C49 - ch 49 test bank PDF

Preview

Summary

ch 49 test bank ...

Description

Chapter 49: Endocrine Problems Lewis: Medical-Surgical Nursing, 10th Edition MULTIPLE CHOICE 1. A 40-yr-old patient with suspected acromegaly is seen at the clinic. To assist in making the

diagnosis, which question should the nurse ask? “Have you had a recent head injury?” “Do you have to wear larger shoes now?” “Is there a family history of acromegaly?” “Are you experiencing tremors or anxiety?”

a. b. c. d.

ANS: B

Acromegaly causes an enlargement of the hands and feet. Head injury and family history are not risk factors for acromegaly. Tremors and anxiety are not clinical manifestations of acromegaly. DIF: Cognitive Level: Apply (application) REF: 1157 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 2. A patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma.

During preoperative teaching, the nurse instructs the patient about the need to cough and deep breathe every 2 hours postoperatively. remain on bed rest for the first 48 hours after the surgery. avoid brushing teeth for at least 10 days after the surgery. be positioned flat with sandbags at the head postoperatively.

a. b. c. d.

ANS: C

To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is discouraged because it may cause leakage of cerebrospinal fluid (CSF) from the suture line. The head of the bed should be elevated 30 degrees to reduce pressure on the sella turcica and decrease the risk for headaches. DIF: Cognitive Level: Apply (application) REF: 1159 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 3. The nurse is planning postoperative care for a patient who is being admitted to the surgical

unit from the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action should be included? a. Palpate extremities for edema. b. Measure urine volume every hour. c. Check hematocrit every 2 hours for 8 hours. d. Monitor continuous pulse oximetry for 24 hours. ANS: B

After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema. Monitoring of urine output and urine specific gravity is essential. Hemorrhage is not a common problem. There is no need to check the hematocrit hourly. The patient is at risk for dehydration, not volume overload. The patient is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed. DIF: Cognitive Level: Apply (application) REF: 1159 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 4. The nurse is assessing a male patient diagnosed with a pituitary tumor causing

panhypopituitarism. Assessment findings consistent with panhypopituitarism include c. elevated blood glucose. d. tachycardia and palpitations.

a. high blood pressure. b. decreased facial hair. ANS: B

Changes in male secondary sex characteristics such as decreased facial hair, testicular atrophy, diminished spermatogenesis, loss of libido, impotence, and decreased muscle mass are associated with decreases in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is likely due to the decrease in thyroid-stimulating hormone (TSH) and thyroid hormones associated with panhypopituitarism. DIF: Cognitive Level: Apply (application) REF: 1158 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 5. Which information will the nurse include when teaching a 50-yr-old male patient about

somatropin (Genotropin)? The medication will be needed for 3 to 6 months. Inject the medication subcutaneously every day. Blood glucose levels may decrease when taking the medication. Stop taking the medication if swelling of the hands or feet occurs.

a. b. c. d.

ANS: B

Somatropin is injected subcutaneously on a daily basis, preferably in the evening. The patient will need to continue on somatropin for life. If swelling or other common adverse effects occur, the health care provider should be notified. Growth hormone will increase blood glucose levels. DIF: Cognitive Level: Apply (application) REF: 1158 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 6. The nurse determines that demeclocycline is effective for a patient with syndrome of

inappropriate antidiuretic hormone (SIADH) based on finding that the patient’s a. weight has increased. c. peripheral edema is increased. b. urinary output is increased. d. urine specific gravity is increased. ANS: B

Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and increases urine output. An increase in weight or an increase in urine specific gravity indicates that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a common clinical manifestation of this disorder.

DIF: Cognitive Level: Apply (application) REF: 1160 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 7. The nurse determines that additional instruction is needed for a patient with chronic syndrome

of inappropriate antidiuretic hormone (SIADH) when the patient makes which statement? “I need to shop for foods low in sodium and avoid adding salt to food.” “I should weigh myself daily and report any sudden weight loss or gain.” “I need to limit my fluid intake to no more than 1 quart of liquids a day.” “I should eat foods high in potassium because diuretics cause potassium loss.”

a. b. c. d.

