Nokea
The nurse is caring for a patient with Cushing's syndrome who is admitted for an adrenalectomy. The patient has a nursing diagnosis of disturbed body image related to changes in appearance caused by the effects of the disease. Which of the following interventions is most helpful?
- A. Reassure the patient that the physical changes are very common in patients with Cushing's syndrome.
- B. Discuss the use of diet and exercise in controlling the weight gain associated with Cushing syndrome.
- C. Teach the patient that most of the physical changes caused by Cushing's syndrome will resolve after surgery.
- D. Remind the patient that the metabolic impact of Cushing's syndrome is of more importance than appearance.
Correct Answer: C
Rationale: The most reassuring communication to the patient is that most of the physical and emotional changes caused by the Cushing's syndrome will resolve after hormone levels return to normal postoperatively. Reassurance that the physical changes are expected or that there are more serious physiological problems associated with Cushing's syndrome are not therapeutic responses. The patient's physiological changes are caused by the high hormone levels, not by the patient's diet or exercise choices.
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The nurse is caring for a patient who has had a transsphenoidal resection of a pituitary tumour. Which of the following nursing actions should be included in the postoperative plan of care?
- A. Monitor urine output every hour.
- B. Palpate extremities for dependent edema.
- C. Check hematocrit hourly for first 12 hours.
- D. Obtain continuous pulse oximetry for 24 hours.
Correct Answer: A
Rationale: After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema and monitoring of urine output and urine specific gravity is essential. Hemorrhage is not a common problem. There is no need to check the hematocrit hourly. The patient is at risk for dehydration, not volume overload. The patient is not at high risk for problems with oxygenation, and continuous pulse oximetry is not needed.
The nurse is caring for a patient with primary hyperparathyroidism who has a serum calcium level of 3.5 mmol/L and a phosphorus of 0.5 mmol/L. Which of the following nursing actions should the nurse include in the plan of care?
- A. Institute routine seizure precautions.
- B. Monitor for positive Chvostek's sign.
- C. Encourage the patient to remain on bed rest.
- D. Encourage 3000-4000 mL of oral fluids daily.
Correct Answer: D
Rationale: The patient with hypercalcemia is at risk for kidney stones, which may be prevented by a high fluid intake. Seizure precautions and monitoring for Chvostek's or Trousseau's sign are appropriate for hypocalcemic patients. The patient should engage in weight-bearing exercise to decrease calcium loss from bone.
The nurse is caring for a patient in a long-term care facility who has these medications prescribed. After the patient is diagnosed with hypothyroidism, which of the following medications should the nurse report to the health care provider?
- A. Docusate
- B. Diazepam
- C. Ibuprofen
- D. Cefoxitin
Correct Answer: B
Rationale: Worsening of mental status and myxedema coma can be precipitated by the use of sedatives, especially in older persons. The nurse should discuss the diazepam with the health care provider before administration. The other medications may be given safely to the patient.
The nurse is caring for a patient with hypertension who is diagnosed with a pheochromocytoma. Which of the following findings should the nurse monitor in the patient?
- A. Flushing
- B. Headache
- C. Bradycardia
- D. Hypoglycemia
Correct Answer: B
Rationale: The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia, severe pounding headache, diaphoresis, and abdominal or chest pain. Elevated blood glucose may also occur because of sympathetic nervous system stimulation. Bradycardia and flushing would not be expected.
Which of the following assessment findings for a patient admitted with Graves' disease requires the most rapid intervention by the nurse?
- A. BP 166/100 mm Hg
- B. Bilateral exophthalmos
- C. Heart rate 136 beats/minute
- D. Temperature 40.4°C (104.7°F)
Correct Answer: D
Rationale: The patient's temperature indicates that the patient may have thyrotoxic crisis and that interventions to lower the temperature are needed immediately. The other findings also require intervention but do not indicate potentially life-threatening complications.