Nurse Zeny is caring for a client in acute addisonian crisis. Which laboratory data would the nurse expect to find?
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Solution
Hyperkalemia
Option A: In adrenal insufficiency, the client has hyperkalemia due to reduced aldosterone secretion.
Option B: BUN increases as the glomerular filtration rate is reduced.
Option C: Hyponatremia is caused by reduced aldosterone secretion.
Option D: Reduced cortisol secretion leads to impaired gluconeogenesis and a reduction of glycogen in the liver and muscle, causing hypoglycemia.
For a diabetic male client with a foot ulcer, the doctor orders bed rest, a wetto- dry dressing change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this client?
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Solution
They debride the wound and promote healing by secondary intention
Option C: For this client, wet-to-dry dressings are most appropriate because they clean the foot ulcer by debriding exudate and necrotic tissue, thus promoting healing by secondary intention.
Option A: Moist, transparent dressings contain exudate and provide a moist wound environment.
Option D: Hydrocolloid dressings prevent the entrance of microorganisms and minimize wound discomfort.
Option B: Dry sterile dressings protect the wound from mechanical trauma and promote healing.
Mr. Domingo with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client’s hypertension is caused by excessive hormone secretion from which of the following glands?
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Solution
Adrenal cortex
Option A: Excessive secretion of aldosterone in the adrenal cortex is responsible for the client’s hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions.
Option B: The pancreas mainly secretes hormones involved in fuel metabolism.
Option C: The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine.
Option D: The parathyroids secrete parathyroid hormone.
Nurse Len should expect to administer which medication to a client with gout?
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Solution
colchicines
Option C: A disease characterized by joint inflammation (especially in the great toe), gout is caused by urate crystal deposits in the joints. The physician prescribes colchicine to reduce these deposits and thus ease joint inflammation.
Option A: Although aspirin is used to reduce joint inflammation and pain in clients with osteoarthritis and rheumatoid arthritis, it isn’t indicated for gout because it has no effect on urate crystal formation.
Option B: Furosemide, a diuretic, doesn’t relieve gout.
Option D: Calcium gluconate is used to reverse a negative calcium balance and relieve muscle cramps, not to treat gout.
A male client with type 1 diabetes is scheduled to receive 30 U of 70/30 insulin. There is no 70/30 insulin available. As a substitution, the nurse may give the client:
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Solution
9 U regular insulin and 21 U neutral protamine Hagedorn (NPH).
Option A: A 70/30 insulin preparation is 70% NPH and 30% regular insulin. Therefore, a correct substitution requires mixing 21 U of NPH and 9 U of regular insulin.
Options B, C, and D: The other choices are incorrect dosages for the prescribed insulin.
Mrs. Cruz uses a cane for assistance in walking. Which of the following statements is true about a cane or other assistive devices?
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Solution
The cane should be used on the unaffected side
Option C: A cane should be used on the unaffected side. A client with osteoarthritis should be encouraged to ambulate with a cane, walker, or other assistive device as needed; their use takes weight and stress off joints.
Which of the following statements explains the main difference between rheumatoid arthritis and osteoarthritis?
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Solution
Osteoarthritis is a localized disease rheumatoid arthritis is systemic
Option B: Osteoarthritis is a localized disease, rheumatoid arthritis is systemic.
Option A: Osteoarthritis isn’t gender-specific, but rheumatoid arthritis is.
Option D: Clients have dislocations and subluxations in both disorders.
Heberden’s nodes are a common sign of osteoarthritis. Which of the following statement is correct about this deformity?
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Solution
It appears on the distal interphalangeal joint
Option B: Heberden’s nodes appear on the distal interphalangeal joint on both men and women.
Option D: Bouchard’s node appears on the dorsolateral aspect of the proximal interphalangeal joint.
A 76-year-old male client had a thromboembolic right stroke; his left arm is swollen. Which of the following conditions may cause swelling after a stroke?
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Solution
Loss of muscle contraction decreasing venous return
Option B: In clients with hemiplegia or hemiparesis loss of muscle contraction decreases venous return and may cause swelling of the affected extremity.
Option A: Contractures or bony calcifications may occur with a stroke, but don’t appear with swelling.
Option C: DVT may develop in clients with a stroke but is more likely to occur in the lower extremities.
Option D: A stroke isn’t linked to protein loss.
A heparin infusion at 1,500 unit/hour is ordered for a 64-year-old client with stroke in evolution. The infusion contains 25,000 units of heparin in 500 ml of saline solution. How many milliliters per hour should be given?
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Solution
30 ml/hour
Option B: An infusion prepared with 25,000 units of heparin in 500 ml of saline solution yields 50 units of heparin per milliliter of solution. The equation is set up as 50 units times X (the unknown quantity) equals 1,500 units/hour, X equals 30 ml/hour.