Nokea
A patient has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the patient knows to do which of the following?
- A. Take the drug concurrent with levothyroxine (Synthroid)
- B. Take each dose of prednisone with a dose of calcium chloride
- C. Gradually replace the prednisone with an OTC alternative
- D. Slowly taper down the dose of prednisone, as ordered
Correct Answer: D
Rationale: Corticosteroid dosages are reduced gradually (tapered) to allow normal adrenal function to return and to prevent steroid-induced adrenal insufficiency. There are no OTC substitutes for prednisone and neither calcium chloride nor levothyroxine addresses the risk of adrenal insufficiency.
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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.
The nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve?
- A. Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3 hours
- B. Administration of dexamethasone IV, followed by an x-ray of the adrenal glands
- C. Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning
- D. Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after the drug is administered
Correct Answer: C
Rationale: Dexamethasone (1 mg) is administered orally at 11 PM, and a plasma cortisol level is obtained at 8 AM the next morning. This test can be performed on an outpatient basis and is the most widely used and sensitive screening test for diagnosis of a pituitary function and adrenal causes of Cushing syndrome.
The nurse is caring for a patient diagnosed with hypothyroidism secondary to Hashimotos thyroiditis. When assessing this patient, what sign or symptom would the nurse expect?
- A. Symptoms of hypothyroidism extreme fatigue, hair loss, brittle nails, dry skin, voice huskiness or hoarseness, menstrual disturbance
- B. Bulging eyes
- C. Palpitations
- D. Flushed skin
Correct Answer: A
Rationale: Symptoms of hypothyroidism include extreme fatigue, hair loss, brittle nails, dry skin, voice huskiness or hoarseness, menstrual disturbance, and numbness and tingling of the fingers. Bulging eyes, palpitations, and flushed skin would be signs and symptoms of hyperthyroidism.
The physician has ordered a fluid deprivation test for a patient suspected of having diabetes insipidus. During the test, the nurse should prioritize what assessments?
- A. Temperature and oxygen saturation
- B. Heart rate and BP
- C. Breath sounds and bowel sounds
- D. Color, warmth, movement, and sensation of extremities
Correct Answer: B
Rationale: The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost. The patients condition needs to be monitored frequently during the test, and the test is terminated if tachycardia, excessive weight loss, or hypotension develops. Consequently, BP and heart rate monitoring are priorities over the other listed assessments.
A patient who has been taking corticosteroids for several months has been experiencing muscle wasting. The patient has asked the nurse for suggestions to address this adverse effect. What should the nurse recommend?
- A. Activity limitation to conserve energy
- B. Consumption of a high-protein diet
- C. Use of OTC vitamin D and calcium supplements
- D. Passive range-of-motion exercises
Correct Answer: B
Rationale: Muscle wasting can be partly addressed through increased protein intake. Passive ROM exercises maintain flexibility, but do not build muscle mass. Vitamin D and calcium supplements do not decrease muscle wasting. Activity limitation would exacerbate the problem.