220 Unit 4

Which symptom of chronic pancreatitis also occurs with acute pancreatitis? Ascites Abdominal pain Protein malabsorption Loss of exocrine function

Abdominal pain (Abdominal pain occurs with both types of pancreatitis, although pain intensity does vary between the two. Ascites, loss of exocrine function, and protein malabsorption occur only with chronic pancreatitis.)

Which assessment finding does the nurse associate with Graves' disease? Increased sweating Intolerance to heat Dyspnea with or without exertion Abnormal protrusion of the eyes

Abnormal protrusion of the eyes (Exophthalmos, or abnormal protrusion of the eyes, is specific to Graves' disease. Manifestations of hyperthyroidism include increased sweating or diaphoresis because of heat intolerance. Dyspnea with or without exertion is also common in patients with hyperthyroidism.)

A client is experiencing an attack of acute pancreatitis. Which nursing intervention is the highest priority for this client? Measure intake and output every shift. Do not administer food or fluids by mouth. Administer opioid analgesic medication. Assist the client to assume a position of comfort.

Administer opioid analgesic medication. (Pain relief is the highest priority for the client with acute pancreatitis.Although measuring intake and output, NPO status, and positioning for comfort are all important, they are not the highest priority.)

Which is the primary risk factor for chronic calcifying pancreatitis? Alcoholism Cholecystitis Viral infection Metabolic disturbances

Alcoholism (Alcoholism is the primary risk factor for chronic calcifying pancreatitis. Cholecystitis is a risk factor for chronic obstructive pancreatitis. Metabolic disturbances and viral infection are risk factors for acute pancreatitis, not chronic calcifying pancreatitis.)

A client has been discharged to home after being hospitalized with an acute episode of pancreatitis. The client, who is an alcoholic, is unwilling to participate in Alcoholics Anonymous (AA), and the client's spouse expresses frustration to the home health nurse regarding the client's refusal. What is the nurse's best response? "Your spouse will sign up for the meetings only when he is ready to deal with his problem." "Keep mentioning the AA meetings to your spouse on a regular basis." "I'll get you some information on the support group Al-Anon." "Tell me more about your frustration with your spouse's refusal to participate in AA."

"I'll get you some information on the support group Al-Anon." (The nurse's best response involves putting the client's spouse in contact with an Al-Anon support group. This action may help with the spouse's frustration and help both to cope with the situation.Telling the spouse that the client will sign up for AA meetings when the client is ready and telling the spouse to keep mentioning AA do not address the spouse's frustration with the client's refusal to participate in AA. Encouraging the spouse to say more about his or her frustration may allow the spouse to vent frustration, but it does not offer any options or solutions.)

Which patient statement demonstrates understanding of radioactive iodine (I-131) therapy? "I will need to take this drug on a daily basis for at least 1 year." "I will isolate myself from my family for 1 week so there is no risk of radiation exposure." "This drug will help decrease my cold intolerance and weight gain." "This drug will be taken up by the thyroid gland and destroy thyroid tissue."

"This drug will be taken up by the thyroid gland and destroy thyroid tissue." (Radioactive iodine is an antithyroid medication that is administered orally. It concentrates in the thyroid gland, where its radioactivity destroys thyroid tissue.)

What does the nurse advice a patient diagnosed with irritable bowel syndrome (IBS) to take during periods of constipation? Bulk-forming laxatives Saline laxatives Stimulant laxatives Stool-softening agents

Bulk-forming laxatives (The nurse advises the patient diagnosed with IBS to take bulk-forming laxatives during periods of constipation. For treatment of constipation-predominant IBS, bulk-forming laxatives are generally taken at mealtimes with a glass of water.Saline and stimulant laxatives are not used for the treatment of constipation-predominant IBS. Stool-softening agents are not effective.)

Which problems commonly occur with myxedema? Select all that apply. Coma Hypertension Hypothermia Hypoglycemia Hypernatremia Respiratory failure

Coma Hypothermia Hypoglycemia Respiratory failure

When assessing for potential serious adverse effects to propylthiouracil (PTU), the nurse will monitor which laboratory test? Kidney function Brain natriuretic peptide Serum electrolytes Complete blood count (CBC)

Complete blood count (CBC) (With antithyroid medications, the nurse should monitor for possible serious adverse reactions such as agranulocytosis, leukopenia, and thrombocytopenia. An abnormal CBC result would indicate bone marrow dysfunction.)

Which symptoms present in a patient with acute pancreatitis indicate complications? Select all that apply. Vertigo Jaundice Depression Darkened urine Clay-colored stools

Jaundice Darkened urine Clay-colored stools (Acute pancreatitis occurs because of an inflammation of the pancreas. The enzymes released by the pancreas cause autolysis of the pancreatic tissue. Jaundice, darkened urine, and clay-colored stools indicate complications of acute pancreatitis. Jaundice occurs because of an obstruction in the biliary tract, where bile cannot be absorbed into the gastrointestinal tract. Bile salts accumulate in the skin, causing a yellowish discoloration. An increase in serum bilirubin due to the biliary obstruction causes darkened urine. Stools become clay-colored because of an obstruction in the biliary tract. Vertigo and depression are not symptoms of acute pancreatitis.)

A patient has been diagnosed with hypothyroidism. What medication is routinely prescribed to treat this disorder? Atenolol Methimazole Levothyroxine sodium Propylthiouracil (PTU)

Levothyroxine sodium (Levothyroxine is a synthetic form of T₄ that is used to treat hypothyroidism. Atenolol is a beta blocker that is used to treat cardiovascular disease. Methimazole and propylthiouracil are used to treat hyperthyroidism.)

In acute pancreatitis, what does elevated serum lipase indicate? Inflammation Pancreatic cell injury Hepatobiliary obstruction Hepatobiliary involvement

Pancreatic cell injury (Elevated serum lipase is caused by pancreatic cell injury. An elevated leukocyte count is indicative of the inflammatory response. The hepatobiliary obstructive process causes elevated bilirubin. Hepatobiliary involvement causes elevated alanine aminotransferase (ALT) and elevated aspartate aminotransferase (AST).)

When assessing a client with hepatitis B, the nurse anticipates which assessment findings? Select all that apply. Recent influenza infection Brown stool Tea-colored urine Right upper quadrant tenderness Itching

Tea-colored urine Right upper quadrant tenderness Itching (Assessment findings the nurse expects to find in a client with Hepatitis B include brown, tea-, or cola-colored urine, right upper quadrant pain due to inflammation of the liver, and itching, irritating skin caused by deposits of bilirubin on the skin secondary to high bilirubin levels and jaundice.Hepatitis B virus, not the influenza virus, causes hepatitis B, which is spread by blood and body fluids. The stool in hepatitis may be tan or clay-colored, and not typically brown.)

A nurse assesses clients at a community health fair. Which client is at greatest risk for the development of hepatitis B? a. A 20-year-old college student who has had several sexual partners b. A 46-year-old woman who takes acetaminophen daily for headaches c. A 63-year-old businessman who travels frequently across the country d. An 82-year-old woman who recently ate raw shellfish for dinner

a. A 20-year-old college student who has had several sexual partners (Hepatitis B can be spread through sexual contact, needle sharing, needle sticks, blood transfusions, hemodialysis, acupuncture, and the maternal-fetal route. A person with multiple sexual partners has more opportunities to contract the infection. Hepatitis B is not transmitted through medications, casual contact with other travelers, or raw shellfish. Although an overdose of acetaminophen can cause liver cirrhosis, this is not associated with hepatitis B. Hepatitis E is found most frequently in international travelers. Hepatitis A is spread through ingestion of contaminated shellfish.)

A nurse cares for a client who has a new colostomy. Which action should the nurse take? a. Empty the pouch frequently to remove excess gas collection. b. Change the ostomy pouch and wafer every morning. c. Allow the pouch to completely fill with stool prior to emptying it. d. Use surgical tape to secure the pouch and prevent leakage.

a. Empty the pouch frequently to remove excess gas collection. (The nurse should empty the new ostomy pouch frequently because of excess gas collection, and empty the pouch when it is one-third to one-half full of stool. The ostomy pouch does not need to be changed every morning. Ostomy wafers with paste should be used to secure and seal the ostomy appliance; surgical tape should not be used.)

A patient, newly diagnosed with hypothyroidism, has received a prescription for thyroid replacement therapy. The nurse will instruct the patient to take this medication at which time of day? a. In the morning b. With the noon meal c. With the evening meal d. At bedtime

a. In the morning (If possible, it is best to administer thyroid drugs taken once daily in the morning so as to decrease the likelihood of insomnia that may result from evening dosing.)

An infection control nurse develops a plan to decrease the number of health care professionals who contract viral hepatitis at work. Which ideas should the nurse include in this plan? (Select all that apply.) a. Policies related to consistent use of Standard Precautions b. Hepatitis vaccination mandate for workers in high-risk areas c. Implementation of a needleless system for intravenous therapy d. Number of sharps used in client care reduced where possible e. Postexposure prophylaxis provided in a timely manner

a. Policies related to consistent use of Standard Precautions c. Implementation of a needleless system for intravenous therapy d. Number of sharps used in client care reduced where possible e. Postexposure prophylaxis provided in a timely manner (Nurses should always use Standard Precautions for client care, and policies should reflect this. Needleless systems and reduction of sharps can help prevent hepatitis. Postexposure prophylaxis should be provided immediately. All health care workers should receive the hepatitis vaccinations that are available.)

A nurse plans care for a client who has acute pancreatitis and is prescribed nothing by mouth (NPO). With which health care team members should the nurse collaborate to provide appropriate nutrition to this client? (Select all that apply.) a. Registered dietitian b. Nursing assistant c. Clinical pharmacist d. Certified herbalist e. Health care provider

a. Registered dietitian c. Clinical pharmacist e. Health care provider (Clients who are prescribed NPO while experiencing an acute pancreatitis episode may need enteral or parenteral nutrition. The nurse should collaborate with the registered dietitian, clinical pharmacist, and health care provider to plan and implement the more appropriate nutritional interventions. The nursing assistant and certified herbalist would not assist with this clinical decision.)

