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Chapter 52
1. A nurse is obtaining a history of a female client during a routine physical exam. The client
indicates a past problem with endocrine gland functioning. The nurse is aware that this
condition could involve which of the following organs?
Select all that apply.
1. Thyroid
2. Adrenals
3. Ovaries
4. Pancreas
5. Uterus
Answer: 1. Thyroid
2. Adrenals
3. Ovaries
4. Pancreas
Rationale:
Thyroid. The endocrine glands and organs include the thyroid. Adrenals. The endocrine
glands and organs include the adrenals. Ovaries. The endocrine glands and organs include the
ovaries. Pancreas. The endocrine glands and organs include the pancreas. Uterus. The uterus
is not considered part of the function of the endocrine system.
2. The nurse is caring for a client with dehydration. The client’s blood pressure and blood
volume have stabilized after several hours of hypotension. The nurse understands that the
condition of the client has stabilized because of the body’s regulation of:
1. Aldosterone.
2. Adrenalin.
3. Dopamine.
4. Thyroxine.
Answer: Aldosterone
Rationale:
The adrenal gland and its hormone aldosterone stimulate the reabsorption of sodium and
passive reabsorption of water, thus increasing blood pressure. Adrenaline may increase blood
pressure, but in response to dehydration, aldosterone will be released by the adrenal gland to
cause the kidneys to hold on to sodium and water, and will increase blood pressure and blood
volume. Dopamine does not influence changes in blood volume. Thyroxine is a thyroid
hormone that does not affect blood pressure and blood volume.

3. The nurse is performing an assessment on a client and notes that the client has thin arms
and legs, purple striae on the abdomen, upper body obesity, and a round red face. The nurse
would suspect the client has a disturbance with the:
5. Adrenal gland.
6. Thyroid gland.
7. Parathyroid gland.
8. Hypothalamus.
Answer: Adrenal gland.
Rationale:
The assessment findings of this client indicate Cushing’s syndrome. Cushing’s syndrome is a
hypermetabolic disorder of the adrenal cortex. The assessment findings of the client do not
indicate associations with the thyroid gland, parathyroid gland, or hypothalamus.
4. The nurse is caring for a client with a diagnosis of hypothyroidism. Which of the following
clinical manifestations would the nurse expect during the physical assessment of the client?
Select all that apply.
1. Lethargy
2. Fatigue
3. Dry skin
4. Hair loss
5. Fever
Answer: 1. Lethargy
2. Fatigue
3. Dry skin
4. Hair loss
Rationale:
Lethargy. Lethargy is a clinical manifestation that indicates hypothyroidism. Fatigue. Fatigue
is a clinical manifestation that indicates hypothyroidism. Dry skin. Dry skin is a clinical
manifestation that indicates hypothyroidism. Hair loss. Hair loss is a clinical manifestation
that indicates hypothyroidism. Fever. Fever is not associated with hypothyroidism. Clients are
sensitive to changes in temperature, but fever is not associated with this condition.
5. Which of the following assessment parameters would the nurse implement as the greatest
priority for a client with severe hypothyroidism?
1. Heart rate
2. Temperature

3. Respiratory rate
4. Oxygen saturation
Answer: Heart rate
Rationale:
Clients with hypothyroidism have seriously decreased thyroid hormone levels, which causes
cardiac problems as evidenced by bradycardia. Temperature is a parameter that may indicate
that the client has a cold intolerance, but it is not the priority assessment parameter.
Respiratory rate and oxygen saturation are parameters that are not associated with potential
problems indicated with hypothyroidism.
6. When caring for a client with hypoparathyroidsim, the nurse would expect which
laboratory findings?
Select all that apply.
1. Low calcium
2. High phosphorous
3. High calcium
4. Low phosphorous
5. Low protein
Answer: 1. Low calcium
2. High phosphorous
Rationale:
Low calcium. When a deficient amount of parathyroid hormone is produced, hypocalcemia
results. High phosphorous. When a deficient amount of parathyroid hormone is produced,
results include high phosphorous levels. High calcium. When a deficient amount of
parathyroid hormone is produced, hypocalcemia results. Low phosphorous. When a deficient
amount of parathyroid hormone is produced, results include high phosphorous levels. Low
protein. Protein levels are not associated with hypoparathyroidism.
7. A client is beginning drug treatment for hypothyroidism and asks the nurse “How do I
know if the drug is working?” The nurse would respond by stating that:
Select all that apply.
1. “You should notice less symptoms of the disorder.”
2. “You will need to have your thyroid levels monitored.”
3. “You will notice at least a 2-pound weight loss.”
4. “You should ask your doctor if the drug is working.”
5. “You will periodically notice a burst in your energy level.”

