Med Surg Acid/Base, Fluids/Electrolytes, Endocrine/Diabetes
You suspect the Somogyi effect in John because at 7:00 AM his blood glucose is 220 mg/dL. Which action will you plan to take? A. Check the patient's blood glucose at 3:00 AM. B. Administer a larger dose of long-acting insulin. C. Educate about the need to increase the rapid-acting insulin dose. D. Remind the patient about the need to avoid snacking at bedtime.
A. Check the patient's blood glucose at 3:00 AM.
The two lab findings in primary hyperthyroidism are which of the following: A. Decreased TSH B. Elevated free thyroxine (free T4) C. Increased TSH
A. Decreased TSH B. Elevated free thyroxine (free T4)
What findings do you expect with M.E.'s physical exam? Select all that apply. A. Exopthalmos on inspection B. Goiter on inspection and palpation C. Intolerance to cold D. Rapid speech E. Decreased appetite, thirst F. Heart palpitations
A. Exopthalmos on inspection B. Goiter on inspection and palpation D. Rapid speech F. Heart palpitations
Today, to evaluate Mr. Brown's diabetes, which test should be ordered? A. Glycosylated hemoglobin level (HgbA1C) B. Fasting blood glucose level C. Oral glucose tolerance test D. Urine dipstick for glucose
A. Glycosylated hemoglobin level (HgbA1C)
What is the normal arterial pH?
7.35-7.45
What is normal blood glucose (BG) range?
70 to 110 mg/dL
You have been teaching John to administer a dose of 10 units of regular insulin and 28 units of NPH insulin. The statement by John that indicates a need for additional instruction is, A. "I need to rotate injection sites among my arms, legs, and abdomen each day." B. "I will buy the 0.5 mL syringes because the line markings will be easier to see." C. "I should draw up the regular insulin first after injecting air into the NPH bottle." D. "I do not need to aspirate the plunger to check for blood before injecting insulin."
A. "I need to rotate injection sites among my arms, legs, and abdomen each day."
Which patient statement after the nurse has completed teaching a patient with type 2 diabetes about taking glipizide (Glucotrol) indicates a need for additional teaching? A. "My diabetes is not as likely to cause complications as if I needed to take insulin." B. "When I become ill, I may have to take insulin to control my blood sugar." C. "If I overeat at a meal, I will still take just the usual dose of medication." D. "Other medications besides the Glucotrol may affect my blood sugar."
A. "My diabetes is not as likely to cause complications as if I needed to take insulin."
You listen to M.E. tell you about her recent history. Which of the following events could have precipitated her disease? Select all that apply. A. A recent UTI and pyelonephritis B.Smoking 2 packs a day C. "My grandmother and mother had thyroid problems" D. My father died last week
A. A recent UTI and pyelonephritis B.Smoking 2 packs a day C. "My grandmother and mother had thyroid problems" D. My father died last week •Can be stress induced (A, D), can be genetic, smoking can inflame the body
Your patient is prescribed levothyroxine (Synthroid). Which assessment is most important for the RN to make during initiation of thyroid replacement? A. Apical pulse rate B. Nutritional Intake C. Intake and output D. Orientation and Alertness
A. Apical pulse rate tell you immediately if its too much or too little
M.E. is getting ready to get discharged soon. What information should you include when teaching your patient about Graves' Disease? Select all that apply. A. Avoid caffeinated beverages to prevent restlessness and sleep disturbances B. Surgical removal of thyroid is the only treatment C. Restriction of iodine intake is needed to reduce thyroid activity D. Antithyroid medications may take several weeks to have an effect E. Symptoms of hypothyroidism may occur if you start taking Radioactive iodine therapy F. Symptoms of hyperthyroidism should be relieved in 1 week with RAI therapy
A. Avoid caffeinated beverages to prevent restlessness and sleep disturbances D. Antithyroid medications may take several weeks to have an effect E. Symptoms of hypothyroidism may occur if you start taking Radioactive iodine therapy
When teaching John who has just been started on intensive insulin therapy about mealtime coverage, which type of insulin will you to discuss? A. NPH (Humulin N) B. detemir (Levemir) C. lispro (Humalog) D. glargine (Lantus)
C. lispro (Humalog)
What would you teach your patient prior to discharge for management of hypothyroidism? Select ALL THAT APPLY. A. Gradually increase your exercise, and add fiber to your diet as well as stool softeners if you are having constipation. B. Make sure you stay in a cold environment since you have intolerance to heat C. Contact your doctor immediately if you have rapid pulse, palpitations, dyspnea, orthopnea, nervousness or insomnia while taking thyroid hormone replacement D. Take your thyroid hormone replacement any time you want during the day. E. Thyroid replacement therapy is a lifelong therapy.
A. Gradually increase your exercise, and add fiber to your diet as well as stool softeners if you are having constipation. C. Contact your doctor immediately if you have rapid pulse, palpitations, dyspnea, orthopnea, nervousness or insomnia while taking thyroid hormone replacement E. Thyroid replacement therapy is a lifelong therapy.
Which would be a reason for you to hold the medication and contact the MD? A. Increased thyroxine (T4). B. Blood pressure 102/62. C. The patient has not had a bowel movement. D. distant, difficult to hear heart sounds.
A. Increased thyroxine (T4).
Patient #3: Mr. Brown is a 60 year-old Caucasian man with diabetes and asthma. He teaches math at a local high school. About 10 years ago, he frequently felt fatigued. He visited a clinic where his fasting blood glucose was 115 mg/dL. To test his glucose tolerance, a meal was offered to him. His blood glucose after 2 hours was 150 mg/dL. At the time, he was obese, weighing 220 pounds at 5 feet, 10 inches height. Per this visit, Mr. Brown had: A. Prediabetes B. Type 1 DM C. Type 2 DM D. Diabetes ketoacidosis
A. Prediabetes
This month he was diagnosed with type 2 diabetes.What is the major pathological difference between type 1 diabetes and type 2 diabetes? A. Type 1 DM there is characterized by the destruction of the pancreatic beta cells. B. Type 2 DM there is characterized by the destruction of the pancreatic beta cells. C. Type 1 DM rises because of insulin resistance D. In type 2 DM there is absolute insulin deficiency.
