The nurse is caring for a client diagnosed with delirium. Which of the following should be the priority for treatment?

Identifying the underlying cause.

Keeping the environment quiet.

Reorienting the client often.

Monitoring nutritional intake.

Answer and Explanation

The Correct Answer is A

A. The priority for treating delirium is to identify and address the underlying cause. Delirium is often a symptom of an acute condition such as infection, metabolic disturbances, medication side effects, or other physical issues. Treating the root cause of delirium can help resolve the condition more effectively.
B. While creating a calm, quiet environment can help reduce confusion and agitation, it is not the most critical aspect of treatment. The main focus should be on addressing the cause of the delirium.
C. Reorienting the client is important for safety and reducing confusion, but it will not be sufficient to resolve the delirium if the underlying cause is not addressed. Reorientation is a supportive measure, not the priority intervention.
D. Although monitoring nutrition is important for overall health, it is not the first priority in treating delirium unless malnutrition is identified as a contributing factor to the delirium.

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Correct Answer is C

Explanation

A. Low serum thyroxine (T4) level In hyperthyroidism, the serum thyroxine (T4) level is typically elevated due to excessive production of thyroid hormones.
B. Decreased serum thyroid stimulating hormone (TSH) In hyperthyroidism, the body produces excess thyroid hormones (T3 and T4), which negatively feedback to the pituitary gland and result in decreased TSH levels. This is a key diagnostic finding.
C. Tachycardia or fine hand tremor Hyperthyroidism often causes symptoms like tachycardia (increased heart rate) and a fine hand tremor due to the overstimulation of the body's metabolism and sympathetic nervous system.
D. Elevated serum thyroid stimulating hormone (TSH) In hyperthyroidism, the TSH level is typically low due to negative feedback from the excess thyroid hormones.
E. Elevated serum thyroxine (T4) In hyperthyroidism, the serum thyroxine (T4) level is elevated because the thyroid gland is producing too much thyroid hormone.

A. The body attacks the thyroid gland, decreasing the amount of thyroid hormone. B. Graves' disease is caused by inflammation of the thyroid gland. C. Immunoglobulins cause excess in thyroid hormones. D. Graves' disease is most commonly seen in men.

Correct Answer is C

Explanation

A. In Graves' disease, the immune system attacks the thyroid gland, but the result is an overproduction of thyroid hormones (hyperthyroidism), not a decrease.
B. Graves' disease is an autoimmune disorder in which the immune system produces antibodies (known as thyroid-stimulating immunoglobulins) that stimulate the thyroid gland to produce excess thyroid hormones. It is not primarily an inflammatory condition.
C. Immunoglobulins cause excess in thyroid hormones Graves' disease is an autoimmune disorder in which the body produces thyroid-stimulating immunoglobulins (TSIs) that bind to thyroid cells and stimulate the thyroid to produce excess thyroid hormones. This leads to hyperthyroidism.
D. Graves' disease is more commonly seen in women, particularly those between the ages of 20 and 40. Men are less likely to develop this condition.

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The nurse is caring for a client diagnosed with delirium. Which of the following should be the priority for treatment?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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