After teaching a client who is recovering from a complete thyroidectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional instruction? a. "I may need calcium replacement after surgery." b. "After surgery, I won't need to take thyroid medication." c. "I'll need to take thyroid hormones for the rest of my life." d. "I can receive pain medication if I feel that I need it."

b. "After surgery, I won't need to take thyroid medication." (After the client undergoes a thyroidectomy, the client must be given thyroid replacement medication for life. He or she may also need calcium if the parathyroid is damaged during surgery, and can receive pain medication postoperatively.)

During a teaching session for a patient on antithyroid drugs, the nurse will discuss which dietary instructions? a. Using iodized salt when cooking b. Avoiding foods containing iodine c. Restricting fluid intake to 2500 mL/day d. Increasing intake of sodium- and potassium-containing foods

b. Avoiding foods containing iodine (Patients on antithyroid therapy need to avoid iodine-containing foods. These foods may interfere with the effectiveness of the antithyroid drug. The other options are incorrect.)

After teaching a client with irritable bowel syndrome (IBS), a nurse assesses the client's understanding. Which menu selection indicates that the client correctly understands the dietary teaching? a. Ham sandwich on white bread, cup of applesauce, glass of diet cola b. Broiled chicken with brown rice, steamed broccoli, glass of apple juice c. Grilled cheese sandwich, small banana, cup of hot tea with lemon d. Baked tilapia, fresh green beans, cup of coffee with low-fat milk

b. Broiled chicken with brown rice, steamed broccoli, glass of apple juice (Clients with IBS are advised to eat a high-fiber diet (30 to 40 g/day), with 8 to 10 cups of liquid daily. Chicken with brown rice, broccoli, and apple juice has the highest fiber content. They should avoid alcohol, caffeine, and other gastric irritants.)

A patient who is taking propylthiouracil (PTU) for hyperthyroidism wants to know how this medicine works. Which explanation by the nurse is accurate? a. It blocks the action of thyroid hormone. b. It slows down the formation of thyroid hormone. c. It destroys overactive cells in the thyroid gland. d. It inactivates already existing thyroid hormone in the bloodstream.

b. It slows down the formation of thyroid hormone. (Propylthiouracil impedes the formation of thyroid hormone but has no effect on already existing thyroid hormone. The other options are incorrect.)

A nurse cares for a client who presents with bradycardia secondary to hypothyroidism. Which medication should the nurse anticipate being prescribed to the client? a. Atropine sulfate b. Levothyroxine sodium (Synthroid) c. Propranolol (Inderal) d. Epinephrine (Adrenalin)

b. Levothyroxine sodium (Synthroid) (The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine sodium. If the heart rate were so slow that it became an emergency, then atropine or epinephrine might be an option for short-term management. Propranolol is a beta blocker and would be contraindicated for a client with bradycardia.)

A nurse plans care for a client with hypothyroidism. Which priority problem should the nurse plan to address first for this client? a. Heat intolerance b. Body image problems c. Depression and withdrawal d. Obesity and water retention

c. Depression and withdrawal (Hypothyroidism causes many problems in psychosocial functioning. Depression is the most common reason for seeking medical attention. Memory and attention span may be impaired. The client's family may have great difficulty accepting and dealing with these changes. The client is often unmotivated to participate in self-care. Lapses in memory and attention require the nurse to ensure that the client's environment is safe. Heat intolerance is seen in hyperthyroidism. Body image problems and weight issues do not take priority over mental status and safety.)

The order reads, "Give levothyroxine (Synthroid), 200 mg, PO once every morning." Which action by the nurse is correct? a. Give the medication as ordered. b. Change the dose to 200 mcg because that is what the prescriber meant. c. Hold the drug until the prescriber returns to see the patient. d. Question the order because the dose is higher than 200 mcg.

d. Question the order because the dose is higher than 200 mcg. (Levothyroxine is dosed in micrograms. A common medication error is to write the intended dose in milligrams instead of micrograms. If not caught, this error would result in a thousandfold overdose. Doses higher than 200 mcg need to be questioned in case this error has occurred. The other options are incorrect.)

The nurse is caring for a patient who is to be discharged after a bowel resection and the creation of a colostomy. Which patient statement demonstrates that additional instruction from the nurse is needed? "I can drive my car in about 2 weeks." "I need to avoid drinking carbonated sodas." "It may take 6 weeks to see the effects of some foods on my bowel patterns." "Stool softeners will help me avoid straining."

"I can drive my car in about 2 weeks." (Additional instruction is needed from the nurse when the patient who is about to be discharged after a bowel resection and colostomy says, "I can drive my car in about 2 weeks." The patient who has had a bowel resection and colostomy would avoid driving for 4 to 6 weeks.The patient needs to avoid drinking sodas and other carbonated drinks because of the gas they produce. He or she may not be able to see the effects of certain foods on bowel patterns for several weeks. The patient must avoid straining at stool.)

What dietary suggestions are indicated for a patient who is in the healing phase after acute pancreatitis? Select all that apply. Bland foods Low-fat foods Low-protein foods Small, frequent meals Low-carbohydrate foods

Bland foods Low-fat foods Small, frequent meals (Patients in the healing phase after acute pancreatitis should have bland, low-fat foods and small, frequent meals. Patients should have a high, not low, carbohydrate diet and a high, not low, protein diet.)

The nurse is teaching a patient with a newly created colostomy about foods to limit or avoid because of flatulence or odors. Which foods are included? Select all that apply. Broccoli Buttermilk Mushrooms Onions Peas Yogurt

Broccoli Mushrooms Onions Peas (Foods the patient with a newly created colostomy needs to limit or avoid because of flatulence or odors include: Broccoli, mushrooms, onions, and peas.Buttermilk will help prevent odors. Yogurt can help prevent flatus.)

Which enzyme is involved in enzymatic fat necrosis of the endocrine and exocrine cells of the pancreas? Lipase Trypsin Elastase Kallikrein

Lipase (The lipase enzyme is involved in enzymatic fat necrosis of both the endocrine and exocrine cells of the pancreas. Trypsin activates elastase, which dissolves the elastic fibers of the blood vessels and ducts. Kallikrein releases vasoactive peptides, bradykinin, and a plasma kinin known as kallidin.)

A client who is admitted to the intensive care unit with hyperthyroidism is fidgeting with the bedcovers and talking extremely fast. What will the nurse do next? Call the primary health care provider. Reduce any stimulation to the client. Keep the client's door open to visualize the client's actions. Tell the client to slow down.

Reduce any stimulation to the client. (The nurse needs to reduce stimulation to the client to prevent complications of hyperthyroidism including cardiac dysrhythmias. The client with hyperthyroidism often has wide mood swings, irritability, decreased attention span, and manic behavior. The nurse also encourages the client to rest, keeps the environment as quiet as possible by closing the door to the room, limits visitors, and eliminates or postpones any nonessential care or treatments.Because the client's behavior is anticipated along with the increased metabolic rate, there is no need to call the primary health care provider. Keeping the client's door open can increase stimulation in the client's environment. Telling the client to slow down is unsupportive and unrealistic.)

A health care worker believes that he may have been exposed to hepatitis A. Which intervention is the highest priority to prevent him from developing the disease? Requesting vaccination for hepatitis A Using a needleless system in daily work Getting the three-part hepatitis B vaccine Requesting an injection of immunoglobulin

Requesting an injection of immunoglobulin (The highest priority intervention to help prevent the health care worker from developing Hepatitis A after exposure to the disease is requesting the administration of immunoglobulin, antibodies to hepatitis A.The vaccine for hepatitis A will take several weeks to stimulate the development of antibodies. Passive immunity in the form of immunoglobulin is needed. Implementing a needleless system and getting the three-part vaccine may prevent the development of hepatitis B, not hepatitis A.)

A nurse prepares to discharge a client with chronic pancreatitis. Which question should the nurse ask to ensure safety upon discharge? a. "Do you have a one- or two-story home?" b. "Can you check your own pulse rate?" c. "Do you have any alcohol in your home?" d. "Can you prepare your own meals?"

a. "Do you have a one- or two-story home?" (A client recovering from chronic pancreatitis should be limited to one floor until strength and activity increase. The client will need a bathroom on the same floor for frequent defecation. Assessing pulse rate and preparation of meals is not specific to chronic pancreatitis. Although the client should be encouraged to stop drinking alcoholic beverages, asking about alcohol availability is not adequate to assess this client's safety.)

A nurse assesses a client who is prescribed alosetron (Lotronex). Which assessment question should the nurse ask this client? a. "Have you been experiencing any constipation?" b. "Are you eating a diet high in fiber and fluids?" c. "Do you have a history of high blood pressure?" d. "What vitamins and supplements are you taking?"

a. "Have you been experiencing any constipation?" (Ischemic colitis is a life-threatening complication of alosetron. The nurse should assess the client for constipation. The other questions do not identify complications related to alosetron.)

A nurse assesses a client with irritable bowel syndrome (IBS). Which questions should the nurse include in this client's assessment? (Select all that apply.) a. "Which food types cause an exacerbation of symptoms?" b. "Where is your pain and what does it feel like?" c. "Have you lost a significant amount of weight lately?" d. "Are your stools soft, watery, and black in color?" e. "Do you experience nausea associated with defecation?"

a. "Which food types cause an exacerbation of symptoms?" b. "Where is your pain and what does it feel like?" e. "Do you experience nausea associated with defecation?" (The nurse should ask the client about factors that may cause exacerbations of symptoms, including food, stress, and anxiety. The nurse should also assess the location, intensity, and quality of the client's pain, and nausea associated with defecation or meals. Clients who have IBS do not usually lose weight and stools are not black in color.)

A nurse teaches a client with hyperthyroidism. Which dietary modifications should the nurse include in this client's teaching? (Select all that apply.) a. Increased carbohydrates b. Decreased fats c. Increased calorie intake d. Supplemental vitamins e. Increased proteins

a. Increased carbohydrates c. Increased calorie intake e. Increased proteins (The client is hypermetabolic and has an increased need for carbohydrates, calories, and proteins. Proteins are especially important because the client is at risk for a negative nitrogen balance. There is no need to decrease fat intake or take supplemental vitamins.)

