Nursing review
Complications
-thyroid hormone replacement will increase the work-load of the heart and increase myocardial oxygen requirements -observe client for development of cardiac failure -have client report tachycardia, chest pain, tremors, weight loss, insomnia
Which is the best action for the nurse to take during a child seizure a. Administer the child rescue dose of oral valium b. loosen the childs clothing and call for help c. place a tongue blade in the childs mouth to prevent aspiration d. carry the child to the infirmary to call 911 and start an IV line
B
During the nurses assessment of child begins to have generalized tonic clonic seizure the drug of choice and method of administration the nurse expect the healthcare provider to order our which of the following a. lorazepam and diazepam combined in an IV solution of D5W b. lorazepam given IV or diazepam given directly into a vein c. phinne barbital administered in an IV solution of D5W .45 normal saline d. phenytoin in a dextrose solution given IV over one hour
B
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? A. Chicken B. Seafood C. Milk D. Eggs
B
Which of the following statements is true about febrile seizures? A) Febrile seizures are usually associated only with bacterial infections B) There is a genetic link to febrile seizures C) Febrile seizures are not associated with long-term complications D) A febrile seizure usually indicates that the child will develop epilepsy later on
C
Which statement by the patient indicates an understanding of discharge instructions given by the nurse about the newly prescribed medication levothyroxine (Synthroid)? A. "I can expect improvement of my symptoms within 1 week." B. "I will stop the medication immediately if I feel pain or weakness in my muscles." C. "I will take this medication in the morning so it does not affect my sleep at night." D. "I will take a double dose to make up for the missed one."
C
A treatment frequently used to treat hyperthyroidism using radioactive iodine works by: A. destroying the pituitary gland responsible for secreting TSH B. replacing the thyroid hormone with a synthetic version C. reducing thyroid hormone secretion by destroying thyroid tissue D. increasing the effectiveness of the negative feedback mechanism.
C. reducing thyroid hormone secretion by destroying thyroid tissue
A nurse is teaching about the pathophysiology of syndrome of inappropriate antidiuretic hormone (SIADH). Which information should the nurse include? SIADH results in excessive: A. renal retention of sodium and water B. renal excretion of sodium without water retention C. renal retention of water without sodium retention. D. renal excretion of water without sodium retention.
C. rental retention of water without sodium retention.
While reading a patient's history, the nurse discovers the patient had exposure to ionizing radiation to the head and neck. Which disease should the nurse assess for in this patient? A. Graves disease B. Hashimoto thyroiditis C. thyroid cancer D. subacute thyroiditis
C. thyroid cancer
Which of the following alterations would the nurse expect to find in a patient with untreated Cushing disease or syndrome? A. weight loss B. pale skin C. truncal obesity d. peripheral edema
C. truncal obesity
What is an education piece to give if a patient is prescribed prednisone or hydrocortisone for addison's for replacing cortisol? What should they report to their doctor?
Education: Patient needs to report if they are having stress such as illness, surgery, or extra stress in life ( will need to increase dosage), take medication exactly as prescribed....don't stop abruptly without consulting with MD.
When assessing for potential serious adverse effects to propylthiouracil (PTU), the nurse will monitor which laboratory test? A. Kidney function B. Brain natriuretic peptide C. Serum electrolytes D. Complete blood count (CBC)
D
What is the Role of Cortisol? What is it referred to as?
"STRESS Hormone" helps the body deal with stress such as illness or injury, increases blood glucose though glucose metabolism, break downs fats, proteins, and carbs, regulates electrolytes.
What are the two key players in both of these conditions?
-Adrenal Cortex -Steroid Hormones: Corticosteroids (specifically Aldosterone (mineralocorticoid) & Cortisol (glucocorticoid)
What are two possible causes of Cushing's? Think what is an external and internal factor causing this?
-Glucocorticoid drug therapy ex: Prednisone -Body causing it: due to tumors and cancer on the *pituitary glands or adrenal cortex, or genetic predisposition
What should a client with a vagal nerve stimulator avoid?
-MRI -Ultrasound diathermy -use of microwave -shortwave radios
The patient with type 1 diabetes mellitus with hypoglycemia is having a seizure. Which medication should the nurse anticipate administering to stop the seizure? 1. Intravenous (IV) dextrose solution 2. IV diazepam (Valium) 3. IV phenytoin (Dilantin) 4. Oral carbamazepine (Tegretol)
1 intravenous (IV) dextrose solution This patient's seizure is caused by low blood glucose, so IV dextrose solution should be given first to stop the seizure. IV diazepam, IV phenytoin, and oral carbamazepine would be used to treat seizures from other causes, such as head trauma, drugs, and infections.
The nurse is teaching the client diagnosed with hyperthyroidism. Which information should be taught to the client? Select all that apply. 1. Notify the HCP if a three (3)-pound weight loss occurs in two (2) days. 2. Discuss ways to cope with the emotional lability. 3. Notify the HCP if taking over-the-counter medication 4. Carry a medical identification card or bracelet. 5. Teach how to take thyroid medications correctly.
1, 2, 3, 4, 1.Weight loss indicates the medication may not be effective and will probably need to be increased. 2.The client needs to know emotional highs and lows are secondary to hyperthyroidism. With treatment, this emotional lability will subside. 3.Any over-the-counter medications (for example, alcohol-based medications) may negatively affect the client's hyperthyroidism or medications being used for treatment. 4.This will help any HCP immediately know of the client's condition, especially if the client is unable to tell the HCP. 5. The client will be on anti thyroid medication not thyroid medication
A client has been diagnosed with hyperthyroidism. Which signs and symptoms may indicate thyroid storm, a complication of this disorder? Select all that apply. 1.Fever 2.Nausea 3.Lethargy 4.Tremors 5.Confusion 6.Bradycardia
1, 2, 4, 5 Thyroid storm is an acute and life-threatening condition that occurs in a client with uncontrollable hyperthyroidism. Symptoms of thyroid storm include elevated temperature (fever), nausea, and tremors. In addition, as the condition progresses, the client becomes confused. The client is restless and anxious and experiences tachycardia.
The parent of a child newly diagnosed with a typical absence seizure is worried. What information should the nurse provide to the parent regarding typical absence seizures? Select all that apply. 1. The occurrence of seizures usually subsides during adolescence. 2. The seizures are characterized by brief staring spells. 3. The seizures are usually precipitated by flashing lights. 4. A seizure is associated with loss of postural tone. 5. The child will usually seem confused after a seizure
1, 2. 3
A 12-year-old with hyperthyroidism is being treated with standard antithyroid drug therapy. A parent calls the office stating that the child has a sore throat and fever.The nurse's best response is which of the following? 1. "Bring your child to the office or emergency room immediately." 2. "Slight fever and sore throat are normal side effects of the medication." 3. "Give your child the appropriate dose of ibuprofen, and call back if symptoms worsen." 4. "Give your child at least 8 oz of clear fluids, and call back if symptoms worsen."
1. A complication of antithyroid drug therapy is leukopenia. Fever and sore throat, therefore, need to be evaluated immediately. This is an essential component of discharge teaching for patients with Graves disease.
38. The occupational health nurse is concerned about preventing occupation-related acquired seizures. Which intervention should the nurse implement? 1. Ensure that helmets are worn in appropriate areas. 2. Implement daily exercise programs for the staff. 3. Provide healthy foods in the cafeteria. 4. Encourage employees to wear safety glasses.
1. Head injury is one of the main reasons for epilepsy that can be prevented through occupational safety precautions and highway safety programs.
45. The client has been newly diagnosed with epilepsy. Which discharge instructions should be taught to the client? Select all that apply. 1. Keep a record of seizure activity. 2. Take tub baths only; do not take showers. 3. Avoid over-the-counter medications. 4. Have anticonvulsant medication serum levels checked regularly. 5. Do not drive alone; have someone in the car.
1. Keeping a seizure and medication chart will be helpful when keeping follow-up appointments with the health-care provider and in identifying activities that may trigger a seizure. 3. Over-the-counter medications may contain ingredients that will interact with antiseizure medications or, in some cases, as with use of stimulants, possibly cause a seizure. 4. Most of the anticonvulsant medications have therapeutic serum levels that should be maintained, and regular checks of the serum levels help to ensure the correct level.
40. The nurse enters the room as the client is beginning to have a tonic-clonic seizure. What action should the nurse implement first? 1. Note the first thing the client does in the seizure. 2. Assess the size of the client's pupils. 3. Determine if the client is incontinent of urine or stool. 4. Provide the client with privacy during the seizure.
1. Noticing the first thing the client does during a seizure provides information and clues as to the location of the seizure in the brain. It is important to document whether the beginning of the seizure was observed.
43. The client is prescribed phenytoin (Dilantin), an anticonvulsant, for a seizure disorder. Which statement indicates the client understands the discharge teaching concerning this medication? 1. "I will brush my teeth after every meal." 2. "I will check my Dilantin level daily." 3. "My urine will turn orange while on Dilantin." 4. "I won't have any seizures while on this medication."
1. Thorough oral hygiene after each meal, gum massage, daily flossing, and regular dental care are essential to prevent or control gingival hyperplasia, which is a common occurrence in clients taking Dilantin.
What are the nursing actions in order when a patient is having status epilepticus?
1. maintain airway 2. provide O2 3. establish IV access (give loading dose diazepam/lorazepam and then phenytoin) 4. perform ECG monitoring 5. monitor pulse ox and ABG results
The client is diagnosed with hypothyroidism. Which signs/symptoms should the nurse expect the client to exhibit? 1. Complaints of extreme fatigue and hair loss. 2. Exophthalmos and complaints of nervousness. 3. Complaints of profuse sweating and flushed skin. 4. Tetany and complaints of stiffness of the hands.
1.A decrease in thyroid hormone causes decreased metabolism, which leads to fatigue and hair loss. 2. These are signs of hyperthyroidism. 3. These are signs of hyperthyroidism. 4. These are signs of parathyroidism
A client is admitted to an emergency department, and a diagnosis of myxedema coma is made. Which action would the nurse prepare to carry out initially? 1. Warm the client. 2.Maintain a patent airway. 3.Administer thyroid hormone. 4.Administer fluid replacement.
2
The patient has an order for phenytoin (Dilantin) 100 mg q8hr IV. Available is a phenytoin injection containing 50 mg/mL. How many milliliters of solution should the nurse draw up for the dose? _____mL
2 100 mg ÷ 50 mg/mL = 2 mL
The nurse is preparing a client with a new diagnosis of hypothyroidism for discharge. The nurse determines that the client understands discharge instructions if the client states that which symptoms are associated with this diagnosis? Select all that apply. 1.Tremors 2.Weight loss 3.Feeling cold 4.Loss of body hair 5.Persistent lethargy 6.Puffiness of the face
3, 4, 5, 6
48. The nurse educator is presenting an in-service on seizures. Which disease process is the leading cause of seizures in the elderly? 1. Alzheimer's disease. 2. Parkinson's disease. 3. Cerebral vascular accident (stroke). 4. Brain atrophy due to aging.
3. A CVA (stroke) is the leading cause of seizures in the elderly; increased intracranial pressure associated with the stroke can lead to seizures.
The client will have an EEG in the morning. The nurse should instruct the client to have which of the following for breakfast? 1. No food or fluids 2. Only coffee or tea if needed 3. A full breakfast as desired without coffee, tea, or energy drinks 4. A liquid breakfast of fruit juice, oatmeal, or smoothie
3. Beverages containing caffeine, such as coffee, tea, cola, and energy drinks, are withheld before an EEG because of the stimulating effects of the caffeine on the brain waves. A meal should not be omitted before an EEG because low blood sugar could alter brain wave patterns; the client does not need to be on a liquid diet or NPO
The nurse assesses a patient for signs of petit mal or absence seizures. What is the classic sign of this seizure disorder? 1. Dizziness 2. Intense anxiety 3.Stiffening of the body 4.Vacant facial expression
4 Vacant facial expression The patient experiencing a petit mal or absence seizure displays a sudden vacant look and usually stares straight ahead. This type of seizure often goes unnoticed by the patient or others. Dizziness and intense anxiety are not commonly associated with petit mal or absence seizures. Stiffening of the body is the tonic phase and is associated with a tonic-clonic seizure, not absence seizure.
The nurse has a prescription to change the patient's levothyroxine (Synthroid) dosage from oral to intravenous (IV). The patient takes 150 mcg/day by mouth, and the prescription is to administer 50% of the oral dose by the IV route. How much will the nurse administer per day?
75 mcg 150 mcg/day × 0.50 = 75 mcg
2. You are called to the Emergency Department to admit a 2-year-old patient who had a 2 minute generalized tonic-clonic seizure associated with fever. The patient is well-appearing and at baseline neurological status 30 minutes after the event. His neurological examination is normal. What should you do? A. Discharge the patient home after seizure education B. Admit the patient to the floor for overnight observation C. Recommend the Emergency Department obtain a head CT D. Obtain screening labs including a CBCD, chemistry panel and CRP E. Discharge the patient home with rectal diazepam.
A
What is the best diagnostic study with which to determine the type of seizure activity while the patient is experiencing the seizure? A) Electroencephalogram (EEG) B) Computed tomography (CT) C) Magnetic resonance imaging (MRI) D) Positron emission tomography (PET)
A The EEG is the best diagnostic study with which to determine the type of seizure a patient is having while experiencing the seizure, because an EEG detects electrical discharges in the brain and records them as waves on a tracing. Electrical activity associated with seizures is excessive and disorganized, but the waves are correlated with different neurologic conditions. CT, MRI, and PET do not detect electrical activity in the brain.
A two-month-old infant is brought to the ER after experiencing a seizure the infinite peers lethargic with very regular respirations and periods of apnea the parent reports the babies no longer interested in feeding and before the seizure rolled off the couch what additional testing should the nurse immediately prepare for a. CT scan of head and dilation of the eyes b. ct scan of the head and EEG c. x rays of head d. x rays of all long bones
A (CT reveals trauma, dilating eyes looks for retinal hemorrhages that are seen in an infant with SBS)
Which of the following will the nurse observe in the client in the ictal phase of a generalized tonic-clonic seizure? A. Jerking in one extremity that spreads gradually to adjacent areas B. Vacant staring and abruptly ceasing all activity C. Facial grimaces, patting motions, and lip smacking D. Loss of consciousness, body stiffening and violent muscle contractions
A generalized tonic-clonic seizure involves both a tonic phase and a clonic phase. The tonic phase consists of loss of consciousness, dilated pupils, and muscular stiffening or contraction, which lasts 20 to 30 seconds. The clonic phase involves repetitive movements. The seizure ends with confusion, drowsiness, and resumption of respiration
Describe a partial seizure.
A partial seizure starts in one region of the cortex and may stay focused or spread (eg. jerking in the extremity spreading to other areas of the body).
What is the status epilepticus? Complications? Tx?
A prolonged seizure lasting at least 30 mins. Complications include decreased O2 levels, brain damage. Tx is a loading dose of diazepam or lorazepam followed by continuous phenytoin.
The nurse is assessing a client in the postictal phase of generalized tonic-clonic seizure. The nurse should determine if the client has: A. drowsiness B. Inability to move C. Parasthesia D. Hypotension
A. Drowsiness The nurse should expect a client in the postictal phase to experience drowsiness to somnolence because exhaustion results from the abnormal spontaneous neuron firing and tonic-clonic motor response.
A 22 year old who hit his head while playing football has a tonic-clonic seizure. Upon wakening from the seizure, the client asks the nurse, "What caused me to have a seizure? I've never had one before." Which cause should the nurse include in the response as a primary cause of tonic-clonic seizures in adults older than age 20? A. Head trauma B. Electrolyte imbalance C. Congenital defect D. Epilepsy
A. Trauma is one of the primary causes of brain damage and seizure activity in adults. Other common causes of seizure activity in adults include neoplasms, withdrawal from drugs and alcohol, and vascular disease.
Which of the following patients is most prone to secondary hyperparathyroidism? A patient with A. chronic renal failure B. primary hyperparathyroidism C. a pituitary tumor D. Graves disease
A. chronic renal failure
Which of the following will the nurse implement to treat a patient with syndrome of inappropriate antidiuretic hormone (SIADH) secretion? A. fluid restriction B. insulin administration C. hypotonic saline administration D. protein restriction
A. fluid restriction
When evaluating the kidney function of a patient with diabetes insipidus (DI), the nurse would observe A. high volume urine output B. high urine osmolarity C. blood in the urine D. protein in the urine
A. high volume urine output
Which of the following problems should the nurse monitor for in a patient with primary hyperaldosteronism? A. hypertension B. hyperglycemia C. hyperkalemia D. hyponatremia
A. hypertension
A patient who is having an acute exacerbation of multiple sclerosis has a prescription for methylprednisolone (Solu-Medrol) 160 mg IV. The label on the vial reads: methylprednisolone 125 mg in 2 mL. How many mL will the nurse administer?
ANS: 2.56 With a concentration of 125 mg/2 mL, the nurse will need to administer 2.56 mL to obtain 160 mg of methylprednisolone. DIF: Cognitive Level: Understand (comprehension) REF: 1430-1431 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
A patient has been taking phenytoin (Dilantin) for 2 years. Which action will the nurse take when evaluating for adverse effects of the medication? a. Inspect the oral mucosa. b. Listen to the lung sounds. c. Auscultate the bowel tones. d. Check pupil reaction to light.
ANS: A Phenytoin can cause gingival hyperplasia, but does not affect bowel tones, lung sounds, or pupil reaction to light. DIF: Cognitive Level: Apply (application) REF: 1424 TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
A 27-year-old patient who has been treated for status epilepticus in the emergency department will be transferred to the medical nursing unit. Which equipment should the nurse have available in the patient's assigned room (select all that apply)? a. Side-rail pads b. Tongue blade c. Oxygen mask d. Suction tubing e. Urinary catheter f. Nasogastric tube
ANS: A, C, D The patient is at risk for further seizures, and oxygen and suctioning may be needed after any seizures to clear the airway and maximize oxygenation. The bed's side rails should be padded to minimize the risk for patient injury during a seizure. Use of tongue blades during a seizure is contraindicated. Insertion of a nasogastric (NG) tube is not indicated because the airway problem is not caused by vomiting or abdominal distention. A urinary catheter is not required unless there is urinary retention .DIF: Cognitive Level: Apply (application) REF: 1426 TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
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."
ANS: A, D, E 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 plans care for a client with hyperparathyroidism. Which intervention should the nurse include in this client's plan of care? a. Ask the client to ambulate in the hallway twice a day. b. Use a lift sheet to assist the client with position changes. c. Provide the client with a soft-bristled toothbrush for oral care. d. Instruct the unlicensed assistive personnel to strain the client's urine for stones.