A. Type 1 DM there is characterized by the destruction of the pancreatic beta cells.
John plans to take a swimming class daily at 1300. You will need to teach him: A. check glucose level before, during, and after swimming. B. delay eating the noon meal until after the swimming class. C. increase the morning dose of neutral protamine Hagedorn (NPH) insulin D. time the morning insulin injection so that the peak occurs while swimming.
A. check glucose level before, during, and after swimming.
A nurse will assess the patient with which signs and symptoms of hypernatremia first? A.Altered sensorium and mental status, confusion B.Blood pressure of 130/85 mmHg C.Urine output of 30 mL/hr D.2+ pitting edema E.Thirst
A.Altered sensorium and mental status, confusion
Patient #1: M.E. is 39 y/o African-American female admitted with dx of Graves' disease Which of the following is true about Graves' disease? Select all that apply. A.Autoimmune disease B.Unknown etiology C.Most often in women age 20 to 40 years of age D.Mild disease that does not require treatment
A.Autoimmune disease B.Unknown etiology C.Most often in women age 20 to 40 years of age
Your patient in the next bed has the following ABG results: pH 7.35, PaCO2 50 mm Hg, HCO3- 28 mEq/L, PaO2 82. Upon assessment, you hear crackles and moist breath sounds. He states that he has had a fever and green-tinged sputum x 1 day. Based on this information, you suspect this patient has developed: A.Compensated respiratory acidosis B.Uncompensated metabolic acidosis C.Compensated respiratory alkalosis D.Compensated metabolic alkalosis
A.Compensated respiratory acidosis
Which of the following nursing interventions would apply to a patient with fluid volume excess? Select all that apply. A.Daily weights B.Strict I/O C.Monitor serum osmolality D.Assess patient for weak, thready pulses E.Assess skin turgor and mobility F.Notify MD if patient develops moist crackles
A.Daily weights B.Strict I/O C.Monitor serum osmolality E.Assess skin turgor and mobility F.Notify MD if patient develops moist crackles Would expect bounding pulse
Which of the following would you expect to see with a magnesium level of 3.0 mEq/L? A.Decreased pulse and decreased BP B.Confusion C.Increased pulse and increased BP D.Vertigo
A.Decreased pulse and decreased BP
Which of the follow are common causes of hypokalemia? Select all that apply. A.Diarrhea and/or vomiting B.Crush injury C.Starvation D.Dialysis E.Insulin therapy
A.Diarrhea and/or vomiting C.Starvation D.Dialysis E.Insulin therapy
A patient with symptoms of DI is admitted to the hospital for evaluation and treatment of the condition. An appropriate nursing diagnosis for the patient is: A.Fluid volume deficit r/t frequent urination B.Impaired gas exchange r/t fluid retention in lungs C.Excess fluid volume r/t intake greater than output D.Risk for impaired skin integrity r/t generalized edema
A.Fluid volume deficit r/t frequent urination
A patient has a K+ level of 6.0 mEq/L, which interventions would RN most likely initiate? Select all that apply. A.Give Sodium polystyrene sulfonate (kayexalate) B.Administer loop or thiazide diuretics C.Withhold K+ from diet and IV sources D.Provide continuous ECG monitoring E.Administration of IV insulin
A.Give Sodium polystyrene sulfonate (kayexalate) B.Administer loop or thiazide diuretics C.Withhold K+ from diet and IV sources D.Provide continuous ECG monitoring E.Administration of IV insulin
The nurse knows that key features of DI include: (select all that apply) A.Increased urine output B.Poor skin turgor C.Hypertension D.Hemodilution E.Weak peripheral pulses F.Concentrated urine (specific gravity > 1.025)
A.Increased urine output B.Poor skin turgor E.Weak peripheral pulses •Anticipate hypotension, hemoconcentration, dilute urine
A patient is treated for SIADH. Treatment is effective upon finding which of the following? Select ALL that apply. A.Peripheral edema is decreased B.Patient's weight has increased C.Urine specific gravity is increased D.Patient's urinary output is increased E.Symptoms of hyponatremia disappear F.Symptoms of hypernatremia disappear
A.Peripheral edema is decreased D.Patient's urinary output is increased E.Symptoms of hyponatremia disappear •If pt weight increases, they are retaining more water and we want the opposite •Want urine specific gravity in normal range
The treatments for a patient with severe hyponatremia include which of the following? A.Replacing fluid with IV therapy using D5W 0.9%NS B.Administer conivaptan (Vaprisol) by IV C.Give Lasix to reduce fluid volume D.Administer D5W 0.45% NS via IV E.Monitor serum sodium levels every 2 hours
A.Replacing fluid with IV therapy using D5W 0.9%NS B.Administer conivaptan (Vaprisol) by IV E.Monitor serum sodium levels every 2 hours
A seizure or coma could be caused by hyponatremia or hypernatremia. A.True B.False
A.True
You have a patient in the emergency room with a history of anorexia nervosa and laxative use for weight loss. Her RR is 28 and her respirations are deep. She has the following ABG results: pH 7.30, PaCO2 30 mm Hg, HCO3- 16 mEq/L, PaO2 85. You suspect this patient has developed: A.Uncompensated metabolic acidosis B.Compensated metabolic acidosis C.Uncompensated metabolic alkalosis D.Compensated respiratory acidosis
A.Uncompensated metabolic acidosis
Which information will you include when teaching Mr. Brown about glyburide (Micronase, DiaBeta, Glynase)? A. Glyburide decreases glucagon secretion from the pancreas. B. Glyburide stimulates insulin production and release from the pancreas. C. Glyburide should be taken even if the morning blood glucose level is low. D. Glyburide should not be used for 48 hours after receiving IV contrast media.
B. Glyburide stimulates insulin production and release from the pancreas.
Which of these ABG lab values are NORMAL? A. PaCO2 45-55 mm Hg, HCO3- 18-28 mEq/L, PaO2 80-100 mm Hg B. PaCO2 35-45 mm Hg, HCO3- 21-28 mEq/L, PaO2 80-100 mm Hg C. PaCO2 30-40 mm Hg, HCO3- 20-30 mEq/L, PaO2 90-100 mm Hg D. PaCO2 35-45 mm Hg, HCO3- 18-28 mEq/L, PaO2 90-100 mm Hg
B. PaCO2 35-45 mm Hg, HCO3- 21-28 mEq/L, PaO2 80-100 mm Hg
M.E. comes back to you a few months later. You notice her goiter has increased in size and she tells you that she has been unresponsive to antithyroid therapy. She is going to be receive a thyroidectomy. While assessing the patient who has just arrived in the post anesthesia recovery unit (PACU) after a thyroidectomy, the nurse obtains these data. Which information is most important to communicate to the surgeon? A. The patient is sleepy and hard to arouse. B. The patient has increasing swelling of neck. C. The patient is complaining of 7/10 incisional pain. D. The patient's cardiac monitor shows heart rate of 112.
