Question 1

When providing postoperative care for a patient who has had bilateral adrenalectomy, which assessment information obtained by the nurse is most important to communicate to the health care provider?

Accepted Answer

A)   The blood glucose is 156 mg/dl.
B)   The patient's blood pressure is 102/50.
C)   The patient has 5/10 incisional pain.
D)   The lungs have bibasilar crackles. B

Question 2

A patient is hospitalized with possible SIADH. The patient is confused and reports a headache, muscle cramps, and twitching. The nurse would expect the initial laboratory results to include a

Accepted Answer

A)   serum sodium of 125 mEq/L (125 mmol/L) .
B)   hematocrit of 52%.
C)   blood urea nitrogen (BUN)  of 22 mg/dl (11.5 mmol/L) .
D)   serum chloride of 110 mEq/L (110 mmol/L) . A

Question 3

After receiving change-of-shift report about these four patients, which patient should the nurse assess first?

Accepted Answer

A)   A 22-year-old admitted with SIADH who has a serum sodium level of 130 mEq/L.
B)   A 31-year-old who has iatrogenic Cushing's syndrome with a capillary blood glucose level of 244 mg/dl.
C)   A 53-year-old who has Addison's disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef) .
D)   A 70-year-old who recently started levothyroxine (Synthroid)  to treat hypothyroidism and has an irregular pulse of 134. D

Question 4

A patient seen at the clinic for an upper respiratory infection reports receiving subcutaneous somatotropin (Genotropin) when asked by the nurse about current medications. The nurse questions the patient further about a history of

Accepted Answer

A)   adrenal disease.
B)   untreated acromegaly.
C)   a pituitary tumor.
D)   diabetes insipidus (DI) .

Question 5

When teaching a patient newly diagnosed with Graves' disease about the disorder, the nurse explains that

Accepted Answer

A)   restriction of iodine intake is needed to reduce thyroid activity.
B)   exercise is contraindicated to avoid increasing metabolic rate.
C)   surgery will eventually be required to remove the thyroid gland.
D)   antithyroid medications may take several weeks to have an effect.

Question 6

When teaching a patient with newly diagnosed hypothyroidism about management of the condition, the nurse should

Accepted Answer

A)   delay teaching about the condition until the patient has responded to replacement therapy.
B)   provide written handouts of all instructions for continued reference as the patient improves.
C)   have a family member teach the patient about the condition when the patient is more alert.
D)   arrange for daily home visits by home health nurses to repeat the necessary instructions.

Question 7

A patient with symptoms of DI is admitted to the hospital for evaluation and treatment of the condition. An appropriate nursing diagnosis for the patient is

Accepted Answer

A)   insomnia related to waking at night to void.
B)   risk for impaired skin integrity related to generalized edema.
C)   excess fluid volume related to intake greater than output.
D)   activity intolerance related to muscle cramps and weakness.

Question 8

A patient is suspected of having a pituitary tumor causing panhypopituitarism. During assessment of the patient, the nurse would expect to find

Accepted Answer

A)   elevated blood glucose.
B)   changes in secondary sex characteristics.
C)   high blood pressure.
D)   tachycardia and cardiac palpitations.

Question 9

A patient is taking high doses of prednisone to control the symptoms of an acute exacerbation of systemic lupus erythematosus. When teaching the patient about the use of prednisone, which information is most important for the nurse to include?

Accepted Answer

A)   Call the doctor if you experience any mood alterations with the prednisone.
B)   Do not stop taking the prednisone suddenly; it should be decreased gradually.
C)   Weigh yourself daily to monitor for weight gain caused by water or increased fat.
D)   Check your temperature daily because prednisone can hide signs of infection.

Question 10

While hospitalized for a fractured femur, a 68-year-old patient is diagnosed with hypothyroidism. Which of these medications on the original admission orders will the nurse need to consult with the health care provider about before it is administered?

Accepted Answer

A)   Docusate (Colace) 
B)   Diazepam (Valium) 
C)   Ibuprofen (Motrin) 
D)   Cefoxitin (Mefoxin)

Question 11

After a patient with a pituitary adenoma has had a hypophysectomy, the nurse will plan to do discharge teaching about the need for

Accepted Answer

A)   insulin use to maintain blood glucose at normal levels.
B)   sodium restriction to prevent fluid retention and hypertension.
C)   oral corticosteroids to replace endogenous cortisol.
D)   chemotherapy to prevent reoccurrence of the tumor.

Question 12

A patient with hyperthyroidism is treated with radioactive iodine (RAI) at a clinic. Before the patient is discharged, the nurse instructs the patient

Accepted Answer

A)   to monitor for symptoms of hypothyroidism, such as easy bruising and cold intolerance.
B)   to discontinue the antithyroid medications taken before the radioactive therapy.
C)   that symptoms of hyperthyroidism should be relieved in about a week.
D)   about radioactive precautions to take with urine, stool, and other body secretions.

Question 13

While assessing a patient who has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy, the nurse obtains these data. Which information is most important to communicate to the surgeon?

Accepted Answer

A)   The patient is complaining of 7/10 incisional pain.
B)   The patient's cardiac monitor shows a heart rate of 112.
C)   The patient has increasing swelling of the neck.
D)   The patient's voice is weak and hoarse sounding.

Question 14

A nursing assessment of a patient with Cushing syndrome reveals that the patient has truncal obesity and thin arms and legs. An additional manifestation of Cushing syndrome that the nurse would expect to find is

Accepted Answer

A)   chronically low blood pressure.
B)   decreased axillary and pubic hair.
C)   purplish red streaks on the abdomen.
D)   bronzed appearance of the skin.

Question 15

RN observes a nursing assistant (NA) caring for a patient after a hypophysectomy. Which action by the NA requires that the RN intervene?

Accepted Answer

A)   The NA lowers the head of the bed to the flat position.
B)   The NA cautions the patient to avoid coughing.
C)   The NA cleans the patient's mouth with a swab.
D)   The NA collects a urine specimen for specific gravity.

Question 16

The first nursing action indicated when a patient returns to the surgical nursing unit following a thyroidectomy is to

Accepted Answer

A)   check the dressing for bleeding.
B)   assess respiratory rate and effort.
C)   support the patient's head with pillows.
D)   take the blood pressure and pulse.

Question 17

A 72-year-old patient is diagnosed with hypothyroidism, and levothyroxine (Synthroid) is prescribed. During initiation of thyroid replacement for the patient, it is most important for the nurse to assess

Accepted Answer

A)   mental status.
B)   nutritional level.
C)   cardiac function.
D)   fluid balance.

Question 18

A patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask?

Accepted Answer

A)   "Have you had a recent head injury?"
B)   "Do you have to wear larger shoes now?"
C)   "Is there any family history of acromegaly?"
D)   "Are you experiencing tremors or anxiety?"

Question 19

Which information obtained when caring for a patient who has just been admitted for evaluation of diabetes insipidus will be of greatest concern to the nurse?

Accepted Answer

A)   The patient has a urine output of 800 ml/hr.
B)   The patient's urine specific gravity is 1.003.
C)   The patient had a recent head injury.
D)   The patient is confused and lethargic.

Question 20

A patient with Cushing syndrome returns to the surgical unit following an adrenalectomy. During the initial postoperative period, the nurse gives the highest priority to

Accepted Answer

A)   monitoring for infection.
B)   protecting the patient's skin.
C)   maintaining fluid and electrolyte status.
D)   preventing severe emotional disturbances.

Exam 50: Nursing Management: Endocrine Problems