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TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Chapter52:AssessmentandManagementofPatientswithEndocrine Disorders  1.

ThenurseiscaringforapatientdiagnosedwithhypothyroidismsecondarytoHashimotosthyroiditis. Whenassessingthispatient,whatsignorsymptomwouldthenurseexpect?

A)

Fatigue

B)

Bulgingeyes

C)

Palpitations

D)

Flushedskin

Ans:

A Feedback: Symptomsofhypothyroidismincludeextremefatigue,hairloss,brittlenails,dryskin,voicehuskiness orhoarseness,menstrualdisturbance,andnumbnessandtinglingofthefingers.Bulgingeyes, palpitations,andflushedskinwouldbesignsandsymptomsofhyperthyroidism.

2.

Apatienthasbeenadmittedtothepost-surgicalunitfollowingathyroidectomy.Topromotecomfortand safety,howshouldthenursebestpositionthepatient?

A)

Side-lying(lateral)withonepillowunderthehead

B)

Headofthebedelevated30degreesandnopillowsplacedunderthehead

C)

Semi-Fowlerswiththeheadsupportedontwopillows

D)

Supine,withasmallrollsupportingtheneck

Ans:

C Feedback: Whenmovingandturningthepatient,thenursecarefullysupportsthepatientsheadandavoidstension onthesutures.Themostcomfortablepositionisthesemi-Fowlersposition,withtheheadelevatedand supportedbypillows.

3.

Apatientwiththyroidcancerhasundergonesurgeryandasignificantamountofparathyroidtissuehas beenremoved.Thenursecaringforthepatientshouldprioritizewhatquestionwhenaddressing

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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potentialcomplications? A)

Doyoufeelanymuscletwitchesorspasms?

B)

Doyoufeelflushedorsweaty?

C)

Areyouexperiencinganydizzinessorlightheadedness?

D)

Areyouhavinganypainthatseemstoberadiatingfromyourbones?

Ans:

A Feedback: Asthebloodcalciumlevelfalls,hyperirritabilityofthenervesoccurs,withspasmsofthehandsandfeet andmuscletwitching.Thisischaracteristicofhypoparathyroidism.Flushing,diaphoresis,dizziness,and painareatypicalsignsoftheresultinghypocalcemia.

4.

ThenurseiscaringforapatientwithadiagnosisofAddisonsdisease.Whatsignorsymptomismost closelyassociatedwiththishealthproblem?

A)

Truncalobesity

B)

Hypertension

C)

Muscleweakness

D)

Moonface

Ans:

C Feedback: PatientswithAddisonsdiseasedemonstratemuscularweakness,anorexia,gastrointestinalsymptoms, fatigue,emaciation,darkpigmentationoftheskin,andhypotension.PatientswithCushingsyndrome demonstratetruncalobesity,moonface,acne,abdominalstriae,andhypertension.

5.

ThenurseiscaringforapatientwithAddisonsdiseasewhoisscheduledfordischarge.Whenteaching thepatientabouthormonereplacementtherapy,thenurseshouldaddresswhattopic?

A)

Thepossibilityofprecipitousweightgain

B)

Theneedforlifelongsteroidreplacement

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Theneedtomatchthedailysteroiddosetoimmediatesymptoms

D)

Theimportanceofmonitoringliverfunction

Ans:

B

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Feedback: Becauseoftheneedforlifelongreplacementofadrenalcortexhormonestopreventaddisoniancrises, thepatientandfamilymembersreceiveexpliciteducationabouttherationaleforreplacementtherapy andproperdosage.Dosesarenotadjustedonashort-termbasis.Weightgainandhepatotoxicityarenot commonadverseeffects. 6.

Thenurseisteachingapatientthatthebodyneedsiodineforthethyroidtofunction.Whatfoodwould bethebestsourceofiodineforthebody?

A)

Eggs

B)

Shellfish

C)

Tablesalt

D)

Redmeat

Ans:

C Feedback: Themajoruseofiodineinthebodyisbythethyroid.Iodizedtablesaltisthebestsourceofiodine.

7.

Apatientisprescribedcorticosteroidtherapy.Whatwouldbepriorityinformationforthenursetogive thepatientwhoisprescribedlong-termcorticosteroidtherapy?

A)

Thepatientsdietshouldbelowproteinwithamplefat.

B)

Thepatientmayexperienceshort-termchangesincognition.

C)

Thepatientisatanincreasedriskfordevelopinginfection.

D)

Thepatientisatadecreasedriskfordevelopmentofthrombophlebitisandthromboembolism.

