Prep U's Chapter 45 and 46
A client's left adrenal medulla has been injured in a motor vehicle accident. What is a possible implication of this injury?
Disruptions in the levels of norepinephrine and epinephrine
Which patient should not receive mitotane as ordered?
The patient experiencing shock
Nicotinic receptors would be found in which location?
Adrenal medulla
A female client is to receive hydrocortisone. What adverse effects on reproduction would the nurse assess? Select all that apply.
Amenorrhea Irregular menses
Which statement is especially important to teach a caregiver of an infant being treated with hydrocortisone?
"Avoid live virus vaccinations."
A client admitted to a cardiac unit asks why a rest period is required each afternoon. The nurse's response should be based on what information regarding the PNS?
"Clients are encouraged to rest and relax during this time, free of families and visitors."
Which statement is included in the care plan of a client prescribed etomidate for Cushing's disease?
"It blocks the production of cortisol."
A client newly diagnosed with Cushing's disease asks how ketoconazole works. What is the nurse's best response?
"It controls cortisol secretions."
A client, prescribed hydrocortisone, states, "I know quite a few different people who have had unpleasant side effects of steroids." How should the nurse best respond to the client's concern?
"It's true, that hydrocortisone can affect nearly every body system, but your health care team will monitor you thoroughly for indications of adverse reactions."
A nurse is providing health education to a client who will be discharged home with a prescription for hydrocortisone. What instruction should the nurse convey to the client?
"Make sure that you take this medication with food."
A nurse is caring for a client with Addison's disease who is receiving fludrocortisone with hydrocortisone. Which statements should be included when teaching appropriate medication administration? Select all that apply.
"Take both medications by 0900." "Measure your weight daily, and report a 5-pound weight gain in one week." "Keep all laboratory and provider appointments."
A nurse is caring for a patient with Cushing's disease who asks why he is receiving ketoconazole (Nizoral), an antifungal medication. What is an appropriate response by the nurse?
"The medication will decrease cortisol levels."
The patient receiving ketoconazole (Nizoral) for Cushing's disease reports a headache. What is the best advice for the nurse to give the patient?
"This might be a reaction to the medication. Talk to your health care provider."
A patient who has been taking ketoconazole for 1 month reports fatigue. What assessment findings are causes for concern related to this therapy? (Select all that apply.)
-A reported change in bowel movements to a lighter color -A yellow tint to the patient's skin - Yellow coloring around the patient's irises
Which client is most directly exhibiting the function of afferent nerves?
A client who has winced with pain during an intramuscular injection
Which client's nicotinic receptors are likely being stimulated the most?
A client who is in anxious while waiting in the pre-operative area
The health care provider suspects that a client has Addison's disease. The nurse knows that the provider will perform what test to confirm this diagnosis?
ACTH stimulation test
A client in distress has been given dobutamine, a medication intended to increase myocardial activity and heart rate. This medication likely stimulates what adrenergic receptor?
Beta-1
A client with asthma is prescribed albuterol to dilate the bronchioles. The nurse understands that this drug is likely acting on which receptors?
Beta-2
The anatomy and physiology instructor is discussing adrenergic receptors with the nursing class. What adrenergic receptor would the instructor tell the students is found in the heart and can stimulate increased myocardial activity and increase heart rate?
Beta1
The body uses tyrosine in the diet to make what substance?
Norepinephrine
Which effect results from activation of beta2 receptors?
Bronchodilation
The nurse is caring for a hospital client who has been prescribed fludrocortisone. The nurse has performed a general assessment of the client, including auscultation of the client's apical heart rate. How should the nurse best follow up assessment of an audible S3?
Contact the care provider promptly.
For what therapeutic effect will the nurse monitor after the administration of metyrapone (Metopirone)?
Decreased ACTH
The nurse is assessing a patient with adrenocortical insufficiency. What presenting symptom supports the patient's diagnosis?
Decreased cardiac output
Which of the following effects might occur following the administration of a cholinergic drug?
Decreased heart rate
Which symptom, if found in the patient being treated for Cushing's disease, indicates medication therapy is therapeutic?
Decreased peripheral edema
A patient with Parkinson's disease is being cared for on your unit. The nurse would be correct in identifying what neurotransmitter as being decreased in this disease?
Dopamine
Which herbal supplement taken with ketoconazole can cause hepatotoxicity?
Echinacea
The nurse is caring for a patient who has been prescribed fludrocortisone and furosemide (Lasix). What assessment is essential to monitor for potential complications with this patient?
Electrolytes
Which condition in a client's history can be a cause of adrenocortical insufficiency?
Histoplasmosis infection
A client diagnosed with metastatic cancer has developed adrenocortical insufficiency. What clinical manifestations would serve to support the diagnosis of adrenocortical insufficiency?
Hyponatremia Hyperkalemia Hypotension
After teaching a group of students about major divisions of the brain, the instructor determines that additional teaching is needed when the students identify what as part of the hindbrain?
Hypothalamus
What is the resulting physiologic effect when the parasympathetic nervous system is stimulated?