A nurse cares for a client who has been diagnosed with a small bowel obstruction. Which assessment findings should the nurse correlate with this diagnosis? (Select all that apply.) a. Serum potassium of 2.8 mEq/L b. Loss of 15 pounds without dieting c. Abdominal pain in upper quadrants d. Low-pitched bowel sounds e. Serum sodium of 121 mEq/L

a. Serum potassium of 2.8 mEq/L c. Abdominal pain in upper quadrants e. Serum sodium of 121 mEq/L (Small bowel obstructions often lead to severe fluid and electrolyte imbalances. The client is hypokalemic (normal range is 3.5 to 5.0 mEq/L) and hyponatremic (normal range is 136 to 145 mEq/L). Abdominal pain across the upper quadrants is associated with small bowel obstruction. Dramatic weight loss without dieting followed by bowel obstruction leads to the probable development of colon cancer. High-pitched sounds may be noted with small bowel obstructions.)

While assessing a client with Graves' disease, the nurse notes that the client's temperature has risen 1° F. Which action should the nurse take first? a. Turn the lights down and shut the client's door. b. Call for an immediate electrocardiogram (ECG). c. Calculate the client's apical-radial pulse deficit. d. Administer a dose of acetaminophen (Tylenol).

a. Turn the lights down and shut the client's door. (A temperature increase of 1° F may indicate the development of thyroid storm, and the provider needs to be notified. But before notifying the provider, the nurse should take measures to reduce environmental stimuli that increase the risk of cardiac complications. The nurse can then call for an ECG. The apical-radial pulse deficit would not be necessary, and Tylenol is not needed because the temperature increase is due to thyroid activity.)

A nurse cares for a client newly diagnosed with Graves' disease. The client's mother asks, "I have diabetes mellitus. Am I responsible for my daughter's disease?" How should the nurse respond? a. "The fact that you have diabetes did not cause your daughter to have Graves' disease. No connection is known between Graves' disease and diabetes." b. "An association has been noted between Graves' disease and diabetes, but the fact that you have diabetes did not cause your daughter to have Graves' disease." c. "Graves' disease is associated with autoimmune diseases such as rheumatoid arthritis, but not with a disease such as diabetes mellitus." d. "Unfortunately, Graves' disease is associated with diabetes, and your diabetes could have led to your daughter having Graves' disease."

b. "An association has been noted between Graves' disease and diabetes, but the fact that you have diabetes did not cause your daughter to have Graves' disease." (An association between autoimmune diseases such as rheumatoid arthritis and diabetes mellitus has been noted. The predisposition is probably polygenic, and the mother's diabetes did not cause her daughter's Graves' disease. The other statements are inaccurate.)

A nurse collaborates with an unlicensed assistive personnel (UAP) to provide care for a client who is in the healing phase of acute pancreatitis. Which statements focused on nutritional requirements should the nurse include when delegating care for this client? (Select all that apply.) a. "Do not allow the client to eat between meals." b. "Make sure the client receives a protein shake." c. "Do not allow caffeine-containing beverages." d. "Make sure the foods are bland with little spice." e. "Do not allow high-carbohydrate food items."

b. "Make sure the client receives a protein shake." c. "Do not allow caffeine-containing beverages." d. "Make sure the foods are bland with little spice." (During the healing phase of pancreatitis, the client should be provided small, frequent, moderate- to high-carbohydrate, high-protein, low-fat meals. Protein shakes can be provided to supplement the diet. Foods and beverages should not contain caffeine and should be bland.)

When reviewing the laboratory values of a patient who is taking antithyroid drugs, the nurse will monitor for which adverse effect? a. Decreased glucose levels b. Decreased white blood cell count c. Increased red blood cell count d. Increased platelet count

b. Decreased white blood cell count (Antithyroid drugs may cause bone marrow suppression, resulting in agranulocytosis, leukopenia, thrombocytopenia, and other problems. The other options are incorrect.)

A nurse cares for a client who has hypothyroidism as a result of Hashimoto's thyroiditis. The client asks, "How long will I need to take this thyroid medication?" How should the nurse respond? a. "You will need to take the thyroid medication until the goiter is completely gone." b. "Thyroiditis is cured with antibiotics. Then you won't need thyroid medication." c. "You'll need thyroid pills for life because your thyroid won't start working again." d. "When blood tests indicate normal thyroid function, you can stop the medication."

c. "You'll need thyroid pills for life because your thyroid won't start working again." (Hashimoto's thyroiditis results in a permanent loss of thyroid function. The client will need lifelong thyroid replacement therapy. The client will not be able to stop taking the medication.)

A nurse cares for a client with acute pancreatitis. The client states, "I am hungry." How should the nurse reply? a. "Is your stomach rumbling or do you have bowel sounds?" b. "I need to check your gag reflex before you can eat." c. "Have you passed any flatus or moved your bowels?" d. "You will not be able to eat until the pain subsides."

c. "Have you passed any flatus or moved your bowels?" (Paralytic ileus is a common complication of acute pancreatitis. The client should not eat until this has resolved. Bowel sounds and decreased pain are not reliable indicators of peristalsis. Instead, the nurse should assess for passage of flatus or bowel movement.)

After teaching a client who has plans to travel to a non-industrialized country, the nurse assesses the client's understanding regarding the prevention of viral hepatitis. Which statement made by the client indicates a need for additional teaching? a. "I should drink bottled water during my travels." b. "I will not eat off another's plate or share utensils." c. "I should eat plenty of fresh fruits and vegetables." d. "I will wash my hands frequently and thoroughly."

c. "I should eat plenty of fresh fruits and vegetables." (The client should be advised to avoid fresh, raw fruits and vegetables because they can be contaminated by tap water. Drinking bottled water, and not sharing plates, glasses, or eating utensils are good ways to prevent illness, as is careful handwashing.)

After teaching a client who is prescribed pancreatic enzyme replacement therapy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching? a. "The capsules can be opened and the powder sprinkled on applesauce if needed." b. "I will wipe my lips carefully after I drink the enzyme preparation." c. "The best time to take the enzymes is immediately after I have a meal or a snack." d. "I will not mix the enzyme powder with food or liquids that contain protein."

c. "The best time to take the enzymes is immediately after I have a meal or a snack." (The enzymes should be taken immediately before eating meals or snacks. If the client cannot swallow the capsules whole, they can be opened up and the powder sprinkled on applesauce, mashed fruit, or rice cereal. The client should wipe his or her lips carefully after drinking the enzyme preparation because the liquid could damage the skin. Protein items will be dissolved by the enzymes if they are mixed together.)

A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the second postoperative day the client states, "I feel numbness and tingling around my mouth." What action should the nurse take? a. Offer mouth care. b. Loosen the dressing. c. Assess for Chvostek's sign. d. Ask the client orientation questions.

c. Assess for Chvostek's sign. (Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which could progress to cause tetany and seizure activity. The nurse should assess the client further by testing for Chvostek's sign and Trousseau's sign. Then the nurse should notify the provider. Mouth care, loosening the dressing, and orientation questions do not provide important information to prevent complications of low calcium levels.)

A nurse plans care for a client who has hypothyroidism and is admitted for pneumonia. Which priority intervention should the nurse include in this client's plan of care? a. Monitor the client's intravenous site every shift. b. Administer acetaminophen (Tylenol) for fever. c. Ensure that working suction equipment is in the room. d. Assess the client's vital signs every 4 hours.

c. Ensure that working suction equipment is in the room. (A client with hypothyroidism who develops another illness is at risk for myxedema coma. In this emergency situation, maintaining an airway is a priority. The nurse should ensure that suction equipment is available in the client's room because it may be needed if myxedema coma develops. The other interventions are necessary for any client with pneumonia, but having suction available is a safety feature for this client.)

A sanitation worker has experienced a needle stick by a contaminated needle that was placed in a trash can. The employee health nurse expects that which drug will be used to provide passive immunity to hepatitis B infection? a. Haemophilus influenzae type b (Hib) b. Varicella virus vaccine (Varivax) c. Hepatitis B immunoglobulin (BayHep B) d. Hepatitis B virus vaccine (inactivated) (Recombivax HB)

c. Hepatitis B immunoglobulin (BayHep B) (Recombivax HB promotes active immunity to hepatitis B infection in people who are considered to be at high risk for potential exposure to the virus, whereas hepatitis B immunoglobulin provides passive immunity for the prophylaxis and postexposure treatment of people exposed to hepatitis B virus or HBs-Ag-positive materials, such as blood, plasma, or serum. Hib and Varivax vaccines are not appropriate for this situation.)

A nurse assesses a client on the medical-surgical unit. Which statement made by the client should alert the nurse to the possibility of hypothyroidism? a. "My sister has thyroid problems." b. "I seem to feel the heat more than other people." c. "Food just doesn't taste good without a lot of salt." d. "I am always tired, even with 12 hours of sleep."

d. "I am always tired, even with 12 hours of sleep." (Clients with hypothyroidism usually feel tired or weak despite getting many hours of sleep. Thyroid problems are not inherited. Heat intolerance is indicative of hyperthyroidism. Loss of taste is not a manifestation of hypothyroidism.)

A nurse assesses a client who is prescribed levothyroxine (Synthroid) for hypothyroidism. Which assessment finding should alert the nurse that the medication therapy is effective? a. Thirst is recognized and fluid intake is appropriate. b. Weight has been the same for 3 weeks. c. Total white blood cell count is 6000 cells/mm³. d. Heart rate is 70 beats/min and regular.

d. Heart rate is 70 beats/min and regular. (Hypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and constipation. If a client's heart rate is bradycardic while on thyroid hormone replacement, this is an indicator that the replacement may not be adequate. Conversely, a heart rate above 100 beats/min may indicate that the client is receiving too much of the thyroid hormone. Thirst, fluid intake, weight, and white blood cell count do not represent a therapeutic response to this medication.)

A patient with hypothyroidism is given a prescription for levothyroxine (Synthroid). When the nurse explains that this is a synthetic form of the thyroid hormone, he states that he prefers to receive more "natural" forms of drugs. What will the nurse explain to him about the advantages of levothyroxine? a. It has a stronger effect than the natural forms. b. Levothyroxine is less expensive than the natural forms. c. The synthetic form has fewer adverse effects on the gastrointestinal tract. d. The half-life of levothyroxine is long enough to permit once-daily dosing.

d. The half-life of levothyroxine is long enough to permit once-daily dosing. (One advantage of levothyroxine over the natural forms is that it can be administered only once a day because of its long half-life. The other options are incorrect.)

