Nokea
During a physical examination, the nurse finds that a patient's thyroid gland cannot be palpated. Which of the following is the best action for the nurse to take?
- A. Palpate the patient's neck more deeply.
- B. Document that the thyroid was nonpalpable.
- C. Notify the health care provider immediately.
- D. Teach the patient about thyroid hormone testing.
Correct Answer: B
Rationale: The thyroid is frequently nonpalpable. The nurse should simply document the finding. There is no need to notify the health care provider immediately about a normal finding. There is no indication for TSH testing unless there is evidence of thyroid dysfunction. Deep palpation of the neck is not appropriate.
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When reviewing the laboratory results for a patient's total calcium level, which of the following information should the nurse consider?
- A. The blood glucose is elevated.
- B. The phosphate level is normal.
- C. The serum albumin level is low.
- D. The magnesium level is normal.
Correct Answer: C
Rationale: Part of the total calcium is bound to albumin, so hypoalbuminemia can lead to misinterpretation of calcium levels. Ionized calcium is unaffected by albumin levels. The other laboratory values will not affect total calcium interpretation.
The nurse is caring for a patient who has clinical manifestations of hypothyroidism. Which of the following laboratory tests is most accurate to evaluate thyroid function?
- A. Thyroxine (T4) level
- B. Triiodothyronine (T3) level
- C. Thyroid-stimulating hormone (TSH) level
- D. Thyrotropin-releasing hormone (TRH) level
Correct Answer: C
Rationale: The most sensitive and accurate laboratory test is measurement of TSH; thus it is often recommended as a first diagnostic test for evaluation of thyroid function. A low TSH level indicates that the patient's hypothyroidism is caused by decreased anterior pituitary secretion of TSH. Low T4 and T3 levels are not diagnostic of the primary cause of the hypothyroidism. TRH levels indicate the function of the hypothalamus.
A patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which of the following patient information is most important for the nurse to communicate to the health care provider before the test?
- A. Bilateral poor peripheral vision
- B. Allergies to iodine and shellfish
- C. Recent weight loss of 8.5 kg
- D. History of ongoing headaches
Correct Answer: B
Rationale: Since the usual contrast media is iodine-based, the health care provider will need to know about the allergy before the CT scan. The other findings are common with any mass in the brain such as a pituitary adenoma.
The nurse is caring for a patient who is scheduled for a 24-hour urine collection for 17-ketosteroids. Which of the following actions should the nurse implement?
- A. Keep the specimen on ice.
- B. Insert a retention catheter.
- C. Have the patient void and save that specimen to start the collection.
- D. Encourage the patient to drink 2-3 L of fluid during the 24 hours.
Correct Answer: A
Rationale: The specimen must be kept on ice or refrigerated until the collection is finished. Voided or catheterized specimens are acceptable for the test. The initial voided specimen is discarded. There is no fluid intake requirement for the 24-hour collection.
The nurse is caring for a patient who is taking spironolactone. Which of the following parameters should the nurse monitor?
- A. Decreased urinary output
- B. Evidence of fluid overload
- C. Increased serum sodium levels
- D. Elevated serum potassium levels
Correct Answer: D
Rationale: Spironolactone is a diuretic and it blocks aldosterone. Recalling that aldosterone increases the excretion of potassium, a medication that blocks aldosterone will tend to cause hyperkalemia. Aldosterone also promotes the reabsorption of sodium and water in the renal tubules, so spironolactone will tend to cause increased urine output, a decreased or normal serum sodium level, and signs of dehydration.