Nokea
The client diagnosed with Cushing's disease has undergone a unilateral adrenalectomy. Which discharge instructions should the nurse discuss with the client?
- A. Instruct the client to take the glucocorticoid and mineralocorticoid medications as prescribed.
- B. Teach the client regarding sexual functioning and androgen replacement therapy.
- C. Explain the signs and symptoms of infection and when to call the health-care provider.
- D. Demonstrate turn, cough, and deep-breathing exercises the client should perform every two (2) hours.
Correct Answer: C
Rationale: Infection signs are critical post-adrenalectomy due to immunosuppression risks. Steroid replacement is for bilateral procedures, androgen therapy is rare, and breathing exercises are inpatient-focused.
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The male client diagnosed with chronic pancreatitis calls and reports to the clinic nurse he has been having a lot of 'gas,' along with frothy and very foul-smelling stools. Which intervention should the nurse implement?
- A. Explain this is common for chronic pancreatitis.
- B. Ask the client to bring in a stool specimen to the clinic.
- C. Arrange an appointment with the HCP for today.
- D. Discuss the need to decrease fat in the diet so this won't happen.
Correct Answer: C
Rationale: Frothy, foul-smelling stools suggest malabsorption (e.g., pancreatic insufficiency), requiring urgent HCP evaluation. Explaining, stool samples, or diet changes are secondary.
The charge nurse of an intensive care unit is making assignments for the night shift. Which client should be assigned to the most experienced intensive care nurse?
- A. The client diagnosed with respiratory failure who is on a ventilator and requires frequent sedation.
- B. The client diagnosed with lung cancer and iatrogenic Cushing's disease with ABGs of pH 7.35, PaO2 88, PaCO2 44, and HCO3 22.
- C. The client diagnosed with Addison's disease who is lethargic and has a BP of 80/45, P 124, and R 28.
- D. The client diagnosed with hyperthyroidism who has undergone a thyroidectomy two (2) days ago and has a negative Trousseau's sign.
Correct Answer: C
Rationale: Addison’s with hypotension (80/45), tachycardia (124), and lethargy suggests adrenal crisis, requiring an experienced nurse. Ventilator care, stable Cushing’s, and post-thyroidectomy are less acute.
The 68-year-old client diagnosed with hyperthyroidism is being treated with radioactive iodine therapy. Which interventions should the nurse discuss with the client?
- A. Explain it will take up to a month for symptoms of hyperthyroidism to subside.
- B. Teach the iodine therapy will have to be tapered slowly over one (1) week.
- C. Discuss the client will have to be hospitalized during the radioactive therapy.
- D. Inform the client after therapy the client will not have to take any medication.
Correct Answer: A
Rationale: Radioactive iodine takes weeks to reduce hyperthyroid symptoms, requiring client understanding. Tapering, hospitalization, and stopping medications are incorrect.
The agitated client is hospitalized with tachycardia, dyspnea, and intermittent chest palpitations. The client's BP is 170/110 mm Hg, and HR is 130 bpm. The client's health history reveals thinning hair, recent 10-lb weight loss, increased appetite, fine hand and tongue tremors, hyperreflexic tendon reflexes, and smooth, moist skin. Which prescribed intervention should be the nurse's priority?
- A. 12-lead electrocardiogram (ECG) and cardiac enzyme levels.
- B. Obtain thyroid-stimulating hormone (TSH) and free T4 levels.
- C. Propranolol 2 mg IV q15 min or until symptoms are controlled.
- D. Propylthiouracil 600-mg oral loading dose; then 200 mg orally q4h.
Correct Answer: C
Rationale: Propranolol provides rapid symptomatic relief of thyrotoxicosis by controlling cardiac and psychomotor manifestations.
The nurse's next door neighbor calls. He says he cannot awaken his 21-year-old wife. The nurse notes that the client is unconscious and is having deep respirations. Her breath has a fruity smell to it. The husband says that his wife has been eating and drinking a lot recently and that last night she vomited before lying down. What is the most appropriate action for the nurse to take?
- A. Start cardiopulmonary resuscitation
- B. Get her to a hospital immediately
- C. Try to rouse her by giving her coffee
- D. Give her sweetened orange juice
Correct Answer: B
Rationale: Fruity breath, unconsciousness, and symptoms of polyphagia, polydipsia, and vomiting suggest diabetic ketoacidosis, requiring immediate hospital care.