A nurse is assessing a client who is receiving metoprolol. Which of the following indicates a therapeutic effect?

Choice A reason:

Purple striations: Purple striations, or stretch marks, are more commonly associated with Cushing’s syndrome, which involves excess cortisol production. Addison’s disease, on the other hand, is characterized by insufficient cortisol and aldosterone production.

Choice B reason:

Hirsutism: Hirsutism refers to excessive hair growth in women in areas where hair is normally minimal or absent. It is not typically associated with Addison’s disease. Hirsutism is more commonly linked to conditions involving excess androgens, such as polycystic ovary syndrome (PCOS).

Choice C reason:

Hyperpigmentation: Hyperpigmentation, or darkening of the skin, is a hallmark symptom of Addison’s disease. This occurs due to increased production of melanocyte-stimulating hormone (MSH) as a byproduct of elevated adrenocorticotropic hormone (ACTH) levels. The skin changes are often most noticeable in areas exposed to friction, such as the elbows, knees, and knuckles.

Choice D reason:

Intention tremors: Intention tremors, which occur during purposeful movement, are not typically associated with Addison’s disease. These tremors are more commonly seen in neurological conditions such as multiple sclerosis or cerebellar disorders.

Choice A reason:

Don sterile gloves: While it is important to maintain cleanliness, sterile gloves are not necessary for administering a suppository. Clean, non-sterile gloves are sufficient to prevent infection and ensure hygiene.

Choice B reason:

Position the client supine with knees bent: The correct position for administering a suppository is the left lateral (Sims) position, not supine with knees bent. The left lateral position allows for easier access to the rectum and helps the suppository stay in place.

Choice C reason:

Use a rectal applicator for insertion: Suppositories are typically inserted using a gloved finger, not a rectal applicator. The gloved finger allows for better control and ensures the suppository is placed correctly.

Choice D reason:

Insert the suppository just beyond the internal sphincter: This is correct. The suppository should be inserted past the internal sphincter to ensure it stays in place and can dissolve properly. This placement helps the medication to be absorbed effectively.

Choice E reason:

Lubricate the index finger: Lubricating the index finger is essential to make the insertion process smoother and more comfortable for the client. It helps prevent trauma to the rectal mucosa and ensures the suppository is inserted easily.