Nokea
The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with?
- A. Hypothyroidism
- B. Hyperthyroidism
- C. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- D. Diabetes insipidus (DI)
Correct Answer: B
Rationale: Clients with hyperthyroidism characteristically are restless despite feeling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarging muscle and fatty tissue surrounding the rear and sides of the eyeball. Hypothyroidism clinical manifestations are the opposite of what is seen in hyperthyroidism, and SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client.
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A client sustained a head injury when falling from a ladder. While in the hospital, the client begins voiding large amounts of clear urine and reports being very thirsty. The client states feeling weak and having experienced an 8 pound weight loss since admission. What condition does the nurse expect the client to be tested for?
- A. Diabetes insipidus (DI)
- B. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
- C. Pituitary tumor
- D. Hypothyroidism
Correct Answer: A
Rationale: With diabetes insipidus, urine output may be as high as 20 L/24 hours. Urine is dilute, with a specific gravity of 1.002 or less. Limiting fluid intake does not control urine excretion. Thirst is excessive and constant. Activities are limited by the frequent need to drink and void. Weakness, dehydration, and weight loss develop. SIADH will have the opposite clinical manifestations. The client's symptoms are related to the trauma and not to a pituitary tumor. The thyroid gland does not cause these symptoms.
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.
What would the nurse expect the health care provider to order for a client with hypothyroidism?
- A. Levothyroxine sodium
- B. Methimazole
- C. Propranolol
- D. Propylthiouracil
Correct Answer: A
Rationale: Hypothyroidism is treated with thyroid replacement therapy, in the form of desiccated thyroid extract or a synthetic product, such as levothyroxine sodium (Synthroid) or liothyronine sodium (Cytomel). Methimazole and propylthiouracil are antithyroid agents used to treat hyperthyroidism. Propranolol is a beta blocker that can be used to treat hyperthyroidism.
A client with severe hypoparathyroidism is experiencing tetany. What medication, prescribed by the physician for emergency use, will the nurse administer to correct the deficit?
- A. Sodium bicarbonate
- B. Fludrocortisone
- C. Calcium gluconate
- D. Methylprednisolone
Correct Answer: C
Rationale: Tetany and severe hypoparathyroidism are treated immediately by the administration of an IV calcium salt, such as calcium gluconate. The other medications are not effective for the treatment of calcium deficit.
A client is receiving a test to determine adrenal function. What medication does the nurse administer as a screening test?
- A. Cosyntropin
- B. Sodium bicarbonate
- C. Fludrocortisone
- D. Glucagon
Correct Answer: A
Rationale: A dose of synthetic ACTH, cosyntropin, is administered intramuscularly as a screening test for adrenal function. The other medications are not screening medications to determine adrenal function.