Chapter 19 Nursing Care of Patients with
Endocrine Disorders
While assessing a patient with an alteration in thyroid function, the nurse notes smooth, fine
hair and warm, dry skin. Which question should the nurse ask this patient?
1. "Have you experienced any recent weight loss?"
2. "Have you been feeling constipated?"
3. "Have you noticed increased bruising?"
4. "Have you noticed a change in your skin color?" - correct answer-Answer: 1
Explanation: 1. The patient with hyperthyroidism can present with dry, warm skin, and the
hair may become fine. Weight loss is another symptom of hyperthyroidism.
2. Constipation is a symptom of hypothyroidism or hyperparathyroidism. Dry, warm skin and
hair that becomes fine are associated with another disorder.
3. Increased bruising is a sign of Cushing syndrome. Dry, warm skin and hair that becomes
fine are associated with another disorder.
4. A change in skin color is a sign of Addison disease. Dry, warm skin and hair that becomes
fine are associated with another disorder.
Page Ref: 566
A patient recovering from a head injury is diagnosed with syndrome of inappropriate
antidiuretic hormone (SIADH). Which should the nurse expect to be prescribed for this
patient? Select all that apply.
1. Restrict fluids.
2. Increase oral fluids.
3. Provide a loop diuretic.
4. Administer Conivaptan.
5. Administer demeclocycline. - correct answer-Answer: 1, 3, 4, 5
Explanation: 1. Fluid intake is restricted to gradually reduce total body water.
2. Increasing fluids will exacerbate hyponatremia in SIADH.
3. Loop diuretics such as furosemide are used to decrease fluid volume.
4. Vasopressin receptor antagonist, such as Conivaptan, is used to correct hyponatremia.
5. Demeclocycline is a tetracycline antibiotic that suppresses ADH activity, resulting in
increased urine production.
Page Ref: 590
The nurse is providing preoperative teaching to a patient scheduled for a subtotal
thyroidectomy. What should the nurse include in these instructions?
1. Report sensations of tingling in toes, fingers, or lips.
2. Report signs of constipation.
3. Report the improvement of hoarseness.
4. Take aspirin before the surgery. - correct answer-Answer: 1
Explanation: 1. Hypoparathyroidism may result from manipulation of the parathyroid glands
during a subtotal thyroidectomy. The lack of circulating parathyroid hormone (PTH) causes
hypocalcemia. Neuromuscular manifestations that result from hypocalcemia include
numbness and tingling around the mouth and in the fingertips.
,2. Hypoparathyroidism may result from manipulation of the parathyroid glands during a
subtotal thyroidectomy. The lack of circulating PTH causes hypocalcemia. Constipation is
associated with hypercalcemia, not hypocalcemia.
3. The improvement of hoarseness would be desired.
4. Antiplatelet agents, such as aspirin, should be withheld prior to surgery.
Page Ref: 570
A patient with hypothyroidism is prescribed levothyroxine sodium (Synthroid). What dietary
adjustment should the nurse instruct the patient to make? Select all that apply.
1. Avoid eating walnuts.
2. Avoid all grapefruit or citrus fruits.
3. Restrict the intake of foods high in fiber.
4. Reduce the intake of green leafy vegetables.
5. Take the medication 30 minutes before eating breakfast in the morning. - correct
answer-Answer: 1, 3, 5
Explanation: 1. The patient should be instructed to avoid excessive intake of foods that are
known to inhibit thyroid hormone utilization, such as walnuts.
2. There is no reason for the patient to avoid grapefruit or other citrus fruits.
3. The patient should be instructed to avoid excessive intake of foods that are known to
inhibit thyroid hormone utilization, such as high-fiber foods.
4. There is no reason for the patient to limit the intake of green leafy vegetables.
5. The patient should be instructed to take the thyroid preparation in the morning 30 minutes
before eating to reduce the possibility of insomnia.
Page Ref: 576
The nurse is caring for a patient with elevated serum T3 and T4 levels who receives a new
prescription for methimazole (Tapazole). Which patient statement indicates that additional
teaching is needed about this medication?
