Nokea
Which of the following findings for a patient who takes levothyroxine to treat hypothyroidism indicates that the nurse should contact the health care provider before administering the medication?
- A. Increased thyroxine (T4) level
- B. Blood pressure 102/62 mm Hg
- C. Distant and difficult to hear heart sounds
- D. Elevated thyroid stimulating hormone level
Correct Answer: A
Rationale: An increased thyroxine level indicates the levothyroxine dose needs to be decreased. The other data are consistent with hypothyroidism and the nurse should administer the Synthroid.
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The nurse is caring for a patient in a long-term care facility who has these medications prescribed. After the patient is diagnosed with hypothyroidism, which of the following medications should the nurse report to the health care provider?
- A. Docusate
- B. Diazepam
- C. Ibuprofen
- D. Cefoxitin
Correct Answer: B
Rationale: Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older persons. The nurse should discuss the diazepam with the health care provider before administration. The other medications may be given safely to the patient.
The nurse is admitting a patient to the hospital who is in an Addisonian crisis. Which of the following patient statements support the nursing diagnosis of ineffective self-health management related to lack of knowledge about management of Addison's disease?
- A. I double my dose of hydrocortisone on the days that I go for a run.
- B. I frequently eat at restaurants, and so my food has a lot of added salt.
- C. I had the stomach flu earlier this week and couldn't take the hydrocortisone.
- D. I take twice as much hydrocortisone in the morning as I do in the afternoon.
Correct Answer: C
Rationale: The need for hydrocortisone replacement is increased with stressors such as illness, and the patient needs to be taught to call the health care provider because medication and IV fluids and electrolytes may need to be given. The other patient statements indicate appropriate management of the Addison's disease.
The nurse is planning teaching for a patient who was admitted with myxedema coma and diagnosed with hypothyroidism. Which of the following strategies is best for the nurse to use?
- A. Delay teaching until patient discharge.
- B. Ensure privacy by asking visitors to leave.
- C. Provide written handouts of all information.
- D. Offer multiple options for management of therapies.
Correct Answer: C
Rationale: Written instructions will be helpful to the patient because initially the hypothyroid patient may be unable to remember to take medications and other aspects of self-care. Since the treatment regimen is somewhat complex, teaching should be initiated well before discharge. Family members or friends should be included in teaching because the hypothyroid patient is likely to forget some aspects of the treatment plan. A simpler regimen will be easier to understand until the patient is euthyroid.
The nurse is caring for a patient following a parathyroidectomy who develops tingling of the lips and a positive Trousseau's sign. Which of the following actions should the nurse take first?
- A. Administer the ordered muscle relaxant.
- B. Give the ordered oral calcium supplement.
- C. Start the PRN oxygen at 2 L minute per cannula.
- D. Have the patient rebreathe using a paper bag.
Correct Answer: D
Rationale: The patient's symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be temporarily reduced by having the patient breathe into a paper bag, which will raise the PaCO2 and create a more acidic pH. The muscle relaxant will have no impact on the ionized calcium level. Although severe hypocalcemia can cause laryngeal stridor, there is no indication that this patient is experiencing laryngeal stridor or needs oxygen. Calcium supplements will be given to normalize calcium levels quickly, but oral supplements will take time to be absorbed.
The nurse is caring for a patient with symptoms of diabetes insipidus who has been admitted to the hospital for evaluation and treatment. Which of the following nursing diagnoses is best for this patient?
- A. Insomnia related to frequent waking at night to void
- B. Impaired gas exchange related to fluid retention in lungs
- C. Excess fluid volume related to intake greater than output
- D. Risk for impaired skin integrity related to generalized edema
Correct Answer: A
Rationale: Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid volume, and fluid retention are not expected.