ANS: B b. Use a lift sheet to assist the client with position changes. Hyperparathyroidism causes increased resorption of calcium from the bones, increasing the risk for pathologic fractures. Using a lift sheet when moving or positioning the client, instead of pulling on the client, reduces the risk of bone injury. Hyperparathyroidism can cause kidney stones, but not every client will need to have urine strained. The priority is preventing injury. Ambulating in the hall and using a soft toothbrush are not specific interventions for this client
1. A client has been admitted with hypoparathyroidism. The client's serum laboratory values are as follows: calcium, 7.2 mg/dL; sodium, 144 mEq/L; magnesium, 1.2 mEq/L; potassium, 5.7 mEq/L. Which medications does the nurse anticipate administering? (Select all that apply.) a. Potassium chloride orally b. Calcium chloride IV c. 3% NS IV solution d. 50% magnesium sulfate e. Calcitriol (Rocaltrol) orally
ANS: B, D The client has hypocalcemia (treated with calcium chloride) and hypomagnesemia (treated with magnesium sulfate). The potassium level is high, so replacement is not needed. The client's sodium level is normal, so hypertonic IV solution is not needed. No information about a vitamin D deficiency is available, so calcitriol is not needed.
20. A client being treated for hypothyroidism has been admitted for pneumonia. Which activity does the nurse include as a priority in this client's care plan? a. Monitor the client's IV site every shift. b. Administer acetaminophen (Tylenol) for fever. c. Ensure that working suction equipment is in the room. d. Assess vital signs every 4 hours.
ANS: C 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 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 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."
ANS: C 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 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
ANS: C 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.
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.
ANS: D 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.
What is Addison's disease?
Addison's: Hyposecretion of Aldosterone & Cortisol (Aldosterone & Addison's both start with A's so Addison's effects both cortisol & aldosterone)
A patient arrives to the nurse practitioner because he was walking to his car when he suddenly lost muscle tone and fell to the ground. He lost consciousness but regained it upon hitting the ground but came to be examined just to be safe. With these symptoms, what type of seizure did the patient have?
An atonic seizure
Nursing Management of Addison's Disease
Administer medications to replace the low hormone levels of cortisol and aldosterone
Describe an absence seizure
An absence seizure usually occurs in children and involves a vacant stare with a brief loss of consciousness that often goes unnoticed.
Which seizure phase occurs minutes before the seizure?
Aural phase
What causes Addison's disease?
Autoimmune due to the adrenal cortex becoming damaged due to the body attacking itself: -Tuberculosis/infections (TB can damage adrenal glands) -Cancer -Hemorrhaging of the adrenal cortex due to a trauma
Addison's patients should avoid what?
Avoid illnesses, stress, strenuous exercise
A patient receives phenytoin (Dilantin) for partial seizures. Which medication will require a higher-than-normal dosage when taken by the patient during this therapy? A) Tiagabine (Gabritril) B) Lamotrigine (Lamictal) C) Gabapentin (Neurontin) D) Phenobarbital (Luminal)
B A normal dosage of lamotrigine is unlikely to be effective against partial seizures when administered with phenytoin, because these medications are metabolized by the same hepatic enzymes, resulting in decreased effectiveness of the lamotrigine. For the lamotrigine to be therapeutically effective, the dosage must be increased when the drug is administered concurrently with phenytoin.
A client who has had seizures asks the nurse about being able to drive because of the seizures. Which response by the nurse is best? A. A person with a history of seizures can drive only during daytime hours B. A person with evidence that the seizures are under medical control can drive C. A person with evidence that seizures occur no more than every 12 months can drive D. A person with a history of seizures can drive if he or she carries a medical identification card
B. Specific motor vehicle regulations and restrictions for people who experience seizures vary locally. Most commonly, evidence that the seizures are under medical control is required before the person is given permission to drive. The typical amount of time a person must be seizure free to drive is two years.
Which patient is most prone to development of Addison disease? A patient with A. thyroid cancer B. autoimmune injury to the adrenal cortex C. viral infection of the parathyroid gland D. bacterial infection of catecholamines.
B. autoimmune injury to the adrenal cortex
A patient is experiencing neurological symptoms of SIADH. Based upon these symptoms, the nurse expects to find which of the following lab results? A. metabolic acidosis B. decreased serum sodium concentrations C. increased serum osmolarity D. hypokalemia
B. decreased serum sodium concentrations
A nurse is asked what causes Cushing disease. How should the nurse respond? Cushing disease is commonly caused by A. autoimmune destruction of the adrenal cortex B. ectopic production of ACTH from a lung tumor C. excessive production of cortisol from a tumor in the adrenal cortex D. excessive production of aldosterone from a tumor in the adrenal cortex
B. ectopic production of ACTH from a lung tumor
A nurse is discussing the pathophysiology of Graves disease. Which information should the nurse include? Graves disease is characterized by: A. ectopic secretion of thyroid hormone by a tumor. B. excessive production of thyroid-stimulating immunoglobulin C. autoimmune destruction of the thyroid gland D. injury to the pituitary, resulting in decreased thyroid-stimulating hormone secretion.
B. excessive production of thyroid-stimulating immunoglobulin
Which of the following should the nurse include in the teaching plan for a client with seizures who is going home with a prescription for gabapentin (Neurontin)? A. Take all the medication until it is gone B. Notify the physician if vision changes occur C. Store gabapentin in the refrigerator D. Take gabapentin with an antacid to protect against ulcers
B. gabapentin (Neurontin) may impair vision. Changes in vision, concentration, or coordination should be reported to the physician. Gabapentin should not be stopped abruptly because of the potential for status epilepticus; this medication must be tapered off. Gabapentin is stored at room temperature and out of direct light. It should not be taken with antacids.
When a nurse is asked what causes acromegaly, how should the nurse respond? Acromegaly is caused by increased secreation of A. prolactin B. growth hormone C. insulin D. glucocorticoids
B. growth hormone
What are partial (focal) seizures?
Begin in part of one cerebral hemisphere Most often in adults two classes: simple and complex
A female patient has prolactinomas (pituitary tumors that secrete prolactin). During the assessment which finding should the nurse expect? A. heavy menstrual periods B. infertility C. breast milk production without pregnancy D. hair loss
C. breast milk production without pregnancy
A patient is e
C. Desmopressin
Which information should be given to the client taking phenytoin (Dilantin)? A. Taking the medication with meals will increase its effectiveness. B. The medication can cause sleep disturbances C. More frequent dental appointments will be needed for special gum care. D. The medication decreases the effects of oral contra- ceptives.
C. More frequent dental appointments will be needed for special gum care. Gingival hyperplasia is a side effect of phenytoin. The client will need more frequent dental visits. Answers A, B, and D do not apply to the medication; therefore, they are incorrect.
The RN has just received change-of-shift report on the medical-surgical unit. Which client will need to be assessed first? a) Client with Hashimoto's thyroiditis and a large goiter b) Client with hypothyroidism and an apical pulse of 51 beats/min c) Client with parathyroid adenoma and flank pain due to a kidney stone d) Client who had a parathyroidectomy yesterday and has muscle twitching
Correct Answer: d A client who is 1 day postoperative for parathyroidectomy and has muscle twitching is showing signs of hypocalcemia and is at risk for seizures. Rapid assessment and intervention are needed. Clients with Hashimoto's thyroiditis are usually stable; this client does not need to be assessed first. Although an apical pulse of 51 is considered bradycardia, a low heart rate is a symptom of hypothyroidism. A client with a kidney stone will be uncomfortable and should be asked about pain medication as soon as possible, but this client does not need to be assessed first.
What effect can starting a dose of levothyroxine sodium (Synthroid) too high or increasing a dose too rapidly have on a client? a) Bradycardia and decreased level of consciousness b) Decreased respiratory rate c) Hypotension and shock d) Hypertension and heart failure
Correct Answer: d 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 be tachycardic, not bradycardic. The client may have an increased respiratory rate. Shock may develop, but only as a late effect and as the result of "pump failure."
The nurse reviews the vital signs of a client diagnosed with Graves' disease and sees that the client's temperature is up to 99.6° F. After notifying the health care provider, what does the nurse do next? a) Administers acetaminophen b) Alerts the Rapid Response Team c) Asks any visitors to leave d) Assesses the client's cardiac status completely
Correct Answer: d If the client's temperature has increased by even 1°, the nurse's first action is to notify the provider. Continuous cardiac monitoring should be the next step. 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. Asking visitors to leave would not be the next action, and if visitors are providing comfort to the client, this would be contraindicated.
What is the difference between Cushing's syndrome & Cushing's disease?
Cushing's Syndrome: caused by an outside cause or medical treatment such as glucocorticoid therapy Cushing's Disease: caused from an inside source due to the pituitary gland producing too much ACTH (Adrenocorticotropic hormone) which causes the adrenal cortex to release too much cortisol.
What is cushing's?
Cushing's: hyper-secretion of CORTISOL (think Cushing and Cortisol both start with C's)
Which statement by the patient indicates teaching was successful regarding hypoparathyroidism? The most common cause of hypoparathyroidism is: A. hypothalamic inactivity B. pituitary hyposecretion C. parathyroid adenoma D. parathyroid gland injury or removal
D. parathyroid gland injury or removal
Which complication will cause the most concern for a nurse who is caring for a patient with hypoparathyroidism? A. osteoporosis B. metabolic acidosis C. insulin resistance D. tetany
D. tetany
Myxedma S/sx
Decreased BMR, chills, lethargy/mental sluggishness, slow heart rate, weight gain, cold sensitivity, depression
Seizures may be identified by A. Jerking movements over entire body B. Staring C. Loss of awareness D. Arm or leg jerking E. All of the above
E. All of the above
Which is a specific investigation of diagnosing seizure disorder? A. EMG B. EOG C. ECT D. ERP E. EEG
E. EEG
What kind of diet should a patient with Addison's follow?
Eat diet high in proteins and carbs, and make sure to consume enough sodium
Myxedma
Hypo thyroidism in adults.
What would be prescribed for replacing aldosterone in a patient with Addison's? What is an education piece to go along with the prescribed drug?
For replacing aldosterone: ex: Fludrocortisone aka Florinef Education: consume enough salt..may need extra salt
Nursing Interventions
Goal: to assist the client to return to hormone balance A.begin thyroid replacement and evaluate client's response; advise client that it will be about 7 days before he or she begins to feel better B.provide a warm environment C.prevent and/or treat constipation D.assess progress: -decrease in body weight -intake and output balance -decrease in visible edema -energy level and mental alertness should increase in 7 to 14 days and continue to rise until normal E. evaluate cardiovascular response to medication Goal: To assist client to understand implications of disease and requirements for health maintenance A. Need for lifelong drug therapy B. Client with diabetes needs to evaluate blood glucose levels more frequently; thyroid preparations may alter effects of hypoglycemic agents C. Continue to reinforce teaching as client begins to make progress; early in the disease, the client may not comprehend information
Cushing's
Hyper secretion of adrenal cortex (high cortisol levels)
Grave's disease
Hyper thyroidism in adults.
Addison's disease
Hypo secretion of adrenal cortex (too little cortisol & aldosterone)
Seizures occur during this phase
Ictal phase
Grave's disease S/sx
Increased BMR, sweating, nervousness, tremors, rapid heart rate, weight loss, enlarged goiter, bulging eyes, heat sensitivity
Which action will the nurse take when evaluating a patient who is taking phenytoin (Dilantin) for adverse effects of the medication?
Inspect the oral mucosa. rational: Phenytoin can cause gingival hyperplasia, but does not affect bowel tones, lung sounds, or pupil reaction to light.
What is status epilepticus?
It is prolonged seizure activity occurring over a 30 minute period.
What is a complex partial seizure?
LOC or blackout for 1-3 minutes Automatisms (client not aware); lip smacking, patting, picking at clothes After seizure may experience amnesia Area of brain most often involved; temporal lobe
Treatment
Medical management: -replacement of thyroid hormone -low-calorie diet to promote weight loss -minimize constipation; increase fiber in diet and fluids.
If a patient is experiencing an Addisonian Crisis what should be given IV STAT?
NEED IV Cortisol STAT: Solu-Cortef and IV fluids (D5NS to keep blood sugar and sodium levels good and fluid status)
Following a thymectomy, a patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe abdominal cramps. Which action should the nurse take first?
Notify the patient's health care provider. rational: The patient's history and symptoms indicate a possible cholinergic crisis. The health care provider should be notified immediately, and it is likely that atropine will be prescribed. The other actions will be appropriate if the patient is not experiencing a cholinergic crisis.
When the nurse is assessing a patient with myasthenia gravis, which action will be most important to take?
Observe respiratory effort. rational: Because respiratory insufficiency may be life threatening, it will be most important to monitor respiratory function. The other data also will be assessed but are not as critical.
What are unclassified or idiopathic seizures?
Occur for no known reason account for half of all seizure activity do not fit into generalized or partial classifications
What is the Role of Aldosterone?
Regulates blood pressure through renin-angiotensin-aldosterone system, helps retain sodium and secretes potassium (balances sodium and potassium levels).
What is the Role of Adrenal Cortex?
Releases steroid hormones and sex hormones
What are Signs & Symptoms of Cushing's? (Remember the mnemonic: "STRESSED"!!!! (remember there is too much of the STRESS hormone CORTISOL)
Skin fragile Truncal obesity with small arms Rounded face (appears like moon), Reproductive issues amennorhea and ED in male(due to adrenal cortex's role in secreting sex hormones) Ecchymosis, Elevated blood pressure Striae on the extremities and abdomen (Purplish) Sugar extremely high (hyperglycemia) Excessive body hair especially in women...and Hirsutism (women starting to have male characteristics), Electrolytes imbalance: hypokalemia Dorsocervical fat pad (Buffalo hump), Depression
What are signs & symptoms of Addison's? *Remember the phrase: "Low STEROID Hormones" (remember you have low production of aldosterone & cortisol which are STEROID hormones)
Sodium & Sugar low (due to low levels of cortisol which is responsible for retention sodium and increases blood glucose), Salt cravings Tired and muscle weakness Electrolyte imbalance of high Potassium and high Calcium Reproductive changes...irregular menstrual cycle and ED in men lOw blood pressure (at risk for vascular collapse)....aldosterone plays a role in regulating BP Increased pigmentation of the skin (hyperpigmentation of the skin) Diarrhea and nausea, Depression
Signs & symptoms of Addisonian crisis: The five S's
Sudden pain in stomach, back, and legs Syncope (going unconscious) Shock Super low blood pressure Severe vomiting, diarrhea and headache
What is an Addisonian Crisis?
This develops when Addison's Disease isn't treated. In addisonian crisis, the patient has extremely LOW CORTISOL levels (life threatening).
What are the six generalized seizures?
Tonic-Clonic- Absence myoclonic tonic clonic atonic
If a patient is experiencing an Addisonian Crisis what should you watch for?
Watch for risk for infection, neuro status (confusion, agitation), electrolyte levels (sodium and potassium, glucose)
Which two levels would you want to closely monitor in Addison's disease?
Watch glucose and K+ level (less cortisol=lower glucose levels, b/c aldosterone is effected it causes hyperkalemia)
What should you instruct an Addison's patient to wear?
Wearing a medical alert bracelet
Cushing's S/Sx
Weight gain, bruising, edema, poor wound healing, hypertension, moon face, buffalo hump, skinny legs, thin skin
Addison's disease S/Sx
Weight loss, dehydration, and hypotension, fatigue, dark skin, hair loss, n/v/d, low bp & blood sugar
Seizures can be related to what?
Withdrawal from alcohol Withdrawal from antiepileptic medication infection fever
During a status epilepticus seizure which intervention would be the highest priority? A. administers lorazepam (Ativan) B. Perform ECG monitoring C. Maintain a patent airway D. Establish IV access E. Review ABG results
You would do all of the interventions listed but the highest priority would be C. Maintain a patent airway
When the entire brain is involved in a seizure, this is what type of seizure?
a generalized seizure
apathy
a lack of feeling, emotion, or interest
A myoclonic seizure is characterized by what?
a sudden, excessive jerk of the body or extremities. The jerk may be forceful enough to hurl the person to the ground. These seizures are brief and may occur in clusters
Social effects of a chronic neurologic disease include (select all that apply) a. divorce. b. job loss. c. depression. d. role changes. e. loss of self-esteem.
a, b, c, d, e Rationale: Social problems related to chronic neurologic disease may include changes in roles and relationships (e.g., divorce, job loss, role changes); other psychologic problems (e.g., depression, loss of self-esteem) also may have social effects.
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. ANS: A 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.
Which care measure is a priority for a patient with multiple sclerosis (MS)? a. Vigilant infection control and adherence to standard precautions b. Careful monitoring of neurologic assessment and frequent reorientation c. Maintenance of a calorie count and hourly assessment of intake and output d. Assessment of blood pressure and monitoring for signs of orthostatic hypotension
a. Vigilant infection control and adherence to standard precautions Infection control is a priority in the care of patients with MS because infection is the most common cause of an exacerbation of the disease. Decreases in cognitive function are less likely, and MS does not typically result in malnutrition, hypotension, or fluid volume excess or deficit.
Hashimoto's thyroiditis
an autoimmune disorder that attacks the thyroid gland causing hypothyroidism
The nurse observes a 74-yr-old man with Parkinson's disease rocking side to side while sitting in the chair. Which action by the nurse is most appropriate? a. Provide the patient with diversional activities. b. Document the activity in the patient's health record. c. Take the patient's blood pressure sitting and standing. d. Ask if the patient is feeling either anxious or depressed.
b. Document the activity in the patient's health record. Patients with Parkinson's disease are instructed to rock from side to side to stimulate balance mechanisms and decrease akinesia.
1. A nurse assesses a client with hyperthyroidism who is prescribed lithium carbonate. Which assessment finding should alert the nurse to a side effect of this therapy? a. Blurred and double vision b. Increased thirst and urination c. Profuse nausea and diarrhea d. Decreased attention and insomnia
b. Increased thirst and urination ANS: B Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. This manifests with increased thirst and urination. Lithium has no effect on vision, gastric upset, or level of consciousness.
MULTIPLE RESPONSE 1. A nurse evaluates the following laboratory results for a client who has hypoparathyroidism: Calcium 7.2 mg/dL Sodium 144 mEq/L Magnesium 1.2 mEq/L Potassium 5.7 mEq/L Based on these results, which medications should the nurse anticipate administering? (Select all that apply.) a. Oral potassium chloride b. Intravenous calcium chloride c. 3% normal saline IV solution d. 50% magnesium sulfate e. Oral calcitriol (Rocaltrol
b. Intravenous calcium chloride d. 50% magnesium sulfate ANS: B, D The client has hypocalcemia (treated with calcium chloride) and hypomagnesemia (treated with magnesium sulfate). The potassium level is high, so replacement is not needed. The client's sodium level is normal, so hypertonic IV solution is not needed. No information about a vitamin D deficiency is evident, so calcitriol is not needed.
Absence seizures (generalized) are:
breif seizures/lasts seconds - may/may not lose consciousness - no loss/change in muscle tone - may occur several times a day - pt appears to be daydreaming - most common in children
A 65-year-old woman was just diagnosed with Parkinson's disease. The priority nursing intervention is a. searching the Internet for educational videos. b. evaluating the home for environmental safety. c. promoting physical exercise and a well-balanced diet. d. designing an exercise program to strengthen and stretch specific muscles.
c Rationale: Promotion of physical exercise and a well-balanced diet are major concerns of nursing care for patients with Parkinson's disease.
