Endocrine
The nurse is caring for a patient admitted with suspected hyperparathyroidism. Because of the potential effects of this disease on electrolyte balance, the nurse should assess this patient for which of the following manifestations?
A. Neurologic irritability
B. Declining urine output
C. Lethargy and weakness
D. Hyperactive bowel sounds
C. Lethargy and Weakness
Hyperparathyroidism can cause hypercalcemia. Signs of hypercalcemia include polyuria, constipation, nausea and vomiting, lethargy, and muscle weakness.
A patient complains of abdominal pain that is difficult to localize. The nurse documents this as which type of pain?
a. Cutaneous
b. Visceral
c. Superficial
d. Somatic
B Visceral
A patient has a new prescription for cyclosporine after having a kidney transplant. Which information in the patient's health history has the most implications for planning patient teaching about the medication at this time?
a. The patient restricts salt to treat prehypertension.
b. The patient drinks 3 to 4 quarts of fluids every day.
c. The patient has many concerns about the effects of cyclosporine.
d. The patient has a glass of grapefruit juice every day for breakfast.
ANS: D
Grapefruit juice can increase the cyclosporine to toxic levels. The patient should be taught to avoid grapefruit juice. High fluid intake will not impact cyclosporine levels or renal function. Cyclosporine may cause hypertension, and the patient's many concerns should be addressed, but these are not potentially life-threatening problems.
The nurse is caring for a patient admitted to the acute care unit with an extra strong thirst and dilute, excessive straw colored urine output (up to 15L/day). What does the nurse suspect?
A. Type 2 Diabetes
B. Diabetes Insipidus (DI)
C. Cushing's disease
D. Addison's disease
B. Diabetes Insipidus
DI is a disorder of the posterior pituitary in which water loss is caused by an ADH deficiency or an inability for the kidneys to respond to ADH. DI results in large volumes of dilute urine because the distal kidney tubules and collecting ducts so not reabsorb water, this leads to polyuria. Dehydration from massive water loss increases thirst.
The three types of responses to pain are physiologic, behavioral, and affective. Which are examples of behavioral responses to pain? Select all that apply.
a. A patient cradles a wrist that was injured in a car accident.
b. A child is moaning and crying due to a stomachache.
c. A patient's pulse is increased following a myocardial infarction.
d. A patient in pain strikes out at a nurse who attempts to bathe him.
e. A patient who has chronic cancer pain is depressed and withdrawn.
f. A child pulls away from a nurse trying to give him an injection.
A, B, F
WRONG ANSWERS: C - physiological response
D - affective response
E - physiological response
When the nurse is admitting a patient who has acute rejection of an organ transplant, which of these already admitted patients will be the most appropriate roommate?
a. A patient who has viral pneumonia
b. A patient with second degree burns
c. A patient who is recovering from an anaphylactic reaction to a bee sting
d. A patient with graft-versus-host disease after a recent bone marrow transplant
c. A patient who is recovering from an anaphylactic reaction to a bee sting
ANS: C
Treatment for a patient with acute rejection includes administration of additional immunosuppressants, and the patient should not be exposed to increased risk for infection as would occur from patients with viral pneumonia, graft-versus-host disease, and burns. There is no increased exposure to infection from a patient with anaphylaxis.
A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment findings, nurse Julia 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?
A - related to tetany secondary to a decreased serum calcium level
B - related to exhaustion secondary to an accelerated metabolic rate
C - related to bone demineralization resulting in pathologic fractures
D - related to edema and dry skin secondary to fluid infiltration into the interstitial spaces
C - related to bone demineralization resulting in pathologic fractures
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.
A nurse instructor is teaching a class of student nurses about the nature of pain. Which statements accurately describe this phenomenon. Select all that apply.
A - pain is whatever the physician treating the pain says it is
B - pain exists whenever the person experiencing it says it exists
C - pain is an emotional and sensory reaction to tissue damage
D - pain is a simple, universal and easy to describe phenomenon
E - pain is classified by duration, location, source, transmission and etiology
B, C, E
WRONG ANSWERS:
A - pain is patient dependent
D - pain is not simple or easy to describe, it is universal
11. In a person having an acute rejection of a transplanted kidney, which of the following would help the nurse understand the course of events? (Select all that apply)
a. A new transplant should be considered
b. Acute rejection can be treated with OKT3
c. Acute rejection usually leads to chronic rejection
d. Corticosteroids are the most successful drugs used to treat acute rejection.
e. Acute rejection is common after a transplant and can be treated with drug therapy.
B, E
B. Acute rejection can be treated with OKT3
E. Acute rejection is common after a transplant and can be treated with drug therapy.
Rationale: Acute rejection is treatable and does not usually require a new transplant. Monoclonal antibodies such as Muromonab-CD3 (Orthoclone OKT3) are used for preventing and treating acute rejection episodes. Calcineurin inhibitors are the most effective immunosuppressants available to treat organ rejection. It is not uncommon to have at least one acute rejection episode, especially with organs from deceased donors. These episodes are usually reversible with additional immunosuppressive therapy that may include increased corticosteroid doses or polyclonal or monoclonal antibodies.
A client with carcinoma of the lung develops the syndrome of inappropriate antidiuretic hormone (SIADH) as a complication of the cancer. The nurse anticipates that which of the following may be prescribed? Select all that apply.
A Radiation
B Chemotherapy
C Increased fluid intake
D Serum sodium blood levels
E Decreased oral sodium intake
F Medication that is antagonistic to antidiuretic hormone (ADH)
Correct Answer: A, B, D, & F.
Cancer is a common cause of SIADH. In clients with SIADH, excessive amounts of water are reabsorbed by the kidney and put into the systemic circulation. The increased water causes hyponatremia (decreased serum sodium levels) and some degree of fluid retention.
One of the most common distinctions of pain is whether it is acute or chronic. Which examples describe chronic pain? Select all that apply.
a. A patient is receiving chemotherapy for bladder cancer.
b. An adolescent is admitted to the hospital for an appendectomy.
c. A patient is experiencing a ruptured aneurysm.
d. A patient who has fibromyalgia requests pain medication.
e. A patient has back pain related to an accident that occurred last year.
f. A patient is experiencing pain from second-degree burns.
A, D, E
WRONG ANSWERS:
B - acute pain
C - Acute Pain
F - Acute Pain
Patients with a heart transplantation are at rick for which of the following complication in the first year after transplantation? (select all that apply)
a. Cancer
b. Infection
c. Rejection
d. Vasculopathy
e. Sudden Cardiac Death