Chapter 50: Nursing Management: Endocrine Problems Flashcards
- A 45-year-old male patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask?
a.
Have you had a recent head injury?
b.
Do you have to wear larger shoes now?
c.
Is there a family history of acromegaly?
d.
Are you experiencing tremors or anxiety?
ANS: B
Acromegaly causes an enlargement of the hands and feet. Head injury and family history are not risk factors for acromegaly. Tremors and anxiety are not clinical manifestations of acromegaly.
- A 42-year-old female patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. During preoperative teaching, the nurse instructs the patient about the need to
a.
cough and deep breathe every 2 hours postoperatively.
b.
remain on bed rest for the first 48 hours after the surgery.
c.
avoid brushing teeth for at least 10 days after the surgery.
d.
be positioned flat with sandbags at the head postoperatively.
ANS: C
To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is discouraged because it may cause leakage of cerebrospinal fluid (CSF) from the suture line. The head of the bed should be elevated 30 degrees to reduce pressure on the sella turcica and decrease the risk for headaches.
- The nurse is planning postoperative care for a patient who is being admitted to the surgical unit form the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action should be included?
a.
Palpate extremities for edema.
b.
Measure urine volume every hour.
c.
Check hematocrit every 2 hours for 8 hours.
d.
Monitor continuous pulse oximetry for 24 hours.
ANS: B
After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema. Monitoring of urine output and urine specific gravity is essential. Hemorrhage is not a common problem. There is no need to check the hematocrit hourly. The patient is at risk for dehydration, not volume overload. The patient is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.
- The nurse is assessing a 41-year-old African American male patient diagnosed with a pituitary tumor causing panhypopituitarism. Assessment findings consistent with panhypopituitarism include
a.
high blood pressure.
b.
decreased facial hair.
c.
elevated blood glucose.
d.
tachycardia and cardiac palpitations.
ANS: B
Changes in male secondary sex characteristics such as decreased facial hair, testicular atrophy, diminished spermatogenesis, loss of libido, impotence, and decreased muscle mass are associated with decreases in follicle stimulating hormone (FSH) and luteinizing hormone (LH). Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is likely due to the decrease in thyroid stimulating hormone (TSH) and thyroid hormones associated with panhypopituitarism.
- Which information will the nurse include when teaching a 50-year-old male patient about somatropin (Genotropin)?
a.
The medication will be needed for 3 to 6 months.
b.
Inject the medication subcutaneously every day.
c.
Blood glucose levels may decrease when taking the medication.
d.
Stop taking the medication if swelling of the hands or feet occurs.
ANS: B
Somatropin is injected subcutaneously on a daily basis, preferably in the evening. The patient will need to continue on somatropin for life. If swelling or other common adverse effects occur, the health care provider should be notified. Growth hormone will increase blood glucose levels.
- The nurse determines that demeclocycline (Declomycin) is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patients
a.
weight has increased.
b.
urinary output is increased.
c.
peripheral edema is decreased.
d.
urine specific gravity is increased.
ANS: B
Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and increases urine output. An increase in weight or an increase in urine specific gravity indicates that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a common clinical manifestation of this disorder.
- The nurse determines that additional instruction is needed for a 60-year-old patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient says which of the following?
a.
I need to shop for foods low in sodium and avoid adding salt to food.
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 diuretics cause potassium loss.
ANS: A
Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred.
- A 56-year-old patient who is disoriented and reports a headache and muscle cramps is hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The nurse would expect the initial laboratory results to include a(n)
a.
elevated hematocrit.
b.
decreased serum sodium.
c.
low urine specific gravity.
d.
increased serum chloride.
ANS: B
When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient. The hematocrit will decrease because of the dilution caused by water retention. Urine will be more concentrated with a higher specific gravity. The serum chloride level will usually decrease along with the sodium level.
- An expected nursing diagnosis for a 30-year-old patient admitted to the hospital with symptoms of diabetes insipidus is
a.
excess fluid volume related to intake greater than output.
b.
impaired gas exchange related to fluid retention in lungs.
c.
sleep pattern disturbance related to frequent waking to void.
d.
risk for impaired skin integrity related to generalized edema.
ANS: C
Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.
- Which information will the nurse teach a 48-year-old patient who has been newly diagnosed with Graves disease?
a.
Exercise is contraindicated to avoid increasing metabolic rate.
b.
Restriction of iodine intake is needed to reduce thyroid activity.
c.
Antithyroid medications may take several months for full effect.
d.
Surgery will eventually be required to remove the thyroid gland.
