Med Surg Ch 42 Coordinating Care for Patients with Adrenal Disorders

The nurse questions which intervention in the patient diagnosed with hypercortisolism? A. Limit salt intake B. Limit foods containing potassium C. Increase weight-bearing exercises D. Avoid use of skin tape

Answer: B Rationale: Hypokalemia develops in the patient with hypercortisolism as cortisol leads to loss of potassium and sodium retention. There would be norationale in limiting potassium in this patient at risk for hypokalemia

Which safety measure is most important for the nurse to institute for a patient who has Cushing's (hypercortisolism) disease? A. Padding the siderails of the patient's bed B. Assisting the patient to change positions slowly C. Using a lift sheet to change the patient's position D. Keeping suctioning equipment at the patient's bedside

Answer: C Rationale: Thinning of skin, along with increased friability of skin, accompanied by fluid retention increase the chances of skin injury due to pressure or friction. Using a lift sheet to reposition a patient decreases sheer forces to the skin.

The nurse monitors for which effects of daily cortisol therapy on a patient's circulating levels of adrenocorticotropic hormone (ACTH) and aldosterone? A. Decreased ACTH, decreased aldosterone B. Decreased ACTH, increased aldosterone C. Increased ACTH, decreased aldosterone D. Increased ACTH, increased aldosterone

Answer: A Rationale: Due to the administration of exogenous cortisol, there is decreased secretion of ACTH from the anterior pituitary gland and decreased aldosterone secretion from the adrenal cortex.

The nurse monitors for which complication in Ms. Davis secondary to her hypercortisolism? A. Osteoporosis B. Hypoglycemia C. Muscle loss D. Hyperkalemia

Answer: A Rationale: Osteoporosis may develop relative to the effects of cortisol on bone density and can increase the risk of pathologic fractures. Patients with hypercortisolism have hyperglycemia, not hypoglycemia, and hypokalemia. Muscle loss is more associated with adrenal insufficiency, not excessive cortisol.

Which serum electrolyte value alerts the nurse to the possibility of hyperaldosteronism? A. Serum sodium, 150 mmol/L; serum potassium, 2.5 mmol/L B. Serum sodium, 140 mmol/L; serum potassium, 5.0 mmol/L C. Serum sodium, 130 mmol/L; serum potassium, 2.5 mmol/L D. Serum sodium, 130 mmol/L; serum potassium, 7.5 mmol/L

Answer: A Rationale: Because the primary actions of aldosterone are sodium and water reabsorption and potassium excretion, patients with hyperaldosteronism develop hypertension and hypokalemia. The action of aldosterone leads to sodium retention and potassium excretion. The sodium may or may not be above normal levels as the patient will also retain water due to retained sodium.

A patient has been receiving doses of prednisone for treatment of rheumatoid arthritis for the past 3 months. If this medication is suddenly discontinued, for which complication is the patient at risk? A. Hypovolemia B. Hypernatremia C. Hypothermia D. Hyperglycemia

Answer: A Rationale: Acute adrenal insufficiency, or adrenal crisis, is a life-threatening emergency that leads to severe hypovolemia and hypotension and may be seen in patients who are abruptly withdrawn from glucocorticoid therapy. Risk factors for adrenal crisis are seen in patients who have underlying adrenal hypofunction and who undergo stressful events such as trauma, surgery, and infections. Because of the decrease in aldosterone and cortisol, the patient loses excess sodium accompanied by fluid loss.

The nurse correlates which assessment findings to the patient diagnosed with hyperaldosteronism? (Select all that apply.) A. Blood pressure, 160/90 mm Hg B. Heart rate, 60 bpm C. Potassium, 3.0 mEq/L D. Glucose, 250 mg/dL E. Sodium, 130 mEq/L

Answer: A and C Rationale: Aldosterone actions include sodium retention and potassium excretion, so patients with hyperaldosteronism manifest elevated blood pressure due to sodium and fluid retention and hypokalemia. These is no effect on glucose as there is with hypercortisolism.

The nurse assesses for which clinical manifestations in the patient admitted with primary hypercortisolism? (Select all that apply.) A. Elevated serum glucose B. Elevated serum potassium C. Elevated urine specific gravity D. Elevated blood pressure E. Elevated temperature

Answer: A and D Rationale: The clinical manifestations of hypercortisolism are directly related to hypersecretion of cortisol and include hyperglycemia, fluid retention, hypokalemia, abnormal fat distribution, and decreased muscle mass. The maldistribution of fats and changes in muscle are related to the effects that glucocorticoids have on fat and protein metabolism.

