Chapter 52
The nurse is caring for a patient diagnosed with hypothyroidism secondary to
Hashimoto’s thyroiditis. When assessing this patient, what sign or symptom would the
1. nurse expect?
A)
Fatigue
B)
Bulging eyes
C)
Palpitations
D)
Flushed skin
Ans:
A
Feedback:
Symptoms of hypothyroidism include extreme fatigue, hair loss, brittle nails, dry skin,
voice huskiness or hoarseness, menstrual disturbance, and numbness and tingling of the
fingers. Bulging eyes, palpitations, and flushed skin would be signs and symptoms of
hyperthyroidism.
A patient has been admitted to the post-surgical unit following a thyroidectomy. To
2. promote comfort and safety, how should the nurse best position the patient?
A)
Side-lying (lateral) with one pillow under the head
B)
Head of the bed elevated 30 degrees and no pillows placed under the head
C)
Semi-Fowler’s with the head supported on two pillows
D)
Supine, with a small roll supporting the neck
Ans:
C
Feedback:
When moving and turning the patient, the nurse carefully supports the patient’s head and
avoids tension on the sutures. The most comfortable position is the semi-Fowler’s
position, with the head elevated and supported by pillows.
A patient with thyroid cancer has undergone surgery and a significant amount of
parathyroid tissue has been removed. The nurse caring for the patient should prioritize
3. what question when addressing potential complications?
A)
“Do you feel any muscle twitches or spasms?“
B)
“Do you feel flushed or sweaty?“
C)
“Are you experiencing any dizziness or lightheadedness?“
D)
“Are you having any pain that seems to be radiating from your bones?“
Ans:
A
Feedback:
As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the
hands and feet and muscle twitching. This is characteristic of hypoparathyroidism.
Flushing, diaphoresis, dizziness, and pain are atypical signs of the resulting
hypocalcemia.
The nurse is caring for a patient with a diagnosis of Addison’s disease. What sign or
4. symptom is most closely associated with this health problem?
A)
Truncal obesity
B)
Hypertension
C)
Muscle weakness
D)
Moon face
Ans:
C
Feedback:
Patients with Addison’s disease demonstrate muscular weakness, anorexia,
gastrointestinal symptoms, fatigue, emaciation, dark pigmentation of the skin, and
hypotension. Patients with Cushing syndrome demonstrate truncal obesity, “moon“ face,
acne, abdominal striae, and hypertension.
The nurse is caring for a patient with Addison’s disease who is scheduled for discharge.
When teaching the patient about hormone replacement therapy, the nurse should address
5. what topic?
A)
The possibility of precipitous weight gain
B)
The need for lifelong steroid replacement
C)
The need to match the daily steroid dose to immediate symptoms
D)
The importance of monitoring liver function
Ans:
B
Feedback:
Because of the need for lifelong replacement of adrenal cortex hormones to prevent
addisonian crises, the patient and family members receive explicit education about the
rationale for replacement therapy and proper dosage. Doses are not adjusted on a shortterm basis. Weight gain and hepatotoxicity are not common adverse effects.
The nurse is teaching a patient that the body needs iodine for the thyroid to function.
6. What food would be the best source of iodine for the body?
A)
Eggs
B)
Shellfish
C)
Table salt
D)
Red meat
Ans:
C
Feedback:
The major use of iodine in the body is by the thyroid. Iodized table salt is the best source
of iodine.
A patient is prescribed corticosteroid therapy. What would be priority information for the
7. nurse to give the patient who is prescribed long-term corticosteroid therapy?
A)
The patient’s diet should be low protein with ample fat.
B)
The patient may experience short-term changes in cognition.
C)
The patient is at an increased risk for developing infection.
D)
The patient is at a decreased risk for development of thrombophlebitis and
thromboembolism.
Ans:
C
Feedback:
The patient is at increased risk of infection and masking of signs of infection. The
cardiovascular effects of corticosteroid therapy may result in development of
thrombophlebitis or thromboembolism. Diet should be high in protein with limited fat.
Changes in appearance usually disappear when therapy is no longer necessary. Cognitive
changes are not common adverse effects.