ANS: C
Medications used to block the synthesis of thyroid hormones may take 2 to 3 months before the full effect is seen. Large doses of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large muscle groups is encouraged to decrease the irritability and hyperactivity associated with high levels of thyroid hormones. Radioactive iodine is the most common treatment for Graves disease although surgery may be used.
- A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next?
a.
Suction the patients airway.
b.
Administer IV calcium gluconate.
c.
Plan for emergency tracheostomy.
d.
Prepare for endotracheal intubation.
ANS: B
The patients clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Endotracheal intubation or tracheostomy may be needed if the calcium does not resolve the stridor. Suctioning will not correct the stridor.
- Which nursing action will be included in the plan of care for a 55-year-old patient with Graves disease who has exophthalmos?
a.
Place cold packs on the eyes to relieve pain and swelling.
b.
Elevate the head of the patients bed to reduce periorbital fluid.
c.
Apply alternating eye patches to protect the corneas from irritation.
d.
Teach the patient to blink every few seconds to lubricate the corneas.
ANS: B
The patient should sit upright as much as possible to promote fluid drainage from the periorbital area. With exophthalmos, the patient is unable to close the eyes completely to blink. Lubrication of the eyes, rather than eye patches, will protect the eyes from developing corneal scarring. The swelling of the eye is not caused by excessive blood flow to the eye, so cold packs will not be helpful.
- A 62-year-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient
a.
about radioactive precautions to take with all body secretions.
b.
that symptoms of hyperthyroidism should be relieved in about a week.
c.
that symptoms of hypothyroidism may occur as the RAI therapy takes effect.
d.
to discontinue the antithyroid medications taken before the radioactive therapy.
ANS: C
There is a high incidence of postradiation hypothyroidism after RAI, and the patient should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum effect not seen for 2 to 3 months, and the patient will continue to take antithyroid medications during this time. The therapeutic dose of radioactive iodine is low enough that no radiation safety precautions are needed.
- Which nursing assessment of a 69-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)?
a.
Fluid balance
b.
Apical pulse rate
c.
Nutritional intake
d.
Orientation and alertness
ANS: B
In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication also is expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes will not result in potentially life-threatening complications.
- An 82-year-old patient in a long-term care facility has several medications prescribed. After the patient is newly diagnosed with hypothyroidism, the nurse will need to consult with the health care provider before administering
a.
docusate (Colace).
b.
ibuprofen (Motrin).
c.
diazepam (Valium).
d.
cefoxitin (Mefoxin).
ANS: C
Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older adults. The nurse should discuss the use of diazepam with the health care provider before administration. The other medications may be given safely to the patient.
- A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving and expected to be discharged in 2 days. Which teaching strategy will be best for the nurse to use?
a.
Provide written reminders of self-care information.
b.
Offer multiple options for management of therapies.
c.
Ensure privacy for teaching by asking visitors to leave.
d.
Delay teaching until patient discharge date is confirmed.
ANS: A
Written instructions will be helpful to the patient because initially the hypothyroid patient may be unable to remember to take medications and other aspects of self-care. Because the treatment regimen is somewhat complex, teaching should be initiated well before discharge. Family members or friends should be included in teaching because the hypothyroid patient is likely to forget some aspects of the treatment plan. A simpler regimen will be easier to understand until the patient is euthyroid.
- A 63-year-old patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should be included in the plan of care?
a.
Restrict the patient to bed rest.
b.
Encourage 4000 mL of fluids daily.
c.
Institute routine seizure precautions.
d.
Assess for positive Chvosteks sign.
ANS: B
The patient with hypercalcemia is at risk for kidney stones, which may be prevented by a high fluid intake. Seizure precautions and monitoring for Chvosteks or Trousseaus sign are appropriate for hypocalcemic patients. The patient should engage in weight-bearing exercise to decrease calcium loss from bone.
- A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action should the nurse take first?
a.
Administer the ordered muscle relaxant.
b.
Give the ordered oral calcium supplement.
c.
Have the patient rebreathe from a paper bag.
d.
Start the PRN oxygen at 2 L/min per cannula.
ANS: C
The patients symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the patient breathe into a paper bag, which will raise the PaCO2 and create a more acidic pH. The muscle relaxant will have no impact on the ionized calcium level. Although severe hypocalcemia can cause laryngeal stridor, there is no indication that this patient is experiencing laryngeal stridor or needs oxygen. Calcium supplements will be given to normalize calcium levels quickly, but oral supplements will take time to be absorbed.
