After a closed head injury, the unconscious 10-year-old child begins to excrete copious amounts of pale urine with an attendant drop in blood pressure (BP). Based on these symptoms, what does the nurse suspect has developed?
a. Diabetes insipidus
b. Diabetes mellitus
c. Hypothyroidism
d. Hyperthyroidism
ANS: A
Diabetes insipidus can be acquired as the result of a head injury or tumor, and suppression of the posterior pituitary causes copious urine output with an attendant drop in BP. The child can become dehydrated very quickly if some remedy is not applied.
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The nurse is collecting data from a client at the ambulatory care clinic. During the meeting, the client asks the nurse about using height and weight tables to determine his ideal weight. What response by the nurse is most appropriate?
1. "It is important for your health that you closely adhere to the recommendations of height and weight tables to avoid weight-related complications." 2. "Height and weight tables are highly subjective." 3. "Using height and weight tables can be problematic because they are often inaccurate." 4. "Height and weight tables have significant limitations for predicting weight status of an individual."
Which statements would the nurse make when discussing age-related changes in the hematologic system? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply
1. "When you are past middle age, your hemoglobin levels will be slightly lower than when you were younger.". 2. "You have less red marrow than when you were younger, but will still have this important component even into old age.". 3. "As you continue to age, we will see big differences in your blood cell counts on lab tests.". 4. "You may not respond to immunizations as well because of changes in your cells related to the immune response.". 5. "It may take your body longer to return to the normal amount of blood cells if you are injured or get sick.".
The nurse is caring for a patient diagnosed with acute pancreatitis who complains of significant pain. Which nursing action holds the highest priority for this patient?
a. Instruct the patient to sit and lean forward. b. Monitor intake and output. c. Monitor laboratory values and note changes. d. Check blood glucose values frequently.
During a comprehensive assessment, the nurse has detected signs of elder abuse in a client. The law requires this nurse to do what?
A) Report the abuse to the appropriate authorities. B) Set up family counseling sessions. C) Find temporary housing for the client. D) Educate the client and family about elder abuse.