Endocrine Nclex review

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

B
Rationale: 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.

Cognitive Level: Application Text Reference: p. 1291
Nursing Process: Assessment NCLEX: Physiological Integrity

2. During preoperative teaching for a patient scheduled for transsphenoidal hypophysectomy for treatment of a pituitary adenoma, the nurse instructs the patient about the need to
a. remain on bed rest for the first 48 hours after the surgery.
b. avoid brushing the teeth for at least 10 days after the surgery.
c. cough and deep-breathe every 2 hours postoperatively.
d. be positioned flat with sandbags at the head postoperatively.

B
Rationale: 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.

Cognitive Level: Application Text Reference: p. 1293
Nursing Process: Implementation NCLEX: Physiological Integrity

3. Following a transsphenoidal resection of a pituitary tumor, an important nursing assessment is
a. monitoring hourly urine output.

b. checking the dressings for serous drainage.
c. palpating for dependent pitting edema.
d. obtaining continuous pulse oximetry.

A
Rationale: After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema and monitoring of urine output and urine specific gravity is essential. There will be no dressing when the transsphenoidal approach is used. 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.

Cognitive Level: Application Text Reference: p. 1293
Nursing Process: Assessment NCLEX: Physiological Integrity

4. A patient is suspected of having a pituitary tumor causing panhypopituitarism. During assessment of the patient, the nurse would expect to find
a. elevated blood glucose.
b. changes in secondary sex characteristics.
c. high blood pressure.
d. tachycardia and cardiac palpitations.

B
Rationale: Changes in secondary sex characteristics are associated with decreases in FSH and LH. Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of decreases in ACTH and cortisol. Bradycardia is likely due to the decrease in TSH and thyroid hormones associated with panhypopituitarism.

Cognitive Level: Application Text Reference: p. 1294
Nursing Process: Assessment NCLEX: Physiological Integrity

5. 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
a. adrenal disease.
b. untreated acromegaly.
c. a pituitary tumor.
d. diabetes insipidus (DI).

C
Rationale: Somatotropin is a recombinant growth hormone product used for adults with growth hormone deficiency, such as that caused by a pituitary tumor. The medication is not used in adrenal disease or DI. The patient with untreated acromegaly will have an excess of growth hormone.

Cognitive Level: Application Text Reference: p. 1294
Nursing Process: Assessment NCLEX: Physiological Integrity

6. A patient with an antidiuretic hormone (ADH)-secreting small-cell cancer of the lung is treated with demeclocycline (Declomycin) to control the symptoms of syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse determines that the demeclocycline is effective upon finding that the
a. patient's daily weight is stable.
b. urine specific gravity is increased.
c. patient's urinary output is increased.
d. peripheral edema is decreased.

C
Rationale: Demeclocycline blocks the action of ADH on the renal tubules and increases urine output. A stable body weight and an increase in urine specific gravity indicate 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.

Cognitive Level: Application Text Reference: p. 1295
Nursing Process: Evaluation NCLEX: Physiological Integrity

7. When teaching a patient with chronic SIADH about long-term management of the disorder, the nurse determines that additional instruction is needed when the patient says,
a. "I need to shop for foods that are low in sodium and avoid adding salt to foods."
b. "I should weigh myself daily and report any sudden weight loss or gain."
c. "I need to limit my fluid intake to no more than 1 quart of liquids a day."
d. "I will eat foods high in potassium because the diuretics cause potassium loss."

A
Rationale: 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.

Cognitive Level: Application Text Reference: p. 1296
Nursing Process: Evaluation
NCLEX: Health Promotion and Maintenance

8. 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
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
Rationale: 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. The BUN is not helpful in diagnosis of SIADH and this BUN value is increased. The serum chloride level will usually decrease along with the sodium level. This chloride value is elevated.

Cognitive Level: Application Text Reference: p. 1295
Nursing Process: Assessment NCLEX: Physiological Integrity

9. 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
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.

A
Rationale: Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema will not be expected because dehydration is a concern with polyuria. The patient drinks large amounts of fluid to compensate for the losses experienced from diuresis. The patient's fluid and electrolyte status remain normal as long as the patient's oral intake can keep up with fluid losses, so muscle cramps and weakness are not concerns.

Cognitive Level: Analysis Text Reference: p. 1296
Nursing Process: Diagnosis NCLEX: Physiological Integrity

10. 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?
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.