The home health nurse is teaching a patient about the care of a new colostomy. Which patient statement demonstrates a correct understanding of the instructions? "A dark or purplish-looking stoma is normal and would not concern me." "If the skin around the stoma is red or scratched, it will heal soon." "I need to check for leakage underneath my colostomy." "I need to strive for a very tight fit when applying the barrier around the stoma."

"I need to check for leakage underneath my colostomy." The patient's statement, "I need to check for leakage underneath my colostomy" shows that the patient correctly understands the instructions about how to care for a new colostomy. The pouch system must be checked frequently for evidence of leakage to prevent excoriation.A purplish stoma is indicative of ischemia and necrosis. Redness or scratched skin around the stoma must be reported to prevent it from beginning to break down. An overly tight fit may lead to necrosis of the stoma.)

A patient with irritable bowel syndrome (IBS) is constipated. The nurse instructs the patient about a management plan. Which patient statement shows an accurate understanding of the nurse's teaching? "A cup (236 mL) of caffeinated coffee with cream & sugar at dinner is OK for me." "I need to go for a walk every evening." "Maintaining a low-fiber diet will manage my constipation." "Limiting the amount of fluid that I drink with meals is very important."

"I need to go for a walk every evening." (The patient statement, "I need to go for a walk every evening," shows that the patient accurately understands the nurse's management plan to treat IBS. Walking every day is an excellent exercise for promoting intestinal motility. Increased ambulation is part of the management plan for IBS, along with increased fluids and fiber and avoiding caffeinated beverages.Caffeinated beverages can cause bloating or diarrhea and need to be avoided in patients with IBS. Fiber is encouraged in patients with IBS because it produces a bulky soft stool and aids in establishing regular bowel habits. At least 8 to 10 cups (2 to 2.5 liters) of fluid need to be consumed daily to promote normal bowel function.)

The nurse is providing teaching about pancreatic enzyme replacement to a patient diagnosed with chronic pancreatitis. What statement by the patient indicates need for further teaching? "I will swallow the tablet without chewing." "I won't mix the enzyme with protein foods." "I will take my pancreatic enzymes after my antacid." "I will take the pancreatic enzyme half an hour before meals."

"I will take the pancreatic enzyme half an hour before meals." (Pancreatic enzymes should be taken with meals and snacks, not a half hour before meals. The pill should be swallowed without chewing. The enzyme should not be mixed with protein foods. The pancreatic enzyme should be taken after an antacid.)

A patient suspected of having irritable bowel syndrome (IBS) is scheduled for a hydrogen breath test. What does the nurse tell the patient about this test? "During the test, you will drink small amounts of an antacid as directed by the technician." "If you have IBS, hydrogen levels may be increased in your breath samples and can be an indication that you have IBS." "The test will take between 30 and 45 minutes to complete." "You must have nothing to drink (except water) for 24 hours before the test."

"If you have IBS, hydrogen levels may be increased in your breath samples and can be an indication that you have IBS." (The nurse tells the patient with IBS who has a hydrogen breath test prescribed that "hydrogen levels may be increased in your breath samples and can indicate that you have IBS." Excess hydrogen levels in patients with IBS are due to bacterial overgrowth in the small intestine that accompanies the disease. The hydrogen travels to the lungs to be excreted.The patient will ingest small amounts of sugar during the test, not an antacid. The test takes longer than 45 minutes to complete. The patient has breath samples taken every 15 minutes for 1 to 2 hours. The patient needs to be NPO (except for water) for 12 hours before the test.)

A patient with colorectal cancer is scheduled for colostomy surgery. Which comment from the nurse is most therapeutic for this patient? "Are you afraid of what your spouse will think of the colostomy?" "Don't worry. You will get used to the colostomy eventually." "Tell me what worries you the most about this procedure." "Why are you so afraid of having this procedure done?"

"Tell me what worries you the most about this procedure." (The most therapeutic comment by the nurse to a patient scheduled for colostomy surgery is "Tell me what worries you the most about this procedure." Asking the patient about what worries him or her is the only question that allows the patient to express fears and anxieties about the diagnosis and treatment.Asking the patient if he or she is afraid is a closed question (i.e., it requires only a "yes" or "no" response). It closes the dialogue and is not therapeutic. Telling the patient not to worry offers reassurance and is a "pat" statement, making it nontherapeutic. "Why" questions place patients on the defense and are not therapeutic because they close the conversation.)

Family members of a client diagnosed with hyperthyroidism are alarmed at the client's frequent mood swings. What is the nurse's best response? "Do the client's mood swings make you feel angry?" "The mood swings would diminish with treatment." "The medications will make the mood swings disappear completely." "Your family member is sick. You must be client."

"The mood swings would diminish with treatment." (Telling the family that the client's mood swings would diminish over time with treatment will provide information to the family, as well as reassurance that this behavior is expected.Asking the family if the client's mood swings make them angry is a closed-ended question and could make the family members feel guilty. The response needs to be client centered. Any medications or treatment may not completely remove the mood swings associated with hyperthyroidism. The family is aware that the client is sick. Telling them to be client can also encourage feelings of guilt and does not address the family's concerns.)

The nurse is caring for a patient who has been admitted multiple times for pancreatitis. The patient has inflammation and fibrosis of the tissue and diminished pancreatic function. What assessment is priority for this patient? Nicotine use Family support Alcohol consumption Adherence to prescribed medication regimen

Alcohol consumption (Alcoholism is a common risk factor for pancreatitis. Nicotine use assessment is not necessary. Family support is important but is not priority. Adherence to the prescribed medication regimen is important but not priority.)

What is a behavioral illness that is known to relate to irritable bowel syndrome (IBS)? Anxiety Schizophrenia Bipolar disorder Attention deficit-hyperactivity disorder (ADHD)

Anxiety (Considerable evidence relates the relationship of stress and mental or behavioral illness, especially anxiety and depression, to IBS. Many patients diagnosed with IBS meet the criteria for at least one primary mental health disorder. There is no known connection between IBS and bipolar disorder, schizophrenia, or ADHD.)

The nurse is teaching a patient taking an antithyroid medication to avoid food items high in iodine. Which food item should the nurse instruct the patient to avoid? Chicken Seafood Milk Eggs

Seafood (Seafood contains high amounts of iodine. The other choices do not.)

A patient is diagnosed with irritable bowel syndrome (IBS). What factors does the nurse suspect as possibly contributing to the patient's condition? Select all that apply. Antihistamines Caffeinated drinks Stress Sleeping pills Combinations of genetic, immunological, and hormonal factors

Caffeinated drinks Stress Combinations of genetic, immunological, and hormonal factors (The factors that the nurse suspects may contribute to IBS include: caffeinated drinks, stress, and combinations of genetic, immunological and hormonal factors. The etiology of IBS remains unclear. Research suggests that a combination of environmental, immunologic, genetic, hormonal, and stress factors play a role in the development and course of the disorder. Examples of environmental factors include foods and fluids like caffeinated or carbonated beverages and dairy products. Infectious agents have also been identified. Several studies have found that patients with IBS often have small-bowel bacterial overgrowth, which causes bloating and abdominal distention.Antihistamines and sleeping pills are not suspected of causing IBS.)

A patient with a bowel obstruction is ordered a Salem sump nasogastric tube (NGT). After the nurse inserts the tube, which nursing intervention is the highest priority for this patient? Attaching the tube to low intermittent suction Auscultating for bowel sounds and peristalsis while the suction runs Connecting the tube to low continuous suction Flushing the tube with 30 mL of normal saline every 24 hours

Connecting the tube to low continuous suction (Most patients with an obstruction have an NGT unless the obstruction is mild. A Salem sump tube is inserted through the nose and placed into the stomach. It is attached to low continuous suction unless otherwise requested by the primary health care provider. This tube has a vent (pigtail) that prevents the stomach mucosa from being pulled away during suctioning. This tube does not require intermittent suctionLevin tubes (no pigtail) do not have a vent and therefore should only be connected to low intermittent suction. They are used much less often than the Salem sump tubes. Bowel sounds would not be auscultated with suction on and running. After appropriate placement is established, the contents are aspirated and the tube is irrigated with 30 mL of normal saline every 4 hours or as requested by the primary health care provider.)

A patient with colorectal cancer is scheduled for a double-barrel colostomy. What is the most accurate statement about this type of ostomy? Double-barrel stomas are the least common. An external rod is used to provide support during healing. The proximal stoma is also referred to as a mucous fistula. The distal stoma is the functioning stoma and eliminates stool.

Double-barrel stomas are the least common. (A double-barrel stomach is the least common type of colostomy. The bowel is dissected and both the proximal and the distal portions are brought to the surface of the abdomen through two stomas. The distal stoma is the nonfunctioning stoma. The proximal stoma eliminates stool. The distal stoma may secrete some mucous and may be referred to as a mucous fistula. An external rod is used to provide support during healing with loop colostomies.)

A patient with colorectal cancer had colostomy surgery performed yesterday. The patient is very anxious about caring for the colostomy and states that the primary health care provider's instructions "seem overwhelming." What does the nurse do first for this patient? Encourage the patient to look at and touch the colostomy stoma Instruct the patient about complete care of the colostomy Schedule a visit from a patient who has a colostomy and is successfully caring for it Suggest that the patient involve family members in the care of the colostomy

Encourage the patient to look at and touch the colostomy stoma (The first action the nurse does for the postoperative colostomy patient who is very anxious about caring for the colostomy is to encourage the patient to look at and touch the colostomy stoma. The initial intervention is to get the patient comfortable looking at and touching the stoma before providing instructions on its care.Instructing the patient about colostomy care will be much more effective after the patient's anxiety level has stabilized. Talking with someone who has gone through a similar experience may be helpful to the patient only after his or her anxiety level has stabilized. The patient has begun to express feelings regarding the colostomy and its care. It is too soon to involve others. The patient must get comfortable with this body image change before attempting to involve family members in colostomy care.)

