Exam 4
A nurse is admitting a client who has acute adrenal insufficiency. Which of the following prescriptions should the nurse expect? -IV therapy with 0.45% sodium chloride -Regular insulin -Hydrocortisone sodium succinate -Sodium polystyrene sulfonate -Furosemide
-Regular insulin -Hydrocortisone sodium succinate -Sodium polystyrene sulfonate -Furosemide
A nurse is reviewing lab results for a client who has Addison's disease. Which of the following lab results should the nurse expect for this client? -Sodium 130 mEq/L -Potassium 6.1 mEq/L -Calcium 11.6 mg/dL -Blood urea nitrogen (BUN) 28 mg/dL -Fasting blood glucose 148 mg/dL
-Sodium -Potassium -Calcium -BUN
Which topic is most important to include in the teaching plan for a client newly diagnosed with Addison's disease who will be taking corticosteroids?1.The importance of watching for signs of hyperglycemia.2.The need to adjust the steroid dose based on dietary intake and exercise.3.To notify the health care provider when the blood pressure is suddenly high.4.How to decrease the dose of the corticosteroids when the client experiences stress.
1Since Addison's disease can be life threatening, treatment often begins with administration of corticosteroids. Corticosteroids, such as prednisone, may be taken orally or intravenously, depending on the client. A serious adverse effect of corticosteroids is hyperglycemia. Clients do not adjust their steroid dose based on dietary intake and exercise, insulin is adjusted based on diet and exercise. Addisonian crisis can occur secondary to hypoadrenocorticism resulting in a crisis situation of acute hypotension, not increased blood pressure. Addison's disease is a disease of inadequate adrenal hormone and therefore the client will have inadequate response to stress. If the client takes more medication than prescribed, there can be a potential increase in potassium depletion, fluid retention, and hyperglycemia. Taking less medication than was prescribed can trigger Addisonian crisis state which is a medical emergency manifested by signs of shock.
A client with Addison's disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effects of corticosteroids? Select all that apply.1. Hyperkalemia2. Skeletal muscle weakness3. Mood changes4. Hypocalcemia5. Increased susceptibility to infection6. Hypotension
2,3,4,5The long-term administration of corticosteroids in therapeutic doses often leads to serious complications or side effects. Corticosteroid therapy is not recommended for minor chronic conditions; the potential benefits of treatment must always be weighed against the risks. Hypokalemia may develop; corticosteroids act on the renal tubules to increase sodium reabsorption and enhance potassium and hydrogen excretion. Corticosteroids stimulate the breakdown of protein for gluconeogenesis, which can lead to skeletal muscle wasting. CNS adverse effects are euphoria, headache, insomnia, confusion, and psychosis. The nurse watches for changes in mood and behavior, emotional stability, sleep pattern, and psychomotor activity, especially with long-term therapy. Hypocalcemia related to anti-vitamin D effect may occur. Corticosteroids cause atrophy of the lymphoid tissue, suppress the cell-mediated immune responses, and decrease the production of antibodies. The nurse must be alert to the possibility of masked infection and delayed healing (anti-inflammatory and immunosuppressive actions). Retention of sodium (and subsequently water) increases blood volume and, therefore, blood pressure.
After stabilization of Addison's disease, the nurse teaches the client about stress management. The nurse should instruct the client to:1.Remove all sources of stress from daily life.2.Use relaxation techniques such as music.3.Take antianxiety drugs daily.4.Avoid discussing stressful experiences.
2Finding alternative methods of dealing with stress, such as relaxation techniques, is a cornerstone of stress management. Removing all sources of stress from one's life is not possible. Antianxiety drugs are prescribed for temporary management during periods of major stress, and they are not an intervention in stress management classes. Avoiding discussion of stressful situations will not necessarily reduce stress.
The nurse is instructing a young adult with Addison's disease how to adjust the dose of glucocorticoids. The nurse should explain that the client may need an increased dosage of glucocorticoids in which of the following situations?1.Completing the spring semester of school.2.Gaining 4 lb (1.8 kg).3.Becoming engaged.4.Undergoing a root canal.
4.Adrenal crisis can occur with physical stress, such as surgery, dental work, infection, flu, trauma, and pregnancy. In these situations, glucocorticoid and mineralocorticoid dosages are increased. Weight loss, not gain, occurs with adrenal insufficiency. Psychological stress has less effect on corticosteroid need than physical stress.
The client diagnosed with Addison's disease is admitted to the emergency department after a day at the lake. The client is lethargic, forgetful, and weak. Which intervention should the nurse implement?1. Start an IV with an 18-gauge needle and infuse NS rapidly.2. Have the client wait in the waiting room until a bed is available.3. Obtain a permit for the client to receive a blood transfusion.4. Collect urinalysis and blood samples for a CBC and calcium level.
1The client was exposed to wind andsun at the lake during the hours prior to being admitted to the emergency department. This predisposes the client to dehydration and an addisonian crisis. Rapid IV fluid replacement is necessary.
Which of the following is the priority for a client in addisonian crisis?1.Controlling hypertension.2.Preventing irreversible shock.3.Preventing infection.4.Relieving anxiety.
2.Addison's disease is caused by a deficiency of adrenal corticosteroids and can result in severe hypotension and shock because of uncontrolled loss of sodium in the urine and impaired mineralocorticoid function. This results in loss of extracellular fluid and dangerously low blood volume. Glucocorticoids must be administered to reverse hypotension. Preventing infection is not an appropriate goal of care in this life-threatening situation. Relieving anxiety is appropriate when the client's condition is stabilized, but the calm, competent demeanor of the emergency department staff will be initially reassuring.
The client who has undergone a bilateral adrenalectomy is concerned about persistent body changes and unpredictable moods. The nurse should tell the client that:1.The body changes are permanent and the client will not be the same as before this condition.2.The body and mood will gradually return to normal.3.The physical changes are permanent, but the mood swings will disappear.4.The physical changes are temporary, but the mood swings are permanent.
2As the body readjusts to normal cortisol levels, mood and physical changes will gradually return to a normal state. The body changes are not permanent, and the mood swings should level off.
After a bilateral adrenalectomy for Cushing's disease, the client will receive periodic testosterone injections. The expected outcome of these injections is:1.Balanced reproductive cycle.2.Restored sodium and potassium balance.3.Stimulated protein metabolism.4.Stabilized mood swings.
3Testosterone is an androgen hormone that is responsible for protein metabolism as well as maintenance of secondary sexual characteristics; therefore, it is needed by both males and females. Removal of both adrenal glands necessitates replacement of glucocorticoids and androgens. Testosterone does not balance the reproductive cycle, stabilize mood swings, or restore sodium and potassium balance.
