Nokea
A client has been diagnosed with nephrogenic diabetes insipidus (DI), and the physician is initiating treatment. What medication does the nurse prepare to administer for this client?
- A. Metolazone
- B. Bumetanide
- C. Furosemide
- D. Hydrochlorothiazide
Correct Answer: D
Rationale: The physician prescribes a thiazide diuretic, such as hydrochlorothiazide. The thiazide acts at the proximal convoluted tubule, leaving less fluid for excretion in the distal convoluted tubules, the portion affected by nephrogenic diabetes insipidus (DI). Consequently, the client excretes water, but the total volume is less than in an untreated state. The other diuretics listed do not work on the proximal convoluted tubule and would not be effective in treatment.
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What would the nurse expect the health care provider to order for a client with hypothyroidism?
- A. Levothyroxine sodium
- B. Methimazole
- C. Propranolol
- D. Propylthiouracil
Correct Answer: A
Rationale: Hypothyroidism is treated with thyroid replacement therapy, in the form of desiccated thyroid extract or a synthetic product, such as levothyroxine sodium (Synthroid) or liothyronine sodium (Cytomel). Methimazole and propylthiouracil are antithyroid agents used to treat hyperthyroidism. Propranolol is a beta blocker that can be used to treat hyperthyroidism.
An adult client has been diagnosed with a rare disorder, Simmonds disease (panhypopituitarism), and placed on hormone replacements. What is important for the nurse to educate the client about regarding the medication?
- A. The medication must be taken as ordered until surgery is scheduled to remove the tumor.
- B. Thyroid medication will be administered for the duration of the client's life.
- C. Adhere to the medication schedule and never omit a dose.
- D. The client must take growth hormone for the duration of his life.
Correct Answer: C
Rationale: Teaching the client to adhere to the medication schedule and never to omit a dose is important. The client will have destruction of the pituitary gland so removal will be unnecessary. More than just thyroid medication will be taken. Growth hormone is only administered to children, not adult clients.
A client is suspected of having acromegaly. What definitive diagnostic testing is the most reliable method of confirming acromegaly?
- A. A serum glucose level
- B. Glucose tolerance test in combination with a GH measurement
- C. Growth hormone levels
- D. Bone radiographs
Correct Answer: B
Rationale: A glucose tolerance test in combination with a GH measurement is the most reliable method of confirming acromegaly. Ingestion of a bolus of glucose should lower GH levels, but GH levels remain elevated in persons with acromegaly. Increased blood levels of IGF-1 can also indicate acromegaly in nonpregnant women, they typically have IGF-1 levels two to three times higher than normal in pregnant women. A serum glucose level is not an indicator of acromegaly. Growth hormone levels and bone radiographs may support the diagnosis but are not reliable indicators.
A client with acromegaly is complaining of severe headaches. What does the nurse suspect is the cause of the headaches that is related to the acromegaly?
- A. A pituitary tumor
- B. A decrease in release in the growth hormone
- C. A decrease in the glucose level
- D. An increase in cerebral edema
Correct Answer: A
Rationale: When the overgrowth is from a tumor, headaches caused by pressure on the sella turcica, a bony depression in which the pituitary gland rests, are common. There is actually an increase in the secretion of the growth hormone. The headaches would not be caused by decreases in glucose levels. The client does not have cerebral edema.
The nurse is caring for a client with hypoparathyroidism. When the nurse taps the client's facial nerve, the client's mouth twitches and the jaw tightens. What is this response documented as related to the low calcium levels?
- A. Positive Chvostek sign
- B. Positive Trousseau sign
- C. Positive paresthesia
- D. Positive Babinski sign
Correct Answer: A
Rationale: If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek sign. A positive Trousseau sign is elicited by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Positive Babinski sign is elicited by stroking the sole of the foot. Paresthesia is not a symptom that can be elicited; it is felt by the client.