Chapter 52: Assessment and Management of Patients With Endocrine Disorders
Chapter 52: Assessment and Management of Patients With Endocrine Disorders
Chapter 52: Assessment and Management of Patients With Endocrine Disorders
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 979
1. The nurse is caring for a patient diagnosed with hypothyroidism secondary to Hashimotos thyroiditis.
When assessing this patient, what sign or symptom would the nurse expect?
A) Fatigue
B) Bulging eyes
C) Palpitations
D) Flushed skin
Ans: A
Feedback:
Symptoms of hypothyroidism include extreme fatigue, hair loss, brittle nails, dry skin, voice huskiness
or hoarseness, menstrual disturbance, and numbness and tingling of the fingers. Bulging eyes,
palpitations, and flushed skin would be signs and symptoms of hyperthyroidism.
2. A patient has been admitted to the post-surgical unit following a thyroidectomy. To promote comfort and
safety, how should the nurse best position the patient?
B) Head of the bed elevated 30 degrees and no pillows placed under the head
Ans: C
Feedback:
When moving and turning the patient, the nurse carefully supports the patients head and avoids tension
on the sutures. The most comfortable position is the semi-Fowlers position, with the head elevated and
supported by pillows.
3. A patient with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has
been removed. The nurse caring for the patient should prioritize what question when addressing
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 980
potential complications?
D) Are you having any pain that seems to be radiating from your bones?
Ans: A
Feedback:
As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and feet
and muscle twitching. This is characteristic of hypoparathyroidism. Flushing, diaphoresis, dizziness, and
pain are atypical signs of the resulting hypocalcemia.
4. The nurse is caring for a patient with a diagnosis of Addisons disease. What sign or symptom is most
closely associated with this health problem?
A) Truncal obesity
B) Hypertension
C) Muscle weakness
D) Moon face
Ans: C
Feedback:
Patients with Addisons disease demonstrate muscular weakness, anorexia, gastrointestinal symptoms,
fatigue, emaciation, dark pigmentation of the skin, and hypotension. Patients with Cushing syndrome
demonstrate truncal obesity, moon face, acne, abdominal striae, and hypertension.
5. The nurse is caring for a patient with Addisons disease who is scheduled for discharge. When teaching
the patient about hormone replacement therapy, the nurse should address what topic?
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 981
Ans: B
Feedback:
Because of the need for lifelong replacement of adrenal cortex hormones to prevent addisonian crises,
the patient and family members receive explicit education about the rationale for replacement therapy
and proper dosage. Doses are not adjusted on a short-term basis. Weight gain and hepatotoxicity are not
common adverse effects.
6. The nurse is teaching a patient that the body needs iodine for the thyroid to function. What food would
be the best source of iodine for the body?
A) Eggs
B) Shellfish
C) Table salt
D) Red meat
Ans: C
Feedback:
The major use of iodine in the body is by the thyroid. Iodized table salt is the best source of iodine.
7. A patient is prescribed corticosteroid therapy. What would be priority information for the nurse to give
the patient who is prescribed long-term corticosteroid therapy?
Ans: C
Feedback:
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 982
The patient is at increased risk of infection and masking of signs of infection. The cardiovascular effects
of corticosteroid therapy may result in development of thrombophlebitis or thromboembolism. Diet
should be high in protein with limited fat. Changes in appearance usually disappear when therapy is no
longer necessary. Cognitive changes are not common adverse effects.
8. A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What is an expected
urinalysis finding?
Ans: C
Feedback:
Patients with diabetes insipidus produce an enormous daily output of very dilute, water-like urine with a
specific gravity of 1.001 to 1.005. The urine contains no abnormal substances such as glucose or
albumin. Leukocytes in the urine are not related to the condition of diabetes insipidus, but would
indicate a urinary tract infection, if present in the urine.
9. The nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test
scheduled for tomorrow. What does the nurse explain that this test will involve?
A) Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3
hours
C) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next
morning
Ans: C
Feedback:
Dexamethasone (1 mg) is administered orally at 11 PM, and a plasma cortisol level is obtained at 8 AM
the next morning. This test can be performed on an outpatient basis and is the most widely used and
sensitive screening test for diagnosis of pituitary and adrenal causes of Cushing syndrome.
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 983
10. You are developing a care plan for a patient with Cushing syndrome. What nursing diagnosis would
have the highest priority in this care plan?
