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Study Guide for Medical-Surgical Nursing: Assessment and Management of Clinical Problems

Sharon L. Lewis RN PhD FAAN, Shannon Ruff Dirksen RN PhD, Linda Bucher RN PhD CEN

Chapter 50

Nursing Management: Endocrine Problems - all with Video Answers

Educators

Chapter Questions

Problem 1

A patient suspected of having acromegaly has an elevated plasma growth hormone (GH) level. In acromegaly, what would the nurse also expect the patient's diagnostic results to indicate?
a. Hyperinsulinemia
b. Plasma glucose of $<70 \mathrm{mg} / \mathrm{dL}(3.9 \mathrm{mmol} / \mathrm{L})$
c. Decreased $\mathrm{GH}$ levels with an oral glucose challenge test
d. Elevated levels of plasma insulin-like growth factor-1 (IGF-1)

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Problem 2

During assessment of the patient with acromegaly, what should the nurse expect the patient to report?
a. Infertility
c. Undesirable changes in appearance
b. Dry, irritated skin
d. An increase in height of 2 to 3 inches a year

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Problem 3

A patient with acromegaly is treated with a transsphenoidal hypophysectomy. What should the nurse do postoperatively?
a. Ensure that any clear nasal drainage is tested for glucose.
b. Maintain the patient flat in bed to prevent cerebrospinal fluid (CSF) leakage.
c. Assist the patient with toothbrushing every 4 hours to keep the surgical area clean.
d. Encourage deep breathing, coughing, and turning to prevent respiratory complications.

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01:43

Problem 4

What findings are commonly found in a patient with a prolactinoma?
a. Gynecomastia in men
b. Profuse menstruation in women
c. Excess follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
d. Signs of increased intracranial pressure, including headache, nausea, and vomiting

Parvati Devi
Parvati Devi
Numerade Educator
02:33

Problem 5

An African American woman with a history of breast cancer has panhypopituitarism from radiation therapy for primary pituitary tumors. Which medications should the nurse teach her about needing for the rest of her life (select all that apply)?
a. Cortisol
d. Levothyroxine (Synthyroid)
b. Vasopressin
e. Growth hormone (somatropin [Omnitrope])
c. Sex hormones
f. Dopamine agonists (bromocriptine [Parlodel])

Rehana Riaz
Rehana Riaz
Numerade Educator

Problem 6

The patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What manifestation should the nurse expect to find?
a. Decreased body weight
c. Increased plasma osmolality
b. Decreased urinary output
d. Increased serum sodium levels

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Problem 7

During care of the patient with SIADH, what should the nurse do?
a. Monitor neurologic status at least every 2 hours.
b. Teach the patient receiving treatment with diuretics to restrict sodium intake.
c. Keep the head of the bed elevated to prevent antidiuretic hormone $(\mathrm{ADH})$ release.
d. Notify the health care provider if the patient's blood pressure decreases more than $20 \mathrm{~mm} \mathrm{Hg}$ from baseline.

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Problem 8

A patient with SIADH is treated with water restriction. What does the patient experience when the nurse determines that treatment has been effective?
a. Increased urine output, decreased serum sodium, and increased urine specific gravity
b. Increased urine output, increased serum sodium, and decreased urine specific gravity
c. Decreased urine output, increased serum sodium, and decreased urine specific gravity
d. Decreased urine output, decreased serum sodium, and increased urine specific gravity

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01:33

Problem 9

The patient with diabetes insipidus is brought to the emergency department with confusion and dehydration after excretion of a large volume of urine today even though several liters of fluid were drunk. What is a diagnostic test that the nurse should expect to be done to help make a diagnosis?
a. Blood glucose
c. Urine specific gravity
b. Serum sodium level
d. Computed tomography (CT) of the head

Qudsiya Anis
Qudsiya Anis
Numerade Educator
03:58

Problem 10

In a patient with central diabetes insipidus, what will the administration of $\mathrm{ADH}$ during a water deprivation test result in?
a. Decrease in body weight
c. Decrease in blood pressure
b. Increase in urinary output
d. Increase in urine osmolality

Norma Kimmel
Norma Kimmel
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Problem 11

A patient with diabetes insipidus is treated with nasal desmopressin acetate (DDAVP). The nurse determines that the drug is not having an adequate therapeutic effect when the patient experiences
a. headache and weight gain.
c. a urine specific gravity of 1.002 .
b. nasal irritation and nausea.
d. an oral intake greater than urinary output.

