Nokea
This nurse is caring for a client who is receiving prescribed tolvaptan. Which of the following findings would indicate a therapeutic response?
- A. Fasting blood glucose 100 mg/dL (5.55 mmol/L) [70-110 mg/dL, 4.0-6.0 mmol/L]
- B. Urine specific gravity 1.010 [1.005-1.030]
- C. Total cholesterol 176 mg/dL (4.55 mmol/L) [-200 mg/dL, 3.5-5.2 mmol/L]
- D. Blood urea nitrogen (BUN) 5 mg/dL (1.785 mmol/L) [10-20 mg/dL, 2.1-8.0 mmol/L]
Correct Answer: B
Rationale: Tolvaptan treats SIADH by increasing free water excretion, lowering urine specific gravity (e.g., 1.010). Glucose, cholesterol, and BUN are not directly affected by tolvaptan.
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The nurse is performing discharge teaching for a client prescribed propylthiouracil (PTU). Which client statement indicates effective understanding?
- A. I should increase my intake of foods containing iodine.
- B. This medication may cause my urine to have a reddish discoloration.
- C. I will need to have my liver enzymes monitored while I take this medication.
- D. If this medication starts to work, I should notice some weight loss.
Correct Answer: C
Rationale: PTU can cause hepatotoxicity, requiring liver enzyme monitoring. Iodine intake should be moderated, PTU does not cause reddish urine, and effective treatment may cause weight gain, not loss.
The following scenario applies to the next 1 items
The emergency department (ED) nurse is caring for a 66-year-old male client
Item 1 of 1
History and Physical
2000: 66-year male arrives at the emergency department (ED) following a recommendation by his primary healthcare provider (PHCP). The client called his PHCP in the morning, reporting a headache, feeling unwell, fatigue, and thirst. He could not check his blood glucose because he reports being out of testing supplies for two weeks. He also reports being unable to take his prescribed antihypertensive and antidiabetic medications for one week because he lost his job. On exam, the client reports feeling fatigued and thirsty. He is alert and completely oriented. His physical exam was within normal limits except for a thready pulse with a rate of 119/minute.
The client has a medical history of type II diabetes mellitus, congestive heart failure (CHF), hypertension, and hyperlipidemia. He is prescribed atorvastatin, metformin, and lisinopril.
Vital Signs
Oral Temperature 98o F (36.7o C)
Pulse 119/minute
Respirations 19/minute
Blood pressure 98/52 mm Hg
Oxygen saturation 96% on room air
Physician Orders
Obtain intravenous (IV) access
Five units of regular insulin via intravenous push (IVP)
Infuse two liters of 0.9% saline over one hour
Obtain capillary blood glucose (CBG) every two hours
Potassium chloride 20 mEq by mouth x 1 dose
Implement seizure precautions
The nurse reviews laboratory work ordered by the primary healthcare provider (PHCP). The nurse obtains physician orders for this client with hyperosmolar hyperglycemic state (HHS) . The nurse is preparing to implement the physician's orders. Which order should the nurse clarify with the physician?
- A. Infuse two liters of 0.9% saline over one hour
- B. Obtain capillary blood glucose every two hours
- C. Potassium chloride 20 mEq by mouth
- D. Implement seizure precautions
Correct Answer: A
Rationale: Infusing 2 liters of saline in one hour is too rapid for HHS, risking fluid overload. Slower infusion (e.g., 1 liter over 2-4 hours) is safer. Other orders align with HHS management.
The nurse is providing discharge instructions to a client who has chronic diabetes insipidus (DI). Which of the following client statements would indicate a correct understanding of the discharge instructions?
- A. I will need to drink no more than $800 \mathrm{ml}$ per day.
- B. I will need to weigh myself at the same time every day.
- C. I should increase salty snacks in my diet.
- D. I need to log my daily fluid intake.
Correct Answer: B, D
Rationale: DI causes excessive urination; daily weighing and logging fluid intake monitor fluid balance. Fluid restriction and salty snacks are inappropriate and worsen dehydration.
The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse recognizes that SIADH can be caused by which condition?
- A. Small cell lung cancer
- B. Tumor on the adrenal medulla
- C. Inflammation in the nephron
- D. Beta cell destruction in the pancreas
Correct Answer: A
Rationale: SIADH results from excess ADH, often caused by small cell lung cancer, which can ectopically produce ADH. Adrenal tumors, nephron inflammation, and beta cell issues do not typically cause SIADH.
The nurse is caring for assigned clients. The nurse should recognize which client is at risk of developing hypoglycemia? A client
- A. with diabetic ketoacidosis receiving continuous regular insulin intravenously.
- B. receiving methylprednisolone for an exacerbation of asthma.
- C. with pancreatitis and is receiving total parenteral nutrition (TPN).
- D. who is nothing by mouth (NPO) status following a coronary artery bypass graft (CABG).
- E. who received six units of lispro insulin one hour ago and has not eaten.
Correct Answer: A, E
Rationale: Continuous insulin in DKA and lispro without food increase hypoglycemia risk due to excess insulin action. Steroids raise glucose, and TPN and NPO status are less directly related.