ENDOCRINE PROBLEMS LEWIS MEDIC AL

ENDOCRINE PROBLEMS LEWIS MEDIC AL

-SURGICAL NURSING,10

th

EDITION EXAM

WITH QUESTIONS AND VERIFIED

ANSWERS!!GRADED A+!!

• 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?

• Delay teaching until closer to discharge date.
• Provide written reminders of information taught.
• Offer multiple options for management of therapies.

d. Ensure privacy for teaching by asking the family to leave. - ANSWER-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 somewhat complex, teaching should be initiated 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 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?

• Restrict the patient to bed rest. 1 / 3

• Encourage 4000 mL of fluids daily.
• Institute routine seizure precautions.

d. Assess for positive Chvostek's sign. - ANSWER-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 develops carpopedal spasms and tingling of the lips following a

parathyroidectomy. Which action will provide the patient with rapid relief from the symptoms?

• Administer the prescribed muscle relaxant.
• Have the patient rebreathe from a paper bag.
• Start the PRN O2 at 2 L/min per cannula.

d. Stretch the muscles with passive range of motion. - ANSWER-ANS: B

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 or range of motion will have no impact on the ionized calcium level.Calcium supplements will be given to normalize calcium levels quickly, but oral supplements will take time to be absorbed.

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

hypoparathyroidism. The nurse should plan to teach the patient about

• bisphosphonates to reduce bone demineralization.
• calcium supplements to normalize serum calcium levels.
• increasing fluid intake to decrease risk for nephrolithiasis.
• including whole grains in the diet to prevent constipation. - ANSWER-ANS: B 2 / 3

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.

. A 40-yr-old patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask?

• "Have you had a recent head injury?"
• "Do you have to wear larger shoes now?"
• "Is there a family history of acromegaly?"

d. "Are you experiencing tremors or anxiety?" - ANSWER-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.

DIF: Cognitive Level: Apply (application) TOP: Nursing Process: Assessment

REF: 1157

MSC: NCLEX: Physiological Integrity

. A patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. During preoperative teaching, the nurse instructs the patient about the

need to:

• cough and deep breathe every 2 hours postoperatively.
• remain on bed rest for the first 48 hours after the surgery.
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