Endocrine Disorder NCLEX Questions

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MS2-T4 From Study Guide book that goes with textbook

A patient suspected of having acromegaly has an elevated plasma growth hormone level. In acromegaly, the nurse would also expect the patient's diagnostic results to include
a. hyperinsulinemia
b. a plasma glucose of less than 70
c. decreased growth hormone levels with an oral glucose challenge test
d. a serum sometomedin C (insulin-like growth-factor) of more than 300

d. a serum somatomedin C (Insulin-like-growth-factor) of more than 300
(rationale- a normal response to growth hormone secretion is stimulation of the liver to produce somatomedin C which stimulates growth of bones and soft tissue. The increased levels of somatomedin C normally inhibit growth hormone, but in acromegaly the pituitary gland secretes GH despite elevated somatomedin C levels.)

During assessment of the patient with acromegaly, the nurse would expect the patient to report
a. infertility
b. dry, irritated skin
c. undesirable changes in appearance
d. an increase in height of 2 to 3 inches per year

c. undesirable changes in appearance
(Rationale- the increased production of growth hormone in acromegaly causes an increase in thickness and width of bones and enlargement of soft tissues, resulting in marked changes in facial features, oily and coarse skin, and speech difficulties. Height is not increased in adults with growth hormone excess because the epiphyses of the bones are closed, and infertility is not a common finding because growth hormone is usually the only pituitary hormone involved in acromegaly.)

A patient with acromegaly is treated with a transphenoidal hypophysectomy. Postoperatively, the nurse
a. ensures that any clear nasal drainage is tested for glucose
b. maintains the patient flat in bed to prevent cerebrospinal fluid leak
c. assists the patient with toothbrushing Q4H to keep the surgical area clean
d. encourages deep breathing and coughing to prevent respiratory complications

a. ensures that any clear nasal drainage is tested for glucose
(Rationale- a transphenoidal hypophysectomy involves entry into the sella turcica through an incision in the upper lip and gingiva into the floor of the nose and the sphenoid sinuses. Postoperative clear nasal drainage with glucose content indicates CSF leakage from an open connection to the brain, putting the patient at risk for meningitis. After surgery, the patient is positioned with the head elevated to avoid pressure on the sella turcica, coughing and straining are avoided to prevent increased ICP and CSF leakage, and although mouth care is required Q4H toothbrushing should not be performed for 7-10post sx.)

During care of a patient with syndrome of inappropriate ADH (SIADH), the nurse should
a. monitor neurologic status Q2H or more often if needed
b. keep the head of the bed elevated to prevent ADH release
c. teach the patient receiving treatment with diuretics to restrict sodium intake
d. notify the physician if the patient's blood pressure decreases more than 20mmHg from baseline

a. monitor neurologic status Q2H or more often if needed
Rationale- the patient with SIADH has marked dilution hyponatremia and should be monitored for decreased neurologic function and convulsions every 2 hours. ADH release is reduced by keeping the head of the bed flat to increase left atrial filling pressure, and sodium intake is supplemented because of hyponatremia and sodium loss caused by diuretics. A reduction in blood pressure indicates a reduction in total fluid volume and is an expected outcome of treatment.)

A patient with SIADH is treated with water restriction and administration of IV fluids. The nurses evaluates that treatment has been effective when the patient experiences
a. increased urine output, decreased serum sodium, and increased urine specific gravity
b. increased urine output, increased serum sodium, and decreased urine specific gravity
c. decreased urine output, increased serum sodium, and decreased urine specific gravity
d. decreased urine output, decreased serum sodium, and increased urine specific gravity

b. increased urine output, increased serum sodium, and decreased urine specific gravity
(rationale- the patient with SIADH has water retention with hyponatremia, decreased urine output and concentrated urine with high specific gravity. improvement in the patient's condition reflected by increased urine output, normalization of serum sodium, and more water in the urine, decreasing the specific gravity.)

In a patient with central diabetes insipidus, administration of aqueous vasopressin during a water deprivation test will result in a
a. decrease in body weight
b. increase in urinary output
c. decrease in blood pressure
d. increase in urine osmolality

d. increase in urine osmolality
(rationale- a patient with DI has a deficiency of ADH with excessive loss of water from the kidney, hypovolemia, hypernatreamia, and dilute urine with a low specific gravity. When vasopressin is administered, the symptoms are reversed, with water retention, decreased urinary output that increases urine osmolality, and an increase in blood pressure.)

