A nurse is caring for a client who has Cushing's syndrome.Which of the following interventions should the nurse expect to perform? (Select all that apply.)

Assess for neck vein distention.

Monitor for an irregular heart rate.

Assess blood glucose level.

Monitor for postural hypotension.

Weigh the client daily.

Answer and Explanation

Correct Answer : A,B,C,D,E

Choice A rationale
Assessing for neck vein distention helps monitor fluid overload, which is common in Cushing's syndrome due to cortisol's effects on fluid retention.
Choice B rationale
Monitoring for an irregular heart rate is important because cortisol can cause electrolyte imbalances and hypertension, which may affect heart rhythm.
Choice C rationale
Assessing blood glucose levels is essential since Cushing's syndrome can cause hyperglycemia due to cortisol's effects on glucose metabolism.
Choice D rationale
Monitoring for postural hypotension helps manage potential complications from cortisol's effects on blood pressure regulation.
Choice E rationale
Weighing the client daily is important for monitoring fluid retention and weight changes associated with Cushing's syndrome.

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Correct Answer is C

Explanation

Choice A rationale
Replacing the water in flower vases daily does not prevent infection for a client with neutropenia, as bacteria can still accumulate.
Choice B rationale
Humidifying the client’s room can increase the risk of mold growth, which is harmful to immunocompromised clients.
Choice C rationale
Serving cooked fruit minimizes the risk of infections from bacteria and fungi present on raw fruits, which is crucial for clients with low WBC counts.
Choice D rationale
Cleaning dentures in a denture cup does not significantly reduce infection risks for immunocompromised clients; proper mouth hygiene is essential but this practice alone is insufficient.

A. Monitor the client’s hydration status. B. Encourage the client to engage in physical activities. C. Administer medications as prescribed. D. Educate the client on dietary needs.

Correct Answer is A

Explanation

Choice A rationale
Monitoring the client’s hydration status is critical for older adults, especially those on a medical-surgical unit, to prevent dehydration, which can lead to serious complications such as renal impairment, confusion, and electrolyte imbalance.
Choice B rationale
Encouraging physical activities is beneficial but is not always feasible or safe for all older clients, especially those with certain medical conditions or mobility limitations.
Choice C rationale
Administering medications as prescribed is essential but is a standard practice for all clients and not specific to older adults' unique needs.
Choice D rationale
Educating the client on dietary needs is important but secondary to monitoring hydration, which addresses more immediate physiological needs and complications.

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A nurse is caring for a client who has Cushing's syndrome.Which of the following interventions should the nurse expect to perform? (Select all that apply.)

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