During care of a patient in myasthenic crisis, maintenance of what is the nurse's first priority for the patient? a. Mobility b. Nutrition c. Respiratory function d. Verbal communication
c. The patient in myasthenic crisis has severe weakness and fatigability of all skeletal muscles, affecting the patient's ability to breathe, swallow, talk, and move. However, the priority of nursing care is monitoring and maintaining adequate ventilation.
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. ANS: C 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 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 d. Initiate telemetry monitoring ANS: C, E 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 male patient with a diagnosis of Parkinson's disease (PD) is admitted to a long-term care facility. Which action should the health care team take to promote adequate nutrition for this patient? a. Provide multivitamins with each meal. b. Provide a diet that is low in complex carbohydrates and high in protein. c. Provide small, frequent meals throughout the day that are easy to chew and swallow. d. Provide the patient with a minced or pureed diet that is high in potassium and low in sodium.
c. Provide small, frequent meals throughout the day that are easy to chew and swallow. Nutritional support is a priority in the care of individuals with PD. Patients may benefit from smaller, more frequent meals that are easy to chew and swallow. Multivitamins are not necessary at each meal. Vitamin and protein intake must be monitored to prevent interactions with medications. Introducing a minced or pureed diet is likely premature, and a low carbohydrate diet is not indicated.
The nurse finds that an 87-year-old woman with Alzheimer's disease is continually rubbing, flexing, and kicking out her legs throughout the day. The night shift reports that this same behavior escalates at night, preventing her from obtaining her required sleep. The next step the nurse should take is to a. ask the physician for a daytime sedative for the patient. b. request soft restraints to prevent her from falling out of her bed. c. ask the physician for a nighttime sleep medication for the patient. d. assess the patient more closely, suspecting a disorder such as restless legs syndrome.
d Rationale: The severity of sensory symptoms of restless legs syndrome (RLS) ranges from infrequent, minor discomfort (paresthesias, including numbness, tingling, and "pins and needles" sensation) to severe pain. The discomfort occurs when the patient is sedentary and is most common in the evening or at night. The pain at night can disrupt sleep and is often relieved by physical activity, such as walking, stretching, rocking, or kicking. In the most severe cases, patients sleep only a few hours at night, which results in daytime fatigue and disruption of the daily routine. The motor abnormalities associated with RLS consist of voluntary restlessness and stereotyped, periodic, involuntary movements. The involuntary movements usually occur during sleep. Symptoms are aggravated by fatigue.
For replacing cortisol in Addison's what would be given? (think what is cortisol?)
ex: Prednisone, Hydrocortisone
An atonic ("drop attack") seizure involves what?
either a tonic episode or a paroxysmal loss of muscle tone and begins suddenly with the person falling to the ground. Consciousness usually returns by the time the person hits the ground, and normal activity can be resumed immediately. Patients with this type of seizure are at a great risk of head injury and often have to wear protective helmets.
What should the client with a vagal nerve stimulator do if they feel and aura coming on?
hold a magnet over the implant to stop or lessen the severity of the seizure
Describe a complex partial seizure
involves facial grimacing with patting and smacking
Hypothyroidism
is characterized by a slow deterioration of tyroid function. It occurs primarily in older adults and five times more frequently in women (age 30 to 60) than in men. *Myxedema coma is a life-threatening form of hypothyroidism *Hashimoto thyroiditis is a chronic autoimmune disorder, which may lead to a goiter and hypothyroidism.
seizures that originiate in one hemisphere are called
partial or focal seizures
tetany
severe muscle twitches, cramps, and spasms
The Tonic phase of a seizure involves:
stiffening or rigidity of the muscles (arms/legs) - last about 10-20 sec - followed by loss of consciousness
Myxedema coma
the extreme manifestation of hypothyroidism; uncommon but potentially lethal.
Exophthalmic goiter is caused by hyperfunction of which endocrine gland? ______________
thyroid
Nursing Management for Cushing's Syndrome
-Prep patient for Hypophysectomy to remove the pituitary tumor -Prep patient for Adrenalectomy: If this is done educate pt about cortisol replacement therapy after surgery -Risk for infection and skin breakdown -Monitor electrolytes blood sugar, potassium, sodium, and calcium levels
What is a surgical intervention for seizures?
-Vagal nerve stimulator -removal or interruption of brain tissue causing seizures
Myxedema S/S
-hypothermia -hyponatremia -hypoglycemia -generalized edema -respiratory failure -coma
47. The nurse asks the male client with epilepsy if he has auras with his seizures. The client says, "I don't know what you mean. What are auras?" Which statement by the nurse would be the best response? 1. "Some people have a warning that the seizure is about to start." 2. "Auras occur when you are physically and psychologically exhausted." 3. "You're concerned that you do not have auras before your seizures?" 4. "Auras usually cause you to be sleepy after you have a seizure."
1. An aura is a visual, auditory, or olfactory occurrence that takes place prior to a seizure and warns the client a seizure is about to occur. The aura often allows time for the client to lie down on the floor or find a safe place to have the seizure.
The nurse identifies the client problem "risk for imbalanced body temperature" fort he client diagnosed with hypothyroidism. Which intervention should be included in the plan of care? 1. Discourage the use of an electric blanket. 2. Assess the client's temperature every two (2) hours. 3. Keep the room temperature cool. 4. Space activities to promote rest.
1.External heat sources (heating pads,electric or warming blankets) should be discouraged because they increase the risk of peripheral vasodilation and vascular collapse. 2. Assessing the client's temperature every two (2) hours is not needed because the temperature will not change quickly. The client needs thyroid hormones to help increase the client's temperature. 3. The room temperature should be kept warm because the client will have complaints of being cold. 4. The client is fatigued and this is an appropriate intervention, but is not applicable to the client problem of "risk for imbalanced body temperature."
The 68-year-old client diagnosed with hyperthyroidism is being treated with radio active iodine therapy. Which interventions should the nurse discuss with the client? 1. Explain it will take up to a month for symptoms of hyperthyroidism to subside. 2. Teach the iodine therapy will have to be tapered slowly over one (1) week. 3. Discuss the client will have to be hospitalized during the radioactive therapy. 4. Inform the client after therapy the client will not have to take any medication.
1.Radioactive iodine therapy is used to destroy the overactive thyroid cells. After treatment, the client is followed closely for three (3) to four (4) weeks until the euthyroid state is reached.
10. Which type of seizure is most likely to cause death for the patient? a. Subclinical seizures b. Myoclonic seizures c. Psychogenic seizures d. Tonic-clonic status epilepticus
10. d. Tonic-clonic status epilepticus is most dangerous because the continuous seizing can cause respiratory insufficiency, hypoxemia, cardiac dysrhythmia, hyperthermia, and systemic acidosis, which can all be fatal. Subclinical seizures may occur in a patient who is sedated, so there is no physical movement. Myoclonic seizures may occur in clusters and have a sudden, excessive jerk of the body that may hurl the person to the ground. Psychogenic seizures are psychiatric in origin and diagnosed with videoelectroencephalography (EEG) monitoring. They occur in patients with a history of emotional abuse or a specific traumatic episode.
11. A patient admitted to the hospital following a generalized tonic-clonic seizure asks the nurse what caused the seizure. What is the best response by the nurse? a. "So many factors can cause epilepsy that it is impossible to say what caused your seizure." b. "Epilepsy is an inherited disorder. Does anyone else in your family have a seizure disorder?" c. "In seizures, some type of trigger causes sudden, abnormal bursts of electrical brain activity." d. "Scar tissue in the brain alters the chemical balance, creating uncontrolled electrical discharges."
11. c. A seizure is a paroxysmal, uncontrolled discharge of neurons in the brain, which interrupts normal function, but the factor that causes the abnormal firing is not clear. Seizures may be precipitated by many factors and although scar tissue may make the brain neurons more likely to fire, it is not the usual cause of seizures. Epilepsy is established only by a pattern of spontaneous, recurring seizures.
12. A patient with a seizure disorder is being evaluated for surgical treatment of the seizures. The nurse recognizes that what is one of the requirements for surgical treatment? a. Identification of scar tissue that is able to be removed b. An adequate trial of drug therapy that had unsatisfactory results c. Development of toxic syndromes from long-term use of antiseizure drugs d. The presence of symptoms of cerebral degeneration from repeated seizures
12. b. Most patients with seizure disorders maintain seizure control with medications but if surgery is considered, three requirements must be met: the diagnosis of epilepsy must be confirmed, there must have been an adequate trial with drug therapy without satisfactory results, and the electroclinical syndrome must be defined. The focal point must be localized but the presence of scar tissue is not required.
13. The nurse teaches the patient taking antiseizure drugs that this method is most commonly used to measure compliance and monitor for toxicity. a. A daily seizure log b. Urine testing for drug levels c. Blood testing for drug levels d. Monthly electroencephalography (EEG)
13. c. Serum levels of antiseizure drugs are monitored regularly to maintain therapeutic levels of the drug, above which patients are likely to experience toxic effects and below which seizures are likely to occur. Many newer drugs do not require drug level monitoring because of large therapeutic ranges. A daily seizure log and urine testing for drug levels will not measure compliance or monitor for toxicity. EEGs have limited value in diagnosis of seizures and even less value in monitoring seizure control.
14. Priority Decision: When teaching a patient with a seizure disorder about the medication regimen, what is it most important for the nurse to emphasize? a. The patient should increase the dosage of the medication if stress is increased. b. Most over-the-counter and prescription drugs are safe to take with antiseizure drugs. c. Stopping the medication abruptly may increase the intensity and frequency of seizures. d. If gingival hypertrophy occurs, the drug should be stopped and the health care provider notified.
14. c. If antiseizure drugs are discontinued abruptly, seizures can be precipitated. Missed doses should be made up if the omission is remembered within 24 hours and patients should not adjust medications without professional guidance because this also can increase seizure frequency and may cause status epilepticus. Antiseizure drugs have numerous interactions with other drugs and the use of other medications should be evaluated by health professionals. If side effects occur, the physician should be notified and drug regimens evaluated.
Following a generalized tonic-clonic seizure, the patient is tired and sleepy. What care should the nurse provide? a. Suction the patient before allowing him to rest. b. Allow the patient to sleep as long as he feels sleepy. c. Stimulate the patient to increase his level of consciousness. d. Check the patient's level of consciousness every 15 minutes for an hour.
16. b. In the postictal phase of generalized tonic-clonic seizures, patients are usually very tired and may sleep for several hours and the nurse should allow the patient to sleep as long as necessary. Suctioning is performed only if needed and decreased level of consciousness is not a problem postictally unless a head injury has occurred during the seizure.
17. During the diagnosis and long-term management of a seizure disorder, what should the nurse recognize as one of the major needs of the patient? a. Managing the complicated drug regimen of seizure control b. Coping with the effects of negative social attitudes toward epilepsy c. Adjusting to the very restricted lifestyle required by a diagnosis of epilepsy d. Learning to minimize the effect of the condition in order to obtain employment
17. b. One of the most common complications of a seizure disorder is the effect it has on the patient's lifestyle. This is because of the social stigma attached to seizures, which causes patients to hide their diagnosis and to prefer not to be identified as having epilepsy. Medication regimens usually require only once- or twice-daily dosing and the major restrictions of lifestyle usually involve driving and high-risk environments. Job discrimination against the handicapped is prevented by federal and state laws and patients only need to identify their disease in case of medical emergencies.
A 3-year-old child had a seizure two days ago when the child's temperature was 105 F. The child has had no previous seizures. Today, the parent and the child are in the physician's office. What should the nurse include when teaching the parent? 1. The child now has epilepsy and will need long-term care for this condition. 2. If the child develops a fever over 101°F, administer ibuprofen. 3. Make sure the child drinks plenty of water every day. 4. Call the physician's office immediately if the child develops a temperature over 100.4°F.
2
A teen comes into the clinic with complaints of having been under a lot of stress recently. The teen is being treated for Addison disease and is taking cortisol and aldosterone orally. Today, the teen shows symptoms of muscle weakness, fatigue, salt craving, and dehydration. What should the nurse discuss with the patient regarding the medications? 1. The dosage may need to be decreased in times of stress. 2. The dosage may need to be increased in times of stress. 3. The aldosterone should be stopped, and the cortisol should be increased. 4. The cortisol may need to be given IV to raise its level.
2. Because the adrenal glands are not producing enough glucocorticoids, the dosage of both the cortisol and aldos terone must be increased and some times tripled in times of stress.
The school nurse notices that a 14-year-old who used to be an excellent student and very active in sports is losing weight and acting very nervous. The teen was recently checked by the primary care provider, who noted the teen had a very low level of TSH. The nurse recognizes that the teen has which condition? 1. Hashimoto thyroid disease. 2. Graves disease. 3. Hypothyroidism. 4. Juvenile autoimmune thyroiditis.
2. Graves disease is hyperthyroidism and presents with low TSH levels, weight loss, and excessive nervousness.
Which signs/symptoms should make the nurse suspect the client is experiencing a thyroid storm? 1. Obstipation and hypoactive bowel sounds. 2. Hyperpyrexia and extreme tachycardia. 3. Hypotension and bradycardia. 4. Decreased respirations and hypoxia.
2. Hyperpyrexia (high fever) and heart rate above 130 beats per minute are signs of thyroid storm, a severely exaggerated hyperthyroidism. 1. These are signs of myxedema (hypothyroidism) coma. Obstipation is extreme constipation. 3. Decreased blood pressure and slow heartrate are signs of myxedema coma. 4. These are signs/symptoms of myxedema coma.
A patient has been receiving scheduled doses of phenytoin (Dilantin) and begins to experience diplopia. What should the nurse immediately assess the patient for? 1. an aura or focal seizure 2.Nystagmus or confusion 3.Abdominal pain or cramping 4.Irregular pulse or palpitatons
2. Nystagmus or confusion Diplopia is a sign of phenytoin toxicity. The nurse should assess for other signs of toxicity, which include neurologic changes, such as nystagmus, ataxia, confusion, dizziness, or slurred speech. An aura, focal seizure, abdominal pain or cramping, irregular pulse, or palpitations are not associated with phenytoin toxicity.
A school-aged child comes in with a sore throat and fever. The child was recently diagnosed with Graves disease and is taking propylthiouracil. What concerns should the nurse have about this child? 1. The child must not be taking her medication. 2. The child may have leukopenia. 3. The child needs to start an antibiotic. 4. The child is participating in sports before she is euthyroid.
2. Propylthiouracil is used to suppress thyroid function. One of the grave complications of the medication is leukopenia.
What instructions should a nurse give to a patient who has focal seizures well controlled with phenytoin (Dilantin) and who has mild gingival hyperplasia? Select all that apply. 1. The drug should be changed immediately. 2. Regular flossing can control gingival tissue growth. 3. Surgical repair of gingival tissue will be required. 4. Regular tooth brushing can limit hyperplasia. 5. Gingival hyperplasia is not related to phenytoin (Dilantin).
2. Regular Flossing can control gingival tissue growth 4. Regular tooth brushing can limit hyperplasia Gingival hyperplasia is a common side effect of phenytoin (Dilantin). The nurse should instruct the patient to maintain good dental hygiene with regular tooth brushing and flossing. Regular flossing not only helps in maintaining good dental hygiene but also helps control gingival tissue growth. Similarly, regular brushing, besides being generally good for dental health, also helps limit gingival hyperplasia. Mild gingival hyperplasia does not require the drug to be replaced. Surgical intervention would be required only if the gingival hyperplasia were extensive, which is not the case with this patient.
42. The unlicensed assistive personnel (UAP) is attempting to put an oral airway in the mouth of a client having a tonic-clonic seizure. Which action should the primary nurse take? 1. Help the UAP to insert the oral airway in the mouth. 2. Tell the UAP to stop trying to insert anything in the mouth. 3. Take no action because the UAP is handling the situation. 4. Notify the charge nurse of the situation immediately.
2. The nurse should tell the UAP to stop trying to insert anything in the mouth of the client experiencing a seizure. Broken teeth and injury to the lips and tongue may result from trying to place anything in the clenched jaws of a client having a tonic-clonic seizure.
Which characteristic of a patient's recent seizure is consistent with a focal seizure? 1. The patient lost consciousness during the seizure. 2.The seizure involved lip smacking and repetitive movements. 3. The patient fell to the ground and became stiff for 20 seconds. 4. The etiology of the seizure involved both sides of the patient's brain
2. The seizure involved lip smacking and repetitive movements The most common complex focal seizure involves lip smacking and automatisms (repetitive movements that may not be appropriate). Loss of consciousness, bilateral brain involvement, and a tonic phase are associated with generalized seizure activity.
The nurse is taking care of a 10-year-old patient diagnosed with Graves disease. The nurse could expect this patient to have recently had which of the following? 1. Weight gain, excessive thirst, and excessive hunger. 2. Weight loss, difficulty sleeping, and heat sensitivity. 3. Weight gain, lethargy, and goiter. 4. Weight loss, poor skin turgor, and constipation.
2. Weight loss, increased activity, and heat intolerance can be expected when the thyroid gland is hyperfunctional.
A patient who is having an acute exacerbation of multiple sclerosis has a prescription for methylprednisolone (Solu-Medrol) 160 mg IV. The label on the vial reads: methylprednisolone 125 mg in 2 mL. How many mL will the nurse administer?
2.56. With a concentration of 125 mg/2 mL, the nurse will need to administer 2.56 mL to obtain 160 mg of methylprednisolone.
The client is admitted to the intensive care department diagnosed with myxedemacoma. Which assessment data warrant immediate intervention by the nurse? 1. Serum blood glucose level of 74 mg/dL. 2. Pulse oximeter reading of 90%. 3. Telemetry reading showing sinus bradycardia. 4. The client is lethargic and sleeps all the time.
2.A pulse oximeter reading of less than 93% is significant. A 90% pulse oximeter reading indicates a PaO2 of approximately 60 on an arterial blood gas test; this is severe hypoxemia and requires immediate intervention. 1. Hypoglycemia is expected in a client with myxedema; therefore, a 74-mg/dL blood glucose level is expected. 3. The client with myxedema coma is in an exaggerated hypothyroid state; a low pulse is expected in a client with hypothyroidism. 4. Lethargy is an expected symptom in a client diagnosed with myxedema; there-fore, this does not warrant immediate intervention
20. A 38-year-old woman has newly diagnosed multiple sclerosis (MS) and asks the nurse what is going to happen to her. What is the best response by the nurse? a. "You will have either periods of attacks and remissions or progression of nerve damage over time." b. "You need to plan for a continuous loss of movement, sensory functions, and mental capabilities." c. "You will most likely have a steady course of chronic progressive nerve damage that will change your personality." d. "It is common for people with MS to have an acute attack of weakness and then not to have any other symptoms for years."
20. a. Most patients with multiple sclerosis (MS) have remissions and exacerbations of neurologic dysfunction or a relapsing-remitting initial course followed by progression with or without occasional relapses, minor remissions, and plateaus that progressively cause loss of motor, sensory, and cerebellar functions. Intellectual function generally remains intact but patients may experience anger, depression, or euphoria. A few people have chronic progressive deterioration and some may experience only occasional and mild symptoms for several years after onset.
