Chapter 37: Care of Patients with Pituitary, Thyroid, Parathyroid, and Adrenal Disorders My Nursing Test Banks

Chapter 37: Care of Patients with Pituitary, Thyroid, Parathyroid, and Adrenal Disorders

MULTIPLE CHOICE

1. Although benign, the pituitary adenoma antagonizes insulin, which would cause:

a.

hyperinsulinism.

b.

hyperglycemia.

c.

hypopituitarism.

d.

hypoglycemia.

ANS: B

The tumor interferes with the effectiveness of insulin, resulting in hyperglycemia.

DIF: Cognitive Level: Comprehension REF: 834 OBJ: 1 (clinical)

TOP: Pituitary Tumor: Effects KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. A patient who had a hypophysectomy 3 days ago begins to have 3000 mL of urine output every shift and complains of thirst and a dry mouth. The nurse interprets these signs as possible:

a.

overreaction to diuretics.

b.

diabetes insipidus.

c.

diabetes mellitus.

d.

glucose intolerance.

ANS: B

Diabetes insipidus is a complication of a hypophysectomy. The posterior lobe of the pituitary gland controls urinary output; when this portion of the pituitary is removed or damaged, there is no secretion of antidiuretic hormone to stop excessive urine output.

DIF: Cognitive Level: Application REF: 834 OBJ: 4 (clinical)

TOP: Hypophysectomy: Complication KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

3. The nurse is aware that the patient has central diabetes insipidus because the disease was the result of the patients having:

a.

brain surgery to remove a tumor.

b.

a kidney disorder.

c.

habitually consumed excessive amounts of water.

d.

a thyroid disorder.

ANS: A

Central diabetes insipidus is caused by insult to the pituitary by brain injury or invasive surgery.

DIF: Cognitive Level: Application REF: 835 OBJ: 6 (clinical)

TOP: Diabetes Insipidus: Central Type KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

4. The nurse is aware that the severe dehydration associated with diabetes insipidus can lead to the serious electrolyte imbalance of:

a.

hypercalcemia.

b.

hypernatremia.

c.

hypocalcemia.

d.

hyperkalemia.

ANS: B

The loss of potassium in the large volume of urine depletes the compensatory mechanisms and hypernatremia results.

DIF: Cognitive Level: Application REF: 838 OBJ: 6 (clinical)

TOP: Diabetes Insipidus: Complication KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The nurse recognizes a need for instruction when the patient with a simple goiter says:

a.

The lump on my throat is my enlarged thyroid.

b.

Treatment will stop the enlargement of the goiter.

c.

I am aware this goiter could develop into cancer.

d.

Im glad my treatment will make this thing go away.

ANS: D

Treatment usually arrests the growth of the goiter but usually does not diminish the size of the growth unless diagnosis is made early in the disease before growth has become excessive.

DIF: Cognitive Level: Comprehension REF: 838 OBJ: 1 (theory)

TOP: Goiter KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

6. The nurse administering potassium iodide for the treatment of goiter will:

a.

pour the solution over ice to make it more palatable.

b.

give the well-diluted solution through a straw.

c.

give the solution on an empty stomach.

d.

mix the solution with an antacid to reduce gastric irritation.

ANS: B

The solution should be diluted and drunk through a straw to avoid staining of teeth.

DIF: Cognitive Level: Comprehension REF: 839 OBJ: 1 (theory)

TOP: Iodine Solutions: Administration KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

7. The nurse is reviewing the health history of a patient. Which finding is most linked to the probability of developing Graves disease?

a.

Smoking

b.

Long-term use of birth control pills

c.

Habitual excessive alcohol consumption

d.

Use of herbal remedies, such as St. Johns wort

ANS: A

Primary hyperthyroidism is also known as Graves disease or toxic goiter. Medications containing iodine, such as amiodarone (an antidysrhythmic heart medication), can predispose to hyperthyroidism. In addition, it has been discovered recently that people who smoke have nearly twice the risk of developing hyperthyroidism when compared with nonsmokers.

