Question 1

A patient diagnosed with hyperthyroid crisis is receiving propylthiouracil (PTU).The nurse will increase monitoring for which adverse reaction?

Accepted Answer

Propylthiouracil (PTU) can cause agranulocytosis, a condition where white blood cell levels drop, increasing the risk of infection. Therefore, monitoring for a decrease, not an elevation, in WBC is crucial.

Question 2

A patient is diagnosed with hyperglycemic hyperosmolar state (HHS).Which interventions would the nurse anticipate? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

Accepted Answer

Hyperglycemic hyperosmolar state (HHS) is a serious complication of diabetes characterized by severe hyperglycemia and dehydration. Management includes potassium supplementation (A) to address electrolyte imbalances, testing for sources of infection (B) since infections can precipitate HHS, increasing IV fluid administration (D) to correct dehydration and reduce blood glucose levels, and monitoring arterial blood gases (E) to assess for metabolic acidosis and other imbalances. Increasing the amount of NPH insulin (C) is not specifically indicated as the initial step in HHS management; instead, insulin therapy is carefully tailored and often involves regular insulin to rapidly decrease blood glucose levels.

Question 3

A patient has been tentatively diagnosed with adrenal insufficiency.Which findings would the nurse evaluate as supporting this diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

Accepted Answer

A,C,D,E

Question 4

A patient is being tested for adrenal insufficiency with the rapid adrenocorticotropic hormone (ACTH)stimulation test.How will the nurse explain this test to the patient?

Accepted Answer

The rapid ACTH stimulation test involves a series of blood samples being drawn after an injection of synthetic ACTH. It does not involve drinking a salty fluid, takes approximately one hour to complete, and can be done at any time of day.

Question 5

The nurse has identified that a patient who has hyperthyroidism has decreased cardiac output.Which interventions are indicated to address this diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

Accepted Answer

The answer of The nurse has identified that a patient...

Question 6

The patient whose lower extremities were crushed in a motor vehicle accident is likely experiencing "fight-or-flight." Which finding would the nurse attribute to that neuroendocrine response?

Accepted Answer

The "fight-or-flight" response is characterized by decreased activity in the digestive and urinary systems, leading to decreased bowel sounds and urinary output. Heart rate may be increased, not 78 bpm, due to increased sympathetic nervous system activity. Bleeding is not necessarily related to the "fight-or-flight" response. Level of consciousness may be altered due to head injury, but not specifically related to the "fight-or-flight" response.

Question 7

A nurse is reviewing laboratory results for a patient just admitted to the intensive care unit.The patient is not known to have diabetes,but initial nonfasting blood sugar is 130 mg/dL.At which point would the nurse expect insulin therapy to begin?

Accepted Answer

The answer of A nurse is reviewing laboratory results for...

Question 8

The nurse realizes that increased interventions to prevent infection are necessary when the patient is under stress.Which effect of cortisol complicates this risk?

Accepted Answer

Cortisol, a stress hormone, can lead to the release of immature neutrophils into the bloodstream. These neutrophils are not as effective in fighting infection, thus increasing the risk of infection during periods of stress.

Question 9

A critically ill patient's plasma cortisol level is 2.6 mcg/dL.Which intervention does the nurse expect?

Accepted Answer

A plasma cortisol level of 2.6 mcg/dL is considered low and could indicate adrenal insufficiency. Treatment for adrenal insufficiency would be warranted. Emergency dialysis is not indicated for this condition. Continued diagnostic testing may be necessary to further evaluate adrenal function, but treatment should not be delayed while waiting for results. Adrenal excess would present with high cortisol levels, which is not the case here.

Question 10

A patient was severely injured when a building exploded.The patient's pain level report does not seem to reflect the severity of these injuries.How would the nurse evaluate this response?

Accepted Answer

The patient's lack of pain response may be due to increased endogenous opioids, which are natural pain-relieving chemicals produced by the body in response to severe stress or injury.

Question 11

A patient who is receiving taper doses of hydrocortisone has been taking oral medication for 3 days.This morning the patient has assessment findings of recurrent adrenal insufficiency.What nursing action,if any,is indicated?