21. During assessment of a patient admitted to the hospital with an acute exacerbation of MS, what should the nurse expect to find? a. Tremors, dysphasia, and ptosis b. Bowel and bladder incontinence and loss of memory c. Motor impairment, visual disturbances, and paresthesias d. Excessive involuntary movements, hearing loss, and ataxia
21. c. Specific neurologic dysfunction of MS is caused by destruction of myelin and replacement with glial scar tissue at specific areas in the nervous system. Motor, sensory, cerebellar, and emotional dysfunctions, including paresthesias as well as patchy blindness, blurred vision, pain radiating along the dermatome of the nerve, ataxia, and severe fatigue, are the most common manifestations of MS. Constipation and bladder dysfunctions, short-term memory loss, sexual dysfunction, anger, and depression or euphoria may also occur. Excessive involuntary movements and tremors are not seen in MS.
23. Mitoxantrone (Novantrone) is being considered as treatment for a patient with progressive-relapsing MS. The nurse explains that a disadvantage of this drug compared with other drugs used for MS is what? a. It must be given subcutaneously every day. b. It has a lifetime dose limit because of cardiac toxicity. c. It is an anticholinergic agent that causes urinary incontinence. d. It is an immunosuppressant agent that increases the risk for infection.
23. b. Mitoxantrone (Novantrone) cannot be used for more than 2 to 3 years because it is an antineoplastic drug that causes cardiac toxicity, leukemia, and infertility. It is a monoclonal antibody given IV monthly when patients have inadequate responses to other drugs. It increases the risk of progressive multifocal leukoencephalopathy.
Priority Decision: A patient with MS has a nursing diagnosis of self-care deficit related to muscle spasticity and neuromuscular deficits. In providing care for the patient, what is most important for the nurse to do? a. Teach the family members how to care adequately for the patient's needs. b. Encourage the patient to maintain social interactions to prevent social isolation. c. Promote the use of assistive devices so the patient can participate in self-care activities. d. Perform all activities of daily living (ADLs) for the patient to conserve the patient's energy.
24. c. The main goal in care of the patient with MS is to keep the patient active and maximally functional and promote self-care as much as possible to maintain independence. Assistive devices encourage independence while preserving the patient's energy. No care activity that the patient can do for himself or herself should be performed by others. Involvement of the family in the patient's care and maintenance of social interactions are also important but are not the priority in care.
25. A patient with newly diagnosed MS has been hospitalized for evaluation and initial treatment of the disease. Following discharge teaching, the nurse realizes that additional instruction is needed when the patient says what? a. "It is important for me to avoid exposure to people with upper respiratory infections." b. "When I begin to feel better, I should stop taking the prednisone to prevent side effects." c. "I plan to use vitamin supplements and a high-protein diet to help manage my condition." d. "I must plan with my family how we are going to manage my care if I become more incapacitated."
25. b. Corticosteroids used in treating acute exacerbations of MS should not be abruptly stopped by the patient because adrenal insufficiency may result and prescribed tapering doses should be followed. Infections may exacerbate symptoms and should be avoided and high-protein diets with vitamin supplements are advocated. Long-term planning for increasing disability is also important.
The nurse should include which interventions in the plan of care for a client with hypothyroidism? Select all that apply. 1.Provide a cool environment for the client. 2.Instruct the client to consume a high-fat diet. 3.Instruct the client about thyroid replacement therapy. 4.Encourage the client to consume fluids and high-fiber foods in the diet. 5.Inform the client that iodine preparations will be prescribed to treat the disorder. 6.Instruct the client to contact the health care provider (HCP) if episodes of chest pain occur
3, 4, 6 The clinical manifestations of hypothyroidism are the result of decreased metabolism from low levels of thyroid hormone. Interventions are aimed at replacement of the hormone and providing measures to support the signs and symptoms related to decreased metabolism. The client often has cold intolerance and requires a warm environment. The nurse encourages the client to consume a well-balanced diet that is low in fat for weight reduction and high in fluids and high-fiber foods to prevent constipation. Iodine preparations may be used to treat hyperthyroidism. Iodine preparations decrease blood flow through the thyroid gland and reduce the production and release of thyroid hormone; they are not used to treat hypothyroidism. The client is instructed to notify the HCP if chest pain occurs because it could be an indication of over replacement of thyroid hormone.
44. The client is admitted to the intensive care department (ICD) experiencing status epilepticus. Which collaborative intervention should the nurse anticipate? 1. Assess the client's neurological status every hour. 2. Monitor the client's heart rhythm via telemetry. 3. Administer an anticonvulsant medication by intravenous push. 4. Prepare to administer a glucocorticosteroid orally.
3. Administering an anticonvulsant medication by intravenous push requires the nurse to have an order or confer with another member of the health-care team.
The nurse is caring for a patient with a diagnosis of hyperthyroidism. An important nursing intervention is which of the following? 1. Encourage an increase in physical activity. 2. Do preoperative teaching for thyroidectomy. 3. Promote opportunities for periods of rest. 4. Do dietary planning to increase caloric intake.
3. Because increased activity is characteristic of hyperthyroidism, providing opportunity for rest is a recommended nursing intervention.
A 13-year-old is being seen for an annual physical examination. The child has lost 10 lb despite reports of excellent appetite. Appearance is normal, except for slightly protruding eyeballs, and the parents report the child has had difficulty sleeping lately. The nurse should do which of the following? 1. Prepare the family for a neurology consult. 2. Explain the need for an ophthalmology consult. 3. Discuss the plan for thyroid function tests. 4. Explain the plan for an 8-hour fasting blood glucose test.
3. Diagnostic evaluation for hyperthyroidism is based on thyroid functiontests. It is expected in this case that T4 and T3 levels would be elevated, as the thyroid gland is overfunctioning.
41. The client who just had a three (3)-minute seizure has no apparent injuries and is oriented to name, place, and time but is very lethargic and just wants to sleep. Which intervention should the nurse implement? 1. Perform a complete neurological assessment. 2. Awaken the client every 30 minutes. 3. Turn the client to the side and allow the client to sleep. 4. Interview the client to find out what caused the seizure.
3. During the postictal (after-seizure) phase, the client is very tired and should be allowed to rest quietly; placing the client on the side will help prevent aspiration and maintain a patent airway.
What is the nursing action of highest priority to be taken with a patient who experiences a generalized tonic/clonic seizure? 1. Restraining the arms and legs 2. Controlling head movement 3. Protecting the head and extremities 4.Inserting a tongue blade between the teeth
3. Protecting the head and extremities Staying with the patient to provide protection of the head and extremities is the most important nursing care activity for a patient experiencing a generalized tonic/clonic seizure. Attempting to restrain or control the jerking movement of the head and extremities during a seizure may cause further injury and even fracture bones. Body parts should not be restrained or controlled. Use of a tongue blade is not acceptable in current practice because it is difficult to insert once the seizure begins and the patient may bite through the tongue blade and aspirate.
46. Which statement by the female client indicates that the client understands factors that may precipitate seizure activity? 1. "It is all right for me to drink coffee for breakfast." 2. "My menstrual cycle will not affect my seizure disorder." 3. "I am going to take a class in stress management." 4. "I should wear dark glasses when I am out in the sun."
3. Tension states, such as anxiety and frustration, induce seizures in some clients, so stress management may be helpful in preventing seizures.
39. The client is scheduled for an electroencephalogram (EEG) to help diagnose a seizure disorder. Which preprocedure teaching should the nurse implement? 1. Tell the client to take any routine antiseizure medication prior to the EEG. 2. Tell the client not to eat anything for eight (8) hours prior to the procedure. 3. Instruct the client to stay awake for 24 hours prior to the EEG. 4. Explain to the client that there will be some discomfort during the procedure.
3. The goal is for the client to have a seizure during the EEG. Sleep deprivation, hyperventilating, or flashing lights may induce a seizure.
The client diagnosed with hypothyroidism is prescribed the thyroid hormone levothyroxine (Synthroid). Which assessment data indicate the medication has been effective? 1. The client has a three (3)-pound weight gain. 2. The client has a decreased pulse rate. 3. The client's temperature is WNL. 4. The client denies any diaphoresis.
3.The client with hypothyroidism frequently has a subnormal temperature,so a temperature WNL indicates the medication is effective. 1. The medication will help increase the client's metabolic rate. A weight gain indicates not enough medication is being taken to put the client in a euthyroid (normal thyroid) state. 2. A decreased pulse rate indicates there is not enough thyroid hormone level; therefore, the medication is not effective. 4. Diaphoresis (sweating) occurs with hyper-thyroidism, not hypothyroidism
The nurse is preparing to administer the following medications. Which medication should the nurse question administering? 1. The thyroid hormone to the client who does not have a T3, T4 level. 2. The regular insulin to the client with a blood glucose level of 210 mg/dL. 3. The loop diuretic to the client with a potassium level of 3.3 mEq/L. 4. The cardiac glycoside to the client who has a digoxin level of 1.4 mg/dL.
3.This potassium level is below normal,which is 3.5 to 5.5 mEq/L. Therefore,the nurse should question administering this medication because loop diuretics cause potassium loss in the urine. 1. The thyroid hormone must be administered daily, and thyroid levels are drawn every six (6) months or so. 2. A blood glucose level of 210 mg/dL requires insulin administration; therefore,the nurse should not question administering this medication 4. The digoxin level is within therapeutic range—0.8 to 2.0 mg/dL; therefore, the nurse should administer this medication.
Which medication order should the nurse question in the client diagnosed with untreated hypothyroidism? 1. Thyroid hormones. 2. Oxygen. 3. Sedatives. 4. Laxatives.
3.Untreated hypothyroidism is characterized by an increased susceptibility to the effects of most hypnotic and sedative agents; therefore, the nurse should question this medication. 1. Thyroid hormones are the treatment of choice for the client diagnosed with hypothyroidism; therefore, the nurse should not question this medication. 2. In untreated hypothyroidism, the medical management is aimed at supporting vital functions, so administering oxygen is an appropriate medication. 4. Clients with hypothyroidism become constipated as a result of decreased metabolism, so laxatives should not be questioned by the nurse.
The nurse sees a client walking in the hallway who begins to have a seizure. The nurse should do which of the following in priority order? 1. Maintain patent airway 2.record the seizure activity observed 3.ease the client to the floor 4. Obtain vital signs
3.ease the client to the floor 1. Maintain patent airway 4. Obtain vital signs 2.record the seizure activity observed
31. A patient with myasthenia gravis is admitted to the hospital with respiratory insufficiency and severe weakness. When is a diagnosis of cholinergic crisis made? a. The patient's respiration is impaired because of muscle weakness. b. Administration of edrophonium (Tensilon) increases muscle weakness. c. Administration of edrophonium (Tensilon) results in improved muscle contractility. d. EMG reveals decreased response to repeated stimulation of muscles.
31. b. The reduction of the acetylcholine (ACh) effect in myasthenia gravis (MG) is treated with anticholinesterase drugs, which prolong the action of ACh at the neuromuscular synapse, but too much of these drugs will cause a cholinergic crisis with symptoms very similar to those of MG. To determine whether the patient's manifestations are due to a deficiency of ACh or to too much anticholinesterase drug, the anticholinesterase drug edrophonium chloride (Tensilon) is administered. If the patient is in cholinergic crisis, the patient's symptoms will worsen; if the patient is in a myasthenic crisis, the patient will improve.
Priority Decision: During care of a patient in myasthenic crisis, maintenance of what is the nurse's first priority for the patient? a. Mobility b. Nutrition c. Respiratory function d. Verbal communication
32. c. The patient in myasthenic crisis has severe weakness and fatigability of all skeletal muscles, affecting the patient's ability to breathe, swallow, talk, and move. However, the priority of nursing care is monitoring and maintaining adequate ventilation.
33. When providing care for a patient with ALS, the nurse recognizes what as one of the most distressing problems experienced by the patient? a. Painful spasticity of the face and extremities b. Retention of cognitive function with total degeneration of motor function c. Uncontrollable writhing and twisting movements of the face, limbs, and body d. Knowledge that there is a 50% chance the disease has been passed to any offspring
33. b. In ALS there is gradual degeneration of motor neurons with extreme muscle wasting from lack of stimulation and use. However, cognitive function is not impaired and patients feel trapped in a dying body. Chorea manifested by writhing, involuntary movements is characteristic of HD. As an autosomal dominant genetic disease, HD also has a 50% chance of being passed to each offspring.
34. In providing care for patients with chronic, progressive neurologic disease, what is the major goal of treatment that the nurse works toward? a. Meet the patient's personal care needs. b. Return the patient to normal neurologic function. c. Maximize neurologic functioning for as long as possible. d. Prevent the development of additional chronic diseases.
34. c. Many chronic neurologic diseases involve progressive deterioration in physical or mental capabilities and have no cure, with devastating results for patients and families. Health care providers can only attempt to alleviate physical symptoms, prevent complications, and assist patients in maximizing function and self-care abilities for as long as possible.
A 12-year-old comes to the clinic with a diagnosis of Graves disease. What information should the nurse discuss with the child? 1. Suggest weight loss. 2. Encourage attending school. 3. Emphasize that the disease will go into remission. 4. Encourage the child to take responsibility for daily medications.
4. Because the child is 12 years old, encouraging responsibility for health care is important. The child still needs family involvement and ongoing supervision but should not be completely dependent on family for care.
A patient with a history of epilepsy is in the postanesthesia recovery unit (PACU) after surgery under local anesthesia. The patient has a tonic-clonic seizure that lasts two minutes. Which action should the nurse take while the patient is having the seizure? 1. Restrain the patient to prevent injury. 2. Administer 50 grams of dextrose intravenously. 3.Reorient the patient to place and time. 4. Ensure the patient has a patent airway
4. Ensure the patient has a patent airway During a tonic-clonic seizure the patient becomes unconscious, has generalized stiffening (tonic phase), and then jerking (clonic phase). The most important nursing intervention is to maintain the patient's open airway. Suctioning equipment should be available. The patient should not be restrained but protected from injury. Intravenous dextrose is not indicated because the patient is not noted to be hypoglycemic. Reorientation is not done with the patient unconscious during the seizure.
37. The male client is sitting in the chair and his entire body is rigid with his arms and legs contracting and relaxing. The client is not aware of what is going on and is making guttural sounds. Which action should the nurse implement first? 1. Push aside any furniture. 2. Place the client on his side. 3. Assess the client's vital signs. 4. Ease the client to the floor. Company. Kindle Edition.
4. The client should not remain in the chair during a seizure. He should be brought safely to the floor so that he will have room to move the extremities.
Which statement made by the client makes the nurse suspect the client is experiencing hyperthyroidism? 1. "I just don't seem to have any appetite anymore." 2. "I have a bowel movement about every 3 to 4 days." 3. "My skin is really becoming dry and coarse." 4. "I have noticed all my collars are getting tighter."
4. The thyroid gland (in the neck) en-larges as a result of the increased need for thyroid hormone production; an enlarged gland is called a goiter. 1. Decreased appetite is a symptom of hypothyroidism, not hyperthyroidism. 2. Constipation is a symptom of hypothyroidism. 3. Dry, coarse skin is a sign of hypothyroidism
The nurse is providing an in-service on thyroid disorders. One of the attendees asks the nurse, "Why don't the people in the United States get goiters as often?" Which statement by the nurse is the best response? 1. "It is because of the screening techniques used in the United States." 2. "It is a genetic predisposition rare in North Americans." 3. "The medications available in the United States decrease goiters." 4. "Iodized salt helps prevent the development of goiters in the United States."
4.Almost all of the iodine entering the body is retained in the thyroid gland. A deficiency in iodine will cause the thyroid gland to work hard and enlarge, which is called a goiter. Goiters are commonly seen in geographical regions having an iodine deficiency. Most table salt in the United States has iodine added. 1. There is no screening for thyroid disorders, just serum thyroid levels. 2. This is not a true statement. 3. Medications do not decrease the development of goiters.
Which nursing intervention should be included in the plan of care for the client diagnosed with hyperthyroidism? 1. Increase the amount of fiber in the diet. 2. Encourage a low-calorie, low-protein diet. 3. Decrease the client's fluid intake to 1,000 mL/day. 4. Provide six (6) small, well-balanced meals a day.
4.The client with hyperthyroidism has an increased appetite; therefore, well-balanced meals served several times throughout the day will help with the client's constant hunger 1. Fiber should be increased in the client diagnosed with hypothyroidism because the client experiences constipation secondary to decreased metabolism. 2. The client with hyperthyroidism should have a high-calorie, high-protein diet. 3. The client's fluid intake should be increased to replace fluids lost through diarrhea and excessive sweating.
6. Delegation Decision: The nurse is preparing to admit a newly diagnosed patient experiencing tonic-clonic seizures. What could the nurse delegate to unlicensed assistive personnel (UAP)? a. Complete the admission assessment. b. Explain the call system to the patient. c. Obtain the suction equipment from the supply cabinet. d. Place a padded tongue blade on the wall above the patient's bed.
6. c. The unlicensed assistive personnel (UAP) is able to obtain equipment from the supply cabinet or department. The RN may need to provide a list of necessary equipment and should set up the equipment and ensure proper functioning. The RN is responsible for the initial history and assessment as well as teaching the patient about the room's call system. Padded tongue blades are no longer used and no effort should be made to place anything in the patient's mouth during a seizure.
7. How do generalized seizures differ from focal seizures? a. Focal seizures are confined to one side of the brain and remain focal in nature. b. Generalized seizures result in loss of consciousness whereas focal seizures do not. c. Generalized seizures result in temporary residual deficits during the postictal phase. d. Generalized seizures have bilateral synchronous epileptic discharges affecting the whole brain at onset of the seizure.
7. d. Generalized seizures have bilateral synchronous epileptic discharge affecting the entire brain at onset of the seizure. Loss of consciousness is also characteristic but many focal seizures also include an altered consciousness. Focal seizures begin in one side of the brain but may spread to involve the entire brain. Focal seizures that start with a local focus and spread to the entire brain, causing a secondary generalized seizure, are associated with a transient residual neurologic deficit postictally known as Todd's paralysis.
9. The patient is diagnosed with complex focal seizures. Which characteristics are related to complex focal seizures (select all that apply)? a. Formerly known as grand mal seizure b. Often accompanied by incontinence or tongue or cheek biting c. Psychomotor seizures with repetitive behaviors and lip smacking d. Altered memory, sexual sensations, and distortions of visual or auditory sensations e. Loss of consciousness and stiffening of the body with subsequent jerking of extremities f. Often involves behavioral, emotional, and cognitive functions with altered consciousness
9. c, d, f. Complex focal seizures are psychomotor seizures with automatisms such as lip smacking. They cause altered consciousness or loss of consciousness producing a dreamlike state and may involve behavioral, emotional, or cognitive experiences without memory of what was done during the seizure. In generalized tonic-clonic seizures (previously known as grand mal seizures) there is loss of consciousness and stiffening of the body with subsequent jerking of extremities. Incontinence or tongue or cheek biting may also occur.
