Nokea
The nurse is performing discharge teaching for a client with Graves' disease. Which of the following client statements indicates effective understanding?
- A. I will take my pulse daily and report a rate less than 60 beats/minute.
- B. I am going to add hot yoga to my exercise routine.
- C. I will increase the amount of fiber in my diet.
- D. I should tell my physician if my blood pressure's top number exceeds 140.
Correct Answer: D
Rationale: Graves' causes hypertension; reporting systolic BP >140 allows timely intervention. Bradycardia is not typical, hot yoga may worsen heat intolerance, and fiber is unrelated to Graves' management.
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The nurse is caring for a client prescribed propylthiouracil (PTU). To monitor the effectiveness of this medication, the nurse anticipates the primary healthcare provider will order a
- A. serum calcium level.
- B. thyroid panel.
- C. fasting blood glucose.
- D. white blood cell (WBC) count.
Correct Answer: B
Rationale: PTU treats hyperthyroidism by reducing thyroid hormone production. A thyroid panel (TSH, T4, T3) monitors effectiveness. Calcium, glucose, and WBC are not directly related to PTU's action.
The nurse is caring for a client who reports diarrhea, unintentional weight loss, and nervousness. The primary healthcare provider (PHCP) orders a thyroid panel, and the nurse understands the client is at the highest risk for
- A. Myxedema
- B. Bell's palsy
- C. Grave's disease
- D. Cushing syndrome
Correct Answer: C
Rationale: Diarrhea, weight loss, and nervousness suggest hyperthyroidism, with Graves' disease as the most common cause due to thyroid overstimulation. Myxedema and Cushing's have opposite symptoms, and Bell's palsy is unrelated.
The following scenario applies to the next 6 items
The nurse in the clinic is caring for a 32-year-old female client.
Item 1 of 6
Nurses' Notes
1559: Client reports to the outpatient clinic with reports of persistent fatigue, weakness, lethargy, and lower back pain over the last 8 months. She is also concerned because she has gained 24 pounds (10.9 kg) over the past 4 months. She stated that the weight gain has been so significant that she developed reddened streaks on her abdomen from the weight gain. The client is concerned because, over the past month, she has noticed she has been drinking more often and has had increased hunger. She has also noticed she is urinating more frequently. She went to urgent care one week ago and tested negative for urinary tract infection. She also noticed that her menstrual cycle has been irregular. She is not on birth control and took a home pregnancy test, which was negative. During the assessment, the client was fully alert and oriented. Clear lung sounds bilaterally. Skin was dry. Excessive facial hair was noted. 1+ pedal and ankle edema bilaterally. Peripheral pulses palpable, 2+, and regular. Body mass index (BMI) of 32. Vital signs: T 97.5° F (36.4° C), P 93, RR 18, BP 145/93, pulse oximetry reading 96% on room air. She is currently taking escitalopram for persistent depressive disorder.
Laboratory Results
Capillary Blood Glucose
1613: 254 mg/dL [70-110 mg/dL]
Select the client findings that require follow-up.
- A. Capillary blood glucose
- B. Peripheral pulse findings
- C. Blood pressure
- D. Not taking birth control
Correct Answer: A, C, F, G
Rationale: Elevated glucose (254 mg/dL) suggests hyperglycemia, needing investigation. BP (145/93) indicates hypertension, requiring monitoring. Edema and BMI of 32 signal potential endocrine or cardiac issues. Peripheral pulses are normal and birth control is unrelated.
The nurse is preparing to administer metformin to a client with diabetes mellitus (type two). Which of the following laboratory test results should the nurse monitor during the therapy?
- A. white blood cell (WBC) count
- B. vitamin B12 level
- C. serum uric acid level
- D. thyroid-stimulating hormone (TSH) level
Correct Answer: B
Rationale: Metformin can cause vitamin B12 deficiency over time, requiring monitoring. WBC, uric acid, and TSH are not primarily affected by metformin.
The nurse is caring for a client who has diabetic ketoacidosis (DKA). Which of the following would indicate the client is achieving the treatment goals?
- A. Mean arterial pressure (MAP) 71 mmHg
- B. Potassium 3.3 mEq/L (mmol) [3.5-5 mEq/L]
- C. Blood glucose 255 mg/dL (14.15 mmol/L) [70-110 mg/dL, 4.0-11.0 mmol/L]
- D. Serum pH 7.33 [7.35 and 7.45]
Correct Answer: D
Rationale: In DKA, treatment aims to correct acidosis, hyperglycemia, and electrolyte imbalances. A serum pH of 7.33 is closer to the normal range (7.35-7.45), indicating improvement in acidosis. MAP of 71 mmHg is low, potassium is below normal, and glucose remains elevated, suggesting ongoing issues.