UNIT 3 Glucose Regulation Exemplar: Cushing's

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 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 who is suspected of having Cushing syndrome is admitted to the hospital. When checking the laboratory reports, which condition should the nurse expect? 1.Hypokalemia 2.Hypovolemia 3.Hypocalcemia 4.Hyponatremia

With glucocorticoid excess, aldosterone hypersecretion occurs and sodium is retained; therefore, potassium is excreted, leading to hypokalemia. Hypervolemia occurs because of sodium and water retention precipitated by aldosterone. Hypocalcemia is not associated with aldosteronism. Aldosterone hypersecretion causes sodium retention and hypernatremia, not hyponatremia.

A child who has been undergoing prolonged steroid therapy takes on a cushingoid appearance. What will the nursing assessment probably reveal? Select all that apply. 1.Truncal obesity 2.Thin extremities 3.Increased linear growth 4.Loss of hair on the body 5.Decreased blood pressure

1,2 An increase in appetite results in deposition of fat on the abdomen and trunk. Muscle wasting results in thin extremities. Increased excretion of calcium causes retardation of linear growth and a resulting short stature. Because of the excess production of androgens, virilization and hirsutism occur. Increased salt and water retention cause hypertension and hypernatremia.

A client with the diagnosis of Cushing syndrome has the following laboratory results: Na (sodium) 149 mEq/L (149 mmol/L); K + (potassium) 3.2 mEq/L (3.2 mmol/L); Hb (hemoglobin) 17 g/dL (170 mmol/L); and glucose 90 mg/dL (5 mmol/L). What should the nurse teach the client? Select all that apply. 1.Avoid foods high in salt. 2.Restrict your fluid intake. 3.Eat foods high in potassium. 4.Limit your carbohydrate intake. 5.Continue your regular diet as before.

1,3 A sodium level of more than 145 mEq (145 mmol/L) is considered hypernatremia; the client should be taught to avoid foods high in sodium (e.g., processed foods, specific condiments). A potassium level less than 3.5 mEq/L (3.5 mmol/L) is considered hypokalemia. Therefore, the client should be encouraged to eat foods high in potassium. Restricting fluid intake will increase the serum sodium level and therefore is contraindicated. A glucose level of 90 mg/dL (5 mmol/L) is within the expected range of less than 110 mg/dL (6 mmol/L) and is not a concern. The laboratory results for serum sodium and serum potassium are not within the expected values, and the client should be taught how to alter the diet.

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 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 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 Rationale: 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.

The nurse is caring for a client diagnosed with Cushing syndrome. What symptoms does the nurse expect the client to exhibit? 1.Lability of mood 2.Hair thinning 3.Increased skin thickness 4.Ectomorphism with a moon face

1 Excess adrenocorticoids cause emotional lability, euphoria, and psychosis. Increased secretion of androgens results in hirsutism. Capillary fragility results in multiple ecchymotic areas, not skin thickness. Although a moon face is associated with corticosteroid therapy, ectomorphism is a term for a tall, thin, genetically determined body type and is not related to adaptations to Cushing syndrome.

A nurse is assessing a client with Cushing syndrome. Which signs should the nurse expect the client to exhibit? Select all that apply. 1.Hirsutism 2.Round face 3.Pitting edema 4.Buffalo hump 5.Hypoglycemia

1,2,4 Hirsutism is caused by excess adrenocortical activity associated with Cushing syndrome. A moon face results from an accumulation of adipose tissue associated with hypercortisolism. A buffalo hump results from an accumulation of adipose tissue associated with hypercortisolism. Pitting edema does not occur, except with concurrent severe heart failure. Hypercortisolism increases gluconeogenesis, causing hyperglycemia, not hypoglycemia.

The nurse is caring for a client after hypophysectomy and notes clear nasal drainage from the client's nostril. The nurse should take which initial action? 1.Lower the head of the bed. 2.Test the drainage for glucose. 3.Obtain a culture of the drainage. 4.Continue to observe the drainage

2 After hypophysectomy, the client should be monitored for rhinorrhea, which could indicate a cerebrospinal fluid leak. If this occurs, the drainage should be collected and tested for the presence of cerebrospinal fluid. Cerebrospinal fluid contains glucose, and if positive, this would indicate that the drainage is cerebrospinal fluid. The head of the bed should remain elevated to prevent increased intracranial pressure. Clear nasal drainage would not indicate the need for a culture. Continuing to observe the drainage without taking action could result in a serious complication.

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 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.

What will the nurse expect diagnostic studies of a client with Cushing syndrome to indicate? 1.Moderately increased serum potassium levels 2.Increased numbers of eosinophils in the blood 3.High levels of 17-ketosteroids in a 24-hour urine test 4.Normal to low levels of adrenocorticotropic hormone (ACTH)

3 High levels of 17-ketosteroids in a 24-hour urine test is a urinary metabolite of steroid hormones that are excreted in large amounts in hyperaldosteronism. With aldosterone hypersecretion, sodium is retained and potassium is excreted, resulting in hypernatremia and hypokalemia. With Cushing syndrome, the eosinophil count is decreased, not increased. ACTH levels usually are high in Cushing syndrome.

