Mr. Carter, a 35-year-old male, presents to the clinic with complaints of fatigue, nausea, intermittent abdominal pain, and jaundice. He reports that he recently returned from a week-long trip to a rural area in Southeast Asia, where he ate local food and drank untreated water. He denies any history of alcohol use or intravenous drug use. Laboratory results include:

Test	Result	Normal Range
ALT (Alanine Aminotransferase)	1.200 U/L	7-56 U/L
AST (Aspartate Aminotransferase)	1.000 U/L	10-40 U/L
Total Bilirubin	5.5 mg/dL	0.1-1.2 mg/dL
Hepatitis A IgM	Positive	Negative

Medications: None reported.

Social History: Works as a teacher, lives alone.

Identify the priority nursing interventions for Mr. Carter. (Select all that apply)

Choice A reason: Addison's Disease is characterized by insufficient production of adrenal hormones, leading to symptoms like weight loss, hyperpigmentation, low blood pressure, and severe fatigue. The lab findings would typically show low sodium, high potassium, and low cortisol levels. RM's lab results and symptoms are not consistent with Addison's Disease, making this an unlikely diagnosis.
Choice B reason: Cushing syndrome results from excess cortisol production, often causing weight gain, particularly around the abdomen and face, thinning skin, and hypertension. RM's symptoms of fatigue, dry skin, hair loss, and weight gain without dietary changes do not align with Cushing syndrome, and her lab results do not indicate elevated cortisol levels.
Choice C reason: Hyperthyroidism is characterized by excessive thyroid hormone production, leading to symptoms like weight loss, anxiety, palpitations, and heat intolerance. RM's symptoms of weight gain, fatigue, and cold intolerance, along with her lab results showing low T4 and T3 and elevated TSH, are not consistent with hyperthyroidism.
Choice D reason: Hypothyroidism occurs due to an underactive thyroid gland producing insufficient thyroid hormones. This leads to symptoms such as fatigue, weight gain, cold intolerance, dry skin, hair loss, and constipation. RM's lab results showing low T4 and T3 levels and elevated TSH align with the diagnosis of hypothyroidism. The body's response to low thyroid hormone levels is to increase TSH production in an attempt to stimulate the thyroid gland. The clinical presentation and lab findings point towards hypothyroidism as the correct diagnosis.

Choice A reason: While CT or MRI scans can be helpful in identifying structural changes in the brain associated with dementia, such as atrophy or the presence of strokes, they are not sufficient on their own to diagnose dementia. These imaging techniques are often used to rule out other causes of cognitive impairment and to support a clinical diagnosis, but they do not provide a complete picture of a patient's cognitive function.
Choice B reason: Patient history and cognitive assessment are the primary methods for diagnosing dementia. The clinical diagnosis is based on a thorough evaluation of the patient's medical history, including any changes in cognitive function, behavior, and daily living activities. Cognitive assessments, such as the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA), are used to evaluate memory, attention, language, and other cognitive abilities. These assessments help to determine the presence and severity of cognitive impairment and differentiate dementia from other conditions that may cause similar symptoms.
Choice C reason: A brain biopsy is not a standard procedure for diagnosing dementia. It is an invasive procedure that involves taking a small sample of brain tissue for examination under a microscope. While it can provide definitive information about certain types of dementia, such as Creutzfeldt-Jakob disease, it is rarely used due to its invasiveness and associated risks.
Choice D reason: An electroencephalogram (EEG) is a test that measures electrical activity in the brain. It can be useful in diagnosing certain neurological conditions, such as epilepsy, but it is not typically used to diagnose dementia. EEGs do not provide detailed information about cognitive function or the structural changes in the brain associated with dementia.