Answer: 1. “You should notice less symptoms of the disorder.”
2. “You will need to have your thyroid levels monitored.”
Rationale:
“You should notice less symptoms of the disorder.” Symptoms of hypothyroidism gradually
fade over a period of 3 to 6 weeks as therapy is initiated. “You will need to have your thyroid
levels monitored.” Clients should be instructed to have their blood levels tested 6 to 8 weeks
after therapy to determine if hormone levels have stabilized. “You will notice at least a 2pound weight loss.” The client may not experience a weight loss with this therapy. “You
should ask your doctor if the drug is working.” Asking the doctor does not provide the client
information on the effectiveness of the drug. “You will periodically notice a burst in your
energy level.” The client will not experience bursts of energy; although there may be
increases in the energy level in general, periodic bursts are not associated with this therapy.
8. The nurse is preparing to administer the synthetic hormone levothyroxine. The nurse
understands that to best facilitate absorption, the drug should be administered:
Select all that apply.
1. On an empty stomach.
2. At least 4 hours before taking antacids.
3. With supplemental calcium.
4. With meals.
5. During the evening hours.
Correct answers
1. On an empty stomach.
2. At least 4 hours before taking antacids.
Rationale:
On an empty stomach. Because the absorption of the synthetic thyroid hormone
levothyroxine is altered by food and selected drugs, herbs, vitamins, and minerals, the nurse
should administer the drug while the client’s stomach is empty, usually as a single dose
before breakfast, and hold food intake for at least 1 hour. At least 4 hours before taking
antacids. The nurse should administer the medication at least 4 hours before taking antacids.
With supplemental calcium. The drug will suppress the TSH, which increases the risk of
osteoporosis, a side effect that can be avoided by the ingestion of calcium. However, the
calcium should not be administered with the drug because it can interfere with the absorption
of the drug. Therefore, calcium is incorrect because it should not be administered at the same
time as the levothyroxine. With meals. Taking levothyroxine with meals will interfere with
the absorption of the drug. During the evening hours. The best time for the administration of
the drug is in the early morning while the stomach is empty, not during the evening hours
while the stomach is full and its contents will alter absorption of the drug.

9. Which of the following nursing diagnoses would be incorporated into the plan of care for a
client with acute adrenal insufficiency?
Select all that apply.
1. Fluid-Volume Deficit
2. Hyponatremia
3. Risk for Ineffective Therapeutic Regimen
4. Knowledge Deficit
5. Fluid-Volume Excess
Answer: 1. Fluid-Volume Deficit
2. Hyponatremia
3. Risk for Ineffective Therapeutic Regimen
4. Knowledge Deficit
Rationale:
Fluid-Volume Deficit. Nurses play a key role in managing fluid replacement and fluid intake
and output. Hyponatremia. Hyponatremia is in the plan of care for this client because it
develops secondary to adrenal insufficiency. Risk for Ineffective Therapeutic Regimen. A
plan for client education and family education must be developed, and clients will be at risk
for ineffective therapeutic regimen. Knowledge Deficit. Clients will require instruction on
lifetime drug therapy and must adhere to the drug schedule. Clients are also advised to learn
how to administer intramuscular injections so that they can self-administer hydrocortisone if
unable to take medications by mouth due to nausea and vomiting. Fluid-Volume Excess.
Clients are dehydrated during this condition; therefore, fluid-volume excess is incorrect.
10. The nurse is developing a plan of care for a client with a diagnosis of
hyperparathyroidism. Nursing interventions for this client would include:
Select all that apply.
1. Decrease environmental stimuli.
2. Promote comfort and rest.
3. Eliminate caffeine from the diet.
4. Monitor vital signs.
5. Liberally apply emollient skin lotion.
Answer: 1. Decrease environmental stimuli.
2. Promote comfort and rest.
3. Eliminate caffeine from the diet.
4. Monitor vital signs.

