Chapter 39. Nursing Care of Patients With Endocrine Disorders My Nursing Test Banks

Chapter 39. Nursing Care of Patients With Endocrine Disorders

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. A patient scheduled for diagnostic tests for hypothyroidism. Which symptoms should the nurse expect to observe in a patient with this disorder?
a. Tremor and oily skin
b. Anxiety and tachycardia
c. Dry skin and slowed heart rate
d. Increase in appetite and diarrhea
____ 2. A patient is prescribed levothyroxine (Synthroid) for hypothyroidism. Which statement should the nurse include when teaching the patient about this medication?
a. If you do not take your medication, you will retain water and begin to see swelling in your feet and legs.
b. Cushings syndrome is a complication of severe hypothyroidism, so you need to take this medication regularly.
c. Thyrotoxicosis results from too little thyroid hormone, so you should monitor your temperature every day.
d. Worsening hypothyroidism can result in a condition called myxedema coma, so it is important to take this medication.
____ 3. The nurse is caring for a patient with a history of asthma who is newly diagnosed with hyperthyroidism. What assessment finding should the licensed practical nurse (LPN) report immediately to the registered nurse (RN)?
a. Heart rate 112 beats/min
b. Temperature 97.2F (36.2C)
c. Blood pressure 112/73 mm Hg
d. Respiratory rate 20 breaths/min
____ 4. The nurse is caring for a patient with exophthalmos secondary to Graves disease. What nursing interventions are appropriate for this patient?
a. Myotic eyedrops and privacy
b. Television and other diversionary activities
c. An accepting attitude and lubricating eyedrops
d. Reassurance that the symptoms will resolve when the Graves disease is under control
____ 5. The nurse is preparing a patient for a thyroidectomy to treat hyperthyroidism. What patient statement indicates to the nurse that the patient understands the preoperative instructions?
a. I know that I should avoid turning my head after surgery.
b. I will probably need thyroid replacement medication after surgery.
c. I will avoid taking any thyroid or antithyroid drugs before surgery.
d. I will need to increase my calorie intake after surgery to avoid weight loss.
____ 6. A patient recovering from a thyroidectomy is being assessed for tetany. What is the most likely cause of tetany after this surgery?
a. Swelling of the incisional area
b. Overdose of preoperative antithyroid medication
c. Accidental removal of the parathyroid glands during surgery
d. Excess circulating thyroid hormone released during manipulation of the gland during surgery
____ 7. A patient who is one day postoperative thyroidectomy reports feeling numb around the mouth and is experiencing random muscle twitches. Which intravenous (IV) medication should the nurse anticipate that the physician will prescribe?
a. Iodine
b. Calcium gluconate
c. Potassium chloride
d. Sodium bicarbonate
____ 8. The nurse is caring for a patient following a thyroidectomy. Which postoperative assessment activity is most important to detect the development of thyrotoxic crisis?
a. Monitor vital signs.
b. Monitor the surgical dressing.
c. Assess for confusion and delirium.
d. Assess hand grips and foot presses.
____ 9. A patient 6 hours after a thyroidectomy has a temperature of 104F, pulse 144 beats per minute, respirations 24 per minute, and blood pressure 184/108 mm Hg. Which orders should the nurse anticipate being prescribed for this patient?
a. Aspirin and bedrest
b. Beta blockers and a cooling blanket
c. Epinephrine and compression dressings
d. Diphenhydramine (Benadryl) and Fowlers position
____ 10. The nurse is caring for a patient following a thyroidectomy. What item is most important to have at the bedside?
a. Hemostats
b. Gauze dressings
c. Tracheostomy set
d. Suture removal kit
