A. Administer propylthiouracil (PTU): PTU is used for treating hyperthyroidism by inhibiting thyroid hormone production. The client's lab results show low Free T4 and elevated TSH, indicating hypothyroidism, not hyperthyroidism. Therefore, PTU is not appropriate for this condition.
B. Provide warm blankets: The client is experiencing hypothermia (temperature 35.6°C or 96.1°F) and lethargy. Providing warm blankets helps in managing low body temperature and preventing further complications. This intervention is necessary to stabilize the client's body temperature.
C. Place the client on a cardiac monitor: The client has bradycardia (heart rate 49/min) and a slow respiratory rate (10/min), which are signs of possible cardiac involvement due to hypothyroidism. Cardiac monitoring is essential to detect and manage any potential arrhythmias or cardiac issues that may arise.
D. Place the client on a high-calorie diet: A high-calorie diet is usually recommended for managing hyperthyroidism due to increased metabolism. However, this client has hypothyroidism, characterized by reduced metabolism and low energy levels, so this intervention is not appropriate.
E. Administer propranolol: Propranolol is used to manage symptoms of hyperthyroidism, such as tachycardia and tremors. Given the client's symptoms and lab results indicating hypothyroidism, propranolol is not indicated for this condition.
F. Administer acetaminophen: Acetaminophen is used to reduce fever, but the client is hypothermic rather than febrile. Administering acetaminophen would not address the client's current issue of low body temperature.
G. Administer levothyroxine: The client has low Free T4 and elevated TSH, indicating hypothyroidism. Levothyroxine is the appropriate medication to manage hypothyroidism by supplementing thyroid hormone levels. This intervention is necessary to treat the underlying thyroid condition.
H. Prepare the client for a subtotal thyroidectomy: A subtotal thyroidectomy is a surgical option considered for severe thyroid disorders, such as thyroid cancer or uncontrollable hyperthyroidism. This client's presentation suggests hypothyroidism rather than a condition requiring surgical intervention.

A. A 40-year-old patient with Cushing syndrome and gynecomastia: While Cushing syndrome requires ongoing management and monitoring, gynecomastia alone is not an urgent concern compared to the symptoms described in option B.
B. A 58-year-old patient with Addison's disease who is exhibiting confusion: Addison's disease can lead to adrenal insufficiency, and confusion could indicate an adrenal crisis or severe electrolyte imbalance. This is a critical situation requiring immediate assessment to prevent severe complications.
C. A 45-year-old patient with Graves' disease and exophthalmos: Graves' disease with exophthalmos is significant but does not typically represent an immediate life-threatening condition compared to the symptoms associated with Addison's disease.
D. A 47-year-old patient with hypothyroidism who is asking for a warm blanket: This patient’s request for a warm blanket suggests they might be experiencing symptoms related to hypothyroidism, such as feeling cold. However, this is less urgent compared to the confusion and potential crisis in option B.

A. Radioactive iodine uptake test: This test is used to assess thyroid function and diagnose thyroid disorders, such as hyperthyroidism. It is not used to diagnose Cushing syndrome.
B. 24-hour cortisol urine study: This test measures cortisol levels in the urine over a 24-hour period and is commonly used to diagnose Cushing syndrome by evaluating elevated cortisol production.
C. Adrenocorticotropic hormone (ACTH) stimulation test: This test evaluates adrenal function and is typically used to assess adrenal insufficiency rather than Cushing syndrome.
D. Edrophonium (Tensilon) test: This test is used to diagnose myasthenia gravis, not Cushing syndrome. It evaluates the effect of the medication on muscle strength.

A. B-type natriuretic peptide (BNP): BNP levels are elevated in heart failure due to increased pressure and stretch in the heart's chambers. It is a key marker used to diagnose and assess the severity of heart failure.
B. Troponin I: This marker is used to diagnose myocardial infarction (heart attack) rather than heart failure. Elevated troponin levels indicate damage to the heart muscle.
C. Blood urea nitrogen (BUN): BUN levels can be elevated in heart failure due to decreased renal perfusion, but it is not as specific for diagnosing heart failure as BNP.
D. Platelet levels: Platelet levels are not directly related to the diagnosis of heart failure. They are more relevant for assessing clotting disorders and other conditions.

