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?

Administer aspirin as prescribed for any sign of hyperthermia.

Keep the client NPO.

Observe the client carefully for signs of hypocalcemia.

Provide a quiet, low-stimulus environment.

Answer and Explanation

The Correct Answer is D

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.

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Correct Answer is ["4"]

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.

A. Obtain a culture of the drainage. B. Check fine drainage for glucose. C. Document the amount of drainage. D. Notify the client's provider.

Correct Answer is B

Explanation

A. Obtaining a culture of the drainage may be necessary, but the immediate concern is to determine if the drainage is cerebrospinal fluid (CSF) or another type of fluid. Checking for glucose content is a rapid way to differentiate CSF from other fluids.

B. Correct. Clear drainage from the nose post-transsphenoidal hypophysectomy may indicate a CSF leak, which is a potential complication. Checking the drainage for glucose can help differentiate CSF from other fluids, as CSF contains glucose. If the drainage tests positive for glucose, it indicates the presence of CSF.

C. Documenting the amount of drainage is important, but determining the nature of the drainage (CSF or other fluid) takes precedence in this situation.

D. Notifying the client's provider is important, but the nurse should gather information about the drainage first by checking for glucose content. This information will be crucial for the healthcare provider to make decisions about further interventions

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Naxlex Comprehensive Predictor Exams

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?

Correct Answer is ["4"]

Explanation

A nurse is caring for a client who is 1 day postoperative following a transsphenoidal hypophysectomy. While assessing the client, the nurse notes a large area of clear drainage seeping from the nasal packing. Which of the following should be the nurse's initial action?

Correct Answer is B

Explanation

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A nurse is caring for a client who is 1 day postoperative following a thyroidectomy and reports severe muscle spasms of the lower extremities. Which of the following actions should the nurse take?

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?

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