ENDOCRINE ASSESSMENT 2

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Q1. The nurse is assessing a client who has
been taking levothyroxine for two
months for hypothyroidism. Which
client statements should the nurse
report?
Select all that apply.

*

1 point

1. “I take my levothyroxine each morning with my coffee or a full glass of grapefruit juice.”

2. “I eat breakfast about 30-60 minutes after taking levothyroxine each morning"

3. “I will notify my healthcare provider immediately if I develop a sore throat/ fever"

4. “The extreme fatigue I was experiencing seems to be improving.”

5. “Each morning, I take levothyroxine, biotin, and a multivitamin.”

Required

Q2. A nurse is caring for a 1-month-old client who is being evaluated for congenital hypothyroidism. The nurse should recognize which of the following as clinical manifestations of hypothyroidism in infants? Select all that apply. *

1 point

1. Difficult to awaken

2. Dry skin

3. Frequent, loose stools

4. Hoarse cry

5. Tachycardia

Required

Q3. The nurse is assessing clients with potential hypothyroidism. Which client most likely has this condition?
*

1 point

A. Thin, anxious-appearing female with exophthalmos with rapid pulse and complaints of diarrhea.

B. Slightly obese, perspiring female who complains of feeling cold all the time with frequent diarrhea.

C. Thin, perspiring male with a hoarse voice, facial edema, and a thick tongue with complaints of diarrhea.

D. Slightly obese female with periorbital edema who complains of cold intolerance, brittle hair, and dry skin.

Q4. Which laboratory test should be assessed by the nurse prior to administering radioactive iodine (RAI) to a female client?
*

1 point

Option 1

1. Thyroid Scan

2. Serum calcium

3. Pregnancy test

4. Metanephrine test

Q5. A middle-aged man comes into the clinic for a check-up. His pulse is 49 beats per minute and the client reports that he has gained 20 pounds in the past two months. The nurse also notices that his skin is cool to touch and that he has three layers of clothing. The nurse suspects hypothyroidism. Which nursing diagnosis should be of the highest priority?
*

1 point

A. Fatigue

B. Activity intolerance

C. Hypothermia

D. Decreased cardiac output

Q6. The nurse is evaluating a client taking levothyroxine for hypothyroidism. Which findings indicate that the client is experiencing an adverse effect? Select all that apply.

*

1 point

A. Heat intolerance

B. Palpitations

C. Bradycardia

D. Constipation

E. Insomnia

F. Weight gain

Required

Q7. While preparing to discharge a 2-year-old newly diagnosed with hypothyroidism, you include which of the following educational points in your discharge teaching?
Select all that apply.

*

1 point

A. Take the thyroid medication at the same time each day.

B. Take the thyroid medication 30 minutes after breakfast.

C. Avoid taking the thyroid medication in the evening.

D. No follow-up labs are necessary

Required

Q8. A nurse is reinforcing teaching with a client who has been prescribed levothyroxine (Synthroid) to treat hypothyroidism. Which of the following should the nurse include in the teaching? (Select all that apply.)
*

1 point

A. Weight gain is expected while taking this medication.

B. Medication should not be discontinued without the advice of the provider.

C. Follow-up serum TSH levels should be obtained.

D. Take the medication on an empty stomach.

E. Use fiber laxatives for constipation.

Required

Q9. A nurse is completing a medication reconciliation for a client who is being transferred to the unit from the ICU and is to start taking propranolol. Which of the following findings in the medical history should the nurse report to the provider as a potential contraindication for taking the medication? *

1 point

A. The client has a history of hypothyroidism.

B. The client has a history of bronchial asthma.

C. The client has a history of tachycardia.

D. The client has a history of migraine headaches.

Q10. The nurse is educating a client with hypothyroidism on the prevention of myxedema coma. Which of the following statements made by the client indicates that teaching was NOT conducted effectively?

Select one:
*

1 point

1. "If I don’t treat hypothyroidism and leave it untreated it can lead to myxedema coma which is a life-threatening complication."

2. "Manifestations of myxedema coma include low blood glucose, low temperature, heart problems and eventually coma.”

3. "I can prevent myxedema coma as long as I take thyroid replacement medications only"

4. "I cannot take any opioid medications."