Ans:

C Feedback:

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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Thepatientisatincreasedriskofinfectionandmaskingofsignsofinfection.Thecardiovasculareffects ofcorticosteroidtherapymayresultindevelopmentofthrombophlebitisorthromboembolism.Diet shouldbehighinproteinwithlimitedfat.Changesinappearanceusuallydisappearwhentherapyisno longernecessary.Cognitivechangesarenotcommonadverseeffects. 8.

Anursecaringforapatientwithdiabetesinsipidusisreviewinglaboratoryresults.Whatisanexpected urinalysisfinding?

A)

Glucoseintheurine

B)

Albuminintheurine

C)

Highlydiluteurine

D)

Leukocytesintheurine

Ans:

C Feedback: Patientswithdiabetesinsipidusproduceanenormousdailyoutputofverydilute,water-likeurinewitha specificgravityof1.001to1.005.Theurinecontainsnoabnormalsubstancessuchasglucoseor albumin.Leukocytesintheurinearenotrelatedtotheconditionofdiabetesinsipidus,butwould indicateaurinarytractinfection,ifpresentintheurine.

9.

ThenursecaringforapatientwithCushingsyndromeisdescribingthedexamethasonesuppressiontest scheduledfortomorrow.Whatdoesthenurseexplainthatthistestwillinvolve?

A)

Administrationofdexamethasoneorally,followedbyaplasmacortisolleveleveryhourfor3 hours

B)

AdministrationofdexamethasoneIV,followedbyanx-rayoftheadrenalglands

C)

Administrationofdexamethasoneorallyat11PM,andaplasmacortisollevelat8AMthenext morning

D)

Administrationofdexamethasoneintravenously,followedbyaplasmacortisollevel3hoursafter thedrugisadministered

Ans:

C Feedback: Dexamethasone(1mg)isadministeredorallyat11PM,andaplasmacortisollevelisobtainedat8AM thenextmorning.Thistestcanbeperformedonanoutpatientbasisandisthemostwidelyusedand sensitivescreeningtestfordiagnosisofpituitaryandadrenalcausesofCushingsyndrome.

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

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10. YouaredevelopingacareplanforapatientwithCushingsyndrome.Whatnursingdiagnosiswould havethehighestpriorityinthiscareplan? A)

Riskforinjuryrelatedtoweakness

B)

Ineffectivebreathingpatternrelatedtomuscleweakness

C)

Riskforlonelinessrelatedtodisturbedbodyimage

D)

Autonomicdysreflexiarelatedtoneurologicchanges

Ans:

A Feedback: Thenursingpriorityistodecreasetheriskofinjurybyestablishingaprotectiveenvironment.The patientwhoisweakmayrequireassistancefromthenurseinambulatingtopreventfallsorbumping cornersorfurniture.Thepatientsbreathingwillnotbeaffectedandautonomicdysreflexiaisnota plausiblerisk.Lonelinessmayormaynotbeanissueforthepatient,butsafetyisapriority.

11. Thenurseisperformingashiftassessmentofapatientwithaldosteronism.Whatassessmentsshouldthe nurseinclude?Selectallthatapply. A)

Urineoutput

B)

Signsorsymptomsofvenousthromboembolism

C)

Peripheralpulses

D)

Bloodpressure

E)

Skinintegrity

Ans:

A,D Feedback: Theprincipalactionofaldosteroneistoconservebodysodium.Alterationsinaldosteronelevels consequentlyaffecturineoutputandBP.Thepatientsperipheralpulses,riskofVTE,andskinintegrity arenottypicallyaffectedbyaldosteronism.

12. Thehomecarenurseisconductingpatientteachingwithapatientoncorticosteroidtherapy.Toachieve consistencywiththebodysnaturalsecretionofcortisol,whenwouldthehomecarenurseinstructthe patienttotakehisorhercorticosteroids?

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

A)

Intheeveningbetween4PMand6PM

B)

Priortogoingtosleepatnight

C)

Atnooneveryday

D)

Inthemorningbetween7AMand8AM

Ans:

D

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Feedback: Inkeepingwiththenaturalsecretionofcortisol,thebesttimeofdayforthetotalcorticosteroiddoseisin themorningfrom7to8AM.Large-dosetherapyat8AM,whentheadrenalglandismostactive, producesmaximalsuppressionofthegland.Also,alarge8AMdoseismorephysiologicbecauseit allowsthebodytoescapeeffectsofthesteroidsfrom4PMto6AM,whenserumlevelsarenormally low,thusminimizingcushingoideffects. 13. Apatientpresentsatthewalk-incliniccomplainingofdiarrheaandvomiting.Thepatienthasa documentedhistoryofadrenalinsufficiency.Consideringthepatientshistoryandcurrentsymptoms,the nurseshouldanticipatethatthepatientwillbeinstructedtodowhichofthefollowing? A)

IncreasehisintakeofsodiumuntiltheGIsymptomsimprove.