B. The patient has increasing swelling of neck. Potential for hematoma, can restrict airway
A patient with type 2 diabetes that is well-controlled with metformin (Glucophage) develops an allergic rash to an antibiotic and the health care provider prescribes prednisone (Deltasone). Your will anticipate that the patient may A. need a diet higher in calories while receiving prednisone. B. require administration of insulin while taking prednisone. C. develop acute hypoglycemia while taking the prednisone. D. have rashes caused by metformin-prednisone interactions.
B. require administration of insulin while taking prednisone.
A patient is experiencing hypercalcemia and has developed renal calculi. What is the effect on the phosphate level in hypercalcemia? A.Phosphate level remain the same B.Phosphate level decreases C.Phosphate level increases D.Phosphate level normalizes
B.Phosphate level decreases
The nurse is caring for a client who has been in good health up to the present and is admitted with cellulitis of the hand. The client's serum potassium level was 4.5 mEq/L yesterday. Today the level is 7 mEq/L. Which of the following is the next appropriate nursing action? A.Call the physician and report results B.Question the results and redraw the specimen C.Encourage the client to increase the intake of bananas D.Initiate seizure precautions
B.Question the results and redraw the specimen
Your patient in the next room has just been admitted for meningitis. She is A & O x 2 (person, place) and is lethargic. Her RR is 34 and her O2 saturation is 87% on room air. Labs are drawn and her BMP shows K+ 2.9 mEq/L. With this information you know that she may be in: A.Respiratory acidosis B.Respiratory alkalosis C.Metabolic acidosis
B.Respiratory alkalosis
A male patient presents with the following lab results: Hgb 15 g/dL, Hct 55% What could this indicate? A.The patient is anemic and requires a blood transfusion. B.The patient is dehydrated and may need IV fluids. C.The results are normal. No action needed. D.The patient is in fluid overload and requires a dose of furosemide.
B.The patient is dehydrated and may need IV fluids.
Patient #2: John is an 18 year-old male recently diagnosed with Type 1 Diabetes. John has received diet instruction. You determine a need for additional instruction when John says: A. "I may have an occasional alcoholic drink if I include it in my meal plan." B. "I will need a bedtime snack because I take an evening dose of NPH insulin." C. "I may eat whatever I want, as long as I use enough insulin to cover the calories." D. "I will eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia."
C. "I may eat whatever I want, as long as I use enough insulin to cover the calories."
What nursing actions should be included in the plan of care for this patient? A. Apply eye patches to protect the cornea from irritation. B. Place cold packs on the eyes to relieve pain and swelling. C. Elevate the head of the patient's bed to reduce periorbital fluid. D. Teach the patient to blink as infrequently as possible.
C. Elevate the head of the patient's bed to reduce periorbital fluid. help reduce the pressure and edema around eyes
Which of the following correctly describes the action of ADH? A.ADH acts on the posterior pituitary gland to increase sodium retention by the kidneys. B.ADH acts on the distal tubules of the kidney to increase sodium reabsorption. C.ADH acts of the distal tubules of the kidney to become more permeable to water. D.ADH is secreted by cardiomyocytes to suppress the action of aldosterone.
C.ADH acts of the distal tubules of the kidney to become more permeable to water.
A patient presents to the ER with complaints of tiredness and heart palpitations. While completing a patient history, the nurse notes the patient is taking a medication, spironolactone, for congestive heart failure. What signs and symptoms would the nurse prepare for? Select all that apply. A.Flattened T waves B.Rhabdomyolysis C.Cardiac arrest D.Paresthesias
C.Cardiac arrest D.Paresthesias
Which of the following would you expect to see with a phosphate level of 1.2 mg/dL? A.Numbness and tingling in the extremities and region around the mouth B.Hypocalcemia C.Cardiac problems (dysrhythmias and heart failure) D.CNS depression such as confusion/coma
C.Cardiac problems (dysrhythmias and heart failure) D.CNS depression such as confusion/coma
Later in your shift, you are floated to the medical unit. One of your patients is a 42 year-old male with a small bowel obstruction. He has a nasogastric tube inserted to the left nare with intermittent suction applied. You observe 550 ml of dark green liquid in the canister, which reminds you that this patient is at risk for: A.Metabolic acidosis B.Respiratory acidosis C.Metabolic alkalosis D.Respiratory alkalosis
C.Metabolic alkalosis
You are teaching your patient about long-term management of SIADH. Which of the following statements made by the patient needs correction by the nurse? A. "I should weight myself daily and report sudden weight loss or gain". B. "I need to limit my fluid intake to no more than 1 quart of liquid per day". C. "I will eat foods high in potassium because the diuretics cause potassium loss". D. "I need to shop for foods that are low in sodium and avoid adding salt".
D. "I need to shop for foods that are low in sodium and avoid adding salt".
A patient receives aspart (NovoLog) insulin at 8:00 AM. Which time will it be most important for the nurse to monitor for symptoms of hypoglycemia? A. 8:00 PM B. 4:00 PM C. 11:30 AM D. 9:00 AM
D. 9:00 AM
Which of the following statements about type 2 DM is correct to share with Mr. Brown? A. Insulin is never used to control blood glucose in patients with type 2 diabetes. B. Complications of type 2 diabetes are less serious than those of type 1 diabetes. C. Type 2 diabetes is usually diagnosed when the patient is admitted with a hyperglycemic coma. D. Changes in diet and exercise may be sufficient to control blood glucose levels in type 2 diabetes.
D. Changes in diet and exercise may be sufficient to control blood glucose levels in type 2 diabetes.
A patient with type 2 diabetes has sensory neuropathy of the feet and legs and peripheral arterial disease. Which information will the nurse include in patient teaching? A. Soak the feet in warm water for an hour every day. B. Buy callus remover for corns or calluses. C. Set heating pads on a low temperature. D. Choose flat-soled leather shoes.