DIF: Cognitive Level: Comprehension REF: 839 OBJ: 1 (theory)

TOP: Graves Disease: Risk Factors KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. The patient with hyperthyroidism is undergoing ablation therapy with radioactive iodine. The precaution the nurse will employ is to:

a.

take radioactive precautions with syringes and bedpans.

b.

use Standard Precautions only.

c.

enforce isolation for 3 days.

d.

wear a mask and eye protectors when caring for patient.

ANS: A

Radioactive iodine (131I) circulates in the blood and is excreted by the kidneys, so radioactive precautions should be taken with any equipment contaminated with blood or urine.

DIF: Cognitive Level: Application REF: 840 OBJ: 1 (theory)

TOP: Ablation Therapy: Care KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

9. The physician has prescribed methimazole (Tapazole). When providing education to the patient, which instruction should be included in the teaching?

a.

The medication can be doubled if the previous dose was missed.

b.

The medication should be taken on a strict schedule.

c.

The medication could be replaced by a less expensive generic substitute.

d.

The medication can be safely taken by pregnant women.

ANS: B

All replacement hormone drugs should be taken on a strict schedule. Doubling up and taking a substitute drug interfere with the effectiveness of the therapy. Pregnant women should not take this drug because of fetal damage.

DIF: Cognitive Level: Application REF: 840 OBJ: 1 (theory)

TOP: Antithyroid Drugs: Instructions KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

10. The nurse clarifies that a subtotal thyroidectomy, which removes only two thirds of the gland, allows:

a.

the patient to take minimum amounts of antithyroid drugs.

b.

continued production and release of thyroid hormones from the remainder of the gland.

c.

the reduction of exophthalmos.

d.

for less postoperative risk than total thyroidectomy.

ANS: B

Patients who do not respond well to antithyroid drug therapy, who are unable to take radioactive iodine, or who have greatly enlarged thyroid glands are candidates for a subtotal thyroidectomy. In the subtotal procedure, two thirds of the glandular mass is removed. The remaining portion of the gland is left intact so production and release of thyroid hormone can continue. There is no need for antithyroid drugs, and the operative risks are the same.

DIF: Cognitive Level: Application REF: 840 OBJ: 5 (clinical)

TOP: Thyroidectomy: Subtotal KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

11. The husband of a patient with Graves disease confides that he is frustrated with his wifes emotional outbursts and wide mood swings. The nurses most helpful response would be:

a.

I know what you mean! She can be quite a handful!

b.

Her antithyroid drugs will smooth the behavior out in a few weeks.

c.

Im afraid this behavior will continue. How are you coping with it now?

d.

If I were you, Id tell her how you feel.

ANS: B

Reassurance that the signs and symptoms will improve with medication is helpful. Responses of she can be quite a handful, Im afraid this behavior will continue, and Id tell her how you feel are inaccurate and nontherapeutic communication.

DIF: Cognitive Level: Analysis REF: 840 OBJ: 1 (theory)

TOP: Graves Disease: Lability KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

12. During the preoperative thyroidectomy instruction to a patient with Graves disease, the patient bursts into tears and says, I am so nervous and cant listen to you. Just get out! The nurses best action is to:

a.

give the patient written preoperative instructions.

b.

inform the charge nurse or surgeon of this stressful behavior.

c.

remind the patient the preoperative information is important.

d.

inform the oncoming shift of this behavior.

ANS: B

Informing the charge nurse or surgeon will alert them to possible ineffective control of the thyroid, which can cause thyroid crisis postoperatively.

DIF: Cognitive Level: Application REF: 840 OBJ: 3 (theory)

TOP: Graves Disease: Complication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

13. When a patient who is 8 hours postoperative from a total thyroidectomy shows a positive Chvosteks sign and complains of muscle cramps, the nurse interprets these assessments as indicative of:

a.

imminent convulsion.

b.

hypoparathyroidism.

c.

hyperkalemia.

d.

thyroid storm.

