A nurse is providing education to a group of parents of toddlers about household items that can be swallowed and block the airway of their child.
The nurse should include which of the following items as a risk for aspiration?

Choice A rationale

Hypertension is not a characteristic manifestation of Addison's disease; rather, hypotension, particularly orthostatic hypotension, is commonly observed. This is due to the deficiency of mineralocorticoids, primarily aldosterone, which leads to impaired sodium and water reabsorption in the renal tubules, resulting in decreased intravascular volume and blood pressure.

Choice B rationale

Weight gain is atypical in Addison's disease; instead, clients often experience weight loss. This is primarily due to the combined effects of anorexia, nausea, vomiting, and diarrhea, which are common gastrointestinal symptoms stemming from glucocorticoid deficiency and metabolic disturbances.

Choice C rationale

Excessive thirst, or polydipsia, is not a primary characteristic of Addison's disease. While severe dehydration from vomiting or diarrhea could induce thirst, the fundamental pathophysiology of Addison's disease, involving hypocortisolism and hypoaldosteronism, does not directly lead to excessive thirst as a predominant symptom.

Choice D rationale

Hyperpigmentation of the skin, particularly in areas exposed to sun and pressure points, is a classic manifestation of Addison's disease. This occurs due to increased production of pro-opiomelanocortin (POMC) in response to low cortisol, leading to elevated levels of melanocyte-stimulating hormone (MSH) fragments that stimulate melanin synthesis in melanocytes.

Choice A rationale

Applying wrist and leg restraints significantly restricts a client's movement and can exacerbate confusion and agitation, potentially leading to increased injury risk and psychological distress. This intervention can also impair circulation and skin integrity if not meticulously monitored, and should only be used as a last resort when less restrictive measures have failed. Normal physiological response to restraint includes increased anxiety.

Choice B rationale

Administering medication to sedate a client might reduce restlessness temporarily but could also deepen confusion, increase the risk of falls, and mask underlying medical issues causing the change in mental status. Pharmacological interventions should be carefully considered, with the lowest effective dose, and after a thorough assessment of the cause of the altered mental state. Normal sedation levels aim for calm without excessive drowsiness.

Choice C rationale

While involving family can be supportive, expecting them to stay with the client constantly in a hospital setting may not always be feasible or sustainable. Although family presence can provide comfort and reorientation, it does not directly address the immediate environmental safety needs of a confused and restless client in a hospital. Normal family roles are supportive.

Choice D rationale

Moving the client to a room closer to the nurses' station allows for more frequent and direct observation by nursing staff. This increased proximity enables prompt intervention if the client attempts to get out of bed, falls, or exhibits further changes in mental status, enhancing safety without resorting to restrictive measures. Normal nursing practice prioritizes close monitoring for at-risk clients.