For a male client with hyperglycemia. which assessment finding best supports a nursing diagnosis of Deficient fluid volume?DiscussA.Cool. clammy skinB.Distended neck veinsC.Increased urine osmolarityD.Decreased serum sodium level
CIn hyperglycemia. urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glycosuria and polyuria. losing body fluids and experiencing fluid volume deficit. Cool. clammy skin; distended neck veins; and a decreased serum sodium level are signs of fluid volume excess. the opposite imbalance.
A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, nurse Richard would suspect which of the following disorders?ADiabetes mellitusBDiabetes insipidusCHypoparathyroidismDHyperparathyroidism
DHyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercalciuria-causing polyuria. While clients with diabetes mellitus and diabetes insipidus also have polyuria, they don't have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than polyuria.
During long-term corticosteroid therapy, the nurse will monitor the patient for Cushing's syndrome, which is manifested bya. weight loss.b. moon face.c. hypotension.d. thickened hair growth.
Moon face
The client is admitted to rule out Cushing's syndrome. Which laboratory tests should the nurse anticipate being ordered?1. Plasma drug levels of quinidine, digoxin,and hydralazine.2. Plasma levels of ACTH and cortisol.3. A 24-hour urine for metanephrine andcatecholamine.4. Spot urine for creatinine and white blood cells(WBCs).
Plasma levels of ACTH and cortisol. The adrenal gland secretes cortisol and the pituitary gland secretes adrenocorti- cotropic hormone (ACTH), a hormone used by the body to stimulate the produc- tion of cortisol.
A nurse in a provider's office is planning care for a client who has a new diagnosis of Graves' disease and a new prescription for methimazole. Which of the following interventions should the nurse include in the plan of care? (Select all)a. Monitor CBCb. Monitor triiodothyronine (T3)c. Instruct the client to increase consumption of shellfishd. Advise the client to take the med at the same time every daye. Inform the client that an adverse effect of this med is iodine toxicity
a. Monitor CBC*Methimazole can can cause a number of hematologic effects, including leukopenia and thrombocytopenia. Monitor CBC.b. Monitor triiodothyronine (T3)*Methimazole reduces thyroid hormone production. Monitor T3.d. Advise the client to take the med at the same time every day*Methimazole should be taken at the same time every day to maintain blood levels
A nurse is reviewing the manifestations of hyperthyroidism with a client. Which of the following findings should the nurse include? (Select all)a. Anorexiab. Heat intolerancec. Constipationd. Palpitationse. Weight lossf. Bradycardia
b. Heat intoleranced. Palpitationse. Weight loss*Hyperthyroidism increases the client's metabolism, causing heat intolerance, palpitations, and weight loss.
A nurse is assessing a client who is 12 hr postop following a thyroidectomy. Which of the following findings is indicative of thyroid crisis? (Select all)a. Bradycardiab. Hypothermiac. Dyspnead. Abdominal paine. Mental confusion
c. Dyspnead. Abdominal paine. Mental confusion
A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar), 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin?AIt decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs.BIt interacts with plasma membrane receptors to inhibit enzymatic actions.CIt interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism.DIt regulates the threshold for water resorption in the kidneys.
cCorticotropin interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. It doesn't decrease cAMP production. The posterior pituitary hormone, antidiuretic hormone, regulates the threshold for water resorption in the kidneys.
A nurse is reviewing the lab findings of a client who has Cushing's disease. Which of the following findings should the nurse expect for this client? -Sodium 150mEq/L -Potassium 3.3mEq/L -Calcium 8.0mg/dL -lymphocyte count 35% -fasting glucose 145 mg/dL
-Sodium -Potassium -Calcium -Fasting glucose
The nurse is performing discharge teaching for a client diagnosed with Cushing's disease. Which statement by the client demonstratesan understanding of the instructions?1. "I will be sure to notify my health-care provider if I start to run a fever."2. "Before I stop taking the prednisone, I will be taught how to taper it off."3. "If I get weak and shaky, I need to eat some hard candy or drink some juice."4. "It is fine if I continue to participate in weekend games of tackle football."
"I will be sure to notify my health-care provider if I start to run a fever." Cushing's syndrome/disease predisposes the client to develop infections as a result of the immunosuppressive nature of thedisease.
At the beginning of a shift, a nurse is assessing a client who has Cushing's disease. Which of the following findings is the priority? -weight gain -fatigue -fragile skin -joint pain
-weight gain
Bone resorption is a possible complication of Cushing's disease. Which of the following interventions should the nurse recommend to help the client prevent this complication?1.Increase the amount of potassium in the diet.2.Maintain a regular program of weight-bearing exercise.3.Limit dietary vitamin D intake.4.Perform isometric exercises.
2Osteoporosis is a serious outcome of prolonged cortisol excess because calcium is resorbed out of the bone. Regular daily weight-bearing exercise (eg, brisk walking) is an effective way to drive calcium back into the bones. The client should also be instructed to have a dietary or supplemental intake of calcium of 1,500 mg daily. Potassium levels are not relevant to prevention of bone resorption. Vitamin D is needed to aid in the absorption of calcium. Isometric exercises condition muscle tone but do not build bones.
The nurse is caring for a client who is scheduled for an adrenalectomy. Which of the following drugs may be included in the preoperative prescriptions to prevent Addison's crisis following surgery?1.Prednisone orally.2.Fludrocortisones subcutaneously.3.Spironolactone intramuscularly.4.Methylprednisolone sodium succinate intravenously.
4A glucocorticoid preparation will be administered intravenously or intramuscularly in the immediate preoperative period to a client scheduled for an adrenalectomy. Methylprednisolone sodium succinate protects the client from developing acute adrenal insufficiency (Addison's crisis) that occurs as a result of the adrenalectomy. Spironolactone is a potassium-sparing diuretic. Prednisone is an oral corticosteroid. Fludrocortisones is a mineral corticoid.
when teaching a patient who has been prescribed a daily dose of prednisone (Deltasone), the nurse knows that the patient will be told to take the medication at which time of day to help reduce adrenal suppression?in the morningat lunchtimeat dinnertimeat bedtime
in the morning
After surgery for bilateral adrenalectomy, the client is kept on bed rest for several days to stabilize the body's need for steroids postoperatively. Which of the following exercises will be most effective for preparing a client for ambulation after a period of bed rest?1.Alternately flexing and extending the knees.2.Alternately abducting and adducting the legs.3.Alternately stretching the Achilles tendons.4.Alternately flexing and relaxing the quadriceps femoris muscles.
