Nokea
The nurse is admitting a patient with Graves' disease to the emergency department in thyrotoxic crisis. Which of these prescribed medications should the nurse administer first?
- A. Propranolol
- B. Propylthiouracil
- C. Methimazole
- D. Iodine
Correct Answer: A
Rationale: β-Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function.
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The nurse is caring for a patient with symptoms of diabetes insipidus who has been admitted to the hospital for evaluation and treatment. Which of the following nursing diagnoses is best for this patient?
- A. Insomnia related to frequent waking at night to void
- B. Impaired gas exchange related to fluid retention in lungs
- C. Excess fluid volume related to intake greater than output
- D. Risk for impaired skin integrity related to generalized edema
Correct Answer: A
Rationale: Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.
The nurse is caring for a patient who has had a transsphenoidal resection of a pituitary tumour. Which of the following nursing actions should be included in the postoperative plan of care?
- A. Monitor urine output every hour.
- B. Palpate extremities for dependent edema.
- C. Check hematocrit hourly for first 12 hours.
- D. Obtain continuous pulse oximetry for 24 hours.
Correct Answer: A
Rationale: After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema and monitoring of urine output and urine specific gravity is essential. Hemorrhage is not a common problem. There is no need to check the hematocrit hourly. The patient is at risk for dehydration, not volume overload. The patient is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.
The nurse is caring for a patient who has an adrenocortical adenoma and hyperaldosteronism. Which of the following actions should the nurse implement?
- A. Provide a potassium-restricted diet.
- B. Monitor the blood pressure every 4 hours.
- C. Evaluate blood glucose level every 4 hours.
- D. Maintain extremities in an elevated position.
Correct Answer: B
Rationale: Hypertension caused by sodium retention is a common complication of hyperaldosteronism. Hyperaldosteronism does not cause elevation in blood glucose. The patient will be hypokalemic and require potassium supplementation before surgery. Edema does not usually occur with hyperaldosteronism.
The nurse is caring for a patient with possible syndrome of inappropriate antidiuretic hormone (SIADH). The patient is confused and reports a headache, muscle cramps, and twitching. Which of the following initial laboratory results should the nurse anticipate?
- A. Elevated hematocrit
- B. Decreased serum sodium
- C. Increased serum chloride
- D. Low urine specific gravity
Correct Answer: B
Rationale: When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient. The hematocrit will decrease because of the dilution caused by water retention. Urine will be more concentrated with a higher specific gravity. The serum chloride level will usually decrease along with the sodium level.
The nurse is caring for a patient with a diagnosis of Cushing's syndrome. Which of the following data should the nurse anticipate finding during the admission assessment?
- A. Persistently low blood pressure
- B. Bronzed appearance of the skin
- C. Decreased axillary and pubic hair
- D. Purplish red streaks on the abdomen
Correct Answer: D
Rationale: Purplish-red striae on the abdomen are a common clinical manifestation of Cushing's syndrome. Hypotension and bronzed-appearing skin are manifestations of Addison's disease. Decreased axillary and pubic hair occur with androgen deficiency.