A nurse is caring for a client who has named someone to serve as their health care proxy. The client states they need clarification about this part of the advance directive.
Which of the following statements by the client indicates that need for clarification?

Choice A rationale

Detergent pods are highly concentrated and can cause severe chemical burns to the esophagus and respiratory tract if ingested. Their bright colors and soft, squeezable nature can attract young children, making them a significant aspiration and poisoning risk due to their caustic properties. Normal esophageal tissue is delicate and easily damaged by corrosives.

Choice B rationale

Television remote controls, while a common household item, are typically too large and irregularly shaped to be easily aspirated into a toddler's airway. The primary concern with remote controls is choking on small, removable parts like batteries, not aspiration of the entire object into the trachea. Normal airway diameter in toddlers is small.

Choice C rationale

A tennis ball, due to its size and spherical shape, can perfectly occlude a toddler's airway, leading to complete obstruction and potential asphyxiation. Its smooth surface makes it difficult to dislodge once aspirated, posing a significant and immediate life-threatening choking hazard for young children. Normal tracheal lumen can be fully occluded by objects of similar diameter.

Choice D rationale

Hairbrushes are generally too large and awkwardly shaped to be aspirated by a toddler. While bristles or small decorative elements could potentially break off and be ingested, the primary concern with a hairbrush itself is not airway obstruction through aspiration of the entire object. Normal pharyngeal reflexes would typically prevent aspiration of such large objects. .

Choice A rationale

While clients with Cushing's syndrome may experience fatigue due to elevated cortisol levels affecting sleep patterns and muscle catabolism, clustering activities only in the morning may not adequately address the fluctuating energy levels or provide sufficient rest periods throughout the day. A more balanced approach involving rest periods and activity modification throughout the day is generally more beneficial.

Choice B rationale

Clients with Cushing's syndrome often experience fluid retention and edema due to the mineralocorticoid effects of excess cortisol. Therefore, increasing fluid intake would exacerbate fluid overload rather than alleviate symptoms. Fluid restriction and diuretic therapy may be necessary to manage fluid balance and prevent complications like hypertension and heart failure.

Choice C rationale

Cushing's syndrome is characterized by endogenous overproduction of cortisol, meaning the body already produces too much. Requesting a medical prescription for cortisol would further elevate cortisol levels, worsening the client's symptoms and potentially leading to adrenal crisis if exogenous cortisol is administered in addition to already elevated endogenous levels. Management focuses on reducing cortisol.

Choice D rationale

Assessing daily weights is crucial for clients with Cushing's syndrome due to the propensity for fluid retention and weight gain caused by increased mineralocorticoid activity of cortisol. Daily weights provide an objective measure of fluid balance and can indicate exacerbation or improvement of edema, helping guide interventions and monitor treatment effectiveness. Normal weight fluctuation should be within 1-2 kg in 24 hours.