B)

IncreasehisintakeofpotassiumuntiltheGIsymptomsimprove.

C)

IncreasehisintakeofglucoseuntiltheGIsymptomsimprove.

D)

IncreasehisintakeofcalciumuntiltheGIsymptomsimprove.

Ans:

A Feedback: ThepatientwillneedtosupplementdietaryintakewithaddedsaltduringepisodesofGIlossesoffluid throughvomitinganddiarrheatopreventtheonsetofaddisoniancrisis.Whilethepatientmay experiencethelossofotherelectrolytes,themajorconcernisthereplacementoflostsodium.

14. Thenurseiscaringforapatientwithhyperparathyroidism.Whatlevelofactivitywouldthenurseexpect topromote? A)

Completebedrest

B)

Bedrestwithbathroomprivileges

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

C)

Outofbed(OOB)tothechairtwiceaday

D)

Ambulationandactivityastolerated

Ans:

D

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Feedback: Mobility,withwalkingoruseofarockingchairforthosewithlimitedmobility,isencouragedasmuch aspossiblebecausebonessubjectedtonormalstressgiveuplesscalcium.Bestrestshouldbe discouragedbecauseitincreasescalciumexcretionandtheriskofrenalcalculi.Limitingthepatientto gettingoutofbedonlyafewtimesadayalsoincreasescalciumexcretionandtheassociatedrisks. 15. Whileassistingwiththesurgicalremovalofanadrenaltumor,theORnurseisawarethatthepatients vitalsignsmaychangeuponmanipulationofthetumor.Whatvitalsignchangeswouldthenurseexpect tosee? A)

Hyperthermiaandtachypnea

B)

Hypertensionandheartratechanges

C)

Hypotensionandhypothermia

D)

Hyperthermiaandbradycardia

Ans:

B Feedback: Manipulationofthetumorduringsurgicalexcisionmaycausereleaseofstoredepinephrineand norepinephrine,withmarkedincreasesinBPandchangesinheartrate.Theuseofsodiumnitroprusside andalpha-adrenergicblockingagentsmayberequiredduringandaftersurgery.Whileothervitalsign changesmayoccurrelatedtosurgicalcomplications,themostcommonchangesarerelatedto hypertensionandchangesintheheartrate.

16. Apatienthasreturnedtothefloorafterhavingathyroidectomyforthyroidcancer.Thenurseknowsthat sometimesduringthyroidsurgerytheparathyroidglandscanbeinjuredorremoved.Whatlaboratory findingmaybeanearlyindicationofparathyroidglandinjuryorremoval? A)

Hyponatremia

B)

Hypophosphatemia

C)

Hypocalcemia

D)

Hypokalemia

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

Ans:

986

C Feedback: Injuryorremovaloftheparathyroidglandsmayproduceadisturbanceincalciummetabolismandresult inadeclineofcalciumlevels(hypocalcemia).Asthebloodcalciumlevelsfall,hyperirritabilityofthe nervesoccurs,withspasmsofthehandsandfeetandmuscletwitching.Thisgroupofsymptomsis knownastetanyandmustbereportedtothephysicianimmediately,becauselaryngospasmmayoccur andobstructtheairway.Hypophosphatemia,hyponatremia,andhypokalemiaarenotexpectedresponses toparathyroidinjuryorremoval.Infact,parathyroidremovalorinjurythatresultsinhypocalcemiamay leadtohyperphosphatemia.

17. Thenurseisplanningthecareofapatientwithhyperthyroidism.Whatshouldthenursespecifyinthe patientsmealplan? A)

Aclearliquiddiet,highinnutrients

B)

Small,frequentmeals,highinproteinandcalories

C)

Threelarge,blandmealsaday

D)

Adiethighinfiberandplant-sourcedfat

Ans:

B Feedback: Apatientwithhyperthyroidismhasanincreasedappetite.Thepatientshouldbecounseledtoconsume severalsmall,well-balancedmeals.High-calorie,high-proteinfoodsareencouraged.Aclearliquiddiet wouldnotsatisfythepatientscaloricorhungerneeds.Adietrichinfiberandfatshouldbeavoided becausethesefoodsmayleadtoGIupsetorincreaseperistalsis.

