Nokea
A nurse evaluates the following laboratory results for a client who has hypoparathyroidism: Calcium 7.2 mg/dL, Sodium 144 mEq/L, Magnesium 1.2 mEq/L, Potassium 5.7 mEq/L. Based on these results, which medications should the nurse anticipate administering?
- A. Oral potassium chloride
- B. Intravenous calcium chloride
- C. 50% normal saline IV solution
- D. 50% magnesium sulfate
- E. Oral calcitriol (Rocaltrol)
Correct Answer: B,D
Rationale: The client has hypocalcemia (calcium 7.2 mg/dL) and hypomagnesemia (magnesium 1.2 mEq/L), requiring intravenous calcium chloride and magnesium sulfate. Potassium is elevated, so potassium chloride is not needed. Sodium is normal, so saline is unnecessary, and no vitamin D deficiency is indicated.
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After teaching a client who is recovering from a complete thyroidectomy, the nurse assesses the client's understanding. Which statement by the client indicates a need for additional instruction?
- A. I may need calcium replacement after surgery
- B. After surgery, I won't need to take thyroid medication
- C. I will need to take thyroid hormones for the rest of my life
- D. I can receive pain medication if I feel that I need it
Correct Answer: B
Rationale: After a complete thyroidectomy, clients require lifelong thyroid hormone replacement due to the removal of the thyroid gland. The statement indicating no need for thyroid medication is incorrect and requires further teaching.
A nurse cares for a client who has hypothyroidism as a result of Hashimoto's thyroiditis. The client asks, 'How long will I need to take this thyroid medication?' How should the nurse respond?
- A. You will need to take this thyroid medication until the goiter is completely gone
- B. Thyroiditis is cured with antibodies. Then you won't need thyroid medication
- C. You'll need thyroid pills for life because your thyroid won't start working again
- D. When blood cell count is 6000 cells/mm³, you can stop the medication
Correct Answer: C
Rationale: Hashimoto's thyroiditis causes permanent thyroid damage, requiring lifelong thyroid hormone replacement. The goiter may not resolve completely, antibodies do not cure thyroiditis, and blood cell count is unrelated to thyroid medication needs.
A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the second postoperative day the client states, 'I feel numbness and tingling around my mouth.' What action should the nurse take?
- A. Offer mouth care
- B. Loosen the dressing
- C. Assess for Chvostek's sign
- D. Ask the client orientation questions
Correct Answer: C
Rationale: Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which could progress to cause tetany and seizure activity. The nurse should assess for Chvostek's sign and Trousseau's sign to confirm hypocalcemia and notify the provider.
A nurse plans care for a client with hyperparathyroidism. Which intervention should the nurse include in this client's plan of care?
- A. Ask the client to ambulate in the hallway twice a day
- B. Use a lift sheet to assist the client with position changes
- C. Provide the client with a soft-bristled toothbrush for oral care
- D. Instruct the unlicensed assistive personnel to strain the client's urine for stones
Correct Answer: B
Rationale: Hyperparathyroidism increases calcium resorption from bones, raising the risk of pathologic fractures. Using a lift sheet reduces the risk of bone injury during movement. Ambulation and oral care are not specific to this condition, and not all clients require urine straining.
A nurse assesses a client who is prescribed thyroid hormone replacement. Which finding indicates a therapeutic response to the medication?
- A. Thirst is recognized and fluid intake is appropriate
- B. Weight has been the same for 3 weeks
- C. Total white blood cell count is 6000 cells/mm³
- D. Heart rate is 70 beats/min and regular
Correct Answer: D
Rationale: Hypothyroidism decreases body functioning, leading to effects like bradycardia. A heart rate of 70 beats/min and regular while on thyroid hormone replacement indicates adequate dosing. Thirst, fluid intake, weight stability, and white blood cell count are not direct indicators of therapeutic response.