ANS: B

Hypoparathyroidism results when the parathyroid glands are accidentally removed during a total thyroidectomy. Chvosteks sign is consistent with the removal of the parathyroid glands. Chvostek sign manifests as muscle irritability when the facial nerve is gently tapped.

DIF: Cognitive Level: Application REF: 845 OBJ: 3 (theory)

TOP: Hypoparathyroidism KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

14. The nurse is caring for a patient who reports abruptly discontinuing his prescribed levothyroxine. Which clinical finding is most consistent with this behavior?

a.

Seizures

b.

Extreme diarrhea

c.

Sudden hypertension

d.

Respiratory distress

ANS: D

Abruptly stopping hormone replacement can cause the patient to go into myxedema coma. Signs and symptoms of myxedema coma include dizziness, respiratory distress, low blood sugar, or hypothermia.

DIF: Cognitive Level: Application REF: 844 OBJ: 3 (clinical)

TOP: Myxedema Coma: Etiology KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

15. A patient with Addisons disease is taking daily doses of corticosteroids to control the symptoms of this disease. The nurse explains that corticosteroids should be:

a.

taken every day.

b.

taken on an empty stomach.

c.

stopped if gastrointestinal symptoms appear.

d.

doubled in the event of stress.

ANS: A

Corticosteroids should be taken every day. Corticosteroids should be administered with food. The medications should not be abruptly discontinued. To provide appropriate serum medication levels, they are not to be doubled or altered without physician consultation.

DIF: Cognitive Level: Comprehension REF: 848 OBJ: 2 (clinical)

TOP: Corticosteroids KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

16. The patient in addisonian crisis is receiving IV fluids for rehydration. The nursing care is focused on:

a.

early assessment of hypotension.

b.

monitoring for hyperglycemia.

c.

keeping the patient cool with sponge baths.

d.

prevention of skin breakdown.

ANS: A

The patient with Addisons disease is at risk for an addisonian crisis. Addisonian crisis requires immediate fluid replacement therapy in order to prevent irreversible shock. Intravenous hydrocortisone is given along with sodium, fluids, and dextrose until blood pressure becomes stable. The hydrocortisone is then tapered off slowly. Hyperkalemia must also be addressed with insulin, Kayexalate, and loop diuretics, and by monitoring arrhythmias and the patients intake and output. Hypoglycemia is treated with IV glucose and with glucagon as needed; blood glucose is monitored every hour.

DIF: Cognitive Level: Comprehension REF: 848 OBJ: 5 (theory)

TOP: Addisonian Crisis: Nursing Care KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

17. The nurse is preparing a patient to undergo a dexamethasone suppression test. Which action is most appropriate?

a.

Instruct the patient to be NPO 6 hours before the test.

b.

Instruct the patient that urine levels will be assessed after a 24-hour collection period.

c.

Administer a steroid the morning of the test.

d.

Instruct the patient that a blood specimen will be collected in the morning.

ANS: D

When assessing for Cushings disease cortisol levels are evaluated. If elevated cortisol levels are noted, a dexamethasone suppression test should be ordered. In preparation for the test, the patient is given a steroid at night, and blood and urine cortisol levels are then measured in the morning.

DIF: Cognitive Level: Application REF: 852 OBJ: 5 (theory)

TOP: Cushings Disease: Diagnosis KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

18. The nurse is caring for a patient scheduled for a thyroidectomy. Which instruction should be included in the preoperative care?

a.

Salt should be avoided during the 2 weeks before surgery.

b.

Medications will be administered to increase the vascularity of the gland before surgery.

c.

Iodine will be administered in the 2 weeks before surgery to increase the level of thyroid hormone being released into the bloodstream.

d.

Medications will be administered in the 2 weeks before surgery to reduce the vascularity of the gland.

ANS: D

Iodine preparations may be given for a period of 10 to 14 days before surgery of the thyroid to reduce the vascularity of the gland, minimizing the danger of releasing large amounts of thyroid hormone into the bloodstream during surgery, and to decrease the risk of hemorrhage.