D
Rationale: Patients with diabetes insipidus compensate for fluid losses by drinking copious amounts of fluids, but a patient who is lethargic will be unable to drink enough fluids and will become hypovolemic. A high urine output, low urine specific gravity, and history of a recent head injury are consistent with diabetes insipidus, but they do not require immediate nursing action to avoid life-threatening complications.

Cognitive Level: Analysis Text Reference: p. 1297
Nursing Process: Assessment NCLEX: Physiological Integrity

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

D
Rationale: Improvement usually begins in 1 to 2 weeks with good results at 4 to 6 weeks. 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.

Cognitive Level: Implementation Text Reference: p. 1301
Nursing Process: Implementation NCLEX: Physiological Integrity

12. A patient with Graves' disease is prepared for surgery with drug therapy consisting of 4 weeks of propylthiouracil (PTU) and 10 days of iodine before surgery. When teaching the patient about the drugs, the nurse explains that the drugs are given preoperatively to
a. eliminate the risk for tetany during the postoperative period.
b. decrease the risk of hypometabolism during and after the surgery.
c. normalize metabolism and decrease the size and vascularity of the gland.
d. assist in differentiating the thyroid and parathyroid glands during surgery.

C
Rationale: Antithyroid drugs and iodine decrease the levels of thyroid hormone and the vascularity of the thyroid gland prior to surgery and lower the risk for postoperative thyrotoxicosis and hemorrhage. Postoperative tetany might be caused by removal of the parathyroid gland during thyroidectomy. The medications will tend to decrease metabolic rate. The medications will not help in differentiating the tissues of the thyroid and parathyroid glands.

Cognitive Level: Application Text Reference: p. 1302
Nursing Process: Implementation NCLEX: Physiological Integrity

13. During the nursing assessment of a patient with Graves' disease, the nurse notes a bounding, rapid pulse and systolic hypertension. Based on these assessment data, which question is important for the nurse to ask the patient?
a. "Do you have any problem with frequent constipation?"
b. "Have you noticed any recent decrease in your appetite?"
c. "Do you ever have any chest pain?"
d. "Have you had recent muscle aches?"

C
Rationale: Angina is a possible complication of Graves' disease, especially for a patient with tachycardia and hypertension. The other clinical manifestations are associated with hypothyroidism.

Cognitive Level: Application Text Reference: p. 1300
Nursing Process: Assessment NCLEX: Physiological Integrity

14. 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?
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.

C
Rationale: The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to prevent airway obstruction. The incisional pain should be treated but is not unusual after surgery. A heart rate of 112 is not unusual in a patient who has been hyperthyroid and has just arrived in the PACU from surgery. Vocal hoarseness is expected after surgery due to edema.

Cognitive Level: Application Text Reference: p. 1304
Nursing Process: Assessment NCLEX: Physiological Integrity

15. A few hours after returning to the surgical nursing unit, a patient who has undergone a subtotal thyroidectomy develops laryngeal stridor and a cramp in the right hand. The nurse anticipates that intervention will include
a. administration of IV morphine.
b. administration of IV calcium gluconate.
c. endotracheal intubation with mechanical ventilation.
d. immediate tracheostomy and manual ventilation.

B
Rationale: The patient's clinical manifestations are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Tracheostomy may be needed if the calcium does not resolve the stridor. There is no indication that morphine is needed. Endotracheal intubation may be done, but only if calcium is not effective in correcting the stridor.

Cognitive Level: Application Text Reference: p. 1304
Nursing Process: Planning NCLEX: Physiological Integrity

16. The nurse identifies a nursing diagnosis of risk for injury: corneal ulceration related to inability to close the eyelids secondary to exophthalmos for a patient with Graves' disease. An appropriate nursing intervention for this problem is to
a. teach the patient to blink every few seconds to lubricate the cornea.
b. elevate the head of the patient's bed to reduce periorbital fluid.
c. apply eye patches to protect the cornea from irritation.
d. place cold packs on the eyes to relieve pain and swelling.

B
Rationale: 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. 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.

Cognitive Level: Application Text Reference: p. 1303
Nursing Process: Planning NCLEX: Physiological Integrity

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

B
Rationale: Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany, and the priority nursing action is to assess the airway. The other actions are also part of the standard nursing care post-thyroidectomy but are not as high in priority.

Cognitive Level: Application Text Reference: p. 1304
Nursing Process: Implementation NCLEX: Physiological Integrity

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

A
Rationale: There is a high incidence of post-radiation 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.

