Adult Health - exam 2

The client with Addison's disease is taking glucocorticoids at home. Which statement indicates that the client understands how to take the medication? 1. "Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage." 2. "My need for glucocorticoids will stabilize, and I will be able to take a predetermined dose once a day." 3. "Glucocorticoids are cumulative, so I will take a dose every third day." 4. "I must take a dose every 6 hours to ensure consistent blood levels of glucocorticoids."

1. "Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage." The need for glucocorticoids changes with circumstances. The basal dose is established when the client is discharged, but this dose covers only normal daily needs and does not provide for additional stressors. As the manager of the medication schedule, the client needs to know signs and symptoms of excessive and insufficient dosages. Glucocorticoid needs fluctuate. Glucocorticoids are not cumulative and must be taken daily. They must never be discontinued suddenly; in the absence of endogenous production, addisonian crisis could result. Two-thirds of the daily dose should be taken at about 0800 and the remainder at about 1600. This schedule approximates the diurnal pattern of normal secretion, with highest levels between 0400 and 0600 and lowest levels in the evening.

When assessing the client with Hodgkin's disease the nurse should observe a client for which finding? 1. Herpes zoster infections 2. discolored teeth 3. hemorrhage 4. hypercellular immunity

1. Herpes zoster infections rationale: herpes zoster infections are common in clines with hodgkin's disease. Discoloring of the teeth is not related to Hodgkin's disease but rather in the ingestion of iron supplements or some antibiotics such as tetracycline. Mild anemia is common in Hodgkin's disease, but the platelet count is not affected until the tumor has invaded the bone marrow. A cellular immunity defect occurs in Hodgkin's disease in which there is little or no reaction to skin sensitivity test period this is called anergy.

A client with hyperthyroidism is to have a thyroidectomy. The health care provider (HCP) has prescribed propranolol. In reviewing the client's history, the nurse notes that the client has asthma. What should the nurse do next? 1. Take the client's pulse and withhold the propranolol if the pulse is <100 beats per minute. 2. Count the client's respirations and withhold the propranolol if the respirations are <20 breaths per minute. 3. Contact the HCP and discuss the prescription for propranolol because of the client's history of having asthma. 4. Instruct the client to make position changes slowly.

3. Contact the HCP and discuss the prescription for propranolol because of the client's history of having asthma. Propranolol hydrochloride is a nonselec-tive beta-blocker of both cardiac and bronchial adrenoreceptors, which competes with epinephrine and norepinephrine for available beta-receptor sites. Propranolol blocks cardiac effects of beta-adrenergic stimulation; as a result, it reduces heart rate; a hypertensive effect is associated with decreased cardiac output. A contraindication of propranolol is bronchial asthma; propranolol can cause bronchio-lar constriction even in normal clients. The nurse takes the apical pulse and BP before administering propranolol. The medication is withheld if the heart rate is <60 beats per minute or the systolic blood pressure is <90 mm Hg.

During the induction stage for treatment of leukemia, the nurse should remove which items that the family has brought into the room? 1. A prayer book 2. a picture 3. a bouquet of flowers 4. a hair brush

3. a bouquet of flowers rationale: the induction phase of chemotherapy is an aggressive treatment to kill leukemia cells. The client is severely immunocompromised and severely at risk for infection. Flowers, herbs, and plants should be avoided during this time. The client's prayer book, pictures, and other personal belongings can be cleaned before being brought into the room to prevent client contact with pathogenic and non pathogenic organisms.

A client with Addison's disease has fluid and electrolyte loss due to inadequate fluid intake and to fluid loss secondary to inadequate adrenal hormone secretion. As the client's oral intake increases, which fluids would be most appropriate? 1. milk and diet soda 2. water and eggnog 3. chicken broth and juice 4. coffee and milkshakes

3. chicken broth and juice Electrolyte imbalances associated with Addison's disease include hypoglycemia, hypona-tremia, and hyperkalemia. Regular salted (not low-salt) chicken or beef broth and fruit juices provide glucose and sodium to replenish these deficits. Diet soda does not contain sugar. Water could cause further sodium dilution. Coffee's diuretic effect would aggravate the fluid deficit. Milk contains potassium and sodium.

The nurse manager is teaching the nursing staff about signs and symptoms related to hypercalcemia in a client with metastatic prostate cancer and tells the staff that which is a late sign or symptom of this oncological emergency? 1. Headache 2. Dysphagia 3. Constipation 4. Electrocardiographic changes

4. Electrocardiographic changes Rationale: Hypercalcemia is a manifestation of bone metastasis in late-stage cancer. Headache and dysphagia are not associated with hypercalcemia. Constipation may occur early in the process. Electrocardiogram changes include shortened ST segment and a widened T wave.

"The client asks the nurse, "They say I have cancer. How can they tell ifI have Hodgkin's disease from a biopsy?" The nurse's answer is based on which scientific rationale?" 1. Biopsies are nuclear medicine scans that can detect cancer. 2. A biopsy is a laboratory test that detects cancer cells. 3. It determines which kind of cancer the client has. 4. The HCP takes a small piece out of the tumor and looks at the cells."

4. The HCP takes a small piece out of the tumor and looks at the cells." A biopsy is the removal of cells from a mass and examination of the tissue under a microscope to determine if the cells are cancerous. Reed-Sternberg cells are diag-nostic for Hodgkin's disease. If the secells are not found in the biopsy, the HCP can re biopsy to make sure the specimen pro- vided the needed sample or, depending on involvement of the tissue, diagnose a non-Hodgkin's lymphoma"

After pituitary surgery, which laboratory finding should the nurse report to the health care provider? 1. urine specific gravity <1.010 2. urine output between 1 and 2 L/day 3. blood glucose level higher than 300 mg/dE (16.7 mmol/L) 4. absence of glucose and ketones in the urine

1. urine specific gravity <1.010 Pituitary diabetes insipidus is a potential complication after pituitary surgery because of possible interference with the production of antidiuretic hormone (ADH). One major manifestation of diabetes insipidus is polyuria because lack of ADH results in insufficient water reabsorption by the kidneys. The polyuria leads to a decreased urine specific gravity (between 1.001 and 1.010). The client may drink and excrete 5 to 40 L of fluid daily. Diabetes insipidus does not affect metabo-lism. A blood glucose level higher than 300 mg/dL (16.7 mmol/L) is associated with impaired glucose metabolism or diabetes mellitus. Urine negative for sugar and ketones is normal.

A client with granulocytopenia has many visitors period to prevent infection what is the most important thing the nurse should tell the visitors to do? 1. Visit only if they do not have a cold. 2. Wash their hands. 3. Leave the children at home. 4. Avoid kissing the client.

2. Wash their hands. Rationale: washing hands before, during, and after care has a significant effect in reducing infections. It is advisable to avoid introducing a cold or children's germs and to avoid kissing the client but the primary prevention technique is hand washing

The nurse is instructing a client about skin care while receiving radiation therapy to the chest. What should the nurse instruct the client to do? 1. Apply lotion if the skin becomes dry. 2. Shave the chest to prevent contamination from chest hair. 3. Wash the area with tepid water and mild soap. 4. Keep the area covered with a nonadherent dressing between treatments.

3. Wash the area with tepid water and mild soap. Rationale: Clients receiving radiation experience dryness or redness in the area of the radiation. The nurse instructs the client to wash the area with soap and water and keep the area dry. The client does not apply lotion, shave, or cover the area.

A client with a family history of cancer asks the nurse what the single most important risk factor is for cancer. Which risk factor should the nurse discuss? 1. family history 2. lifestvle choices 3. age 4. menopause or hormonal events

3. age Rationale: Because more than 50% of the cancers occur in people who are older than age 65, the single most important factor in determining risk would be age.

When conducting a health history with a female client with thyrotoxicosis, the nurse should ask about which changes in the menstrual cycle? 1. dysmenorrhea 2. metrorrhagia 3. oligomenorrhea 4. menorrhagia

3. oligomenorrhea A change in the menstrual interval, dimin- produced its ou ished menstrual flow (oligomenorrhea), or even the absence of menstruation (amenorrhea) may result w CN: from the hormonal imbalances of thyrotoxicosis. therapies; ( Oligomenorrhea in women and decreased libido and 7. 3. Propr impotence in men are common features of thyro- tive beta-block. toxicosis. Dysmenorrhea is painful menstruation. adrenoreceptor Metrorrhagia, blood loss between menstrual peri- and norepinep ods, is a symptom of hypothyroidism. Menorrhagia, Propranolol bl excessive bleeding during menstrual periods, is a stimulation; as symptom of hypothyroidism.

The nurse is creating a plan of care for the client with multiple myeloma and includes which priority intervention in the plan? 1. Encouraging fluids 2. Providing frequent oral care 3. Coughing and deep breathing 4. Monitoring the red blood cell count

1. Encouraging fluids Rationale: Hypercalcemia caused by bone destruction is a priority concern in the client with multiple myeloma. The nurse would administer fluids in adequate amounts to maintain a urine output of 1.5 to 2 L/day; this requires about 3 L of fluid intake per day. The fluid is needed not only to dilute the calcium overload but also to prevent protein from precipitating in the renal tubules. Options 2, 3, and 4 may be components of the plan of care but are not the priority in this client.

The nurse is caring for a client with lung cancer and bone metastasis. What signs and symptoms would the nurse recognize as indications of a possible oncological emergency? Select all that apply. 1. Facial edema in the morning 2. Weight loss of 20 lb (9 kg) in 1 month 3. Serum calcium level of 12 mg/dL (3.0 mmol/L) 4. Serum sodium level of 136 mg/dL (136 mmol/L) 5. Serum potassium level of 3.4 mg/dL (3.4 mmol/L) 6. Numbness and tingling of the lower extremities

1. Facial edema in the morning 3. Serum calcium level of 12 mg/dL (3.0 mmol/L) 6. Numbness and tingling of the lower extremities Rationale: Oncological emergencies include sepsis, disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, superior vena cava syndrome, and tumor lysis syndrome. Blockage of blood flow to the venous system of the head resulting in facial edema is a sign of superior vena cava syndrome. A serum calcium level of 12 mg/dL (3.0 mmol/L) indicates hypercalcemia. Numbness and tingling of the lower extremities could be a sign of spinal cord compression. Mild hypokalemia and weight loss are not oncological emergencies. A sodium level of 136 mg/dL (136 mmol/L) is a normal level.

The nurse is caring for a client who has had an adrenalectomy and is monitoring the client for signs of adrenal insufficiency. Which signs and symptoms indicate adrenal insufficiency in this client? 1. Hypotension and fever 2. Mental status changes and hypertension 3. Subnormal temperature and hypotension 4. Complaints of weakness and hypertension

1. Hypotension and fever Rationale: The nurse would be alert to signs and symptoms of adrenal insufficiency after adrenalectomy. These signs and symptoms include weakness, hypotension, fever, and mental status changes. The remaining options are incorrect.

The nurse is conducting a history and monitoring laboratory values on a client with multiple myeloma. What assessment findings would the nurse expect to note? Select all that apply. 1. Pathological fracture 2. Urinalysis positive for Bence Jones protein 3. Hemoglobin level of 15.5 g/dL (155 mmol/L) 4. Calcium level of 9.0 mg/dL (2.25 mmol/L) 5. Serum creatinine level of 2.0 mg/dL (176.6 mcmol/L)

1. Pathological fracture 2. Urinalysis positive for Bence Jones protein 5. Serum creatinine level of 2.0 mg/dL (176.6 mcmol/L) Rationale: Multiple myeloma is a B cell neoplastic condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of mature plasma cells in the bone marrow. The client with multiple myeloma may experience pathological fractures, hypercalcemia, anemia, recurrent infections, and renal failure. In addition, Bence Jones proteinuria is a finding. A serum calcium level of 9.0 mg/dL (2.25 mmol/L) and a hemoglobin level of 15.5 g/dL (155 mmol/L) are normal values. A serum creatinine level of 2.0 mg/dL (176.6 mcmol/L) is elevated, indicating a renal problem.

A male client expresses concern about how a hypophysectomy will affect his sexual function. Which statement provides the most accurate information about the physiologic effects of hypophysectomy in a male? 1. Removing the source of excess hormone should restore the client's libido, erectile function, and fertility. 2. Potency will be restored, but the client will remain infertile. 3. Fertility will be restored, but impotence and decreased libido will persist. 4. Exogenous hormones will be needed to restore erectile function after the adenoma is removed.

1. Removing the source of excess hormone should restore the client's libido, erectile function, and fertility. The client's sexual problems are directly related to the excessive prolactin level. Removing the source of excessive hormone secretion shouldallow the client to return gradually to a normal physiologic pattern. Fertility will return, and erectile function and sexual desire will return to baseline as hormone levels return to normal.

A 29-year-old woman is concerned about her personal risk factors for malignant melanoma. She is upset because her 49-year-old sister was recently diagnosed with the disease. After gathering information about the client's history of sun exposure, what should the nurse tell the client? 1. Some melanomas have a familial component, and she should seek medical advice. 2. Her personal risk is low because most melanomas occur at age 60 or later. 3. Her personal risk is low because melanoma does not have a familial component. 4. She should not worry because she did not experience severe sunburn as a child.

