Nokea
The nurse is caring for a patient who had radical neck surgery and develops hypoparathyroidism. Which of the following information should the nurse include in the teaching plan?
- A. Use of bisphosphonates to reduce bone demineralization.
- B. Include whole grains in the diet to prevent constipation.
- C. Take calcium supplementation to normalize serum calcium levels.
- D. Ensure a high fluid intake to decrease risk for nephrolithiasis.
Correct Answer: C
Rationale: Oral calcium supplements are used to maintain the serum calcium in normal range and prevent the complications of hypocalcemia. Whole-grain foods decrease calcium absorption and will not be recommended. Bisphosphonates will lower serum calcium levels further by preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of hypoparathyroidism and low calcium levels.
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The nurse is teaching a patient with persistent syndrome of inappropriate antidiuretic hormone (SIADH) about long-term management. Which of the following patient statements indicate that additional instruction is needed?
- A. I should weigh myself daily and report any sudden weight loss or gain.
- B. I need to limit my fluid intake to no more than 1 L of liquids a day.
- C. I will eat foods high in potassium because the diuretics cause potassium loss.
- D. I need to shop for foods that are low in sodium and avoid adding salt to foods.
Correct Answer: D
Rationale: Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed. The other patient statements are correct and indicate successful teaching has occurred.
Which of the following assessment findings for a patient admitted with Graves' disease requires the most rapid intervention by the nurse?
- A. BP 166/100 mm Hg
- B. Bilateral exophthalmos
- C. Heart rate 136 beats/minute
- D. Temperature 40.4°C (104.7°F)
Correct Answer: D
Rationale: The patient's temperature indicates that the patient may have thyrotoxic crisis and that interventions to lower the temperature are needed immediately. The other findings also require intervention but do not indicate potentially life-threatening complications.
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.
The nurse is assessing a patient who has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy and obtains these data. Which of the following information is most important to communicate to the surgeon?
- A. The patient is sleepy and hard to arouse.
- B. The patient has increasing swelling of the neck.
- C. The patient is complaining of 7/10 incisional pain.
- D. The patient's cardiac monitor shows a heart rate of 112.
Correct Answer: B
Rationale: The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to prevent airway obstruction. The incisional pain should be treated but is not unusual after surgery. A heart rate of 112 is not unusual in a patient who has been hyperthyroid and has just arrived in the PACU from surgery. Sleepiness in the immediate postoperative period is expected.
The nurse is providing preoperative teaching for a patient scheduled for a hypophysectomy for treatment of a pituitary adenoma. Which of the following instructions should the nurse include in patient teaching?
- A. Cough and deep breathe every 2 hours postoperatively
- B. Bed rest for the first 24 hours after the surgery
- C. Be positioned flat with sandbags at the head postoperatively
- D. Have a NG tube after the surgery
Correct Answer: D
Rationale: The patient should be taught that they will have a NG tube after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is discouraged because it may cause leakage of cerebrospinal fluid (CSF) from the suture line. The head of the bed should be elevated 30 degrees to reduce pressure on the sella turcica and decrease the risk for headaches.