The Client with Addison's Disease

87. The client with Addison's disease should anticipate the need for increased glucocorticoid supplementation when: 1. returning to work after a weekend. 2. going on vacation. 3. having oral surgery. 4. having a routine medical checkup.

3. having oral surgery.

84. When teaching a client about taking oral glucocorticoids, how should the nurse instruct the client to take the medication? 1. with a full glass of water 2. on an empty stomach 3. at bedtime to increase absorption 4. with meals or with an antacid

4. with meals or with an antacid

78. 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.

3. idiopathic atrophy of the adrenal gland.

80. The nurse should assess a client with Addison's disease for: 1. weight gain. 2. hunger. 3. lethargy. 4. muscle spasms.

3. lethargy.

85. Which indicator is best 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

4. daily weight

70. 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 situation 1. completing the spring semester of school 2. gaining 4 lb (1.8 kg) 3. becoming engaged 4. having wisdom teeth extracted

4. having wisdom teeth extracted

82. The client with Addison's disease is taking glucocorticoids at home. Which statement indicates that the client understands how to take the medication? 1. "various circumstances increase the need for glucocorticoids, so 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."

1. "various circumstances increase the need for glucocorticoids, so will need to adjust the dosage."

75. The client's wife asks the nurse whether the IV infusion is meeting her husband's nutritional needs because he has vomited several times. The nurse's response should be based on the knowledge that 1 L of 5% dextrose in normal saline delivers: 1. 170 cal. 2. 250 cal. 3. 340 cal. 4. 500 cal.

1. 170 cal.

81. 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 healthcare provider (HCP) when the blood pressure is suddenly high 4. How to decrease the dose of the corticosteroids when the client experiences stress

1. The importance of watching for signs of hyperglycemia

74. The client is receiving an IV infusion of 5% dextrose in normal saline running at 125 mL/h. When hanging a new bag of fluid, the nurse notes swelling and hardness at the infusion site. The nurse should first: 1. discontinue the infusion. 2. apply a warm soak to the site. 3. stop the flow of solution temporarily. 4. irrigate the needle with normal saline.

1. discontinue the infusion.

86. Which outcome is a priority 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

1. maintenance of medication compliance

79. 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 healthcare provider (HCP). 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. 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 healthcare provider (HCP). 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.

72. Which is an expected finding in a client with adrenal crisis (addisonian crisis)? 1. fluid retention 2. pain 3. peripheral edema 4. hunger

2. pain

71. Which goal is the priority for a client in addisonian crisis? 1. controlling hypertension 2. preventing irreversible shock 3. preventing infection 4. relieving anxiety

2. preventing irreversible shock

73. A client with Addison's disease is taking corticosteroid replacement therapy. The nurse should instruct the client about which side effect of corticosteroids? Select all that apply. 1. hyperkalemia 2. skeletal muscle weakness 3. mood changes 4. hypocalcemia 5. increased susceptibility to infection 6. hypotension

2. skeletal muscle weakness 3. mood changes 4. hypocalcemia 5. increased susceptibility to infection

77. 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.

2. use relaxation techniques such as music.

83. 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.

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.

76. A client with Addison's disease has fluid and electrolyte loss due to inadequate fluid intake and fluid loss secondary to inadequate adrenal hormone secretion. As the client's oral intake increases, which fluid would be most appropriate? 1. milk and diet soda 2. water and eggnog 3. chicken broth and juice 4. coffee and milkshakes

3. chicken broth and juice

88. The nurse should teach the client with Addison's disease that the bronze-colored skin is thought to be caused by: 1. hypersensitivity to sun exposure. 2. increased serum bilirubin level. 3. adverse effects of the glucocorticoid therapy. 4. increased secretion of adrenocorticotropic hormone (ACTH).

4. increased secretion of adrenocorticotropic hormone (ACTH).