Lewis 4th Ed: Ch 51 - Endocrine Problems 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 shows now?”
c. “Are you experiencing tremors or anxiety?”
d. “Is there any family hx of acromegaly?”
b. “Do you have to wear larger shows now?”
Acromegaly causes enlargement of the hands and feet. Head injury and family hx are not risk factors. Tremors and anxiety are not clinical manifestations.
How Does Acromegaly Cause Enlargement of Hands and Feet?
Acromegaly is caused by excess growth hormone (GH) secretion, usually due to a pituitary adenoma (benign tumor). GH stimulates the liver to produce insulin-like growth factor-1 (IGF-1), which promotes bone and soft tissue growth.
How It Causes Enlargement:
1. Increased Bone Growth (After Epiphyseal Plate Closure)
• Unlike gigantism, which occurs in children before growth plates close, acromegaly affects adults after puberty.
• Long bones no longer grow in length, but bones of the hands, feet, face, and jaw thicken due to periosteal bone growth.
2. Soft Tissue Overgrowth
• Cartilage, ligaments, and tendons thicken, causing:
• Larger hands and feet (patients may notice their shoe or ring size increasing).
• Thickened facial features (frontal bossing, enlarged nose, jaw protrusion).
• Deepened voice from vocal cord thickening.
• Enlarged tongue (macroglossia), contributing to sleep apnea.
3. Joint & Nerve Compression
• Soft tissue swelling can cause:
• Carpal tunnel syndrome (leading to hand numbness/tingling).
• Arthropathy (joint pain and stiffness from cartilage overgrowth).
Key Clinical Signs of Acromegaly:
✔ Enlarged hands, feet, and facial features
✔ Widened jaw and teeth spacing (mandibular overgrowth)
✔ Thick, oily skin
✔ Sweating and headaches (due to tumor compression)
✔ Hypertension and diabetes (GH antagonizes insulin
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 breath every 2 hours postoperatively
b. Bed rest for the first 24 hours after surgery
c. Be positioned flat with sandbags at the head postoperatively
d. Have a nasogastric (NG) tube after surgery.
d. Have a NG tube after surgery.
What is a Hypophysectomy?
A hypophysectomy is a surgical procedure to remove the pituitary gland, which is located at the base of the brain. This surgery is typically performed to treat pituitary adenomas (tumors), Cushing’s disease, acromegaly, or other conditions affecting hormone regulation.
The most common approach is the transsphenoidal route, where the surgeon accesses the pituitary gland through the nose and sphenoid sinus. Less commonly, a craniotomy (opening the skull) may be needed for larger tumors.
Why is “d. Have a NG tube after surgery” the correct answer?
A nasogastric (NG) tube is often placed postoperatively for patients undergoing a hypophysectomy for the following reasons:
1. Prevents Increased Intracranial Pressure (ICP)
• Straining during vomiting or swallowing can increase ICP, which is dangerous after pituitary surgery.
• An NG tube helps decompress the stomach, preventing nausea and vomiting.
2. Minimizes Pressure on the Surgical Site
• The pituitary gland is near critical brain structures, including the optic nerves and hypothalamus.
• Avoiding unnecessary pressure (e.g., from vomiting) prevents disrupting the surgical site.
3. Reduces the Risk of Cerebrospinal Fluid (CSF) Leaks
• A common complication of a hypophysectomy is a CSF leak, where spinal fluid escapes from the nose.
• NG tube placement reduces excessive swallowing, which can increase CSF drainage and delay healing.
4. Prepares for Postoperative Nasal Packing
• The patient will likely have nasal packing to control bleeding.
• The NG tube allows for easier stomach decompression without disturbing the nasal packing.
Why Are the Other Options Incorrect?
• (a) Cough and deep breath every 2 hours postoperatively → Incorrect
• Deep breathing is encouraged, but forceful coughing is avoided to prevent ICP elevation.
• (b) Bed rest for the first 24 hours after surgery → Incorrect
• Patients do not need strict bed rest; they are usually encouraged to be in semi-Fowler’s position to promote drainage and healing.
• (c) Be positioned flat with sandbags at the head postoperatively → Incorrect
• Flat positioning increases ICP and risk of CSF leaks. Instead, patients are kept in a semi-upright position (30–45 degrees).
