Chapter 51

Question 1

The nurse is assessing a client with suspected acromegaly 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. “Are you experiencing tremors or anxiety?”
d. “Is there any family history of acromegaly?”

Answer 1

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.

Question 2

The nurse is providing preoperative teaching for a client scheduled for a hypophysectomy for treatment of a pituitary adenoma. Which of the following instructions should the nurse include in client teaching?
a. Cough and deep breathe every 2 hours postoperatively
b. Bed rest for the first 24 hours after the surgery
c. Be positioned flat with sandbags at the head postoperatively
d. Have a NG tube after the surgery

Answer 2

D
The client should be taught that they will have a NG tube after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is discouraged because it may cause leakage of cerebro-spinal 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

Question 3

The nurse is caring for a client who has had a transsphenoidal resection of a pituitary tumour. Which of the following nursing actions should be included in the postoperative plan of care?
a. Monitor urine output every hour.
b. Palpate extremities for dependent edema.
c. Check hematocrit hourly for first 12 hours.
d. Obtain continuous pulse oximetry for 24 hours.

Answer 3

A

After pituitary surgery, the client is at risk for diabetes insipidus caused by cerebral edema and 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 client is at risk for dehydration, not volume overload. The client is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.

Question 4

A client is suspected of having a pituitary tumour causing panhypopituitarism. During assessment of the client, which of the following findings should the nurse anticipate?
a. High blood pressure
b. Elevated blood glucose
c. Tachycardia and cardiac palpitations
d. Changes in secondary sex characteristics

Answer 4

: D
Changes in secondary sex characteristics 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.

Question 5

Which of the following information should the nurse include when teaching a client about use of somatropin?
a. The medication will improve vaginal dryness.
b. Inject the medication subcutaneously every day.
c. Blood glucose levels will decrease when taking the medication.
d. Stop taking the medication if swelling of the hands or feet occurs.

Answer 5

B
Somatropin is injected subcutaneously on a daily basis, preferably in the evening. The client will need to continue on somatropin for life. If swelling or other adverse effects occur, the health care provider should be notified. Growth hormone will increase blood glucose levels.

Question 6

. A client is being treated with a medication to block the effect of antidiuretic hormone to control the symptoms of syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings indicates that the medication is effective?
a. Decreased peripheral edema
b. Increased weight
c. Increased urine specific gravity
d. Increased urinary output

Answer 6

D

Agents that block the effect of ADH on the renal tubules may be prescribed, thereby allowing more dilution of urine leading to an increased 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.

Question 7

The nurse is teaching a client with chronic syndrome of inappropriate antidiuretic hormone (SIADH) about long-term management. Which of the following client statements indicate that additional instruction is needed?
a. “I should weigh myself daily and report any sudden weight loss or gain.”
b. “I need to limit my fluid intake to no more than 1 L of liquids a day.”
c. “I will eat foods high in potassium because the diuretics cause potassium loss.”
d. “I need to shop for foods that are low in sodium and avoid adding salt to foods.”

Answer 7

D
Clients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other client statements are correct and indicate successful teaching has occurred.

Question 8

The nurse is caring for a client with possible syndrome of inappropriate antidiuretic hormone (SIADH). The client is confused and reports a headache, muscle cramps, and twitching. Which of the following initial laboratory results should the nurse anticipate?
a. Elevated hematocrit
b. Decreased serum sodium
c. Increased serum chloride
d. Low urine specific gravity

Answer 8

B
When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the client. 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.

Question 9

The nurse is caring for a client with symptoms of diabetes insipidus who has been admitted to the hospital for evaluation and treatment. Which of the following nursing diagnoses is best for this client?
a. Insomnia related to frequent waking at night to void
b. Impaired gas exchange related to fluid retention in lungs
c. Excess fluid volume related to intake greater than output
d. Risk for impaired skin integrity related to generalized edema

Answer 9

A

Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.

Question 10

Which of the following information should the nurse include when teaching a client 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. Surgery will eventually be required to remove the thyroid gland.
d. Antithyroid medications may take several weeks to have an effect.

Answer 10

D
Medications used to block the synthesis of thyroid hormones may take several weeks before an 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.

Question 11

A few hours after returning to the surgical nursing unit, a client who has undergone a subtotal thyroidectomy develops laryngeal stridor and a cramp in the right hand. Which of the following actions should the nurse anticipate implementing first?
a. Infuse IV calcium gluconate.
b. Suction the client’s airway.
c. Prepare for endotracheal intubation.
d. Assist with emergency tracheostomy.

Answer 11

A
The client’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.

