Answer to Question 1
Ans: D
Feedback:
A severe form of hyperthyroidism called thyroid storm is characterized by high fever, extreme tachycardia, and altered mental status. The nurse need not observe for memory impairment, cold intolerance, or constipation as characteristics of thyroid storm. Memory impairment, cold intolerance, and constipation are the manifestations of myxedema, which is a severe form of hypothyroidism.
Answer to Question 2
Ans: A
Feedback:
The nurse should observe for signs of therapeutic responses, which include increased appetite, weight loss, mild diuresis, an increased pulse rate, and decreased puffiness of the face, hands, and feet. The nurse need not observe for swollen neck, excessive sweating, or heat intolerance as signs of responding to therapy. Swollen neck, sore throat, and cough may occur after 2 to 3 days of administering radioactive iodine. Sweating and flushing are the adverse reactions to thyroid hormones.
NUrse :0
The nurse is using Standard Precautions to draw blood.
The nurse uses a noninvasive bladder ultrasound to measure the client’s bladder volume.
Testing the Achilles tendon reflex with client in a supine position
The client is positioned for the examination