A nurse in the emergency department is caring for a female client brought to the ER by family for fatigue.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Answer and Explanation

The Correct Answer is []

Rationale:

Potential Condition: Hypothyroidism - The client exhibits signs consistent with hypothyroidism, including fatigue, weight gain, decreased appetite, hair loss, constipation, and intolerance to cold. The laboratory results show low serum T3 and T4 levels, confirming this diagnosis.
Actions to Take:
- Request a prescription for Thyroid hormone replacement: This is crucial for managing hypothyroidism and restoring normal metabolic function.
- Administer supplemental oxygen: Given the client’s low oxygen saturation (92%), this intervention is essential to ensure adequate oxygen delivery and prevent further complications.
Parameters to Monitor:
- Bowel function: Monitoring bowel habits is important since constipation is a common symptom of hypothyroidism, and managing this aspect can improve the patient's overall comfort and health.
- Oxygen saturation: Continuous assessment of oxygen levels is necessary to address the patient's respiratory needs and detect any further deterioration.

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Correct Answer is A

Explanation

A. Clients with Cushing’s Syndrome often experience muscle weakness, osteoporosis, and a risk of fractures due to excess cortisol. Implementing fall precautions is the highest priority to prevent injury.
B. Addressing coping mechanisms is important but not as immediate a safety concern as fall prevention.
C. Avoiding infections is crucial due to immunosuppression from elevated cortisol; however, preventing falls remains a more immediate concern.
D. Encouraging incentive spirometer use may support lung function, but it is not the highest priority compared to preventing falls.

A. Report dizziness at once. B. Get up slowly, turning the entire body. C. Drive in daylight hours only. D. Change your position using the logroll technique.

Correct Answer is B

Explanation

A. While reporting dizziness is important, it does not directly aid in managing vertigo episodes.
B. Instructing the client to get up slowly while turning their entire body helps to reduce vertigo symptoms by minimizing head movement, which can trigger or worsen dizziness in Meniere’s disease.
C. Driving is not recommended during symptomatic periods of vertigo, as it could be unsafe.
D. The logroll technique is typically used for clients with spinal issues rather than vertigo management in Meniere’s disease.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client diagnosed with Cushing's Syndrome. Which of the following actions should be the nurse's highest priority?

Correct Answer is A

Explanation

A nurse is providing teaching to a client with Meniere's disease. The nurse recognizes that which of the following instructions should be given to the client regarding vertigo?

Correct Answer is B

Explanation

A nurse is in the emergency department (ED) and is caring for a client that has arrived by ambulance after a cervical spinal cord injury. Which assessment should be the priority for the nurse to perform at this time?

A client is admitted for treatment of the Syndrome of Inappropriate Antidiuretic Hormone (SIADH). The nurse should initiate which of the following interventions?

A nurse is performing a tonometry test on a client with a suspected diagnosis of glaucoma. The nurse looks at the documented test results and notes an intraocular pressure (IOP) value of 23 mm Hg. What should the nurse's initial action be?

A nurse is caring for a client with hyperthyroidism. The nurse recognizes that beta blockers may be used for which of the following?

The nurse is caring for a client who sustained a head injury in a motor vehicle accident and is diagnosed with a subdural hematoma and increased intracranial pressure. Which nursing intervention is appropriate for this client?

A nurse is caring for a client that has been diagnosed with external otitis. Which of the following clinical symptoms should the nurse be monitoring?

The nurse is providing teaching on the miotic medication the client has been prescribed for glaucoma. The client asks the nurse about the purpose of the medication. Which response should the nurse provide to the client?