Ans: A
Feedback:
The nursing priority is to decrease the risk of injury by establishing a protective environment. The
patient who is weak may require assistance from the nurse in ambulating to prevent falls or bumping
corners or furniture. The patients breathing will not be affected and autonomic dysreflexia is not a
plausible risk. Loneliness may or may not be an issue for the patient, but safety is a priority.
11. The nurse is performing a shift assessment of a patient with aldosteronism. What assessments should the
nurse include? Select all that apply.
A) Urine output
C) Peripheral pulses
D) Blood pressure
E) Skin integrity
Ans: A, D
Feedback:
The principal action of aldosterone is to conserve body sodium. Alterations in aldosterone levels
consequently affect urine output and BP. The patients peripheral pulses, risk of VTE, and skin integrity
are not typically affected by aldosteronism.
12. The home care nurse is conducting patient teaching with a patient on corticosteroid therapy. To achieve
consistency with the bodys natural secretion of cortisol, when would the home care nurse instruct the
patient to take his or her corticosteroids?
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 984
Ans: D
Feedback:
In keeping with the natural secretion of cortisol, the best time of day for the total corticosteroid dose is in
the morning from 7 to 8 AM. Large-dose therapy at 8 AM, when the adrenal gland is most active,
produces maximal suppression of the gland. Also, a large 8 AM dose is more physiologic because it
allows the body to escape effects of the steroids from 4 PM to 6 AM, when serum levels are normally
low, thus minimizing cushingoid effects.
13. A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a
documented history of adrenal insufficiency. Considering the patients history and current symptoms, the
nurse should anticipate that the patient will be instructed to do which of the following?
Ans: A
Feedback:
The patient will need to supplement dietary intake with added salt during episodes of GI losses of fluid
through vomiting and diarrhea to prevent the onset of addisonian crisis. While the patient may
experience the loss of other electrolytes, the major concern is the replacement of lost sodium.
14. The nurse is caring for a patient with hyperparathyroidism. What level of activity would the nurse expect
to promote?
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 985
Ans: D
Feedback:
Mobility, with walking or use of a rocking chair for those with limited mobility, is encouraged as much
as possible because bones subjected to normal stress give up less calcium. Best rest should be
discouraged because it increases calcium excretion and the risk of renal calculi. Limiting the patient to
getting out of bed only a few times a day also increases calcium excretion and the associated risks.
15. While assisting with the surgical removal of an adrenal tumor, the OR nurse is aware that the patients
vital signs may change upon manipulation of the tumor. What vital sign changes would the nurse expect
to see?
Ans: B
Feedback:
Manipulation of the tumor during surgical excision may cause release of stored epinephrine and
norepinephrine, with marked increases in BP and changes in heart rate. The use of sodium nitroprusside
and alpha-adrenergic blocking agents may be required during and after surgery. While other vital sign
changes may occur related to surgical complications, the most common changes are related to
hypertension and changes in the heart rate.
16. A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that
sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory
finding may be an early indication of parathyroid gland injury or removal?
A) Hyponatremia
B) Hypophosphatemia
C) Hypocalcemia
D) Hypokalemia
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 986
Ans: C
Feedback:
Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result
in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the
nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is
known as tetany and must be reported to the physician immediately, because laryngospasm may occur
and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not expected responses
to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may
lead to hyperphosphatemia.
17. The nurse is planning the care of a patient with hyperthyroidism. What should the nurse specify in the
patients meal plan?
Ans: B
Feedback:
A patient with hyperthyroidism has an increased appetite. The patient should be counseled to consume
several small, well-balanced meals. High-calorie, high-protein foods are encouraged. A clear liquid diet
would not satisfy the patients caloric or hunger needs. A diet rich in fiber and fat should be avoided
because these foods may lead to GI upset or increase peristalsis.
18. A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is
being cared for on the critical care unit. The priority nursing diagnosis for a patient with this condition is
what?
C) Hypothermia
Ans: B
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 987
Feedback:
The priority nursing diagnosis for a patient with SIADH is excess fluid volume, as the patient retains
fluids and develops a sodium deficiency. Restricting fluid intake is a typical intervention for managing
this syndrome. Temperature imbalances are not associated with SIADH. The patient is not at risk for
neurovascular dysfunction or a compromised airway.
19. A patient with hypofunction of the adrenal cortex has been admitted to the medical unit. What would the
nurse most likely find when assessing this patient?
B) Jaundice
D) Decreased BP
Ans: D
Feedback:
Decreased BP may occur with hypofunction of the adrenal cortex. Decreased function of the adrenal
cortex does not affect the patients body temperature, urine output, or skin tone.