____ 11. A nurse is approached by a neighbor who has a neck growth that appears to be a goiter. What should the nurse do?
a. Advise the neighbor to switch to iodized salt when cooking.
b. Palpate the neighbors thyroid gland for enlargement or nodules.
c. Ask if the neighbor has numbness or tingling in the hands or lips.
d. Question the neighbor about symptoms of hypothyroidism or hyperthyroidism.
____ 12. While doing volunteer health screenings at a local mall a patient with a large growth on the neck approaches the nurse. What finding should alert the nurse to send the patient to the physician immediately?
a. The patient seems depressed.
b. The growth is difficult to conceal with clothing.
c. The patient complains of being very tired lately.
d. The patient makes a funny high-pitched sound with each breath.
____ 13. A patient develops hyperparathyroidism related to a benign tumor. What laboratory result should the nurse expect to see?
a. Elevated serum calcium
b. Decreased serum calcium
c. Elevated serum potassium
d. Decreased serum potassium
____ 14. A patient with hyperparathyroidism asks why ambulation three times per day is necessary because it is so difficult to do so. Which response by the nurse is best?
a. Walking is good for you; I walk three times a day.
b. Walking is important for preventing cardiovascular disease.
c. Walking will keep the calcium where it belongsin your bones.
d. Walking is important to maintaining adequate serum calcium levels.
____ 15. The nurse is caring for a patient who is newly diagnosed with acromegaly. Which treatment does the nurse anticipate?
a. Adrenalectomy
b. Irradiation of the thyroid gland
c. Irradiation or removal of the pituitary gland
d. Administration of IV beta blockers
____ 16. A patient is newly diagnosed with acromegaly. Which nursing diagnosis should the nurse identify as being appropriate for this patient?
a. Imbalanced Nutrition
b. Body Image Disturbance
c. Ineffective Airway Clearance
d. Risk for Complications related to fluid imbalance
____ 17. The nurse is planning care for a patient with diabetes insipidus. What data should the nurse to monitor this patient?
a. Pupil responses and hand grasps
b. Intake and output and daily weight
c. Bowel sounds and abdominal girth
d. Blood glucose before meals and at bedtime
____ 18. A patient is newly diagnosed with diabetes insipidus. Which medications should the nurse anticipate being prescribed for long-term patient management?
a. Mithramycin
b. Inderal (propranolol)
c. Desmopressin acetate
d. Calcium and vitamin D
____ 19. The nurse determines that treatment has been effective for a patient with diabetes insipidus. Which laboratory value did the nurse use to come to this conclusion?
a. Urine ketones
b. Serum potassium
c. Fasting blood glucose
d. Urine specific gravity
____ 20. The nurse is caring for a patient with lung cancer who develops syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Which assessment findings should the nurse expect?
a. Fatigue and weakness
b. Poor skin turgor and polyuria
c. Weight gain and concentrated urine
d. Truncal obesity and thin extremities
____ 21. After collecting data the nurse determines that a patient is at risk for compression fractures. What health problem caused the nurse to come to this conclusion?
a. Hypothyroidism
b. Hyperthyroidism
c. Hypoparathyroidism
d. Hyperparathyroidism
____ 22. A patient with chronic obstructive pulmonary disease prescribed corticosteroid therapy asks what the medication does. What should the nurse respond to the patient?
a. It is an anti-infective and helps kill bacteria.
b. The medication causes your airways to dilate.
c. The medication is an expectorant that helps you cough up secretions.
d. It is an anti-inflammatory agent that reduces the swelling in your airways.
____ 23. A patient with chronic obstructive pulmonary disease develops Cushings syndrome related to long-term steroid use. The physician writes an order to discontinue the steroids. Which action by the nurse is most appropriate?
a. Question the order.
