Cushings
A nurse is reviewing discharge teaching with a client who has Cushing's syndrome. Which statement by the client indicates that the instructions related to dietary management were understood? A. "I can eat foods that contain potassium" B. "I will need to limit the amount of protein in my diet" C. "I am fortunate that I can eat all the salty foods I enjoy" D. "I am fortunate that I do not need to follow any special diet"
A A diet that is low in calories, carbohydrates, & sodium but ample in protein & potassium content is encouraged for a client with Cushing. This diet promotes weight loss, edema reduction, & hypertension, control of hypokalemia & rebuilding of wasted tissue.
What is important to teach a patient with Cushing's syndrome? (Select all) A. Wearing a medic alert bracelet B. Avoid stress & high temperatures C. Diet high in sodium, protein, & carbs D. Monitor for signs & symptoms of infection E. Report hot, dry, flushed face
A patient with Cushing should be instructed to wear a medical identification bracelet, avoid exposure to high temps, infections & emotional disturbances (stress may produce or precipitate acute adrenal insufficiency). Diet should be high in protein, adequate potassium, low sodium & calories. Patient needs to report any signs such as hot, dry, flushed face that may lead to complications. Answers: A, B, D, E
What would be included in the discharge teaching plan for a client w/Cushing's disease? (Select all) A. Monitor BP twice a week & keep a log to share w/HCP B. Avoid potatoes, bananas, & cantaloupes in diet C. Use salt instead of salt substitute w/your meals D. Report to your healthcare provider if you are feeling hot, dry, flushed in face E. Do a complete home assessment to identify potential hazards for falls
A, D, E Monitor BP because of hypertension. Potassium is needed in diet & sodium is restricted. Report S&S that may indicate potential complications. Patient at risk for falls due to weakness from muscle wasting & loss of bone matrix.
The nurse is caring for a 65 year old with a possible pituitary tumor who is scheduled for a CT scan w/contrast. Which information about the patient is important to discuss with the health care provider before the test? A. History of renal insufficiency B. Complains of chronic headache C. Recent bilateral visual field loss D. Blood glucose level of 134 mg/dL
A. Contrast media may cause acute kidney injury in patients with poor renal function, the health care provider will need to prescribe therapies such as IV fluids to prevent this complication.
Which assessment finding of a 48 year old patient who had a bilateral adrenalectomy requires the MOST rapid action by the nurse? A. The blood pressure is 88/50 mm Hg B. Lungs have bibasilar crackles C. Blood glucose is 192 mg/dL D. The patient reports 6/10 incisional pain
A. The decreased BP indicates possible adrenal insufficiency. The nurse should immediately notify the health care provider so that corticosteroid medications can be administered. Prevention & treatment of acute adrenal insufficiency is priority.
A patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma. During the preoperative teaching, the nurse instructs the patient about the need to? A. Avoid brushing teeth for at least 10 days after surgery B. Remain on bed rest for the first 48 hours after surgery C. Cough & deep breathe every 2 hours postoperatively D. Be positioned flat with sandbags at the head postoperatively
A. To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days after surgery. It is not necessary to remain on bed rest. Coughing is discouraged because it may cause leakage of CSF. Head of the bed should be elevated 30 degrees.
What is a normal urine cortisol level? A. 60-120 mcq/24 hr B. 120-140 mcq/24 hr C. 80-120 mcq/24 hr D. 100-140 mcq/24hr
C. Normal urine cortisol 80-120 mcq/24 hr, higher than 120 may indicate Cushing syndrome
The nurse will plan to teach a patient to minimize physical & emotional stress while the patient is undergoing? A. A water deprivation test B. Testing for serum T3 & T4 levels C. A 24 hour urine test for free cortisol D. A radioactive iodine (I-131) uptake test
C. Physical & emotional stress can affect the results of free cortisol test. The other tests are not impacted by stress.
The nurse will teach a patient who is scheduled to complete a 24 hour urine collection for 17-Ketosteroids to? A. Void & save that specimen to start the collection B. Drink at least 3 L fluid during the 24 hours C. Keep the specimen refrigerated or on ice D. Insert & maintain a retention catheter
C. The specimen must be kept on ice or refrigerated until the collection is finished. Voided or catheterized specimens are acceptable for the test. The initial voided specimen is discarded. There is no fluid intake requirement.
A patient will be scheduled in the outpatient clinic for blood cortisol testing. Which instruction will the nurse provide? A. "You will need to lie down for 30 minutes before the blood is drawn" B. "Do not have anything to eat or drink before the blood test is obtained" C. "Avoid adding any salt to your food for 24 hours before the test" D. "Come to the laboratory to have the blood drawn early in the morning"
D. Cortisol levels are usually drawn in the morning, when the levels are highest. The other instructions would be given to patients who were having other endocrine testing.
Which of the following patient's are at risk for developing Cushing's syndrome? A. A patient with a tumor on the pituitary gland, which is causing too much ACTH to be secreted B. A patient taking glucocorticoids for several weeks C. A patient with a tuberculosis infection D. A patient who is post-op from an adrenalectomy
B. A patient taking glucocorticoids for several weeks. Cushing's DISEASE is caused by the pituitary gland producing too much ACTH. Cushing's SYNDROME is caused by medication therapy such as glucocorticoids.
The nurse is caring for a patient following an adrenalectomy. The HIGHEST priority in the immediate postoperative period is to? A. Protect the patient's skin B. Balance fluid & electrolytes C. Monitor for signs of infection D. Prevent emotional disturbances
B. After adrenalectomy, the patient is at risk for circulatory instability caused by fluctuating hormone levels, & the focus of care is to assess & maintain fluid & electrolyte status through the use of IV fluids & corticosteroids. Other goals are important but not as life threatening as circulatory collapse.
