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The nurse is caring for a client with Addison's disease. Which statement, if made by the client, would require follow-up?
- A. I started using table salt instead of salt substitutes.
- B. I joined a gym to train for an upcoming marathon.
- C. I recently started wearing a MedicAlert bracelet.
- D. If I start to feel ill, I should call my doctor right away.
Correct Answer: B
Rationale: Addison's causes weakness and hypotension; marathon training is excessive and risky, requiring follow-up. Salt use, MedicAlert, and calling the doctor are appropriate.
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This nurse is caring for a client who is receiving prescribed sitagliptin. Which assessment findings indicate the client is experiencing a severe adverse effect?
- A. Nasal stuffiness
- B. Abdominal pain
- C. Headache
- D. Occasional dry cough
Correct Answer: B
Rationale: Abdominal pain may indicate pancreatitis, a rare but severe sitagliptin adverse effect, requiring immediate attention. Nasal stuffiness, headache, and dry cough are less severe.
The nurse is caring for a client who has nephrogenic diabetes insipidus. Which of the following medications should the nurse expect to be prescribed for the client?
- A. prednisone
- B. hydrochlorothiazide
- C. verapamil
- D. lithium
Correct Answer: B
Rationale: Nephrogenic diabetes insipidus reduces kidney response to ADH. Hydrochlorothiazide paradoxically reduces urine output by increasing sodium excretion, concentrating urine. Prednisone, verapamil, and lithium are unrelated or worsen DI.
The following scenario applies to the next 1 items
The nurse in the emergency department cares for a 45-year-old female
Nurses’ Note
The client reports significant fatigue that has worsened over the past eight weeks. Additionally, the client reports constipation, hair loss, and a 3-kilogram (6.6 pounds) weight gain. She reports missing work because of difficulty concentrating and persistent fatigue.
The client is alert and fully oriented. She appears fatigued and reports dizziness when she moves quickly. Periorbital edema, various bruises, and facial swelling were noted on assessment. Peripheral pulses were intact and weak. The client denies any pain.
Vital Signs
Oral temperature 97 F (36.1o C); Pulse 51/minute; Respirations 15/minute.
BP 93/61 mm Hg; Oxygen saturation 95% on room air.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, two (2) actions the nurse should take to address that condition, and two (2) parameters the nurse should monitor to assess the client's progress.
- A. Obtain a prescription for levothyroxine, Obtain a prescription for methimazole, Have the client complete a blood transfusion consent, Obtain an order for a urine cortisol level, Initiate fall precautions.
- B. Vital Signs, Serum TSH/T3/T4 levels, Intake and Output, Cortisol Level, BUN and Creatinine.
- C. Graves' disease, Cushing's syndrome, Hypothyroidism, Systemic Lupus Erythematosus, Adrenal Insufficiency.
Correct Answer: C, A, E, B
Rationale: Fatigue, weight gain, and bradycardia suggest hypothyroidism. Levothyroxine treats it, fall precautions address dizziness, and TSH/T3/T4 and vital signs monitor progress.
The nurse is performing a physical assessment on a client with Cushing's disease. Which assessment findings should the nurse expect?
- A. Hypotension
- B. Acne
- C. Hirsutism
- D. Buffalo hump
- E. Truncal obesity
Correct Answer: B, C, D, E
Rationale: Cushing's disease from excess cortisol causes acne, hirsutism (excess hair), buffalo hump, and truncal obesity due to fat redistribution. Hypertension, not hypotension, is typical.
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.