LACHARITY Endocrine

Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide? glipizide is a sulfonylurea

"Be sure to take glipizide 30 minutes before meals." The client should take glipizide twice a day, 30 minutes before a meal, because food decreases its absorption. The drug doesn't cause hyponatremia and therefore doesn't necessitate monthly serum sodium measurement. The client must continue to monitor the blood glucose level during glipizide therapy.

The patient with type 2 diabetes is "nothing by mouth" (NPO) for a cardiac catheterization. An LPN/LVN who is administering medications to this patient asks you (the supervising RN) whether the patient should receive his ordered repaglinide (Prandin). What is your best response?

"No, because this drug should be given 1 to 30 minutes before meals and the patient is NPO."

The LPN/LVN asks you why the patient with Cushing disease has bruising and petechiae across her abdomen. What is your best response?

"Patients with Cushing disease have very fragile capillaries." A key cardiovascular feature seen in patients with Cushing disease is capillary fragility, which results in bruising and petechiae. Bleeding disorders are not a sign of Cushing disease, and although these patients have delicate skin, this is not the cause of the bruising. You may want to investigate whether the patient fell, but these patients have bruising and petechiae despite falls.

While performing an admission assessment on a patient with type 2 diabetes, he tells you that he routinely drinks 3 beers a day. What is your priority follow-up question at this time

1."Do you have any days when you do not drink?" √ 2."When during the day do you drink your beers?" 3."Do you drink any other forms of alcohol?" 4."Have you ever had a lipid profile completed?" *Alcohol has the potential for causing alcohol-induced hypoglycemia. It is important to know when the patient drinks alcohol and to teach the patient to ingest it shortly after meals to prevent this complication. The other questions are important, but not urgent. The lipid profile question is important because alcohol can raise plasma triglycerides but is not as urgent as the potential for hypoglycemia.

You are preceptor for a senior nursing student who will teach a diabetic patient about self-care during sick days. For which statement by the student must you intervene?

1."When you are sick, be sure to monitor your blood glucose at least every 4 hours." √ 2."Test your urine for ketones whenever your blood glucose level is less than 240 mg/dL." 3."To prevent dehydration, drink 8 ounces of sugar-free liquid every hour while you are awake." 4."Continue to eat your meals and snacks at the usual times." *Urine ketone testing should be done whenever the patient's blood glucose is greater than 240 mg/dL. All of the other teaching points are appropriate "sick day rules." For dehydration, teaching should also include that if the patient's blood glucose is lower than her target range, she should drink fluids containing sugar.

A patient with type 1 diabetes reports feeling dizzy. What should the nurse do first?

1.Check the patient's blood pressure. 2.Give the patient some orange juice. 3.Give the patient's morning dose of insulin. 4.√Use a glucometer to check the patient's glucose level. *Before orange juice or insulin is given, the patient's blood glucose level should be checked. Checking blood pressure is a good idea but is not the first action the nurse should take.

A patient with diabetes has hot, dry skin; rapid and deep respirations; and a fruity odor to his breath. As charge nurse, you observe a newly-graduated RN performing all the following patient tasks. Which one requires that you intervene immediately?

1.Checking the patient's fingerstick glucose level 2.*Encouraging the patient to drink orange juice 3.Checking the patient's order for sliding-scale insulin dosing 4.Assessing the patient's vital signs every 15 minutes

A patient has newly-diagnosed type 2 diabetes. Which action should you assign to an LPN/LVN instead of a UAP?

1.Measuring the patient's vital signs every shift 2.Checking the patient's glucose level before each meal 3.√Administering subcutaneous insulin on a sliding scale as needed 4.Assisting the patient with morning care *The UAP's scope of practice includes checking vital signs and assisting with morning care. UAPs with special training can check the patient's glucose level before meals. It is generally not within the UAP's scope of practice to administer medications, but this is within the scope of practice of the LPN/LVN.

While working in the diabetes clinic, you obtain this information about an 8-year-old with type 1 diabetes. Which finding is most important to address when planning child and parent education?