A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What
8. is an expected urinalysis finding?
A)
Glucose in the urine
B)
Albumin in the urine
C)
Highly dilute urine
D)
Leukocytes in the urine
Ans:
C
Feedback:
Patients with diabetes insipidus produce an enormous daily output of very dilute, waterlike urine with a specific gravity of 1.001 to 1.005. The urine contains no abnormal
substances such as glucose or albumin. Leukocytes in the urine are not related to the
condition of diabetes insipidus, but would indicate a urinary tract infection, if present in
the urine.
The nurse caring for a patient with Cushing syndrome is describing the dexamethasone
suppression test scheduled for tomorrow. What does the nurse explain that this test will
9. involve?
A)
Administration of dexamethasone orally, followed by a plasma cortisol level every
hour for 3 hours
B)
Administration of dexamethasone IV, followed by an x-ray of the adrenal glands
C)
Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8
AM the next morning
D)
Administration of dexamethasone intravenously, followed by a plasma cortisol
level 3 hours after the drug is administered
Ans:
C
Feedback:
Dexamethasone (1 mg) is administered orally at 11 PM, and a plasma cortisol level is
obtained at 8 AM the next morning. This test can be performed on an outpatient basis and
is the most widely used and sensitive screening test for diagnosis of pituitary and adrenal
causes of Cushing syndrome.
You are developing a care plan for a patient with Cushing syndrome. What nursing
10. diagnosis would have the highest priority in this care plan?
A)
Risk for injury related to weakness
B)
Ineffective breathing pattern related to muscle weakness
C)
Risk for loneliness related to disturbed body image
D)
Autonomic dysreflexia related to neurologic changes
Ans:
A
Feedback:
The nursing priority is to decrease the risk of injury by establishing a protective
environment. The patient who is weak may require assistance from the nurse in
ambulating to prevent falls or bumping corners or furniture. The patient’s breathing will
not be affected and autonomic dysreflexia is not a plausible risk. Loneliness may or may
not be an issue for the patient, but safety is a priority.
The nurse is performing a shift assessment of a patient with aldosteronism. What
11. assessments should the nurse include? Select all that apply.
A)
Urine output
B)
Signs or symptoms of venous thromboembolism
C)
Peripheral pulses
D)
Blood pressure
E)
Skin integrity
Ans:
A, D
Feedback:
The principal action of aldosterone is to conserve body sodium. Alterations in
aldosterone levels consequently affect urine output and BP. The patient’s peripheral
pulses, risk of VTE, and skin integrity are not typically affected by aldosteronism.
The home care nurse is conducting patient teaching with a patient on corticosteroid
therapy. To achieve consistency with the body’s natural secretion of cortisol, when would
12. the home care nurse instruct the patient to take his or her corticosteroids?
A)
In the evening between 4 PM and 6 PM
B)
Prior to going to sleep at night
C)
At noon every day
D)
In the morning between 7 AM and 8 AM
Ans:
D
Feedback:
In keeping with the natural secretion of cortisol, the best time of day for the total
corticosteroid dose is in the morning from 7 to 8 AM. Large-dose therapy at 8 AM, when
the adrenal gland is most active, produces maximal suppression of the gland. Also, a
large 8 AM dose is more physiologic because it allows the body to escape effects of the
steroids from 4 PM to 6 AM, when serum levels are normally low, thus minimizing
cushingoid effects.
A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient
has a documented history of adrenal insufficiency. Considering the patient’s history and
current symptoms, the nurse should anticipate that the patient will be instructed to do
13. which of the following?
A)
Increase his intake of sodium until the GI symptoms improve.
B)
Increase his intake of potassium until the GI symptoms improve.
C)
Increase his intake of glucose until the GI symptoms improve.
D)
Increase his intake of calcium until the GI symptoms improve.
Ans:
A
Feedback:
The patient will need to supplement dietary intake with added salt during episodes of GI
losses of fluid through vomiting and diarrhea to prevent the onset of addisonian crisis.
While the patient may experience the loss of other electrolytes, the major concern is the
replacement of lost sodium.
