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After a transsphenoidal adenohypophysectomy, a client is likely to undergo hormone replacement therapy. A transsphenoidal adenohypophysectomy is performed to treat which type of cancer?
- A. Esophageal carcinoma
- B. Laryngeal carcinoma
- C. Pituitary carcinoma
- D. Colorectal carcinoma
Correct Answer: C
Rationale: A transsphenoidal adenohypophysectomy is a surgical procedure performed to remove benign or malignant tumors located in the pituitary gland. Pituitary carcinoma refers to a type of cancer that originates in the pituitary gland. Therefore, this surgery is indicated for treating pituitary carcinoma by removing the tumor from the pituitary gland. After the surgery, hormone replacement therapy may be necessary to replace the hormones that were previously produced by the removed adenohypophysis (anterior pituitary gland).
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Following a transsphenoidal hypophysectomy, the nurse should assess the client care fully for which of the following conditions?
- A. Hypocortisolism.
- B. Hyperglycemia
- C. Hypoglycemia
- D. Hypercalcemia
Correct Answer: A
Rationale: Following a transsphenoidal hypophysectomy, the nurse should assess the client carefully for hypocortisolism, also known as adrenal insufficiency. This is because the procedure involves removing the pituitary gland, which plays a critical role in regulating cortisol production by the adrenal glands. Without proper cortisol production, the client may develop symptoms such as weakness, fatigue, low blood pressure, weight loss, and nausea. Monitoring for signs of hypocortisolism is crucial for prompt detection and intervention to prevent adrenal crisis, which can be life-threatening. Hyperglycemia, hypoglycemia, and hypercalcemia are not typically direct concerns following a transsphenoidal hypophysectomy.
A mother calls the school nurse saying that her daughter has developed a school phobia. She has been out of school 3 days. The nurse's recommendations should include which intervention?
- A. Immediately return the child to school.
- B. Explain to the child that this is the last day she can stay home.
- C. Determine the cause of phobia before returning the child to school.
- D. Seek professional counseling before forcing the child to return to school.
Correct Answer: C
Rationale: The appropriate intervention in this situation would be to determine the cause of the school phobia before immediately returning the child to school. School phobia, also known as school refusal, can be triggered by various factors such as bullying, academic stress, separation anxiety, or other psychological issues. By identifying the underlying cause of the phobia, the school nurse can better support the child and provide appropriate interventions to address the specific issues that are contributing to the child's reluctance to attend school. This approach helps ensure that the child receives the necessary support and resources needed to successfully reintegrate into the school environment.
While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of what assessment parameters?
- A. Platelet count, prothrombin time, and partial thromboplastin time
- B. Platelet count, blood glucose levels, and white blood cell (WBC) count
- C. Thrombin time, calcium levels, and potassium levels
- D. Fibrinogen level, WBC, and platelet count
Correct Answer: A
Rationale: When monitoring a client for the development of disseminated intravascular coagulation (DIC), it is important to assess key parameters that can indicate abnormal clotting and bleeding tendencies. The platelet count is essential as DIC can lead to thrombocytopenia (low platelet count). Prothrombin time (PT) and partial thromboplastin time (PTT) are coagulation tests that evaluate the extrinsic and intrinsic pathways of blood clotting, respectively. Prolongation of these times can indicate abnormal coagulation processes seen in DIC. Monitoring these parameters allows healthcare providers to assess and manage DIC promptly to prevent further complications.
What instruction should the nurse give to then patient taking propan0lol (Inderal) for hypertension?
- A. Have potassium level checked
- B. Do not stop medication abruptly
- C. Report any changes in appetite
- D. Resume usual daily activities
Correct Answer: B
Rationale: The nurse should instruct the patient taking propranolol (Inderal) for hypertension to not stop the medication abruptly. Suddenly stopping propranolol can lead to rebound hypertension and potentially dangerous side effects. It is important for the patient to gradually taper off the medication under the guidance of a healthcare provider to avoid complications. Therefore, advising the patient not to stop the medication abruptly is a crucial instruction to ensure their safety and well-being.
During chemotherapy for lymphocytic leukemia, a client develops abdominal pain, fever, and "horse barn" smelling diarrhea. It would be most important for the nurse to advise the physician to order:
- A. Enzyme-linked immunosuppressant assay
- B. Stool for Clostridium difficile test
- C. Flat palate X-ray of the abdomen
- D. Electrolyte panel and hemogram
Correct Answer: B
Rationale: The client's symptoms of abdominal pain, fever, and "horse barn" smelling diarrhea are concerning for Clostridium difficile infection, especially in the setting of receiving chemotherapy which can weaken the immune system. Clostridium difficile is a bacteria that can cause severe diarrhea and inflammation of the colon. Testing for Clostridium difficile in the stool is crucial for diagnosing the infection and guiding appropriate treatment. Therefore, advising the physician to order a stool test for Clostridium difficile would be the most important in this scenario to confirm the diagnosis and initiate appropriate management.