1. "This medication will increase my metabolism."
2. "I must contact my physician if I plan to become pregnant."
3. "It may take several weeks for this medication to take effect."
4. "I may take a beta-blocker along with this medication." - correct answer-Answer: 1
Explanation: 1. Hyperthyroidism is treated by administering methimazole or PTU,
medications that reduce TH production, thereby decreasing metabolism.
2. Methimazole crosses the placenta and cannot be taken during pregnancy.
3. Antithyroid medications inhibit thyroid hormone production but have no effect on
already-produced and circulating thyroid hormone. It can take several weeks for the patient
to experience the effects.
4. To rapidly reduce the cardiovascular symptoms associated with hyperthyroidism,
propranolol (Inderal) or esmolol, a rapid-acting parenteral beta-blocker, may be used along
with methimazole.
Page Ref: 569
A patient with Addison disease is experiencing problems with fluid balance. What actions
should the nurse take to help this patient? Select all that apply.
1. Teach to sit and stand slowly.
2. Monitor cardiac monitor rhythm.
3. Turn and reposition every 2 hours while awake.
, 4. Weigh the patient daily at the same time and in the same clothing.
5. Encourage oral fluid intake of 3000 mL/day and increased salt intake. - correct
answer-Answer: 1, 2, 4, 5
Explanation: 1. The nurse should teach the patient to sit and stand slowly, and provide
assistance as necessary. Extracellular fluid volume deficit causes orthostatic hypotension,
dizziness, and possible loss of consciousness. These manifestations increase the risk of
injury from falls.
2. A drop in aldosterone levels can reduce renal excretion of potassium, leading to increased
blood levels and the potential for cardiac dysrhythmias.
3. Turning and repositioning would be beneficial to maintain skin integrity, not to address a
fluid imbalance.
4. The nurse should weigh the patient daily at the same time and in the same clothing
because dehydration is manifested by weight loss.
5. The nurse should encourage an oral fluid intake of 3000 mL/day and an increased salt
intake. Cortisol deficiency increases fluid loss, leading to extracellular fluid volume depletion.
Oral fluid replacement is necessary to balance this loss. An increase in dietary sodium can
reduce the hyponatremia characteristic of adrenal insufficiency.
Page Ref: 586-587
The nurse is reviewing postoperative care for a patient scheduled for a thyroidectomy. What
information should the nurse include in this teaching?
1. "Avoid the use of iodized salt after your procedure."
2. "Plastic surgery may be required to conceal the surgical scar."
3. "Use iodized salt when preparing foods."
4. "Perform neck flexion and extension exercises twice daily for several weeks
postoperatively." - correct answer-Answer: 1
Explanation: 1. The nurse anticipates that the patient who has a thyroidectomy will require a
lifelong prescription for a thyroid preparation. Iodized salt and iodine preparations should not
be taken with thyroid preparations.
2. Typically the scar fades to a small line, so plastic surgery is not needed.
3. Iodized salt and iodine preparations should not be taken with thyroid preparations.
4. The patient is instructed to support the neck by placing both hands behind the neck when
sitting up in bed, while moving about, and while coughing. Neck extension would place
stress on the suture line.
Page Ref: 576
The nurse in the postanesthesia care area is concerned that a patient recovering from a
subtotal thyroidectomy is experiencing postoperative complications. What finding led the
nurse to come to this conclusion? Select all that apply.
1. Hoarse voice
2. Restlessness and irritability
3. Blood pressure 92/56 mmHg
4. Heart rate 116 beats per minute
5. High-pitched, squeaky sound with breathing - correct answer-Answer: 3, 4, 5
Explanation: 1. Hoarseness is expected immediately after a subtotal thyroidectomy. It is too
soon to suspect laryngeal nerve damage in this patient.
2. Restlessness and irritability are vague symptoms that could result from the anesthesia,
the surgical procedure, or recovery. This is not considered a postoperative complication.