4Alternately flexing and relaxing the quadriceps femoris muscles helps prepare the client for ambulation. This exercise helps maintain the strength in the quadriceps, which is the major muscle group used when walking. The other exercises listed do not increase a client's readiness for walking
which teaching is appropriate for a pt who is taking an inhaled glucocorticoid for asthma?"exhale while pushing in on the canister of the inhaler""blow your nose after taking the medication""rinse mouth throughly after taking this med""do not eat immediately after taking the med"
"rinse mouth throughly after taking this med"
A nurse is providing discharge teaching for a client who had a transsphenoidal hypophysectomy. Which of the following instructions should the nurse include? -Brush teeth after every meal or snack -Avoid bending at the knees -Eat a high fiber diet -Notify provider of increased swallowing -Notify provider of diminished sense of smell
-Eat a high fiber diet -Notify provider of increased swallowing
A nurse is providing medication teaching for a client who has Addison's disease and is taking hydrocortisone. Which of the following instructions should the nurse include? -Take on an empty stomach -Notify the provider of any illness or stress -Report any manifestations of weakness or dizziness -Do not discontinue the medication suddenly -Eat a low sodium diet
-Notify the provider of any illness or stress -Do not discontinue the medication suddenly -Report any manifestations of weakness or dizziness
A nurse is caring for a client who is 6 hours post op following a transsphenoidal hypophysectomy. The nurse should test the client's nasal drainage for the presence of which of the following? -RBCs -ketones -glucose -Streptococci
-glucose
A client with Addison's disease is admitted to the medical unit. The client has fluid and electrolyte loss due to inadequate fluid intake and to fluid loss secondary to inadequate adrenal hormone secretion. As the client's oral intake increases, which of the following fluids would be most appropriate?1.Milk and diet soda.2.Water and eggnog.3.Bouillon and juice.4.Coffee and milkshakes.
3Electrolyte imbalances associated with Addison's disease include hypoglycemia, hyponatremia, and hyperkalemia. Salted bouillon and fruit juices provide glucose and sodium to replenish these deficits. Diet soda does not contain sugar. Water could cause further sodium dilution. Coffee's diuretic effect would aggravate the fluid deficit. Milk contains potassium and sodium.
To assist the nurse in evaluating the patients hydration status, assessment would includea.orthostatic hypotension and neck vein filling.b.pupil checks and Kernig sign.c.Chvostek and Trousseau signs.d.S4 gallop and edema.
ANS: AAssessment for orthostatic hypotension and neck vein filling is an important way to evaluate hydration status.
Which of the following is the best indicator for determining whether a client with Addison's disease is receiving the correct amount of glucocorticoid replacement?1.Skin turgor.2.Temperature.3.Thirst.4.Daily weight.
4Measuring daily weight is a reliable, objective way to monitor fluid balance. Rapid variations in weight reflect changes in fluid volume, which suggests insufficient control of the disease and the need for more glucocorticoids in the client with Addison's disease. Nurses should instruct clients taking oral steroids to weigh themselves daily and to report any unusual weight loss or gain. Skin turgor testing does supply information about fluid status, but daily weight monitoring is more reliable. Temperature is not a direct measurement of fluid balance. Thirst is a nonspecific and very late sign of weight loss.
The client has developed iatrogenic Cushing's disease. Which statement is the scientific rationale for the development of this diagnosis?1. The client has an autoimmune problem causing the destruction of the adrenal cortex.2. The client has been taking steroid medications for an extended period for another disease process.3. The client has a pituitary gland tumor causing the adrenal glands to produce too much cortisol.4. The client has developed an adrenal gland problem for which the health-care provider does not have an explanation.
The client has been taking steroid medications for an extended period for another disease process. "iatrogenic" means a problem has been caused by a medical treatment or procedure—in this case, treatment with steroids for another problem. Clients taking steroids over a period of time develop the clinical manifestations of Cushing's disease. Disease processes for which long-term steroids are prescribed include chronic obstructive pulmonary disease, cancer, and arthritis.
A nurse in a provider's office is reviewing the health record of a client who is being evaluated for Graves' disease. The nurse should identify that which of the following lab results is an expected finding?a. Decreased thyrotropin receptor antibodiesb. Decreased thyroid-stimulating hormone (TSH)c. Decreased free thyroxine indexd. Decreased triiodothyronine
b. Decreased thyroid-stimulating hormone (TSH)*In the presence of Graves' disease, low TSH is an expected finding. The pituitary gland decreases the production of TSH when thyroid hormone levels are elevated.
During long-term corticosteroid therapy, the nurse will monitor the patient's laboratory results for adverse effects, such as: (SATA)increased serum potassiumdecreased serum potassiumincreased sodium levelsdecreased sodium levelshyperglycemiahypoglycemia
decreased serum potassiumincreased sodium levelshyperglycemia
The client with Addison's disease should anticipate the need for increased glucocorticoid supplementation in which of the following situations?1.Returning to work after a weekend.2.Going on vacation.3.Having oral surgery.4.Having a routine medical checkup.
3Illness or surgery places tremendous stress on the body, necessitating increased glucocorticoid dosage. Extreme psychological stress also necessitates dosage adjustment. Increased dosages are needed in times of stress to prevent drug-induced adrenal insufficiency. Returning to work after the weekend, a vacation, or a routine checkup usually will not alter glucocorticoid dosage needs.
A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate?AInfusing I.V. fluids rapidly as orderedBEncouraging increased oral intakeCRestricting fluidsDAdministering glucose-containing I.V. fluids as ordered
CTo reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.
A client with diabetes insipidus is taking antidiuretic hormone. Which of the following symptoms would alert the need to decrease the dosage?AAlopecia.BJaundice.CDiarrhea.DDrowsiness.
DOne of the side effects of taking antidiuretic hormone is water intoxication which is manifested by a headache, drowsiness, light-headedness, and shortness of breath. This could indicate the need to reduce the dosage. Options A, B, and C are not related signs to this medication.
The nurse should tell the client to do which of the following when teaching the client about taking oral glucocorticoids?1."Take your medication with a full glass of water."2."Take your medication on an empty stomach."3."Take your medication at bedtime to increase absorption."4."Take your medication with meals or with an antacid."
4Oral steroids can cause gastric irritation and ulcers and should be administered with meals, if possible, or otherwise with an antacid. Only instructing the client to take the medication with a full glass of water will not help prevent gastric complications from steroids. Steroids should never be taken on an empty stomach. Glucocorticoids should be taken in the morning, not at bedtime.
