A nurse is reviewing laboratory results and notes that a client has an elevated thyroid-stimulating hormone (TSH) level. Which of the following assessment findings would the nurse expect?

A. Cyanosis: Cyanosis is a late sign of hypoxemia, not specifically hypercapnia. It indicates poor oxygenation of tissues but does not directly reflect elevated carbon dioxide levels in the blood.
B. Arrhythmias: Arrhythmias may occur in respiratory failure due to hypoxemia or acid-base disturbances. However, they are not the most specific indicator of severe hypercapnia and can result from a range of metabolic or cardiac causes.
C. Asterixis: Asterixis, or "flapping tremor," is a neurologic manifestation of severe hypercapnia and altered mental status. It results from elevated CO₂ levels affecting brain function and is often seen in CO₂ narcosis or advanced respiratory failure.
D. Tachycardia: Tachycardia is a common compensatory response to hypoxia or hypercapnia, but it is nonspecific. It can be seen in many conditions and is not a definitive sign of severe carbon dioxide retention.

A. Swelling of the optic nerve: Swelling of the optic nerve, also known as papilledema, is a clear sign of increased intracranial pressure and indicates a worsening neurological condition. It results from pressure transmitted through the cerebrospinal fluid, leading to compromised optic nerve function.
B. Respiratory rate of 12/min: A respiratory rate of 12 breaths per minute is within normal limits for adults and does not indicate deterioration. While respiratory changes can be a late sign of increased ICP, a rate of 12 alone is not concerning.
C. Changes to pupil size and shape: Alterations in pupil size and shape often reflect pressure on cranial nerves, particularly the oculomotor nerve (CN III), which is a critical warning sign of brain herniation or increased ICP. This is a significant cue of neurologic decline.
D. Blood pressure of 108/74 mm Hg: This blood pressure reading is within a normal range and does not independently suggest a worsening neurologic condition. Worrisome signs would include widened pulse pressure or elevated systolic pressure, which may signal Cushing’s triad.
E. Decreasing Glasgow Coma scores: A drop in the Glasgow Coma Scale score indicates a decline in consciousness, which is a key sign of worsening intracranial pathology. Monitoring GCS trends is essential in patients with increased ICP to identify neurological deterioration early.