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.
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Confronting bullying behavior directly establishes clear professional boundaries and expectations within the unit. This approach fosters a psychologically safe environment, which is crucial for team cohesion and optimal patient care. Addressing the issue promptly prevents escalation and demonstrates leadership commitment to a respectful workplace, promoting accountability and encouraging healthier communication patterns among staff.
Choice B rationale
Modeling bullying behavior is counterproductive and unethical, as it normalizes and perpetuates harmful actions within the workplace. Such actions undermine trust, decrease morale, and can lead to increased stress, burnout, and higher staff turnover rates. A nurse manager's role is to promote a positive and supportive work environment, not to emulate detrimental behaviors.
Choice C rationale
Ignoring horizontal violence, even if not physical, can have significant negative psychological and professional consequences for staff members and the unit. Verbal abuse and gossip erode trust, create a toxic work environment, and can lead to increased anxiety, depression, and decreased job satisfaction, ultimately impacting patient care quality.
Choice D rationale
While logging observed behavior is a useful documentation tool, waiting for an annual evaluation to address horizontal violence delays necessary intervention. Prompt and direct confrontation is essential to mitigate immediate harm and prevent further escalation. Addressing the issue in a timely manner demonstrates a commitment to a safe workplace and supports a healthy team dynamic.
Correct Answer is ["-2"]
Explanation
Step 1 is to calculate the change in blood pressure. Change in systolic blood pressure = 148 mm Hg - 130 mm Hg = 18 mm Hg. Change in diastolic blood pressure = 88 mm Hg - 80 mm Hg = 8 mm Hg.
Step 2 is to calculate the change in weight. Change in weight = 44.5 kg - 42.2 kg = 2.3 kg.
Step 3 is to calculate the change in pulse oximetry. Change in pulse oximetry = 98% - 100% = -2%.
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