Question 12

The nurse is caring for a client with Graves’ disease who has exophthalmos. Which of the following actions shouldbe included in the plan of care?
a. Apply eye patches to protect the cornea from irritation.
b. Place cold packs on the eyes to relieve pain and swelling.
c. Elevate the head of the client’s bed to reduce periorbital fluid.
d. Teach the client to blink every few seconds to lubricate the cornea.

Answer 12

C

The client should sit upright as much as possible to promote fluid drainage from the periorbital area. With exophthalmos the client 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.

Question 13

The nurse is caring for a client with hyperthyroidism who is being treated with radioactive iodine (RAI) at the clinic. Which of the following information should the nurse provide to the client prior to discharge?
a. Symptoms of hyperthyroidism should be relieved in about a week.
b. Hypothyroidism may occur as the RAI therapy takes effect.
c. Discontinue the antithyroid medications taken before the radioactive therapy.
d. Teach radioactive precautions to use with urine, stool, and other body secretions.

Answer 13

B
There is a high incidence of postradiation hypothyroidism after RAI, and the client should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum effect not seen for 2–3 months, and the client 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.

Question 14

The nurse is caring for an older-adult client who is diagnosed with hypothyroidism and has a prescription for levothyroxine. Which of the following assessments is most important for the nurse to make during initiation of thyroid replacement?
a. Apical pulse rate
b. Nutritional intake
c. Intake and output
d. Orientation and alertness

Answer 14

A
In older clients, 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 will not result in potentially life-threatening complications.

Question 15

The nurse is caring for a client in a long-term care facility who has these medications prescribed. After the client is diagnosed with hypothyroidism, which of the following medications should the nurse report to the health care provider?
a. Docusate
b. Diazepam
c. Ibuprofen
d. Cefoxitin

Answer 15

B
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 be given safely to the client.

Question 16

The nurse is planning teaching for a client who was admitted with myxedema coma and diagnosed with hypothyroidism. Which of the following strategies isbest for the nurse to use?
a. Delay teaching until client discharge.
b. Ensure privacy by asking visitors to leave.
c. Provide written handouts of all information.
d. Offer multiple options for management of therapies.

Answer 16

C
Written instructions will be helpful to the client because initially the hypothyroid client may be unable to remember to take medications and other aspects of self-care. Since 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 client is likely to forget some aspects of the treatment plan. A simpler regimen will be easier to understand until the client is euthyroid.

Question 17

The nurse is caring for a client with primary hyperparathyroidism who has a serum calcium level of 3.5 mmol/L and a phosphorus of 0.55 mmol/L. Which of the following nursing actions should the nurse include in the plan of care?
a. Institute routine seizure precautions.
b. Monitor for positive Chvostek’s sign.
c. Encourage the client to remain on bed rest.
d. Encourage 3 000–4 000 mL of oral fluids daily.

Answer 17

D
The client 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 clients. The client should engage in weight-bearing exercise to decrease calcium loss from bone.

Question 18

The nurse is caring for a client following a parathyroidectomy who develops tingling of the lips and a positive Trousseau’s sign. Which of the following actions should the nurse take first?
a. Administer the ordered muscle relaxant.
b. Give the ordered oral calcium supplement.
c. Start the PRN oxygen at 2 L/minute per cannula.
d. Have the client rebreathe using a paper bag.

Answer 18

D
The client’s symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the client breathe into a paper bag, which will raise the PaCO2 and create a more acidic pH. The muscle relaxant will have no impact on the ionized calcium level. Although severe hypocalcemia can cause laryngeal stridor, there is no indication that this client is experiencing laryngeal stridor or needs oxygen. Calcium supplements will be given to normalize calcium levels quickly, but oral supplements will take time to be absorbed.

Question 19

The nurse is caring for a client who had radical neck surgery and develops hypoparathyroidism. Which of the following information should the nurse should include in the teaching plan?
a. Use of bisphosphonates to reduce bone demineralization.
b. Include whole grains in the diet to prevent constipation.
c. Take calcium supplementation to normalize serum calcium levels.
d. Ensure a high fluid intake to decrease risk for nephrolithiasis.

Answer 19

C
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.

Question 20

Which of the following findings for a client who takes levothyroxine to treat hypothyroidism indicates that the nurse should contact the health care provider before administering the medication?
a. Increased thyroxine (T4) level
b. Blood pressure 102/62 mm Hg
c. Distant and difficult to hear heart sounds
d. Elevated thyroid stimulating hormone level

Answer 20

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 Synthroid.