The nurse is caring for a patient with hyperparathyroidism. What level of activity would
14. the nurse expect to promote?
A)
Complete bed rest
B)
Bed rest with bathroom privileges
C)
Out of bed (OOB) to the chair twice a day
D)
Ambulation and activity as tolerated
Ans:
D
Feedback:
Mobility, with walking or use of a rocking chair for those with limited mobility, is
encouraged as much as possible because bones subjected to normal stress give up less
calcium. Best rest should be discouraged because it increases calcium excretion and the
risk of renal calculi. Limiting the patient to getting out of bed only a few times a day also
increases calcium excretion and the associated risks.
While assisting with the surgical removal of an adrenal tumor, the OR nurse is aware that
the patient’s vital signs may change upon manipulation of the tumor. What vital sign
15. changes would the nurse expect to see?
A)
Hyperthermia and tachypnea
B)
Hypertension and heart rate changes
C)
Hypotension and hypothermia
D)
Hyperthermia and bradycardia
Ans:
B
Feedback:
Manipulation of the tumor during surgical excision may cause release of stored
epinephrine and norepinephrine, with marked increases in BP and changes in heart rate.
The use of sodium nitroprusside and alpha-adrenergic blocking agents may be required
during and after surgery. While other vital sign changes may occur related to surgical
complications, the most common changes are related to hypertension and changes in the
heart rate.
A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The
nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured
or removed. What laboratory finding may be an early indication of parathyroid gland
16. injury or removal?
A)
Hyponatremia
B)
Hypophosphatemia
C)
Hypocalcemia
D)
Hypokalemia
Ans:
C
Feedback:
Injury or removal of the parathyroid glands may produce a disturbance in calcium
metabolism and result in a decline of calcium levels (hypocalcemia). As the blood
calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and
feet and muscle twitching. This group of symptoms is known as tetany and must be
reported to the physician immediately, because laryngospasm may occur and obstruct the
airway. Hypophosphatemia, hyponatremia, and hypokalemia are not expected responses
to parathyroid injury or removal. In fact, parathyroid removal or injury that results in
hypocalcemia may lead to hyperphosphatemia.
The nurse is planning the care of a patient with hyperthyroidism. What should the nurse
17. specify in the patient’s meal plan?
A)
A clear liquid diet, high in nutrients
B)
Small, frequent meals, high in protein and calories
C)
Three large, bland meals a day
D)
A diet high in fiber and plant-sourced fat
Ans:
B
Feedback:
A patient with hyperthyroidism has an increased appetite. The patient should be
counseled to consume several small, well-balanced meals. High-calorie, high-protein
foods are encouraged. A clear liquid diet would not satisfy the patient’s caloric or hunger
needs. A diet rich in fiber and fat should be avoided because these foods may lead to GI
upset or increase peristalsis.
A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion
(SIADH) is being cared for on the critical care unit. The priority nursing diagnosis for a
18. patient with this condition is what?
A)
Risk for peripheral neurovascular dysfunction
B)
Excess fluid volume
C)
Hypothermia
D)
Ineffective airway clearance
Ans:
B
Feedback:
The priority nursing diagnosis for a patient with SIADH is excess fluid volume, as the
patient retains fluids and develops a sodium deficiency. Restricting fluid intake is a
typical intervention for managing this syndrome. Temperature imbalances are not
associated with SIADH. The patient is not at risk for neurovascular dysfunction or a
compromised airway.
A patient with hypofunction of the adrenal cortex has been admitted to the medical unit.
19. What would the nurse most likely find when assessing this patient?
A)
Increased body temperature
B)
Jaundice
C)
Copious urine output
D)
Decreased BP
Ans:
D
Feedback:
Decreased BP may occur with hypofunction of the adrenal cortex. Decreased function of
the adrenal cortex does not affect the patient’s body temperature, urine output, or skin
tone.
The nurse is assessing a patient diagnosed with Graves’ disease. What physical
20. characteristics of Graves’ disease would the nurse expect to find?
