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"I'm concerned because I'm so tired all the time.": Fatigue is a common manifestation of SLE caused by chronic inflammation, anemia, or medication effects. While it impacts daily function, it is not an immediate threat compared to signs of infection, which can become life-threatening quickly in immunosuppressed clients.

"I feel like I'm isolated from all my friends now.": Emotional concerns like isolation are important in managing chronic illness, but they are not urgent physical issues. Addressing psychosocial health is necessary, but it does not take precedence over symptoms that may indicate infection or disease flare.

"I have a lot of questions about this disease.": Education is vital for long-term disease management and patient empowerment. However, it is not an immediate priority when signs of acute illness, such as fever, are present and require prompt clinical attention.

Vitiligo: Vitiligo is an autoimmune condition characterized by depigmented patches of skin due to melanocyte destruction. It is more commonly associated with Addison's disease, not Cushing’s syndrome, which involves cortisol excess rather than deficiency.

Myxedema: Myxedema refers to the severe hypothyroid state marked by non-pitting edema, dry skin, and slowed metabolism. It is associated with thyroid hormone deficiency, not the glucocorticoid excess seen in Cushing's syndrome.

Heat intolerance: Heat intolerance is a symptom more commonly linked to hyperthyroidism, where an increased metabolic rate leads to overheating. Clients with Cushing’s syndrome typically experience weight gain, fatigue, and cold intolerance rather than heat sensitivity.

"I will have to move out of my family's home until I am no longer contagious.": It is not necessary for the client to move out of the home, but precautions such as proper ventilation, wearing a mask, and isolating in a separate room can reduce the risk of transmission to household members during the contagious period.

"I will cover my mouth with my hands when I have to cough.": Covering the mouth is essential, but using the hands increases the risk of spreading bacteria through contact with surfaces. The client should be instructed to use a tissue or the inside of the elbow to minimize contamination.

"I will not go in public areas until I am cured.": Total avoidance of public areas is not necessary, but the client should avoid crowded places and public transport during the initial phase of treatment, typically the first few weeks, when they are still contagious.

A client who is newly diagnosed with type 1 diabetes mellitus and cannot afford insulin: This situation requires case management or social work referral to assist with access to medications and insurance. It does not indicate the need for palliative care, as diabetes is a chronic condition that can be managed effectively with proper support.

A client who has Meniere’s disease and cannot safely ambulate due to vertigo: While vertigo significantly affects quality of life, it is not life-limiting. This client would benefit more from physical therapy, home safety evaluation, and symptom management, rather than palliative care services.

A client who had a stroke and cannot eat or drink without choking: This client may need speech therapy, nutritional support, or possibly enteral feeding, but not necessarily palliative care unless their overall prognosis is poor or complications are expected to worsen.

Maintain the head of the bed greater than 45°: Elevating the head of the bed beyond 30° increases pressure and shear forces on the sacrum, contributing to skin breakdown. The bed should be maintained at the lowest elevation necessary to reduce pressure injury risk.

Place a donut-shaped cushion under the client’s sacrum: Donut-shaped cushions can impede blood flow and concentrate pressure on surrounding tissues, increasing the risk of pressure injuries rather than preventing them. Specialty foam or gel cushions are preferred for pressure redistribution.

Massage bony prominences three times daily: Massaging over bony areas is contraindicated as it may cause further tissue damage in areas already at risk for pressure injury. Prevention strategies focus on pressure relief, skin protection, and improved circulation without direct trauma.

N95 respirator: N95 respirators are required for airborne precautions, such as with tuberculosis, measles, or varicella. Bacterial meningitis, caused by organisms like Neisseria meningitidis, requires droplet precautions, which do not necessitate an N95 mask.

Goggles: Goggles are used for protection against splashes or sprays of bodily fluids, particularly in procedures that may cause aerosolization. While helpful in certain situations, goggles are not required as part of standard droplet precautions for meningitis.

Disposable gown: Gowns are worn during contact precautions or when there is a risk of contamination from bodily fluids. They are not routinely required for droplet precautions unless the nurse anticipates contact with large amounts of secretions.

Tinnitus: Tinnitus is not a typical adverse effect of ethambutol. It is more commonly associated with other anti-tuberculosis drugs such as streptomycin, which can cause ototoxicity, especially affecting the auditory and vestibular systems.

Peripheral edema: Peripheral edema is not commonly linked to ethambutol use. It may occur with certain cardiovascular medications or conditions but is not an expected side effect of this antitubercular drug.

Bradycardia: Bradycardia is not a recognized adverse effect of ethambutol. This medication primarily affects the eyes rather than the cardiovascular system. Monitoring for vision changes is a higher priority when assessing for side effects.

Administer vasopressin to the client: Vasopressin is used to constrict splanchnic circulation and reduce portal pressure, helping control variceal bleeding. However, medication administration requires functional IV access, which must be verified or established before proceeding.

Request blood from the blood bank: Blood transfusion is necessary to treat hemorrhagic shock and restore circulating volume, but requesting blood is not the immediate priority before ensuring access for administration.

Insert an indwelling urinary catheter: Monitoring urine output is important for assessing renal perfusion and fluid status, but it is not the most urgent intervention when the client is actively bleeding and hemodynamically unstable.

"Lie down after meals.": Lying down after eating increases the risk of gastric contents refluxing into the esophagus due to gravity. Clients with GERD should remain upright for at least 2 to 3 hours after meals to minimize symptoms.

"Eat a snack 1 hour before going to bed.": Eating close to bedtime can exacerbate GERD symptoms by increasing gastric volume and acid production, especially when the client lies down soon after eating. A longer gap between the last meal and sleep is advised.

"Eat three large meals each day.": Large meals increase gastric pressure and acid production, worsening reflux symptoms. Clients with GERD should eat smaller, more frequent meals to reduce gastric distension and minimize acid reflux episodes.

The client will be on bed rest while continuous bladder irrigation is in place.: Bed rest is not required solely due to continuous bladder irrigation (CBI). Early ambulation is encouraged postoperatively to prevent complications such as deep vein thrombosis and promote recovery.

Cold compresses will be used to manage bladder spasms.: Bladder spasms are common after prostate surgery, but they are typically managed with anticholinergic medications, such as oxybutynin, rather than cold compresses.

The client will have an NG tube in place for 48 hr postoperatively.: An NG tube is not routinely used following a radical prostatectomy unless the client develops complications like ileus or vomiting. Its use is not part of standard postoperative care.