Question

A nurse is caring for a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What laboratory finding should the nurse anticipate?

Answer 1

Correct Answers:

Urine specific gravity 1.032

Rationale :

🟣 In SIADH, excessive antidiuretic hormone (ADH) causes abnormal water retention.

🟣 Water retention leads to concentrated urine, resulting in an elevated urine specific gravity (greater than 1.030).

🟣 Although the body retains water, sodium becomes diluted, causing hyponatremia.

🟣 Serum becomes diluted while urine becomes concentrated, which is a hallmark pattern of SIADH.

🟣 Therefore, a high urine specific gravity is a classic laboratory finding in this disorder.

❌ Serum osmolality 302 mOsm/kg

SIADH causes dilution of the blood, leading to low serum osmolality, not elevated levels. A value of 302 would suggest dehydration instead.

❌ Hematocrit 55%

Water retention in SIADH causes dilution of blood components, often lowering hematocrit. An elevated hematocrit suggests hemoconcentration, not fluid overload.

❌ Serum sodium 148 mEq/L

SIADH causes hyponatremia, not hypernatremia. Sodium levels are typically below 135 mEq/L.

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Answer 2

Correct Answers:

Long-acting insulin twice daily and rapid-acting insulin with meals

Rationale :

🔷 Clients with type 1 diabetes require both basal and bolus insulin coverage.

🔷 Long-acting insulin provides steady basal insulin levels throughout the day and night.

🔷 Rapid-acting insulin before meals controls postprandial glucose spikes.

🔷 This approach mimics the body's natural insulin secretion pattern.

🔷 Intensive insulin therapy provides the most effective glycemic control and reduces long-term complications.

❌ Rapid-acting insulin mixed with intermediate-acting insulin twice daily

This regimen does not provide flexible meal coverage. It increases risk of hypoglycemia and does not mimic physiologic insulin release.

❌ Twice a day single-dose injection with intermediate-acting insulin

Intermediate insulin alone does not adequately control post-meal glucose spikes. Type 1 diabetes requires both basal and bolus coverage.

❌ Once a day single-dose injection with long-acting insulin

Long-acting insulin alone does not manage meal-related glucose elevations. Type 1 diabetes always requires rapid-acting insulin with meals.

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Answer 3

Correct Answers:

Muscle wasting

Rationale :

🔵 Cushing syndrome results from prolonged exposure to excessive cortisol.

🔵 High cortisol levels cause protein breakdown, leading to muscle wasting and weakness, particularly in the extremities.

🔵 Clients often develop proximal muscle weakness, making it difficult to climb stairs or rise from a chair.

🔵 Although central weight gain occurs, muscle tissue in the arms and legs becomes thinner.

🔵 Therefore, muscle wasting is a classic and consistent finding in Cushing syndrome.

❌ Weight loss

Cushing syndrome typically causes weight gain, especially in the trunk and face. Weight loss is more consistent with Addison’s disease.

❌ Thickened skin

Cushing syndrome causes thin, fragile skin, not thickened skin. Clients often develop purple striae and easy bruising.

❌ Hypoglycemia

Cortisol increases blood glucose levels, leading to hyperglycemia, not hypoglycemia.

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Answer 4

Correct Answers:

Increased creatinine
Increased phosphorus

Rationale :

✅ Correct Answer: Increased creatinine

🟣 In ESRD, the kidneys lose the ability to filter waste products.

🟣 Creatinine accumulates in the blood due to decreased renal clearance.

🟣 Elevated creatinine is a key indicator of impaired kidney function.

🟣 Rising levels reflect worsening renal failure.

🟣 Increased creatinine is expected in end-stage renal disease.

✅ Correct Answer: Increased phosphorus

🟣 Diseased kidneys cannot effectively excrete phosphorus.

🟣 This leads to hyperphosphatemia, a common ESRD finding.

🟣 Elevated phosphorus contributes to bone disease and vascular calcification.

🟣 High phosphorus also suppresses calcium levels.

🟣 Therefore, increased phosphorus is expected in ESRD.

❌ Increased calcium

ESRD typically causes low calcium levels due to phosphate retention and impaired vitamin D activation. Hypercalcemia is not expected.

❌ Increased glomerular filtration rate

GFR is significantly decreased in ESRD. Kidney filtration capacity is severely impaired.

❌ Increased iron

Clients with ESRD commonly develop anemia, often requiring iron supplementation. Iron levels are not typically elevated.

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Answer 5

Correct Answers:

Protect the airway with aspiration precautions.

