Which of the following laboratory test results would suggest to the nurse Len that a client has a corticotropin-secreting pituitary adenoma?
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Solution
High corticotropin and high cortisol levels
Option C: A corticotropin-secreting pituitary tumor would cause high corticotropin and high cortisol levels.
Options A and D: A high corticotropin level with a low cortisol level and a low corticotropin level with a low cortisol level would be associated with hypocortisolism.
Option B: Low corticotropin and high cortisol levels would be seen if there was a primary defect in the adrenal glands.
Nurse Lourdes is teaching a client recovering from Addisonian crisis about the need to take fludrocortisone acetate and hydrocortisone at home. Which statement by the client indicates an understanding of the instructions?
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Solution
“I’ll take two-thirds of the dose when I wake up and one-third in the late afternoon.”
Option C: Hydrocortisone, a glucocorticoid, should be administered according to a schedule that closely reflects the body’s own secretion of this hormone; therefore, two-thirds of the dose of hydrocortisone should be taken in the morning and one-third in the late afternoon. This dosage schedule reduces adverse effects.
A 66-year-old client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, the nurse would suspect which of the following disorders?
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Solution
Hyperparathyroidism
Option D: Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercalciuria-causing polyuria.
Options A and B: While clients with diabetes mellitus and diabetes insipidus also have polyuria, they don’t have bone pain and increased sleeping.
Option C: Hypoparathyroidism is characterized by urinary frequency rather than polyuria.
Jomari is diagnosed with hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is stabilized and prepared for discharge. When preparing the client for discharge and home management, which of the following statements indicates that the client understands her condition and how to control it?
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Solution
“I can avoid getting sick by not becoming dehydrated and by paying attention to my need to urinate, drink, or eat more than usual.”
Option A: Inadequate fluid intake during hyperglycemic episodes often leads to HHNS. By recognizing the signs of hyperglycemia (polyuria, polydipsia, and polyphagia) and increasing fluid intake, the client may prevent HHNS.
Option B: Drinking a glass of non-diet soda would be appropriate for hypoglycemia.
Option C: A client whose diabetes is controlled with oral antidiabetic agents usually doesn’t need to monitor blood glucose levels.
Option D: A high carbohydrate diet would exacerbate the client’s condition, particularly if fluid intake is low.
Cyrill with severe head trauma sustained in a car accident is admitted to the intensive care unit. Thirty-six hours later, the client’s urine output suddenly rises above 200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings support the nurse’s suspicion of diabetes insipidus?
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Solution
Below-normal urine osmolality level, above-normal serum osmolality level
Option D: In diabetes insipidus, excessive polyuria causes dilute urine, resulting in a below-normal urine osmolality level. At the same time, polyuria depletes the body of water, causing dehydration that leads to an above-normal serum osmolality level.
Options A, B, and C: For the same reasons, diabetes insipidus doesn’t cause above-normal urine osmolality or below-normal serum osmolality levels.
Nurse Sugar is assessing a client with Cushing’s syndrome. Which observation should the nurse report to the physician immediately?
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Solution
An irregular apical pulse
Option B: Because Cushing’s syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician.
Option A: Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention.
Options C and D: Dry mucous membranes and frequent urination signal dehydration, which isn’t associated with Cushing’s syndrome.
Ruby is receiving thyroid replacement therapy develops the flu and forgets to take her thyroid replacement medicine. The nurse understands that skipping this medication will put the client at risk for developing which of the following life threatening complications?
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Solution
Myxedema coma
Option C: Myxedema coma, severe hypothyroidism, is a life-threatening condition that may develop if thyroid replacement medication isn’t taken.
Option A: Exophthalmos, protrusion of the eyeballs, is seen with hyperthyroidism.
Option B: Thyroid storm is life-threatening but is caused by severe hyperthyroidism.
Option D: Tibial myxedema, peripheral mucinous edema involving the lower leg, is associated with hypothyroidism but isn’t life-threatening.
Norma asks for information about osteoarthritis. Which of the following statements about osteoarthritis is correct?
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Solution
Osteoarthritis is the most common form of arthritis
Option C: Osteoarthritis is the most common form of arthritis and can be extremely debilitating. It can afflict people of any age, although most are elderly.
JP has been diagnosed with gout and wants to know why colchicine is used in the treatment of gout. Which of the following actions of colchicines explains why it’s effective for gout?
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Solution
Decreases inflammation
Option C: The action of colchicines is to decrease inflammation by reducing the migration of leukocytes to synovial fluid.
Options A, B, and D: Colchicine doesn’t replace estrogen, decrease infection, or decrease bone demineralization.
When prioritizing care, which of the following clients should the nurse Olivia assess first?
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Solution
A 33-year-old client with a recent diagnosis of Guillain-Barre syndrome
Option B: Guillain-Barre syndrome is characterized by ascending paralysis and potential respiratory failure. The order of client assessment should follow client priorities, with disorder of airways, breathing, and then circulation. There’s no information to suggest the postmyocardial infarction client has an arrhythmia or other complication. There’s no evidence to suggest hemorrhage or perforation for the remaining clients as a priority of care.