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A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize as progressing to myxedema coma? Select all that apply.

Hypertension

Restlessness

Increased level of alertness

Tachycardia

Hypotension

Bradycardia

Hypoventilation

Hyperventilation

Answer and Explanation

Correct Answer : E,F,G

Choice A reason:

Hypertension is not typically associated with myxedema coma. Myxedema coma is characterized by severe hypothyroidism, which usually leads to low blood pressure (hypotension) rather than high blood pressure (hypertension). Therefore, hypertension is not a clinical manifestation that indicates progression to myxedema coma.

Choice B reason:

Restlessness is not a common symptom of myxedema coma. Patients with myxedema coma often present with lethargy, confusion, or even coma due to the severe slowing of metabolic processes. Restlessness is more commonly associated with hyperthyroidism or other conditions that increase metabolic activity.

Choice C reason:

An increased level of alertness is contrary to the symptoms of myxedema coma. Myxedema coma typically presents with decreased mental status, including confusion, stupor, or coma. Therefore, an increased level of alertness would not be indicative of progression to myxedema coma.

Choice D reason:

Tachycardia (rapid heart rate) is not a typical symptom of myxedema coma. Instead, myxedema coma is associated with bradycardia (slow heart rate) due to the severe hypothyroid state. Tachycardia is more commonly seen in hyperthyroid conditions.

Choice E reason:

Hypotension (low blood pressure) is a key clinical manifestation of myxedema coma. The severe hypothyroid state leads to decreased cardiac output and vascular resistance, resulting in hypotension. This is a critical sign that the nurse should recognize as indicative of progression to myxedema coma.

Choice F reason:

Bradycardia (slow heart rate) is another hallmark of myxedema coma. The decreased metabolic rate in severe hypothyroidism leads to a reduced heart rate. Recognizing bradycardia is essential in identifying the progression to myxedema coma.

Choice G reason:

Hypoventilation (reduced breathing rate) is a significant symptom of myxedema coma. The severe hypothyroid state can lead to respiratory depression, resulting in hypoventilation. This can further exacerbate the patient’s condition and requires immediate medical attention.

Choice H reason:

Hyperventilation (increased breathing rate) is not associated with myxedema coma. Patients with myxedema coma typically experience hypoventilation due to the severe slowing of metabolic processes. Hyperventilation would be more indicative of conditions that increase metabolic activity or respiratory drive.

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Correct Answer is B

Explanation

Choice A reason: An increase in temperature is not a primary indicator of hypovolemic shock. While fever can occur due to infection or inflammation, it is not directly related to hypovolemic shock, which is primarily characterized by a significant loss of blood or fluids leading to decreased perfusion and oxygenation of tissues.

Choice B reason: A decrease in urinary output is a critical sign of hypovolemic shock. When the body loses a significant amount of blood or fluids, the kidneys receive less blood flow, leading to reduced urine production. This is a compensatory mechanism to conserve fluids and maintain blood pressure. Normal urine output is typically around 30 to 50 mL per hour, so a drop below this range is concerning.

Choice C reason: An increase in heart rate is a common response to hypovolemic shock as the body attempts to maintain cardiac output and blood pressure despite the loss of blood volume. Tachycardia (increased heart rate) is one of the early signs of shock, indicating that the heart is working harder to pump blood to vital organs.

Choice D reason: A decrease in respiratory rate is not typical of hypovolemic shock. In fact, hypovolemic shock often leads to an increased respiratory rate (tachypnea) as the body tries to compensate for decreased oxygen delivery to tissues. A decrease in respiratory rate could indicate other issues but is not a hallmark of hypovolemic shock.

A. Rosebud-like stoma orifice B. Stoma oozing red drainage C. Shiny, moist stoma D. Purplish-colored stoma

Correct Answer is D

Explanation

Choice A Reason:

A rosebud-like stoma orifice is a normal finding for a newly created colostomy. This appearance indicates that the stoma is healthy and well-formed. The stoma should protrude slightly from the abdomen and have a pink or red color, similar to the inside of the mouth. This indicates good blood flow and proper healing. Therefore, a rosebud-like stoma orifice does not need to be reported to the provider.

Choice B Reason:

A stoma oozing red drainage can be concerning, but it is not uncommon for a new stoma to have some minor bleeding or oozing, especially in the immediate postoperative period. This can occur due to the delicate nature of the tissue and the recent surgical intervention. However, if the drainage is excessive or persistent, it should be monitored closely and reported if it does not improve. Minor oozing is generally expected and does not necessarily indicate a serious problem.

Choice C Reason:

A shiny, moist stoma is a normal finding and indicates that the stoma is healthy. The stoma should be moist and have a shiny appearance, similar to the inside of the mouth. This moisture is necessary for the proper function and health of the stoma. Therefore, a shiny, moist stoma does not need to be reported to the provider.

Choice D Reason:

A purplish-colored stoma is an abnormal finding and should be reported to the provider immediately. This discoloration can indicate compromised blood flow to the stoma, which can lead to tissue necrosis if not addressed promptly. A healthy stoma should be pink or red, indicating good blood circulation. Any deviation from this color, especially a purplish or dark color, is a sign of potential ischemia or other serious complications that require immediate medical attention.

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A client has been diagnosed with myxedema from long-standing hypothyroidism. What clinical manifestations of this disorder does the nurse recognize as progressing to myxedema coma? Select all that apply.

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who returns to the nursing unit from the recovery room after a sigmoid colon resection for adenocarcinoma. The client had an episode of intraoperative bleeding. Which finding indicates to the nurse that the client may be developing hypovolemic shock?

Correct Answer is B

Explanation

A nurse in a PACU is assessing a client who has a newly created colostomy. Which of the following findings should the nurse report to the provider?

Correct Answer is D

Explanation

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