Nokea
The nurse supervises a graduate nurse caring for a client newly admitted for postoperative management following a thyroidectomy. Which of the following actions by the graduate nurse indicates effective planning of the client's care?
- A. A bottle of sterile water and petroleum-based gauze is at the bedside.
- B. Obtains a prescription for magnesium sulfate.
- C. The bedside is prepared with a tracheostomy set, oxygen, and suction.
- D. Applies a cervical collar to the client
Correct Answer: C
Rationale: Post-thyroidectomy, airway obstruction from swelling or hemorrhage is a risk. A tracheostomy set, oxygen, and suction are essential for emergency airway management. Sterile water and gauze are insufficient, magnesium sulfate is unrelated, and a cervical collar may restrict breathing.
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The following scenario applies to the next 6 items
The nurse in the clinic is caring for a 32-year-old female client.
Item 4 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]
For each potential order, click to specify whether the potential order is indicated or not indicated for the client.
- A. Serum hemoglobin A1C
- B. 24-hour urinary cortisol levels
- C. Serum complete metabolic panel
- D. Serum clonidine suppression test
- E. Serum complete blood count
- F. Administration of a prescribed corticosteroid
- G. Referral for neurology consultation
Correct Answer: A, B, C, E
Rationale: HbA1C assesses long-term glucose control, 24-hour cortisol tests for Cushing's, CMP evaluates electrolytes and glucose, and CBC checks for infection or anemia. Clonidine suppression is for pheochromocytoma, corticosteroids are not indicated, and neurology referral is unnecessary without neurological symptoms.
The nurse is counseling a client who has prediabetes. The nurse understands that the client is meeting the treatment goal, as evidenced by
- A. total cholesterol of 215 mg/dL (5.55 mmol/L) [ < 200 mg/dL, < 5.2 mmol/L]
- B. hemoglobin A1C of 5.4% [ < 6.4%]
- C. fasting blood glucose 128 mg/dL (7.10 mmol/L) [70-110 mg/dL, 4.0-6.0 mmol/L]
- D. random blood glucose of 210 mg/dL (11.66 mmol/L) [70-110 mg/dL, 4.0-6.0 mmol/L]
Correct Answer: B
Rationale: Prediabetes goals include HbA1C <5.7%; 5.4% indicates good control. Elevated cholesterol, fasting, and random glucose suggest ongoing issues.
The nurse is reviewing the diet of the client with hypoparathyroidism. The nurse understands that the client should be on what type of diet?
- A. High-calorie, low-calcium diet
- B. Low-calcium, low-phosphorus diet
- C. High-phosphorus, low-calcium diet
- D. High-calcium, low-phosphorus diet
Correct Answer: D
Rationale: Hypoparathyroidism reduces PTH, lowering calcium. A high-calcium, low-phosphorus diet compensates, as high phosphorus can further bind calcium.
The nurse is caring for a client who has diabetes mellitus. Which of the following would indicate the client is achieving the treatment goals?
- A. Fasting blood glucose 145 mg/dl (8.05 mmol/L) [70-110 mg/dL, 4.0-6.0 mmol/L]
- B. Creatinine 2.3 mg/dl (203.32 μmol/L) [Male: 0.6-1.2 mg/dL Female: 0.5-1.1 mg/dL, Male 49-93 ¼mol/L Female 22-75 ¼mol/L]
- C. Urine Specific Gravity 1.043 [1.005-1.030]
- D. Hemoglobin A1C 6.7% [ < 7%]
Correct Answer: D
Rationale: HbA1C of 6.7% indicates good long-term glucose control (target <7%). Elevated fasting glucose, creatinine, and urine specific gravity suggest poor control or complications like renal issues.
The nurse is preparing to administer metformin to a client with diabetes mellitus (type two). Which of the following laboratory test results should the nurse monitor during the therapy?
- A. white blood cell (WBC) count
- B. vitamin B12 level
- C. serum uric acid level
- D. thyroid-stimulating hormone (TSH) level
Correct Answer: B
Rationale: Metformin can cause vitamin B12 deficiency over time, requiring monitoring. WBC, uric acid, and TSH are not primarily affected by metformin.