Prioritization, Delegation, and Assignment Chapter 14

The patient with hyperparathyroidism who is not a candidate for surgery asks you why she is receiving IV normal saline and IV furosemide. What is your best response? 1) "This therapy is to protect your kidney function." 2) "You are receiving these therapies to prevent edema formation." 3) "Diuretic and hydration therapies are used to reduce your serum calcium." 4) "These therapies may help to improve your candidacy for surgery."

"Diuretic and hydration therapies are used to reduce your serum calcium."

A 24-year-old patient with diabetes insipidus makes all of these statements when you are preparing the patient for discharge from the hospital. Which statement indicates to you that the patient needs additional teaching? 1) "I will drink fluids equal to the amount of my urine output." 2) "I will weigh myself every day using the same scale." 3) "I will wear my medical alert bracelet at all times." 4) "I will gradually wean myself off the vasopressin."

"I will gradually wean myself off the vasopressin."

The LPN/LVN asks you why the patient with Cushing disease has bruising and petechiae across her abdomen. What is your best response? 1) "Patients with Cushing disease often have bleeding disorders." 2) "Patients with Cushing disease have very fragile capillaries." 3) "Please ask the patient if she slipped or fell during the night." 4) "Thin and delicate skin can result in development of bruising."

"Patients with Cushing disease have very fragile capillaries."

As the shift begins, you are assigned to care for the following patients. Which patient should you assess first? 1) 38-year-old with Graves disease and a heart rate of 94 beats/min. 2) 63-year-old with type 2 diabetes and fingerstick glucose level of 137 mg/dL. 3) 58-year-old with hypothyroidism and a heart rate of 48 beats/min. 4) 49-year-old with Cushing disease and dependent edema rated as 1+

58-year-old with hypothyroidism and a heart rate of 48 beats/min.

You are caring for the following patients with endocrine disorders. Which one must you assess first? 1) 21-year-old with diabetes insipidus whose urine output overnight was 2000 mL. 2) 55-year-old with syndrome of inappropriate antidiuretic hormone (SIADH) who is demanding that the UAP refill his water pitcher. 3) 65-year-old with Addison disease whose morning potassium level is 6.2 mEq/L. 4) 48-year-old with Cushing disease with a weight gain of 1.5 lb over the past 4 days.

65-year-old with Addison disease whose morning potassium level is 6.2 mEq/L.

Which patients should you, as the charge nurse, assign to the care of an LPN/LVN, under the supervision of the RN team leader? 1) 51-year-old who has just undergone bilateral adrenalectomy 2) 83-year-old with type 2 diabetes and chronic obstructive pulmonary disease. 3) 38-year-old with myocardial infarction preparing for discharge. 4) 72-year-old with mental status changes admitted from a long-term care facility.

83-year-old with type 2 diabetes and chronic obstructive pulmonary disease.

You are instructing a senior nursing student on the techniques for palpation of the thyroid gland. What precaution would you be sure to include when instructing the student about thyroid palpation? 1) Always stand to the side of the patient. 2) Instruct the patient not to swallow. 3) Palpate using one hand and then the other. 4) Always palpate the thyroid gland gently.

Always palpate the thyroid gland gently.

Which actions should you delegate to the LPN/LVN for the care of a patient with hypothyroidism? SELECT ALL THAT APPLY. 1) Assessing and recording the rate and depth of respirations. 2) Auscultating lung sounds every 4 hours. 3) Creating an individualized nursing care plan for the patient. 4) Administering sedation medications every 6 hours. 5) Checking blood pressure, heart rate, and respirations every 4 hours. 6) Reminding the patient to report any episodes of chest pain or discomfort.

Assessing and recording the rate and depth of respirations. Auscultating lung sounds every 4 hours. Reminding the patient to report any episodes of chest pain or discomfort.

You are providing care for a patient who underwent thyroidectomy 2 days ago. Which laboratory value requires close monitoring by a nurse? 1) Calcium level 2) Sodium level 3) Potassium level 4) White blood cell count

Calcium level

Assessment findings for a patient with Cushing disease include all of the following. For which finding would you notify the physician immediately? 1) Purple striae present on the abdomen and thighs. 2) Weight gain of 1 lb since the previous day. 3) Dependent edema rated as 1+ in the ankles and calves. 4) Crackles bilaterally in the lower lobes of the lungs.

Crackles bilaterally in the lower lobes of the lungs.

When providing care for a patient with Addison disease, you should be alert for which laboratory value change? 1) Decreased hematocrit 2) Increased sodium level 3) Decreased potassium level 4) Decreased calcium level

Decreased hematocrit

A patient with adrenal insufficiency is to be discharged and will take prednisone (Deltasone) 10 mg orally each day. Which instruction would you be sure to teach the patient? 1) Excessive weight gain or swelling should be reported to the physician. 2) Changing positions rapidly may cause hypotension. 3) A diet with foods low in sodium may be beneficial. 4) Signs of hypoglycemia may occur while taking this drug.

Excessive weight gain or swelling should be reported to the physician.

