Nokea
The student nurse is caring for a patient with goitre and possible hyperthyroidism. Which of the following actions by the student nurse should cause the nursing instructor to intervene?
- A. Palpates the neck to check thyroid size.
- B. Checks the blood pressure on both arms.
- C. Administers nonmedicated eye drops to the patient's eyes.
- D. Lowers the thermostat to decrease the temperature in the room.
Correct Answer: A
Rationale: Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided. The other actions by the student nurse are appropriate when caring for a patient with an enlarged thyroid.
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A patient with a possible pituitary adenoma is scheduled for a computed tomography (CT) scan with contrast media. Which of the following patient information is most important for the nurse to communicate to the health care provider before the test?
- A. Bilateral poor peripheral vision
- B. Allergies to iodine and shellfish
- C. Recent weight loss of 8.5 kg
- D. History of ongoing headaches
Correct Answer: B
Rationale: Since the usual contrast media is iodine-based, the health care provider will need to know about the allergy before the CT scan. The other findings are common with any mass in the brain such as a pituitary adenoma.
A patient who has diabetes mellitus asks the nurse what the glycosylated hemoglobin (HbA1c) test measures. Which of the following explanations should be the basis of the nurse's response?
- A. Glucose levels 2 hours after a meal
- B. Circulating, non-fasting glucose levels
- C. Glucose control over the past 3 months
- D. Hypoglycemic episodes in the past 90 days
Correct Answer: C
Rationale: Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose testing after a meal or random testing may reveal impaired glucose tolerance and indicate prediabetes, but it is not done on patients who already have a diagnosis of diabetes. There is no test to evaluate for hypoglycemic episodes in the past.
A patient is scheduled for a growth hormone stimulation test. Which of the following items should the nurse obtain in preparation for the test?
- A. Basin of ice
- B. Cardiac monitor
- C. Vial of glargine insulin
- D. Intravenous dextrose solution
Correct Answer: D
Rationale: Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be prepared to administer glucose IV immediately or have a sweet snack available for the patient immediately following the test. Regular insulin is used to induce hypoglycemia (glargine is never given intravenously). The patient does not require cardiac monitoring during the test. Although blood samples for some tests must be kept on ice, this is not true for the growth hormone stimulation test.
The nurse is evaluating the laboratory results for a patient who has increased secretion of the anterior pituitary hormones. Which of the following findings should the nurse anticipate when reviewing the laboratory findings?
- A. Decreased serum thyroxine levels
- B. Elevated serum aldosterone levels
- C. An increase in urinary free cortisol
- D. Low urinary excretion of catecholamines
Correct Answer: C
Rationale: Increased secretion of adrenocorticotropic hormone (ACTH) by the anterior pituitary gland will lead to an increase in serum and urinary cortisol levels. An increase, rather than a decrease, in thyroxine level would be expected with increased secretion of thyroid-stimulating hormone (TSH) by the anterior pituitary. Aldosterone and catecholamine levels are not controlled by the anterior pituitary.
The nurse is teaching a patient how to prepare for an oral glucose tolerance test (OGTT). Which of the following patient response indicates that the teaching has been effective?
- A. Fast 12 hours before the procedure
- B. Clear fluid diet 12 hours prior to the test
- C. Drink only full fluids 6 hours before the test
- D. No fluid or food restrictions prior to the test
Correct Answer: A
Rationale: Fasting for 12 hours before the procedure demonstrates that teaching has been effective. The patient is to be NPO 12 hours prior to the test. A clear fluid diet 12 hours pretest is not indicated. A full fluid diet 6 hours pretest is not indicated.