Nokea
The nurse is providing care for an older adult patient whose current medication regimen includes levothyroxine (Synthroid). As a result, the nurse should be aware of the heightened risk of adverse effects when administering an IV dose of what medication?
- A. A fluoroquinalone antibiotic
- B. A loop diuretic
- C. A proton pump inhibitor (PPI)
- D. A benzodiazepine
Correct Answer: D
Rationale: Oral thyroid hormones interact with many other medications. Even in small IV doses, hypnotic and sedative agents may induce profound somnolence, lasting far longer than anticipated and leading to narcosis (stupor like condition). Furthermore, they are likely to cause respiratory depression, which can easily be fatal because of decreased respiratory reserve and alveolar hypoventilation. Antibiotics, PPIs and diuretics do not cause the same risk.
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The nurse is assessing a patient diagnosed with Graves disease. What physical characteristics of Graves disease would the nurse expect to find?
- A. Hair loss
- B. Moon face
- C. Bulging eyes
- D. Fatigue
Correct Answer: C
Rationale: Clinical manifestations of the endocrine disorder Graves disease include exophthalmos (bulging eyes) and fine tremor in the hands. Graves disease is not associated with hair loss, a moon face, or fatigue.
A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal?
- A. Hyponatremia
- B. Hypophosphatemia
- C. Hypocalcemia
- D. Hypokalemia
Correct Answer: C
Rationale: Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as tetany and must be reported to the physician immediately, because laryngospasm may occur and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not expected responses to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may lead to hyperphosphatemia.
A 30 year-old female patient has been diagnosed with Cushing syndrome. What psychosocial nursing diagnosis should the nurse most likely prioritize when planning the patients care?
- A. Decisional conflict related to treatment options
- B. Spiritual distress related to changes in cognitive function
- C. Disturbed body image related to changes in physical appearance
- D. Powerlessness related to disease progression
Correct Answer: C
Rationale: Cushing syndrome causes characteristic physical changes that are likely to result in disturbed body image. Decisional conflict and powerless may exist, but disturbed body image is more likely to be present. Cognitive changes take place in patients with Cushing syndrome, but these may or may not cause spiritual distress.
A patient is undergoing testing for suspected adrenocortical insufficiency. The care team should ensure that the patient has been assessed for the most common cause of adrenocortical insufficiency. What is the most common cause of this health problem?
- A. Therapeutic use of corticosteroids
- B. Pheochromocytoma
- C. Inadequate secretion of ACTH
- D. Adrenal tumor
Correct Answer: A
Rationale: Therapeutic use of corticosteroids is the most common cause of adrenocortical insufficiency. The other options also cause adrenocortical insufficiency, but they are not the most common causes.
The nurse is performing a shift assessment of a patient with aldosteronism. What assessments should the nurse include? Select all that apply.
- A. Urine output
- B. Signs or symptoms of venous thromboembolism
- C. Peripheral pulses
- D. Blood pressure
- E. Skin integrity
Correct Answer: A,D
Rationale: The principal action of aldosterone is to conserve body sodium. Alterations in aldosterone levels consequently affect urine output and BP. The patients peripheral pulses, risk of VTE, and skin integrity are not typically affected.