Which autoimmune disorder may be triggered by a bacterial or viral infection? Graves' disease Thyroid cancer Myxedema coma Hashimoto's disease

Hashimoto's disease (Chronic thyroiditis, also known as Hashimoto's disease, is an autoimmune disorder that may be triggered by a bacterial or viral infection. Graves' disease is also an autoimmune disorder that results in hyperthyroidism. Thyroid cancer may be congenital or may be caused by various factors such as infections or surgical injury. Myxedema coma is a complication of untreated hypothyroidism; it is not an autoimmune disorder.)

A client with newly diagnosed hypothyroidism tells the nurse, "I just want to feel better now. Why can't I just get a standard dose of medication instead of all this dosage adjustment?" The nurse explains that starting levothyroxine sodium (Synthroid) at a high dose may cause which of these problems? Bradycardia and decreased level of consciousness Decreased respiratory rate and hypoxemia Hypotension and shock Hypertension and heart failure

Hypertension and heart failure (Hypertension and heart failure are possible if the levothyroxine sodium dose is started too high or raised too rapidly, because levothyroxine would essentially put the client into a hyperthyroid state.The client would experience tachycardia, not bradycardia. The client may have an increased respiratory rate when taking high doses of thyroid replacement therapy. Shock may develop, but only as a late effect and as the result of "pump failure.")

Which assessment finding is consistent with a diagnosis of viral hepatitis? Icteric skin Dark-brown stool Light-colored urine Left upper quadrant tenderness

Icteric skin (Findings in viral hepatitis include fever, jaundice or icterus, itching, clay-colored stool, dark urine, right upper quadrant tenderness, and nausea.)

For a patient taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently, the nurse would closely monitor for which possible serious adverse effect? Acute confusion Cardiac dysrhythmias Orthostatic hypotension Increased bruising

Increased bruising (Levothyroxine can compete with protein-binding sites of warfarin, allowing more warfarin to be unbound or free, thus increasing effects of warfarin and risk of bleeding. Bleeding commonly presents as bruising.)

The nurse would suspect a patient is taking too much levothyroxine (Synthroid) when the patient exhibits which adverse effect? Lethargy Irritability Weight gain Feeling cold

Irritability (Irritability is a symptom of hyperthyroidism and may indicate toxicity of the medication. The other choices are signs of hypothyroidism.)

A patient presents to the emergency department with pain in the left lower quadrant of the abdomen. The patient reports nausea after eating, diarrhea, and abdominal bloating. What diagnosis does the nurse suspect? Hemorrhoids Umbilical hernia Intestinal obstruction Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) (Patients with pain in the left lower abdominal quadrant, nausea after eating, diarrhea, and bloating have symptoms that are consistent with irritable bowel syndrome (IBS). The symptoms are not consistent with hemorrhoids, umbilical hernia, or intestinal obstruction.)

When assessing a patient with hepatitis B, the nurse anticipates which assessment findings? Select all that apply. Itching Brown stool Tea-colored urine Recent influenza infection Right upper quadrant tenderness

Itching Tea-colored urine Right upper quadrant tenderness (The urine may be brown, tea-, or cola-colored in patients with hepatitis. Inflammation of the liver may cause right upper quadrant pain. Deposits of bilirubin on the skin, secondary to high bilirubin levels, and jaundice irritate the skin and cause itching. Hepatitis B virus, not the influenza virus, causes hepatitis B, which is spread by blood and body fluids. The stool in hepatitis may be tan or clay-colored.)

The nurse is caring for a patient with chronic pancreatitis. What assessment findings are related to this disease process? Select all that apply. Diarrhea Jaundice Polydipsia Polyphagia Weight gain

Jaundice Polydipsia Polyphagia (Jaundice, polydipsia, and polyphagia are manifestations observed in chronic pancreatitis. Jaundice occurs because of chronic inflammation in the biliary tract; bile cannot drain into the small intestines. Excessive thirst (polydipsia) and an increased appetite (polyphagia) occur because the patient has chronic organ dysfunction and develops diabetes mellitus (of which both symptoms are common). Diarrhea is not a symptom of chronic pancreatitis. Weight loss occurs in chronic pancreatitis.)

What teaching does the home health nurse give the family of a client with hepatitis C to prevent the spread of the infection? The client must not consume alcohol. Avoid sharing the bathroom with the client. Members of the household must not share toothbrushes. Drink only bottled water and avoid ice.

Members of the household must not share toothbrushes. (The nurse teaches the family of a client with Hepatitis C that toothbrushes, razors, towels, and any other items may spread blood and body fluids and must not be shared.The client should not consume alcohol, but abstention will not prevent spread of the virus. The client may share a bathroom if he or she is continent. To prevent hepatitis A when traveling to foreign countries, bottled water should be consumed and ice made from tap water needs to be avoided.)

Which individual has the greatest risk for developing hepatitis A? Health care worker Intravenous drug user Patient receiving hemodialysis Person who consumes raw oysters

Person who consumes raw oysters (Undercooked or raw shellfish from contaminated waters and food handled by those who have not washed their hands thoroughly are at risk for hepatitis A. Intravenous drug users, those undergoing hemodialysis, and health care workers are more at risk for hepatitis B or C, which is spread by blood or body fluids.)

What finding is consistent with a diagnosis of irritable bowel syndrome (IBS)? Decreased hemoglobin Positive hydrogen breath test Elevated white blood cell (WBC) count Elevated erythrocyte sedimentation rate (ESR)

Positive hydrogen breath test (A positive hydrogen breath test is indicative of irritable bowel syndrome (IBS). Patients with IBS do not usually have decreased hemoglobin, an elevated white blood cell (WBC) count, or an elevated erythrocyte sedimentation rate (ESR).)

A patient with an intestinal obstruction has pain that changes from a "colicky" intermittent type to constant discomfort. What does the nurse do first? Administers medication for pain Changes the nasogastric suction level from "intermittent" to "constant" Positions the patient in high-Fowler's position Prepares the patient for emergency surgery

Prepares the patient for emergency surgery (The first action the nurse takes for a patient with intestinal obstruction whose pain changes from "colicky" intermittent type to constant discomfort is to prepare the patient for emergency surgery. The change in pain type could be indicative of perforation or peritonitis and will require immediate surgical intervention.Pain medication may mask the patient's symptoms but will not address the root cause. A change in the nasogastric suction rate will not resolve the cause of the patient's pain and could be particularly ineffective if a nonvented tube is in use. A high-Fowler's position will have no effect on an intestinal perforation or peritonitis, which this patient is likely experiencing.)

The nurse sees a note in a patient's medical record that the patient has IBS-M. What does this mean? The patient has IBS with mostly diarrhea. The patient has IBS with mainly constipation. The patient has IBS with a mix of diarrhea and constipation. The patient has IBS with motility changes of alternating diarrhea and constipation.

The patient has IBS with a mix of diarrhea and constipation. ("IBS-M" means the patient has irritable bowel syndrome (IBS) with a mix of diarrhea and constipation. A patient who has mostly diarrhea would have a classification of IBS-D. A patient with mainly constipation would have a classification of IBS-C. A patient with alternating diarrhea and constipation would have a classification of IBS-A.)

A patient is being evaluated in the emergency department (ED) for a possible small bowel obstruction. Which signs/symptoms does the nurse expect to assess? Cramping intermittently, metabolic acidosis, and minimal vomiting Intermittent lower abdominal cramping, obstipation, and metabolic alkalosis Metabolic acidosis, upper abdominal distention, and intermittent cramping Upper abdominal distention, metabolic alkalosis, and a great amount of vomiting

Upper abdominal distention, metabolic alkalosis, and a great amount of vomiting (A small bowel obstruction is characterized by upper or epigastric abdominal distention, metabolic alkalosis, and a great amount of vomiting.Intermittent lower abdominal cramping and metabolic acidosis are all symptoms of a large bowel obstruction.)

A nurse cares for a client who states, "My husband is repulsed by my colostomy and refuses to be intimate with me." How should the nurse respond? a. "Let's talk to the ostomy nurse to help you and your husband work through this." b. "You could try to wear longer lingerie that will better hide the ostomy appliance." c. "You should empty the pouch first so it will be less noticeable for your husband." d. "If you are not careful, you can hurt the stoma if you engage in sexual activity."

a. "Let's talk to the ostomy nurse to help you and your husband work through this." (The nurse should collaborate with the ostomy nurse to help the client and her husband work through intimacy issues. The nurse should not minimize the client's concern about her husband with ways to hide the ostomy. The client will not hurt the stoma by engaging in sexual activity.)

A nurse cares for a client who had a colostomy placed in the ascending colon 2 weeks ago. The client states, "The stool in my pouch is still liquid." How should the nurse respond? a. "The stool will always be liquid with this type of colostomy." b. "Eating additional fiber will bulk up your stool and decrease diarrhea." c. "Your stool will become firmer over the next couple of weeks." d. "This is abnormal. I will contact your health care provider."

a. "The stool will always be liquid with this type of colostomy." (The stool from an ascending colostomy can be expected to remain liquid because little large bowel is available to reabsorb the liquid from the stool. This finding is not abnormal. Liquid stool from an ascending colostomy will not become firmer with the addition of fiber to the client's diet or with the passage of time.)

A nurse teaches a client who is recovering from acute pancreatitis. Which statements should the nurse include in this client's teaching? (Select all that apply.) a. "Take a 20-minute walk at least 5 days each week." b. "Attend local Alcoholics Anonymous (AA) meetings weekly." c. "Choose whole grains rather than foods with simple sugars." d. "Use cooking spray when you cook rather than margarine or butter." e. "Stay away from milk and dairy products that contain lactose." f. "We can talk to your doctor about a prescription for nicotine patches."

b. "Attend local Alcoholics Anonymous (AA) meetings weekly." d. "Use cooking spray when you cook rather than margarine or butter." f. "We can talk to your doctor about a prescription for nicotine patches." (The client should be advised to stay sober, and AA is a great resource. The client requires a low-fat diet, and cooking spray is low in fat compared with butter or margarine. If the client smokes, he or she must stop because nicotine can precipitate an exacerbation. A nicotine patch may help the client quit smoking. The client must rest until his or her strength returns. The client requires high carbohydrates and calories for healing; complex carbohydrates are not preferred over simple ones. Dairy products do not cause a problem.)

