Chapter 50 Bridge to NCLEX Examination
The number of the question corresponds to the same-numbered outcome at the beginning of the chapter.
1.
After a hypophysectomy for acromegaly, postoperative nursing care should focus on
a.
frequent monitoring of serum and urine osmolarity.
b.
parenteral administration of a GH-receptor antagonist.
c.
keeping the patient in a recumbent position at all times.
d.
patient teaching regarding the need for lifelong hormone therapy.
1. Correct answer: a
Rationale: A possible postoperative complication after a hypophysectomy is transient diabetes insipidus (DI). It
may occur because of the loss of antidiuretic hormone (ADH), which is stored in the posterior lobe of the
pituitary gland, or because of cerebral edema related to manipulation of the pituitary gland during surgery. To
assess for DI, urine output and serum and urine osmolarity should be monitored closely.
2.
A patient with a head injury develops SIADH. Manifestations the nurse would expect to find
include
a.
hypernatremia and edema.
b.
muscle spasticity and hypertension.
c.
low urine output and hyponatremia.
d.
weight gain and decreased glomerular filtration rate.
2. Correct answer: c
Rationale: Excess ADH increases the permeability of the renal distal tubule and collecting ducts, 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 (i.e., dilutional
hyponatremia). Hyponatremia causes muscle cramping, pain, and weakness. Initially, the patient displays thirst,
dyspnea on exertion, and fatigue. Patients with the syndrome of inappropriate antidiuretic hormone secretion
(SIADH) experience low urinary output and increased body weight. As the serum sodium level falls (usually to
less than 120 mEq/L), manifestations become more severe and include vomiting, abdominal cramps, muscle
twitching, and seizures. As plasma osmolality and serum sodium levels continue to decline, cerebral edema may
occur, leading to lethargy, anorexia, confusion, headache, seizures, and coma.
3.
The health care provider prescribes levothyroxine (Synthroid) for a patient with hypothyroidism.
After teaching regarding this drug, the nurse determines that further instruction is needed when the patient
says
a.
“I can expect the medication dose may need to be adjusted.”
b.
“I only need to take this drug until my symptoms are improved.”
c.
“I can expect to return to normal function with the use of this drug.”
d.
“I will report any chest pain or difficulty breathing to the doctor right away.”
3. Correct answer: b
Rationale: Levothyroxine (Synthroid) is the drug of choice to treat hypothyroidism. The need for thyroid
replacement therapy is usually lifelong.
4.
After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the
patient develops
a.
muscle weakness and weight loss.
b.
hyperthermia and severe tachycardia.
c.
hypertension and difficulty swallowing.
d.
laryngospasms and tingling in the hands and feet.
4. Correct answer: d
Rationale: Painful tonic spasms of smooth and skeletal muscles can cause laryngospasms that may compromise
breathing. These spasms may be related to tetany, which occurs if the parathyroid glands are removed or
damaged during surgery, which leads to hypocalcemia.
5.
Important nursing intervention(s) when caring for a patient with Cushing syndrome include
(select all that apply)
a.
restricting protein intake.
b.
monitoring blood glucose levels.
c.
observing for signs of hypotension.
d.
administering medication in equal doses.
e.
protecting patient from exposure to infection.
5. Correct answers: b, e
Rationale: Hyperglycemia occurs with Cushing disease because of glucose intolerance (associated with
cortisol-induced insulin resistance) and increased gluconeogenesis by the liver. High levels of corticosteroids
increase susceptibility to infection and delay wound healing.
6.
is to
a.
An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism
monitor blood glucose levels.
b.
restrict fluid and sodium intake.
c.
administer potassium-sparing diuretics.
d.
advise the patient to make postural changes slowly.
6. Correct answer: c
Rationale: Before surgery, patients should be treated with potassium-sparing diuretics (spironolactone
[Aldactone], eplerenone [Inspra]) to normalize serum potassium levels. Spironolactone and eplerenone block
the binding of aldosterone to the mineralocorticoid receptor in the terminal distal tubules and collecting ducts of
the kidney, thus increasing sodium excretion, water excretion, and potassium retention. Oral potassium
supplements may also be necessary.
7.
To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking
corticosteroids to
a.
increase calcium intake to 1500 mg/day.
b.
perform glucose monitoring for hypoglycemia.
c.
obtain immunizations due to high risk of infections.
d.
avoid abrupt position changes because of orthostatic hypotension.
7. Correct answer: a
Rationale: 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 [Fosamax]),
and institution of a low-impact exercise program.
8.
is
The nurse teaches the patient that the best time to take corticosteroids for replacement purposes
a.
once a day at bedtime.
b.
every other day on awakening.
c.
on arising and in the late afternoon.
d.
at consistent intervals every 6 to 8 hours.
8. Correct answer: c
Rationale: As replacement therapy, glucocorticoids are usually administered in divided doses: two thirds in the
morning and one third in the afternoon. This dosage schedule reflects normal circadian rhythm in endogenous
hormone secretion and decreases the side effects associated with corticosteroid replacement therapy.