Nokea
A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a documented history of adrenal insufficiency. Considering the patients history and current symptoms, the nurse should anticipate that the patient will be instructed to do which of the following?
- A. Increase his intake of sodium until the GI symptoms improve
- B. Increase his intake of potassium until the GI symptoms improve
- C. Increase his intake of glucose until the GI symptoms improve
- D. Increase his intake of calcium until the GI symptoms improve
Correct Answer: A
Rationale: The patient will need to supplement dietary intake with added salt during episodes of GI losses of fluid through vomiting and diarrhea to prevent the onset of addisonian crisis. While the patient may experience the loss of other electrolytes, the major concern is the replacement of lost sodium.
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A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal?
- A. Hyponatremia
- B. Hypophosphatemia
- C. Hypocalcemia
- D. Hypokalemia
Correct Answer: C
Rationale: Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as tetany and must be reported to the physician immediately, because laryngospasm may occur and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not expected responses to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may lead to hyperphosphatemia.
The nurse is providing care for an older adult patient whose current medication regimen includes levothyroxine (Synthroid). As a result, the nurse should be aware of the heightened risk of adverse effects when administering an IV dose of what medication?
- A. A fluoroquinalone antibiotic
- B. A loop diuretic
- C. A proton pump inhibitor (PPI)
- D. A benzodiazepine
Correct Answer: D
Rationale: Oral thyroid hormones interact with many other medications. Even in small IV doses, hypnotic and sedative agents may induce profound somnolence, lasting far longer than anticipated and leading to narcosis (stupor like condition). Furthermore, they are likely to cause respiratory depression, which can easily be fatal because of decreased respiratory reserve and alveolar hypoventilation. Antibiotics, PPIs and diuretics do not cause the same risk.
What should the nurse teach a patient on corticosteroid therapy in order to reduce the patients risk of adrenal insufficiency?
- A. Take the medication late in the day to mimic the bodys natural rhythms
- B. Always have enough medication on hand to avoid running out
- C. Skip up to 2 doses in cases of illness involving nausea
- D. Take up to 1 extra dose per day during times of stress
Correct Answer: B
Rationale: The patient and family should be informed that acute adrenal insufficiency and underlying symptoms will recur if corticosteroid therapy is stopped abruptly without medical supervision. The patient should be instructed to have an adequate supply of the corticosteroid medication always available to avoid running out. Doses should not be skipped or added without explicit instructions to do so. Corticosteroids should normally be taken in the morning to mimic natural rhythms.
The nurse is planning the care of a patient with hyperthyroidism. What should the nurse specify in the patients meal plan?
- A. A clear liquid diet, high in nutrients
- B. Small, frequent meals, high in protein and calories
- C. Three large, bland meals a day
- D. A diet high in fiber and plant-sourced fat
Correct Answer: B
Rationale: A patient with hyperthyroidism has an increased appetite. The patient should be counseled to consume several small, well-balanced meals. High-calorie, high-protein foods are encouraged. A clear liquid diet would not satisfy the patients caloric or hunger needs. A diet rich in fiber and fat should be avoided because these foods may lead to GI upset or increase peristalsis.
The nurse is caring for a patient at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the patient? Select all that apply.
- A. Epistaxis
- B. Pallor
- C. Rapid respiratory rate
- D. Bounding pulse
- E. Hypotension
Correct Answer: B,C,E
Rationale: The patient at risk is monitored for signs and symptoms indicative of addisonian crisis, which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness. Epistaxis and a bounding pulse are not symptoms or signs of an addisonian crisis.