Community Health Nursing Test 3 Answer Key 4

77. A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will prescribe diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client does not comply with the recommended treatment, which complication may arise? 1. Cerebral edema 2. Hypovolemic shock 3. Severe hyperkalemia 4. Tetany Noncompliance with treatment for SIADH may lead to water intoxication from fluid retention caused by excessive antidiuretic hormone. This, in turn, limits water excretion and increases the risk for cerebral edema. Hypovolemic shock results from, severe deficient fluid volume; in contrast, SIADH causes excess fluid volume. The major electrolyte disturbance in SIADH is dilutional hyponatremia, not hyperkalemia. Because SIADH doesn't alter renal function, potassium excretion remains normal; therefore, severe hyperkalemia doesn't occur. Tetany results from hypocalcemia, an electrolyte disturbance not associated with SIADH. 78. A client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should the nurse provide? 1. "Administer desmopressin while the suspension is cold." 2. "Your condition isn't chronic, so you won't need to wear a medical identification bracelet." 3. "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." 4. "You won't need to monitor your fluid intake and output after you start taking desmopressin." Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and get adequate fluid replacement. 79. A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? 1. Blood urea nitrogen (BUN) level of 12 mg/dl 2. Blood glucose level of 90 mg/dl 3. Serum sodium level of 134 mEq/L 4. Serum potassium level of 5.8 mEq/L Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level . 80. The nurse understands that for the parathyroid hormone to exert its effect, what must be present? 1. Decreased phosphate level 2. Adequate vitamin D level 3. Functioning thyroid gland 4. Increased calcium level Adequate vitamin D must be present for parathyroid hormone to exert its effect — that is to help regulate calcium metabolism. Vitamin D promotes calcium absorption from the intestines . 81. The nurse is caring for a client with diabetes insipidus. The nurse should anticipate the administration of: 1. insulin. 2. furosemide (Lasix). 3. potassium chloride. 4. vasopressin (Pitressin). Vasopressin is given subcutaneously in the acute management of diabetes insipidus. Insulin is used to manage diabetes mellitus. Furosemide causes diuresis. Potassium chloride is given for hypokalemia. 82. Which of the following would the nurse expect to assess in an elderly client with Hashimoto's thyroiditis? 1. Weight loss, increased appetite, and hyperdefecation 2. Weight loss, increased urination, and increased thirst 3. Weight gain, decreased appetite, and constipation 4. Weight gain, increased urination, and purplish-red striae Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of hypothyroidism. It's seen most frequently in women over age 40. Weight gain, decreased appetite, constipation, lethargy, dry cool skin, brittle nails, coarse hair, muscle cramps, weakness, and sleep apnea are symptoms of Hashimoto's thyroiditis. Weight loss, increased appetite, and hyperdefecation are characteristic of hyperthyroidism. Weight loss, increased urination, and increased thirst are characteristic of uncontrolled diabetes mellitus. Weight gain, increased urination, and purplish-red striae are characteristic of hypercortisolism. 83. Parathyroid hormone (PTH) has which effects on the kidney? 1. Stimulation of calcium reabsorption and phosphate excretion 2. Stimulation of phosphate reabsorption and calcium excretion 3. Increased absorption of vitamin D and excretion of vitamin E 4. Increased absorption of vitamin E and excretion of vitamin D PTH stimulates the kidneys to reabsorb calcium and excrete phosphate and converts vitamin D to its active form, 1,25-dihydroxyvitamin D. PTH doesn't have a role in the metabolism of vitamin E. 84. A client with hyperthyroidism is about to receive radioactive iodine as an outpatient. What safety measures should the nurse teach the client to protect his family while he undergoes treatment? 1. Good hand washing 2. How to isolate himself in one room of the house 3. Use of disposable eating utensils 4. Not worrying about precautions The client with hyperthyroidism can receive radioactive iodine as an outpatient with some precautions, such as using disposable eating utensils, and avoiding kissing, sexual intercourse, and holding babies. Good hand washing is always necessary to prevent the spread of infection; however, it provides no protection against radioactive iodine therapy. Isolation isn't necessary, but radiation precautions are. 85. What does a positive Chvostek's sign indicate? 1. Hypocalcemia 2. Hyponatremia 3. Hypokalemia 4. Hypermagnesemia Chvostek's sign is elicited by tapping the client's face lightly over the facial nerve, just below the temple. If the client's facial muscles twitch, it indicates hypocalcemia. Hyponatremia is indicated by weight loss, abdominal cramping, muscle weakness, headache, and postural hypotension. Hypokalemia causes paralytic ileus and muscle weakness. Clients with hypermagnesemia exhibit a loss of deep tendon reflexes, coma, or cardiac arrest. 