Week 6 Endocrine

EASY

100

Which medication order should the nurse question in the client diagnosed with untreated hypothyroidism? A) Thyroid hormones. B) Oxygen. C) Sedatives. D) Laxatives.

C) Untreated hypothyroidism is characterized by an increased susceptibility to the effects of most hypnotic and sedative agents; therefore, the nurse should question this medication.

200

Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)? A) Increased thyroxine (T4) level B) Blood pressure 112/62 mm Hg C) Distant and difficult to hear heart sounds D) Elevated thyroid stimulating hormone level

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.

300

Which nursing assessment of a 69-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)? A) Fluid balance B) Apical pulse rate C) Nutritional intake D) Orientation and alertness

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.

400

An 82-year-old patient in a long-term care facility has several medications prescribed. After the patient is newly diagnosed with hypothyroidism, the nurse will need to consult with the health care provider before administering A) docusate (Colace). B) ibuprofen (Motrin). C) diazepam (Valium). D) cefoxitin (Mefoxin).

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.

500

A 62-year-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.

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.

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100

The nurse is admitting a client who has been diagnosed with primary adrenal cortex insufficiency (Addison's disease). Which signs and symptoms support the diagnosis of Addison's disease? A) Bronze pigmentation, hypotension, and anorexia B) Moon face, buffalo hump, and hyperglycemia C) Hirsutism, fever, and irritability D)Tachycardia, bulging eyes, and goiter

A) Bronze pigmentation of the skin, particularly of the knuckles and other areas of skin creases, occurs in Addison disease. Hypotension and anorexia also occur. Moon face, buffalo hump, and hyperglycemia are due to Cushing syndrome, which is hyperfunction of the adrenal gland.

200

The client diagnosed with possible Addison disease is admitted to the emergency department. The client is lethargic, confused, and weak. Which intervention should the emergency department implement first? A) Have the lab draw serum cortisol levels stat. B) Check the client's medic alert bracelet to confirm Addison disease. C) Administer replacement steroids intravenously. D) Start an intravenous line and administer normal saline rapidly

B) The nurse should look for an identification band alerting the health-care professional of a chronic disease and then start the intravenous line and administer steroids.

300

The nurse is caring for a client diagnosed with Addison disease. Which nursing interventions should be implemented? A) Place the client in contact isolation. B) Administer intravenous and oral steroid medications. C) Provide a brightly lit room and recreational activities. D) Consult occupational therapy for work retraining.

B) Clients diagnosed with Addison disease have adrenal gland hypofunction. The client will require glucocorticosteroids, mineral steroids, and androgens.

400

The nurse is planning the care of a client diagnosed with Addison’s disease. Which intervention should be included? A) Administer steroid medications. B) Place the client on fluid restriction. C) Provide frequent stimulation. D) Consult physical therapy for gait training.

A) Clients diagnosed with Addison’s disease have adrenal gland hypofunction. The hormones normally produced by the gland must be replaced. Steroids and androgens are produced by the adrenal gland.

500

The client diagnosed with Addison’s disease is admitted to the emergency department after a day at the lake. The client is lethargic, forgetful, and weak. Which intervention should the nurse implement? A) Start an IV with an 18-gauge needle and infuse NS rapidly. B) Have the client wait in the waiting room until a bed is available. C) Obtain a permit for the client to receive a blood transfusion. D) Collect urinalysis and blood samples for a CBC and calcium level.

A) The client was exposed to wind and sun at the lake during the hours prior to being admitted to the emergency department. This predisposes the client to dehydration and an addisonian crisis. Rapid IV fluid replacement is necessary.

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100

The nurse is admitting the client diagnosed with rule-out Cushing syndrome. Which laboratory tests would confirm the diagnosis of Cushing syndrome? A) Complete blood count (CBC) and erythrocyte sedimentation rate (ESR). B) Plasma levels of adrenocorticotropic hormone (ACTH) and cortisol. C) 24-hour urine for metanephrine and catecholamine. D) Early morning spot urine specimen for protein and glucose.

B) The adrenal gland secretes cortisol; the pituitary gland secretes adrenocorticotropic hormone (ACTH), a hormone used by the body to stimulate the production of cortisol. Twenty-four-hour urine specimens for 17-hydroxycorticosteroids and 17-ketosteroids may be collected to determine the client's urine cortisol level.

200

The nurse is performing discharge teaching for a client diagnosed with Cushing disease. Which statement made by the client indicates the client needs further discharge instructions? A) “I will be sure to notify my HCP if I start to run a fever.” B) “Before I stop taking the prednisone, I will be taught how to taper it off.” C) “If I get thirsty and urinate a lot, I should let my doctor know.” D) “I should be sure and take safety precautions to prevent an injury.”