Characteristics of diabetes insipidus (DI) area.hyperglycemia and hyperosmolarity.b.hyperglycemia and peripheral edema.c.intense thirst and passage of excessively large quantities of dilute urine.d.peripheral edema and pulmonary crackles.
ANS: CThe clinical diagnosis is made by the dramatic increase in dilute urine output in the absence of diuretics, a fluid challenge, or hyperglycemia. Characteristics of DI are intense thirst and the passage of excessively large quantities of very dilute urine.
Which of the following nursing interventions should be initiated on all patients with SIADH?a.Placing the patient on an air mattressb.Forcing fluidsc.Initiating seizure precautionsd.Applying soft restraints
ANS: CThe patient with SIADH has an excess of ADH secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia. Symptoms of severe hyponatremia include an inability to concentrate, mental confusion, apprehension, seizures, a decreased level of consciousness, coma, and death.
A nurse is planning care for a client who has Cushing's disease. The nurse should identify that clients who have Cushing's are at an increased risk of which of the following? -infection -gastric ulcer -renal calculi -bone fractures -dysphagia
-infection -gastric ulcers -bone fractures
While a patient with SIADH is receiving hypertonic saline, the nurse assesses for signs that the saline must be stopped. These signs would includea.decreased CVP and decreased PAP.b.bradycardia and thirst.c.hypotension and wheezing.d.hypertension and lung crackles.
ANS: DHypertension and lung crackles are signs of fluid overload. The hypertonic solution may pull fluid out of cells and tissues. Whereas weight gain signifies continual fluid retention, weight loss indicates loss of body fluid.
When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description?Asulfisoxazole (Gantrisin)Bmexiletine (Mexitil)Cprednisone (Orasone)Dlithium carbonate (Lithobid)
ASulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesn't cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia.
Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications?ATetanic contractionsBNeck vein distentionCWeight lossDPolyuria
BSIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe SIADH can cause such complications as vascular fluid overload, signaled by neck vein distention. This syndrome isn't associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria).
The nurse is admitting a client diagnosed with primary adrenal cortex insufficiency (Addison's disease). Which clinical manifestations should the nurse expect to assess?1. Moon face, buffalo hump, and hyperglycemia.2. Hirsutism, fever, and irritability.3. Bronze pigmentation, hypotension, andanorexia.4. Tachycardia, bulging eyes, and goiter.
Bronze pigmentation, hypotension, anorexia Bronze pigmentation of the skin, particu- larly of the knuckles and other areas of skin creases, occurs in Addison's disease. Hypotension and anorexia also occur with Addison's disease.
When instructing the female client diagnosed with hyperparathyroidism about diet, nurse Gina should stress the importance of which of the following?ARestricting fluidsBRestricting sodiumCForcing fluidsDRestricting potassium
CThe client should be encouraged to force fluids to prevent renal calculi formation. Sodium should be encouraged to replace losses in urine. Restricting potassium isn't necessary in hyperparathyroidism.
When monitoring for therapeutic response to prednisone, the nurse will look for which potential outcome?increased lymphocyte levelsdecreased inflammationincreased growth characteristicsdecrease in cushings syndrome characteristics
Decreased inflammation
A nurse is providing instructions to a client who has Graves' disease and has a new prescription for propranolol. Which of the following information should the nurse include?a. "An adverse effect of this med is jaundice."b. "Take your pulse before each dose."c. "The purpose of this med is to decrease production of thyroid hormone."d. "You should stop taking this med if you have a sore throat."
b. "Take your pulse before each dose."*Propranolol can cause bradycardia. The client should take their pulse before each dose. If there is a significant change, they should withhold the dose and consult the provider.
A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide?A"Administer desmopressin while the suspension is cold."B"Your condition isn't chronic, so you won't need to wear a medical identification bracelet."C"You may not be able to use desmopressin nasally if you have nasal discharge or blockage."D"You won't need to monitor your fluid intake and output after you start taking desmopressin."
cQuestion 27 Explanation:Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable, the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and receive adequate fluid replacement.
the nurse has provided teaching about oral corticosteroid therapy to a patient. which statement by the pt shows a need for more teaching?"i will report any fever or sore throat symptoms""i will stay away from anyone who has a cold or infection""i can stop this medication if i have severe adverse effects""i will take this drug with food or milk"
"i can stop this medication if i have severe adverse effects"
Which actions prescribed by the health care provider for the patient with Addison disease should the nurse delegate to the experienced unlicensed assistive personnel (UAP)? Select all that apply.1. Weigh the patient every morning.2. Obtain fingerstick glucose before each meal and at bedtime.3. Check vital signs every 2 hours.4. Monitor for cardiac dysrhythmias.5. Administer oral prednisone 10 mg every morning.6. Record intake and output.
1, 2, 3, 6Weighing patients, recording intake and output, and checking vital signs are all within the scope of practice for a UAP. An experienced UAP would have been trained to perform fingerstick glucose monitoring. The nurse should make sure that the UAP has mastered this skill and then instruct the UAP to record and inform him or her about the results. Administering medications and monitoring for cardiac dysrhythmias are within the scope of practice of licensed nurses.
Which of the following is a priority outcome for the client with Addison's disease?1.Maintenance of medication compliance.2.Avoidance of normal activities with stress.3.Adherence to a 2-g sodium diet.4.Prevention of hypertensive episodes.
1Medication compliance is an essential part of the self-care required to manage Addison's disease. The client must learn to adjust the glucocorticoid dose in response to the normal and unexpected stresses of daily living. The nurse should instruct the client never to stop taking the drug without consulting the health care provider to avoid an addisonian crisis. Regularity in daily habits makes adjustment easier, but the client should not be encouraged to withdraw from normal activities to avoid stress. The client does not need to restrict sodium. The client is at risk for hyponatremia. Hypotension, not hypertension, is more common with Addison's disease.
The client with Addison's disease is taking glucocorticoids at home. Which of the following statements indicate that the client understands how to take the medication?1."Various circumstances increase the need for glucocorticoids, so I will need to adjust the dosage."2."My need for glucocorticoids will stabilize and I will be able to take a predetermined dose once a day."3."Glucocorticoids are cumulative, so I will take a dose every third day."4."I must take a dose every 6 hours to ensure consistent blood levels of glucocorticoids."
