Question 1

The nurse is assessing a male patient diagnosed with a pituitary tumor causing panhypopituitarism. Assessment findings consistent with panhypopituitarism include

Accepted Answer

Changes in male secondary sex characteristics such as decreased facial hair,testicular atrophy,diminished spermatogenesis,loss of libido,impotence,and decreased muscle mass 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.

Question 2

Which nursing assessment of a 70-yr-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)?

Accepted Answer

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 3

An 82-yr-old patient in a long-term care facility is newly diagnosed with hypothyroidism. The nurse will need to consult with the health care provider before administering the prescribed

Accepted Answer

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 4

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?

Accepted Answer

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 5

The nurse determines that additional instruction is needed for a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH)when the patient makes which statement?

Accepted Answer

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 6

An expected patient problem for a patient admitted to the hospital with symptoms of diabetes insipidus is

Accepted Answer

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

Question 7

Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)?

Accepted Answer

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 8

A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action will provide the patient with rapid relief from the symptoms?

Accepted Answer

The patient's symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the patient breathe into a paper bag,which will raise the PaCO₂ and create a more acidic pH. Applying as-needed O₂ or range of motion will have no impact on the ionized calcium level. Calcium supplements will be given to normalize calcium levels quickly,but oral supplements will take time to be absorbed.

Question 9

Which nursing action will be included in the plan of care for a patient with Graves' disease who has exophthalmos?

Accepted Answer

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 10

A patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/L)and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should be included in the plan of care?

Accepted Answer

The patient 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 patients. The patient should engage in weight-bearing exercise to decrease calcium loss from bone.

Question 11

A patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. During preoperative teaching,the nurse instructs the patient about the need to

Accepted Answer

To avoid disruption of the suture line,the patient should avoid brushing the teeth for 10 days after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is discouraged because it may cause leakage of cerebrospinal 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.

Question 12

A 62-yr-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient

Accepted Answer

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 13

Which information will the nurse include when teaching a 50-yr-old male patient about somatropin (Genotropin)?

Accepted Answer

Somatropin is injected subcutaneously on a daily basis,preferably in the evening. The patient will need to continue on somatropin for life. If swelling or other common adverse effects occur,the health care provider should be notified. Growth hormone will increase blood glucose levels.

Question 14

The nurse determines that demeclocycline is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)based on finding that the patient's

Accepted Answer

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 15

A 56-yr-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)

Accepted Answer

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 16

Which information will the nurse teach a patient who has been newly diagnosed with Graves' disease?

Accepted Answer

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 17

A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. The nurse should plan to teach the patient about

Accepted Answer

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.

Question 18

A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving. Discharge is expected to occur in 2 days. Which teaching strategy is likely to result in effective patient self-management at home?

Accepted Answer

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 19

The nurse is planning postoperative care for a patient who is being admitted to the surgical unit from the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action should be included?

Accepted Answer

After pituitary surgery,the patient is at risk for diabetes insipidus caused by cerebral edema. 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 patient is at risk for dehydration,not volume overload. The patient is not at high risk for problems with oxygenation,and continuous pulse oximetry is not needed.

Question 20

A 40-yr-old patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis,which question should the nurse ask?

Accepted Answer

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.

Quiz 49: Endocrine Problems

The nurse is assessing a male patient diagnosed with a pituitary tumor causing panhypopituitarism. Assessment findings consistent with panhypopituitarism include

Which nursing assessment of a 70-yr-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid) ?

An 82-yr-old patient in a long-term care facility is newly diagnosed with hypothyroidism. The nurse will need to consult with the health care provider before administering the prescribed

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?

The nurse determines that additional instruction is needed for a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient makes which statement?

An expected patient problem for a patient admitted to the hospital with symptoms of diabetes insipidus is

Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid) ?

A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action will provide the patient with rapid relief from the symptoms?

Which nursing action will be included in the plan of care for a patient with Graves' disease who has exophthalmos?

A patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14 mg/dL (3.5 mmol/L) . Which nursing action should be included in the plan of care?

A patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. During preoperative teaching,the nurse instructs the patient about the need to

A 62-yr-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI) . The nurse instructs the patient

Which information will the nurse include when teaching a 50-yr-old male patient about somatropin (Genotropin) ?

The nurse determines that demeclocycline is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patient's

A 56-yr-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)

Which information will the nurse teach a patient who has been newly diagnosed with Graves' disease?

A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. The nurse should plan to teach the patient about

A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving. Discharge is expected to occur in 2 days. Which teaching strategy is likely to result in effective patient self-management at home?

The nurse is planning postoperative care for a patient who is being admitted to the surgical unit from the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action should be included?

A 40-yr-old patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis,which question should the nurse ask?