A nurse assesses a client diagnosed with adrenal hypofunction. Which client statement should the nurse correlate with this diagnosis?
a. "I have a terrible craving for potato chips."
b. "I cannot seem to drink enough water."
c. "I no longer have an appetite for anything."
d. "I get hungry even after eating a meal."
ANS: A
The nurse correlates a client's salt craving with adrenal hypofunction. Excessive thirst is related to diabetes insipidus or diabetes mellitus. Clients who have hypothyroidism often have a decrease in appetite. Excessive hunger is associated with diabetes mellitus.
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There is dead tissue throughout the patient's nonhealing abdominal wound. The nurse prepares for which intervention needed to encourage this wound to heal?
1. Diet analysis for protein adequacy 2. Keeping the wound covered to increase oxygen to the wound bed 3. Debridement of devitalized tissue 4. Introduction of air into the wound for drying
During a routine health assessment, the nurse notes that an 8-month-old infant has a significant head lag. Which is the most appropriate action?
a. Recheck head control at next visit. b. Teach the parents appropriate exercises. c. Schedule the child for further evaluation. d. Refer the child for further evaluation if the anterior fontanel is still open.
While assessing vital signs of a patient with a head injury and increased intracranial pressure (IICP), a nurse notes that the patient's respiratory rate is 8 breaths/min. How will the nurse interpret this finding?
A) bradypnea is uncommon in patient with IICP B) IICP most commonly results in tachypnea C) bradypnea is a response to IICP D) this is a normal respiratory rate
The nurse is assisting with placement of epidural anesthesia for a woman who is in labor. To help prevent maternal hypotension, which is the nurse's initial action?
a. Administer 40 to 80 mcg of intravenous phenylephrine. b. Infuse a bolus of 500 to 1000 mL of IV crystalloid solution. c. Monitor the patient's blood pressure closely during epidural placement. d. Turn the patient onto her left side and give a rapid bolus of crystalloid solution.