The nurse has reviewed the nurses' notes at 0940, vital signs at 0945, and laboratory reports at 1020.
For each assessment finding, click to specify if the finding is consistent with diabetes, pancreatitis, or hyperthyroidism. Each finding may support more than one disease process or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row.
Weight
Heart rate
T3 level
Blood glucose
The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"B"},"D":{"answers":"A"}}
Diabetes:
• Weight
• Blood glucose
Pancreatitis:
• None
Hyperthyroidism:
• Heart rate
• T3 level
Rationale:
• Weight: The client has experienced unintended weight loss, which is a common symptom of diabetes due to the body's inability to use glucose effectively, leading to fat and muscle breakdown.
• Heart rate: Tachycardia is a hallmark of hyperthyroidism due to increased metabolic activity and sympathetic nervous system stimulation.
• T3 level: The T3 level is within the normal range but on the higher end, which can still support hyperthyroidism when considered with other clinical findings.
• Blood glucose: An elevated blood glucose level of 250 mg/dL is consistent with diabetes, as normal fasting levels are below 106 mg/dL.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Genital herpes: Herpes simplex virus (HSV) is a common sexually transmitted infection, but it is not a nationally notifiable disease. Reporting is not mandatory in most jurisdictions, although counseling and partner notification are recommended.
B. Varicella zoster: Chickenpox (primary varicella infection) is reportable in some states, but herpes zoster (shingles) is generally not required to be reported. However, outbreaks in certain settings, such as schools or healthcare facilities, may need notification.
C. Tuberculosis: Tuberculosis is a highly contagious airborne disease that requires mandatory reporting to public health authorities. Reporting ensures contact tracing, outbreak control, and public health interventions to prevent further transmission.
D. Clostridium difficile: While Clostridium difficile infections are of significant concern in healthcare settings, they are not universally reportable to the local health department. Infection control measures are implemented within facilities, but routine reporting is not always required.
Correct Answer is D
Explanation
A. Position the client with the head of the bed elevated to a 15° angle: Clients with pericarditis typically experience relief when sitting up and leaning forward, as this reduces pressure on the inflamed pericardium. A 15° elevation is too low to provide significant relief.
B. Check the client for jugular venous flattening: Pericarditis, especially when complicated by cardiac tamponade, leads to jugular venous distension rather than flattening due to impaired venous return to the heart.
C. Administer an anticoagulant medication to the client: Anticoagulants are not routinely used in pericarditis because they may increase the risk of hemorrhagic pericardial effusion, particularly if pericarditis is due to an inflammatory or infectious cause.
D. Assess the client for a paradoxical blood pressure: Pulsus paradoxus, a significant drop in systolic blood pressure during inspiration, is a key sign of cardiac tamponade, a life-threatening complication of pericarditis. Monitoring for this helps in early detection and management.
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