Adult Nursing Concepts-Questions

1.A client who has been taking prednisone to treat lupus erythematosus has discontinued the medication because of lack of funds to buy the drug. When the nurse becomes aware of the situation, which assessment is most important for the nurse to make first?

1. Blood pressure. 2. Breath sounds. 3. Capillary refill. 4. Skin integrity.

Answer 1 Rationale: 1. Withdrawal from glucocorticoid therapy can precipitate addisonian crisis, which is characterized by circulatory collapse and shock. Hypotension is a major manifestation of addisonian crisis and must be treated vigorously. 2.An adult is readmitted to the medical/surgical care unit in addisonian crisis. He is exhibiting signs of tachycardia, dehydration, hyponatremia, hyperkalemia, and hypoglycemia. The nurse should expect that the initial orders for this client will include 1. starting an IV solution of saline and dextrose. 2. administration of oxygen via 100% nonrebreathing mask. 3. administering potassium chloride. 4. preparing for an emergency tracheostomy. Answer: 1 Rationale: Needs immediate replacement of glucocorticoids. Why not 0xygen? Not otmally given at 100%. 3. Excess Mineralocorticoid causes mood disturbances, hypertension, acne.Excess glucocorticoids causes increase adipose tissue esp. in the trunk. Can see this on Cushing's syndrome. If patient constantly lashes at family: there is an increase in ______________? 4.In Cushing syndrome, patient exhibits central obesity with large trunk with thin extremeties, buffalo hump, and fatty cheeks( moon face) 5. In conn's disease, you will see hypertension and hyperkalemia due to increase in glucocoroid. 6.In pheochromocytoma, there is life- threatening hypertension due to increase in catecholamines which stimualtes the SNS.other s/s: palpitation, sweating. 7. post adrenalectomy, theer is a need for life-long corticosteroid replacement and should not alter the dosage. 8. Client with grave's: "why do i need to take inderal( propanolol)" To relieve symptoms of GD: tachucardia, paplpiattion, heat intolerance 9. The nurse is caring for a client who is status postthyroidectomy. The client is exhibiting hyperreflexia, muscle twitching, and spasms. The first action the nurse should perform is to 1. prepare to send a blood sample to the laboratory for a calcium level. 2. assess for additional signs of tetany. 3. place the client in semi-Fowler's position. 4. administer post-op pain medication. Answer Rationale: 1. During a thyroidectomy it is possible for the parathyroid glands to be removed or damaged. If the parathyroid glands are disturbed, hypocalcemia may result. 2. Muscle twitching and spasms are already indicative of tetany after a thyroidectomy; therefore, a calcium level should be drawn and calcium given to correct a life-threatening emergency. 10. An adult who has Grave's disease just received a dose of sodium 131I. Which of the following statements made to the nurse best demonstrates an understanding of immediate care needs? 1. "I should be able to go home after about two hours if I don't have any vomiting." 2. "I have my belongings with me to stay in the isolation room for the next 24 hours." 3. "My daughter is pregnant, so I told her I will not be able to see her for the next month." 4. "I brought my antithyroid drug with me so I will not miss a dose." Answer 1 Rationale: 1. The client remains in the outpatient department for about two hours to be monitored for vomiting. 2. Only very high-dose therapy necessitates hospitalization for isolation. Normally the client has to remain in the outpatient department for about two hours. 3. The client should avoid close body contact with infants, young children, or pregnant women during the first 24 hours, although the radiation risk is minimal. 4. Antithyroid drugs need to be discontinued at least five days before treatment.