Chapter 54: Endocrine Problems Harding: Lewis’s Medical-Surgical Nursing, 12th Edition

Harding: Lewis’s Medical -Surgical Nursing, 12th Edition MULTIPLE CHOICE 1. 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. DIF: Cognitive Level : Apply (Application) TOP: Nursing Process : Assessment MSC: NCLEX: Physiological Integrity 2. A patient is scheduled for trans sphenoidal hypoph ysectomy 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 afte r 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 cervica l collar is not needed. DIF: Cognitive Level : Apply (Application) TOP: Nursing Process : Implementation MSC: NCLEX: Physiological Integrity 3. The nurse is planning postoperative care for a patient who is being admitted to the surgical unit from the recovery roo m after trans sphenoidal 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. Th e 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. DIF: Cognitive Level : Apply (Application) TOP: Nursing Process : Planning MSC: NCLEX: Physiological Integrity 4. The nurse is assessing a male patient diagnosed with a pituitary tumor causing pan hypopituitarism . Which assessment finding is consistent with pan hypopituitarism ? a. High blood pressure b. Decreased facial hair c. Elevated blood glucose d. Intermitte nt 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 pan hypopituitarism because of decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is due to the decrease in thyroid -stimulating hormone (TSH) an d thyroid hormones associated with pan hypopituitarism . DIF: Cognitive Level : Apply (Application) TOP: Nursing Process : Assessment MSC: NCLEX: Phys iological Integrity 5. Which information will the nurse include when teaching a 50 -year-old male patient about som atropin (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 incre ase blood glucose levels. DIF: Cognitive Level : Apply (Application) TOP: Nursing Process : Implementation MSC: NCLEX: Physiological Integrity 6. Which finding indicates to the nurse that demeclocycline has been effective for a patient with syndrome of inappropri ate 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 incr eases 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. DIF: Cognitive Level : Apply (Application) TOP: Nursing