1. Some melanomas have a familial component, and she should seek medical advice. Rationale: Malignant melanoma may have a familial basis, especially in families with dysplastic nevi syndrome. First-degree relatives should be monitored closely. Malignant melanoma occurs most often in the 20- to 45-year-old age group. Severe sunburn as a child does increase the risk; however, this client is at increased risk because of her family history.

Which information should the nurse include in the teaching plan of a female client with bilateral adrenalectomy? 1. The client will need steroid replacement for the rest of her life. 2. The client must decrease the dose of steroid medication carefully to prevent crisis. 3. The client will require steroids only until her body can manufacture sufficient quantities. 4. The client will need to take steroids whenever her life involves physical or emotional stress.

1. The client will need steroid replacement for the rest of her life. Bilateral adrenalectomy requires lifelong adrenal hormone replacement therapy. If unilateral surgery is performed, most clients gradually rees-tablish a normal secretion pattern. The client and family will require extensive teaching and support to maintain self-care management at home. Information on dosing, adverse effects, what to do if a dose is missed, and follow-up examinations is needed in the teaching plan. Although steroids are tapered when given for an intermittent or onetime problem, they are not discontinued when given to clients who have undergone bilateral adrenalec-tomy because the clients will not regain the ability to manufacture steroids. Steroids must be taken on a daily basis, not just during periods of physical or emotional stress.

What should the nurse teach decline with neutropenia to avoid? 1. Using suppositories for enemas 2. using a high efficiency particulate air ( HEPA) 3. Performing perianal care after every bowel movement 4. performing oral care after every meal

1. Using suppositories for enemas rationale: the neutropenic client is at risk for infection, especially bacterial infection of the respiratory and gastrointestinal tracts. Breaks can mucous membrane, such as those that could be caused by the insertion of a Suppository or animal tube, would be a break in the first line of the body's defense and a direct port of entry for infection. The client would neutropenia is encouraged to wear a HEPA filter mask and to use an incentives parameter for pulmonary hygiene. The client needs to know the importance of completing meticulous total body hygiene daily, including perianal care after every bowel movement, to decrease the flora and normal body orifices the client also needs to know the importance of performing oral care after every meal and every four hours while the client is awake to decrease the bacterial buildup in the oropharynx

When caring for a client with a central venous line, which nursing actions should be implemented in the plan of care for chemotherapy administration? Select all that apply. 1. Verify patency of the line by the presence of a blood return at regular intervals. 2. Inspect the insertion site for swelling, erythema, or drainage. 3. Administer a cytotoxic agent to keep the regimen on schedule even if blood return is not present. 4. If unable to aspirate blood, reposition the client and encourage the client to cough. 5. Contact the health care provider about verifying placement if the status is questionable.

1. Verify patency of the line by the presence of a blood return at regular intervals. 2. Inspect the insertion site for swelling, erythema, or drainage. 4. If unable to aspirate blood, reposition the client and encourage the client to cough. 5. Contact the health care provider about verifying placement if the status is questionable. Rationale: A major concern with IV administration of cytotoxic agents is vessel irritation or extravasation. The Oncology Nursing Society and hospital guidelines require frequent reevaluation of blood return when administering vesicant or non-vesicant chemotherapy due to the risk of extrava-sation. These guidelines apply to peripheral and central venous lines. The nurse should also assess the insertion site for signs of infiltration, such as swelling and redness. In addition, central venous lines may be long-term venous access devices. Thus, difficulty drawing or aspirating blood may indicate the line is against the vessel wall or may indicate the line has occlusion. Having the client cough or move position may change the status of the line if it is temporarily against a vessel wall. Occlusion warrants more thorough evaluation via X-ray study to verify placement if the status is questionable and may require a declotting regimen. The nurse shouldnot administer any drug if the IV line is not open or does not have an adequate blood return.

The nurse is taking care of a client with neutropenia. Which nursing action is most important in preventing cross-contamination? 1. changing gloves immediately after use 2. standing 2 feet (61 cm) from the client 3. speaking minimally when in the room 4. wearing protective coverings

1. changing gloves immediately after use Bedside rails, call bells, drug administration controls operated by the client, and other r surface areas are frequently touched by caregivers with used gloves. Changing gloves immediately after use protects the client from contamination by organ-isms. Cross-contamination is a break in technique of serious consequence to the severely compromised client. Standing 2 feet (61 cm) from the client, speaking minimally, and wearing protective covering shirts are not required in standard interventions for risk of infection. brig

Which outcome is a priority for the client with Addison's disease? 1. maintenance of medication compliance 2. avoidance of normal activities with stress 3. adherence to a 2-g sodium diet 4. prevention of hypertensive episodes

1. maintenance of medication compliance Medication compliance is an essential part of the self-care required to manage Addison's disease. The client must learn to adjust the glucocorticoid dose in response to the normal and unexpected stresses of daily living. The nurse should instruct the client never to stop taking the drug without consulting the health care provider (HCP)[I to avoid an addisonian crisis. Regularity in daily habits makes adjustment easier, but the client should not be encouraged to withdraw from normal activities to avoid stress. The client does not need to restrict sodium. The client is at risk for hyponatremia. Hypotension, not hypertension, is more common with Addison's disease.

Propylthiouracil (PTU) is prescribed for a client with Graves' disease. Which symptom should the nurse teach the client to report? 1. sore throat 2. excessive menstruation 3. constipation 4. increased urine output

1. sore throat The most serious adverse effects of PTU are leukopenia and agranulocytosis, which usually occur within the first 3 months of treatment. The client should be taught to promptly report to the health care provider (HCP) LI signs and symptoms of infection, such as a sore throat and fever. Clients having a sore throat and fever should have an immediate white blood cell count and differential performed, and the drug must be withheld until the results are obtained. Painful menstruation, con-stipation, and increased urine output are not associated with PTU therapy.

The nurse is conducting discharge education with a client newly diagnosed with Addison's dis-ease. Which information should be included in the client and family teaching plan? Select all that apply. 1. Addison's disease will resolve over a few weeks, requiring no further treatment. 2. Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. 3. Fatigue, weakness, dizziness, and mood changes need to be reported to the health care provider (HCP). 4. A medical identification bracelet should be worn 5. Family members need to be informed about the warning signals of adrenal crisis. 6. Dental work or surgery will require adjustment of daily medication.

2. Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations. 3. Fatigue, weakness, dizziness, and mood changes need to be reported to the health care provider (HCP). 4. A medical identification bracelet should be worn 5. Family members need to be informed about the warning signals of adrenal crisis. 6. Dental work or surgery will require adjustment of daily medication. Addison's disease occurs when the client does not produce enough steroids from the adrenal cortex. Lifetime steroid replacement is needed. The client should be taught lifestyle management techniques to avoid stress and maintain rest periods. A medical identification bracelet should be worn, and the family should be taught signs and symptoms that indicate an impending adrenal crisis, such as fatigue, weakness, dizzi-ness, or mood changes. Dental work, infections, and surgery commonly require an adjusted dosage of steroids.

When caring for a client with an internal radiation implant, the nurse should observe which principles? Select all that apply. 1. Limiting the time with the client to 1 hour per shift. 2. Keeping pregnant women out of the client's room. 3. Placing the client in a private room with a private bath. 4. Wearing a lead shield when providing direct client care. 5. Removing the dosimeter film badge when entering the client's room. 6. Allowing individuals younger than 16 years old in the room as long as they are 6 feet away from the client.

2. Keeping pregnant women out of the client's room. 3. Placing the client in a private room with a private bath. 4. Wearing a lead shield when providing direct client care. Rationale: The time that the nurse spends in the room of a client with an internal radiation implant is 30 minutes per shift. The client must be placed in a private room with a private bath. Lead shielding can be used to reduce the transmission of radiation. The dosimeter film badge must be worn when in the client's room. Children younger than 16 years of age and pregnant women are not allowed in the client's room.

Bone resorption is a possible complication of Cushing's disease. To help the client prevent this complication, what should the nurse recommend to the client? 1. Increase the amount of potassium in the diet. 2. Maintain a regular program of weight-bearing exercise. 3. Limit dietary vitamin D intake. 4. Perform isometric exercises.

2. Maintain a regular program of weight-bearing exercise. Osteoporosis is a serious outcome of prolonged cortisol excess because calcium is resorbed out of the bone. Regular daily weight-bearing exercise (e.g., brisk walking) is an effective way to drive calcium back into the bones. The client should also be instructed to have a dietary or supplemental intake of calcium of 1,500 mg daily. Potassium levels are not relevant to prevention of bone resorp-tion. Vitamin D is needed to aid in the absorption of calcium. Isometric exercises condition muscle tone but do not build bones.

The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate? 1. Increase calories. 2. Restrict sodium. 3. Restrict potassium. 4. Reduce fat to 10%.

2. Restrict sodium. A primary dietary intervention is to restrict sodium, thereby reducing fluid retention. Increased protein catabolism results in loss of muscle mass and necessitates supplemental protein intake. The client may be asked to restrict total calories to reduce weight. The client should be encouraged to eat potassium-rich foods because serum levels are typically depleted. Although reducing fat intake as part of an overall plan to restrict calories is appropriate, fat intake of <20% of total calories is not recommended.

The client who has undergone a bilateral adrenalectomy is concerned about persistent body changes and unpredictable moods. What should the nurse teach the client about these changes? 1. The body changes are permanent, and the client will not be the same as before this condition. 2. The body and mood will gradually return to normal. 3. The physical changes are permanent, but the mood swings will disappear. 4. The physical changes are temporary, but the mood swings are permanent.

2. The body and mood will gradually return to normal. As the body readjusts to normal cortisol levels, mood and physical changes will gradually return to a normal state. The body changes are not permanent, and the mood swings should level off.

When explaining the long-term toxic effects of cancer treatments on the immune system, what should the nurse tell the client? 1. Clients with persistent immunologic abnormalities after treatment are at a much greater risk for infection than clients with a history of splenectomy. 2. The use of radiation and combination chemotherapy can result in more frequent and more severe immune system impairment. 3. Long-term immunologic effects have been studied only in clients with breast and lung cancer. 4. The helper T cells recover more rapidly than do the suppressor T cells, which results in positive helper cell balance that can last 5 years.

2. The use of radiation and combination chemotherapy can result in more frequent and more severe immune system impairment. Rationale: Studies of long-term immunologic effects in clients treated for leukemia, Hodgkin's disease, and breast cancer reveal that combination treatments of chemotherapy and radiation can cause overall bone marrow suppression, decreased leukocyte counts, and profound immunosuppression.Persistent and severe immunologic impairment may follow radiation and chemotherapy (especially multiagent therapy). There is no evidence of greater risk of infection in clients with persistent immunologic abnormalities. Suppressor T cells recover more rapidly than do the helper T cells.

A client who is receiving chemotherapy develops stomatitis. What should the nurse instruct the client to do? 1. Rinse the mouth with full-strength hydrogen peroxide every 4 hours. 2. Use a soft-bristled toothbrush after each meal. 3. Drink hot tea with honey to soothe the painful oral mucosa. 4. Avoid using dental floss until the stomatitis is resolved.

2. Use a soft-bristled toothbrush after each meal. Rationale: Stomatitis is an inflammation of the mucous membranes of the mouth resulting from chemotherapy. Using a soft-bristled toothbrush prevents further bleeding and irritation to the already irritated gums and mucous membranes. Hydrogen peroxide can further irritate the mouth. Fluids need to be lukewarm instead of hot; dental floss can be used if it is done gently.

After stabilization of Addison's disease, the nurse teaches the client about stress management. What should the nurse instruct the client to do? 1. Remove all sources of stress from dailv life. 2. Use relaxation techniques such as music. 3. Take antianxiety drugs daily. 4. Avoid discussing stressful experiences.

2. Use relaxation techniques such as music. Finding alternative methods of dealing with stress, such as relaxation techniques, is a cornerstone of stress management. Removing all sources of stress from one's life is not possible. Antianxiety drugs are prescribed for temporary management during periods of major stress, and they are not an intervention in stress management classes. Avoiding discussion of stressful situations will not necessarily reduce stress.

The nurse is evaluating the client's understanding about combination chemotherapy. Which statement by the client about reasons for using combination chemotherapy indicates the need for further explanation? 1. Combining chemotherapy is used to interrupt cell growth cycle at different points 2. combination chemotherapy is used to destroy cancer cells and treat side effects simultaneously 3. combination chemotherapy is used to decrease resistance 4. combination chemotherapy is used to minimize the toxicity from using high doses of a single agent

2. combination chemotherapy is used to destroy cancer cells and treat side effects simultaneously rationale: combination chemotherapy does not mean two groups of drugs, one to kill the cancer cells and want to treat the adverse effects of chemotherapy. Combination chemotherapy means that multiple drugs are given to interrupt the cell growth cycle at different points, decrease resistance to a chemotherapy agent, and minimize the toxicity associated with the use of high dose of a single agent ( i.e By using multiple agents with different toxicities)

A client with diabetes insipidus is receiving vasopressin. Which sign indicates that the drug is having the intended effect? 1. lower blood pressure 2. concentration of urine 3. normal insulin levels 4. improved glucose metabolism

2. concentration of urine The major characteristic of diabetes insipidus is decreased tubular reabsorption of water due to insufficient amounts of antidiuretic hormone (ADH). Vasopressin is administered to the client with diabetes insipidus because it has pressor and ADH activities. Vasopressin works to increase the concentration of the urine by increasing tubular reabsorption, thus preserving up to 90% water. Vasopressin is administered to the client with diabetes insipidus because it is a synthetic ADH. The administration of vasopressin results in increased tubular reabsorption of water, and it is effective for emergency treatment or daily maintenance of mild diabetes insipidus. Vasopressin does not lower blood pressure or affect insulin production or glucose metabolism.

