Adrenal Disorders
A patient with Addison's disease asks the nurse what causes the disease. Which is the best response by the nurse? "Addison's disease is the result of corticosteroid use." "Addison's disease is always caused by an autoimmune disorder." "Addison's disease is caused by the presence of an adrenal tumor." "Addison's disease is the result of the decreased production of adrenal corticosteroids."
"Addison's disease is the result of the decreased production of adrenal corticosteroids." Addison's disease is the result of decreased production of adrenal corticosteroids, which may be the result of an autoimmune disorder. The cause of Addison's disease may also be iatrogenic.
The nurse is caring for a patient with Addison's disease who has abdominal pain, a craving for salt, and the following vital signs: temperature 101.3° F, heart rate 118, respiratory rate 24, and blood pressure 86/52. Which nursing intervention is the priority? Wash hands and maintain a calm environment Evaluate the metabolic panel for hyponatremia Administer 100 mL of 0.9% saline solution intravenously Check a glucose level and give 25% dextrose intravenously
Wash hands Because the patient has signs and symptoms of Addisonian crisis, the priority nursing intervention is to prevent infection and avoid stress. The patient cannot cope with stress because corticosteroids cannot be produced, so the nurse should maintain a calm environment.
The nurse is providing discharge teaching to a patient with Cushing's syndrome. Which statement made by the patient indicates the need for further teaching? "I will be sure to take precautions to avoid injuries and infection." "I should notify my health care provider if I become short of breath." "I may need to have my medication dosage adjusted during times of stress." "I should stop taking my medications because they caused Cushing's syndrome."
"I should stop taking my medications because they caused Cushing's syndrome." This statement indicates the patient needs further teaching because even though corticosteroids cause Cushing's syndrome, the patient should not abruptly stop taking this medication as it could cause Addisonian crisis.
The nurse is educating a patient with Cushing's syndrome about preventative care. Which statements by the patient indicate the teaching was effective? Select all that apply. "I should wear a medical alert bracelet at all times." "I should avoid doing yardwork when it is hot outside." "An elevated temperature is expected and not concerning." "I should carry an emergency bag with methylprednisolone." "I should notify my health care provider if I experience weakness."
"I should wear a medical alert bracelet at all times." This statement indicates that patient teaching was effective because patients with Cushing's syndrome should wear a medical alert bracelet at all times. "I should avoid doing yardwork when it is hot outside." This statement indicates that patient teaching was effective because patients with Cushing's syndrome should avoid extreme temperatures. "I should notify my health care provider if I experience weakness." This statement indicates that patient teaching was effective because patients with Cushing's syndrome should notify the health care provider if weakness, fainting, fever, or nausea and vomiting occur.
The health care provider has ordered methylprednisolone, 75 mg, to be administered intravenously for a patient in Addisonian crisis. Methylprednisolone is supplied at 120 mg/2mL. How many milliliters would the nurse administer? Round your answer to one decimal place.
1.3 To determine the amount of methylprednisolone in milliliters to give to a patient in Addisonian crisis, the nurse would divide the ordered 75 mg by the available 120 mg and then multiply by 2 mL to get 1.25 mL. Rounding to one decimal place results in an amount for administration of 1.3 mL
Which information is most important for the nurse to include in the discharge teaching provided to a patient with Addison's disease? The etiology of Addison's disease Methods to avoid stressful situations Follow-up appointment date and time The need to monitor weight every week
Follow-up appointment date and time Patients with Addison's disease should be informed of the importance of keeping scheduled follow-up appointments to appropriately manage the disease.
The nurse is caring for a patient with Addison's disease who has abdominal pain, vomiting, and the following vital signs: temperature 101.1° F, heart rate 110, respiratory rate 22, and blood pressure 84/58. Which action should the nurse take first? Give acetaminophen, 500 mg, orally Order a complete blood count and metabolic panel Obtain a baseline weight and weigh the patient daily Administer a 1000-mL IV bolus of normal saline solution
Administer a 1000-mL IV bolus of normal saline solution. A patient with history of Addison's disease who has signs and symptoms of Addisonian crisis needs aggressive management with large volumes of isotonic fluid to reverse hypotension.
The nurse is caring for a patient with adrenocortical hyperplasia. Which treatment would the nurse expect the health care provider to prescribe for this patient? Radiation of the tumor Transsphenoidal resection Decreased corticosteroid dose Administration of mifepristone
Administration of mifepristone Mifepristone drug therapy is expected for adrenocortical hyperplasia.
