Which admission assessment findings should the nurse document related to a client who has been diagnosed with Cushing’s syndrome?

Husky voice and complaints of hoarseness.

Warm, soft, moist, salmon-colored skin.

Visible swelling of the neck, with no pain.

Central-type obesity, with thin extremities.

Answer and Explanation

The Correct Answer is D

Choice A reason: A husky voice and complaints of hoarseness are not related to Cushing's syndrome, but may indicate a thyroid disorder or vocal cord damage.

Choice B reason: Warm, soft, moist, salmon-colored skin is not a characteristic of Cushing's syndrome, but may be seen in hyperthyroidism or infection.

Choice C reason: Visible swelling of the neck, with no pain, is not a sign of Cushing's syndrome, but may indicate a goiter or thyroid enlargement.

Choice D reason: Central-type obesity, with thin extremities, is a common feature of Cushing's syndrome, which is caused by excess cortisol production or exposure. Cortisol causes fat redistribution to the trunk, face, and back of the neck, while causing muscle wasting and weakness in the arms and legs.

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Correct Answer is A

Explanation

Choice A reason: Demonstrating the use of visual scanning during meals can help the client overcome the difficulty with visual perception, which is a common problem after a CVA. Visual perception is the ability to interpret and process the information received from the eyes. A CVA can damage the parts of the brain that are responsible for visual perception, causing impairments such as hemianopia, neglect, or agnosia. Visual scanning is a technique that involves moving the eyes or the head from side to side to scan the entire visual field and compensate for the missing or distorted information. Visual scanning can help the client see all the food on the tray and eat more adequately.

Choice B reason: Explaining that weight loss will be reversed after the acute phase of the stroke has ended is not a helpful response to the family's concern, as it does not address the current issue of the client's nutritional status. Weight loss is a common complication of CVA, due to factors such as dysphagia, anorexia, depression, or medication side effects. Weight loss can affect the client's recovery, immunity, and quality of life. Weight loss may or may not be reversed after the acute phase of the stroke, depending on the client's condition, treatment, and rehabilitation.

Choice C reason: Suggesting that the family bring foods from home that the client enjoys eating is not a sufficient response to the family's concern, as it does not address the underlying cause of the client's poor intake. The client's difficulty with visual perception may prevent her from seeing or recognizing the food, regardless of whether it is from the hospital or from home. The family should also consider the client's dietary restrictions, allergies, and preferences before bringing any food from home.

Choice D reason: Encouraging the family to offer to feed the client when she does not eat her entire meal is not an appropriate response to the family's concern, as it may undermine the client's autonomy and dignity. The client's difficulty with visual perception may not affect her ability to feed herself, as long as she can see the food and the utensils. The family should respect the client's independence and self-care, and only assist her when necessary. The family should also avoid forcing or coaxing the client to eat more than she wants, as this may cause discomfort or resentment.

A. Cleanse the tongue and mouth with swabs. B. Administer a topical analgesic per protocol. C. Obtain a soft diet for the client. D. Encourage frequent mouth care.

Correct Answer is B

Explanation

Choice A reason: Cleaning the tongue and mouth with swabs is not the best initial nursing action, as it can cause more irritation and pain to the mucous membranes. Swabs can be abrasive and harsh on the inflamed and ulcerated tissues. The client should use a soft toothbrush or a sponge to gently clean the tongue and mouth, and avoid alcohol-based mouthwashes or rinses.

Choice B reason: Administering a topical analgesic per protocol is the best initial nursing action, as it can provide immediate relief and comfort to the client. Topical analgesics can numb the nerve endings and reduce the sensation of pain in the tongue and mouth. The client should follow the health care provider's instructions on how to apply the analgesic, and avoid eating or drinking for at least 30 minutes after the application.

Choice C reason: Obtaining a soft diet for the client is a correct nursing action, but not the best initial one, as it can help prevent further trauma and damage to the mucous membranes. A soft diet consists of foods that are easy to chew and swallow, such as soups, puddings, yogurts, and mashed potatoes. The client should avoid foods that are spicy, acidic, salty, or hard, such as citrus fruits, tomatoes, chips, and nuts.

Choice D reason: Encouraging frequent mouth care is a correct nursing action, but not the best initial one, as it can help prevent infection and promote healing of the mucous membranes. Frequent mouth care involves rinsing the mouth with water or saline solution several times a day, especially after meals and before bedtime. The client should also keep the lips moist with a lip balm or petroleum jelly.

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Which admission assessment findings should the nurse document related to a client who has been diagnosed with Cushing’s syndrome?

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