Which of the following is not a typical signs & symptom of Cushing's syndrome? A. Hirsutism B. Hyperpigmentation of the skin C. Moon face D. Purplish striae
B. Cushing manifestations include: weight gain, moon face w/plethora, purple/red striae, buffalo hump, supraclavicular fat pad, thin hair, acne, women (menstrual disorders, hirsutism, & virilization) men (feminization, gynecomastia, & impotence) Hyperpigmentation of skin (Addison manifestation)
A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, the nurse would expect to find? A. weight loss, buffalo hump, & moon face B. HTN, peripheral edema, & petechiae C. abdominal & buttock striae, truncal obesity & hypotension D. anorexia, signs of dehydration, & hyperpigmentation of skin
B. The effect of glucocorticoid excess include weight gain from accumulation & redistribution of adipose tissue, sodium & water retention, glucose intolerance, protein wasting loss of bone structure loss of collagen & capillary fragility. Corticosteroid deficiency: hypotension, dehydration, weight loss, & hyperpigmentation of skin.
A 56 yr old female patient w/Cushing syndrome is admitted for adrenalectomy. Which intervention by the nurse will be most helpful for the patient problem of disturbed body image related to changes in appearance? A. Reassure patient that the physical changes are very common in patients with Cushing. B. Remind the patient that most of the physical changes caused by Cushing syndrome will resolve after surgery. C. Discuss the use of diet & exercise in controlling the weight gain associated with cushing syndrome. D. Teach the patient that the metabolic impact of Cushing syndrome is of more importance than appearance.
B. The most reassuring & accurate communication to the patient is that the physical & emotional changes caused by Cushing syndrome will resolve after hormone levels return to normal postoperatively.
While assessing a client with Cushing's syndrome, which clincial assessment finding should be reported to the physician immediately? A. Dependent edema of +1 in ankles & calves B. Weight gain 1 lb since the previous day C. Spiked T waves on EKG monitor D. Respiratory crackles in bilateral lower lung fields
D. Crackles means he is retaining fluid & is a PRIORITY. Inverted T waves would be a concern.
A patient with Cushing's syndrome will be undergoing an adrenalectomy. Which of the following will be included in the patient's discharge teaching after procedure? A. Avoiding avocadoes & pears B. Declomycin therapy C. Glucocorticoid replacement therapy D. Signs & symptoms of Grave's disease
C. Exogenous corticosteroid therapy will be needed.
A patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the nurse expect during the assessment? A. Chronically low blood pressure B. Bronzed appearance of the skin C. Purplish streaks on the abdomen D. Decreased axillary & public hair
C. Purplish streaks on the abdomen are a common manifestation of Cushing syndrome. Manifestations of Addison's disease include: hypotension & bronzed appearing skin. Manifestations of androgen deficiency include: decreased axillary & public hair
Which of the following are clinical manifestations of Cushing Syndrome? (Select all) A. weight gain B. moon face C. purple/red striae D. Hyperkalemia E. Hypokalemia F. Hyponatremia
Clinical manifestations of Cushing's include: weight gain, moon face w/plethora, purple/red striae, buffalo hump, supraclavicular fat pad, thin hair, acne, hyperglycemia, HTN, muscle wasting, loss bone matrix, delay wound healing, hypokalemia & hypernatremia Answers: A, B, C, E
Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is MOST important to report to the health care provider? A. Patient has not been taking the prescribed vit D. B. Patient's BP is 148/94 mm Hg. C. Patient has bilateral 2+ pitting ankle edema D. Patient stopped taking the medication 2 days ago
D. Sudden cessation of corticosteroids after taking the medication for a week or more can lead to adrenal insufficiency, w/problems such as severe hypotension & hypoglycemia. Corticosteroids should NOT be stopped abruptly, they must be gradually tapered off.
The nurse is planning postoperative care for a patient who is being admitted to the surgical unit from the recovery room after transsphenoidal resection of a pituitary tumor, which nursing action should be included? A. Check hematocrit every 2 hours for 8 hours B. Palpate extremities for edema C. Monitor continuous pulse ox for 24 hours D. Measure urine volume every hour
D. After pituitary surgery, the patient is at risk for diabetes insipidus (DI) caused by cerebral edema. Monitoring for urine output & urine specific gravity is essential. The patient is at risk for dehydration not volume overload.
The diet for a Cushing patient should include? (Select all) A. Adequate fluid intake, 2-3 L B. Fluid restriction C. Increase protein D. Increase potassium E. Increase sodium F. Decrease/restrict sodium
Diet for Cushing should include: fluid restriction (body holding on to fluid), increase protein (help with wound healing), increase potassium (Cushing manifestation is hypokalemia), decrease sodium (Cushing manifestation is HYPERnatremia), & decrease fat Answers: B, C, D, F
The nurse should expect to assess which clinical manifestations in an adolescent with Cushing's syndrome? (Select all) A. Hyperkalemia B. Hyperglycemia C. Hypotension D. Cushingoid features E. Susceptibility to infections F. Hyponatremia
In Cushing's syndrome, physiologic disturbances seen are cushingoid features, hyperglycemia, susceptibility to infection, hypertension, hypokalemia & hypernatremia Answer: B, D, E,
A nurse notes in the medical record that the client w/Cushing's syndrome is experiencing fluid overload. Which interventions should be included in the plan of care? (Select all) A. Monitoring daily weight B. Monitoring intake & output C. Maintaining low potassium diet D. Monitoring extremities for edema E. Maintaining a low sodium diet
The client with Cushing's syndrome experiencing fluid overload should be maintained on a high potassium & low sodium diet. Decreased sodium intake decreases renal retention of sodium & water. Monitoring for weight, intake, output, & extremities for edema are appropriate nursing interventions. Answers: A, B, D, E,
