Nokea
The nurse is caring for a patient following a parathyroidectomy who develops tingling of the lips and a positive Trousseau's sign. Which of the following actions should the nurse take first?
- A. Administer the ordered muscle relaxant.
- B. Give the ordered oral calcium supplement.
- C. Start the PRN oxygen at 2 L minute per cannula.
- D. Have the patient rebreathe using a paper bag.
Correct Answer: D
Rationale: The patient's symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the patient breathe into a paper bag, which will raise the PaCO2 and create a more acidic pH. The muscle relaxant will have no impact on the ionized calcium level. Although severe hypocalcemia can cause laryngeal stridor, there is no indication that this patient is experiencing laryngeal stridor or needs oxygen. Calcium supplements will be given to normalize calcium levels quickly, but oral supplements will take time to be absorbed.
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The nurse is caring for an older-adult patient who is diagnosed with hypothyroidism and has a prescription for levothyroxine. Which of the following assessments is most important for the nurse to make during initiation of thyroid replacement?
- A. Apical pulse rate
- B. Nutritional intake
- C. Intake and output
- D. Orientation and alertness
Correct Answer: A
Rationale: In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias. The medication is also expected to improve mental status and fluid balance and will increase metabolic rate and nutritional needs, but these changes will not result in potentially life-threatening complications.
The nurse is caring for a patient who has an adrenocortical adenoma and hyperaldosteronism. Which of the following actions should the nurse implement?
- A. Provide a potassium-restricted diet.
- B. Monitor the blood pressure every 4 hours.
- C. Evaluate blood glucose level every 4 hours.
- D. Maintain extremities in an elevated position.
Correct Answer: B
Rationale: Hypertension caused by sodium retention is a common complication of hyperaldosteronism. Hyperaldosteronism does not cause elevation in blood glucose. The patient will be hypokalemic and require potassium supplementation before surgery. Edema does not usually occur with hyperaldosteronism.
The nurse is caring for a patient with symptoms of diabetes insipidus who has been admitted to the hospital for evaluation and treatment. Which of the following nursing diagnoses is best for this patient?
- A. Insomnia related to frequent waking at night to void
- B. Impaired gas exchange related to fluid retention in lungs
- C. Excess fluid volume related to intake greater than output
- D. Risk for impaired skin integrity related to generalized edema
Correct Answer: A
Rationale: Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.
The nurse is caring for a patient with inappropriate antidiuretic hormone (SIADH) due to a head trauma who is receiving a hypertonic saline IV solution to counteract hyponatremia. The nurse will expect the saline solution to be administered until the patient's serum sodium reaches which of the following levels?
- A. 120 mmol/L.
- B. 130 mmol/L.
- C. 128 mmol/L.
- D. 138 mmol/L.
Correct Answer: C
Rationale: If the patient is hyponatremic, hypertonic saline may be administered until the serum sodium level reaches at least 130 mmol/L. Hypernatremia is evident with a sodium level of 168 mmol/L.
The nurse is admitting a patient with Graves' disease to the emergency department in thyrotoxic crisis. Which of these prescribed medications should the nurse administer first?
- A. Propranolol
- B. Propylthiouracil
- C. Methimazole
- D. Iodine
Correct Answer: A
Rationale: β-Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid storm. The other medications take days to weeks to have an impact on thyroid function.