Accepted Answer

Recurrent adrenal insufficiency is a potential side effect of tapering off hydrocortisone, but it requires medical attention. The nurse should discuss the assessment findings with the primary healthcare provider to determine the best course of action for the patient.

Question 12

A patient who is being mechanically ventilated has been prescribed hydrocortisone for treatment of adrenal insufficiency.Which nursing intervention should be implemented?

Accepted Answer

The answer of A patient who is being mechanically ventilated...

Question 13

A patient who has required an insulin drip is being transitioned to subcutaneous insulin.Which intervention would the nurse anticipate?

Accepted Answer

Administering the prescribed dose of NPH insulin 2 hours before discontinuing the insulin drip is the appropriate way to transition a patient from an insulin drip to subcutaneous insulin. This allows enough time for the NPH insulin to take effect before the drip is discontinued, preventing a gap in insulin coverage. Option A is not appropriate as administering insulin every two hours is too frequent and could result in hypoglycemia. Option C is not necessary as tapering the drip rate is not required if the patient is transitioning to subcutaneous insulin. Option D is not appropriate as the dosage of NPH insulin should be based on the patient's current insulin requirements, not a multiple of their current drip rate.

Question 14

A patient is receiving radiation treatment for laryngeal cancer.Which ECG change would the nurse evaluate as indicating need to assess this patient for hypothyroidism?

Accepted Answer

Inverted T wave is a common ECG change seen in patients with hypothyroidism, which is a potential side effect of radiation treatment for laryngeal cancer. Therefore, if the patient exhibits an inverted T wave, the nurse should assess for signs and symptoms of hypothyroidism. Shortened PR interval, P wave inversion, and atrial fibrillation are not specifically related to hypothyroidism.

Question 15

A nurse is providing care to a patient diagnosed with urinary sepsis.Which symptoms would the nurse evaluate as indicating the patient has entered the flow stage of metabolic response to this physiologic stress? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

Accepted Answer

During the flow phase of metabolic response to stress, the body attempts to compensate for the stressor. An increased heart rate (A) and cardiac output (C) are common as the body tries to improve perfusion and oxygen delivery to tissues. A fever (D) is also typical as part of the inflammatory response to infection, such as urinary sepsis.

Question 16

A patient is still hypermetabolic two weeks after his injury.What finding would the nurse expect?

Accepted Answer

Hypermetabolism indicates increased metabolic activity, and if it persists for two weeks after an injury, it is most likely due to muscle wasting.

Question 17

The nurse is advised that a patient diagnosed with hyperthyroid crisis will be admitted from the emergency department.The nurse prepares to care for a patient with which possible conditions? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

Accepted Answer

A patient with hyperthyroid crisis may present with symptoms such as atrial fibrillation, high fever, heart failure, and agitation. Constipation is not a common symptom of hyperthyroid crisis and therefore is an incorrect choice.

Question 18

Which nursing interventions are indicated to support the outcome of "maintain normal body temperature" for a patient with hyperthyroidism?

Accepted Answer

Hyperthyroidism can lead to increased body temperature. A cooling blanket is an appropriate intervention to help reduce fever and maintain normal body temperature if it exceeds 102°F.

Question 19

Because a patient is experiencing the fight-or-flight stage of the stress response,the nurse would be least concerned about which laboratory finding?

Accepted Answer

The answer of Because a patient is experiencing the fight-or-flight...

Question 20

A critically ill patient requires IV insulin for persistent hyperglycemia.Current fingerstick blood glucose is 68 mg/dL.According to international critical care guidelines,which nursing intervention is indicated?

Accepted Answer

The answer of A critically ill patient requires IV insulin...

Quiz 32: Metabolic Response to Stress

A patient diagnosed with hyperthyroid crisis is receiving propylthiouracil (PTU) .The nurse will increase monitoring for which adverse reaction?

A patient is diagnosed with hyperglycemic hyperosmolar state (HHS) .Which interventions would the nurse anticipate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A patient has been tentatively diagnosed with adrenal insufficiency.Which findings would the nurse evaluate as supporting this diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A patient is being tested for adrenal insufficiency with the rapid adrenocorticotropic hormone (ACTH) stimulation test.How will the nurse explain this test to the patient?

The nurse has identified that a patient who has hyperthyroidism has decreased cardiac output.Which interventions are indicated to address this diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.