Nclex Questions Thyroid

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After several diagnostic tests, a client is diagnosed with diabetes
3. Diabetes insipidus is characterized by hyposecretion of antid-
insipidus. The nurse performs an assessment on the client, know-
iuretic hormone, and the kidney tubules fail to reabsorb water.
ing that which symptom is most indicative of this disorder?
Polydipsia and polyuria are classic symptoms of diabetes in-
1.Fatigue
sipidus. The urine is pale, and the specific gravity is low. Anorexia
2.Diarrhea
and weight loss occur. Option 1 is a vague symptom. Options 2
3.Polydipsia
and 4 are not specific to this disorder.
4.Weight gain
A client is admitted to an emergency department, and a diagnosis
of myxedema coma is made. Which action would the nurse pre-
2. The initial nursing action would be to maintain a patent airway.
pare to carry out initially?
Oxygen would be administered, followed by fluid replacement,
1.Warm the client.
keeping the client warm, monitoring vital signs, and administering
2.Maintain a patent airway.
thyroid hormones by the intravenous route
3.Administer thyroid hormone.
4.Administer fluid replacement
The nurse is providing discharge instructions to a client who
has Cushing's syndrome. Which client statement indicates that
2 A diet low in carbohydrates and sodium but ample in protein and
instructions related to dietary management are understood?
potassium is encouraged for a client with Cushing's syndrome.
1"I will need to limit the amount of protein in my diet."
Such a diet promotes weight loss, reduction of edema and hyper-
2."I should eat foods that have a lot of potassium in them."
tension, control of hypokalemia, and rebuilding of wasted tissue.
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."
The nurse is preparing a client with a new diagnosis of hy-
pothyroidism for discharge. The nurse determines that the client
understands discharge instructions if the client states that which
symptoms are associated with this diagnosis? Select all that
3,4,5,6,
apply.
Feeling cold, hair loss, lethargy, and facial puffiness are signs of
1.Tremors
hypothyroidism. Tremors and weight loss are signs of hyperthy-
2.Weight loss
roidism
3.Feeling cold
4.Loss of body hair
5.Persistent lethargy
6.puffiness of the face
A client has just been admitted to the nursing unit following
3 Thyroidectomy is the removal of the thyroid gland, which is
thyroidectomy. Which assessment is the priority for this client?
located in the anterior neck. It is very important to monitor airway
1Hypoglycemia
status as any swelling to the surgical site could cause respiratory
2.Level of hoarseness
distress. Although all the options are important for the nurse to
3.Respiratory distress
monitor, the priority nursing action is to monitor the airway.
4.Edema at the surgical site
A client has been diagnosed with hyperthyroidism. Which signs
and symptoms may indicate thyroid storm, a complication of this 1,2,4,5
disorder? Select all that apply Thyroid storm is an acute and life-threatening condition that oc-
1. Fever curs in a client with uncontrollable hyperthyroidism. Symptoms
2.Nausea of thyroid storm include elevated temperature (fever), nausea,
3.Lethargy and tremors. In addition, as the condition progresses, the client
4.Tremors becomes confused. The client is restless and anxious and expe-
5.Confusion riences tachycardia.
6.Bradycardia
3,4,6
The nurse should include which interventions in the plan of care The clinical manifestations of hypothyroidism are the result of
for a client with hypothyroidism? Select all that apply. decreased metabolism from low levels of thyroid hormone. In-
1.Provide a cool environment for the client. terventions are aimed at replacement of the hormone and pro-
2.Instruct the client to consume a high-fat diet. viding measures to support the signs and symptoms related to
3.Instruct the client about thyroid replacement therapy. decreased metabolism. The client often has cold intolerance and
4.Encourage the client to consume fluids and high-fiber foods in requires a warm environment. The nurse encourages the client to
the diet. consume a well-balanced diet that is low in fat for weight reduction
5.Inform the client that iodine preparations will be prescribed to and high in fluids and high-fiber foods to prevent constipation.
treat the disorder. Iodine preparations may be used to treat hyperthyroidism. Iodine
6.Instruct the client to contact the health care provider (HCP) if preparations decrease blood flow through the thyroid gland and
episodes of chest pain occur. reduce the production and release of thyroid hormone; they are
not used to treat hypothyroidism. The client is instructed to notify

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the HCP if chest pain occurs because it could be an indication of
overreplacement of thyroid hormone
The nurse is caring for a client after thyroidectomy. The nurse
Hypocalcemia, resulting in tetany, can develop after thyroidectomy
notes that calcium gluconate is prescribed for the client. The nurse
if the parathyroid glands are accidentally removed during surgery.
determines that this medication has been prescribed for which
Manifestations develop 1 to 7 days after surgery. If the client devel-
purpose?
ops numbness and tingling around the mouth, fingertips, or toes;
1.To treat thyroid storm
muscle spasms; or twitching, the health care provider is notified
2.To prevent cardiac irritability
immediately. Calcium gluconate should be readily available in the
3.To treat hypocalcemic tetany
nursing unit.