1.Most recent hemoglobin A1C level of 7.8% 2.Many questions about diet choices from the parents 3.Child's participation in soccer practice after school 2 days a week √4.Morning preprandial glucose range of 55 to 70 mg/dL *The low morning fasting blood glucose level indicates possible nocturnal hypoglycemia, risk for permanent neurologic damage and adverse developmental outcomes

Which actions can the school nurse delegate to UAPs who are working with a 7-year-old child with type 1 diabetes in an elementary school? (Select all that apply.)

1.Obtaining information about the child's usual insulin use from the parents √2.Administering oral glucose tablets when blood glucose level falls below 60 mg/dL 3.Teaching the child about what foods have high carbohydrate levels √ 4.Obtaining blood glucose readings using the child's blood glucose monitor √ 5.Reminding the child to have a snack after the physical education class

You are serving as preceptor to a nurse who has recently graduated and passed the RN licensure examination. The new nurse has only been on the unit for 2 days. Which patient should you assign to the new nurse?

58-year-old with diabetes who has cellulitis of the left ankle *The new nurse is still on orientation to the unit. Appropriate patient assignments at this time include patients whose conditions are stable and not complex

Which patients should you, as the charge nurse, assign to the care of an LPN/LVN, under the supervision of the RN team leader?

83-year-old with type 2 diabetes and chronic obstructive pulmonary disease The 83-year-old has no complicating factors at the moment. Providing care for patients in stable and uncomplicated condition falls within the LPN/LVN's educational preparation and scope of practice, with the care always being provided under the supervision and direction of an RN. The nurse should assess the patient who has just undergone surgery and the newly-admitted patient. The patient who is preparing for discharge after myocardial infarction may need some complex teaching.

A male client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis indicates that the client's hypertension is caused by excessive hormone secretion from which of the following glands?

Adrenal Cortex Excessive secretion of aldosterone in the adrenal cortex is responsible for the client's hypertension. This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone.

You are instructing a senior nursing student on the techniques for palpation of the thyroid gland. What precaution would you be sure to instruct the student about thyroid palpation?

Always palpate the thyroid gland gently. The thyroid gland should always be palpated gently because vigorous palpation can stimulate a thyroid storm in a patient who may have hyperthyroidism. You should stand either behind or in front of the patient and use both hands to palpate the thyroid. Having the patient swallow can help with locating the thyroid gland.

You are caring for a diabetic patient who is developing diabetic ketoacidosis (DKA). Which task delegation is most appropriate?

Ask the unit clerk to page the physician to come to the unit. *The nurse should not leave the patient. The scope of the unit clerk's job includes calling and paging physicians. LPNs/LVNs generally do not administer IV push medication. IV fluid administration is not within the scope of practice of UAPs. Patients with DKA already have a high glucose level and do not need orange juice.

Which actions should you delegate to the LPN/LVN for the care of a patient with hypothyroidism? (Select all that apply.)

Assessing and recording the rate and depth of respirations Auscultating lung sounds every 4 hours Reminding the patient to report any episodes of chest pain or discomfort Assessment, auscultation, and reminding patients about information that has been taught to them are within the scope of practice of the LPN/LVN. Certainly the LPN/LVN could check the patient's vital signs, but this would be more appropriately delegated to the UAP. Creating nursing care plans falls within the scope of practice of the RN. The use of sedation is discouraged for patients with hypothyroidism because it may make respiratory problems more difficult. If sedation is used, dosage is reduced and it is not given around the clock.

Which factor reported by Ms. H supports the diagnosis of Cushing disease?

Cessation of menses at age 33 Women with hypercortisolism may report a history of cessation of menses. Increased androgen production can interrupt the normal hormone feedback mechanism for the ovary, which decreases the production of estrogens and progesterone and results in oligomenorrhea (scant or infrequent menses).

