The nurse providing care for a client with Cushing syndrome has identified the nursing diagnosis of risk for injury related to weakness. How should the nurse best reduce this risk?

Provide constant supervision

Establish fall-prevention measures

Encourage bed rest whenever possible

Encourage the use of assistive devices

Answer and Explanation

The Correct Answer is B

Reasoning:

Choice A reason: Constant supervision is impractical and not the most effective way to reduce fall risk in Cushing syndrome. While supervision can help, it does not address environmental hazards or promote independence. Muscle weakness from corticosteroid-induced myopathy increases fall risk, making targeted prevention strategies more practical and effective.

Choice B reason: Fall-prevention measures, such as removing obstacles, ensuring adequate lighting, and using non-slip mats, directly address the risk of injury from muscle weakness in Cushing syndrome. These measures reduce environmental hazards and promote safety, effectively mitigating the risk of falls due to corticosteroid-induced myopathy and osteoporosis.

Choice C reason: Encouraging bed rest increases the risk of complications like muscle atrophy and thromboembolism in Cushing syndrome. Prolonged immobility exacerbates muscle weakness and bone loss, both already worsened by corticosteroids, making bed rest counterproductive to maintaining strength and reducing injury risk from falls.

Choice D reason: Assistive devices like canes or walkers can help, but they are not the primary strategy. Fall-prevention measures address environmental risks broadly, benefiting all patients with weakness. Devices are useful for severe mobility issues but are less comprehensive than environmental modifications for preventing falls in Cushing syndrome.

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Correct Answer is D

Explanation

Reasoning:

Choice A reason: Dilute urine is not expected in SIADH, as excessive ADH promotes water reabsorption in the kidneys’ collecting ducts, leading to concentrated urine with high osmolality. Dilute urine is characteristic of diabetes insipidus, where ADH deficiency causes excessive water loss, producing large volumes of dilute urine.

Choice B reason: Hypernatremia is not a manifestation of SIADH. Excessive ADH causes water retention, diluting serum sodium and leading to hyponatremia. Hypernatremia occurs in conditions like diabetes insipidus, where water loss concentrates sodium, opposite to the fluid overload seen in SIADH.

Choice C reason: Increased serum osmolality is not typical in SIADH. Water retention due to excessive ADH dilutes serum sodium and osmol Jon the same paragraph, and the correct answer with detailed scientific rationales for each choice. The text will be in regular font, with no bold, and each question will be clearly numbered with two lines skipped after the number and one line after the question. I will avoid in-text citations and ensure scientific explanations are detailed and at least 58 words long.

Choice D reason: Concentrated urine is a hallmark of SIADH due to excessive ADH, which promotes water reabsorption in the renal collecting ducts, reducing urine volume and increasing its osmolality. This contrasts with diabetes insipidus, where dilute urine is produced, making concentrated urine a key diagnostic feature of SIADH.

A. Offer liquids frequently, in large quantities B. Allow optimum physical activity before meals to expedite digestion C. Help the client sit upright when eating and feed slowly D. Instruct the client to lie on the bed when eating

Correct Answer is C

Explanation

Reasoning:

Choice A reason: Offering large quantities of liquids frequently increases aspiration risk in clients with dysphagia from neurological disorders. Large volumes can overwhelm swallowing mechanisms, leading to choking or pneumonia. Controlled, small sips with proper positioning are safer to ensure nutrition without compromising airway safety.

Choice B reason: Allowing physical activity before meals may improve appetite but does not address swallowing difficulties. Activity does not facilitate safe swallowing in neurological disorders, where muscle coordination is impaired. Proper positioning and pacing during feeding are more effective to prevent aspiration and ensure nutritional intake.

Choice C reason: Helping the client sit upright and feeding slowly minimizes aspiration risk in neurological dysphagia. Upright positioning aligns the airway to prevent food or liquid entry, and slow feeding allows better coordination of swallowing muscles, reducing choking and ensuring adequate nutrition, critical for safe intake.

Choice D reason: Instructing the client to lie down while eating is dangerous in dysphagia, as it increases aspiration risk. Lying down allows food or liquids to enter the airway, potentially causing pneumonia. Upright positioning is essential to facilitate safe swallowing and prevent complications in neurological disorders.

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The nurse providing care for a client with Cushing syndrome has identified the nursing diagnosis of risk for injury related to weakness. How should the nurse best reduce this risk?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client has been diagnosed with syndrome of inappropriate antidiuretic hormone secretion (SIADH). Which of the following manifestations would be expected in this client?

Correct Answer is D

Explanation

A client with a neurological disorder has difficulty swallowing. The nurse should take special care with the client’s diet because of a potential risk of imbalanced nutrition. Which measure may be taken by the nurse to ensure that the client’s diet allows for easy swallowing?

Correct Answer is C

Explanation

A client is diagnosed with a right-sided stroke. The client is now experiencing hemianopsia. How can the nurse help the client manage potential sensory and perceptual difficulties?

A nurse is assisting a client who had a recent stroke with getting dressed for physical therapy. The client looks at each piece of clothing before putting it on the body. The client states, “This is how I know what item I am holding.” What impairment is this client likely experiencing?

Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?

A client has been placed on corticosteroid therapy for Addison's disease. The nurse should be aware of which of the following side effects associated with this type of therapy? (Select all that apply)

While monitoring a client for the development of disseminated intravascular coagulation (DIC), the nurse should take note of which assessment parameters?

A client receiving long-term treatment with high-dose corticosteroids is expected to exhibit which of the following?

A client has been taking tricyclic antidepressants for many years for the treatment of depression. The client has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this client? (Select all that apply)

A client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?