b. Monitor the patients weight daily.
c. Monitor the patients blood glucose level.
d. Instruct the patient to report worsening respiratory symptoms.
____ 24. The nurse develops a nursing diagnosis of fluid volume excess related to sodium retention secondary to steroid therapy as evidenced by weight gain of 12 pounds in 2 weeks and edema of lower extremities. Which goal is most appropriate?
a. Patient will verbalize importance of low-sodium diet.
b. Ankle circumference will be measured for edema daily.
c. Patients fluid volume will decrease as evidenced by discontinuing steroids.
d. Patient will have improved fluid balance as evidenced by weight returning to baseline.
____ 25. A patient is demonstrating manifestations of a pheochromocytoma. Which intervention is the most important for the nurse to implement?
a. Provide a calm, quiet environment.
b. Encourage frequent intake of fluids.
c. Offer distraction such as television or music.
d. Assist with ambulation at least three times a day.
____ 26. A patient enters the emergency department in adrenal crisis. The patient is lethargic and vital signs are blood pressure 85/52 mm Hg and pulse 88 beats/min. Which event in the patients week most likely precipitated this crisis?
a. Eating a high-fat diet
b. Being laid off from a job
c. Taking Tylenol for a headache
d. Maintaining usual exercise of walking each night
____ 27. The nurse is assisting with discharge of a patient with Addisons disease following an adrenal crisis. Which instruction is most important for the nurse to reinforce?
a. The need for a well-balanced diet
b. How to monitor blood glucose levels
c. The importance of 30 minutes of exercise each day
d. The importance of taking steroid replacements as prescribed
____ 28. The LPN is caring for a patient with diabetes insipidus and obtains a urine specific gravity reading of 1.002. Which response by the LPN is most important?
a. Document the results.
b. Advise the patient to drink less water.
c. Report the reading to the RN because therapy is ineffective.
d. Report the reading to the RN because the patient may be receiving too much medication.
____ 29. A patient with an adrenal disorder is prescribed fludrocortisone. What is important for the nurse to monitor in this patient?
a. Serum calcium levels
b. Serum potassium levels
c. Thyroid hormone levels
d. Serum magnesium levels
____ 30. A patient is diagnosed with hyperthyroidism. What should the nurse realize as being the most common cause of this disorder?
a. Graves disease
b. Multinodular goiter
c. Radiation exposure
d. Excess thyrotropin-releasing hormone (TRH) from the hypothalamus
____ 31. The nurse is reviewing discharge instructions with a patient recovering from a hypophysectomy. What should the nurse emphasize with this teaching?
a. Be sure to take your prescribed bromocriptine (Parlodel) every day.
b. You must learn to accept the enlargement of soft tissues that occurred before surgery.
c. Visual changes you experienced before surgery will begin to reverse within 6 months.
d. Be sure to take the thyroid hormone, corticosteroids, and sex hormones that have been prescribed for you.
____ 32. The nurse is caring for a patient with diabetes insipidus. What type of IV fluid should the nurse expect to be ordered for fluid replacement?
a. Isotonic
b. Hypotonic
c. Hypertonic
d. Parenteral nutrition
____ 33. The nurse is caring for patients in a primary care physician office. Which patient should the nurse recognize as being the highest risk for iodine deficiency?
a. A 52-year-old vegan with dietary sodium restrictions
b. A 49-year-old with celiac disease who takes digoxin (Lanoxin)
c. A 44-year-old lacto-vegetarian with a 40 pack-year smoking history
d. A 28-year-old with lactose intolerance and a history of Graves disease
____ 34. The LPN is assisting in the care of a 51-year-old patient recovering from a hypophysectomy. Which observation should the nurse identify as needing immediate intervention?
a. Urine specific gravity of 1.19
