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A client with Hashimoto's thyroiditis and a history of two myocardial infarctions and coronary artery disease is to receive levothyroxine (Synthroid). Because of the client's cardiac history, the nurse would expect that the client's initial dose for the thyroid replacement would be which of the following?

  • A. 25 g/day, initially
  • B. Delayed until after thyroid surgery
  • C. 100 g/day, initially
  • D. Initiated before thyroid surgery
Correct Answer: A

Rationale: In a client with a history of two myocardial infarctions and coronary artery disease, initiating levothyroxine therapy with a low starting dose of 25 mcg/day is recommended. Thyroid hormone replacement therapy can potentially worsen underlying cardiac conditions, so a cautious approach is necessary. The dose may be gradually titrated upwards based on thyroid function tests and the client's response. Delaying treatment until after thyroid surgery (option B) is not necessary in this scenario if the client requires thyroid hormone replacement. Initiating levothyroxine before thyroid surgery (option D) is not relevant to the given clinical situation. Starting with a higher dose of 100 mcg/day (option C) may pose a higher risk of cardiac complications in this client with a cardiac history.

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Which of the following is the humoral immune response?

  • A. B cells phagocytise the foreign antigen
  • B. T cells are stimulated by B cells and turn into plasma cells, which produce antibodies or memory cells.
  • C. B cells are stimulated by T helper cells or macrophages and turn into plasma cells, which produce antibodies or memory cells.
  • D. T cells produce antibodies.
Correct Answer: C

Rationale: The humoral immune response involves the activation of B cells, which are stimulated by T helper cells or macrophages. When B cells are activated, they differentiate into plasma cells that produce antibodies specific to the foreign antigen. These antibodies can neutralize pathogens, tag them for destruction by other immune cells, or activate the complement system. In addition to producing antibodies, memory B cells are also generated during this process, providing long-lasting immunity upon re-exposure to the same antigen. This coordinated response is an essential part of the adaptive immune system's defense mechanism against foreign invaders.

Mrs. Zeno continues to become a weaker despite .treatment with neostigmine. Edrophonium HCL is ordered:

  • A. For its synergestic effect
  • B. Because of the client's resistance to
  • C. To rule out cholinergic crisis Neostigmine
  • D. To confirm the diagnosis of myasthenia
Correct Answer: C

Rationale: Edrophonium HCL is ordered to rule out cholinergic crisis caused by possible overdose of neostigmine. In myasthenia gravis, patients are normally given neostigmine to help improve muscle strength by prolonging the effect of acetylcholine at the neuromuscular junction. However, if too much neostigmine is given, it can lead to a cholinergic crisis characterized by excess stimulation at the neuromuscular junction. Edrophonium HCL is a fast-acting drug that can help differentiate between a myasthenic crisis (worsening of symptoms due to under-dosing of anti-cholinesterase medication like neostigmine) and a cholinergic crisis (worsening of symptoms due to over-dosing). By administering edrophonium HCL, the healthcare provider can observe the patient's response and determine if the weakness is due to under-treatment or over-treatment with

A client requires minor surgery for removal of a basal cell tumor. The anesthesiologist administers the anesthetic ketamine hydrochloride (Ketalar), 60g IV. After Ketamine administration, the nurse should monitor the client for:

  • A. Muscle rigidity and spasms
  • B. Hiccups
  • C. Extrapyramidal reactions
  • D. Respiratory depression
Correct Answer: A

Rationale: Ketamine hydrochloride (Ketalar) is a dissociative anesthetic that can cause muscle rigidity and spasms as a side effect. This is known as a dose-dependent reaction to ketamine administration. Monitoring for muscle rigidity and spasms is important to ensure the client's safety and to provide appropriate management if this adverse effect occurs. It is essential for the nurse to closely observe the client for any signs of muscle rigidity and spasms after the administration of ketamine.

A 62-year old client diagnosed with pyelonephritis and possible septicemia has had five urinary tract infections over the past 2 years. She's fatigued from lack of sleep; urinates frequently, even during the night, and has lost weight recently. Tests reveal the following: sodium level 152mEq/L, osmolarity 340mOsm/L, glucose level 125mg/dl, and potassium level of 3.8mEq/L. Which of the following nursing diagnoses is most appropriate for this client?

  • A. Deficient fluid volume related to inability to conserve water
  • B. Imbalanced nutrition: Less than body requirements related to hypermetabolic state
  • C. Deficient fluid volume related to osmotic diuresis induced by hypernatremia
  • D. Imbalanced nutrition: Less than body requirements related to catabolic effects of insulin deficiency
Correct Answer: C

Rationale: The client's elevated sodium level of 152 mEq/L indicates hypernatremia, which can lead to osmotic diuresis, causing excessive urination and subsequent fluid loss. This fluid loss can result in deficient fluid volume. The client's symptoms of frequent urination, fatigue from lack of sleep, and weight loss are indicative of dehydration due to the osmotic diuresis. Therefore, the most appropriate nursing diagnosis for this client is Deficient fluid volume related to osmotic diuresis induced by hypernatremia.

The nurse is caring for a patient receiving warfarin therapy. Which of the following findings is essential to report to the physician?

  • A. Bleeding time 3 (normal = 2-5 sec) c.PTT 29 (normal = 30-45 sec)
  • B. INR 4 (normal = 2-3 sec)
  • C. PT 20 (normal = 9-12 sec)
Correct Answer: B

Rationale: An INR of 4 is higher than the normal therapeutic range for patients receiving warfarin therapy, which is typically between 2-3. An INR value above the therapeutic range indicates that the patient is at an increased risk of bleeding complications. Therefore, it is essential to report this finding to the physician for further evaluation and possible adjustment of the warfarin dosage to prevent excessive bleeding. The other values provided (A and C) are within or close to the normal ranges, so they would not warrant immediate concern compared to the elevated INR level.

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