86. A client is diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Laboratory results reveal serum sodium level 130 mEq/L and urine specific gravity 1.030. Which nursing intervention would help prevent complications associated with SIADH? 1. Restricting fluids to 800 ml/day 2. Administering vasopressin as ordered 3. Elevating the client's head of bed to 90 degrees 4. Restricting sodium intake to 1 gm/day Excessive release of antidiuretic hormone (ADH) disturbs fluid and electrolyte balance in SIADH. The excessive ADH causes an inability to excrete dilute urine, retention of free water, expansion of extracellular fluid volume, and hyponatremia. Symptomatic treatment begins with restricting fluids to 800 ml/day. Vasopressin is administered to clients with diabetes insipidus a condition in which circulating ADH is deficient. Elevating the head of the bed decreases vascular return and decreases atrial-filling pressure, which increases ADH secretion worsening the client's condition. The client's sodium is low and, therefore, shouldn't be restricted. 87. A client is seen in the clinic with a possible parathormone deficiency. Diagnosis of this condition includes the analysis of serum electrolytes. Which electrolytes would the nurse expect to be abnormal? 1. Sodium 2. Potassium 3. Calcium 4. Chloride 5. Glucose 6. Phosphorous A client with a parathormone deficiency has abnormal calcium and phosphorous values because parathormone regulates these two electrolytes. Potassium, chloride, sodium, and glucose aren't affected by a parathormone deficiency. 88. The nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone replacement therapy? 1. methimazole (Tapazole) 2. thyroid USP desiccated (Thyroid USP Enseals) 3. liothyronine (Cytomel) 4. levothyroxine (Synthroid) Levothyroxine is the agent of choice for thyroid hormone replacement therapy because its standard hormone content gives it predictable results. Methimazole is an antithyroid medication used to treat hyperthyroidism. Thyroid USP desiccated and liothyronine are no longer used for thyroid hormone replacement therapy because they may cause fluctuating plasma drug levels, increasing the risk of adverse effects. 89. A client 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 life-threatening complication? 1. Exophthalmos 2. Thyroid storm 3. Myxedema coma 4. Tibial myxedema Myxedema coma, severe hypothyroidism, is a life-threatening condition that may develop if thyroid replacement medication isn't taken. Exophthalmos, protrusion of the eyeballs, is seen with hyperthyroidism. Thyroid storm is lifethreatening but is caused by severe hyperthyroidism. Tibial myxedema, peripheral mucinous edema involving the lower leg, is associated with hypothyroidism but isn't life-threatening . 90. A client is transferred to a rehabilitation center after being treated in the hospital for a stroke. Because the client has a history of Cushing's syndrome (hypercortisolism) and chronic obstructive pulmonary disease (COPD), the nurse formulates a nursing diagnosis of: 1. Risk for imbalanced fluid volume related to excessive sodium loss. 2. Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. 3. Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing's syndrome. 4. Decreased cardiac output related to hypotension secondary to Cushing's syndrome. Cushing's syndrome causes tissue catabolism, resulting in thinning skin and connective tissue loss; along with immobility related to stroke, these factors increase this client's risk for impaired skin integrity. The exaggerated glucocorticoid activity in Cushing's syndrome causes sodium and water retention which, in turn, leads to edema and hypertension. Therefore, Risk for imbalanced fluid volume and Decreased cardiac output are inappropriate nursing diagnoses. Increased glucocorticoid activity also causes persistent hyperglycemia, eliminating Ineffective health maintenance related to frequent hypoglycemic episodes as an appropriate nursing diagnosis. 91. The physician orders laboratory tests to confirm hyperthyroidism in a client with classic signs and symptoms of this disorder. Which test result would confirm the diagnosis? 1. No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test 2. A decreased TSH level 3. An increase in the TSH level after 30 minutes during the TSH stimulation test 4. Below-normal levels of serum triiodothyronine (T3) and serum thyroxine (T4) as detected by radioimmunoassay 92. 1. No increase in the thyroid-stimulating hormone (TSH) level after 30 minutes during the TSH stimulation test In the TSH test, failure of the TSH level to rise after 30 minutes confirms hyperthyroidism. A decreased TSH level indicates a pituitary deficiency of this hormone. Below-normal levels of T3 and T4, as detected by radioimmunoassay, signal hypothyroidism. A below-normal T4 level also occurs in malnutrition and liver disease and may result from administration of phenytoin and certain other drugs. 