Nokea
A patient with systemic lupus erythematosus has a prescription for 2 weeks of high-dose prednisone therapy. When teaching the patient about the prednisone, which of the following information is most important for the nurse to include?
- A. Call the doctor if you experience any mood alterations with the prednisone.
- B. Do not stop taking the prednisone suddenly; it should be decreased gradually.
- C. A weight-bearing exercise program will help minimize the risk for osteoporosis.
- D. Weigh yourself daily to monitor for weight gain caused by water or increased fat.
Correct Answer: B
Rationale: Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped. Mood alterations and weight gain are possible adverse effects of corticosteroid use, but these are not life-threatening effects. Osteoporosis occurs when patients take corticosteroids for longer periods.
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The nurse is admitting a patient with possible syndrome of inappropriate antidiuretic hormone (SIADH) due to a head trauma. Which of the following information obtained by the nurse is most important to communicate rapidly to the health care provider?
- A. The patient complains of dyspnea with activity.
- B. The patient has a urine specific gravity of 1.025.
- C. The patient has a recent weight gain of 5.6 kg.
- D. The patient has a serum sodium level of 119 mmol/L.
Correct Answer: D
Rationale: A serum sodium of less than 120 mmol/L increases the risk for complications such as seizures and needs rapid correction. The other data are not unusual for a patient with SIADH and do not indicate the need for rapid action.
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.
The nurse is caring for a patient with acute adrenal insufficiency. Which of the following findings indicate that the prescribed therapies are effective?
- A. Increasing serum sodium levels
- B. Decreasing blood glucose levels
- C. Decreasing serum chloride levels
- D. Increasing serum potassium levels
Correct Answer: A
Rationale: Clinical manifestations of Addison's disease include hyponatremia and an increase in sodium level indicates improvement. The other values indicate that treatment has not been effective.
The nurse is providing postoperative care for a patient who had a bilateral adrenalectomy. Which assessment information requires the most rapid action by the nurse?
- A. The blood glucose is 8 mmol/L.
- B. The lungs have bibasilar crackles.
- C. The patient's BP is 88/50 mm Hg.
- D. The patient has 5/10 incisional pain.
Correct Answer: C
Rationale: The decreased BP indicates possible adrenal insufficiency. The nurse should immediately notify the health care provider so that corticosteroid medications can be administered. The nurse should also address the elevated glucose, incisional pain, and crackles with appropriate collaborative or nursing actions, but prevention and treatment of acute adrenal insufficiency is the priority after adrenalectomy.
The nurse is caring for an older-adult patient who is diagnosed with hypothyroidism and has a prescription for levothyroxine. Which of the following assessments is most important for the nurse to make during initiation of thyroid replacement?
- A. Apical pulse rate
- B. Nutritional intake
- C. Intake and output
- D. Orientation and alertness
Correct Answer: A
Rationale: In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication is also expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes will not result in potentially life-threatening complications.