A 34-year-old female is diagnosed with hypo-thyroidism. What information should the nurse obtain from conducting a focused assessment? Select all that apply. 1. rapid pulse 2. decreased energy and fatigue 3. weight gain of 10 lb (4.5 kg) 4. fine, thin hair with hair loss 5. constipation 6. menorrhagia

2. decreased energy and fatigue 3. weight gain of 10 lb (4.5 kg) 5. constipation 6. menorrhagia Clients with hypothyroidism exhibit symptoms indicating a lack of thyroid hor-mone. Bradycardia, decreased energy and lethargy, memory problems, weight gain, coarse hair, con-stipation, and menorrhagia are common signs and symptoms of hypothyroidism.

A client has had a bilateral adrenalectomy. For which potential complication should the nurse assess the client? 1. postoperative confusion 2. delayed wound healing 3. pulmonary emboli 4. malnutrition

2. delayed wound healing Persistent cortisol excess undermines the collagen matrix of the skin, impairing wound healing. It also carries an increased risk of infection and of bleeding. The wound should be observed and documentation performed regarding the status of healing. Confusion and emboli are not expected complications after adrenalectomy. Malnutrition also is not an expected complication after adre-nalectomy. Nutritional status should be regained postoperatively.

A client with thyrotoxicosis says to the nurse, "I'm so irritable. I'm having problems at work because I lose my temper very easily." Which response by the nurse would give the client the most accurate explanation of this behavior? "You are experiencing: 1. temporary confusion brought on by your illness." 2. excess thyroid hormone in your system." 3. worry about the seriousness of your illness." 4. stress of trying to manage a career and cope with illness.

2. excess thyroid hormone in your system." A typical sign of thyrotoxicosis is irritability caused by the high levels of circulating thyroid hormones in the body. This symptom decreases as the client responds to therapy. Thyrotoxicosis does not cause confusion. The client may be worried about her illness, and stress may influence her mood; however, irritability is a common symptom of thyrotoxicosis, and the client should be informed of that fact rather than blamed.

Which goal is the priority for a client in addisonian crisis? 1. controlling hypertension 2. preventing irreversible shock 3. preventing infection 4. relieving anxiety

2. preventing irreversible shock Addison's disease is caused by a deficiency of adrenal corticosteroids and can result in severe hypotension and shock because of uncontrolled loss of sodium in the urine and impaired mineralocorticoid function. This results in loss of extracellular fluid and dangerously low blood volume. Glucocorticoids must be administered to reverse hypotension. Preventing infection is not an appropriate goal of care in this life-threatening situation. Relieving anxiety is appropriate when the client's condition is stabilized, but the calm, competent demeanor of the emergency department staff will be initially reassuring.

A nurse is caring for a client who is undergoing chemotherapy. Current laboratory values are noted on the medical record. Which action would be most appropriate for the nurse to implement? Laboratory Results Test- Result Hemoglobin- 12.0 g/dL (120 g/L) Platelet count- 108,000/mm? (108 × 109/L) WBC count- 1,600/mm? (1.6 x 109/L) ANC- <1,000/mm? (1 × 109/L) 1. wearing a protective gown and particulate respiratory mask when completing treatments 2. washing hands before and after entering the room 3. restricting visitors 4. contacting the health care provider (HCP) for a prescription for hematopoietic factors such as erythropoietin

2. washing hands before and after entering the room Rationale: Chemotherapy causes myelosuppression with a decrease in red blood cells (RBCs), WBCs, and platelets. This client's data demonstrate neu-tropenia, placing the client at risk for infection. An ANC of 500 to 1,000/mm' (0.5 to 1 × 10°/L) indicates a moderate risk of infection; <500/mm° (0.5 × 10°/L) indicates severe neutropenia and a high risk of infection. When the WBC count is low and immature WBCs are present, normal phagocytosis is impaired. Precautions to protect the client from life-threatening infections may be instituted when ANC is <1,000/mm' (1 × 10°/L). Handwashing is the best way to avoid the spread of infection. It is not necessary to wear a gown and mask to take care of this client. It is also not necessary to restrict visitors; however, visitors should be screened to avoid exposing the client to possible infections. Erythropoietin is used for stimulating RBCs, not WBCs. Granulocyte colony-stimulating factors or granulocyte macrophage colony-stimulating factors are useful for treating neutropenia.

A client who is recovering from a bilateral adrenalectomy has a client-controlled analgesia (PCA) system with morphine sulfate. What should the nurse do to manage safe administration of the morphine? 1. Observe the client at regular intervals for opioid addiction. 2. Encourage the client to reduce analgesic use and tolerate the pain. 3. Evaluate pain control at least every 2 hours. 4. Increase the amount of morphine if the client does not administer the medication.

3. Evaluate pain control at least every 2 hours. Pain control should be evaluated at least every 2 hours for the client with a PCA sys-tem. Addiction is not a common problem for the postoperative client. A client should not be encouraged to tolerate pain; in fact, other nursing actions besides PCA should be implemented to enhance the action of opioids. One of the purposes of PCA is for the client to determine frequency of administering the medication; the nurse should not interfere unless the client is not obtaining pain relief. The nurse should ensure that the client is instructed on the use of the PCA control button and that the button is always within reach.

The nurse is reviewing the laboratory results for a client with a diagnosis of leukemia and notes that the absolute neutrophil count is decreased. The nurse interprets this to mean that the client is at risk for which problem? 1. Anemia 2. Bleeding 3. Infection 4. Dehydration

3. Infection Rationale:Neutrophils arise from stem cells and complete the maturation process in the bone marrow. They belong to a class of leukocytes known as granulocytes because of the large number of granules present inside each cell. Neutrophils provide the first internal line of defense, via phagocytosis, against foreign invaders (especially bacteria) in blood and extracellular fluid. If the neutrophil count is low, the client is at risk for infection. The remaining options are not associated with the function of neutrophils.

The nurse is monitoring a client for signs and symptoms related to superior vena cava syndrome. Which is an early sign of this oncological emergency? 1. Cyanosis 2. Arm edema 3. Periorbital edema 4. Mental status changes

3. Periorbital edema Rationale: Superior vena cava syndrome occurs when the superior vena cava is compressed or obstructed by tumor growth. Early signs and symptoms generally occur in the morning and include edema of the face, especially around the eyes, and client complaints of tightness of a shirt or blouse collar. As the compression worsens, the client experiences edema of the hands and arms. Cyanosis and mental status changes are late signs.

Cortisone acetate and fludrocortisone acetate are prescribed as replacement therapy for a client with Addison's disease. What administration schedule should be followed for this therapy? 1. Take both drugs three times a day. 2. Take the entire dose of both drugs first thing in the morning. 3. Take all the fludrocortisone acetate and two-thirds of the cortisone acetate in the morning, and take the remaining cortisone acetate in the afternoon. 4. Take half of each drug in the morning and the remaining half of each drug at bedtime.

3. Take all the fludrocortisone acetate and two-thirds of the cortisone acetate in the morning, and take the remaining cortisone acetate in the afternoon. Fludrocortisone acetate can be administered once a day, but cortisone acetate administration should follow the body's natural diurnal pattern of secretion, in which greater amounts of cortisol are secreted during the daytime to meet the increaseddemand of the body. To mimic this pattern, baseline administration of cortisone acetate is typically 25 mg in the morning and 12.5 mg in the afternoon. Taking it three times a day would result in an excessive dose. Taking the drug only in the morning would not meet the needs of the body later in the day and evening.

A client is to have a hypophysectomy. To minimize the risk of postoperative respiratory complications, what should the nurse instruct the client to do? 1. Limit use of pain medications. 2. Turn the head from side to side. 3. Take deep breaths. 4. Clear the throat and cough.

3. Take deep breaths. Deep breathing is the best choice for helping prevent atelectasis. The client should be placed in the semi-Fowler's position (or as pre-scribed) and taught deep breathing, sighing, mouth breathing, and how to avoid coughing. The client should receive sufficient medication to control postoperative pain. Frequent position changes help loosen lung secretions, but deep breathing is most important in preventing atelectasis. Coughing is contraindicated because it increases intracranial pressure and can cause cerebrospinal fluid to leak from the point at which the sella turcica was entered.

A client with hyperthyroidism is to be treated with radioactive iodine (RAI, I-131). Following treatment, what should the nurse should teach the client to do? 1. Monitor for signs and symptoms of hyperthyroidism. 2. Rest for 1 week to prevent complications of the medication. 3. Take thyroxine replacement for the remainder of the client's life. 4. Assess for hypertension and tachycardia resulting from altered thyroid activity.

3. Take thyroxine replacement for the remainder of the client's life. The client needs to be educated about the need for lifelong thyroid hormone replacement. Permanent hypothyroidism is the major complication of radioactive iodine treatment. Lifelong medical follow-up and thyroid replacement are warranted. The client needs to monitor for signs and symptoms of hypothyroidism, not hyperthyroidism. Resting for 1 week is not necessary. Hypertension and tachycardia are signs of hyperthyroidism, not hypothyroidism.

A client with Cushing's disease tells the nurse that the health care provider (HCP) said the morning serum cortisol level was within normal limits. The client asks, "How can that be? I'm not imagining all these symptoms!" The nurse's response will be based on which information? 1. Some clients are very sensitive to the effects of cortisol and develop symptoms even with normal levels. 2. A single random blood test cannot provide reliable information about endocrine levels. 3. The excessive cortisol levels seen in Cushing's disease commonly result from loss of the normal diurnal secretion pattern. 4. Tumors tend to secrete hormones irregularly, and the hormones are generally not present in the blood.

3. The excessive cortisol levels seen in Cushing's disease commonly result from loss of the normal diurnal secretion pattern. Cushing's disease is commonly caused by loss of the diurnal cortisol secretion pattern. The client's random morning cortisol level may be within normal limits, but secretion continues at that level throughout the entire day. Cortisol levels should normally decrease after the morning peak. Analysis of a 24-hour urine specimen is often useful in identifying the cumulative excess. Clients will not have symptoms with normal cortisol levels. Hormones are present in the blood.

A client with Graves' disease has exophthal-mos. What should the nurse teach the client to do to prevent corneal irritation? 1. Massage the eyes every 4 hours. 2. Instill an ophthalmic anesthetic as prescribed. 3. Wear dark-colored glasses when awake. 4. Cover both eyes with moistened gauze pads at night.

3. Wear dark-colored glasses when awake. Treatment of mild ophthalmopathy that may accompany thyrotoxicosis includes measures such as wearing sunglasses to protect the eyes from corneal irritation. Treatment of ophthalmopa-thy should be performed in consultation with an ophthalmologist. Massaging the eyes will not help to protect the cornea. An ophthalmic anesthetic is used to examine and possibly treat a painful eye, not protect the cornea. Covering the eyes with moist gauze pads is not a satisfactory nursing measure to protect the eyes of a client with exophthalmos because treatment is not focused on moisture to the eye but rather on protecting the cornea and optic nerve. In exoph-thalmos, the retrobulbar connective tissues and extraocular muscle volume are expanded because of fluid retention. The pressure is also increased.

148. The nurse is making client rounds following shift report. Which client should the nurse assess first? 1. a 38-year-old woman receiving internal radiation therapy for cervical cancer 2. a 27-vear-old man with leukemia hospitalized for induction of high-dose chemotherapy 3. a 75-year-old man with metastatic prostate cancer with a pathologic fracture of the femur who is in pain 4. a 23-year-old woman undergoing surgery for placement of a central venous catheter

3. a 75-year-old man with metastatic prostate cancer with a pathologic fracture of the femur who is in pain Rationale: The nurse should first assess the 75-year-old man with prostate cancer because of the client's age, need for pain management, extended bed rest, and the potential for preexisting nutritional deficits. The nurse should plan to spend a focused but short time with the woman receiving internal radiation. The client who will receive chemotherapy will require more observation after receiving the medication. The nurse can assess the client who will have a central venous catheter after assuring the older client is comfortable.

A client receiving radiation to the head and neck is experiencing stomatitis. What can the nurse recommend to relieve this symptom? 1. evaluation by a dentist 2. alcohol-based mouthwash rinses 3. artificial saliva 4. vigorous brushing of teeth after each meal

3. artificial saliva Rationale: Head and neck radiation can cause the complication of stomatitis and decreased salivary flow. A saliva substitute will assist with dryness, moistening food, and swallowing. Meticulous mouth care is needed; however, alcohol and vigorous brushing will increase irritation. Evaluation by a dentist to perform necessary dental work is done prior to initiation of therapy.

