Chapter 45: Assessment and
Management of Patients with Endocrine
Disorders
1. A client has been admitted to the postsurgical unit following a thyroidectomy. To promote
comfort and safety, how should the nurse best position the client?
A. Side-lying with one pillow under the head
B. Head of the bed elevated 30 degrees and no pillows placed under the head
C. Semi-Fowler with the head supported on two pillows
D. Supine, with a small roll supporting the neck - correct answer-ANS: C
Rationale: When moving and turning the client, the nurse carefully supports the client's head
and avoids tension on the sutures. The most comfortable position is the semi-Fowler
position, with the head elevated and supported by pillows.
2. A client with thyroid cancer has undergone surgery and a significant amount of
parathyroid tissue has been removed. The nurse caring for the client should prioritize what
question when addressing potential complications?
A. "Do you feel any muscle twitches or spasms?"
B. "Do you feel flushed or sweaty?"
C. "Are you experiencing any dizziness or lightheadedness?"
D. "Are you having any pain that seems to be radiating from your bones?" - correct
answer-ANS: A
Rationale: As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms
of the hands and feet and muscle twitching. This is characteristic of hypoparathyroidism.
Flushing, diaphoresis, dizziness, and pain are atypical signs of the resulting hypocalcemia.
3. The nurse is caring for a client with a diagnosis of Addison disease. What sign or
symptom is most closely associated with this health problem?
A. Truncal obesity
B. Hypertension
C. Muscle weakness
D. Moon face - correct answer-ANS: C
Rationale: Clients with Addison disease demonstrate muscular weakness, anorexia,
gastrointestinal symptoms, fatigue, emaciation, dark pigmentation of the skin, and
hypotension. Clients with Cushing syndrome demonstrate truncal obesity, "moon" face,
acne, abdominal striae, and hypertension.
4. The nurse is caring for a client with Addison disease who is scheduled for discharge.
When teaching the client about hormone replacement therapy, the nurse should address
what topic?
A. The possibility of precipitous weight gain
, B. The need for lifelong steroid replacement
C. The need to match the daily steroid dose to immediate symptoms
D. The importance of monitoring liver function - correct answer-ANS: B
Rationale: Because of the need for lifelong replacement of adrenal cortex hormones to
prevent addisonian crises, the client and family members receive explicit education about
the rationale for replacement therapy and proper dosage. Doses are not adjusted on a
short-term basis. Weight gain and hepatotoxicity are not common adverse effects.
5. A client is prescribed corticosteroid therapy. What would be priority information for the
nurse to give the client who is prescribed long-term corticosteroid therapy?
A. The client's diet should be low protein with ample fat.
B. The client may experience short-term changes in cognition.
C. The client is at an increased risk for developing infection.
D. The client is at a decreased risk for development of thrombophlebitis and
thromboembolism. - correct answer-ANS: C
Rationale: The client is at increased risk of infection and masking of signs of infection. The
cardiovascular effects of corticosteroid therapy may result in development of
thrombophlebitis or thromboembolism. The diet should be high in protein with limited fat.
Changes in appearance usually disappear when therapy is no longer necessary. Cognitive
changes are not common adverse effects.
6. A nurse caring for a client with diabetes insipidus is reviewing laboratory results. What is
an expected urinalysis finding?
A. Glucose in the urine
B. Albumin in the urine
C. Highly dilute urine
D. Leukocytes in the urine - correct answer-ANS: C
Rationale: Clients with diabetes insipidus produce an enormous daily output of very dilute,
water-like urine with a specific gravity of 1.001 to 1.005. The urine contains no abnormal
substances such as glucose or albumin. Leukocytes in the urine are not related to the
condition of diabetes insipidus, but if present would indicate a urinary tract infection.
7. The nurse caring for a client with Cushing syndrome is describing the dexamethasone
suppression test scheduled for tomorrow. What does the nurse explain that this test will
involve?
A. Administration of dexamethasone orally, followed by a plasma cortisol level every hour for
3 hours
B. Administration of dexamethasone IV, followed by an x-ray of the adrenal glands
C. Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the
next morning
D. Administration of dexamethasone intravenously, followed by a plasma cortisol level 3
hours after the drug is given - correct answer-ANS: C
Rationale: Dexamethasone (1 mg) is given orally at 11 PM, and a plasma cortisol level is
obtained at 8 AM the next morning. This test can be performed on an outpatient basis and is
Management of Patients with Endocrine
Disorders
1. A client has been admitted to the postsurgical unit following a thyroidectomy. To promote
comfort and safety, how should the nurse best position the client?
