ANSWERS AND RATIONALES

1. 2. Diabetes insipidus is excessive urine

output due to decreased amounts of
antidiuretic hormone. Because of the
excessive urine output, it is necessary
to monitor intake and output.

2. 3. Explanation is all that is necessary.

The client is not given a
radioisotope. Fluids are not pushed
prior to the procedure. The client
frequently is
given an iodine dye, so the nurse
should ask about allergies to
shellfish.

3. 2. A transsphenoidal approach goes

through the roof of the mouth, which
has many organisms. Meningitis can
occur. Answer 1 is a true statement but
not the primary reason in this case.
Antibiotics do not lower spinal fluid
pressure. Answer 4 is a true statement,
but antibiotics are not hormones.

4. 1. Dripping in the back of the throat

after a transsphenoidal
hypophysectomy may be
cerebrospinal fluid (CSF). CSF
contains glucose. Saliva and mucus
do not.

5. 4. The client must take steroid

replacements every day for the rest of
his/her life. Answer 1 is not an
appropriate diet. The client should be
on a high- sodium, low-potassium
diet. The fights should decrease as
mood swings decrease after surgery.
The medications do not cause
photosensitivity.

6. 2. A calm environment is
important to reduce activity.
Hyperthyroidism makes a person
hyperactive and easily
distractible. There is no reason to
assess for emotional trauma. The
hyperthyroid client is usually
hyperactive, so there would be no
need for range-of-motion exercises.

7. 4. Hyperthyroidism causes tachycardia,

which can be severe enough to cause
heart failure. Pulse rates can be 100 to
150 per minute.

8. 1. Exophthalmos (protrusion of the eyes) may be so
severe that the eyelids cannot close. Artificial tears
will keep the eyes moist so that abrasions do not
occur. The client who has exophthalmos may or
may not have glasses. Bed rest and monitoring pulse
rate may be appropriate for a client who has
exophthalmos because exophthalmos occurs in
persons who are hyperthyroid. However, the
question asks what nursing care is essential because
the client has exophthalmos.
9. 1. Swelling in the operative site could cause
airway obstruction. The nurse should have a
tracheostomy set and oxygen readily available for 48
hours after thyroidectomy. A thoracotomy tray is not
indicated. This client is not likely to need
intervention in the thoracic cavity. A dressing
set is unlikely to be needed in the immediate
postoperative period. An ice collar might be
indicated but is not critical to have at the bedside.
10. 4. Following a thyroidectomy, the client is in semi-
sitting position so drainage would go to the back of
the neck. Because of the neck incision, the client
should not be rolled to the side. The bleeding is
unlikely to be inside the throat. Blood trickling
down the throat might be seen in a client who has
had a tonsillectomy.
11. 3. Carpal spasm is a sign of tetany and is known as
Chvostek’s sign. Tetany may occur if the
parathyroids have been inadvertently removed or
damaged. The parathyroids regulate calcium
phosphorus balance. Hypocalcemia causes tetany.
Most clients who have been intubated during
surgery have a sore throat. Pain in the incision
area is normal in the immediate postoperative
period.
12. 3. Hypothyroidism causes decreased metabolic
rate, which will cause lowered body temperature
and pulse and decreased digestion of food. The
skin is dry, and the hair thins.
13. 3. Hypothyroidism causes constipation and
obesity. A diet high in roughage and low in
calories is appropriate. The client should not be
given a high-calorie diet. There is no need for
fluid restriction or alteration in protein.
14. 1. Chest pain on exertion suggests angina. In addition
to a slow heart rate, the client with hypothyroidism
frequently has atherosclerosis. Thyroxine will
increase the heart rate, and the heart will require more
oxygen. Angina is a likely and serious complication
that can occur. She will also probably lose weight and
have an increased pulse. These are expected when
taking thyroxine. Cramps are not likely to be related
to taking thyroxine.
CHAPTER 10 ■ The Endocrine System 71
15. 2. Her symptoms suggest ketoacidosis. She must
receive medical treatment at once. Coffee will not
help her and is contraindicated because she is
unresponsive. Sweetened orange juice is not
indicated for ketoacidosis. It would be appropriate
for hypoglycemia if the client is conscious.
There is no indication for cardiopulmonary
resuscitation.
16. 1. Hypoglycemic reactions occur at peak action
time. Peak action time for regular insulin is two to
four hours after injection, which would be mid-
morning.
17. 3. Injection sites should be rotated to prevent tissue
damage. Insulin is injected at a 90-degree angle into
the deep subcutaneous tissue, not the muscle.
Insulin does not need to be refrigerated. The open
vial should be kept in the box to protect it from
light. Insulin should not be kept at temperature
extremes, such as the glove compartment of the car
on a hot day.
18. 2. Eating out with friends is very important to an
adolescent. Snacks will be allowed on his diet. He
should be taught how to use the exchange lists in
managing his diet.
19. 2. The nurse should immediately assess the skin.
Behavior change and irritability suggest
hypoglycemia. The nurse could also do a finger
stick and check the glucose level. If the client is
hypoglycemic, the client will have pale, cold,
clammy skin and will need treatment (ingestion of
a rapid-acting carbohydrate) at once.
20. 1. Pruritus vulvae (itching of the vulva) frequently
accompanies diabetes. Monilial infections are
common due to the change in pH. Eructation is
belching or burping, and singultus is hiccups. Neither
of these is particularly related to diabetes.
21. 2. Slight head elevation will reduce pressure on the
sella turcica, where the pituitary gland is located, and
edema formation in the area. This position may help
promote respiratory effort; however, that is not the
primary reason in this client. This position does not
prevent acidosis or promote oxygenation.
22. 4. Because the pituitary or master gland was
removed, the client will need to take life-long
medications, not just until the client feels better.
All of the other actions are appropriate. The client
should not bend over to tie shoes because this
increases intracranial pressure.
Answer 1 is correct. Remember, the client had a
transsphenoidal procedure in which the incision
is in the mouth above the gum line. The client
must take medications daily for the rest of his/her
life, so a Medic-Alert bracelet is appropriate.
72 UNIT II ■ Medical-Surgical Nursing
23. 3. A gradual return to normal will occur after adrenalectomy when there are no longer abnormal amounts of steroids being produced.

24. 2. Hypoparathyroidism causes a decrease in calcium, which is manifested by tetany.

25. 3. Most diabetic women can safely have babies if they receive good medical supervision during
pregnancy. There is a slightly higher incidence of fetal loss and malformations in babies of diabetic mothers but not enough to
preclude the chance of a normal baby. There is no way to prevent the child from later developing diabetes. Diabetes is an
inherited condition.

26. 2. The onset of regular insulin is within 30 minutes. It should not be given until the client can eat within 15 to 30 minutes so that
he will not develop hypoglycemia.

27. 2. Diabetes is not a contraindication for sports. Changes in activity level will alter the utilization of glucose, so he will need to work
closely with
 his physician to regulate exercise, insulin, and diet control.

28. 4. The symptoms are the cardinal symptoms of diabetes mellitus: polydipsia, polyphagia, and polyuria. The client
with hypothyroidism would have fatigue and weight gain and would complain of being cold all the time. The
person with acute pyelonephritis would probably complain of frequent urination and flank pain and might have a
fever. The person with Addison’s disease would have polyuria and low blood sugar and might go into
hypovolemic shock.

29. 4. An ingrown toenail may cause infection, which can be very serious for the diabetic client. The physician should be
notified. It is not appropriate for the practical nurse to initiate treatment.
2. In hypothyroidism, the metabolic rate is decreased. This causes an increased susceptibility to sedative