Question 21

The nurse is caring for a client with a diagnosis of Cushing’s syndrome. Which of the following data should the nurse anticipate finding during the admission assessment?
a. Chronically low blood pressure
b. Bronzed appearance of the skin
c. Decreased axillary and pubic hair
d. Purplish red streaks on the abdomen

Answer 21

D
Purplish-red striae on the abdomen are a common clinical manifestation of Cushing’s syndrome. Hypotension and bronzed-appearing skin are manifestations of Addison’s disease. Decreased axillary and pubic hair occur with androgen deficiency.

Question 22

The nurse is caring for a client with Cushing’s syndrome who is admitted foran adrenalectomy. The client has a nursing diagnosis of disturbed body image related to changes in appearance caused by the effects of the disease. Which of the followinginterventionsis most helpful?
a. Reassure the client that the physical changes are very common in clients with Cushing’s syndrome.
b. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome.
c. Teach the client that most of the physical changes caused by Cushing’s syndrome will resolve after surgery.
d. Remind the client that the metabolic impact of Cushing’s syndrome is of more importance than appearance.

Answer 22

C
The most reassuring communication to the client is that most of the physical and emotional changes caused by the Cushing’s syndrome will resolve after hormone levels return to normal postoperatively. Reassurance that the physical changes are expected or that there are more serious physiological problems associated with Cushing’s syndrome are not therapeutic responses. The client’s physiological changes are caused by the high hormone levels, not by the client’s diet or exercise choices.

Question 23

The nurse is caring for a client with acute adrenal insufficiency. Which of the following findings indicate that the prescribed therapies are effective?
a. Increasing serum sodium levels
b. Decreasing blood glucose levels
c. Decreasing serum chloride levels
d. Increasing serum potassium levels

Answer 23

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.

Question 24

The nurse is admitting a client to the hospital who is in an Addisonian crisis. Which of the following client statements support the nursing diagnosis of ineffective self-health management related to lack of knowledge about management of Addison’s disease?
a. “I double my dose of hydrocortisone on the days that I go for a run.”
b. “I frequently eat at restaurants, and so my food has a lot of added salt.”
c. “I had the stomach flu earlier this week and couldn’t take the hydrocortisone.”
d. “I take twice as much hydrocortisone in the morning as I do in the afternoon.”

Answer 24

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

Question 25

A client with systemic lupus erythematosus has a prescription for 2 weeks of high-dose prednisone therapy. When teaching the client about the prednisone, which of the following 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. A weight-bearing exercise program will help minimize the risk for osteoporosis.
d. Weigh yourself daily to monitor for weight gain caused by water or increased fat.

Answer 25

B
Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped. Mood alterations and weight gain are possible adverse effects of corticosteroid use, but these are not life-threatening effects. Osteoporosis occurs when clients take corticosteroids for longer periods.

Question 26

The nurse is caring for a client who has an adrenocortical adenoma and hyperaldosteronism. Which of the following actions should the nurse implement?
a. Provide a potassium-restricted diet
b. Monitor the blood pressure every 4 hours
c. Evaluate blood glucose level every 4 hours
d. Maintain extremities in an elevated position

Answer 26

B
Hypertension caused by sodium retention is a common complication of hyperaldosteronism. Hyperaldosteronism does not cause elevation in blood glucose. The client will be hypokalemic and require potassium supplementation before surgery. Edema does not usually occur with hyperaldosteronism.

Question 27

The nurse is caring for a client with hypertension who is diagnosed with a pheochromocytoma. Which of the following findings should the nurse monitor in the client?
a. Flushing
b. Headache
c. Bradycardia
d. Hypoglycemia

Answer 27

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

Question 28

The nurse is providing discharge teaching for a client who had a hypophysectomy. Which of the following information should the nurse include?
a. Oral corticosteroids as a lifelong treatment
b. Chemotherapy to prevent reoccurrence of the tumour.
c. Insulin use to maintain blood glucose at normal levels.
d. Sodium restriction to prevent fluid retention and hypertension.

Answer 28

A
Antidiuretic hormone (ADH), cortisol, and thyroid hormone replacement will be needed for life after hypophysectomy. Without the effects of adrenocorticotropic hormone (ACTH) and cortisol, the blood glucose and serum sodium will be low unless cortisol is replaced. An adenoma is a benign tumour, and chemotherapy will not be needed.

Question 29

When developing a plan of care for a client with syndrome of inappropriate antidiuretic hormone (SIADH), which of the following interventions should the nurse include?
a. Encourage fluids to 2 000 mL/day.
b. Offer client ice chips to suck on.
c. Monitor for increased peripheral edema.
d. Keep head of bed elevated to 30 degrees.

