When caring for a client, whose being treated for hyperthyroidism, it's important to:

Correct Answer: B

Rationale: When caring for a client with hyperthyroidism, it is important to monitor the client for signs of restlessness, sweating, and excessive weight loss during thyroid replacement therapy. Treatment for hyperthyroidism often involves thyroid replacement therapy to restore the balance of thyroid hormones in the body. Monitoring for signs and symptoms of overmedication or undermedication is crucial to ensure the client's health and well-being. Restlessness, sweating, and weight loss can be indicators of an imbalance in thyroid hormone levels and may require adjustments in medication dosage. Regular monitoring and communication with healthcare providers are essential in managing the client's condition effectively.

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.

Correct Answer: D

Rationale: A brain abscess can be caused by direct invasion of the brain by microorganisms, spread of infection by other organs (such as the heart or lungs), or spread of infection from nearby sites (such as sinuses or the middle ear). In some cases, multiple mechanisms can contribute to the development of a brain abscess. Therefore, the correct answer is that a brain abscess can be caused by all of the above mechanisms.