The nurse is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find:

Correct Answer: C

Rationale: Cushing's syndrome is a disorder characterized by excessive levels of cortisol in the body. One of the classic physical manifestations of Cushing's syndrome is the accumulation of adipose (fat) tissue in specific areas, such as the trunk (central obesity) and dorsocervical area (referred to as a "buffalo hump"). This redistribution of body fat is a key feature in Cushing's syndrome. The thick, coarse skin is commonly seen in conditions like acromegaly, not in Cushing's syndrome. Weight gain in the arms and legs is not a typical finding in Cushing's syndrome. Additionally, hypertension, rather than hypotension, is more commonly associated with excess cortisol levels in Cushing's syndrome.

Correct Answer: B

Rationale: The majority of lumbar disc herniations occur at the level of L4-L5. This is because the L4-L5 disc segment bears the highest amount of stress and load in the lumbar spine due to its location and mechanics. The intervertebral disc between the fourth (L4) and fifth (L5) lumbar vertebrae is subject to repetitive movements and mechanical stress, making it more susceptible to herniation compared to other levels in the lumbar spine. Additionally, the anatomy of the L4-L5 disc makes it more prone to degeneration and herniation, leading to a higher prevalence of herniated discs at this level.

Correct Answer: C

Rationale: The disease mentioned in the question is likely myasthenia gravis. Myasthenia gravis is an autoimmune disorder where the body's immune system attacks acetylcholine receptors at the neuromuscular junction. Acetylcholine is a neurotransmitter responsible for transmitting nerve impulses to muscles. In myasthenia gravis, the immune system destroys or blocks the acetylcholine receptor sites on muscle cells, leading to a decrease in the number of functioning receptor sites. This results in muscle weakness and fatigue because the communication between nerves and muscles is impaired. This is why the nurse would base the reply on the knowledge that there is a decreased number of functioning acetyl-choline receptor sites as the underlying cause of the disease.

Correct Answer: B

Rationale: When a client presents with right-sided weakness, it indicates that the underlying issue is likely located in the left hemisphere of the brain. This is due to the contralateral organization of the brain where the right side of the brain controls the left side of the body, and vice versa. Therefore, in Mr. Franco's case, the right-sided weakness suggests the affected lobe is the left lobe of his brain, not the right lobe as stated in option B.

Correct Answer: A

Rationale: Maintaining strict records of intake and output is the best way to assess the client's fluid balance in this situation. Severe burns can lead to fluid loss, which can result in dehydration and other complications. By carefully monitoring the amount of fluid the client is taking in (intake) and the amount of fluid being eliminated from the body (output), healthcare providers can assess the client's fluid balance and make necessary adjustments to prevent dehydration or fluid overload. This approach provides accurate and specific information to guide fluid management and ensure optimal recovery for the client with burns. Monitoring skin turgor, daily weight, and checking for edema are also important measures, but maintaining strict records of intake and output is the most direct and effective method for assessing fluid balance in a client with burns.