Nursing Elites

1. When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamines, Nurse April is most likely to detect:

• A. A blood pressure of 130/70 mm Hg
• B. A blood glucose level of 130 mg/dl
• C. Bradycardia
• D. A blood pressure of 176/88 mm Hg

Correct answer: D

Rationale: Pheochromocytoma is a tumor of the adrenal medulla that secretes excessive catecholamines, leading to symptoms such as hypertension. The normal blood pressure range is around 120/80 mm Hg, so a blood pressure reading of 176/88 mm Hg is most likely to be detected in a client with pheochromocytoma. Choices A, B, and C are incorrect because pheochromocytoma typically presents with hypertension, not a normal or low blood pressure (choice A), not related to blood glucose levels (choice B), and not bradycardia (choice C).

2. Nurse Wayne is aware that a positive Chvostek's sign indicates:

• A. Hypocalcemia
• B. Hyponatremia
• C. Hypokalemia
• D. Hypermagnesemia

Correct answer: A

Rationale: A positive Chvostek's sign indicates hypocalcemia. This sign is elicited by tapping the facial nerve anterior to the ear, resulting in facial muscle twitching due to increased neuromuscular irritability from low calcium levels. Hyponatremia (Choice B) is characterized by low sodium levels, but it does not present with Chvostek's sign. Hypokalemia (Choice C) is low potassium levels, and hypermagnesemia (Choice D) is high magnesium levels, neither of which are associated with Chvostek's sign.

3. 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.

4. Nurse Troy is aware that the most appropriate nursing diagnosis for a client with Addison's disease is:

• A. Risk for infection
• B. Excessive fluid volume
• C. Urinary retention
• D. Hypothermia

Correct answer: A

Rationale: The most appropriate nursing diagnosis for a client with Addison's disease is 'Risk for infection.' Addison's disease is characterized by corticosteroid deficiency, which leads to immune suppression, making these clients more susceptible to infections. This diagnosis reflects the increased vulnerability of clients with Addison's disease to infections. Choices B, C, and D are incorrect because Addison's disease does not typically present with excessive fluid volume, urinary retention, or hypothermia as primary concerns.

5. 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.

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