Nokea
A client with Cushing's disease tells the nurse that the physician said the morning serum cortisol level was within normal limits. The client asks, 'How can that be? I'm not imagining all these symptoms!' The nurse's response will be based on which of the following?
- A. Some clients are very sensitive to the effects of cortisol and develop symptoms even with normal levels.'
- B. A single random blood test cannot provide reliable information about endocrine levels.'
- C. The excessive cortisol levels seen in Cushing's disease commonly result from loss of the normal diurnal secretion pattern.'
- D. Tumors tend to secrete hormones irregularly, and the hormones are generally not present in the blood.'
Correct Answer: C
Rationale: Cushing's disease disrupts the normal diurnal cortisol rhythm, leading to consistently high levels, which may not be captured in a single morning test.
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A client post-lithotripsy asks about expected symptoms. The nurse should explain:
- A. Bruising at the site.
- B. Severe flank pain.
- C. Clear urine output.
- D. Fever above 102°F.
Correct Answer: A
Rationale: Bruising is common post-lithotripsy due to shock wave impact on tissues.
The nurse is caring for a client experiencing acute mountain sickness (AMS). The nurse anticipates a prescription for which medication?
- A. Sodium bicarbonate
- B. Acetazolamide
- C. Tamsulosin
- D. Dutasteride
Correct Answer: B
Rationale: Acetazolamide promotes acclimatization by inducing bicarbonate diuresis, alleviating AMS symptoms. Sodium bicarbonate (A) is used for acidosis, tamsulosin (C) for prostate issues, and dutasteride (D) for benign prostatic hyperplasia, none of which treat AMS.
The client has a latex allergy. What should the nurse teach the client to do before having surgery at a free-standing surgery center? Select all that apply.
- A. Determine that there will be a latex-safe environment for surgery.
- B. Report symptoms experienced with the latex allergy (e.g., rhinitis, conjunctivitis, flushing).
- C. Notify the health care providers at the surgery center.
- D. Wear a stainless steel medical alert bracelet into the surgical suite.
- E. Ask to have the surgery at a hospital.
Correct Answer: A,B,C
Rationale: Treatment and diagnostic evaluation must be done in a latex-safe environment. Signs/symptoms may be mild to anaphylaxis. Clients with latex allergy are advised to notify their health care providers and to wear a medical ID; however, all metal and jewelry must be removed prior to surgery as they could conduct an electrical current.
The client with glaucoma is scheduled for a hip replacement. Which of the following orders would require clarification before the nurse carries it out?
- A. Administer morphine sulfate.
- B. Administer atropine sulfate.
- C. Teach deep-breathing exercises.
- D. Teach leg lifts and muscle-setting exercises.
Correct Answer: B
Rationale: Atropine sulfate can increase intraocular pressure, which is contraindicated in glaucoma. The nurse should clarify this order to ensure it is safe for the client.
A client with uric acid stones is prescribed a low-purine diet. Which food is allowed?
- A. Liver.
- B. Chicken.
- C. Apples.
- D. Sardines.
Correct Answer: C
Rationale: Apples are low in purines, suitable for a uric acid stone diet.