b. Hemoglobin level of 13.2 g/dL
c. Urinary output of 800 mL in 4 hours
d. Complaints of pain at a 5 on a scale of 0 to 10
____ 35. The LPN admits a well-known patient to the clinic and notes that the patients face and features seem broader and coarser. Which laboratory test should the nurse expect to be prescribed for this patient?
a. Cortisol
b. Growth hormone
c. Glucose tolerance test
d. Vanillylmandelic acid (VMA)
____ 36. After a thyroid scan, a patient is diagnosed with a hot nodule. What should this finding suggest to the nurse?
a. The nodule is malignant and a thyroidectomy is necessary.
b. The nodule is benign and may need a biopsy to confirm the diagnosis.
c. The nodule is malignant and chemotherapy must be started immediately.
d. The nodule is benign but will be treated with chemotherapy and radiation.
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 37. A patient is admitted to the hospital with new-onset diabetes insipidus. Which nursing diagnoses should the nurse include in the plan of care? (Select all that apply.)
a. Risk for Deficient Fluid Volume
b. Risk for Injury related to fractures
c. Risk for Injury related to hypertension
d. Knowledge Deficit related to disease process
e. Impaired Gas Exchange related to decreased oxygenation
____ 38. A patient being discharged is prescribed treatment for long-term hypoparathyroidism. What should the nurse include in discharge teaching? (Select all that apply.)
a. Eat a diet high in calcium.
b. Eat a diet high in phosphates.
c. Have regular eye examinations.
d. Add iron-rich foods to your diet.
e. Follow up with regular laboratory tests.
f. Take oral calcium and vitamin D supplements as prescribed.
____ 39. A patient is suspected of having dilutional hyponatremia. What manifestations of this disorder should the nurse expect to observe in this patient? (Select all that apply.)
a. Nausea
b. Headache
c. Constipation
d. Weak, slow pulse
e. Muscle weakness
f. Elevated blood pressure
____ 40. A patient is prescribed to ingest a high-calcium diet. What foods should the nurse instruct the patient to ingest? (Select all that apply.)
a. Chicken
b. Potatoes
c. Beef and pork
d. Sardines, salmon
e. Milk, cheese, and yogurt
f. Whole grain breads and cereals
____ 41. A patient with suspected hyperthyroidism is scheduled for a radioactive iodine uptake test. What symptoms of hyperthyroidism should the nurse note on the medical record? (Select all that apply.)
a. Fatigue
b. Tremor
c. Weight loss
d. Constipation
e. Buffalo hump
f. Cold intolerance
____ 42. A patient diagnosed with syndrome of inappropriate antidiuretic hormone is scheduled for surgery in a few days. What should the nurse expect to be prescribed for this patient to help manage the symptoms until surgery? (Select all that apply.)
a. Salt restriction
b. Fluid restriction
c. Furosemide (Lasix)
d. Conivaptan (Vaprisol)
e. Hypertonic saline infusion
____ 43. The nurse is assisting in the preparation of a patient for a hypophysectomy. What should the nurse emphasize when teaching this patient? (Select all that apply.)
a. Blow the nose twice a day
b. Use an incentive spirometer.
c. Avoid bending from the waist.
d. Cough using the huff technique.
e. Perform deep breathing exercises.
____ 44. Planning is underway to determine the best course of treatment for a patient with hyperparathyroidism. What should the nurse expect to observe when collecting data from this patient? (Select all that apply.)
a. Fatigue
b. Nausea
c. Confusion
d. Depression
e. Hypertension
____ 45. While collecting data the nurse suspects a patient is experiencing manifestations of Addisons disease. What observations did the nurse make to come to this conclusion? (Select all that apply.)
a. Ankle edema
b. Bronzing of the skin
c. Blood pressure 90/55 mm Hg
d. Bruises over the upper chest and arms
e. Weight loss 10 lbs from last examination