Final Answer:
✅ (d) Have a NG tube after surgery
• Helps prevent vomiting & ICP increase.
• Reduces risk of CSF leaks.
• Minimizes swallowing strain on the surgical site.
• Supports post-op nasal packing and recovery.
Thus, preoperative teaching should include informing the patient that an NG tube will be in place after the surgery.
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. Monitor urine output every hour
Why is “Monitor urine output every hour” the correct answer?
After a transsphenoidal resection of a pituitary tumor, the patient is at high risk for developing diabetes insipidus (DI) due to damage or manipulation of the posterior pituitary gland, which produces antidiuretic hormone (ADH, vasopressin).
How Does This Lead to DI?
• If ADH secretion is impaired, the kidneys cannot retain water, leading to:
• Excessive urine output (polyuria, >200 mL/hr)
• Severe dehydration
• Hypernatremia (due to water loss)
• Low urine specific gravity (dilute urine, <1.005)
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 BP
b. Elevated blood glucose
c. Tachycardia and cardiac palpitations
d. Changes in secondary sex characteristics
d. Changes in secondary sex characteristics
Changes in secondary sex characteristics are associated with decreases in follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
Panhypopituitarism & Pituitary Tumors
Panhypopituitarism is a condition in which the pituitary gland fails to produce most or all of its hormones, often due to a pituitary tumor that compresses the gland and disrupts hormone production.
Why is the correct answer “d. Changes in secondary sex characteristics”?
• FSH (Follicle-Stimulating Hormone) and LH (Luteinizing Hormone) are produced by the anterior pituitary and regulate sex hormone production.
• If these hormones are deficient, the person may experience loss of secondary sex characteristics such as:
• Men: Decreased facial/body hair, testicular atrophy, erectile dysfunction, infertility.
• Women: Irregular or absent menstruation, breast atrophy, decreased libido.
• This occurs because low FSH and LH result in low estrogen or testosterone.
Why Not the Other Options?
1. a. High BP (Hypertension)
• Incorrect because hypopituitarism usually leads to low blood pressure due to a lack of ACTH, which reduces cortisol and aldosterone production.
• Low aldosterone → Sodium & water loss → Hypotension.
2. b. Elevated Blood Glucose
• Incorrect because ACTH deficiency causes low cortisol, which actually results in hypoglycemia (low blood sugar), not hyperglycemia.
• Cortisol is needed for gluconeogenesis (glucose production).
3. c. Tachycardia and Cardiac Palpitations
• Incorrect because low TSH (thyroid-stimulating hormone) leads to hypothyroidism, which causes bradycardia (slow heart rate), not tachycardia.
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 SQ 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. Inject the medication SQ every day.
The correct answer, “Inject the medication SQ every day,” is chosen because somatropin is a recombinant human growth hormone that must be administered subcutaneously (SQ) on a daily basis to be effective. This regimen helps to mimic the natural secretion of growth hormone and ensures optimal therapeutic benefits.
Why the Other Choices Are Incorrect:
1. (a) “The medication will improve vaginal dryness.”
• Incorrect: Somatropin is not used for vaginal dryness. It is primarily indicated for growth hormone deficiency, Turner syndrome, chronic kidney disease, and muscle-wasting conditions associated with HIV.
2. (c) “Blood glucose levels will decrease when taking the medication.”
• Incorrect: Somatropin can actually increase blood glucose levels. It can cause insulin resistance, leading to hyperglycemia in some patients.
3. (d) “Stop taking the medication if swelling of the hands or feet occurs.”
• Incorrect: While swelling (peripheral edema) is a known side effect, patients should not stop the medication on their own. Instead, they should report the symptom to their healthcare provider, who may adjust the dose or monitor for other complications.
Why Daily SQ Injection Is Important:
• Mimics natural growth hormone secretion: In normal physiology, growth hormone is released in a pulsatile manner. Daily injections help sustain the necessary levels.
• Ensures effectiveness: Missing doses can reduce the benefits of treatment, particularly in children with growth hormone deficiency.
• Consistent absorption: Subcutaneous administration allows for steady absorption and distribution in the body.
Thus, b. Inject the medication SQ every day is the best educational point to include when teaching a patient about somatropin.
