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A client with hyperaldosteronism is being treated with spironolactone (Aldactone) before surgery. Which precautions does the nurse teach this client?
- A. Read the label before using salt substitutes
- B. Do not add salt to your food when you eat
- C. Avoid exposure to sunlight
- D. Take Tylenol instead of aspirin for pain
Correct Answer: A
Rationale: Spironolactone is a potassium-sparing diuretic used to control potassium levels in hyperaldosteronism. Excessive potassium intake, such as from potassium chloride-based salt substitutes, can lead to hyperkalemia, a serious complication. Clients should read labels to avoid such substitutes.
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A nurse plans care for a client with a growth hormone deficiency. Which action should the nurse include in this client's plan of care?
- A. A 36-year-old female who has used oral contraceptives for 5 years
- B. A 42-year-old male who experienced head trauma 3 years ago
- C. A 35-year-old female with hormone delivery to mellitus and iodine
- D. A 64-year-old male with adult-onset diabetes mellitus
Correct Answer: B
Rationale: Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction. The other factors do not increase the risk of this condition. For care planning, identifying the client with a history of head trauma as high risk guides appropriate interventions.
A nurse is caring for a client who was prescribed high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition. The client's symptoms have now resolved and the client asks, 'When can I stop taking these medications?' How should the nurse respond?
- A. It is possible for the inflammation to recur if you stop the medication
- B. Once you start corticosteroids, you have to be weaned off them
- C. You have to decrease the dose slowly so your hormones will work again
- D. The drug suppresses your immune system, which must be built back up
Correct Answer: B
Rationale: One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone and adrenal production of cortisol.
A nurse assesses a client who is recovering from a transsphenoidal hypophysectomy. The nurse notes nuchal rigidity. Which action should the nurse take first?
- A. I will no longer need to limit my fluid intake after surgery
- B. Document the finding and monitor the client
- C. Take vital signs, including temperature
- D. I will wear slip-on shoes after surgery to limit bending over
Correct Answer: C
Rationale: Nuchal rigidity may indicate a complication such as meningitis or cerebrospinal fluid leak following transsphenoidal hypophysectomy. Taking vital signs, including temperature, is the priority to assess for signs of infection or other systemic issues that require immediate intervention.
A nurse cares for a client with adrenal hyperfunction. The client screams at her husband, bursts into tears, and throws a pitcher against the wall. She then tells the nurse, 'I feel like I am going crazy.' How should the nurse respond?
- A. I will ask your doctor to order a psychiatric consult for you
- B. Your behavior is a result of your condition and will improve with treatment
- C. I will close the door to your room and restrict visitors
Correct Answer: B
Rationale: Hypercortisolism can cause the client to exhibit neurotic to psychotic behavior due to elevated cortisol levels. The client needs to understand that this behavior is a result线�1:27 PM 7/1/2025 result of their condition and will improve with treatment. A psychiatric consult, support groups, or restricted visitors are not necessary at this time.
A nurse cares for a client with a growth hormone deficiency. Which action should the nurse include in this client's plan of care?
- A. Avoid intramuscular medication
- B. Place the client in protective isolation
- C. Use a lift sheet to re-position the client
- D. Monitor growth hormone levels regularly
Correct Answer: C
Rationale: Clients with growth hormone deficiency may have weakened bones due to reduced bone density. Using a lift sheet to reposition the client minimizes the risk of fractures or injury during movement, which is a priority in care planning.