A patient with DI is treated with nasal desmopression. The nurse recognize that the drug is not having an adequate therapeutic effect the the patient experiences
a. headache and weight gain
b. nasal irritation and nausea
c. a urine specific gravity of 1.002
d. an oral intake greater than urinary output

c. a urine specific gravity of 1.002
(rationale- normal urine specific gravity is 1.003 to 1.030, and urine with a specific gravity of 1.002 is very dilute, indicating that there continues to be excessive loss of water and that treatment of DI is inadequate. H/A, weight gain, and oral intake greater the urinary output are signs of volume excess that occur with overmedication. Nasal irritation & nausea may also indicate overmedication.)

When caring for a patient with nephrogenic DI, the nurse would expect treatment to include
a. fluid restriction
b. thiazide diuretics
c. a high-sodium diet
d. chlorpropamide (DIabinese)

b. thiazide diuretics
(Rationale- in nephrogenic Di the kidney is unable to respond to ADH, so vasopressin or hormone analogs are not effective. Thiazide diuretics slow the glomerular filtration rate in the kidney and produce a decrease in urine output. Low-sodium diets are also thought to decrease urine output. Fluids are not restricted, because the patient could become easily dehydrated.)

A patient with Grave's dz asks the nurse what caused the disorder. The best response by the nurse is
a. "The cause of Grave's disease is not known, although it is thought to be genetic."
b. "It is usually associated with goiter formation from an iodine deficiency over a long period of time."
c. "Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones"
d. "In genetically susceptible persons antibodies form that attack thyroid tissue and stimulate overproduction of thyroid hormones."

d. "In genetically susceptible persons antibodies form that attack thyroid tissue and stimulate overproduction of thyroid hormones."
(rationale- The antibodies present in Graves' disease that attack thyroid tissue cause hyperplasia of the gland and stimulate TSH receptors on the thyroid and activate the production of thyroid hormones, creating hyperthyroidism. The disease is not directly genetic, but individuals appear to have a genetic susceptibility to become sensitized to develop autoimmune antibodies. Goiter formation from insufficient iodine intake is usually associated with hypothyroidism.)

A patient is admitted to the hospital in thyrotoxic crisis. On physical assessment of the patient, the nurse would expect to find
a. hoarseness and laryngeal stridor
b. bulging eyeballs and arrhythmias
c. elevated temperature and signs of heart failure
d. lethargy progressing suddenly to impairment of consciousness

c. elevated temperature and signs of heart failure
(rationale- a hyperthyroid crisis results in marked manifestations of hyperthyroidism, with fever tachycardia, heart failure, shock, hyperthermia, agitation, N/V/D, delirium, and coma. Although exophthalmos may be present in the patient with Gravs' dz, it is not a significant factor in hyperthyroid crisis. Hoarsness and laryngeal stridor are characteristic of the tetany of hypoparathyroidism, and lethargy progressing to coma is characteristic of myxedema coma, a complication of hypothyroidism.

Preoperative instructions for the patient scheduled for a subtotal thyroidectomy includes teaching the patient
a. how to support the head with the hands when moving
b. that coughing should due avoided to prevent pressure on the incision
c. that the head and neck will need to remain immobile until the incision heals
d. that any tingling around the lips or in the fingers after surgery is expected and temporary

a. how to support the head with the hands when moving
(rationale- to prevent strain on the suture line postoperatively, the head must be manually supported while turning and moving in bed, but range-of-motion exercise for the head and neck are also taught preoperatively to be gradually implemented after surgery. There is no contraindication for coughing and deep breathing, and they should be carrier out postoperatively. Tingling around the lips or fingers is a sign of hypocalcemia, which may occur if the parathyroid glands are inadvertently removed during surgery, and should be reported immediately.)