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Problem 12

When caring for a patient with nephrogenic diabetes insipidus, what should the nurse expect the treatment to include?
a. Fluid restriction
c. A high-sodium diet
b. Thiazide diuretics
d. Chlorpropamide (Diabinese)

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01:38

Problem 13

What characteristic is related to Hashimoto's thyroiditis?
a. Enlarged thyroid gland
b. Viral-induced hyperthyroidism
c. Bacterial or fungal infection of thyroid gland
d. Chronic autoimmune thyroiditis with antibody destruction of thyroid tissue

Rehana Riaz
Rehana Riaz
Numerade Educator
01:58

Problem 14

Which statement accurately describes Graves' disease?
a. Exophthalmos occurs in Graves' disease.
b. It is an uncommon form of hyperthyroidism.
c. Manifestations of hyperthyroidism occur from tissue desensitization to the sympathetic nervous system.
d. Diagnostic testing in the patient with Graves' disease will reveal an increased thyroid-stimulating hormone (TSH) level.

Ashley Thompson
Ashley Thompson
Numerade Educator

Problem 15

A patient with Graves' disease asks the nurse what caused the disorder. What is the best response by the nurse?
a. "The cause of Graves' disease is not known, although it is thought to be genetic."
b. "It is usually associated with goiter formation from an iodine deficiency over a long period of time."
c. "Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones."
d. "In genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion."

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Problem 16

A patient is admitted to the hospital with thyrotoxicosis. On physical assessment of the patient, what should the nurse expect to find?
a. Hoarseness and laryngeal stridor
b. Bulging eyeballs and dysrhythmias
c. Elevated temperature and signs of heart failure
d. Lethargy progressing suddenly to impairment of consciousness

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00:30

Problem 17

What medication is used with thyrotoxicosis to block the effects of the sympathetic nervous stimulation of the thyroid hormones?
a. Potassium iodide
c. Propylthiouracil (PTU)
b. Atenolol (Tenormin)
d. Radioactive iodine (RAI)

Joanna Quigley
Joanna Quigley
Numerade Educator
02:32

Problem 18

Which characteristics describe the use of RAI (select all that apply)?
a. Often causes hypothyroidism over time
b. Decreases release of thyroid hormones
c. Blocks peripheral conversion of $\mathrm{T}_4$ to $\mathrm{T}_3$
d. Treatment of choice in nonpregnant adults
e. Decreases thyroid secretion by damaging thyroid gland
f. Often used with iodine to produce euthyroid before surgery

Jared Adelman
Jared Adelman
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Problem 19

What preoperative instruction should the nurse give to the patient scheduled for a subtotal thyroidectomy?
a. How to support the head with the hands when turning in bed
b. Coughing should be avoided to prevent pressure on the incision
c. Head and neck will need to remain immobile until the incision heals
d. Any tingling around the lips or in the fingers after surgery is expected and temporary

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Problem 20

As a precaution for vocal cord paralysis from damage to the recurrent laryngeal nerve during thyroidectomy surgery, what equipment should be in the room in case it is needed for this emergency situation?
a. Tracheostomy tray
b. Oxygen equipment
c. IV calcium gluconate
d. Paper and pencil for communication

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Problem 21

When providing discharge instructions to a patient who had a subtotal thyroidectomy for hyperthyroidism, what should the nurse teach the patient?
a. Never miss a daily dose of thyroid replacement therapy.
b. Avoid regular exercise until thyroid function is normalized.
c. Use warm saltwater gargles several times a day to relieve throat pain.
d. Substantially reduce caloric intake compared to what was eaten before surgery.

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01:38

Problem 22

What is a cause of primary hypothyroidism in adults?
a. Malignant or benign thyroid nodules
b. Surgical removal or failure of the pituitary gland
c. Surgical removal or radiation of the thyroid gland
d. Autoimmune-induced atrophy of the thyroid gland

Rehana Riaz
Rehana Riaz
Numerade Educator
02:43

Problem 23

The nurse has identified the nursing diagnosis of fatigue for a patient who is hypothyroid. What should the nurse do while caring for this patient?
a. Monitor for changes in orientation, cognition, and behavior.
b. Monitor for vital signs and cardiac rhythm response to activity.
c. Monitor bowel movement frequency, consistency, shape, volume, and color.
d. Assist in developing well-balanced meal plans consistent with level of energy expenditure.

Syed Hasan
Syed Hasan
Numerade Educator

Problem 24

Priority Decision: When replacement therapy is started for a patient with long-standing hypothyroidism, what is most important for the nurse to monitor the patient for?
a. Insomnia
b. Weight loss
c. Nervousness
d. Dysrhythmias

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Problem 25

A patient with hypothyroidism is treated with levothyroxine (Synthroid). What should the nurse include when teaching the patient about this therapy?
a. Explain that alternate-day dosage may be used if side effects occur.
b. Provide written instruction for all information related to the drug therapy.
c. Assure the patient that a return to normal function will occur with replacement therapy.
d. Inform the patient that the drug must be taken until the hormone balance is reestablished.

