Cushing's Disease / syndrome

A female client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem? a. depression b. neuropathy c. hypoglycemia d. hyperthyroidism

a. depression Agitation, irritability, poor memory, loss of appetite, and neglect of one's appearance may signal depression, which is common in clients with Cushing's syndrome. Neuropathy affects clients with diabetes mellitus — not Cushing's syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite.

a client with Cushing's syndrome is admitted to the medical surgical unit. during the admission assessment, the nurse notes that the client has a flat affect but is irritable when questioned, has a poor memory, reports a loss of appetite, wants to sleep all the time, and doesn't care if she gets well. what collaborative action should the nurse take in response to the information? a. discuss with the health care provider a concern for depression b. request a neurology consult for a CT scan c. discuss with the dietician a need for nutritional consult d. request a social service consult for home evaluation

a. discuss with the health care provider a concern for depression Cushing's syndrome develops because of an excess of cortisol, in this case from prolonged exogenous steroid administration. depression and a marked change in personality are common. it is important that the client be taught how to deal with the emotional changes of the disease

The nurse is caring for a client who has had an adrenalectomy and is monitoring the client for signs of adrenal insufficiency. Which signs and symptoms indicate adrenal insufficiency in this client? a. Hypotension and fever b. Mental status changes and hypertension c. Subnormal temperature and hypotension d. Complaints of weakness and hypertension

a. hypotension and fever The nurse should be alert to signs and symptoms of adrenal insufficiency after adrenalectomy. These signs and symptoms include weakness, hypotension, fever, and mental status changes. The remaining options are incorrect.

The nurse is developing a plan of care for a client with Cushing's syndrome. The nurse documents a client problem of excess fluid volume. Which nursing actions should be included in the care plan for this client? Select all that apply. a. Monitor daily weight. b. Monitor intake and output. c. Assess extremities for edema. d. Maintain a high-sodium diet. e. Maintain a low-potassium diet.

a. monitor daily weight b. monitor intake and output c. assess extremities for edema The client with Cushing's syndrome and a problem of excess fluid volume should be on daily weights and intake and output and have extremities assessed for edema. He or she should be maintained on a high-potassium, low-sodium diet. Decreased sodium intake decreases renal retention of sodium and water.

Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following? a. muscle weakness b. tremors c. diaphoresis d. constipation

a. muscle weakness Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.

In a 29-year-old female client who is being successfully treated for Cushing's syndrome, nurse Lyzette would expect a decline in: a. serum glucose level b. hair loss c. bone mineralization d. menstrual flow

a. serum glucose level Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth also declines. Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.

The nurse is providing discharge instructions to a client who has Cushing's syndrome. Which client statement indicates that instructions related to dietary management are understood? a. "I will need to limit the amount of protein in my diet." b. "I should eat foods that have a lot of potassium in them." c. "I am fortunate that I can eat all of the salty foods I enjoy." d. "I am fortunate that I do not need to follow any special diet."

b. "I should eat foods that have a lot of potassium in them." A diet low in carbohydrates and sodium but ample in protein and potassium is encouraged for a client with Cushing's syndrome. Such a diet promotes weight loss, reduction of edema and hypertension, control of hypokalemia, and rebuilding of wasted tissue

A client is diagnosed with Cushing's syndrome. When reviewing the recent laboratory results, the nurse should expect an excess of which substance? a. Calcium b. Cortisol c. Epinephrine d. Norepinephrine

b. cortisol Cushing's syndrome is characterized by an excess of cortisol, a glucocorticoid. Glucocorticoids are produced by the adrenal cortex. Calcium would be decreased in this disorder. Epinephrine and norepinephrine are produced by the adrenal medulla.

The nurse is caring for a postoperative client who has had an adrenalectomy. What should the nurse check for during the client's focused assessment? a. peripheral edema b. Bilateral exophthalmos c. Signs and symptoms of hypovolemia d. signs and symptoms of hypocalcemia

c. Signs and symptoms of hypovolemia Aldosterone, secreted by the adrenal cortex, plays a major role in fluid volume balance by retaining sodium and water. Thus, a deficiency can cause hypovolemia. A deficiency of adrenocortical hormones (such as after adrenalectomy) does not cause the clinical manifestations noted in the remaining options.

