Rodolfo, an 85 year old, is admitted for comtinuous cramping pain as the result of intermittent claudication. When conducting an initial physical assessment, the nurse is unable to palpate the pedal pulses. Which of the following actions should the nurse take first?

Correct Answer: D

Rationale: In this scenario, the nurse's first action should be to obtain a Doppler ultrasound device to assess the pedal pulses. If the nurse was unable to palpate the pedal pulses initially, the use of a Doppler can help in accurately identifying the pulses. It is essential to confirm the absence or presence of peripheral pulses before taking any further actions. This will provide crucial information for the physician to determine the appropriate course of treatment. Conducting a Doppler assessment will assist in evaluating the severity of the situation and guide the next steps in the patient's care plan.

Correct Answer: D

Rationale: When a diabetic client develops an infection, such as sinusitis and otitis media with a fever, the stress response can increase blood glucose levels. Infections trigger the release of stress hormones like cortisol and adrenaline, which can lead to insulin resistance. Insulin requirements may increase during an infection due to the elevated blood glucose levels and the body's increased demand for energy to fight the infection. Therefore, the diabetic client with sinusitis and otitis media accompanied by a fever of 100.8°F (38.2°C) will likely require an increase in their insulin dosage to help control their blood glucose levels during this period.

Correct Answer: D

Rationale: In a 28-year-old female client who is being successfully treated for Cushing syndrome, a decline in menstrual flow would be expected due to the normalization of the hormonal imbalances associated with Cushing syndrome. Cushing syndrome can lead to elevated levels of cortisol, which can disrupt the normal menstrual cycle by affecting the production of reproductive hormones. As treatment successfully addresses the underlying cause of the hormonal imbalance, such as surgery to remove the source of excessive cortisol production or medication to control cortisol levels, the menstrual cycle is likely to return to normal, resulting in a decline in menstrual flow. This improvement in menstrual regularity is a positive indicator of successful treatment for Cushing syndrome in female clients.

Correct Answer: A

Rationale: Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, is a progressive and fatal neurodegenerative disease that affects the nerve cells in the brain and spinal cord. The average life expectancy for individuals with ALS is around 2 to 5 years from the time of diagnosis. Therefore, the normal life expectancy for 50% of patients with ALS would be closer to the midpoint of this range, which is approximately 3 years. While some individuals may live longer than 3 years with ALS, for 50% of patients, this would be a reasonable estimate based on the typical progression of the disease.

Correct Answer: A

Rationale: When a patient is suspected to have a possible skull fracture, the nurse should observe him for signs of brain injury. Signs of brain injury can include changes in level of consciousness, altered pupil size or reaction to light, slurred speech, weakness or numbness in extremities, seizures, severe headache, vomiting, and vision changes. Monitoring for these signs would help in early detection of any worsening condition or complications related to the skull fracture. It is crucial to assess and monitor the patient's neurological status closely to provide timely interventions and prevent further damage.