Nursing Elites

1. What health concerns should Nurse Oliver expect a client with hypothyroidism to report?

• A. Increased appetite and weight loss
• B. Puffiness of the face and hands
• C. Nervousness and tremors
• D. Thyroid gland swelling

Correct answer: B

Rationale: Puffiness of the face and hands is a classic symptom of hypothyroidism. This occurs due to fluid retention and is commonly observed in individuals with an underactive thyroid gland. Increased appetite and weight loss (Choice A) are more indicative of hyperthyroidism, where there is an overproduction of thyroid hormones leading to increased metabolism. Nervousness and tremors (Choice C) are associated with hyperthyroidism, not hypothyroidism. Thyroid gland swelling (Choice D) typically indicates goiter, which can be present in both hyperthyroidism and hypothyroidism but is not a specific symptom that clients with hypothyroidism commonly report.

2. When teaching a male client diagnosed with type 1 diabetes mellitus how diet and exercise affect insulin requirements, Nurse Joy should include which guideline?

• A. You'll need more insulin when you exercise or increase your food intake.
• B. You'll need less insulin when you exercise or reduce your food intake.
• C. You'll need less insulin when you increase your food intake.
• D. You'll need more insulin when you exercise or decrease your food intake.

Correct answer: B

Rationale: When a person with type 1 diabetes exercises, it typically lowers blood glucose levels. As a result, insulin needs are reduced when exercise or food intake is decreased. Choice A is incorrect because more insulin is not typically needed when exercise or food intake is increased. Choice C is incorrect because increasing food intake would generally require more insulin to cover the additional glucose from the food. Choice D is incorrect as decreasing food intake usually leads to a lower need for insulin.

3. A nurse is assigned to care for a group of clients. On reviewing the clients' medical records, the nurse determines that which client is at risk for deficient fluid volume?

• A. A client with a colostomy
• B. A client with congestive heart failure
• C. A client with decreased kidney function
• D. A client receiving frequent wound irrigations

Correct answer: A

Rationale: The correct answer is A. Clients with a colostomy are at risk for deficient fluid volume due to the loss of fluid through the colostomy. In colostomy, there can be increased fluid loss through the stoma, which may lead to dehydration and electrolyte imbalances. Choices B, C, and D do not directly relate to the risk for deficient fluid volume. Clients with congestive heart failure are more prone to fluid overload rather than deficient volume. Clients with decreased kidney function are at risk for fluid retention, not deficient volume. Clients receiving frequent wound irrigations may be at risk for infection, but this does not directly indicate deficient fluid volume.

4. Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, Nurse Tina assesses the client, who now has nausea, a temperature of 105°F (40.5°C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

• A. Diabetic ketoacidosis
• B. Thyroid crisis
• C. Hypoglycemia
• D. Tetany

Correct answer: B

Rationale: The correct answer is B: Thyroid crisis. Thyroid crisis, also known as thyroid storm, is a life-threatening condition that can occur after a thyroidectomy. Symptoms include high fever, tachycardia, extreme restlessness, and other signs of severe hyperthyroidism. Diabetic ketoacidosis (choice A) is a complication of diabetes characterized by hyperglycemia, ketosis, and acidosis, not typically seen post-thyroidectomy. Hypoglycemia (choice C) is low blood sugar levels and would not present with the symptoms described. Tetany (choice D) is a condition of involuntary muscle spasms due to low calcium levels and is not directly related to the symptoms observed in this scenario.

5. A client with DM visits the health care clinic. The client's diabetes has been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200 mg/dl. Which medication, if added to the client's regimen, may have contributed to the hyperglycemia?

• A. Atenolol (Tenormin)
• B. Prednisone (Deltasone)
• C. Phenelzine (Nardil)
• D. Allopurinol (Zyloprim)

Correct answer: B

Rationale: The correct answer is B. Prednisone is a corticosteroid that can cause hyperglycemia by increasing glucose production in the liver. Atenolol (Choice A) is a beta-blocker that typically does not affect blood glucose levels significantly. Phenelzine (Choice C) is a monoamine oxidase inhibitor used for depression and does not directly impact blood glucose levels. Allopurinol (Choice D) is a xanthine oxidase inhibitor used to manage gout and does not contribute to hyperglycemia.

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