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. Increased urinary output
Agents that bloc the effect of DH on the renal tubules may be prescribed, thereby allowing more dilution of urine 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 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. “I need to shop for foods that are low in sodium and avoid adding salt to foods”
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.
Syndrome of Inappropriate Antidiuretic Hormone (SIADH) is a condition where the body produces excessive antidiuretic hormone (ADH), leading to water retention and dilutional hyponatremia (low sodium levels in the blood).
Key Features of SIADH:
• Excess ADH secretion → Increased water reabsorption in the kidneys
• Dilutional hyponatremia (low sodium due to excess water, not sodium loss)
• Low serum osmolality (blood is more diluted)
• High urine osmolality (concentrated urine due to water retention)
• Low urine output despite normal fluid intake
• No significant peripheral edema (fluid is retained intracellularly)
Common Causes of SIADH:
• Central Nervous System (CNS) Disorders: Stroke, trauma, infections (e.g., meningitis)
• Pulmonary Conditions: Pneumonia, tuberculosis, small cell lung cancer (which can produce ectopic ADH)
• Medications: SSRIs, carbamazepine, vincristine, NSAIDs, opioids
• Post-surgical States: Common after brain surgery or pituitary procedures
Treatment & Management:
1. Fluid Restriction (typically ≤ 1 L/day)
2. Increase Sodium Intake (not restrict it, as the incorrect answer in the question suggests)
3. Diuretics (e.g., furosemide) in severe cases to promote free water excretion
4. Hypertonic Saline (3%) for severe hyponatremia to correct sodium levels safely
5. Medications: Demeclocycline (reduces kidney response to ADH), Tolvaptan (vasopressin receptor antagonist)
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. Decreased serum sodium
Why is Serum Sodium Decreased in SIADH?
In SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion):
• The body retains too much water due to excess antidiuretic hormone (ADH).
• This dilutes the blood, causing low sodium levels (dilutional hyponatremia).
• Symptoms include confusion, headache, muscle cramps, and twitching due to low sodium affecting nerve and muscle function.
Why Are the Other Answers Incorrect?
• Elevated hematocrit (a) → Incorrect; hematocrit is low due to diluted blood.
• Increased serum chloride (c) → Incorrect; chloride also decreases along with sodium.
• Low urine specific gravity (d) → Incorrect; urine is concentrated (high specific gravity) because excess ADH prevents water loss.
Key Point:
SIADH = too much water, low sodium, leading to confusion, muscle issues, and seizures if severe.
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 the lungs.
c. Excess fluid volume related to intake greater than output.
d. Risk for impaired skin integrity related to generalized edema.
a. Insomnia related to frequent waking at night to void.
Nocturia occurs as a result of the polyuria caused by diabetes insipidus.
Which of the following information should the nurse include when teaching a client who has been newly diagnosed with Grave’s 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. Antithyroid medications may take several weeks to have an effect.
A few hours after returning to the surgical 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 first?
a. Infuse IV calcium gluconate
b. Suction the client’s airway
c. Prepare for endotracheal intubation
d. Assist with emergency tracheostomy.
a. Infuse IV calcium gluconate
The correct answer is “a. Infuse IV calcium gluconate” because the patient is experiencing hypocalcemia after a subtotal thyroidectomy, which can lead to laryngeal stridor and muscle cramps due to hypocalcemic tetany.
Why Does This Happen?
• During a thyroidectomy, the parathyroid glands may be damaged or accidentally removed, leading to hypoparathyroidism.
• The parathyroid glands regulate calcium levels, and their dysfunction can cause a sudden drop in serum calcium.
• Hypocalcemia symptoms include:
• Laryngeal stridor (due to airway muscle spasms)
• Muscle cramps/twitching (e.g., Trousseau’s sign – hand spasm)
• Tingling/numbness around the mouth or extremities
• Seizures in severe cases
Why Not the Other Options?
• b. Suction the airway → Stridor is due to muscle spasms, not secretions, so suctioning won’t help.
• c. Prepare for intubation → This may be needed if calcium replacement does not resolve symptoms, but IV calcium is the first-line treatment.
• d. Emergency tracheostomy → Tracheostomy is only for severe airway obstruction, which can often be prevented by treating hypocalcemia.
