Question 1

The nurse is caring for a patient following an adrenalectomy.The highest priority in the immediate postoperative period is to

Accepted Answer

After adrenalectomy,the patient is at risk for circulatory instability caused by fluctuating hormone levels,and the focus of care is to assess and maintain fluid and electrolyte status through the use of IV fluids and corticosteroids.The other goals are also important for the patient but are not as immediately life threatening as the circulatory collapse that can occur with fluid and electrolyte disturbances.

Question 2

Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency?

Accepted Answer

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 3

The nurse is caring for a patient admitted with diabetes insipidus (DI).Which information is most important to report to the health care provider?

Accepted Answer

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 4

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)?

Accepted Answer

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 5

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)?

Accepted Answer

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 6

A patient has just arrived on the unit after a thyroidectomy.Which action should the nurse take first?

Accepted Answer

Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany.The priority nursing action is to assess the airway.The other actions are also part of the standard nursing care postthyroidectomy but are not as high of a priority.

Question 7

After a 22-year-old female patient with a pituitary adenoma has had a hypophysectomy,the nurse will teach about the need for

Accepted Answer

Antidiuretic hormone (ADH),cortisol,and thyroid hormone replacement will be needed for life after hypophysectomy.Without the effects of adrenocorticotropic hormone (ACTH)and cortisol,the blood glucose and serum sodium will be low unless cortisol is replaced.An adenoma is a benign tumor,and chemotherapy will not be needed.

Question 8

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?

Accepted Answer

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 9

Which question will the nurse in the endocrine clinic ask to help determine a patient's risk factors for goiter?

Accepted Answer

Medications that contain thyroid-inhibiting substances can cause goiter.Milk intake,neck injury,and immunization history are not risk factors for goiter.

Question 10

The nurse will plan to monitor a patient diagnosed with a pheochromocytoma for

Accepted Answer

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 11

A 56-year-old female patient has an adrenocortical adenoma,causing hyperaldosteronism.The nurse providing care should

Accepted Answer

Hypertension caused by sodium retention is a common complication of hyperaldosteronism.Hyperaldosteronism does not cause an elevation in blood glucose.The patient will be hypokalemic and require potassium supplementation before surgery.Edema does not usually occur with hyperaldosteronism.

Question 12

A 37-year-old patient has just arrived in the postanesthesia recovery unit (PACU)after a thyroidectomy.Which information is most important to communicate to the surgeon?

Accepted Answer

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 patient who has been hyperthyroid and has just arrived in the PACU from surgery.Sleepiness in the immediate postoperative period is expected.

Question 13

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)?

Accepted Answer

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 14

Which assessment finding for a 33-year-old female patient admitted with Graves' disease requires the most rapid intervention by the nurse?

Accepted Answer

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 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?

Accepted Answer

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

Which prescribed medication should the nurse administer first to a 60-year-old patient admitted to the emergency department in thyroid storm?

Accepted Answer

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 17

A 37-year-old patient is being admitted with a diagnosis of Cushing syndrome.Which findings will the nurse expect during the assessment?

Accepted Answer

Purplish-red striae on the abdomen are a common clinical manifestation of Cushing syndrome.Hypotension and bronzed-appearing skin are manifestations of Addison's disease.Decreased axillary and pubic hair occur with androgen deficiency.

Question 18

A 44-year-old female patient with Cushing syndrome is admitted for adrenalectomy.Which intervention by the nurse will be most helpful for a nursing diagnosis of disturbed body image related to changes in appearance?

Accepted Answer

The most reassuring communication to the patient is that the physical and emotional changes caused by the Cushing syndrome will resolve after hormone levels return to normal postoperatively.Reassurance that the physical changes are expected or that there are more serious physiologic problems associated with Cushing syndrome are not therapeutic responses.The patient's physiological changes are caused by the high hormone levels,not by the patient's diet or exercise choices.

Question 19

After receiving change-of-shift report about the following four patients,which patient should the nurse assess first?

Accepted Answer

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 20

Which assessment finding of a 42-year-old patient who had a bilateral adrenalectomy requires the most rapid action by the nurse?

Accepted Answer

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.

Quiz 50: Nursing Management: Endocrine Problems