M/S Exam 3 Review

What does the thyroid gland normally produce? Select all that apply. a) iodine b) thyroid-stimulating hormone (TSH) c) T3 (triiodothyronine) d) T4 (thyroxine) e) calcitonin f) thyrotropin-releasing hormone (TRH)

C, D, E *The thyroid gland normally produces thyroid hormone (T3 and T4) and calcitonin. The pituitary gland produces TSH to regulate the thyroid gland. The hypothalamus gland produces TRH to regulate the pituitary gland.*

A middle-aged female client complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine 253 ng/dl. A 6-hour radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these assessment findings, the nurse should suspect: a) Graves' disease b) multinodular goiter c) Hashimoto's thyroiditis d) thyroiditis

a) Graves' disease *Graves' disease, an autoimmune disease causing hyperthyroidism, is most prevalent in middle-aged females. In Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and thyroid hormone levels low. In thyroiditis, radioactive iodine uptake is low (?2%), and a client with a multinodular goiter will show an uptake in the high-normal range (3% to 10%).*

A nurse should expect to administer which medication to a client with gout? a) furosemide b) aspirin c) colchicine d) calcium gluconate

c) colchicine *A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The physician orders colchicine to reduce these deposits and thus ease joint inflammation. Although aspirin reduces joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn't indicated for gout because it has no effect on urate crystal formation. Furosemide, a diuretic, doesn't relieve gout. Calcium gluconate reverses a negative calcium balance and relieves muscle cramps; it doesn't treat gout.*

The nurse is caring for a client with multiple organ failure who is in metabolic acidosis. Which pair of organs is responsible for regulatory processes and compensation? a) pancreas and heart b) kidneys and liver c) heart and lungs d) lungs and kidneys

d) lungs and kidneys *The lungs and kidneys facilitate the ratio of bicarbonate to carbonic acid. Carbon dioxide is one of the components of carbonic acid. The lungs regulate carbonic acid levels by releasing or conserving CO2 by increasing or decreasing the respiratory rate. The kidneys assist in acid-base balance by retaining or excreting bicarbonate ions.*

A client has been diagnosed with hypothyroidism. Which statement by the client would demonstrate appropriate teaching by the nurse? a) "I will stop taking the prescribed daily aspirin." b) "I will stop attending group activities." c) "I will increase my daily caloric intake." d) "I will increase fiber and fluids in my diet."

"I will increase fiber and fluids in my diet." *Clients with hypothyroidism typically have constipation. A diet high in fiber and fluids can help prevent this. Group activities have nothing to do with the current issue. A nurse would not change medical prescriptions by telling the client to stop taking the prescribed aspirin. Increasing caloric consumption is not appropriate with hypothyroidism.*

TSH

0.4 - 4.0 mU/L

Serum T3

80 - 200 ng/dL *Appears to be a more accurate indicator of hyperthyroidism or severity of the disorder, as T4 levels are often within range.*

Serum Free T4

Measurement of unbound thyroxine. 0.9 - 1.7 ng/dL

A nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse do?

Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.

Desmopressin (DDAVP)

Synthetic vasopressin without the vascular effects of natural ADH. Has a longer duration of action and fewer adverse effects than other preparations previously used to treat the disease. It is given intranasally. One or two administrations daily (i.e., every 12 to 24 hours) usually control the symptoms. Vasopressin causes vasoconstriction; thus, it must be used cautiously in patients with coronary artery disease.

After being sick for three days, a client with a history of diabetes mellitus is admitted to the hospital with diabetic ketoacidosis (DKA). Which diagnostic test will the nurse prioritize in monitoring? a) serum potassium b) serum sodium c) serum calcium d) serum chloride

a) serum potassium *The nurse would prioritize the monitoring of the client's potassium level because potassium leaves the cell during periods of acidosis, causing hyperkalemia, which may cause cardiac arrhythmias. As blood glucose levels normalize with treatment, potassium reenters the cell, causing hypokalemia if levels aren't monitored closely. Hypokalemia places the client at risk for cardiac arrhythmias such as ventricular tachycardia. DKA has a lesser effect on serum calcium, sodium, and chloride levels. Changes in these levels don't typically cause cardiac arrhythmias, which the nurse would consider a priority.*

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? a) Perform isometric exercises b) Monitor potassium levels c) Maintain a regular program of weight-bearing exercise d) Limit daily intake of vitamin D

c) 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 resorption. Vitamin D is needed to aid in the absorption of calcium. Isometric exercises condition muscle tone but do not build bones.*

A nurse is caring for a client in addisonian crisis. Which medication order should the nurse question? a) normal saline b) potassium chloride c) hydrocortisone d) fludrocortisone

potassium chloride *The nurse should question an order for potassium chloride because addisonian crisis results in hyperkalemia. Administering potassium chloride is contraindicated. Because the client is hyponatremic, an order for normal saline solution is appropriate. Hydrocortisone and fludrocortisone are used to replace deficient adrenal cortex hormones.*

A coworker asks another nurse if a client received their pathology report. The coworker is not directly involved in the care of the client. How should the nurse respond? Select all that apply. a) "If you log into the client's chart, you will be able to read the information." b) "The report came back, and the pathology was benign." c) "You need to review the hospital policy related to client privacy." d) "I'm sorry, but I'm not at liberty to give you that information." e) "Information can only be shared if you're involved in the client's care."

