A client diagnosed with transient ischemic attacks (TIAs) is scheduled for a carotid endarterectomy (CEA). The nurse explains that this procedure will be done for what purpose?

Reasoning:

Choice A reason: Pale thick skin is not a typical effect of long-term corticosteroid use. Corticosteroids cause skin thinning due to reduced collagen production, leading to fragile, atrophic skin prone to bruising. Thick skin is more associated with conditions like scleroderma, not the catabolic effects of corticosteroids on skin tissue.

Choice B reason: Moon face is a classic sign of long-term corticosteroid use, resulting from fat redistribution to the face due to glucocorticoid-induced lipolysis and lipogenesis. Excess cortisol promotes fat deposition in the face and trunk, creating a rounded facial appearance, a hallmark of Cushing syndrome or iatrogenic corticosteroid effects.

Choice C reason: Weight loss is not expected with long-term corticosteroid use. Corticosteroids increase appetite and promote fat redistribution, leading to weight gain, particularly in the trunk and face. Weight loss may occur in conditions like Addison’s disease, where cortisol is deficient, not in hypercortisolism states.

Choice D reason: Hypotension is not a common effect of corticosteroids. They can cause fluid retention and increased blood volume due to mineralocorticoid activity, potentially leading to hypertension. Hypotension is more associated with adrenal insufficiency, where cortisol and aldosterone deficiencies reduce vascular tone and fluid balance.

Reasoning:

Choice A reason: Diabetes insipidus is likely due to the client’s symptoms of polyuria, thirst, and weight loss following a head injury. Trauma can disrupt the posterior pituitary, reducing ADH secretion, leading to excessive dilute urine output, dehydration, and subsequent thirst and weight loss from fluid depletion, consistent with central DI.

Choice B reason: A pituitary tumor may cause diabetes insipidus but is not the condition itself. Tumors can disrupt ADH production, but the symptoms described—polyuria, thirst, and weight loss—point directly to diabetes insipidus as the primary condition, with a tumor being a potential underlying cause requiring further investigation.

Choice C reason: Hypothyroidism, caused by thyroid hormone deficiency, leads to symptoms like fatigue and weight gain, not polyuria or weight loss. It is unrelated to head injury or ADH dysfunction, making it an unlikely diagnosis for the client’s symptoms of excessive urine output and dehydration.

Choice D reason: SIADH causes water retention, leading to concentrated urine, hyponatremia, and potential weight gain, opposite to the client’s symptoms of dilute urine, weight loss, and thirst. Head injury may cause SIADH, but the clinical presentation aligns with diabetes insipidus, not water retention.