4.To stimulate release of parathyroid hormone
The nurse is reviewing the laboratory test results for a client with a
3. The client with Cushing's syndrome experiences hyperkalemia,
diagnosis of Cushing's syndrome. Which laboratory finding would
hyperglycemia, an elevated WBC count, and elevated plasma
the nurse expect to note in this client
cortisol and adrenocorticotropic hormone levels. These abnor-
malities are caused by the effects of excess glucocorticoids and
1.A platelet count of 200,000 cells/mm3
mineralocorticoids in the body. The laboratory values listed in
2.A blood glucose level of 110 mg/dL
options 1, 2, and 4 would not be noted in the client with Cushing's
3.A potassium (K+) level of 5.5 mEq/L
syndrome.
4.A white blood cell (WBC) count of 6000 cells/mm3
The nurse caring for a client with a diagnosis of hypoparathy-
2
roidism reviews the laboratory results of blood tests for this client
Hypoparathyroidism is related to a lack of parathyroid hormone
and notes t
secretion or a decreased effectiveness of parathyroid hormone
1Unresponsive pupils
on target tissues. The end result of this disorder is hypocalcemia.
2.Positive Trousseau's sign
When serum calcium levels are critically low, the client may exhibit
3.Negative Chvostek's sign
Chvostek's and Trousseau's signs, which indicate potential tetany.
4.Hyperactive bowel soundshat the calcium level is extremely low.
Options 1, 3, and 4 are not related to the presence of hypocal-
The nurse should expect to note which on assessment of the
cemia.
client?
4.
The nurse is caring for a client with a diagnosis of Addison's Addisonian crisis is a serious life-threatening response to acute
disease. The nurse is monitoring the client for signs of Addisonian adrenal insufficiency that most commonly is precipitated by a
crisis. The nurse should assess the client for which manifestation major stressor. The client in Addisonian crisis may demonstrate
that would be associated with this crisis? any of the signs and symptoms of Addison's disease, but the pri-
1.Agitation mary problems are sudden profound weakness; severe abdom-
2.Diaphoresis inal, back, and leg pain; hyperpyrexia followed by hypothermia;
3.Restlessness peripheral vascular collapse; coma; and renal failure. Options 1,
4.Severe abdominal pain 2, and 3 do not identify clinical manifestations associated with
Addisonian crisis.
The nurse is performing an assessment on a client with a diag- 4
nosis of Cushing's syndrome. Which should the nurse expect to With excessive secretion of adrenocorticotropic hormone (ACTH)
note on assessment of the client? and chronic corticosteroid use, the person with Cushing's syn-
1.Skin atrophy drome develops a rounded moon-like face; prominent jowls; red
2.The presence of sunken eyes cheeks; and hirsutism on the upper lip, lower cheek, and chin.
3.Drooping on one side of the face Options 1, 2, and 3 are not associated with the assessment
4.A rounded "moon-like" appearance to the face findings in Cushing's syndrome.
The nurse is performing an assessment on a client with a diag-
1.
nosis of myxedema (hypothyroidism). Which assessment finding
Myxedema is a deficiency of thyroid hormone. The client will
should the nurse expect to note in this client
present with a puffy, edematous face, especially around the eyes
1. Dry skin
(periorbital edema), along with coarse facial features, dry skin,
2.Thin, silky hair
and dry, coarse hair and eyebrows. Options 2, 3, and 4 are noted
3.Bulging eyeballs
in the client with hyperthyroidism.
4.Fine muscle tremors
The nurse is performing an assessment on a client with a diag- 2
nosis of hyperthyroidism. Which assessment finding should the Hyperthyroidism is clinically manifested by goiter (increase in the
nurse expect to note in this client? size of the thyroid gland) and exophthalmos (bulging eyeballs).