Rationale:
Decrease environmental stimuli. Decrease environmental stimuli because clients experience
insomnia and restlessness with this disorder. Promote comfort and rest. Promoting comfort
and rest will lessen the anxiety of the client. Eliminate caffeine from the diet. Elimination of
caffeine is recommended because caffeine will increase the hand tremors and nervousness
that occur with clients with this disorder. Monitor vital signs. Monitoring vital signs is
necessary to detect any early complications such as thyroid storm. Should thyroid storm
occur, the nurse would expect changes in the vital signs such as tachycardia and
hyperpyrexia. Liberally apply emollient skin lotion. Application of skin lotion is not indicated
for this client.
11. A client with hypoparathyroidism has a low serum calcium level. In order to test for the
clinical manifestation consistent with this laboratory result, the nurse would:
Select all that apply.
1. Tap over the facial nerve of the client.
2. Place a tourniquet on the client’s arm.
3. Have the client open and close both hands.
4. Ask the client to count backwards.
5. Press lightly on the client’s shoulders.
Answer: 1. Tap over the facial nerve of the client.
2. Place a tourniquet on the client’s arm.
Rationale:
Tap over the facial nerve of the client. Tapping over the facial nerve will cause spasm and
twitching of the mouth, indicating hypocalcemia; this is referred to as the Chvostek’s sign.
Place a tourniquet on the client’s arm. Placing a tourniquet or BP cuff on the client’s arm to
assess for carpopedal spasm can also indicate hypocalcemia. This is referred to as the
Trousseau’s sign. Have the client open and close both hands. This is not a test for
hypocalcemia. Ask the client to count backwards. This is not a test for hypocalcemia. Press
lightly on the client’s shoulders. This is not a test for hypocalcemia.
12. Following surgery for hyperpitutarism, a client complains of a supra-orbital headache.
The nurse suspects a possible CSF leak and would:
Select all that apply.
1. Maintain bed rest.
2. Keep HOB elevated 30 degrees.
3. Administer antibiotics.
4. Medicate for pain.
5. Inform the client that headaches are expected.

Answer: 1. Maintain bed rest.
2. Keep HOB elevated 30 degrees.
3. Administer antibiotics.
4. Medicate for pain.
Rationale:
Maintain bed rest. Postoperative care of clients with a CSK leak should include bed rest.
Keep HOB elevated 30 degrees. Postoperative care of clients with a CSK leak should include
continued elevation of the head of the bed. Administer antibiotics. Postoperative care of
clients with a CSK leak should include being placed on prophylactic antibiotics. Medicate for
pain. Mild analgesics will be prescribed for pain. Inform the client that headaches are
expected. Headaches are not expected after surgery and are a sign of a CSF leak.
13. The nurse is admitting a client with acute adrenal insufficiency. Which of the following
questions would the nurse ask to establish subjective data regarding this disease?
Select all that apply.
1. “Have you been able to maintain your daily activities?”
2. “Have you noticed any food cravings lately?”
3. “Have you been sleeping well?”
4. “Have you experienced any stress or trauma recently?”
5. “Have experienced any numbness in your extremities?”
Answer: 1. “Have you been able to maintain your daily activities?”
2. “Have you noticed any food cravings lately?”
3. “Have you been sleeping well?”
4. “Have you experienced any stress or trauma recently?”
Rationale:
“Have you been able to maintain your daily activities?” Clients with this condition may not
be mentally alert, and therefore may have difficulty in maintaining activities of daily living.
“Have you noticed any food cravings lately?” Clients with this condition will experience food
cravings. “Have you been sleeping well?” Clients with this disorder may have sleep
disturbances. “Have you experienced any stress or trauma recently?” Stress and trauma can
cause adrenal insufficiency to progress into adrenal crisis. “Have you experienced any
numbness in your extremities?”These symptoms are not associated with adrenal insufficiency
or crisis.
14. A nurse is providing discharge instructions to a newly diagnosed client with
hyperthyroidism. The nurse would instruct the client to avoid:
Select all that apply.