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Problem 26

A patient who recently had a calcium oxalate renal stone had a bone density study, which showed a decrease in her bone density. What endocrine problem could this patient have?
a. SIADH
b. Hypothyroidism
c. Cushing syndrome
d. Hyperparathyroidism

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Problem 27

What is an appropriate nursing intervention for the patient with hyperparathyroidism?
a. Pad side rails as a seizure precaution.
b. Increase fluid intake to 3000 to $4000 \mathrm{~mL}$ daily.
c. Maintain bed rest to prevent pathologic fractures.
d. Monitor the patient for Trousseau's and Chvostek's signs.

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Problem 28

A patient has been diagnosed with hypoparathyroidism. What manifestations should the nurse expect to observe (select all that apply)?
a. Skeletal pain
b. Dry, scaly skin
c. Personality changes
d. Abdominal cramping
e. Cardiac dysrhythmias
f. Muscle spasms and stiffness

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Problem 29

When the patient with parathyroid disease experiences symptoms of hypocalcemia, what is a measure that can be used to temporarily raise serum calcium levels?
a. Administer IV normal saline.
b. Have patient rebreathe in a paper bag.
c. Administer furosemide (Lasix) as ordered.
d. Administer oral phosphorus supplements.

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01:13

Problem 30

A patient with hypoparathyroidism resulting from surgical treatment of hyperparathyroidism is preparing for discharge. What should the nurse teach the patient?
a. Milk and milk products should be increased in the diet.
b. Parenteral replacement of parathyroid hormone will be required for life.
c. Calcium supplements with vitamin D can effectively maintain calcium balance.
d. Bran and whole-grain foods should be used to prevent GI effects of replacement therapy.

Asma Venkitta
Asma Venkitta
Numerade Educator

Problem 31

A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, what should the nurse expect to find?
a. Hypertension, peripheral edema, and petechiae
b. Weight loss, buffalo hump, and moon face with acne
c. Abdominal and buttock striae, truncal obesity, and hypotension
d. Anorexia, signs of dehydration, and hyperpigmentation of the skin

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00:56

Problem 32

A patient is scheduled for a bilateral adrenalectomy. During the postoperative period, what should the nurse expect related to the administration of corticosteroids?
a. Reduced to promote wound healing
b. Withheld until symptoms of hypocortisolism appear
c. Increased to promote an adequate response to the stress of surgery
d. Reduced because excessive hormones are released during surgical manipulation of adrenal glands

Simon Sauvageau
Simon Sauvageau
Numerade Educator

Problem 33

A patient with Addison's disease comes to the emergency department with complaints of nausea, vomiting, diarrhea, and fever. What collaborative care should the nurse expect?
a. IV administration of vasopressors
b. IV administration of hydrocortisone
c. IV administration of $\mathrm{D}_5 \mathrm{~W}$ with $20 \mathrm{mEq} \mathrm{KCl}$
d. Parenteral injections of adrenocorticotropic hormone $(\mathrm{ACTH})$

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Problem 34

During discharge teaching for the patient with Addison's disease, which statement by the patient indicates that the nurse needs to do additional teaching?
a. "I should always call the doctor if I develop vomiting or diarrhea."
b. "If my weight goes down, my dosage of steroid is probably too high."
c. "I should double or triple my steroid dose if I undergo rigorous physical exercise."
d. "I need to carry an emergency kit with injectable hydrocortisone in case I can't take my medication by mouth."

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Problem 35

A patient who is on corticosteroid therapy for treatment of an autoimmune disorder has the following additional drugs ordered. Which one is used to prevent corticosteroid-induced osteoporosis?
a. Potassium
b. Furosemide (Lasix)
c. Alendronate (Fosamax)
d. Pantoprazole (Protonix)

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02:31

Problem 36

A patient with mild iatrogenic Cushing syndrome is on an alternate-day regimen of corticosteroid therapy. What does the nurse explain to the patient about this regimen?
a. It maintains normal adrenal hormone balance.
b. It prevents ACTH release from the pituitary gland.
c. It minimizes hypothalamic-pituitary-adrenal suppression.
d. It provides a more effective therapeutic effect of the drug.

Danielle Ashley
Danielle Ashley
Numerade Educator

Problem 37

When caring for a patient with primary hyperaldosteronism, the nurse would question a health care provider's prescription for which drug?
a. Furosemide (Lasix)
b. Amiloride (Midamor)
c. Spironolactone (Aldactone)
d. Aminoglutethimide (Cytadren)

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Problem 38

Priority Decision: What is the priority nursing intervention during the management of the patient with pheochromocytoma?
a. Administering IV fluids
b. Monitoring blood pressure
c. Administering $\beta$-adrenergic blockers
d. Monitoring intake and output and daily weights

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