Mrs. A. is scheduled for a unilateral adrenalectomy. Her postoperative course is uneventful. Which discharge goal is most realistic for Mrs. A.?

Correct Answer: B

Rationale: The correct answer is B) Having greatly reduced symptoms on maintenance cortisone. Rationale: After a unilateral adrenalectomy, the patient will experience a decrease in cortisol production from the affected adrenal gland. As a result, the patient may require maintenance cortisone to replace the lost cortisol and manage symptoms effectively. This option reflects a realistic goal for Mrs. A. as it acknowledges the need for ongoing medical management post-surgery to control symptoms and ensure optimal health. Option A) Being free of symptoms without medication is incorrect because after adrenalectomy, the patient may still require cortisone replacement therapy to manage symptoms effectively. Option C) Being free of symptoms on daily ACTH injections is incorrect as ACTH is not typically used for symptom management post-adrenalectomy. Option D) Having activity restricted for life is incorrect as with proper medical management, patients can resume normal activities post-surgery. Educational Context: Understanding the postoperative care and management of patients undergoing adrenalectomy is crucial for healthcare providers. It is essential to recognize the need for cortisone replacement therapy and ongoing symptom management to ensure the patient's well-being and quality of life. By selecting the most appropriate discharge goal for Mrs. A., healthcare providers can support her recovery and long-term health outcomes effectively.

Correct Answer: C

Rationale: Rationale: The correct answer is C) Insulin. Insulin is indeed the hormone released by beta islet cells in the pancreas. It plays a crucial role in regulating blood glucose levels by promoting the uptake of glucose into cells for energy production or storage. Option A) Progesterone is a female sex hormone produced mainly in the ovaries and plays a role in the menstrual cycle and pregnancy. It is not produced by the pancreas. Option B) Glucagon is another hormone produced in the pancreas by alpha islet cells. Unlike insulin, glucagon acts to increase blood glucose levels by stimulating the liver to release stored glucose into the bloodstream. Option D) Parathormone, also known as parathyroid hormone, is released by the parathyroid glands and regulates calcium levels in the blood, not glucose levels. In an educational context, understanding the hormones of the endocrine system is vital for healthcare professionals like nurses to effectively manage conditions like diabetes. Knowing which hormone is responsible for lowering blood glucose levels (insulin) and which one raises it (glucagon) is essential for providing proper care to patients with diabetes. This knowledge helps in medication administration, patient education, and overall disease management.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Check the apical pulse, blood pressure, and temperature every 4 hours. This task can be delegated to an experienced certified nursing assistant (CNA) because it involves routine monitoring of vital signs, which is within the scope of practice for a CNA and does not require advanced medical knowledge. Option A instructing the patient to report symptoms is important but should be done by a licensed healthcare provider who can interpret these symptoms in the context of the patient's condition. Option C involves drawing blood for hormone levels, which requires specific training and should be done by a phlebotomist or a nurse. Option D explaining medication side effects should be done by a nurse or provider who can provide comprehensive information and answer questions. Educationally, it's important to understand delegation in healthcare settings. Delegating tasks appropriately ensures that each team member works within their scope of practice, optimizing efficiency and patient care. It's crucial to recognize the competencies of different healthcare professionals and assign tasks accordingly to promote safe and effective patient management.

Correct Answer: B

Rationale: Assigning the 58-year-old diabetic with peripheral neuropathy and cellulitis of the left ankle (Option B) to the new nurse is the most appropriate choice. This patient's condition is stable and requires routine wound care and monitoring. It provides an opportunity for the new nurse to practice essential nursing skills like wound dressing changes, assessing neurovascular status, and administering medications for pain and infection. Option A should be avoided as the patient is showing signs of a medical emergency, hyperglycemia with mental status changes and rapid, deep breathing, requiring immediate intervention beyond the scope of a new nurse. Option C involves a patient who has just undergone major surgery and needs close monitoring, making it unsuitable for a new nurse. Option D presents a patient with diabetic ketoacidosis requiring intensive management and swift decision-making skills, which may overwhelm a new nurse. This scenario teaches the importance of appropriate patient assignment based on acuity and complexity, ensuring new nurses can build their confidence and competence gradually while providing safe and effective care. It emphasizes the significance of matching patient needs with the skill level and experience of the nurse for optimal patient outcomes.