93. When instructing the client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of: 1. restricting fluids. 2. restricting sodium. 3. forcing fluids. 4. restricting potassium. The client should be encouraged to force fluids to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn't necessary in hyperparathyroidism . 94. Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine dysfunction would experience: 1. heat intolerance and systolic hypertension. 2. weight gain and heat intolerance. 3. diastolic hypertension and widened pulse pressure. 4. anorexia and hyperexcitability. An increased metabolic rate in a client with hyperthyroidism caused by excess serum thyroxine leads to systolic hypertension and heat intolerance. Weight loss — not gain — occurs due to the increased metabolic rate. Diastolic blood pressure decreases due to decreased peripheral resistance. Heat intolerance and widened pulse pressure can occur but systolic hypertension and diastolic hypertension don't. Clients with hyperthyroidism experience an increase in appetite — not anorexia. 95. A client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize? 1. "You must lie flat for 24 hours after surgery." 2. "You must avoid coughing, sneezing, and blowing your nose." 3. "You must restrict your fluid intake." 4. "You must report ringing in your ears immediately." After a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing, and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The head of the bed must be elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24 hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake. Visual, not auditory, changes are a potential complication of hypophysectomy. 96. The client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for: 1. exophthalmos and conjunctival redness 2. flushed, warm, moist skin 3. systolic murmur at the left sternal border 4. decreased body temperature and cold intolerance Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension, anorexia, constipation, decreased intellectual function, and depression. The other options are typical findings in a client with hyperthyroidism. 97. For a client in addisonian crisis, it would be very risky for a nurse to administer: 1. potassium chloride. 2. normal saline solution. 3. hydrocortisone. 4. fludrocortisone. Addisonian crisis results in hyperkalemia; therefore, administering potassium chloride is contraindicated. Because the client will be hyponatremic, normal saline solution is indicated. Hydrocortisone and fludrocortisone are both useful in replacing deficient adrenal cortex hormones . 98. A client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse should assess for potential complications by: 1. testing for ketones in the urine. 2. testing urine specific gravity. 3. checking temperature every 4 hours. 4. performing capillary glucose testing every 4 hours. The nurse should perform capillary glucose testing every 4 hours because excess cortisol may cause insulin resistance, placing the client at risk for hyperglycemia. Urine ketone testing isn't indicated because the client does secrete insulin and, therefore, isn't at risk for ketosis. Urine specific gravity isn't indicated because although fluid balance can be compromised, it usually isn't dangerously imbalanced. Temperature regulation may be affected by excess cortisol and isn't an accurate indicator of infection. 99. The nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication? 1. Tetany 2. Hemorrhage 3. Thyroid storm 4. Laryngeal nerve damage Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction. 100. During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and: 1. sodium. 2. potassium. 3. magnesium. 4. phosphorus. PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect sodium, potassium, or magnesium regulation. 101. A client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client, which "related-to" phrase should the nurse add? 1. Related to bone demineralization resulting in pathologic fractures 2. Related to exhaustion secondary to an accelerated metabolic rate 3. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces 4. Related to tetany secondary to a decreased serum calcium level Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This, in turn, may diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury. Hyperparathyroidism doesn't accelerate the metabolic rate. A decreased thyroid hormone level, not an increased parathyroid hormone level, may cause edema and dry skin secondary to fluid infiltration into the interstitial spaces. Hyperparathyroidism causes hypercalcemia, not hypocalcemia; therefore, it isn't associated with tetany. 102. A client 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? 