A client reports feeling tired, cold, and short of breath at times. Assessment reveals tachycardia and reduced energy. What would the nurse expect the health care provider to order?

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: A sodium level of 150 mEq/L indicates hypernatremia, which occurs in diabetes insipidus when fluid restriction exacerbates water loss from polyuria. Without adequate ADH, the kidneys cannot conserve water, and restricting fluids further increases serum sodium concentration, reflecting dehydration and supporting the suspicion of fluid restriction.

Choice B reason: A phosphate level of 4.0 mg/dL is within the normal range and unrelated to fluid restriction in diabetes insipidus. Phosphate levels are affected by bone metabolism or renal function, not directly by ADH deficiency or fluid intake, making this finding irrelevant to the client’s fluid management strategy.

Choice C reason: A blood glucose level of 60 mg/dL is at the lower end of normal but unrelated to fluid restriction in diabetes insipidus. Glucose levels are affected by metabolic conditions like diabetes mellitus, not water balance issues caused by ADH deficiency, so this does not indicate fluid restriction.

Choice D reason: A potassium level of 2.9 mmol/L indicates hypokalemia, which is not directly linked to fluid restriction in diabetes insipidus. Potassium imbalances may result from other causes, like diuretic use or gastrointestinal losses, but they do not reflect the dehydration or sodium concentration changes associated with restricted fluid intake.