When assessing an adult client experiencing diarrhea, the nurse notes a round "moon" face, a buffalo hump at the nape of the neck, and a velvety discoloration around the neck. What is the possible cause of these signs?

Bell's palsy

Myxedema

Cushing's syndrome

Scleroderma

Answer and Explanation

The Correct Answer is C

A. Bell's palsy: Bell's palsy is characterized by sudden, unilateral facial weakness or paralysis. It does not cause the specific physical signs described in the question, such as a "moon" face, buffalo hump, or velvety discoloration around the neck.

B. Myxedema: Myxedema is associated with severe hypothyroidism and can lead to symptoms such as facial swelling and changes in skin texture, but it does not typically cause a round face, buffalo hump, or velvety neck discoloration. The velvety discoloration around the neck is more characteristic of insulin resistance rather than hypothyroidism.

C. Cushing's syndrome: Cushing's syndrome is caused by excess cortisol and is known for the characteristic signs described. A "moon" face, buffalo hump, and skin changes such as velvety discoloration (often termed "acanthosis nigricans") are hallmark features of this condition. These symptoms align with the body’s response to prolonged high levels of cortisol.

D. Scleroderma: Scleroderma involves skin thickening and tightening, primarily affecting the hands and face, but it does not typically cause a "moon" face, buffalo hump, or velvety neck discoloration. The changes in scleroderma are more related to skin fibrosis and less to the specific physical features listed.

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Correct Answer is D

Explanation

A) "Do you feel like crying often?": This question is more focused on assessing mood rather than cognitive function. While mood is an important aspect of mental health, it is not the primary focus in a neurological examination. The goal of a neurological assessment is to evaluate cognitive functions, orientation, and mental status.
B) "Do you have a history of psychotic disorder?": Asking about a history of psychotic disorders might be relevant in some contexts but does not directly assess the current mental status of the client. This question is more about past psychiatric history than current cognitive or neurological function.
C) "Can you tell me about your mood today?": While understanding a client’s mood can be valuable for overall mental health assessment, this question does not specifically assess cognitive functions or orientation. It is important to evaluate mood, but it is not the primary question for assessing neurological status.
D) "Can you tell me where you are right now?": This question is appropriate for assessing orientation, a key component of a neurological examination. Orientation questions assess a person's awareness of their current environment, which helps evaluate their cognitive function and mental status. This is directly relevant to a neurological assessment as it determines if the client is aware of their surroundings, which is crucial for understanding cognitive and neurological function.

A. Instruct the patient on Tripod positioning B. Restrict the client's fluid intake to less than 2 L/day. C. Provide the client with a low-protein diet. D. Have the client use the early-morning hours for exercise and activity.

Correct Answer is A

Explanation

A) Instruct the patient on Tripod positioning: Tripod positioning involves the patient sitting or standing with their hands on their knees or a table, which helps in optimizing lung expansion and improving breathing. This position can help clients with COPD ease their breathing by increasing the use of accessory muscles and allowing the diaphragm to work more efficiently.
B) Restrict the client's fluid intake to less than 2 L/day: Restricting fluid intake is generally not recommended for COPD patients unless there are specific signs of fluid retention or other contraindications. Adequate fluid intake is important to keep mucus thin and easier to expel. Restricting fluids may worsen mucus thickness and make it harder to clear secretions.
C) Provide the client with a low-protein diet: COPD patients often need a higher-protein diet to help maintain muscle mass and support overall nutritional status. A low-protein diet would not be appropriate as it could lead to muscle wasting and decreased respiratory muscle strength.
D) Have the client use the early-morning hours for exercise and activity: While physical activity is important, the timing of exercise should be tailored to the client's individual tolerance and condition. Early-morning exercise might not be suitable for all patients, especially if they experience morning respiratory symptoms or have other considerations. The key is to find an optimal time that aligns with the patient's energy levels and condition.

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When assessing an adult client experiencing diarrhea, the nurse notes a round "moon" face, a buffalo hump at the nape of the neck, and a velvety discoloration around the neck. What is the possible cause of these signs?

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Correct Answer is A

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