Chapter 39. Nursing Care of Patients With Endocrine Disorders
Answer Section

MULTIPLE CHOICE

1. ANS: C
Symptoms of hypothyroidism are related to the reduced metabolic rate and include fatigue, weight gain, bradycardia, constipation, mental dullness, feeling cold, shortness of breath, decreased sweating, and dry skin and hair. A. B. D. These symptoms are associated with hyperthyroidism.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

2. ANS: D
If a patient does not take medication to correct hypothyroidism, worsening hypothyroidism will occur, which can lead to myxedema coma. A. Fluid excess is not directly related to hypothyroidism. C. Thyrotoxicosis occurs with too much, not too little, thyroid hormone. B. Cushings syndrome is caused by deficient cortisol, not thyroid hormone.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

3. ANS: A
A heart rate of 112 beats per minute is abnormal. B. C. D. All the other vital signs are normal.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

4. ANS: D
Lubricating eyedrops will help keep the eyes moist if the patient is unable to close them. An accepting attitude is important if the patients body image is disturbed. A. B. Diversion and myotic eyedrops do not address the problem. D. Symptoms will not resolve with treatment.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

5. ANS: B
Most patients require thyroid replacement therapy after thyroidectomy. A. Patients should be taught range-of-motion exercises, not to avoid turning the head. D. Calories will need to be reduced, not increased. C. Antithyroid drugs may be ordered to stabilize thyroid function prior to surgery.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Evaluation

6. ANS: D
Tetany can occur if the parathyroid glands are accidentally removed during thyroid surgery. Because of the proximity of the parathyroid glands to the thyroid, it is sometimes difficult for the surgeon to avoid them. In the absence of parathyroid hormone, serum calcium levels drop, and tetany results. D. Excess thyroid hormone causes a thyrotoxic crisis. A. B. Swelling and antithyroid medication do not cause tetany.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

7. ANS: B
In the absence of parathyroid hormone, serum calcium levels drop, and tetany results. IV calcium gluconate is given to treat acute tetany. A. C. D. Sodium, potassium, and iodine will not help restore calcium level.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

8. ANS: A
Symptoms of thyrotoxic crisis include tachycardia, high fever, hypertension (with eventual heart failure and hypotension), dehydration, restlessness, and delirium or coma; it is important to monitor vital signs to detect symptoms early. B. C. D. Monitoring the dressing and neurological status are good parts of routine care but do not help detect thyrotoxic crisis.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

9. ANS: B
If thyrotoxic crisis occurs, treatment is first directed toward relieving the life-threatening symptoms. Acetaminophen is given for the fever. IV fluids and a cooling blanket may be ordered to cool the patient. A beta-adrenergic blocker, such as propranolol, is given for tachycardia. A. Aspirin is avoided because it binds with the same serum protein as T4, freeing additional T4 into the circulation. C. Epinephrine will make symptoms worse. Compression dressing on the thyroid could impair the airway. D. Benadryl and Fowlers position do not address the problem.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

10. ANS: C
A tracheostomy set is most essential in case swelling impedes the airway. A. Hemostats are not necessary. B. D. Dressings and a suture removal kit may be needed at some point, but they are not as important as airway maintenance.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

11. ANS: D
Further assessment is the first step in deciding what to do. B. Palpating the gland is inappropriate because the patient might be experiencing hyperthyroidism. A. Instructing about iodized salt is not appropriate without a definitive diagnosis. C. Numbness and tingling signify a parathyroid, not a thyroid, problem.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

12. ANS: D
The patient is exhibiting stridor, which indicates poor airway clearance. Airway problems always take priority. A. B. C. These findings are concerning however airway takes the priority.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

13. ANS: A
Over activity of one or more of the parathyroid glands causes an increase in parathyroid hormone (PTH), with a subsequent increase in the serum calcium level (hypercalcemia). This is achieved through movement of calcium out of the bones and into the blood, absorption in the small intestine, and reabsorption by the kidneys. C. D. Potassium level is not affected. B. The serum calcium level will not be decreased.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

14. ANS: C
Walking and weight-bearing exercises help keep calcium in the bones. B. Exercise helps prevent cardiovascular disease, but this is not the reason it is recommended. A. The nurse should not give advice based on his or her own habits. D. Walking keeps calcium in the bones, not the blood.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

15. ANS: B
Treatment of acromegaly includes irradiation or removal of the pituitary to reduce growth hormone levels. A. B. D. Adrenalectomy, beta blockers, and thyroid irradiation do not address the problem, which is in the pituitary.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

16. ANS: B
Body image disturbance is likely due to changes in physical appearance. A. C. D. Airway clearance, nutrition, and fluid balance are not directly affected.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

17. ANS: B
Fluid balance is best monitored with daily weights; intake and output may also be helpful. C. D. Bowel sounds, abdominal girth, and blood glucose are not affected. A. Neurological symptoms would occur only late in the disorder if the patient does not receive care.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

18. ANS: C
In patients who require long-term therapy, synthetic antidiuretic hormone (ADH) (desmopressin, or DDAVP) in the form of a nasal spray is used, usually twice a day. A. B. D. Inderal, calcium, and mithramycin will not affect fluid balance.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

