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A client with Addison's disease is being treated with fludrocortisone (Florinef). Which electrolyte imbalance should the nurse monitor for?
- A. Hyperkalemia.
- B. Hyponatremia.
- C. Hypernatremia.
- D. Hypocalcemia.
Correct Answer: C
Rationale: The correct answer is C: Hypernatremia. Fludrocortisone is a mineralocorticoid that promotes sodium retention and potassium excretion, leading to an increase in sodium levels. Addison's disease involves low levels of cortisol and aldosterone, so fludrocortisone is used to replace aldosterone. Monitoring for hypernatremia is crucial to prevent complications like hypertension and fluid retention. Hyperkalemia (A) is not expected due to the drug's potassium-excreting effect. Hyponatremia (B) is unlikely as the drug promotes sodium retention. Hypocalcemia (D) is not directly related to fludrocortisone therapy.
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A client with a history of chronic heart failure is experiencing severe shortness of breath and has pink, frothy sputum. Which action should the nurse take first?
- A. Administer morphine sulfate.
- B. Place the client in a high Fowler's position.
- C. Initiate continuous ECG monitoring.
- D. Prepare the client for intubation.
Correct Answer: B
Rationale: The correct action for the nurse to take first is to place the client in a high Fowler's position (Choice B). This position helps improve lung expansion and oxygenation by reducing pressure on the diaphragm and improving ventilation. With severe shortness of breath and pink, frothy sputum, the priority is to optimize respiratory function. Administering morphine sulfate (Choice A) may be indicated later for pain and anxiety but is not the immediate priority. Initiating continuous ECG monitoring (Choice C) is important but not as urgent as addressing the respiratory distress. Preparing the client for intubation (Choice D) should be considered if respiratory distress worsens, but initial interventions should focus on improving oxygenation through positioning.
The healthcare provider is assessing a client with chronic obstructive pulmonary disease (COPD). Which finding should the provider expect?
- A. Increased anteroposterior chest diameter.
- B. Decreased respiratory rate.
- C. Dull percussion sounds over the lungs.
- D. Hyperresonance on chest percussion.
Correct Answer: A
Rationale: The correct answer is A: Increased anteroposterior chest diameter. In COPD, the chronic airway obstruction leads to air trapping, causing the chest to become hyperinflated. This results in an increase in the anteroposterior chest diameter, often referred to as "barrel chest."
Explanation for why other choices are incorrect:
B: Decreased respiratory rate is not typically seen in COPD; patients often exhibit an increased respiratory rate due to difficulty breathing.
C: Dull percussion sounds over the lungs are associated with conditions like pneumonia or pleural effusion, not COPD.
D: Hyperresonance on chest percussion is typically found in conditions like emphysema, a type of COPD, but it is not specific to COPD as a whole.
The healthcare provider is assessing a client with Cushing's syndrome. Which clinical manifestation should the healthcare provider expect to find?
- A. Hyperpigmentation of the skin.
- B. Hypotension.
- C. Moon face and buffalo hump.
- D. Weight loss.
Correct Answer: C
Rationale: The correct answer is C: Moon face and buffalo hump. In Cushing's syndrome, excessive cortisol production leads to characteristic symptoms like moon face (round, puffy face) and buffalo hump (fat accumulation at the back of the neck). This is due to redistribution of fat in the body. Hyperpigmentation (choice A) is seen in Addison's disease, not Cushing's. Hypotension (choice B) is unlikely due to the cortisol-induced sodium retention. Weight loss (choice D) is less common in Cushing's due to the metabolic changes causing weight gain.
A client with heart failure is prescribed digoxin (Lanoxin). Which sign of digoxin toxicity should the nurse teach the client to report?
- A. Increased appetite.
- B. Yellow or blurred vision.
- C. Weight gain.
- D. Nasal congestion.
Correct Answer: B
Rationale: The correct answer is B: Yellow or blurred vision. Digoxin toxicity can lead to visual disturbances, such as yellow or blurred vision, due to its effects on the optic nerve. The nurse should teach the client to report this symptom immediately as it indicates a serious adverse effect. Increased appetite (A), weight gain (C), and nasal congestion (D) are not specific signs of digoxin toxicity and are more commonly associated with other health conditions or side effects of medications. It is crucial for the nurse to emphasize the importance of monitoring and reporting any visual changes to prevent serious complications from digoxin toxicity.
A client with chronic renal failure is prescribed epoetin alfa (Epogen). Which outcome indicates that the medication is effective?
- A. Increased urine output.
- B. Decreased blood pressure.
- C. Improved hemoglobin levels.
- D. Stable potassium levels.
Correct Answer: C
Rationale: The correct answer is C: Improved hemoglobin levels. Epoetin alfa is a medication used to treat anemia in patients with chronic renal failure by stimulating red blood cell production. Improved hemoglobin levels indicate that the medication is effective in addressing the anemia associated with renal failure. Increased urine output (A) is not a direct outcome of epoetin alfa therapy. Decreased blood pressure (B) and stable potassium levels (D) are not specific indicators of the medication's effectiveness in treating anemia.