Cognitive Level: Application Text Reference: pp. 1304-1305
Nursing Process: Implementation NCLEX: Physiological Integrity

19. 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
a. mental status.
b. nutritional level.
c. cardiac function.
d. fluid balance.

C
Rationale: In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication is also expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes do not indicate a need to change the therapy.

Cognitive Level: Application Text Reference: p. 1306
Nursing Process: Assessment NCLEX: Physiological Integrity

20. 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?
a. Docusate (Colace)
b. Diazepam (Valium)
c. Ibuprofen (Motrin)
d. Cefoxitin (Mefoxin)

B
Rationale: Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older adults. The nurse should discuss the diazepam with the health care provider before administration. The other medications may safely be given to the patient.

Cognitive Level: Application Text Reference: p. 1300
Nursing Process: Implementation NCLEX: Physiological Integrity

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

B
Rationale: 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. Teaching should not be delayed, but family members or friends should be included in teaching to assist the patient. The nurse, not a family member, is responsible for patient teaching. Because thyroid replacement does not begin to improve alertness immediately, it is not appropriate to schedule daily home health visits for teaching.

Cognitive Level: Application Text Reference: p. 1308
Nursing Process: Planning NCLEX: Physiological Integrity

22. A patient with primary hyperparathyroidism has a serum calcium level of 14 mg/dl (3.5 mmol/L), phosphorus of 1.7 mg/dl (0.55 mmol/L), serum creatinine of 2.2 mg/dl (194 mmol/L), and a high urine calcium. While the patient awaits surgery, the nurse should
a. institute seizure precautions such as padded siderails.
b. assist the patient to perform range-of-motion exercises QID.
c. monitor the patient for positive Chvostek's or Trousseau's sign.
d. encourage the patient to drink 4000 ml of fluid daily.

D
Rationale: 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 rather than range-of-motion because weight-bearing decreases calcium loss from bone.

Cognitive Level: Application Text Reference: pp. 1309-1310
Nursing Process: Implementation NCLEX: Physiological Integrity

23. Following a thyroidectomy, a patient develops carpal spasm while the nurse is taking a blood pressure on the left arm. Which action by the nurse is appropriate?
a. Administer the ordered muscle relaxant.
b. Have the patient rebreathe using a paper bag.
c. Start oxygen at 2 to 3 L/min per cannula.
d. Give the ordered oral calcium supplement.

B
Rationale: Carpal spasm after a thyroidectomy suggests that the patient has hypocalcaemia caused by damage to the parathyroid glands. The symptoms of hypocalcemia will be temporarily reduced by having the patient breath into a paper bag, which will raise the PaCO2 and create a more acidic pH. The muscle relaxant will not impact on ionized calcium level. There is no indication that the patient is experiencing laryngeal stridor or needs oxygen. IV calcium supplements will be given to normalize calcium level quickly.

Cognitive Level: Application Text Reference: pp. 1310-1311
Nursing Process: Implementation NCLEX: Physiological Integrity

24. After neck surgery, a patient develops hypoparathyroidism. The nurse should plan to teach the patient about
a. calcium supplementation to normalize serum calcium levels.
b. including whole grains in the diet to prevent constipation.
c. use of bisphosphonates to reduce bone demineralization.
d. having a high fluid intake to decrease risk for nephrolithiasis.

A
Rationale: 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 level further by preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of hypoparathyroidism and low calcium levels.

Cognitive Level: Application Text Reference: p. 1311
Nursing Process: Planning
NCLEX: Health Promotion and Maintenance

25. A patient with hypoparathyroidism receives instructions from the nurse regarding symptoms of hypocalcemia and hypercalcemia. The nurse teaches the patient that if mild symptoms of hypocalcemia occur, the patient should
a. increase the daily fluid intake to twice the usual amount.
b. self-administer IM calcium before calling the doctor.
c. call an ambulance because the symptoms will progress to seizures.
d. rebreathe with a paper bag and then seek medical assistance.

D
Rationale: Rebreathing may help alleviate mild symptoms, but it will only temporarily increase ionized calcium level, so the patient should call the health care provider. There is no need to increase fluid intake. Calcium is not given IM but is given slowly through the IV route. Mild hypocalcemia is unlikely to progress to seizures.

Cognitive Level: Application Text Reference: p. 1311
Nursing Process: Implementation
NCLEX: Health Promotion and Maintenance

26. 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
a. chronically low blood pressure.
b. decreased axillary and pubic hair.
c. purplish red streaks on the abdomen.
d. bronzed appearance of the skin.

