 4 hours
- Drawing blood to measure levels of thyroid-stimulating hormone, triiodothyronine, and thyroxine
- Teaching the patient about side effects of the drug propylthiouracil
Ans: 2
Monitoring vital signs and recording their values are within the education and scope of practice of UAPs. An experienced UAP should have been taught how to monitor the apical pulse. However, a nurse should observe the UAP to be sure that the UAP has mastered this skill. Instructing and teaching patients, as well as performing venipuncture to obtain laboratory samples, are more suited to the education and scope of practice of licensed nurses. In some facilities, an experienced UAP may perform venipuncture, but only after special training. Focus: Delegation, Supervision, Assignment.
As the shift begins, the nurse is assigned to care for the following patients.
Which patient should the nurse assess first?
1. A 38-year-old patient with Graves disease and a heart rate of 94 beats/min
2. A 63-year-old patient with type 2 diabetes and fingerstick glucose level of 137 mg/dL (7.6 mmol/L)
3. A 58-year-old patient with hypothyroidism and a heart rate of 48 beats/min
4. A 49-year-old patient with Cushing disease and dependent edema rated as +1
Ans: 3
Although patients with hypothyroidism often have cardiac problems that include bradycardia, a heart rate of 48 beats/min may have significant implications for cardiac output and hemodynamic stability. Patients with Graves disease usually have a rapid heart rate, but 94 beats/min is within normal limits. The patient with diabetes may need sliding-scale insulin dosing. This is important but not urgent. Patients with Cushing disease frequently have dependent edema. Focus: Prioritization.
A patient is hospitalized with adrenocortical insufficiency. Which nursing activity should the nurse delegate to unlicensed assistive personnel (UAP)?
- Reminding the patient to change positions slowly
- Assessing the patient for muscle weakness
- Teaching the patient how to collect a 24-hour urine sample
- Revising the patient’s nursing plan of care
Ans: 1
Patients with hypofunction of the adrenal gland often have hypotension and should be instructed to change positions slowly. After a patient has been so instructed, it is appropriate for the UAP to remind the patient of the instructions. Assessing, teaching, and planning nursing care require more education and should be done by licensed nurses. Focus: Delegation, Supervision.
Assessment findings for a patient with Cushing disease include all of the following. For which finding would the nurse notify the health care provider (HCP) immediately?
- Purple striae present on the abdomen and thighs
- Weight gain of 1 lb (0.5 kg) since the previous day
- Dependent edema rated as + 1 in the ankles and calves 4. Crackles bilaterally in the lower lobes of the lungs
Ans: 4
The presence of crackles in the patient’s lungs indicates excess fluid volume caused by excess water and sodium reabsorption and may be a symptom of pulmonary edema, which must be treated rapidly. Striae (stretch marks), weight gain, and dependent edema are common findings in patients with Cushing disease. These findings should be monitored but do not require urgent action. Focus: Prioritization; Test Taking Tip: Findings that the nurse should immediately report to the HCP are those that can indicate a worsening of the patient’s condition that must be treated to prevent further worsening or threat to life.
The nurse is preparing to discharge a patient with hyperpituitarism caused by a benign pituitary tumor, who is prescribed the drug bromocriptine. Which key points would the nurse teach the patient about this drug? Select all that apply.
- Take this drug with a meal or snack to avoid gastrointestinal (GI) symptoms.
- Side effects of bromocriptine include severe fatigue and reflux after meals.
- Seek medical care if you experience chest pain or dizziness while taking this drug.
- If the drug causes headaches, you can take over-the-counter acetaminophen.
- Treatment starts with a high dose, which is gradually lowered.
- The purpose of bromocriptine is to shrink your pituitary to normal size.
Ans: 1, 3, 4, 6
Bromocriptine is a dopamine agonist drug that stimulates dopamine receptors in the brain and inhibits the release of growth hormone and prolactin. In most cases, small tumors decrease until the pituitary gland is of normal size. Side effects of bromocriptine include orthostatic (postural) hypotension, headaches, nausea, abdominal cramps, and constipation. Give bromocriptine with a meal or a snack to reduce GI side effects. Treatment starts with a low dose and is gradually increased until the desired level is reached. Patients taking bromocriptine should be taught to seek medical care immediately if chest pain, dizziness, or watery nasal discharge occurs because of the possibility of serious side effects, including cardiac dysrhythmias, coronary artery spasms, and cerebrospinal fluid leakage. Also, if the patient is a female of childbearing age who becomes pregnant, the drug should be stopped. Focus: Prioritization.