19. ANS: D
Urine specific gravity is a good measure of urine concentration and antidiuretic hormone (ADH) function. B. Diabetes insipidus does not directly affect potassium level. A. C. Blood glucose and urine ketones are monitored in diabetes mellitus, not diabetes insipidus.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Evaluation

20. ANS: C
Excess antidiuretic hormone (ADH) causes water retention, with weight gain and concentrated urine. B. Poor skin turgor and polyuria are associated with diabetes insipidus, not SIADH. D. Truncal obesity and thin extremities are signs of Cushings syndrome. A. Fatigue and weakness are nonspecific.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation| Cognitive Level: Application

21. ANS: D
Hyperparathyroidism causes calcium to move from bone to blood, increasing risk of fracture. C. Hypoparathyroidism does not pull calcium from bone. A. B. Thyroid problems do not affect calcium movement.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential| Cognitive Level: Analysis

22. ANS: D
Corticosteroids are potent anti-inflammatory agents. A. B. C. Corticosteroids are not antibiotics, bronchial dilators, or expectorants.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

23. ANS: A
Steroids should always be tapered, never stopped abruptly, to prevent adrenal crisis. B. C. D. These actions are appropriate for patients on high-dose steroids, but abrupt cessation of the drug is life-threatening.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

24. ANS: D
Having improved fluid balance as evidenced by weight returning to baseline addresses the problem. A. B. Verbalizing the importance of a low-sodium diet and measuring ankle circumference daily are actions. C. Discontinuing steroids is not evidence of improved fluid volume.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

25. ANS: A
The patient with a pheochromocytoma is in a fight-or-flight state and needs a calm, quiet environment. C. D. Distraction and ambulation will stimulate the patient. B. Fluids do not address the problem.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care EnvironmentSafety and Infection Control | Cognitive Level: Application

26. ANS: B
Stress causes a need for an increase in cortisol, the bodys stress hormone. Being laid off is a stressor. A. C. D. Tylenol, walking, and a high-fat diet are not unusually stressful.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

27. ANS: D
Steroid replacements are essential because the patient with Addisons disease does not have adequate steroid hormones. B. Blood glucose levels are monitored if a patient is on high-dose steroids, not for replacement steroids. A. C. Diet and exercise are important but are not immediately life-threatening if not carried out.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

28. ANS: C
Normal urine specific gravity is 1.010 to 1.025. 1.002 is too low, meaning therapy is not effective. A. Results should be documented, but it is most important to assure the patient is treated. D. It is unlikely the patient is receiving too much medication. B. The patient needs to drink to replace water lost in urine.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

29. ANS: B
Fludrocortisone is a mineral corticoid replacement, so it will cause sodium and water retention and potassium loss. Potassium should be monitored. A. C. D. It will not directly affect calcium, magnesium, or thyroid hormone levels.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

30. ANS: A
A variety of disorders can cause hyperthyroidism. Graves disease is the most common cause; it is thought to be an autoimmune disorder, because thyroid-stimulating antibodies are present in the blood of these patients. B. C. D. Multinodular goiter, radiation, and excess TRH are less commonly the cause.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

31. ANS: D
If the pituitary is removed, lifelong replacement of thyroid hormone, corticosteroids, and sex hormones is important to maintain homeostasis. A. Bromocriptine reduces growth hormone release. B. Soft tissue will reduce in size some; telling the patient to learn to accept it is not therapeutic. C. Visual changes may not reverse.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

32. ANS: B
Hypotonic IV fluids, such as 0.45% saline, may be ordered to replace intravascular volume without adding excessive sodium. IV fluids are especially important if the patient is unable to take oral fluids. A. C. Isotonic and hypertonic fluids will add sodium. D. There is no reason for this patient to be prescribed parenteral nutrition.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPharmacological and Parenteral Therapies | Cognitive Level: Application