Other clinical manifestations include nervousness, fatigue, weight
1Dry skin loss, muscle cramps, and heat intolerance. Additional signs found
2.Bulging eyeballs in this disorder include tachycardia; shortness of breath; exces-
3. Periorbital edema sive sweating; fine muscle tremors; thin, silky hair and thin skin;
4.Coarse facial features infrequent blinking; and a staring appearance.

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The nurse is developing a plan of care for a client with Cushing's
syndrome. The nurse documents a client problem of excess fluid
volume. Which nursing actions should be included in the care plan 1,2,3
for this client? Select all that apply. The client with Cushing's syndrome and a problem of excess fluid
volume should be maintained on a high-potassium, low-sodium
1. Monitor daily weight. diet. Decreased sodium intake decreases renal retention of sodi-
2.Monitor intake and output. um and water. Options 1, 2, and 3 are appropriate interventions
3.Assess extremities for edema. for the client with excess fluid volume.
4.Maintain a high-sodium diet.
5.Maintain a low-potassium diet.
The nurse is caring for a client who has had an adrenalectomy and
is monitoring the client for signs of adrenal insufficiency. Which
1
signs and symptoms indicate adrenal insufficiency in this client?
The nurse should be alert to signs and symptoms of adrenal
insufficiency after adrenalectomy. These signs and symptoms in-
1.Hypotension and fever
clude weakness, hypotension, fever, and mental status changes.
2.Mental status changes and hypertension
Options 2, 3, and 4 are incorrect options.
3.Subnormal temperature and hypotension
4.Complaints of weakness and hypertension
The nurse is providing home care instructions to the client with a
diagnosis of Cushing's syndrome and prepares a list of instruc- 1,2,3,4
tions for the client. Which instructions should be included on the The client with Cushing's syndrome should be instructed to
list? Select all that apply. take the medications exactly as prescribed. The nurse should
. emphasize the importance of continuing medications, consult-
1.The signs and symptoms of hypoadrenalism ing with the health care provider (HCP) before purchasing any
2.The signs and symptoms of hyperadrenalism over-the-counter medications, and maintaining regular outpatient
3.Instructions to take the medications exactly as prescribed follow-up care. The nurse also should instruct the client in the
4.The importance of maintaining regular outpatient follow-up care signs and symptoms of both hypoadrenalism and hyperadrena-
5.A reminder to read the labels on over-the-counter medications lism.
before purchase
...d. A normal response to growth hormone (GH) secretion
is stimulation of the liver to produce somatomedin C, or
. A patient suspected of having acromegaly has an elevated
insulin-like growth factor-1 (IGF-1), which stimulates
plasma growth hormone (GH) level. In acromegaly, what would
growth of bones and soft tissues. The increased levels of
the nurse also expect the patient's diagnostic results to indicate?
somatomedin C normally inhibit GH but in acromegaly
a. Hyperinsulinemia
the pituitary gland secretes GH despite elevated IGF-1
b. Plasma glucose of <70 mg/dL (3.9 mmol/L)
levels. When both GH and IGF-1 levels are increased,
c. Decreased GH levels with an oral glucose challenge test
overproduction of GH is confirmed. GH also causes elevation
d. Elevated levels of plasma insulin-like growth factor-1 (IGF--1)
of blood glucose and normally GH levels fall during an oral
glucose challenge but not in acromegaly.
...c. The increased production of GH in acromegaly causes an
During assessment of the patient with acromegaly, what should increase in thickness and width of bones and enlargement of
the nurse expect the patient to report? soft tissues, resulting in marked changes in facial features,
a. Infertility oily and coarse skin, and speech difficulties. Infertility
c. Undesirable changes in appearance is not a common finding because GH is usually the only
b. Dry, irritated skin pituitary hormone involved in acromegaly. Height is not
d. An increase in height of 2 to 3 inches a year increased in adults with GH excess because the epiphyses
of the bones are closed.
...a. A transsphenoidal hypophysectomy involves entry into
the sella turcica through an incision in the upper lip and
A patient with acromegaly is treated with a transsphenoidal hy-
gingiva into the floor of the nose and the sphenoid sinuses.
pophysectomy. What should the nurse do postoperatively?
Postoperative clear nasal drainage with glucose content
a. Ensure that any clear nasal drainage is tested for glucose
indicates cerebrospinal fluid (CSF) leakage from an open
b. Maintain the patient flat in bed to prevent cerebrospinal fluid
connection to the brain, putting the patient at risk for
(CSF) leakage.
meningitis. After surgery, the patient is positioned with
c. Assist the patient with toothbrushing every 4 hours to keep the
the head elevated to avoid pressure on the sella turcica.
surgical area clean.
