Nokea
The nurse determined that the client's fluid volume deficit from HHNS has resolved. Which serum laboratory finding led to the nurse's conclusion?
- A. Decreased glucose
- B. Decreased sodium
- C. Decreased osmolality
- D. Decreased potassium
Correct Answer: C
Rationale: A normalizing of the serum osmolality indicates that the fluid volume deficit is resolving.
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Which monitoring approach is best for the nurse to recommend?
- A. Using the urine with a chemical reagent strip
- B. Using a glucometer to check capillary blood glucose levels
- C. Having laboratory personnel draw venous blood samples
- D. Arranging for testing by a home health agency nurse
Correct Answer: B
Rationale: A glucometer provides accurate, real-time blood glucose levels for effective diabetes management.
The client is diagnosed with hypothyroidism. Which signs/symptoms should the nurse expect the client to exhibit?
- A. Complaints of extreme fatigue and hair loss.
- B. Exophthalmos and complaints of nervousness.
- C. Complaints of profuse sweating and flushed skin.
- D. Tetany and complaints of stiffness of the hands.
Correct Answer: A
Rationale: Hypothyroidism causes fatigue and hair loss due to slowed metabolism. Exophthalmos/nervousness (hyperthyroidism), sweating, and tetany are unrelated.
A woman with a tumor of the adrenal cortex says to the nurse, 'Will I always look this ugly? I hate having a beard.' What is the best response for the nurse to make?
- A. After surgery, you will not develop any more symptoms, but the changes you have now will linger.'
- B. That varies from person to person. You should ask your physician.'
- C. After surgery, your appearance should gradually return to normal.'
- D. Electrolysis and plastic surgery should make your appearance normal.'
Correct Answer: C
Rationale: Post-adrenalectomy, hormonal imbalances causing symptoms like hirsutism should resolve, gradually normalizing appearance.
The nurse is preparing to discharge the client following a unilateral adrenalectomy to treat hyperaldosteronism caused by an adenoma. Which instruction should be included in this client's discharge teaching?
- A. Avoid foods high in potassium
- B. Self-monitor blood pressure daily
- C. Stop drugs taken before adrenalectomy
- D. Carry epinephrine for emergency use
Correct Answer: B
Rationale: Self-monitoring BP is necessary as hypertension may persist in 20% of clients post-adrenalectomy.
Which nursing care measure is essential because a client has exophthalmos?
- A. Administer artificial tears.
- B. Encourage the client to wear her glasses.
- C. Promote bed rest.
- D. Monitor her pulse rate every four hours.
Correct Answer: A
Rationale: Exophthalmos (bulging eyes) in hyperthyroidism causes dry eyes, requiring artificial tears to prevent corneal damage.