Davis Ch. 42: Adrenal Disorders

Which clinical manifestation would indicate to the nurse that the client may have pheochromocytoma? a. Hypertension b. Hypoglycemia c. Hyponatremia d. Hyperpigmentation

a. Hypertension

A client diagnosed with pheochromocytoma is post-operative following an adrenalectomy. What clinical data should the nurse monitor following surgery? Select all that apply. a. Red blood cell level b. Blood pressure c. Heart rate d. Blood glucose level e. Blood potassium level

b. Blood pressure c. Heart rate d. Blood glucose level

Which hormones are produced by the adrenal glands? Select all that apply. a. Insulin b. Cortisol c. Epinephrine d. Aldosterone e. Norepinephrine

b. Cortisol c. Epinephrine d. Aldosterone e. Norepinephrine

Which clinical manifestations should the nurse anticipate when providing care to a client experiencing Addison's disease? Select all that apply. a. Hyperglycemia b. Hyponatremia c. Hyperkalemia d. Hypertension e. Hypocalcemia

b. Hyponatremia c. Hyperkalemia

Which adverse reactions to the prescribed exogenous corticosteroid medication should the nurse monitor for? Select all that apply. a. Hyperglycemia b. Fluid retention c. Increased muscle mass d. Abnormal fat distribution e. Decreased serum potassium

a. Hyperglycemia b. Fluid retention d. Abnormal fat distribution e. Decreased serum potassium Rationale: An adverse reaction to prescribed exogenous corticosteroid medication is Cushing's syndrome. Cushing's syndrome manifests with hyperglycemia, fluid retention, hypokalemia, and abnormal fat distribution. This syndrome also manifests with decreased, not increased, muscle mass. Other clinical manifestations of Cushing's syndrome for Mrs. DeToro may include virilization (male sexual characteristics developing in females), breast atrophy, vocal changes (deepening), and amenorrhea.

The nurse is providing care for a 35-year-old female client, Mrs. DeToro, who was admitted to the hospital with weakness, fatigue, nausea, and abdominal pain. When conducting the health history, Mrs. DeToro tells the nurse that she was diagnosed with Addison's disease a year ago and is concerned that her current symptoms might be related to her diagnosis. Which assessment findings support the nurse's suspicion that Mrs. DeToro is experiencing an adrenal crisis? Select all that apply. a. Hypoglycemia b. Hyperkalemia c. Hypernatremia d. Severe hypotension e. Severe hypovolemia

a. Hypoglycemia c. Hypernatremia d. Severe hypotension e. Severe hypovolemia Rationale: Adrenal crisis is a life-threatening emergency that leads to severe hypovolemia and hypotension. The client is also at risk for hyperkalemia and hypoglycemia related to lack of mineralocorticoids and glucocorticoids. Risk factors for adrenal crisis include stressful events such as trauma, surgery, and infections.

Mrs. DeToro is admitted to the medical-surgical unit for further monitoring. Which actions are appropriate? Select all that apply. a. Monitor intake and output b. Assess for hypertension c. Monitor blood glucose d. Administer IV cortisone e. Place the bed in the lowest position

a. Monitor intake and output c. Monitor blood glucose d. Administer IV cortisone e. Place the bed in the lowest position Rationale: The nursing assessment for a patient who is experiencing an adrenal crisis should include monitoring intake and output as well as blood glucose. Fluid loss occurs secondary to lack of mineralocorticoid and glucocorticoid, leading to loss of sodium followed by loss of water through the kidneys. Hypoglycemia occurs due to decreased cortisol. You would monitor for hypotension, not hypertension. IV cortisone is a priority for the treatment of the adrenal crisis and placing the bed in the lowest position is for safety.

Which clinical manifestations should the nurse anticipate when providing care to a client diagnosed with Cushing's disease? Select all that apply. a. Moon face b. Hypotension c. Buffalo hump d. Hypoglycemia e. Hypotension

a. Moon face c. Buffalo hump

Which diagnostic tests should the nurse anticipate will be ordered for Mrs. DeToro by the healthcare provider to evaluate her adrenal gland? Select all that apply. a. Serum potassium b. Serum magnesium c. Serum sodium d. Computed tomography (CT) e. Abdominal x-ray

a. Serum potassium c. Serum sodium d. Computed tomography (CT) Rationale: Appropriate diagnostic tests include serum potassium (to monitor for hypokalemia), serum sodium (to monitor for hyponatremia), and a CT scan (to assess for changes in the size and morphology of the adrenal gland). You would not anticipate a serum magnesium level nor an abdominal x-ray for this patient.