Coughing and straining are avoided to prevent increased
d. Encourage deep breathing, coughing, and turning to prevent
intracranial pressure and CSF leakage. Although mouth
respiratory complications.
care is required every 4 hours, toothbrushing should not be
performed because injury to the suture line may occur

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The patient is diagnosed with syndrome of inappropriate antidi- b. With increased antidiuretic hormone (ADH), the
uretic hormone (SIADH). What manifestation should permeability of the renal distal tubules is increased, so
the nurse expect to find? water is reabsorbed into circulation. Decreased output
a. Decreased body weight of concentrated urine with increased urine osmolality
c. Increased plasma osmolality and specific gravity occur. In addition, fluid retention
b. Decreased urinary output with weight gain, serum hypoosmolality, dilutional
d. Increased serum sodium levels hyponatremia, and hypochloremia occur.
a. The patient with syndrome of inappropriate antidiuretic
During care of the patient with SIADH, what should the nurse do?
hormone (SIADH) has marked dilutional hyponatremia
a. Monitor neurologic status at least every 2 hours.
and should be monitored for decreased neurologic function
b. Teach the patient receiving treatment with diuretics to restrict
and seizures every 2 hours. Sodium intake is supplemented
sodium intake.
because of the hyponatremia and sodium loss caused by
c. Keep the head of the bed elevated to prevent antidiuretic
diuretics. ADH release is reduced by keeping the head of the
hormone (ADH) release.
bed flat to increase left atrial filling pressure. A reduction
d. Notify the health care provider if the patient's blood pressure
in blood pressure (BP) indicates a reduction in total fluid
decreases more than 20 mm Hg from baseline.
volume and is an expected outcome of treatment.
A patient with SIADH is treated with water restriction. What does
the patient experience when the nurse determines
that treatment has been effective?
b. The patient with SIADH has water retention with
a. Increased urine output, decreased serum sodium, and in-
hyponatremia, decreased urine output, and concentrated
creased urine specific gravity
urine with high specific gravity. Improvement in the
b. Increased urine output, increased serum sodium, and de-
patient's condition is reflected by increased urine output,
creased urine specific gravity
normalization of serum sodium, and more water in the
c. Decreased urine output, increased serum sodium, and de-
urine, thus decreasing the specific gravity.
creased urine specific gravity
d. Decreased urine output, decreased serum sodium, and in-
creased urine specific gravity
The patient with diabetes insipidus is brought to the emergency
c. Patients with diabetes insipidus (DI) excrete large
department with confusion and dehydration after
amounts of urine with a specific gravity of less than
excretion of a large volume of urine today even though several
1.005. Blood glucose would be tested to diagnose diabetes
liters of fluid were drunk. What is a diagnostic test
mellitus. The serum sodium level is expected to be low
that the nurse should expect to be done to help make a diagnosis?
with DI but is not diagnostic. To diagnose central DI a
a. Blood glucose
water deprivation test is required. Then a CT of the head
c. Urine specific gravity
may be done to determine the cause. Nephrogenic DI is
b. Serum sodium level
differentiated from central DI with determination of the
d. Computed tomography (CT) of the head
In a patient with central diabetes insipidus, what will the adminis- d. A patient with central diabetes insipidus has a deficiency
tration of ADH during a water deprivation test of ADH with excessive loss of water from the kidney,
result in? hypovolemia, hypernatremia, and dilute urine with a low
a. Decrease in body weight specific gravity. When vasopressin is administered, the
c. Decrease in blood pressure symptoms are reversed, with water retention, decreased urinary
b. Increase in urinary output output that increases urine osmolality, and an
d. Increase in urine osmolality increase in BP.
A patient with diabetes insipidus is treated with nasal desmo-
c. Normal urine specific gravity is 1.005 to 1.025 and urine
pressin acetate (DDAVP). The nurse determines that the
with a specific gravity of 1.002 is very dilute, indicating
drug is not having an adequate therapeutic effect when the patient
that there continues to be excessive loss of water and that
experiences
treatment of diabetes insipidus is inadequate. Headache,
a. headache and weight gain.
weight gain, and oral intake greater than urinary output are
c. a urine specific gravity of 1.002.
signs of volume excess that occur with overmedication.
b. nasal irritation and nausea.
