Lewis Medical Surgical -- Chapter 54 Endocrine Problems

A 40-year-old patient with suspected acromegaly is seen at the clinic. To assist in making the

diagnosis, which question would the nurse ask?

a. ―Have you had a recent head injury?‖

b. ―Do you have to wear larger shoes now?‖

c. ―Is there a family history of acromegaly?‖

d. ―Are you experiencing tremors or anxiety?‖

ANS: 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.

A patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. Which information would the nurse include in preoperative teaching?

a. Cough and deep breathe every 2 hours postoperatively.

b. Remain on bed rest for the first 48 hours postoperatively.

c. Avoid brushing teeth for at least 10 days after the surgery.

d. You will be positioned flat with a cervical collar after surgery.

ANS: C

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. A cervical collar is not needed.

The nurse is planning postoperative care for a patient who is being admitted to the surgical

unit from the recovery room after transsphenoidal resection of a pituitary tumor. Which nursing action would be included?

a. Palpate extremities for edema.

b. Measure urine volume every hour.

c. Check hematocrit every 2 hours for 8 hours.

d. Monitor continuous pulse oximetry for 24 hours.

ANS: B

After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema.

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 patient is at risk for

dehydration, not volume overload. The patient is not at high risk for problems with

oxygenation, so continuous pulse oximetry is not needed.

The nurse is assessing a male patient diagnosed with a pituitary tumor causing panhypopituitarism. Which assessment finding is consistent with panhypopituitarism?

a. High blood pressure

b. Decreased facial hair

c. Elevated blood glucose

d. Intermittent tachycardia

ANS: B

Changes in male secondary sex characteristics such as decreased facial hair, testicular atrophy,

diminished spermatogenesis, loss of libido, impotence, and decreased muscle mass are

associated with decreases in follicle-stimulating hormone (FSH) and luteinizing hormone

(LH). Fasting hypoglycemia and hypotension occur in panhypopituitarism because of

decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is due to the

decrease in thyroid-stimulating hormone (TSH) and thyroid hormones associated with

panhypopituitarism.

Which information will the nurse include when teaching a 50-year-old male patient about

somatropin (Genotropin)?

a. The medication will be needed for 3 to 6 months.

b. Inject the medication subcutaneously every evening.

c. Blood glucose levels may decrease when taking the medication.

d. Stop taking the medication if swelling of the hands or feet occurs.

ANS: B

Somatropin is injected subcutaneously daily, preferably in the evening. The patient will need

to continue on somatropin for life. If swelling or other common adverse effects occur, the

health care provider should be notified. Growth hormone will increase blood glucose levels

Which finding indicates to the nurse that demeclocycline has been effective for a patient with

syndrome of inappropriate antidiuretic hormone (SIADH)?

a. Weight has increased.

b. Urinary output has increased.

c. Peripheral edema has increased.

d. Urine specific gravity has increased.

ANS: B

Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and

increases urine output, producing more dilute urine. 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.

Which patient statement indicates to the nurse that further instruction is needed about chronic

syndrome of inappropriate antidiuretic hormone (SIADH)?

a. ―I should weigh myself daily and report sudden weight loss or gain.‖

b. ―I need to shop for foods low in sodium and avoid adding salt to food.‖

c. ―I need to limit my fluid intake to no more than 1 quart of liquids a day.‖

d. ―I should eat foods high in potassium because diuretics cause potassium loss.‖

ANS: B

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.

A patient who is disoriented and reports a headache and muscle cramps is hospitalized with syndrome of inappropriate antidiuretic hormone (SIADH). Which initial laboratory result

would the nurse expect?

a. Elevated hematocrit

b. Decreased serum sodium

c. Increased serum chloride

d. Low urine specific gravity

ANS: B

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. Urine will be more concentrated with a higher specific gravity. The

serum chloride level will usually decrease along with the sodium level.

Which problem would the nurse anticipate for a patient admitted to the hospital with diabetes

Insipidus?

a. Generalized edema

b. Respiratory distress

c. Fluid volume overload

d. Disturbed sleep pattern

ANS: D

Nocturia occurs because of the polyuria caused by diabetes insipidus. Edema, excess fluid

volume, and respiratory distress are not expected.

