Nokea
A patient is suspected of having a pituitary tumour causing panhypopituitarism. During assessment of the patient, which of the following findings should the nurse anticipate?
- A. High blood pressure
- B. Elevated blood glucose
- C. Tachycardia and cardiac palpitations
- D. Changes in secondary sex characteristics
Correct Answer: D
Rationale: Changes in secondary sex characteristics are associated with decreases in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is likely due to the decrease in thyroid-stimulating hormone (TSH) and thyroid hormones associated with panhypopituitarism.
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A few hours after returning to the surgical nursing unit, a patient who has undergone a subtotal thyroidectomy develops laryngeal stridor and a cramp in the right hand. Which of the following actions should the nurse anticipate implementing first?
- A. Infuse IV calcium gluconate.
- B. Suction the patient's airway.
- C. Prepare for endotracheal intubation.
- D. Assist with emergency tracheotomy
Correct Answer: A
Rationale: The patient's clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Endotracheal intubation or tracheotomy may be needed if the calcium does not resolve the stridor. Suctioning will not correct the stridor.
The nurse is admitting a patient with Graves' disease to the emergency department in thyrotoxic crisis. Which of these prescribed medications should the nurse administer first?
- A. Propranolol
- B. Propylthiouracil
- C. Methimazole
- D. Iodine
Correct Answer: A
Rationale: β-Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function.
The nurse is teaching a patient with persistent syndrome of inappropriate antidiuretic hormone (SIADH) about long-term management. Which of the following patient statements indicate that additional instruction is needed?
- A. I should weigh myself daily and report any sudden weight loss or gain.
- B. I need to limit my fluid intake to no more than 1 L of liquids a day.
- C. I will eat foods high in potassium because the diuretics cause potassium loss.
- D. I need to shop for foods that are low in sodium and avoid adding salt to foods.
Correct Answer: D
Rationale: Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred.
The nurse is caring for a patient who has had a transsphenoidal resection of a pituitary tumour. Which of the following nursing actions should be included in the postoperative plan of care?
- A. Monitor urine output every hour.
- B. Palpate extremities for dependent edema.
- C. Check hematocrit hourly for first 12 hours.
- D. Obtain continuous pulse oximetry for 24 hours.
Correct Answer: A
Rationale: After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema and 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. The patient is at risk for dehydration, not volume overload. The patient is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.
The nurse is caring for an older-adult patient who is diagnosed with hypothyroidism and has a prescription for levothyroxine. Which of the following assessments is most important for the nurse to make during initiation of thyroid replacement?
- A. Apical pulse rate
- B. Nutritional intake
- C. Intake and output
- D. Orientation and alertness
Correct Answer: A
Rationale: In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication is also expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes will not result in potentially life-threatening complications.