Sem 3 - Unit 2 - Glucose Regulation - NCO

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome? 1 Urine output 2 Glucose level 3 Serum potassium 4 Immune response

2 Glucose level As a result of increased cortisol levels, glucose metabolism is altered, which may contribute to an increase in blood glucose levels. Increased mineralocorticoids will decrease urine output. Sodium is retained by the kidneys, but potassium is excreted. The immune response is suppressed.

A nurse is caring for a client with a diagnosis of Cushing syndrome. Which clinical manifestations does the nurse expect to identify? Select all that apply. 1 Polyuria 2 Obese trunk 3 Hypotension 4 Sleep disturbance 5 Thin arms and legs

2 Obese trunk 4 Sleep disturbance 5 Thin arms and legs Truncal obesity is a key feature of Cushing syndrome. Sleep disturbance is caused by the altered diurnal secretion of cortisol. Thin arms and legs are caused by protein catabolism, which causes muscle wasting. Polyuria is associated with diabetes mellitus and primary aldosteronism, not Cushing syndrome. Obesity is caused by the overproduction of adrenal cortisol hormone associated with Cushing syndrome. Hypertension, not hypotension, is associated with Cushing syndrome because of sodium and water retention. `

A client with a tentative diagnosis of Cushing syndrome has an increased cortisol level. What response should the nurse assess this client for? 1 Hypovolemia 2 Hyperkalemia 3 Hypoglycemia 4 Hypernatremia

4 Hypernatremia A client with Cushing syndrome secretes excess amounts of cortisol, a corticosteroid that acts to retain sodium and water, resulting in hypernatremia and edema. Hypervolemia, not hypovolemia, is caused by fluid retention. Hypokalemia, not hyperkalemia, occurs because potassium is lost when there is sodium retention. Hyperglycemia, not hypoglycemia, results from cortisol-induced glucose intolerance.

A nurse is assessing a client admitted to the hospital with a tentative diagnosis of a pituitary tumor. What signs of Cushing syndrome does the nurse identify? 1 Retention of sodium and water 2 Hypotension and a rapid, thready pulse 3 Increased fatty deposition in the extremities 4 Hypoglycemic episodes in the early morning

1 Retention of sodium and water Increased levels of steroids and aldosterone cause sodium and water retention in clients with Cushing syndrome. Hypertension, not hypotension, is expected because of sodium and water retention. The extremities will be thin; subcutaneous fat deposits occur in the upper trunk, especially the back between the scapulae. Hyperglycemia, not hypoglycemia, occurs because of increased secretion of glucocorticoids. Hyperglycemia is sustained and not restricted to the morning hours.

A client with diabetes who is receiving long-term corticosteroid therapy is admitted to the hospital with leg ulcers. What increased risk does the nurse consider when assessing this client? 1 Weight loss 2 Hypoglycemia 3 Decreased blood pressure 4 Inadequate wound healing

4 Inadequate wound healing Because the antiinflammatory response is depressed as a result of increased cortisol levels, the wounds of clients receiving long-term corticosteroid therapy tend to heal slowly. A common finding associated with long-term corticosteroid use is weight gain, caused not only by fluid retention but also by alterations in fat, carbohydrate, and protein metabolism. Persistent hyperglycemia (steroid diabetes) occurs because of altered glucose metabolism. Hypertension, not hypotension, occurs as a result of sodium and fluid retention.

A nurse is assessing a female client with Cushing syndrome. Which clinical findings can the nurse expect to identify? Select all that apply. 1 Hirsutism 2 Menorrhagia 3 Buffalo hump 4 Dependent edema 5 Migraine headaches

1 Hirsutism 3 Buffalo hump Excessive hairiness, especially a male pattern of hair distribution on a woman (hirsutism), occurs with Cushing syndrome because of an androgen excess. Cushing syndrome results from excess adrenocortical activity. Hypercortisolism causes fat redistribution, resulting in "buffalo hump"; it also contributes to slow wound healing, hirsutism, weight gain, hypertension, acne, thin arms and legs, and behavioral changes. Menorrhagia (excessive menstrual bleeding) does not occur; menses may cease or be scanty because of virilization. Edema does not occur except when severe heart failure is present. Headaches do not occur with this syndrome.

