Nokea
The nurse is caring for a client prescribed propylthiouracil (PTU). To monitor the effectiveness of this medication, the nurse anticipates the primary healthcare provider will order a
- A. serum calcium level.
- B. thyroid panel.
- C. fasting blood glucose.
- D. white blood cell (WBC) count.
Correct Answer: B
Rationale: PTU treats hyperthyroidism by reducing thyroid hormone production. A thyroid panel (TSH, T4, T3) monitors effectiveness. Calcium, glucose, and WBC are not directly related to PTU's action.
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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 nurse has received an order to prepare a client for a water deprivation test. The nurse understands that this test is used to diagnose
- A. hyperthyroidism
- B. pheochromocytoma
- C. diabetes insipidus (DI)
- D. syndrome of inappropriate antidiuretic hormone (SIADH)
Correct Answer: C
Rationale: The water deprivation test diagnoses diabetes insipidus by assessing the body's ability to concentrate urine without fluid intake, distinguishing it from SIADH or other conditions.
The nurse is caring for a client scheduled for an adrenalectomy after being diagnosed with pheochromocytoma. Which preoperative clinical data is essential for the nurse to monitor?
- A. intake and output
- B. blood glucose
- C. vital signs
- D. hemoglobin and hematocrit
Correct Answer: C
Rationale: Pheochromocytoma causes catecholamine surges, leading to hypertension and tachycardia. Monitoring vital signs is critical preoperatively to manage these fluctuations and ensure stability.
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.
The following scenario applies to the next 1 items
The emergency department (ED) nurse is caring for a 66-year-old male client
Item 1 of 1
History and Physical
2000: 66-year male arrives at the emergency department (ED) following a recommendation by his primary healthcare provider (PHCP). The client called his PHCP in the morning, reporting a headache, feeling unwell, fatigue, and thirst. He could not check his blood glucose because he reports being out of testing supplies for two weeks. He also reports being unable to take his prescribed antihypertensive and antidiabetic medications for one week because he lost his job. On exam, the client reports feeling fatigued and thirsty. He is alert and completely oriented. His physical exam was within normal limits except for a thready pulse with a rate of 119/minute.
The client has a medical history of type II diabetes mellitus, congestive heart failure (CHF), hypertension, and hyperlipidemia. He is prescribed atorvastatin, metformin, and lisinopril.
Vital Signs
Oral Temperature 98o F (36.7o C)
Pulse 119/minute
Respirations 19/minute
Blood pressure 98/52 mm Hg
Oxygen saturation 96% on room air
Physician Orders
Obtain intravenous (IV) access
Five units of regular insulin via intravenous push (IVP)
Infuse two liters of 0.9% saline over one hour
Obtain capillary blood glucose (CBG) every two hours
Potassium chloride 20 mEq by mouth x 1 dose
Implement seizure precautions
The nurse reviews laboratory work ordered by the primary healthcare provider (PHCP). The nurse obtains physician orders for this client with hyperosmolar hyperglycemic state (HHS) . The nurse is preparing to implement the physician's orders. Which order should the nurse clarify with the physician?
- A. Infuse two liters of 0.9% saline over one hour
- B. Obtain capillary blood glucose every two hours
- C. Potassium chloride 20 mEq by mouth
- D. Implement seizure precautions
Correct Answer: A
Rationale: Infusing 2 liters of saline in one hour is too rapid for HHS, risking fluid overload. Slower infusion (e.g., 1 liter over 2-4 hours) is safer. Other orders align with HHS management.