Which information will the nurse teach a patient who has been newly diagnosed with Graves' disease?

a. Antithyroid medications may take months for full effect.

b. Restriction of iodine intake will help reduce thyroid activity.

c. Exercise is contraindicated to avoid increasing metabolic rate.

d. Surgery will eventually be required to remove the thyroid gland.

ANS: A

Medications used to block the synthesis of thyroid hormones may take 2 months before the

full 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.

A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a

cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action

will the nurse anticipate next?

a. Plan for emergency tracheostomy.

b. Administer IV calcium gluconate.

c. Prepare for endotracheal intubation.

d. Begin thyroid hormone replacement.

ANS: B

The patient'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. Thyroid hormone replacement may be needed eventually but will not improve the

symptoms of hypocalcemia.

Which action will the nurse include in the plan of care for a patient with Graves' disease who

has exophthalmos?

a. Place cold packs on the eyes to relieve pain and swelling.

b. Elevate the head of the patient's bed to reduce periorbital fluid.

c. Apply alternating eye patches to protect the corneas from irritation.

d. Teach the patient to blink every few seconds to lubricate the corneas.

ANS: B

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 to

blink. 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.

A patient who has hyperthyroidism is treated with radioactive iodine (RAI). What information

would the nurse include in discharge teaching?

a. Take radioactive precautions with all body secretions.

b. Symptoms of hyperthyroidism should be relieved in about a week.

c. Symptoms of hypothyroidism will occur as the RAI therapy takes effect.

d. Discontinue the antithyroid medications that were taken before the RAI therapy.

ANS: C

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.

Which nursing assessment of a 70-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

ANS: 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.

An 82-year-old patient in a long-term care facility is newly diagnosed with hypothyroidism.

Which prescribed drug would the nurse discuss with the health care provider?

a. Docusate (Colace)

b. Ibuprofen (Motrin)

c. Diazepam (Valium)

d. Cefoxitin (Mefoxin)

ANS: C

Worsening of mental status and myxedema coma can be precipitated using 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.

A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is

improving. Discharge is expected to occur in 2 days. Which teaching strategy is likely to

result in effective patient self-management at home?

a. Delay teaching until closer to discharge date.

b. Provide written reminders of information taught.

c. Offer multiple options for management of therapies.

d. Ensure privacy for teaching by asking the family to leave.

ANS: B

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. Because the

treatment regimen is complex, teaching should be started well before discharge. Family

members or friends should be included in teaching because the hypothyroid patient is likely to

forget some aspects of the treatment plan. A simpler regimen will be easier to understand until

the patient is euthyroid.

A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action will provide the patient with rapid temporary relief from the symptoms?

a. Start the PRN O2 at 2 L/min per cannula.

b. Administer the prescribed muscle relaxant.

c. Have the patient rebreathe from a paper bag.

d. Stretch the muscles with passive range of motion.

ANS: C

The patient's symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be

temporarily reduced by having the patient breathe into a paper bag, which will raise the

PaCO2 and create a more acidic pH. Applying as-needed O2, muscle relaxants, or stretching

will have no impact on the ionized calcium level.

A patient who had radical neck surgery to remove a malignant tumor developed

hypoparathyroidism. Which topic would the nurse plan to teach the patient?

a. Bisphosphonates to reduce bone demineralization

b. Calcium supplements to normalize serum calcium levels

c. Increasing fluid intake to decrease risk for nephrolithiasis

d. Including whole grains in the diet to prevent constipation

ANS: B

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.

Kidney stones are not a complication of hypoparathyroidism and low calcium levels.

A patient who has hypothyroidism and hypertension is prescribed levothyroxine (Synthroid).

Which finding indicates that the nurse should contact the health care provider before

administering the medication?

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

ANS: A

An increased thyroxine level indicates the levothyroxine dose needs to be decreased. The

other data are consistent with hypothyroidism and the nurse would administer the

levothyroxine.

A patient is being admitted with a diagnosis of Cushing syndrome. Which finding will the

nurse expect during the assessment?

a. Chronically low blood pressure

b. Bronzed appearance of the skin

c. Purplish streaks on the abdomen

d. Decreased axillary and pubic hair

ANS: C

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.