D. Choose flat-soled leather shoes.
The following are all nursing diagnoses related to fluid volume imbalance EXCEPT: A. Decreased cardiac output related to decreased fluid intake B. Excess fluid volume related to increased sodium retention C. Activity intolerance related to increased fluid retention D. Hypovolemia related to intractable emesis
D. Hypovolemia related to intractable emesis This is a medical dx, not nursing dx
Which of the following is NOT related to type 2 DM? A. Impaired insulin receptors leading to insulin resistance B. B cells fatigue leading to marked decrease in insulin level C. Irregular glycogenesis by the liver leading to hyperglyemia D. T cells attacking and destroying B cells leading to absolute insulin deficiency
D. T cells attacking and destroying B cells leading to absolute insulin deficiency
Concerning SIADH...Which information when obtained by the nurse is most important to communicate to the MD? A. The patient complains of dyspnea with activity. B. The patient has a urine specific gravity of 1.025 C. The patient has a recent weight gain of 8 lb. D. The patient has a serum sodium level of 119 mEq/L.
D. The patient has a serum sodium level of 119 mEq/L. critical serum sodium level
You are discussing diet for a patient in renal failure who has hyperphosphatemia. Which statement demonstrates your teaching has been effective? A.I will snack on sunflower seeds and pumpkin seeds more often. B.I will buy some lentils and beans when I go to the store today. C.It's too bad I won't be able to eat pasta now. D.I should limit my intake of salmon and dairy.
D.I should limit my intake of salmon and dairy.
Which of the following is not a cause of sodium imbalance? A.Dehydration B.Excessive salt intake/loss C.Diabetes insipidus D.Osteoporosis E.Diarrhea and vomiting
D.Osteoporosis
When caring for a patient with a dx of Cushing syndrome, which classic findings could you expect to find during your initial admission assessment? A.Chronically low blood pressure B.Bronzed appearance of skin C.Decreased axillary and pubic hair D.Purplish red streaks on the abdomen E.Moon face
D.Purplish red streaks on the abdomen E.Moon face Would expect High BP
Goiter can occur in both hyperthyroidism and hypothyroidism. True False
True
Hyperthyroidism is hyperactivity of the thyroid gland with sustained increase in synthesis and release of thyroid hormones. True False
True
A 72-year-old patient is diagnosed with hypothyroidism and levothyroxine (Synthroid) is prescribed. Which assessment is most important for the nurse to make during initiation of thyroid replacement? a. Apical pulse rate b. Nutritional intake c. Intake and output d. Orientation and alertness
a. Apical pulse rate In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication also is expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes will not result in potentially life-threatening complications.
A few hours after returning to the surgical nursing unit, a patient who has undergone a subtotal thyroidectomy develops laryngeal stridor and a cramp in the right hand. Which action will the nurse anticipate a. Assessment of serum calcium levels. b. Suction the patient's airway. c. Prepare for endotracheal intubation. d. Assist with emergency tracheostomy.
a. Assessment of serum calcium levels. The patient's clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Endotracheal intubation or tracheostomy may be needed if the calcium does not resolve the stridor.Suctioning will not correct the stridor.
Intramuscular glucagon is administered to an unresponsive patient for treatment of hypoglycemia. Which action should the nurse take after the patient regains consciousness? a. Give the patient a snack of cheese and crackers. b. Have the patient drink a glass of orange juice or nonfat milk. c. Administer a continuous infusion of 5% dextrose for 24 hours. d. Assess the patient for symptoms of hyperglycemia.
a. Give the patient a snack of cheese and crackers. Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and nonfat milk will elevate blood sugar rapidly, but the cheese and crackers will stabilize blood sugar. Administration of glucose intravenously might be used in patients who were unable to take in nutrition orally. The patient should be assessed for symptoms of hypoglycemia after glucagon administration.
The nurse is caring for a patient who has a serum calcium level of 7.5 mg/dL. Which of the following could contribute to this electrolyte level? (Select all that apply) a. Inadequate oral intake of calcium b. Inadequate intake of vitamin D c. Removal/destruction of the thyroid glands d. Removal/destruction of the parathyroid glands
a. Inadequate oral intake of calcium b. Inadequate intake of vitamin D d. Removal/destruction of the parathyroid glands Causes of hypocalcemia include inadequate oral intake, lactose intolerance, inadequate intake of vitamin D, gastrointestinal wound drainage, immobility, removal/destruction of parathyroid glands
When a patient is hospitalized with acute adrenal insufficiency, which assessment finding by the nurse indicates that the prescribed therapies are effective? a. Increasing serum sodium levels b. Decreasing blood glucose levels c. Decreasing serum chloride levels d. Increasing serum potassium levels
a. Increasing serum sodium levels Clinical manifestations of Addison's disease include hyponatremia and an increase in sodium level indicates improvement. The other values indicate that treatment has not been effective.
A patient with symptoms of diabetes insipidus is admitted to the hospital for evaluation and treatment of the condition. An appropriate nursing diagnosis for the patient is a. Insomnia related to frequent waking at night to void. b. Impaired gas exchange related to fluid retention in lungs. c. Excess fluid volume related to intake greater than output. d. Risk for impaired skin integrity related to generalized edema.
a. Insomnia related to frequent waking at night to void. Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.
Which nursing action will be included in the postoperative plan of care for a patient who has had a transsphenoidal resection of a pituitary tumor? a. Monitor urine output every hour. b. Palpate extremities for dependent edema. c. Check hematocrit hourly for first 12 hours. d. Obtain continuous pulse oximetry for 24 hours.
a. Monitor urine output every hour. After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema and monitoring of urine output and urine specific gravity is essential. Hemorrhage is not a common problem. There is no need to check the hematocrit hourly. The patient is at risk for dehydration, not volume overload. The patient is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.
Which action should the nurse take first when caring for a patient who has just arrived on the unit after a thyroidectomy? a. Check the dressing for bleeding. b. Assess respiratory rate and effort. c. Take the blood pressure and pulse. d. Support the patient's head with pillows.
b. Assess respiratory rate and effort. Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany, and the priority nursing action is to assess the airway. The other actions also are part of the standard nursing care post thyroidectomy but are not as high in priority.