After several days in the hospital, Mrs. DeToro's condition has stabilized and she is approaching discharge. Which topics should the nurse include in the discharge teaching plan? Select all that apply. a. Taking oral hormone replacement daily b. Wearing a medical-alert bracelet when traveling c. Monitoring for symptoms of corticosteroid excess d. Using prescribed sedatives for sleep e. Monitoring for anticipated weight loss

a. Taking oral hormone replacement daily c. Monitoring for symptoms of corticosteroid excess Rationale: Topics that you should include in Mrs. DeToro's discharge teaching include the importance of taking oral hormone replacement daily and monitoring for symptoms of corticosteroid excess. A medical-alert bracelet should be worn at all times, not just when traveling. The client should be warned against the use of prescribed sedatives for sleep, as Mrs. DeToro's diagnosis contradicts this classification of medication. The client should be taught to monitor for weight gain, not weight loss, due to the prescribed glucocorticoids necessary for treatment.

Which statement made by a client diagnosed with adrenal insufficiency requires further education by the nurse? a. "I need to take my oral hormone replacement every day." b. "I no longer need to worry about symptoms of my disorder because it cannot recur." c. "I will purchase and wear a medical alert bracelet." d. "I will notify my doctor if I begin to gain weight."

b. "I no longer need to worry about symptoms of my disorder because it cannot recur."

The nurse receives several prescriptions for Mrs. DeToro. Which is the priority to administer? a. IV furosemide (Lasix) b. IV glucocorticoid (Cortisol) c. PO sodium polystyrene sulfonate (Kayexalate) d. PO hydrocortisone sodium succinate (Solu-Cortef)

b. IV glucocorticoid (Cortisol) Rationale: The priority medication for this client is an IV glucocorticoid such as Cortisol. IV furosemide (Lasix) is not appropriate for this patient as a hallmark finding for adrenal crisis is fluid volume deficit, not fluid volume excess. Kayexalate is only administered if the client is experiencing hyperkalemia. While PO Solu-Cortef may be appropriate for Mrs. DeToro, the definitive treatment is IV cortisol.

Which laboratory data should the nurse anticipate when providing care for a client who is experiencing hypercortisolism? a. Decreased cortisol level b. Increased glucose level c. Increased potassium level d. Increased serum sodium level

b. Increased glucose level Rationale: Patients with hypercortisolism present with hyperglycemia, hypokalemia, fluid retention, thinning of the skin, fat maldistribution, increased protein metabolism, and suppressed inflammatory and immune responses.

Which hormones should the nurse anticipate being affected for a client who is diagnosed with an adrenal medulla tumor? Select all that apply. a. Insulin b. Cortisol c. Epinephrine d. Aldosterone e. Norepinephrine

c. Epinephrine e. Norepinephrine

Mrs. DeToro is at risk for pheochromocytoma as a result of the current diagnosis. Which assessment is the priority to monitor for while providing care? a. Eupnea b. Bradycardia c. Hypertension d. Hypoglycemia

c. Hypertension Rationale: Pheochromocytomas are rare catecholamine-secreting tumors of the adrenal medulla. Clinical manifestations of this disorder are related to the systematic actions of epinephrine and norepinephrine and include tachycardia (not bradycardia), hypertension, headaches, palpitations, hyperhidrosis, hypermetabolism, and hyperglycemia (not hypoglycemia). Eupnea, the term for normal respirations, would not be assessed for as a result of this complication. The severity of attacks correlates to the amount of catecholamine release. Paroxysmal (sudden-onset) hypertension is seen in some patients, with blood pressure elevations in excess of 250/140 mm Hg, posing a life-threatening emergency.

When formulating the plan of care for Mrs. DeToro, which psychosocial nursing diagnosis is a priority? a. Fluid volume deficit b. Risk for unstable blood glucose c. Risk for decreased cardiac output d. Body image disturbance

d. Body image disturbance Rationale: While all of these nursing diagnoses are appropriate for a patient who is experiencing an adrenal crisis, the priority psychosocial nursing diagnosis is disturbed body image due to the hyperpigmentation of the skin.

Prolonged use of which type of medication can lead to Cushing's syndrome? a. Angiotensin-converting enzyme inhibitor b. Nonsteroidal anti-inflammatory c. Anticoagulant d. Corticosteroid

d. Corticosteroid

Mrs. DeToro's laboratory values indicate she is experiencing an adrenal crisis. Which treatment should the nurse anticipate? Select all that apply. a. Digoxin b. Furosemide c. Sliding scale insulin d. IV fluid with glucose e. IV glucocorticoids

d. IV fluid with glucose e. IV glucocorticoids Rationale: Cortisol replacement is the definitive treatment for adrenal insufficiency. Patients presenting with acute adrenal insufficiency require emergency stabilization with IV fluids and glucose, along with IV administration of glucocorticoids (cortisol), such as 50 to 100 mg of hydrocortisone sodium succinate (Solu-Cortef) or 4 to 12 mg of dexamethasone (Decadron).

The nurse is assessing a client diagnosed with adrenal cortical insufficiency. What clinical manifestations will the nurse expect to observe? Select all that apply. a. Weight gain b. Increased secretion of corticotropin-releasing hormone and adrenocorticotropic hormone c. Hypertension d. Increased secretion of melanocyte-stimulating hormone e. Darkened, bronzed hyperpigmentation

d. Increased secretion of melanocyte-stimulating hormone e. Darkened, bronzed hyperpigmentation