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
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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Administering a nebulized beta-adrenergic: Administering a nebulized beta-adrenergic agonist (such as albuterol) is the highest priority because it rapidly opens the airways by relaxing the bronchial smooth muscle. This intervention is crucial for immediate relief of bronchospasm and improving ventilation during an asthma exacerbation.
B. Initiating oxygen therapy: While oxygen therapy is important for maintaining adequate oxygenation, it does not address the underlying bronchoconstriction. Therefore, it is secondary to bronchodilator administration in terms of priority.
C. Providing immediate rest for the client: Rest is important, but it is not an immediate priority in an acute asthma exacerbation. The primary focus should be on improving airway patency and breathing.
D. Positioning the client in high-Fowler's: Positioning the client in high-Fowler's position can help facilitate breathing and maximize lung expansion, but it does not address the acute bronchospasm. Thus, it is a supportive measure rather than the highest priority.
Correct Answer is A
Explanation
A. Regular insulin: Regular insulin is the preferred insulin for the treatment of diabetic ketoacidosis (DKA) because it has a rapid onset of action and can be administered intravenously. This allows for quick correction of hyperglycemia and ketoacidosis.
B. NPH insulin: NPH (Neutral Protamine Hagedorn) insulin is an intermediate-acting insulin that does not act quickly enough to be effective in the acute management of DKA. It is used for basal glycemic control and not for emergencies.
C. Insulin detemir: Insulin detemir is a long-acting insulin and is not suitable for the acute treatment of DKA. It is used for maintaining basal levels of insulin over a longer period rather than for rapid glucose control.
D. Insulin glargine: Insulin glargine is also a long-acting insulin used to provide a steady level of insulin over 24 hours and is not appropriate for acute management of DKA, which requires rapid-acting insulin.
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