ANS: A

Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred. DIF: Cognitive Level: Apply (application) REF: 1160 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 8. A 56-yr-old patient who is disoriented and reports a headache and muscle cramps is

hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The nurse would expect the initial laboratory results to include a(n) a. elevated hematocrit. c. increased serum chloride. b. decreased serum sodium. d. low urine specific gravity. ANS: B

When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient. The hematocrit will decrease because of the dilution caused by water retention. Urine will be more concentrated with a higher specific gravity. The serum chloride level will usually decrease along with the sodium level. DIF: Cognitive Level: Understand (comprehension) REF: 1160 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 9. An expected patient problem for a patient admitted to the hospital with symptoms of diabetes

insipidus is excess fluid volume related to intake greater than output. impaired gas exchange related to fluid retention in lungs. sleep pattern disturbance related to frequent waking to void. risk for impaired skin integrity related to generalized edema.

a. b. c. d.

ANS: C

Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected. DIF: Cognitive Level: Apply (application) REF: 1161 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 10. Which information will the nurse teach a patient who has been newly diagnosed with Graves’

disease? a. Exercise is contraindicated to avoid increasing metabolic rate. b. Restriction of iodine intake is needed to reduce thyroid activity.

c. Antithyroid medications may take several months for full effect. d. Surgery will eventually be required to remove the thyroid gland. ANS: C

Medications used to block the synthesis of thyroid hormones may take 2 to 3 months before the full effect is seen. Large doses of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large muscle groups is encouraged to decrease the irritability and hyperactivity associated with high levels of thyroid hormones. Radioactive iodine is the most common treatment for Graves’ disease, although surgery may be used. DIF: Cognitive Level: Apply (application) REF: 1165 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 11. A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a

cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action will the nurse anticipate next? a. Suction the patient’s airway. b. Administer IV calcium gluconate. c. Plan for emergency tracheostomy. d. Prepare for endotracheal intubation. ANS: B

The patient’s clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Endotracheal intubation or tracheostomy may be needed if the calcium does not resolve the stridor. Suctioning will not correct the stridor. DIF: Cognitive Level: Apply (application) REF: 1168 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 12. Which nursing action will be included in the plan of care for a patient with Graves’ disease

who has exophthalmos? Place cold packs on the eyes to relieve pain and swelling. Elevate the head of the patient’s bed to reduce periorbital fluid. Apply alternating eye patches to protect the corneas from irritation. Teach the patient to blink every few seconds to lubricate the corneas.

a. b. c. d.

ANS: B

The patient should sit upright as much as possible to promote fluid drainage from the periorbital area. With exophthalmos, the patient is unable to close the eyes completely to blink. Lubrication of the eyes, rather than eye patches, will protect the eyes from developing corneal scarring. The swelling of the eye is not caused by excessive blood flow to the eye, so cold packs will not be helpful. DIF: Cognitive Level: Apply (application) REF: 1167 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 13. A 62-yr-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The

nurse instructs the patient a. about radioactive precautions to take with all body secretions. b. that symptoms of hyperthyroidism should be relieved in about a week. c. that symptoms of hypothyroidism may occur as the RAI therapy takes effect.

d. to discontinue the antithyroid medications taken before the radioactive therapy. ANS: C

There is a high incidence of postradiation hypothyroidism after RAI, and the patient should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum effect not seen for 2 to 3 months, and the patient will continue to take antithyroid medications during this time. The therapeutic dose of radioactive iodine is low enough that no radiation safety precautions are needed. DIF: Cognitive Level: Apply (application) REF: 1166 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 14. Which nursing assessment of a 70-yr-old patient is most important to make during initiation

of thyroid replacement with levothyroxine (Synthroid)? c. Nutritional intake d. Orientation and alertness

a. Fluid balance b. Apical pulse rate ANS: B

In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication also is expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes will not result in potentially life-threatening complications. DIF: Cognitive Level: Analyze (analysis) REF: 1169 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 15. An 82-yr-old patient in a long-term care facility is newly diagnosed with hypothyroidism. The

nurse will need to consult with the health care provider before administering the prescribed c. diazepam (Valium). d. cefoxitin (Mefoxin).

a. docusate (Colace). b. ibuprofen (Motrin). ANS: C

Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older adults. The nurse should discuss the use of diazepam with the health care provider before administration. The other medications may be given safely to the patient. DIF: Cognitive Level: Apply (application) REF: 1169 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 16. A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is

improving. Discharge is expected to occur in 2 days. Which teaching strategy is likely to result in effective patient self-management at home? a. Delay teaching until closer to discharge date. b. Provide written reminders of information taught. c. Offer multiple options for management of therapies. d. Ensure privacy for teaching by asking the family to leave. ANS: B