A nurse is providing care to a patient with Cushing's syndrome. On examination, the nurse notes gynecomastia, truncal obesity, and bruising. The patient reports pain of "9" on a scale of 1 to 10. Which nursing action is priority? Assess vital signs Reposition the patient Provide emotional support Administer pain medication
Assess vital signs Because Cushing's syndrome can cause hypertension, the nurse's priority is to begin assessing vital signs to determine the cause of the patient's pain or rule out hypertension.
A patient with suspected Addison's disease arrives in the emergency department, lethargic and confused. Which action by the nurse is the priority? Check the patient's medical alert bracelet Obtain serum potassium and sodium levels Establish an intravenous (IV) line and administer normal saline fluid rapidly Administer intravenous methylprednisolone immediately and every six Addisonian crisis hours.
Check medical alert bracelet Because the patient may have Addison's disease, assessing the patient's medical alert bracelet will provide the best information about how to care for this patient.
Which is the most common cause of primary adrenal insufficiency? Autoimmune dysfunction Decreased production of corticosteroids Long-term overuse of oral corticosteroids Lack of secretion of adrenocorticotropic hormone (ACTH) by the pituitary gland
Decreased production of corticosteroids Primary adrenal insufficiency, also known as Addison's disease, is caused by decreased production of corticosteroids related to hypofunctioning of the adrenal cortex.
Which manifestations would the nurse expect to find when assessing a patient with Addison's disease? Select all that apply Hypotension Weakness Diarrhea Hyperglycemia Thin and fragile skin
Hypotension Orthostatic hypotension is a clinical manifestation of Addison's disease related to low levels of cortisol and fluid imbalances in the body. Weakness Weakness is a clinical manifestation of Addison's disease related to low levels of cortisol and fluid imbalances in the body. Diarrhea Diarrhea is a clinical manifestation of Addison's disease related to low levels of cortisol in the body.
Which is the most common cause of Cushing's syndrome? Multiple unknown factors Long-term corticosteroid use Acute overdose of prednisone Decreased release of glucocorticoids
Long-term corticosteroid use Cushing's syndrome is most commonly caused by long-term use of corticosteroids, particularly glucocorticoids.
A nurse is caring for a patient with Cushing's syndrome whose blood pressure is 160/100 mm Hg on two occasions. Which adrenal hormone is likely altered in this patient? Estrogen Progesterone Glucocorticoid Mineralocorticoid
Mineralcorticoid Mineralocorticoid excess may cause hypertension secondary to fluid retention and is the hormone that is likely altered in this patient with Cushing's syndrome.
Which manifestations would the nurse expect to find when assessing a patient with Cushing's syndrome? Select all that apply Obesity Bruising Edema Bronze skin Abdominal pain
Obesity Cushing's syndrome causes accumulation of adipose tissue in the trunk, resulting in obesity. Bruising Cushing's syndrome results in collagen loss, which makes the skin bruise more easily. Edema Cushing's syndrome, the result of mineralocorticoid excess, may cause fluid retention—resulting in edema.
The nurse notes a "moon" face, abdominal striae, truncal obesity, and hirsutism during the assessment of a patient with Addison's disease who takes daily oral corticosteroids. Which order by the health care provider would the nurse anticipate? Transsphenoidal resection Discontinue corticosteroid therapy Increase the daily corticosteroid dose Obtain a plasma adrenocorticotropic hormone (ACTH) level
Obtain ACTH level High or normal ACTH levels indicate Cushing's syndrome, which would be helpful in confirming a diagnosis of Cushing's syndrome in this patient with Addison's disease, and would be an expected health care provider order.
Which orders would the nurse expect the health care provider to give for a patient diagnosed with Cushing's syndrome secondary to a pituitary adenoma? Select all that apply. Adrenalectomy Radiation therapy Corticosteroids daily Increase sodium diet Transsphenoidal resection
Radiation therapy Radiation therapy is an expected order for a patient with Cushing's syndrome related to a pituitary adenoma. Transsphenoidal resection Transsphenoidal resection is an expected order for a patient with Cushing's syndrome related to a pituitary adenoma.
A nurse is discussing dietary management with a patient diagnosed with Addison's disease. Which meal would the nurse recommend to this patient? Egg white omelet and oranges Grilled skinless chicken with carrots Pork chop with rice and fresh broccoli Tomato soup with grilled cheese sandwich
Tomato soup with grilled cheese sandwich This is the best meal to recommend to a patient with Addison's disease because it has a high sodium content, which is needed to adjust for sodium loss related to insufficient cortisol levels.
