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The nurse is administering a medication to a client with hyperthyroidism to block the production of thyroid hormone. The client is not a candidate for surgical intervention at this time. What medication should the nurse administer to the client?
- A. Levothyroxine
- B. Spironolactone
- C. Propylthiouracil
- D. Propranolol
Correct Answer: C
Rationale: Antithyroid drugs, such as propylthiouracil and methimazole, are given to block the production of thyroid hormone preoperatively or for long-term treatment for clients who are not candidates for surgery or radiation treatment. Levothyroxine would increase the level of thyroid and be contraindicated in this client. Spironolactone is a diuretic and does not have the action of blocking production of thyroid hormone, and neither does propranolol, which is a beta-blocker.
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The nurse is instructing a client about taking corticosteroid therapy for adrenal insufficiency. What statement made by the client indicates a need for further instruction?
- A. I will take the corticosteroid medication until my adrenal glands begin to work.'
- B. I will not omit any of the doses of my medication.'
- C. I will seek medical attention for dosage readjustments whenever I am under stress.'
- D. I will get plenty of rest and avoid exposure to infection.'
Correct Answer: A
Rationale: The nurse should explain adrenal insufficiency and the importance of lifetime corticosteroid replacement. The other statements indicate that the client is educated about medication administration.
A client is suspected of having acromegaly. What definitive diagnostic testing is the most reliable method of confirming acromegaly?
- A. A serum glucose level
- B. Glucose tolerance test in combination with a GH measurement
- C. Growth hormone levels
- D. Bone radiographs
Correct Answer: B
Rationale: A glucose tolerance test in combination with a GH measurement is the most reliable method of confirming acromegaly. Ingestion of a bolus of glucose should lower GH levels, but GH levels remain elevated in persons with acromegaly. Increased blood levels of IGF-1 can also indicate acromegaly in nonpregnant women, they typically have IGF-1 levels two to three times higher than normal in pregnant women. A serum glucose level is not an indicator of acromegaly. Growth hormone levels and bone radiographs may support the diagnosis but are not reliable indicators.
What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking prescribed antithyroid medication?
- A. Thyrotoxic crisis
- B. Myxedema coma
- C. Diabetes insipidus
- D. Syndrome of inappropriate antidiuretic hormone secretion
Correct Answer: A
Rationale: Thyrotoxic crisis, an abrupt and life-threatening form of hyperthyroidism, is thought to be triggered by extreme stress, infection, diabetic ketoacidosis, trauma, toxemia of pregnancy, or manipulation of a hyperactive thyroid gland during surgery or physical examination. Although rare, this condition may occur in clients with undiagnosed or inadequately treated hyperthyroidism. Myxedema coma is associated with hypothyroidism. Diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) clinical manifestations do not correlate with medication taken for hyperthyroidism.
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 diabetes insipidus is extremely dehydrated and is unable to take oral fluids. Fluid therapy is prescribed. Which intervention would be most important for the client?
- A. Measuring the urine output every 30 minutes
- B. Monitoring the rate of IV infusions
- C. Measuring the fluid intake
- D. Weighing the client daily
Correct Answer: A
Rationale: The nurse must measure the urine output every 30 minutes when administering prescribed fluid and drug therapy when the client is acutely ill or extremely dehydrated, fails to take oral fluids, or is beginning to receive medical treatment. Doing so ensures adequate kidney function. Although monitoring the rate of IV infusions, measuring fluid intake, and weighing the client daily are important, measuring the urine output every 30 minutes is the priority.