Nokea
The nurse is teaching a client about the dietary restrictions related to a diagnosis of hyperparathyroidism. What foods should the nurse encourage the client to avoid?
- A. Bananas
- B. Chicken livers
- C. Hamburger
- D. Milk
Correct Answer: D
Rationale: Clients with hyperparathyroidism should use a low-calcium diet (fewer dairy products) and drink at least 3 to 4 L of fluid daily to dilute the urine and prevent renal stones from forming. It is especially important that the client drink fluids before going to bed and periodically throughout the night to avoid concentrated urine. Bananas, chicken livers, and hamburgers do not require avoidance. Milk is the highest in calcium content.
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A client has been diagnosed with nephrogenic diabetes insipidus (DI), and the physician is initiating treatment. What medication does the nurse prepare to administer for this client?
- A. Metolazone
- B. Bumetanide
- C. Furosemide
- D. Hydrochlorothiazide
Correct Answer: D
Rationale: The physician prescribes a thiazide diuretic, such as hydrochlorothiazide. The thiazide acts at the proximal convoluted tubule, leaving less fluid for excretion in the distal convoluted tubules, the portion affected by nephrogenic diabetes insipidus (DI). Consequently, the client excretes water, but the total volume is less than in an untreated state. The other diuretics listed do not work on the proximal convoluted tubule and would not be effective in treatment.
Which of the following precautions would be most appropriate when caring for a client being treated with radioactive iodine (RAI) for a thyroid tumor?
- A. Administer prescribed corticosteroids carefully.
- B. Handle body fluids carefully.
- C. Monitor the respiratory status.
- D. Administer the prescribed medications at the same time each day.
Correct Answer: B
Rationale: The nurse handles body fluids carefully to prevent spread of contamination. Corticosteroids are not prescribed for thyroid tumor. Monitoring the respiratory status and administering prescribed medicines at the same time each day are unrelated to the care of a client receiving RAI.
A client with acromegaly has been given the option of a surgical approach or a medical approach. The client decides to have a surgical procedure to remove the pituitary gland. What does the nurse understand this surgical procedure is called?
- A. Hypophysectomy
- B. Hysteroscopy
- C. Thyroidectomy
- D. Ablation
Correct Answer: A
Rationale: The treatment of choice is surgical removal of the pituitary gland (transsphenoidal hypophysectomy) through a nasal approach. The surgeon may substitute an endoscopic technique using microsurgical instruments to reduce surgical trauma. A hysteroscopy is a gynecologic procedure. The thyroid gland is not involved for a surgical procedure. Ablation is not a removal of the pituitary gland.
The instructor is teaching a group of students about Simmonds disease. The instructor determines that additional instruction is necessary when the students identify which hormone as being involved?
- A. Growth hormone
- B. Luteinizing hormone
- C. Adrenocorticotropic hormone
- D. Oxytocin
Correct Answer: D
Rationale: Oxytocin is a hormone of the posterior pituitary gland and would not be involved. Simmonds disease affects all hormones of the anterior pituitary: GH (bones and muscles), adrenocorticotropic hormone (ACTH, adrenals), thyroid-stimulating hormone (TSH, thyroid), follicle-stimulating hormone (FSH, ovaries and testes), luteinizing hormone (LH, ovaries), interstitial cell-stimulating hormone (ICSH (LH), testes), and prolactin (breasts).
The nurse is instructing a client about the use of pegvisomant for the treatment of acromegaly. How will the nurse instruct to take this medication?
- A. Injected subcutaneously once a day
- B. Injected intramuscularly once a month
- C. Administer via an implanted port once a month
- D. Injected intramuscularly one every 6 months
Correct Answer: A
Rationale: Pegvisomant, a GH receptor antagonist, is the newest and most effective drug for treating acromegaly. Injected subcutaneously once a day, it normalizes the IGF-I level in 93% to 97% of cases by blocking the GH stimulation of IGF-I produced by the liver.