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The nurse is caring for a client scheduled for a computed tomography (CT) scan with contrast. The nurse recognizes which medication should be held after the procedure?
- A. labetalol
- B. metformin
- C. levodopa
- D. ondansetron
Correct Answer: B
Rationale: Metformin should be held after a CT scan with contrast due to the risk of lactic acidosis if contrast-induced nephropathy occurs. Labetalol, levodopa, and ondansetron are not affected by contrast.
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The nurse has administered five units of regular insulin and ten units of NPH insulin. After administering both prescribed insulins, the nurse should assess the client for hypoglycemia
- A. thirty minutes after administration.
- B. two to four hours after administration.
- C. four to six hours after administration.
- D. ten to twelve hours after administration.
Correct Answer: B
Rationale: Regular insulin peaks in 2–4 hours, posing the highest hypoglycemia risk during this time. NPH insulin peaks later (4–12 hours). Assessing 2–4 hours after administration aligns with regular insulin’s peak effect.
The nurse is reviewing the diet of the client with hypoparathyroidism. The nurse understands that the client should be on what type of diet?
- A. High-calorie, low-calcium diet
- B. Low-calcium, low-phosphorus diet
- C. High-phosphorus, low-calcium diet
- D. High-calcium, low-phosphorus diet
Correct Answer: D
Rationale: Hypoparathyroidism reduces PTH, lowering calcium. A high-calcium, low-phosphorus diet compensates, as high phosphorus can further bind calcium.
The following scenario applies to the next 6 items
The nurse in the clinic is caring for a 32-year-old female client.
Item 4 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]
For each potential order, click to specify whether the potential order is indicated or not indicated for the client.
- A. Serum hemoglobin A1C
- B. 24-hour urinary cortisol levels
- C. Serum complete metabolic panel
- D. Serum clonidine suppression test
- E. Serum complete blood count
- F. Administration of a prescribed corticosteroid
- G. Referral for neurology consultation
Correct Answer: A, B, C, E
Rationale: HbA1C assesses long-term glucose control, 24-hour cortisol tests for Cushing's, CMP evaluates electrolytes and glucose, and CBC checks for infection or anemia. Clonidine suppression is for pheochromocytoma, corticosteroids are not indicated, and neurology referral is unnecessary without neurological symptoms.
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 nurse observes the newly hired registered nurse prepare to administer neutral protamine hagedorn (NPH) insulin to a client. Which action by the newly hired nurse requires follow-up?
- A. asks the client which site the insulin was last injected.
- B. checks the client's blood glucose levels prior to administering the insulin injection.
- C. shakes the insulin vial before withdrawing insulin.
- D. reminds the client to report symptoms of clammy skin and disorientation.
Correct Answer: C
Rationale: NPH insulin should be gently rolled, not shaken, to mix the suspension without creating bubbles, which can affect dosing accuracy. Asking about injection sites, checking glucose, and reminding about hypoglycemia symptoms are correct actions.