A client undergoing a bilateral adrenalectomy has postoperative prescriptions for hydromorphone hydrochloride 2 mg to be administered subcutaneously every 4 hours as needed for pain. Why should the nurse administer hydromorphone in small doses? A small dose is: 1. less likely to cause dependency. 2. less irritating to subcutaneous tissues in small doses. 3. as potent as morphine in larger doses. 4. excreted before accumulating in toxic amounts in the body.

3. as potent as morphine in larger doses. Hydromorphone hydrochloride is about five times more potent than morphine sulfate, from which it is prepared. Therefore, it is administered only in small doses. Hydromorphone hydrochloride can cause dependency in any dose; however, fear of dependency developing in the postoperative period is unwarranted. The dose is determined by the client's need for pain relief. Hydromorphone hydrochloride is not irritating to subcutaneous tissues. As with opioid analgesics, excretion depends on normal liver function.

But the nurses administering medications with clients with myeloid leukemia and does not know the use, dose, or side effects period to obtain the most up-to-date information about this drug what should the nurse do? 1. Check a commercially published drug guide. 2. Read a pharmacology book 3. consult the drug guide provided by the clinical agency 4. review information at the drug manufacturers website

3. consult the drug guide provided by the clinical agency rationale: the most current pharmacology information is found in the clinical agency's drug guide, which may be available on electronics sources that are frequently updated and can be transmitted to a handheld device or by logging into the Internet or hospitals intranet, if possible. A commercially published drug guide and pharmacology textbooks are outdated once published and, therefore, may not have current information. The manufacturer's website has the potential for bias.

The nurse caring for a client who is receiving external beam radiation therapy for treatment of lung cancer. What should the nurse assess the client for while receiving radiation therapy? 1. diarrhea 2. improved energy level 3. dysphagia 4. normal white blood cell count

3. dysphagia Rationale: Radiation-induced esophagitis with dys-phagia is particularly common in clients who receive radiation to the chest. The anatomic location of the esophagus is posterior to the mediastinum and is within the field of primary treatment. Diarrhea may occur with radiation to the abdomen. Decreased energy level and decreased white blood cell count are potential complications of radiation therapy.

The nurse is teaching the client with Addison's disease to anticipate the need for increased glucocorticoid supplementation. When will the client likely need to increase the dose of glucocorticoids? 1. returning to work after a weekend 2. going on vacation 3. having oral surgery 4. having a routine medical checkup

3. having oral surgery Illness or surgery places tremendous stress on the body, necessitating increased glucocorticoid dosage. Extreme psychological stress also necessitates dosage adjustment. Increased dosages are needed in times of stress to prevent drug-induced adrenal insufficiency. Returning to work after the weekend, a vacation, or a routine checkup usually will not alter glucocorticoid dosage needs.

A client newly diagnosed with primary Addison's disease asks the nurse about the cause of the disease. What should the nurse tell the client? «The disease is caused by: 1. insufficient secretion of growth hormone (GH)." 2. dysfunction of the hypothalamic pituitary. 3. idiopathic atrophy of the adrenal gland." 4. oversecretion of the adrenal medulla."

3. idiopathic atrophy of the adrenal gland." Primary Addison's disease refers to a problem in the gland itself that results from idiopathic atrophy of the glands. The process is believed to be autoimmune in nature. The most common causes of primary adrenocortical insufficiency are autoimmune destruction (70%) and tuberculosis (20%). Insufficient secretion of GH causes dwarfism or growth delay. Hyposecretion of glucocorticoids, aldosterone, and androgens occurs with Addison's disease. Pituitary dysfunction can cause Addison's disease, but this is not a primary disease pro-cess. Oversecretion of the adrenal medulla causes pheochromocytoma.

A client with cancer is receiving radiation therapy and develops thrombocytopenia. What is the priority nursing goal to prevent which effect of thrombocytopenia for this client? 1. pain related to spontaneous bleeding episodes 2. altered nutrition related to anemia 3. injury related to the decreased platelet count 4. skin breakdown related to decreased tissue perfusion

3. injury related to the decreased platelet count Rationale: This client is at high risk for bleeding because of the decreased platelet count. The priority nursing goal is to prevent injury to this clientby preventing bleeding occurrences. Spontaneous bleeding may cause pain but is not the priority. The client has a low platelet count, but not a low hemoglobin count such as exists in anemia. Skin integrity is a risk but not a priority.

A client has been diagnosed with Addison's disease. The nurse should plan with the client to manage which effect of the disease? 1. weight gain 2. hunger 3. lethargy 4. muscle spasms

3. lethargy Although many of the disease signs and symptoms are vague and nonspecific, most clients experience lethargy and depression as early symp-toms. Other early signs and symptoms include mood changes, emotional lability, irritability, weight loss, muscle weakness, fatigue, nausea, and vomiting. Most clients experience a loss of appetite. Muscles become weak, not spastic, because of adrenocortical insufficiency.

Following a transsphenoidal hypophysectomy, a client has a cerebrospinal fluid leak. The nurse should prepare the client for which treatment of the leak? 1. packing the nose with pressure dressings 2. returning the client to surgery to close the leak 3. maintaining bed rest with the head of the bed elevated to 30 degrees 4. administering high-dose corticosteroid therapy

3. maintaining bed rest with the head of the bed elevated to 30 degrees If CSF leakage is suspected or con-firmed, the client is treated initially with bed rest with the head of the bed elevated to decrease pressure on the graft site. Most leaks heal spontane-ously, but occasionally, surgical repair of the site in the sella turcica is needed. Repacking the nose will not heal the leak at the graft site in the dura. The client will not be returned to surgery immediately because most leaks heal spontaneously. High-dose corticosteroid therapy is not effective in healing a CSF leak.

Client with Hodgkin's disease develops B symptoms. Which symptom is a manifestation of B symptoms? 1. A low-grade fever (temperature lower than 100 degrees Fahrenheit (37 degrees Celsius) 2. a weight loss of 5 percent or less of body weight 3. night sweats 4. not progressing to an advanced stage

3. night sweats rationale: a temperature higher than 100.4 degrees Fahrenheit or 38 degrees Celsius, profuse night sweats, and an unintentional weight loss of 10% of body weight represent the cluster of clinical manifestation known as bee symptoms. 40% of clients with Hodgkin's disease have B symptoms and B symptoms are more common in advanced stages of the disease.

The nurse is planning care with a client with acute leukemia who has mucositis. What should the nurse advise the client to use for mouth care? 1. lemon-glycerin swabs 2. a commercial mouthwash 3. normal saline 4. a commercial toothpaste and brush

3. normal saline Rationale: Simple rinses with saline or a baking soda and water solution are effective and moisten the oral mucosa. Commercial mouthwashes and lemon glycerin swabs contain glycerin and alcohol,which are drying to the mucosa and should be avoided. Brushing after each meal is recommended, but every 4 hours may be too traumatic. During acute leukemia, the neutrophil and platelet counts are often low, and a soft-bristle toothbrush, instead of the client's usual brush, should be used to prevent bleeding gums.

A nurse is planning an educational program about cancer prevention and detection. Which group would benefit most from education regarding potential risk factors for melanoma? 1. adults older than age 35 2. senior citizens who have been repeatedly exposed to the effects of ultraviolet A and ultraviolet B rays 3. parents with children 4. employees of a chemical factory

3. parents with children Rationale: Sun damage is a cumulative process. Parents should be taught to apply sunscreen and teach their children to use sunscreen at an early age. Although preventive education is always valuable, serious sunburns in childhood are associated with an increased risk of melanoma. Adults and senior citizens have already been exposed to the harmful effects of the sun and, although they, too, should use sunscreen, they are not the group that will most benefit from intervention. Exposure to chemicals is not a risk factor for melanoma.

A client has had an adrenalectomy. What is the priority goal for this client in the first 24 hours after surgery? 1. beginning oral nutrition 2. promoting self-care activities 3. preventing adrenal crisis 4. ambulating in the hallway

3. preventing adrenal crisis The priority in the first 24 hours after adrenalectomy is to identify and prevent adrenal crisis. Monitoring of vital signs is the most important evaluation measure. Hypotension, tachycardia, orthostatic hypotension, and arrhythmias can be indicators of pending vascular collapse and hypo-volemic shock that can occur with adrenal crisis. Beginning oral nutrition is important, but not necessarily in the first 24 hours after surgery, and it is not more important than preventing adrenal crisis. Promoting self-care activities is not as important as preventing adrenal crisis. Ambulating in the hallway is not a priority in the first 24 hours after adrenalectomy.

The client would hodgkin's disease undergoes an excisional cervical lymph node biopsy under local anaesthesia. After the procedure, what does the nurse assess first? 1. Vital signs 2. the incision 3. the airway 4. neurological signs

3. the airway rationale: assessing for an open airway is always first period the procedure involves the neck; The anesthesia may have affected the swallowing reflex, or the inflammation may have closed in on the airway, leading to ineffective airway exchange. Once a pattern Airways confirmed and an effective breathing pattern established, the circulation is checked. Vital signs and the incision are assessed as soon as possible, but only after it is established at the Airways patent and the client is breathing normally. A neurological assessment is completed as soon as possible after another assessment.

A nurse is making follow-up phone calls to clients being treated for cancer. In which order of priority from first to last should the nurse return the calls? All options must be used. 1. the client receiving chemotherapy who has a loss of appetite 2. the client who underwent a mastectomy 2 weeks ago who called for information on the Reach for Recovery program 3. the client receiving spinal radiation for bone cancer metastases who has urinary incontinence 4. the client with colon cancer who has questions about a high-fiber diet

3. the client receiving spinal radiation for bone cancer metastases who has urinary incontinence 1. the client receiving chemotherapy who has a loss of appetite 4. the client with colon cancer who has questions about a high-fiber diet 2. the client who underwent a mastectomy Rationale: Using Maslow's hierarchy of needs to set priorities, the nurse should first call the client with bone cancer metastases to the spine because this client is at risk for compression, damage, or severing of the spinal cord. The nurse should evaluate the client immediately for urinary incontinence, paralysis, difficulty ambulating, and possible weakness or loss of motor function. The nurse should next call the client with loss of appetite to assess weight loss and suggest ways to increase the appe-tite. The client with colon cancer requires assistance with diet planning, also a physiologic need, but this client is not at high risk for weight loss. Lastly, the nurse should obtain information on Reach to Recovery and return the call to the client with a mastectomy. The needs of this client are the least urgent.

The nurse has documented the problem of body image distortion for a client with a diagnosis of Cushing's syndrome. The nurse identifies nursing interventions related to this problem and includes these interventions in the plan of care. Which nursing intervention is inappropriate? 1. Encourage the client's expression of feelings. 2. Assess the client's understanding of the disease process. 3. Encourage family members to share their feelings about the disease process. 4. Encourage the client to recognize that the body changes need to be dealt with.

4. Encourage the client to recognize that the body changes need to be dealt with. Rationale:Encouraging the client to understand that the body changes that occur in this disorder need to be dealt with is an inappropriate nursing intervention. This option does not address the client's feelings. The remaining options are appropriate because they address the client and family feelings regarding the disorder.

A client has had an hypophysectomy. What signs of a potential complication should the nurse teach the client to report? 1. acromegaly 2. Cushing's disease 3. diabetes mellitus 4. hypopituitarism

4. hypopituitarism Most clients who undergo adenoma removal experience a gradual return of normal pituitary secretion and do not experience complications. However, hypopituitarism can cause growth hor-mone, gonadotropin, thyroid-stimulating hormone, and adrenocorticotropic hormone deficits. The client should be taught to monitor for change in mental status, energy level, muscle strength, and cognitive function. In adults, changes in sexual function, impotence, or decreased libido should be reported. Acromegaly and Cushing's disease are conditions of hypersecretion. Diabetes mellitus is related to the function of the pancreas and is not directly related to the function of the pituitary.

The nurse is caring for a client who is scheduled for an adrenalectomy. Which drug may be included in the preoperative prescriptions to prevent Addison's crisis following surgery? 1. prednisone orally 2. fludrocortisones subcutaneously 3. spironolactone intramuscularly 4. methylprednisolone sodium succinate intravenously

4. methylprednisolone sodium succinate intravenously A glucocorticoid preparation will be administered intravenously or intramuscularly in the immediate preoperative period to a client scheduled for an adrenalectomy. Methylprednisolone sodium succinate protects the client from developing acute adrenal insufficiency (Addison's crisis) that occurs as a result of the adrenalec-tomy. Spironolactone is a potassium-sparing diuretic. Prednisone is an oral corticosteroid. Fludrocortisones is a mineral corticoid.

The anti-diuretic hormone is __________ in Diabetes Insipidus and _________ in SIADH. A. high, low B. absent, absent C. low, high D. low, low

C. low, high

A nurse has just received report on four cli-ents. Which client should the nurse see first? 1. A client who underwent a thyroidectomy and has new onset hoarseness. 2. A client who has Cushing's syndrome who has been noted to have a blood sugar of 134 mg/dL (7.4 mmol/L). 3. A client who is in renal failure and a laboratory report noting a creatinine of 3.2 mg/dL (282.3 pmol/L). 4. A client who was diagnosed with ulcerative colitis and recently passed 100 mL of loose bloody stools.

