A female client reports that her hair is becoming coarse and breaking off, that the outer part of her eyebrows have disappeared, and that her eyes are puffy. What follow-up question is best for the nurse to ask?

Correct Answer: D

Rationale: The correct follow-up question for the nurse to ask in this scenario is "D) Have you had recent cold intolerance or unusual fatigue?" This question is most appropriate because the client's symptoms (coarse hair, eyebrow changes, puffy eyes) are indicative of hypothyroidism, a condition where the thyroid gland is underactive. Cold intolerance and unusual fatigue are common symptoms of hypothyroidism, so asking about these can provide valuable information for further assessment and potential diagnosis. Option A) "Have you noticed any changes in your fingernails?" is less relevant in this context as changes in the nails are not specific to thyroid dysfunction. Option B) "Have you had any changes in weight or energy levels?" While weight gain and low energy can be seen in hypothyroidism, they are not as specific to the symptoms described by the client. Option C) "Do you have a family history of thyroid problems?" While family history can be important in assessing risk factors for thyroid disorders, the client's current symptoms are more indicative of her own thyroid status rather than her family history. In an educational context, it is crucial for nurses to understand the importance of thorough assessment and the relevance of specific questions based on presenting symptoms. This question highlights the need for critical thinking in connecting symptoms to potential underlying conditions, demonstrating the importance of holistic care and assessment in nursing practice.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Severe tenderness and guarding. When the gallbladder is inflamed, it typically results in acute cholecystitis, which presents with severe tenderness and guarding upon palpation. This is due to the inflammation of the gallbladder wall, causing localized pain and sensitivity to touch. Option B) Slight discomfort upon palpation is incorrect because inflammation of the gallbladder usually elicits more than just slight discomfort. The severity of the tenderness is typically more pronounced in cases of cholecystitis. Option C) A sensation of fullness is incorrect because a sensation of fullness is not a characteristic finding associated with an inflamed gallbladder. The key feature is tenderness and guarding due to the inflammatory process. Option D) No symptoms unless the gallbladder is extremely inflamed is incorrect because even mild inflammation of the gallbladder can present with symptoms such as tenderness and guarding upon palpation. Educationally, understanding the signs and symptoms of gallbladder inflammation is crucial for nurses to assess and intervene promptly, especially in patients with risk factors for gallbladder disease. Recognizing the specific manifestations of gallbladder inflammation helps in timely diagnosis and treatment to prevent complications such as gallbladder rupture or infection.

Correct Answer: B

Rationale: In the context of starting a screening program for hypothyroidism, the nurse should consider beginning at an African-American senior citizens' center (Option B) for several reasons. Firstly, hypothyroidism is more prevalent among older adults, making a senior citizens' center a suitable location for screening. African-Americans also have a higher risk of developing hypothyroidism compared to other ethnic groups, further supporting the choice of this demographic. Additionally, older adults may have limited access to healthcare services and may benefit from on-site screenings. Options A, C, and D are not ideal choices for starting a screening program for hypothyroidism. A business and professional women's group (Option A) may not represent a demographic with a high prevalence of hypothyroidism. Similarly, a daycare center in a Hispanic neighborhood (Option C) and an after-school center for Native American teens (Option D) cater to populations that are not typically at high risk for hypothyroidism. From an educational perspective, this question highlights the importance of considering demographic factors and prevalence rates when planning health screening programs. It emphasizes the need for targeted and strategic approaches to healthcare interventions, especially when dealing with conditions that disproportionately affect specific populations. Nurses and healthcare providers must be knowledgeable about epidemiological data and cultural considerations to effectively address community health needs.

Correct Answer: B

Rationale: In this scenario, the correct answer is B) Observe the antecubital fossa for inflammation. This assessment is crucial because a fever in a client with a PICC line could indicate phlebitis, which is inflammation of the vein. Observing the antecubital fossa can help the nurse identify early signs of inflammation, such as redness, warmth, and swelling, which are indicative of phlebitis. Option A is incorrect because while inspecting the PICC insertion site for signs of infection is important, in this case, the focus is on assessing for inflammation in the antecubital fossa. Option C, auscultating lung sounds for signs of respiratory distress, is not directly related to the assessment of a fever in a client with a PICC line. Option D, checking for signs of phlebitis or thrombosis along the catheter site, seems relevant but does not specifically address the immediate concern of assessing for inflammation in the antecubital fossa. Educationally, this question highlights the importance of understanding the implications of a fever in a client with a PICC line and the significance of assessing for early signs of phlebitis. It emphasizes the need for nurses to be thorough in their assessments to promptly identify and address potential complications in clients with invasive devices.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) Monitor for hypokalemia. Diabetes insipidus, caused by a pituitary tumor, leads to excessive urination and subsequent loss of water and electrolytes, particularly sodium and potassium. As a result, hypokalemia (low potassium levels) is a common complication that the nurse should closely monitor for. Option A) Monitoring for elevated blood pressure is not directly related to the pathophysiology of diabetes insipidus caused by a pituitary tumor. While diabetes insipidus can lead to dehydration, impacting blood pressure, it is not the most significant complication to monitor in this case. Option B) Monitoring for ketonuria is more relevant in conditions like diabetic ketoacidosis, which is not typically associated with diabetes insipidus. Option C) Monitoring for peripheral edema is more commonly seen in conditions like heart failure or renal issues, rather than diabetes insipidus. Understanding the specific electrolyte imbalances and complications associated with diabetes insipidus due to a pituitary tumor is crucial for nurses caring for these patients. Monitoring potassium levels closely can prevent potentially serious consequences such as cardiac arrhythmias and muscle weakness.