A child diagnosed with meningitis is having generalized tonic clonic seizures what should the nurse do first a. Administer a blow by oxygen and call for additional help b. Reassure the parents that seizures are common in children with meningitis c. Coll a code and ask the parents to leave the room d. assess the child's temperature and blood pressure
A
A child with a seizure disorder has been having episodes during which she drops her pencil and simply appears to be daydreaming this is most likely an a. Absence seizure b. Akenetic seizure c. Non-epileptic seizure d. Simple spasm seizure
A
The nurse is conducting discharge teaching related to a new prescription for phenytoin (Dilantin). Which statements are appropriate to include in the teaching for this patient and his family? Select all that apply. A) "Be sure to call the clinic if you or your family notice increased anxiety or agitation." B) "You may have some mild sedation. Do not drive until you know how this drug will affect you." C) "This drug may cause easy bruising. If you notice this, call the clinic immediately." D) "It is very important to have good oral hygiene and visit your dentist regularly." E) "You may continue to have wine with your evening meals but only in moderation."
A, B, D Patients receiving an antiepileptic drug are at increased risk for suicidal thoughts and behavior beginning early in their treatment. The U.S. Food and Drug Administration (FDA) advises that patients, families, and caregivers be informed of the signs that may precede suicidal behavior and be encouraged to report these immediately. Mild sedation can occur in patients taking phenytoin even at therapeutic levels. Carbamazepine(Tegretol), not phenytoin, increases the risk for hematologic effects, such as easy bruising. Phenytoin causes gingival hyperplasia in about 20% of patients who take it. Dental hygiene is important. Patients receiving phenytoin should avoid alcohol and other central nervous system depressants because they have an additive depressant effect.
A 27-year-old patient who has been treated for status epilepticus in the emergency department will be transferred to the medical nursing unit. Which equipment should the nurse have available in the patient's assigned room (select all that apply)? a. Side-rail pads b. Tongue blade c. Oxygen mask d. Suction tubing e. Urinary catheter f. Nasogastric tube
A, C, D The patient is at risk for further seizures, and oxygen and suctioning may be needed after any seizures to clear the airway and maximize oxygenation. The bed's side rails should be padded to minimize the risk for patient injury during a seizure. Use of tongue blades during a seizure is contraindicated. Insertion of a nasogastric (NG) tube is not indicated because the airway problem is not caused by vomiting or abdominal distention. A urinary catheter is not required unless there is urinary retention.
A patient who needs an antiepileptic medication for tonic-clonic seizures is unresponsive. Which antiepileptic medication(s) should the nurse avoid administering to this patient? (Choose all that apply.) A) Tiagabine (Gabitril) B) Phenytoin (Dilantin) C) Topiramate (Topamax) D) Gabapentin (Neurontin) E) ethosuximide (Zarontin) F) Phenobarbital (Luminal)
A, C, D, E Because the patient is unresponsive, the nurse avoids administering medications by mouth, because doing so exposes the patient to an increased risk of aspiration. Until the level of consciousness improves and the patient can swallow, the nurse should not administer tiagabine, topiramate, gabapentin, or ethosuximide, which are available for oral administration only. In addition, tiagabine, gabapentin, and ethosuximide are not indicated therapy for tonic-clonic seizures. Topiramate, phenytoin, and phenobarbital are suitable for tonic-clonic seizures, but only phenytoin and phenobarbital, which may be administered intravenously, are indicated for an unresponsive patient.
The patient with type 1 diabetes mellitus with hypoglycemia is having a seizure. Which medication should the nurse anticipate administering to stop the seizure? A. IV dextrose solution B. IV diazepam (Valium) C. IV phenytoin (Dilantin) D. Oral carbamazepine (Tegretol)
A. This patient's seizure is caused by low blood glucose, so IV dextrose solution should be given first to stop the seizure. IV diazepam, IV phenytoin, and oral carbamazepine would be used to treat seizures from other causes such as head trauma, drugs, and infections.
After change-of-shift report, which patient should the nurse assess first? a. Patient with myasthenia gravis who is reporting increased muscle weakness b. Patient with a bilateral headache described as "like a band around my head" c. Patient with seizures who is scheduled to receive a dose of phenytoin (Dilantin) d. Patient with Parkinson's disease who has developed cogwheel rigidity of the arms
A. Because increased muscle weakness may indicate the onset of a myasthenic crisis, the nurse should assess this patient first. The other patients should also be assessed, but do not appear to need immediate nursing assessments or actions to prevent life-threatening complications.
A patient has been taking phenytoin (Dilantin) for 2 years. Which action will the nurse take when evaluating for adverse effects of the medication? a. Inspect the oral mucosa. b. Listen to the lung sounds. c. Auscultate the bowel tones. d. Check pupil reaction to light.
A. Phenytoin can cause gingival hyperplasia, but does not affect bowel tones, lung sounds, or pupil reaction to light.
A patient reports feeling numbness and tingling of the left arm before experiencing a tonic-clonic seizure. The nurse determines that this history is consistent with what type of seizure? a. Focal b. Atonic c. Absence d. Myoclonic
A. The initial symptoms of a focal seizure involve clinical manifestations that are localized to a particular part of the body or brain. Symptoms of an absence seizure are staring and a brief loss of consciousness. In an atonic seizure, the patient loses muscle tone and (typically) falls to the ground. Myoclonic seizures are characterized by a sudden jerk of the body or extremities.
The nurse observes a patient ambulating in the hospital hall when the patient's arms and legs suddenly jerk and the patient falls to the floor. The nurse will first a. assess the patient for a possible head injury. b. give the scheduled dose of divalproex (Depakote). c. document the timing and description of the seizure. d. notify the patient's health care provider about the seizure.
A. The patient who has had a myoclonic seizure and fall is at risk for head injury and should first be evaluated and treated for this possible complication. Documentation of the seizure, notification of the seizure, and administration of antiseizure medications are also appropriate actions, but the initial action should be assessment for injury.
A nurse is reviewing trigger factors that can cause seizures with a client who has a new diagnosis of generalized seizures. Which of the following information should the nurse include in this review? Select all that apply _____A. Overwhelming fatigue should be avoided _____B. Caffeinated products should be removed from the diet _____C. Looking at flashing lights should be limited _____D. Aerobic exercise may be performed _____E. Episodes of hypoventilation should be limited _____F. Use of aerosol hairspray is recommended
A. Correct The nurse should instruct the client to avoid overwhelming fatigue, which may trigger a seizure by stimulating abnormal electrical neuron activity B. Correct Caffeinated products may trigger a seizure by stimulating abnormal electrical neuron activity C. Correct Flashing lights can trigger seizures D. Incorrect The client should decrease physical activity to avoid seizures E. Excess hyperventilation may trigger a seizure F. Aeorosol hairsprays may trigger a seizure
A nurse is assessing a client who has a seizure disorder. The client reports he thinks he is about to have a seizure. Which of the following actions should the nurse implement? Select all that apply. _____A. Provide Privacy _____B. Ease the client to the floor if standing _____C. Move furniture away from the client _____D. Loosen the client's clothing _____E. Protect the client's head with padding _____F. Restrain the client
A. Correct. The nurse should implement privacy to minimize client's embarrassment B. Correct The nurse should ease the client to the floor to prevent falling C. Correct. Move furniture away to prevent injury D. Correct Loosening of clothes minimizes restriction of movement E. Correct This protects the client's head from injury by placing the client's head in the nurse's lap or using a pillow or blanket under the head during a seizure
Assessment
A. Risk factors -monitor prevalent in women -can be associated with using medications such as amiodarone and lithium B.Early clinical manifestations -extreme fatigue, menstrual disturbances -hair loss, brittle nails, and dry/coarse skin -intolerance to cold -constipation, apathy C. Late clinical manifestations -subnormal temperature -cardiac complications (bradycaedia, heart failure, hypotension) -weight gain and edema, thickened skin -change or decrease in level or consciousness D. Diagnostics -DECREASED in serum T3 and T4 levels -INCREASED in serum TSH level
Which of the following is the most priority nursing diagnosis in a patient with seizure disorders? A. Risk for injury related to seizure activity B. Fear related to the possibility of seizures C. Ineffective individual coping related to stresses imposed by epilepsy D. Deficient knowledge related to epilepsy and its control
A. Risk for injury related to seizure activity
Nurse Gina is taking care of a client that was diagnosed with Addison Disease. The physician involved ordered a mineralcorticoid and glucocorticoid to treat his condition. The client asks the nurse why these medications are necessary. The following response by the nurse can best describe why he needs to take these medications. A. The medications the physician ordered will replace the hormone that your body is not producing adequately. B. Your parathyroid gland is not secreting the cortisol that your body needs. C. Your body is producing too much hormone and this medication will suppress your immune response to prevent the secretion of too much cortisol. D. The steroids that the physician ordered will help your muscles grow since your condition will attack your muscles
A. The medications the physician ordered will replace the hormone that your body is not producing adequately.
You are caring for a patient who is taking levothyroxine (Synthroid) to treat hypothyroidism. The patient reports palpitations, weight loss, and diarrhea. You suspect which of the following adverse effects of this drug? A. hyperthyroidism B. Addison's disease C. Myxedema D. hyperglycemia
A. hyperthyroidism
A nurse is checking the level of thyroid-stimulating hormone (TSH) in a patient with Graves disease. What will the lab report reveal? TSH is: A. low B. high C. normal D. variable
A. low
When talking with a 30-year old woman who will receive radioactive iodine-131 (Iodotope) to treat Grave's disease, you should include which of the following instructions? (Select all that apply) A. report weight gain and edema B. use effective contraception C. allow 2 to 3 months for full effects D. expect period blood sampling E. obtain regular eye examinations
A. report weight gain and edema B. use effective contraception C. allow 2 to 3 months for full effects D. expect period blood sampling
A patient has thyroid carcinoma. Which of the following will the nurse find upon assessment? A. small thyroid nodule B. elevated T3 and T4 C. large, diffuse goiter D. thyroid gland atrophy
A. small thyroid nodule
A potential treatment for Addison disease is fludrocortisone. A. true B. false
A. true
A nurse is asked what causes myxedema coma. How should the nurse respond? Causes of myxedema coma include: A. untreated hypothyroidism B. subclinical hyperthyroidism C. thyroid storm D. a reaction to abnormally high levels of thyroid autoantibodies
A. untreated hypothyroidism
A nurse is caring for a client who just experienced a generalized seizure. Which of the following actions should the nurse perform first? A. Keep the client in a side-lying position B. Monitor the client's vital signs C. Reorient the client to the environment D. Check the client for injuries
A.Keep the client in a side-lying position
18. The nurse is assessing a client with Graves' disease and finds that the client's temperature has risen 1° F. Before notifying the health care provider, which action by the nurse takes priority? a. Turn the lights down in the client's room and shut the door. b. Call for an immediate electrocardiogram (ECG). c. Calculate the client's apical-radial pulse deficit. d. Administer a dose of acetaminophen (Tylenol).
ANS: A A temperature increase of 1° F may indicate the development of thyroid storm, and the provider needs to be notified. 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.
After change-of-shift report, which patient should the nurse assess first? a. Patient with myasthenia gravis who is reporting increased muscle weakness b. Patient with a bilateral headache described as "like a band around my head" c. Patient with seizures who is scheduled to receive a dose of phenytoin (Dilantin) d. Patient with Parkinson's disease who has developed cogwheel rigidity of the arms
ANS: A Because increased muscle weakness may indicate the onset of a myasthenic crisis, the nurse should assess this patient first. The other patients should also be assessed, but do not appear to need immediate nursing assessments or actions to prevent life-threatening complications. DIF: Cognitive Level: Analyze (analysis) REF: 1438-1439 OBJ: Special Questions: Prioritization; Multiple Patients TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment
6. The client is receiving methimazole (Tapazole). Which statement by the client indicates good understanding of teaching regarding this medication? a. "If I become pregnant, I need to notify my health care provider immediately." b. "Liver problems can occur with this drug so I need to report jaundice." c. "I will take my pulse daily, and if it is too fast, I will call my provider." d. "This medication may cause dyspnea or vertigo. I will be careful with activity."
ANS: A Methimazole can cause birth defects, and clients should not take it if they are pregnant. Liver problems can occur with propylthiouracil (PTU). The client does not need to take his or her pulse daily. Dyspnea and vertigo are not side effects of methimazole.
A patient reports feeling numbness and tingling of the left arm before experiencing a tonic-clonic seizure. The nurse determines that this history is consistent with what type of seizure? a. Focal b. Atonic c. Absence d. Myoclonic
ANS: A The initial symptoms of a focal seizure involve clinical manifestations that are localized to a particular part of the body or brain. Symptoms of an absence seizure are staring and a brief loss of consciousness. In an atonic seizure, the patient loses muscle tone and (typically) falls to the ground. Myoclonic seizures are characterized by a sudden jerk of the body or extremities. DIF: Cognitive Level: Understand (comprehension) REF: 1421 TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
The nurse observes a patient ambulating in the hospital hall when the patient's arms and legs suddenly jerk and the patient falls to the floor. The nurse will first a. assess the patient for a possible head injury. b. give the scheduled dose of divalproex (Depakote). c. document the timing and description of the seizure. d. notify the patient's health care provider about the seizure.
ANS: A The patient who has had a myoclonic seizure and fall is at risk for head injury and should first be evaluated and treated for this possible complication. Documentation of the seizure, notification of the seizure, and administration of antiseizure medications are also appropriate actions, but the initial action should be assessment for injury. DIF: Cognitive Level: Apply (application) REF: 1423 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
19. A client has undergone a complete thyroidectomy. Which statement by the client indicates that further instruction is needed? 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 life." d. "I can receive pain medication if I feel that I need it."
ANS: B 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.
17. A client has diabetes mellitus. Her daughter has recently been diagnosed with Graves' disease. The client asks the nurse if she is responsible for the fact that her daughter has Graves' disease. Which is the best response of the nurse? a. "No connection is known between Graves' disease and diabetes, so you can be certain that the fact that you have diabetes did not cause your daughter to have 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." c. "Graves' disease is associated with autoimmune diseases such as rheumatoid arthritis, but not with a disease such as diabetes." d. "Unfortunately, Graves' disease is associated with diabetes, and your diabetes could have led to your daughter having Graves' disease."
ANS: B An association between autoimmune diseases such as rheumatoid arthritis and diabetes mellitus has been noted. The predisposition is probably polygenic and the client's diabetes did not cause her daughter's Graves' disease. The other statements are inaccurate.
13. The nurse is reviewing client medical histories. Which client is at greatest risk for hyperparathyroidism? a. Client with pregnancy-induced hypertension b. Client receiving dialysis for end-stage kidney disease c. Older adult client with moderate heart failure d. Older adult client on home oxygen therapy
ANS: B Clients who have chronic kidney disease do not completely activate vitamin D and poorly absorb calcium from the GI tract. They are chronically hypocalcemic, and this triggers overstimulation of the parathyroid glands. The other factors do not place a client at higher risk for hyperparathyroidism.
14. A client has hyperparathyroidism. Which intervention is the priority for the nurse to add to the client's plan of care? a. Instruct the client to place both hands behind the neck when moving. b. Use a lift sheet to assist the client with position changes. c. Instruct the client to use a soft-bristled toothbrush. d. Strain all urine for at least 24 hours and send stones to the laboratory.
ANS: B Hyperparathyroidism causes increased resorption of calcium from the bones, increasing the risk for pathologic fractures. Using a lift sheet when moving or positioning the client, instead of pulling on the client, reduces the risk of bone injury. Hyperparathyroidism can cause kidney stones, but not every client will need to have urine strained. The priority is preventing injury. Supporting the neck with movement and using a soft toothbrush are not needed for this client.
The home health registered nurse (RN) is planning care for a patient with a seizure disorder related to a recent head injury. Which nursing action can be delegated to a licensed practical/vocational nurse (LPN/LVN)? a. Make referrals to appropriate community agencies. b. Place medications in the home medication organizer. c. Teach the patient and family how to manage seizures. d. Assess for use of medications that may precipitate seizures.
ANS: B LPN/LVN education includes administration of medications. The other activities require RN education and scope of practice. DIF: Cognitive Level: Apply (application) REF: 1426 OBJ: Special Questions: Delegation TOP: Nursing Process: Planning MSC: NCLEX: Safe and Effective Care Environment
4. A client with hyperthyroidism is taking lithium carbonate. Which finding indicates that the client is having side effects of this therapy? a. Blurred vision b. Increased thirst and urination c. Increased sweating and diarrhea d. Decreased attention span and insomnia
ANS: B Lithium antagonizes antidiuretic hormone and can cause symptoms of diabetes insipidus. The other choices are not specific to lithium.
A high school teacher who has just been diagnosed with epilepsy after having a generalized tonic-clonic seizure tells the nurse, "I cannot teach anymore, it will be too upsetting if I have a seizure at work." Which response by the nurse is best? a. "You might benefit from some psychologic counseling." b. "Epilepsy usually can be well controlled with medications." c. "You will want to contact the Epilepsy Foundation for assistance." d. "The Department of Vocational Rehabilitation can help with work retraining."
ANS: B The nurse should inform the patient that most patients with seizure disorders are controlled with medication. The other information may be necessary if the seizures persist after treatment with antiseizure medications is implemented. DIF: Cognitive Level: Apply (application) REF: 1422 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
ollowing a thymectomy, a 62-year-old male patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe abdominal cramps. Which action should the nurse take first? a. Auscultate the patient's bowel sounds. b. Notify the patient's health care provider. c. Administer the prescribed PRN antiemetic drug. d. Give the scheduled dose of prednisone (Deltasone).
ANS: B The patient's history and symptoms indicate a possible cholinergic crisis. The health care provider should be notified immediately, and it is likely that atropine will be prescribed. The other actions will be appropriate if the patient is not experiencing a cholinergic crisis. DIF: Cognitive Level: Apply (application) REF: 1438-1439 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
A client has been diagnosed with hypothyroidism. Which medication is the nurse prepared to administer to treat the client's bradycardia? a. Atropine sulfate b. Levothyroxine sodium (Synthroid) c. Propranolol (Inderal) d. Epinephrine (Adrenalin)
ANS: B 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. Inderal is a beta blocker and would be contraindicated for a client with bradycardia.
Which assessment is most important for the nurse to make regarding a patient with myasthenia gravis? a. Pupil size b. Grip strength c. Respiratory effort d. Level of consciousness
ANS: C Because respiratory insufficiency may be life threatening, it will be most important to monitor respiratory function. The other data also will be assessed but are not as critical. DIF: Cognitive Level: Apply (application) REF: 1438-1439 OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
While the nurse is transporting a patient on a stretcher to the radiology department, the patient begins having a tonic-clonic seizure. Which action should the nurse take? a. Insert an oral airway during the seizure to maintain a patent airway. b. Restrain the patient's arms and legs to prevent injury during the seizure. c. Time and observe and record the details of the seizure and postictal state. d. Avoid touching the patient to prevent further nervous system stimulation.
ANS: C Because the diagnosis and treatment of seizures frequently are based on the description of the seizure, recording the length and details of the seizure is important. Insertion of an oral airway and restraining the patient during the seizure are contraindicated. The nurse may need to move the patient to decrease the risk of injury during the seizure. DIF: Cognitive Level: Apply (application) REF: 1422 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
12. A client with hypothyroidism as a result of Hashimoto's thyroiditis asks the nurse how long she will have to take thyroid medication. Which is the nurse's best response? 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."
ANS: C Hashimoto's thyroiditis results in a permanent loss of thyroid function. The client will need lifelong thyroid replacement therapy. The other answers are incorrect.