Cushing disease is diagnosed in Ms. H because of increased secretion of adrenocorticotropic hormone (ACTH), and she is scheduled for an adrenalectomy. Which preoperative actions should the nurse delegate to the LPN/LVN? (Select all that apply.)

Checking the patient's fingerstick glucose results Administering insulin on a sliding scale as needed The educational preparation of the LPN/LVN includes fingerstick glucose monitoring and administering subcutaneous medications. Assessing cardiac rhythms and reviewing laboratory results require additional education and skill, and are appropriate to the RN's scope of practice.

When providing care for a patient with Addison disease, you should be alert for which laboratory value change?

Decreased hematocrit A patient with Addison disease is at risk for anemia. The nurse should expect this patient's sodium level to decrease, and potassium and calcium levels to increase.

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

Deposits of adipose tissue in the trunk and dorsocervical area Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

A female client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem?

Depression Agitation, irritability, poor memory, loss of appetite, and neglect of one's appearance may signal depression, which is common in clients with Cushing's syndrome. Neuropathy affects clients with diabetes mellitus — not Cushing's syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite.

A patient with adrenal insufficiency is to be discharged and will take prednisone (Deltasone) 10 mg orally each day. Which instruction would you be sure to teach the patient?

Excessive weight gain or swelling should be reported to the physician. Rapid weight gain and edema are signs of excessive drug therapy, and the dosage of the drug would need to be adjusted. Hypertension, hyponatremia, hyperkalemia, and hyperglycemia are common in patients with adrenal hypofunction.

A 58-year-old with type 2 diabetes was admitted to your unit with a diagnosis of chronic obstructive pulmonary disease (COPD) exacerbation. When you prepare a care plan for this patient, what would you be sure to include? (Select all that apply.)

Fingerstick blood glucose checks before meals and at bedtime. Sliding-scale insulin dosing as ordered Demonstration of the components of foot care *When a diabetic patient is ill, glucose levels become elevated, and administration of insulin may be necessary. Teaching or reviewing the components of proper foot care is always a good idea with a diabetic patient. Bed rest is not necessary, and glucose level may be better controlled when a patient is more active. The Atkins diet recommends decreasing the consumption of carbohydrates and is not a good diet for diabetic patients.

When instructing the female client diagnosed with hyperparathyroidism about diet, nurse Gina should stress the importance of which of the following?

Forcing fluids The 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.

Adrenal hypo function: insufficiency

Hypertension, hyperglycemia, hyperkalemia, hyponatremia

Ms. B's blood pressure is now 84/50 mm Hg. Which order from the health care provider would you implement first?

Infuse normal saline at 250 mL/hr. The patient is hypotensive and most likely hypovolemic. Because the patient already has an IV line, the IV fluids should be started first to address the primary problem. The second IV line and typing and cross matching need to be accomplished rapidly, and the blood sample may be drawn at the same time the second IV line is inserted. The patient needs cortisol replacement, but with nausea and vomiting present, the oral route is not the best option.

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?

It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism.

Which actions will you delegate to the UAP in providing care for Ms. B? (Select all that apply.)

Measuring vital signs every 15 minutes √ 3. Recording intake and output accurately every hour √ 4. Getting a baseline weight to guide therapy The patient is experiencing nausea and vomiting, so oral fluids are not appropriate at this time. The UAP can take frequent vital sign measurements, record intake and output, and weigh the patient. The nurse should instruct the UAP about what variations in vital signs must be reported.

A patient with pheochromocytoma underwent surgery to remove his adrenal glands. Which nursing intervention should you delegate to a UAP?

Monitoring lying and standing blood pressure every 4 hours with a cuff placed on the same arm Monitoring vital signs is within the education and scope of practice for UAPs. The nurse should be sure to instruct the UAP that blood pressure measurements are to be taken with the cuff on the same arm each time. Revising the care plan and instructing and assessing patients are beyond the scope of UAPs and fall within the purview of licensed nurses.

For a patient with hyperthyroidism, which task will you delegate to an experienced UAP?

