Med Surg TB Chapter 49
A 45-year-old male 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 a family history of acromegaly?
D) Are you experiencing tremors or anxiety?
Answer: B
A 42-year-old female patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. During preoperative teaching, the nurse instructs the patient about the need to
A) cough and deep breathe every 2 hours postoperatively.
B) remain on bed rest for the first 48 hours after the surgery.
C) avoid brushing teeth for at least 10 days after the surgery.
D) be positioned flat with sandbags at the head postoperatively.
Answer: C
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 should 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.
Answer: B
The nurse is assessing a 41-year-old African American male patient diagnosed with a pituitary tumor causing panhypopituitarism. Assessment findings consistent with panhypopituitarism include
A) high blood pressure.
B) decreased facial hair.
C) elevated blood glucose.
D) tachycardia and cardiac palpitations
Answer: B
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 day.
C) Blood glucose levels may decrease when taking the medication.
D) Stop taking the medication if swelling of the hands or feet occurs
Answer: B
The nurse determines that demeclocycline (Declomycin) is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patients
A) weight has increased.
B) urinary output is increased.
C) peripheral edema is decreased.
D) urine specific gravity is increased.
Answer: B
The nurse determines that additional instruction is needed for a 60-year-old patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient says which of the following?
A) I need to shop for foods low in sodium and avoid adding salt to food.
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 diuretics cause potassium loss
Answer: A
A 56-year-old patient who is disoriented and reports a headache and muscle cramps is hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The nurse would expect the initial laboratory results to include a(n)
A) elevated hematocrit.
B) decreased serum sodium.
C) low urine specific gravity.
D) increased serum chloride
Answer: B
An expected nursing diagnosis for a 30-year-old patient admitted to the hospital with symptoms of diabetes insipidus is
A) excess fluid volume related to intake greater than output.
B) impaired gas exchange related to fluid retention in lungs.
C) sleep pattern disturbance related to frequent waking to void.
D) risk for impaired skin integrity related to generalized edema
Answer: C
Which information will the nurse teach a 48-year-old patient 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) Antithyroid medications may take several months for full effect.
D) Surgery will eventually be required to remove the thyroid gland.
Answer: C
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) Suction the patients airway.
B) Administer IV calcium gluconate.
C) Plan for emergency tracheostomy.
D) Prepare for endotracheal intubation
Answer: B
Which nursing action will be included in the plan of care for a 55-year-old 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 patients 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
Answer: B
A 62-year-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The nurse instructs the patient
A) about radioactive precautions to take with all body secretions.
B) that symptoms of hyperthyroidism should be relieved in about a week.
C) that symptoms of hypothyroidism may occur as the RAI therapy takes effect.
D) to discontinue the antithyroid medications taken before the radioactive therapy
Answer: C
Which nursing assessment of a 69-year-old patient is most important to make during initiation of thyroid replacement with levothyroxine (Synthroid)?
A) Fluid balance
B) Apical pulse rate
C) Nutritional intake
D) Orientation and alertness
Answer: B
An 82-year-old patient in a long-term care facility has several medications prescribed. After the patient is newly diagnosed with hypothyroidism, the nurse will need to consult with the health care provider before administering
A) docusate (Colace).
B) ibuprofen (Motrin).
C) diazepam (Valium).
D) cefoxitin (Mefoxin)
Answer: C
A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is improving and expected to be discharged in 2 days. Which teaching strategy will be best for the nurse to use?
A) Provide written reminders of self-care information.
B) Offer multiple options for management of therapies.
C) Ensure privacy for teaching by asking visitors to leave.
D) Delay teaching until patient discharge date is confirmed.
Answer: A
A 63-year-old patient with primary hyperparathyroidism has a serum phosphorus level of 1.7 mg/dL (0.55 mmol/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 Chvosteks sign
Answer: B
A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy. Which action should the nurse take first?
A) Administer the ordered muscle relaxant.
B) Give the ordered oral calcium supplement.
C) Have the patient rebreathe from a paper bag.
D) Start the PRN oxygen at 2 L/min per cannula.
Answer: C
A patient who had radical neck surgery to remove a malignant tumor developed hypoparathyroidism. The nurse should plan to teach the patient about
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.
Answer: B
Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse should contact the health care provider before administering levothyroxine (Synthroid)?
A) Increased thyroxine (T4) level
B) Blood pressure 112/62 mm Hg
C) Distant and difficult to hear heart sounds
D) Elevated thyroid stimulating hormone level
Answer: A
A 37-year-old patient is being admitted with a diagnosis of Cushing syndrome. Which findings 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
Answer: C
A 44-year-old female patient with Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be most helpful for a nursing diagnosis of 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.
Answer: D
Which finding indicates to the nurse that the current therapies are effective for a patient with acute adrenal insufficiency?
A) Increasing serum sodium levels
B) Decreasing blood glucose levels
C) Decreasing serum chloride levels
D) Increasing serum potassium levels
Answer: A
A 38-year-old male patient is admitted to the hospital in Addisonian crisis. Which patient statement supports a nursing diagnosis of ineffective self-health management related to lack of knowledge about management of Addisons disease?