20. The nurse is assessing a patient diagnosed with Graves disease. What physical characteristics of Graves
disease would the nurse expect to find?
A) Hair loss
B) Moon face
C) Bulging eyes
D) Fatigue
Ans: C
Feedback:
Clinical manifestations of the endocrine disorder Graves disease include exophthalmos (bulging eyes)
and fine tremor in the hands. Graves disease is not associated with hair loss, a moon face, or fatigue.
21. A patient with suspected adrenal insufficiency has been ordered an adrenocorticotropic hormone
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 988
(ACTH) stimulation test. Administration of ACTH caused a marked increase in cortisol levels. How
should the nurse interpret this finding?
Ans: A
Feedback:
22. The physician has ordered a fluid deprivation test for a patient suspected of having diabetes insipidus.
During the test, the nurse should prioritize what assessments?
Ans: B
Feedback:
The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the
body weight is lost. The patients condition needs to be monitored frequently during the test, and the test
is terminated if tachycardia, excessive weight loss, or hypotension develops. Consequently, BP and heart
rate monitoring are priorities over the other listed assessments.
23. A nurse works in a walk-in clinic. The nurse recognizes that certain patients are at higher risk for
different disorders than other patients. What patient is at a greater risk for the development of
hypothyroidism?
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 989
Ans: A
Feedback:
Even though osteoporosis is not a risk factor for hypothyroidism, the condition occurs most frequently in
older women.
24. A patient with a recent diagnosis of hypothyroidism is being treated for an unrelated injury. When
administering medications to the patient, the nurse should know that the patients diminished thyroid
function may have what effect?
A) Anaphylaxis
Ans: D
Feedback:
In all patients with hypothyroidism, the effects of analgesic agents, sedatives, and anesthetic agents are
prolonged. There is no direct increase in the risk of anaphylaxis, nausea, or drug interactions, although
these may potentially result from the prolonged half-life of drugs.
25. A patient has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions
should the nurse include in this patients immediate care? Select all that apply.
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 990
E) Administering corticosteroids
Ans: B, D
Feedback:
Thyroid storm necessitates interventions to reduce heart rate and temperature. Diuretics, insulin, and
steroids are not indicated to address the manifestations of this health problem.
26. The nurses assessment of a patient with thyroidectomy suggests tetany and a review of the most recent
blood work corroborate this finding. The nurse should prepare to administer what intervention?
B) IV calcium gluconate
C) STAT levothyroxine
Ans: B
Feedback:
When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration
of IV calcium gluconate. This has a much faster therapeutic effect than PO calcium or vitamin D
supplements. PTH and levothyroxine are not used to treat this complication.
27. A patient has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To
prevent adrenal insufficiency, the nurse should ensure that the patient knows to do which of the
following?
Ans: D
Feedback:
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 991
Corticosteroid dosages are reduced gradually (tapered) to allow normal adrenal function to return and to
prevent steroid-induced adrenal insufficiency. There are no OTC substitutes for prednisone and neither
calcium chloride nor levothyroxine addresses the risk of adrenal insufficiency.
28. Following an addisonian crisis, a patients adrenal function has been gradually regained. The nurse
should ensure that the patient knows about the need for supplementary glucocorticoid therapy in which
of the following circumstances?
B) Periods of dehydration
D) Administration of a vaccine
Ans: A
Feedback:
29. A 30 year-old female patient has been diagnosed with Cushing syndrome. What psychosocial nursing
diagnosis should the nurse most likely prioritize when planning the patients care?
Ans: C
Feedback:
Cushing syndrome causes characteristic physical changes that are likely to result in disturbed body
image. Decisional conflict and powerless may exist, but disturbed body image is more likely to be
present. Cognitive changes take place in patients with Cushing syndrome, but these may or may not
cause spiritual distress.
30. A patient with pheochromocytoma has been admitted for an adrenalectomy to be performed the
following day. To prevent complications, the nurse should anticipate preoperative administration of
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 992
A) IV antibiotics
B) Oral antihypertensives
C) Parenteral nutrition
D) IV corticosteroids
Ans: D
Feedback:
31. A patient is undergoing testing for suspected adrenocortical insufficiency. The care team should ensure
that the patient has been assessed for the most common cause of adrenocortical insufficiency. What is
the most common cause of this health problem?
