Nursing Elites

1. During preoperative teaching for a female client undergoing subtotal thyroidectomy, which statement should the nurse include?

• A. The head of your bed must remain flat for 24 hours after surgery.
• B. You should avoid deep breathing and coughing after surgery.
• C. You won't be able to swallow for the first day or two.
• D. You must avoid hyperextending your neck after surgery.

Correct answer: D

Rationale: The correct answer is D. Instructing the client to avoid hyperextending the neck after thyroid surgery is crucial to prevent stress on the surgical site and reduce the risk of complications such as strain on the incision or damage to the healing tissues. Choices A, B, and C are incorrect because: A) Keeping the head of the bed flat for 24 hours is not necessary after a thyroidectomy; elevation of the head of the bed can actually help reduce swelling and improve comfort. B) Encouraging deep breathing and coughing after surgery is essential to prevent respiratory complications such as pneumonia, so this advice is incorrect. C) Difficulty swallowing after thyroid surgery is not a typical outcome, so this statement is inaccurate and should not be included in the preoperative teaching.

2. When caring for a female client with a history of hypoglycemia, Nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description?

• A. Sulfisoxazole (Gantrisin)
• B. Mexiletine (Mexitil)
• C. Prednisone (Orasone)
• D. Lithium carbonate (Lithobid)

Correct answer: A

Rationale: The correct answer is A, Sulfisoxazole (Gantrisin). Sulfisoxazole is known to potentiate hypoglycemia, making it unsafe for clients with a history of hypoglycemia. Choice B, Mexiletine, is a medication used to treat certain heart rhythm problems and is not associated with hypoglycemia. Choice C, Prednisone, is a corticosteroid and does not potentiate hypoglycemia. Choice D, Lithium carbonate, is commonly used to treat bipolar disorder and does not typically potentiate hypoglycemia. Therefore, the drug that Nurse Ruby should avoid in this case is Sulfisoxazole (Gantrisin) to prevent worsening the client's hypoglycemic condition.

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

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

Correct answer: A

Rationale: In SIADH, there is excessive release of antidiuretic hormone (ADH), leading to water retention and dilutional hyponatremia. Hyponatremia is a hallmark finding in SIADH due to the imbalance between water and sodium levels. Hyperkalemia (Choice B) is not typically associated with SIADH. Hypercalcemia (Choice C) involves elevated calcium levels, which are not directly related to SIADH. Hypernatremia (Choice D) is the opposite of what occurs in SIADH, where sodium levels are usually diluted due to water retention.

4. A client with hypothyroidism is prescribed levothyroxine. The nurse should teach the client to take this medication:

• A. With meals
• B. Before bedtime
• C. On an empty stomach in the morning
• D. With a glass of milk

Correct answer: C

Rationale: Levothyroxine should be taken on an empty stomach in the morning to enhance absorption and efficacy. Taking it with meals (Choice A) may interfere with absorption due to food interactions. Taking it before bedtime (Choice B) can lead to difficulties with absorption and may disrupt the sleep cycle. Consuming levothyroxine with a glass of milk (Choice D) is not recommended as calcium in milk can interfere with its absorption. Therefore, the best practice is to take levothyroxine on an empty stomach in the morning to ensure optimal effectiveness.

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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