The nurse cares for a client with history of thyroid issues who presents with symptoms of suspected myxedema coma. What nursing assessments should the nurse prioritize? Select all that apply

A. Weigh the client is important for long-term monitoring of fluid balance and thyroid therapy, but in an acute myxedema coma, weight measurement is not a priority because the client’s immediate life-threatening risks are related to respiratory and cardiovascular compromise, not gradual weight changes. B. Assessing the skin for bruising or discoloration is not a primary concern in myxedema coma. While hypothyroidism can cause dry, pale, or yellowish skin, bruising is not a hallmark of acute myxedema. This is secondary and not urgent. C. Measuring the client’s respiratory rate and depth is a priority assessment because myxedema coma can cause hypoventilation, respiratory depression, and CO₂ retention. Early identification of respiratory compromise is critical for preventing hypoxia and respiratory failure. D. Auscultating the client’s apical pulse is essential because myxedema coma can result in bradycardia, hypotension, and decreased cardiac output. Cardiovascular assessment is critical to detect life-threatening cardiac complications. E. Assessing skin turgor on the forearm is generally used to assess dehydration, but in myxedema coma, the skin is often edematous (non-pitting myxedema), making turgor assessment less reliable and not a priority.