1. A client who underwent a thyroidectomy and has new onset hoarseness. New onset of hoarseness following a thy-roidectomy may be a sign of tracheal edema and impending airway obstruction, and the nurse should evaluate this client first. The client with Cushing's syndrome may have increased blood sugars associated with stress and hospitalization and will need further information to determine whether the blood sugar was obtained when the client was fasting. A client in renal failure would be expected to have an increase in creatinine, and the nurse can later follow up to compare this result with previous results. The client with ulcerative colitis will experience loose, bloody stools and needs to be continuously evaluated for amounts, but this is not the nurse's first prioritv.

The nurse is teaching a wellness class to a group of women at their workplace. Which findings represent the highest risk for developing cancer? 1. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years 2. Family history of colorectal cancer and consumes a high-fiber diet 3. Limits fat consumption and has regular mammography and Pap screenings 4. Exercises five times every week and does not consume alcoholic beverages

1. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years Rationale: Cancer prevention and early detection are associated with the following behaviors: limited alcohol use, regular physical activity, maintaining a normal body weight, obtaining regular cancer screenings, avoiding cigarette smoking and other tobacco use, using sunscreen with SPF 15 or higher, and practicing healthy dietary habits (e.g., reduced fat and increased fruits and vegetables).

The nurse is performing an assessment on a client with a diagnosis of myxedema (hypothyroidism). Which assessment finding would the nurse expect to note in this client? 1. Dry skin 2. Thin, silky hair 3. Bulging eyeballs 4. Fine muscle tremors

1. Dry skin Rationale:Myxedema is a deficiency of thyroid hormone. The client will present with a puffy, edematous face, especially around the eyes (periorbital edema), along with coarse facial features; dry skin; and dry, coarse hair and eyebrows. The remaining options are noted in the client with hyperthyroidism.

The nurse is admitting a client who is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH) and has serum sodium of 118 mEq/L (118 mmol/L). Which prescriptions would the nurse anticipate receiving? Select all that apply. 1. Initiate an infusion of 3% NaCl. 2. Administer intravenous furosemide. 3. Restrict fluids to 800 mL over 24 hours. 4. Elevate the head of the bed to high-Fowler's. 5. Administer a vasopressin antagonist as prescribed.

1. Initiate an infusion of 3% NaCl. 3. Restrict fluids to 800 mL over 24 hours. 5. Administer a vasopressin antagonist as prescribed. Rationale:Clients with SIADH experience excess secretion of antidiuretic hormone (ADH), which leads to excess intravascular volume, a declining serum osmolarity, and dilutional hyponatremia. Management is directed at correcting the hyponatremia and preventing cerebral edema. Hypertonic saline is prescribed when the hyponatremia is severe, less than 120 mEq/L (120 mmol/L). An intravenous (IV) infusion of 3% saline is hypertonic. Hypertonic saline must be infused slowly as prescribed, and an infusion pump must be used. Fluid restriction is a useful strategy aimed at correcting dilutional hyponatremia. Vasopressin is an ADH; vasopressin antagonists are used to treat SIADH. Furosemide may be used to treat extravascular volume and dilutional hyponatremia in SIADH, but it is only safe to use if the serum sodium is at least 125 mEq/L (125 mmol/L). When furosemide is used, potassium supplementation would also occur and serum potassium levels would be monitored. To promote venous return, the head of the bed would not be raised more than 10 degrees for the client with SIADH. Maximizing venous return helps to avoid stimulating stretch receptors in the heart that signal to the pituitary that more ADH is needed.

A client is hospitalized with a diagnosis of adrenal insufficiency. Which findings does the nurse identify as supportive of this diagnosis? Select all that apply. 1. Irritability 2. Complaints of nausea 3. Sodium level of 128 mEq/L (128 mmol/L) 4. Potassium level of 3.2 mEq/L (3.2 mmol/L) 5. Blood pressure lying 138/70 mm Hg and standing 110/58 mm Hg

1. Irritability 2. Complaints of nausea 3. Sodium level of 128 mEq/L (128 mmol/L) 5. Blood pressure lying 138/70 mm Hg and standing 110/58 mm Hg Rationale:Findings consistent with a diagnosis of adrenal insufficiency include nausea, vomiting, and diarrhea; hyponatremia; salt craving; hyperkalemia; and orthostatic hypotension. Irritability and depression may also occur in primary adrenal hypofunction.

A nurse is assessing the status of a client who returned to the surgical nursing unit after a parathyroidectomy procedure. The nurse would place highest priority on which assessment finding? 1. Laryngeal stridor 2. Difficulty voiding 3. Mild incisional pain 4. Absence of bowel sounds

1. Laryngeal stridor During the early postoperative period, the nurse carefully observes the client for signs of bleeding, which may cause swelling and compression of adjacent tissues. Laryngeal stridor results from compression of the trachea and is a harsh, high-pitched sound heard on inspiration and expiration. Laryngeal stridor is an acute emergency, necessitating immediate attention to avoid complete obstruction of the airway. The other options describe usual postoperative problems that are not life threatening.

A client with Graves' disease has exophthalmos and is experiencing photophobia. Which nursing action would best assist the client with these manifestations? 1. Obtain dark glasses for the client. 2. Lubricate the eyes with tap water every 2 to 4 hours. 3. Administer methimazole every 8 hours around the clock. 4. Instruct the client to avoid straining or heavy lifting because this effort can increase eye pressure.

1. Obtain dark glasses for the client. Rationale:Because photophobia (light intolerance) accompanies this disorder, wearing dark glasses is helpful in alleviating the problem. Tap water, which is hypotonic, could actually cause more swelling to the eye because it could pull fluid into the interstitial space. In addition, the client would be at risk for developing an eye infection because the solution is not sterile. Methimazole is a thyroid inhibitor, but medication therapy for Graves' disease does not help to alleviate the clinical manifestation of exophthalmos. There is no need to avoid straining or heavy lifting with exophthalmos.

A nurse is reviewing the assessment findings for a client who was admitted to the hospital with a diagnosis of diabetes insipidus. The nurse understands that which manifestations are associated with this disorder? Select all that apply. 1. Polyuria 2. Polydipsia 3. Concentrated urine 4. Complaints of excessive thirst 5. Specific gravity lower than 1.005

1. Polyuria 2. Polydipsia 4. Complaints of excessive thirst 5. Specific gravity lower than 1.005 Rationale:A triad of clinical symptoms—polyuria, polydipsia, and excessive thirst—often occurs suddenly in the client with diabetes insipidus. The urine is dilute, with a specific gravity lower than 1.005, and the urine osmolality is low (50 to 200 mOsm/L).

A 70-year-old patient has multiple myeloma. His wife calls to report that he sleeps most of the day, is confused when awake, and reports nausea and constipation. Which complication of cancer is most likely caused by? 1. hypercalcemia 2. tumor lysis syndrome 3. spinal cord compression 4. superior vena cava

1. hypercalcemia Rationale: Hypercalcemia can occur with multiple myeloma. Immobility and dehydration can contribute to or worsen hypercalcemia. The manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, electrocardiographic changes, polyuria and nocturia, anorexia, nausea, and vomiting.

A client is seen in the clinic for complaints of thirst, frequent urination, and headaches. After diagnostic studies, diabetes insipidus is diagnosed. Desmopressin is prescribed. The client asks why this medication was prescribed. Which is a correct statement by the nurse? 1. "It relieves the headaches." 2. "It increases water reabsorption." 3. "It stimulates the production of aldosterone." 4. "It decreases the production of the antidiuretic hormone."

2. "It increases water reabsorption." Rationale:Desmopressin is an antidiuretic hormone (ADH) used in the treatment of diabetes insipidus. It promotes renal conservation of water by acting on the collecting ducts of the kidney to increase the permeability to water, which results in increased water reabsorption. Desmopressin does not relieve headaches, stimulate aldosterone, or decrease production of ADH.

Which patient is statistically and medically at the highest risk of developing cancer? 1. A 68-yr-old white woman who has BRCA-1 gene and is obese 2. A 56-yr-old black man with hepatitis C who drinks alcohol daily 3. An 18-yr-old Hispanic man who eats fast food once per week and drinks alcohol 4. An 80-yr-old Asian woman with coronary artery disease on blood pressure medication.

2. A 56-yr-old black man with hepatitis C who drinks alcohol daily Rationale: The combination of statistically identified risk factors in addition to current liver disease (hepatitis C that is linked to the development of liver cancer) and the added promotor of alcohol makes this patient at the highest risk. Second is the white woman with the gene for breast cancer and the added promotor of obesity. Most cancer cases are diagnosed in people older than 55 years of age. The overall incidence of cancer is higher in men than women. Cancer incidence is higher in blacks, then whites, and then people from other cultures.

The nurse is preparing to care for a client after parathyroidectomy. The nurse would plan for which action for this client? 1. Maintain an endotracheal tube for 24 hours. 2. Administer a continuous mist of room air or oxygen. 3. Use only a rectal thermometer for temperature measurement. 4. Place the client in a flat position with the head and neck immobilized.

2. Administer a continuous mist of room air or oxygen. Rationale:Humidification of air or oxygen helps to liquefy mucous secretions and promotes easier breathing after parathyroidectomy. Pooling of thick mucous secretions in the trachea, bronchi, and lungs will cause respiratory obstruction. The client will not necessarily have an endotracheal tube in place. Tympanic temperatures can be taken. Rectal temperatures only are not required. Semi-Fowler's position is the position of choice to assist in lung expansion and prevent edema.

The nurse is performing an assessment on a client with a diagnosis of hyperthyroidism. Which assessment finding would the nurse expect to note in this client? 1. Dry skin 2. Bulging eyeballs 3. Periorbital edema 4. Coarse facial features

2. Bulging eyeballs Rationale:Hyperthyroidism is clinically manifested by goiter (increase in the size of the thyroid gland) and exophthalmos (bulging eyeballs). Other clinical manifestations include nervousness, fatigue, weight loss, muscle cramps, and heat intolerance. Additional signs found in this disorder include tachycardia; shortness of breath; excessive sweating; fine muscle tremors; thin, silky hair and thin skin; infrequent blinking; and a staring appearance.

A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially? 1. Warm the client. 2. Maintain a patent airway. 3. Administer thyroid hormone. 4. Administer fluid replacement.

2. Maintain a patent airway. Rationale:Myxedema coma is a rare but serious disorder that results from persistently low thyroid production. Coma can be precipitated by acute illness, rapid withdrawal of thyroid medication, anesthesia and surgery, hypothermia, and the use of sedatives and opioid analgesics. In myxedema coma, the initial nursing action is to maintain a patent airway. Oxygen needs to be administered, followed by fluid replacement, keeping the client warm, monitoring vital signs, and administering thyroid hormones by the intravenous route.

One day following a subtotal thyroidectomy, a client begins to have tingling in the fingers and toes. What should the nurse do first? 1. Encourage the client to flex and extend the fingers and toes. 2. Notify the health care provider (HCP). 3. Assess the client for thrombophlebitis. 4. Ask the client to speak.

2. Notify the health care provider (HCP). Tetany may occur after thyroidectomy if the parathyroid glands are accidentally injured or removed during surgery. This would cause a disturbance in serum calcium levels. An early sign of tetany is numbness and tingling of the fingers or toes and in the circumoral region. Tetany may occur from 1 to 7 days postoperatively. Late signs and symptoms of tetany include seizures, contraction of the glottis, and respiratory obstruction. The nurse should notify the HCP . Exercising the joints in the fingers and toes will not relieve the tetany. The client is not exhibiting signs of thrombophlebitis. There is no indication of nerve damage that would cause the client not to be able to speak.

The nurse is reviewing the laboratory test results for a client with leukemia receiving chemotherapy. The nurse notes that the white blood cell and neutrophil counts are extremely low and places the client on neutropenic precautions. Which interventions are components of these types of precautions? Select all that apply. 1. Allowing only fresh fruits in the client's room 2. Removing fresh-cut flowers from the client's room 3. Encouraging the client to eat any types of fresh vegetables 4. Instructing family members on the proper technique for hand washing 5. Instructing family members to wear a mask when entering the client's room

2. Removing fresh-cut flowers from the client's room 4. Instructing family members on the proper technique for hand washing 5. Instructing family members to wear a mask when entering the client's room Rationale:In the immunocompromised client, a low-bacteria diet is necessary. This includes avoiding the intake of fresh fruits and vegetables. Thorough cooking of all food also is required. Cut flowers and any standing water are removed from the room because both tend to harbor bacteria. Anyone who enters the client's room needs to perform strict and thorough hand washing and wear a mask.

The nurse is preparing for a client's postoperative return to the unit after a parathyroidectomy procedure. The nurse would ensure that which piece of medical equipment is at the client's bedside? 1. Cardiac monitor 2. Tracheotomy set 3. Intermittent gastric suction device 4. Underwater seal chest drainage system

2. Tracheotomy set Rationale:Respiratory distress caused by hemorrhage and swelling and compression of the trachea is a paramount concern for the nurse managing the care of a postoperative client who has had a parathyroidectomy. An emergency tracheotomy set is routinely placed at the bedside of the client who has undergone this type of surgery in anticipation of this complication. The items in the remaining options are not specifically needed with this surgical procedure.

