Early this morning a client had a subtotal thyroidectomy. During evening rounds, the nurse assesses the client, who has now nausea, a temperature of 105F (40.5C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?

Correct Answer: C

Rationale: The signs and symptoms described - nausea, elevated temperature, tachycardia, and extreme restlessness - are indicative of a thyroid crisis, also known as thyroid storm. A thyroid storm is a life-threatening condition that can occur after thyroid surgery such as a subtotal thyroidectomy. It is characterized by an exaggerated state of hyperthyroidism, leading to a surge of thyroid hormones in the bloodstream. This can result in severe symptoms such as high fever, tachycardia, nausea, agitation, and even confusion or delirium.

Correct Answer: C

Rationale: Hepatic encephalopathy is a neuropsychiatric complication of advanced liver disease, such as cirrhosis, where the liver's ability to metabolize ammonia is impaired. As a result, there is an increase in serum ammonia levels, leading to alterations in brain function and neurotransmission. Symptoms such as confusion, restlessness, and asterixis (flapping tremor) are characteristic of hepatic encephalopathy caused by increased ammonia levels affecting the brain. Therefore, altered thought processes in Mrs. Silang are primarily related to the increased serum ammonia levels rather than other factors like massive ascites formation, fluid volume excess, or altered clotting mechanism.

Correct Answer: A

Rationale: In preparing a 52-year-old male patient like Mr. Umali for a barium enema to evaluate acute ulcerative colitis, the nurse can expect that he will be contraindicated with cathartics. Cathartics, which are substances that induce bowel movements, are generally contraindicated in patients being evaluated for acute colitis as they can exacerbate the condition and cause additional discomfort. In contrast, using oil retention enemas or radiopaque tablets may not be suitable for a patient with acute ulcerative colitis. Positioning in a high Fowler's position following the procedure is not related to the preparation for a barium enema in this case.

Correct Answer: C

Rationale: Pyridoxine, also known as vitamin B6, is necessary for the prevention of INH-induced peripheral neuropathy. INH can lead to a deficiency of vitamin B6 in the body, which in turn can cause nerve damage and peripheral neuropathy. By supplementing the diet with pyridoxine, the risk of developing peripheral neuropathy as a side effect of INH administration can be minimized. It is an important preventive measure recommended for those undergoing treatment with INH to ensure the proper functioning of the nervous system and prevent nerve damage.

Correct Answer: D

Rationale: The primary complication of osteoporosis is fractures. Osteoporosis is a condition characterized by low bone mass and deterioration of bone tissue, leading to increased bone fragility and susceptibility to fractures. Fractures, especially in the spine, hip, and wrist, are common complications of osteoporosis and can significantly impact an individual's quality of life. Patients with osteoporosis are at an increased risk of fractures from minor trauma or even during normal daily activities. Therefore, preventing fractures is a key focus in the management of osteoporosis to minimize pain, disability, and complications associated with bone fractures.