Priority Decision: A patient with diabetes calls the clinic because she is experiencing nausea and flu-like symptoms. Which advice from the nurse will be the best for this patient?

Correct Answer: D

Rationale: In this scenario, option D, "Monitor the blood glucose every 1 to 2 hours and call if it rises over 150 mg/dL (8.3 mmol/L)," is the best advice for the patient with diabetes experiencing nausea and flu-like symptoms. This is the correct answer because it aligns with the principles of diabetic management. Monitoring blood glucose levels closely during illness is crucial as illnesses can impact blood sugar levels. In this situation, hyperglycemia could exacerbate the patient's symptoms and lead to complications. By monitoring and acting on blood glucose levels above 150 mg/dL, the patient can prevent potential health risks. Option A, "Administer the usual insulin dosage," is incorrect because during illness, the body's insulin needs may change, and administering the usual dosage without monitoring can be dangerous. Option B, "Hold fluid intake until the nausea subsides," is incorrect as staying hydrated is essential, especially in diabetes, to prevent dehydration and maintain overall health. Option C, "Come to the clinic immediately for evaluation and treatment," while important in some cases, may not be necessary as the first step. Monitoring blood glucose levels allows for immediate action if levels are elevated, and the patient may not need to rush to the clinic if they can manage their condition at home with proper guidance. Educationally, this question highlights the importance of proactive diabetes management during illness. It emphasizes the need for patients to monitor their blood glucose levels closely and take appropriate actions based on monitoring results to prevent complications. It also reinforces the idea that individualized care is essential in managing chronic conditions like diabetes, especially during acute situations.

Correct Answer: D

Rationale: The correct answer is D) Autoimmune-induced atrophy of the thyroid gland. In primary hypothyroidism, the thyroid gland is unable to produce sufficient thyroid hormones due to damage or dysfunction. The most common cause of primary hypothyroidism in adults is autoimmune thyroiditis, also known as Hashimoto's disease. This condition involves the immune system mistakenly attacking the thyroid gland, leading to its inflammation and eventual atrophy, resulting in decreased hormone production. Option A) Malignant or benign thyroid nodules: While thyroid nodules can affect thyroid function, they are not a primary cause of hypothyroidism. Nodules can lead to hyperthyroidism or remain asymptomatic. Option B) Surgical removal or failure of the pituitary gland: This would result in secondary hypothyroidism, where the pituitary gland fails to produce enough thyroid-stimulating hormone (TSH) to stimulate the thyroid gland. Option C) Surgical removal or radiation of the thyroid gland: This would also lead to hypothyroidism, but it would be considered iatrogenic or secondary hypothyroidism, as it is a direct consequence of thyroid gland removal or damage, not autoimmune-induced atrophy. Educational context: Understanding the causes of primary hypothyroidism is crucial for healthcare professionals to accurately diagnose and treat patients with thyroid disorders. Knowing the role of autoimmune processes in thyroid dysfunction helps in providing appropriate interventions and management strategies for individuals with Hashimoto's disease. This knowledge is essential for healthcare providers in various fields, including endocrinology, primary care, and nursing, to ensure optimal patient care and outcomes.

Correct Answer: A

Rationale: In the case of a patient with primary hyperaldosteronism, the correct answer to question the healthcare provider's prescription would be A) Furosemide (Lasix). This is because primary hyperaldosteronism results in excessive aldosterone production, leading to sodium and water retention, potassium excretion, and hypertension. Furosemide, a loop diuretic, would exacerbate potassium loss, which is already a concern in these patients due to aldosterone's effects on potassium excretion. Option B) Spironolactone (Aldactone) is actually a preferred treatment for primary hyperaldosteronism as it is a potassium-sparing diuretic and an aldosterone receptor antagonist, helping to counteract the effects of excess aldosterone. Option C) Amiloride (Midamor) is another potassium-sparing diuretic and could also be considered appropriate in this scenario. Option D) Aminoglutethimide (Cytadren) is not typically used in the treatment of primary hyperaldosteronism. Aminoglutethimide is an adrenal steroid inhibitor primarily used in the management of Cushing's syndrome. In an educational context, understanding the rationale behind drug choices in specific endocrine disorders is crucial for nursing practice. This knowledge ensures safe and effective patient care by being able to identify appropriate medications and question prescriptions that may be contraindicated or potentially harmful in certain conditions like primary hyperaldosteronism.

Correct Answer: A

Rationale: In the case of an insulin-dependent diabetic like Mr. Weber experiencing occasional severe reactions leading to unconsciousness in the afternoon, the most appropriate nursing action is to place a tube of commercially prepared glucose paste at his bedside (Option A). This is because severe hypoglycemia can lead to unconsciousness, and administering glucose quickly is crucial to raise blood sugar levels rapidly and reverse the hypoglycemic state. Option B, administering regular insulin, is incorrect as it would further lower Mr. Weber's blood sugar levels, worsening his condition. Option C, checking his level of consciousness every hour, is not as effective as providing immediate intervention with glucose paste. Option D, keeping a supply of orange juice in the refrigerator, is less concentrated than glucose paste and may not act quickly enough to address severe hypoglycemia. Educationally, this question highlights the importance of rapid response in managing hypoglycemic emergencies in diabetic patients. It emphasizes the critical role of glucose administration in quickly reversing the effects of low blood sugar to prevent serious complications like unconsciousness. This scenario also underscores the significance of preparedness and having appropriate supplies readily available to address medical emergencies effectively.

Correct Answer: C

Rationale: The correct answer is C) maintains blood pressure within normal limits. Rationale: 1. The adrenal gland plays a crucial role in regulating blood pressure through the secretion of aldosterone and cortisol. In Cushing syndrome, excessive cortisol production can lead to high blood pressure. By managing the symptoms through a strict diet, Mrs. A's blood pressure can be kept within normal limits. 2. Option A) has gained 5 lb: Weight gain is a common symptom of Cushing syndrome due to cortisol's role in metabolism. Weight gain would not indicate that the diet is helping manage the symptoms. 3. Option B) has consistently low blood sugar values: While cortisol can influence blood sugar levels, low blood sugar values would not be an expected outcome of managing Cushing syndrome symptoms through diet alone. 4. Option D) becomes more moody: Mood changes are also common in Cushing syndrome due to the impact of excess cortisol on the brain. However, mood changes alone would not be a reliable indicator of the effectiveness of the diet in managing symptoms. Educational Context: Understanding the effects of adrenal tumors and Cushing syndrome on the body is essential for healthcare professionals caring for patients with endocrine disorders. Monitoring blood pressure is a critical aspect of managing these patients, and recognizing the effects of diet on symptom management is crucial for providing comprehensive care. This question assesses the test-taker's knowledge of the physiological effects of Cushing syndrome and the role of diet in symptom management.