While collecting data the nurse suspects a patient is experiencing manifestations of Addison's disease. What observations did the nurse make to come to this conclusion? (Select all that apply.)
a. Ankle edema
b. Bronzing of the skin
c. Blood pressure 90/55 mm Hg
d. Bruises over the upper chest and arms
e. Weight loss 10 lbs from last examination
ANS: B, C, E
In primary AI, increased ACTH may produce hyperpigmentation of the skin, causing the patient to have a tanned or bronze appearance. The most significant sign of Addison's disease is hypotension. Low cortisol levels cause weight loss. A. D. Ankle edema and bruising are not manifestations of Addison's disease.
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Medications are used with extreme caution in clients with personality disorders because of their questionable effectiveness
If a client is receiving an antipsychotic medication, it is especially important for the nurse to monitor the client for side effects of: a. Increased thirst and urination, nausea, and anorexia b. Dry mouth, altered taste, sexual dysfunction, and dizziness c. Bone marrow depression, gastrointestinal symptoms, and confusion d. Extrapyramidal movements, dry mouth, blurred vision, and photophobia
Some cultures see personal touching as an insult unless you are intimately related. In the secondary health care setting, the need for touching to administer care may produce what within the patient?
a. Cultural strain b. Impaired functioning c. Cultural insult d. Increased self-care deficit
The school nurse has identified several children who rarely spend time with either parent in the evening after school. What issues does the nurse realize as contributors to this trend? (Select all that apply.)
A) Both parents work B) Children preoccupied with school work C) Television is substituted for conversation D) Children participate in many after-school activities E) Meals are eaten at different times by family members