1The need for glucocorticoids changes with circumstances. The basal dose is established when the client is discharged, but this dose covers only normal daily needs and does not provide for additional stressors. As the manager of the medication schedule, the client needs to know signs and symptoms of excessive and insufficient dosages. Glucocorticoid needs fluctuate. Glucocorticoids are not cumulative and must be taken daily. They must never be discontinued suddenly; in the absence of endogenous production, addisonian crisis could result. Two-thirds of the daily dose should be taken at about 8 am and the remainder at about 4 pm. This schedule approximates the diurnal pattern of normal secretion, with highest levels between 4 and 6 am and lowest levels in the evening.
Which of the following would be an expected finding in a client with adrenal crisis (addisonian crisis)?1.Fluid retention.2.Pain.3.Peripheral edema.4.Hunger.
2Adrenal hormone deficiency can cause profound physiologic changes. The client may experience severe pain (headache, abdominal pain, back pain, or pain in the extremities). Inhibited gluconeogenesis commonly produces hypoglycemia, and impaired sodium retention causes decreased, not increased, fluid volume. Edema would not be expected. Gastrointestinal disturbances, including nausea and vomiting, are expected findings in Addison's disease, not hunger.
The nurse should assess a client with Addison's disease for which of the following?1. Weight gain.2. Hunger.3. Lethargy.4. Muscle spasms.
3Although many of the disease signs and symptoms are vague and nonspecific, most clients experience lethargy and depression as early symptoms. Other early signs weight loss, muscle weakness, fatigue, nausea, and vomiting. Most clients experience a loss of appetite. Muscles become weak, not spastic, because of adrenocortical insufficiency.
A client who is recovering from a bilateral adrenalectomy has a patient-controlled analgesia (PCA) system with morphine sulfate. Which of the following actions is a priority nursing intervention for the client?1.Observing the client at regular intervals for opioid addiction.2.Encouraging the client to reduce analgesic use and tolerate the pain.3.Evaluating pain control at least every 2 hours.4.Increasing the amount of morphine if the client does not administer the medication.
3Pain control should be evaluated at least every 2 hours for the client with a PCA system. Addiction is not a common problem for the postoperative client. A client should not be encouraged to tolerate pain; in fact, other nursing actions besides PCA should be implemented to enhance the action of opioids. One of the purposes of PCA is for the client to determine frequency of administering the medication; the nurse should not interfere unless the client is not obtaining pain relief. The nurse should ensure that the client is instructed on the use of the PCA control button and that the button is always within reach.
When teaching a client newly diagnosed with primary Addison's disease, the nurse should explain that the disease results from:1.Insufficient secretion of growth hormone (GH).2.Dysfunction of the hypothalamic pituitary.3.Idiopathic atrophy of the adrenal gland.4.Oversecretion of the adrenal medulla.
3Primary Addison's disease refers to a problem in the gland itself that results from idiopathic atrophy of the glands. The process is believed to be autoimmune in nature. The most common causes of primary adrenocortical insufficiency are autoimmune destruction (70%) and tuberculosis (20%). Insufficient secretion of GH causes dwarfism or growth delay. Hyposecretion of glucocorticoids, aldosterone, and androgens occur with Addison's disease. Pituitary dysfunction can cause Addison's disease, but this is not a primary disease process. Oversecretion of the adrenal medulla causes pheochromocytoma.
A client reports that she has gained weight and that her face and body are "rounder," while her legs and arms have become thinner. A tentative diagnosis of Cushing's disease is made. The nurse should further assess the client for:1.Orthostatic hypotension.2.Muscle hypertrophy in the extremities.3.Bruised areas on the skin.4.Decreased body hair.
3Skin bruising from increased skin and blood vessel fragility is a classic sign of Cushing's disease. Hyperpigmentation and bruising are caused by the hypersecretion of glucocorticoids. Fluid retention causes hypertension, not hypotension. Muscle wasting occurs in the extremities. Hair on the head thins, while body hair increases.
The nurse is instructing a college student with Addison's disease how to adjust the dose of glucocorticoids. The nurse should explain that the client may need an increased dosage of glucocorticoids in which situation1. completing the spring semester of school2. gaining 4 lb (1.8 kg)3. becoming engaged4. having wisdom teeth extracted
4Adrenal crisis can occur with physical stress, such as surgery, dental work, infection, flu, trauma, and pregnancy. In these situations, glucocorticoid and mineralocorticoid dosages are increased. Weight loss, not gain, occurs with adrenal insufficiency. Psychological stress has less effect on corticosteroid need than physical stress.
Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus?Aantidiuretic hormone (ADH).Bthyroid-stimulating hormone (TSH).Cfollicle-stimulating hormone (FSH).Dluteinizing hormone (LH).
AADH is the hormone clients with diabetes insipidus lack. The client's TSH, FSH, and LH levels won't be affected.
When caring for a male client with diabetes insipidus, nurse Juliet expects to administer:Avasopressin (Pitressin Synthetic).Bfurosemide (Lasix).Cregular insulin.D10% dextrose.
ABecause diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.
The neuroendocrine stress response produces which of the following? (Select all that apply.)a.Elevated blood pressureb.Decreased gastric motilityc.Tachycardiad.Heightened pain awarenesse.Increased glucose
ANS: A, B, C, EThe fight-or-flight response, or sympathetic nervous response, releases catecholamine that causes an increased heart rate and blood pressure. Blood is shunted form nonessential organs such as the stomach, glucose is made available to the brain cells, and pain awareness is decreased.
A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before the surgery, nurse Jacob reviews preoperative and postoperative instructions given to the client earlier. Which postoperative instruction should the nurse emphasize?A"You must lie flat for 24 hours after surgery."B"You must avoid coughing, sneezing, and blowing your nose."C"You must restrict your fluid intake."D"You must report ringing in your ears immediately."
BAfter a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing, and blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The head of the bed must be elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24 hours after a hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake. Visual, not auditory, changes are a potential complication of hypophysectomy.
The patient at risk for developing SIADH may be takinga.adenosine (Adenocard).b.diltiazem (Cardizem).c.heparin sodium.d.acetaminophen.
ANS: DTylenol increases the release of ADH.
A nurse is instructing a client regarding intranasal Vasopressin (Pitressin). The nurse tells the client that which of the following is a side effect specific to the medication?ARunny nose.BHeadache.CFlushing.DNausea.
AVasopressin administered via intranasal route causes nasal congestion/Runny nose. Options B, C, and D are the side effects of the medication administered intravenously.
The nurse is planning the care of a client diagnosed with Addison's disease. Which intervention should be included?1. Administer steroid medications.2. Place the client on fluid restriction.3. Provide frequent stimulation.4. Consult physical therapy for gait training.
