Lewis's Medical Surgical Nursing Test Bank 11th Edition [Harding]
Chapter 49 - Endocrine Problems
1. A 45-year-old male patient with suspected acromegaly is seen at the clinic. To
assist in making the diagnosis, which question should the nurse ask?
A. Have you had a recent head injury?
B. Do you have to wear larger shoes now?
C. Is there a family history of acromegaly?
D. Are you experiencing tremors or anxiety?
Answer: B
Explanation: Acromegaly causes an enlargement of the hands and feet due to excessive
growth hormone. Asking about increased shoe size directly relates to this characteristic
change. Head injury and family history are not risk factors, and tremors or anxiety are not
typical manifestations.
2. A 42-year-old female patient is scheduled for transsphenoidal hypophysectomy
to treat a pituitary adenoma. During preoperative teaching, the nurse instructs
the patient about the need to
A. cough and deep breathe every 2 hours postoperatively.
B. remain on bed rest for the first 48 hours after the surgery.
C. avoid brushing teeth for at least 10 days after the surgery.
D. be positioned flat with sandbags at the head postoperatively.
Answer: C
Explanation: Avoiding tooth brushing for about 10 days helps prevent disruption of the
surgical suture line in the mouth or nose, reducing the risk of cerebrospinal fluid leak or
infection. Coughing is discouraged, bed rest is not required, and the head of the bed is
elevated, not flat.
3. The nurse is planning postoperative care for a patient who is being admitted to
the surgical unit form the recovery room after transsphenoidal resection of a
pituitary tumor. Which nursing action should be included?
A. Palpate extremities for edema.
B. Measure urine volume every hour.
C. Check hematocrit every 2 hours for 8 hours.
D. Monitor continuous pulse oximetry for 24 hours.
Answer: B
,Explanation: Hourly urine measurement is essential after pituitary surgery to monitor for
diabetes insipidus, a potential complication caused by decreased antidiuretic hormone.
Edema, hematocrit changes, and continuous pulse oximetry are not standard priorities for this
procedure.
4. The nurse is assessing a 41-year-old African American male patient diagnosed
with a pituitary tumor causing panhypopituitarism. Assessment findings
consistent with panhypopituitarism include
A. high blood pressure.
B. decreased facial hair.
C. elevated blood glucose.
D. tachycardia and cardiac palpitations.
Answer: B
Explanation: Panhypopituitarism involves deficiencies in multiple pituitary hormones.
Decreased facial hair results from reduced follicle-stimulating hormone and luteinizing
hormone, affecting secondary sex characteristics. Hypotension, hypoglycemia, and
bradycardia are more likely than hypertension, hyperglycemia, or tachycardia.
5. Which information will the nurse include when teaching a 50-year-old male
patient about somatropin (Genotropin)?
A. The medication will be needed for 3 to 6 months.
B. Inject the medication subcutaneously every day.
C. Blood glucose levels may decrease when taking the medication.
D. Stop taking the medication if swelling of the hands or feet occurs.
Answer: B
Explanation: Somatropin is a growth hormone replacement administered by daily
subcutaneous injection, often in the evening. Treatment is typically lifelong, not short-term. It
may increase blood glucose, and swelling should be reported, not used as a reason to stop the
medication without consulting a provider.
6. The nurse determines that demeclocycline (Declomycin) is effective for a patient
with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding
that the patients
A. weight has increased.
B. urinary output is increased.
C. peripheral edema is decreased.
D. urine specific gravity is increased.
Answer: B
,Explanation: Demeclocycline blocks the action of ADH in the kidneys, promoting water
excretion and increasing urine output. This indicates effectiveness in counteracting SIADH.
Weight gain, decreased urine output, or high specific gravity would suggest ongoing fluid
retention.
7. The nurse determines that additional instruction is needed for a 60-year-old
patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH)
when the patient says which of the following?
A. I need to shop for foods low in sodium and avoid adding salt to food.
B. I should weigh myself daily and report any sudden weight loss or gain.
C. I need to limit my fluid intake to no more than 1 quart of liquids a day.
D. I will eat foods high in potassium because diuretics cause potassium loss.
Answer: A
Explanation: Patients with SIADH are at risk for hyponatremia and may require sodium
supplementation, not restriction. The other statements show correct understanding of daily
weight monitoring, fluid restriction, and potassium intake if on certain diuretics.
8. A 56-year-old patient who is disoriented and reports a headache and muscle
cramps is hospitalized with possible syndrome of inappropriate antidiuretic
hormone (SIADH). The nurse would expect the initial laboratory results to
include a(n)
A. elevated hematocrit.
B. decreased serum sodium.
C. low urine specific gravity.
D. increased serum chloride.
Answer: B
Explanation: SIADH causes water retention and dilutional hyponatremia, leading to
symptoms like disorientation, headache, and cramps. Hematocrit is typically decreased due to
hemodilution, urine specific gravity is high, and chloride levels usually decrease with
sodium.