Nasal irritation and nausea may also indicate overdosage.
d. an oral intake greater than urinary output
When caring for a patient with nephrogenic diabetes insipidus, b. In nephrogenic diabetes insipidus, the kidney is unable to
what should the nurse expect the treatment to respond to ADH, so vasopressin or hormone analogs are not
include? effective. Thiazide diuretics slow the glomerular filtration
a. Fluid restriction rate (GFR) in the kidney and produce a decrease in urine
c. A high-sodium diet output. Low-sodium diets (<3 g/day) are also thought to
b. Thiazide diuretics decrease urine output. Fluids are not restricted because the
d. Chlorpropamide (Diabinese) patient could easily become dehydrated
Which statement accurately describes Graves' disease? a. Exophthalmos or protrusion of the eyeballs may occur
a. Exophthalmos occurs in Graves' disease. in Graves' disease from increased fat deposits and fluid in
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b. It is an uncommon form of hyperthyroidism. the orbital tissues and ocular muscles, forcing the eyeballs
c. Manifestations of hyperthyroidism occur from tissue desensiti- outward. Graves' disease is the most common form of
zation to the sympathetic nervous system. hyperthyroidism. Increased metabolic rate and sensitivity
d. Diagnostic testing in the patient with Graves' disease will reveal of the sympathetic nervous system lead to the clinical
an increased thyroid-stimulating hormone manifestations. Thyroid-stimulating hormone (TSH) level is
(TSH) level. decreased in Graves' disease.
A patient with Graves' disease asks the nurse what caused the
disorder. What is the best response by the nurse? d. In Graves' disease, antibodies to the TSH receptor are
a. "The cause of Graves' disease is not known, although it is formed, attach to the receptors, and stimulate the thyroid
thought to be genetic." gland to release triiodothyronine (T3), thyroxine (T4),
b. "It is usually associated with goiter formation from an iodine or both, creating hyperthyroidism. The disease is not
deficiency over a long period of time." directly genetic but individuals appear to have a genetic
c. "Antibodies develop against thyroid tissue and destroy it, caus- susceptibility to develop autoimmune antibodies. Goiter
ing a deficiency of thyroid hormones." formation from insufficient iodine intake is usually
d. "In genetically susceptible persons, antibodies are formed that associated with hypothyroidism.
cause excessive thyroid hormone secretion."
c. A hyperthyroid crisis results in marked manifestations
of hyperthyroidism, with severe tachycardia, heart failure,
A patient is admitted to the hospital with thyrotoxicosis. On phys-
shock, hyperthermia, restlessness, irritability, abdominal
ical assessment of the patient, what should the
pain, vomiting, diarrhea, delirium, and coma. Although
nurse expect to find?
exophthalmos may be present in the patient with Graves'
a. Hoarseness and laryngeal stridor
disease, it is not a significant factor in hyperthyroid crisis.
b. Bulging eyeballs and dysrhythmias
Hoarseness and laryngeal stridor are characteristic of the
c. Elevated temperature and signs of heart failure
tetany of hypoparathyroidism and lethargy progressing to
d. Lethargy progressing suddenly to impairment of consciousness
coma is characteristic of myxedema coma, a complication
of hypothyroidism.
b. The ²-adrenergic blocker atenolol is used to block
What medication is used with thyrotoxicosis to block the effects of
the sympathetic nervous system stimulation by thyroid
the sympathetic nervous stimulation of the
hormones. Potassium iodide is used to prepare the patient
thyroid hormones?
for thyroidectomy or for treatment of thyrotoxic crisis
a. Potassium iodide
to inhibit the synthesis of thyroid hormones. Antithyroid
c. Propylthiouracil (PTU)
medications inhibit the synthesis of thyroid hormones.
b. Atenolol (Tenormin)
Radioactive iodine (RAI) therapy destroys thyroid tissue,
d. Radioactive iodine (RAI)
which limits thyroid hormone secretion.
a. To prevent strain on the suture line postoperatively, the
What preoperative instruction should the nurse give to the patient patient's head must be manually supported while turning
scheduled for a subtotal thyroidectomy? and moving in bed but range-of-motion exercises for the
a. How to support the head with the hands when turning in bed head and neck are also taught preoperatively to be gradually
b. Coughing should be avoided to prevent pressure on the incision implemented after surgery. There is no contraindication for
c. Head and neck will need to remain immobile until the incision coughing and deep breathing and these should be carried
heals out postoperatively. Tingling around the lips or fingers is a
d. Any tingling around the lips or in the fingers after surgery is sign of hypocalcemia, which may occur if the parathyroid
expected and temporary glands are inadvertently removed during surgery. This sign
should be reported immediately.
