Nokea
A 30 year-old female patient has been diagnosed with Cushing syndrome. What psychosocial nursing diagnosis should the nurse most likely prioritize when planning the patients care?
- A. Decisional conflict related to treatment options
- B. Spiritual distress related to changes in cognitive function
- C. Disturbed body image related to changes in physical appearance
- D. Powerlessness related to disease progression
Correct Answer: C
Rationale: Cushing syndrome causes characteristic physical changes that are likely to result in disturbed body image. Decisional conflict and powerless may exist, but disturbed body image is more likely to be present. Cognitive changes take place in patients with Cushing syndrome, but these may or may not cause spiritual distress.
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The home care nurse is conducting patient teaching with a patient on corticosteroid therapy. To achieve consistency with the bodys natural secretion of cortisol, when would the home care nurse instruct the patient to take his or her corticosteroids?
- A. In the evening between 4 PM and 6 PM
- B. Prior to going to sleep at night
- C. At noon every day
- D. In the morning between 7 AM and 8 AM
Correct Answer: D
Rationale: In keeping with the natural secretion of cortisol, the best time of day for the total corticosteroid dose is in the morning from 7 to 8 AM. Large-dose therapy at 8 AM, when the adrenal gland is most active, produces maximal suppression of the gland. Also, a large 8 AM dose is more physiologic because it allows the body to escape effects of the steroids from 4 PM to 6 AM, when serum levels are normally low, thus minimizing cushingoid effects.
The nurse providing care for a patient with Cushing syndrome has identified the nursing diagnosis of risk for injury related to weakness. How should the nurse best reduce this risk?
- A. Establish falls prevention measures
- B. Encourage bed rest whenever possible
- C. Encourage the use of assistive devices
- D. Provide constant supervision
Correct Answer: A
Rationale: The nurse should take action to prevent the patients risk for falls. Bed rest carries too many harmful effects, however, and assistive devices may or may not be necessary. Constant supervision is not normally required or practicable.
A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a documented history of adrenal insufficiency. Considering the patients history and current symptoms, the nurse should anticipate that the patient will be instructed to do which of the following?
- A. Increase his intake of sodium until the GI symptoms improve
- B. Increase his intake of potassium until the GI symptoms improve
- C. Increase his intake of glucose until the GI symptoms improve
- D. Increase his intake of calcium until the GI symptoms improve
Correct Answer: A
Rationale: The patient will need to supplement dietary intake with added salt during episodes of GI losses of fluid through vomiting and diarrhea to prevent the onset of addisonian crisis. While the patient may experience the loss of other electrolytes, the major concern is the replacement of lost sodium.
The nurse is caring for a patient at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the patient? Select all that apply.
- A. Epistaxis
- B. Pallor
- C. Rapid respiratory rate
- D. Bounding pulse
- E. Hypotension
Correct Answer: B,C,E
Rationale: The patient at risk is monitored for signs and symptoms indicative of addisonian crisis, which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness. Epistaxis and a bounding pulse are not symptoms or signs of an addisonian crisis.
A patient with pheochromocytoma has been admitted for an adrenalectomy to be performed the following day. To prevent complications, the nurse should anticipate preoperative administration of which of the following?
- A. IV antibiotics
- B. Oral antihypertensives
- C. Parenteral nutrition
- D. IV corticosteroids
Correct Answer: D
Rationale: IV administration of corticosteroids (methylprednisolone sodium succinate [Solu-Medrol]) may begin on the evening before surgery and continue during the early postoperative period to prevent adrenal insufficiency. Antibiotics, antihypertensives, and parenteral nutrition do not prevent adrenal insufficiency or other common complications of adrenalectomy.