A nurse cares for a client with hepatitis C. The client's brother states, "I do not want to contract this infection, so I will not go into his hospital room." How should the nurse respond? a. "If you wear a gown and gloves, you will not get this virus." b. "Viral hepatitis is not spread through casual contact." c. "This virus is only transmitted through a fecal specimen." d. "I can give you an update on your brother's status from here."

b. "Viral hepatitis is not spread through casual contact." (Although family members may be afraid that they will contract hepatitis C, the nurse should educate the client's family about how the virus is spread. Viral hepatitis, or hepatitis C, is spread via blood-to-blood transmission and is associated with illicit IV drug needle sharing, blood and organ transplantation, accidental needle sticks, unsanitary tattoo equipment, and sharing of intranasal cocaine paraphernalia. Wearing a gown and gloves will not decrease the transmission of this virus. Hepatitis C is not spread through casual contact or a fecal specimen. The nurse would be violating privacy laws by sharing the client's status with the brother.)

A nurse cares for a client with colon cancer who has a new colostomy. The client states, "I think it would be helpful to talk with someone who has had a similar experience." How should the nurse respond? a. "I have a good friend with a colostomy who would be willing to talk with you." b. "The enterostomal therapist will be able to answer all of your questions." c. "I will make a referral to the United Ostomy Associations of America." d. "You'll find that most people with colostomies don't want to talk about them."

c. "I will make a referral to the United Ostomy Associations of America." (Nurses need to become familiar with community-based resources to better assist clients. The local chapter of the United Ostomy Associations of America has resources for clients and their families, including Ostomates (specially trained visitors who also have ostomies). The nurse should not suggest that the client speak with a personal contact of the nurse. Although the enterostomal therapist is an expert in ostomy care, talking with him or her is not the same as talking with someone who actually has had a colostomy. The nurse should not brush aside the client's request by saying that most people with colostomies do not want to talk about them. Many people are willing to share their ostomy experience in the hope of helping others.)

A nurse cares for a client with elevated triiodothyronine and thyroxine, and normal thyroid-stimulating hormone levels. Which actions should the nurse take? (Select all that apply.) a. Administer levothyroxine (Synthroid). b. Administer propranolol (Inderal). c. Monitor the apical pulse. d. Assess for Trousseau's sign. e. Initiate telemetry monitoring.

c. Monitor the apical pulse. e. Initiate telemetry monitoring. (The client's laboratory findings suggest that the client is experiencing hyperthyroidism. The increased metabolic rate can cause an increase in the client's heart rate, and the client should be monitored for the development of dysrhythmias. Placing the client on a telemetry monitor might also be a precaution. Levothyroxine is given for hypothyroidism. Propranolol is a beta blocker often used to lower sympathetic nervous system activity in hyperthyroidism. Trousseau's sign is a test for hypocalcemia.)

A nurse assesses a client with a mechanical bowel obstruction who reports intermittent abdominal pain. An hour later the client reports constant abdominal pain. Which action should the nurse take next? a. Administer intravenous opioid medications. b. Position the client with knees to chest. c. Insert a nasogastric tube for decompression. d. Assess the client's bowel sounds.

d. Assess the client's bowel sounds. (A change in the nature and timing of abdominal pain in a client with a bowel obstruction can signal peritonitis or perforation. The nurse should immediately check for rebound tenderness and the absence of bowel sounds. The nurse should not medicate the client until the provider has been notified of the change in his or her condition. The nurse may help the client to the knee-chest position for comfort, but this is not the priority action. The nurse need not insert a nasogastric tube for decompression.)

A 19-year-old student was diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 1 week, she called the clinic to report that she does not feel better. Which response from the nurse is correct? a. "It will probably require surgery for a cure to happen." b. "The full therapeutic effects may not occur for 3 to 4 weeks." c. "Is it possible that you did not take your medication as instructed?" d. "Let's review your diet; it may be causing absorption problems."

b. "The full therapeutic effects may not occur for 3 to 4 weeks." (Patients need to understand that it may take up to 3 to 4 weeks to see the full therapeutic effects of thyroid drugs. The other options are incorrect.)

A patient has been taking levothyroxine (Synthroid) for more than one decade for primary hypothyroidism. Today she calls because she has a cousin who can get her the same medication in a generic form from a pharmaceutical supply company. Which is the nurse's best advice? a. "This would be a great way to save money." b. "There's no difference in brands of this medication." c. "This should never be done; once you start with a certain brand, you must stay with it." d. "It's better not to switch brands unless we check with your doctor."

d. "It's better not to switch brands unless we check with your doctor." (Switching brands of levothyroxine during treatment can destabilize the course of treatment. Thyroid function test results need to be monitored more carefully when switching products.)

A client is being discharged with a prescription for propylthiouracil (PTU). Which statement by the client indicates a need for further teaching by the nurse? "I can return to my job at the day care center." "I must call the primary health care provider if my urine is dark." "I must faithfully take the drug every 8 hours." "I need to report weight gain."

"I can return to my job at the day care center." (The client would not return to the job at the day care center because PTU reduces blood cell counts and the immune response, which increases the risk for infection. The client does not, however, need to remain completely at home.Dark urine may indicate liver toxicity or failure, and the client must notify the primary health care provider immediately. Taking PTU regularly at the same time each day provides better drug levels and ensures consistent medication action. The client must notify the primary health care provider of weight gain because this may indicate hypothyroidism requiring titration of the medication to a lower dose.)

The nurse reviews the vital signs of a client diagnosed with Graves' disease and notes that the client's temperature is 99.6°F (37.6°C). After notifying the primary health care provider, what does the nurse do next? Administers acetaminophen Alerts the Rapid Response Team Asks any visitors to leave Assesses the client's cardiac status

Assesses the client's cardiac status (Graves' disease is manifested by symptoms of hyperthyroidism and increased metabolic rate, including fever. The nurse must next assess the client's cardiac status as atrial fibrillation or other dysrhythmia may have developed. If the client has a cardiac monitor, the nurse needs to check for any dysrhythmias. Administering a nonsalicylate antipyretic such as acetaminophen is appropriate, but is not a priority action for this client. Alerting the Rapid Response Team is not needed at this time as no instability has been noted. Asking visitors to leave is not necessary if the visitors are providing comfort to the client.)

A nurse assesses a client with hypothyroidism who is admitted with acute appendicitis. The nurse notes that the client's level of consciousness has decreased. Which actions should the nurse take? (Select all that apply.) a. Infuse intravenous fluids. b. Cover the client with warm blankets. c. Monitor blood pressure every 4 hours. d. Maintain a patent airway. e. Administer oral glucose as prescribed.

a. Infuse intravenous fluids. b. Cover the client with warm blankets. d. Maintain a patent airway. (A client with hypothyroidism and an acute illness is at risk for myxedema coma. A decrease in level of consciousness is a symptom of myxedema. The nurse should infuse IV fluids, cover the client with warm blankets, monitor blood pressure every hour, maintain a patent airway, and administer glucose intravenously as prescribed.)

After teaching a client who has been diagnosed with hepatitis A, the nurse assesses the client's understanding. Which statement by the client indicates a correct understanding of the teaching? a. "Some medications have been known to cause hepatitis A." b. "I may have been exposed when we ate shrimp last weekend." c. "I was infected with hepatitis A through a recent blood transfusion." d. "My infection with Epstein-Barr virus can co-infect me with hepatitis A."

b. "I may have been exposed when we ate shrimp last weekend." (The route of acquisition of hepatitis A infection is through close personal contact or ingestion of contaminated water or shellfish. Hepatitis A is not transmitted through medications, blood transfusions, or Epstein-Barr virus. Toxic and drug-induced hepatitis is caused from exposure to hepatotoxins, but this is not a form of hepatitis A. Hepatitis B can be spread through blood transfusions. Epstein-Barr virus causes a secondary infection that is not associated with hepatitis A.)

A nurse plans care for a client with acute pancreatitis. Which intervention should the nurse include in this client's plan of care to reduce discomfort? a. Administer morphine sulfate intravenously every 4 hours as needed. b. Maintain nothing by mouth (NPO) and administer intravenous fluids. c. Provide small, frequent feedings with no concentrated sweets. d. Place the client in semi-Fowler's position with the head of bed elevated.

b. Maintain nothing by mouth (NPO) and administer intravenous fluids. (The client should be kept NPO to reduce GI activity and reduce pancreatic enzyme production. IV fluids should be used to prevent dehydration. The client may need a nasogastric tube. Pain medications should be given around the clock and more frequently than every 4 to 6 hours. A fetal position with legs drawn up to the chest will promote comfort.)

A patient, newly diagnosed with hypothyroidism, receives a prescription for a thyroid hormone replacement drug. The nurse assesses for which potential contraindication to this drug? a. Infection b. Diabetes mellitus c. Liver disease d. Recent myocardial infarction

d. Recent myocardial infarction (Contraindications to thyroid preparations include known drug allergy to a given drug product, recent myocardial infarction, adrenal insufficiency, and hyperthyroidism. The other options are incorrect.)

The nurse suspects that a client may have acute pancreatitis as evidenced by which group of laboratory results? Deceased calcium, elevated amylase, decreased magnesium Elevated bilirubin, elevated alkaline phosphatase Elevated lipase, elevated white blood cell (WBC) count, elevated glucose Decreased blood urea nitrogen (BUN), elevated calcium, elevated magnesium

Elevated lipase, elevated white blood cell (WBC) count, elevated glucose (Elevated lipase, along with increased WBC and increased glucose, suggests acute pancreatitis. Also, increased are serum amylase, serum trypsin, and serum elastase.Many pancreatic and nonpancreatic disorders can cause increased serum amylase levels. Bilirubin and alkaline phosphatase levels will be increased only if pancreatitis is accompanied by biliary dysfunction. Usually, calcium and magnesium will be increased and BUN increased, not decreased, in acute pancreatitis.)

