Nokea
The nurse is teaching a client who has Graves' disease about self-management. Which of the following should the nurse include in the teaching plan?
- A. Stool softeners can be taken daily to prevent constipation.
- B. Thyroid replacement should be taken first thing in the morning.
- C. Report any significant weight gain while taking the antithyroid medication.
- D. Maintain the prescribed fluid restriction to prevent fluid overload.
Correct Answer: C
Rationale: In Graves' disease, antithyroid meds control hyperthyroidism; significant weight gain may signal overtreatment, needing reporting. Stool softeners, thyroid replacement, and fluid restriction are for hypothyroidism or other conditions.
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The nurse is planning care for a client following bilateral adrenalectomy. The nurse should anticipate a prescription for which postoperative medication?
- A. Pantoprazole
- B. Propylthiouracil (PTU)
- C. Propranolol
- D. Hydrocortisone
Correct Answer: D
Rationale: Bilateral adrenalectomy removes adrenal glands, necessitating lifelong hydrocortisone replacement to provide glucocorticoids and prevent adrenal insufficiency. Pantoprazole, PTU, and propranolol are not indicated for this purpose.
The nurse in the clinic is caring for a 32-year-old female client.
Item 6 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]
Orders
1714:
Arrange for a follow-up appointment in 3 days
Lab orders: serum complete blood count, complete metabolic panel, hemoglobin A1C
24-hour urinary cortisol excretion
Progress Notes
Follow-up appointment 3 days later
1544: Client presents for a 3-day follow-up. Laboratory findings confirm Cushing's disease with the 24-hour urine cortisol test at 125 mcg/24 hour [10 to 100 mcg/24]. CMP showed hyperglycemia, hypernatremia, and hypokalemia. Will refer to endocrinology for further evaluation and management. Will prescribe potassium supplementation.
For each of the statements made by the client, click to specify whether the statement indicates an understanding or requires follow-up of the discharge teaching provided on Cushing's disease.
- A. I should start using a salt substitute to season my foods.
- B. Exercise such as swimming is appropriate.
- C. I should start eating snacks high in sodium and potassium.
- D. I will limit my caffeine consumption.
- E. This condition requires me to avoid getting the seasonal influenza vaccine.
- F. I should notify my doctor if I start to develop constipation and muscle weakness.
Correct Answer: A, C, E
Rationale: Salt substitutes reduce sodium, appropriate for Cushing's-related hypertension. High sodium snacks are incorrect due to fluid retention risks. Limiting caffeine is good, and avoiding vaccines is wrong—immunizations are crucial. Notifying the doctor about weakness is correct.
The nurse cares for a 38-year-old female client recently diagnosed with Graves' disease. The client presents with a visibly enlarged thyroid gland, heat intolerance, excessive sweating, and unintentional weight loss. What additional signs or symptoms may be present in this client?
- A. Increased heart rate and palpitations
- B. Diarrhea and frequent bowel movements
- C. Tremors, particularly in the hands and fingers
- D. Eye changes such as exophthalmos
- E. Intolerance to cold temperatures
Correct Answer: A, B, C, D
Rationale: Graves' disease, a hyperthyroid condition, causes tachycardia, palpitations, diarrhea, tremors, and exophthalmos due to increased metabolism and autoimmunity. Cold intolerance is a hypothyroid symptom.
The nurse is caring for a client receiving prescribed dexamethasone. Which of the following adverse reactions may occur?
- A. Infection
- B. Hypotension
- C. Peripheral edema
- D. Hypoglycemia
- E. Weight loss
- F. Insomnia
Correct Answer: A,C,F
Rationale: Dexamethasone, a corticosteroid, increases infection risk, causes fluid retention (peripheral edema), and insomnia. Hypotension, hypoglycemia, and weight loss are not typical; hypertension, hyperglycemia, and weight gain are more common.
The nurse assesses clients for the risk of developing hyperosmolar hyperglycemic syndrome. Which of the following clients should the nurse consider to be at greatest risk?
- A. 63-year-old with diabetes mellitus (type two) who works outdoors and recently had an increased dosage of metformin.
- B. 55-year-old with diabetes mellitus (type one) who was recently hospitalized for pneumonia and occasionally forgets to take their long-acting insulin.
- C. 15-year-old with diabetes mellitus (type one) who has a hemoglobin A1C of 7.6% [ < 7%] and has gained 4 lbs (1.8 kg) in the past month.
- D. 45-year-old who was recently diagnosed with diabetes mellitus (type two) and was prescribed glipizide in addition to metformin.
Correct Answer: A
Rationale: HHS is common in type 2 diabetes, especially in older adults. Outdoor work risks dehydration, and increased metformin may not control severe hyperglycemia, heightening HHS risk.