Chapter 51 Flashcards
The nurse is assessing a client with suspected acromegaly 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. “Are you experiencing tremors or anxiety?”
d. “Is there any family history of acromegaly?”
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.
The nurse is providing preoperative teaching for a client scheduled for a hypophysectomy for treatment of a pituitary adenoma. Which of the following instructions should the nurse include in client teaching?
a. Cough and deep breathe every 2 hours postoperatively
b. Bed rest for the first 24 hours after the surgery
c. Be positioned flat with sandbags at the head postoperatively
d. Have a NG tube after the surgery
D
The client should be taught that they will have a NG tube after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is discouraged because it may cause leakage of cerebro-spinal 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 caring for a client who has had a transsphenoidal resection of a pituitary tumour. Which of the following nursing actions should be included in the postoperative plan of care?
a. Monitor urine output every hour.
b. Palpate extremities for dependent edema.
c. Check hematocrit hourly for first 12 hours.
d. Obtain continuous pulse oximetry for 24 hours.
A
After pituitary surgery, the client is at risk for diabetes insipidus caused by cerebral edema and 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 client is at risk for dehydration, not volume overload. The client is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.
A client is suspected of having a pituitary tumour causing panhypopituitarism. During assessment of the client, which of the following findings should the nurse anticipate?
a. High blood pressure
b. Elevated blood glucose
c. Tachycardia and cardiac palpitations
d. Changes in secondary sex characteristics
: D
Changes in secondary sex characteristics 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 of the following information should the nurse include when teaching a client about use of somatropin?
a. The medication will improve vaginal dryness.
b. Inject the medication subcutaneously every day.
c. Blood glucose levels will decrease when taking the medication.
d. Stop taking the medication if swelling of the hands or feet occurs.
B
Somatropin is injected subcutaneously on a daily basis, preferably in the evening. The client will need to continue on somatropin for life. If swelling or other adverse effects occur, the health care provider should be notified. Growth hormone will increase blood glucose levels.
. A client is being treated with a medication to block the effect of antidiuretic hormone to control the symptoms of syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings indicates that the medication is effective?
a. Decreased peripheral edema
b. Increased weight
c. Increased urine specific gravity
d. Increased urinary output
D
Agents that block the effect of ADH on the renal tubules may be prescribed, thereby allowing more dilution of urine leading to an increased 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 is teaching a client with chronic syndrome of inappropriate antidiuretic hormone (SIADH) about long-term management. Which of the following client statements indicate that additional instruction is needed?
a. “I should weigh myself daily and report any sudden weight loss or gain.”
b. “I need to limit my fluid intake to no more than 1 L of liquids a day.”
c. “I will eat foods high in potassium because the diuretics cause potassium loss.”
d. “I need to shop for foods that are low in sodium and avoid adding salt to foods.”
D
Clients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other client statements are correct and indicate successful teaching has occurred.
The nurse is caring for a client with possible syndrome of inappropriate antidiuretic hormone (SIADH). The client is confused and reports a headache, muscle cramps, and twitching. Which of the following initial laboratory results should the nurse anticipate?
a. Elevated hematocrit
b. Decreased serum sodium
c. Increased serum chloride
d. Low urine specific gravity
B
When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the client. 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.
The nurse is caring for a client with symptoms of diabetes insipidus who has been admitted to the hospital for evaluation and treatment. Which of the following nursing diagnoses is best for this client?
a. Insomnia related to frequent waking at night to void
b. Impaired gas exchange related to fluid retention in lungs
c. Excess fluid volume related to intake greater than output
d. Risk for impaired skin integrity related to generalized edema
A
Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.
Which of the following information should the nurse include when teaching a client 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. Surgery will eventually be required to remove the thyroid gland.
d. Antithyroid medications may take several weeks to have an effect.
D
Medications used to block the synthesis of thyroid hormones may take several weeks before an 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 few hours after returning to the surgical nursing unit, a client who has undergone a subtotal thyroidectomy develops laryngeal stridor and a cramp in the right hand. Which of the following actions should the nurse anticipate implementing first?
a. Infuse IV calcium gluconate.
b. Suction the client’s airway.
c. Prepare for endotracheal intubation.
d. Assist with emergency tracheostomy.
A
The client’s 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.
The nurse is caring for a client with Graves’ disease who has exophthalmos. Which of the following actions shouldbe included in the plan of care?
a. Apply eye patches to protect the cornea from irritation.
b. Place cold packs on the eyes to relieve pain and swelling.
c. Elevate the head of the client’s bed to reduce periorbital fluid.
d. Teach the client to blink every few seconds to lubricate the cornea.
C
The client should sit upright as much as possible to promote fluid drainage from the periorbital area. With exophthalmos the client is unable to close the 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.
The nurse is caring for a client with hyperthyroidism who is being treated with radioactive iodine (RAI) at the clinic. Which of the following information should the nurse provide to the client prior to discharge?
a. Symptoms of hyperthyroidism should be relieved in about a week.
b. Hypothyroidism may occur as the RAI therapy takes effect.
c. Discontinue the antithyroid medications taken before the radioactive therapy.
d. Teach radioactive precautions to use with urine, stool, and other body secretions.
B
There is a high incidence of postradiation hypothyroidism after RAI, and the client should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum effect not seen for 2–3 months, and the client 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.
