During assessment of the patient with acromegaly, what should the nurse expect the patient to report?

Correct Answer: C

Rationale: In the assessment of a patient with acromegaly, the nurse should expect the patient to report undesirable changes in appearance. Acromegaly is a condition caused by excessive growth hormone production, leading to abnormal growth of body tissues over time. This results in characteristic physical changes such as enlarged hands, feet, and facial features, which can be distressing for the patient. Option A, infertility, is not typically associated with acromegaly. Acromegaly primarily affects physical characteristics rather than reproductive functions. Option B, dry, irritated skin, is not a common symptom of acromegaly. Skin changes in acromegaly are more related to thickening and coarsening rather than dryness and irritation. Option D, an increase in height of 2 to 3 inches a year, is not a typical presentation of acromegaly. Once the growth plates in the bones have fused during puberty, further height increase due to acromegaly is not expected. It is important for nurses to understand the manifestations of endocrine disorders like acromegaly to provide holistic care to patients. Recognizing the physical changes associated with acromegaly allows nurses to support patients emotionally and facilitate appropriate referrals for further evaluation and management. By understanding the specific symptoms of acromegaly, nurses can contribute to early detection and effective management of this condition.

Correct Answer: B

Rationale: In this scenario, the correct collaborative care the nurse should expect for a patient with Addison's disease presenting with symptoms of nausea, vomiting, diarrhea, and fever is IV administration of hydrocortisone (Option B). The rationale behind this is that Addison's disease is characterized by adrenal insufficiency, leading to a deficiency in cortisol production. During times of stress or illness, such as in this case, the body requires higher levels of cortisol to manage the physiological response. Therefore, administering exogenous hydrocortisone helps to replace the deficient cortisol, stabilize the patient's condition, and prevent an adrenal crisis. Option A, IV administration of vasopressors, is incorrect because vasopressors are used to increase blood pressure in conditions like shock, not to address adrenal insufficiency. Option C, IV administration of D5W with 20 mEq KCl, is incorrect as it is a solution for fluid and potassium replacement but does not address the underlying cortisol deficiency seen in Addison's disease. Option D, parenteral injections of adrenocorticotropic hormone (ACTH), is also incorrect as the primary treatment for Addison's disease is cortisol replacement, not ACTH administration. Understanding the appropriate collaborative care for patients with endocrine disorders like Addison's disease is crucial for nurses to provide safe and effective care. Recognizing the signs and symptoms of adrenal insufficiency and knowing the appropriate interventions can prevent potentially life-threatening complications in these patients.

Correct Answer: A

Rationale: The correct answer to the question "In evaluating the effectiveness of a new insulin dosage for a diabetic patient, the nurse would check the urine for sugar and acetone (Option A)" is grounded in the principles of diabetes management and monitoring. Checking the urine for sugar and acetone is a critical aspect of monitoring insulin dosage effectiveness in diabetic patients. When insulin is administered, its primary role is to facilitate the uptake of glucose into cells for energy production. Therefore, by monitoring urine for sugar (glucose) levels, healthcare providers can assess if the insulin dosage is effectively lowering blood glucose levels. Additionally, checking for acetone in the urine is important because in uncontrolled diabetes, the body may start breaking down fats for energy, leading to the production of ketones like acetone. The presence of acetone in the urine can indicate a state of diabetic ketoacidosis, which requires immediate medical attention. Analyzing the other options: B) Collecting a 24-hour urine specimen for acetone determination is not a practical or necessary method for evaluating the effectiveness of insulin dosage. Spot checks for acetone in the urine are sufficient for routine monitoring. C) Weighing the patient daily is not directly related to evaluating the effectiveness of insulin dosage. Weight changes can be influenced by various factors beyond insulin dosage adjustments. D) Rotating the site of injection is important for insulin administration to prevent lipodystrophy (changes in fat tissue) and ensure optimal insulin absorption. While site rotation is a good practice, it is not directly linked to evaluating the effectiveness of a new insulin dosage. In an educational context, understanding the rationale behind monitoring parameters for diabetic patients is crucial for nurses and healthcare professionals involved in diabetes care. Effective monitoring helps in optimizing insulin therapy, preventing complications, and promoting better patient outcomes. This question highlights the significance of urine analysis in diabetes management and reinforces the importance of evidence-based practice in nursing care.

Correct Answer: C

Rationale: The correct answer to the question is option C: Urine test negative for sugar and acetone. This choice indicates that the patient has learned the health teaching about diet and insulin administration. Here's a detailed educational rationale for this question: Correct Answer (Option C): When a patient's urine test is negative for sugar and acetone, it suggests that their blood glucose levels are under control. This outcome indicates that the patient has understood and implemented the teachings about diet and insulin administration effectively. By maintaining stable blood sugar levels, the patient is following the prescribed diet and insulin regimen, which is crucial for managing diabetes. Incorrect Answers: A) A weight gain of 6 lb: Weight gain can be a sign of poor diabetes management, indicating uncontrolled blood sugar levels. It is not a desirable outcome in this context. B) An elevated blood glucose: Elevated blood glucose levels would indicate that the patient has not effectively learned to manage their diabetes through diet and insulin administration. D) Beginning hypertrophy at an injection site: Hypertrophy at the injection site can occur due to improper insulin administration techniques, such as not rotating injection sites. It is not a positive indicator of effective learning. Educational Context: In teaching about the endocrine system, particularly diabetes management involving diet and insulin administration, it is crucial for patients to understand the principles of maintaining blood glucose levels within the target range. Monitoring urine for sugar and acetone levels is a common practice to assess blood glucose control. Educating patients on these aspects empowers them to make informed decisions regarding their health and ensures better management of their condition. In conclusion, monitoring urine for sugar and acetone provides a direct indicator of how well a patient is managing their diabetes through diet and insulin administration. This outcome demonstrates the application of knowledge into practice, leading to improved health outcomes for the patient.

Correct Answer: C

Rationale: Rationale: The correct answer is C) Chest pain. Chest pain in a patient with hypothyroidism starting levothyroxine therapy needs immediate follow-up care because it can indicate a potential complication known as myocardial infarction. Hypothyroidism can lead to cardiovascular issues, and the initiation of levothyroxine can sometimes exacerbate underlying heart conditions. Option A) Dry skin is a common symptom of hypothyroidism and is not typically an urgent concern that necessitates immediate follow-up care. Option B) Cold intolerance is another common symptom of hypothyroidism and, while uncomfortable for the patient, does not indicate an acute issue requiring immediate attention. Option D) Constipation is also a symptom of hypothyroidism and, although it can impact the patient's quality of life, it does not pose an immediate threat to their health. Educational Context: Understanding the signs and symptoms of hypothyroidism and its management with levothyroxine is crucial in clinical practice. Recognizing when certain symptoms may indicate a need for urgent medical attention is essential for providing safe and effective care to patients with endocrine disorders. This question highlights the importance of differentiating between common symptoms of a condition and those that may signify a more serious complication requiring immediate intervention.