Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is assessing a client who is admitted with hyperthyroidism. The client reports a weight loss of 5.4 kg (12 lb) in the last 2 months, increased appetite, increased perspiration, fatigue, menstrual irregularity, and restlessness. Which of the following actions should the nurse take to prevent a thyroid crisis?
A. Administer aspirin as prescribed for any sign of hyperthermia.
Administering aspirin for hyperthermia is not a standard intervention for hyperthyroidism. Hyperthermia can occur in severe cases of hyperthyroidism, but the primary intervention is to address the underlying thyroid dysfunction and provide supportive care.
B. Keep the client NPO.
Keeping the client NPO (nothing by mouth) is not directly related to preventing a thyroid crisis in hyperthyroidism. It may be necessary for certain pre-operative preparations or if the client is undergoing specific procedures, but it does not address the prevention of a thyroid crisis.
C. Observe the client carefully for signs of hypocalcemia.
While monitoring for signs of hypocalcemia is important in some cases of thyroid dysfunction, it is not the primary action to prevent a thyroid crisis. In hyperthyroidism, the focus is on managing excessive thyroid hormone levels.
D. Provide a quiet, low-stimulus environment.
Correct. Providing a quiet, low-stimulus environment is a crucial nursing intervention for clients with hyperthyroidism. They can be highly sensitive to external stimuli due to their increased metabolic rate. A calm environment helps reduce stress and the risk of exacerbating symptoms, potentially preventing a thyroid crisis.
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Full Explanation
A. Administering aspirin for hyperthermia is not a standard intervention for hyperthyroidism. Hyperthermia can occur in severe cases of hyperthyroidism, but the primary intervention is to address the underlying thyroid dysfunction and provide supportive care.
B. Keeping the client NPO (nothing by mouth) is not directly related to preventing a thyroid crisis in hyperthyroidism. It may be necessary for certain pre-operative preparations or if the client is undergoing specific procedures, but it does not address the prevention of a thyroid crisis.
C. While monitoring for signs of hypocalcemia is important in some cases of thyroid dysfunction, it is not the primary action to prevent a thyroid crisis. In hyperthyroidism, the focus is on managing excessive thyroid hormone levels.
D. Correct. Providing a quiet, low-stimulus environment is a crucial nursing intervention for clients with hyperthyroidism. They can be highly sensitive to external stimuli due to their increased metabolic rate. A calm environment helps reduce stress and the risk of exacerbating symptoms, potentially preventing a thyroid crisis.
Similar Questions
The primary health-care provider prescribes a cough syrup 0.4 g every 4 hours. The dosage strength of the syrup is 100 mg/5 mL. The medication bottle contains a measuring spoon that measures in teaspoons and tablespoons. How many teaspoons will the nurse instruct the client to take?
Full Explanation
Step 1: Convert the Prescribed Dose to Milligrams
The prescribed dose is 0.4 grams (g), but the medication strength is in milligrams (mg). We need to use the same unit for both.
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There are 1000 mg in 1 g.
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To convert 0.4 g to mg, we multiply by 1000.
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0.4×1000=400
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The prescribed dose is 400 mg.
Step 2: Calculate the Volume (in mL) Needed for the Dose
We know that 5 mL of the syrup contains 100 mg of medication. We need to find out how many mL are needed for 400 mg.
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To find out how many groups of 100 mg are in 400 mg, we divide:
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400÷100=4
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This means we need 4 times the volume of syrup that contains 100 mg.
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The volume for 100 mg is 5 mL. So, we multiply 4 by 5 mL.
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4×5 mL=20 mL
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The total volume needed per dose is 20 mL.
Step 3: Convert the Volume to Teaspoons
The measuring spoon is in teaspoons (tsp). We need to convert 20 mL to teaspoons.
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There are 5 mL in 1 teaspoon.
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To find out how many teaspoons are in 20 mL, we divide 20 by 5.
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20÷5=4
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The dose is 4 teaspoons.
The nurse will instruct the client to take 4 teaspoons.
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A nurse is preparing a teaching session about reducing the risk of complications of diabetes mellitus. Which of the following information should the nurse plan to include in the teaching? (Select all that apply.)
A. Sustain hyperglycemia to reduce deterioration of nerve.
Incorrect. Sustaining hyperglycemia is not a recommended approach. In fact, it is crucial to maintain blood glucose levels within a target range to prevent complications associated with diabetes.
B. Maintain optimal blood pressure to prevent kidney damage.
Correct. Maintaining optimal blood pressure is important for preventing kidney damage, which is a common complication of diabetes. High blood pressure can exacerbate kidney problems in individuals with diabetes.
C. Reduce cholesterol and saturated fat intake.
Correct. Reducing cholesterol and saturated fat intake is important for managing cardiovascular risk factors associated with diabetes. Elevated cholesterol levels are a risk factor for heart disease, which is more prevalent in individuals with diabetes.
D. Enroll in a smoking cessation program.
Correct. Enrolling in a smoking cessation program is essential. Smoking increases the risk of cardiovascular disease, which is already elevated in individuals with diabetes. Quitting smoking is a crucial step in reducing this risk.
E. Increase physical activity.
Correct. Increasing physical activity is an important component of diabetes management. Regular exercise helps improve insulin sensitivity, maintain a healthy weight, and reduce the risk of cardiovascular complications.
Full Explanation
A. Incorrect. Sustaining hyperglycemia is not a recommended approach. In fact, it is crucial to maintain blood glucose levels within a target range to prevent complications associated with diabetes.
B. Correct. Maintaining optimal blood pressure is important for preventing kidney damage, which is a common complication of diabetes. High blood pressure can exacerbate kidney problems in individuals with diabetes.
C. Correct. Reducing cholesterol and saturated fat intake is important for managing cardiovascular risk factors associated with diabetes. Elevated cholesterol levels are a risk factor for heart disease, which is more prevalent in individuals with diabetes.
D. Correct. Enrolling in a smoking cessation program is essential. Smoking increases the risk of cardiovascular disease, which is already elevated in individuals with diabetes. Quitting smoking is a crucial step in reducing this risk.
E. Correct. Increasing physical activity is an important component of diabetes management. Regular exercise helps improve insulin sensitivity, maintain a healthy weight, and reduce the risk of cardiovascular complications.
The primary healthcare provider prescribes a cough syrup of 0.4 g every 4 hours. The dosage strength of the syrup is 100 mg/5 mL. The medication bottle contains a measuring spoon that measures in teaspoons and tablespoons. How many teaspoons will the nurse instruct the client to take?
Full Explanation
One gram is equal to 1000 milligrams, one milliliter is equal to 0.2 teaspoons, and one teaspoon is equal to 5 milliliters. Using these conversion factors, the nurse can perform the following steps:
- Multiply the prescribed amount of cough syrup by 1000 to get the equivalent in milligrams: 0.4 g x 1000 = 400 mg
- Divide the equivalent in milligrams by the dosage strength of the syrup to get the equivalent in milliliters: 400 mg / 100 mg/5 mL = 20 mL
- Multiply the equivalent in milliliters by 0.2 to get the equivalent in teaspoons: 20 mL x 0.2 = 4 teaspoons
Therefore, the nurse will instruct the client to take 4 teaspoons of cough syrup every 4 hours.