C, D, E *The nurse should tell the coworker that information about the client cannot be shared due to health privacy laws. In addition, client information can only be shared with those who are involved in the immediate care of the client. Hospital policies usually address such issues, and this information is covered during orientation and annually as an update.*

A client with diabetes mellitus develops sinusitis and otitis media accompanied by a temperature of 100.8° F (38.2° C). What should the nurse anticipate in this client's plan of care? a) An increased need for insulin and blood glucose monitoring b) Prepare the client for transillumination of the sinuses c) Bilateral nasal and tympanic membrane cultures d) Alternation of hot and cold compresses

a) An increased need for insulin and blood glucose monitoring *Insulin requirements increase in response to growth, pregnancy, increased food intake, stress, surgery, infection, illness, increased insulin antibodies, and some medications. Insulin requirements are decreased by hypothyroidism, decreased food intake, exercise, and some medications. Culture and sensitivity testing of purulent nasal drainage to show the causative bacterial organisms is rarely done with sinus infection, and tympanic membranes are never cultured by the nurse. Although a practitioner can illuminate the sinuses, it is not routine and is not necessary for diagnosis. Warm compresses can be applied for clients with sinusitis for comfort, however, hot compresses are not applied. Cold compresses are applied after sinus surgery, not in the case of acute infection.*

Which factor, if described by the parents of a child with cystic fibrosis (CF), indicates that the parents understand the underlying problem of the disease? a) an abnormality in the body's mucus-secreting glands b) reaction to the formation of antibodies against streptococcus c) formation of fibrous cysts in various body organs d) failure of the pancreatic ducts to develop properly

a) an abnormality in the body's mucus-secreting glands *CF is characterized by a dysfunction in the body's mucus-producing exocrine glands. The mucus secretions are thick and sticky rather than thin and slippery. The mucus obstructs the bronchi, bronchioles, and pancreatic ducts. Mucus plugs in the pancreatic ducts can prevent pancreatic digestive enzymes from reaching the small intestine, resulting in poor digestion and poor absorption of various food nutrients. Fibrous cysts do not form in various organs. Cystic fibrosis is an autosomal recessive inherited disorder and does not involve any reaction to the formation of antibodies against streptococcus.*

The nurse is assessing the client's understanding of the use of medications. Which medication may cause a complication with the treatment plan of a client with diabetes? a) aspirin b) steroids c) ACE inhibitors d) sulfonylureas

b) steroids *Steroids can cause hyperglycemia because of their effects on carbohydrate metabolism, making diabetic control more difficult. Aspirin is not known to affect glucose metabolism. Sulfonylureas are oral hypoglycemic agents used in the treatment of diabetes mellitus. ACE inhibitors are not known to affect glucose metabolism.*

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? a) Take the client's pulse and withhold the propranolol if the pulse is <100 beats per minute. b) Instruct the client to make position changes slowly. c) Contact the HCP and discuss the prescription for propranolol because of the client's history of having asthma. d) Count the client's respirations and withhold the propranolol if the respirations are less than 20 breaths per minute.

c) Contact the HCP and discuss the prescription for propranolol because of the client's history of having asthma. *Propranolol hydrochloride is a nonselective 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 bronchiolar 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.*

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? a) "Tighten your stomach muscles as you inhale and breathe normally." b) "Sit in an upright position, and take a deep breath." c) "Raise your shoulders and expand your chest." d) "Hold your abdomen firmly with a pillow, and take several deep breaths."

d) "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.*

Which outcome is a priority for the client with Addison's disease? a) prevention of hypertensive episodes b) avoidance of daily activities with stress c) strict adherence to a 2-gm sodium diet d) maintenance of medication compliance

d) 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) 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.*

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? a) infusing I.V. fluids rapidly as ordered b) administering glucose-containing I.V. fluids as ordered c) encouraging increased oral intake d) restricting fluids

d) restricting fluids *To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.*

A 24-year-old client with diabetes mellitus sustains a large laceration that requires suturing. Which statement indicates that the client understands wound healing? a) "If I don't get an infection, the scar may fade in 1 to 3 years." b) "It's so hard to predict when this scar will disappear." c) "My scar will fade within 4 months." d) "This procedure won't leave a scar."

b) "It's so hard to predict when this scar will disappear." *In a client with diabetes, wound healing is delayed and unable to be predicted. A specific time frame for healing is unrealistic as is the statement that suturing does not produce a scar.*

A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? a) pitting edema of the legs b) an irregular apical pulse c) frequent urination d) dry mucous membranes

b) an irregular apical pulse *Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.*

A client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should the nurse provide? a) "You won't need to monitor your fluid intake and output after you start taking desmopressin." b) "Your condition isn't chronic, so you won't need to wear a medical identification bracelet." c) "Administer desmopressin while the suspension is cold." d) "You may not be able to use desmopressin nasally if you have nasal discharge or blockage."

d) "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." *The nurse should advise the client that desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and get adequate fluid replacement.*