Chapter 50 NCLEX Questions Endocrine
1. 1.ID: 809608854
The nurse is caring for a patient admitted with suspected hyperparathyroidism. Because of the potential effects of
this disease on electrolyte balance, the nurse should assess this patient for what manifestation?
A.
Neurologic irritability
B.
Declining urine output
C.
Lethargy and weakness Correct
D.
Hyperactive bowel sounds
Hyperparathyroidism can cause hypercalcemia. Signs of hypercalcemia include muscle weakness, polyuria,
constipation, nausea and vomiting, lethargy, and memory impairment. Neurologic irritability, declining urine output,
and hyperactive bowel sounds do not occur with hypercalcemia.
Awarded 0.0 points out of 1.0 possible points.
2. 2.ID: 809608848
The nurse should monitor for increases in which laboratory value for the patient as a result of being treated with
dexamethasone (Decadron)?
A.
Sodium
B.
Calcium
C.
Potassium
D.
Blood glucose Correct
Hyperglycemia or increased blood glucose level is an adverse effect of corticosteroid therapy. Sodium, calcium, and
potassium levels are not directly affected by dexamethasone.
Awarded 0.0 points out of 1.0 possible points.
3. 3.ID: 809608846
The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instructions regarding
desmopressin acetate (DDAVP) would be mostappropriate?
A.
The patient can expect to experience weight loss resulting from increased diuresis.
B.
The patient should alternate nostrils during administration to prevent nasal irritation. Correct
C.
The patient should monitor for symptoms of hypernatremia as a side effect of this drug.
D.
The patient should report any decrease in urinary elimination to the health care provider.
DDAVP is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. Inhaled
DDAVP can cause nasal irritation, headache, nausea, and other signs of hyponatremia. Diuresis will be decreased
and is expected, and hypernatremia should not occur.
Awarded 0.0 points out of 1.0 possible points.
4. 4.ID: 809608840
What is a nursing priority in the care of a patient with a diagnosis of hypothyroidism?
A.
Providing a dark, low-stimulation environment
B.
Closely monitoring the patient's intake and output
C.
Patient teaching related to levothyroxine (Synthroid) Correct
D.
Patient teaching related to radioactive iodine therapy
A euthyroid state is most often achieved in patients with hypothyroidism by the administration of levothyroxine
(Synthroid). It is not necessary to carefully monitor intake and output, and low stimulation and radioactive iodine
therapy are indicated in the treatment of hyperthyroidism.
Awarded 0.0 points out of 1.0 possible points.
5. 5.ID: 809608842
A patient has been taking oral prednisone for the past several weeks after having a severe reaction to poison ivy.
The nurse has explained the procedure for gradual reduction rather than sudden cessation of the drug. What is the
rationale for this approach to drug administration?
A.
Prevention of hypothyroidism
B.
Prevention of diabetes insipidus
C.
Prevention of adrenal insufficiency Correct
D.
Prevention of cardiovascular complications
Sudden cessation of corticosteroid therapy can precipitate life-threatening adrenal insufficiency. Diabetes insipidus,
hypothyroidism, and cardiovascular complications are not common consequences of suddenly stopping
corticosteroid therapy.
Awarded 0.0 points out of 1.0 possible points.
6. 6.ID: 809608856
The surgeon was unable to spare a patient's parathyroid gland during a thyroidectomy. Which assessments should
the nurse prioritize when providing postoperative care for this patient?
A.
Assessing the patient's white blood cell levels and assessing for infection
B.
Monitoring the patient's hemoglobin, hematocrit, and red blood cell levels
C.
Monitoring the patient's serum calcium levels and assessing for signs of hypocalcemia Correct
D.
Monitoring the patient's level of consciousness and assessing for acute delirium or agitation
Loss of the parathyroid gland is associated with hypocalcemia. Infection and anemia are not associated with loss of
the parathyroid gland, whereas cognitive changes are less pronounced than the signs and symptoms of
hypocalcemia.
Awarded 0.0 points out of 1.0 possible points.