What assessment finding indicates a possibility of hyperthyroidism in a patient? Intolerance to cold Decreased appetite Heart rate of 54 beats/min Considerable loss of weight without dieting

Considerable loss of weight without dieting (A patient who is not on a diet but has lost considerable weight is a likely candidate for hyperthyroidism. Although hyperthyroidism can cause increased appetite, there is considerable weight loss and an increase in the number of bowel movements per day. The patient with hyperthyroidism is intolerant to heat, not cold, and has diaphoresis. Bradycardia is indicative of hypothyroidism; an elevated heart rate is a sign of hyperthyroidism.)

When providing dietary teaching to a client with hepatitis, what practice does the nurse recommend? Having a larger meal early in the morning Consuming increased carbohydrates and moderate protein Restricting fluids to 1500 mL/day Limiting alcoholic beverages to once weekly

Consuming increased carbohydrates and moderate protein (To repair the liver, the nurse recommends that the client adopt a high-carbohydrate and moderate-protein diet. Fats may cause dyspepsia.The client with hepatitis feels full easily and needs to have four to six small meals daily. Fluids are restricted with ascites caused by cirrhosis. Not all clients with hepatitis progress to cirrhosis. Complete abstention from alcohol is necessary until the liver enzymes return to normal.)

The Certified Wound, Ostomy, and Continence Nurse is teaching a patient with colorectal cancer how to care for a newly created colostomy. Which patient statement reflects a correct understanding of the necessary self-management skills? "I will have my spouse change the bag for me." "If I have any leakage, I'll put a towel over it." "I can put aspirin tablets in the pouch in order to reduce odor" "I will apply a non-alcoholic skin sealant around the stoma and allow it to dry prior to applying the bag."

"I will apply a non-alcoholic skin sealant around the stoma and allow it to dry prior to applying the bag." (The patient statement that reflects a correct understanding of necessary self-management skills to care for a newly created colostomy is, "I will apply a non-alcoholic sealant around the stoma and allow it to dry prior to putting the bag on." Teach the patient and family to apply a skin sealant (preferably without alcohol) and allow it to dry before application of the appliance (colostomy bag) to facilitate less painful removal of the tape or adhesive.It is not realistic that the spouse will always change the patient's bag and does not reflect correct understanding of self-management skills. A towel is not an acceptable or effective way to cope with leakage. Putting an aspirin in the pouch will not reduce odor and can lead to ulcers in the stoma.)

Which statement by the patient indicates an understanding of discharge instructions given by the nurse about the newly prescribed medication levothyroxine (Synthroid)? "I can expect improvement of my symptoms within 1 week." "I will stop the medication immediately if I feel pain or weakness in my muscles." "I will take this medication in the morning so it does not affect my sleep at night." "I will take a double dose to make up for the missed one."

"I will take this medication in the morning so it does not affect my sleep at night." (Levothyroxine increases basal metabolic rate and thus may cause insomnia. Patients should not double the dose or stop taking the medication abruptly. It may take up to 4 weeks for a therapeutic response to occur.)

The nurse is teaching a client about thyroid replacement therapy. Which statement by the client indicates a need for further teaching? "I will have more energy with this medication." "I will take the medication every morning." "If I continue to lose weight, I may need an increased dose." "If I gain weight and feel tired, I may need an increased dose."

"If I continue to lose weight, I may need an increased dose." (The statement, "If I continue to lose weight, I may need an increased dose," indicates a need for further teaching. Weight loss indicates a need for a decreased dose, not an increased dose.One of the symptoms of hypothyroidism is lack of energy. Thyroid replacement therapy would cause the client to have more energy. The correct time to take thyroid replacement therapy is in the morning. Gaining weight and continuing to feel tired is an indication that the dose may need to be increased.)

A patient receiving propylthiouracil (PTU) asks the nurse, "How does this medication relieve symptoms?" What is the nurse's best response? "PTU causes the pituitary gland to secrete thyroid-stimulating hormone, which blocks the production of hormones by the thyroid gland." "PTU helps your thyroid gland synthesize and use iodine, which produces hormones better." "PTU inhibits the formation of new thyroid hormone, thus returning your metabolism to normal." "PTU removes thyroid hormones that are already circulating in your bloodstream, thus decreasing the adverse effects of this medication."

"PTU inhibits the formation of new thyroid hormone, thus returning your metabolism to normal." (PTU is an antithyroid medication used to treat hyperthyroidism. It works by inhibiting the synthesis of new thyroid hormone. It does not inactivate present hormone.)

A client has developed acute pancreatitis after also developing gallstones. Which is the highest priority nursing instruction for this client to avoid further attacks of pancreatitis? "You may need a surgical consult for removal of your gallbladder." "See your health care provider (HCP) immediately when experiencing symptoms of a gallbladder attack." "If you have a gallbladder attack and pain does not resolve within a few days, call your health care provider." "You'll need to drastically modify your alcohol intake."

"See your health care provider (HCP) immediately when experiencing symptoms of a gallbladder attack." (The highest priority nursing instruction for the client to avoid more attacks of pancreatitis is to report symptoms of gallbladder attacks immediately to the HCP.The client may not require removal of the gallbladder. That decision is made by the HCP. The client must see the provider promptly when experiencing gallbladder disease and should not wait. Because this client's acute pancreatitis is likely related to gallstones, alcohol consumption need not be restricted.)

The nurse is caring for a client recently diagnosed with type 1 diabetes mellitus who has had an episode of acute pancreatitis. The client asks the nurse how he developed diabetes when the disease does not run in the family. What is the nurse's best response? "The diabetes could be related to your obesity." "Look online for general information about diabetes." "Do you consume alcohol on a frequent basis?" "Type 1 diabetes can occur when the pancreas is affected or destroyed by disease."

"Type 1 diabetes can occur when the pancreas is affected or destroyed by disease." (The nurse's best response is to tell the client that type 1 diabetes can occur when the pancreas is affected or destroyed by disease. This is the only response that accurately describes the relationship of the client's diabetes to pancreatic destruction.Type 2, not type 1, diabetes is usually related to obesity. Telling the client to look online for information is inappropriate because some information available online is incorrect at best.Many factors could produce acute pancreatitis other than alcohol consumption.)

A client is taking methimazole (Tapazole) for hyperthyroidism and would like to know how soon this medication will begin working. What is the nurse's best response? "You will see effects of this medication immediately." "You will see effects of this medication within 1 week." "You will see full effects from this medication within 1 to 2 days." "You will see some effects of this medication within 2 weeks."

"You will see some effects of this medication within 2 weeks." (The nurse's best response is that the client will see some effects of this medication within 2 weeks. Methimazole (Tapazole) blocks thyroid hormone production by preventing iodide binding in the thyroid gland. The response to these drugs is delayed because the client may have large amounts of stored thyroid hormones that continue to be released. It may take several more weeks before metabolism returns to normal.Although onset of action is 30 to 40 minutes after an oral dose, the client will not see therapeutic effects immediately. Effects will take 2 weeks to become apparent when methimazole is used. Methimazole needs to be taken every 8 hours for an extended period of time. Levels of triiodothyronine (T₃) and thyroxine (T₄) will be monitored and dosages adjusted as levels fall.)

A client receiving methimazole (Tapazole) calls the home health nurse and mentions that his heart rate is slower than usual. What is the nurse's best response? Advise the client to go to a calming environment. Ask whether the client has increased cold sensitivity or weight gain. Instruct the client to see his primary health care provider immediately. Tell the client to check his pulse again and call back later.

Ask whether the client has increased cold sensitivity or weight gain. (The nurse's best response is to ask the client if he is experiencing increased sensitivity to cold and/or weight gain. These could be symptoms of hypothyroidism, indicating an overcorrection by the medication. The client must be assessed further because he may require a lower dose of medication.A calming environment will not increase the client's heart rate. The client will want to notify the primary health care provider about the change in heart rate. If other symptoms such as chest pain, shortness of breath, or confusion accompany the slower heart rate, then the client would notify the primary health care provider or go to the ED immediately. If the client was concerned enough to call because his heart rate was slower than usual, the nurse needs to stay on the phone with the client while he rechecks his pulse. This time could also be spent providing education about normal ranges for that client.)

While assessing a patient with an endocrine disorder, the nurse hears an audible bruit over the thyroid gland. The presence of a mass or cyst is noted on the patient's ultrasound report. The primary health care provider prescribes radioactive iodine. What condition might the patient be experiencing? Hypothyroidism Hyperthyroidism Hypoparathyroidism Hyperparathyroidism

Hyperthyroidism (An audible bruit heard over the thyroid gland because of increased blood flow is an indication of hyperthyroidism. A mass or cyst indicates an enlarged thyroid gland, which may be a goiter. The primary health care provider prescribes radioactive iodine therapy to ablate the enlarged thyroid gland. Hypothyroidism is characterized by weight gain and impaired cardiac and respiratory functions and is treated with levothyroxine, which is a thyroid hormone supplement. Hypoparathyroidism is characterized by excessive or inappropriate muscle contractions and is treated with parathormone. Hyperparathyroidism is characterized by weight loss, an increased risk of fracture, and renal calculi. It is treated with calcitonin.)

The nurse is reviewing the adverse effects of antithyroid medications for a patient prescribed propylthiouracil (PTU). What potential serious adverse effects should the nurse discuss with the patient during discharge teaching? (Select all that apply.) Kidney damage Increased urination Joint pain Bone marrow toxicity Liver toxicity

Joint pain Bone marrow toxicity Liver toxicity (The most damaging or serious adverse effects of the antithyroid medications are liver and bone marrow toxicity. Myalgias and arthralgias (joint pain) may also occur with PTU.)

A client who had been hospitalized with pancreatitis is being discharged with home health services. The client is severely weakened after this illness. Which nursing intervention is the highest priority in conserving the client's strength? Limiting the client's activities to one floor of the home Instructing the client to take an as-needed (PRN) sleeping medication at night Arranging for the client to have a nutritional consult to assess the client's diet Asking the health care provider for a request for PRN nasal oxygen

Limiting the client's activities to one floor of the home (Limiting the client's activities to one floor of the home is the highest priority nursing intervention. This will prevent tiring the client unnecessarily with stair climbing.A PRN sleeping medication will not increase the client's strength level or conserve strength.Arranging for a nutritional consult or placing the client on PRN nasal oxygen will not necessarily result in an increase in the client's strength level or conserve strength. No information suggests that the client has any history of breathing difficulties.)

