Nursing Elites

1. What is the mechanism of action of corticotropin (Acthar) when prescribed as replacement therapy for a male client who has undergone surgical removal of a pituitary tumor?

• A. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs.
• B. It interacts with plasma membrane receptors to inhibit enzymatic actions.
• C. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism.
• D. It regulates the threshold for water reabsorption in the kidneys.

Correct answer: C

Rationale: Corticotropin (ACTH) stimulates the adrenal cortex to secrete cortisol and other hormones, affecting protein, fat, and carbohydrate metabolism. Choice A is incorrect because corticotropin does not decrease cAMP production; instead, it stimulates enzymatic actions. Choice B is incorrect because corticotropin does not inhibit enzymatic actions but rather produces enzymatic actions. Choice D is incorrect because corticotropin's mechanism of action does not involve regulating the threshold for water reabsorption in the kidneys.

2. A client with type 1 diabetes mellitus is admitted with diabetic ketoacidosis (DKA). Which of the following interventions should be the nurse's priority?

• A. Administer intravenous insulin
• B. Start an intravenous line and infuse normal saline
• C. Monitor serum potassium levels
• D. Obtain an arterial blood gas (ABG)

Correct answer: B

Rationale: The correct answer is to start an intravenous line and infuse normal saline. In diabetic ketoacidosis (DKA), the priority intervention is fluid resuscitation with normal saline to restore intravascular volume and improve perfusion. Administering insulin without first addressing dehydration and electrolyte imbalances can lead to further complications. Monitoring serum potassium levels and obtaining an arterial blood gas (ABG) are important aspects of DKA management but come after initial fluid resuscitation.

3. After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?

• A. Primary hypothyroidism
• B. Graves' disease
• C. Thyrotoxicosis
• D. Euthyroidism

Correct answer: A

Rationale: Levothyroxine is the preferred agent for primary hypothyroidism because it provides the necessary replacement of thyroid hormone in patients with deficient thyroid function. Choice B, Graves' disease, is an autoimmune disorder that causes hyperthyroidism and is typically treated with antithyroid medications or radioactive iodine. Choice C, thyrotoxicosis, refers to the clinical state resulting from excessive thyroid hormone action and is not typically treated with levothyroxine. Choice D, euthyroidism, describes a normal thyroid function and would not require treatment with levothyroxine.

4. A client with hyperthyroidism is prescribed propranolol. The nurse explains that this medication is used to:

• A. Increase thyroid hormone production
• B. Decrease thyroid hormone production
• C. Relieve symptoms such as tachycardia and anxiety
• D. Prevent weight loss

Correct answer: C

Rationale: Propranolol is a beta-blocker that works by blocking the effects of adrenaline, which helps to reduce symptoms such as tachycardia (fast heart rate) and anxiety in individuals with hyperthyroidism. Choices A and B are incorrect because propranolol does not affect thyroid hormone production; it only addresses symptoms. Choice D is incorrect because propranolol does not prevent weight loss associated with hyperthyroidism.

5. Nurse Ruth 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?

• A. Tetany
• B. Hemorrhage
• C. Thyroid storm
• D. Laryngeal nerve damage

Correct answer: A

Rationale: The correct answer is 'Tetany.' Tetany is characterized by muscle twitching, tingling, and numbness, which are indicative of hypocalcemia. After a thyroidectomy, accidental removal or damage to the parathyroid glands can lead to decreased calcium levels, resulting in tetany. Choice B, 'Hemorrhage,' is incorrect as it typically presents with symptoms such as sudden swelling, increased pain, or drop in blood pressure. Choice C, 'Thyroid storm,' is incorrect as it involves a sudden exacerbation of hyperthyroidism, leading to symptoms like fever, tachycardia, and confusion. Choice D, 'Laryngeal nerve damage,' is incorrect as it would manifest with voice changes, difficulty swallowing, or respiratory distress, not the symptoms described in the scenario.

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