a. A tracheostomy tray is in the room to use if vocal cord
As a precaution for vocal cord paralysis from damage to the
paralysis occurs from recurrent laryngeal nerve damage or
recurrent laryngeal nerve during thyroidectomy surgery,
for laryngeal stridor from tetany. The oxygen equipment
what equipment should be in the room in case it is needed for this
may be useful but will not improve oxygenation with vocal
emergency situation?
cord paralysis without a tracheostomy. IV calcium salts will
a. Tracheostomy tray
be used if hypocalcemia occurs from parathyroid damage.
c. IV calcium gluconate
The paper and pencil for communication may be helpful,
b. Oxygen equipment
especially if a tracheostomy is performed, but will not aid in
d. Paper and pencil for communication
emergency oxygenation of the patient
When providing discharge instructions to a patient who had a d. With the decrease in thyroid hormone postoperatively,
subtotal thyroidectomy for hyperthyroidism, what calories need to be reduced substantially to prevent weight
should the nurse teach the patient? gain. When a patient has had a subtotal thyroidectomy, thyroid
a. Never miss a daily dose of thyroid replacement therapy. replacement therapy is not given because exogenous hormone
b. Avoid regular exercise until thyroid function is normalized. inhibits pituitary production of TSH and delays or prevents
c. Use warm saltwater gargles several times a day to relieve throat the restoration of thyroid tissue regeneration. Regular exercise
pain. stimulates the thyroid gland and is encouraged. Saltwater

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d. Substantially reduce caloric intake compared to what was eaten gargles are used for dryness and irritation of the mouth and
before surgery. throat following radioactive iodine therapy.
d. Both Graves' disease and Hashimoto's thyroiditis are
What is a cause of primary hypothyroidism in adults? autoimmune disorders that eventually destroy the thyroid
a. Malignant or benign thyroid nodules gland, leading to primary hypothyroidism. Thyroid
b. Surgical removal or failure of the pituitary gland tumors most often result in hyperthyroidism. Secondary
c. Surgical removal or radiation of the thyroid gland hypothyroidism occurs as a result of pituitary failure and
d. Autoimmune-induced atrophy of the thyroid gland iatrogenic hypothyroidism results from thyroidectomy or
radiation of the thyroid gland
When replacement therapy is started for a patient with d. All these manifestations may occur with treatment
long-standing hypothyroidism, what is of hypothyroidism. However, as a result of the effects
most important for the nurse to monitor the patient for? of hypothyroidism on the cardiovascular system, when
a. Insomnia thyroid replacement therapy is started myocardial oxygen
c. Nervousness consumption is increased and the resultant oxygen demand
b. Weight loss may cause angina, cardiac dysrhythmias, and heart failure,
d. Dysrhythmias so monitoring for dysrhythmias is most important.
A patient with hypothyroidism is treated with levothyroxine (Syn-
throid). What should the nurse include when
teaching the patient about this therapy? b. Because of the mental sluggishness, inattentiveness, and
a. Explain that alternate-day dosage may be used if side effects memory loss that occur with hypothyroidism, it is important
occur. to provide written instructions and repeat information when
b. Provide written instruction for all information related to the drug teaching the patient. Replacement therapy must be taken for
therapy. life and alternate-day dosing is not therapeutic. Although
c. Assure the patient that a return to normal function will occur most patients return to a normal state with treatment,
with replacement therapy. cardiovascular conditions and psychoses may persist.
d. Inform the patient that the drug must be taken until the hormone
balance is reestablished
A patient who recently had a calcium oxalate renal stone had a
bone density study, which showed a decrease in her d. The patient with hyperparathyroidism may have calcium
bone density. What endocrine problem could this patient have? nephrolithiasis, skeletal pain, decreased bone density,
a. SIADH psychomotor retardation, or cardiac dysrhythmias. The
c. Cushing syndrome other endocrine problems would not be related to calcium
b. Hypothyroidism kidney stones or decreased bone density
d. Hyperparathyroidism
b. A high fluid intake is indicated in hyperparathyroidism
to dilute the hypercalcemia and flush the kidneys so that
What is an appropriate nursing intervention for the patient with
calcium stone formation is reduced. Seizures are not
hyperparathyroidism?
