ATI-RN Adult Medical Surgical Nursing Detailed Answer Key ATI Complex Endocrine Practice-latest 2022/2023
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ATI-RN Adult Medical Surgical Nursing
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Galen College Of Nursing
ATI-RN Adult Medical Surgical Nursing Detailed Answer Key ATI Complex Endocrine Practice-latest 2020/2021A nurse is caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the hands, the soles of the feet, and around the lips. Fo...
ati rn adult medical surgical nursing detailed answer key ati complex endocrine practice latest 20222023
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ATI-RN Adult Medical Surgical Nursing
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ATI Complex Endocrine Practice
Created on:08/13/2018Page 21.A nurse is caring for a client who is 1 day postoperative following a subtotal thyroidectomy. The client reports a tingling sensation in the hands, the soles of the feet, and around the lips. For which of the following findings should the nurse assess the client?
A.Chvostek's sign
Rationale: The nurse should suspect that the client has hypocalcemia, a possible complication following subtotal thyroidectomy. Manifestations of hypocalcemia include numbness
and tingling in the hands, the soles of the feet, and around the lips, typically appearing between 24 and 48 hr after surgery. To elicit Chvostek's sign, the nurse should tap the client's face at a point just below and in front of the ear. A positive response would be twitching of the ipsilateral (same side only) facial muscles, suggesting neuromuscular excitability due to hypocalcemia.
B.Babinski's sign
Rationale: Babinski's sign is a diagnostic test for brain damage or upper motor neuron damage. It is positive if the toes flare up when the nurse strokes the plantar aspect of the foot.
C.Brudzinski's sign
Rationale: Brudzinski's sign is an indication of meningeal irritation, such as in clients who have meningitis. With the client supine, the nurse should place one hand behind his head and places her other hand on his chest. The nurse then raises the client's head with her hand behind his head, while the hand on his chest restrains him and prevents him from rising. Flexion of the client's lower extremities constitutes a positive sign.
D.Kernig's sign
Rationale: Kernig's sign is an indication of meningeal irritation, such as in clients who have meningitis. The nurse performs the maneuver with the client supine with his hips and knees in flexion. The inability to extend the client's knees fully without causing pain constitutes a positive test.
2.A nurse is caring for an adolescent client who has a long history of diabetes mellitus and is being admitted to the emergency department confused, flushed, and with an acetone odor on the breath. Diabetic ketoacidosis is suspected. The nurse should anticipate using which of the following types of insulin to treat this client?
A.NPH insulin
Rationale: Isophane NPH insulin is intermediate-acting. It has an onset of action of 1 to 3 hr and is not appropriate for emergency treatment of ketoacidosis.
B.Insulin glargine
Rationale: Insulin glargine is a long-acting insulin, with an onset of 2 to 4 hr. It is not appropriate for emergency treatment of ketoacidosis.
C.Insulin detemir
Rationale: Insulin detemir is an intermediate-acting insulin. It has an onset of action of 1 hr and is not appropriate for emergency treatment of ketoacidosis. Detailed Answer Key
ATI Complex Endocrine Practice
Created on:08/13/2018Page 3D.Regular insulin
Rationale:
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