Final Review/Critical thinking questions

A patient with an acute kidney injury has longer QRS intervals on an EKG than were noted in the previous shift. Which action would the RN take first?

• Notify the provider

• Document the QRS interval measurement

• Check the patient's recent potassium level

• Review the chart for the patient's creatinine level

Answer explanation

The RN would need to check the patient's most recent potassium level as an increasing QRS interval is suggestive of hyperkalemia.

A patient who is lethargic with deep, rapid respirations has the following ABG results:

pH 7.32

PaO2 88 mm Hg

PaCo2 35 mm Hg

HCO3 16 mEq/L.

How would the RN interpret these results?

• Metabolic acidosis

• Metabolic alkalosis

• Respiratory acidosis

• Respiratory alkalosis

Which finding indicates to the nurse that demeclocycline has been effective in a patient with SIADH?

• Weight has increased

• Urinary output has increased

• Peripheral edema has increased

• Urine specific gravity has increased

Answer explanation

Demeclocycline blocks the action of ADH and increases urine output, producing more dilute urine.

A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a cramp in the right hand upon returning to the surgical unit. Which collaborative action should the nurse anticipate NEXT?

• Plan for emergency tracheostomy

• Administer IV calcium gluconate

• Prepare for endotracheal intubation

• Begin thyroid hormone replacement

Answer explanation

These manifestations correlate with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery.

Which action will the nurse include in the POC for a patient with Graves' Disease who has exophthalmos?

• Place cold packs on the eyes to relieve pain and swelling

• Teach the patient to blink every few seconds to lubricate the corneas

• Elevate the head of the bed to promote fluid drainage from the periorbital area

• Cover the eyes with eye patches to protect from corneal abrasions.

Answer explanation

The patient should stay upright as much as possible to promote drainage from the periorbital area. Patients are unable to fully close their eyes to blink. Lubricating eye drops will protect their eyes over eye patches.

A patient who has hypothyroidism and hypertension is prescribed levothyroxine (Synthroid). Which finding should prompt the nurse to contact the provider prior to administering the medication?

• Increased T4 level

• BP of 114/63

• Distant or difficult to hear heart sounds

• Elevated TSH levels

Answer explanation

An increased T4 level indicates that the levothyroxine dose needs to be reduced. The nurse should contact the provider prior to administering the medication.

A patient is being admitted with a diagnosis of Cushing's syndrome. Which findings will the nurse expect during the assessment?

• Chronically low blood pressure

• Bronze appearance of the skin.

• Purple streaks on the abdomen

• Decreased axillary and pubic hair

Answer explanation

Purpleish-red striae on the abdomen are a common clinical manifestation of Cushings.

Which of the following indicates that the current therapy is effective for a patient who has acute adrenal insufficiency?

• Increasing sodium levels

• Decreasing blood glucose levels

• Decreasing sodium chloride levels

• Increasing serum potassium levels

Answer explanation

Clinical manifestations of Addison's disease (adrenal insufficiency) include hyponatremia. An increase in sodium levels indicates improvement.

***The nurse is taking care of a patient in Addisonian crisis. Which statement from the patient indicates the need to plan additional teaching?

• "I frequently eat out at restaurants, and my food has a lot of added salt"

• "Last week I had the flu, so I couldn't take the hydrocortisone"

• "I always double the dose of hydrocortisone on the days that I go for a long run"

• "I take twice as much hydrocortisone in the morning as I do in the afternoon"

Answer explanation

The need for additional hydrocortisone increases with stressors like illnesses, strenuous exercise, etc.

Which medication would the nurse identify as a potential risk to a patient's MSK system?

• The patient takes a multivitamin daily with calcium

• The patient has asthma requiring frequent oral corticosteorids

• The patient takes hormone replacement therapy for hot flashes

• The patient has headaches that are treated with NSAIDs

Answer explanation

Frequent or chronic use of corticosteroids increases the risk of osteoporosis and avascular necrosis.