DIF: Cognitive Level: Application REF: 841 OBJ: 3 (theory)

TOP: Hyperthyroidism: Medication Safety Alert

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

MULTIPLE RESPONSE

19. The nurse uses a visual aid to demonstrate the effects of a benign pituitary adenoma, which include: (Select all that apply.)

a.

gigantism in children.

b.

acromegaly in adults.

c.

muscle weakness.

d.

excessive hair growth.

e.

joint pain.

ANS: A, B, C, E

There is no hirsutism with a pituitary tumor.

DIF: Cognitive Level: Comprehension REF: 834 OBJ: 1 (clinical)

TOP: Pituitary Tumor: Effects KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

20. The nurse planning the hypophysectomy postoperative instructions that will be given to the patient before surgery will include: (Select all that apply.)

a.

presence of drip pad under nose.

b.

postponing brushing teeth.

c.

presence of nasal packing for several days.

d.

need to cough and deep breathe.

e.

avoiding bending over.

ANS: A, B, C, E

Patient should not cough, sneeze, or blow nose as this could lead to a cerebrospinal fluid leak.

DIF: Cognitive Level: Application REF: 834 OBJ: 4 (clinical)

TOP: Hypophysectomy: Postoperative Instructions

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

21. The nurse planning care for a patient with diabetes insipidus will include: (Select all that apply.)

a.

maintaining fluid therapy.

b.

conserving energy.

c.

supporting dietary choices to reduce diarrhea.

d.

assessing for bradycardia.

e.

encouraging exercise to reduce weight.

ANS: A, B, D

Diabetes insipidus patients are constipated and frail from weight loss.

DIF: Cognitive Level: Application REF: 837 OBJ: 1 (theory)

TOP: Diabetes Insipidus: Signs and Symptoms

KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

22. A tumor of the pituitary has caused the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse plans interventions for: (Select all that apply.)

a.

assisting with activities of daily living because of weakness.

b.

recording accurate urine output because of oliguria.

c.

weighing daily to assess edema.

d.

assessing for changes in level of conscious because of confusion and seizures.

e.

assessing stool for occult blood.

ANS: A, B, C, D

There is no threat of GI hemorrhage with SIADH.

DIF: Cognitive Level: Application REF: 838 OBJ: 1 (clinical)

TOP: SIADH: Care KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

23. The nurse lists the classic signs and symptoms of hyperthyroidism, which are: (Select all that apply.)

a.

tremulousness.

b.

bradycardia.

c.

exertional dyspnea.

d.

scanty menstruation.

e.

increased thirst and urination.

ANS: A, C, D, E

All the options except for bradycardia are classic signs of the condition (tachycardia is). In addition, there is ankle edema, diarrhea, decreased libido, difficulty concentrating, and exophthalmos.

DIF: Cognitive Level: Comprehension REF: 839 OBJ: 1 (theory)

TOP: Hyperthyroidism: Classic Signs and Symptoms

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

24. The immediate postoperative care of a person who had a total thyroidectomy will include: (Select all that apply.)

a.

placing the patient in a prone position.

b.

supporting the head with sandbags.

c.

assessing for vital signs every hour.

d.

assessing ability to swallow.

e.

assessing for bleeding.

ANS: B, D, E

The immediate postoperative care of a person who had a total thyroidectomy would include placing the patient in high Fowlers position, supporting the head with sandbags, assessing for vital signs every 15 minutes, assessing the ability to swallow, and assessing for bleeding.

DIF: Cognitive Level: Application REF: 841 OBJ: 5 (clinical)

TOP: Thyroidectomy: Postoperative Care

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

25. On the first postoperative day following a total thyroidectomy, the nurse assesses signs that indicate a developing thyroid storm, which are: (Select all that apply.)

a.

rising temperature (over 101 F).

b.

pulse dropping below 60.

c.

brief attention span.

d.

apprehension and restlessness.

e.

respirations below 14.

ANS: A, C, D

Rising temperature, pulse, and respirations are the first signs.