Endocrine Disorders
While assessing a patient with an alteration in thyroid function, the nurse notes smooth, fine
hair and warm, dry skin. Which question should the nurse ask this patient?
1. "Have you experienced any recent weight loss?"
2. "Have you been feeling constipated?"
3. "Have you noticed increased bruising?"
4. "Have you noticed a change in your skin color?" - correct answer-Answer: 1
Explanation: 1. The patient with hyperthyroidism can present with dry, warm skin, and the
hair may become fine. Weight loss is another symptom of hyperthyroidism.
2. Constipation is a symptom of hypothyroidism or hyperparathyroidism. Dry, warm skin and
hair that becomes fine are associated with another disorder.
3. Increased bruising is a sign of Cushing syndrome. Dry, warm skin and hair that becomes
fine are associated with another disorder.
4. A change in skin color is a sign of Addison disease. Dry, warm skin and hair that becomes
fine are associated with another disorder.
Page Ref: 566
A patient recovering from a head injury is diagnosed with syndrome of inappropriate
antidiuretic hormone (SIADH). Which should the nurse expect to be prescribed for this
patient? Select all that apply.
1. Restrict fluids.
2. Increase oral fluids.
3. Provide a loop diuretic.
4. Administer Conivaptan.
5. Administer demeclocycline. - correct answer-Answer: 1, 3, 4, 5
Explanation: 1. Fluid intake is restricted to gradually reduce total body water.
2. Increasing fluids will exacerbate hyponatremia in SIADH.
3. Loop diuretics such as furosemide are used to decrease fluid volume.
4. Vasopressin receptor antagonist, such as Conivaptan, is used to correct hyponatremia.
5. Demeclocycline is a tetracycline antibiotic that suppresses ADH activity, resulting in
increased urine production.
Page Ref: 590
The nurse is providing preoperative teaching to a patient scheduled for a subtotal
thyroidectomy. What should the nurse include in these instructions?
1. Report sensations of tingling in toes, fingers, or lips.
2. Report signs of constipation.
3. Report the improvement of hoarseness.
4. Take aspirin before the surgery. - correct answer-Answer: 1
Explanation: 1. Hypoparathyroidism may result from manipulation of the parathyroid glands
during a subtotal thyroidectomy. The lack of circulating parathyroid hormone (PTH) causes
hypocalcemia. Neuromuscular manifestations that result from hypocalcemia include
numbness and tingling around the mouth and in the fingertips.
,2. Hypoparathyroidism may result from manipulation of the parathyroid glands during a
subtotal thyroidectomy. The lack of circulating PTH causes hypocalcemia. Constipation is
associated with hypercalcemia, not hypocalcemia.
3. The improvement of hoarseness would be desired.
4. Antiplatelet agents, such as aspirin, should be withheld prior to surgery.
Page Ref: 570
A patient with hypothyroidism is prescribed levothyroxine sodium (Synthroid). What dietary
adjustment should the nurse instruct the patient to make? Select all that apply.
1. Avoid eating walnuts.
2. Avoid all grapefruit or citrus fruits.
3. Restrict the intake of foods high in fiber.
4. Reduce the intake of green leafy vegetables.
5. Take the medication 30 minutes before eating breakfast in the morning. - correct
answer-Answer: 1, 3, 5
Explanation: 1. The patient should be instructed to avoid excessive intake of foods that are
known to inhibit thyroid hormone utilization, such as walnuts.
2. There is no reason for the patient to avoid grapefruit or other citrus fruits.
3. The patient should be instructed to avoid excessive intake of foods that are known to
inhibit thyroid hormone utilization, such as high-fiber foods.
4. There is no reason for the patient to limit the intake of green leafy vegetables.
5. The patient should be instructed to take the thyroid preparation in the morning 30 minutes
before eating to reduce the possibility of insomnia.
Page Ref: 576
The nurse is caring for a patient with elevated serum T3 and T4 levels who receives a new
prescription for methimazole (Tapazole). Which patient statement indicates that additional
teaching is needed about this medication?