associated with hyperparathyroidism. Impending tetany
a. Pad side rails as a seizure precaution.
of hypoparathyroidism after parathyroidectomy can be
b. Increase fluid intake to 3000 to 4000 mL daily.
noted with Trousseau's and Chvostek's signs. The patient
c. Maintain bed rest to prevent pathologic fractures.
with hyperparathyroidism is at risk for pathologic fractures
d. Monitor the patient for Trousseau's and Chvostek's signs
resulting from decreased bone density but mobility is
encouraged to promote bone calcification.
A patient has been diagnosed with hypoparathyroidism. What
manifestations should the nurse expect to observe b, c, d, e, f. In hypoparathyroidism the patient has
(select all that apply)? inadequate circulating parathyroid hormone (PTH) that
a. Skeletal pain leads to hypocalcemia from the inability to maintain serum
d. Abdominal cramping calcium levels. With hypocalcemia there is muscle stiffness
b. Dry, scaly skin and spasms, which can lead to cardiac dysrhythmias and
e. Cardiac dysrhythmias abdominal cramps. There can also be personality and visual
c. Personality changes changes and dry, scaly skin.
f. Muscle spasms and stiffness
When the patient with parathyroid disease experiences symptoms b. Rebreathing in a paper bag promotes carbon dioxide
of hypocalcemia, what is a measure that can be retention in the blood, which lowers pH and creates an
used to temporarily raise serum calcium levels? acidosis. An acidemia enhances the solubility and ionization
a. Administer IV normal saline. c. Administer furosemide (Lasix) of calcium, increasing the proportion of total body calcium
as ordered. available in physiologically active form and relieving the
b. Have patient rebreathe in a paper bag. symptoms of hypocalcemia. Saline promotes calcium
d. Administer oral phosphorus supplements. excretion, as does furosemide. Phosphate levels in the blood

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are reciprocal to calcium and an increase in phosphate
promotes calcium excretion.
A patient with hypoparathyroidism resulting from surgical treat-
ment of hyperparathyroidism is preparing for c. The hypocalcemia that results from PTH deficiency is
discharge. What should the nurse teach the patient? controlled with calcium and vitamin D supplementation and
a. Milk and milk products should be increased in the diet. possibly oral phosphate binders. Replacement with PTH is
b. Parenteral replacement of parathyroid hormone will be required not used because of antibody formation to PTH, the need for
for life. parenteral administration, and cost. Milk products, although
c. Calcium supplements with vitamin D can effectively maintain good sources of calcium, also have high levels of phosphate,
calcium balance. which reduce calcium absorption. Whole grains and foods
d. Bran and whole-grain foods should be used to prevent GI containing oxalic acid also impair calcium absorption
effects of replacement therapy
A patient is admitted to the hospital with a diagnosis of Cushing a. The effects of adrenocortical hormone excess,
syndrome. On physical assessment of the patient, especially glucocorticoid excess, include weight gain from
what should the nurse expect to find? accumulation and redistribution of adipose tissue, sodium
a. Hypertension, peripheral edema, and petechiae and water retention, glucose intolerance, protein wasting,
b. Weight loss, buffalo hump, and moon face with acne loss of bone structure, loss of collagen, and capillary
c. Abdominal and buttock striae, truncal obesity, and hypotension fragility leading to petechiae. Clinical manifestations of
d. Anorexia, signs of dehydration, and hyperpigmentation of the adrenocortical hormone deficiency include hypotension,
skin dehydration, weight loss, and hyperpigmentation of the skin.
c. Although the patient with Cushing syndrome has excess
A patient is scheduled for a bilateral adrenalectomy. During the corticosteroids, removal of the glands and the stress of
postoperative period, what should the nurse expect surgery require that high doses of corticosteroids (cortisone)
related to the administration of corticosteroids? be administered postoperatively for several days before
a. Reduced to promote wound healing weaning the dose. The nurse should monitor the patient's
b. Withheld until symptoms of hypocortisolism appear vital signs postoperatively to detect whether large amounts
c. Increased to promote an adequate response to the stress of of hormones were released during surgical manipulation,
surgery obtain morning urine specimens for cortisol measurement
d. Reduced because excessive hormones are released during to evaluate the effectiveness of the surgery, and provide
surgical manipulation of adrenal glands dressing changes with aseptic technique to avoid infection
as usual inflammatory responses are suppressed.
