Question

The nurse is caring for a client

Answer 1

Correct Answers:

Provide warm blankets.
Place the client on a cardiac monitor.
Administer levothyroxine.

Rationale :

Provide warm blankets

🍃 The client’s temperature is 35.6°C (96.1°F), indicating hypothermia, which is a classic sign of severe hypothyroidism (myxedema).

🍃 Providing warm blankets is a safe, supportive measure to gradually raise the core body temperature.

🍃 Rapid rewarming is avoided; gentle warming prevents cardiovascular stress.

Place the client on a cardiac monitor

✳️ The client’s heart rate is 49/min, showing bradycardia, another sign of severe hypothyroidism.

✳️ Bradycardia increases the risk of hypoperfusion, arrhythmias, and cardiac arrest.

✳️ Continuous cardiac monitoring is essential for detecting life-threatening changes early.

Administer levothyroxine

💎 The client has elevated TSH and low free T4, confirming primary hypothyroidism (likely untreated due to medication nonadherence).

💎 Levothyroxine is the first-line hormone replacement therapy and must be initiated promptly to restore thyroid function.

💎 It is essential to correct hormone deficiency and prevent progression to myxedema coma.

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Answer 2

Correct Answers:

A 58-year-old patient with Addison's disease who is exhibiting confusion.

Rationale :

✳️ A client with Addison’s disease who is now confused may be experiencing an Addisonian crisis, a life-threatening endocrine emergency.

✳️ This crisis is caused by a deficiency of cortisol and presents with hypotension, hyponatremia, hyperkalemia, and altered mental status.

✳️ Immediate intervention is needed to prevent shock, coma, or death, and includes administering IV corticosteroids, fluids, and glucose.

✳️ Among the options, this client’s symptoms indicate the most unstable condition, and the nurse must prioritize assessment and treatment to prevent rapid deterioration.

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Answer 3

Correct Answers:

24-hour cortisol urine study

Rationale :

🍃 A 24-hour urine cortisol test measures free cortisol excreted in the urine and is a primary diagnostic tool for Cushing syndrome.

🍃 Cushing syndrome causes chronic hypercortisolism, leading to symptoms such as hypertension, hyperglycemia, and hypokalemia.

🍃 The test helps distinguish true hypercortisolism from transient or stress-related cortisol elevations.

🍃 This noninvasive test provides a comprehensive view of cortisol secretion over a full day, making it more accurate than a single blood test.

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Answer 4

Correct Answers:

B-type natriuretic peptide (BNP)

Rationale :

✔️ BNP is released from the ventricles in response to increased stretching and volume overload, making it a key marker of heart failure.

✔️ Elevated BNP levels are highly sensitive for identifying acute decompensated heart failure, especially in clients presenting with shortness of breath and fatigue.

✔️ BNP helps differentiate cardiac causes of dyspnea from respiratory or other systemic issues.

✔️ It is a standard test ordered in emergency and inpatient settings when congestive heart failure is suspected.

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Answer 5

Correct Answers:

Nervousness and tachycardia

Rationale :

💎 Excessive levothyroxine leads to symptoms of hyperthyroidism, such as anxiety, restlessness, heat intolerance, and tachycardia.

💎 Overmedication raises T3/T4 levels, which overstimulate the body's metabolism and sympathetic nervous system.

💎 Clients may also experience palpitations, weight loss, insomnia, and tremors.

💎 Recognizing these signs is essential for prompt dosage adjustment to avoid serious complications like atrial fibrillation or thyroid storm.

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Answer 6

Correct Answers:

Bone fracture

Rationale :

✳️ Clients with Cushing syndrome experience increased bone resorption and reduced bone formation due to excess cortisol, which leads to osteoporosis.

✳️ This increases the risk for fragility fractures, particularly in the spine, ribs, and hips.

✳️ Long-term corticosteroid use, a common cause of Cushing syndrome, significantly impacts calcium metabolism and bone density.

✳️ Nurses should monitor for signs of bone pain and teach fall prevention strategies to minimize fracture risk.

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Answer 7

Correct Answers:

You will need to increase your dose of corticosteroids due to the stress of surgery.

Rationale :

🍃 Clients with Addison’s disease cannot produce adequate cortisol, especially during times of physical stress such as surgery.

🍃 Therefore, their maintenance dose of corticosteroids like hydrocortisone must be increased temporarily to prevent Addisonian crisis.

🍃 This stress dose is critical to support hemodynamic stability and glucose regulation during recovery.

🍃 The client must be taught that stressors (e.g., surgery, infection) require dose adjustments as part of lifelong management.

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Answer 8

Correct Answers:

You will receive glucose checks and sliding-scale insulin until your hormone levels are corrected

Rationale :

✔️ Cushing disease, caused by a pituitary adenoma, results in excess ACTH and subsequent high cortisol levels, which elevate blood glucose.

✔️ Hyperglycemia is a common metabolic consequence and requires glucose monitoring and sometimes temporary insulin administration.

✔️ Once the underlying condition (e.g., pituitary tumor) is treated, glucose levels typically return to normal, and insulin may no longer be needed.

✔️ The client must understand this is a temporary but essential part of their care while cortisol levels remain elevated.

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Answer 9

Correct Answers:

"Avoid being close to pregnant women and children for 7 days after your treatment!'

Rationale :

💎 Radioactive iodine (RAI) therapy emits radiation, which can pose a hazard to others, especially pregnant women and children, due to rapidly dividing cells.

