Endocrine System

Question 1

The nurse determines that demeclocycline (Declomycin) is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patient’s:
weight has increased.
urinary output is increased.
peripheral edema is decreased.
urine specific gravity is increased.

Answer 1

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.

Question 2

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?
“I need to shop for foods low in sodium and avoid adding salt to food.”
“I should weigh myself daily and report any sudden weight loss or gain.”
“I need to limit my fluid intake to no more than 1 quart of liquids a day.”
“I will eat foods high in potassium because diuretics cause potassium loss.”

Answer 2

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.

Question 3

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):
elevated hematocrit.
decreased serum sodium.
low urine specific gravity.
increased serum chloride.

Answer 3

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.

Question 4

An expected nursing diagnosis for a 30-year-old patient admitted to the hospital with symptoms of diabetes insipidus is:
excess fluid volume related to intake greater than output.
impaired gas exchange related to fluid retention in lungs.
sleep pattern disturbance related to frequent waking to void.
risk for impaired skin integrity related to generalized edema.

Answer 4

ANS: C
Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.

Question 5

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?
Suction the patient’s airway.
Administer IV calcium gluconate.
Plan for emergency tracheostomy.
Prepare for endotracheal intubation.

Answer 5

ANS: B
The patient’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.

Question 6

Which information will the nurse teach a 48-year-old patient who has been newly diagnosed with Graves’ disease?
Exercise is contraindicated to avoid increasing metabolic rate.
Restriction of iodine intake is needed to reduce thyroid activity.
Antithyroid medications may take several months for full effect.
Surgery will eventually be required to remove the thyroid gland.

Answer 6

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

Question 7

12. Which nursing action will be included in the plan of care for a 55-year-old patient with Graves’ disease who has exophthalmos?
    Place cold packs on the eyes to relieve pain and swelling.
    Elevate the head of the patient’s bed to reduce periorbital fluid.
    Apply alternating eye patches to protect the corneas from irritation.
    Teach the patient to blink every few seconds to lubricate the corneas.

Answer 7

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.

Question 8

A 62-year-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient:
about radioactive precautions to take with all body secretions.
that symptoms of hyperthyroidism should be relieved in about a week.
that symptoms of hypothyroidism may occur as the RAI therapy takes effect.
to discontinue the antithyroid medications taken before the radioactive therapy.

Answer 8

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.

Question 9

Which nursing assessment of a 69-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)?
Fluid balance
Apical pulse rate
Nutritional intake
Orientation and alertness

Answer 9

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

Question 10

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:
docusate (Colace).
ibuprofen (Motrin).
diazepam (Valium). 
cefoxitin (Mefoxin).

Answer 10

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.

Question 11

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?
Provide written reminders of self-care information.
Offer multiple options for management of therapies.
Ensure privacy for teaching by asking visitors to leave.
Delay teaching until patient discharge date is confirmed.

Answer 11

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.

Question 12

Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)?
Increased thyroxine (T4) level
Blood pressure 112/62 mm Hg
Distant and difficult to hear heart sounds Elevated thyroid stimulating hormone level

Answer 12

ANS: 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 levothyroxine

Question 13

Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency?
Increasing serum sodium levels 
Decreasing blood glucose levels 
Decreasing serum chloride levels 
Increasing serum potassium levels

Answer 13

ANS: 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.

Question 14

A 38-year-old male patient is admitted to the hospital in Addisonian crisis. Which patient statement supports a nursing diagnosis of ineffective self-health management related to lack of knowledge about management of Addison’s disease?
“I frequently eat at restaurants, and my food has a lot of added salt.”
“I had the stomach flu earlier this week, so I couldn’t take the hydrocortisone.”
“I always double my dose of hydrocortisone on the days that I go for a long run.”
“I take twice as much hydrocortisone in the morning dose as I do in the afternoon.”

Answer 14

ANS: B
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.

Question 15

A 29-year-old woman with systemic lupus erythematosus has been prescribed 2 weeks of high-dose prednisone therapy. Which information about the prednisone is most important for the nurse to include?
“Weigh yourself daily to monitor for weight gain caused by increased appetite.”
“A weight-bearing exercise program will help minimize the risk for osteoporosis.”
“The prednisone dose should be decreased gradually rather than stopped suddenly.”
“Call the health care provider if you experience mood alterations with the prednisone.”

Answer 15

ANS: C
Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped. Mood alterations and weight gain are possible adverse effects of corticosteroid use, but these are not life-threatening effects. Osteoporosis occurs when patients take corticosteroids for longer periods.

Question 16

The nurse will plan to monitor a patient diagnosed with a pheochromocytoma for:
flushing.
headache. 
bradycardia. 
hypoglycemia.

Answer 16

ANS: B
The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia, severe headache, diaphoresis, and abdominal or chest pain. Elevated blood glucose may also occur because of sympathetic nervous system stimulation. Bradycardia and flushing would not be expected.

Question 17

Which intervention will the nurse include in the plan of care for a 52-year-old male patient with syndrome of inappropriate antidiuretic hormone (SIADH)?
Monitor for peripheral edema.
Offer patient hard candies to suck on.
Encourage fluids to 2 to 3 liters per day.
Keep head of bed elevated to 30 degrees.

