MED SURG Exam 4 Questions With 100%
Verified Solutions
An 82-year-old patient in a long-term care facility has several
medications prescribed. After the patient is newly diagnosed with
hypothyroidism, the nurse will need to consult with the health care
provider before administering
a.
docusate (Colace).
b. ibuprofen
(Motrin).
c.
diazepam (Valium).
d.
cefoxitin (Mefoxin). - ANSWER -ANS: C
Worsening of mental status and myxedema coma can be precipitated
by the use of sedatives, especially in older adults. The nurse should
discuss the use of diazepam with the health care provider before
administration.
The other medications may be given safely to the patient
A patient who was admitted with myxedema coma and diagnosed
with hypothyroidism is improving and expected to be discharged in 2
days. Which teaching strategy will be best for the nurse to use?
a.
Provide written reminders of self-care information. b.
Offer multiple options for management of therapies. c.
Ensure privacy for teaching by asking visitors to leave.
,d.
Delay teaching until patient discharge date is confirmed - ANSWER -
ANS: A
Written instructions will be helpful to the patient because initially the
hypothyroid patient may be unable to remember to take medications
and other aspects of self-care. Because the treatment regimen is
somewhat complex, teaching should be initiated well before
discharge. Family members or friends should be included in
teaching because the hypothyroid patient is likely to forget some
aspects of the treatment plan. A simpler regimen will be easier to
understand until the patient is euthyroid
A 63-year-old patient with primary hyperparathyroidism has a serum
phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14 mg/dL
(3.5 mmol/L). Which nursing action should be included in the plan of
care?
a.
Restrict the patient to bed rest.
b.
Encourage 4000 mL of fluids daily.
c.
Institute routine seizure precautions.
d.
Assess for positive Chvosteks sign - ANSWER -ANS: B
The patient with hypercalcemia is at risk for kidney stones, which
may be prevented by a high fluid intake.
Seizure precautions and monitoring for Chvosteks or Trousseaus
sign are appropriate for hypocalcemic patients. The patient
,should engage in weight-bearing exercise to decrease calcium
loss from bone
A patient develops carpopedal spasms and tingling of the lips
following a parathyroidectomy. Which action should the
nurse take
first ?
a.
Administer the ordered muscle relaxant.
b.
Give the ordered oral calcium supplement.
c.
Have the patient rebreathe from a paper bag.
d.
Start the PRN oxygen at 2 L/min per cannula - ANSWER -ANS: C The
patients symptoms suggest mild hypocalcemia. The symptoms of
hypocalcemia will be temporarily reduced by having the patient
breathe into a paper bag, which will raise the PaCO
2 and create a more acidic pH. The muscle relaxant will have no
impact on the ionized calcium level. Although severe
hypocalcemia can cause laryngeal stridor, there is no indication
that this patient is experiencing laryngeal stridor or needs oxygen.
Calcium supplements will be given to normalize calcium levels
quickly, but oral supplements will take time to be absorbed.
A patient who had radical neck surgery to remove a malignant tumor
developed hypoparathyroidism. The nurse should plan to teach the
patient about
a.
bisphosphonates to reduce bone demineralization. b.
, calcium supplements to normalize serum calcium levels.
c. increasing fluid intake to decrease risk for
nephrolithiasis. d.
including whole grains in the diet to prevent constipation - ANSWER -
ANS: B
Oral calcium supplements are used to maintain the serum calcium in
normal range and prevent the complications of hypocalcemia. Whole
grain foods decrease calcium absorption and will not be
recommended.
Bisphosphonates will lower serum calcium levels further by
preventing calcium from being reabsorbed from bone. Kidney
stones are not a complication of hypoparathyroidism and low
calcium levels
Which finding for a patient who has hypothyroidism and hypertension
indicates that the nurse should contact the health care provider
before administering levothyroxine
(Synthroid)?
a.
Increased thyroxine (T
4)
level
b.
Blood pressure 112/62 mm Hg
c.
Distant and difficult to hear heart sounds
d.
