When the nurse is preparing to assess the thyroid gland of a client with suspected hypothyroidism, why is it important to bring a cup of water to the physical examination?
to prevent further dehydration
to assist the client to feel more comfortable
to observe the movement of the thyroid gland
to promote the nurse-client relationship
The Correct Answer is C
A. To prevent further dehydration:
While preventing dehydration is important, it is not the primary reason for bringing a cup of water when assessing the thyroid gland. Dehydration is addressed through overall fluid management rather than during a specific thyroid exam.
B. To assist the client to feel more comfortable:
Providing comfort is essential, but bringing a cup of water specifically for comfort during a thyroid exam is not typically necessary. The primary focus of the water in this context is related to the assessment process.
C. To observe the movement of the thyroid gland:
Observing the movement of the thyroid gland during swallowing can help the nurse assess for abnormalities. Having the client drink water allows the nurse to observe the thyroid gland's movement, which can indicate the presence of goiters, nodules, or other irregularities.
D. To promote the nurse-client relationship:
Promoting a good nurse-client relationship is always beneficial, but bringing a cup of water for this specific purpose is not relevant to the physical assessment of the thyroid gland. The water's main purpose is to facilitate the physical examination process.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
(a) Diarrhea: Diarrhea is an abnormal gastrointestinal response characterized by frequent, loose, or watery stools. It can be caused by infections, medications, or underlying gastrointestinal disorders. Pallor, or paleness of the skin, typically does not directly lead to diarrhea unless there are specific underlying conditions affecting both circulation and gastrointestinal function.
(b) Diaphoresis: Diaphoresis refers to excessive sweating, which can occur due to sympathetic nervous system activation, fever, or anxiety. While diaphoresis may be associated with conditions causing increased sympathetic activity, it is not directly related to pallor, which indicates reduced blood flow to the skin.
(c) Fainting: Pallor is often a sign of decreased blood flow to the skin, indicating potential hypoperfusion. If severe, this reduced circulation can lead to fainting (syncope) due to inadequate blood supply to the brain. Therefore, after noting pallor, the nurse should be prepared to manage the client for potential fainting episodes by ensuring safety and providing appropriate interventions.
(d) Vomiting: Vomiting is the forceful expulsion of stomach contents through the mouth and can be caused by various factors such as gastrointestinal irritation, infection, or systemic illnesses. Pallor does not directly cause vomiting, although severe systemic conditions affecting circulation could potentially lead to nausea and vomiting as part of a broader clinical picture.
Correct Answer is A
Explanation
A) Obesity II:
A Body Mass Index (BMI) of 37 falls within the range of 35 to 39.9, which is classified as Obesity Class II according to the World Health Organization (WHO) BMI categories. This classification indicates a higher risk of obesity-related health conditions and complications.
B) Overweight:
The overweight category corresponds to a BMI range of 25 to 29.9. A BMI of 37 is significantly higher than this range, indicating a more severe level of excess weight and associated health risks.
C) Normal weight:
Normal weight is defined by a BMI range of 18.5 to 24.9. A BMI of 37 is well above this range, indicating that the patient has excess body weight far beyond what is considered normal.
D) Obesity:
While the term "obesity" generally refers to a BMI of 30 or higher, specific classes of obesity (Class I, II, and III) are defined for more precise categorization. A BMI of 37 specifically places the patient in the Obesity II category.
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