A nurse is reinforcing discharge teaching about postpartum activity restrictions to a client who had a cesarean birth 2 days ago. Which of the following statements by the client indicates an understanding of the teaching?

Rationale:

 • Report of menstrual cycle: The client’s last menstrual period was 3 months ago, indicating amenorrhea. This is commonly seen in hyperthyroidism due to hormonal imbalances that interfere with normal menstrual regulation.

 • Weight change: She reports a 3-month history of unintentional weight loss with a good appetite, which reflects the increased metabolic rate typically caused by elevated thyroid hormone levels in hyperthyroidism.

 • Skin condition: Her skin is described as warm and moist, which is consistent with hyperthyroidism. Excess thyroid hormone increases heat production and stimulates the sweat glands.

 • Neck exam: The presence of a visible goiter suggests thyroid gland enlargement, often due to overstimulation by thyroid-stimulating immunoglobulins in autoimmune hyperthyroidism like Graves' disease. A goiter can occur in Hypothyroidism (e.g., Hashimoto's thyroiditis) as the gland tries to compensate. Therefore, this finding is consistent with both.

 • Laboratory results: Elevated T3 (230 ng/dL), free T4 (3.4 ng/dL), and TSI (150%) confirm hyperthyroidism. These values exceed the normal range and strongly indicate an overactive thyroid gland.

 • Eye appearance: Exophthalmos (protruding eyes) is observed, a hallmark of Graves’ disease. This autoimmune feature is linked exclusively to hyperthyroidism and is caused by inflammation and tissue buildup behind the eyes.

Rationale:

A. “I should try to focus on pleasant images to help replace stressful and negative feelings I have.”: This describes guided imagery, a relaxation technique that uses visualization to reduce stress. While helpful, it does not involve the cognitive restructuring.

B. “I will use my smartwatch to monitor my sleep and heart rate to assist me with gaining voluntary control over my stress.”: This reflects biofeedback, where physiological responses are tracked and managed through conscious control. It involves physical awareness, not cognitive reinterpretation of stress.

C. "I should reassess the situation and change my perceptions of stress by replacing irrational beliefs.”: This is cognitive reframing, a technique that helps clients identify and challenge distorted thinking and replace it with more rational, constructive thoughts to alter their emotional responses to stress.

D. "I will tense my muscles for 8 seconds and then relax them to release the tension caused by my stress.”: This refers to progressive muscle relaxation, which targets physical symptoms of stress rather than the cognitive processes addressed in cognitive reframing.