A nurse assesses a patient with hypothyroidism who is admitted with acute appendicitis. The nurse notes that the patient's level of consciousness has decreased. What action does the nurse perform?
Restricts oral intake.
Monitor blood pressure every 4 hours.
Administer SQ insulin as prescribed.
Maintain a patent airway.
The Correct Answer is D
A decrease in the level of consciousness is a serious sign and could be an indication of worsening conditions. It is essential for the nurse to ensure that the patient's airway is open and clear, as a compromised airway can lead to hypoxia and a further decrease in consciousness. Therefore, maintaining a patent airway should be the nurse's priority action in this situation.
While monitoring blood pressure and restricting oral intake may be important interventions in certain situations, they are not the priority actions in this scenario. Administering SQ insulin may not be necessary for a patient with hypothyroidism and acute appendicitis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
"Coffee-ground" emesis is a term used to describe vomit that has the appearance of coffee grounds, which indicates that the vomit contains partially digested blood. This is a serious symptom that could be indicative of an upper gastrointestinal bleed. An endoscopy is a diagnostic test that allows healthcare providers to visually examine the upper gastrointestinal tract and identify the source of bleeding.
Barium studies and angiography are not typically used to diagnose upper gastrointestinal bleeds. Gastric analysis may be useful in other diagnostic situations, but it is not the most appropriate test for a patient with "coffee-ground" emesis.
Correct Answer is ["A","B","E"]
Explanation
Answer c is incorrect because hyperthyroidism typically causes hypertension, not hypotension. Answer d is also incorrect because hyperthyroidism typically causes increased, not decreased, deep tendon reflexes. Answer f is incorrect because hyperthyroidism typically causes diarrhea, not constipation.
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