Written instructions will be helpful to the patient because initially the hypothyroid patient may be unable to remember to take medications and other aspects of self-care. Because the treatment regimen is somewhat complex, teaching should be initiated well before discharge. Family members or friends should be included in teaching because the hypothyroid patient is likely to forget some aspects of the treatment plan. A simpler regimen will be easier to understand until the patient is euthyroid. DIF: Cognitive Level: Apply (application) REF: 1170 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 17. A patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55

mmol/L) and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should be included in the plan of care? a. Restrict the patient to bed rest. b. Encourage 4000 mL of fluids daily. c. Institute routine seizure precautions. d. Assess for positive Chvostek’s sign. ANS: B

The patient with hypercalcemia is at risk for kidney stones, which may be prevented by a high fluid intake. Seizure precautions and monitoring for Chvostek’s or Trousseau’s sign are appropriate for hypocalcemic patients. The patient should engage in weight-bearing exercise to decrease calcium loss from bone. DIF: Cognitive Level: Apply (application) REF: 1173 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 18. A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy.

Which action will provide the patient with rapid relief from the symptoms? a. Administer the prescribed muscle relaxant. b. Have the patient rebreathe from a paper bag. c. Start the PRN O2 at 2 L/min per cannula. d. Stretch the muscles with passive range of motion. ANS: B

The patient’s symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the patient breathe into a paper bag, which will raise the PaCO2 and create a more acidic pH. Applying as-needed O2 or range of motion will have no impact on the ionized calcium level. Calcium supplements will be given to normalize calcium levels quickly, but oral supplements will take time to be absorbed. DIF: Cognitive Level: Apply (application) REF: 1174 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 19. A patient who had radical neck surgery to remove a malignant tumor developed

hypoparathyroidism. The nurse should plan to teach the patient about bisphosphonates to reduce bone demineralization. calcium supplements to normalize serum calcium levels. increasing fluid intake to decrease risk for nephrolithiasis. including whole grains in the diet to prevent constipation.

a. b. c. d.

ANS: B

Oral calcium supplements are used to maintain the serum calcium in normal range and prevent the complications of hypocalcemia. Whole grain foods decrease calcium absorption and will not be recommended. Bisphosphonates will lower serum calcium levels further by preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of hypoparathyroidism and low calcium levels. DIF: Cognitive Level: Apply (application) REF: 1174 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity 20. Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse

should contact the health care provider before administering levothyroxine (Synthroid)? Increased thyroxine (T4) level Blood pressure 112/62 mm Hg Distant and difficult to hear heart sounds Elevated thyroid stimulating hormone level

a. b. c. d.

ANS: A

An increased thyroxine level indicates the levothyroxine dose needs to be decreased. The other data are consistent with hypothyroidism and the nurse should administer the levothyroxine. DIF: Cognitive Level: Apply (application) REF: 1169 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity 21. A patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the

nurse expect during the assessment? a. Chronically low blood pressure b. Bronzed appearance of the skin

c. Purplish streaks on the abdomen d. Decreased axillary and pubic hair

ANS: C

Purplish-red striae on the abdomen are a common clinical manifestation of Cushing syndrome. Hypotension and bronzed-appearing skin are manifestations of Addison’s disease. Decreased axillary and pubic hair occur with androgen deficiency. DIF: Cognitive Level: Understand (comprehension) REF: 1175 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity 22. A 44-yr-old female patient with Cushing syndrome is admitted for adrenalectomy. Which

intervention by the nurse will be most helpful for the patient problem of disturbed body image related to changes in appearance? a. Reassure the patient that the physical changes are very common in patients with Cushing syndrome. b. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome. c. Teach the patient that the metabolic impact of Cushing syndrome is of more importance than appearance. d. Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery. ANS: D

The most reassuring and accurate communication to the patient is that the physical and emotional changes caused by the Cushing syndrome will resolve after hormone levels return to normal postoperatively. Reassurance that the physical changes are expected or that there are more serious physiologic problems associated with Cushing syndrome are not therapeutic responses. The patient’s physiological changes are caused by the high hormone levels, not by the patient’s diet or exercise choices. DIF: Cognitive Level: Apply (application) REF: 1177 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity 23. Which finding indicates to the nurse that the current therapies are effective for a patient with

acute adrenal insufficiency? a. Increasing serum sodium levels b. Decreasing blood glucose levels

c. Decreasing serum chloride levels d. Increasing serum potassium levels

ANS: A

Clinical manifestations of Addison’s disease include hyponatremia and an increase in sodium level indicates improvement. The other values indicate that treatment has not been effective. DIF: Cognitive Level: Apply (application) REF: 1178 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity 24. The nurse admits a patient to the hospital in Addisonian crisis. Which patient statement

supports the need to plan additional teaching? “I frequently eat at restaurants, and my food has a lot of added salt.” “I had the flu earlier this ...