Which of the following should the nurse include when preparing to teach a class on the regulation and functions of electrolytes? a. Sodium is essential to maintain fluid water balance b. Magnesium is essential to the function the kidneys c. Less calcium is excreted with aging d. Potassium does not affect conduction system of the heart
a. Sodium is essential to maintain fluid water balance Sodium is essential for the maintenance of fluid water balance.
A patient is admitted with diabetes mellitus, has a glucose level of 380 mg/dl, and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which of the following respiratory patterns would the nurse expect to find? a. Central apnea b. Hypoventilation c. Kussmaul respirations d. Cheyne-Stokes respirations
c. Kussmaul respirations Kussmaul respirations rapid deep breathing to help blow off Co2, all others will retain Co2
The nurse is evaluating a 45-year-old patient diagnosed with type 2 diabetes mellitus. Which of the following symptoms reported by the patient is considered one of the classic clinical manifestations of diabetes? a. excessive thirst and hunger b. excessive urination and shortness of breath c. Decreased appetite and fatigue d. Low urine output and tachypnea
a. excessive thirst and hunger Classical symptoms of Diabetes: polyuria, polydipsia, and polyphagia related to high glucose concentrations in the blood and the inability to utilize glucose for energy.
Which assessment finding for a patient who takes levothyroxine(Synthroid) to treat hypothyroidism indicates that the nurse should contact the health care provider before administering the medication? a. increased thyroxine (T4) level b. Blood pressure 102/62 mm Hg c. Distant and difficult to hear heart sounds d. Elevated thyroid stimulating hormone level
a. increased thyroxine (T4) level increased thyroxine level indicates the levothyroxine dose needs to be decreased. The other data are consistent with hypothyroidism and the nurse should administer the Synthroid.
A patient with suspected acromegaly is seen at the clinic. To assist in making the diagnosis, which question should the nurse ask? a. "Have you had a recent head injury?" b. "Do you have to wear larger shoes now?" c. "Are you experiencing tremors or anxiety?" d. "Is there any family history of acromegaly?"
b. "Do you have to wear larger shoes now?" Acromegaly causes an enlargement of the hands and feet. Head injury and family history are not risk factors for acromegaly. Tremors and anxiety are not clinical manifestations of acromegaly.
A 54-year-old patient admitted with type 2 diabetes, asks the nurse what "type 2" means. Which of the following is the most appropriate response by the nurse? a. "With type 2 diabetes, the body of the pancreas becomes inflamed." b. "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased." c. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." d. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."
b. "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased." Type two diabetes is a problem with insulin being utilized by the cells. A type-2 diabetic may have normal or reduced insulin secretion from the pancreas
Which patient with type 1 diabetes mellitus would be at the highest risk for developing hypoglycemic unawareness (a form of neuropathy that causes the individual not to feel symptoms of hypoglycemia) ? a. A 16-year-old patient who is on the school track team b. A 73-year-old patient who takes propranolol (Inderal) for hypertension c. A 45-year-old patient with diabetic retinopathy d. A 24-year-old patient with a hemoglobin A1C of 8.9%
b. A 73-year-old patient who takes propranolol (Inderal) for hypertension Hypoglycemic unawareness is a condition in which a person does not experience the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or lose consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counter regulatory hormones that produce these symptoms. Elderly patients and patients who use beta-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.
A patient with systemic lupus erythematosus has a prescription for 2 weeks of high-dose prednisone therapy. When teaching the patient about the prednisone, which information is most important for the nurse to include? a. Call the doctor if you experience any mood alterations with the prednisone. b. Do not stop taking the prednisone suddenly; it should be decreased gradually. c. A weight-bearing exercise program will help minimize the risk for osteoporosis. d. Weigh yourself daily to monitor for weight gain caused by water or increased fat.
b. Do not stop taking the prednisone suddenly; it should be decreased gradually. Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped. Mood alterations and weight gain are possible adverse effects of corticosteroid use, but these are not life-threatening effects. Osteoporosis occurs when patients take corticosteroids for longer periods.
Which information will the nurse include when teaching a patient about use of somatropin (Genotropin) for treatment of growth hormone deficiency? a. the medication will improve vaginal dryness. b. Inject the medication subcutaneously every day. c. Blood glucose levels will decrease when taking the medication. d. Stop taking the medication if swelling of the hands or feet occurs.
b. Inject the medication subcutaneously every day. Somatropin is injected subcutaneously on a daily basis, preferably in the evening. The patient will need to continue on somatropin for life.If swelling or other adverse effects occur, the health care provider should be notified. Growth hormone will increase blood glucose levels.
You are caring for an elderly patient who is receiving IV fluids postoperatively. During the 8:00 am assessment of this patient, you note that the IV solution, which was ordered to infuse at 125 ml/hr, has infused 950 ml since it was hung at 4:00 am. Which of the following is the priority nursing intervention? a. Notify the physician and complete an incident report. b. Listen to the patient's lung sounds and assess respiratory status. c. Obtain a new bag of IV solution to maintain patency of the site. d. Slow the rate to keep vein open until next bag is due at noon.
b. Listen to the patient's lung sounds and assess respiratory status. Rapid infusion could cause hypervolemia therefore, assessing the patients lung sounds and oxygenation status is most important.
The nurse is beginning to teach a diabetic patient about vascular complications of diabetes. Which of the following information would be appropriate for the nurse to include? a. Vascular complications do not occur in type 1 diabetes but rather in type 2 only b. Microvascular complications specific to diabetes most commonly affects the capillary membranes of the eyes, the kidneys, skin and nerves. c. High insulin levels cause renal damage resulting vascular complications. d. Exercise does not help to lower blood glucose levels in diabetic patients.
b. Microvascular complications specific to diabetes most commonly affects the capillary membranes of the eyes, the kidneys, skin and nerves. Microvascular complications specific to diabetes most commonly affects the capillary membranes of the eyes, the kidneys, skin and nerves. Vascular complications can occur in both type-1 and type-2 diabetics. Exercise does help to lower blood sugar levels.
Which of the following nursing interventions is most appropriate when caring for a patient with dehydration? a. Auscultate lung sounds q2hr. b. Monitor daily weight and intake and output. c. Monitor diastolic blood pressure for increases. d. Encourage the patient to reduce sodium intake.
b. Monitor daily weight and intake and output. Weight is one of the best indicators of fluid balance. Strict intake and output can also help determine fluid volume status.
