Nursing Elites

1. 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.

2. The healthcare provider is assessing a client with Addison's disease. Which of the following symptoms is consistent with this condition?

• A. Hypertension
• B. Hyperglycemia
• C. Hyperpigmentation
• D. Weight gain

Correct answer: C

Rationale: Hyperpigmentation is a characteristic symptom of Addison's disease. In Addison's disease, there is a decrease in cortisol production, leading to an increase in adrenocorticotropic hormone (ACTH) secretion by the pituitary gland. Excess ACTH can stimulate melanocytes, resulting in hyperpigmentation. Choices A, B, and D are not typically associated with Addison's disease. Hypertension is more commonly associated with conditions involving excess cortisol production, such as Cushing's syndrome. Hyperglycemia may occur in diabetes mellitus but is not a hallmark of Addison's disease. Weight loss, rather than weight gain, is a common symptom of Addison's disease due to decreased cortisol levels.

3. A client with Addison's disease is being educated on managing the condition. Which of the following statements indicates a need for further teaching?

• A. I should carry an emergency kit with hydrocortisone at all times.
• B. I need to increase my sodium intake during hot weather.
• C. I can skip my medication if I feel well.
• D. I should avoid stress as much as possible.

Correct answer: C

Rationale: The correct answer is C. Clients with Addison's disease should not skip their medication, even if they feel well, as consistent medication is necessary to manage the condition. Choice A is correct as carrying an emergency kit with hydrocortisone is essential for managing potential adrenal crises. Choice B is correct as increasing sodium intake during hot weather helps prevent electrolyte imbalances. Choice D is correct as stress can trigger adrenal crisis in individuals with Addison's disease, so stress management is crucial.

4. The client with hypothyroidism is being educated by the healthcare provider about taking levothyroxine. Which of the following instructions should be included?

• A. Take the medication with meals
• B. Take the medication at bedtime
• C. Take the medication on an empty stomach in the morning
• D. Take the medication with a glass of milk

Correct answer: C

Rationale: The correct answer is to take levothyroxine on an empty stomach in the morning. This instruction is essential to enhance absorption and efficacy of the medication. Taking levothyroxine with meals, at bedtime, or with a glass of milk can interfere with its absorption and effectiveness, leading to suboptimal treatment outcomes.

5. The nurse is caring for a client with syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following clinical manifestations should the nurse expect?

• A. Hypernatremia
• B. Hypotension
• C. Decreased urine output
• D. Polyuria

Correct answer: C

Rationale: The correct answer is C: 'Decreased urine output.' Syndrome of inappropriate antidiuretic hormone (SIADH) is characterized by excessive release of antidiuretic hormone, leading to water retention and decreased urine output. Therefore, the nurse should expect the client to have decreased urine output. Choices A, B, and D are incorrect. Hypernatremia (Choice A) is not typically associated with SIADH as it usually leads to dilutional hyponatremia. Hypotension (Choice B) is not a common clinical manifestation of SIADH. Polyuria (Choice D) is the opposite of what is expected in a client with SIADH, who typically presents with decreased urine output.

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