The nurse is caring for an older-adult client who is diagnosed with hypothyroidism and has a prescription for levothyroxine. Which of the following assessments is most important for the nurse to make during initiation of thyroid replacement?
a. Apical pulse rate
b. Nutritional intake
c. Intake and output
d. Orientation and alertness
A
In older clients, 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 will not result in potentially life-threatening complications.
The nurse is caring for a client in a long-term care facility who has these medications prescribed. After the client is diagnosed with hypothyroidism, which of the following medications should the nurse report to the health care provider?
a. Docusate
b. Diazepam
c. Ibuprofen
d. Cefoxitin
B
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 be given safely to the client.
The nurse is planning teaching for a client who was admitted with myxedema coma and diagnosed with hypothyroidism. Which of the following strategies isbest for the nurse to use?
a. Delay teaching until client discharge.
b. Ensure privacy by asking visitors to leave.
c. Provide written handouts of all information.
d. Offer multiple options for management of therapies.
C
Written instructions will be helpful to the client because initially the hypothyroid client may be unable to remember to take medications and other aspects of self-care. Since 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 client is likely to forget some aspects of the treatment plan. A simpler regimen will be easier to understand until the client is euthyroid.
The nurse is caring for a client with primary hyperparathyroidism who has a serum calcium level of 3.5 mmol/L and a phosphorus of 0.55 mmol/L. Which of the following nursing actions should the nurse include in the plan of care?
a. Institute routine seizure precautions.
b. Monitor for positive Chvostek’s sign.
c. Encourage the client to remain on bed rest.
d. Encourage 3 000–4 000 mL of oral fluids daily.
D
The client 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 clients. The client should engage in weight-bearing exercise to decrease calcium loss from bone.
The nurse is caring for a client following a parathyroidectomy who develops tingling of the lips and a positive Trousseau’s sign. Which of the following actions should the nurse take first?
a. Administer the ordered muscle relaxant.
b. Give the ordered oral calcium supplement.
c. Start the PRN oxygen at 2 L/minute per cannula.
d. Have the client rebreathe using a paper bag.
D
The client’s symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the client 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 client 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.
The nurse is caring for a client who had radical neck surgery and develops hypoparathyroidism. Which of the following information should the nurse should include in the teaching plan?
a. Use of bisphosphonates to reduce bone demineralization.
b. Include whole grains in the diet to prevent constipation.
c. Take calcium supplementation to normalize serum calcium levels.
d. Ensure a high fluid intake to decrease risk for nephrolithiasis.
C
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 levels further by preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of hypoparathyroidism and low calcium levels.
Which of the following findings for a client who takes levothyroxine to treat hypothyroidism indicates that the nurse should contact the health care provider before administering the medication?
a. Increased thyroxine (T4) level
b. Blood pressure 102/62 mm Hg
c. Distant and difficult to hear heart sounds
d. Elevated thyroid stimulating hormone level
A
An increased thyroxine level indicates the levothyroxine dose needs to be decreased. The other data are consistent with hypothyroidism and the nurse should administer the Synthroid.
The nurse is caring for a client with a diagnosis of Cushing’s syndrome. Which of the following data should the nurse anticipate finding during the admission assessment?
a. Chronically low blood pressure
b. Bronzed appearance of the skin
c. Decreased axillary and pubic hair
d. Purplish red streaks on the abdomen
D
Purplish-red striae on the abdomen are a common clinical manifestation of Cushing’s syndrome. Hypotension and bronzed-appearing skin are manifestations of Addison’s disease. Decreased axillary and pubic hair occur with androgen deficiency.
The nurse is caring for a client with Cushing’s syndrome who is admitted foran adrenalectomy. The client has a nursing diagnosis of disturbed body image related to changes in appearance caused by the effects of the disease. Which of the followinginterventionsis most helpful?
a. Reassure the client that the physical changes are very common in clients with Cushing’s syndrome.
b. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome.
c. Teach the client that most of the physical changes caused by Cushing’s syndrome will resolve after surgery.
d. Remind the client that the metabolic impact of Cushing’s syndrome is of more importance than appearance.
C
The most reassuring communication to the client is that most of the physical and emotional changes caused by the Cushing’s syndrome will resolve after hormone levels return to normal postoperatively. Reassurance that the physical changes are expected or that there are more serious physiological problems associated with Cushing’s syndrome are not therapeutic responses. The client’s physiological changes are caused by the high hormone levels, not by the client’s diet or exercise choices.
The nurse is caring for a client with acute adrenal insufficiency. Which of the following findings indicate that the prescribed therapies are effective?
a. Increasing serum sodium levels
b. Decreasing blood glucose levels
c. Decreasing serum chloride levels
d. Increasing serum potassium levels
A
Clinical manifestations of Addison’s disease include hyponatremia and an increase in sodium level indicates improvement. The other values indicate that treatment has not been effective.
The nurse is admitting a client to the hospital who is in an Addisonian crisis. Which of the following client statements support the nursing diagnosis of ineffective self-health management related to lack of knowledge about management of Addison’s disease?
a. “I double my dose of hydrocortisone on the days that I go for a run.”
b. “I frequently eat at restaurants, and so my food has a lot of added salt.”
c. “I had the stomach flu earlier this week and couldn’t take the hydrocortisone.”
d. “I take twice as much hydrocortisone in the morning as I do in the afternoon.”
C
The need for hydrocortisone replacement is increased with stressors such as illness, and the client needs to be taught to call the health care provider because medication and IV fluids and electrolytes may need to be given. The other client statements indicate appropriate management of the Addison’s disease.
