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An adult client has been diagnosed with a rare disorder, Simmonds disease (panhypopituitarism), and placed on hormone replacements. What is important for the nurse to educate the client about regarding the medication?
- A. The medication must be taken as ordered until surgery is scheduled to remove the tumor.
- B. Thyroid medication will be administered for the duration of the client's life.
- C. Adhere to the medication schedule and never omit a dose.
- D. The client must take growth hormone for the duration of his life.
Correct Answer: C
Rationale: Teaching the client to adhere to the medication schedule and never to omit a dose is important. The client will have destruction of the pituitary gland so removal will be unnecessary. More than just thyroid medication will be taken. Growth hormone is only administered to children, not adult clients.
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The nurse is caring for a client with hypoparathyroidism. When the nurse taps the client's facial nerve, the client's mouth twitches and the jaw tightens. What is this response documented as related to the low calcium levels?
- A. Positive Chvostek sign
- B. Positive Trousseau sign
- C. Positive paresthesia
- D. Positive Babinski sign
Correct Answer: A
Rationale: If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek sign. A positive Trousseau sign is elicited by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Positive Babinski sign is elicited by stroking the sole of the foot. Paresthesia is not a symptom that can be elicited; it is felt by the client.
The nurse is caring for a client who has developed diabetes insipidus. The cause is unknown, and the physician has ordered a diagnostic test to determine if the cause is nephrogenic or neurogenic. What test will the nurse prepare the client for?
- A. Urine specific gravity
- B. Fluid deprivation test
- C. Urine osmolality
- D. Serum osmolality
Correct Answer: B
Rationale: A fluid deprivation test can diagnose diabetes insipidus (DI) and differentiate neurogenic DI from nephrogenic DI. The other tests listed are nonspecific tests that help support diagnosis.
A client with Addison disease has a blood glucose level above 80 mg/dL 30 minutes after receiving 15 g of carbohydrates for symptoms of hypoglycemia. Which action would the nurse take next?
- A. Inform the physician immediately.
- B. Give the client milk and graham crackers.
- C. Instruct the client to remain in bed.
- D. Check the client's blood glucose level before each meal.
Correct Answer: B
Rationale: Milk and graham crackers contain forms of carbohydrates that take longer to absorb and tend to maintain the blood glucose level for an extended period. The physician should be informed if the client continues to be symptomatic and the blood glucose level is below 80 mg/dL. Maintaining bed rest protects the client from injuries from a fall but does not address the blood glucose issue. Assessing the client's blood glucose level provides a numeric assessment of the blood glucose level and would be performed in an ongoing fashion.
The nurse is teaching a client about the dietary restrictions related to a diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid?
- A. Bananas
- B. Chicken livers
- C. Hamburger
- D. Milk
Correct Answer: D
Rationale: Clients with hyperparathyroidism should use a low-calcium diet (fewer dairy products) and drink at least 3 to 4 L of fluid daily to dilute the urine and prevent renal stones from forming. It is especially important that the client drink fluids before going to bed and periodically throughout the night to avoid concentrated urine. Bananas, chicken livers, and hamburgers do not require avoidance. Milk is the highest in calcium content.
The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with?
- A. Hypothyroidism
- B. Hyperthyroidism
- C. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- D. Diabetes insipidus (DI)
Correct Answer: B
Rationale: Clients with hyperthyroidism characteristically are restless despite feeling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarging muscle and fatty tissue surrounding the rear and sides of the eyeball. Hypothyroidism clinical manifestations are the opposite of what is seen in hyperthyroidism, and SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client.