C
Rationale: 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.

Cognitive Level: Comprehension Text Reference: pp. 1312-1314
Nursing Process: Assessment NCLEX: Physiological Integrity

27. A patient with Cushing syndrome is admitted to the hospital to have laparoscopic adrenalectomy. During the admission assessment, the patient tells the nurse, "The worst thing about this disease is how terrible I look. I feel awful about it." The best response by the nurse is
a. "Let me show you how to dress so that the changes are not so noticeable."
b. "I do not think you look bad. Your appearance is just altered by your disease."
c. "Most of the physical and mental changes caused by the disease will gradually improve after surgery."
d. "You really should not worry about how you look in the hospital. We see many worse things."

C
Rationale: The most reassuring 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. The response beginning "Let me show you how to dress" indicates that the changes are permanent and that the patient's appearance needs disguising. The response beginning, "I do not think you look bad" does not acknowledge the patient's feelings and also fails to communicate that the changes will be resolved after surgery. And the response beginning "You really should not worry about how you look in the hospital" implies that the patient's appearance is not good.

Cognitive Level: Application Text Reference: p. 1314
Nursing Process: Implementation NCLEX: Psychosocial Integrity

28. 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?
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
Rationale: During the immediate postoperative period, marked fluctuation in cortisol levels may occur and the nurse must be alert for signs of acute adrenal insufficiency such as hypotension. The nurse should also address the elevated glucose, incisional pain, and crackles with appropriate collaborative or nursing actions, but prevention and treatment of acute adrenal insufficiency is the priority after adrenalectomy.

Cognitive Level: Application Text Reference: p. 1315
Nursing Process: Assessment NCLEX: Physiological Integrity

29. 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
a. monitoring for infection.
b. protecting the patient's skin.
c. maintaining fluid and electrolyte status.
d. preventing severe emotional disturbances.

C
Rationale: After adrenalectomy, the patient is at risk for circulatory instability caused by fluctuating hormone levels, and the focus of care is to assess and maintain fluid and electrolyte status through the use of IV fluids and corticosteroids. The other goals are also important for the patient but are not as immediately life-threatening as circulatory collapse.

Cognitive Level: Application Text Reference: p. 1315
Nursing Process: Planning NCLEX: Physiological Integrity

30. A patient is hospitalized with acute adrenal insufficiency. The nurse determines that the patient is responding favorably to treatment upon finding
a. decreasing serum sodium.
b. decreasing serum potassium.
c. decreasing blood glucose.
d. increasing urinary output.

B
Rationale: Clinical manifestations of Addison's disease include hyperkalemia and a decrease in potassium level indicates improvement. Decreasing serum sodium and decreasing blood glucose indicate that treatment has not been effective. Changes in urinary output are not an effective way of monitoring treatment for Addison's disease.

Cognitive Level: Application Text Reference: pp. 1313, 1316
Nursing Process: Evaluation NCLEX: Physiological Integrity

31. A patient is admitted to the hospital in addisonian crisis 1 month after a diagnosis of Addison's disease. The nurse identifies the nursing diagnosis of ineffective therapeutic regimen management related to lack of knowledge of management of condition when the patient says,
a. "I double my dose of hydrocortisone on the days that I go for a run."
b. "I had the stomach flu earlier this week and couldn't take the hydrocortisone."
c. "I frequently eat at restaurants, and so my food has a lot of added salt."
d. "I do yoga exercises almost every day to help me reduce stress and relax."

B
Rationale: The need for hydrocortisone replacement is increased with stressors such as illness, and the patient needs to be taught to call the health care provider because medication and IV fluids and electrolytes may need to be given. The other patient statements indicate appropriate management of the Addison's disease.

Cognitive Level: Application Text Reference: pp. 1316, 1319
Nursing Process: Diagnosis NCLEX: Physiological Integrity

32. A patient who uses every-other-day prednisone therapy for rheumatoid arthritis complains of not feeling as well on the non-prednisone days and asks the nurse about taking prednisone daily instead. The best response to the patient is that
a. an every-other-day schedule mimics the normal pattern of cortisol secretion from the adrenal gland.
b. glucocorticoids are taken on a daily basis only when they are being used for replacement therapy.
c. if it improves the symptoms, it would be acceptable to take half the usual dose every day.
d. there is less effect on normal adrenal function when prednisone is taken every other day.