1. "This medication will increase my metabolism."
2. "I must contact my physician if I plan to become pregnant."
3. "It may take several weeks for this medication to take effect."
4. "I may take a beta-blocker along with this medication." - correct answer-Answer: 1
Explanation: 1. Hyperthyroidism is treated by administering methimazole or PTU,
medications that reduce TH production, thereby decreasing metabolism.
2. Methimazole crosses the placenta and cannot be taken during pregnancy.
3. Antithyroid medications inhibit thyroid hormone production but have no effect on
already-produced and circulating thyroid hormone. It can take several weeks for the patient
to experience the effects.
4. To rapidly reduce the cardiovascular symptoms associated with hyperthyroidism,
propranolol (Inderal) or esmolol, a rapid-acting parenteral beta-blocker, may be used along
with methimazole.
Page Ref: 569
A patient with Addison disease is experiencing problems with fluid balance. What actions
should the nurse take to help this patient? Select all that apply.
1. Teach to sit and stand slowly.
2. Monitor cardiac monitor rhythm.
3. Turn and reposition every 2 hours while awake.
, 4. Weigh the patient daily at the same time and in the same clothing.
5. Encourage oral fluid intake of 3000 mL/day and increased salt intake. - correct
answer-Answer: 1, 2, 4, 5
Explanation: 1. The nurse should teach the patient to sit and stand slowly, and provide
assistance as necessary. Extracellular fluid volume deficit causes orthostatic hypotension,
dizziness, and possible loss of consciousness. These manifestations increase the risk of
injury from falls.
2. A drop in aldosterone levels can reduce renal excretion of potassium, leading to increased
blood levels and the potential for cardiac dysrhythmias.
3. Turning and repositioning would be beneficial to maintain skin integrity, not to address a
fluid imbalance.
4. The nurse should weigh the patient daily at the same time and in the same clothing
because dehydration is manifested by weight loss.
5. The nurse should encourage an oral fluid intake of 3000 mL/day and an increased salt
intake. Cortisol deficiency increases fluid loss, leading to extracellular fluid volume depletion.
Oral fluid replacement is necessary to balance this loss. An increase in dietary sodium can
reduce the hyponatremia characteristic of adrenal insufficiency.
Page Ref: 586-587
The nurse is reviewing postoperative care for a patient scheduled for a thyroidectomy. What
information should the nurse include in this teaching?
1. "Avoid the use of iodized salt after your procedure."
2. "Plastic surgery may be required to conceal the surgical scar."
3. "Use iodized salt when preparing foods."
4. "Perform neck flexion and extension exercises twice daily for several weeks
postoperatively." - correct answer-Answer: 1
Explanation: 1. The nurse anticipates that the patient who has a thyroidectomy will require a
lifelong prescription for a thyroid preparation. Iodized salt and iodine preparations should not
be taken with thyroid preparations.
2. Typically the scar fades to a small line, so plastic surgery is not needed.
3. Iodized salt and iodine preparations should not be taken with thyroid preparations.
4. The patient is instructed to support the neck by placing both hands behind the neck when
sitting up in bed, while moving about, and while coughing. Neck extension would place
stress on the suture line.
Page Ref: 576
The nurse in the postanesthesia care area is concerned that a patient recovering from a
subtotal thyroidectomy is experiencing postoperative complications. What finding led the
nurse to come to this conclusion? Select all that apply.
1. Hoarse voice
2. Restlessness and irritability
3. Blood pressure 92/56 mmHg
4. Heart rate 116 beats per minute
5. High-pitched, squeaky sound with breathing - correct answer-Answer: 3, 4, 5
Explanation: 1. Hoarseness is expected immediately after a subtotal thyroidectomy. It is too
soon to suspect laryngeal nerve damage in this patient.
2. Restlessness and irritability are vague symptoms that could result from the anesthesia,
the surgical procedure, or recovery. This is not considered a postoperative complication.