Answer 17

ANS: B
Sucking on hard candies decreases thirst for a patient on fluid restriction. Patients with SIADH are on fluid restrictions of 800 to 1000 mL/day. Peripheral edema is not seen with SIADH. The head of the bed is elevated no more than 10 degrees to increase left atrial filling pressure and decrease antidiuretic hormone (ADH) release.

Question 18

The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is most important to report to the health care provider?
The patient is confused and lethargic.
The patient reports a recent head injury.
The patient has a urine output of 400 mL/hr.
The patient’s urine specific gravity is 1.003.

Answer 18

ANS: A
The patient’s confusion and lethargy may indicate hypernatremia and should be addressed quickly. In addition, patients with DI 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 diabetes insipidus, but they do not require immediate nursing action to avoid life-threatening complications.

Question 19

Which prescribed medication should the nurse administer first to a 60-year-old patient admitted to the emergency department in thyroid storm?
Propranolol (Inderal)
Propylthiouracil (PTU) 
Methimazole (Tapazole) 
Iodine (Lugol’s solution)

Answer 19

ANS: A
B -Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days
to weeks to have an impact on thyroid function.

Question 20

Which assessment finding for a 33-year-old female patient admitted with Graves’ disease requires the most rapid intervention by the nurse?
Bilateral exophthalmos
Heart rate 136 beats/minute 
Temperature 103.8° F (40.4° C) 
Blood pressure 166/100 mm Hg

Answer 20

ANS: C
The patient’s temperature indicates that the patient may have thyrotoxic crisis and that interventions to lower the temperature are
needed immediately. The other findings also require intervention but do not indicate potentially life-threatening complications.

Question 21

A 23-year- old patient is admitted with diabetes insipidus. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?
Titrate the infusion of 5% dextrose in water.
Teach the patient how to use desmopressin (DDAVP) nasal spray.
Assess the patient’s hydration status every 8 hours.
Administer subcutaneous DDAVP.

Answer 21

ANS: D
Administration of medications is included in LPN/LVN education and scope of practice. Assessments, patient teaching, and titrating fluid infusions are more complex skills and should be done by the RN.

Question 22

Which information is most important for the nurse to communicate rapidly to the health care provider about a patient admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH)?
The patient has a recent weight gain of 9 lb.
The patient complains of dyspnea with activity.
The patient has a urine specific gravity of 1.025.
The patient has a serum sodium level of 118 mEq/L.

Answer 22

ANS: D
A serum sodium of less than 120 mEq/L increases the risk for complications such as seizures and needs rapid correction. The other data are not unusual for a patient with SIADH and do not indicate the need for rapid action.

Question 23

After receiving change-of-shift report about the following four patients, which patient should the nurse assess first?
A 31-year-old female with Cushing syndrome and a blood glucose level of 244 mg/dL
A 70-year-old female taking levothyroxine (Synthroid) who has an irregular pulse of 134.
A 53-year-old male who has Addison’s disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef).
A 22-year-old male admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L

Answer 23

ANS: B
Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The patient’s high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for life-threatening complications.

Question 24

Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone (Deltasone) 40 mg daily for 3 weeks is most important to report to the health care provider?
Patient’s blood pressure is 148/94 mm Hg.
Patient has bilateral 2+ pitting ankle edema.
Patient stopped taking the medication 2 days ago. Patient has not been taking the prescribed vitamin D.

Answer 24

ANS: C
Sudden cessation of corticosteroids after taking the medication for a week or more can lead to adrenal insufficiency, with problems such as severe hypotension and hypoglycemia. The patient will need immediate evaluation by the health care provider to prevent and/or treat adrenal insufficiency. The other information will also be reported, but does not require rapid treatment.

Question 25

The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first?
Patient with Hashimoto’s thyroiditis and a heart rate of 102.
Patient with tetany who has a new order for IV calcium chloride.
Patient with Cushing syndrome and a blood glucose of 140 mg/dL.
Patient with Addison’s disease who takes hydrocortisone twice daily.

Answer 25

ANS: B
Emergency treatment of tetany requires IV administration of calcium; ECG monitoring will be required because cardiac arrest may occur if high calcium levels result from too-rapid administration. The information about the other patients indicates that they are more stable than the patient with tetany.

Question 26

After obtaining the information shown in the accompanying figure regarding a patient with Addison’s disease, which prescribed action will the nurse take first?
Give 4 oz of fruit juice orally. 
Recheck the blood glucose level. 
Infuse 5% dextrose and 0.9% saline. 
Administer oxygen therapy as needed.

Answer 26

ANS: C
The patient’s poor skin turgor, hypotension, and hyponatremia indicate an Addisonian crisis. Immediate correction of the hypovolemia and hyponatremia is needed. The other actions may also be needed but are not the initial action for the patient.

Question 27

A patient is to receive methylprednisolone (Solu-Medrol) 100 mg. The label on the medication states: methylprednisolone 125 mg in 2 mL. How many milliliters will the nurse administer?

Answer 27

ANS: 1.6

A concentration of 125 mg in 2 mL will result in 100 mg in 1.6 mL.