B) Pheochromocytoma
D) Adrenal tumor
Ans: A
Feedback:
Therapeutic use of corticosteroids is the most common cause of adrenocortical insufficiency. The other
options also cause adrenocortical insufficiency, but they are not the most common causes.
32. The nurse providing care for a patient with Cushing syndrome has identified the nursing diagnosis of
risk for injury related to weakness. How should the nurse best reduce this risk?
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 993
Ans: A
Feedback:
The nurse should take action to prevent the patients risk for falls. Bed rest carries too many harmful
effects, however, and assistive devices may or may not be necessary. Constant supervision is not
normally required or practicable.
33. A patient with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with
the patient to improve the patients nutritional intake. What foods should a patient with Cushing
syndrome eat to optimize health? Select all that apply.
Ans: A, C, D
Feedback:
Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and
osteoporosis. Referral to a dietitian may assist the patient in selecting appropriate foods that are also low
in sodium and calories.
34. A patient on corticosteroid therapy needs to be taught that a course of corticosteroids of 2 weeks
duration can suppress the adrenal cortex for how long?
A) Up to 4 weeks
B) Up to 3 months
C) Up to 9 months
D) Up to 1 year
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 994
Ans: D
Feedback:
Suppression of the adrenal cortex may persist up to 1 year after a course of corticosteroids of only 2
weeks duration.
35. A patient with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal
hypophysectomy. What would be most important for the nurse to monitor before, during, and after
surgery?
A) Blood glucose
C) Weight
D) Oral temperature
Ans: A
Feedback:
Before, during, and after this surgery, blood glucose monitoring and assessment of stools for blood are
carried out. The patients blood sugar is more likely to be volatile than body weight or temperature.
Hematuria is not a common complication.
36. What should the nurse teach a patient on corticosteroid therapy in order to reduce the patients risk of
adrenal insufficiency?
A) Take the medication late in the day to mimic the bodys natural rhythms.
Ans: B
Feedback:
The patient and family should be informed that acute adrenal insufficiency and underlying symptoms
will recur if corticosteroid therapy is stopped abruptly without medical supervision. The patient should
be instructed to have an adequate supply of the corticosteroid medication always available to avoid
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 995
running out. Doses should not be skipped or added without explicit instructions to do so. Corticosteroids
should normally be taken in the morning to mimic natural rhythms.
37. The nurse is caring for a patient at risk for an addisonian crisis. For what associated signs and symptoms
should the nurse monitor the patient? Select all that apply.
A) Epistaxis
B) Pallor
D) Bounding pulse
E) Hypotension
Ans: B, C, E
Feedback:
The patient at risk is monitored for signs and symptoms indicative of addisonian crisis, which can
include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness.
Epistaxis and a bounding pulse are not symptoms or signs of an addisonian crisis.
38. A patient has been assessed for aldosteronism and has recently begun treatment. What are priority areas
for assessment that the nurse should frequently address? Select all that apply.
A) Pupillary response
C) Potassium level
D) Peripheral pulses
E) BP
Ans: C, E
Feedback:
Patients with aldosteronism exhibit a profound decline in the serum levels of potassium, and
hypertension is the most prominent and almost universal sign of aldosteronism. Pupillary response,
peripheral pulses, and renal function are not directly affected.
NURSINGTB.COM
BRUNNER AND SUDDARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING 14TH EDITION HINKLE TEST BANK
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 996
39. A patient who has been taking corticosteroids for several months has been experiencing muscle wasting.
The patient has asked the nurse for suggestions to address this adverse effect. What should the nurse
recommend?
Ans: B
Feedback:
Muscle wasting can be partly addressed through increased protein intake. Passive ROM exercises
maintain flexibility, but do not build muscle mass. Vitamin D and calcium supplements do not decrease
muscle wasting. Activity limitation would exacerbate the problem.
40. The nurse is providing care for an older adult patient whose current medication regimen includes
levothyroxine (Synthroid). As a result, the nurse should be aware of the heightened risk of adverse
effects when administering an IV dose of what medication?
A) A fluoroquinalone antibiotic
B) A loop diuretic
D) A benzodiazepine
Ans: D
Feedback:
Oral thyroid hormones interact with many other medications.Even in small IV doses, hypnotic and
sedative agents may induce profound somnolence, lasting far longer than anticipated and leading to
narcosis (stupor like condition). Furthermore, they are likely to cause respiratory depression, which can
easily be fatal because of decreased respiratory reserve and alveolar hypoventilation. Antibiotics, PPIs
and diuretics do not cause the same risk.
NURSINGTB.COM