Monitoring the apical pulse, blood pressure, and temperature every 4 hours Monitoring vital signs and recording their values are within the education and scope of practice of UAPs. An experienced UAP should have been taught how to monitor the apical pulse. However, a nurse should observe the UAP to be sure that the UAP has mastered this skill. Instructing and teaching patients, as well as performing venipuncture to obtain laboratory samples, are more suited to the education and scope of practice of licensed nurses. In some facilities, an experienced UAP may perform venipuncture, but only after special training.

You are the charge nurse. Which patients would be appropriate to assign to a newly graduated nurse who has just completed orientation to the unit? (Select all that apply.)

Ms. L with pheochromocytoma, who is scheduled for adrenalectomy and needs preoperative teaching Mr. J with hyperaldosteronism, whose current serum potassium level is 3.2 mEq/L The new nurse graduate who has just completed orientation should be assigned patients whose conditions are relatively stable and not complex. The new graduate should be familiar with the adrenal surgery after completing her orientation and should be able to provide the teaching the patient needs. The patient with a low potassium level will need some form of potassium supplementation, which the new nurse should be able to administer. The patient in addisonian crisis should be assigned to an experienced nurse. The fearful, anxious patient would also benefit from being cared for by an experienced nurse.

Ms. B is admitted through the emergency department (ED) after being hit in the abdomen by an automobile. An 18-gauge IV catheter is inserted in the left forearm and normal saline is started at 100 mL/hr. The UAP reports that her blood pressure has dropped to 92/58 mm Hg and she is reporting weakness, fatigue, and abdominal pain. When you assess Ms. B, you also discover that she is nauseated and has just vomited 560 mL.

Notify the health care provider. These signs and symptoms indicate adrenal crisis (addisonian crisis), or acute adrenocortical insufficiency—a life-threatening event in which the need for cortisol and aldosterone is greater than the available supply. The other actions are important and will likely be implemented rapidly, because a common cause of acute adrenal gland hypofunction is hemorrhage, but the health care provider must be notified immediately.

Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug reactions and interactions. Which type of drug interacts adversely with glucagon?

Oral anticoagulants As a normal body protein, glucagon only interacts adversely with oral anticoagulants, increasing the anticoagulant effects. It doesn't interact adversely with anabolic steroids, beta-adrenergic blockers, or thiazide diuretics.

Which vital sign value reported by the UAP is of most concern for a patient with Cushing disease (hypercortisolism)?

Oral temperature of 101.8° F (38.8° C) A patient with hypercortisolism is immunosuppressed because excess cortisol reduces the number of circulating lymphocytes and inhibits production of cytokines and inflammatory chemicals such as histamine. These patients are at greater risk for infection.

A female patient is admitted with a diagnosis of primary hypofunction of the adrenal glands. Which assessment finding supports this diagnosis?

Patchy areas of pigment loss over the face Vitiligo, or patchy areas of pigment loss with increased pigmentation at the edges, is seen with primary hypofunction of the adrenal glands and is caused by autoimmune destruction of melanocytes in the skin. The other findings are signs of pituitary hypofunction.

An LPN/LVN's assessment of two diabetic patients reveals all of these findings. Which would you instruct the LPN/LVN to report immediately?

Profuse perspiration *Profuse perspiration is a symptom of hypoglycemia, a complication of diabetes that requires urgent treatment. A glucose level of 185 mg/dL will need coverage with sliding-scale insulin, but this is not urgent. Numbness and tingling, as well as bunions, are related to the chronic nature of diabetes and are not urgent problems.

The educational preparation of the LPN/LVN includes fingerstick glucose monitoring and administering subcutaneous medications. Assessing cardiac rhythms and reviewing laboratory results require additional education and skill, and are appropriate to the RN's scope of practice.

Providing the patient with a soft toothbrush Reminding the patient to change positions in bed every 2 hours The UAP can provide articles for self-care and reinforce what the RN has already taught the patient. The UAP can also remind the patient about changing positions. Instructing and assessing are within the scope of practice of the professiona

Which change in vital signs would you instruct the UAP to report immediately for a patient with hyperthyroidism?