Nurse Ronn is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find: a. hypotension b. thick, coarse skin c. Deposits of adipose tissue in the trunk and dorsocervical area d. weight gain in arms and legs

c. deposits of adipose tissue in the trunk and dorsocervical area Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

The nurse is aware that the following is the most common cause of hyperaldosteronism? a. excessive sodium intake b. pituitary adenoma c. deficient potassium intake d. an adrenal adenoma

d. an adrenal adenoma An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake as well as of pituitary stimulation.

The nurse is instructing a client with Cushing's syndrome on follow-up care. Which of these client statements would indicate a need for further instruction? a. "I should avoid contact sports." b. "I should check my ankles for swelling." c. "I need to avoid foods high in potassium." d. "I need to check my blood glucose regularly."

c. "I need to avoid foods high in potassium." Hypokalemia is a common characteristic of Cushing's syndrome, and the client is instructed to consume foods high in potassium. Clients with this condition experience activity intolerance, osteoporosis, and frequent bruising. Fluid volume excess results from water and sodium retention. Hyperglycemia is caused by an increased cortisol secretion.

A client with suspected Cushing's syndrome is scheduled for adrenal venography. A nurse has provided instructions to the client regarding the test. Which statement by the client indicates a need for further instruction? a. "I need to sign an informed consent." b. "The insertion site will be locally anesthetized." c. "I will be placed in a high-sitting position for the test." d. "I may feel a burning sensation after the dye is injected."

c. "I will be placed in a high-sitting position for the test." The test aids in determining whether signs and symptoms are caused by abnormalities in the adrenal gland. The nurse assesses the client for allergies to iodine before the test. The client is informed that the supine position is necessary to access the femoral vein. An informed consent form is required, the insertion site will be locally anesthetized, and the client will experience a transient burning sensation after the dye is injected.

the nurse is caring for a client with Cushing's disease. during change of shift report, which assessment laboratory data would the nurse anticipate communicating? Select all that apply. a. serum sodium level b. hemoglobin and hematocrit c. serum potassium level d. blood glucose level e. white blood cell count f. creatinine clearance total

a. serum sodium level c. serum potassium level d. blood glucose level Cushing's disease results in an excess cortisol in the blood typically caused by a pituitary tumor secreting adrenocorticotropic hormone (ACTH). ACTH stimulates the adrenal glands to produce cortisol. Cortisol is important in controlling blood pressure and metabolism. electrolyte disturbance is common for the nurse to report. sodium retention is typically accompanied by potassium depletion. clients exhibit

A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar), 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin? a. it decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs b. it interacts with plasma membrane receptors to inhibit enzymatic actions c. it interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. d. it regulates the threshold for water resorption in the kidneys

c. it interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism Corticotropin interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism. It doesn't decrease cAMP production. The posterior pituitary hormone, antidiuretic hormone, regulates the threshold for water resorption in the kidneys.

The nurse has documented the problem of body image distortion for a client with a diagnosis of Cushing's syndrome. The nurse identifies nursing interventions related to this problem and includes these interventions in the plan of care. Which nursing intervention is inappropriate? a. encourage the client's expression of feelings. b. Assess the client's understanding of the disease process. c. Encourage family members to share their feelings about the disease process. d. Encourage the client to recognize that the body changes need to be dealt with.

d. Encourage the client to recognize that the body changes need to be dealt with. Encouraging the client to understand that the body changes that occur in this disorder need to be dealt with is an inappropriate nursing intervention. This option does not address the client's feelings. The remaining options are appropriate because they address the client and family feelings regarding the disorder.

The nurse is caring for a client with a diagnosis of Cushing's syndrome. Which expected signs and symptoms should the nurse monitor for? Select all that apply. a. Anorexia b. Dizziness c. Weight loss d. Moon face e. Hypertension f. Truncal obesity

d. Moon face e. Hypertension f. Truncal obesity A client with Cushing's syndrome may exhibit a number of different manifestations. These could include moon face, truncal obesity, and a buffalo hump fat pad. Other signs include hypokalemia, peripheral edema, hypertension, increased appetite, and weight gain. Dizziness is not part of the clinical picture for this disorder.

A client has been diagnosed with Cushing's syndrome. The nurse should assess the client for which expected manifestations of this disorder? a. Dizziness b. Weight loss c. Hypoglycemia d. Truncal obesity

d. truncal obesity The client with Cushing's syndrome may exhibit a number of different manifestations. These may include moon face, truncal obesity, and a "buffalo hump" fat pad. Other signs include hyperglycemia, hypernatremia, hypocalcemia, peripheral edema, hypertension, increased appetite, and weight gain. Dizziness is not part of the clinical picture for this disorder.