Chapter 54 - Endocrine Problems - NCLEX Questions

Chapter 54 - Endocrine Problems - NCLEX Questions Leave the first rating Students also studied Terms in this set (45) Science MedicineNursing Save Endocrine NCLEX questions 121 terms awebstePreview Chapter 52: Assessment: Endocrine ...22 terms kathleenoconnor0 Preview Chapter 15 - Infection NCLEX Questi...29 terms kathleenoconnor0 Preview Lewis M 45 terms use A 40-year-old patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question would the nurse ask?

• Have you had a recent head injury?
• Do you have to wear larger shoes now?
• Is there a family history of acromegaly?‖
• Are you experiencing tremors or anxiety?‖

ANS: B

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.A patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. Which information would the nurse include in preoperative teaching?

• Cough and deep breathe every 2 hours

postoperatively.

• Remain on bed rest for the first 48 hours

postoperatively.

• Avoid brushing teeth for at least 10 days after the

surgery.

• You will be positioned flat with a cervical collar after

surgery.

ANS: C

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. A cervical collar is not needed.

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 would be included?

• Palpate extremities for edema.
• Measure urine volume every hour.
• Check hematocrit every 2 hours for 8 hours.
• Monitor continuous pulse oximetry for 24 hours.

ANS: B

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, so continuous pulse oximetry is not needed.The nurse is assessing a male patient diagnosed with a pituitary tumor causing panhypopituitarism. Which assessment finding is consistent with panhypopituitarism?

• High blood pressure
• Decreased facial hair
• Elevated blood glucose
• Intermittent tachycardia

ANS: B

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 because of decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is due to the decrease in thyroid-stimulating hormone (TSH) and thyroid hormones associated with panhypopituitarism.Which information will the nurse include when teaching a 50-year-old male patient about somatropin (Genotropin)?

• The medication will be needed for 3 to 6 months.
• Inject the medication subcutaneously every evening.
• Blood glucose levels may decrease when taking the

medication.

• Stop taking the medication if swelling of the hands or

feet occurs.

ANS: B

Somatropin is injected subcutaneously daily, 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.Which finding indicates to the nurse that demeclocycline has been effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)?

• Weight has increased.
• Urinary output has increased.
• Peripheral edema has increased.
• Urine specific gravity has increased.

ANS: B

Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and increases urine output, producing more dilute urine. 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.

Which patient statement indicates to the nurse that further instruction is needed about chronic syndrome of inappropriate antidiuretic hormone (SIADH)?

• I should weigh myself daily and report sudden weight

loss or gain.‖

• I need to shop for foods low in sodium and avoid

adding salt to food.

• I need to limit my fluid intake to no more than 1 quart

of liquids a day.‖

• I should eat foods high in potassium because diuretics

cause potassium loss.‖

ANS: B

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.A patient who is disoriented and reports a headache and muscle cramps is hospitalized with syndrome of inappropriate antidiuretic hormone (SIADH). Which initial laboratory result would the nurse expect?

• Elevated hematocrit
• Decreased serum sodium
• Increased serum chloride
• Low urine specific gravity

ANS: B

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.Which problem would the nurse anticipate for a patient admitted to the hospital with diabetes insipidus?

• Generalized edema
• Respiratory distress
• Fluid volume overload
• Disturbed sleep pattern

ANS: D

Nocturia occurs because of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and respiratory distress are not expected.Which information will the nurse teach a patient who has been newly diagnosed with Graves' disease?

• Antithyroid medications may take months for full effect.
• Restriction of iodine intake will help reduce thyroid

activity.

• Exercise is contraindicated to avoid increasing

metabolic rate.

• Surgery will eventually be required to remove the

thyroid gland.

ANS: A

Medications used to block the synthesis of thyroid hormones may take 2 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.

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?

• Plan for emergency tracheostomy.
• Administer IV calcium gluconate.
• Prepare for endotracheal intubation.
• Begin thyroid hormone replacement.

ANS: B

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. Thyroid hormone replacement may be needed eventually but will not improve the symptoms of hypocalcemia.Which action will the nurse include in the plan of care for a patient with Graves' disease who has exophthalmos?

• Place cold packs on the eyes to relieve pain and

swelling.

• Elevate the head of the patient's bed to reduce

periorbital fluid.

• Apply alternating eye patches to protect the corneas

from irritation.

• Teach the patient to blink every few seconds to

lubricate the corneas.

ANS: B

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.A patient who has hyperthyroidism is treated with radioactive iodine (RAI). What information would the nurse include in discharge teaching?

• Take radioactive precautions with all body secretions.
• Symptoms of hyperthyroidism should be relieved in

about a week.

• Symptoms of hypothyroidism will occur as the RAI

therapy takes effect.

• Discontinue the antithyroid medications that were

taken before the RAI therapy.

ANS: C

There is a high incidence of post radiation 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.Which nursing assessment of a 70-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)?

• Fluid balance
• Apical pulse rate
• Nutritional intake
• Orientation and alertness

ANS: B

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.