These data are obtained by the RN who is assessing a client who had a transsphenoidal hypophysectomy yesterday. What information has the most immediate implications for the client's care?

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Question 1 of 5

These data are obtained by the RN who is assessing a client who had a transsphenoidal hypophysectomy yesterday. What information has the most immediate implications for the client's care?

Correct Answer: C

Rationale: Headache and stiff neck post-hypophysectomy suggest meningitis or CSF leak, needing urgent action.

Question 2 of 5

A patient is seen in the ER after abruptly discontinuing her thyroid medication. She is hypotensive, hypoglycemic, and is unresponsive. This clinical picture is most common with:

Correct Answer: B

Rationale: Myxedema coma occurs from persistently low thyroid production, often after acute illness, rapid discontinuation of thyroid medication, or hypothermia. Signs include hypotension, coma, hypoglycemia, edema, bradycardia, and respiratory failure.

Question 3 of 5

The nurse is caring for a client who has lung cancer and has developed syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following would be an expected finding?

Correct Answer: A

Rationale: SIADH causes hyponatremia (low sodium) due to excessive water retention.

Question 4 of 5

The nurse has become aware of the following client situations. It would be a priority for the nurse to follow up with the client who

Correct Answer: B

Rationale: Tight dressing post-thyroidectomy suggests hematoma or bleeding, a potential airway emergency.

Question 5 of 5

The nurse is aware of the following client situations. The nurse should first follow up with the client who

Correct Answer: C

Rationale: Muscle weakness in DKA suggests hypokalemia, a life-threatening complication.

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