A nurse is caring for a client who has Cushing's syndrome. Which of the following interventions should the nurse expect to perform? (Select all that apply.)

Assess for neck vein distention

Monitor for postural hypotension

Assess blood glucose level

Monitor for an irregular heart rate

Weigh the client daily

Answer and Explanation

Correct Answer : A,C,D,E

A. Assess for neck vein distention: Neck vein distention can occur in Cushing's syndrome due to fluid retention and hypertension. It is an important sign to monitor as it can indicate complications like heart failure.

B. Monitor for postural hypotension: Clients with Cushing's syndrome typically have hypertension rather than hypotension. Therefore, postural hypotension is not a common issue to monitor for in these patients.

C. Assess blood glucose level: Hyperglycemia is common in Cushing's syndrome due to increased cortisol levels, which promote glucose production and reduce glucose uptake by cells. Monitoring blood glucose is essential to manage this condition.

D. Monitor for an irregular heart rate: Cushing's syndrome can cause electrolyte imbalances (like hypokalemia), which may lead to cardiac arrhythmias, so monitoring for an irregular heart rate is important.

E. Weigh the client daily: Daily weight monitoring helps track fluid retention, which is common in Cushing's syndrome due to cortisol-induced fluid retention. This can help in managing the client’s fluid status and detecting worsening of symptoms.

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Correct Answer is C

Explanation

A. Percuss each lung segment for 15 min.: Percussing each lung segment for 15 minutes is excessive and could be uncomfortable or even harmful to the child. CPT sessions are typically shorter and are rotated among different lung segments to effectively clear secretions without causing discomfort or damage.

B. Perform vibration during the client's inspirations. Vibration is usually performed during the client's expirations, not inspirations. This helps to dislodge mucus and facilitate its removal during the exhalation phase when the airways are narrowing and pushing mucus out.

C. Administer albuterol prior to CPT: Administering a bronchodilator like albuterol before CPT helps to open the airways, making it easier to clear mucus. This is a recommended practice to enhance the effectiveness of CPT and improve airway clearance.

D. Perform CPT immediately after the child eats. Performing CPT immediately after eating is not advisable because it can lead to discomfort, nausea, or vomiting. It is typically recommended to wait at least 1-2 hours after meals to perform CPT.

A. "Your blood sugar is very unstable." B. "Your blood sugar is too high after meals." C. "Your average blood sugar is high." D. "You have many dangerously low blood sugar levels."

Correct Answer is C

Explanation

A. "Your blood sugar is very unstable." While high HbA1C levels can indicate poor glucose control, they do not specifically indicate instability in blood sugar levels (i.e., frequent fluctuations between high and low levels). HbA1C does not capture short-term variations in blood glucose; it only provides an average over a few months.

B. "Your blood sugar is too high after meals." Although postprandial (after-meal) glucose levels contribute to overall blood glucose levels, HbA1C measures the average blood glucose level over several months and is not specific to postprandial glucose levels. A high HbA1C suggests elevated glucose levels overall, not just after meals.

C. "Your average blood sugar is high." HbA1C measures the average blood sugar level over an extended period, typically 2-3 months. A result of 9% indicates that the client's average blood glucose levels have been consistently high, suggesting poor long-term glucose control. This is a precise and appropriate statement reflecting the meaning of the HbA1C result.

D. "You have many dangerously low blood sugar levels." A high HbA1C indicates elevated blood glucose levels over time, not low levels. Low blood sugar levels (hypoglycemia) would not contribute to a high HbA1C. In fact, frequent hypoglycemia would more likely result in a lower HbA1C, not a higher one.

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