Which patient meets the diagnostic criteria for diabetes mellitus? a. Patient with a fasting blood glucose of 111 mg/dL b. Patient with a hemoglobin A1C of 8.4% c. Patient with a 2-hour plasma glucose level of 184 mg/dL during an oral glucose tolerance test d. Patient with a random plasma glucose level of 190 mg/dL
b. Patient with a hemoglobin A1C of 8.4% Diagnostics to confirm diabetes Random blood glucose= 200+ Fasting blood glucose = 126+ Oral glucose tolerance = 200+A1c = 6.5 +
While performing patient teaching regarding hypercalcemia, which of the following statements are appropriate (select all that apply)? a. Have patient restrict fluid intake to less than 2000 ml/day. b. Renal calculi may occur as a complication of hypercalcemia. c. Weight-bearing exercises can help keep calcium in the bones. d. The patient should increase daily fluid intake to 3000 to 4000 ml. e. Treatment of heartburn can best be managed with Tums on a prn basis.
b. Renal calculi may occur as a complication of hypercalcemia. c. Weight-bearing exercises can help keep calcium in the bones. d. The patient should increase daily fluid intake to 3000 to 4000 ml. Renal calculi may be more likely to form in hypercalcemia. Weight-bearing exercises can help to put calcium back into the bone structure. Patients should increase intake of fluids to decrease the likelihood of renal calculi. Ingesting Tums would increase calcium levels.
While assessing a patient who has just arrived in the post anesthesia recovery unit (PACU) after a thyroidectomy, the nurse obtains these data. Which information is most important to communicate to the surgeon? a. The patient is sleepy and hard to arouse. b. The patient has increasing swelling of the neck. c. The patient is complaining of 7/10 incisional pain. d. The patient's cardiac monitor shows a heart rate of 112.
b. The patient has increasing swelling of the neck. The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to prevent airway obstruction. The incisional pain should be treated but is not unusual after surgery. A heart rate of112 is not unusual in a patient who has been hyperthyroid and has just arrived in the PACU from surgery. Sleepiness in the immediate postoperative period is expected.
Which information obtained by the nurse when caring for a patient who has diabetes insipidus (DI) is most important to report to the health care provider? a. The patient had a recent head injury. b. The patient is confused and lethargic. c. The patient has a urine output of 400 mL/hr. d. The patient's urine specific gravity is 1.003.
b. The patient is confused and lethargic. The patient's confusion and lethargy may indicate hypernatremia and should be addressed quickly. In addition, patients with DI compensate for fluid losses by drinking copious amounts of fluids, but a patient who is lethargic will be unable to drink enough fluids and will become hypovolemic. A high urine output, low urine specific gravity, and history of a recent head injury are consistent with diabetes insipidus, but they do not require immediate nursing action to avoid life-threatening complications.
A patient is hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The patient is confused and reports a headache, muscle cramps, and twitching. The nurse would expect the initial laboratory results to include: a. an elevated hematocrit. b. decreased serum sodium. c. an increased serum chloride. d. a low urine specific gravity.
b. decreased serum sodium. When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient. The hematocrit will decrease because of the dilution caused by water retention. Urine will be more concentrated with a higher specific gravity. The serum chloride level will usually decrease along with the sodium level.
A 78-year-old patient in a long-term care facility has these medications prescribed. After the patient is diagnosed with hypothyroidism, the nurse will need to consult with the health care provider before administration of a. docusate (Colace). b. diazepam (Valium). c. ibuprofen (Motrin). d. cefoxitin (Mefoxin).
b. diazepam (Valium). Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older adults. The nurse should discuss the diazepam with the health care provider before administration. The other medications may be given safely to the patient.
A diabetic patient is started on intensive insulin therapy. The nurse will plan to teach the patient about mealtime coverage using _____ insulin. a. NPH b. lispro c. detemir d. glargine
b. lispro Rapid or short acting insulin is used for mealtime coverage for patients receiving intensive insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.
When caring for a patient who has an adrenocortical adenoma, causing hyperaldosteronism, the nurse should a. provide a potassium-restricted diet. b. monitor the blood pressure every 4 hours. c. monitor blood glucose level every 4 hours. d. relieve edema by elevating the extremities.
b. monitor the blood pressure every 4 hours. Hypertension caused by sodium retention is a common complication of hyperaldosteronism. Hyperaldosteronism does not cause elevation in blood glucose. The patient will be hypokalemic and require potassium supplementation before surgery. Edema does not usually occur with hyperaldosteronism.
A patient with hyperthyroidism is treated with radioactive iodine (RAI) at a clinic. Before the patient is discharged, the nurse instructs the patient a. that symptoms of hyperthyroidism should be relieved in about a week. b. that symptoms of hypothyroidism may occur as the RAI therapy takes effect. c. to discontinue the antithyroid medications taken before the radioactive therapy. d. about radioactive precautions to take with urine, stool, and other body secretions.
b. that symptoms of hypothyroidism may occur as the RAI therapy takes effect. There is a high incidence of post radiation hypothyroidism after RAI, and the patient should be monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum effect not seen for 2 to 3 months, and the patient will continue to take antithyroid medications during this time. The therapeutic dose of radioactive iodine is low enough that no radiation safety precautions are needed.
A patient is admitted to the hospital in Addisonian crisis. Which patient statement supports the nursing diagnosis of ineffective self-health management related to lack of knowledge about management of Addison's disease? a. "I double my dose of hydrocortisone on the days that I go for a run." b. "I frequently eat at restaurants, and so my food has a lot of added salt." c. "I had the stomach flu earlier this week and couldn't take the hydrocortisone." d. "I take twice as much hydrocortisone in the morning as I do in the afternoon."
c. "I had the stomach flu earlier this week and couldn't take the hydrocortisone." The need for hydrocortisone replacement is increased with stressors such as illness, and the patient needs to be taught to call the health care provider because medication and IV fluids and electrolytes may need to be given. The other patient statements indicate appropriate management of the Addison's disease.
After receiving change-of-shift report about the following four patients, which patient should the nurse assess first? a. A 31-year-old with Cushing syndrome and a blood glucose level of 244 mg/dL b. A 22-year-old admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mEq/L c. A 70-year-old who recently started taking levothyroxine (Synthroid) and has an irregular pulse of 134 d. A 53-year-old who has Addison's disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef).
c. A 70-year-old who recently started taking levothyroxine (Synthroid) and has an irregular pulse of 134 Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The patient's high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for life-threatening complications.