DIF: Cognitive Level: Application REF: 843 OBJ: 3 (theory)

TOP: Thyroid Storm: Signs and Symptoms

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

26. The nurse is evaluating the laboratory results of a patient suspected of having hyperparathyroidism. Which finding(s) would be consistent with this condition? (Select all that apply.)

a.

Decreased serum calcium levels

b.

Decreased serum phosphate levels

c.

Increased calcium levels in the urine

d.

Decreased phosphate levels in the urine

e.

Increased serum calcium levels

ANS: B, C, E

The laboratory findings of the patient with hyperparathyroidism include increased serum calcium levels, decreased serum phosphate levels, and increased calcium and phosphate in the urine.

DIF: Cognitive Level: Analysis REF: 846 OBJ: 4 (theory)

TOP: Comparison of Hyperparathyroidism and Hypoparathyroidism

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

COMPLETION

27. The nurses major contribution to the care of a patient with Cushings syndrome is that of __________ and __________.

ANS:

education, support

support, education

Patients with Cushings syndrome have a frustrating time dealing with their own lability and fatigue. They need support and education and referral for assistance.

DIF: Cognitive Level: Comprehension REF: 852-853 OBJ: 6 (theory)

TOP: Cushings Syndrome KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

MATCHING

The nurse associates the pathophysiology to the signs of the condition it causes in the adult. Match the hormonal change to the symptom it would produce.

a.

Decreased growth hormone

b.

Increased thyroid hormone

c.

Decreased follicle-stimulating hormone

d.

Decreased thyroid hormone

e.

Increased antidiuretic hormone

28. Pathologic fractures

29. Weight gain, fatigue, and lethargy

30. Hyponatremia, edema

31. High metabolism rate

32. Menstrual irregularities

28. ANS: A DIF: Cognitive Level: Analysis REF: 835

OBJ: 1 (theory) TOP: Endocrine Disorders: Signs and Symptoms

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

29. ANS: D DIF: Cognitive Level: Analysis REF: 835

OBJ: 1 (theory) TOP: Endocrine Disorders: Signs and Symptoms

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

30. ANS: E DIF: Cognitive Level: Analysis REF: 835

OBJ: 1 (theory) TOP: Endocrine Disorders: Signs and Symptoms

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

31. ANS: B DIF: Cognitive Level: Analysis REF: 835

OBJ: 1 (theory) TOP: Endocrine Disorders: Signs and Symptoms

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

32. ANS: C DIF: Cognitive Level: Analysis REF: 835

OBJ: 1 (theory) TOP: Endocrine Disorders: Signs and Symptoms

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

The nurse traces the closed loop of thyroid secretion. Place the events in appropriate order.

a.

Hypothalamus is activated.

b.

Pituitary releases thyroid-stimulating hormone (TSH).

c.

Drop in norepinephrine level.

d.

Thyroid releases thyroid hormone.

e.

Satisfaction of norepinephrine level signals hypothalamus in negative feedback.

f.

Thyrotropin-releasing hormone (TRH) is secreted.

33. Step 1

34. Step 2

35. Step 3

36. Step 4

37. Step 5

38. Step 6

33. ANS: C DIF: Cognitive Level: Analysis REF: 838

OBJ: 1 (theory) TOP: Thyroid Hormone: Stimulation

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

34. ANS: A DIF: Cognitive Level: Analysis REF: 838

OBJ: 1 (theory) TOP: Thyroid Hormone: Stimulation

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

35. ANS: F DIF: Cognitive Level: Analysis REF: 838

OBJ: 1 (theory) TOP: Thyroid Hormone: Stimulation

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

36. ANS: B DIF: Cognitive Level: Analysis REF: 838

OBJ: 1 (theory) TOP: Thyroid Hormone: Stimulation

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

37. ANS: D DIF: Cognitive Level: Analysis REF: 838

OBJ: 1 (theory) TOP: Thyroid Hormone: Stimulation

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

38. ANS: E DIF: Cognitive Level: Analysis REF: 838

OBJ: 1 (theory) TOP: Thyroid Hormone: Stimulation

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

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