Nokea
The nurse is caring for a patient who is scheduled for a 24-hour urine collection for 17-ketosteroids. Which of the following actions should the nurse implement?
- A. Keep the specimen on ice.
- B. Insert a retention catheter.
- C. Have the patient void and save that specimen to start the collection.
- D. Encourage the patient to drink 2-3 L of fluid during the 24 hours.
Correct Answer: A
Rationale: The specimen must be kept on ice or refrigerated until the collection is finished. Voided or catheterized specimens are acceptable for the test. The initial voided specimen is discarded. There is no fluid intake requirement for the 24-hour collection.
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The nurse is caring for a patient in the outpatient clinic who has a prescription for blood cortisol testing. Which of the following instructions should the nurse provide for the patient?
- A. Avoid adding any salt to your foods for 24 hours before the test.
- B. You will need to lie down for 30 minutes before the blood is drawn.
- C. Come to the laboratory to have the blood drawn early in the morning.
- D. Do not have anything to eat or drink before the blood test is obtained.
Correct Answer: C
Rationale: Cortisol levels are usually drawn in the morning when levels are highest. The other instructions would be given to patients who were having other endocrine testing.
The nurse is caring for a patient who is taking spironolactone. Which of the following parameters should the nurse monitor?
- A. Decreased urinary output
- B. Evidence of fluid overload
- C. Increased serum sodium levels
- D. Elevated serum potassium levels
Correct Answer: D
Rationale: Spironolactone is a diuretic and it blocks aldosterone. Recalling that aldosterone increases the excretion of potassium, a medication that blocks aldosterone will tend to cause hyperkalemia. Aldosterone also promotes the reabsorption of sodium and water in the renal tubules, so spironolactone will tend to cause increased urine output, a decreased or normal serum sodium level, and signs of dehydration.
The nurse is teaching a patient how to prepare for an oral glucose tolerance test (OGTT). Which of the following patient response indicates that the teaching has been effective?
- A. Fast 12 hours before the procedure
- B. Clear fluid diet 12 hours prior to the test
- C. Drink only full fluids 6 hours before the test
- D. No fluid or food restrictions prior to the test
Correct Answer: A
Rationale: Fasting for 12 hours before the procedure demonstrates that teaching has been effective. The patient is to be NPO 12 hours prior to the test. A clear fluid diet 12 hours pretest is not indicated. A full fluid diet 6 hours pretest is not indicated.
During a physical examination, the nurse finds that a patient's thyroid gland cannot be palpated. Which of the following is the best action for the nurse to take?
- A. Palpate the patient's neck more deeply.
- B. Document that the thyroid was nonpalpable.
- C. Notify the health care provider immediately.
- D. Teach the patient about thyroid hormone testing.
Correct Answer: B
Rationale: The thyroid is frequently nonpalpable. The nurse should simply document the finding. There is no need to notify the health care provider immediately about a normal finding. There is no indication for TSH testing unless there is evidence of thyroid dysfunction. Deep palpation of the neck is not appropriate.
A patient is scheduled for a growth hormone stimulation test. Which of the following items should the nurse obtain in preparation for the test?
- A. Basin of ice
- B. Cardiac monitor
- C. Vial of glargine insulin
- D. Intravenous dextrose solution
Correct Answer: D
Rationale: Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be prepared to administer glucose IV immediately or have a sweet snack available for the patient immediately following the test. Regular insulin is used to induce hypoglycemia (glargine is never given intravenously). The patient does not require cardiac monitoring during the test. Although blood samples for some tests must be kept on ice, this is not true for the growth hormone stimulation test.