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The nurse cares for a 38-year-old female client recently diagnosed with Graves' disease. The client presents with a visibly enlarged thyroid gland, heat intolerance, excessive sweating, and unintentional weight loss. What additional signs or symptoms may be present in this client?
- A. Increased heart rate and palpitations
- B. Diarrhea and frequent bowel movements
- C. Tremors, particularly in the hands and fingers
- D. Eye changes such as exophthalmos
- E. Intolerance to cold temperatures
Correct Answer: A, B, C, D
Rationale: Graves' disease, a hyperthyroid condition, causes tachycardia, palpitations, diarrhea, tremors, and exophthalmos due to increased metabolism and autoimmunity. Cold intolerance is a hypothyroid symptom.
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The nurse is caring for a client with the syndrome of inappropriate antidiuretic hormone (SIADH). Which assessment finding requires immediate follow-up?
- A. Disorientation
- B. High urine specific gravity
- C. Oliguria
- D. Increased thirst
Correct Answer: A
Rationale: SIADH causes water retention and hyponatremia, which can lead to disorientation—a neurological symptom requiring urgent follow-up to prevent seizures or coma. Other findings are expected.
The nurse is educating a group of students on the effects of corticosteroids. It would be appropriate for the nurse to identify the following adverse effects associated with corticosteroids.
- A. Mood lability
- B. Immunosuppression
- C. Hypoglycemia
- D. Hyperkalemia
- E. Weight gain
Correct Answer: A, B, E
Rationale: Corticosteroids cause mood changes, suppress immunity, and promote weight gain via fluid retention and fat redistribution. They cause hyperglycemia, not hypoglycemia, and hypokalemia, not hyperkalemia.
The nurse assesses clients for the risk of developing hyperosmolar hyperglycemic syndrome. Which of the following clients should the nurse consider to be at greatest risk?
- A. 63-year-old with diabetes mellitus (type two) who works outdoors and recently had an increased dosage of metformin.
- B. 55-year-old with diabetes mellitus (type one) who was recently hospitalized for pneumonia and occasionally forgets to take their long-acting insulin.
- C. 15-year-old with diabetes mellitus (type one) who has a hemoglobin A1C of 7.6% [ < 7%] and has gained 4 lbs (1.8 kg) in the past month.
- D. 45-year-old who was recently diagnosed with diabetes mellitus (type two) and was prescribed glipizide in addition to metformin.
Correct Answer: A
Rationale: HHS is common in type 2 diabetes, especially in older adults. Outdoor work risks dehydration, and increased metformin may not control severe hyperglycemia, heightening HHS risk.
The nurse is caring for a client receiving prescribed dexamethasone. Which of the following adverse reactions may occur?
- A. Infection
- B. Hypotension
- C. Peripheral edema
- D. Hypoglycemia
- E. Weight loss
- F. Insomnia
Correct Answer: A,C,F
Rationale: Dexamethasone, a corticosteroid, increases infection risk, causes fluid retention (peripheral edema), and insomnia. Hypotension, hypoglycemia, and weight loss are not typical; hypertension, hyperglycemia, and weight gain are more common.
The nurse prepares to administer intermediate-acting insulin to a client with diabetes mellitus. Place the following actions in the order in which they should be performed when preparing the injection, starting from first to last.
- A. Gently roll the bottle of intermediate-acting insulin in the palms of your hands to mix the insulin.
- B. Remove air bubbles in the syringe by tapping on the syringe.
- C. Inspect the bottle for the type of insulin and the expiration date.
- D. Pull back the plunger to draw air into the syringe and inject it into the vial.
- E. Turn the bottle upside down and draw the insulin dose into the syringe.
- F. Clean the rubber stopper with an alcohol swab.
Correct Answer: C, F, A, D, E, B
Rationale: Inspect the bottle for type and expiration, clean the stopper, roll to mix, draw air and inject into vial, draw dose, then remove bubbles to ensure accurate, safe administration.