Nokea
The nurse is caring for a client with a confirmed pregnancy in her first trimester with hyperthyroidism. The nurse anticipates the physician will prescribe
- A. levothyroxine
- B. calcitriol
- C. methimazole
- D. propylthiouracil (PTU)
Correct Answer: D
Rationale: Propylthiouracil (PTU) is preferred in the first trimester of pregnancy for hyperthyroidism due to lower teratogenic risk compared to methimazole. Levothyroxine treats hypothyroidism, and calcitriol manages calcium levels.
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The nurse is assessing a client with pheochromocytoma. Which of the following would be an expected finding?
- A. hyperglycemia
- B. hypertension
- C. ataxia
- D. oliguria
- E. headache
Correct Answer: A, B, E
Rationale: Pheochromocytoma releases catecholamines, causing hyperglycemia, hypertension, and headaches. Ataxia and oliguria are not typical findings.
The nurse is teaching a client about newly prescribed insulin glargine. The nurse recognizes the need for further instruction when the client makes the following statement?
- A. I will take this insulin right before my meals.
- B. I should roll this vial of insulin before removing it with the syringe.
- C. This insulin will help control my glucose for 24 hours.
- D. I can only inject this insulin into my abdomen.
- E. I'm glad to know I can mix this with my regular insulin.
Correct Answer: A,B,D,E
Rationale: Insulin glargine is a long-acting insulin taken once daily, not before meals, provides 24-hour coverage, and should not be mixed with other insulins. It is clear and does not require rolling, and can be injected in multiple sites, not just the abdomen. Only the statement about 24-hour control is correct.
The nurse is caring for a client newly diagnosed with Cushing's disease. Which of the following client statements requires follow-up?
- A. I will need to eat more potassium-rich foods.
- B. I will need more steroids during periods of stress.
- C. I will be at a higher risk for an infection.
- D. I should do weight-bearing exercises.
Correct Answer: A
Rationale: Cushing's causes hyperkalemia, so more potassium-rich foods are harmful and need follow-up. Extra steroids for stress, infection risk, and weight-bearing exercises are appropriate.
The nurse assesses clients for the risk of developing hyperosmolar hyperglycemic syndrome. Which of the following clients should the nurse consider to be at greatest risk?
- A. 63-year-old with diabetes mellitus (type two) who works outdoors and recently had an increased dosage of metformin.
- B. 55-year-old with diabetes mellitus (type one) who was recently hospitalized for pneumonia and occasionally forgets to take their long-acting insulin.
- C. 15-year-old with diabetes mellitus (type one) who has a hemoglobin A1C of 7.6% [ < 7%] and has gained 4 lbs (1.8 kg) in the past month.
- D. 45-year-old who was recently diagnosed with diabetes mellitus (type two) and was prescribed glipizide in addition to metformin.
Correct Answer: A
Rationale: HHS is common in type 2 diabetes, especially in older adults. Outdoor work risks dehydration, and increased metformin may not control severe hyperglycemia, heightening HHS risk.
The nurse cares for a 38-year-old female client recently diagnosed with Graves' disease. The client presents with a visibly enlarged thyroid gland, heat intolerance, excessive sweating, and unintentional weight loss. What additional signs or symptoms may be present in this client?
- A. Increased heart rate and palpitations
- B. Diarrhea and frequent bowel movements
- C. Tremors, particularly in the hands and fingers
- D. Eye changes such as exophthalmos
- E. Intolerance to cold temperatures
Correct Answer: A, B, C, D
Rationale: Graves' disease, a hyperthyroid condition, causes tachycardia, palpitations, diarrhea, tremors, and exophthalmos due to increased metabolism and autoimmunity. Cold intolerance is a hypothyroid symptom.