Rapid heart rate The cardiac problems associated with hyperthyroidism include tachycardia, increased systolic blood pressure, and decreased diastolic blood pressure. Patients with hyperthyroidism also may have increased body temperature related to increased metabolic rate. Respiratory changes are usually not symptomatic of this condition.

in providing nursing care for Ms. L, which action should you delegate to the UAP?

Reminding the patient not to smoke, drink caffeinated beverages, or change positions suddenly The UAP should remind the patient about elements of the care regimen that the nurse has already taught the patient. Assessing, instructing, and identifying stressful situations that may trigger a hypertensive crisis require additional education and skill appropriate to the scope of practice of the professional RN.

In a 29-year-old female client who is being successfully treated for Cushing's syndrome, nurse Lyzette would expect a decline in:

Serum glucose level. Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth also declines. Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.

A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which of the following is the most important laboratory test for confirming this disorder?

Serum osmolarity A client with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level is variable.

A UAP tells you that while assisting with the morning care of a postoperative patient with type 2 diabetes who has been given insulin, the patient asked if she will always need to take insulin now. What is your priority for teaching the patient?

Talk with the patient about the relationship between illness and increased glucose levels. *Long-acting insulins mimic the action of the pancreas. Regular insulin is the only insulin that can be given IV.

A nursing student will assess Ms. H. Which findings will you teach the student nurse to expect if a patient has Cushing disease? (Select all that apply.)

Truncal obesity Bruising Hypertension Dependent edema A patient with Cushing disease typically has paperlike thin skin and weight gain as a result of an increase in total body fat caused by slow turnover of plasma fatty acids. Weight loss is to be expected in a patient with hypocortisolism (e.g., Addison disease). The other findings are typical of a patient with Cushing disease.

A client with diabetes who uses insulin isophane has been diagnosed with hypertension. The healthcare provider has prescribed atenolol, a beta blocker. The nurse should teach the client to be aware that the addition of atenolol to the use of the insulin can cause:

hypoglycemia. There is a direct interaction between the effects of insulin and those of beta blockers. The nurse must be aware that there is a potential for hypoglycemic effects of insulin isophane when a beta blocker is added to the client's medication regimen. The client's blood sugar should be monitored. The client will not experience hyperglycemia, hunger or thirst when using these drugs in combination.

A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer:

phentolamine (Regitine) Pheochromocytoma causes excessive production of epinephrine and norepinephrine, natural catecholamines that raise the blood pressure. Phentolamine, an alpha-adrenergic blocking agent given by I.V. bolus or drip, antagonizes the body's response to circulating epinephrine and norepinephrine, reducing blood pressure quickly and effectively. Although methyldopa is an antihypertensive agent available in parenteral form, it isn't effective in treating hypertensive emergencies. Mannitol, a diuretic, isn't used to treat hypertensive emergencies. Felodipine, an antihypertensive agent, is available only in extended-release tablets and therefore doesn't reduce blood pressure quickly enough to correct hypertensive crisis.

You are caring for a diabetic patient admitted with hypoglycemia that occurred at home. Which teaching points for treatment of hypoglycemia at home would you include in a teaching plan for the patient and family before discharge? (Select all that apply.)

√ 1. Signs and symptoms of hypoglycemia include hunger, irritability, weakness, headache, and blood glucose less than 60 mg/dL. 2.Treat hypoglycemia with 4 to 8 g of carbohydrate such as glucose tablets or 1/4 cup of fruit juice. 3.Retest blood glucose in 30 minutes. √ 4.Repeat the carbohydrate treatment if the symptoms do not resolve. √ 5.Eat a small snack of carbohydrate and protein if the next meal is more than an hour away. The manifestations listed in option 1 are correct. The symptoms should be treated with carbohydrate, but 10 to 15 g (not 4 to 8 g). Glucose should be retested at 15 minutes; 30 minutes is too long to wait.