A client has hypothyroidism. Which problem does the nurse address as a priority for this client? a. Heat intolerance b. Body image problems c. Depression and withdrawal d. Obesity
ANS: C 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.
On the second postoperative day after a subtotal thyroidectomy, the client tells the nurse that he feels numbness and tingling around his mouth. Which is the nurse's priority intervention? a. Offer mouth care. b. Loosen the dressing. c. Assess Chvostek's sign. d. Assess the client hourly.
ANS: C 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. The other choices do not address the emergency situation.
3. Which dietary modification does the nurse provide for a client with hyperthyroidism? a. Decreased calories and proteins and increased carbohydrates b. Elimination of carbohydrates and increased proteins and fats c. Increased calories, proteins, and carbohydrates d. Supplemental vitamins and reduction of calories
ANS: C The client is hypermetabolic and has an increased need for calories, carbohydrates, and proteins. Proteins are especially important because the client is at risk for a negative nitrogen balance. The other modifications are inappropriate for a client with hyperthyroidism.
1. A client presents with elevations in triiodothyronine (T3) and thyroxine (T4) and with normal thyroid-stimulating hormone (TSH) levels. Which is the nurse's priority intervention? a. Administer levothyroxine (Synthroid). b. Administer propranolol (Inderal). c. Monitor the apical pulse. d. Assess for Trousseau's sign
ANS: C 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. Synthroid is given for hypothyroidism. Propranolol is a beta blocker often used to lower sympathetic nervous system activity in
2. Which is the best instruction for the nurse to give a client scheduled for a thyroid scan? a. "You will have external beam radiation." b. "No radiation is used for this scan." c. "No special radiation precautions are needed." d. "Your thyroid will be radioactive for weeks."
ANS: C The radioactive iodine used in thyroid scans is of low intensity and has such a short half-life that the client is not considered to be a radiation hazard. Thus, no radiation precautions are necessary. The other statements are inaccurate.
8. Which client statement alerts 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 10 or 12 hours of sleep."
ANS: D 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 hyperthyroidism.
15. When taking the blood pressure of a client after a parathyroidectomy, the nurse notes that the client's hand has gone into flexion contractions. Which laboratory result does the nurse correlate with this condition? a. Serum potassium, 2.9 mEq/L b. Serum potassium, 5.8 mEq/L c. Serum sodium, 122 mEq/L d. Serum calcium, 6.9 mg/dL
ANS: D Hypocalcemia destabilizes excitable membranes and can lead to muscle twitches, spasms, and tetany. This effect of hypocalcemia is enhanced in the presence of tissue hypoxia. The flexion contractions (Trousseau's sign) that occur during blood pressure measurement are indicative of hypocalcemia, not the other electrolyte imbalances, which include hypokalemia, hyperkalemia, and hyponatremia.
11. A client has hypothyroidism and has been started on levothyroxine (Synthroid). Which assessment finding leads the nurse to conclude that the treatment is effective? A. Thirst is recognized and the client drinks fluids appropriately. 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.
ANS: D 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. The other assessment findings do not give any indication as to whether treatment is successful.
A client scheduled for a partial thyroidectomy asks the nurse why she is being given an iodine preparation before surgery. Which is the nurse's best response? a. "Iodine will help make the internal surgical environment sterile." b. "It is given to stimulate the storage of excess thyroid hormones." c. "This will replace the hormones you will lose after your operation." d. "It will prevent excessive bleeding during surgery."
ANS: D Iodine preparations decrease the size and vascularity of the thyroid gland, reducing the risk for hemorrhage and the potential for thyroid storm during surgery. The other answers are not accurate.
Which information about a 72-year-old patient who has a new prescription for phenytoin (Dilantin) indicates that the nurse should consult with the health care provider before administration of the medication? a. Patient has generalized tonic-clonic seizures. b. Patient experiences an aura before seizures. c. Patient's most recent blood pressure is 156/92 mm Hg. d. Patient has minor elevations in the liver function tests.
ANS: D Many older patients (especially with compromised liver function) may not be able to metabolize phenytoin. The health care provider may need to choose another antiseizure medication. Phenytoin is an appropriate medication for patients with tonic-clonic seizures, with or without an aura. Hypertension is not a contraindication for phenytoin therapy. DIF: Cognitive Level: Apply (application) REF: 1424 TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
6. Twelve hours after a total thyroidectomy, the client develops stridor. Which is the nurse's priority intervention? a. Reassure the client that the voice change is temporary. b. Document the finding and assess the client hourly. c. Hyperextend the client's neck and apply oxygen. d. Prepare for emergency tracheostomy and call the health care provider.
ANS: D 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. The other choices do not address the emergency situation.
Which prescribed intervention will the nurse implement first for a patient in the emergency department who is experiencing continuous tonic-clonic seizures? a. Give phenytoin (Dilantin) 100 mg IV. b. Monitor level of consciousness (LOC). c. Obtain computed tomography (CT) scan. d. Administer lorazepam (Ativan) 4 mg IV.
ANS: D To prevent ongoing seizures, the nurse should administer rapidly acting antiseizure medications such as the benzodiazepines. A CT scan is appropriate, but prevention of any seizure activity during the CT scan is necessary. Phenytoin will also be administered, but it is not rapidly acting. Patients who are experiencing tonic-clonic seizures are nonresponsive, although the nurse should assess LOC after the seizure. DIF: Cognitive Level: Apply (application) REF: 1424 OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
After teaching the parents of a child with febrile seizures about methods to lower temperature other than medication, which of the following statements indicates successful teaching? A) We'll add extra blankets when he complains of being cold B) We'll wrap him in a blanket if he starts shivering C) We'll make the bath water cold enough to make him shiver D) We'll use a solution of half alcohol and half water when sponging him
B
The nurse would suspect a patient is taking too much levothyroxine (Synthroid) when the patient exhibits which adverse effect? A. Lethargy B. Irritability C. Weight Gain D. Feeling Cold
B
a nurse has just started working in a neurology unit. which statement by the nurse would indicate adequate knowledge of seizures a. clonic seizures activity is usually interpreted as falling b. its not unusual to develop seizures after a head injury bc of brain trauma c. focal discharge in the brain may lead to absence seizures that can go unnoticed d. the epileptogenic focus in the brain needs multiple stimuli bc it will discharge and cause a seizure
B
After the nurse administers lidocaine for ventricular tachycardia, the patient experiences status epilepticus. Which medication could be administered to treat both problems? A) Diazepam (Valium) B) Phenytoin (Dilantin) C) Phenobarbital (Luminal) D) Carbamazepine (Tegretol)
B Diazepam is a first-line therapy for the initial control of generalized convulsive status epilepticus; however, because the patient is also experiencing ventricular tachycardia, phenytoin may be a better choice of antiepileptic agent because it is indicated for both conditions. Once the patient's condition has stabilized, maintenance therapy may include phenytoin; however, oral phenytoin is not indicated as maintenance antidysrhythmic therapy. Phenobarbital is indicated for status epilepticus; but, because of its side effect profile, it has been replaced clinically by diazepam and phenytoin. Carbamazepine is not indicated for status epilepticus.
The nurse is providing discharge teaching to the parents of a toddler who experienced a febrile seizure the nurse knows clarification is needed when the mother says a. my child will likely have another seizure b. My child seven-year-old brother is also at high risk for febrile seizures c. I'll give my child acetaminophen when ill to prevent a fever from rising too high to rapidly d. most children with febrile seizures do not require seizure medicine
B (not common over the age of 7)
The nurse is teaching a patient who is newly diagnosed with epilepsy about her disease. Which statement made by the nurse best describes the goals of antiepilepsy medication therapy? A) "With proper treatment we can completely eliminate your seizures." B) "Our goal is to reduce your seizures to an extent that helps you live a normal life." C) "Epilepsy medication does not reduce seizures in most patients." D) "These drugs will help control your seizures until you have surgery."
B) "Our goal is to reduce your seizures to an extent that helps you live a normal life." Epilepsy is treated successfully with medication in a majority of patients. However, the dosages needed to completely eliminate seizures may cause intolerable side effects. Neurosurgery is indicated only for patients in whom medication therapy is unsuccessful.
The nurse is preparing to give ethosuximide (Zarontin). The nurse understands that this drug is only indicated for which seizure type? A) Tonic-clonic B) Absence C) Simple partial D) Complex partial
B) Absence Absence seizures are the only indication for ethosuximide. The drug effectively eliminates absence seizures in approximately 60% of patients and effectively controls 80% to 90% of cases.
The nurse provides information to the caregiver of a 68-year-old man with epilepsy who has tonic-clonic seizures. Which statement, if made by the caregiver, requires further teaching? A. "It is normal for a person to be sleepy after a seizure." B. "I should call 911 if breathing stops during the seizure." C. "The jerking movements may last for 30 to 40 seconds." D. "Objects should not be placed in the mouth during a seizure."
B. Caregivers do not need to call an ambulance or send a person to the hospital after a single seizure unless the seizure is prolonged, another seizure immediately follows, or extensive injury has occurred. Altered breathing is a clinical manifestation of a tonic-clonic seizure. Contact emergency medical services (or call 911) if breathing stops for more than 30 seconds. No objects (e.g., oral airway, padded tongue blade) should be placed in the mouth. Lethargy is common in the postictal phase of a seizure. Jerking of the extremities occurs during the clonic phase of a tonic-clonic seizure. The clonic phase may last 30 to 40 seconds.
A patient has been receiving scheduled doses of phenytoin (Dilantin) and begins to experience diplopia. The nurse immediately assesses the patient for A. an aura or focal seizure. B. nystagmus or confusion. C. abdominal pain or cramping. D. irregular pulse or palpitations.
B. Diplopia is a sign of phenytoin toxicity. The nurse should assess for other signs of toxicity, which include neurologic changes, such as nystagmus, ataxia, confusion, dizziness, or slurred speech. An aura, focal seizure, abdominal pain or cramping, irregular pulse, or palpitations are not associated with phenytoin toxicity.
For a patient taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently, the nurse would closely monitor for which possible serious adverse effect? A. Acute confusion B. Increased bruising C. Cardiac dysrhythmias D. Orthostatic hypotension
B. 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.
A patient receiving propylthiouracil (PTU) asks the nurse, "How does this medication relieve symptoms?" What is the nurse's best response? A. "PTU helps your thyroid gland synthesize and use iodine, which produces hormones better." B. "PTU inhibits the formation of new thyroid hormone, thus returning your metabolism to normal." C. "PTU causes the pituitary gland to secrete thyroid-stimulating hormone, which blocks the production of hormones by the thyroid gland." D. "PTU removes thyroid hormones that are already circulating in your bloodstream, thus decreasing the adverse effects of this medication."
B. 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.
The nurse would suspect a patient is taking too much levothyroxine (Synthroid) when the patient exhibits which adverse effect? A. Lethargy B. Irritability C. Feeling cold D. Weight gain
B. Irritability is a symptom of hyperthyroidism and may indicate toxicity of the medication. The other choices are signs of hypothyroidism.
The home health registered nurse (RN) is planning care for a patient with a seizure disorder related to a recent head injury. Which nursing action can be delegated to a licensed practical/vocational nurse (LPN/LVN)? a. Make referrals to appropriate community agencies. b. Place medications in the home medication organizer. c. Teach the patient and family how to manage seizures. d. Assess for use of medications that may precipitate seizures.
B. LPN/LVN education includes administration of medications. The other activities require RN education and scope of practice.
Which characteristic of a patient's recent seizure is consistent with a focal seizure? A. The patient lost consciousness during the seizure. B. The seizure involved lip smacking and repetitive movements. C. The patient fell to the ground and became stiff for 20 seconds. D. The etiology of the seizure involved both sides of the patient's brain.
B. The most common complex focal seizure involves lip smacking and automatisms (repetitive movements that may not be appropriate). Loss of consciousness, bilateral brain involvement, and a tonic phase are associated with generalized seizure activity.
A high school teacher who has just been diagnosed with epilepsy after having a generalized tonic-clonic seizure tells the nurse, "I cannot teach anymore, it will be too upsetting if I have a seizure at work." Which response by the nurse is best? a. "You might benefit from some psychologic counseling." b. "Epilepsy usually can be well controlled with medications." c. "You will want to contact the Epilepsy Foundation for assistance." d. "The Department of Vocational Rehabilitation can help with work retraining."
B. The nurse should inform the patient that most patients with seizure disorders are controlled with medication. The other information may be necessary if the seizures persist after treatment with antiseizure medications is implemented.
Following a thymectomy, a 62-year-old male patient with myasthenia gravis receives the usual dose of pyridostigmine (Mestinon). An hour later, the patient complains of nausea and severe abdominal cramps. Which action should the nurse take first? a. Auscultate the patient's bowel sounds. b. Notify the patient's health care provider. c. Administer the prescribed PRN antiemetic drug. d. Give the scheduled dose of prednisone (Deltasone).
B. The patient's history and symptoms indicate a possible cholinergic crisis. The health care provider should be notified immediately, and it is likely that atropine will be prescribed. The other actions will be appropriate if the patient is not experiencing a cholinergic crisis.
A 20-year-old client presents to the clinic with complaints of breast tenderness, nausea, vomiting, and absence of menses for 2 months. She has a history of a seizure disorder well controlled with carbamazepine (Tegretol). She tells the nurse that she has been taking her oral contraceptives as directed, but she wonders if she might be pregnant. The nurse's best response to her concern should be which of the following? A. "You can't be pregnant if you have been taking your oral contraceptives correctly." B. "Carbamazepine can decrease the effectiveness of oral contraceptive drugs, so we need to do a pregnancy test." C. "There is no need to worry. Oral contraceptives are very effective." D. "Taking antiseizure drugs with oral contraceptives significantly decreases your risk of getting pregnant."
B. "Carbamazepine can decrease the effectiveness of oral contraceptive drugs, so we need to do a pregnancy test.
A patient with pheochromocytoma eats a meal with food containing tyrosine. What should the nurse monitor for in this patient? A. buffalo hump B. hypertension C. moon face D. sterility
B. hypertension
A nurse is caring for a client that has been diagnosed with hypothyroidism. The nurse expects to find the following medications. Which is used to treat hypothyroidism, on the patient's medication list A. propylthiouracil B. levothyroxine C. levophed D. propranolol
B. levothyroxine
A patient with Graves disease has subcutaneous swelling of the anterior leg. What term should the nurse document in the chart? A. papilledema B. pretibial myxedema C. diplopia D. acropachy
B. pretibial myxedema
A patient has chronic hyperparathyroidism. Which complication should the nurse monitor for the patient? A. polyuria B. renal calculi (stones) C. weight loss D. acromegaly
B. renal calculi (stones)
A clinician would suspect thyrotoxicosis if a patient presented with which of the following symptoms? A. confusion and gait disturbance B. weight loss and enlarged thyroid gland C. slow tendon reflexes and muscle stiffness D. peripheral edema and dry skin
B. weight loss and enlarged thyroid gland
A patient receiving propylthiouracil (PTU) asks the nurse, "How does this medication relieve symptoms?" What is the nurse's best response? A. "PTU causes the pituitary gland to secrete thyroid-stimulating hormone, which blocks the production of hormones by the thyroid gland." B. "PTU helps your thyroid gland synthesize and use iodine, which produces hormones better." C. "PTU inhibits the formation of new thyroid hormone, thus returning your metabolism to normal." D. "PTU removes thyroid hormones that are already circulating in your bloodstream, thus decreasing the adverse effects of this medication."
C
The nurse prepares a female patient who takes phenobarbital (Luminal) and oral contraceptives for discharge. Which intervention is the nurse's priority before discharge? A) Planning for regular exercise in a safe setting B) Making a medication reminder sign for the home C) Instructing the patient to get help before climbing stairs D) Helping the patient plan another form of birth control
C Because phenobarbital can cause lethargy, drowsiness, and dizziness, the nurse instructs the patient to get help when climbing stairs to help prevent injury. The nurse instructs the patient to continue precautions to maintain safety until the full effects of the drug are known. Of secondary importance, the nurse instructs the patient to use an alternative form of birth control, because the effect of the oral contraceptives is blunted with concomitant administration of phenobarbital. The nurse instructs the patient to plan exercise, because the lethargy from this medication can contribute to deconditioning. The nurse also instructs the patient to post a sign as a reminder to take phenobarbital once a day to maintain adherence to therapy.
A patient's pharmacotherapy includes valproic acid (Depakene), and the prescriber wants to add carbamazepine (Tegretol). After the new medication is added, which phenomenon is the nurse most likely to observe in the patient? A) Less amnesia after a convulsion B) Increased number of convulsions C) Changes in nature of convulsions D) Improved level of consciousness
C Concomitant administration of carbamazepine with a benzodiazepine such as temazepam increases the risk of carbamazepine toxicity because both medications are metabolized in the liver through cytochrome P450 enzymes. As a result, the enzyme supply is exhausted, impairing the removal of these drugs from the blood. This can cause higher circulating drug levels for longer periods, thereby increasing the risk of toxicity for both drugs. The patient is more likely to experience deep, prolonged sleep rather than poor sleep and should be less likely to experience generalized seizures. The patient is likely to experience hypotension after the administration of both agents; however, circulatory collapse is less likely.
The nurse prepares to administer carbamazepine (Tegretol) to a patient receiving temazepam (Restoril). Which risk to the patient is increased by the concomitant administration of these medications? A) Inability to have sound sleep B) Incidence of absence seizures C) Carbamazepine toxicity D) Circulatory collapse
C Concomitant administration of carbamazepine with a benzodiazepine such as temazepam increases the risk of carbamazepine toxicity because both medications are metabolized in the liver through cytochrome P450 enzymes. As a result, the enzyme supply is exhausted, impairing the removal of these drugs from the blood. This can cause higher circulating drug levels for longer periods, thereby increasing the risk of toxicity for both drugs. The patient is more likely to experience deep, prolonged sleep rather than poor sleep and should be less likely to experience generalized seizures. The patient is likely to experience hypotension after the administration of both agents; however, circulatory collapse is less likely.
The nurse finds a patient on the floor who is unresponsive but exhibiting spasms of the trunk and flexion of the arm alternating with periods of relaxation. Which finding should the nurse include in the nursing documentation? A) Patient on floor as a result of loss of consciousness B) Patient fallen to floor, exhibiting tonic convulsions C) Patient exhibiting arm flexion with trunk spasms D) Patient fallen to floor as a result of tonic-clonic seizure
C The nurse documents an objective description of the event by stating that the patient is exhibiting arm flexion and trunk spasms and therefore that the patient is experiencing a type of generalized seizure involving tonic-clonic convulsive activity. The nurse does not know how the patient got to the floor; however, the facts that the patient was found on the floor and is unresponsive should be documented. The nurse avoids documenting that the patient fell, fell because of the convulsions, or first lost consciousness, because the nurse did not witness the sequence of events.
What information should the nurse provide to a patient who will self-administer an antiepileptic agent for the first time at home? A) Report any vision or hearing problems with levetiracetam (Keppra). B) Stir phenobarbital (Luminal) elixir into a cold carbonated beverage. C) Have a complete blood count monthly while taking carbamazepine (Tegretol). D) Administer pregabalin (Lyrica) every morning on an empty stomach.