1. Stress.
2. Infections.
3. Crowds.
4. Contact sports.
5. Driving.
Answer: 1. Stress.
2. Infections.
Rationale:
Stress. Clients should be instructed to avoid additional stress, which can lead to
complications of the disease. This should be done until the disease is under control.
Infections. Clients should be instructed to avoid infections, which can lead to complications
of the disease. This should be done until the disease is under control. Crowds. Avoiding
crowds is not necessary with hyperthyroid disorders. Contact sports. Avoiding contact sports
is not necessary with hyperthyroid disorders. Driving. Avoiding driving is not necessary with
hyperthyroid disorders.
15. Which of the following nursing diagnoses would the nurse include as the highest priority
in the discharge teaching for a client with hypoparathyroidism?
1. Risk for Injury
2. Altered Nutrition
3. Impaired Mobility
4. Risk for Infection
Answer: Risk for Injury
Rationale:
Discharge priorities for patients with parathyroid disease are focused on safety related to falls
and fracture prevention. Follow-up home visits are warranted to assess how the client has
modified the environment to enhance safety. Altered nutrition is included because the client
will need to be instructed on the intake of vitamin D in the diet, but it is not the priority.
Mobility is not affected with this disorder unless the client develops bone fractures related to
the low levels of calcium; the question does not imply that the client has bone fractures. Risk
for infection is not the priority for these clients.
16. An elderly client has a decline in the function of the endocrine system. The nurse would
alert the client to notify the health care provider under which conditions?
Select all that apply.
1. Infection
2. Trauma

3. Surgery
4. Stress
5. Slowed metabolism
Answer: 1. Infection
2. Trauma
3. Surgery
4. Stress
Rationale:
Infection. The elderly client should notify the health care provider of infection because this
condition may quickly destabilize older clients; the aging body is less capable of responding
to either internal or external stressors. Trauma. The elderly client should notify the health care
provider of trauma because this condition may quickly destabilize older clients; the aging
body is less capable of responding to either internal or external stressors. Surgery. The elderly
client should notify the health care provider of surgery because this condition may quickly
destabilize older clients; the aging body is less capable of responding to either internal or
external stressors. Stress. The elderly client should notify the health care provider of stress
because this condition may quickly destabilize older clients; the aging body is less capable of
responding to either internal or external stressors. Slowed metabolism. The elderly client may
not be able to determine if metabolism has slowed, and elderly clients already have a slower
metabolism.
17. An elderly client has been diagnosed with a pituitary tumor that cannot be entirely
surgically removed. The nurse would:
Select all that apply.
1. Provide clear instructions on the medications and side effects.
2. Refer the client to the local support group for pituitary tumors.
3. Refer the client to the hospital chaplain.
4. Provide emotional support for the concerns of the client.
5. Ask the family if the client has advance directives.
Answer: 1. Provide clear instructions on the medications and side effects.
2. Refer the client to the local support group for pituitary tumors.
3. Refer the client to the hospital chaplain.
4. Provide emotional support for the concerns of the client.
Rationale:
Provide clear instructions on the medications and side effects. Medication will have to be
used when a pituitary tumor cannot be entirely removed. Older patients will need simple but