A patient with Cushing syndrome is admitted for an adrenalectomy. Which information would

likely help the patient cope with a disturbed body image related to changes in appearance?

a. Reassure the patient that the physical changes are very common in patients with

Cushing syndrome.

b. Discuss the use of diet and exercise in controlling the weight gain associated with

Cushing syndrome.

c. Teach the patient that the metabolic impact of Cushing syndrome is of more

importance than appearance.

d. Remind the patient that most of the physical changes caused by Cushing syndrome

will resolve after surgery.

ANS: D

The most reassuring and accurate 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. Reassurance that the physical changes are expected or that there are

more serious physiologic problems associated with Cushing syndrome minimize the patient's

concerns. The patient's physiological changes are caused by the high hormone levels, not by

the patient's diet or exercise choices.

Which finding indicates to the nurse that the current therapies are effective for a patient who

has acute adrenal insufficiency?

a. Increasing serum sodium levels

b. Decreasing blood glucose levels

c. Decreasing serum chloride levels

d. Increasing serum potassium levels

ANS: 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.

The nurse admits a patient to the hospital in Addisonian crisis. Which patient statement

supports the need to plan additional teaching?

a. ―I frequently eat at restaurants, and my food has a lot of added salt.‖

b. ―I had the flu earlier this week, so I couldn't take the hydrocortisone.‖

c. ―I always double my dose of hydrocortisone on the days that I go for a long run.‖

d. ―I take twice as much hydrocortisone in the morning dose as I do in the afternoon.‖

ANS: B

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.

A patient with systemic lupus erythematosus has been prescribed 2 weeks of high-dose

prednisone therapy. Which information about the prednisone is most important for the nurse

to include?

a. ―Weigh yourself daily to monitor for weight gain.‖

b. ―The prednisone dose should be decreased gradually.‖

c. ―A weight-bearing exercise program will help minimize risk for osteoporosis.‖

d. ―Call the health care provider if you have mood changes with the prednisone.‖

ANS: 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 patients take corticosteroids for

longer periods.

Which action would the nurse take when providing care for a patient who has an

adrenocortical adenoma causing hyperaldosteronism?

a. Check blood glucose level every 4 hours.

b. Monitor the blood pressure every 4 hours.

c. Elevate the patient's legs to prevent edema.

d. Order the patient a potassium-restricted diet.

ANS: B

Hypertension caused by sodium retention is a common complication of hyperaldosteronism.

Hyperaldosteronism does not cause an elevation in blood glucose. The patient will be

hypokalemic and require potassium supplementation before surgery. Edema does not usually

occur with hyperaldosteronism.

Which finding would the nurse plan to assess for in a patient diagnosed with a

Pheochromocytoma?

a. Flushing

b. Headache

c. Bradycardia

d. Hypoglycemia

ANS: B

The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia,

severe headache, diaphoresis, and abdominal or chest pain. Elevated blood glucose may occur

because of sympathetic nervous system stimulation. Bradycardia and flushing would not be

expected.

Which topic would the nurse teach a patient who had a hypophysectomy to remove a pituitary

Adenoma?

a. Sodium restriction to prevent fluid retention

b. Insulin to maintain normal blood glucose levels

c. Oral corticosteroids to replace endogenous cortisol

d. Chemotherapy to prevent malignant tumor recurrence

ANS: C

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 tumor, and chemotherapy will not be needed.

Which intervention will the nurse include in the plan of care for a patient with syndrome of

inappropriate antidiuretic hormone (SIADH)?

a. Encourage fluids to 2 to 3 L/day.

b. Offer the patient sugarless gum to chew.

c. Monitor for increasing peripheral edema.

d. Keep head of bed elevated to 30 degrees.

ANS: B

Chewing on sugarless gum decreases thirst for a patient on 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 antidiuretic hormone (ADH) release.

A patient has just arrived on the unit after a thyroidectomy. Which action would the nurse take first?

a. Observe the dressing for bleeding.

b. Check the blood pressure and pulse.

c. Assess the patient's respiratory effort.

d. Support the patient's head with pillows.