Administer steroid medications Clients diagnosed with Addison's disease have adrenal gland hypofunction. The hormones normally produced by the gland must be replaced. Steroids and androgens are produced by the adrenal gland.
The nurse is conducting discharge education with a client newly diagnosed with Addison's disease. Which information should be included in the client and family teaching plan? Select all that apply.1.Addison's disease will resolve over a few weeks, requiring no further treatment.2.Avoiding stress and maintaining a balanced lifestyle will minimize risk for exacerbations.3.Fatigue, weakness, dizziness, and mood changes need to be reported to the physician.4.A medical identification bracelet should be worn.5.Family members need to be informed about the warning signals of adrenal crisis.6.Dental work or surgery will require adjustment of daily medication.
2, 3, 4, 5, 6.Addison's disease occurs when the client does not produce enough steroids from the adrenal cortex. Lifetime steroid replacement is needed. The client should be taught lifestyle management techniques to avoid stress and maintain rest periods. A medical identification bracelet should be worn and the family should be taught signs and symptoms that indicate an impending adrenal crisis, such as fatigue, weakness, dizziness, or mood changes. Dental work, infections, and surgery commonly require an adjusted dosage of steroids.
The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate?1.Increase calories.2.Restrict sodium.3.Restrict potassium.4.Reduce fat to 10%.
2A primary dietary intervention is to restrict sodium, thereby reducing fluid retention. Increased protein catabolism results in loss of muscle mass and necessitates supplemental protein intake. The client may be asked to restrict total calories to reduce weight. The client should be encouraged to eat potassium-rich foods because serum levels are typically depleted. Although reducing fat intake as part of an overall plan to restrict calories is appropriate, fat intake of less than 20% of total calories is not recommended.
The client diagnosed with Cushing's disease has undergone a unilateral adrenalectomy. Which discharge instructions should the nurse discuss with the client?1. Instruct the client to take the glucocorticoid and mineralocorticoid medications as prescribed.2. Teach the client regarding sexual functioning and androgen replacement therapy.3. Explain the signs and symptoms of infection and when to call the health-care provider.4. Demonstrate turn, cough, and deep-breathing exercises the client should perform everytwo (2) hours.
3Notifying the HCP if signs/symptoms of infection develop is an instruction given to all surgical clients on discharge.
Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia?A AcromegalyB Type 1 diabetes mellitusCHypothyroidismDDeficient growth hormone
AAcromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn't associated with hyperglycemia, nor is growth hormone deficiency.
. Patients who have sustained head trauma or have undergone resection of a pituitary tumor have an increased risk of developinga.type 1 diabetes.b.type 2 diabetes.c.DI.d.myxedema coma.
ANS: CAny patient who has head trauma or resection of a pituitary tumor has an increased risk of developing DI.
A patient is admitted with a long history of mental illness. Her husband states she has been drinking up to 10 gallons of water each day for the past 2 days and refuses to eat. The patient is severely dehydrated and soaked with urine. The nurse suspectsa.central diabetes insipidus (DI).b.nephrogenic DI.c.psychogenic (dipsogenic) DI.d.iatrogenic DI.
ANS: CPsychogenic diabetes insipidus (DI) is a rare form of the disease that occurs with compulsive drinking of more than 5 L of water a day. Long-standing psychogenic DI closely mimics nephrogenic DI because the kidney tubules become less responsive to antidiuretic hormone as a result of prolonged conditioning to hypotonic urine.
The onset of seizures in the patient with DI indicatesa.increased potassium levels.b.hyperosmolality.c.severe dehydration.d.toxic ammonia levels.
ANS: CThis excessive intake of water reduces the serum osmolality to a more normal level and prevents dehydration. In the person with decreased level of consciousness, the polyuria leads to severe hypernatremia, dehydration, decreased cerebral perfusion, seizures, loss of consciousness, and death.
A patient presenting with diabetes insipidus (DI) exhibitsa.hyperosmolality and hypernatremia.b.hyperosmolality and hyponatremia.c.hypo-osmolality and hypernatremia.d.hypo-osmolality and hyponatremia.
ANS: AIn central DI, there is an inability to secrete an adequate amount of antidiuretic hormone (arginine vasopressin) in response to an osmotic or nonosmotic stimuli, resulting in inappropriately dilute urine. Hypernatremia is usually associated with serum hyperosmolality.
Patients with central DI are treated witha.vasopressin.b.insulin.c.glucagon.d.propylthiouracil.
ANS: APatients with central DI who are unable to synthesize antidiuretic hormone (ADH) require replacement ADH (vasopressin) or an ADH analog. The most commonly prescribed drug is the synthetic analog of ADH,desmopressin (DDAVP). DDAVP can be given intravenously, subcutaneously, or as a nasal spray. A typical DDAVP dose is 1 to 2 mcg intravenously or subcutaneously every 12 hours.
After a patient has been diagnosed with SIADH, the nurse would expect the first line of treatment to includea.fluid restriction.b.hypotonic intravenous fluid.c.D5W.d.fluid bolus.
ANS: AReduction in fluid intake is one component of the treatment plan for SIADH.
Decreased urine osmolality is a sign ofa.hyperglycemia.b.diabetes insipidus.c.thyroid crisis.d.SIADH.
ANS: BDecreased urine osmolality is a sign of DI.
. During the first 24 hours when the nurse administers hypertonic saline in a patient with SIADH, the serum sodium should be raised no more thana.5 mEq/day.b.12 mEq/day.c.20 mEq/day.d.25 mEq/day.
ANS: BOne recommended regimen is an IV rate that provides sufficient sodium to raise serum sodium levels by up to 12 mEq/day for the first 24 hours (no more than 0.5 mEq each hour), with a total increase of 18 mEq/L in the initial 48 hours.
In the syndrome of inappropriate antidiuretic hormone (SIADH), the physiologic effect isa.massive diuresis, leading to hemoconcentration.b.dilutional hyponatremia, reducing sodium concentration to critically low levels.c.hypokalemia from massive diuresis.d.serum osmolality greater than 350 mOsm/kg.
ANS: BPatients with SIADH have an excess of antidiuretic hormone secreted into the bloodstream, more than the amount needed to maintain normal blood volume and serum osmolality. Excessive water is resorbed at the kidney tubule, leading to dilutional hyponatremia.
The major electrolyte disturbances that result from diuresis area.low calcium and high phosphorus levels.b.low potassium and low sodium levels.c.high sodium and low phosphorus levels.d.low calcium and low potassium levels.
