Nokea
A patient presents with tiredness, weakness, anorexia, apathy, abdominal pain, hyperpigmentation and postural hypertension. Upon infection he appears to be in cardiogenic shock and his blood volume is depleted. His sodium levels are low, potassium levels are high. Which of the following would also be elevated?
- A. TSH
- B. T4
- C. Adrenal hormone
- D. ACTH
Correct Answer: D
Rationale: The correct answer is D: ACTH. In this scenario, the patient is exhibiting symptoms of adrenal insufficiency, specifically Addison's disease. ACTH levels would be elevated due to the lack of negative feedback from cortisol, which is typically low in adrenal insufficiency. TSH (A) and T4 (B) would be normal or low due to the hypofunction of the adrenal gland, not the thyroid. Adrenal hormones (C) would be low in adrenal insufficiency, not elevated.
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For the patient with hyperthyroidism, what intervention should you delegate to the experienced certified nursing assistant?
- A. Instruct the patient to report palpitations, dyspnea, vertigo, or chest pain.
- B. Check the apical pulse, blood pressure, and temperature every 4 hours.
- C. Draw blood for thyroid-stimulating hormone, T3, and T4 levels.
- D. Explain the side effects of propylthiouracil (PTU) to the patient.
Correct Answer: B
Rationale: Checking the apical pulse, blood pressure, and temperature every 4 hours is within the scope of practice for a certified nursing assistant and helps monitor the patient's condition.
Which is a water soluble vitamin?
- A. D
- B. B12
- C. A
- D. K
Correct Answer: B
Rationale: The correct answer is B: B12. Vitamin B12 is water-soluble because it dissolves in water, allowing it to be easily absorbed and transported in the bloodstream. It plays a crucial role in nerve function, red blood cell production, and DNA synthesis. Vitamins D, A, and K are fat-soluble vitamins, meaning they are absorbed along with fats in the diet and are stored in the body's fat tissues. Since they are not water-soluble, they require bile for absorption and are stored in the body for longer periods. Hence, B12 is the only water-soluble vitamin among the given choices.
The “melting of flesh into urine,†an old-timey name, is most descriptive of untreated:
- A. diabetes mellitus.
- B. Addison’s disease.
- C. diabetes insipidus.
- D. Cushing syndrome.
Correct Answer: A
Rationale: The correct answer is A: diabetes mellitus. This term describes the breakdown of body tissues for energy due to lack of insulin, leading to the production of ketones in the urine. In diabetes mellitus, the body cannot use glucose properly, causing the breakdown of fats and proteins. Addison's disease (B) involves adrenal insufficiency, not tissue breakdown. Diabetes insipidus (C) is a disorder of water balance, not tissue breakdown. Cushing syndrome (D) is characterized by excess cortisol production, not tissue breakdown into urine.
You are precepting a nurse who has recently graduated and passed the NCLEX examination. The new nurse has been on the unit for only 2 days. Which patient should you assign to the new nurse?
- A. A 68-year-old diabetic who is experiencing signs of hyperglycemia including rapid, deep breathing and mental status changes
- B. A 58-year-old diabetic with peripheral neuropathy and cellulitis of the left ankle
- C. A 49-year-old diabetic who has just returned from post-anesthesia care unit (PACU) after a below-the-knee amputation (BKA)
- D. A 72-year-old diabetic with diabetic ketoacidosis (DKA) on an IV insulin drip
Correct Answer: B
Rationale: The 58-year-old diabetic with peripheral neuropathy and cellulitis is a stable patient, and this case provides an opportunity for the new nurse to practice assessment and care management.
All the following adverse effects can be produced by beta-blockers EXCEPT:
- A. Hypotension
- B. Heart failure
- C. Bronchodilation
- D. Heart block
Correct Answer: C
Rationale: The correct answer is C: Bronchodilation. Beta-blockers primarily work by blocking the beta-adrenergic receptors, leading to a decrease in heart rate and contractility. This can result in adverse effects such as hypotension, heart failure, and heart block due to the reduced cardiac output. However, bronchodilation is not a typical adverse effect of beta-blockers. In fact, beta-blockers can cause bronchoconstriction in patients with underlying respiratory conditions like asthma, making choice C the correct answer. Choices A, B, and D are incorrect because hypotension, heart failure, and heart block are known adverse effects associated with beta-blockers due to their mechanism of action on the cardiovascular system.