b. Vomiting and diarrhea are early indicators of Addisonian
crisis and fever indicates an infection, which is causing
A patient with Addison's disease comes to the emergency depart-
additional stress for the patient. Treatment of a crisis requires
ment with complaints of nausea, vomiting, diarrhea,
immediate glucocorticoid replacement and IV hydrocortisone,
and fever. What collaborative care should the nurse expect?
fluids, sodium, and glucose are necessary for 24 hours.
a. IV administration of vasopressors
Addison's disease is a primary insufficiency of the adrenal
b. IV administration of hydrocortisone
gland and adrenocorticotropic hormone (ACTH) is not
c. IV administration of D5W with 20 mEq KCl
effective, nor would vasopressors be effective with the fluid
d. Parenteral injections of adrenocorticotropic hormone (ACTH)
deficiency of Addison's disease. Potassium levels are increased
in Addison's disease and KCl would be contraindicated
During discharge teaching for the patient with Addison's disease, b. A weight reduction in the patient with Addison's disease may
which statement by the patient indicates that the indicate a fluid loss and a dose of replacement therapy that is
nurse needs to do additional teaching? too low rather than too high. Because vomiting and diarrhea
a. "I should always call the doctor if I develop vomiting or diarrhea." are early signs of crisis and because fluid and electrolytes
b. "If my weight goes down, my dosage of steroid is probably too must be replaced, patients should notify their health care
high." provider if these symptoms occur. Patients with Addison's
c. "I should double or triple my steroid dose if I undergo rigorous disease are taught to take two to three times their usual dose
physical exercise." of steroids if they become ill, have teeth extracted, or engage
d. "I need to carry an emergency kit with injectable hydrocortisone in rigorous physical activity and should always have injectable
in case I can't take my medication by mouth." hydrocortisone available if oral doses cannot be taken.
A patient who is on corticosteroid therapy for treatment of an c. Alendronate (Fosamax) is used to prevent corticosteroidin-
autoimmune disorder has the following additional duced
drugs ordered. Which one is used to prevent corticosteroid-in- osteoporosis. Potassium is used to prevent the
duced osteoporosis? mineralocorticoid effect of hypokalemia. Furosemide
a. Potassium (Lasix) is used to decrease sodium and fluid retention from
c. Alendronate (Fosamax) the mineralocorticoid effect. Pantoprazole (Protonix) is used
b. Furosemide (Lasix) to prevent gastrointestinal (GI) irritation from an increase in
d. Pantoprazole (Protonix) secretion of pepsin and hydrochloric acid

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 Nclex Questions Thyroid
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A patient with mild iatrogenic Cushing syndrome is on an alter-
c. Taking corticosteroids on an alternate-day schedule for
nate-day regimen of corticosteroid therapy. What does
pharmacologic purposes is less likely to suppress ACTH
the nurse explain to the patient about this regimen?
production from the pituitary and prevent adrenal atrophy.
a. It maintains normal adrenal hormone balance.
Normal adrenal hormone balance is not maintained during
b. It prevents ACTH release from the pituitary gland.
glucocorticoid therapy because excessive exogenous
c. It minimizes hypothalamic-pituitary-adrenal suppression.
hormone is used.
d. It provides a more effective therapeutic effect of the drug
When caring for a patient with primary hyperaldosteronism, the
c. Taking corticosteroids on an alternate-day schedule for
nurse would question a health care provider's
pharmacologic purposes is less likely to suppress ACTH
prescription for which drug?
production from the pituitary and prevent adrenal atrophy.
a. Furosemide (Lasix)
Normal adrenal hormone balance is not maintained during
c. Spironolactone (Aldactone)
glucocorticoid therapy because excessive exogenous
b. Amiloride (Midamor)
hormone is used.
d. Aminoglutethimide (Cytadren)
What is the priority nursing intervention during the management
b. Pheochromocytoma is a catecholamine-producing tumor
of the patient with
of the adrenal medulla, which may cause severe, episodic
pheochromocytoma?
hypertension; severe, pounding headache; and profuse
a. Administering IV fluids
sweating. Monitoring for a dangerously high BP before
c. Administering ²-adrenergic blockers
surgery is critical, as is monitoring for BP fluctuations
b. Monitoring blood pressure
during medical and surgical treatment.
d. Monitoring intake and output and daily weights

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