Nokea
A nurse plans care for a client with Cushing's disease. Which action should the nurse include in this client's plan of care to prevent injury?
- A. Pad the siderails of the client's bed
- B. Assist the client to change positions slowly
- C. Use a lift sheet to change the client's position
- D. Place the client in a position with the head of the bed elevated
Correct Answer: C
Rationale: Cushing's syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive bone demineralization and increases the risks for pathologic bone fracture. Using a lift sheet to change the client's position minimizes the risk of fractures, providing the most effective protection compared to other options.
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A nurse cares for a client who is recovering from a hypophysectomy. Which action should the nurse take?
- A. I must wash the incision with peroxide and redress it daily
- B. I shall cough and deep breathe every 2 hours while I am awake
- C. Avoid activities that increase intracranial pressure
- D. Apply petroleum jelly to lips to avoid dryness
Correct Answer: C
Rationale: After this surgery, the client must take care to avoid activities that can increase intracranial pressure. The client should avoid bending from the waist, bearing down, coughing, or lying flat. With this approach, there is no incision to clean and dress. Protection from sun exposure is not necessary after this procedure.
After teaching a client with acromegaly who is scheduled for a hypophysectomy, the nurse assesses the client's understanding. Which statement made by the client indicates a need for additional teaching?
- A. I will no longer need to limit my fluid intake after surgery
- B. I am glad no visible incision will result from this surgery
- C. I will wear slip-on shoes after surgery to limit bending over
- D. I must avoid coughing to prevent complications
Correct Answer: C
Rationale: Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement are not reversible. It is appropriate for the client to drink as needed postoperatively and to avoid bending over to prevent increased intracranial pressure. However, stating that they will wear slip-on shoes to limit bending over is correct, but the phrasing in option C suggests a misunderstanding if it implies no other precautions are needed.
A nurse is caring for a client who was prescribed high-dose corticosteroid therapy for 1 month to treat a severe inflammatory condition. The client's symptoms have now resolved and the client asks, 'When can I stop taking these medications?' How should the nurse respond?
- A. It is possible for the inflammation to recur if you stop the medication
- B. Once you start corticosteroids, you have to be weaned off them
- C. You have to decrease the dose slowly so your hormones will work again
- D. The drug suppresses your immune system, which must be built back up
Correct Answer: B
Rationale: One of the most common causes of adrenal insufficiency, a life-threatening problem, is the sudden cessation of long-term, high-dose corticosteroid therapy. This therapy suppresses the hypothalamic-pituitary-adrenal axis and must be withdrawn gradually to allow for pituitary production of adrenocorticotropic hormone and adrenal production of cortisol.
How should the nurse interpret these results?
- A. Pituitary Hyperfunction
- B. Pituitary hypofunction
- C. Pituitary-induced diabetes mellitus
- D. Normal pituitary response to insulin
Correct Answer: D
Rationale: Some tests for pituitary function involve administering agents that are known to stimulate the secretion of specific pituitary hormones and then measuring the response. Such tests are termed stimulation tests. The stimulation test for GH or ACTH assessment involves injecting the client with regular insulin (0.05 to 1 unit/kg of body weight) and checking circulating levels of GH and ACTH. A normal response indicates adequate pituitary function.
A nurse plans care for a client with a growth hormone deficiency. Which action should the nurse include in this client's plan of care?
- A. A 36-year-old female who has used oral contraceptives for 5 years
- B. A 42-year-old male who experienced head trauma 3 years ago
- C. A 35-year-old female with hormone delivery to mellitus and iodine
- D. A 64-year-old male with adult-onset diabetes mellitus
Correct Answer: B
Rationale: Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction. The other factors do not increase the risk of this condition. For care planning, identifying the client with a history of head trauma as high risk guides appropriate interventions.