When providing discharge instructions to a patient following a subtotal thyroidectomy, the nurse advises the patient to
a. never miss a daily dose of thyroid replacement therapy
b. avoid regular exercise until thyroid function is normalized
c. avoid eating foods such as soybeans, turnips, and rutabagas
d. use warm salt water gargles several times a day to relieve throat pain

c. avoid eating foods such as soybeans, turnips, and rutabagas
(Rationale- when a patient has had a subtotal thyroidectomy, thyroid replacement therapy is not given, because exogenous hormone inhibits pituitary production of TSH and delays or prevents the restoration of thyroid tissue regeneration. However, the patient should avoid goitrogens, foods that inhibit thyroid, such as soybeans, turnips, rutabagas, and peanut skins. REgular exercise stimulates the thyroid gland and is encourage. Salt water gargles are used for dryness and irritation of the mouth and throat following radioactive iodine therapy.)

Causes of primary hypothyroidism in adults include
a. malignant or benign thyroid nodules
b. surgical removal or failure of the pituitary gland
c. surgical removal or radiation of thyroid gland
d. autoimmune-induced atrophy of the gland

d. autoimmune-induced atrophy of the gland
(rationale- both Graves disease and Hasimotos thyroiditis are autoimmune disorders that eventually destroy the thyroid gland, leading to primary hypothyroidism. Thyroid tumors most often result in hyperthyroidism. Secondary hypothyroidism occurs as a result of pituitary failure, and iatrogenic hypothyroidism results from thyroidectomy or radiation of the thyroid gland.)

Physical changes of hypothyroidism that must be monitored when replacement therapy is started include
a. achlorhydria and constipation
b. slowed mental processes and lethargy
c. anemia and increased capillary fragility
d. decreased cardiac contractility and coronary atherosclerosis

d. decreased cardiac contractility and coronary atherosclerosis
(rationale- hypothyroidism affects the heart in many ways, causing cardiomyopathy, coronary atherosclerosis, bradycardia, pericardial effusions, and weakened cardiac contractility. when thyroid replacement therapy is started, myocardial oxygen consumption is increased and the resultant oxygen demand may cause angina, cardiac arrhythmias, and heart failures. It is important to monitor patients with compromised cardiac status when starting replacement therapy.)

A patient with hypothyroidism is treated with Synthroid. When teaching the patient about the therapy, the nurse
a. explains that caloric intake must be reduced when drug therapy is started
b. provides written instruction for all information related to the medication therapy
c. assures the patient that a return to normal function will occur with replacement therapy
d. informs the patient that medications must be taken until hormone balance is reestablished

b. provides written instruction for all information related to the medication therapy
(rationale- because of the mental sluggishness, inattentiveness, and memory loss that occur with hypothyroidism, it is important to provide written instructions and repeat information when teaching the patient. Caloric intake can be increased when drug therapy is started, because of an increased metabolic rate, and replacement therapy must be taken for life. Although most patients return to a normal state with treatment, cardiovascular conditions and psychoses may persist.)

An appropriate nursing intervention for the patient with hyperparathyroidism is to
a. pad side rails as a seizure precaution
b. increase fluid intake to 3000 to 4000ml/day
c. maintain bed rest to prevent pathologic fractures
d. monitor the patient for Trousseau's phenomenon or Chvostek's sign

b. increase fluid intake to 3000 to 4000ml/day
(Rationale-A high fluid intake is indicated in hyperparathyroidism to dilute hypercalcemia and flush the kidneys so that calcium stone formation is reduced.)

When the patient with parathyroid disease experiences symptoms of hypocalcemia, a measure that can be used to temporarily raise serum calcium levels is to
a. administer IV normal saline
b. have the patient rebreathe in a paper bag
c. administer Lasix as ordered
d. administer oral phosphorous supplements

b. have the patient rebreathe in a paper bag
(rationale- rebreathing in a paper bag promotes carbon dioxide retention in the blood, which lowers pH and creates an acidosis. An academia enhances the solubility and ionization of calcium, increasing the proportion of total body calcium available in physiologically active form and relieving the symptoms of hypocalcemia. Saline promotes calcium excretion, as does Lasix. Phosphate levels in the blood are reciprocal to calcium and an increase in phosphate promotes calcium excretion.)

