Hesi Quiz 2 Questions

24. A client is scheduled for an adrenalectomy. Which nursing intervention should the nurse anticipate will be prescribed for this client? 1 Administer intravenous (IV) steroids. 2 Provide a high-protein diet. 3 Collect a 24-hour urine specimen. 4 Withhold all medications for 48 hours.

1 Administer intravenous (IV) steroids. Steroid therapy usually is instituted preoperatively and continued intraoperatively to prepare for the acute adrenal insufficiency that follows surgery. The diet must supply ample, not high, protein and potassium; however, it must be low in calories, carbohydrates, and sodium to promote weight loss and reduce fluid retention. A 24-hour urine specimen is unnecessary. Glucocorticoids must be administered preoperatively to prevent adrenal insufficiency during surgery.

25. A client admitted to the hospital in the oliguric phase of acute renal failure estimates that the urine output for the last 12 hours was less than 240 mL. The nurse reviews the plan of care and notes a prescription for 900 mL of water to be given orally over the next 24 hours. The nurse concludes that this amount of fluid was prescribed to: 1 Equal the expected urinary output for the next 24 hours 2 Prevent the development of hypostatic pneumonia and fever 3 Compensate for both insensible and expected output over the next 24 hours 4 Prevent hyperkalemia, which can lead to life-threatening cardiac dysrhythmias

3 Compensate for both insensible and expected output over the next 24 hours Insensible losses are 400 to 500 mL in 24 hours; the measured output is about 400 mL in 24 hours based on the available history. Based on the history, the expected urinary output should be about 400 mL in the next 24 hours, far less than 900 mL. At least 2500 mL daily is necessary to help prevent hypostatic pneumonia and its associated fever. Hyperkalemia in acute renal failure is caused by inadequate glomerular filtration and is not related to fluid intake.

23. A client is scheduled for a bilateral adrenalectomy. Before surgery, steroids are administered to the client. What does the nurse determine is the reason for the steroids? 1 Foster accumulation of glycogen in the liver 2 Increase the inflammatory action to promote scar formation 3 Facilitate urinary excretion of salt and water following surgery 4 Compensate for sudden lack of these hormones following surgery

4 Compensate for sudden lack of these hormones following surgery Adrenal steroids help an individual adjust to stress. Unless received from external sources, there is no hormone available to cope with surgical stresses after an adrenalectomy. Glucose stores (glycogen) will be used by the body to adapt to surgery. Insulin is the hormone that facilitates conversion of glucose to glycogen. Steroids do not increase inflammatory reactions. Steroids will result in fluid retention, not loss.