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A nurse is receiving a patient from the emergency room (ER) with an admitting diagnosis of hypothyroid disorder.

Admitting diagnosis

acute hypothyroid disorder

Physician order

Synthroid 0.1 mg po daily

The receiving medical- surgical nurse would expect the patient to exhibit which signs and symptoms? Select all that apply

cold intolerance

depression dry skin

weakness and fatigue

constipation

mental alertness

Question Solution

Correct Answer : A,B,C,D

A. Cold intolerance: Patients with hypothyroidism often have difficulty regulating body temperature, leading to a heightened sensitivity to cold.

B. Depression: Hypothyroidism can affect mood and cognitive function, often leading to symptoms of depression.

C. Weakness and fatigue: Low thyroid hormone levels can cause significant fatigue and muscle weakness due to a slower metabolism.

D. Constipation: A slowed metabolism can also affect gastrointestinal motility, resulting in constipation.

E. Mental alertness: This is typically not expected in hypothyroid patients. In fact, they may experience cognitive impairments, memory issues, or slowed thinking rather than mental alertness.

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A. Assess the pedal pulses for a full minute. B. Assess the apical pulse for a full minute. C. Assess the popliteal pulses with a Doppler device for a minimum of five minutes. D. Assess the apical pulse with a pulse oximeter.

Correct Answer is B

Explanation

A. Assessing the pedal pulses does not provide relevant information about the irregularity of the radial pulse.

B. Assessing the apical pulse for a full minute is appropriate in this situation, as it provides a more accurate measurement of the heart rate and rhythm, especially when the radial pulse is irregular.

C. Assessing the popliteal pulses with a Doppler device is not necessary and does not directly address the irregular radial pulse.

D. While a pulse oximeter can provide information about oxygen saturation, it does not assess heart rate or rhythm.

A. Severe pitting, very swollen leg and indentation that lasts for a long time, 8 mm deep B. Slight indentation, with no perceptible swelling of the leg. 2 mm deep C. Moderate pitting, with indentation that subsides rapidly, 4 mm deep D. Deep pitting, swollen leg, and indentation that remains for a short time, 6 mm deep

Correct Answer is A

Explanation

A. +4 pitting edema is characterized by severe pitting that creates a deep indentation (greater than 8 mm) that remains for a prolonged period. This description matches the findings in option

B. This describes +1 pitting edema, which is not consistent with +4 edema.

C. This option describes +2 or +3 pitting edema, as the indentation subsides rapidly, which does not align with +4.

D. Although this describes deep pitting, the depth is less than 8 mm, which is not consistent with +4 edema.

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Correct Answer is B

Explanation

Correct Answer is A

Explanation

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A nurse is assessing a client's radial pulse and determines that the pulse is irregular. Which action should the nurse take?

Correct Answer is B

Explanation

A nurse is assessing a client with a history of heart failure who presents with severe edema in the lower extremities. The nurse would document the presence of +4 pitting edema after noting which finding?

Correct Answer is A

Explanation

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