ANS: BSerum sodium may be low as a result of the movement of water from the intracellular space into the extracellular (vascular) space. The serum potassium level is often normal; a low serum potassium level in diabetic ketoacidosis suggests that a significant potassium deficiency may be present.
Desmopressin acetate (DDAVP) is given to a patient with diabetes insipidus. Which of the following therapeutic response should you expect?ADecreased blood pressure.BDecreased attention span.CDecreased urinary output.DDecreased blood sugar.
CThe therapeutic response of this medication is decreased urine output because it promotes renal conservation of water. Options A, B, and D are unrelated effect to this medication.
The nurse should teach the client with Addison's disease that the bronze-colored skin is thought to be caused by which of the following?1.Hypersensitivity to sun exposure.2.Increased serum bilirubin level.3.Adverse effects of the glucocorticoid therapy.4.Increased secretion of adrenocorticotropic hormone (ACTH).
4Bronzing, or general deepening of skin pigmentation, is a classic sign of Addison's disease and is caused by melanocyte-stimulating hormone produced in response to increased ACTH secretion. The hyperpigmentation is typically found in the distal portion of extremities and in areas exposed to the sun. Additionally, areas that may not be exposed to the sun, such as the nipples, genitalia, tongue, and knuckles, become bronze-colored. Treatment of Addison's disease usually reverses the hyperpigmentation. Bilirubin level is not related to the pathophysiology of Addison's disease. Hyperpigmentation is not related to the effects of the glucocorticoid therapy.
A nurse is planning to teach a client who is being evaluated for addisons disease about the adrenocorticotropic hormone (ACTH) stimulation test. The nurse should base the instructions on which of the following?the ACTH stimulation test measures the response by the kidneys to ACTHin the presence of the primary adrenal insufficiency, plasma cortisol levels rise in response to administration of ACTHACTH is a hormone produced by the pituitary glandThe client is instructed to take a dose of ACTH by mouth the evening before the test
ACTH is a hormone produced by the pituitary gland
An older patient presents with a serum glucose level of 900 mg/dL, hematocrit of 55%, and no serum ketones. Immediate attention must be given toa.clotting factors.b.rehydration.c.administration of insulin.d.sodium replacement.
ANS: BThe physical examination may reveal a profound fluid deficit. Signs of severe dehydration include longitudinal wrinkles in the tongue, decreased salivation, and decreased central venous pressure, with increases in heart rate and rapid respirations (Kussmaul air hunger does not occur). In older patients, assessment of clinical signs of dehydration is challenging.
A patient with bronchogenic oat cell carcinoma has a drop in urine output. The laboratory reports a serum sodium level of 120 mEq/L, a serum osmolality level of 220 mOsm/kg, and urine specific gravity of 1.035. The nurse would suspecta.diuresis.b.DI.c.SIADH.d.hyperaldosteronism.
ANS: CA decreased urine output, hyponatremia, hypoosmolality, and high urine specific gravity are classic signs of SIADH. Oat cell carcinoma is a precipitating factor for SIADH.
A nurse is preparing to receive a client from the PACU who is postop following a thyroidectomy. The nurse should ensure that which of the following equipment is available? (Select all)a. Suction equipmentb. Humidified oxygenc. Flashlightd. Tracheostomy traye. Chest tube tray
a. Suction equipment*Pt can require oral/tracheal suctioning. Ensure that suctioning equipment is availableb. Humidified oxygen*Pt can require supplemental oxygen due to respiratory complications. Humidified oxygen thins secretions and promotes respiratory exchange. This equipment should be available.d. Tracheostomy tray*Pt can experience respiratory obstruction. A tracheostomy tray should be available at bedside.
The nurse should monitor the client with Cushing's disease for which of the following?1.Postprandial hypoglycemia.2.Hypokalemia.3.Hyponatremia.4.Decreased urine calcium level.
2Sodium retention is typically accompanied by potassium depletion. Hypertension, hypokalemia, edema, and heart failure may result from the hypersecretion of aldosterone. The client with Cushing's disease exhibits postprandial or persistent hyperglycemia. Clients with Cushing's disease have hypernatremia, not hyponatremia. Bone resorption of calcium increases the urine calcium level.
Which of the following should the nurse include in the teaching plan of a female client with bilateral adrenalectomy?1.Emphasizing that the client will need steroid replacement for the rest of her life.2.Instructing the client about the importance of tapering steroid medication carefully to prevent crisis.3.Informing the client that steroids will be required only until her body can manufacture sufficient quantities.4.Emphasizing that the client will need to take steroids whenever her life involves physical or emotional stress.
1Bilateral adrenalectomy requires lifelong adrenal hormone replacement therapy. If unilateral surgery is performed, most clients gradually reestablish a normal secretion pattern. The client and family will require extensive teaching and support to maintain self-care management at home. Information on dosing, adverse effects, what to do if a dose is missed, and follow-up examinations is needed in the teaching plan. Although steroids are tapered when given for an intermittent or one-time problem, they are not discontinued when given to clients who have undergone bilateral adrenalectomy because the clients will not regain the ability to manufacture steroids. Steroids must be taken on a daily basis, not just during periods of physical or emotional stress.
A client has an adrenal tumor and is scheduled for a bilateral adrenalectomy. During preoperative teaching, the nurse teaches the client how to do deep breathing exercises after surgery by telling the client to:1."Sit in an upright position and take a deep breath."2."Hold your abdomen firmly with a pillow and take several deep breaths."3."Tighten your stomach muscles as you inhale and breathe normally."4."Raise your shoulders to expand your chest.
2Effective splinting for a high incision reduces stress on the incision line, decreases pain, and increases the client's ability to deep-breathe effectively. Deep breathing should be done hourly by the client after surgery. Sitting upright ignores the need to splint the incision to prevent pain. Tightening the stomach muscles is not an effective strategy for promoting deep breathing. Raising the shoulders is not a feature of deep-breathing exercises.
Because of steroid excess after a bilateral adrenalectomy, the nurse should assess the client for:1.Postoperative confusion.2.Delayed wound healing.3.Emboli.4.Malnutrition.
2Persistent cortisol excess undermines the collagen matrix of the skin, impairing wound healing. It also carries an increased risk of infection and of bleeding. The wound should be observed and documentation performed regarding the status of healing. Confusion and emboli are not expected complications after adrenalectomy. Malnutrition also is not an expected complication after adrenalectomy. Nutritional status should be regained postoperatively.