Management of Post-Thyroidectomy Hypocalcemia:
• Monitor calcium levels (especially within the first 24–48 hours)
• Give IV calcium gluconate if symptomatic
• Oral calcium and vitamin D for long-term management if needed
The nurse is caring for a client with Graves disease who has exophthalmos. Which of the following actions should be 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 clients bed to reduce periorbital fluid.
d. Teach the client to blink every few seconds to lubricate the cornea.
c. Elevate the head of the clients bed to reduce periorbital fluid.
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. Hypothyroidism may occur as the RAI therapy takes effect.
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 the thyroid replacement?
a. Apical pulse rate
b. Nutritional intake
c. Intake and output
d. Orientation and alertness
a. Apical pulse rate
In older clients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias.
Why is “Apical Pulse Rate” the Most Important Assessment?
When initiating levothyroxine therapy in older adults with hypothyroidism, the apical pulse rate is the most critical assessment because:
1. Levothyroxine Increases Myocardial Oxygen Demand
• Hypothyroidism slows metabolism and heart rate.
• When thyroid hormone replacement is initiated, metabolism increases, placing more demand on the heart.
2. Risk of Angina & Dysrhythmias
• Older adults, especially those with underlying heart disease, may not tolerate the sudden increase in cardiac workload.
• This can lead to angina (chest pain), atrial fibrillation, or even myocardial infarction (heart attack).
• Apical pulse monitoring helps detect tachycardia (increased heart rate) or irregular rhythms early.
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. Diazepam
Worsening of mental status and myxedema can be precipitated by the used of sedatives especially in older adults.
The nurse is planning teaching for a client who was admitted with myxedema coma and diagnosed with hypothyroidism. Which of the following strategies is best 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. Provide written handouts of all information.
The correct answer is “c. Provide written handouts of all information.”
Why?
Clients recovering from myxedema coma (a severe form of hypothyroidism that can cause coma, respiratory failure, and cardiovascular collapse) often experience:
• Cognitive impairment: Memory problems, difficulty concentrating, and slow thinking.
• Fatigue and confusion: It may take time for mental function to fully recover.
• Slow information processing: Verbal instructions alone may not be effective.
By providing written handouts, the nurse ensures that:
1. The client has a reference to review later when they are more alert.
2. The client’s family or caregivers can assist in reinforcing the information.
3. The client does not have to rely solely on memory or verbal explanations.
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. Encourage 3 000–4 000 mL of oral fluids daily.
The normal reference ranges for calcium and phosphorus in the blood are:
• Serum Calcium: 2.2 – 2.6 mmol/L
• Serum Phosphorus: 0.81 – 1.45 mmol/L
In the scenario from your image:
• The patient’s calcium level is 3.5 mmol/L, which is high (hypercalcemia).
• The phosphorus level is 0.55 mmol/L, which is low (hypophosphatemia).
These findings are consistent with primary hyperparathyroidism, which causes increased calcium and decreased phosphorus due to excessive parathyroid hormone (PTH) secretion. Encouraging high fluid intake (3,000–4,000 mL/day) helps prevent kidney stone formation, a common complication of hypercalcemia.
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. Have the client rebreathe using a paper bag.
Explanation of the Correct Answer: Rebreathing with a Paper Bag
The client recently had a parathyroidectomy and is showing signs of hypocalcemia, as indicated by:
• Tingling of the lips
• Positive Trousseau’s sign (a classic indicator of hypocalcemia, where the hand spasms when the blood pressure cuff is inflated)
Why Does Hypocalcemia Occur After Parathyroidectomy?
• The parathyroid glands regulate calcium levels by releasing parathyroid hormone (PTH), which increases calcium in the blood.
• After parathyroidectomy (removal of one or more parathyroid glands), calcium levels can drop rapidly because the body suddenly lacks PTH, leading to hypocalcemia.
• Symptoms include muscle cramps, tetany, paresthesia (tingling), and severe cases may cause laryngospasm or seizures.
Why is Rebreathing into a Paper Bag the First Action?
• Rebreathing increases CO₂ (PaCO₂) levels in the blood.
• Increased CO₂ leads to a mild respiratory acidosis, which helps reduce symptoms of hypocalcemia by increasing ionized calcium levels (the active form of calcium).
