Nokea
The nurse is caring for a client experiencing an adrenal crisis (Addisonian crisis). The nurse should be prepared to administer which intravenous fluid?
- A. Lactated Ringers (LR)
- B. 0.9% saline
- C. Dextrose 5% in water (D5W)
- D. Dextrose 5% in water and Lactated Ringers (D5LR)
Correct Answer: B
Rationale: 0.9% saline is used in adrenal crisis to correct hypotension and hyponatremia caused by cortisol and aldosterone deficiency. D5W or D5LR may be used later, but saline is the priority for fluid resuscitation.
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The nurse is providing discharge instructions to a client who has chronic diabetes insipidus (DI). Which of the following client statements would indicate a correct understanding of the discharge instructions?
- A. I will need to drink no more than $800 \mathrm{ml}$ per day.
- B. I will need to weigh myself at the same time every day.
- C. I should increase salty snacks in my diet.
- D. I need to log my daily fluid intake.
Correct Answer: B, D
Rationale: DI causes excessive urination; daily weighing and logging fluid intake monitor fluid balance. Fluid restriction and salty snacks are inappropriate and worsen dehydration.
The following scenario applies to the next 6 items
The nurse in the clinic is caring for a 32-year-old female client.
Item 1 of 6
Nurses' Notes
1559: Client reports to the outpatient clinic with reports of persistent fatigue, weakness, lethargy, and lower back pain over the last 8 months. She is also concerned because she has gained 24 pounds (10.9 kg) over the past 4 months. She stated that the weight gain has been so significant that she developed reddened streaks on her abdomen from the weight gain. The client is concerned because, over the past month, she has noticed she has been drinking more often and has had increased hunger. She has also noticed she is urinating more frequently. She went to urgent care one week ago and tested negative for urinary tract infection. She also noticed that her menstrual cycle has been irregular. She is not on birth control and took a home pregnancy test, which was negative. During the assessment, the client was fully alert and oriented. Clear lung sounds bilaterally. Skin was dry. Excessive facial hair was noted. 1+ pedal and ankle edema bilaterally. Peripheral pulses palpable, 2+, and regular. Body mass index (BMI) of 32. Vital signs: T 97.5° F (36.4° C), P 93, RR 18, BP 145/93, pulse oximetry reading 96% on room air. She is currently taking escitalopram for persistent depressive disorder.
Laboratory Results
Capillary Blood Glucose
1613: 254 mg/dL [70-110 mg/dL]
Select the client findings that require follow-up.
- A. Capillary blood glucose
- B. Peripheral pulse findings
- C. Blood pressure
- D. Not taking birth control
Correct Answer: A, C, F, G
Rationale: Elevated glucose (254 mg/dL) suggests hyperglycemia, needing investigation. BP (145/93) indicates hypertension, requiring monitoring. Edema and BMI of 32 signal potential endocrine or cardiac issues. Peripheral pulses are normal and birth control is unrelated.
The nurse is performing discharge teaching for a client prescribed propylthiouracil (PTU). Which client statement indicates effective understanding?
- A. I should increase my intake of foods containing iodine.
- B. This medication may cause my urine to have a reddish discoloration.
- C. I will need to have my liver enzymes monitored while I take this medication.
- D. If this medication starts to work, I should notice some weight loss.
Correct Answer: C
Rationale: PTU can cause hepatotoxicity, requiring liver enzyme monitoring. Iodine intake should be moderated, PTU does not cause reddish urine, and effective treatment may cause weight gain, not loss.
The following scenario applies to the next 1 items.
The nurse in the physician's office is caring for a 41-year-old female client.
Item 1 of 1
Progress Notes
1043
Subjective: Client presents for a follow-up appointment five weeks after she was prescribed sertraline for depressive symptoms. She reports no improvement and even reports worsening as she is having difficulty focusing at work. Specifically, she reports feeling like she is in a 'brain fog.' Two weeks ago, she started taking over-the-counter stool softeners because of constipation, which did not improve even after introducing more fiber in her diet. Finally, she reports that her shoes are no longer fitting because of edema in her ankles and feet.
Objective: Client is alert and oriented to person, place, and time. 2+ peripheral pulses. S1/S2 heart tones. Hypoactive bowel sounds in all quadrants. Clear lung sounds. Trace periorbital and 1+ pedal edema.
Assessment and plan: Will order laboratory testing as this client is showing strong clinical signs of primary hypothyroidism.
Vital Signs
T 97°F (36.1°C) P 58 RR 16 BP 107/65 Pulse oximetry reading 98% on room air
Orders
obtain thyroid panel
discontinue sertraline
The nurse reviews the physician's progress notes, orders, and the client's vital signs. Complete the sentence below with the appropriate answers. If the client has primary hypothyroidism, the client's thyroid panel will have a high...... and low......
- A. thyroid-stimulating hormone (TSH)
- B. free thyroxine (T4)
- C. serum triiodothyronine (T3)
- D. thyroid-stimulating hormone (TSH).
- E. free thyroxine (T4).
- F. thyrotropin receptor antibodies (TRAbs).
Correct Answer: A, B
Rationale: Primary hypothyroidism involves low thyroid hormone production, so TSH rises to stimulate the gland, and free T4 falls due to reduced output. T3 and TRAbs are less specific here.
The nurse is creating a teaching plan for a client diagnosed with pheochromocytoma. Which statement, if made by the client, would require follow-up?
- A. It will be very important to reduce the stress in my life.
- B. This condition may cause my glucose to decrease.
- C. I will need to monitor my blood pressure closely.
- D. If I feel tired, it is okay for me to have an energy drink.
- E. Diuretics will be prescribed to help eliminate the fluid I may retain.
Correct Answer: B, D, E
Rationale: Pheochromocytoma causes catecholamine excess, raising glucose, not lowering it. Energy drinks can worsen hypertension and are unsafe. Diuretics are not standard; fluid retention is not typical. Stress reduction and BP monitoring are appropriate.