ANS: C

Airway obstruction is a possible complication after thyroidectomy because of swelling or

bleeding at the site or tetany. 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 of a

priority.

The nurse is caring for a patient following an adrenalectomy. Which goal is the highest

priority in the immediate postoperative period?

a. Protecting the patient's skin

b. Monitoring for signs of infection

c. Balancing fluids and electrolytes

d. Preventing emotional disturbances

ANS: C

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 the circulatory collapse that can occur

with fluid and electrolyte disturbances.

The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is

most important to report to the health care provider?

a. The patient is confused and lethargic.

b. The patient reports a recent head injury.

c. The patient has a urine output of 400 mL/hr.

d. The patient's urine specific gravity is 1.003.

ANS: A

The patient's confusion and lethargy may indicate hypernatremia and would be addressed

quickly. In addition, patients with DI 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.

Which prescribed medication would the nurse expect will have the most rapid effect on a

patient admitted to the emergency department in thyroid storm?

a. Iodine

b. Methimazole

c. Propylthiouracil

d. Propranolol (Inderal)

ANS: D

-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.

Which assessment finding for an adult admitted with Graves' disease requires the most rapid intervention by the nurse?

a. Heart rate 136 beats/min

b. Severe bilateral exophthalmos

c. Temperature 103.8F (40.4C)

d. Blood pressure 166/100 mm Hg

ANS: C

The patient's temperature indicates that the patient 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.

A patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy.

Which information about the patient is most important to communicate to the surgeon?

a. Difficult to awaken

b. Increasing neck swelling

c. Reports 7/10 incisional pain

d. Cardiac rate 112 beats/min

ANS: B

The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to

prevent airway obstruction. The incisional pain would be treated but is not unusual after

surgery. A heart rate of 112 beats/min is not unusual in a patient who has been hyperthyroid

and has just arrived in the PACU from surgery. Sleepiness in the immediate postoperative

period is expected.

Which assessment finding in a patient who had a bilateral adrenalectomy requires the most

rapid action by the nurse?

a. The blood glucose is 192 mg/dL.

b. The lungs have bibasilar crackles.

c. The patient reports 6/10 incisional pain.

d. The blood pressure (BP) is 88/50 mm Hg.

ANS: D

The decreased BP indicates possible adrenal insufficiency. The nurse would immediately

notify the health care provider so that corticosteroid medications can be administered. The

nurse would also address the elevated glucose, incisional pain, and crackles with appropriate

collaborative or nursing actions, but prevention and treatment of acute adrenal insufficiency

are the priorities after adrenalectomy.

A patient is admitted with diabetes insipidus. Which action will be appropriate for the

registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse

(LPN/VN)?

a. Titrate the infusion of 5% dextrose in water.

b. Administer prescribed subcutaneous DDAVP.

c. Assess the patient's overall hydration status every 8 hours.

d. Teach the patient to use desmopressin (DDAVP) nasal spray.

ANS: B

Administration of medications is included in LPN/VN education and scope of practice.

Assessments, patient teaching, and titrating fluid infusions are more complex skills and would

be done by the RN.

Which information is most important for the nurse to communicate rapidly to the health care

provider about a patient admitted with possible syndrome of inappropriate antidiuretic

hormone (SIADH)?

a. The patient has a weight gain of 9 pounds.

b. The patient reports some dyspnea with activity.

c. The patient has a urine specific gravity of 1.025.

d. The patient has a serum sodium level of 118 mEq/L.

ANS: D

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.

After receiving change-of-shift report about the following four patients, which patient would

the nurse assess first?

a. A 31-year-old female patient with Cushing syndrome and a blood glucose level of

244 mg/dL

b. A 70-year-old female patient taking levothyroxine (Synthroid) who has an

irregular pulse of 134

c. A 53-year-old male patient who has Addison's disease and is due for a prescribed

dose of hydrocortisone (Solu-Cortef)

d. A 22-year-old male patient admitted with syndrome of inappropriate antidiuretic

hormone (SIADH) who has a serum sodium level of 130 mEq/L

ANS: B

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.