C The nurse instructs the patient taking carbamazepine to have complete blood counts as directed, usually every month at first, because iminostilbenes can cause bone marrow suppression. Patients taking levetiracetam are told to report changes in mood or behavior or motor difficulties. Patients taking phenobarbital are instructed to mix the elixir with fruit juice, milk, or water but not a carbonated beverage. The nurse instructs the patient taking pregabalin to take the medication in 2 or 3 doses and to avoid sudden withdrawal of the medication.
an otherwise healthy 18mo has a hx of febrile seizures. the child is visiting the clinic today for a wellness check up. which statement made by the the child's father would indicate a need for teaching a. i have ibuprofen available in case its needed b. my child should outgrow these seizures by age 5 c. i always keep phenobarbital with me incase of a fever d. the most likely time for a seizure is when the fever is rising
C (more for prolonged seuizures)
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.) A. Kidney Damage B. Increased urination C. Joint pain D. Bone marrow toxicity E. Liver toxicity
C, D, E
1. Which of the following statements made by a client taking phenytoin indicates understanding of the nurse's teaching? A. "I will increase the dose if my seizures don't stop." B. "I don't need to contact my health care provider before taking an over-the-counter cold remedy." C. "I will take good care of my teeth and see my dentist regularly." D. "I cannot take this drug with food."
C.
The nurse is caring for a group of patients on a medical unit. After receiving report, which patient should the nurse see first? A. A 42-year-old patient with multiple sclerosis who was admitted with sepsis B. A 72-year-old patient with Parkinson's disease who has aspiration pneumonia C. A 38-year-old patient with myasthenia gravis who declined prescribed medications D. A 45-year-old patient with amyotrophic lateral sclerosis who refuses enteral feedings
C. Patients with myasthenia gravis who discontinue pyridostigmine (Mestinon) will develop a myasthenic crisis. Myasthenia crisis results in severe muscle weakness and can lead to a respiratory arrest.
Which assessment is most important for the nurse to make regarding a patient with myasthenia gravis? a. Pupil size b. Grip strength c. Respiratory effort d. Level of consciousness
C. Because respiratory insufficiency may be life threatening, it will be most important to monitor respiratory function. The other data also will be assessed but are not as critical.
While the nurse is transporting a patient on a stretcher to the radiology department, the patient begins having a tonic-clonic seizure. Which action should the nurse take? a. Insert an oral airway during the seizure to maintain a patent airway. b. Restrain the patient's arms and legs to prevent injury during the seizure. c. Time and observe and record the details of the seizure and postictal state. d. Avoid touching the patient to prevent further nervous system stimulation.
C. Because the diagnosis and treatment of seizures frequently are based on the description of the seizure, recording the length and details of the seizure is important. Insertion of an oral airway and restraining the patient during the seizure are contraindicated. The nurse may need to move the patient to decrease the risk of injury during the seizure.
Which patient statement demonstrates understanding of radioactive iodine (I-131) therapy? A. "I will need to take this drug on a daily basis for at least 1 year." Incorrect B. "This drug will help decrease my cold intolerance and weight gain." C. "This drug will be taken up by the thyroid gland and destroy thyroid tissue." D. "I will isolate myself from my family for 1 week so there is no risk of radiation exposure."
C. Radioactive iodine is an antithyroid medication that is administered orally. It concentrates in the thyroid gland, where its radioactivity destroys thyroid tissue.
Which nursing diagnosis is likely to be a priority in the care of a patient with myasthenia gravis (MG)? A. Acute confusion B. Bowel incontinence C. Activity intolerance D. Disturbed sleep pattern
C. The primary feature of MG is fluctuating weakness of skeletal muscle. Bowel incontinence and confusion are unlikely signs of MG, and although sleep disturbance is likely, activity intolerance is usually of primary concern.
What is the priority nursing intervention in the postictal phase of a seizure? A. Reorient the client to time, person, and place B. Determine the client's level of sleepiness C. Assess the client's breathing pattern D. Position the client comfortably
C. A priority for the client in the postictal phase is to assess the client's breathing pattern for effective rate, rhythm, and depth. The nurse should apply oxygen and ventilation to the client as appropriate.
Which of the following is contraindicated for a client with seizure precautions? A. Encouraging him to perform his own personal hygiene B. Allowing him to wear his own clothing C. Assessing his oral temperature with a glass thermometer D. Encouraging him to be out of bed
C. Assessing his oral temperature with a glass thermometer
A nurse is providing discharge instructions to a female client who has a prescription for phenytoin (Dilantin). Which of the following information should the nurse include? A. Consider taking oral contraceptives when on this medication. B. Watch for receding gums when taking the medication C. Take the medication at the same time every day D. Provide a urine sample to determine therapeutic levels of the medication.
C. Correct-The nurse should instruct the client to take take phyentoin at the same time every day to enhance effectiveness A . Client should not take oral contraceptives because phyentoin decreases its effectiveness B. Phyentoin causes overgrowth of gums C. The client should have periodic blood tests to determine therapeutic levels.
A nurse is completing discharge teaching to a client who has seizures and received a vagal nerve stimulator to decrease seizure activity. Which of the following information should the nurse include in the teaching? A. The use of microwave to the heat food is permitted B. Inform the provider to order only an MRI when a scan is needed C. Place a magnet over the implantable device when an aura occurs D. The use of ultrasound diathermy for pain management is recommended
C. Correct: The client should be instructed to hold a magnet over the implantable device when an aura occurs so as to decrease seizure activity A. Incorrect: The client should be instructed to avoid using a microwave, which may affect the stimulator B. Incorrect: The client should be instructed to inform his providers about the stimulator, which would be affected if an MRI were performed. D. Incorrect: The client should be instructed to avoid the use of the ultrasound diathermy for pain management because of its effect on the stimulator
The client is scheduled to receive phenytoin (Dilantin) through a nasogastric tube and has a tube-feeding supplement running continuously. The head of the bed is elevated to 30 degrees. Prior to administering the medication, the nurse should: A. Elevate the head of the bed to 60 degrees B. Draw blood to determine the Dilantin level after giving the morning dose in order to determine if client has toxic blood level C. Stop the tube feeding 1 hour before giving Dilantin and hold tube feeding for 1 hour after giving Dilantin D. Flush the NGT with 150 ml of water before and after giving the Dilantin
C. In order for Dilantin to be properly absorbed and provide maximum benefit to the client, nutritional supplements must be stopped before and after delivery. The head of the bed is elevated 30 degrees since this client has a tube feeding infusing; it is not necessary to elevate the bed any further. Blood levels are usually drawn before giving a dose of dilantin, not after. It is not necessary to flush with such large amounts of water before and after Dilantin
A patient has graves disease, and the nurse notices protrusion of the eyeball globe/orbit. What term should the nurse use to describe this finding? A. optic nerve damage B. palsies C. exophthalmos D. extraocular eye strain
C. exophthalmos
Which assessment finding by the nurse is a classic symptom of diabetes insipidus (DI)? A. hypertension B. overhydration C. low urine osmolarity D. pulmonary edema
C. low urine osmolarity
Parents ask the nurse why their infant should be treated for congenital hypothyroidism. What is the nurse's best response. If left untreated, congenital hypothyroidism results in: A. hyperactivity and attention deficit disorder B. increased risk of childhood thyroid cancer. C. mental retardation and stunted growth D. liver, kidney and pancreas failure
C. mental retardation and stunted growth
A client is being discharged with propylthiouracil (PTU). Which statement by the client indicates a need for further teaching by the nurse? a) "I can return to my job at the nursing home." b) "I must call if my urine is dark." c) "I must faithfully take the drug every 8 hours." d) "I need to report weight gain."
Correct Answer: a The client should avoid large crowds and people who are ill 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 provider immediately. Taking PTU regularly at the same time each day provides better drug levels and ensures better drug action. The client must notify the provider of weight gain because this may indicate hypothyroidism; a lower drug dose may be required.
A client recently admitted with hyperparathyroidism has a very high urine output. Of these actions, what does the nurse do next? a) Calls the health care provider b) Monitors intake and output c) Performs an immediate cardiac assessment d) Slows the rate of IV fluids
Correct Answer: b Diuretic and hydration therapies are used most often for reducing serum calcium levels in clients with hyperparathyroidism. Usually, a diuretic that increases kidney excretion of calcium is used together with IV saline in large volumes to promote renal calcium excretion. The health care provider does not need to be notified in this situation, given the information available in the question. Cardiac assessment is part of the nurse's routine evaluation of the client. Slowing the rate of IV fluids is contraindicated because the client will become dehydrated due to the use of diuretics to increase kidney excretion of calcium.
A client had a parathyroidectomy 18 hours ago. Which finding requires immediate attention? a) Edema at the surgical site b) Hoarseness c) Pain on moving the head d) Sore throat
Correct Answer: b Hoarseness or stridor is an indication of respiratory distress and requires immediate attention. Edema at the surgical site of any surgery is an expected finding. Pain when the client moves the head or attempts to lift the head off the bed is an expected finding after a parathyroidectomy. Any time a client has been intubated for surgery, a sore throat is a common occurrence in the postoperative period. This is especially true for clients who have had surgery involving the neck.
A client being treated for hyperthyroidism calls the home health nurse and mentions that his heart rate is slower than usual. What is the nurse's best response? a) Advise the client to go to a calming environment. b) Ask whether the client has increased cold sensitivity or weight gain. c) Instruct the client to see his health care provider immediately. d) Tell the client to check his pulse again and call back later.
Correct Answer: b Increased sensitivity to cold and weight gain are 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 have any effect on the client's heart rate. The client will want to notify the 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 should see the health care provider 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 re-checks his pulse. This time could also be spent providing education about normal ranges for that client.
A client has been diagnosed with hypothyroidism. What medication is usually prescribed to treat this disorder? a) Atenolol (Tenormin) b) Levothyroxine sodium (Synthroid) c) Methimazole (Tapazole) d) Propylthiouracil
Correct Answer: b Levothyroxine is a synthetic form of thyroxine (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.
Family members of a client diagnosed with hyperthyroidism are alarmed at the client's frequent mood swings. What is the nurse's response? a) "How does that make you feel?" b) "The mood swings should diminish with treatment." c) "The medications will make the mood swings disappear completely." d) "Your family member is sick. You must be patient."
Correct Answer: b Telling the family that the client's mood swings should diminish over time with treatment will provide information to the family, as well as reassurance. Asking how the family feels is important; however, the response should focus on the client. 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 patient introduces guilt and does not address the family's concerns.
The nurse manager for the medical-surgical unit is making staff assignments. Which client will be most appropriate to assign to a newly graduated RN who has completed a 6-week unit orientation? a) Client with chronic hypothyroidism and dementia who takes levothyroxine (Synthroid) daily b) Client with follicular thyroid cancer who has vocal hoarseness and difficulty swallowing c) Client with Graves' disease who is experiencing increasing anxiety and diaphoresis d) Client with hyperparathyroidism who has just arrived on the unit after a parathyroidectomy
Correct Answer: b The client with chronic hypothyroidism and dementia is the most stable of the clients described and would be most appropriate to assign to an inexperienced RN. A client with vocal hoarseness and difficulty swallowing is at higher risk for complications and requires close observation by a more experienced nurse. Increasing anxiety and diaphoresis in a client with Graves' disease can be an indication of impending thyroid storm, which is an emergency; this is not a situation to be managed by a newly graduated RN. A client who has just arrived on the unit after a parathyroidectomy requires close observation for bleeding and airway compromise and requires assessment by an experienced nurse.
A client admitted with hyperthyroidism is fidgeting with the bedcovers and talking extremely fast. What does the nurse do next? a) Calls the provider b) Encourages the client to rest c) Immediately assesses cardiac status d) Tells the client to slow down
Correct Answer: b The client with hyperthyroidism often has wide mood swings, irritability, decreased attention span, and manic behavior. The nurse should accept the client's behavior and provide a calm, quiet, and comfortable environment. Because the client's behavior is expected, there is no need to call the provider. Monitoring the client's cardiac status is part of the nurse's routine assessment. Telling the client to slow down is unsupportive and unrealistic.
Which action does the postanesthesia care unit (PACU) nurse perform first when caring for a client who has just arrived after a total thyroidectomy? a) Assess the wound dressing for bleeding. b) Give morphine sulfate 4 to 8 mg IV for pain. c) Monitor oxygen saturation using pulse oximetry. d) Support the head and neck with sandbags.
Correct Answer: c Airway assessment and management is always the first priority with every client. This is especially important for a client who has had surgery that involves potential bleeding and edema near the trachea. Assessing the wound dressing for bleeding is a high priority, although this is not the first priority. Pain control and supporting the head and neck with sandbags are important priorities, but can be addressed after airway assessment.
A client with hypothyroidism is being discharged. Which environmental change may the client experience in the home? a) Frequent home care b) Handrails in the bath c) Increased thermostat setting d) Strict infection-control measures
Correct Answer: c Manifestations of hypothyroidism include cold intolerance. Increased thermostat settings or additional clothing may be necessary. A client with a diagnosis of hypothyroidism can be safely managed at home with adequate discharge teaching regarding medications and instructions on when to notify the health care provider or home health nurse. In general, hypothyroidism does not cause mobility issues. Activity intolerance and fatigue may be an issue, however. A client with hypothyroidism is not immune-compromised or contagious, so no environmental changes need to be made to the home.
An older client with an elevated serum calcium level is receiving IV furosemide (Lasix) and an infusion of normal saline at 150 mL/hr. Which nursing action can the RN delegate to unlicensed assistive personnel (UAP)? a) Ask the client about any numbness or tingling. b) Check for bone deformities in the client's back. c) Measure the client's intake and output hourly. d) Monitor the client for shortness of breath.
Correct Answer: c Measuring intake and output is a commonly delegated nursing action that is within the UAP scope of practice. Numbness and tingling is part of the client assessment that needs to be completed by a licensed nurse. Bony deformities can be due to pathologic fractures; physical assessment is a complex task that cannot be delegated. An older client receiving an IV at 150 mL/hr is at risk for congestive heart failure; careful monitoring for shortness of breath is the responsibility of the RN.
An RN and LPN/LVN are caring for a group of clients on the medical-surgical unit. Which client will be the best to assign to the LPN/LVN? a) Client with Graves' disease who needs discharge teaching after a total thyroidectomy b) Client with hyperparathyroidism who is just being admitted for a parathyroidectomy c) Client with infiltrative ophthalmopathy who needs administration of high-dose prednisone (Deltasone) d) Newly diagnosed client with hypothyroidism who needs education about the use of thyroid supplements
Correct Answer: c Medication administration for the client with infiltrative ophthalmopathy is within the scope of practice of the LPN/LVN. Discharge teaching is a complex task that cannot be delegated to the LPN/LVN. A client being admitted for a parathyroidectomy needs preoperative teaching, which must be provided by the RN. A client who has a new diagnosis will have questions about the disease and prescribed medications; teaching is a complex task that is appropriate for the RN.
A client has hyperparathyroidism. Which incident witnessed by the nurse requires the nurse's intervention? a) The client eating a morning meal of cereal and fruit b) The physical therapist walking with the client in the hallway c) Unlicensed assistive personnel pulling the client up in bed by the shoulders d) Visitors talking with the client about going home
Correct Answer: c The client with hyperparathyroidism is at risk for pathologic fracture. All members of the health care team must move the client carefully. A lift sheet should be used to re-position the client. The client with hyperparathyroidism is not restricted from eating and should maintain a balanced diet. The client can benefit from moderate exercise and physical therapy, and is not restricted from having visitors.
The nurse is teaching a client about thyroid replacement therapy. Which statement by the client indicates a need for further teaching? a) "I should have more energy with this medication." b) "I should take it every morning." c) "If I continue to lose weight, I may need an increased dose." d) "If I gain weight and feel tired, I may need an increased dose."
Correct Answer: c 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 should help the client have more energy. The correct time to take thyroid replacement therapy is in the morning. If the client is gaining weight and continues to feel tired, that is an indication that the dose may need to be increased.
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? a) "You should see effects of this medication immediately." b) "You should see effects of this medication within 1 week." c) "You should see full effects from this medication within 1 to 2 days." d) "You should see some effects of this medication within 2 weeks."
Correct Answer: d Methimazole is an iodine preparation that decreases blood flow through the thyroid gland. This action reduces the production and release of thyroid hormone. The client should see some effects within 2 weeks; however, 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 effects immediately. Effects will take longer than 1 week 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.
The nurse is preparing the room for the client returning from a thyroidectomy. Which items are important for the nurse to have available for this client? (Select all that apply.) a) Calcium gluconate b) Emergency tracheotomy kit c) Furosemide (Lasix) d) Hypertonic saline e) Oxygen f) Suction
Correct Answers: a, b, e, f Calcium gluconate should be available at the bedside to treat hypocalcemia and tetany that might occur if the parathyroid glands have been injured during the surgery. Equipment for an emergency tracheotomy must be kept at the bedside in the event that hemorrhage or edema should occlude the airway. Respiratory distress can result from swelling or damage to the laryngeal nerve leading to spasm, so it is important that the nurse work with respiratory therapy to have oxygen ready at the bedside for the client on admission. Because of the potential for increased secretions, it is important that a working suction device is present at the bedside for admission of the client from the operating room. Furosemide might be useful in the postoperative client to assist with urine output; however, this is not of added importance for this client. Hypertonic saline would not be of benefit to this client as the client is not hyponatremic.
For a patient taking levothyroxine (Synthroid) and warfarin (Coumadin) concurrently, the nurse would closely monitor for which possible serious adverse effect? A. Acute confusion B. Cardiac dysrhythmias C. Orthostatic hypotension D. Increased bruising
D
Parents of a child with generalized seizures asked the nurse for information to give their child's teachers which of the following should be included a. a soft how did spoon should be kept nearby to be put between the child's teeth at the onset of a seizure b. well the child onto the abdomen with the head to the left so any contents can flow from the mouth c. if a seizure last longer than 10 minutes the parents or an ambulance should be called d. as the child grows medication dosages may need to be adjusted to control seizure activity
D
The nurse explains that febrile seizures: a. occur when the body temperature exceeds 38.3 C (101 F). b. can be prevented by anticonvulsant medication. c. usually lead to the development of epilepsy. d. occur when the temperature rises quickly.
D
Which of the following statements obtained from the nursing history of a toddler would alert the nurse to suspect that the child has had a febrile seizure? A) The child has had a low-grade fever for several weeks B) The family history is negative for convulsions C) The seizure resulted in respiratory arrest D) The seizure occurred when the child had a respiratory infection
D
Which patient statement demonstrates understanding of radioactive iodine (I-131) therapy? A. "I will need to take this drug on a daily basis for at least 1 year." B. "I will isolate myself from my family for 1 week so there is no risk of radiation exposure." C. "This drug will help decrease my cold intolerance and weight gain." D. "This drug will be taken up by the thyroid gland and destroy thyroid tissue."