Which of the following actions is caused by secretion of mineralocorticoid? A. Increased urine output B. Sodium reabsorption C. Potassium excretion D. Decreased immune response

Answer: B Mineralocorticoid is secreted by the Adrenal Cortex. It's target organ are Distal tubules and collecting ducts in the kidney. It's action is to Promote sodium reabsorption and potassium excretion by the kidney. (see table 42.1)

The nurse recognizes which patient is at greatest risk for adrenal insufficiency? A. A 19-year-old male B. A 35-year-old female C. A 45-year-old male D. An 80-year-old female

Answer: B Rationale: Females are most often affected by adrenal insufficiency, and it has a peaked incidence in people 30 to 50 years of age.

The nurse notes that which disorder places the patient at greatest risk for hypertensive crisis? A. Hypothyroidism B. Pheochromocytoma C. Diabetes insipidus D. Adrenal insufficiency

Answer: B Rationale: Pheochromocytomas are catecholamine secreting tumors of the adrenal medulla. Because of excessive catecholamine secretion, pheochromocytomas may precipitate life-threatening hypertension or cardiac arrhythmias. Hypothyroidism results in sluggish metabolism. Diabetes insipidus may lead to hypovolemia and hypotension secondary to large losses of dilute urine. Patients with adrenal insufficiency are at risk for hypovolemia secondary to sodium and water losses due to lack of glucocorticoids and mineralocorticoids.

The function of the adrenal glands is under the direct control of which structure? A. Hypothalamus B. Anterior pituitary gland C. Posterior pituitary gland D. Sympathetic nervous system

Answer: B Under the control of the anterior pituitary gland, the adrenal cortex secretes glucocorticoids (cortisol), mineralocorticoids (aldosterone), and sex hormones (androgens and estrogens).

Which of the following is secreted from the adrenal medulla? A. Aldosterone B. Cortisol C. Epinephrine D. Vasopressin

Answer: C The adrenal medulla secretes Catecholamines (epinephrine and norepinephrine), which target the Cells of the body. Catecholamines mimic actions of the sympathetic nervous system. (see table 42.1)

The nurse correlates primary hypercortisolism to dysfunction of which gland? A. Hypothalamus B. Anterior pituitary gland C. Adrenal cortex D. Adrenal medulla

Answer: C Rationale: Cortisol is the primary glucocorticoid released from the adrenal cortex. Primary endocrine disorders are associated with the endocrine gland, and in this example, the adrenal cortex. Secondary endocrine disorders are related to anterior pituitary gland dysfunction, and tertiary disorders are related to hypothalamic dysfunction. The adrenal medulla secretes epinephrine and norepinephrine.

Which of the following patients is at greatest risk for primary hypercortisolism? A. A 65-year-old male B. A 56-year-old female C. A 44-year-old male D. A 28-year-old female

Answer: D Rationale: Females are five times more likely to develop primary hypercortisolism, and the peak incidence of hypersecreting tumors of the \ adrenal and pituitary glands is in the 25- to 40-year age range.

Which patient statement indicates a need for further clarification regarding medications after a bilateral adrenalectomy? A. "I will take my cortisol replacement with food." B. "I will avoid aspirin and aspirin-containing products." C. "If I have any kind of stress, I will need my cortisol dose increased." D. "If I have nausea or vomiting, I will skip the medication until is it resolved."

Answer: D Rationale: Patients who undergo bilateral adrenalectomy are dependent upon daily doses of exogenous glucocorticoids. Missing doses of these medications may lead to acute adrenal crisis.

Which assessment maneuver is contraindicated in the patient suspected of having a pheochromocytoma? A. Having the patient attempt to touch the chin to the chest B. Inflating the blood pressure cuff above 200 mm Hg C. Attempting to dorsiflex the feet D. Palpating the abdomen

Answer: D Rationale: Pheochromocytomas are rare catecholamine secreting tumors of the adrenal medulla. Because of excessive catecholamine (epinephrine and norepinephrine) secretion, pheochromocytomas may precipitate life-threatening hypertension or cardiac arrhythmias, leading to sudden death. Due to the vascularity of these tumors, palpation of the abdomen is avoided to decrease risk of hypertensive crisis.

The nurse correlates which clinical manifestation to the pathophysiology of adrenal insufficiency? A. Heat intolerance B. Weight gain C. Peripheral edema D. Hypoglycemia

Answer: D Rationale: Secondary to the decreased secretion of cortisol and aldosterone in patients with adrenal insufficiency, the patient is at risk for hyperkalemia and hypoglycemia. Other clinical manifestations include weakness, weight loss, fatigue, nausea, abdominal pain, gastroenteritis, and emotional lability. Hyperpigmentation of the skin and mucous membranes and decreased pubic and axillary hair (secondary to decreased secretion of sex hormones) are also observed. As the loss of sodium and water continues, the patient may develop dehydration and hypotension.