Answer 29

B
Sucking on ice chips or chewing sugarless gum decreases thirst for a client on fluid restriction. Clients with SIADH are on fluid restrictions of 800–1 000 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 antidiuretic hormone (ADH) release

Question 30

Which of the following actions should the nurse take first when caring for a client who has just arrived on the unit after a thyroidectomy?
a. Check the dressing for bleeding.
b. Assess respiratory rate and effort.
c. Take the blood pressure and pulse.
d. Support the client’s head with pillows.

Answer 30

B
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.

Question 31

The nurse is caring for a client with Cushing’s syndrome who returns to the surgical unit following an adrenalectomy. Which of the following actions during the initial postoperative period has the highest priority?
a. Monitoring for infection
b. Protecting the client’s skin
c. Maintaining fluid and electrolyte status
d. Preventing severe emotional disturbances

Answer 31

C
After adrenalectomy, the client 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 client but are not as immediately life-threatening as the circulatory collapse that can occur with fluid and electrolyte disturbances.

Question 32

Which of the following information obtained by the nurse when caring for a client who has diabetes insipidus (DI) is most important to report to the health care provider?
a. History of a recent head injury.
b. Confusion and lethargy
c. Urine output of 400 mL/hour.
d. Urine specific gravity is 1.003.

Answer 32

B
The client’s confusion and lethargy may indicate hypernatremia and should be addressed quickly. In addition, clients with DI compensate for fluid losses by drinking copious amounts of fluids, but a client 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 complication

Question 33

The nurse is admitting a client with Graves’ disease to the emergency department in thyrotoxic crisis. Which of these prescribed medications should the nurse administer first?
a. propranolol
b. propylthiouracil
c. methimazole
d. iodine

Answer 33

A
b-adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function.

Question 34

Which of the following assessment findings for a client admitted with Graves’ disease requires the most rapid intervention by the nurse?
a. BP 166/100 mm Hg
b. Bilateral exophthalmos
c. Heart rate 136 beats/minute
d. Temperature 40.4°C (104.7°F)

Answer 34

: D
The client’s temperature indicates that the client may have thyrotoxic crisis and that interventions to lower the temperature are needed immediately. The other findings also require intervention but do not indicate potentially life-threatening complications.

Question 35

The nurse is assessing a client who has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy and obtains these data. Which of the following information is most important to communicate to the surgeon?
a. The client is sleepy and hard to arouse.
b. The client has increasing swelling of the neck.
c. The client is complaining of 7/10 incisional pain.
d. The client’s cardiac monitor shows a heart rate of 112.

Answer 35

B
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 client who has been hyperthyroid and has just arrived in the PACU from surgery. Sleepiness in the immediate postoperative period is expected.

Question 36

The nurse is providing postoperative care for a client who had a bilateral adrenalectomy. Which assessment information requires the most rapid action by the nurse?
a. The blood glucose is 9.8 mmol/L.
b. The lungs have bibasilar crackles.
c. The client’s BP is 88/50 mm Hg.
d. The client has 5/10 incisional pain.

Answer 36

C
The decreased BP indicates possible adrenal insufficiency. The nurse should immediately notify the health care provider so that corticosteroid medications can be administered. 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.

Question 37

The nurse is caring for a client with hypothyroidism who is receiving a hypertonic saline IV solution to counteract hyponatremia. The nurse will expect the saline solution to be administered until the client’s serum sodium reaches which of the following levels?
a. 112 mmol/L
b. 120 mmol/L
c. 132 mmol/L
d. 168 mmol/L

Answer 37

C
If the client is hyponatremic, hypertonic saline may be administered until the serum sodium level reaches at least 130 mmol/L. Hypernatremia is evident with a sodium level of 168 mmol/L.

Question 38

The nurse is admitting a client with possible syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following information obtained by the nurse is most important to communicate rapidly to the health care provider?
a. The client complains of dyspnea with activity.
b. The client has a urine specific gravity of 1.025.
c. The client has a recent weight gain of 3.6 kg.
d. The client has a serum sodium level of 119 mmol/L.

Answer 38

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

Question 39

After receiving change-of-shift report, which of the following four clients should the nurse assess first?
a. A 31-year-old with Cushing’s syndrome and a blood glucose level of 13.7 mmol/L
b. A 22-year-old admitted with syndrome of inappropriate antidiuretic hormone
(SIADH) who has a serum sodium level of 130 mmol/L
c. A 70-year-old who recently started taking levothyroxine and has an irregular pulse
of 134
d. A 53-year-old who has Addison’s disease and is due for a scheduled dose of
hydrocortisone.

Answer 39

C
Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The client’s high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other clients also require nursing assessment and/or actions but are not at risk for life-threatening complication