A patient is admitted to the medical unit with possible Graves disease (hyperthyroidism). Which assessment finding supports this diagnosis? 1) Periorbital diagnosis 2) Bradycardia 3) Exophthalmos 4) Hoarse voice

Exophthalmos

Two UAPs are assisting a patient with Cushing disease to move up in bed. Which action by the UAPs requires your immediate intervention? 1) Positioning themselves on opposite sides of the patient's bed. 2) Grasping under the patient's arms to pull him up in bed. 3) Lowering the side rails of the patient's bed before moving him. 4) Removing the pillow before moving the patient up in bed.

Grasping under the patient's arms to pull him up in bed.

You admit a patient whose assessment reveals prominent brow ridge, large hands and feet, and large lips and nose. Which pituitary hormone do you suspect is elevated? 1) Thyroid-stimulating hormone 2) Growth hormone 3) Adrenocorticotropic hormone 4) Vasopressin antidiuretic hormone

Growth hormone

A patient with pheochromocytoma underwent surgery to remove his adrenal glands. Which nursing intervention should you delegate to a UAP? 1) Revising the nursing care plan to include strategies to provide a calm and restful environment postoperatively. 2) Instructing the patient to avoid smoking and drinking caffeine-containing beverages. 3) Assessing the patient's skin and mucous membranes for signs of adequate hydration. 4) Monitoring lying and standing blood pressure every 4 hours with a cuff placed on the same arm.

Monitoring lying and standing blood pressure every 4 hours with a cuff placed on the same arm.

For a patient with hyperthyroidism, which task will you delegate to an experienced UAP? 1) Instructing the patient to report any occurrence of palpitations, dyspnea, vertigo, or chest pain. 2) Monitoring the apical pulse, blood pressure, and temperature every 4 hours. 3) Drawing blood to measure levels of thyroid-stimulating hormone, triiodothyronine, and thyroxine. 4) Teaching the patient about side effects of the drug proplylthiouracil.

Monitoring the apical pulse, blood pressure, and temperature every 4 hours.

For the patient with pheochromocytoma, which physical assessment technique would you instruct an LPN/LVN to avoid? 1) Listening for abdominal bowel sounds in all four quadrants. 2) Palpating the abdomen in all four quadrants. 3) Checking the blood pressure every hour. 4) Assessing the mucous membranes for hydration status.

Palpating the abdomen in all four quadrants.

A female patient is admitted with a diagnosis of primary hypofunction of the adrenal gland. Which assessment finding supports this diagnosis? 1) Patchy areas of pigment loss over the face. 2) Decreased muscle strength. 3) Greatly increased urine output. 4) Scalp alopecia.

Patchy areas of pigment loss over the face.

You are caring for a patient who has just undergone hypophysectomy for hyperpituitarism. Which postpoperative finding requires immediate intervention? 1) Presence of glucose in the nasal drainage. 2) Presence of nasal packing in the nares. 3) Urine output of 40 to 50 mL/hr. 4) Patient reports of thirst.

Presence of glucose in the nasal drainage.

Which change in vital signs would you instruct the UAP to report immediately for a patient with hyperthyroidism? 1) Rapid heart rate. 2) Decreased systolic blood pressure. 3) Increased respiratory rate. 4) Decreased oral temperature.

Rapid heart rate.

A patient is hospitalized with adrenocortical insufficiency. Which nursing activity should you delegate to a UAP? 1) Reminding the patient to change positions slowly. 2) Assessing the patient for muscle weakness. 3) Teaching the patient how to collect a 24-hour urine sample. 4) Revising the patient's nursing plan of care.

Reminding the patient to change positions slowly.

You are preparing a care plan for a patient with Cushing disease. Which nursing diagnoses would you be sure to include? SELECT ALL THAT APPLY. 1) Risk for Injury related to the potential for bruising 2) Disturbed Body Image 3) Imbalanced Nutrition: Less than Body Requirements 4) Risk for Injury related to the potential for hypertension 5) Risk for Infection

Risk for Injury related to the potential for bruising Disturbed Body Image Risk for Injury related to the potential for hypertension Risk for Infection

You are caring for a patient with hyperthyroidism who had a partial throidectomy yesterday. Which change in assessment would you report to the health care provider immediately? 1) Temperature elevation to 100.2 F 2) Heart rate increase from 64 beats/min to 76 beats/min. 3) Respiratory rate decrease from 26 breaths/min to 16 breaths/min. 4) Pulse oximetry reading of 92%

Temperature elevation to 100.2 F

Which health care provider orders for the patient with Addison disease should you delegate to the experienced UAP? SELECT ALL THAT APPLY. 1) Weigh the patient every morning. 2) Obtain fingerstick glucose before each meal and at bedtime. 3) Check vital signs every 2 hours. 4) Monitor for cardiac dysrhythmias. 5) Administer oral prednisone 10 mg every morning. 6) Record intake and output.

Weigh the patient every morning. Obtain fingerstick glucose before each meal and at bedtime. Check vital signs every 2 hours. Record intake and output.