Nokea
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.
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Following an addisonian crisis, a patients adrenal function has been gradually regained. The nurse should ensure that the patient knows about the need for supplementary glucocorticoid therapy in which of the following circumstances?
- A. Episodes of high psychosocial stress
- B. Periods of dehydration
- C. Episodes of physical exertion
- D. Administration of a vaccine
Correct Answer: A
Rationale: During stressful procedures or significant illnesses, additional supplementary therapy with glucocorticoids is required to prevent addisonian crisis. Physical activity, dehydration and vaccine administration would not normally be sufficiently demanding such to require glucocorticoids.
A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding?
- A. Glucose in the urine
- B. Albumin in the urine
- C. Highly dilute urine
- D. Leukocytes in the urine
Correct Answer: C
Rationale: Patients with diabetes insipidus produce an enormous daily output of very dilute, water-like urine with a specific gravity of 1.001 to 1.005. The urine contains no abnormal substances such as glucose or albumin. Leukocytes in the urine are not related to the condition of diabetes insipidus, but would indicate a urinary tract infection, if present in the urine.
A patient is prescribed corticosteroid therapy. What would be priority information for the nurse to give the patient who is prescribed long-term corticosteroid therapy?
- A. The patients diet should be low protein with ample fat
- B. The patient may experience short-term changes in cognition
- C. The patient is at an increased risk for developing infection
- D. The patient is at a decreased risk for development of thrombophlebitis and thromboembolism
Correct Answer: C
Rationale: The patient is at increased risk of infection and masking of signs of infection. The cardiovascular effects of corticosteroid therapy may result in development of thrombophlebitis or thromboembolism. Diet should be high in protein with limited fat. Changes in appearance usually disappear when therapy is no longer necessary. Cognitive changes are not common adverse effects.
What should the nurse teach a patient on corticosteroid therapy in order to reduce the patients risk of adrenal insufficiency?
- A. Take the medication late in the day to mimic the bodys natural rhythms
- B. Always have enough medication on hand to avoid running out
- C. Skip up to 2 doses in cases of illness involving nausea
- D. Take up to 1 extra dose per day during times of stress
Correct Answer: B
Rationale: The patient and family should be informed that acute adrenal insufficiency and underlying symptoms will recur if corticosteroid therapy is stopped abruptly without medical supervision. The patient should be instructed to have an adequate supply of the corticosteroid medication always available to avoid running out. Doses should not be skipped or added without explicit instructions to do so. Corticosteroids should normally be taken in the morning to mimic natural rhythms.
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.