Nursing Elites

1. The healthcare provider is monitoring a client with Cushing's syndrome. Which of the following findings should be reported to the healthcare provider immediately?

• A. Hyperglycemia
• B. Hypertension
• C. Low-grade fever
• D. Weight gain

Correct answer: C

Rationale: In a client with Cushing's syndrome, a low-grade fever should be reported immediately as it may indicate an infection. Clients with Cushing's syndrome are immunosuppressed, making them more susceptible to infections. Hyperglycemia and hypertension are common findings in Cushing's syndrome and are managed as part of the condition. Weight gain is also a common symptom in Cushing's syndrome and may not require immediate reporting unless it is sudden and severe.

2. An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, Nurse Libby prepares to take emergency action to prevent the potential complication of:

• A. Thyroid storm.
• B. Cretinism.
• C. Myxedema coma.
• D. Hashimoto's thyroiditis.

Correct answer: C

Rationale: The scenario described with hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area is indicative of myxedema coma, a severe and life-threatening complication of hypothyroidism. Myxedema coma requires immediate emergency treatment to prevent further deterioration. Choice A, thyroid storm, is a complication of hyperthyroidism characterized by an increase in body temperature, heart rate, and blood pressure. Choice B, cretinism, refers to untreated congenital hypothyroidism leading to mental and physical growth retardation. Choice D, Hashimoto's thyroiditis, is an autoimmune condition leading to hypothyroidism but does not present with the acute, life-threatening symptoms described in the scenario.

3. A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse the hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer:

• A. Phentolamine (Regitine)
• B. Methyldopa (Aldomet)
• C. Mannitol (Osmitrol)
• D. Felodipine (Plendil)

Correct answer: A

Rationale: In a hypertensive crisis due to pheochromocytoma, the appropriate medication to administer is Phentolamine (Regitine), an alpha-adrenergic blocker. Phentolamine acts quickly to block the effects of excess catecholamines that are released in pheochromocytoma, helping to rapidly lower blood pressure. Methyldopa (Aldomet) is an alpha-2 adrenergic agonist used for chronic hypertension, not for acute crises like pheochromocytoma. Mannitol (Osmitrol) is an osmotic diuretic used to reduce intracranial pressure and treat cerebral edema, not indicated for hypertensive crises. Felodipine (Plendil) is a calcium channel blocker used for chronic management of hypertension, not for acute hypertensive crises like those seen in pheochromocytoma.

4. A client with diabetes insipidus is receiving desmopressin therapy. The nurse should monitor for which of the following potential side effects?

• A. Hyponatremia
• B. Hypernatremia
• C. Hypokalemia
• D. Hypercalcemia

Correct answer: A

Rationale: The correct answer is A: Hyponatremia. Desmopressin, a medication used to treat diabetes insipidus, can cause the retention of water without sodium, leading to dilutional hyponatremia. This occurs because desmopressin increases water reabsorption in the kidneys without affecting sodium levels. Hypernatremia (choice B) is unlikely because desmopressin does not cause excessive sodium retention. Hypokalemia (choice C) and hypercalcemia (choice D) are not typically associated with desmopressin therapy for diabetes insipidus.

5. The client with DM is being taught about the signs of hyperglycemia. Which symptom should the nurse include?

• A. Excessive thirst
• B. Sweating
• C. Shaking
• D. Hunger

Correct answer: A

Rationale: Excessive thirst, also known as polydipsia, is a hallmark symptom of hyperglycemia. When blood glucose levels are high, the body tries to eliminate the excess glucose through urine, leading to increased urination and subsequent thirst. Sweating, shaking, and hunger are more commonly associated with hypoglycemia, not hyperglycemia. Sweating can occur when blood sugar levels drop too low, shaking is a sign of hypoglycemia, and hunger is often a result of low blood sugar levels triggering the body to seek fuel.

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