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endocrine NCLEX MED SURG EXAM 3A nurse is collecting data regarding a client after a thyroidectomy and notes that the client has developed hoarseness and a weak voice. Which nursing action is appropriate? 1. Check for signs of bleeding. 2. Administer calcium gluconate. 3. Notify the registered...

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  • 2. mai 2024
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endocrine NCLEX MED SURG EXAM 3

A nurse is collecting data regarding a client after a thyroidectomy and notes that the client has
developed hoarseness and a weak voice. Which nursing action is appropriate?



1. Check for signs of bleeding.

2. Administer calcium gluconate.

3. Notify the registered nurse immediately.

4. Reassure the client that this is usually a temporary condition. - correct answer *4. Reassure the client
that this is usually a temporary condition.*

*rationale* Weakness and hoarseness of the voice can occur as a result of trauma of the laryngeal nerve.
If this develops, the client should be reassured that the problem will subside in a few days. Unnecessary
talking should be discouraged. It is not necessary to notify the registered nurse immediately. These signs
do not indicate bleeding or the need to administer calcium gluconate.



A nurse is reviewing discharge teaching with a client who has Cushing's syndrome. Which statement by
the client indicates that the instructions related to dietary management were understood?



1. "I can eat foods that contain potassium."

2. "I will need to limit the amount of protein in my diet."

3. "I am fortunate that I can eat all the salty foods I enjoy."

4. "I am fortunate that I do not need to follow any special diet." - correct answer *1. "I can eat foods that
contain potassium."*



*rationale* A diet that is low in calories, carbohydrates, and sodium but ample in protein and potassium
content is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, the
reduction of edema and hypertension, the control of hypokalemia, and the rebuilding of wasted tissue.



A nurse is caring for a postoperative parathyroidectomy client. Which of the following would require the
nurse's immediate attention?

,1. Incisional pain

2. Laryngeal stridor

3. Difficulty voiding

4. Abdominal cramps - correct answer *2. Laryngeal stridor*



*rationale* During the postoperative period, the nurse carefully observes the client for signs of
hemorrhage, which cause swelling and the compression of adjacent tissue. Laryngeal stridor is a harsh,
high-pitched sound heard on inspiration and expiration that is caused by the compression of the trachea
and that leads to respiratory distress. It is an acute emergency situation that requires immediate
attention to avoid the complete obstruction of the airway.



A nurse assists in developing a plan of care for a client with hyperparathyroidism receiving calcitonin-
human (Cibacalcin). Which outcome has the highest priority regarding this medication?



1. Relief of pain

2. Absence of side effects

3. Reaching normal serum calcium levels

4. Verbalization of appropriate medication knowledge - correct answer *3. Reaching normal serum
calcium levels*



*rationale* Hypercalcemia can occur in clients with hyperparathyroidism, and calcitonin is used to lower
plasma calcium level. The highest priority outcome in this client situation would be a reduction in serum
calcium level. Option 1 is unrelated to this medication. Although options 2 and 4 are expected outcomes,
they are not the highest priority for administering this medication.



A nursing instructor asks a student to describe the pathophysiology that occurs in Cushing's disease.
Which statement by the student indicates an accurate understanding of this disorder?

1. "Cushing's disease is characterized by an oversecretion of insulin."

2. "Cushing's disease is characterized by an oversecretion of glucocorticoid hormones."

3. "Cushing's disease is characterized by an undersecretion of corticotropic hormones."

4. "Cushing's disease is characterized by an undersecretion of glucocorticoid hormones." - correct
answer *2. "Cushing's disease is characterized by an oversecretion of glucocorticoid hormones."*

,*rationale* Cushing's syndrome is characterized by an oversecretion of glucocorticoid hormones.
Addison's disease is characterized by the failure of the adrenal cortex to produce and secrete
adrenocortical hormones. Options 1 and 4 are inaccurate regarding Cushing's syndrome.



A nurse would expect to note which interventions in the plan of care for a client with hypothyroidism?
*Select all that apply.*



1. Provide a cool environment for the client.

2. Instruct the client to consume a high-fat diet.

3. Instruct the client about thyroid replacement therapy.

4. Encourage the client to consume fluids and high-fiber foods in the diet.

5. Instruct the client to contact the health care provider if episodes of chest pain occur.

6. Inform the client that iodine preparations will be prescribed to treat the disorder. - correct answer *3.
Instruct the client about thyroid replacement therapy.*

*4. Encourage the client to consume fluids and high-fiber foods in the diet.*

*5. Instruct the client to contact the health care provider if episodes of chest pain occur.*



*rationale* The clinical manifestations of hypothyroidism are the result of decreased metabolism from
low levels of thyroid hormone. Interventions are aimed at replacement of the hormones and providing
measures to support the signs and symptoms related to a decreased metabolism. The nurse encourages
the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and
high-fiber foods to prevent constipation. The client often has cold intolerance and requires a warm
environment. The client would notify the health care provider if chest pain occurs since it could be an
indication of overreplacement of thyroid hormone. Iodine preparations are used to treat
hyperthyroidism. These medications decrease blood flow through the thyroid gland and reduce the
production and release of thyroid hormone.



Which nursing action would be appropriate to implement when a client has a diagnosis of
pheochromocytoma?



1. Weigh the client.

2. Test the client's urine for glucose.

3. Monitor the client's blood pressure.

, 4. Palpate the client's skin to determine warmth. - correct answer *3. Monitor the client's blood
pressure.*

*rationale* Hypertension is the major symptom that is associated with pheochromocytoma. The blood
pressure status is monitored by taking the client's blood pressure. Glycosuria, weight loss, and
diaphoresis are also clinical manifestations of pheochromocytoma, but hypertension is the major
symptom.



A nurse is caring for a client with pheochromocytoma. The client is scheduled for an adrenalectomy.
During the preoperative period, the priority nursing action would be to monitor the:



1. Vital signs

2. Intake and output

3. Blood urea nitrogen (BUN) level

4. Urine for glucose and acetone - correct answer *1. Vital signs*



*rationale* Hypertension is the hallmark of pheochromocytoma. Severe hypertension can precipitate a
brain attack (stroke) or sudden blindness. Although all of the options are accurate nursing interventions
for the client with pheochromocytoma, the priority nursing action is to monitor the vital signs,
particularly the blood pressure.



A nurse is caring for a client with pheochromocytoma. The client asks for a snack and something warm to
drink. The appropriate choice for this client to meet nutritional needs would be which of the following?



1. Crackers with cheese and tea

2. Graham crackers and warm milk

3. Toast with peanut butter and cocoa

4. Vanilla wafers and coffee with cream and sugar - correct answer *2. Graham crackers and warm milk*



*rationale* The client with pheochromocytoma needs to be provided with a diet that is high in vitamins,
minerals, and calories. Of particular importance is that food or beverages that contain caffeine (e.g.,
chocolate, coffee, tea, and cola) are prohibited.

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