Nokea
The nurse preceptor observes a newly hired nurse care for a client with a myxedema coma. It would require follow up by the nurse preceptor if the newly hired nurse is observed
- A. applying a cooling blanket to the client.
- B. requesting a prescription for hydrocortisone.
- C. removing the water pitcher from the bedside.
- D. placing an oral endotracheal tube at the bedside for potential use.
Correct Answer: A
Rationale: Myxedema coma is a severe hypothyroid state with hypothermia. A cooling blanket worsens this; a warming blanket is needed. Hydrocortisone addresses adrenal insufficiency, removing water prevents dilutional hyponatremia, and an endotracheal tube is prudent for potential respiratory support.
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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 preparing a presentation on Cushing's disease. It would be correct if the nurse states that Cushing's disease is caused by
- A. destruction to pancreatic beta cells.
- B. excessive discharge of thyroid-stimulating hormone (TSH).
- C. decrease in the secretion of androgens and glucocorticoids.
- D. increase in the secretion of adrenocorticotropin hormone (ACTH).
Correct Answer: D
Rationale: Cushing's disease results from excess ACTH from the pituitary, overstimulating cortisol production. Beta cell destruction, TSH, and decreased androgens/glucocorticoids are unrelated.
The nurse is assessing a client with hypothyroidism. Which of the following assessment findings would be expected?
- A. Decreased libido
- B. Bradycardia
- C. Heat intolerance
- D. Fatigue
- E. Constipation
Correct Answer: A, B, D, E
Rationale: Hypothyroidism slows metabolism, leading to decreased libido, bradycardia, fatigue, and constipation. Heat intolerance is associated with hyperthyroidism, not hypothyroidism.
The nurse reviews laboratory data for a client with suspected diabetes mellitus (DM). Which action should the nurse take based on the client's hemoglobin A1C? See Exhibit.
- A. assess the client for an infection
- B. instruct the client that the results are within normal limits
- C. assess the client's urine for glycosuria
- D. educate the client on a diet with low-glycemic foods
Correct Answer: D
Rationale: Without specific HbA1C values, a suspected DM diagnosis warrants dietary education on low-glycemic foods to manage blood sugar. Infection or glycosuria assessment depends on results, and normal limits are unlikely if DM is suspected.
The nurse has instructed a client with diabetes mellitus (type 1) about proper exercise. Which of the following statements by the client would indicate a correct understanding of the teaching?
- A. I should carry a snack rich in protein just in case I feel shaky.
- B. I will not take my prescribed daily glargine insulin if I plan on exercising.
- C. I can initially expect my glucose level to rise with vigorous exercise, but if I continue exercising, my levels may eventually decrease.
- D. I should start my exercise near the time that my insulin peaks.
Correct Answer: C
Rationale: Vigorous exercise can initially raise blood glucose due to stress hormones, but prolonged activity increases glucose uptake by muscles, lowering levels. Carrying a carbohydrate-rich snack, not protein, is best for hypoglycemia. Insulin should never be skipped, and exercising at peak insulin time risks hypoglycemia.