Lewis- Ch.51 Nursing Management: Endocrine Problems

Question 1

2. 3. 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?”

Answer 1

b. “Do you have to wear larger shoes now?”

Question 2

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

Answer 2

d. Have a NG tube after the surgery

Question 3

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.

Answer 3

a. Monitor urine output every hour.

Question 4

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

Answer 4

d. Changes in secondary sex characteristics

Question 5

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 thalmkmqe hands or feet occurs.

Answer 5

b. Inject the medication subcutaneously every day.

Question 6

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

Answer 6

d. Increased urinary output

Question 7

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.”

Answer 7

d. “I need to shop for foods that are low in sodium and avoid adding salt to foods.”

Question 8

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

Answer 8

b. Decreased serum sodium

Question 9

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

Answer 9

a. Insomnia related to frequent waking at night to void

Question 10

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.

Answer 10

d. Antithyroid medications may take several weeks to have an effect.

Question 11

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.

Answer 11

a. Infuse IV calcium gluconate.

Question 12

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.

Answer 12

c. Elevate the head of the client’s bed to reduce periorbital fluid.

Question 13

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.

Answer 13

b. Hypothyroidism may occur as the RAI therapy takes effect.

Question 14

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

Answer 14

a. Apical pulse rate

Question 15

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

Answer 15

b. Diazepam

Question 16

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.

Answer 16

c. Provide written handouts of all information.

Question 17

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.

Answer 17

d. Encourage 3 000–4 000 mL of oral fluids daily.

Question 18

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.

Answer 18

d. Have the client rebreathe using a paper bag.

Question 19

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

Answer 19

c. Take calcium supplementation to normalize serum calcium levels.

Question 20

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

Answer 20

a. Increased thyroxine (T4) level

Question 21

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

Answer 21

d. Purplish red streaks on the abdomen

Question 22

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.

Answer 22

c. Teach the client that most of the physical changes caused by Cushing’s syndrome
will resolve after surgery.

Question 23

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

Answer 23

a. Increasing serum sodium levels

Question 24

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.”

Answer 24

c. “I had the stomach flu earlier this week and couldn’t take the hydrocortisone.”

Question 25

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.

Answer 25

b. Do not stop taking the prednisone suddenly; it should be decreased gradually.

Question 26

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

Answer 26

b. Monitor the blood pressure every 4 hours

Question 27

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

Answer 27

b. Headache

Question 28

he 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.

Answer 28

a. Oral corticosteroids as a lifelong treatment

Question 29

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.

Answer 29

b. Offer client ice chips to suck on.

Question 30

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.

Answer 30

b. Assess respiratory rate and effort.

Question 31

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

Answer 31

c. Maintaining fluid and electrolyte status

Question 32

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.

Answer 32

b. Confusion and lethargy

Question 33

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

Answer 33

a. propranolol

Question 34

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)

Answer 34

d. Temperature 40.4°C (104.7°F)

Question 35

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.

Answer 35

b. The client has increasing swelling of the neck.

Question 36

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.

Answer 36

c. The client’s BP is 88/50 mm Hg.

Question 37

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

Answer 37

c. 132 mmol/L

Question 38

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.

Answer 38

d. The client has a serum sodium level of 119 mmol/L.

Question 39

After receiving change-of-shift report, which of the following four clients should the nurse assess first? a. b. A 31-year-old with Cushing’s syndrome and a blood glucose level of 13.7 mmol/L 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.

Answer 39

c. A 70-year-old who recently started taking levothyroxine and has an irregular pulse