A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, the nurse would expect to find
a. HTN, peripheral edema, and petechiae
b. weight loss, buffalo hump, and moon face with acne
c. abdominal and buttock striae, truncal obesity, and hypotension
d. anorexia, signs of dehydration, and hyper pigmentation of the skin

a. HTN, peripheral edema, and petechiae
(rationale- The effects of glucocorticoid excess include weight gain from accumulation and redistribution of adipose tissue, sodium and water retention, glucose intolerance, protein wasting, loss of bone structure, loss of collagen, and capillary fragility. Clinical manifestations of corticosteroid deficiency include hypotension, dehydration, weight loss, and hyperpigmentation of the skin.)

To prevent complications in the patient with Cushing syndrome, the nurse monitors the patient for
a. hypotension
b. hypoglycemia
c. cardiac arrhythmias
d. decreased cardiac output

c. cardiac arrhythmias
(rationale- electrolyte changes that occur in Cushing syndrome include sodium retention and potassium excretion by the kidney, resulting in hypokalemia, which may lead to cardiac arrhythmias or arrest. Hypotension, hypoglycemia, and decreased cardiac strength and output are characteristic of adrenal insufficiency.)

A patient is scheduled for bilateral adrenalectomy. During the postoperative period, the nurse would expect administration of corticosteroids to be
a. reduced to promote wound healing
b. withheld until symptoms of hypocortisolism appear
c. increased to promote an adequate response to the stress of surgery
d. reduced because excessive hormones are released during surgical manipulation of the glands

c. increased to promote an adequate response to the stress of surgery
(rationale- although the patient with Cushing syndrome has excess corticosteroids, removal of the glands and the stress of surgery require that high doses of cortisone be administered postoperatively for several days. The nurse should monitor the patient postoperatively to detect whether large amounts of hormones were released during surgical manipulation and to ensure the healing is satisfactory.)

A patient with Addison's disease comes to the emergency department with complaints of N/V/D, and fever. The nurse would expect collaborative care to include
a. parenteral injections of ACTH
b. IV administration of vasopressors
c. IV administration of hydrocortisone
d. IV administration of D5W with 20mEq of KCl

c. IV administration of hydrocortisone
(rationale- vomiting and diarrhea are early indicators of addisonian crisis and fever indicates an infection, which s causing additional stress for the patient. treatment of a crisis requires immediate glucocorticoid replacement, and IV hydrocortisone, fluids, sodium and glucose are necessary for 24hours. Addison's disease is a primary insufficiency of the adrenal gland, and ACTH is not effective, nor would vasopressors be effective with the fluid deficiency of Addison's. Potassium levels are increased in Addison's dz, and KCl would be contraindicated.)

The nurse determines that the patient in acute adrenal insufficiency is responding favorably to treatment when
a. the patient appears alert and oriented
b. the patient's urinary output has increased
c. pulmonary edema is reduced as evidenced by clear lung sounds
d. laboratory tests reveal serum elevations of K and glucose and a decrease in sodium

a. the patient appears alert and oriented
(rationale- confusion, irritability, disorientation, or depressioni s often present in the patient with Addison's dz, and a positive response to therapy would be indicated by a return to alertness and orientation. Other indication of response to therapy would be a decreased urinary output, decreased serum potassium, and increased serum sodium and glucose. The patient with Addison's would be very dehydrated and volume-depleted and would not have pulmonary edema.)

The most important nursing intervention during the medical and surgical treatment of the patient with a pheochromocytoma is
a. administering IV fluids
b. monitoring blood pressure
c. monitoring I&O and daily weights
d. administering B-adrenergic blocking agents

b. monitoring blood pressure38
(rationale- a pheochromocytoma is a catecholamine-producing tumor of the adrenal medulla, which may cause severe, episodic HTN; severe, pounding headache; and profuse sweating. Monitoring for dangerously high BP before surgery is critical, as is monitoring for BP fluctuation during medical and surgical tx.)

When caring for a patient with primary hyperaldosteronism, the nurse would question a physician's order for the use of
a. Lasix
b. amiloride (midamor)
c. spironolactone (aldactone)
d. aminoglutethimide (cytadren)

a. Lasix37
(rationale- hyperaldosteronism is an excess of aldosterone, which is manifested by sodium and water retention and potassium excretion. Lasix is a potassium-wasting diuretic that would increase the potassium deficiency. Aminoglutethimide blocks aldosterone synthesis; amiloride is apotassium-sparing diuretic; and spironolactone blocks mineralocorticoid receptors in the kidney, increasing secretion of sodium and water and retention of potassium.)

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