• This provides temporary relief while a more definitive treatment, such as calcium replacement, is arranged.
Why Are the Other Options Incorrect?
• (a) Administer the ordered muscle relaxant → Incorrect
• This does not address the underlying hypocalcemia and could mask worsening symptoms, leading to respiratory complications.
• (b) Give the ordered oral calcium supplement → Not the first priority
• Oral calcium takes time to absorb, whereas rebreathing offers immediate symptom relief.
• If the hypocalcemia is severe, IV calcium gluconate would be more appropriate than oral supplements.
• (c) Start PRN oxygen at 2 L/min per nasal cannula → Not necessary
• Hypocalcemia is not an oxygenation issue; giving oxygen does not correct the problem.
• Rebreathing CO₂ is more effective in counteracting symptoms than supplemental oxygen.
Final Summary:
• Rebreathing into a paper bag temporarily increases PaCO₂, shifting calcium balance to relieve symptoms of acute hypocalcemia.
• This is a short-term intervention while definitive calcium supplementation (oral or IV) is initiated.
• If symptoms worsen (e.g., severe tetany, laryngospasm), IV calcium is needed urgently.
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. Take calcium supplementation to normalize serum calcium levels.
Explanation of the Correct Answer: Take Calcium Supplementation to Normalize Serum Calcium Levels
The patient developed hypoparathyroidism after radical neck surgery, likely due to accidental removal or damage to the parathyroid glands. This condition leads to hypocalcemia because the parathyroid glands regulate calcium levels by secreting parathyroid hormone (PTH), which increases calcium absorption and release from bones.
Why Calcium Supplementation is Necessary
• Without adequate PTH, calcium levels drop, leading to hypocalcemia.
• Symptoms of hypocalcemia include tetany, muscle cramps, tingling, Chvostek’s and Trousseau’s signs, and, in severe cases, seizures or cardiac arrhythmias.
• Calcium supplements (often with vitamin D) help maintain normal calcium levels, preventing these complications.
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 Hgc.
c. Distant and difficult to hear heart sounds
d. Elevated thyroid stimulating hormone level
a. Increased thyroxine (T4) level
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 streaks on the abdomen
Cushing’s Syndrome & Purple Striae (Stretch Marks)
Cushing’s syndrome is caused by excess cortisol (due to steroid use or adrenal/pituitary dysfunction). Key symptoms include:
• Purplish-red striae (stretch marks) on the abdomen, thighs, or breasts due to weakened skin and collagen breakdown from prolonged high cortisol.
• Moon face, buffalo hump, and central obesity from abnormal fat distribution.
• Muscle weakness, high blood pressure, osteoporosis, and delayed wound healing.
Why Are the Other Answers Incorrect?
• (a) Chronically low blood pressure → Incorrect; Cushing’s causes hypertension (high BP), not low BP.
• (b) Bronzed skin appearance → Incorrect; seen in Addison’s disease (low cortisol), not Cushing’s.
• (c) Decreased axillary/pubic hair → Incorrect; Cushing’s may cause increased hair growth (hirsutism) in women due to excess androgens.
Final Key Point:
Cushing’s syndrome = high cortisol → purple stretch marks, central obesity, muscle weakness, and hypertension.
The nurse is caring for a client with Cushing’s syndrome who is admitted for an 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 following interventions is 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. Teach the client that most of the physical changes caused by Cushing’s syndrome will resolve after surgery.
body image disturbances are a significant issue for patients with Cushing’s syndrome due to the physical changes caused by excess cortisol (e.g., moon face, buffalo hump, purple striae, weight gain).
Why is (c) the Best Answer?
• It provides reassurance that the changes are not permanent and will improve after surgery.
• Addresses the patient’s emotional concerns, which is essential for psychological well-being.
• Encourages adherence to treatment by helping the patient focus on long-term improvement.
Why Are the Other Options Less Effective?
• (a) Simply stating that changes are common does not give hope for improvement.
• (b) Diet and exercise can help, but they do not fully reverse the effects of cortisol.
• (d) Minimizing appearance concerns does not acknowledge the emotional distress caused by these changes.
Key Takeaway
For patients struggling with disturbed body image, the most helpful approach is reassurance that physical changes will improve, helping them cope with their condition and recovery process.