9. An expected nursing diagnosis for a 30-year-old patient admitted to the hospital
with symptoms of diabetes insipidus is
A. excess fluid volume related to intake greater than output.
B. impaired gas exchange related to fluid retention in lungs.
C. sleep pattern disturbance related to frequent waking to void.
D. risk for impaired skin integrity related to generalized edema.
Answer: C
, Explanation: Diabetes insipidus causes polyuria and nocturia, disrupting sleep. Fluid volume
deficit, not excess, is the primary concern. Edema and fluid retention in the lungs are not
associated with this condition.
10. Which information will the nurse teach a 48-year-old patient who has been
newly diagnosed with Graves disease?
A. Exercise is contraindicated to avoid increasing metabolic rate.
B. Restriction of iodine intake is needed to reduce thyroid activity.
C. Antithyroid medications may take several months for full effect.
D. Surgery will eventually be required to remove the thyroid gland.
Answer: C
Explanation: Antithyroid medications like methimazole or propylthiouracil can take 2–3
months to fully control thyroid hormone levels. Exercise is encouraged, iodine restriction is
not standard, and radioactive iodine is more common than surgery for definitive treatment.
11. A patient who had a subtotal thyroidectomy earlier today develops laryngeal
stridor and a cramp in the right hand upon returning to the surgical nursing
unit. Which collaborative action will the nurse anticipate next?
A. Suction the patients airway.
B. Administer IV calcium gluconate.
C. Plan for emergency tracheostomy.
D. Prepare for endotracheal intubation.
Answer: B
Explanation: Stridor and hand cramping suggest hypocalcemia and tetany due to parathyroid
gland injury during thyroid surgery. IV calcium gluconate is the immediate treatment. Airway
interventions may follow if calcium does not relieve stridor. Suctioning alone is ineffective.
12. Which nursing action will be included in the plan of care for a 55-year-old
patient with Graves disease who has exophthalmos?
A. Place cold packs on the eyes to relieve pain and swelling.
B. Elevate the head of the patients bed to reduce periorbital fluid.
C. Apply alternating eye patches to protect the corneas from irritation.
D. Teach the patient to blink every few seconds to lubricate the corneas.
Answer: B
Explanation: Elevating the head of the bed promotes fluid drainage from the periorbital area,
reducing edema. Patients with exophthalmos may not blink fully; artificial tears and eye
protection are used. Cold packs and eye patches are not standard interventions.
Chapter 49 - Endocrine Problems
1. A 45-year-old male patient with suspected acromegaly is seen at the clinic. To
assist in making the diagnosis, which question should the nurse ask?
A. Have you had a recent head injury?
B. Do you have to wear larger shoes now?
C. Is there a family history of acromegaly?
D. Are you experiencing tremors or anxiety?
Answer: B
Explanation: Acromegaly causes an enlargement of the hands and feet due to excessive
growth hormone. Asking about increased shoe size directly relates to this characteristic
change. Head injury and family history are not risk factors, and tremors or anxiety are not
typical manifestations.
2. A 42-year-old female patient is scheduled for transsphenoidal hypophysectomy
to treat a pituitary adenoma. During preoperative teaching, the nurse instructs
the patient about the need to
A. cough and deep breathe every 2 hours postoperatively.
B. remain on bed rest for the first 48 hours after the surgery.
C. avoid brushing teeth for at least 10 days after the surgery.
D. be positioned flat with sandbags at the head postoperatively.
Answer: C
Explanation: Avoiding tooth brushing for about 10 days helps prevent disruption of the
surgical suture line in the mouth or nose, reducing the risk of cerebrospinal fluid leak or
infection. Coughing is discouraged, bed rest is not required, and the head of the bed is
elevated, not flat.
3. The nurse is planning postoperative care for a patient who is being admitted to
the surgical unit form the recovery room after transsphenoidal resection of a
pituitary tumor. Which nursing action should be included?
A. Palpate extremities for edema.
B. Measure urine volume every hour.
C. Check hematocrit every 2 hours for 8 hours.
D. Monitor continuous pulse oximetry for 24 hours.
Answer: B
,Explanation: Hourly urine measurement is essential after pituitary surgery to monitor for
diabetes insipidus, a potential complication caused by decreased antidiuretic hormone.
Edema, hematocrit changes, and continuous pulse oximetry are not standard priorities for this
procedure.
4. The nurse is assessing a 41-year-old African American male patient diagnosed
with a pituitary tumor causing panhypopituitarism. Assessment findings
consistent with panhypopituitarism include
A. high blood pressure.
B. decreased facial hair.
C. elevated blood glucose.
D. tachycardia and cardiac palpitations.
Answer: B
Explanation: Panhypopituitarism involves deficiencies in multiple pituitary hormones.
