A nurse is assisting with the care of a client.

Complete the following sentence by using the lists of options.

After notifying the provider, the nurse should first

______

and then

_______

A. “I may notice an increase in the firmness of my breasts.”: During menopause, breasts typically become less firm and more fatty due to decreased estrogen levels. Loss of glandular tissue and changes in connective tissue elasticity cause breasts to feel softer, not firmer.

B. "My estrogen levels will elevate”: Estrogen levels decline significantly during menopause, not elevate. This hormonal decrease leads to many of the physical and emotional symptoms associated with menopause, including hot flashes, vaginal dryness, and bone density loss.

C. "I may experience more vaginal dryness.": Vaginal dryness is a common and expected symptom during menopause due to the reduction in estrogen. Lower estrogen levels cause thinning and decreased lubrication of the vaginal tissues, often resulting in discomfort during intercourse and increased risk of irritation or infection.

D. "I may become cold more often.": Clients undergoing menopause typically experience hot flashes and night sweats, not an increased tendency to feel cold. Hot flashes are sudden sensations of heat and are one of the most recognized and frequent symptoms of menopausal transition.

• Report of menstrual cycle (absent for 3 months): The nurse’s notes state that the client has not had a menstrual period for three months. In hyperthyroidism, menstrual irregularities such as amenorrhea are common due to hormonal imbalance. This supports hyperthyroidism based on the client's current symptoms..
• Weight change (unplanned weight loss): The client reports experiencing unplanned weight loss over three months despite having a good appetite. This suggests an increased metabolic rate, which is consistent with hyperthyroidism. Unintentional weight loss despite normal eating is a key indicator.
• Skin condition (warm and moist): The client's skin is described as warm and moist during physical assessment. Hyperthyroidism causes increased blood flow and sweat gland activity, leading to this type of skin condition. It reflects the body's accelerated metabolic processes.
• Neck exam (goiter visualized): The nurse notes the presence of a visible goiter on neck examination. A goiter indicates thyroid gland enlargement, which occurs in hyperthyroidism due to overstimulation and overproduction of thyroid hormones. This is a major physical finding.
• Laboratory results (T3, T4, TSI ordered): The provider orders tests for T3, Free T4, and TSI to evaluate thyroid function. These specific labs are ordered when hyperthyroidism is suspected, particularly TSI which is associated with Graves’ disease. The decision to order them aligns with the findings.
• Eye appearance (exophthalmos noted): Exophthalmos, or outward bulging of the eyes, is noted by the nurse. This finding is strongly associated with hyperthyroidism, especially Graves' disease. It occurs due to inflammation and fluid buildup behind the eyes, worsening as thyroid dysfunction progresses.