B) The client has too much cortisol and would not be on prednisone, a steroid medication. The nurse should clarify the instructions with the client.

300

The client admitted for chronic obstructive pulmonary disease (COPD) has developed iatrogenic Cushing disease. Which is a scientific rationale for the development of this problem? A) The client's chronic lack of oxygen has destroyed the adrenal glands. B) The client has a pituitary tumor that causes an overproduction of cortisol. C) The client has been taking steroid medications for an extended time. D) The HCP cannot explain why the client has this problem.

C) Iatrogenic means that a problem has been caused by the medical treatment or procedure used to treat another problem. Clients taking exogenous steroids over a period of time, such as those with COPD, develop the clinical manifestations of Cushing disease. Disease processes for which long-term steroids are prescribed include COPD, cancer, and arthritis.

400

The client diagnosed with Cushing disease has developed 2+ peripheral edema in the last 24 hours. The primary intravenous rate is 100 mL per hour, and he is receiving an intravenous piggyback (IVPB) medication in 50 mL of fluid every 6 hours. He has an oral intake of 2450 mL and a recorded output of 3000 mL. Which intervention should the nurse implement first? A) Convert the intravenous fluids to a saline lock. B) Notify the HCP. C) Teach the client to measure all output. D) Assess the lung fields and jugular vein.

D) The nurse should first perform a complete assessment to determine further evidence of heart failure and make sure that all urine output is measured before slowing the IV and notifying the HCP. The 24-hour intake is 2600 mL of IV fluid+ 2450 mL oral intake = 5050 total intake, and total output is 3000 mL.

500

The nurse writes a problem of “altered glucose metabolism” for a client diagnosed with Cushing disease. Which interventions should the nurse implement? A) Monitor blood glucose levels before meals and at bedtime. B) Perform a head-to-toe assessment every shift. C) Use therapeutic communication to allow the client to discuss feelings. D) Assess bowel sounds and temperature every 4 hours.

A) Blood glucose levels should be obtained to monitor for the effects of insulin resistance caused by Cushing disease.

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100

Which nursing intervention should be included in the plan of care for the client diagnosed with hyperthyroidism? A) Increase the amount of fiber in the diet. B) Encourage a low-calorie, low-protein diet. C) Decrease the client’s fluid intake to 1,000 mL/day. D) Provide six (6) small, well-balanced meals a day.

D) The client with hyperthyroidism has an increased appetite; therefore, wellbalanced meals served several times throughout the day will help with the client’s constant hunger.

200

Which statement made by the client makes the nurse suspect the client is experiencing hyperthyroidism? A) “I just don’t seem to have any appetite anymore.” B) “I have a bowel movement about every 3 to 4 days.” C) “My skin is really becoming dry and coarse.” D) “I have noticed all my collars are getting tighter.”

D) The thyroid gland (in the neck) enlarges as a result of the increased need for thyroid hormone production; an enlarged gland is called a goiter.

300

The 68-year-old client diagnosed with hyperthyroidism is being treated with radioactive iodine therapy. Which interventions should the nurse discuss with the client? A) Explain it will take up to a month for symptoms of hyperthyroidism to subside. B) Teach the iodine therapy will have to be tapered slowly over one (1) week. C) Discuss the client will have to be hospitalized during the radioactive therapy. D) Inform the client after therapy the client will not have to take any medication.

A) Radioactive iodine therapy is used to destroy the overactive thyroid cells. After treatment, the client is followed closely for three (3) to four (4) weeks until the euthyroid state is reached.

400

When providing discharge instructions to a patient who has a subtotal thyroidectomy for hyperthyroidism, what should the nurse teach the patient? A) Never miss a daily dose of thyroid replacement therapy B) Avoid regular exercise until thyroid function is normalized C) Use warm saltwater gargles several times a day to relieve throat pain D) Substantially reduce caloric intake compared to what was eaten before surgery

D) With the decrease in thyroid hormone postoperatively, calories will need to be reduced substantially to prevent weight gain

500

Which action by a new registered nurse (RN) caring for a patient with a goiter and possible hyperthyroidism indicates that the charge nurse needs to do more teaching? A) The RN checks the blood pressure on both arms. B) The RN palpates the neck thoroughly to check thyroid size. C) The RN lowers the thermostat to decrease the temperature in the room. D) RN orders nonmedicated eye drops to lubricate the patient’s bulging eyes.

B) Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided. The other actions by the new RN are appropriate when caring for a patient with an enlarged thyroid.