Endocrine Disorders - NCLEX

Endocrine Disorders - NCLEX 4.6 (8 reviews) Students also studied Terms in this set (25) Science Medicine Save Endocrine Disorder NCLEX Questio...24 terms AnnaLawrence23 Preview Endocrine NCLEX questions 121 terms awebstePreview Endocrine Disorders 19 terms nsalazar15Preview Med Su 86 terms Jasm After a hypophysectomy for acromegaly, what should be the priority of postoperative nursing care?

• Frequent monitoring of serum and urine osmolarity
• Parenteral administration of a growth hormone

receptor antagonist

• Keeping the patient in a recumbent position for 2 days
• Patient teaching relate to lifelong ACTH and TSH

hormone replacement

• Frequent monitoring of serum and urine osmolarity

A possible postoperative complication after hypophysectomy is transient diabetes insipidus (DI). This may occur because of loss of antidiuretic hormone (ADH), which is stored in the posterior lobe of the pituitary, or cerebral edema related to manipulation of the pituitary during surgery. To assess for DI, monitor urine output and serum and urine osmolarity closely.The patient has small cell lung cancer. Which finding indicates a complication of the condition?

A. Serum sodium level: 128 mg/dL

B. Serum potassium level: 4.5 mEq

C. Urine output: 30 mL/hour

D. Urine specific gravity: 1.012

A. Serum sodium level: 128 mg/dL

Malignancy, especially small cell lung cancer, can cause syndrome of inappropriate antidiuretic hormone (SIADH), which results in increased reabsorption of water and dilutional hyponatremia. The other three options are normal findings.The patient has SIADH with a serum sodium level of 128 mEq/L. What action do you anticipate?

• Increase sodium-rich foods.
• Rapidly infuse hypertonic intravenous (IV) fluids.
• Restrict fluids.
• Administer calcitonin.
• Restrict fluids.

When symptoms of SIADH are mild and the serum sodium level is more than 125 mEq/L, the only treatment may be restriction of fluids to 800 to 1000 mL per day.Severe hyponatremia (less than 120 mEq/L) may be treated with slow infusion of hypertonic saline.A patient with a head injury develops SIADH. What symptoms do you expect to find?

• Hypernatremia and edema
• Low urinary output and thirst
• Muscle spasticity and hypertension
• Weight gain and decreased glomerular filtration rate
• Low urinary output and thirst

Excess ADH increases the permeability of the renal distal tubule and collecting duct, which leads to the reabsorption of water into the circulation. Consequently, extracellular fluid volume expands, plasma osmolality declines, the glomerular filtration rate increases, and sodium levels decline (dilutional hyponatremia).Hyponatremia causes muscle cramping, pain, and weakness. Initially, the patient displays thirst, dyspnea on exertion, and fatigue.

The patient had pituitary surgery yesterday. Which symptom is most important for you to monitor?

A. Urine specific gravity: 1.005

• Voids 10 L/day
• Crackles auscultated in lung bases

D. Temperature: 100.4° F (38° C)

• Voids 10 L/day

Diabetes insipidus (DI) is a deficiency of production or secretion of antidiuretic hormone (ADH) or a decreased renal response to ADH. It is characterized by polydipsia (5 to 20 L/day) with low specific gravity (less than 1.005). The last two options are more likely related to atelectasis and are less important than DI.Which nursing action should be done for a patient with DI?

• Monitor levels of urine ketones.
• Administer desmopressin acetate (DDAVP).
• Administer prednisone by intravenous push (IVP).
• Monitor blood glucose levels hourly.
• Administer desmopressin acetate (DDAVP).

Patients with DI have decreased production and secretion of ADH and increased urine output with low specific gravity. DDAVP is used for ADH replacement. DI is not related to glucose metabolism and ketones and does not need close monitoring. Prednisone is not used to treat DI.You are providing discharge instructions to a patient with DI. Which patient teaching regarding DDAVP is most appropriate?

• The patient can expect to experience weight loss

because of increased diuresis.

• The patient should alternate nostrils during

administration to prevent nasal irritation.

