A nurse is assisting with the care of a client in the emergency department.

Exhibits

The nurse is reviewing the client’s health information. For each potential provider’s prescription, tick to specify if the assessment findings is consistent with myocardial infraction or gastroesophageal reflux disease (Gerd), each finding may support more than one disease process.

Choice A reason: Providing emotional support is important for a client who has ulcerative colitis, as the condition can affect their quality of life and mental health. However, this is not the priority action for a nurse who is caring for a client who is experiencing an acute exacerbation of ulcerative colitis, as it does not address the immediate physical needs of the client.

Choice B reason: Evaluating fluid and electrolyte levels is the priority action for a nurse who is caring for a client who is experiencing an acute exacerbation of ulcerative colitis, as the client is at risk of dehydration, hypovolemia, and electrolyte imbalances due to diarrhea, vomiting, and poor oral intake. The nurse should monitor the client’s vital signs, urine output, weight, skin turgor, mucous membranes, and laboratory values such as serum sodium, potassium, chloride, bicarbonate, blood urea nitrogen (BUN), and creatinine.

Choice C reason: Promoting physical mobility is beneficial for a client who has ulcerative colitis, as it can help prevent complications such as deep vein thrombosis (DVT), pulmonary embolism (PE), and pressure ulcers. However, this is not the priority action for a nurse who is caring for a client who is experiencing an acute exacerbation of ulcerative colitis, as the client may have abdominal pain, fatigue, and weakness that limit their mobility. The nurse should encourage rest and provide comfort measures such as positioning, heat therapy, and analgesics.

Choice D reason: Reviewing stress factors that can cause disease exacerbation is helpful for a client who has ulcerative colitis, as stress can trigger or worsen inflammation in the bowel. However, this is not the priority action for a nurse who is caring for a client who is experiencing an acute exacerbation of ulcerative colitis, as it does not address the immediate physical needs of the client. The nurse should teach the client about stress management techniques and refer them to appropriate resources such as counseling or support groups.

Choice A: Blurred vision is not a typical finding of hypothyroidism. It can be caused by other conditions, such as diabetes, glaucoma, or eye strain.

Choice B: Bradycardia is a slow heart rate, usually below 60 beats per minute. This is a common finding of hypothyroidism, as the thyroid hormone regulates the metabolic rate and affects the cardiovascular system. Low levels of thyroid hormone can cause the heart to beat slower and weaker.

Choice C: Insomnia is difficulty falling or staying asleep. This is not a common finding of hypothyroidism, as low thyroid hormone levels can cause fatigue, lethargy, and excessive sleepiness.

Choice D: Moist skin is not a common finding of hypothyroidism, as low thyroid hormone levels can cause dry skin, hair loss, and britle nails. Moist skin can be a sign of hyperthyroidism, which is the opposite condition of hypothyroidism.