A)
Hair loss
B)
Moon face
C)
Bulging eyes
D)
Fatigue
Ans:
C
Feedback:
Clinical manifestations of the endocrine disorder Graves’ disease include exophthalmos
(bulging eyes) and fine tremor in the hands. Graves’ disease is not associated with hair
loss, a moon face, or fatigue.
A patient with suspected adrenal insufficiency has been ordered an adrenocorticotropic
hormone (ACTH) stimulation test. Administration of ACTH caused a marked increase in
21. cortisol levels. How should the nurse interpret this finding?
A)
The patient’s pituitary function is compromised.
B)
The patient’s adrenal insufficiency is not treatable.
C)
The patient has insufficient hypothalamic function.
D)
The patient would benefit from surgery.
Ans:
A
Feedback:
An adrenal response to the administration of a stimulating hormone suggests inadequate
production of the stimulating hormone. In this case, ACTH is produced by the pituitary
and, consequently, pituitary hypofunction is suggested. Hypothalamic function is not
relevant to the physiology of this problem. Treatment exists, although surgery is not
likely indicated.
The physician has ordered a fluid deprivation test for a patient suspected of having
22. diabetes insipidus. During the test, the nurse should prioritize what assessments?
A)
Temperature and oxygen saturation
B)
Heart rate and BP
C)
Breath sounds and bowel sounds
D)
Color, warmth, movement, and sensation of extremities
Ans:
B
Feedback:
The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until
3% to 5% of the body weight is lost. The patient’s condition needs to be monitored
frequently during the test, and the test is terminated if tachycardia, excessive weight loss,
or hypotension develops. Consequently, BP and heart rate monitoring are priorities over
the other listed assessments.
A nurse works in a walk-in clinic. The nurse recognizes that certain patients are at higher
risk for different disorders than other patients. What patient is at a greater risk for the
23. development of hypothyroidism?
A)
A 75-year-old female patient with osteoporosis
B)
A 50-year-old male patient who is obese
C)
A 45-year-old female patient who used oral contraceptives
D)
A 25-year-old male patient who uses recreational drugs
Ans:
A
Feedback:
Even though osteoporosis is not a risk factor for hypothyroidism, the condition occurs
most frequently in older women.
A patient with a recent diagnosis of hypothyroidism is being treated for an unrelated
injury. When administering medications to the patient, the nurse should know that the
24. patient’s diminished thyroid function may have what effect?
A)
Anaphylaxis
B)
Nausea and vomiting
C)
Increased risk of drug interactions
D)
Prolonged duration of effect
Ans:
D
Feedback:
In all patients with hypothyroidism, the effects of analgesic agents, sedatives, and
anesthetic agents are prolonged. There is no direct increase in the risk of anaphylaxis,
nausea, or drug interactions, although these may potentially result from the prolonged
half-life of drugs.
A patient has been admitted to the critical care unit with a diagnosis of thyroid storm.
What interventions should the nurse include in this patient’s immediate care? Select all
25. that apply.
A)
Administering diuretics to prevent fluid overload
B)
Administering beta blockers to reduce heart rate
C)
Administering insulin to reduce blood glucose levels
D)
Applying interventions to reduce the patient’s temperature
E)
Administering corticosteroids
Ans:
B, D
Feedback:
Thyroid storm necessitates interventions to reduce heart rate and temperature. Diuretics,
insulin, and steroids are not indicated to address the manifestations of this health
problem.
The nurse’s assessment of a patient with thyroidectomy suggests tetany and a review of
the most recent blood work corroborate this finding. The nurse should prepare to
26. administer what intervention?
A)
Oral calcium chloride and vitamin D
B)
IV calcium gluconate
C)
STAT levothyroxine
D)
Administration of parathyroid hormone (PTH)
Ans:
B
Feedback:
When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is
administration of IV calcium gluconate. This has a much faster therapeutic effect than PO
calcium or vitamin D supplements. PTH and levothyroxine are not used to treat this
complication.
A patient has been taking prednisone for several weeks after experiencing a
hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that
27. the patient knows to do which of the following?
A)
Take the drug concurrent with levothyroxine (Synthroid).
B)
Take each dose of prednisone with a dose of calcium chloride.