D
Rationale: An alternate-day regimen is given to minimize the impact of exogenous glucocorticoids on adrenal gland function. The normal pattern of cortisol secretion is diurnal. Glucocorticoids are taken daily when being used for replacement therapy, but this is not the only indication for daily use. Taking half the usual dose would not achieve the goal of minimizing adrenal gland suppression.

Cognitive Level: Application Text Reference: p. 1314
Nursing Process: Implementation NCLEX: Physiological Integrity

33. 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?
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.

B
Rationale: Acute adrenal insufficiency may occur if exogenous glucocorticoids are suddenly stopped. Mood alterations and weight gain are possible adverse effects of glucocorticoid use, but these are not life-threatening effects. Glucocorticoids do mask the signs of infection, but temperature elevation tends to be suppressed, so other signs of infection should be monitored.

Cognitive Level: Application Text Reference: p. 1314
Nursing Process: Implementation NCLEX: Physiological Integrity

34. A patient has an adrenocortical adenoma causing hyperaldosteronism and is scheduled for laparoscopic surgery to remove the tumor. During care before surgery, the nurse should
a. monitor blood glucose level every 4 hours.
b. provide a potassium-restricted diet.
c. monitor the blood pressure every 4 hours.
d. relieve edema by elevating the extremities.

C
Rationale: Hypertension caused by sodium retention is a common complication of hyperaldosteronism. Hyperaldosteronism does not cause elevation in blood glucose. The patient will be hypokalemic and require potassium supplementation prior to surgery. Edema does not usually occur with hyperaldosteronism.

Cognitive Level: Application Text Reference: pp. 1319-1320
Nursing Process: Implementation NCLEX: Physiological Integrity

35. A patient with a possible pheochromocytoma is admitted to the hospital for evaluation and diagnostic testing. During an attack, the nurse will monitor for hypertension and
a. hypoglycemia.
b. bradycardia.
c. headache.
d. flushing.

C
Rationale: The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia, severe headache, diaphoresis, and abdominal or chest pain. Elevated blood glucose may also occur due to sympathetic nervous system stimulation. Bradycardia and flushing would not be expected.

Cognitive Level: Application Text Reference: p. 1320
Nursing Process: Assessment NCLEX: Physiological Integrity

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

A
Rationale: The head of the bed should be elevated about 30 degrees to decrease pressure on the sella turcica and avoid headaches. The other actions by the NA are appropriate after this surgery.

Cognitive Level: Application Text Reference: p. 1293
Nursing Process: Implementation
NCLEX: Safe and Effective Care Environment

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

C
Rationale: ADH, cortisol, and thyroid hormone replacement will be needed for life after hypophysectomy. Without the effects of ACTH and cortisol, the blood glucose and serum sodium will be low unless cortisol is replaced. An adenoma is a benign tumor, and chemotherapy will not be needed.

Cognitive Level: Application Text Reference: p. 1293
Nursing Process: Planning NCLEX: Physiological Integrity

38. A patient is admitted with possible SIADH. Which information obtained by the nurse is most important to communicate rapidly to the health care provider?
a. The patient complains of a severe headache.
b. The patient complains of severe thirst.
c. The patient has a urine specific gravity of 1.025.
d. The patient has a serum sodium level of 119 mEq/L.

D
Rationale: A serum sodium of less than 120 mEq/L increases the risk for complications such as seizures and needs rapid correction. The other data are not unusual for a patient with SIADH and do not indicate the need for rapid action.

Cognitive Level: Application Text Reference: p. 1295
Nursing Process: Assessment NCLEX: Physiological Integrity

39. When developing a plan of care for a patient with SIADH, which interventions will the nurse include?
a. Encourage fluids to 2000 ml/day.
b. Offer patient hard candies to suck on.
c. Monitor for increased peripheral edema.
d. Keep head of bed elevated to 30 degrees.

B
Rationale: Sucking on hard candies decreases thirst for patient on a fluid restriction. Patients with SIADH are on fluid restrictions of 800 to 1000 ml/day. Peripheral edema is not seen with SIADH. The head of the bed is elevated no more than 10 degrees to increase left atrial filling pressure and decrease ADH release.

Cognitive Level: Application Text Reference: p. 1296
Nursing Process: Planning NCLEX: Physiological Integrity

40. After receiving change-of-shift report about these four patients, which patient should the nurse assess first?
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
Rationale: Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The patient's high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for life-threatening complications.

Cognitive Level: Application Text Reference: p. 1306
Nursing Process: Planning NCLEX: Physiological Integrity

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