A) frequently eat at restaurants, and my food has a lot of added salt.
B) I had the stomach flu earlier this week, so I couldnt 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
Answer: B
A 29-year-old woman 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 caused by increased appetite.
B) A weight-bearing exercise program will help minimize the risk for osteoporosis.
C) The prednisone dose should be decreased gradually rather than stopped suddenly.
D) Call the health care provider if you experience mood alterations with the prednisone
Answer: C
A 56-year-old female patient has an adrenocortical adenoma, causing hyperaldosteronism. The nurse providing care should
A) monitor the blood pressure every 4 hours.
B) elevate the patients legs to relieve edema.
C) monitor blood glucose level every 4 hours.
D) order the patient a potassium-restricted diet.
Answer: A
The nurse will plan to monitor a patient diagnosed with a pheochromocytoma for
A) flushing.
B) headache.
C) bradycardia.
D) hypoglycemia.
Answer: B
After a 22-year-old female patient with a pituitary adenoma has had a hypophysectomy, the nurse will teach about the need for
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.
Answer: C
Which intervention will the nurse include in the plan of care for a 52-year-old male patient with syndrome of inappropriate antidiuretic hormone (SIADH)?
A) Monitor for peripheral edema.
B) Offer patient hard candies to suck on.
C) Encourage fluids to 2 to 3 liters per day.
D) Keep head of bed elevated to 30 degrees.
Answer: B
A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse take first?
A) Observe the dressing for bleeding.
B) Check the blood pressure and pulse.
C) Assess the patients respiratory effort.
D) Support the patients head with pillows
Answer: C
The nurse is caring for a patient following an adrenalectomy. The highest priority in the immediate postoperative period is to
A) protect the patients skin.
B) monitor for signs of infection.
C) balance fluids and electrolytes.
D) prevent emotional disturbances.
Answer: C
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 patients urine specific gravity is 1.003.
Answer: A
Which prescribed medication should the nurse administer first to a 60-year-old patient admitted to the emergency department in thyroid storm?
A) Propranolol (Inderal)
B) Propylthiouracil (PTU)
C) Methimazole (Tapazole)
D) Iodine (Lugols solution)
Answer: A
Which assessment finding for a 33-year-old female patient admitted with Graves disease requires themost rapid intervention by the nurse?
A) Bilateral exophthalmos
B) Heart rate 136 beats/minute
C) Temperature 103.8 F (40.4 C)
D) Blood pressure 166/100 mm Hg
Answer: C
A 37-year-old patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy. Which information is most important to communicate to the surgeon?
A) The patient reports 7/10 incisional pain.
B) The patient has increasing neck swelling.
C) The patient is sleepy and difficult to arouse.
D) The patients cardiac rate is 112 beats/minute
Answer: B
Which assessment finding of a 42-year-old patient who had a bilateral adrenalectomy requires the most rapid action by the nurse?
A) The blood glucose is 176 mg/dL.
B) The lungs have bibasilar crackles.
C) The blood pressure (BP) is 88/50 mm Hg.
D) The patient reports 5/10 incisional pain
Answer: C
A 23-year-old patient is admitted with diabetes insipidus. Which action will be most appropriate for the registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse (LPN/LVN)?
A) Titrate the infusion of 5% dextrose in water.
B) Teach the patient how to use desmopressin (DDAVP) nasal spray.
C) Assess the patients hydration status every 8 hours.
D) Administer subcutaneous DDAVP.
Answer: D
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 recent weight gain of 9 lb.
B) The patient complains of 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
Answer: D
After receiving change-of-shift report about the following four patients, which patient should the nurse assess first?
A) A 31-year-old female with Cushing syndrome and a blood glucose level of 244 mg/dL
B) A 70-year-old female taking levothyroxine (Synthroid) who has an irregular pulse of 134
C) A 53-year-old male who has Addisons disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef).
D) A 22-year-old male admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L
Answer: B
Which question will the nurse in the endocrine clinic ask to help determine a patients risk factors for goiter?
A) How much milk do you drink?
B) What medications are you taking?
C) Are your immunizations up to date?
D) Have you had any recent neck injuries?
Answer: B
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
Answer: D
Which finding by the nurse when assessing a patient with Hashimotos thyroiditis and a goiter will require the most immediate action?
A) New-onset changes in the patients voice
B) Apical pulse rate at rest 112 beats/minute
C) Elevation in the patients T3 and T4 levels
D) Bruit audible bilaterally over the thyroid gland
Answer: A
Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone (Deltasone) 40 mg daily for 3 weeks is most important to report to the health care provider?
A) Patients 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
Answer: C
The cardiac telemetry unit charge nurse receives status reports from other nursing units about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac unit first?
A) Patient with Hashimotos 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 Addisons disease who takes hydrocortisone twice daily
Answer: B