Nokea
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.
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The nurse is caring for a patient with a diagnosis of Cushing's syndrome. Which of the following data should the nurse anticipate finding during the admission assessment?
- A. Persistently low blood pressure
- B. Bronzed appearance of the skin
- C. Decreased axillary and pubic hair
- D. Purplish red streaks on the abdomen
Correct Answer: D
Rationale: Purplish-red striae on the abdomen are a common clinical manifestation of Cushing's syndrome. Hypotension and bronzed-appearing skin are manifestations of Addison's disease. Decreased axillary and pubic hair occur with androgen deficiency.
The nurse is admitting a patient to the hospital who is in an Addisonian crisis. Which of the following patient statements support the nursing diagnosis of ineffective self-health management related to lack of knowledge about management of Addison's disease?
- A. I double my dose of hydrocortisone on the days that I go for a run.
- B. I frequently eat at restaurants, and so my food has a lot of added salt.
- C. I had the stomach flu earlier this week and couldn't take the hydrocortisone.
- D. I take twice as much hydrocortisone in the morning as I do in the afternoon.
Correct Answer: C
Rationale: The need for hydrocortisone replacement is increased with stressors such as illness, and the patient needs to be taught to call the health care provider because medication and IV fluids and electrolytes may need to be given. The other patient statements indicate appropriate management of the Addison's disease.
Which of the following information should the nurse include when teaching a patient about use of somatropin?
- A. The medication will improve vaginal dryness.
- B. Inject the medication subcutaneously every day.
- C. Blood glucose levels will decrease when taking the medication.
- D. Stop taking the medication if swelling of the hands or feet occurs.
Correct Answer: B
Rationale: Somatropin is injected subcutaneously on a daily basis, preferably in the evening. The patient will need to continue on somatropin for life. If swelling or other adverse effects occur, the health care provider should be notified. Growth hormone will increase blood glucose levels.
Which of the following assessment findings for a patient admitted with Graves' disease requires the most rapid intervention by the nurse?
- A. BP 166/100 mm Hg
- B. Bilateral exophthalmos
- C. Heart rate 136 beats/minute
- D. Temperature 40.4°C (104.7°F)
Correct Answer: D
Rationale: The patient's temperature indicates that the patient may have thyrotoxic crisis and that interventions to lower the temperature are needed immediately. The other findings also require intervention but do not indicate potentially life-threatening complications.
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.