Decreased facial hair results from reduced follicle-stimulating hormone and luteinizing
hormone, affecting secondary sex characteristics. Hypotension, hypoglycemia, and
bradycardia are more likely than hypertension, hyperglycemia, or tachycardia.
5. Which information will the nurse include when teaching a 50-year-old male
patient about somatropin (Genotropin)?
A. The medication will be needed for 3 to 6 months.
B. Inject the medication subcutaneously every day.
C. Blood glucose levels may decrease when taking the medication.
D. Stop taking the medication if swelling of the hands or feet occurs.
Answer: B
Explanation: Somatropin is a growth hormone replacement administered by daily
subcutaneous injection, often in the evening. Treatment is typically lifelong, not short-term. It
may increase blood glucose, and swelling should be reported, not used as a reason to stop the
medication without consulting a provider.
6. The nurse determines that demeclocycline (Declomycin) is effective for a patient
with syndrome of inappropriate antidiuretic hormone (SIADH) based on finding
that the patients
A. weight has increased.
B. urinary output is increased.
C. peripheral edema is decreased.
D. urine specific gravity is increased.
Answer: B
,Explanation: Demeclocycline blocks the action of ADH in the kidneys, promoting water
excretion and increasing urine output. This indicates effectiveness in counteracting SIADH.
Weight gain, decreased urine output, or high specific gravity would suggest ongoing fluid
retention.
7. The nurse determines that additional instruction is needed for a 60-year-old
patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH)
when the patient says which of the following?
A. I need to shop for foods low in sodium and avoid adding salt to food.
B. I should weigh myself daily and report any sudden weight loss or gain.
C. I need to limit my fluid intake to no more than 1 quart of liquids a day.
D. I will eat foods high in potassium because diuretics cause potassium loss.
Answer: A
Explanation: Patients with SIADH are at risk for hyponatremia and may require sodium
supplementation, not restriction. The other statements show correct understanding of daily
weight monitoring, fluid restriction, and potassium intake if on certain diuretics.
8. A 56-year-old patient who is disoriented and reports a headache and muscle
cramps is hospitalized with possible syndrome of inappropriate antidiuretic
hormone (SIADH). The nurse would expect the initial laboratory results to
include a(n)
A. elevated hematocrit.
B. decreased serum sodium.
C. low urine specific gravity.
D. increased serum chloride.
Answer: B
Explanation: SIADH causes water retention and dilutional hyponatremia, leading to
symptoms like disorientation, headache, and cramps. Hematocrit is typically decreased due to
hemodilution, urine specific gravity is high, and chloride levels usually decrease with
sodium.
9. An expected nursing diagnosis for a 30-year-old patient admitted to the hospital
with symptoms of diabetes insipidus is
A. excess fluid volume related to intake greater than output.
B. impaired gas exchange related to fluid retention in lungs.
C. sleep pattern disturbance related to frequent waking to void.
D. risk for impaired skin integrity related to generalized edema.
Answer: C
, Explanation: Diabetes insipidus causes polyuria and nocturia, disrupting sleep. Fluid volume
deficit, not excess, is the primary concern. Edema and fluid retention in the lungs are not
associated with this condition.
10. Which information will the nurse teach a 48-year-old patient who has been
newly diagnosed with Graves disease?
A. Exercise is contraindicated to avoid increasing metabolic rate.
B. Restriction of iodine intake is needed to reduce thyroid activity.
C. Antithyroid medications may take several months for full effect.
D. Surgery will eventually be required to remove the thyroid gland.
Answer: C
Explanation: Antithyroid medications like methimazole or propylthiouracil can take 2–3
months to fully control thyroid hormone levels. Exercise is encouraged, iodine restriction is
not standard, and radioactive iodine is more common than surgery for definitive treatment.
11. A patient who had a subtotal thyroidectomy earlier today develops laryngeal
stridor and a cramp in the right hand upon returning to the surgical nursing
unit. Which collaborative action will the nurse anticipate next?
A. Suction the patients airway.
B. Administer IV calcium gluconate.
C. Plan for emergency tracheostomy.
D. Prepare for endotracheal intubation.
Answer: B
Explanation: Stridor and hand cramping suggest hypocalcemia and tetany due to parathyroid
gland injury during thyroid surgery. IV calcium gluconate is the immediate treatment. Airway
interventions may follow if calcium does not relieve stridor. Suctioning alone is ineffective.
12. Which nursing action will be included in the plan of care for a 55-year-old
patient with Graves disease who has exophthalmos?
A. Place cold packs on the eyes to relieve pain and swelling.
B. Elevate the head of the patients bed to reduce periorbital fluid.
C. Apply alternating eye patches to protect the corneas from irritation.
D. Teach the patient to blink every few seconds to lubricate the corneas.
Answer: B
Explanation: Elevating the head of the bed promotes fluid drainage from the periorbital area,
reducing edema. Patients with exophthalmos may not blink fully; artificial tears and eye
protection are used. Cold packs and eye patches are not standard interventions.