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. Increasing serum sodium levels
Why is Increasing Serum Sodium a Sign of Effective Treatment in Acute Adrenal Insufficiency?
Acute adrenal insufficiency (Addisonian crisis) occurs due to a deficiency of cortisol and aldosterone, leading to:
• Hyponatremia (low sodium) due to aldosterone deficiency, which normally helps retain sodium.
• Hyperkalemia (high potassium) since aldosterone also helps excrete potassium.
• Hypoglycemia (low blood sugar) due to cortisol deficiency, which normally maintains glucose levels.
Correct Answer: (a) Increasing Serum Sodium Levels
• Effective treatment (hydrocortisone & fluids) corrects sodium loss, so an increase in serum sodium means therapy is working.
Why Are the Other Options Incorrect?
• (b) Decreasing blood glucose levels → Incorrect
• Glucose is already low in Addison’s disease. Effective treatment should increase blood glucose, not decrease it.
• (c) Decreasing serum chloride levels → Incorrect
• Chloride follows sodium, so as sodium levels rise with treatment, chloride should also increase, not decrease.
• (d) Increasing serum potassium levels → Incorrect
• High potassium is a sign of adrenal insufficiency. Effective treatment should decrease potassium, not increase it.
Key Takeaway:
Rising sodium levels mean treatment is working in Addison’s disease because it indicates fluid and electrolyte balance is being restored.
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. “I had the stomach flu earlier this week and couldn’t take the hydrocortisone.”
A client with systemic lupus erythematosus has a prescription for 2 weeks of high-dose prednisone therapy. When teaching the client about the prednisone, which of the following information is most important for the nurse to include?
a. Call the doctor if you experience any mood alterations with the prednisone.
b. Do not stop taking the prednisone suddenly; it should be decreased gradually.
c. A weight-bearing exercise program will help minimize the risk for osteoporosis.
d. Weigh yourself daily to monitor for weight gain caused by water or increased fat
b. Do not stop taking the prednisone suddenly; it should be decreased gradually.
The nurse is caring for a client who has an adrenocortical adenoma and
hyperaldosteronism. Which of the following actions should the nurse implement?
a. Provide a potassium-restricted diet
b. Monitor the blood pressure every 4 hours
c. Evaluate blood glucose level every 4 hours
d. Maintain extremities in an elevated position
b. Monitor the blood pressure every 4 hours
Hypertension caused by sodium retention is a common complication of hyperaldosteronism.
Explanation of the Question
The question involves a client with an adrenocortical adenoma and hyperaldosteronism. Hyperaldosteronism is a condition where the adrenal glands produce too much aldosterone, leading to sodium retention, potassium loss, and fluid imbalance, which causes hypertension.
Why is “b. Monitor the blood pressure every 4 hours” the correct answer?
✅ Correct Answer: “b. Monitor the blood pressure every 4 hours”
• Hypertension is a key complication of hyperaldosteronism due to excessive sodium retention and increased fluid volume.
• Monitoring BP helps assess the severity of hypertension and evaluate the effectiveness of treatment, including medications such as spironolactone (a potassium-sparing diuretic) or antihypertensives.
• Frequent BP monitoring is crucial to prevent hypertensive crises, strokes, or cardiovascular complications.
The nurse is caring for a client with hypertension who is diagnosed with a pheochromocytoma. Which of the following findings should the nurse monitor in the
client?
a. Flushing
b. Headache
c. Bradycardia
d. Hypoglycemia
b. Headache
The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia,
severe pounding headache, diaphoresis, and abdominal or chest pain.
The nurse is providing discharge teaching for a client who had a hypophysectomy. Which
of the following information should the nurse include?
a. Oral corticosteroids as a lifelong treatment
b. Chemotherapy to prevent reoccurrence of the tumour.
c. Insulin use to maintain blood glucose at normal levels.
d. Sodium restriction to prevent fluid retention and hypertension.
a. Oral corticosteroids as a lifelong treatment
When developing a plan of care for a client with syndrome of inappropriate antidiuretic
hormone (SIADH), which of the following interventions should the nurse include?
a. Encourage fluids to 2 000 mL/day.
b. Offer client ice chips to suck on.
c. Monitor for increased peripheral edema.
d. Keep head of bed elevated to 30 degrees.
b. Offer client ice chips to suck on.
