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. Hepatomegaly B. Crackles in the lungs C. Dry, hacking cough D. Dizziness

Correct Answer is A

Explanation

A. Hepatomegaly: Hepatomegaly, or enlargement of the liver, is a common finding in right-sided heart failure due to congestion of the liver from impaired venous return. It indicates systemic venous congestion.

B. Crackles in the lungs: Crackles in the lungs are more commonly associated with left-sided heart failure, which leads to pulmonary congestion. Right-sided heart failure primarily causes systemic venous congestion rather than pulmonary issues.

C. Dry, hacking cough: A dry, hacking cough is not typically associated with right-sided heart failure. It is more related to left-sided heart failure or other pulmonary conditions.

D. Dizziness: Dizziness can occur in various conditions, including heart failure, but it is not a specific finding for right-sided heart failure. It is often due to decreased cardiac output or orthostatic hypotension.

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