The nurse evaluates which of the following clients to have hypermagnesemia? a. A client who has chronic alcoholism and a magnesium level of 1.3 mEq/L b. A client who has hyperthyroidism and a magnesium level of 1.6 mEq/L c. A client who has renal failure, takes antacids, and has a magnesium level of 2.9 mEq/L d. A client who has congestive heart disease, takes a diuretic, and has a magnesium level of 2.3 mEq/L
c. Answer A client who has renal failure, takes antacids, and has a magnesium level of 2.9 mEq/L This patient's serum magnesium level is either low or within normal range (1.7 to 2.2 mg/dL)
A patient with Graves' disease has exophthalmos. Which nursing action will be included in the plan of care? a. Apply eye patches to protect the cornea from irritation. b. Place cold packs on the eyes to relieve pain and swelling. c. Elevate the head of the patient's bed to reduce periorbital fluid. d. Teach the patient to blink every few seconds to lubricate the cornea.
c. Elevate the head of the patient's bed to reduce periorbital fluid. The patient should sit upright as much as possible to promote fluid drainage from the periorbital area. With exophthalmos the patient is unable to close the eyes completely. Lubrication of the eyes, rather than eye patches, will protect the eyes from developing corneal scarring. The swelling of the eye is not caused by excessive blood flow to the eye, so cold packs will not be helpful.
The nurse assesses a client to be experiencing muscle cramps, numbness, and tingling of the extremities, and twitching of the facial muscle and eyelid when the facial nerve is tapped. The nurse reports this assessment as consistent with which of the following? a. Hypokalemia b. Hypernatremia c. Hypocalcemia d. hypermagnesemia
c. Hypocalcemia These are all signs and symptoms related to hypocalcemia.
The primary purpose for sulfonylureas, such as long-acting glyburide (Micronase), is to: a. Induce hypoglycemia by decreasing insulin sensitivity. b. Improve insulin sensitivity and decrease hyperglycemia. c. Stimulate the beta cells of the pancreas to secrete insulin. d. Decrease insulin sensitivity by enhancing glucose uptake.
c. Stimulate the beta cells of the pancreas to secrete insulin. Sulfonylureas are "secreters" and they cause the pancreas to increase secretion of insulin. Watch for hypoglycemia. Do not take if meal is skipped.
A patient with Cushing syndrome who is admitted for adrenalectomy has a nursing diagnosis of disturbed body image related to changes in appearance caused by the effects of the disease. Which intervention by the nurse will be most helpful? a. Reassure the patient that the physical changes are very common inpatients with Cushing syndrome. b. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome. c. Teach the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery. d. Remind the patient that the metabolic impact of Cushing syndrome is of more importance than appearance.
c. Teach the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery. The most reassuring communication to the patient is that the physical and emotional changes caused by the Cushing syndrome will resolve after hormone levels return to normal postoperatively. Reassurance that the physical changes are expected or that there are more serious physiological problems associated with Cushing syndrome are not therapeutic responses. The patient's physiological changes are caused by the high hormone levels, not by the patient's diet or exercise choices.
When providing postoperative care for a patient who had a bilateral adrenalectomy, which assessment information requires the most rapid action by the nurse? a. The blood glucose is 176 mg/dL. b. The lungs have bibasilar crackles. c. The patient's BP is 88/50 mm Hg. d. The patient has 5/10 incisional pain.
c. The patient's BP is 88/50 mm Hg. The decreased BP indicates possible adrenal insufficiency. The nurse should immediately notify the health care provider so that corticosteroid medications can be administered. The nurse should also address the elevated glucose, incisional pain, and crackles with appropriate collaborative or nursing actions, but prevention and treatment of acute adrenal insufficiency is the priority after adrenalectomy.
After radical neck surgery, a patient develops hypoparathyroidism. The nurse should plan to teach the patient about a. use of bisphosphonates to reduce bone demineralization. b. including whole grains in the diet to prevent constipation. c. calcium supplementation to normalize serum calcium levels. d. having a high fluid intake to decrease risk for nephrolithiasis.
c. calcium supplementation to normalize serum calcium levels. Oral calcium supplements are used to maintain the serum calcium in normal range and prevent the complications of hypocalcemia. Whole-grain foods decrease calcium absorption and will not be recommended. Bisphosphonates will lower serum calcium levels further by preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of hypoparathyroidism and low calcium levels.
A patient with Cushing syndrome returns to the surgical unit following an adrenalectomy. During the initial postoperative period, the nurse gives the highest priority to ______ to prevent severe emotional disturbances. a. monitoring for infection. b. protecting the patient's skin. c. maintaining fluid and electrolyte status. d. preventing severe emotional disturbances.
c. maintaining fluid and electrolyte status. After adrenalectomy, the patient is at risk for circulatory instability caused by fluctuating hormone levels, and the focus of care is to assess and maintain fluid and electrolyte status through the use of IV fluids and corticosteroids. The other goals also are important for the patient but are not as immediately life-threatening as the circulatory collapse that can occur with fluid and electrolyte disturbances.
When teaching a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) about long-term management of the disorder, the nurse determines that additional instruction is needed when the patient says, a. "I should weigh myself daily and report any sudden weight loss or gain." b. "I need to limit my fluid intake to no more than 1 quart of liquids a day." c. "I will eat foods high in potassium because the diuretics cause potassium loss." d. "I need to avoid foods with salt and shop for low sodium foods."
d. "I need to avoid foods with salt and shop for low sodium foods." Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred.
The nurse has taught a patient admitted with diabetes, cellulitis, and osteomyelitis about the principles of foot care. The nurse evaluates that the patient understands the principles of foot care if the patient makes which of the following statements? a. "I should only walk barefoot in nice dry weather." b. "I am lucky my shoes fit so nice and tight because they give me firm support." c. "When I am allowed up out of bed, I should check the bath water with my toes." d. "I should look at the condition of my feet every day."
d. "I should look at the condition of my feet every day." Daily inspection is important to verify the integrity of their feet. Patients with diabetic neuropathy should not walk barefoot or wear tight fitting shoes. They may also have loss of temperature sensation so they should not expose their extremities to hot water (thermometer is best).