Sucking on ice chips or chewing sugarless gum decreases thirst for a client on fluid restriction.
Which of the following actions should the nurse take first when caring for a client who has
just arrived on the unit after a thyroidectomy?
a. Check the dressing for bleeding.
b. Assess respiratory rate and effort.
c. Take the blood pressure and pulse.
d. Support the client’s head with pillows.
b. Assess respiratory rate and effort.
Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany, and the priority nursing action is to assess the airway. The other actions are also part of the standard nursing care post-thyroidectomy but are not as
high in priority.
The nurse is caring for a client with Cushing’s syndrome who returns to the surgical unit following an adrenalectomy. Which of the following actions during the initial
postoperative period has the highest priority?
a. Monitoring for infection
b. Protecting the client’s skin
c. Maintaining fluid and electrolyte status
d. Preventing severe emotional disturbances
c. Maintaining fluid and electrolyte status
Which of the following information obtained by the nurse when caring for a client who has diabetes insipidus (DI) is most important to report to the health care provider?
a. History of a recent head injury.
b. Confusion and lethargy
c. Urine output of 400 mL/hour.
d. Urine specific gravity is 1.003.
b. Confusion and lethargy
The client’s confusion and lethargy may indicate hypernatremia and should be addressed quickly.
The nurse is admitting a client with Graves’ disease to the emergency department in thyrotoxic crisis. Which of these prescribed medications should the nurse administer first?
a. propranolol
b. propylthiouracil
c. methimazole
d. iodine
a. propranolol
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.
Which of the following assessment findings for a client admitted with Graves’ disease requires the most rapid intervention by the nurse?
a. BP 166/100 mm Hg
b. Bilateral exophthalmos
c. Heart rate 136 beats/minute
d. Temperature 40.4°C (104.7°F)
d. Temperature 40.4°C (104.7°F)
Why is a Temperature of 40.4°C (104.7°F) the Most Critical Finding?
The most urgent concern in a client with Graves’ disease (hyperthyroidism) is the risk of thyroid storm (thyrotoxic crisis), which is a life-threatening emergency.
✅ Correct Answer: d. Temperature 40.4°C (104.7°F)
• A high fever is a key sign of thyroid storm, which can quickly lead to severe hypermetabolism, multiple organ failure, and death if not treated immediately.
• Other symptoms of thyroid storm include:
• Extremely high heart rate (>140 bpm)
• Hypertension followed by hypotension (shock)
• Altered mental status (agitation, delirium, seizures, coma)
• Severe sweating and dehydration
• Rapid intervention is needed to lower body temperature, reduce thyroid hormone levels, and prevent cardiovascular collapse.
Why Are the Other Options Incorrect?
1. (a) BP 166/100 mm Hg → Incorrect
• Hypertension is common in Graves’ disease but is not immediately life-threatening.
• A hypertensive crisis (BP >180/120 mm Hg) would be more urgent, but in this case, fever is a bigger concern.
2. (b) Bilateral exophthalmos → Incorrect
• Exophthalmos (eye bulging) is a chronic symptom of Graves’ disease.
• It is not an emergency, though it can cause vision problems if severe.
3. (c) Heart rate 136 beats/minute → Incorrect
• Tachycardia is expected in hyperthyroidism, but it alone does not require the most rapid intervention.
• If it were above 140 bpm or associated with symptoms of shock or arrhythmia, it would be more concerning.
Why Is Thyroid Storm an Emergency?
• Thyroid storm has a high mortality rate if untreated.
• Immediate interventions include:
• Cooling measures (ice packs, cooling blankets, acetaminophen)
• Beta-blockers (e.g., propranolol) to control HR and BP
• Antithyroid medications (e.g., propylthiouracil or methimazole)
• IV fluids & electrolyte management
• Glucocorticoids (reduce thyroid hormone conversion)
Final Answer:
✅ “d. Temperature 40.4°C (104.7°F)” → High fever is a sign of thyroid storm, which requires the most rapid intervention.
