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The nurse is caring for a client who reports diarrhea, unintentional weight loss, and nervousness. The primary healthcare provider (PHCP) orders a thyroid panel, and the nurse understands the client is at the highest risk for
- A. Myxedema
- B. Bell's palsy
- C. Grave's disease
- D. Cushing syndrome
Correct Answer: C
Rationale: Diarrhea, weight loss, and nervousness suggest hyperthyroidism, with Graves' disease as the most common cause due to thyroid overstimulation. Myxedema and Cushing's have opposite symptoms, and Bell's palsy is unrelated.
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The nurse is caring for a client who presents with a blood glucose level of 45 mg/dL (2.4975 mmol/L) [70-110 mg/dL, 4.0-11.0 mmol/L]. Which of the following findings are expected?
- A. Blurred vision
- B. Increased urinary output
- C. Cool and clammy skin
- D. Palpitations
- E. Orthostatic hypotension
- F. Paresthesias
Correct Answer: C, D, F
Rationale: Hypoglycemia causes sympathetic activation (cool, clammy skin; palpitations) and neurological symptoms (paresthesias). Blurred vision and increased urination are more typical of hyperglycemia, and orthostatic hypotension is less directly related.
The nurse is preparing to administer metformin to a client with diabetes mellitus (type two). Which of the following laboratory test results should the nurse monitor during the therapy?
- A. white blood cell (WBC) count
- B. vitamin B12 level
- C. serum uric acid level
- D. thyroid-stimulating hormone (TSH) level
Correct Answer: B
Rationale: Metformin can cause vitamin B12 deficiency over time, requiring monitoring. WBC, uric acid, and TSH are not primarily affected by metformin.
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 assisting a client with their newly prescribed insulin pump. The nurse understands which insulin is commonly loaded into the pump?
- A. Rapid acting
- B. Ultra long-acting insulin
- C. Intermediate acting
- D. Long acting
Correct Answer: A
Rationale: Rapid-acting insulin, such as lispro or aspart, is used in insulin pumps to mimic physiological insulin delivery for basal and bolus dosing. Long-acting or intermediate-acting insulins are not suitable for pumps.
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.