Question 1

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

Accepted Answer

? -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 2

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.

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 tumour, and chemotherapy will not be needed.

Question 3

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)

Accepted Answer

The client's temperature indicates that the client 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 4

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.

Accepted Answer

The client's confusion and lethargy may indicate hypernatremia and should be addressed quickly. In addition, clients with DI compensate for fluid losses by drinking copious amounts of fluids, but a client 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 5

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.

Accepted Answer

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

Question 6

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.

Accepted Answer

Sucking on ice chips or chewing sugarless gum decreases thirst for a client on fluid restriction. Clients with SIADH are on fluid restrictions of 800-1 000 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 7

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.

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

Question 8

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

Accepted Answer

After adrenalectomy, the client 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 client but are not as immediately life-threatening as the circulatory collapse that can occur with fluid and electrolyte disturbances.

Question 9

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.

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.

Question 10

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

Accepted Answer

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

Question 11

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

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 12

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."

Accepted Answer

The need for hydrocortisone replacement is increased with stressors such as illness, and the client needs to be taught to call the health care provider because medication and IV fluids and electrolytes may need to be given. The other client statements indicate appropriate management of the Addison's disease.

Question 13

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

Accepted Answer

The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia, severe pounding 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 14

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.

Accepted Answer

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

Question 15

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.

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 clients take corticosteroids for longer periods.

Question 16

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 followinglevels?
A)112 mmol/L
B)120 mmol/L
C)132 mmol/L
D)168 mmol/L

Accepted Answer

If the client is hyponatremic, hypertonic saline may be administered until the serum sodium level reaches at least 130 mmol/L. Hypernatremia is evident with a sodium level of 168 mmol/L.

Question 17

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.

Accepted Answer

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.

Question 18

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

Accepted Answer

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

Question 19

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.

Accepted Answer

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

Quiz 51: Nursing Management Endocrine Problems

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?

The nurse is providing discharge teaching for a client who had a hypophysectomy. Which of the following information should the nurse include?

Which of the following assessment findings for a client admitted with Graves' disease requires the most rapid intervention by the nurse?

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?

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

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?

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?

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?

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?

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?

The nurse is caring for a client with acute adrenal insufficiency. Which of the following findings indicate that the prescribed therapies are effective?

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?

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?

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 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?

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 followinglevels?

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?

The nurse is caring for a client who has an adrenocortical adenoma and hyperaldosteronism. Which of the following actions should the nurse implement?

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?