Rationale :

🔴 Myxedema coma is a life-threatening complication of severe hypothyroidism.

🔴 Clients experience decreased level of consciousness, hypoventilation, and diminished protective reflexes.

🔴 Airway compromise is the most immediate threat due to reduced respiratory drive.

🔴 Applying aspiration precautions and ensuring airway patency prevents respiratory failure.

🔴 According to ABCs (Airway, Breathing, Circulation), airway protection is the top priority.

❌ Turn the client every 2 hours and as needed.

Repositioning is important to prevent skin breakdown. However, airway and breathing take priority in a coma state.

❌ Check the client's blood pressure every hour.

Monitoring hemodynamics is important, but airway management is more urgent.

❌ Provide warm blankets to increase body temperature.

Passive warming may be used cautiously. Aggressive warming can cause vasodilation and cardiovascular collapse.

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Answer 6

Correct Answers:

Provide the client with high-protein meals.

Rationale :

🟢 Cushing syndrome caused by excess corticosteroids leads to significant protein catabolism, resulting in muscle wasting and tissue breakdown.

🟢 Providing a high-protein diet helps counteract protein loss and supports tissue repair and muscle maintenance.

🟢 Clients with Cushing syndrome are also at risk for poor wound healing, and adequate protein intake promotes recovery.

🟢 Increased cortisol levels also weaken connective tissue, making nutritional support essential.

🟢 Therefore, dietary planning should include high-protein intake to reduce muscle wasting and maintain strength.

❌ Restrict the intake of high-potassium food.

Cushing syndrome can cause hypokalemia, so potassium intake is often encouraged rather than restricted. Limiting potassium would worsen electrolyte imbalance.

❌ Advise the client to avoid physical activity.

Moderate activity helps maintain muscle mass and prevent further weakness. Complete avoidance of activity may worsen deconditioning.

❌ Prepare the client for an adrenalectomy.

Corticosteroid-induced Cushing syndrome is typically managed by gradual steroid tapering, not surgery. Adrenalectomy is reserved for adrenal tumors.

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Answer 7

Correct Answers:

50

Rationale :

Rate (mL/hr) = Total Volume (mL) ÷ Time (hr)

100 mL ÷ 2 hr = 50 mL/hr

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Answer 8

Correct Answers:

Creatinine level

Rationale :

🔵 An elevated creatinine (2.3 mg/dL) indicates impaired kidney function.

🔵 Chronic hyperglycemia damages the glomerular capillaries, leading to diabetic nephropathy, a major microvascular complication.

🔵 Persistent kidney damage reduces the kidneys’ ability to filter waste products effectively.

🔵 Elevated creatinine and BUN levels suggest declining glomerular filtration rate (GFR).

🔵 Therefore, an increased creatinine level reflects a chronic complication of diabetes affecting the renal system.

❌ Weight gain

A 5-pound weight gain may relate to lifestyle factors or medication effects. It is not by itself evidence of a chronic diabetic complication.

❌ Fasting plasma glucose

A fasting glucose of 129 mg/dL indicates hyperglycemia but reflects current glycemic control. It does not directly confirm organ damage.

❌ Glycosylated hemoglobin

An HbA1c of 8.4% shows poor long-term glucose control. However, it indicates risk for complications rather than established organ damage.

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Answer 9

Correct Answers:

"Take this medication on an empty stomach."

Rationale :

🔵 Levothyroxine is best absorbed when taken on an empty stomach, typically 30–60 minutes before breakfast.

🔵 Food, calcium, iron, and certain medications can significantly reduce absorption, decreasing therapeutic effectiveness.

🔵 Consistent timing each day helps maintain stable thyroid hormone levels.

🔵 Clients should take it with a full glass of water and avoid taking it with other medications simultaneously.

🔵 Proper administration ensures optimal management of hypothyroidism and symptom control.

❌ Levothyroxine should be taken with meals.

Taking levothyroxine with food decreases absorption. This may prevent adequate thyroid hormone replacement.

❌ You can expect a full therapeutic effect in 1 week.

Full therapeutic effects typically take 4–6 weeks. Thyroid hormone adjustments require gradual titration.

❌ Stop the medication if symptoms start to improve.

Levothyroxine is a lifelong therapy in most cases. Stopping the medication can cause recurrence of hypothyroid symptoms

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Answer 10

Correct Answers:

Blood pressure of 189/103 mm Hg

Rationale :

🔴 Hyperthyroidism increases metabolic rate and sympathetic stimulation, elevating cardiovascular workload.

