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Which of the following actions should the nurse take first when caring for a patient who has just arrived on the unit after a thyroidectomy?
- A. Check the dressing for bleeding.
- B. Assess respiratory rate and effort.
- C. Take the blood pressure and pulse.
- D. Support the patient's head with pillows.
Correct Answer: B
Rationale: Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany, and the priority nursing action is to assess the airway. The other actions are also part of the standard nursing care post-thyroidectomy but are not as high in priority.
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The nurse is caring for a patient with a diagnosis of Cushing's syndrome. Which of the following data should the nurse anticipate finding during the admission assessment?
- A. Persistently low blood pressure
- B. Bronzed appearance of the skin
- C. Decreased axillary and pubic hair
- D. Purplish red streaks on the abdomen
Correct Answer: D
Rationale: Purplish-red striae on the abdomen are a common clinical manifestation of Cushing's syndrome. Hypotension and bronzed-appearing skin are manifestations of Addison's disease. Decreased axillary and pubic hair occur with androgen deficiency.
Which of the following information should the nurse include when teaching a patient about use of somatropin?
- A. The medication will improve vaginal dryness.
- B. Inject the medication subcutaneously every day.
- C. Blood glucose levels will decrease when taking the medication.
- D. Stop taking the medication if swelling of the hands or feet occurs.
Correct Answer: B
Rationale: Somatropin is injected subcutaneously on a daily basis, preferably in the evening. The patient will need to continue on somatropin for life. If swelling or other adverse effects occur, the health care provider should be notified. Growth hormone will increase blood glucose levels.
The nurse is admitting a patient to the hospital who is in an Addisonian crisis. Which of the following patient statements support the nursing diagnosis of ineffective self-health management related to lack of knowledge about management of Addison's disease?
- A. I double my dose of hydrocortisone on the days that I go for a run.
- B. I frequently eat at restaurants, and so my food has a lot of added salt.
- C. I had the stomach flu earlier this week and couldn't take the hydrocortisone.
- D. I take twice as much hydrocortisone in the morning as I do in the afternoon.
Correct Answer: C
Rationale: The need for hydrocortisone replacement is increased with stressors such as illness, and the patient needs to be taught to call the health care provider because medication and IV fluids and electrolytes may need to be given. The other patient statements indicate appropriate management of the Addison's disease.
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.
The nurse is caring for a patient with Cushing's syndrome who is admitted for an adrenalectomy. The patient has a nursing diagnosis of disturbed body image related to changes in appearance caused by the effects of the disease. Which of the following interventions is most helpful?
- A. Reassure the patient that the physical changes are very common in patients with Cushing's syndrome.
- B. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome.
- C. Teach the patient that most of the physical changes caused by Cushing's syndrome will resolve after surgery.
- D. Remind the patient that the metabolic impact of Cushing's syndrome is of more importance than appearance.
Correct Answer: C
Rationale: The most reassuring communication to the patient is that most of the physical and emotional changes caused by the Cushing's syndrome will resolve after hormone levels return to normal postoperatively. Reassurance that the physical changes are expected or that there are more serious physiological problems associated with Cushing's syndrome are not therapeutic responses. The patient's physiological changes are caused by the high hormone levels, not by the patient's diet or exercise choices.