Nokea
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.
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The nurse is caring for a client with type 1 diabetes mellitus who develops hyperglycemia between 5:00 and 6:00 AM as a result of the nighttime release of growth hormone. The nurse should recognize that this condition is consistent with
- A. dawn phenomenon.
- B. Somogyi effect.
- C. hyperosmolar hyperglycemic syndrome (HHS).
- D. diabetic ketoacidosis (DKA).
Correct Answer: A
Rationale: Dawn phenomenon is early morning hyperglycemia from growth hormone and cortisol release, common in type 1 diabetes. Somogyi involves rebound from hypoglycemia, and HHS and DKA are acute complications.
This nurse is caring for a client who is receiving prescribed sitagliptin. The nurse understands that this medication is intended to treat which condition?
- A. Hyperlipidemia
- B. Diabetes mellitus
- C. Hypothyroidism
- D. Hypertension
Correct Answer: B
Rationale: Sitagliptin, a DPP-4 inhibitor, treats type 2 diabetes mellitus by enhancing incretin effects to lower blood glucose. It does not treat hyperlipidemia, hypothyroidism, or hypertension.
The nurse is developing a plan of care for a client with hypothyroidism that is not controlled with medication. The nurse should recommend
- A. applying lotion after a warm bath.
- B. high-fiber snacks.
- C. caffeinated beverages to promote energy.
- D. physical activities with frequent rest breaks.
- E. adding fans to the room to keep it cool.
Correct Answer: A, B, D
Rationale: Hypothyroidism causes dry skin, constipation, and fatigue. Lotion hydrates skin, high-fiber snacks aid bowel movements, and rest breaks accommodate low energy. Caffeine may overstimulate, and fans are unhelpful as clients feel cold, not hot.
The nurse is assessing a client with diabetic ketoacidosis (DKA). Which of the following would be an expected finding?
- A. Thready pulse
- B. Jugular venous distention (JVD)
- C. Coarse tremors
- D. Tachycardia
- E. Orthostatic hypotension
Correct Answer: A, D, E
Rationale: DKA causes dehydration, leading to thready pulse, tachycardia, and orthostatic hypotension. JVD suggests fluid overload, and coarse tremors are not typical.
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.