A client with a history of diabetes insipidus seeks medical attention for an exacerbation of symptoms. Which laboratory finding indicates to the nurse that the client has been restricting fluids in an attempt to control the symptoms?

Reasoning:

Choice A reason: Explaining that physical changes in Cushing’s syndrome, like moon face and weight gain, result from excessive corticosteroids helps the client understand their condition. Cortisol excess causes fat redistribution and metabolic changes, and education promotes adherence to treatment and coping with body image changes, improving psychological and physical management.

Choice B reason: Offering cool, comfortable clothing or bedding addresses symptoms like heat intolerance in Cushing’s syndrome due to cortisol’s metabolic effects. However, it is less critical than education about the condition, as it does not address the underlying cause or promote understanding and adherence to long-term management strategies.

Choice C reason: Increasing salt and fluid intake is appropriate for Addison’s disease, not Cushing’s syndrome, where cortisol’s mineralocorticoid effects cause fluid retention and hypertension. This intervention could worsen fluid overload and hyponatremia, making it inappropriate and potentially harmful for managing Cushing’s syndrome symptoms.

Choice D reason: A high-carbohydrate, low-protein diet is not recommended for Cushing’s syndrome. Cortisol excess causes protein catabolism and hyperglycemia, so a balanced diet with adequate protein supports muscle maintenance and glucose control. This dietary suggestion does not address the metabolic needs of the condition.

Reasoning:

Choice A reason: Monitoring temperature every 4 hours is critical in neutropenia, a common complication of Hodgkin disease treatment. Low neutrophil counts increase infection risk, and fever is an early sign of infection. Regular temperature checks enable prompt detection and treatment of infections, preventing sepsis in immunocompromised clients.

Choice B reason: Omitting fresh fruits and vegetables is not universally recommended for neutropenia. While some diets limit raw produce to reduce bacterial exposure, this is less critical than fever monitoring. Neutropenic precautions focus on infection prevention, with temperature monitoring being a more direct and urgent intervention.

Choice C reason: Positioning to increase lung expansion is relevant for respiratory conditions but not a priority in neutropenia. Neutropenia increases infection risk, not respiratory compromise. Monitoring for fever is more critical, as infections are the primary concern in clients with low neutrophil counts from Hodgkin disease therapy.

Choice D reason: Avoiding IM injections is important in neutropenia to reduce infection risk at injection sites, but it is secondary to fever monitoring. Injections can introduce bacteria, but fever detection through regular temperature checks is a more proactive and essential intervention for early infection identification in neutropenic clients.