Nokea
The client newly diagnosed with hyperthyroidism has a fever of 101.3°F (38.5°C). Which additional assessment findings should the nurse identify as those associated with thyroid storm? Select all that apply.
- A. Hypoventilation
- B. Heart rate 140 bpm
- C. Diarrhea last 4 days
- D. Periorbital edema
- E. Recent tooth extraction
Correct Answer: B,C,E
Rationale: Tachycardia, diarrhea, and recent stress (e.g., tooth extraction) are associated with thyroid storm due to excessive thyroid hormone.
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Which statement by the client indicates a misunderstanding of the expected surgical outcome?
- A. My appearance will gradually become normal.
- B. I'll need to take replacement hormones.
- C. I'll need to see my physician regularly.
- D. The surgical incision will be inconspicuous.
Correct Answer: A
Rationale: In acromegaly, physical changes such as enlarged hands or facial features are typically irreversible, even after surgery.
The nurse administers a usual morning dose of 4 units of regular insulin and 8 units of NPH insulin at 7:30 am to the client with a blood glucose level of 110 mg/dL. Which statements regarding the client's insulin are correct?
- A. The onset of the regular insulin will be at 7:45 am and the peak at 1:00 pm.
- B. The onset of the regular insulin will be at 8:00 am and the peak at 10:00 am.
- C. The onset of the NPH insulin will be at 8:00 am and the peak at 10:00 am.
- D. The onset of the NPH insulin will be at 12:30 pm and the peak at 11:30 pm.
Correct Answer: B
Rationale: The onset of regular insulin (short acting) is one-half to 1 hour, and the peak is 2 to 3 hours. The onset of NPH insulin (intermediate acting) is 2 to 4 hours, and the peak is 4 to 12 hours.
The diabetic educator is teaching a class on diabetes type 1 and is discussing sick-day rules. Which interventions should the diabetes educator include in the discussion? Select all that apply.
- A. Take diabetic medication even if unable to eat the client's normal diabetic diet.
- B. If unable to eat, drink liquids equal to the client's normal caloric intake.
- C. It is not necessary to notify the health-care provider (HCP) if ketones are in the urine.
- D. Test blood glucose levels and test urine ketones once a day and keep a record.
- E. Call the health-care provider if glucose levels are higher than 180 mg/dL.
Correct Answer: A,B
Rationale: Continuing insulin and consuming caloric liquids (e.g., juice) prevent DKA during illness. Ketones require HCP notification, daily testing is insufficient, and 180 mg/dL is too low for notification.
Postoperatively, the nurse should consult the physician before encouraging the client who has undergone a subtotal thyroidectomy to perform which activity?
- A. Forced coughing
- B. Decompelling
- C. Ambulating
- D. Dangling legs
Correct Answer: A
Rationale: Forced coughing can increase pressure in the neck, risking bleeding or wound disruption post-thyroidectomy.
At the beginning of thyroid replacement therapy after a thyroidectomy, the nurse must monitor the client closely for side effects. Which findings would the nurse expect to detect if the client is receiving more thyroid hormone replacement than required? Select all that apply.
- A. Hyperglycemia
- B. Tachycardia
- C. Insomnia
- D. Hirsutism
- E. Hypertension
Correct Answer: B,C,E
Rationale: Excess thyroid hormone can cause tachycardia, insomnia, and hypertension due to increased metabolic rate.