18. Apatientwithadiagnosisofsyndromeofinappropriateantidiuretichormonesecretion(SIADH)is beingcaredforonthecriticalcareunit.Theprioritynursingdiagnosisforapatientwiththisconditionis what? A)

Riskforperipheralneurovasculardysfunction

B)

Excessfluidvolume

C)

Hypothermia

D)

Ineffectiveairwayclearance

Ans:

B

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

987

Feedback: TheprioritynursingdiagnosisforapatientwithSIADHisexcessfluidvolume,asthepatientretains fluidsanddevelopsasodiumdeficiency.Restrictingfluidintakeisatypicalinterventionformanaging thissyndrome.TemperatureimbalancesarenotassociatedwithSIADH.Thepatientisnotatriskfor neurovasculardysfunctionoracompromisedairway. 19. Apatientwithhypofunctionoftheadrenalcortexhasbeenadmittedtothemedicalunit.Whatwouldthe nursemostlikelyfindwhenassessingthispatient? A)

Increasedbodytemperature

B)

Jaundice

C)

Copiousurineoutput

D)

DecreasedBP

Ans:

D Feedback: DecreasedBPmayoccurwithhypofunctionoftheadrenalcortex.Decreasedfunctionoftheadrenal cortexdoesnotaffectthepatientsbodytemperature,urineoutput,orskintone.

20. ThenurseisassessingapatientdiagnosedwithGravesdisease.WhatphysicalcharacteristicsofGraves diseasewouldthenurseexpecttofind? A)

Hairloss

B)

Moonface

C)

Bulgingeyes

D)

Fatigue

Ans:

C Feedback: ClinicalmanifestationsoftheendocrinedisorderGravesdiseaseincludeexophthalmos(bulgingeyes) andfinetremorinthehands.Gravesdiseaseisnotassociatedwithhairloss,amoonface,orfatigue.

21. Apatientwithsuspectedadrenalinsufficiencyhasbeenorderedanadrenocorticotropichormone

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

988

(ACTH)stimulationtest.AdministrationofACTHcausedamarkedincreaseincortisollevels.How shouldthenurseinterpretthisfinding? A)

Thepatientspituitaryfunctioniscompromised.

B)

Thepatientsadrenalinsufficiencyisnottreatable.

C)

Thepatienthasinsufficienthypothalamicfunction.

D)

Thepatientwouldbenefitfromsurgery.

Ans:

A Feedback: Anadrenalresponsetotheadministrationofastimulatinghormonesuggestsinadequateproductionof thestimulatinghormone.Inthiscase,ACTHisproducedbythepituitaryand,consequently,pituitary hypofunctionissuggested.Hypothalamicfunctionisnotrelevanttothephysiologyofthisproblem. Treatmentexists,althoughsurgeryisnotlikelyindicated.

22. Thephysicianhasorderedafluiddeprivationtestforapatientsuspectedofhavingdiabetesinsipidus. Duringthetest,thenurseshouldprioritizewhatassessments? A)

Temperatureandoxygensaturation

B)

HeartrateandBP

C)

Breathsoundsandbowelsounds

D)

Color,warmth,movement,andsensationofextremities

Ans:

B Feedback: Thefluiddeprivationtestiscarriedoutbywithholdingfluidsfor8to12hoursoruntil3%to5%ofthe bodyweightislost.Thepatientsconditionneedstobemonitoredfrequentlyduringthetest,andthetest isterminatediftachycardia,excessiveweightloss,orhypotensiondevelops.Consequently,BPandheart ratemonitoringareprioritiesovertheotherlistedassessments.

23. Anurseworksinawalk-inclinic.Thenurserecognizesthatcertainpatientsareathigherriskfor differentdisordersthanotherpatients.Whatpatientisatagreaterriskforthedevelopmentof hypothyroidism? A)

A75-year-oldfemalepatientwithosteoporosis

TestBank-Brunner&Suddarth'sTextbookofMedical-SurgicalNursing14e(Hinkle2017)

B)

A50-year-oldmalepatientwhoisobese

C)

A45-year-oldfemalepatientwhousedoralcontraceptives

D)

A25-year-oldmalepatientwhousesrecreationaldrugs

Ans:

A

989

Feedback: Eventhoughosteoporosisisnotariskfactorforhypothyroidism,theconditionoccursmostfrequentlyin olderwomen. 24. Apatientwitharecentdiagnosisofhypothyroidismisbeingtreatedfora...