Nokea
The nurse is caring for a client with the syndrome of inappropriate antidiuretic hormone (SIADH). Which assessment finding requires immediate follow-up?
- A. Disorientation
- B. High urine specific gravity
- C. Oliguria
- D. Increased thirst
Correct Answer: A
Rationale: SIADH causes water retention and hyponatremia, which can lead to disorientation—a neurological symptom requiring urgent follow-up to prevent seizures or coma. Other findings are expected.
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The nurse has provided medication instruction to a client who has been prescribed metformin. Which of the following statements, if made by the client, would indicate a correct understanding of the teaching?
- A. This medication may cause me to have bloating or loose stools.
- B. I will need to take my blood glucose prior to taking this medication.
- C. If I eat fewer carbohydrates in a day, I should skip a dose.
- D. The goal of this medication is to increase my hemoglobin A1C.
Correct Answer: A
Rationale: Metformin commonly causes gastrointestinal side effects like bloating or loose stools. Blood glucose checks are not required before dosing, skipping doses is inappropriate, and metformin aims to lower, not increase, HbA1c.
The nurse is educating a group of students on the effects of corticosteroids. It would be appropriate for the nurse to identify the following adverse effects associated with corticosteroids.
- A. Mood lability
- B. Immunosuppression
- C. Hypoglycemia
- D. Hyperkalemia
- E. Weight gain
Correct Answer: A, B, E
Rationale: Corticosteroids cause mood changes, suppress immunity, and promote weight gain via fluid retention and fat redistribution. They cause hyperglycemia, not hypoglycemia, and hypokalemia, not hyperkalemia.
The nurse is caring for a client receiving prescribed dexamethasone. Which of the following adverse reactions may occur?
- A. Infection
- B. Hypotension
- C. Peripheral edema
- D. Hypoglycemia
- E. Weight loss
- F. Insomnia
Correct Answer: A,C,F
Rationale: Dexamethasone, a corticosteroid, increases infection risk, causes fluid retention (peripheral edema), and insomnia. Hypotension, hypoglycemia, and weight loss are not typical; hypertension, hyperglycemia, and weight gain are more common.
The nurse is caring for a client who has been prescribed a 14-day course of prednisone. Which of the following statements, if made by the nurse, would be correct?
- A. This medication may make you gain weight.
- B. It is best to take this medication in the morning with food.
- C. If you have further pain, it is okay to take naproxen.
- D. Your blood pressure may decrease while taking this medication.
- E. Do not abruptly stop taking this medication.
Correct Answer: A,B,E
Rationale: Prednisone can cause weight gain, should be taken in the morning with food to mimic cortisol rhythms and reduce gastrointestinal upset, and must not be stopped abruptly to prevent adrenal insufficiency. Naproxen should be avoided due to increased gastrointestinal bleeding risk, and prednisone typically increases, not decreases, blood pressure.
The nurse is preparing to administer tolvaptan to a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following laboratory test results should the nurse review before administering the medication?
- A. hemoglobin (Hgb) and white blood cell (WBC) count
- B. alanine aminotransferase (ALT) and aspartate aminotransferase (AST)
- C. troponin and myoglobin
- D. serum glucose and serum hemoglobin A1C
Correct Answer: B
Rationale: Tolvaptan can cause liver injury, so ALT and AST (liver function tests) should be reviewed before administration. Hemoglobin/WBC, troponin/myoglobin, and glucose/HbA1c are not primary concerns.