clear instructions on medications that they will be receiving along with the potential side
effects. Refer the client to the local support group for pituitary tumors. Referring the client to
a support group is appropriate for this condition. Refer the client to the hospital chaplain. The
client may need emotional/religious support. Provide emotional support for the concerns of
the client. The nurse should provide emotional support to the client. Ask the family if the
client has advance directives. The nurse should ask the client rather than the family about
advance directives. This is something that should be asked when the client is admitted to the
hospital, not after the client has been informed of his condition.
18. Which of following nursing diagnoses would the nurse include in the plan of care for an
elderly client with a pituitary adenoma?
Select all that apply.
1. Knowledge Deficit
2. Ineffective Coping
3. Risk for Injury
4. Disturbed Body Image
5. Ineffective Breathing Patterns
Answer: 1. Knowledge Deficit
2. Ineffective Coping
3. Risk for Injury
4. Disturbed Body Image
Rationale:
Knowledge Deficit. Clients will need instructions on the medications that may have to be
used to inhibit hormone production. Older patients may need simple but clear instructions on
the medications and the side effects. Ineffective Coping. Ineffective coping is appropriate
because the client may have a change in physical appearance that may be disheartening for
the client and lead to depression. Risk for Injury. Patients may experience difficulty with
vision, which places them at risk for injury. Disturbed Body Image. Clients may have a
disturbed body image because of the changes in physical appearance with this disorder.
Ineffective Breathing Patterns. Ineffective breathing patterns are not associated with this
disorder.
19. A client is concerned about passing on her endocrine disorder to her children. The nurse
responds by discussing which of the following significant promises for the future in
endocrinology?
Select all that apply.
1. Genetic etiology
2. Genetic counseling
3. Gene therapy

4. Genetic screening of infants
5. Immunizations
Answer: 1. Genetic etiology
2. Genetic counseling
3. Gene therapy
4. Genetic screening of infants
Rationale:
Genetic etiology. The field of genetics holds significant promise in endocrinology in the
future. Genetic counseling. The field of genetic counseling holds significant promise in
endocrinology in the future. Gene therapy. The field of gene therapy holds significant
promise in endocrinology in the future. Genetic screening of infants. The field of genetic
screening of infants holds significant promise in endocrinology in the future. Immunizations.
Immunizations have not been an aspect considered in the research on this topic.
20. The nurse is aware that advances have been made in the diagnosis and treatment of
endocrine disorders in recent years due to the development of:
Select all that apply.
1. New diagnostic imaging technologies.
2. An immunoassay test of hormones.
3. Improved laboratory techniques for genetic studies.
4. New synthetic hormones.
5. Hormone agonists.
Answer: 1. New diagnostic imaging technologies.
2. An immunoassay test of hormones.
3. Improved laboratory techniques for genetic studies.
4. New synthetic hormones.
5. Hormone agonists.
Rationale:
New diagnostic imaging technologies. Significant advances have been made in research in
the diagnosis and treatment of endocrine disorders in recent years due to the development of
new diagnostic imaging technologies. An immunoassay test of hormones. Significant
advances have been made in research in the diagnosis and treatment of endocrine disorders in
recent years due to the development of an immunoassay test of hormones. Improved
laboratory techniques for genetic studies. Significant advances have been made in research in
the diagnosis and treatment of endocrine disorders in recent years due to improved laboratory
techniques for genetic studies. New synthetic hormones. Significant advances have been

made in research in the diagnosis and treatment of endocrine disorders in recent years due to
the development of new synthetic hormones and hormone agonists. Hormone agonists.
Significant advances have been made in research in the diagnosis and treatment of endocrine
disorders in recent years due to the development of new synthetic hormones and hormone
agonists.
21. Which of the following advances offer hope for a cure in patient with endocrine
problems?
Select all that apply.
1. Biochemistry
2. Technology
3. Genetics
4. Pharmacology
5. Diet therapy
Answer: 1. Biochemistry
2. Technology
3. Genetics
4. Pharmacology
Rationale:
Biochemistry. Advances in biochemistry offer hope in the search for cures and care of the
patient with endocrine problems. Technology. Advances in technology offer hope in the
search for cures and care of the patient with endocrine problems. Genetics. Advances in
genetics offer hope in the search for cures and care of the patient with endocrine problems.
Pharmacology. Advances in pharmacology offer hope in the search for cures and care of the
patient with endocrine problems. Diet therapy. Diet therapy has not been associated with a
cure in this area.

Test Bank for Timby's Introductory Medical-Surgical Nursing
Loretta A Donnelly-Moreno, Brigitte Moseley
9781975172237, 9781975172268

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