Q11. A client diagnosed with hypothyroidism has been taking levothyroxine in increasing doses over the past week. Which findings, if present, would indicate to the nurse that the drug dosage is too high?
Sata
*

1 point

1. Irritability

2. Weight gain

3. Tachycardia

4. Tremors

5. Headache

6. Bradycardia

Required

A12. An 80-year-old female arrives at the ED with a temperature of 94°F, blood pressure of 88/60 mmHg, heart rate of 52, respirations of 40/min, and oxygen saturation of 84%. She has a history of hypothyroidism but lives alone and does not remember taking her medication in the past 4 weeks. She appears lethargic. Which of the following is the appropriate initial nursing action? *

1 point

A. Prepare for endotracheal intubation.

B. Cover the client with a warming blanket.

C. Prepare to administer IV levothyroxine.

D. Send blood to the lab for a serum thyroid panel.

Q13. A nurse is assessing a client who has hypothyroidism and is receiving thyroid hormone replacement therapy. Which of the following findings should indicate to the nurse the need for a decrease in the medication dosage?
*

1 point

A. Hand tremors

B. Bradycardia

C. Pale skin

D. Slow speech

Q14. A client diagnosed with hypothyroidism has received dietary education from the nurse. Which snack selection chosen by the client would indicate that education has been successful?
*

1 point

1. Cup of almonds

2. Cheese and crackers

3. Popcorn

4. Sweet potato fries

Q15. The nurse is conducting teaching with a family whose newborn infant was diagnosed with hypothyroidism. Which point is important for the nurse to emphasize during the teaching?
*

1 point

1. Physical growth will be stunted.

2. Expect the child to be developmentally delayed.

3. Hormone replacement therapy will prevent complications.

4. This rare problem is always hereditary.

Q16. The nurse cautions the client with hypothyroidism to avoid which implementation?
*

1 point

1.Warm environmental temperatures.

2.Narcotic sedatives.

3.Increased physical exercise.

4.A diet high in fiber.

Q17. What side effects would the nurse expect to find in a client who has received too much levothyroxine?

SATA

1 point

1. Angina

2. Bradycardia

3. Hypotension

4. Heat intolerance

5. Tremors

Required

Q18. A nurse is caring for a client diagnosed with hypothyroidism. Which of the following is an indication of myxedema coma?
*

1 point

A. Hypocalcemia

B. Tachycardia

C. Tachypnea

D. Decreased body temperature

Q19. The nurse is caring for a client with hypothyroidism. Which dietary consideration is most important for the nurse to teach this client?
*

1 point

1. Increase carbohydrate intake.

2. Decrease fluid intake.

3. Avoid shellfish.

4. Increase fiber.

Q20. The nurse determines which action has highest priority when caring for the client diagnosed with hypoparathyroidism?

*

1 point

1. Develop a teaching plan.

2. Plan measures to deal with cardiac dysrhythmias.

3. Take measures to prevent a respiratory infection.

4. Assess laboratory results.

Q21. The nurse is caring for a client with hypocalcemia related to hypoparathyroidism. The nurse should anticipate which clinical manifestation in this client?
*

1 point

1. Facial twitching when area over cranial nerve VII is tapped

2. Decreased neuromuscular excitability

3. Decreased gastrointestinal activity and constipation

4. Bounding peripheral pulses in the lower extremities

Q22. Which type of foods does the nurse encourage for the client diagnosed with hypoparathyroidism?
*

1 point

1. Foods high in phosphorus.

2. Foods high in calcium.

3. Foods low in sodium.

4. Foods low in potassium.

Q23. The nurse is taking care of a client with hypoparathyroidism. The nurse understands that patients with hypoparathyroidism have a low serum calcium level. The nurse should be alert for the following signs and symptoms of hypocalcemia, except:
*

1 point

A. Kernig’s sign

B. Trousseau’s sign

C. Hyperactive deep tendon reflexes

D. Chvostek’s sign

Q24. The nurse is reviewing the diet of the patient with hypoparathyroidism. The nurse understands that the client should be on what type of diet?
*

1 point

A. High calorie, low calcium diet

B. Low calcium, low phosphorus diet

C. High phosphorus, low calcium diet

D. High calcium, low phosphorus diet

Q25. The nurse is caring for a client with hyperparathyroidism. The nurse will monitor the client for which complications? Select all that apply.
*

1 point

1. Kidney stones

2. Diarrhea

3. Osteoporosis

4. Tetany

5. Fluid volume deficit

Required

Q26. The nurse assesses a client who is diagnosed with hypoparathyroidism. Which data, if found in the client's medical history, are associated with the diagnosis of hypoparathyroidism? (Select all that apply.)
*

1 point

1. Carpal spasms.

2. History of convulsions.

3. Renal calculi.

4. Pathologic fractures.

5. Muscle irritability.

Required

Q27. A patient was admitted to the ER due to low serum calcium levels. Upon further examination, he demonstrates carpopedal spasms and reports numbness in his lips and hands. An ECG was taken and revealed a prolonged QT interval. Upon assessment of the client, the nurse should suspect which condition?
*