Which of these nursing actions in the plan of care for a patient who has diabetes insipidus (DI) will be most appropriate for the RN to delegate to an experienced LPN/LVN? a. Titrate the infusion of 5% dextrose in water. b. Teach patient how to use DDAVP nasal spray. c. Assess patient's hydration status every 8 hours. d. Administer subcutaneous desmopressin (DDAVP).
d. Administer subcutaneous desmopressin (DDAVP). Administration of medications is included in LPN/LVN education and scope of practice. Assessments, patient education, and titrating fluid infusions are more complex skills and should be done by the RN.
Which information will the nurse include when teaching a patient who has been newly diagnosed with Graves' disease? a. Exercise is contraindicated to avoid increasing metabolic rate. b. Restriction of iodine intake is needed to reduce thyroid activity. c. Surgery will eventually be required to remove the thyroid gland. d. Antithyroid medications may take several weeks to have an effect.
d. Antithyroid medications may take several weeks to have an effect. Medications used to block the synthesis of thyroid hormones may take several weeks before an effect is seen. Large doses of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large muscle groups is encouraged to decrease the irritability and hyperactivity associated with high levels of thyroid hormones.Radioactive iodine is the most common treatment for Graves' disease, although surgery may be used.
A patient with primary hyperparathyroidism has a serum calcium level of 14 mg/dL (3.5 mmol/L) and a phosphorus of 1.7 mg/dL (0.55 mmol/L). Which nursing action should be included in the plan of care? a. Institute routine seizure precautions. b. Monitor for positive Chvostek's sign. c. Encourage the patient to remain on bed rest. d. Encourage 3000 to 4000 mL of oral fluids daily.
d. Encourage 3000 to 4000 mL of oral fluids daily. The patient with hypercalcemia is at risk for kidney stones, which maybe prevented by a high fluid intake. Seizure precautions and monitoring for Chvostek's or Trousseau's sign are appropriate for hypocalcemic patients. The patient should engage in weight-bearing exercise to decrease calcium loss from bone.
When planning care for a patient with dehydration related to nausea and vomiting, the nurse would anticipate which of the following fluid shifts to occur because of the fluid volume DEFICIT? a. Fluid movement from the blood vessels into the cells b. Fluid movement from the interstitial spaces into the cells c. Fluid movement from the blood vessels into interstitial spaces d. Fluid movement from the interstitial space into the blood vessels
d. Fluid movement from the interstitial space into the blood vessels Fluid volume loss causes the blood to become more concentrated and leads to fluid shifting out of the cell to the intravascular space.
Following a parathyroidectomy, a patient develops tingling of the lips and a positive Trousseau's sign. Which action should the nurse take first? a. Administer the ordered muscle relaxant. b. Give the ordered oral calcium supplement. c. Start the PRN oxygen at 2 L/min per cannula. d. Have the patient rebreathe using a paper bag.
d. Have the patient rebreathe using a paper bag. The patient's symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the patient breathe into a paper bag, which will raise the PaCO2 and create a more acidic pH. The muscle relaxant will have no impact on the ionized calcium level. Although severe hypocalcemia can cause laryngeal stridor, there is no indication that this patient is experiencing laryngeal stridor or needs oxygen. Calcium supplements will be given to normalize calcium levels quickly, but oral supplements will take time to be absorbed.
You are caring for a patient receiving calcium carbonate for the treatment of osteopenia. Which of the following serum laboratory results would you identify as an adverse effect related to this therapy? a. Sodium falling to 138 mEq/L b. Potassium rising to 4.1 mEq/L c. Magnesium rising to 2.9 mg/dl d. Phosphorus falling to 2.1 mg/dl
d. Phosphorus falling to 2.1 mg/dl Calcium and phosphorus have inverse relationship. When giving calcium replacement watch for signs of low phosphorus.
The client is admitted with a serum sodium level of 110 mEq/L. Which nursing intervention should be implemented? a. Encourage fluids orally. b. Administer 10% saline solution IVPB. c. Administer antidiuretic hormone intranasally. d. Place on seizure precautions.
d. Place on seizure precautions. The patient will need to be placed on seizure precautions immediately prior to treatment. A cause must be identified before treatment can be initiated.
When caring for a patient with a diagnosis of Cushing syndrome, which data will the nurse expect to find during the admission assessment? a. Chronically low blood pressure b. Bronzed appearance of the skin c. Decreased axillary and pubic hair d. Purplish red streaks on the abdomen
d. Purplish red streaks on the abdomen Purplish-red striae on the abdomen are a common clinical manifestation of Cushing syndrome. Hypotension and bronzed-appearing skin are manifestations of Addison's disease. Decreased axillary and pubic hair occur with androgen deficiency.
A patient is admitted with possible syndrome of inappropriate antidiuretic hormone (SIADH). Which information obtained by the nurse is most important to communicate rapidly to the health care provider? a. The patient complains of dyspnea with activity. b. The patient has a urine specific gravity of 1.025. c. The patient has a recent weight gain of 8 lb. d. The patient has a serum sodium level of 119 mEq/L.
d. The patient has a serum sodium level of 119 mEq/L. A serum sodium of less than 120 mEq/L increases the risk for complications such as seizures and needs rapid correction. The other data are not unusual for a patient with SIADH and do not indicate the need for rapid action.
During preoperative teaching for a patient scheduled for transsphenoidal hypophysectomy for treatment of a pituitary adenoma, the nurse instructs the patient about the need to: a. cough and deep breathe every 2 hours postoperatively. b. remain on bed rest for the first 48 hours after the surgery. c. be positioned flat with sandbags at the head postoperatively. d. avoid brushing the teeth for at least 10 days after the surgery.
d. avoid brushing the teeth for at least 10 days after the surgery. To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is discouraged because it may cause leakage of cerebrospinal fluid (CSF) from the suture line.The head of the bed should be elevated 30 degrees to reduce pressure on the sella turcica and decrease the risk for headaches.
A patient is treated with demeclocycline (Declomycin) to control the symptoms of syndrome of inappropriate antidiuretic hormone (SIADH). The nurse determines that the demeclocycline is effective upon finding that the: a. peripheral edema is decreased. b. patient's weight has increased. c. urine specific gravity is increased. d. patient's urinary output is increased.
d. patient's urinary output is increased. Demeclocycline blocks the action of ADH on the renal tubules and increases urine output. An increase in weight or an increase i n urine specific gravity indicates that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a common clinical manifestation of this disorder.