A nurse is caring for a client with Cushing syndrome. Which cardiovascular complication should the nurse assess for in this client? 1.Chest pain 2.Tachycardia 3.Hypertension 4.Atrial fibrillation

3 Hypertension is a cardiovascular complication found in clients with Cushing syndrome due to increased metabolic demands and catecholamines. Chest pain is seen in clients with hyperthyroidism and hypothyroidism. Tachycardia and atrial fibrillation are manifestations of dysrhythmias, which are associated with hypothyroidism or hyperthyroidism, parathyroidism, and pheochromocytoma.

The nurse is caring for a client scheduled for a transsphenoidal hypophysectomy. The preoperative teaching instructions should include which statement? 1."Your hair will need to be shaved." 2."You will receive spinal anesthesia." 3."You will need to ambulate after surgery." 4."Brushing your teeth needs to be avoided for at least 2 weeks after surgery."

4 A trans-sphenoidal hypophysectomy is a surgical approach that uses the nasal sinuses and nose for access to the pituitary gland. Based on the location of the surgical procedure, spinal anesthesia would not be used. In addition, the hair would not be shaved. Although ambulating is important, specific to this procedure is avoiding brushing the teeth to prevent disruption of the surgical site

A client with a diagnosis of addisonian crisis is being admitted to the intensive care unit. Which findings will the interprofessional health care team focus on? Select all that apply. 1.Hypotension 2.Leukocytosis 3.Hyperkalemia 4.Hypercalcemia 5.Hypernatremia

1,3 In Addison's disease, also known as adrenal insufficiency, destruction of the adrenal gland leads to decreased production of adrenocortical hormones, including the glucocorticoid cortisol and the mineralocorticoid aldosterone. Addisonian crisis, also known as acute adrenal insufficiency, occurs when there is extreme physical or emotional stress and lack of sufficient adrenocortical hormones to manage the stressor. Addisonian crisis is a life-threatening emergency. One of the roles of endogenous cortisol is to enhance vascular tone and vascular response to the catecholamines epinephrine and norepinephrine. Hypotension occurs when vascular tone is decreased and blood vessels cannot respond to epinephrine and norepinephrine. The role of aldosterone in the body is to support the blood pressure by holding salt and water and excreting potassium. When there is insufficient aldosterone, salt and water are lost and potassium builds up; this leads to hypotension from decreased vascular volume, hyponatremia, and hyperkalemia. The remaining options are not associated with addisonian crisis.

The parents of a young man suspected of having Cushing syndrome express anxiety about their son's condition. What should the nurse tell the parents to help them better understand the illness? 1.He will need to take exogenous steroids for several months. 2.His condition will indicate improvement when he gains weight. 3.He may have mood swings or depression as a result of his illness. 4.His physical changes are permanent but may improve with therapy.

3 High levels of steroids result in emotional changes; the actual cause is unknown, but knowing the response may help the parents to better cope with their son's behavior. The need to receive exogenous steroids for several months is unnecessary. Cushing syndrome is related to an excessive production of steroids. Weight loss, not weight gain, indicates an improving condition. The changes are not permanent with adequate therapy.

When a client is receiving dexamethasone for adrenocortical insufficiency, what action does the nurse take to monitor for an adverse effect of the medication? 1.Auscultate for bowel sounds. 2.Assess deep tendon reflexes. 3.Culture respiratory secretions. 4.Measure blood glucose levels.

4 Corticosteroids, such as dexamethasone, have a hyperglycemic effect, and blood glucose levels should be monitored routinely. Assessing bowel sounds is unnecessary; corticosteroids are not known to precipitate cessation of gastrointestinal activity. Although corticosteroids may increase the risk of developing an infection, routine culturing of respiratory secretions is unnecessary. Culturing respiratory secretions becomes necessary when the client exhibits adaptations of a respiratory infection. Monitoring deep tendon reflexes is required when administering magnesium sulfate, not dexamethasone.

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 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.

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 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 primary healthcare provider prescribes a low-sodium, high-potassium diet for a client with Cushing syndrome. Which explanation should the nurse provide to the client about the need to follow this diet? 1."The use of salt probably contributed to the disease." 2."Excess weight will be gained if sodium is not limited." 3."The loss of excess sodium and potassium in the urine requires less renal stimulation." 4."Excessive aldosterone and cortisone cause retention of sodium and loss of potassium."

4 Clients with Cushing syndrome must limit their intake of salt and increase their intake of potassium. The kidneys are retaining sodium and excreting potassium. An excessive secretion of adrenocortical hormones in Cushing syndrome, not increased or high sodium intake, is the problem. Although sodium retention causes fluid retention and weight gain, the need for increased potassium also must be considered. Because of steroid therapy, excess sodium may be retained, although potassium may be excreted.