1 point

A. Hyperthyroidism

B. Hypothyroidism

C. Hyperparathyroidism

D. Hypoparathyroidism

Q28. What is priority for the client experiencing hyperparathyroid crisis? *

1 point

1. Support for airway and breathing.

2. Continuous cardiac monitoring for arrhythmias.

3. Provide safety precautions.

4. Prepare for emergency tracheostomy.

Q29. 15.The nurse is caring for a patient with a history of hyperparathyroidism who is complaining of nausea. Upon assessment, the nurse notes the patient is tachycardic, with a QT interval of 0.3 seconds and slight abdominal distention. What action should the nurse take first?
*

1 point

A. Encourage intake of vitamin D-rich foods

B. Notify MD

C. Hold patient’s scheduled furosemide

D. Assess for Chvostek’s sign

Q30.Which client is at greatest risk for hyperparathyroidism?

1 point

A. A 50-year-old female client

B. A 65-year-old female client

C. A 42-year-old male client

D. A male client over 60 years old

Q31. A nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which medication should the nurse prepare to administer as prescribed to the client?
*

1 point

1. Calcium chloride

2. Calcium gluconate

3. Calcitonin (Miacalcin)

4. Large doses of vitamin D

Q32. The nurse is caring for a school-aged child with a diagnosis of secondary hyperparathyroidism after treatment for chronic renal disease. Which serum lab data should receive priority attention by the nurse?
*

1 point

a. Osmolality and sodium

b. Blood urea nitrogen and magnesium

c. Calcium and phosphorus

d. Glucose and potassium

Q33. The nurse is caring for a patient that has just been diagnosed with primary hyperparathyroidism. With knowledge regarding this disease, the nurse should expect which laboratory value to be present?
*

1 point

A. Serum potassium level of 4.1 mEq/L

B. RBC of 5.2 x million/uL

C. Serum calcium level of 11.2 mg/dL

D. Serum sodium level of 120 mmol/L

Q34.The nurse is teaching a client with hyperparathyroidism how to manage the condition at home. Which response by the client indicates the need for additional teaching?
*

1 point

A. "I should consume less than 1 liter of fluid per day."

B. "I should use my treadmill or go for walks daily."

C. "I should follow a moderate-calcium, high-fiber diet."

D. "My alendronate helps keep calcium from coming out of my bones."

Q35. A nurse is teaching a wellness class to middle-age women. She instructs the women who are present that their risk of developing osteoporosis is increased if: *

1 point

A. They have a history of long-term steroid use

B. They have a history of hypoparathyroidism

C. They have taken excessive amounts of estrogen

D. They lift weights at a gym

Q36. The nurse assesses a client with hyperparathyroidism who had a parathyroidectomy 4 hours ago. Which assessment technique should the nurse use to check for complications in this client? *

1 point

1.Ask client to place backs of the hands against each other to provide hyperflexion of the wrist while the elbows remain flexed

2.Instruct client to lie down and run the heel of one foot down the shin of the other leg

3.Perform Romberg test by asking the client to stand with eyes closed and feet together

4.Place blood pressure (BP) cuff on arm, inflate to pressure > than systolic BP, and hold in place for 3 minutes

Q37. The nurse is preparing to administer Prednisone 5 mg to a client with Hyperparathyroidism. The nurse understands that Prednisone is given to the client because:
*

1 point

A. Prednisone increases the clients’ immune function

B. Prednisone increases the clients’ Vitamin D levels

C. Prednisone decreases GI absorption of calcium

D. Prednisone decreases the release of Calcium by the bones

Q38. A nurse in an intensive care unit is admitting a client who has myxedema coma. Which of the following should the nurse anticipate in caring for this client? (Select all that apply.) *

1 point

A. Observe cardiac monitor for inverted T wave.

B. Observe for evidence of urinary tract infection.

C. Initiate IV fluids using 0.9% sodium chloride.

D. Expect a prescription for levothyroxine (Synthroid) IV bolus.

E. Provide warmth using a heating pad.

Required

Q39. The nurse preceptor observes a newly hired nurse care for a client with a myxedema coma. It would require follow up by the nurse preceptor if the newly hired nurse is observed *

1 point

A. applying a cooling blanket to the client.

B. requesting a prescription for hydrocortisone.

C. removing the water pitcher from the bedside.

D. placing an oral endotracheal tube at the bedside.

Q40. A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action should the nurse prepare to carry out initially?
*

1 point

A. Warm the client.

B. Maintain a patent airway.

C. Administer thyroid hormone.

D. Administer fluid replacement

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