Increased GI motility
A client prescribed hydrocortisone cypionate should be educated to what fact related to the medication?
It is a combination of a mineralocorticoid and adrenocorticoid.
In determining therapy for a child being treated for Cushing's disease, which medication would not be administered?
Ketoconazole (Nizoral)
The nurse is caring for a client with inoperable adrenocortical carcinoma and is aware that the health care provider will most likely order which medication?
Mitotane
A patient receiving hydrocortisone has started estrogen hormonal replacement therapy. What is the nurse's best intervention?
Monitor the patient's blood glucose levels frequently.
A nurse is administering hydrocortisone cypionate (Cortef) to a child. What nursing intervention is essential?
Monitor the patient's height and weight.
Cholinergic receptors are classified as nicotinic or muscarinic. What is a result of the stimulation of the nicotinic receptors?
Muscle contraction
Which common adverse effects should a nurse assess for when caring for a client prescribed ketoconazole?
Nausea, vomiting, and abdominal pain
The nurse administers a drug that stimulates beta2 receptors. What type of health condition would this drug treat?
Respiratory disease
The nurse is caring for a client who has just been admitted to the intensive care unit with a diagnosis of addisonian crisis. The nurse would expect that this client may exhibit a craving for what element?
Salt
Which laboratory value monitored in a patient receiving fludrocortisone acetate requires immediate action by the nurse?
Sodium 150 mEq/L
The patient being treated for Addison's disease that is responding to therapy would have which assessment finding?
Stable blood pressure
The nurse accompanies the health care provider into the client's room and remains after the client is told he has cancer and a poor prognosis. The client's respirations become rapid and deep, his pupils dilate and he appears diaphoretic. What type of response is the nurse witnessing?
Sympathetic nervous system (SNS) response
A patient reports nausea when taking ketoconazole (Nizoral). What is the best advice for the nurse to give the patient?
Take the medication with food.
The nurse is conducting an assessment of a newly admitted client. What assessment finding should suggest to the nurse that the client's muscarinic cholinergic receptors are being stimulated?
The client has "pinpoint" pupils.
The nurse is assessing a client. What assessment finding is the clearest indicator of autonomic function?
The client's respiratory rate is 22 breaths per minute
The nurse administers hydrocortisone cypionate (Cortef). What intervention is appropriate for this medication?
The nurse will monitor the patient's blood glucose level.
The nurse is evaluating the therapeutic effects of fludrocortisone acetate (Florinef acetate). Which assessment finding best indicates that the medication is working?
The patient's blood pressure is 130/90 mm Hg seated and 128/89 mm Hg when standing.
The nurse is assessing the patient on mitotane therapy. Which assessment finding requires action by the nurse?
The patient's blood pressure is 140/90 mm Hg sitting and 90/50 mm Hg standing.
What statement best explains the central and peripheral nervous system?
The two main divisions that control the nervous system are the central and peripheral nervous system.
The physiology instructor explains to the nursing students that beta-2 stimulation leads to:
Vasodilation of blood vessels
In what location is acetylcholine normally synthesized?
Within cholinergic nerves themselves
A client with a visible "buffalo hump" and a history of impaired wound healing has been referred for care to the endocrinology department. This client's signs and symptoms are most likely to be attributed to what factor?
adrenocortical excess
A nurse is caring for a patient who is having a sympathetic response. A sympathetic response involves:
an increase in blood pressure, bronchi dilation, and decreased bowel sounds
A client with a diagnosis of Cushing's is not a surgical candidate and is consequently being treated with ketoconazole. The nurse should be aware that ketoconazole achieves a therapeutic effect by what means?
inhibiting the enzymes that contribute to cortisol synthesis
When planning nursing care for a client prescribed long-term therapy for Addison's disease, the nurse should address what nursing diagnosis that results from the client's increased risk?
risk for infection related to medication therapy
A client has been admitted to the emergency department with a diverse constellation of signs and symptoms. What diagnostic finding is most consistent with a diagnosis of Addison's disease?
serum sodium 128 mEq/L (128 mmol/L)
What medication creates a safety risk when combined with long-term fludrocortisone therapy?
warfarin
A nurse is reviewing the structure and function of the nervous system in preparation for working on a neurological floor. What characteristic of neurons should the nurse identify?
Neurons convey action potentials to other neurons without being in physical contact.
A nurse is reading an article about the fight or flight response that includes a discussion of a neurotransmitter. Which neurotransmitter most likely would be addressed?
Norepinephrine
Which assessment finding indicates a therapeutic response to mitotane therapy?
The patient can lift 10 pounds and was previously unable to lift 5 pounds.
Which assessment finding indicates to the nurse that ketoconazole (Nizoral) therapy is effective?
The patient has a decreased blood glucose level.
A nurse is assessing a patient receiving fludrocortisone acetate replacement therapy. What finding requires immediate action by the nurse?
The patient is reporting gastric pain.
Which patient should not receive ketoconazole (Nizoral) as ordered for Cushing's disease?
The patient with elevated liver function tests
Which patient should not start hydrocortisone therapy as ordered at 8 a.m.?
The patient with sepsis