• The patient should monitor for symptoms of

hypernatremia as a side effect of this drug.

• The patient should report any decrease in urinary

elimination to the health care provider.

• The patient should alternate nostrils during administration to prevent nasal

irritation.DDAVP is used to treat DI by replacing the ADH that the patient is lacking. DDAVP can cause nasal irritation, headache, nausea, and other signs of hyponatremia.What is the most important finding in a patient who had a total thyroidectomy for thyroid cancer today?

• Positive Chvostek's sign
• Pain rated 8

C. Calcium level: 9 mg/dL

D. White blood cell count: 11,500/μL

• Positive Chvostek's sign

Thyroid surgery can affect the parathyroid, which can cause hypocalcemia, indicated by a positive Chvostek's sign from the tetany caused by hypocalcemia.This systemic problem takes priority over pain. A calcium level of 9mg is normal.Which is a characteristic diagnostic study finding in a patient with hyperthyroidism?

• Elevated thyroid-stimulating hormone (TSH) level
• Elevated level of free thyroxine (free T4)
• Decreased cortisol level
• Decreased iodine levels
• Elevated level of free thyroxine (free T4)

The two primary laboratory findings used to confirm hyperthyroidism are elevated free thyroxine (free T4) and decreased TSH levels. TSH would be high in hypothyroidism.Which is an important nursing action for a patient who has had subtotal thyroidectomy?

• Administer propylthiouracil (PTU).
• Monitor for thyrotoxic crisis (thyroid storm).
• Administer propranolol (Inderal).
• Monitor for harsh vibratory respirations.
• Monitor for harsh vibratory respirations.

One of the most serious complications of thyroidectomy or neck surgery is airway edema, which can cause stridor. A tracheotomy setup should be kept at the bedside. PTU is an antithyroid drug sometimes given before surgery as an alternative treatment or to help shrink the thyroid before surgery. Thyroid storm is a rare condition in which all of the hyperthyroid manifestations are heightened, but it is not a risk after the gland's removal.

After thyroid surgery, you suspect damage to or removal of the parathyroid glands when the patient develops

• muscle weakness and weight loss.
• hyperthermia and severe tachycardia.
• hypertension and difficulty swallowing.
• laryngeal stridor and tingling in the hands and feet.
• laryngeal stridor and tingling in the hands and feet.

Laryngeal stridor (harsh, vibratory sound) may occur during inspiration and expiration as a result of edema of the laryngeal nerve. Laryngeal stridor may also be related to tetany, which occurs if the parathyroid glands are removed or damaged during surgery, leading to hypocalcemia.The surgeon was unable to spare a patient's parathyroid gland during a thyroidectomy. Which of the following assessments should you prioritize when providing postoperative care for this patient?

• Assessing the patient's white blood cell levels and

assessing for infection

• Monitoring the patient's hemoglobin, hematocrit, and

red blood cell levels

• Monitoring the patient's serum calcium levels and

assessing for signs of hypocalcemia

• Monitoring the patient's level of consciousness and

assessing for acute delirium or agitation

• Monitoring the patient's serum calcium levels and assessing for signs of

hypocalcemia Loss of the parathyroid gland is associated with hypocalcemia. Infection and anemia are not associated with loss of the parathyroid gland, and cognitive changes are less pronounced than the signs and symptoms of hypocalcemia.Which is the best indication that the patient has responded appropriately to levothyroxine?

• Normal thyroid-stimulating hormone (TSH) level
• Elevated free thyroxine (free T4) level
• Myxedema
• Cretinism
• Normal thyroid-stimulating hormone (TSH) level

Effective dosing with the thyroid replacement medication returns the patient to a euthyroid state with normal findings.The following patients are assigned to you for the shift.Which patient should you assess first?