A. Side-lying with one pillow under the head
B. Head of the bed elevated 30 degrees and no pillows placed under the head
C. Semi-Fowler with the head supported on two pillows
D. Supine, with a small roll supporting the neck - correct answer-ANS: C
Rationale: When moving and turning the client, the nurse carefully supports the client's head
and avoids tension on the sutures. The most comfortable position is the semi-Fowler
position, with the head elevated and supported by pillows.
2. A client with thyroid cancer has undergone surgery and a significant amount of
parathyroid tissue has been removed. The nurse caring for the client should prioritize what
question when addressing potential complications?
A. "Do you feel any muscle twitches or spasms?"
B. "Do you feel flushed or sweaty?"
C. "Are you experiencing any dizziness or lightheadedness?"
D. "Are you having any pain that seems to be radiating from your bones?" - correct
answer-ANS: A
Rationale: As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms
of the hands and feet and muscle twitching. This is characteristic of hypoparathyroidism.
Flushing, diaphoresis, dizziness, and pain are atypical signs of the resulting hypocalcemia.
3. The nurse is caring for a client with a diagnosis of Addison disease. What sign or
symptom is most closely associated with this health problem?
A. Truncal obesity
B. Hypertension
C. Muscle weakness
D. Moon face - correct answer-ANS: C
Rationale: Clients with Addison disease demonstrate muscular weakness, anorexia,
gastrointestinal symptoms, fatigue, emaciation, dark pigmentation of the skin, and
hypotension. Clients with Cushing syndrome demonstrate truncal obesity, "moon" face,
acne, abdominal striae, and hypertension.
4. The nurse is caring for a client with Addison disease who is scheduled for discharge.
When teaching the client about hormone replacement therapy, the nurse should address
what topic?
A. The possibility of precipitous weight gain
, B. The need for lifelong steroid replacement
C. The need to match the daily steroid dose to immediate symptoms
D. The importance of monitoring liver function - correct answer-ANS: B
Rationale: Because of the need for lifelong replacement of adrenal cortex hormones to
prevent addisonian crises, the client and family members receive explicit education about
the rationale for replacement therapy and proper dosage. Doses are not adjusted on a
short-term basis. Weight gain and hepatotoxicity are not common adverse effects.
5. A client is prescribed corticosteroid therapy. What would be priority information for the
nurse to give the client who is prescribed long-term corticosteroid therapy?
A. The client's diet should be low protein with ample fat.
B. The client may experience short-term changes in cognition.
C. The client is at an increased risk for developing infection.
D. The client is at a decreased risk for development of thrombophlebitis and
thromboembolism. - correct answer-ANS: C
Rationale: The client is at increased risk of infection and masking of signs of infection. The
cardiovascular effects of corticosteroid therapy may result in development of
thrombophlebitis or thromboembolism. The diet should be high in protein with limited fat.
Changes in appearance usually disappear when therapy is no longer necessary. Cognitive
changes are not common adverse effects.
6. A nurse caring for a client with diabetes insipidus is reviewing laboratory results. What is
an expected urinalysis finding?
A. Glucose in the urine
B. Albumin in the urine
C. Highly dilute urine
D. Leukocytes in the urine - correct answer-ANS: C
Rationale: Clients with diabetes insipidus produce an enormous daily output of very dilute,
water-like urine with a specific gravity of 1.001 to 1.005. The urine contains no abnormal
substances such as glucose or albumin. Leukocytes in the urine are not related to the
condition of diabetes insipidus, but if present would indicate a urinary tract infection.
7. The nurse caring for a client with Cushing syndrome is describing the dexamethasone
suppression test scheduled for tomorrow. What does the nurse explain that this test will
involve?
A. Administration of dexamethasone orally, followed by a plasma cortisol level every hour for
3 hours
B. Administration of dexamethasone IV, followed by an x-ray of the adrenal glands
C. Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the
next morning
D. Administration of dexamethasone intravenously, followed by a plasma cortisol level 3
hours after the drug is given - correct answer-ANS: C
Rationale: Dexamethasone (1 mg) is given orally at 11 PM, and a plasma cortisol level is
obtained at 8 AM the next morning. This test can be performed on an outpatient basis and is