Which medication should be available to provide emergency treatment if a client develops tetany after a subtotal thyroidectomy? 1. sodium phosphate 2. calcium gluconate 3. echothiophate iodide 4. sodium bicarbonate

2. calcium gluconate The client with tetany is suffering from hypocalcemia, which is treated by administering an IV preparation of calcium, such as calcium gluconate or calcium chloride. Oral calcium is then necessary until normal parathyroid function returns. Sodium phosphate is a laxative. Echothiophate iodide is an eye preparation used as a miotic for an antiglaucoma effect. Sodium bicarbonate is a potent systemic antacid.

A client with a large goiter is scheduled for a subtotal thyroidectomy to treat thyrotoxicosis. Saturated solution of potassium iodide (SSKI) is prescribed preoperatively for the client. What should the nurse explain to the client about the expected outcome of using this drug? The drug helps: 1. slow progression of exophthalmos. 2. reduce the vascularity of the thyroid gland. 3. decrease the body's ability to store thyroxine. 4. increase the body's ability to excrete thyroxine.

2. reduce the vascularity of the thyroid gland. SKI is frequently administered before a thyroidectomy because it helps decrease the vascu-larity of the thyroid gland. A highly vascular thyroid gland is very friable, a condition that presents a hazard during surgery. Preparation of the client for surgery includes depleting the gland of thyroid hormone and decreasing vascularity. SKI does not decrease the progression of exophthalmos, and it does not decrease the body's ability to store thyroxine or increase the body's ability to excrete thyroxine.

The nurse is completing a health assessment of a 42-year-old female with suspected Graves' dis-ease. When conducting a focused assessment, what should the nurse assess the client for? 1. anorexia 2. tachycardia 3. weight gain 4. cold skin

2. tachycardia Graves' disease, the most common type of thyrotoxicosis, is a state of hypermetabolism. The increased metabolic rate generates heat and produces tachycardia and fine muscle tremors. Anorexia is associated with hypothyroidism. Loss of weight, despite a good appetite and adequate caloric intake, is a common feature of hyperthyroidism. Cold skin is associated with hypothyroidism.

The nurse is instructing the client with hypothyroidism who takes levothyroxine 100 mcg, digoxin, and simvastatin. The nurse judges that the teaching regarding the use of these medications is effective if the client will take: 1. the levothyroxine with breakfast and the other medications after breakfast. 2. the levothyroxine before breakfast and the other medications 4 hours later. 3. all medications together 1 hour after eating breakfast. 4. all medications before going to bed.

2. the levothyroxine before breakfast and the other medications 4 hours later. Levothyroxine must be given at the same time each day on an empty stomach, preferably ½ to 1 hour before breakfast. Other medications may impair the action of levothyroxine absorption; the client should separate doses of other medications by 4 to 5 hours.

A 60-year-old female is diagnosed with hypothyroidism. What additional information should the nurse obtain when conducting a focused assessment? 1. tachycardia 2. weight gain 3. diarrhea 4. nausea

2. weight gain Typical signs and symptoms of hypothyroidism include weight gain, fatigue, decreased energy, apathy, brittle nails, dry skin, cold intoler-ance, hair loss, constipation, and numbness and tingling in the fingers. Tachycardia is a sign of hyperthyroidism, not hypothyroidism. Diarrhea and nausea are not symptoms of hypothyroidism.

The nurse is instructing a client with Cushing's syndrome on follow-up care. Which of these client statements would indicate a need for further instruction? 1. "I need to avoid contact sports." 2. "I would check my ankles for swelling." 3. "I need to avoid foods high in potassium." 4. "I need to check my blood glucose regularly."

3. "I need to avoid foods high in potassium." Rationale:Hypokalemia is a common characteristic of Cushing's syndrome, and the client is instructed to consume foods high in potassium. Clients with this condition experience activity intolerance, osteoporosis, and frequent bruising. Fluid volume excess results from water and sodium retention. Hyperglycemia is caused by an increased cortisol secretion.

A nurse is providing home care instructions to a client with a diagnosis of Addison's disease. Which statement by the client indicates a need for further instruction? 1. "I need to wear a MedicAlert bracelet." 2. "I need to purchase a travel kit that contains cortisone." 3. "I will need to take daily medications until my symptoms decrease." 4. "I need an increased dose of glucocorticoid medication during stressful minor illnesses."

3. "I will need to take daily medications until my symptoms decrease." Rationale:Client teaching includes the need for lifelong daily medications. The client also is instructed to carry or wear a medical identification card or bracelet. A travel kit will need to be purchased. It needs to contain oral cortisone along with intramuscular preparations for self-injection and intravenous vials for emergency injection by a primary health care provider. Increased glucocorticoid dosage during stressful minor illnesses will be necessary.

The nurse is caring for a client with Addison's disease. The client asks the nurse about the risks associated with this disease, specifically about addisonian crisis. Regarding prevention of this complication, how would the nurse inform the client? 1. "You can take either hydrocortisone or fludrocortisone for replacement." 2. "You need to take your fludrocortisone 3 times a day to prevent a crisis." 3. "You need to increase salt in your diet, particularly during stressful situations." 4. "You need to decrease your dosages of glucocorticoids and mineralocorticoids during stressful situations." Submit

3. "You need to increase salt in your diet, particularly during stressful situations." Rationale:Addison's disease is a result of adrenocortical insufficiency, and management is focused on treating the underlying cause. Hormone therapy is used for replacement. Hydrocortisone has both glucocorticoid and mineralocorticoid properties and needs to be taken 3 times daily, with two thirds of the daily dose taken on awakening. Fludrocortisone is taken once daily in the morning. Salt additives are necessary, particularly during times of stress, to compensate for excess heat or humidity as a result of the condition. There needs to be an increased dose of cortisol given for stressful situations such as surgery or hospitalization. Therefore, option 3 is the correct answer.

The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? 1. It is delivered via an Ommaya reservoir and extension catheter. 2. It is instilled in the bladder via a urinary catheter and retained for 1 to 3 hours. 3. A Silastic catheter will be percutaneously placed in the abdomen for chemotherapy administration. 4. The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

3. A Silastic catheter will be percutaneously placed in the abdomen for chemotherapy administration. Intraperitoneal chemotherapy is delivered to the peritoneal cavity via a temporary percutaneously inserted Silastic catheter and drained from this catheter after the dwell time in the peritoneum. The Ommaya reservoir is used for intraventricular chemotherapy. Intravesical bladder chemotherapy is delivered via a urinary catheter. Intraarterial chemotherapy is delivered via a surgically placed catheter that delivers chemotherapy via an external or internal infusion pump.

Levothyroxine is prescribed for a client diagnosed with hypothyroidism. Upon review of the client's record, the nurse notes that the client is taking warfarin. Which modification to the plan of care would the nurse review with the client's primary health care provider? 1. A decreased dosage of levothyroxine 2. An increased dosage of levothyroxine 3. A decreased dosage of warfarin sodium 4. An increased dosage of warfarin sodium

3. A decreased dosage of warfarin sodium Levothyroxine accelerates the degradation of vitamin K-dependent clotting factors. As a result, the effects of warfarin are enhanced. If thyroid hormone replacement therapy is instituted in a client who has been taking warfarin, the dosage of warfarin would be reduced.

The nurse is reviewing the laboratory test results for a client with a diagnosis of Cushing's syndrome. Which laboratory finding would the nurse expect to note in this client? 1. A platelet count of 200,000 mm3 (200 × 109/L) 2. A blood glucose level of 99 mg/dL (5.5 mmol/L) 3. A potassium (K+) level of 3.0 mEq/L (3.0 mmol/L) 4. A white blood cell (WBC) count of 6000 mm3 (6 × 109/L)

3. A potassium (K+) level of 3.0 mEq/L (3.0 mmol/L) Rationale:The client with Cushing's syndrome experiences hypokalemia, hyperglycemia, an elevated WBC count, elevated plasma cortisol and adrenocorticotropic hormone levels among other abnormalities. These abnormalities are caused by the effects of excess glucocorticoids and mineralocorticoids in the body. The normal potassium level is 3.5 to 5.0 mEq/L (3.5 to 5.0 mmol/L). The laboratory values listed in the remaining options would not be noted in the client with Cushing's syndrome.

The nurse would include which interventions in the plan of care for a client with hyperthyroidism? Select all that apply. 1. Provide a warm environment for the client. 2. Instruct the client to consume a low-fat diet. 3. A thyroid-releasing inhibitor will be prescribed. 4. Encourage the client to consume a well-balanced diet. 5. Instruct the client that thyroid replacement therapy will be needed. 6. Instruct the client that episodes of chest pain are expected to occur.

3. A thyroid-releasing inhibitor will be prescribed. 4. Encourage the client to consume a well-balanced diet. Rationale:The clinical manifestations of hyperthyroidism are the result of increased metabolism caused by high levels of thyroid hormone. Interventions are aimed at reduction of the hormones and measures to support the signs and symptoms related to an increased metabolism. The client often has heat intolerance and requires a cool environment. The nurse encourages the client to consume a well-balanced diet because clients with this condition experience increased appetite. Iodine preparations are used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone. Thyroid replacement is needed for hypothyroidism. The client would notify the primary health care provider if chest pain occurs because it could be an indication of an excessive medication dose.

A client with hyperthyroidism is to take saturated solution of potassium iodide (SSKI). What should the nurse do when administering this drug? 1. Pour the solution over ice chips. 2. Mix the solution with an antacid. 3. Dilute the solution with water, milk, or fruit juice and have the client drink it with a straw. 4. Disguise the solution in a pureed fruit or vegetable.

3. Dilute the solution with water, milk, or fruit juice and have the client drink it with a straw. SSKI should be diluted well in milk, water, juice, or a carbonated beverage before administration to help disguise the strong, bitter taste. Also, this drug is irritating to the mucosa if taken undiluted. The client should sip the diluted preparation through a drinking straw to help prevent staining of the teeth. Pouring the solution over ice chips will not sufficiently dilute the SSKI or cover the taste. Antacids are not used to dilute or cover the taste of SSKI. Mixing in a puree would put the SSKI in contact with the teeth.

A nurse is reviewing the assessment findings and laboratory data for a client with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). The nurse understands that which symptoms are associated characteristics of this disorder? Select all that apply. 1. Hypernatremia 2. Signs of water deficit 3. High urine osmolality 4. Low serum osmolality 5. Hypotonicity of body fluids 6. Continued release of antidiuretic hormone (ADH)

3. High urine osmolality 4. Low serum osmolality 5. Hypotonicity of body fluids 6. Continued release of antidiuretic hormone (ADH) Rationale:SIADH is characterized by inappropriate continued release of ADH. This results in water intoxication, manifested as fluid volume expansion, hypotonicity of body fluids, and hyponatremia as a result of the high urine osmolality and low serum osmolality.

The nurse is assessing the nasal dressing on a client who had a transsphenoidal resection of the pituitary gland. The nurse notes a small amount of serosanguineous drainage that is surrounded by clear fluid on the nasal dressing. Which nursing action is most appropriate? 1. Document the findings. 2. Reinforce the dressing. 3. Notify the primary health care provider (PHCP). 4. Mark the area of drainage with a pen and monitor for further drainage.

3. Notify the primary health care provider (PHCP). Rationale:Cerebrospinal fluid (CSF) leakage after cranial surgery may be detected by noting drainage that is serosanguineous surrounded by an area of straw-colored or pale drainage. The physical appearance of CSF drainage is that of a halo. If the nurse notes the presence of this type of drainage, the PHCP needs to be notified. The remaining options are inappropriate nursing actions

Immediately following a thyroidectomy, the nurse asks the client to say "hello." The client moves the lips, but is not able to speak the word. What should the nurse do next? 1. Give the client a sip of water. 2. Have the client take a deep breath and cough. 3. Notify the surgeon. 4. Check client's pupillary response.

3. Notify the surgeon. The nurse first should notify the surgeon; inability to speak may indicate laryngeal nerve damage. The client should not receive water until fully recovered from anesthesia. Coughing now will irritate the throat. The client is responsive, so the immediate action is not to do a pupillary check.

Following a subtotal thyroidectomy, the nurse asks the client to speak immediately upon regaining consciousness. The client is not able to make a sound. The nurse determines that the client is experiencing which complication of the surgery? 1. internal hemorrhage 2. decreasing level of consciousness 3. laryngeal nerve damage 4. upper airway obstruction

3. laryngeal nerve damage Laryngeal nerve damage is a potential complication of thyroid surgery because of the proximity of the thyroid gland to the recurrent laryngeal nerve. Asking the client to speak helps assess for signs of laryngeal nerve damage. Persistent or worsening hoarseness and weak voice are signs of laryngeal nerve damage and should be reported to the health care provider (HCP) - immediately. Internal hemorrhage is detected by changes in vital signs. The client's level of consciousness can be partially assessed by asking her to speak, but that is not the primary reason for doing so in this situation. Upper airway obstruction is detected by color and respiratory rate and pattern

The nurse is caring for a patient with anorexia secondary to chemotherapy. Which strategy would be most appropriate to increase the patient's nutritional intake? 1. Increase intake of liquids at mealtime to stimulate the appetite. 2. Serve three large meals per day plus snacks between each meal. 3. Avoid the use of liquid protein supplements to encourage eating at mealtimes. 4. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

4. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods. Rationale: The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (e.g., peanut butter, skim milk powder, cheese, honey, brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.