💎 Clients should maintain physical distance, avoid sharing utensils, and use separate bathrooms if possible for at least 7 days after treatment.

💎 This protects others from radiation exposure while the radioactive material clears from the body.

💎 The therapy’s goal is to destroy thyroid tissue and reduce thyroid hormone production, not increase it.

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Answer 10

Correct Answers:

75

Rationale :

✍️Use the formula:

✳️mL/hr = Total volume (mL) ÷ Time (hr)

🔺Given

Total volume = 1800 mL
Time = 24 hours

↪ 1800 ÷ 24

👉= 75 mL/hr

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RN ATI MedicalSurg W Exam

No.

1 :
The nurse is caring for a client

Answer Options

Provide warm blankets

Place the client on a cardiac monitor

✳️ The client’s heart rate is 49/min, showing bradycardia, another sign of severe hypothyroidism.

Administer levothyroxine

2 :
At the beginning of the shift, a nurse receives a report on the following four patients. Which patient should the nurse place priority on assessing first?

3 :
A nurse is caring for a client who has hypokalemia, hyperglycemia, and hypertension. A diagnosis of Cushing syndrome is suspected. Which of the following tests would the nurse anticipate the health care provider will order to help confirm the diagnosis of Cushing syndrome?

4 :
A client seen in the clinic with shortness of breath and fatigue is being evaluated for a possible diagnosis of heart failure. Which laboratory result will be the most useful for diagnosing heart failure?

5 :
A client with a history of hypothyroidism has accidentally been taking double her prescribed dose of levothyroxine. Which assessment findings would the nurse expect due to an excess of this medication?

6 :
A nurse is caring for a client who has developed Cushing syndrome due to long-term corticosteroid therapy to treat multiple sclerosis. The nurse understands that Cushing syndrome puts the client at increased risk for which complication?

7 :
A client who takes daily hormone replacement therapy for Addison's disease is scheduled for an outpatient surgical procedure. Which of the following instructions should the nurse include when providing discharge education to the client?

9 :
A nurse is providing education to a client who has Graves' disease and who will be returning home after receiving their first dose of radioactive iodine therapy. Which of the following information should the nurse include?

10 :
A nurse is preparing to administer total parental nutrition (TPN) 1800 mL to infuse over 24 hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number .Use a leading zero if it applies. Do not use a trailing zero.)

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RN ATI MedicalSurg W Exam

No.

1 : The nurse is caring for a client

Answer Options

Provide warm blankets

Place the client on a cardiac monitor

✳️ The client’s heart rate is 49/min, showing bradycardia, another sign of severe hypothyroidism.

Administer levothyroxine

2 : At the beginning of the shift, a nurse receives a report on the following four patients. Which patient should the nurse place priority on assessing first?

3 : A nurse is caring for a client who has hypokalemia, hyperglycemia, and hypertension. A diagnosis of Cushing syndrome is suspected. Which of the following tests would the nurse anticipate the health care provider will order to help confirm the diagnosis of Cushing syndrome?

4 : A client seen in the clinic with shortness of breath and fatigue is being evaluated for a possible diagnosis of heart failure. Which laboratory result will be the most useful for diagnosing heart failure?

5 : A client with a history of hypothyroidism has accidentally been taking double her prescribed dose of levothyroxine. Which assessment findings would the nurse expect due to an excess of this medication?

6 : A nurse is caring for a client who has developed Cushing syndrome due to long-term corticosteroid therapy to treat multiple sclerosis. The nurse understands that Cushing syndrome puts the client at increased risk for which complication?

7 : A client who takes daily hormone replacement therapy for Addison's disease is scheduled for an outpatient surgical procedure. Which of the following instructions should the nurse include when providing discharge education to the client?

9 : A nurse is providing education to a client who has Graves' disease and who will be returning home after receiving their first dose of radioactive iodine therapy. Which of the following information should the nurse include?

10 : A nurse is preparing to administer total parental nutrition (TPN) 1800 mL to infuse over 24 hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number .Use a leading zero if it applies. Do not use a trailing zero.)

1 :
The nurse is caring for a client

2 :
At the beginning of the shift, a nurse receives a report on the following four patients. Which patient should the nurse place priority on assessing first?

3 :
A nurse is caring for a client who has hypokalemia, hyperglycemia, and hypertension. A diagnosis of Cushing syndrome is suspected. Which of the following tests would the nurse anticipate the health care provider will order to help confirm the diagnosis of Cushing syndrome?

4 :
A client seen in the clinic with shortness of breath and fatigue is being evaluated for a possible diagnosis of heart failure. Which laboratory result will be the most useful for diagnosing heart failure?

5 :
A client with a history of hypothyroidism has accidentally been taking double her prescribed dose of levothyroxine. Which assessment findings would the nurse expect due to an excess of this medication?

6 :
A nurse is caring for a client who has developed Cushing syndrome due to long-term corticosteroid therapy to treat multiple sclerosis. The nurse understands that Cushing syndrome puts the client at increased risk for which complication?

7 :
A client who takes daily hormone replacement therapy for Addison's disease is scheduled for an outpatient surgical procedure. Which of the following instructions should the nurse include when providing discharge education to the client?

9 :
A nurse is providing education to a client who has Graves' disease and who will be returning home after receiving their first dose of radioactive iodine therapy. Which of the following information should the nurse include?

10 :
A nurse is preparing to administer total parental nutrition (TPN) 1800 mL to infuse over 24 hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number .Use a leading zero if it applies. Do not use a trailing zero.)