C)
Gradually replace the prednisone with an OTC alternative.
D)
Slowly taper down the dose of prednisone, as ordered.
Ans:
D
Feedback:
Corticosteroid dosages are reduced gradually (tapered) to allow normal adrenal function
to return and to prevent steroid-induced adrenal insufficiency. There are no OTC
substitutes for prednisone and neither calcium chloride nor levothyroxine addresses the
risk of adrenal insufficiency.
Following an addisonian crisis, a patient’s adrenal function has been gradually regained.
The nurse should ensure that the patient knows about the need for supplementary
28. glucocorticoid therapy in which of the following circumstances?
A)
Episodes of high psychosocial stress
B)
Periods of dehydration
C)
Episodes of physical exertion
D)
Administration of a vaccine
Ans:
A
Feedback:
During stressful procedures or significant illnesses, additional supplementary therapy
with glucocorticoids is required to prevent addisonian crisis. Physical activity,
dehydration and vaccine administration would not normally be sufficiently demanding
such to require glucocorticoids.
A 30 year-old female patient has been diagnosed with Cushing syndrome. What
psychosocial nursing diagnosis should the nurse most likely prioritize when planning the
29. patient’s care?
A)
Decisional conflict related to treatment options
B)
Spiritual distress related to changes in cognitive function
C)
Disturbed body image related to changes in physical appearance
D)
Powerlessness related to disease progression
Ans:
C
Feedback:
Cushing syndrome causes characteristic physical changes that are likely to result in
disturbed body image. Decisional conflict and powerless may exist, but disturbed body
image is more likely to be present. Cognitive changes take place in patients with Cushing
syndrome, but these may or may not cause spiritual distress.
A patient with pheochromocytoma has been admitted for an adrenalectomy to be
performed the following day. To prevent complications, the nurse should anticipate
30. preoperative administration of which of the following?
A)
IV antibiotics
B)
Oral antihypertensives
C)
Parenteral nutrition
D)
IV corticosteroids
Ans:
D
Feedback:
IV administration of corticosteroids (methylprednisolone sodium succinate [SoluMedrol]) may begin on the evening before surgery and continue during the early
postoperative period to prevent adrenal insufficiency. Antibiotics, antihypertensives, and
parenteral nutrition do not prevent adrenal insufficiency or other common complications
of adrenalectomy.
A patient is undergoing testing for suspected adrenocortical insufficiency. The care team
should ensure that the patient has been assessed for the most common cause of
31. adrenocortical insufficiency. What is the most common cause of this health problem?
A)
Therapeutic use of corticosteroids
B)
Pheochromocytoma
C)
Inadequate secretion of ACTH
D)
Adrenal tumor
Ans:
A
Feedback:
Therapeutic use of corticosteroids is the most common cause of adrenocortical
insufficiency. The other options also cause adrenocortical insufficiency, but they are not
the most common causes.
The nurse providing care for a patient with Cushing syndrome has identified the nursing
diagnosis of risk for injury related to weakness. How should the nurse best reduce this
32. risk?
A)
Establish falls prevention measures.
B)
Encourage bed rest whenever possible.
C)
Encourage the use of assistive devices.
D)
Provide constant supervision.
Ans:
A
Feedback:
The nurse should take action to prevent the patient’s risk for falls. Bed rest carries too
many harmful effects, however, and assistive devices may or may not be necessary.
Constant supervision is not normally required or practicable.
A patient with Cushing syndrome has been hospitalized after a fall. The dietician
consulted works with the patient to improve the patient’s nutritional intake. What foods
33. should a patient with Cushing syndrome eat to optimize health? Select all that apply.
A)
Foods high in vitamin D
B)
Foods high in calories
C)
Foods high in protein
D)
Foods high in calcium
E)
Foods high in sodium
Ans:
A, C, D
Feedback:
Foods high in vitamin D, protein, and calcium are recommended to minimize muscle
wasting and osteoporosis. Referral to a dietitian may assist the patient in selecting
appropriate foods that are also low in sodium and calories.
34. A patient on corticosteroid therapy needs to be taught that a course of corticosteroids of 2
weeks’ duration can suppress the adrenal cortex for how long?