The nurse is assessing a client who has just arrived in the postanesthesia recovery unit
(PACU) after a thyroidectomy and obtains these data. Which of the following information is most important to communicate to the surgeon?
a. The client is sleepy and hard to arouse.
b. The client has increasing swelling of the neck.
c. The client is complaining of 7/10 incisional pain.
d. The client’s cardiac monitor shows a heart rate of 112.
b. The client has increasing swelling of the neck.
The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to prevent airway obstruction. The incisional pain should be treated but is not unusual after surgery. A heart rate of 112 is not unusual in a client who has been hyperthyroid and has
just arrived in the PACU from surgery. Sleepiness in the immediate postoperative period is
expected.
The nurse is providing postoperative care for a client who had a bilateral adrenalectomy.
Which assessment information requires the most rapid action by the nurse?
a. The blood glucose is 9.8 mmol/L.
b. The lungs have bibasilar crackles.
c. The client’s BP is 88/50 mm Hg.
d. The client has 5/10 incisional pain.
c. The client’s BP is 88/50 mm Hg.
The decreased BP indicates possible adrenal insufficiency. The nurse should immediately notify the health care provider so that corticosteroid medications can be administered. The nurse should also address the elevated glucose, incisional pain, and crackles with appropriate collaborative or nursing actions, but prevention and treatment of acute adrenal insufficiency is the priority after adrenalectomy.
The nurse is caring for a client with hypothyroidism who is receiving a hypertonic saline IV solution to counteract hyponatremia. The nurse will expect the saline solution to be administered until the client’s serum sodium reaches which of the following levels?
a. 112 mmol/L
b. 120 mmol/L
c. 132 mmol/L
d. 168 mmol/L
c. 132 mmol/L
This question focuses on managing hyponatremia in a client with hypothyroidism who is receiving hypertonic saline therapy.
Explanation:
• Hyponatremia refers to a low serum sodium level, typically less than 135 mmol/L. Severe hyponatremia, which is less than 120 mmol/L, can cause neurological symptoms such as confusion, seizures, or coma.
• Hypertonic saline (3% NaCl) is used cautiously to correct severe hyponatremia. The goal is to raise sodium levels safely to avoid complications like osmotic demyelination syndrome (ODS).
• Target sodium level: The goal of treatment is usually to increase serum sodium to at least 130 to 135 mmol/L, at which point symptoms improve, and further correction can proceed more gradually.
• The correct answer is 132 mmol/L (option C) because this level is within the safe correction range and avoids overcorrection, which could lead to hypernatremia or neurological complications.
Key Points:
1. Hypertonic saline is used cautiously and only for severe cases (typically when sodium is less than 120 mmol/L or if the patient is symptomatic).
2. Sodium correction should not exceed 8 to 12 mmol/L per 24 hours to avoid complications.
3. Stopping hypertonic saline around 130 to 135 mmol/L helps prevent overcorrection and hypernatremia.
4. Hypernatremia, such as 168 mmol/L in option D, is dangerously high and could lead to dehydration, neurological impairment, or coma.
Clinical Relevance:
• Nurses must monitor sodium levels frequently, often every 2 to 4 hours during correction.
• Rate of infusion matters, since rapid correction increases the risk of ODS.
• Patients should be monitored for symptoms of fluid overload or neurological changes, including confusion, lethargy, or seizures.
Would you like me to simplify or expand on any part?
The nurse is admitting a client with possible syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following information obtained by the nurse is most
important to communicate rapidly to the health care provider?
a. The client complains of dyspnea with activity.
b. The client has a urine specific gravity of 1.025.
c. The client has a recent weight gain of 3.6 kg.
d. The client has a serum sodium level of 119 mmol/L.
d. The client has a serum sodium level of 119 mmol/L.
A serum sodium of less than 120 mmol/L increases the risk for complications such as seizures and needs rapid correction.
After receiving change-of-shift report, which of the following four clients should the nurse
assess first?
a. A 31-year-old with Cushing’s syndrome and a blood glucose level of 13.7 mmol/L
b. A 22-year-old admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mmol/L
c. A 70-year-old who recently started taking levothyroxine and has an irregular pulse of 134
d. A 53-year-old who has Addison’s disease and is due for a scheduled dose of hydrocortisone.
c. A 70-year-old who recently started taking levothyroxine and has an irregular pulse of 134
Initiation of
