A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the health care provider immediately?

Frequent urination

An irregular apical pulse

Dry mucous membranes

Pitting edema of the legs

Answer and Explanation

The Correct Answer is B

Reasoning:

Choice A reason: Frequent urination may occur in Cushing’s syndrome due to hyperglycemia-induced osmotic diuresis, but it is not immediately life-threatening. It reflects chronic metabolic changes rather than an acute emergency, so it is less urgent than an irregular pulse, which could indicate a cardiovascular crisis.

Choice B reason: An irregular apical pulse is critical to report immediately in Cushing’s syndrome, as cortisol excess increases cardiovascular risk, including arrhythmias like atrial fibrillation. Irregular pulses may indicate acute cardiac instability, requiring urgent intervention to prevent complications like stroke or heart failure in this high-risk population.

Choice C reason: Dry mucous membranes may suggest dehydration but are not typical in Cushing’s syndrome, which causes fluid retention. Even if present, they are less urgent than an irregular pulse, as dehydration can be managed with fluids, whereas cardiac arrhythmias pose an immediate threat requiring prompt attention.

Choice D reason: Pitting edema in the legs is common in Cushing’s syndrome due to cortisol’s mineralocorticoid effects causing fluid retention. While important, it is a chronic issue manageable with diuretics and not as immediately life-threatening as an irregular pulse, which could indicate acute cardiac complications.

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Correct Answer is A

Explanation

Reasoning:

Choice A reason: Limiting visitor interaction reduces stimulation, which can increase intracranial pressure (ICP) in clients with cerebral aneurysms. Emotional or physical stress from interactions raises blood pressure, potentially increasing ICP and risking aneurysm rupture, making this a critical measure to maintain stability and prevent catastrophic bleeding.

Choice B reason: Interaction causing violence is not a typical concern in cerebral aneurysm management. Aneurysms may cause neurological symptoms, but violence is unrelated to visitor interactions. The primary risk is increased ICP from stimulation, not behavioral changes, making this an incorrect rationale for limiting visitors.

Choice C reason: Emotional distress from interactions may occur but is not the primary reason to limit visitors. The main concern in cerebral aneurysms is preventing ICP increases from stimulation, which could lead to rupture. Emotional impact on treatment adherence is secondary to this immediate physical risk.

Choice D reason: Migraines are not a direct consequence of visitor interactions in cerebral aneurysm cases. While headaches may occur, the primary concern is increased ICP from stimulation, which raises blood pressure and risks aneurysm rupture, not triggering migraines, which are unrelated to this context.

A. An increased number of erythrocytes B. Erythrocytes that are microcytic and hypochromic C. Clustering of platelets with sickled red blood cells D. Erythrocytes that are macrocytic and hyperchromic

Correct Answer is B

Explanation

Reasoning:

Choice A reason: An increased number of erythrocytes is not indicative of iron-deficiency anemia, which is characterized by reduced red blood cell production due to low iron availability for hemoglobin synthesis. Increased erythrocytes suggest compensatory mechanisms or polycythemia, not the reduced erythropoiesis seen in iron deficiency.

Choice B reason: Microcytic and hypochromic erythrocytes are hallmarks of iron-deficiency anemia. Low iron impairs hemoglobin synthesis, leading to smaller (microcytic) and paler (hypochromic) red blood cells. This matches the client’s low hemoglobin and hematocrit, confirming iron deficiency as the cause of the anemia.

Choice C reason: Clustering of platelets with sickled red blood cells is specific to sickle cell anemia, not iron-deficiency anemia. Sickle cell disease involves hemoglobin S, causing cell deformation, not iron deficiency. Platelet clustering is unrelated to the microcytic, hypochromic cells of iron deficiency.

Choice D reason: Macrocytic and hyperchromic erythrocytes suggest megaloblastic anemia, typically from vitamin B12 or folate deficiency, not iron deficiency. Iron-deficiency anemia produces microcytic, hypochromic cells due to impaired hemoglobin synthesis, making macrocytic, hyperchromic cells inconsistent with the client’s laboratory findings.

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A nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the health care provider immediately?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is caring for a client with a cerebral aneurysm. Why does the nurse limit the interaction of visitors or family members with the client who has an aneurysm?

Correct Answer is A

Explanation

The nurse observes the laboratory studies for a client in the hospital with fatigue, feeling cold all of the time, and hemoglobin of 8.6 g/dL and a hematocrit of 28%. What finding would be an indicator of iron-deficiency anemia?

Correct Answer is B

Explanation

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