A. Weight gain and lethargy: These symptoms are more commonly associated with hypothyroidism or insufficient thyroid hormone levels, not with excess levothyroxine.
B. Nervousness and tachycardia: Excessive levothyroxine can lead to symptoms of hyperthyroidism, such as increased heart rate (tachycardia) and nervousness. These symptoms are consistent with an overdose of levothyroxine.
C. Facial puffiness and constipation: These symptoms are indicative of hypothyroidism, not hyperthyroidism. They would not be expected with an excess of levothyroxine.
D. Hypotension and intolerance to cold: These are symptoms of hypothyroidism and would not typically occur with an excess of levothyroxine. Excess levothyroxine usually causes symptoms of hyperthyroidism.

A. Ataxic dysarthria: This is not a common complication associated with Cushing syndrome. It is more related to neurological disorders affecting speech and coordination.
B. Hypotension: Cushing syndrome typically causes hypertension rather than hypotension due to fluid retention and increased vascular resistance.
C. Hyperkalemia: Cushing syndrome is associated with hypokalemia rather than hyperkalemia due to the effects of excess cortisol on potassium levels.
D. Bone fracture: Cushing syndrome increases the risk of osteoporosis and bone fractures due to prolonged exposure to high levels of cortisol, which affects bone density and strength.

A. Limit your intake of high sodium foods for several days after the procedure to prevent hypernatremia: This is not typically recommended for clients with Addison's disease. In fact, they often need more sodium.
B. Limit fluid intake to 1,500 mL per day for the next five days after the surgery to prevent fluid retention: This is not appropriate for clients with Addison's disease. They generally need to maintain adequate hydration.
C. You will need to increase your dose of corticosteroids due to the stress of surgery: Stress, including surgery, increases the body’s need for corticosteroids in clients with Addison's disease. Therefore, increasing the dose is crucial to prevent adrenal crisis.
D. Avoid taking hydrocortisone after the procedure due to the risk of surgical-site infection: Hydrocortisone should not be avoided. It is essential for managing Addison's disease and preventing an adrenal crisis, especially under stress.

A. B-type natriuretic peptide (BNP): BNP levels are elevated in heart failure due to the heart's response to increased pressure and volume overload. This biomarker is used specifically to diagnose and assess the severity of heart failure.
B. Troponin I: This is a marker for myocardial injury and is used to diagnose acute myocardial infarction rather than heart failure.
C. Blood urea nitrogen (BUN): While elevated BUN can be associated with renal dysfunction or fluid overload in heart failure, it is not specific to diagnosing heart failure.
D. Platelet levels: These are not directly related to diagnosing heart failure and do not provide information about cardiac function.

A. It is important that you taper off of the corticosteroids you are taking which have caused this disorder: This statement is not applicable because the client has a pituitary adenoma causing Cushing disease, not iatrogenic Cushing syndrome from corticosteroid use.
B. You will need to have your adrenal glands removed to reverse your symptoms: For Cushing disease caused by a pituitary adenoma, treatment typically involves surgical removal of the pituitary tumor, not the adrenal glands.
C. You will need to begin taking hydrocortisone, and increase your dose during times of stress: This is incorrect as hydrocortisone replacement is used for Addison's disease, not for managing Cushing disease.
D. You will receive glucose checks and sliding-scale insulin until your hormone levels are corrected: While glucose monitoring might be necessary due to hyperglycemia, the primary treatment for Cushing disease involves addressing the source of excess cortisol, which is the pituitary adenoma.

A. "You may need to repeat this therapy again in three weeks if the first dose doesn't achieve optimal results": Radioactive iodine therapy may require additional doses, but this is not determined by a set timeframe such as three weeks. The need for additional therapy is based on the individual’s response and thyroid function tests.
B. "Avoid being close to pregnant women and children for 7 days after your treatment": This is correct as radioactive iodine therapy can emit radiation, and avoiding close contact with vulnerable populations such as pregnant women and children helps minimize their exposure to radiation.
C. "You may need to begin corticosteroid replacement therapy after this treatment": This is incorrect because corticosteroid replacement is not typically required after radioactive iodine therapy for Graves' disease. The treatment primarily targets the thyroid gland.
D. "The purpose of this therapy is to increase your levels of thyroid hormone": This is incorrect. The purpose of radioactive iodine therapy is to reduce thyroid hormone production by destroying thyroid tissue, which helps to manage hyperthyroidism in Graves' disease.