A)
Up to 4 weeks
B)
Up to 3 months
C)
Up to 9 months
D)
Up to 1 year
Ans:
D
Feedback:
Suppression of the adrenal cortex may persist up to 1 year after a course of
corticosteroids of only 2 weeks’ duration.
A patient with Cushing syndrome as a result of a pituitary tumor has been admitted for a
transsphenoidal hypophysectomy. What would be most important for the nurse to
35. monitor before, during, and after surgery?
A)
Blood glucose
B)
Assessment of urine for blood
C)
Weight
D)
Oral temperature
Ans:
A
Feedback:
Before, during, and after this surgery, blood glucose monitoring and assessment of stools
for blood are carried out. The patient’s blood sugar is more likely to be volatile than body
weight or temperature. Hematuria is not a common complication.
What should the nurse teach a patient on corticosteroid therapy in order to reduce the
36. patient’s risk of adrenal insufficiency?
A)
Take the medication late in the day to mimic the body’s natural rhythms.
B)
Always have enough medication on hand to avoid running out.
C)
Skip up to 2 doses in cases of illness involving nausea.
D)
Take up to 1 extra dose per day during times of stress.
Ans:
B
Feedback:
The patient and family should be informed that acute adrenal insufficiency and
underlying symptoms will recur if corticosteroid therapy is stopped abruptly without
medical supervision. The patient should be instructed to have an adequate supply of the
corticosteroid medication always available to avoid running out. Doses should not be
skipped or added without explicit instructions to do so. Corticosteroids should normally
be taken in the morning to mimic natural rhythms.
The nurse is caring for a patient at risk for an addisonian crisis. For what associated signs
37. and symptoms should the nurse monitor the patient? Select all that apply.
A)
Epistaxis
B)
Pallor
C)
Rapid respiratory rate
D)
Bounding pulse
E)
Hypotension
Ans:
B, C, E
Feedback:
The patient at risk is monitored for signs and symptoms indicative of addisonian crisis,
which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor;
and extreme weakness. Epistaxis and a bounding pulse are not symptoms or signs of an
addisonian crisis.
A patient has been assessed for aldosteronism and has recently begun treatment. What are
priority areas for assessment that the nurse should frequently address? Select all that
38. apply.
A)
Pupillary response
B)
Creatinine and BUN levels
C)
Potassium level
D)
Peripheral pulses
E)
BP
Ans:
C, E
Feedback:
Patients with aldosteronism exhibit a profound decline in the serum levels of potassium,
and hypertension is the most prominent and almost universal sign of aldosteronism.
Pupillary response, peripheral pulses, and renal function are not directly affected.
39. A patient who has been taking corticosteroids for several months has been experiencing
muscle wasting. The patient has asked the nurse for suggestions to address this adverse
effect. What should the nurse recommend?
A)
Activity limitation to conserve energy
B)
Consumption of a high-protein diet
C)
Use of OTC vitamin D and calcium supplements
D)
Passive range-of-motion exercises
Ans:
B
Feedback:
Muscle wasting can be partly addressed through increased protein intake. Passive ROM
exercises maintain flexibility, but do not build muscle mass. Vitamin D and calcium
supplements do not decrease muscle wasting. Activity limitation would exacerbate the
problem.
The nurse is providing care for an older adult patient whose current medication regimen
includes levothyroxine (Synthroid). As a result, the nurse should be aware of the
40. heightened risk of adverse effects when administering an IV dose of what medication?
A)
A fluoroquinalone antibiotic
B)
A loop diuretic
C)
A proton pump inhibitor (PPI)
D)
A benzodiazepine
Ans:
D
Feedback:
Oral thyroid hormones interact with many other medications.Even in small IV doses,
hypnotic and sedative agents may induce profound somnolence, lasting far longer than
anticipated and leading to narcosis (stupor like condition). Furthermore, they are likely to
cause respiratory depression, which can easily be fatal because of decreased respiratory
reserve and alveolar hypoventilation. Antibiotics, PPIs and diuretics do not cause the
same risk.