A nurse is performing a physical examination on an adolescent male suspected of having an endocrine disorder. Which of the following assessment findings might be indicative of a problem with the thyroid gland?
Development of a buffalo hump and moon face
Central obesity and purple striations
Sudden weight loss without dieting
Positive Trosseau's sign when checking the client's blood pressure
The Correct Answer is C
A. Development of a buffalo hump and moon face:
This is associated with Cushing's syndrome, a disorder characterized by prolonged exposure to high levels of cortisol.
B. Central obesity and purple striations:
Also indicative of Cushing's syndrome, where excess cortisol can lead to the accumulation of fat in the abdominal area (central obesity) and the development of purple stretch marks (striae).
C. Sudden weight loss without dieting:
This is more characteristic of hyperthyroidism, where the thyroid gland is overactive, leading to increased metabolism and unintended weight loss.
D. Positive Trousseau's sign when checking the client's blood pressure:
Trousseau's sign is associated with hypocalcemia and is seen in conditions affecting the parathyroid gland rather than the thyroid. It involves carpal spasm induced by inflating a blood pressure cuff above the systolic pressure for a few minutes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Monitoring the patient's breathing and reviewing the patient's arterial blood gases:
Rationale: While respiratory status is crucial in any patient assessment, arterial blood gases primarily evaluate respiratory function. Neutropenia directly affects the immune system, not respiratory function.
Appropriateness: Not directly related to assessing neutropenia.
B. Monitoring the patient's temperature and reviewing the patient's complete blood count with differential:
Rationale: Neutropenia can cause fever due to the increased risk of infection. Monitoring temperature and reviewing the complete blood count (CBC) with differential, specifically the neutrophil count, is essential in evaluating neutropenia and identifying potential infections.
Appropriateness: Correct. Monitoring temperature and reviewing CBC with differential are crucial in assessing neutropenia.
C. Monitoring the patient's blood pressure and reviewing the patient's hematocrit:
Rationale: Blood pressure assessment and hematocrit evaluation are essential aspects of general patient care but are not specific to neutropenia.
Appropriateness: Not directly related to assessing neutropenia.
D. Monitoring the patient's heart rate and reviewing the patient's hemoglobin:
Rationale: Heart rate monitoring and hemoglobin assessment are crucial in various clinical situations but are not specific indicators of neutropenia.
Appropriateness: Not directly related to assessing neutropenia.
Correct Answer is B
Explanation
A. Increase the intake of vitamin E to enhance absorption:
While vitamin C can enhance iron absorption, vitamin E does not play a significant role in iron absorption. Vitamin C-rich foods can be advised to enhance iron absorption.
B. Iron will cause the stools to darken in color:
This statement is accurate. Iron supplements can cause stools to appear darker in color, often black or greenish-black. This change in stool color is normal and expected when taking iron supplements.
C. Take the iron with dairy products to enhance absorption:
Dairy products can inhibit iron absorption. It's better to take iron supplements with vitamin C-rich foods or orange juice to enhance absorption.
D. Limit foods high in fiber due to the risk for diarrhea:
Fiber-rich foods do not necessarily need to be limited when taking iron supplements. However, some individuals may experience constipation when taking iron supplements, in which case increasing fluid intake and dietary fiber can help alleviate constipation.
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