Module 8 quiz rationales PDF

Preview

Summary

quiz 8 rationales...

Description

Module 8: Endocrine Assignment 1. A nurse administers desmopressin to a client who has a diagnosis of diabetes insipidus. The nurse recognizes that which the following laboratory findings indicate a therapeutic effect of the medication? A) Serum sodium 146 mEq/L B) Blood glucose 80 mg/dL C) Urine specific gravity 1.015 D) Blood urea nitrogen (BUN) 15 mg/dL Rationale: C, urine specific gravity 1.015 is the correct answer because for patients with diabetes insipidus who are taking desmopressin, we want to monitor urine specific gravity levels and this value is within normal limits. The serum sodium level of 146 would be an indicator that the medication is not having a therapeutic effect because this value is high. Blood glucose 80 does not apply to our patient with diabetes insipidus, so this does not relate to the desmopressin treatment being therapeutic. Blood urea nitrogen would give us information about the kidneys and therefore is not the best answer because we are looking for the lab value that would indicate that the desmopressin is having a therapeutic effect which would be the urine specific gravity.

2. A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect? A) Hyperpigmentation B) Weight gain C) Hirsutism D) Purple striations Rationale: A, hyperpigmentation is the correct answer because bronze skin (hyperpigmentation due to the overproduction of melanocytes) is a manifestation of Addison’s disease. B is incorrect because weight loss is a manifestation of Addison’s disease not weight gain. Hirsutism and purple striations would be seen in the patient with Cushing’s disease, so these are not correct answers.

3. A nurse is caring for a client who has Cushing's syndrome. Which of the following interventions should the nurse expect to perform? (Select all that apply.) A) Assess blood glucose level B) Assess for neck vein distention C) Monitor for an irregular heart rate D) Monitor for postural hypotension E) Weigh the client daily Rationale: A, assess blood glucose level is correct because the patient with Cushing’s syndrome can become hyperglycemic, therefore the nurse should expect to perform this intervention. The nurse should also expect to assess neck vein distension as these patients can become hypervolemic. The nurse would also want to weigh the client daily to assess whether they have weight gain which could indicate hypervolemia. The nurse would not expect to monitor for an irregular heart rate as this is something we

would do for a patient with Addison’s disease so that is not a correct answer. We would monitor for postural hypotension with our patient with Addison’s disease as well so that is an incorrect answer.

4. A nurse is care for client on the medical floor. Which client should be assessed first? A) The client diagnosed with syndrome of inappropriate ant diuretic hormone (SIADH) who has a weight gain of 1.5 pounds since yesterday B) The client diagnosed with pituitary tumor who had developed diabetes insipidus (DI) and has an intake of 1,500 mL and an output of 1,600 mL in the last 8 hours C) The client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH) who is having a muscle twitching D) The client diagnosed with diabetes insipidus (DI) who is complaining of feeling tired after having to get up at night. Rationale: C, the client diagnosed with SIADH who is having muscle twitching is correct because muscle twitching is an early sign of sodium imbalance and if we do not see this patient immediately there could be neurological complications. A is incorrect because we would expect to see a weight gain of 1.5 pounds in a patient with SIADH because they have excess release of ADH, and water is retained. B is incorrect because the client with diabetes insipidus have an intake and output that are relatively the same so that is not concerning. D is incorrect because the patient with DI must urinate frequently so it is expected that they will be tired after having to get up multiple times a night.

5. A client diagnosed with Cushing’s disease has undergone a unilateral adrenalectomy. Which discharge instructions should the nurse discuss with the client? A) Instruct the client to take the glucocorticoid and mineralocorticoid medications as prescribed. B) Teach the client regarding sexual functioning and androgen replacement therapy C) Explain the signs and symptoms of infection and when to call the health care provider D) Demonstrate turn, cough, and deep-breathing exercises the client should perform every 2 hours Rationale: C, explain the signs and symptoms of infection and when to call the health care provider is correct because this is absolutely something we would want to discuss with this patient after the surgery. A is incorrect because glucocorticoid and mineralocorticoid medications would be indicated for a bilateral adrenalectomy. B is incorrect because we would not expect a change in sexual function and androgen replacement therapy after this surgery. D is incorrect because we would perform these exercises with them while they are still in the hospital and recovering from the surgery. The question is asking about what discharge instructions the nurse should discuss with the patient, so C is the correct answer.

