Deck 32: Metabolic Response to Stress

Question 1

A patient diagnosed with hyperthyroid crisis is receiving propylthiouracil (PTU).The nurse will increase monitoring for which adverse reaction?

A)Tremors
B)Emotional outbursts
C)Elevation of white blood cells (WBC)
D)Widening of pulse pressure

Answer 1

Elevation of white blood cells (WBC)

Question 2

A patient is diagnosed with hyperglycemic hyperosmolar state (HHS).Which interventions would the nurse anticipate? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Potassium supplementation
B)Testing for sources of infection
C)Increasing amount of NPH insulin administered
D)Increasing IV fluid administration
E)Monitoring arterial blood gases

Answer 2

Potassium supplementation
Testing for sources of infection
Increasing IV fluid administration
Monitoring arterial blood gases

Question 3

A patient has been tentatively diagnosed with adrenal insufficiency.Which findings would the nurse evaluate as supporting this diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)The patient's low blood pressure is not responding to fluid infusion.
B)The patient's heart rate is consistently lower than 60 beats/min.
C)The patient has had a fever for a week.
D)Arterial blood gas results reveal acidosis.
E)The patient reports abdominal pain.

Answer 3

The patient's low blood pressure is not responding to fluid infusion.
The patient has had a fever for a week.
Arterial blood gas results reveal acidosis.
The patient reports abdominal pain.

Question 4

A patient is being tested for adrenal insufficiency with the rapid adrenocorticotropic hormone (ACTH)stimulation test.How will the nurse explain this test to the patient?

A)"You will drink about a cup of a salty-tasting fluid during this test."
B)"It will take several hours to complete this test."
C)"We have to do this test first thing in the morning,just after you awaken."
D)"A series of blood samples will be drawn during this test."

Question 5

The nurse has identified that a patient who has hyperthyroidism has decreased cardiac output.Which interventions are indicated to address this diagnosis? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Monitor for development of peripheral edema.
B)Keep room warm.
C)Provide medications to manage pain.
D)Frequently reassure and calm the patient.
E)Monitor activity tolerance.

Question 6

The patient whose lower extremities were crushed in a motor vehicle accident is likely experiencing "fight-or-flight." Which finding would the nurse attribute to that neuroendocrine response?

A)Heart rate is 78.
B)Bowel sounds are diminished.
C)The patient has very little bleeding from the injury.
D)The patient has decreased level of consciousness.

Question 7

A nurse is reviewing laboratory results for a patient just admitted to the intensive care unit.The patient is not known to have diabetes,but initial nonfasting blood sugar is 130 mg/dL.At which point would the nurse expect insulin therapy to begin?

A)When fasting blood sugar exceeds 110 mg/dL
B)When the patient shows assessment findings associated with hyperglycemia
C)If another random blood glucose is in the same range as this initial reading
D)When fasting blood glucose levels reach 180 mg/dL

Question 8

The nurse realizes that increased interventions to prevent infection are necessary when the patient is under stress.Which effect of cortisol complicates this risk?

A)Increased release of histamines
B)Increased production of eosinophils
C)Release of immature neutrophils
D)Increasing serum sodium levels

Question 9

A critically ill patient's plasma cortisol level is 2.6 mcg/dL.Which intervention does the nurse expect?

A)Treatment for adrenal insufficiency
B)Treatment for adrenal excess
C)Continued diagnostic testing of adrenal function
D)Emergency dialysis

Question 10

A patient was severely injured when a building exploded.The patient's pain level report does not seem to reflect the severity of these injuries.How would the nurse evaluate this response?

A)The patient is in shock and cannot respond to painful stimuli.
B)Someone at the scene must have given the patient pain medication.
C)The patient has increased endogenous opioids.
D)The patient does not understand the severity of the injuries.

Question 11

A patient who is receiving taper doses of hydrocortisone has been taking oral medication for 3 days.This morning the patient has assessment findings of recurrent adrenal insufficiency.What nursing action,if any,is indicated?

A)These symptoms may come and go for several days,so no action is necessary.
B)Discuss this assessment with the primary healthcare provider.
C)Give a dose of methylprednisolone instead of hydrocortisone.
D)Give the next hydrocortisone by IV.

Question 12

A patient who is being mechanically ventilated has been prescribed hydrocortisone for treatment of adrenal insufficiency.Which nursing intervention should be implemented?

A)Range of motion exercising
B)Monitor urine for onset of cloudiness
C)Increase monitoring for thrombus development
D)Mix all IV medications in D5W for administration

Question 13

A patient who has required an insulin drip is being transitioned to subcutaneous insulin.Which intervention would the nurse anticipate?

A)Administering NPH insulin subcutaneously every 2 hours according to fingerstick blood sugar.
B)Administering the prescribed dose of NPH insulin 2 hours before discontinuing the insulin drip.
C)Tapering the insulin drip administration rate over the next several days.
D)Plan to administer twice the number of units of NPH insulin that the patient has been receiving per hour in regular insulin.

Question 14

A patient is receiving radiation treatment for laryngeal cancer.Which ECG change would the nurse evaluate as indicating need to assess this patient for hypothyroidism?

A)Inverted T wave
B)Shortened PR interval
C)P wave inversion
D)Atrial fibrillation

Question 15

A nurse is providing care to a patient diagnosed with urinary sepsis.Which symptoms would the nurse evaluate as indicating the patient has entered the flow stage of metabolic response to this physiologic stress? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)The patient's heart rate has increased to 125 beats/min.
B)The patient's respiratory rate has dropped from 24 to 18.
C)The patient's cardiac output has increased.
D)The patient's temperature is 101.6°F.
E)The patient's blood pressure has been stable for 24 hours.

Question 16

A patient is still hypermetabolic two weeks after his injury.What finding would the nurse expect?

A)Muscle wasting
B)Low serum BUN levels
C)Hypoglycemia
D)Decreased level of consciousness

Question 17

The nurse is advised that a patient diagnosed with hyperthyroid crisis will be admitted from the emergency department.The nurse prepares to care for a patient with which possible conditions? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Select all that apply.

A)Atrial fibrillation
B)High fever
C)Heart failure
D)Constipation
E)Agitation

Question 18

Which nursing interventions are indicated to support the outcome of "maintain normal body temperature" for a patient with hyperthyroidism?

A)Keep room door closed.
B)Provide an additional blanket.
C)Consider a cooling blanket if fever is greater than 102°F.
D)Place a scarflike covering over the patient's head.

Question 19

Because a patient is experiencing the fight-or-flight stage of the stress response,the nurse would be least concerned about which laboratory finding?

A)Serum glucose 80 mg/L
B)Serum potassium 3.3 mEq/L
C)Serum sodium 148 mEq/L
D)Total bilirubin 2.4 mg/dL

Question 20

A critically ill patient requires IV insulin for persistent hyperglycemia.Current fingerstick blood glucose is 68 mg/dL.According to international critical care guidelines,which nursing intervention is indicated?

A)Call for a laboratory glucose test.
B)Increase the rate of the insulin drip by 2 units per hour.
C)Administer 10 mL of D5W by bolus injection.
D)Administer 0.5 g sugar dissolved in orange juice by mouth.