A client is being evaluated for hypothyroid-ism. To plan care, the nurse should ask the client about which sign or symptom? 1. corneal abrasion 2. weight loss 3. diarrhea 4. fatigue

4. fatigue A major problem for the person with hypothyroidism is fatigue. Other signs and symptoms include lethargy, personality changes, generalized edema, impaired memory, slowed speech, cold intolerance, dry skin, muscle weakness, constipa-tion, weight gain, and hair loss. Incomplete closure of the eyelids, hypermetabolism, and diarrhea are associated with hyperthyroidism.

A client with hypothyroidism has started to take thyroid hormone replacement therapy and asks the nurse about the reason for feeling sad and depressed. What should the nurse tell the client? "The feelings of sadness and depression are caused by: 1. the side effects of thyroid hormone replacement therapy and will diminish over time." 2. a condition unrelated to hypothyroidism and require follow-up." 3. having a chronic illness and are normal." 4. low thyroid hormone levels and will improve with replacement therapy.

4. low thyroid hormone levels and will improve with replacement therapy. Hypothyroidism may contribute to sadness and depression. This client needs to know that these feelings may be related to low thyroid hormone levels and may improve with treatment. Replacement therapy does not cause depression. Depression may accompany chronic illness, but it is not "normal."

A patient who is receiving radiation to the head and neck as treatment for an invasive cancer reports mouth sores and pain? 1. provide ice chips to soothe the irritation 2. weigh the patient every month to monitor for weight loss 3. cleanse the mouth every 2 to 4 hours with hydrogen peroxide 4. provide high-protein and high-calories, soft foods every 2 hours

4. provide high-protein and high-calories, soft foods every 2 hours Rationale: A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories to aid healing. Extremes of temperature are to be avoided. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Patients should be weighed at least twice each week to monitor for weight loss.

Which patient is most at risk for developing Syndrome of Inappropriate Anti-diuretic Hormone (SIADH)? A. A patient diagnosed with small cell lung cancer. B. A patient whose kidney tubules are failing to reabsorb water. C. A patient with a tumor on the anterior pituitary gland. D. A patient taking Declomycin.

A. A patient diagnosed with small cell lung cancer.

You are developing a care plan for a patient with SIADH. Which of the following would be a potential nursing diagnosis for this patient? A. Fluid volume overload B. Fluid volume deficient C. Acute pain D. Impaired skin integrity

A. Fluid volume overload

A patient arrives to the ER and is unable to give you a health history due to altered mental status. The family reports the patient has gained over 10 lbs in 1 week and says it is mainly "water" weight. In addition, they report the patient hasn't been able to urinate or eat within the past week as well and was recently diagnosed with small cell lung cancer. On assessment, you note the patient's HR is 115 and BP 180/92. Patient sodium level is 90. Which of the following conditions do you suspect the patient is most likely presenting with? A. SIADH B. Diabetes Insipidus C. Addison's Disease D. Fluid Volume Deficient

A. SIADH

Where is the anti-diuretic hormone PRODUCED in the body? A. Anterior pituitary gland B. Posterior pituitary gland C. Hypothalamus D. Medulla

C. Hypothalamus

Which of the following signs and symptoms is NOT expected with Diabetes Insipidus? A. Polyuria B. Polydipsia C. Polyphagia D. Extreme thirst

C. Polyphagia Polyphagia means excessive eating.

Where is the anti-diuretic hormone SECRETED in the body? A. Hypothalamus B. Thyroid C. Posterior Pituitary gland D. Anterior pituitary gland

C. Posterior Pituitary gland

A patient with SIADH is undergoing IV treatment of a hypertonic IV solution of 3% saline and IV Lasix. Which of the following nursing findings requires intervention? A. Sodium level of 136. B. Patient reports urinating more frequently. C. Potassium level of 5.0. D. Assessment finding of crackles throughout the lung fields.

D. Assessment finding of crackles throughout the lung fields.

After a bilateral adrenalectomy for Cushing's disease, the client will receive periodic testosterone injections. What is the expected outcome of these injections? 1. balanced reproductive cycle 2. restored sodium and potassium balance 3. stimulated protein metabolism 4. stabilized mood swings

3. stimulated protein metabolism Testosterone is an androgen hormone that is responsible for protein metabolism as well as maintenance of secondary sexual characteristics; therefore, it is needed by both males and females. Removal of both adrenal glands necessitates replacement of glucocorticoids and androgens. Testosterone does not balance the reproductive cycle, stabilize mood swings, or restore sodium and potassium balance.

A client is to have a transsphenoidal hypophysectomy to remove a large, invasive pituitary tumor. Where should the nurse tell the client the surgical incision will be made? 1. back of the mouth 2. high in the nares 3. sinus channel below the right eye 4. upper gingival mucosa in the space between the upper gums and lip

4. upper gingival mucosa in the space between the upper gums and lip With transsphenoidal hypophysectomy, the sella turcica is entered from below, through the sphenoid sinus. There is no external incision; the incision is made between the upper lip and gums.

In providing care to the client with leukemia who has developed thrombocytopenia, the nurse assesses the most common sites for bleeding. Which is not a common site? 1. Biliary system 2. gastrointestinal tract 3. brain and meninges 4. pulmonary system

1. Biliary system rationale: the biliary system is not especially prone to hemorrhage. Thrombocytopenia (a low platelet count) leaves the client at a risk for a potentially life threatening spontaneous hemorrhage in the gastrointestinal, respiratory, and intercranial cavities.

Which topic is most important to include in the teaching plan for a client newly diagnosed with Addison's disease who will be taking corticosteroids? 1. the importance of watching for signs of hyperglycemia 2. the need to adjust the steroid dose based on dietary intake and exercise 3. to notify the health care provider (HCP) when the blood pressure is suddenly high 4. how to decrease the dose of the corticosteroids when the client experiences stress

1. the importance of watching for signs of hyperglycemia Since Addison's disease can be life threatening, treatment often begins with administration of corticosteroids. Corticosteroids, such as prednisone, may be taken orally or intravenously, depending on the client. A serious adverse effect of corticosteroids is hyperglycemia. Clients do not adjust their steroid dose based on dietary intake and exercise; insulin is adjusted based on diet and exercise. Addisonian crisis can occur secondary to hypoadrenocorticism, resulting in a crisis situation of acute hypotension, not increased blood pressure. Addison's disease is a disease of inadequate adrenal hormone, and therefore, the client will have inadequate response to stress. If the client takes more medication than prescribed, there can be a potential increase in potassium depletion, fluid retention, and hyperglycemia. Taking less medication than was prescribed can trigger addisonian crisis state, which is a medical emergency manifested by signs of shock.

A client with neutropenia has an absolute neutrophil count (ANC) of 900 (0.9 × 10°/L). The nurse teaches the client to prevent which risk of neutropenia? 1. bleeding 2. infection 3. hemorrhagic stroke 4. sickle cell crisis

2. infection A client is at moderate risk for infection when the ANC is <1,000 (1 × 10°/L). The client does not have a platelet disorder and is not at risk for bleeding or hemorrhagic stroke. The client does not have sickle cell anemia and is not at risk for a crisis.

In the early postoperative period after a bilateral adrenalectomy, the client has a temperature of 101°F (38.3°C). What should the nurse assess first to determine the cause of the elevated temperature? 1. dehydration 2. lung expansion 3. wound infection 4. urinary tract infection

2. lung expansion Poor lung expansion from bed rest, pain, and retained anesthesia is a common cause of postoperative temperature elevation, and the nurse should first assess that the client is taking deep breaths every 1 to 2 hours. The client will have postoperative IV fluid replacement prescribed to prevent dehydration. Wound infections typically appear 4 to 7 days after surgery. Urinary tract infections are not common with this surgery.

What is an expected finding in a client with adrenal crisis (addisonian crisis)? 1. fluid retention 2. pain 3. peripheral edema 4. hunger

2. pain Adrenal hormone deficiency can cause profound physiologic changes. The client may experience severe pain (headache, abdominal pain, back pain, or pain in the extremities). Inhibited gluconeogenesis commonly produces hypoglycemia, and impaired sodium retention causes decreased, not increased, fluid volume. Edema would not be expected. Gastrointestinal disturbances, including nausea and vomiting, are expected findings in Addison's disease, not hunger.

A nurse is conducting a cancer risk screening program. Which client is at greatest risk for skin cancer? 1. a 45-year-old health care worker 2. a 15-year-old high school student 3. a 30-year-old butcher 4. a 60-year-old mountain biker

4. a 60-year-old mountain biker Rationale: Basal cell carcinoma occurs most commonly in sun-exposed areas of the body. The incidence of skin cancer is highest in older people who live in the mountains or spend outdoor leisure time at higher altitudes.

Which indicator is best for determining whether a client with Addison's disease is receiving the correct amount of glucocorticoid replacement? 1. skin turgor 2. temperature 3. thirst 4. daily weight

4. daily weight Measuring daily weight is a reliable, objective way to monitor fluid balance. Rapid variations in weight reflect changes in fluid volume, which suggests insufficient control of the disease and the need for more glucocorticoids in the client with Addison's disease. Nurses should instruct clients taking oral steroids to weigh themselves daily and to report any unusual weight loss or gain. Skin turgor testing does supply information about fluid status, but daily weight monitoring is more reliable. Temperature is not a direct measurement of fluid balance. Thirst is a nonspecific and very late sign of weight loss.

A client is diagnosed with Cushing's syndrome. When reviewing the recent laboratory results, the nurse would expect an excess of which substance? 1. Calcium 2. Cortisol 3. Epinephrine 4. Norepinephrine

2. Cortisol Cushing's syndrome is characterized by an excess of cortisol, a glucocorticoid. Glucocorticoids are produced by the adrenal cortex. Calcium would be decreased in this disorder. Epinephrine and norepinephrine are produced by the adrenal medulla.

a client with a family history of cancer asked the nurse what the single most important risk factor is for cancer. Which first factor would the nurse discuss. 1. family history 2. lifestyle choices 3. age 4. menopause or hormonal events

3. age rationale: because more than 50% of the cancers occur in people who are older than age 65, the single most important factor in determining risk would be age

The nurse is instructing a college student with Addison's disease how to adjust the dose of glucocorticoids. The nurse should explain that the client may need an increased dosage of glucocorticoids in which situation? 1. completing course work. 2. gaining 4 lb (1.8 kg) 3. becoming engaged 4. having wisdom teeth extracted

4. having wisdom teeth extracted Adrenal crisis can occur with physical stress, such as surgery, dental work, infection, flu, trauma, and pregnancy. In these situations, glucocorticoid and mineralocorticoid dosages are increased. Weight loss, not gain, occurs with adrenal insufficiency. Psychological stress has less effect on corticosteroid need than physical stress.

1. Which client is at highest risk for colorectal cancer? The client: 1. who smoked 1 pack a day for 30 years 2. who follows a vegetarian diet 3. who has been treated for Crohn's disease for 20 years 4. with a family history of lung cancer

3. who has been treated for Crohn's disease for 20 years Rationale: Clients over age 50 who have a history of inflammatory bowel disease are at risk for colon cancer. The client who smokes is at high risk for lung cancer. While the exact cause is not always known, other risk factors for colon cancer are a diet high in animal fats, including a large amount of red meat and fatty foods with low fiber, and the presence of colon cancer in a first-generation relative.

"A diagnosis of Hodgkin's disease is suspected in a 12 year old child seen in a clinic. Several diagnostic studies are performed to determine the presence of this disease. Which diagnostic test results confirm the diagnosis of Hodgkin's disease?" 1. Elevated vanillylmandelic acid urinary levels. 2. The presence of blast cells in the bone marrow. 3. The presence of Epstein-Barr virus in the blood. 4. The presence of Reed-Sternberg cells in the lymph nodes"

4. The presence of Reed-Sternberg cells in the lymph nodes" Hodgkin's disease is a malignancy of the lymph nodes. The presence of giant, multinucleated cells (Reed-sternberg cells) is the classic characteristic of this disease. The presence of blast cells in the bone marrow indicates leukemia. Epstein Barr virus is associated with infectious mononucleosis. Elevated levels of vanillylmandelic acid in the urine may be found in children with neuroblastoma."

When teaching a client about taking oral glucocorticoids, how should the nurse instruct the client to take the medication? 1. with a full glass of water 2. on an empty stomach 3. at bedtime to increase absorption 4. with meals or with an antacid

4. with meals or with an antacid Oral steroids can cause gastric irritation and ulcers and should be administered with meals, if possible, or otherwise with an antacid. Only instructing the client to take the medication with a full glass of water will not help prevent gastric complications from steroids. Steroids should never be taken on an empty stomach. Glucocorticoids should be taken in the morning, not at bedtime.

a client has undergone a lymph node biopsy. the nurse anticipates that the report will reveal which result if the client has Hodgkin's lymphoma?" 1. Reed-Sternberg cells. 2. Philadelphia chromosome. 3. Epstein-Barr virus. 4. Herpes simplex virus.