6. A client diagnosed with Addison’s disease is admitted to the unit after a day at the lake. The client is lethargic, forgetful, and weak. Which intervention should the nurse implement? A) Start an IV with 18-gauge needle and infuse normal saline rapidly

B) Have the client wait until you are done with the morning medications C) Obtain a consent for the client to receive a blood transfusion D) Collect urinalysis and blood samples for a CBC and calcium level Rationale: A, start an IV and infuse normal saline is the correct answer because this patient is at risk of going into an Addisonian crisis, so we want to intervene as quick as possible by initiating an infusion of normal saline. B is incorrect because we need to take care of this patient now, they are a priority. C is incorrect because this client does not need a blood transfusion, that is not indicated for Addison’s disease. D is incorrect because while we may want to collect a urinalysis and blood samples, there is a better answer to implement first to prevent our patient from going into an Addisonian crisis.

7. A client diagnosed with type 2 diabetes is admitted with hyperosmolar hyperglycemic syndrome (HHS) coma. Which assessment data should the nurse expect the client to exhibit? A) Kussmaul respirations B) Diarrhea and epigastric pain C) Dry mucous membranes D) Fruity breath Rationale: C, dry mucous membranes is the correct answer because we would expect a patient admitted with HHS coma to exhibit this as they will be dehydrated. A and D are incorrect because Kussmaul respirations and fruity breath would be seen in a patient with DKA not HHS. B is incorrect because we would not expect our patient with HHS to have diarrhea and epigastric pain, this would be an unexpected finding.

8. A client with type 2 diabetes controlled with biguanide oral diabetic medication is scheduled for a computed tomography (CT) scan with contrast of the abdomen to evaluate pancreatic function. Which intervention should the nurse implement? A) Provide a high-fat diet 24 hours prior to test B) Hold the metformin medication for 48 hours prior to test. C) Obtain an informed consent form for the test D) Administer pancreatic enzymes prior to the test Rationale: B, hold the metformin for 48 hours prior to the test is the correct answer because it must be held for a test with contrast medium because it increases the risk for lactic acidosis which can lead to renal problems. We would not want the patient to eat a high fat diet 24 hours prior to the test therefore A is incorrect. C is important as we would want to obtain informed consent for the test, however there is a better answer. D is incorrect because giving pancreatic enzymes prior would not be indicated for this test, this would alter how the pancreas functions and could alter the results of the scan.

9. A nurse is discussing ways to prevent diabetic ketoacidosis with the client diagnoses with type 1 diabetes. Which instruction is most important to discuss with the client? A) Refer the client to the American Diabetic Association

B) Do not take any over-the-counter medications C) Take the prescribed insulin even when unable to eat because of illness D) Explain the need to get the annual flu and pneumonia vaccines. Rationale: C, take the prescribed insulin even when unable to eat because of illness is correct because it is important that the patient is well informed on the consequences of not adhering to their diabetes medication. DKA can be fatal therefore adherence to their insulin therapy is the most important thing to discuss with the patient. A is incorrect because we may want to refer the client to the American Diabetic Association, however that is not the most important thing to discuss with them at the moment. B is incorrect because the patient can still take OTC medications, and this is not the most important thing to discuss with them. D is incorrect because although they should be educated on vaccines, education on their medication adherence is the most important thing for this patient with whom we are discussing ways to prevent DKA.

10. The nurse is caring for a client who has pheochromocytoma. What is the priority nursing intervention for this client? A) Monitor the client's intake and output and urine specific gravity. B) Monitor blood pressure for severe hypertension. C) Monitor blood pressure for severe hypotension. D) Administer medication to increase cardiac output. Rationale: B, monitor BP for severe hypertension is correct because hypertension is the major symptom associated with pheochromocytoma. A is incorrect because monitoring the client’s intake and output and urine specific gravity may be important but it is not the priority for this patient. C monitor BP for severe hypotension is incorrect because we would want to monitor for hypertension, not hypotension. D is incorrect because we would not want to give this patient a medication that would increase their cardiac output as this would mean their blood pressure would be increased as well.

References Assessment Technology Institute [ATI]. (2019). RN Adult Medical Surgical Nursing. Kansas City, MO: Author. Assessment Technology Institute [ATI]. (2019). RN Pharmacology for nursing. Kansas City, MO: Author.

Ignatavicius, D.,Workman, L., Blair, M., Rebar, C., & Winkelman, C. (2016). Medical surgical nursing: Patient-centered collaborative care (9th) St. Louis, MO: Saunders/Elsevier....