Nokea
A patient who has diabetes mellitus asks the nurse what the glycosylated hemoglobin (HbA1c) test measures. Which of the following explanations should be the basis of the nurse's response?
- A. Glucose levels 2 hours after a meal
- B. Circulating, non-fasting glucose levels
- C. Glucose control over the past 3 months
- D. Hypoglycemic episodes in the past 90 days
Correct Answer: C
Rationale: Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose testing after a meal or random testing may reveal impaired glucose tolerance and indicate prediabetes, but it is not done on patients who already have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in the past.
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A patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which of the following patient information is most important for the nurse to communicate to the health care provider before the test?
- A. Bilateral poor peripheral vision
- B. Allergies to iodine and shellfish
- C. Recent weight loss of 8.5 kg
- D. History of ongoing headaches
Correct Answer: B
Rationale: Since the usual contrast media is iodine-based, the health care provider will need to know about the allergy before the CT scan. The other findings are common with any mass in the brain such as a pituitary adenoma.
The nurse is caring for a patient who is taking spironolactone. Which of the following parameters should the nurse monitor?
- A. Decreased urinary output
- B. Evidence of fluid overload
- C. Increased serum sodium levels
- D. Elevated serum potassium levels
Correct Answer: D
Rationale: Spironolactone is a diuretic and it blocks aldosterone. Recalling that aldosterone increases the excretion of potassium, a medication that blocks aldosterone will tend to cause hyperkalemia. Aldosterone also promotes the reabsorption of sodium and water in the renal tubules, so spironolactone will tend to cause increased urine output, a decreased or normal serum sodium level, and signs of dehydration.
The student nurse is caring for a patient with goitre and possible hyperthyroidism. Which of the following actions by the student nurse should cause the nursing instructor to intervene?
- A. Palpates the neck to check thyroid size.
- B. Checks the blood pressure on both arms.
- C. Administers nonmedicated eye drops to the patient's eyes.
- D. Lowers the thermostat to decrease the temperature in the room.
Correct Answer: A
Rationale: Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided. The other actions by the student nurse are appropriate when caring for a patient with an enlarged thyroid.
Which of the following information about a patient who is scheduled for an oral glucose tolerance test should be reported to the health care provider before starting the test?
- A. Occasional orthostatic dizziness
- B. A 5 kg weight gain in the last month
- C. Intake of 1 L of water an hour previously
- D. Oral corticosteroid use for rheumatoid arthritis
Correct Answer: D
Rationale: Corticosteroids can affect blood glucose results. The other information will be provided to the provider but will not affect the test results.
The nurse is caring for a patient who has clinical manifestations of hypothyroidism. Which of the following laboratory tests is most accurate to evaluate thyroid function?
- A. Thyroxine (T4) level
- B. Triiodothyronine (T3) level
- C. Thyroid-stimulating hormone (TSH) level
- D. Thyrotropin-releasing hormone (TRH) level
Correct Answer: C
Rationale: The most sensitive and accurate laboratory test is measurement of TSH; thus it is often recommended as a first diagnostic test for evaluation of thyroid function. A low TSH level indicates that the patient's hypothyroidism is caused by decreased anterior pituitary secretion of TSH. Low T4 and T3 levels are not diagnostic of the primary cause of the hypothyroidism. TRH levels indicate the function of the hypothalamus.