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The nurse is assessing a client with a myxedema coma. Which of the following would be an expected finding?
- A. Glucose 59 mg/dL (3.28 mmol/L) [70-110 mg/d, 4.0-6.0 mmol/L]
- B. Sodium 155 mEq/L (mmol/L) [135-145 mEq/L, mmol/L]
- C. Serum pH 7.49 [7.35-7.45]
Correct Answer: A
Rationale: Myxedema coma, a severe hypothyroid state, can cause hypoglycemia due to reduced metabolism. Hypernatremia and alkalosis are not typical; hyponatremia and acidosis are more common.
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The nurse is caring for a client who has acute pancreatitis. Based on the 11:15 AM vital signs, the nurse should prioritize which action? Click to view the exhibit for additional client information.
- A. Obtain a 12-lead electrocardiogram
- B. Assess the client for pain
- C. Apply oxygen via nasal cannula
- D. Infuse 500 ml 0.9% sodium chloride (normal saline) bolus
Correct Answer: B
Rationale: Acute pancreatitis causes severe pain, a hallmark symptom. Without vital signs data, pain assessment is the priority to guide treatment and comfort, preceding ECG, oxygen, or fluids.
The nurse is reviewing newly prescribed medications for assigned clients. Which of the following prescribed medications should the nurse question?
- A. Furosemide for a client with hyperparathyroidism
- B. Methimazole for a client with hyperthyroidism
- C. Hydrocortisone for a client with diabetes insipidus
- D. Prazosin for a client with pheochromocytoma
Correct Answer: C
Rationale: Hydrocortisone is inappropriate for diabetes insipidus, which requires desmopressin to manage water reabsorption. Furosemide may be used in hyperparathyroidism, methimazole treats hyperthyroidism, and prazosin manages hypertension in pheochromocytoma.
The nurse is caring for a client with Addison's disease. Which statement, if made by the client, would require follow-up?
- A. I started using table salt instead of salt substitutes.
- B. I joined a gym to train for an upcoming marathon.
- C. I recently started wearing a MedicAlert bracelet.
- D. If I start to feel ill, I should call my doctor right away.
Correct Answer: B
Rationale: Addison's causes weakness and hypotension; marathon training is excessive and risky, requiring follow-up. Salt use, MedicAlert, and calling the doctor are appropriate.
The nurse is caring for a client who is receiving newly prescribed prednisone. Which of the following medications should the client avoid while receiving this medication?
- A. valsartan
- B. naproxen
- C. omeprazole
- D. acetaminophen
Correct Answer: B
Rationale: Naproxen, an NSAID, should be avoided with prednisone due to increased risk of gastrointestinal bleeding and ulceration. Valsartan, omeprazole, and acetaminophen are generally safe with prednisone, though monitoring is needed.
The nurse is preparing to administer a regular insulin IV bolus to a client. The primary health care provider (PHCP) has prescribed an initial bolus dose of 0.1 unit/kg. The client weighs 242 lbs. How much regular insulin should the nurse administer to the client as an IV bolus?
Correct Answer: 11
Rationale: Convert 242 lbs to kg: 242 ÷ 2.2 = 110 kg. Calculate dose: 110 kg × 0.1 unit/kg = 11 units. Thus, 11 units of regular insulin should be administered.