Nokea
A few hours after returning to the surgical nursing unit, a patient who has undergone a subtotal thyroidectomy develops laryngeal stridor and a cramp in the right hand. Which of the following actions should the nurse anticipate implementing first?
- A. Infuse IV calcium gluconate.
- B. Suction the patient's airway.
- C. Prepare for endotracheal intubation.
- D. Assist with emergency tracheotomy
Correct Answer: A
Rationale: The patient's clinical manifestations of stridor and cramping are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery. Endotracheal intubation or tracheotomy may be needed if the calcium does not resolve the stridor. Suctioning will not correct the stridor.
You may also like to solve these questions
The nurse is providing preoperative teaching for a patient scheduled for a hypophysectomy for treatment of a pituitary adenoma. Which of the following instructions should the nurse include in patient teaching?
- A. Cough and deep breathe every 2 hours postoperatively
- B. Bed rest for the first 24 hours after the surgery
- C. Be positioned flat with sandbags at the head postoperatively
- D. Have a NG tube after the surgery
Correct Answer: D
Rationale: The patient should be taught that they will have a NG tube after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is discouraged because it may cause leakage of cerebrospinal fluid (CSF) from the suture line. The head of the bed should be elevated 30 degrees to reduce pressure on the sella turcica and decrease the risk for headaches.
Which of the following findings for a patient who takes levothyroxine to treat hypothyroidism indicates that the nurse should contact the health care provider before administering the medication?
- A. Increased thyroxine (T4) level
- B. Blood pressure 102/62 mm Hg
- C. Distant and difficult to hear heart sounds
- D. Elevated thyroid stimulating hormone level
Correct Answer: A
Rationale: An increased thyroxine level indicates the levothyroxine dose needs to be decreased. The other data are consistent with hypothyroidism and the nurse should administer the Synthroid.
The nurse is caring for a patient who has an adrenocortical adenoma and hyperaldosteronism. Which of the following actions should the nurse implement?
- A. Provide a potassium-restricted diet.
- B. Monitor the blood pressure every 4 hours.
- C. Evaluate blood glucose level every 4 hours.
- D. Maintain extremities in an elevated position.
Correct Answer: B
Rationale: Hypertension caused by sodium retention is a common complication of hyperaldosteronism. Hyperaldosteronism does not cause elevation in blood glucose. The patient will be hypokalemic and require potassium supplementation before surgery. Edema does not usually occur with hyperaldosteronism.
Which of the following information should the nurse include when teaching a patient who has been newly diagnosed with Graves' disease?
- A. Exercise is contraindicated to avoid increasing metabolic rate.
- B. Restriction of iodine intake is needed to reduce thyroid activity.
- C. Surgery will eventually be required to remove the thyroid gland.
- D. Antithyroid medications may take several weeks to have an effect.
Correct Answer: D
Rationale: Medications used to block the synthesis of thyroid hormones may take several weeks before an effect is seen. Large doses of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large muscle groups is encouraged to decrease the irritability and hyperactivity associated with high levels of thyroid hormones. Radioactive iodine is the most common treatment for Graves' disease although surgery may be used.
A patient is being treated with a medication to block the effect of antidiuretic hormone to control the symptoms of syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following findings indicates that the medication is effective?
- A. Decreased peripheral edema
- B. Increased weight
- C. Increased urine specific gravity
- D. Increased urinary output
Correct Answer: D
Rationale: Agents that block the effect of ADH on the renal tubules may be prescribed, thereby allowing more dilution of urine leading to an increased urine output. An increase in weight or an increase in urine specific gravity indicates that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden weight gain without edema is a common clinical manifestation of this disorder.