A nurse is assisting with the plan of care for a client who is 4 hr postoperative from a subtotal thyroidectomy. Which of the following implementations should the nurse recommend?

Check for bleeding on the dressing at the back of the client’s neck.

Ensure that acetylcysteine IV is readily available.

Place the client in a side-lying position.

Check the client for asterixis.

Answer and Explanation

The Correct Answer is A

Choice A: Check for bleeding on the dressing at the back of the client’s neck. This is an implementation that the nurse should recommend for a client who is 4 hr postoperative from a subtotal thyroidectomy, which is a surgical removal of part of the thyroid gland. The nurse should check for bleeding on the dressing at the back of the client’s neck because this is where blood can pool and go unnoticed. Bleeding can cause hematoma, compression of the airway, and respiratory distress.

Choice B: Ensure that acetylcysteine IV is readily available. This is not an implementation that the nurse should recommend for a client who is 4 hr postoperative from a subtotal thyroidectomy. Acetylcysteine IV is an antidote for acetaminophen overdose, which can cause liver damage, but it is not related to thyroid surgery.

Choice C: Place the client in a side-lying position. This is not an implementation that the nurse should recommend for a client who is 4 hr postoperative from a subtotal thyroidectomy. The nurse should place the client in a semi-Fowler’s position, which is a position with the head of the bed elevated to 30 to 45 degrees. This position can facilitate breathing, reduce edema, and prevent aspiration.

Choice D: Check the client for asterixis. This is not an implementation that the nurse should recommend for a client who is 4 hr postoperative from a subtotal thyroidectomy. Asterixis is a sign of hepatic encephalopathy, which is a condition caused by liver failure, but it is not related to thyroid surgery.

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Correct Answer is A

Explanation

Choice A: “Monitor blood glucose levels every 4 hours.” This is the priority action for the nurse to recommend to the client because it will help them detect and prevent hyperglycemia or hypoglycemia, which can lead to serious complications such as diabetic ketoacidosis or cerebral edema.

Choice B: “Consume 15 grams of carbohydrates every 1 to 2 hours.” This is an important action for the nurse to recommend to the client, but not the priority. The client should consume carbohydrates to prevent hypoglycemia, especially if they have nausea, vomiting, or diarrhea, but this should be done after monitoring their blood glucose levels.

Choice C: “Drink 8 ounces of ﬂuid every hour while awake.” This is a necessary action for the nurse to recommend to the client, but not the priority. The client should drink ﬂuids to prevent dehydration and electrolyte imbalance, which can worsen hyperglycemia, but this should be done after monitoring their blood glucose levels.

Choice D: “Take the usual dosage of insulin.” This is a required action for the nurse to recommend to the client, but not the priority. The client should take their insulin as prescribed to control their blood glucose levels, but this should be done after monitoring their blood glucose levels and adjusting the dosage if needed.

A. Purple striations B. Tremors C. Buﬀalo hump D. Obese extremities E. Moon face

Correct Answer is ["A","C","E"]

Explanation

Choice A: Purple striations. These are also known as striae, and they are caused by the thinning and weakening of the skin and underlying connective tissue due to cortisol. They appear as purple or red lines on the abdomen, thighs, breasts, or arms.

Choice C: Buﬀalo hump. This is a term used to describe the accumulation of fat on the upper back and neck due to cortisol. It gives the appearance of a hump or a rounded shape.

Choice E: Moon face. This is a term used to describe the rounding and fullness of the face due to cortisol. It gives the

appearance of a moon-like shape.

Choice B: Tremors. These are not a clinical manifestation of Cushing’s syndrome, but rather a sign of hyperthyroidism, which is a condition caused by excess thyroid hormone production or exposure. Thyroid hormone aﬀects the nervous system and causes increased muscle activity and tremors.

Choice D: Obese extremities. These are not a clinical manifestation of Cushing’s syndrome, but rather a sign of hypothyroidism, which is a condition caused by low thyroid hormone production or exposure. Thyroid hormone aﬀects the metabolism of carbohydrates, proteins, and fats, and causes decreased energy expenditure and weight gain.

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