Nokea
After receiving change-of-shift report, which of the following four patients should the nurse assess first?
- A. A 31-year-old with Cushing's syndrome and a blood glucose level of 13.7 mmol/L.
- B. A 22-year-old admitted with syndrome of inappropriate antidiuretic hormone (SIADH) who has a serum sodium level of 130 mmol/L.
- C. A 70-year-old who recently started taking levothyroxine and has an irregular pulse of 134
- D. A 53-year-old who has Addison's disease and is due for a scheduled dose of hydrocortisone.
Correct Answer: C
Rationale: Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The patient's high pulse rate needs rapid investigation by the nurse to assess for and intervene with any cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for life-threatening complications.
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The nurse is teaching a patient with persistent syndrome of inappropriate antidiuretic hormone (SIADH) about long-term management. Which of the following patient statements indicate that additional instruction is needed?
- A. I should weigh myself daily and report any sudden weight loss or gain.
- B. I need to limit my fluid intake to no more than 1 L of liquids a day.
- C. I will eat foods high in potassium because the diuretics cause potassium loss.
- D. I need to shop for foods that are low in sodium and avoid adding salt to foods.
Correct Answer: D
Rationale: Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred.
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.
The nurse is caring for a patient with possible syndrome of inappropriate antidiuretic hormone (SIADH). The patient is confused and reports a headache, muscle cramps, and twitching. Which of the following initial laboratory results should the nurse anticipate?
- A. Elevated hematocrit
- B. Decreased serum sodium
- C. Increased serum chloride
- D. Low urine specific gravity
Correct Answer: B
Rationale: When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient. The hematocrit will decrease because of the dilution caused by water retention. Urine will be more concentrated with a higher specific gravity. The serum chloride level will usually decrease along with the sodium level.
The nurse is caring for a patient with hypertension who is diagnosed with a pheochromocytoma. Which of the following findings should the nurse monitor in the patient?
- A. Flushing
- B. Headache
- C. Bradycardia
- D. Hypoglycemia
Correct Answer: B
Rationale: The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia, severe pounding headache, diaphoresis, and abdominal or chest pain. Elevated blood glucose may also occur because of sympathetic nervous system stimulation. Bradycardia and flushing would not be expected.
A patient is suspected of having a pituitary tumour causing panhypopituitarism. During assessment of the patient, which of the following findings should the nurse anticipate?
- A. High blood pressure
- B. Elevated blood glucose
- C. Tachycardia and cardiac palpitations
- D. Changes in secondary sex characteristics
Correct Answer: D
Rationale: Changes in secondary sex characteristics are associated with decreases in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is likely due to the decrease in thyroid-stimulating hormone (TSH) and thyroid hormones associated with panhypopituitarism.