Nokea
The nurse is teaching a client who is to receive lypressin nasal spray as treatment for neurogenic diabetes insipidus about administration. Which client statement indicates the need for additional teaching?
- A. I'll inhale fully after spraying the drug.'
- B. If my nose gets irritated, I'll call my physician.'
- C. I should hold the spray container upright.'
- D. While sitting up, I'll place the nozzle in my nostril.'
Correct Answer: A
Rationale: When administering lypressin nasal spray, the client should not inhale the drug. Calling the physician if he or she experiences nasal irritation, holding the container upright, and placing the nozzle in the nostril while sitting up are appropriate.
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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.
A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestation(s) of this disorder does the nurse recognize is progressing to myxedema coma? Select all that apply.
- A. Hypothermia
- B. Hypertension
- C. Hypotension
- D. Hypoventilation
- E. Hyperventilation
Correct Answer: A,C,D
Rationale: Severe hypothyroidism is called myxedema. Advanced, untreated myxedema can progress to myxedema coma. Signs of this life-threatening event are hypothermia, hypotension, and hypoventilation. Hypertension and hyperventilation indicate increased metabolic responses, which are the opposite of what the client would be experiencing.
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.
A client is scheduled for a hypophysectomy for the management of a pituitary tumor. What is the nurse priority when caring for this client? Select all that apply.
- A. Assure the client that he will make it through the surgery without any difficulty.
- B. Help the client cope with changes in physical appearance.
- C. Pace activities to accommodate the client's fatigue.
- D. Relieve discomfort from headaches, abdominal distention, and skeletal pain.
- E. Encourage self-care and activities as client's endurance permits.
Correct Answer: B,C,D,E
Rationale: Until the client has surgery or receives radiation treatment, nursing priorities include helping the client cope with changes in physical appearance; pacing activities to accommodate the client's fatigue; and relieving discomfort from headaches, abdominal distention resulting from organ enlargement, and skeletal pain. Assuring the client that he will make it through the surgery without any difficulty is not appropriate as it dismisses the client's concerns and does not address specific care priorities.
What would the nurse expect the health care provider to order for a client with hypothyroidism?
- A. Levothyroxine sodium
- B. Methimazole
- C. Propranolol
- D. Propylthiouracil
Correct Answer: A
Rationale: Hypothyroidism is treated with thyroid replacement therapy, in the form of desiccated thyroid extract or a synthetic product, such as levothyroxine sodium (Synthroid) or liothyronine sodium (Cytomel). Methimazole and propylthiouracil are antithyroid agents used to treat hyperthyroidism. Propranolol is a beta blocker that can be used to treat hyperthyroidism.