🔴 A blood pressure of 189/103 mm Hg indicates severe hypertension.

🔴 Uncontrolled hypertension increases risk for stroke, myocardial infarction, and heart failure.

🔴 Severe hypertension may signal progression toward thyroid storm, a life-threatening emergency.

🔴 Immediate intervention is required to prevent cardiovascular complications.

❌ Weight loss of 3 pounds in 1 week

Weight loss is common due to increased metabolism. While concerning over time, it is not immediately life-threatening.

❌ Report of ongoing nervousness

Nervousness and anxiety are typical hyperthyroid symptoms. They do not represent an acute emergency.

❌ Heart rate of 106 beats/minute

Mild tachycardia is common in hyperthyroidism. While monitoring is needed, it is less urgent than severe hypertension.

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QLexNursing

1 :
A nurse is caring for a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What laboratory finding should the nurse anticipate?

2 :
A nurse is caring for a client with type 1 diabetes. Which regimen will achieve the best blood glucose control for this client?

3 :
What finding should the nurse identify as consistent with Cushing syndrome?

4 :
A nurse is caring for a client with end-stage renal disease (ESRD). What laboratory finding(s) should the nurse anticipate? Select all that apply.

5 :
A nurse is caring for a client in a myxedema coma. Which action should the nurse prioritize?

6 :
The nurse is planning care for a client with Cushing syndrome related to high-dose corticosteroid use. What action should the nurse include in the plan of care for this client?

7 :
A nurse is preparing to administer fluconazole 400 mg via intravenous (IV) infusion over 2 hours. Available is fluconazole 400 mg in 100 mL 0.9% sodium chloride (NaCl). At what rate will the nurse set the infusion? (Round to the nearest whole number.)

8 :
An assessment was made

Answer Options

9 :
The nurse plans discharge education for a client with hypothyroidism and a new levothyroxine prescription. What statement should the nurse include in the teaching?

10 :
The nurse is caring for a client with hyperthyroidism. What assessment finding requires immediate follow-up by the nurse?

QLexNursing

1 : A nurse is caring for a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What laboratory finding should the nurse anticipate?

2 : A nurse is caring for a client with type 1 diabetes. Which regimen will achieve the best blood glucose control for this client?

3 : What finding should the nurse identify as consistent with Cushing syndrome?

4 : A nurse is caring for a client with end-stage renal disease (ESRD). What laboratory finding(s) should the nurse anticipate? Select all that apply.

5 : A nurse is caring for a client in a myxedema coma. Which action should the nurse prioritize?

6 : The nurse is planning care for a client with Cushing syndrome related to high-dose corticosteroid use. What action should the nurse include in the plan of care for this client?

7 : A nurse is preparing to administer fluconazole 400 mg via intravenous (IV) infusion over 2 hours. Available is fluconazole 400 mg in 100 mL 0.9% sodium chloride (NaCl). At what rate will the nurse set the infusion? (Round to the nearest whole number.)

8 : An assessment was made

Answer Options

9 : The nurse plans discharge education for a client with hypothyroidism and a new levothyroxine prescription. What statement should the nurse include in the teaching?

10 : The nurse is caring for a client with hyperthyroidism. What assessment finding requires immediate follow-up by the nurse?

1 :
A nurse is caring for a client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What laboratory finding should the nurse anticipate?

2 :
A nurse is caring for a client with type 1 diabetes. Which regimen will achieve the best blood glucose control for this client?

3 :
What finding should the nurse identify as consistent with Cushing syndrome?

4 :
A nurse is caring for a client with end-stage renal disease (ESRD). What laboratory finding(s) should the nurse anticipate? Select all that apply.

5 :
A nurse is caring for a client in a myxedema coma. Which action should the nurse prioritize?

6 :
The nurse is planning care for a client with Cushing syndrome related to high-dose corticosteroid use. What action should the nurse include in the plan of care for this client?

7 :
A nurse is preparing to administer fluconazole 400 mg via intravenous (IV) infusion over 2 hours. Available is fluconazole 400 mg in 100 mL 0.9% sodium chloride (NaCl). At what rate will the nurse set the infusion? (Round to the nearest whole number.)

8 :
An assessment was made

9 :
The nurse plans discharge education for a client with hypothyroidism and a new levothyroxine prescription. What statement should the nurse include in the teaching?

10 :
The nurse is caring for a client with hyperthyroidism. What assessment finding requires immediate follow-up by the nurse?