• Graves' disease with a heart rate of 92 beats/minute
• Type 2 diabetes with a glucose level of 170 mg/dL
• Hypothyroidism with a heart rate of 44 beats/minute
• Thyroid surgery with a calcium level of 10 mg/dL
• Hypothyroidism with a heart rate of 44 beats/minute

Hypothyroidism can cause bradycardia with decreased cardiac output and cardiac contractility, but this rate is slow enough that the patient needs assessment for adequate perfusion.The patient with hyperparathyroidism has a calcium level of 12 mg/dL. What complication should you assess the patient for?

• Tetany
• Renal calculi
• Periorbital edema
• Hyperglycemia
• Renal calculi

The PTH causes hypercalcemia, and the kidneys cannot reabsorb the excess calcium, leading to hypercalciuria. Along with the large amount of urinary phosphate, this can lead to calculi formation.You are caring for a patient admitted with suspected hyperparathyroidism. Because of the potential effects of this disease on electrolyte balance, for what should you assess this patient?

• Neurologic irritability
• Declining urine output
• Lethargy and weakness
• Hyperactive bowel sounds
• Lethargy and weakness

Hyperparathyroidism can cause hypercalcemia. Signs of hypercalcemia include polyuria, constipation, nausea, vomiting, lethargy, and muscle weakness.

What is a clinical manifestation of hypoparathyroidism?

• Exophthalmos
• Purple striae on abdomen and thighs
• Pernicious anemia
• Tingling in lips and fingertips
• Tingling in lips and fingertips

The clinical manifestations of hypoparathyroidism result from hypocalcemia. They can include tetany, characterized by tingling of the lips and stiffness of the extremities.Which clinical manifestation is most important for you to monitor in a patient with Cushing disease?

• Periorbital edema
• Pitting pedal edema
• Flu with a temperature of 100.4° F (38° C)
• Blood glucose level of 150 mg
• Flu with a temperature of 100.4° F (38° C)

Patients with Cushing disease are immunosuppressed and have a blunted response to infection What is the most likely complication for you to monitor in a patient who had surgery on the adrenal glands today?

• Rising pulse and falling blood pressure
• Temperature and purulent discharge
• Hypocalcemia
• Hyperphosphatemia
• Rising pulse and falling blood pressure

The adrenal glands are highly vascular, and the risk of hemorrhage is increased.Rapid or significant changes in blood pressure, respirations, or heart rate are important to monitor. This risk is highest 24 to 48 hours after surgery.Which laboratory result is most likely for a patient diagnosed with Cushing disease?

• Hypokalemia
• Decreased serum cortisol level
• Eosinophilia
• Thrombocytopenia
• Hypokalemia

The excessive adrenocortical activity produces hyperglycemia, hypokalemia, hypercalcemia, and elevated plasma cortisol levels.Which is a risk of long-term Cushing disease?

• Polycythemia
• Pheochromocytoma
• Osteoporosis
• Rheumatoid arthritis
• Osteoporosis

Protein wasting is caused by the catabolic effects of cortisol on peripheral tissue.This leads to bone loss, which leads to osteoporosis and subsequent pathologic fractures.A patient with primary Addison's disease who just ran a marathon has a heart rate of 130 beats/minute and blood pressure of 82/60 mm Hg. Besides intravenous (IV) isotonic fluids, what do you anticipate will be administered?

• Whole blood
• Solu-Cortef
• Vancomycin
• Calcium gluconate
• Solu-Cortef (hydrocortisone)

Acute adrenal insufficiency is caused by excessive stress. In addition to the usual treatment, corticosteroids must be administered so the adrenal glands can respond.To control the side effects of corticosteroid therapy, what should you teach the patient who is taking corticosteroids?

• Increase the calcium intake to 1500 mg/day.
• Perform glucose monitoring for hypoglycemia.
• Obtain immunizations because of the high risk of

infections.

• Avoid abrupt position changes because of orthostatic

hypotension.

• Increase the calcium intake to 1500 mg/day.

Because patients often receive corticosteroid treatment for prolonged periods (more than 3 months), corticosteroid-induced osteoporosis is an important concern. Therapies to reduce the resorption of bone may include increased calcium intake, vitamin D supplementation, bisphosphonates (e.g., alendronate), and institution of a low-impact exercise program.