1. Reed-Sternberg cells. RATIONALE: histological isolation of Reed-Sternberg cells in lymph node biopsy examination is a diagnostic feature of Hodgkin's lymphoma. Philadelphia chromosome is attribted to chronic myelogenous leukemia. viruses are much smaller than can be visualized with cytology. STRATEGY: the core issue of the question is knowledge of characteristic findings in the diagnosis of lymphoma. use nursing knowledge and the process of elimination to make a selection.

As the nurse assists the postoperative client out of bed, the client reports having gas pains in the abdomen. To reduce this discomfort, what should the nurse do? 1. Encourage the client to ambulate. 2. Insert a rectal tube. 3. Insert a nasogastric (NG) tube. 4. Encourage the client to drink carbonated liquids.

1. Encourage the client to ambulate. Decreased mobility is one of the most common causes of abdominal distention related to retained gas in the intestines. Peristalsis has been inhibited by general anesthesia, analgesics, and inactivity during the immediate postoperative period. Ambulation increases peristaltic activity and helps move gas. Walking can prevent the need for a rectal tube, which is a more invasive procedure. An NG tube is also a more invasive procedure and requires a prescription. It is not a preferred treatment for gas postoperatively. Walking should prevent the need for further interventions. Carbonated liquids can increase gas formation.

The nurse should monitor the client with Cushing's disease for which finding? 1. postprandial hypoglycemia 2. hypokalemia 3. hyponatremia 4. decreased urine calcium level

2. hypokalemia Sodium retention is typically accompanied by potassium depletion. Hypertension, hypokalemia, edema, and heart failure may result from the hypersecretion of aldosterone. The client with Cushing's disease exhibits postprandial or persistent hyperglycemia. Clients with Cushing's disease have hypernatremia, not hyponatremia. Bone resorption of calcium increases the urine calcium level.

As part of chemotherapy education, the nurse teaches a female client about the risk for bleeding and self-care during the period of greatest bone marrow suppression (the nadir). The nurse understands that further teaching is needed if the client makes which statement? 1. "I should avoid blowing my nose." 2. "I may need a platelet transfusion if my platelet count is too low." 3. "I'm going to take aspirin for my headache as soon as I get home." 4. "I will count the number of pads and tampons I use when menstruating."

3. "I'm going to take aspirin for my headache as soon as I get home." Rationale: During the period of greatest bone marrow suppression (the nadir), the platelet count may be low, less than 20,000 cells mm3 (20.0 × 10 9 /L). The correct option describes an incorrect statement by the client. Aspirin and nonsteroidal antiinflammatory drugs and products that contain aspirin should be avoided

A client is beginning external beam radiation therapy to the right axilla after a lumpectomy for breast cancer. Which information should the nurse include in client teachine? 1. Use a heating pad under the right arm 2. Immobilize the right arm 3. Place ice on the area after each treatment 4. Apply deodorant only under the left arm

4. Apply deodorant only under the left arm Rationale: The nurse should instruct the client to avoid applying chemicals (such as a deodorant) or heat or cold (such as with a heating pad or ice pack) to the area being treated. The client should be encouraged to use the extremity to prevent muscle atrophy and contractures.

A patient receiving an initial dose of chemotherapy to treat metastatic colon cancer is at risk for tumor lysis syndrome (TLS). The nurse would monitor for which laboratory finding associated with this oncologic emergency? 1. Hypokalemia 2. Hypercalcemia 3. Hyperuricemia 4. Hypophosphatemia

3. Hyperuricemia Rationale: TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.

The nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which would the nurse expect to note specifically in this disorder? 1. Increased calcium level 2. Increased white blood cells 3. Decreased blood urea nitrogen level 4. Decreased number of plasma cells in the bone marrow

1. Increased calcium level Rationale: Findings indicative of multiple myeloma are an increased number of plasma cells in the bone marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating bone tissue, and an elevated blood urea nitrogen level. An increased white blood cell count may or may not be present and is not related specifically to multiple myeloma.

The nurse is evaluating a client with hyperthyroidism who is taking propylthiouracil (PTU) 100 mg/day in three divided doses for maintenance therapy. Which statement from the client indicates the drug is effective? 1. "I have excess energy throughout the day." 2. "I'm able to sleep and rest at night." 3. "I've lost weight since taking this medication." 4. "I do perspire throughout the entire day."

2. "I'm able to sleep and rest at night." PTU is a prototype of thioamide anti-thyroid drugs. It inhibits production of thyroid hormones and peripheral conversion of T, to the more active T,. A client taking this antithyroid drug should be able to sleep and rest well at night since the level of thyroid hormones is reduced in the blood. Excess energy throughout the day, loss of weight, and perspiring through the day are symptoms of hyperthyroidism indicating the drug has not produced its outcome.

A client has an adrenal tumor and is scheduled for a bilateral adrenalectomy. During preoperative teaching, the nurse teaches the client how to do deep-breathing exercises after surgery. What should the nurse tell the client to do? 1. "Sit in an upright position, and take a deep breath." 2. "Hold your abdomen firmly with a pillow, and take several deep breaths." 3. "Tighten your stomach muscles as you inhale, and breathe normally." 4. "Raise your shoulders to expand your chest."

2. "Hold your abdomen firmly with a pillow, and take several deep breaths." Effective splinting for a high incision reduces stress on the incision line, decreases pain, and increases the client's ability to deep breathe effectively. Deep breathing should be done hourly by the client after surgery. Sitting upright ignores the need to splint the incision to prevent pain. Tightening the stomach muscles is not an effective strategy for promoting deep breathing. Raising the shoulders is not a feature of deep-breathing exercises.

Following a transsphenoidal hypophysectomy, the nurse should assess the client for which sign of a potential complication? 1. cerebrospinal fluid (CSF) leak 2. fluctuating blood glucose levels 3. Cushing's syndrome 4. cardiac arrhythmias

1. cerebrospinal fluid (CSF) leak A major focus of nursing care after transs-phenoidal hypophysectomy is the prevention of and monitoring for a CSF leak. CSF leakage can occur if the patch or incision is disrupted. The nurse should monitor for signs of infection, including elevated temperature, increased white blood cell count, rhinorrhea, nuchal rigidity, and persistent headache. Hypoglycemia and adrenocortical insufficiency may occur. Monitoring for fluctuating blood glucose levels is not related specifically to transsphenoidal hypophysectomy. The client will be given IV fluids postoperatively to supply carbohydrates. Cushing's disease results from adrenocortical excess, not insufficiency. Monitoring for cardiac arrhythmias is important, but arrhythmias are not anticipated following a transsphenoidal hypophysectomy.

The nurse is evaluating the client's understanding about combination chemotherapy. Which statement by the client about reasons for using combination chemotherapy indicates the need for further explanation? 1. "Combination chemotherapy is used to interrupt cell growth cycle at different points." 2. "Combination chemotherapy is used to destroy cancer cells and treat side effects simultaneously." 3. "Combination chemotherapy is used to decrease resistance. 4. "Combination chemotherapy is used to minimize the toxicity from using high doses of a single agent".

2. "Combination chemotherapy is used to destroy cancer cells and treat side effects simultaneously." Rationale: Combination chemotherapy does not mean two groups of drugs, one to kill the cancer cells and one to treat the adverse effects of the che-motherapy. Combination chemotherapy means that multiple drugs are given to interrupt the cell growth cycle at different points, decrease resistance to a chemotherapy agent, and minimize the toxicity associated with use of a high dose of a single agent (i.e., by using multiple agents with different toxicities).

A client diagnosed with Cushing's syndrome is admitted to the hospital and scheduled for a dexa-methasone suppression test. What should the nurse do during this test? 1. Collect a 24-hour urine specimen to measure serum cortisol levels. 2. Administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning. 3. Draw blood samples before and after exercise to evaluate the effect of exercise on serum cortisol levels. 4. Administer an injection of adrenocorticotropic hormone (ACTH) 30 minutes before drawing blood to measure serum cortisol levels.

2. Administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning. When Cushing's syndrome is suspected, a 24-hour urine collection for free cortisol is performed. Levels of 50 to 100 mcg/day (1,379 to 2,756 mmol/L) in adults indicate Cushing's syn-drome. If these results are borderline, a high-dose dexamethasone suppression test is done. The dexa-methasone is given at 2300 to suppress secretion of the corticotrophin-releasing hormone. A plasma cortisol sample is drawn at 0800. Normal cortisol level <5 mcg/dL (140 mmol/L) indicates normal adrenal response.

A client with Addison's disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effects of corticosteroids? Select all that apply. 1. hyperkalemia 2. skeletal muscle weakness 3. mood changes 4. hypocalcemia 5. increased susceptibility to infection 6. hypotension

2. skeletal muscle weakness 3. mood changes 4. hypocalcemia 5. increased susceptibility to infection The long-term administration of corticosteroids in therapeutic doses often leads to serious complications or side effects. Corticosteroid therapy is not recommended for minor chronic conditions; the potential benefits of treatment must always be weighed against the risks. Hypokalemia may develop; corticosteroids act on the renal tubules to increase sodium reab-sorption and enhance potassium and hydrogen excretion. Corticosteroids stimulate the breakdown of protein for gluconeogenesis, which can lead to skeletal muscle wasting. CNS adverse effects are euphoria, headache, insomnia, confusion, and psy-chosis. The nurse watches for changes in mood and behavior, emotional stability, sleep pattern, and psychomotor activity, especially with long-term therapy. Hypocalcemia related to anti-vitamin D effect may occur. Corticosteroids cause atrophy of the lymphoid tissue, suppress the cell-mediated immune responses, and decrease the production of antibodies. The nurse must be alert to the possibility of masked infection and delayed healing (anti-inflammatory and immunosuppressive actions). Retention of sodium (and subsequently water) increases blood volume and, therefore, blood pressure.

The nurse is assigned to care for several patients on a medical unit. Which patient would the nurse assess first? 1. A 60-yr-old patient with a blood pressure of 92/64 mm Hg and hemoglobin of 9.8 g/dL 2. A 50-yr-old patient with a respiratory rate of 26 breaths/minute and an elevated D-dimer 3. A 40-yr-old patient with a temperature of 100.8°F (38.2°C) and a neutrophil count of 256/µL 4. A 30-yr-old patient with a pulse of 112 beats/min and a white blood cell count of 14,000/µL

3. A 40-yr-old patient with a temperature of 100.8°F (38.2°C) and a neutrophil count of 256/µL Rationale: A low-grade fever greater than 100.4°F (38°C) in a patient with a neutrophil count below 500/µL is a medical emergency and may indicate an infection. An infection in a neutropenic patient could lead to septic shock and possible death if not treated immediately.

The nurse is planning care with a client with acute leukemia who has mucositis. What should the nurse advise the client to use for mouth care? 1. Lemon glycerin swabs 2. a commercial mouthwash 3. normal saline 4. a commercial toothpaste and brush

3. normal saline rationale: simple rinses with saline or baking soda and water solution are effective and moisten the oral mucosa. Commercial mouthwashes and lemon glycerin swabs contain glycerin and alcohol which are drying to the mu cosa and should be avoided. Brushing after each meal is recommended, but after every four hours maybe too traumatic. During acute leukemia, the neutrophil and platelet counts are often low, and a soft bristle toothbrush, instead of the client's usual toothbrush, should be used to prevent bleeding gums.

The client with Addison's disease is concerned about the bronze-color of his skin. What should the nurse tell the client about the cause of the bronze color? 1. hypersensitivity to sun exposure 2. increased serum bilirubin level 3. adverse effects of the glucocorticoid therapy 4. increased secretion of adrenocorticotropic hormone (ACTH)

4. increased secretion of adrenocorticotropic hormone (ACTH) Bronzing, or general deepening of skin pigmentation, is a classic sign of Addison's disease and is caused by melanocyte-stimulating hormone produced in response to increased ACTH secre-tion. The hyperpigmentation is typically found in the distal portion of extremities and in areas exposed to the sun. Additionally, areas that may not be exposed to the sun, such as the nipples, genita-lia, tongue, and knuckles, become bronze colored. Treatment of Addison's disease usually reverses the hyperpigmentation. Bilirubin level is not related to the pathophysiology of Addison's disease. Hyperpigmentation is not related to the effects of the glucocorticoid therapy.

69. Which statement indicates that the client with diabetes insipidus understands how to manage care? The client will: 1. maintain normal fluid and electrolyte balance. 2. select a diabetic diet correctly. 3. state dietary restrictions. 4. exhibit serum glucose level within normal range.

69. 1. Because diabetes insipidus involves excretion of large amounts of fluid, maintaining normal fluid and electrolyte balance is a priority for this client. Special dietary programs or restrictions are not indicated in treatment of diabetes insipidus. Serum glucose levels are priorities in diabetes mel-litus but not in diabetes insipidus.

To provide oral hygiene for a client recovering from transsphenoidal hypophysectomy, what should the nurse instruct the client to do? 1. Rinse the mouth with saline. 2. Perform frequent toothbrushing. 3. Clean the teeth with an electric toothbrush. 4. Floss the teeth thoroughly.

1. Rinse the mouth with saline. After transsphenoidal surgery, the client must be careful not to disturb the suture line while healing occurs. Frequent oral care should be provided with rinses of saline, and the teeth may be gently cleaned with oral swabs. Frequent or vigorous toothbrushing or flossing is contraindicated because it may disturb or cause tension on the suture line.