You are preparing a care plan for a patient with Cushing disease. Which nursing diagnoses would you be sure to include? (Select all that apply.)

√ 1.Risk for Injury related to the potential for bruising √ 2.Disturbed Body Image 3.Imbalanced Nutrition: Less than Body Requirements √ 4.Risk for Injury related to the potential for hypertension √ 5.Risk for Infection A patient with Cushing disease experiences body changes affecting body image and is at risk for bruising, infection, and hypertension. Such a patient usually gains weight.

The UAP reports to you that a patient with type 1 diabetes has a question about exercise. What important points would you be sure to teach this patient? (Select all that apply.)

√ guidelines are based on blood glucose and urine ketone levels. √You can exercise vigorously if your blood glucose is between 100 and 250 mg/dL. √A 5- to 10-minute warm-up and cool-down period should be included in your exercise. *Guidelines for exercise are based on blood glucose and urine ketone levels. Patients should test blood glucose before, during, and after exercise to be sure that it is safe. When ketones are present in urine, the patient should not exercise because they indicate that current insulin levels are not adequate. Vigorous exercise is permitted in patients with type 1 diabetes if glucose levels are between 100 and 250 mg/dL. Warm-up and cool-down should be included in exercise to gradually increase and decrease the heart rate.

You are orienting a new graduate nurse who is providing diabetes education for a patient about insulin injection. For which teaching statement by the new nurse must you intervene?

√1."To prevent lipohypertrophy, be sure to rotate injection sites from the abdomen to the thighs." 2."To correctly inject the insulin, lightly grasp a fold of skin and inject at a 90-degree angle." 3."Always draw your regular insulin into the syringe first before your NPH insulin." 4."Avoid injecting the insulin into scarred sites because those areas slow the absorption rate of insulin." While it is important to rotate injection sites for insulin, it is preferred that the injection sites be rotated within one anatomic site (e.g., the abdomen) to prevent day-to-day changes in the absorption rate of the insulin. All of the other teaching points are appropriate.

The experienced UAP has been delegated to take vital signs and check fingerstick glucose on a diabetic patient who is postoperative. Which vital sign change would you instruct the UAP to report immediately?

√Glucose increase from 190 mg/dL to 236 mg/dL *An unexpected rise in blood glucose is associated with increased mortality and morbidity after surgical procedures. Current ADA guidelines recommend insulin protocols to maintain blood glucose levels between 140 and 180 mg/dL. Also, unexpected rises in blood glucose values may indicate wound infection.

You are caring for an 81-year-old adult with type 2 diabetes, hypertension, and peripheral vascular disease. Which admission assessment findings increase the patient's risk for development of hyperglycemic-hyperosmolar state (HHS)? (Select all that apply.)

√Hydrochlorothiazide (HCTZ) prescribed to control her diabetes √ 3.Avoids consuming liquids in the evening *HHS often occurs in older adults with type 2 diabetes. Risk factors include taking diuretics and inadequate fluid intake. Weight loss (not weight gain) would be a symptom. While the patient's blood pressure is high, this is not a risk factor. A urine output of 50 to 75 mL/hr is adequate.

Ms. H had a complete adrenalectomy, and you are preparing to educate her about cortisol replacement therapy. Which key points will you include in the teaching plan? (Select all that apply.)

√Take your medication in divided doses, with the first dose in the morning and the second dose between 4 and 6 PM." √"Weigh yourself daily using the same scale and wearing the same amount of clothes." √ 4."Never skip a dose of medication." √ 5."Call your doctor if you experience persistent nausea, severe diarrhea, or fever." √ 6."Report any rapid weight gain, round face, fluid retention, or swelling to your doctor. Cortisol replacement drugs should be taken with meals or snacks, because the patient can develop gastrointestinal irritation when the drugs (cortisone, hydrocortisone [Cortef], prednisone [Deltasone], fludrocortisone [Florinef]) are taken on an empty stomach. All of the other teaching points are appropriate.