Which clinical indicators can the nurse expect when assessing a client with Cushing syndrome? Select all that apply. 1 Lability of mood 2 Slow wound healing 3 A decrease in the growth of hair 4 Ectomorphism with a moon face 5 An increased resistance to bruising

1 Lability of mood 2 Slow wound healing Excess adrenocorticoids cause emotional lability, euphoria, and psychosis. Hypercortisolism impairs the inflammatory response, slowing wound healing. Increased secretion of androgens results in hirsutism. Although a moon face is associated with corticosteroid therapy, ectomorphism is a term for a tall, thin, genetically determined body type and is unrelated to Cushing syndrome. There is increased bruising because capillary fragility results in multiple ecchymotic areas.

A nurse is caring for a client with a diagnosis of Cushing syndrome. What is the most common cause of Cushing syndrome that the nurse should consider before assessing this client for physiologic responses? 1 Pituitary hypoplasia 2 Hyperplasia of the adrenal cortex 3 Deprivation of adrenocortical hormones 4 Insufficient adrenocorticotropic hormone (ACTH) production

2 Hyperplasia of the adrenal cortex Hyperplasia of the adrenal cortex leads to increased secretion of cortical hormones, which causes signs of Cushing syndrome. Pituitary hypoplasia is a malfunction of the pituitary that will result in Simmonds disease (panhypopituitarism), which has clinical manifestations similar to those for Addison disease. Cushing syndrome results from excessive cortical hormones. ACTH stimulates production of adrenal hormones. Inadequate ACTH will result in Addisonian signs and symptoms.

Which treatment intervention should be provided to a client diagnosed with Cushing's disease? 1 Increase cortisol levels 2 Increase sodium levels 3 Decrease blood glucose levels 4 Decrease serum calcium levels

3 Decrease blood glucose levels Cushing's disease affects the glucose metabolism and results in reduced glucose uptake by tissues and increased blood glucose levels; therefore interventions to regulate blood glucose levels should be undertaken. Hypersecretion of cortisol causes Cushing's disease; therefore interventions should be aimed at decreasing the cortisol levels. Sodium levels are elevated in hypercortisolism; therefore interventions to decrease these levels should be initiated. Measures to increase the low serum calcium levels in Cushing's disease will be beneficial to the client.

A nurse is caring for a newly admitted client with a diagnosis of Cushing syndrome. Why should the nurse monitor this client for clinical indicators of diabetes mellitus? 1 Cortical hormones stimulate rapid weight loss. 2 Tissue catabolism results in a negative nitrogen balance. 3 Glucocorticoids accelerate the process of gluconeogenesis. 4 Excessive adrenocorticotropic hormone (ACTH) secretion damages pancreatic tissue.

3 Glucocorticoids accelerate the process of gluconeogenesis. Excess glucocorticoids cause hyperglycemia, and signs of diabetes mellitus may develop ACTH, which causes sodium retention and subsequent weight gain. Although muscle wasting is associated with excessive corticoid production, this will not cause diabetes mellitus. ACTH affects the adrenal cortex, not the pancreas.

A male client who is receiving prolonged steroid therapy complains of always being thirsty and urinating frequently. What is the nurse's best initial action? 1 Have the client assessed for an enlarged prostate. 2 Obtain a urine specimen from the client to test for ketonuria. 3 Perform a finger stick to test the client's blood glucose level. 4 Assess the client's lower extremities for the presence of pitting edema

3 Perform a finger stick to test the client's blood glucose level. The client has signs of an increased serum glucose level, which may result from steroid therapy; testing the blood glucose level is a method of gathering more data. The symptoms are not those of benign prostatic hyperplasia. The blood glucose level, not the amount of ketones in the urine, should be assessed. The symptoms presented are not those of fluid retention, but of hyperglycemia.

A client is admitted to the hospital with a diagnosis of Cushing syndrome. What signs and symptoms will the client most likely exhibit? 1 Hyperkalemia and edema 2 Hypotension and sodium loss 3 Muscle wasting and hypoglycemia 4 Muscle weakness and frequent urination

4 Muscle weakness and frequent urination Increased gluconeogenesis may lead to hyperglycemia and glycosuria, which can produce urinary frequency; protein catabolism will cause muscle weakness. As sodium ions are retained, potassium is excreted; the result is hypokalemia. Edema occurs because of sodium retention. Hypotension and sodium loss are signs of Addison syndrome; in Cushing syndrome retention of sodium and fluids leads to hypervolemia and hypertension. Muscle wasting results from increased protein catabolism; however, hyperglycemia rather than hypoglycemia will result from increased gluconeogenesis.