Verified Solutions
An 82-year-old patient in a long-term care facility has several
medications prescribed. After the patient is newly diagnosed with
hypothyroidism, the nurse will need to consult with the health care
provider before administering
a.
docusate (Colace).
b. ibuprofen
(Motrin).
c.
diazepam (Valium).
d.
cefoxitin (Mefoxin). - ANSWER -ANS: C
Worsening of mental status and myxedema coma can be precipitated
by the use of sedatives, especially in older adults. The nurse should
discuss the use of diazepam with the health care provider before
administration.
The other medications may be given safely to the patient
A patient who was admitted with myxedema coma and diagnosed
with hypothyroidism is improving and expected to be discharged in 2
days. Which teaching strategy will be best for the nurse to use?
a.
Provide written reminders of self-care information. b.
Offer multiple options for management of therapies. c.
Ensure privacy for teaching by asking visitors to leave.
,d.
Delay teaching until patient discharge date is confirmed - ANSWER -
ANS: A
Written instructions will be helpful to the patient because initially the
hypothyroid patient may be unable to remember to take medications
and other aspects of self-care. Because the treatment regimen is
somewhat complex, teaching should be initiated well before
discharge. Family members or friends should be included in
teaching because the hypothyroid patient is likely to forget some
aspects of the treatment plan. A simpler regimen will be easier to
understand until the patient is euthyroid
A 63-year-old patient with primary hyperparathyroidism has a serum
phosphorus level of 1.7 mg/dL (0.55 mmol/L) and calcium of 14 mg/dL
(3.5 mmol/L). Which nursing action should be included in the plan of
care?
a.
Restrict the patient to bed rest.
b.
Encourage 4000 mL of fluids daily.
c.
Institute routine seizure precautions.
d.
Assess for positive Chvosteks sign - ANSWER -ANS: B
The patient with hypercalcemia is at risk for kidney stones, which
may be prevented by a high fluid intake.
Seizure precautions and monitoring for Chvosteks or Trousseaus
sign are appropriate for hypocalcemic patients. The patient
,should engage in weight-bearing exercise to decrease calcium
loss from bone
A patient develops carpopedal spasms and tingling of the lips
following a parathyroidectomy. Which action should the
nurse take
first ?
a.
Administer the ordered muscle relaxant.
b.
Give the ordered oral calcium supplement.
c.
Have the patient rebreathe from a paper bag.
d.
Start the PRN oxygen at 2 L/min per cannula - ANSWER -ANS: C The
patients symptoms suggest mild hypocalcemia. The symptoms of
hypocalcemia will be temporarily reduced by having the patient
breathe into a paper bag, which will raise the PaCO
2 and create a more acidic pH. The muscle relaxant will have no
impact on the ionized calcium level. Although severe
hypocalcemia can cause laryngeal stridor, there is no indication
that this patient is experiencing laryngeal stridor or needs oxygen.
Calcium supplements will be given to normalize calcium levels
quickly, but oral supplements will take time to be absorbed.
A patient who had radical neck surgery to remove a malignant tumor
developed hypoparathyroidism. The nurse should plan to teach the
patient about
a.
bisphosphonates to reduce bone demineralization. b.
, calcium supplements to normalize serum calcium levels.
c. increasing fluid intake to decrease risk for
nephrolithiasis. d.
including whole grains in the diet to prevent constipation - ANSWER -
ANS: B
Oral calcium supplements are used to maintain the serum calcium in
normal range and prevent the complications of hypocalcemia. Whole
grain foods decrease calcium absorption and will not be
recommended.
Bisphosphonates will lower serum calcium levels further by
preventing calcium from being reabsorbed from bone. Kidney
stones are not a complication of hypoparathyroidism and low
calcium levels
Which finding for a patient who has hypothyroidism and hypertension
indicates that the nurse should contact the health care provider
before administering levothyroxine
(Synthroid)?
a.
Increased thyroxine (T
4)
level
b.
Blood pressure 112/62 mm Hg
c.
Distant and difficult to hear heart sounds
d.
