The nurse is caring for a client with a medical diagnosis of Cushing's syndrome.
What would the nurse include in the plan of care?

Cluster activities in the morning when well rested.

Teach the client to increase fluid intake.

Request a medical prescription for cortisol.

Assess daily weights.

Answer and Explanation

The Correct Answer is D

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.

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Correct Answer is ["9"]

Explanation

Step 1 is: Heart rate 120 BPM = 2 points (HR > 100 BPM).

Step 2 is: Strong cry = 2 points (Strong cry/cough).

Step 3 is: Well-flexed = 2 points (Well flexed).

Step 4 is: Reflex-crying = 2 points (Cry/sneeze).

Step 5 is: Body pink; acrocyanosis present in hands and feet = 1 point (Body pink, extremities blue).

Step 6 is: Add up all the points: 2 + 2 + 2 + 2 + 1 = 9.

Answer: 9.

A. The need for frequent enemas to stimulate bowel movements. B. The importance of avoiding medications that can cause constipation. C. The importance of maintaining a high-fiber diet. D. Strict adherence to a low-protein diet. E. The need for daily laxative use to promote bowel movements. F. The need for surgical intervention to correct the condition. G. The need for frequent visits to the emergency department for bowel management.

Correct Answer is ["B","F"]

Explanation

Choice A rationale

Frequent enemas are sometimes used in the management of Hirschsprung's disease, but their primary purpose is to empty the bowel of accumulated stool, not to stimulate bowel movements. The disease is characterized by an absence of ganglion cells, which prevents normal peristalsis, making stimulation ineffective.

Choice B rationale

Avoiding medications that can cause constipation is crucial for children with Hirschsprung's disease. Since their colon lacks the necessary ganglion cells for normal peristalsis, any further slowing of bowel transit due to medication can exacerbate fecal impaction and increase the risk of enterocolitis.

Choice C rationale

Maintaining a high-fiber diet is generally contraindicated in Hirschsprung's disease. High-fiber diets increase stool bulk, which can worsen constipation and impaction in a colon that is unable to propel stool effectively due to the absence of ganglion cells in the affected segment.

Choice D rationale

There is no specific evidence or recommendation for strict adherence to a low-protein diet in the management of Hirschsprung's disease. Dietary interventions primarily focus on managing constipation and preventing enterocolitis, rather than protein restriction, which can impact growth and development.

Choice E rationale

Daily laxative use is generally not recommended as a primary long-term management strategy for Hirschsprung's disease. While laxatives might provide temporary relief, they do not address the underlying physiological defect and can lead to dependency or electrolyte imbalances. Surgical correction is the definitive treatment.

Choice F rationale

Surgical intervention is the definitive treatment for Hirschsprung's disease. This involves removing the aganglionic segment of the bowel, allowing for normal peristalsis to be restored. Without surgery, the child will continue to experience severe constipation, impaction, and potential life-threatening complications like enterocolitis.

Choice G rationale

While complications like enterocolitis in Hirschsprung's disease may necessitate emergency department visits, the goal of management is to minimize these occurrences through appropriate medical and surgical interventions. Frequent visits for routine bowel management indicate suboptimal long-term care, not a planned approach.

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The nurse is caring for a client with a medical diagnosis of Cushing's syndrome. What would the nurse include in the plan of care?

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Naxlex Comprehensive Predictor Exams

When calculating a 1-minute APGAR, the nurse evaluates the following assessment data: Heart rate 120 BPM; strong cry; well-flexed; reflex-crying: body pink; acrocyanosis present in hands and feet. In view of these findings, the nurse should assign an APGAR score of:

Correct Answer is ["9"]

Explanation

A nurse is caring for a child diagnosed with Hirschsprung's disease. Which of the following should the nurse include in the education of the child's parents? (Select All that Apply.)

Correct Answer is ["B","F"]

Explanation

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The nurse is caring for a client with a medical diagnosis of Cushing's syndrome.
What would the nurse include in the plan of care?