A nurse is developing a plan of care for a client with a new diagnosis of Graves' disease.
Which of the following interventions does the nurse include in the plan of care?
Keeping the room well-lit at all time
Encouraging frequent ambulation and exercise
Providing a high-calorie and high protein diet
Placing extra blankets over the client
The Correct Answer is C
Choice A rationale: Clients with Graves' disease may have increased sensitivity to light due to ocular manifestations like photophobia, so keeping the room well-lit may can cause eye irritation.
Choice B rationale: Encouraging frequent ambulation and exercise may worsen the symptoms of hyperthyroidism, such as tachycardia, palpitations, and tremors.
Choice C rationale: This is because clients with Graves' disease have an increased
metabolic rate and may experience weight loss, muscle wasting, and fatigue. A high- calorie and high protein diet can help prevent these complications and provide adequate nutrition for the client.
Choice D rationale: Placing extra blankets over the client may increase the body temperature and cause heat intolerance, which is another common symptom of Graves' disease.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale: Metformin does not significantly affect insulin release from the pancreas or glucagon secretion but reduces glucose production by the liver and enhances insulin sensitivity in tissues.
Choice B rationale: Metformin primarily works by reducing glucose production in the liver and improving the body's response to insulin, thereby lowering blood sugar levels.
Choice C rationale: Metformin does not notably slow carbohydrate absorption in the small intestine.
Choice D rationale: Metformin does not directly increase insulin production from the pancreas.
Correct Answer is C
Explanation
Choice A rationale: Irregular respirations, bradycardia, and widened pulse pressure might indicate increased intracranial pressure.
Choice B rationale: This set of symptoms is often seen in cardiac tamponade and is referred to as the Beck’s triad and not Cushing's triad.
Choice C rationale: Cushing's triad is a set of clinical signs associated with increased intracranial pressure (ICP) and typically includes bradycardia (slow heart rate),
hypertension (elevated blood pressure), and irregular breathing patterns. Fixed pupils can also be present in some cases, but it's important to note that this triad is not always consistently present and may vary from person to person.
Choice D rationale: This set of symptoms describes symptoms of shock, not specifically Cushing's triad.
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