D
a mother reports that her school age child has been reprimanded for daydreaming during class. the mother is concerned because her other child has been diagnosed with absence seizures. this behavior is new, and the childs grades are dropping. what is the most appropriate action by the nurse a. refer the hcild to an audiologist for a hearing assessment b. refer the child to the special education department to assess for a learning disability c. refer the child to the PCP to assess for ADHD d. refer the child to the PCP to assess for absence seizures
D
The patient is receiving IV antiepileptic therapy. Which parenteral antiepileptic drug is effective against generalized seizures? A) Phenytoin (Dilantin) B) Fosphenytoin (Cerebyx) C) Phenobarbital (Luminal) D) Valproic acid (Depakene)
D Valproic acid is indicated in all its forms for generalized seizures, including tonic-clonic, absence, and myoclonic seizures. Phenytoin, fosphenytoin, and phenobarbital are parenteral antiepileptic medications, effective in the treatment of partial seizures and, secondarily, generalized tonic-clonic seizures.
Which statement by the patient indicates an understanding of discharge instructions given by the nurse about the newly prescribed medication levothyroxine (Synthroid)? A. "I will take a double dose to make up for the missed one." B. "I can expect improvement of my symptoms within 1 week." C. "I will stop the medication immediately if I feel pain or weakness in my muscles." D. "I will take this medication in the morning so it does not affect my sleep at night."
D. 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 patient taking an antithyroid medication to avoid food items high in iodine. Which food item should the nurse instruct the patient to avoid? A. Milk B. Eggs C. Chicken D. Seafood
D. Seafood contains high amounts of iodine. The other choices do not.
A 76-year-old patient is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease. Which information is most important for the nurse to report to the health care provider? a. Shuffling gait b. Tremor at rest c. Cogwheel rigidity of limbs d. Uncontrolled head movement
D. Dyskinesia is an adverse effect of the Sinemet, indicating a need for a change in medication or decrease in dose. The other findings are typical with Parkinson's disease.
Which information about a 72-year-old patient who has a new prescription for phenytoin (Dilantin) indicates that the nurse should consult with the health care provider before administration of the medication? a. Patient has generalized tonic-clonic seizures. b. Patient experiences an aura before seizures. c. Patient's most recent blood pressure is 156/92 mm Hg. d. Patient has minor elevations in the liver function tests.
D. Many older patients (especially with compromised liver function) may not be able to metabolize phenytoin. The health care provider may need to choose another antiseizure medication. Phenytoin is an appropriate medication for patients with tonic-clonic seizures, with or without an aura. Hypertension is not a contraindication for phenytoin therapy.
Which prescribed intervention will the nurse implement first for a patient in the emergency department who is experiencing continuous tonic-clonic seizures? a. Give phenytoin (Dilantin) 100 mg IV. b. Monitor level of consciousness (LOC). c. Obtain computed tomography (CT) scan. d. Administer lorazepam (Ativan) 4 mg IV.
D. To prevent ongoing seizures, the nurse should administer rapidly acting antiseizure medications such as the benzodiazepines. A CT scan is appropriate, but prevention of any seizure activity during the CT scan is necessary. Phenytoin will also be administered, but it is not rapidly acting. Patients who are experiencing tonic-clonic seizures are nonresponsive, although the nurse should assess LOC after the seizure.
Which intervention is most effective in minimizing the risk of seizure activity in a client who is undergoing diagnostic studies after having experienced several episodes of seizures? A. Maintain the client on bed rest B. Administer butabarbital sodium 30 mg PO three times a day C. Close the door to the room to minimize stimulation D. Administer carbamazepine 200 mg PO twice per day
D. Administer carbamazepine 200 mg PO Carbamazepine is an anticonvulsant that helps prevent further seizures
What nursing assessments should be documented at the beginning of the ictal phase of a seizure? A. Heart rate, respirations, pulse oximeter, and BP B. Last dose of anticonvulsant and circumstances at the time C. Type of visual, auditory, and olfactory aura the client experienced D. Movement of the head and eyes and muscle rigidity
D. During a seizure, the nurse should note movement of the client's head and eyes and muscle rigidity, especially when the seizure first begins, to obtain clues about the location of the trigger focus in the brain
Auras are typical of A. Primary GTCS B. Absence seizures C. Myoclonic seizures D. Partial seizures
D. Partial seizures
It is the night before a client is to have a CT scan of the head without contrast. The nurse should tell the client: A. You must shampoo your hair tonight to remove all oil and dirt B. You may drink fluids until midnight but after that drink nothing until the scan is completed C. You will have some hair shaved to attach the small electrode to your scalp D. You will need to hold your head very still during the examination
D. You will need to hold your head very still during the examination
A nurse is asked what is the most common cause of primary hypothyroidism in adults. How the nurse answer? The most common cause is: A. bacterial infection of the thyroid gland B. viral infection of the thyroid gland C. congenital hypothyroidism D. autoimmune thyroiditis
D. autoimmune thyroiditis
A patient is experiencing a thyroid storm. Which assessment findings will the nurse observe? A. hypotension and bradycardia leading to shock B. pulmonary edema and bronchoconstriction leading to respiratory arrest C. hypercoagulability and formation of deep vein thrombosis leading to pulmonary emboli D. fever and tachycardia leading to high-output heart failure.
D. fever and tachycardia leading to high-output heart failure.
Which of the following assessment signs and symptoms will the nurse find in a patient with hypothyroidism? A. weight loss B. diarrhea C. heat intolerance D. lethargy
D. lethargy
A nurse is checking the lab results for a patient with Addison disease. Which result will the nurse expect to find? A. low serum potassium levels B. elevated serum calcium levels C. elevated serum glucose levels D. low serum cortisol levels
D. low serum cortisol levels
A patient has damage to the posterior pituitary caused by a tumor. Which type of diabetes insipidus (DI) should the nurse monitor for in this patient? A. vascular B. nephrogenic C. psychogenic D. neurogenic
D. neurogenic
15. Priority Decision: The nurse finds a patient in bed having a generalized tonic-clonic seizure. During the seizure activity, what actions should the nurse take (select all that apply)? a. Loosen restrictive clothing. b. Turn the patient to the side. c. Protect the patient's head from injury. d. Place a padded tongue blade between the patient's teeth. e. Restrain the patient's extremities to prevent soft tissue and bone injury.
a, b, c. The focus is on maintaining a patent airway and preventing patient injury. The nurse should not place objects in the patient's mouth or restrain the patient.
A nurse is going over trigger factors for a client recently diagnosed with generalized seizures, which of the following should the nurse include in the review? a-overwhelming fatigue should be avoided b-caffeinated products should be removed from diet c-aerobic exercise may be performed d-episodes of hypoventilation should be limited e-use of aerosol hairspray is recommended
a,b-fatigue and caffeine are risk factors for seizures. The client should also decrease physical activity, which can trigger a seizure. HyPERventilation can trigger a seizure. The client should avoid aerosol hairspray, which may trigger a seizure by stimulating abnormal electrical neuron activity.
A client is post-ictle, what should the nurse do FIRST? a-keep client side-lying b-monitor vital signs c-reorient client to environment d-check client for injuries
a-the greatest risk to the client is aspiration during the postictal phase, so this is the priority
The patient with type 1 diabetes mellitus is having a seizure. Which medication should the nurse anticipate will be administered first? a. IV dextrose solution b. IV diazepam (Valium) c. IV phenytoin (Dilantin) d. Oral carbamazepine (Tegretol)
a. IV dextrose solution This patient's seizure could be caused by low blood glucose, so IV dextrose solution would be given first to stop the seizure. IV diazepam, IV phenytoin, and oral carbamazepine would be used first to treat seizures from other causes such as head trauma, drugs, and infections. These drugs will be tried if the IV dextrose is ineffective.
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 ANS: A, C, E 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 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. ANS: A, B, D 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.
A 48-yr-old man was just diagnosed with Huntington's disease. His 20-yr-old son is upset about his father's diagnosis. What is the nurse's best response? a. Provide emotional and psychologic support. b. Encourage him to get diagnostic genetic testing. c. Explain that cognitive deterioration will be treated with counseling. d. Instruct that chorea and psychiatric disorders can be treated with haloperidol (Haldol).
a. Provide emotional and psychologic support. The patient's son will first need emotional and psychologic support. He should be taught about diagnostic genetic testing but should decide for himself with a genetic counselor if and when he wants this done. The treatment plan for his father will be determined based on his father's needs.
A patient with myasthenia gravis is admitted to the hospital with respiratory insufficiency and severe weakness. When is a diagnosis of cholinergic crisis made? a. The patient's respiration is impaired because of muscle weakness. b. Administration of edrophonium (Tensilon) increases muscle weakness. c. Administration of edrophonium (Tensilon) results in improved muscle contractility. d. EMG reveals decreased response to repeated stimulation of muscles.
b. The reduction of the acetylcholine (ACh) effect in myasthenia gravis (MG) is treated with anticholinesterase drugs, which prolong the action of ACh at the neuromuscular synapse, but too much of these drugs will cause a cholinergic crisis with symptoms very similar to those of MG. To determine whether the patient's manifestations are due to a deficiency of ACh or to too much anticholinesterase drug, the anticholinesterase drug edrophonium chloride (Tensilon) is administered. If the patient is in cholinergic crisis, the patient's symptoms will worsen; if the patient is in a myasthenic crisis, the patient will improve.
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." ANS: B 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.
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." ANS: B 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.
The nurse provides information to the caregiver of a 68-yr-old man with epilepsy who has tonic-clonic seizures. Which statement by the caregiver indicates a need for further teaching? a. "It is normal for a person to be sleepy after a seizure." b. "I should call 911 if breathing stops during the seizure." c. "The jerking movements may last for 30 to 40 seconds." d. "Objects should not be placed in the mouth during a seizure."
b. "I should call 911 if breathing stops during the seizure." Caregivers do not need to call an ambulance or send a person to the hospital after a single seizure unless the seizure is prolonged, another seizure immediately follows, or extensive injury has occurred. Altered breathing is a clinical manifestation of a tonic-clonic seizure. Contact emergency medical services (or call 911) if breathing stops for more than 30 seconds. No objects (e.g., oral airway, padded tongue blade) should be placed in the mouth. Lethargy is common in the postictal phase of a seizure. Jerking of the extremities occurs during the clonic phase of a tonic-clonic seizure. The clonic phase may last 30 to 40 seconds.
The nurse teaches a 38-yr-old woman who has migraine headaches about sumatriptan (Imitrex). Which statement by the patient requires clarification by the nurse? a. "The injection might feel like a bee sting." b. "This medicine will prevent a migraine headache." c. "I can take another dose if the first does not work." d. "This drug for migraine headaches could cause birth defects."
b. "This medicine will prevent a migraine headache." Sumatriptan is given to abort an ongoing migraine headache and is not used to prevent migraine headaches. When given as a subcutaneous injection, this drug may cause transient pain and redness at the injection site. This drug may be repeated after a specified time period if the first dose is not effective. This drug should be avoided during pregnancy and is classified as a Food and Drug Administration Pregnancy Risk Category C drug.
A nurse assesses clients for potential endocrine disorders. Which client is at greatest risk for hyperparathyroidism? a. A 29-year-old female with pregnancy-induced hypertension b. A 41-year-old male receiving dialysis for end-stage kidney disease c. A 66-year-old female with moderate heart failure d. A 72-year-old male who is prescribed home oxygen therapy
b. A 41-year-old male receiving dialysis for end-stage kidney disease ANS: B Clients who have chronic kidney disease do not completely activate vitamin D and poorly absorb calcium from the GI tract. They are chronically hypocalcemic, and this triggers overstimulation of the parathyroid glands. Pregnancy-induced hypertension, moderate heart failure, and home oxygen therapy do not place a client at higher risk for hyperparathyroidism.
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) ANS: B 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 female patient complains of a throbbing headache. The nurse learns the patient has experienced photophobia and headaches previously. Which diagnosis does the nurse suspect? a. Cluster headache b. Migraine headache c. Polycythemia vera d. Hemorrhagic stroke
b. Migraine headache Although a headache may occur with any of these options, a migraine headache is the only one that has a throbbing headache with an aura (the photophobia). Headache from polycythemia vera is from erythrocytosis. The cluster headache pain is sharp and stabbing. The headache associated with a hemorrhagic stroke has a sudden onset and is not recurrent.
A patient has been receiving scheduled doses of phenytoin (Dilantin) and begins to experience diplopia. Which additional findings would the nurse expect? a. An aura or focal seizure b. Nystagmus or confusion c. Abdominal pain or cramping d. Irregular pulse or palpitations
b. Nystagmus or confusion Diplopia is a sign of phenytoin toxicity. The nurse should assess for other signs of toxicity, which include neurologic changes, such as nystagmus, ataxia, confusion, dizziness, or slurred speech. An aura, focal seizure, abdominal pain or cramping, irregular pulse, or palpitations are not associated with phenytoin toxicity.
A 50-yr-old male patient has been diagnosed with amyotrophic lateral sclerosis (ALS). What strategy will prevent a common cause of death for patients with ALS? a. Reduce fat intake. b. Reduce the risk of aspiration. c. Decrease injury related to falls. d. Decrease pain secondary to muscle weakness.
b. Reduce the risk of aspiration. Reducing the risk of aspiration can help prevent respiratory infections that are a common cause of death from deteriorating muscle function. Reducing fat intake may reduce cardiovascular disease, but this is not a common cause of death for patients with ALS. Decreasing injury related to falls and decreasing pain secondary to muscle weakness are important nursing interventions for patients with ALS but are unrelated to causes of death for these patients.
In providing care for patients with chronic, progressive neurologic disease, what is the major goal of treatment that the nurse works toward? a. Meet the patient's personal care needs. b. Return the patient to normal neurologic function. c. Maximize neurologic functioning for as long as possible. d. Prevent the development of additional chronic diseases.
c. Many chronic neurologic diseases involve progressive deterioration in physical or mental capabilities and have no cure, with devastating results for patients and families. Health care providers can only attempt to alleviate physical symptoms, prevent complications, and assist patients in maximizing function and self-care abilities for as long as possible.
The nurse provides dietary instructions to the in-home caregiver of a 45-yr-old man with Huntington's disease. The nurse is most concerned if the caregiver makes which statement? a. "Depression is common and may cause a decrease in appetite." b. "If swallowing becomes difficult, a feeding tube may be needed." c. "Calories should be restricted to prevent unnecessary weight gain." d. "Muscles in the face are affected, and chewing may become impossible."
c. "Calories should be restricted to prevent unnecessary weight gain." Patients with Huntington's disease may require 4000 to 5000 calories per day to maintain body weight. Weight loss occurs in patients with Huntington's disease because of choreic movements, difficulty swallowing, depression, and mental deterioration.
The nurse is caring for a group of patients on a medical unit. After receiving report, which patient should the nurse see first? a. A 42-yr-old patient with multiple sclerosis who was admitted with sepsis b. A 72-yr-old patient with Parkinson's disease who has aspiration pneumonia c. A 38-yr-old patient with myasthenia gravis who declined prescribed medications d. A 45-yr-old patient with amyotrophic lateral sclerosis who refuses enteral feedings
c. A 38-yr-old patient with myasthenia gravis who declined prescribed medications Patients with myasthenia gravis who discontinue pyridostigmine (Mestinon) will experience myasthenic crisis. Myasthenia crisis results in severe muscle weakness and can lead to a respiratory arrest.
Which nursing diagnosis is a priority in the care of a patient with myasthenia gravis (MG)? a. Acute confusion b. Bowel incontinence c. Activity intolerance d. Disturbed sleep pattern
c. Activity intolerance The primary feature of MG is fluctuating weakness of skeletal muscle. Bowel incontinence and confusion are unlikely signs of MG. Although sleep disturbance is likely, activity intolerance is of primary concern.
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. ANS: C 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.
When establishing a diagnosis of multiple sclerosis (MS), which diagnostic tests will the nurse expect? Select all that apply. a. EEG b. ECG c. CT scan d. Carotid duplex scan e. Evoked response testing f. Cerebrospinal fluid analysis
c. CT scan e. Evoked response testing f. Cerebrospinal fluid analysis No definitive diagnostic test exists for MS. Along with history and physical examination, CT scan, evoked response testing, cerebrospinal fluid analysis, and MRI are used to establish a diagnosis of MS. EEG, ECG, and carotid duplex scan are not used to diagnose MS.
Which characteristic will the nurse associate with a focal seizure? a. The patient lost consciousness during the seizure. b. The seizure involved both sides of the patient's brain. c. The seizure involved lip smacking and repetitive movements. d. The patient fell to the ground and became stiff for 20 seconds.
c. The seizure involved lip smacking and repetitive movements. Complex focal seizure is characterized commonly by lip smacking and automatisms (repetitive movements that may not be appropriate). Loss of consciousness, bilateral brain involvement, and a tonic phase are associated with generalized seizure activity.
Which type of seizure occurs in children, is also known as a petit mal seizure, and consists of a staring spell that lasts for a few seconds? a. Atonic b. Simple focal c. Typical absence d. Atypical absence
c. The typical absence seizure is also known as petit mal and the child has staring spells that last for a few seconds. Atonic seizures occur when the patient falls from loss of muscle tone accompanied by brief unconsciousness. Simple focal seizures have focal motor, sensory, or autonomic symptoms related to the area of the brain involved without loss of consciousness. Staring spells in atypical absence seizures last longer than those in typical absence seizures and are accompanied by peculiar behavior during the seizure or confusion after the seizure.
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." ANS: D 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 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. ANS: D 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
A nurse cares for a client who is recovering from a parathyroidectomy. When taking the client's blood pressure, the nurse notes that the client's hand has gone into flexion contractions. Which laboratory result does the nurse correlate with this condition? a. Serum potassium: 2.9 mEq/L b. Serum magnesium: 1.7 mEq/L c. Serum sodium: 122 mEq/L d. Serum calcium: 6.9 mg/dL
d. Serum calcium: 6.9 mg/dL ANS: D Hypocalcemia destabilizes excitable membranes and can lead to muscle twitches, spasms, and tetany. This effect of hypocalcemia is enhanced in the presence of tissue hypoxia. The flexion contractions (Trousseau's sign) that occur during blood pressure measurement are indicative of hypocalcemia, not the other electrolyte imbalances, which include hypokalemia, hyponatremia, and hypomagnesemia.
22. The nurse explains to a patient newly diagnosed with MS that the diagnosis is made primarily by a. spinal x-ray findings. b. T-cell analysis of the blood. c. analysis of cerebrospinal fluid. d. history and clinical manifestations.
d. There is no specific diagnostic test for MS. A diagnosis is made primarily by history and clinical manifestations. Certain diagnostic tests may be used to help establish a diagnosis of MS. Positive findings on MRI include evidence of at least two inflammatory demyelinating lesions in at least two different locations within the central nervous system (CNS). Cerebrospinal fluid (CSF) may have increased immunoglobulin G and the presence of oligoclonal banding. Evoked potential responses are often delayed in persons with MS.
This seizure phase is characterized by the rest and recovery phase and may include the patient sleeping for days.
postictal phase
How long do patients lose consciousness during a generalized seizure?
seconds to minutes
Feeling cold, hair loss, lethargy, and facial puffiness are
signs of HYPOTHYROIDISM
The signs and symptoms of the aural phase can include:
skins sensations unusual smells visual changes with light
