Nokea
The nurse is caring for a client diagnosed with a myxedema coma. The nurse should anticipate a prescription for which of the following medications?
- A. Levothyroxine
- B. Methimazole
- C. Tolvaptan
- D. Hydrochlorothiazide
- E. Hydrocortisone
Correct Answer: A,E
Rationale: Myxedema coma, a severe hypothyroidism emergency, requires levothyroxine to restore thyroid hormone levels and hydrocortisone to address potential adrenal insufficiency. Methimazole treats hyperthyroidism, and tolvaptan and hydrochlorothiazide manage fluid balance, not hypothyroidism.
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The nurse is caring for a client with Cushing's disease. Which of the following complications are associated with this condition?
- A. cataracts
- B. diabetes mellitus
- C. orthostatic hypotension
- D. osteoporosis
- E. venous thromboembolism
Correct Answer: A, B, D, E
Rationale: Cushing's excess cortisol causes cataracts, diabetes from hyperglycemia, osteoporosis from bone loss, and thromboembolism from hypercoagulability. Orthostatic hypotension is not typical.
The nurse supervises a graduate nurse caring for a client newly admitted for postoperative management following a thyroidectomy. Which of the following actions by the graduate nurse indicates effective planning of the client's care?
- A. A bottle of sterile water and petroleum-based gauze is at the bedside.
- B. Obtains a prescription for magnesium sulfate.
- C. The bedside is prepared with a tracheostomy set, oxygen, and suction.
- D. Applies a cervical collar to the client
Correct Answer: C
Rationale: Post-thyroidectomy, airway obstruction from swelling or hemorrhage is a risk. A tracheostomy set, oxygen, and suction are essential for emergency airway management. Sterile water and gauze are insufficient, magnesium sulfate is unrelated, and a cervical collar may restrict breathing.
The nurse plans care for a client experiencing a hyperglycemic-hyperosmolar state (HHS). The nurse should anticipate which prescriptions from the primary healthcare provider (PHCP)?
- A. 0.9% saline infusion
- B. Glargine insulin
- C. Sodium polystyrene
- D. Sodium bicarbonate
Correct Answer: A
Rationale: HHS involves severe hyperglycemia and dehydration. 0.9% saline corrects fluid loss. Glargine is long-acting and not ideal for acute HHS, sodium polystyrene treats hyperkalemia, and bicarbonate is rarely used unless pH is critically low.
A post-adrenalectomy client is admitted to the intensive care unit and is on intravenous hydrocortisone. Which nursing intervention should be included in the client's plan of care?
- A. Monitor blood glucose levels frequently
- B. Keep the client supine for 24 hours
- C. Discontinue hydrocortisone once vital signs become stable
- D. Educate the client on how to properly clean the wound at home
Correct Answer: A
Rationale: Adrenalectomy removes cortisol production; hydrocortisone replacement can raise glucose. Frequent monitoring prevents hyperglycemia. Keeping supine is unnecessary, discontinuation risks adrenal crisis, and wound care education is premature in ICU.
The following scenario applies to the next 1 items
The nurse cares for a client who arrived at the emergency department (ED) complaining of generalized weakness
Item 1 of 1
History and Physical
23-year-male arrives at the emergency department (ED) reporting a headache, feeling unwell, fatigue, and thirst. The symptoms started one day ago and have worsened. He could not check his blood glucose because he reports being out of testing supplies for two weeks.
On exam, the client reports feeling fatigued and thirsty. He is lethargic and completely oriented. His physical exam revealed sunken eyes, skin that was hot to the touch, very dry mucous membranes, with white patches on his tongue.
The client has a medical history of type I diabetes mellitus.
Vital Signs
Oral Temperature 100o F (37.8o C)
Pulse 123/minute
Respirations 24/minute
Blood pressure 94/50 mm Hg
O2 saturation 96% on room air
Complete the sentence below from the list of options. The client is at highest risk of developing....... based on the client's.............
- A. hyperglycemic-hyperosmolar state
- B. metabolic alkalosis
- C. diabetic ketoacidosis
- D. positive serum ketones.
- E. glycosylated hemoglobin.
- F. potassium level.
Correct Answer: C, D
Rationale: In type 1 diabetes, fatigue, thirst, and dry mucous membranes with elevated glucose suggest DKA. Positive serum ketones confirm ketosis, a hallmark of DKA due to insulin deficiency.