1. Above-normal urine and serum osmolality levels 2. Below-normal urine and serum osmolality levels 3. Above-normal urine osmolality level, below-normal serum osmolality level 4. Below-normal urine osmolality level, above-normal serum osmolality level 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. For the same reasons, diabetes insipidus doesn't cause above-normal urine osmolality or below-normal serum osmolality levels. 103. The nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? 1. Pitting edema of the legs 2. An irregular apical pulse 3. Dry mucous membranes 4. Frequent urination 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. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome. 104. A female client who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia? 1. Acromegaly 2. Type 1 diabetes mellitus 3. Hypothyroidism 4. Deficient growth hormone Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn't associated with hyperglycemia, nor is growth hormone deficiency. 105. A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction would be most important to include in the client's teaching plan? 1. "Maintain a moderate exercise program." 2. "Rest as much as possible." 3. "Lose weight." 4. "Jog at least 2 miles per day." A moderate exercise program will help strengthen bones and prevent the bone loss that occurs from excess parathyroid hormone. Walking or swimming provides the most beneficial exercise. Because of weakened bones, a rigorous exercise program such as jogging would be contraindicated. Weight loss might be beneficial but it isn't as important as developing a moderate exercise program. 106. The nurse should expect a client with hypothyroidism to report which health concern(s)? 1. Increased appetite and weight loss 2. Puffiness of the face and hands 3. Nervousness and tremors 4. Thyroid gland swelling Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of hyperthyroidism (Graves' disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement (goiter). 107. After undergoing a subtotal thyroidectomy, a client develops hypothyroidism. The physician prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent? 1. Primary hypothyroidism 2. Graves' disease 3. Thyrotoxicosis 4. Euthyroidism Levothyroxine is the preferred agent to treat primary hypothyroidism and cretinism, although it also may be used to treat secondary hypothyroidism. It is contraindicated in Graves' disease and thyrotoxicosis because these conditions are forms of hyperthyroidism. Euthyroidism, a term used to describe normal thyroid function, wouldn't require any thyroid preparation. 108. Which condition would the nurse expect to find in a client diagnosed with hyperparathyroidism? 1. Hypocalcemia 2. Hypercalcemia 3. Hyperphosphatemia 4. Hypophosphaturia Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low (hyperphosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased. 109. Which of the following would indicate that a client has developed water intoxication secondary to treatment for diabetes insipidus? 1. Confusion and seizures 2. Sunken eyeballs and spasticity 3. Flaccidity and thirst 4. Tetany and increased blood urea nitrogen (BUN) levels. Classic signs of water intoxication include confusion and seizures, both of which are caused by cerebral edema. Weight gain will also occur. Sunken eyeballs, thirst, and increased BUN levels indicate fluid volume deficit. Spasticity, flaccidity, and tetany are unrelated to water intoxication. 110. Which of the following is the most common cause of hyperaldosteronism? 1. Excessive sodium intake 2. A pituitary adenoma 3. Deficient potassium intake 4. An adrenal adenoma An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake as well as of pituitary stimulation. 111. The nurse is developing a teaching plan for a client diagnosed with diabetes insipidus. The nurse should include information about which hormone that's lacking in clients with diabetes insipidus? 1. Antidiuretic hormone (ADH) 2. Thyroid-stimulating hormone (TSH) 3. Follicle-stimulating hormone (FSH) 4. Luteinizing hormone (LH) ADH is the hormone clients with diabetes insipidus lack. The client's TSH, FSH, and LH levels won't be affected. 112. A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should the nurse recognize as an adverse reaction to the drug? 1. Dysuria 2. Leg cramps 3. Tachycardia 4. Blurred vision Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine. Adverse reactions to this agent include tachycardia. The other options aren't associated with levothyroxine. 113. A client with Hashimoto's thyroiditis and a history of two myocardial infarctions and coronary artery disease is to receive levothyroxine (Synthroid). Because of the client's cardiac history, the nurse would expect that the client's initial dose for the thyroid replacement would be: 1. 25 g/day, initially. 2. 100 g/day, initially. 3. delayed until after thyroid surgery. 4. initiated before thyroid surgery. Elderly clients and clients with cardiac disease should begin with low-dose levothyroxine increased at 2- to 4-week intervals until 100 g/day is reached. This slow titration prevents further cardiac stress. Younger clients would be started on the usual maintenance dose of 100 g/day. Clients with Hashimoto's thyroiditis don't require surgical intervention. 