In the early postoperative period after a bilateral adrenalectomy, the client has an increased temperature. The nurse should assess the client further for signs of:1.Dehydration.2.Poor lung expansion.3.Wound infection.4.Urinary tract infection.
2Poor lung expansion from bed rest, pain, and retained anesthesia is a common cause of slight postoperative temperature elevation. Nursing care includes turning the client and having the client cough and deep-breathe every 1 to 2 hours, or more frequently as prescribed. The client will have postoperative IV fluid replacement prescribed to prevent dehydration. Wound infections typically appear 4 to 7 days after surgery. Urinary tract infections would not be typical with this surgery.
A client diagnosed with Cushing's syndrome is admitted to the hospital and scheduled for a dexamethasone suppression test. During this test, the nurse should1.Collect a 24-hour urine specimen to measure serum cortisol levels.2.Administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning.3.Draw blood samples before and after exercise to evaluate the effect of exercise on serum cortisol levels.4.Administer an injection of adrenocorticotropic hormone (ACTH) 30 minutes before drawing blood to measure serum cortisol levels.
2When Cushing's syndrome is suspected a 24-hour urine collection for free cortisol is performed. Levels of 50 to 100 mcg/day (1,379 to 2,756 nmol/L) in adults indicate Cushing's syndrome. If these results are borderline a high-dose dexamethasone suppression test is done. The Dexamethasone is given at 11 pm to suppress secretion of the corticotrophin-releasing hormone. A plasma cortisol sample is drawn at 8 am. Normal cortisol level less than 5 mcg/dL (140 nmol/L) indicates normal adrenal response.
The nurse writes a problem of "altered body image" for a 34-year-old client diagnosed with Cushing's disease. Which intervention should be implemented?1. Monitor blood glucose levels prior to meals and at bedtime.2. Perform a head-to-toe assessment on the client every shift.3. Use therapeutic communication to allow the client to discuss feelings.4. Assess bowel sounds and temperature every four (4) hours.
3 Allowing the client to ventilate feelings about the altered body image is the most appropriate intervention. The nurse cannot do anything to help the client's buffalo hump or moon face.
Which of the following indicates that the client with Addison's disease is receiving too much glucocorticoid replacement?1.Anorexia.2.Dizziness.3.Rapid weight gain.4.Poor skin turgor.
3 Rapid weight gain, because it reflects excess fluids, is a warning sign that the client is receiving too much hormone replacement. It may be difficult to individualize the correct dosage for a client taking glucocorticoids, and the therapeutic range between underdosage and overdosage is narrow. Maintaining the client on the lowest dose that provides satisfactory clinical response is always the goal of pharmacotherapeutics. Fluid balance is an important indicator of the adequacy of hormone replacement. Anorexia is not present with glucocorticoid therapy because these drugs increase the appetite. Dizziness is not specific to the effects of glucocorticoid therapy. Poor skin turgor is a late sign of fluid volume deficit.
A client with Cushing's disease tells the nurse that the physician said the morning serum cortisol level was within normal limits. The client asks, "How can that be? I'm not imagining all these symptoms!" The nurse's response will be based on which of the following concepts?1.Some clients are very sensitive to the effects of cortisol and develop symptoms even with normal levels.2.A single random blood test cannot provide reliable information about endocrine levels.3.The excessive cortisol levels seen in Cushing's disease commonly result from loss of the normal diurnal secretion pattern.4.Tumors tend to secrete hormones irregularly, and the hormones are generally not present in the blood.
3Cushing's disease is commonly caused by loss of the diurnal cortisol secretion pattern. The client's random morning cortisol level may be within normal limits, but secretion continues at that level throughout the entire day. Cortisol levels should normally decrease after the morning peak. Analysis of a 24-hour urine specimen is often useful in identifying the cumulative excess. Clients will not have symptoms with normal cortisol levels. Hormones are present in the blood.
Cortisone acetate and fludrocortisone acetate are prescribed as replacement therapy for a client with Addison's disease. What administration schedule should be followed for this therapy?1.Take both drugs three times a day.2.Take the entire dose of both drugs first thing in the morning.3.Take all the fludrocortisone acetate and two-thirds of the cortisone acetate in the morning, and take the remaining cortisone acetate in the afternoon.4.Take half of each drug in the morning and the remaining half of each drug at bedtime.
3Fludrocortisone acetate can be administered once a day, but cortisone acetate administration should follow the body's natural diurnal pattern of secretion. Greater amounts of cortisol are secreted during the day to meet the increased demand of the body. Typically, baseline administration of cortisone acetate is 25 mg in the morning and 12.5 mg in the afternoon. Taking it three times a day would result in an excessive dose. Taking the drug only in the morning would not meet the needs of the body later in the day and evening.
A priority in the first 24 hours after a bilateral adrenalectomy is:1.Beginning oral nutrition.2.Promoting self-care activities.3.Preventing adrenal crisis.4.Ambulating in the hallway.
3The priority in the first 24 hours after adrenalectomy is to identify and prevent adrenal crisis. Monitoring of vital signs is the most important evaluation measure. Hypotension, tachycardia, orthostatic hypotension, and arrhythmias can be indicators of pending vascular collapse and hypovolemic shock that can occur with adrenal crisis. Beginning oral nutrition is important, but not necessarily in the first 24 hours after surgery, and it is not more important than preventing adrenal crisis. Promoting self-care activities is not as important as preventing adrenal crisis. Ambulating in the hallway is not a priority in the first 24 hours after adrenalectomy
Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia?AAcromegalyBType 1 diabetes mellitusCHypothyroidismDDeficient growth hormone
AAcromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn't associated with hyperglycemia, nor is growth hormone deficiency.
Which outcome indicates that treatment of a male client with diabetes insipidus has been effective?AFluid intake is less than 2,500 ml/day.BUrine output measures more than 200 ml/hour.CBlood pressure is 90/50 mm Hg.DThe heart rate is 126 beats/minute.
ADiabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn't been effective.
A priority for patient education when discharged with long-term antidiuretic hormone deficiency isa.daily intake and output.b.attention to thirst.c.a low-sodium diet.d.daily weights.
ANS: DDaily weights on the same scale are an excellent assessment of fluid status. A weight gain or loss of 1 kg (2.2 lb) is equal to 1 L of fluid.
The diagnosis of SIADH is made when which of the following conditions is present?a.Decreased ADH level and hyperkalemiab.Decreased ADH level and hypernatremiac.Increased ADH level and serum ketonesd.Increased ADH level and low serum osmolality
ANS: DSIADH occurs when there are increased levels of ADH in the blood compared with a low serum osmolality.