When providing community education, the nurse emphasizes that which group needs to receive immunization for hepatitis B? Clients who work with shellfish Men who engage in sex with men Clients traveling to a third-world country Clients with elevations of aspartate aminotransferase and alanine aminotransferase

Men who engage in sex with men (Men who prefer sex with men are at increased risk for hepatitis B, which is spread by the exchange of blood and body fluids during sexual activity.Consuming raw or undercooked shellfish may cause hepatitis A, not hepatitis B. Travel to third-world countries exposes the traveler to contaminated water and risk for hepatitis A. Hepatitis B is not of concern, unless the client is exposed to blood and body fluids during travel. Clients who have liver disease should receive the vaccine, but men who have sex with men are at higher risk for contracting hepatitis B.)

Which action does the postanesthesia care unit (PACU) nurse perform first when caring for a client who has just arrived after a total thyroidectomy? Assess the wound dressing for bleeding. Administer morphine sulfate for pain. Monitor oxygen saturation using pulse oximetry. Support the head and neck with pillows.

Monitor oxygen saturation using pulse oximetry. (Airway assessment and management is always the first priority with every client. This is especially important for a client t who has had surgery that involves potential bleeding and edema near the trachea. Remember the ABCs (airway, breathing, and circulation) of physical assessment.Assessing the wound dressing for bleeding is a high priority, which is performed after assessing airway and breathing. Pain control and supporting the head and neck with pillows are important priorities, but can be addressed after airway assessment.)

Which set of assessment findings indicates to the nurse that a client may have acute pancreatitis? Absence of jaundice, pain of gradual onset Absence of jaundice, pain in right abdominal quadrant Presence of jaundice, pain worsening when sitting up Presence of jaundice, pain worsening when lying supine

Presence of jaundice, pain worsening when lying supine (Pain that worsens when lying supine and the presence of jaundice are the only assessment findings indicative of acute pancreatitis.Pain associated with acute pancreatitis usually has an abrupt onset, is located in the mid-epigastric or upper left quadrant, and lessens with sitting up. Also, jaundice is present.)

A client has been placed on enzyme replacement for treatment of chronic pancreatitis. In teaching the client about this therapy, the nurse advises the client not to mix enzyme preparations with foods containing which element? Carbohydrates High fat High fiber Protein

Protein (The nurse tells the client not to mix enzyme preparations with foods containing protein because the enzymes will dissolve the food into a watery substance. Pancreatic-enzyme replacement therapy (PERT) is the standard of care to prevent malnutrition, malabsorption, and excessive weight loss (Chart 59-3). Pancrelipase is usually prescribed in capsule or tablet form and contains varying amounts of amylase, lipase, and protease.No evidence suggests that enzyme preparations should not be mixed with carbohydrates, food with high fat content, and food with high fiber content.)

The nurse is assessing a client who has recurrent attacks of pancreatitis and is concerned about possible alcohol abuse as an underlying cause of these attacks. To elicit this information, what will the nurse do initially? Ask the client about binge drinking. Question the client whether drinking increases on weekends. Provide privacy and use the CAGE questionnaire (Cut down, Annoyed by criticism, Guilt about drinking, and Eye-opener drinks) Ask the client's spouse to describe the client's drinking

Provide privacy and use the CAGE questionnaire (Cut down, Annoyed by criticism, Guilt about drinking, and Eye-opener drinks) (Initially, the nurse needs to provide privacy and establish a trusting relationship to help obtain information from the client about alcohol use. The CAGE questionnaire is useful as well.Topics such as binge drinking or tending to drink more on holidays or weekends may put the client on the defensive rather than provide the desired information. It has not yet been determined whether the client engages in binge drinking. Asking the client client's spouse will decrease nurse-client trust.)

A client at the medical clinic is being evaluated for hypothyroidism. For which of these symptoms consistent with hypothyroidism does the nurse assess? Select all that apply. Pulse rate below 60 beats per minute Agitation and inability to sleep Increasing thermostat settings in the home Increase in appetite over the last year Bizarre or manic behavior

Pulse rate below 60 beats per minute Increasing thermostat settings in the home (The nurse assesses the client with hypothyroidism for bradycardia (heart rate below 60). Blood pressure and heart rate and rhythm must be monitored as well as any indications of shock (e.g., hypotension, decreased urine output, changes in mental status). Intolerance to cold is also noted and increasing thermostat settings in the home or additional clothing may be necessary for comfort.Hypothyroidism does not cause agitation and inability to sleep; those symptoms are consistent with hyperthyroidism. Hypothyroidism can cause lethargy, apathy, drowsiness, decreased attention span, and memory. The client often reports an increase in time spent sleeping, sometimes up to 14 to 16 hours daily. The appetite decreases rather than increases and constipation frequently ensues. Bizarre or manic behaviors do not occur with hypothyroidism. Mood swings may occur with hyperthyroidism along with laughing and crying without cause.)

What is the most common cause of hypothyroidism in the United States? Intake of tyrosine Consumption of saltwater fish Reduced intake of iodide Radioactive iodine treatment

Radioactive iodine treatment (The most common cause of hypothyroidism in the United States is radioactive iodine (RAI) treatment and thyroid surgery for hyperthyroidism. Hypothyroidism was common in the Midwest region of the U.S. before iodide was added to table salt and saltwater fish was widely available. Tyrosine and iodide are compounds essential to produce thyroid hormones. Saltwater fish is a good source of iodide and prevents hypothyroidism. Endemic goiter due to hypothyroidism is found in areas where soil and water have little natural iodide.)

The nurse is attempting to position a client having an acute attack of pancreatitis in the most comfortable position possible. In which position does the nurse place this client? Supine, with a pillow supporting the abdomen Up in a chair between frequent periods of ambulation High-Fowler's position, with pillows used as needed Side-lying position, with knees drawn up to the chest

Side-lying position, with knees drawn up to the chest (The side-lying position with the knees drawn up has been found to be the most comfortable possible position to relieve abdominal discomfort related to acute pancreatitis.No evidence suggests that supine position, sitting up in a chair, or high-Fowler's position has any effect on abdominal discomfort related to acute pancreatitis.)

A nurse teaches a client who is prescribed an unsealed radioactive isotope. Which statements should the nurse include in this client's education? (Select all that apply.) a. "Do not share utensils, plates, and cups with anyone else." b. "You can play with your grandchildren for 1 hour each day." c. "Eat foods high in vitamins such as apples, pears, and oranges." d. "Wash your clothing separate from others in the household." e. "Take a laxative 2 days after therapy to excrete the radiation."

a. "Do not share utensils, plates, and cups with anyone else." d. "Wash your clothing separate from others in the household." e. "Take a laxative 2 days after therapy to excrete the radiation." (A client who is prescribed an unsealed radioactive isotope should be taught to not share utensils, plates, and cups with anyone else; to avoid contact with pregnant women and children; to avoid eating foods with cores or bones, which will leave contaminated remnants; to wash clothing separate from others in the household and run an empty cycle before washing other people's clothing; and to take a laxative on days 2 and 3 after receiving treatment to help excrete the contaminated stool faster.)

A nurse teaches a client with hepatitis C who is prescribed ribavirin (Copegus). Which statement should the nurse include in this client's discharge education? a. "Use a pill organizer to ensure you take this medication as prescribed." b. "Transient muscle aching is a common side effect of this medication." c. "Follow up with your provider in 1 week to test your blood for toxicity." d. "Take your radial pulse for 1 minute prior to taking this medication."

a. "Use a pill organizer to ensure you take this medication as prescribed." (Treatment of hepatitis C with ribavirin takes up to 48 weeks, making compliance a serious issue. The nurse should work with the client on a strategy to remain compliant for this length of time. Muscle aching is not a common side effect. The client will be on this medication for many weeks and does not need a blood toxicity examination. There is no need for the client to assess his or her radial pulse prior to taking the medication.)

A patient has a diagnosis of primary hypothyroidism. Which statement accurately describes this problem? a. The hypothalamus is not secreting thyrotropin-releasing hormone (TRH); therefore, thyroid-stimulating hormone (TSH) is not released from the pituitary gland. b. The pituitary gland is dysfunctional and is not secreting TSH. c. The abnormality is in the thyroid gland itself. d. The abnormality is caused by an insufficient intake of iodine.

c. The abnormality is in the thyroid gland itself. (Primary hypothyroidism stems from an abnormality in the thyroid gland itself and occurs when the thyroid gland is not able to perform one of its many functions. Secondary hypothyroidism begins at the level of the pituitary gland and results from reduced secretion of TSH. TSH is needed to trigger the release of the T₃ and T₄ stored in the thyroid gland. Tertiary hypothyroidism is caused by a reduced level of the TRH from the hypothalamus. This reduced level, in turn, reduces TSH and thyroid hormone levels.)

A 19-year-old woman has been diagnosed with hypothyroidism and has started thyroid replacement therapy with levothyroxine (Synthroid). After 6 months, she calls the nurse to say that she feels better and wants to stop the medication. Which response by the nurse is correct? a. "You can stop the medication if your symptoms have improved." b. "You need to stay on the medication for at least 1 year before a decision about stopping it can be made." c. "You need to stay on this medication until you become pregnant." d. "Medication therapy for hypothyroidism is usually lifelong, and you should not stop taking the medication."

d. "Medication therapy for hypothyroidism is usually lifelong, and you should not stop taking the medication." (These medications must never be abruptly discontinued, and lifelong therapy is usually the norm. The other options are incorrect.)

A nurse assesses a client who is recovering from a total thyroidectomy and notes the development of stridor. Which action should the nurse take first? a. Reassure the client that the voice change is temporary. b. Document the finding and assess the client hourly. c. Place the client in high-Fowler's position and apply oxygen. d. Contact the provider and prepare for intubation.

d. Contact the provider and prepare for intubation. (Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema. One emergency measure is to remove the surgical clips to relieve the pressure. This might be a physician function. The nurse should prepare to assist with emergency intubation or tracheostomy while notifying the provider or the Rapid Response Team. Stridor is an emergency situation; therefore, reassuring the client, documenting, and reassessing in an hour do not address the urgency of the situation. Oxygen should be applied, but this action will not keep the airway open.)