Nokea
The nurse is attending to a client with recent, significant weight gain. Which of the following diseases decreases the basal metabolic rate?
- A. Cancer
- B. Hypothyroidism
- C. Chronic obstructive pulmonary disease (COPD)
- D. Cardiac failure
Correct Answer: B
Rationale: Hypothyroidism slows metabolism, reducing basal metabolic rate and causing weight gain. Cancer, COPD, and cardiac failure often increase metabolic demand or are unrelated.
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The nurse is planning a staff education program about conditions that increase cortisol levels. Which of the following conditions should the nurse include?
- A. Addison's disease
- B. Congestive heart failure (CHF)
- C. Renal failure
- D. Cushing's disease
Correct Answer: D
Rationale: Cushing's disease increases cortisol due to excess ACTH. Addison's reduces cortisol, and CHF and renal failure do not directly elevate cortisol levels.
The nurse is caring for a client who developed a thyroid storm. The nurse should obtain a prescription for
- A. enalapril.
- B. calcium gluconate.
- C. levothyroxine.
- D. propranolol.
Correct Answer: D
Rationale: Thyroid storm is a life-threatening hyperthyroid state. Propranolol, a beta-blocker, reduces heart rate, blood pressure, and other hypermetabolic symptoms. Enalapril is for hypertension, calcium gluconate for hypocalcemia, and levothyroxine worsens hyperthyroidism.
The nurse is discussing the functions of the parathyroid hormone (PTH) with a student. Which of the following statements would be correct for the nurse to make? The parathyroid hormone
- A. moves calcium from bones to the bloodstream.
- B. promotes renal tubular reabsorption of calcium.
- C. controls bodily functions such as metabolism and heart rate.
- D. promotes renal tubular reabsorption of phosphorus.
- E. causes the retention of sodium and the excretion of potassium.
Correct Answer: A, B
Rationale: PTH raises blood calcium by mobilizing it from bones and increasing renal reabsorption. Metabolism and heart rate are thyroid functions, and PTH reduces, not increases, phosphorus reabsorption.
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 following scenario applies to the next 1 items.
The nurse is caring for a client in the emergency department (ED) with an altered level of consciousness
Item 1 of 1
History and Physical
A 53-year-old male presented to the emergency department (ED) with his wife because the client had become quite tired over the past several days. Today, he was difficult to arouse and spoke incoherently. The client responded to his name during the assessment but did not answer any other questions. Peripheral pulses were thready. Obvious tenting was noted in the skin, which was warm and quite dry. No facial drooping was observed, and when asked to hold out his arms, he could not perform the task. In fact, he did not have many purposeful movements during the exam. The client has a medical history of gout, bipolar disorder, and hypothyroidism, for which he takes levothyroxine, allopurinol, and quetiapine. She reports that he has been taking his medications as prescribed. However, she noted he was recently placed on Prednisone 20 mg PO BID for a gout flare. He self-discontinued the drug after taking it for two weeks and feeling better, and he did not taper as directed.
Vital Signs
Temperature 98.0° F (37° C)
Pulse 121/minute
Respirations 16/minute
Blood Pressure 90/60 mm Hg
Pulse oximetry 95% on room air
Diagnostics
12-lead electrocardiogram: sinus tachycardia with peaked T waves
Complete the sentence below by dragging one (1) condition and one (1) assessment finding. The client is at highest risk for............. related to the client's...........
- A. myxedema coma
- B. catatonia
- C. adrenal crisis
- D. cessation of prednisone
- E. lack of purposeful movement
- F. history of hypothyroidism
Correct Answer: C, D
Rationale: Abrupt cessation of prednisone in a client on chronic steroids can precipitate adrenal crisis due to suppressed adrenal function. Altered consciousness, thready pulses, and dehydration support this risk.