33. ANS: A
Vegetarians who consume sea salt, which contains virtually no iodine, are at higher risk of iodine deficiency. B. C. D. These patients are at a lesser risk for developing an iodine deficiency.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis

34. ANS: C
Tumors, trauma, or other problems in the hypothalamus or pituitary gland can lead to decreased production or release of antidiuretic hormone (ADH), causing diabetes insipidus and resulting in excess urinary output. A. B. The listed hemoglobin and urine specific gravity are within normal limits for the patient. D. Pain is not the highest priority in this scenario.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

35. ANS: B
Growth hormone is elevated in individuals with acromegaly (gigantism). A. C. D. The patients manifestations do not indicate the need for these laboratory tests to be prescribed.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

36. ANS: B
A hot nodule indicates a benign tumor. A fine-needle aspiration biopsy confirms the diagnosis. A. C. If the thyroid scan shows a cold nodule, the tumor is malignant. D. Chemotherapy and radiation are not used to treat a hot benign tumor.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Analysis

MULTIPLE RESPONSE

37. ANS: A, D
Diabetes insipidus causes excessive urination and fluid loss. C. Hypotension, not hypertension, would more likely be related to fluid loss. B. E. Bone fracture and impaired gas exchange are not related to diabetes insipidus.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

38. ANS: A, B, C, E, F
A high calcium diet with calcium supplements is necessary to maintain serum calcium levels. Eye examinations are important because calcifications can occur in the eyes, and cataracts can develop. A high-phosphate diet may lower serum calcium. Follow-up laboratory tests are important to be sure the calcium level is normal. D. Hypoparathyroidism will not alter iron stores; increased intake of iron-rich foods is not necessary.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

39. ANS: A, B, E, F
Manifestations of dilutional hyponatremia include bounding pulse, elevated blood pressure, muscle weakness, headache, personality changes, nausea, diarrhea, convulsions, and coma. C. D. Constipation and slow weak pulse are not manifestations of this disorder.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

40. ANS: D, E
Milk products and canned fish are high in calcium. A. B. C. F. Meats, chicken, potatoes, and grains are not as high in calcium.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

41. ANS: A, B, C
Weight loss, fatigue, heat intolerance, tremor, increased pulse and blood pressure, and agitation or nervousness may be seen with hyperthyroidism. D. F. Cold intolerance and constipation are seen with hypothyroidism. E. Buffalo hump is seen in Cushings syndrome.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Application

42. ANS: B, C, D, E
Symptoms of SIADH can be alleviated by restricting fluids to 800 to 1000 mL per 24 hours. Hypertonic saline fluids may be administered intravenously. A loop diuretic such as furosemide (Lasix) increases water excretion. A vasopressin receptor antagonist such as conivaptan (Vaprisol) may be used to block the action of ADH in the kidney. A. Oral salt may be encouraged to maintain the serum sodium level.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

43. ANS: B, C, E
The nurse should emphasize that it will be important after surgery to avoid any actions that increase pressure on the surgical site, such as coughing, sneezing, nose blowing, straining to move bowels, or bending from the waist. Instruct the patient in deep-breathing exercises or use of an incentive spirometer. A. Nose blowing should be avoided. D. Because coughing can raise intracranial pressure it is contraindicated.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityReduction of Risk Potential | Cognitive Level: Application

44. ANS: A, B, C, D
Signs and symptoms of hyperparathyroidism are caused primarily by the increase in serum calcium level. Symptoms include fatigue, nausea, confusion, and depression. E. Hypertension is not a manifestation of hyperparathyroidism.

PTS: 1 DIF: Moderate
KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application

45. ANS: B, C, E
In primary AI, increased ACTH may produce hyperpigmentation of the skin, causing the patient to have a tanned or bronze appearance. The most significant sign of Addisons disease is hypotension. Low cortisol levels cause weight loss. A. D. Ankle edema and bruising are not manifestations of Addisons disease.

PTS: 1 DIF: Moderate
KEY: Client Need: Physiological IntegrityPhysiological Adaptation | Cognitive Level: Analysis

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