Nokea
A patient with a recent diagnosis of hypothyroidism is being treated for an unrelated injury. When administering medications to the patient, the nurse should know that the patients diminished thyroid function may have what effect?
- A. Anaphylaxis
- B. Nausea and vomiting
- C. Increased risk of drug interactions
- D. Prolonged duration of effect
Correct Answer: D
Rationale: In all patients with hypothyroidism, the effects of analgesic agents, sedatives, and anesthetic agents are prolonged. There is no direct increase in the risk of anaphylaxis, nausea, or drug interactions, although these may potentially result from the prolonged half-life of drugs.
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A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding?
- A. Glucose in the urine
- B. Albumin in the urine
- C. Highly dilute urine
- D. Leukocytes in the urine
Correct Answer: C
Rationale: Patients with diabetes insipidus produce an enormous daily output of very dilute, water-like urine with a specific gravity of 1.001 to 1.005. The urine contains no abnormal substances such as glucose or albumin. Leukocytes in the urine are not related to the condition of diabetes insipidus, but would indicate a urinary tract infection, if present in the urine.
A patient on corticosteroid therapy needs to be taught that a course of corticosteroids of 2 weeks duration can suppress the adrenal cortex for how long?
- A. Up to 4 weeks
- B. Up to 3 months
- C. Up to 9 months
- D. Up to 1 year
Correct Answer: D
Rationale: Suppression of the adrenal cortex may persist up to 1 year after a course of corticosteroids of only 2 weeks duration.
While assisting with the surgical removal of an adrenal tumor, the OR nurse is aware that the patients vital signs may change upon manipulation of the tumor. What vital sign changes would the nurse expect to see?
- A. Hyperthermia and tachypnea
- B. Hypertension and heart rate changes
- C. Hypotension and hypothermia
- D. Hyperthermia and bradycardia
Correct Answer: B
Rationale: Manipulation of the tumor during surgical excision may cause release of stored epinephrine and norepinephrine, with marked increases in BP and changes in heart rate. The use of sodium nitroprusside and alpha-adrenergic blocking agents may be required during and after surgery. While other vital sign changes may occur related to surgical complications, the most common changes are related to hypertension and changes in the heart rate.
Following an addisonian crisis, a patients adrenal function has been gradually regained. The nurse should ensure that the patient knows about the need for supplementary glucocorticoid therapy in which of the following circumstances?
- A. Episodes of high psychosocial stress
- B. Periods of dehydration
- C. Episodes of physical exertion
- D. Administration of a vaccine
Correct Answer: A
Rationale: During stressful procedures or significant illnesses, additional supplementary therapy with glucocorticoids is required to prevent addisonian crisis. Physical activity, dehydration and vaccine administration would not normally be sufficiently demanding such to require glucocorticoids.
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.