114. When administering spironolactone (Aldactone) to a client who has had a unilateral adrenalectomy, the nurse should instruct the client about which possible adverse effect of the drug? 1. Constipation 2. Menstrual irregularities 3. Hypokalemia 4. Hypernatremia Spironolactone can cause menstrual irregularities and decreased libido. Men may also experience gynecomastia and impotence. Diarrhea, hyponatremia, and hyperkalemia are also adverse effects of spirolactone. 115. When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, the nurse is most likely to detect: 1. a blood pressure of 130/70 mm Hg. 2. a blood glucose level of 130 mg/dl. 3. bradycardia. 4. a blood pressure of 176/88 mm Hg. Pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, causes hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn't associated with the other options. 116. A 68-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 disorder? 1. Diabetes mellitus 2. Diabetes insipidus 3. Hypoparathyroidism 4. Hyperparathyroidism 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. While clients with diabetes mellitus and diabetes insipidus also have polyuria, they don't have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than polyuria. 117. The nurse 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? 1. "I'll take my hydrocortisone in the late afternoon, before dinner." 2. "I'll take all of my hydrocortisone in the morning, right after I wake up." 3. "I'll take two-thirds of the dose when I wake up and one-third in the late afternoon." 4. "I'll take the entire dose at bedtime." 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. 118. Which outcome indicates that treatment of a client with diabetes insipidus has been effective? 1. Fluid intake is less than 2,500 ml/day. 2. Urine output measures more than 200 ml/hr. 3. Blood pressure is 90/50 mm Hg. 4. Heart rate is 126 beats/min. Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hr indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/min indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective. 119. On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life-threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery? 1. Hypocalcemia 2. Hyponatremia 3. Hyperkalemia 4. Hypermagnesemia Hypocalcemia may follow thyroid surgery if the parathyroid glands were removed accidentally. Signs and symptoms of hypocalcemia may be delayed for up to 7 days after surgery. Thyroid surgery doesn't directly cause serum sodium, potassium, or magnesium abnormalities. Hyponatremia may occur if the client inadvertently received too much fluid; however, this can happen to any surgical client receiving I.V. fluid therapy, not just one recovering from thyroid surgery. Hyperkalemia and hypermagnesemia usually are associated with reduced renal excretion of potassium and magnesium, not thyroid surgery. 120. For a client with hyperthyroidism, treatment is most likely to include: 1. a thyroid hormone antagonist. 2. thyroid extract. 3. a synthetic thyroid hormone. 4. emollient lotions. Thyroid hormone antagonists, which block thyroid hormone synthesis, combat increased production of thyroid hormone. Treatment of hyperthyroidism also may include radioiodine therapy, which destroys some thyroid gland cells, and surgery to remove part of the thyroid gland; both treatments decrease thyroid hormone production. Thyroid extract, synthetic thyroid hormone, and emollient lotions are used to treat hypothyroidism. 121. Before discharge, what should a client with Addison's disease be instructed to do when exposed to periods of stress? 1. Administer hydrocortisone I.M. 2. Drink 8 oz of fluids. 3. Perform capillary blood glucose monitoring four times daily. 4. Continue to take his usual dose of hydrocortisone. Clients with Addison's disease and their family members should know how to administer I.M. hydrocortisone during periods of stress. It's important to keep well hydrated during stress, but the critical component in this situation is to know how and when to use I.M. hydrocortisone. Capillary blood glucose monitoring isn't indicated in this situation because the client doesn't have diabetes mellitus. Hydrocortisone replacement doesn't cause insulin resistance. 122. A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should monitor the client closely for the related problem of: 1. severe hypotension. 2. excessive thirst. 3. profound neuromuscular irritability. 4. acute gastritis. Hypoparathyroidism may slow bone resorption, reduce the serum calcium level, and cause profound neuromuscular irritability (as evidenced by tetany). Hypoparathyroidism doesn't alter blood pressure or affect the thirst mechanism, which usually is triggered by fluid volume deficit. Gastritis doesn't cause or result from hypoparathyroidism. ADVERTISEMENT ADVERTISEMENT