A patient with pheochromocytoma underwent surgery to remove his adrenal glands. Which nursing intervention should the nurse delegate to an unlicensed assistive personnel (UAP)?
- Revising the nursing care plan to include strategies to provide a calm and restful environment postoperatively
- Instructing the patient to avoid smoking and drinking caffeine-containing beverages
- Assessing the patient’s skin and mucous membranes for signs of adequate hydration
- Monitoring lying and standing blood pressure every 4 hours with a cuff placed on the same arm
Ans: 4
Monitoring vital signs is within the education and scope of practice for UAPs. The nurse should be sure to instruct the UAP that blood pressure measurements are to be taken with the cuff on the same arm each time and instructed to record and inform the RN of the results. Revising the care plan and instructing and assessing patients are beyond the scope of UAPs and fall within the purview of licensed nurses. Focus: Delegation, Supervision.
The LPN/LVN is assigned to provide care for a patient with pheochromocytoma. Which physical assessment technique should the RN instruct the LPN/LVN to avoid?
- Listening for abdominal bowel sounds in all four quadrants
- Palpating the abdomen in all four quadrants
- Checking the blood pressure every hour
- Assessing the mucous membranes for hydration status
Ans: 2
Palpating the abdomen can cause the sudden release of catecholamines and severe hypertension. All of the other assessments are appropriate for the LPN/LVN assigned to care for this patient. Focus: Assignment, Supervision.
A patient with adrenal insufficiency is to be discharged and will take prednisone 10 mg orally each day. Which instruction would the nurse be sure to teach the patient?
- Excessive weight gain or swelling should be reported to the health care provider.
- Changing positions rapidly may cause hypotension and dizziness.
- A diet with foods low in sodium may be beneficial to prevent side effects.
- Signs of hypoglycemia may occur while taking this drug.
Ans: 1
Rapid weight gain and edema are signs of excessive drug therapy, and the dosage of the drug would need to be adjusted. Hypertension, hyponatremia, hyperkalemia, and hyperglycemia are common in patients with adrenal hypofunction. Focus: Prioritization.
The nurse is caring for a patient who has just undergone hypophysectomy for hyperpituitarism. Which postoperative finding requires immediate intervention?
- Presence of glucose in the nasal drainage
- Presence of nasal packing in the nares
- Urine output of 40 to 50 mL/hr
- Patient reports of thirst
Ans: 1
The presence of glucose in nasal drainage indicates that the fluid is cerebrospinal fluid (CSF) and suggests a CSF leak. Packing is normally inserted in the nares after the surgical incision is closed. Urine output of 40 to 50 mL/hr is adequate, and patients may experience thirst postoperatively. When patients are thirsty, nursing staff should encourage fluid intake. Focus: Prioritization.
Which patient should the charge nurse assign to the care of an LPN/LVN, under the supervision of the RN team leader?
- A 51-year-old patient who has just undergone bilateral adrenalectomy
- A 83-year-old patient with type 2 diabetes and chronic obstructive pulmonary disease
- A 38-year-old patient with myocardial infarction preparing for discharge
- A 72-year-old patient with mental status changes admitted from a long- term care facility
Ans: 2
The 83-year-old has no complicating factors at the moment. Providing care for patients in stable and uncomplicated condition falls within the LPN/LVN’s educational preparation and scope of practice, with the care always being provided under the supervision and direction of an RN. The RN should assess the patient who has just undergone surgery and the newly admitted patient. The patient who is preparing for discharge after myocardial infarction may need some complex teaching. Focus: Assignment, Supervision.
The nurse is providing care for a patient who underwent thyroidectomy 2 days ago. Which laboratory value requires close monitoring by the nurse?
- Calcium level
- Sodium level
- Potassium level
- White blood cell count
Ans: 1
The parathyroid glands are located on the back of the thyroid gland. The parathyroids are important in maintaining calcium and phosphorus balance. The nurse should be attentive to all patient laboratory values, but calcium and phosphorus levels are especially important to monitor after thyroidectomy because abnormal values could be the result of removal of the parathyroid glands during the procedure. Focus: Prioritization.