7. 7.ID: 948121697
The patient with systemic lupus erythematosus had been diagnosed with syndrome of inappropriate antidiuretic
hormone (SIADH). What should the nurse expect to include in this patient's plan of care (select all that apply)?
A.
Obtain weekly weights.
B.
Limit fluids to 1000 mL per day.* Correct
C.
Monitor for signs of hypernatremia.
D.
Minimize turning and range of motion.
E.
Keep the head of the bed at 10 degrees or less elevation. Correct
The care for the patient with SIADH will include limiting fluids to 1000 mL per day or less to decrease weight,
increase osmolality, and improve symptoms; and keeping the head of the bed elevated at 10 degrees or less to
enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of ADH. The
weights should be done daily along with intake and output. Signs of hyponatremia should be monitored, and
frequent turning, positioning, and range-of-motion exercises are important to maintain skin integrity and joint
mobility.
Awarded 0.0 points out of 2.0 possible points.
8. 8.ID: 809608852
A 50-year-old female patient smokes, is getting a divorce, and is reporting eye problems. On assessment of this
patient, the nurse notes exophthalmos. What other abnormal assessments should the nurse expect to find in this
patient?
A.
Puffy face, decreased sweating, and dry hair
B.
Muscle aches and pains and slow movements
C.
Decreased appetite, increased thirst, and pallor
D.
Systolic hypertension and increased heart rate Correct
The patient's manifestations point to Graves' disease or hyperthyroidism, which would also include systolic
hypertension and increased heart rate and increased thirst. Puffy face, decreased sweating; dry, coarse hair;
muscle aches and pains and slow movements; decreased appetite and pallor are all manifestations of
hypothyroidism.
Awarded 0.0 points out of 1.0 possible points.
9. 9.ID: 809608836
A patient with a severe pounding headache has been diagnosed with hypertension. However, the hypertension is
not responding to traditional treatment. What should the nurse expect as the next step in management of this
patient?
A.
Administration of β-blocker medications
B.
Abdominal palpation to search for a tumor
C.
Administration of potassium-sparing diuretics
D.
A 24-hour urine collection for fractionated metanephrines Correct
Pheochromocytoma should be suspected when hypertension does not respond to traditional treatment. The 24-hour
urine collection for fractionated metanephrines is simple and reliable with elevated values in 95% of people with
pheochromocytoma. In a patient with pheochromocytoma preoperatively an α-adrenergic receptor blocker is used to
reduce BP. Abdominal palpation is avoided to avoid a sudden release of catecholamines and severe hypertension.
Potassium-sparing diuretics are not needed. Most likely they would be used for hyperaldosteronism, which is
another cause of hypertension.
Awarded 0.0 points out of 1.0 possible points.
10. 10.ID: 809608850
The patient with an adrenal hyperplasia is returning from surgery for an adrenalectomy. For
what immediate postoperative risk should the nurse plan to monitor the patient?
A.
Vomiting
B.
Infection
C.
Thomboembolism
D.
Rapid BP changes Correct
The risk of hemorrhage is increased with surgery on the adrenal glands as well as large amounts of hormones being
released in the circulation, which may produce hypertension and cause fluid and electrolyte imbalances to occur for
the first 24 to 48 hours after surgery. Vomiting, infection, and thromboembolism may occur postoperatively with any
surgery.
Awarded 0.0 points out of 1.0 possible points.
11. 11.ID: 809608838
The patient is brought to the ED following a car accident and is wearing medical identification that says she has
Addison's disease. What should the nurse expect to be included in the collaborative care of this patient?
A.
Low sodium diet
B.
Increased glucocorticoid replacement Correct
C.
Suppression of pituitary ACTH synthesis
D.
Elimination of mineralocorticoid replacement
The patient with Addison's disease needs lifelong glucocorticoid and mineralocorticoid replacement and has an
increased need with illness, injury, or stress, as this patient is experiencing. The patient with Addison's may also
need a high sodium diet. Suppression of pituitary ACTH synthesis is done for Cushing syndrome. Elimination of
mineralocorticoid replacement cannot be done for Addison's disease.