Which question will the nurse in the endocrine clinic ask to help determine a patient's risk

factors for goiter?

a. ―How much milk do you drink?‖

b. ―What medications are you taking?‖

c. ―Have you had a recent neck injury?‖

d. ―Are your immunizations up to date?‖

ANS: B

Medications that contain thyroid-inhibiting substances can cause goiter. Milk intake, neck

injury, and immunization history are not risk factors for goiter

Which finding by the nurse when assessing a patient with a large pituitary adenoma is most

important to report to the health care provider?

a. Changes in visual field

b. Milk leaking from breasts

c. Blood glucose 150 mg/dL

d. Nausea and projectile vomiting

ANS: D

Nausea and projectile vomiting may indicate increased intracranial pressure, which will

require rapid actions for diagnosis and treatment. Changes in the visual field, elevated blood

glucose, and galactorrhea are common with pituitary adenoma, but these do not require rapid

action to prevent life-threatening complications.

Which finding by the nurse when assessing a patient with Hashimoto's thyroiditis and a goiter will require the most immediate action?

a. New-onset changes in the patient's voice

b. Elevation in the patient's T3 and T4 levels

c. Resting apical pulse rate 112 beats/min

d. Bruit audible bilaterally over the thyroid gland

ANS: A

Changes in the patient's voice indicate that the goiter is compressing the laryngeal nerve and

may lead to airway compression. The other findings will also be reported but are expected

with Hashimoto's thyroiditis and do not require immediate action.

Which information obtained by the nurse in the clinic about a patient who has been taking

prednisone 40 mg daily for 3 weeks is most important to report to the health care provider?

a. Patient's blood pressure is 148/94 mm Hg.

b. Patient has bilateral 2+ pitting ankle edema.

c. Patient stopped taking the medication 2 days ago.

d. Patient has not been taking the prescribed vitamin D.

ANS: C

Sudden cessation of corticosteroids after taking the medication for a week or more can lead to

adrenal insufficiency, with problems such as severe hypotension and hypoglycemia. The

patient will need immediate evaluation by the health care provider to prevent or treat adrenal

insufficiency. The other information will also be reported but does not require rapid treatment.

The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient would be transferred to the cardiac unit first?

a. Patient with Hashimoto's thyroiditis and a heart rate of 102

b. Patient with tetany who has a new order for IV calcium chloride

c. Patient with Cushing syndrome and a blood glucose of 140 mg/dL

d. Patient with Addison's disease who takes IV hydrocortisone twice daily

ANS: B

Emergency treatment of tetany requires IV administration of calcium; electrocardiographic

monitoring will be required because cardiac arrest may occur if high calcium levels result

from too-rapid administration. The information about the other patients indicates that they are

more stable than the patient with tetany.

After obtaining the information shown in the accompanying figure regarding a patient with

Addison's disease, which prescribed action will the nurse take first?

Assessment

Reports fatigue

Bronze-colored skin

Poor skin turgor

Vital Signs

BP 76/40 mmHg

Heart rate 126 beats/min

Respiration 24 breaths/min

Oxygen saturation 94%

Laboratory Data

Sodium 123 mEq/L

Potassium 5.1 mEq/L

Glucose 62 mg/dL

a. Give 4 oz of fruit juice orally.

b. Recheck the blood glucose level.

c. Administer O2 therapy as needed.

d. Infuse 5% dextrose and 0.9% saline.

ANS: D

The patient's poor skin turgor, hypotension, and hyponatremia indicate an Addisonian crisis.

Immediate correction of the hypovolemia and hyponatremia is needed. The other actions may

also be needed but are not the most crucial action for maintaining perfusion in the patient.

A patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55mmol/L) and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should be included in

the plan of care?

a. Restrict the patient to bed rest.

b. Encourage 4000 mL of fluids daily.

c. Institute routine seizure precautions.

d. Assess for positive Chvostek's sign.

ANS: B

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

to decrease calcium loss from bone.

A patient is to receive methylprednisolone 100 mg. The label on the medication states:

methylprednisolone 125 mg in 2 mL. How many milliliters will the nurse administer?

____________

ANS: 1.6

A concentration of 125 mg in 2 mL will result in 100 mg in 1.6 mL.