Nokea
The nurse is preparing a presentation on Cushing's disease. It would be correct if the nurse states that Cushing's disease is caused by
- A. destruction to pancreatic beta cells.
- B. excessive discharge of thyroid-stimulating hormone (TSH).
- C. decrease in the secretion of androgens and glucocorticoids.
- D. increase in the secretion of adrenocorticotropin hormone (ACTH).
Correct Answer: D
Rationale: Cushing's disease results from excess ACTH from the pituitary, overstimulating cortisol production. Beta cell destruction, TSH, and decreased androgens/glucocorticoids are unrelated.
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The nurse prepares to administer intermediate-acting insulin to a client with diabetes mellitus. Place the following actions in the order in which they should be performed when preparing the injection, starting from first to last.
- A. Gently roll the bottle of intermediate-acting insulin in the palms of your hands to mix the insulin.
- B. Remove air bubbles in the syringe by tapping on the syringe.
- C. Inspect the bottle for the type of insulin and the expiration date.
- D. Pull back the plunger to draw air into the syringe and inject it into the vial.
- E. Turn the bottle upside down and draw the insulin dose into the syringe.
- F. Clean the rubber stopper with an alcohol swab.
Correct Answer: C, F, A, D, E, B
Rationale: Inspect the bottle for type and expiration, clean the stopper, roll to mix, draw air and inject into vial, draw dose, then remove bubbles to ensure accurate, safe administration.
The following scenario applies to the next 1 items
The nurse in the physician's office is providing education to a client with diabetes mellitus (type one)
Item 1 of 1
Nurses' Note
1655: Client reports to the clinic with an interest in a prescription for an insulin pump. The client reports that he has been inconvenienced by injecting himself with insulin over the past year, considering he is traveling more for work. The client indicates that he heard about insulin pumps and thinks it would be a good fit for his lifestyle.
Orders
1730:
Continuous subcutaneous insulin infusion (insulin pump)
The nurse evaluates the client's understanding following a teaching session regarding the newly prescribed continuous subcutaneous insulin infusion (insulin pump). Click to specify if the client statement indicates effective understanding or requires follow-up
- A. I will load my aspart insulin into my pump.
- B. I will change the infusion set every 5-7 days.
- C. By having this pump, I will be able to check my glucose level less often.
- D. I will keep an extra vial of insulin in my car.
- E. If I remove my pump, it could cause me to develop hypoglycemia.
- F. Using this pump will lower my risk for diabetic ketoacidosis.
- G. I should roll my vial of insulin prior to putting it into the pump.
Correct Answer: A
Rationale: Aspart is fast-acting, ideal for pumps, and rotating sites prevents complications. Pumps don't check glucose, car storage risks temperature damage, removal risks hyperglycemia, and DKA risk remains. Rolling insulin is unnecessary for pumps.
The nurse is caring for a client immediately following transsphenoidal hypophysectomy. It would be essential for the nurse to obtain a prescription for which medication?
- A. Ondansetron
- B. Methimazole
- C. Omeprazole
- D. Methylphenidate
Correct Answer: A
Rationale: Transsphenoidal hypophysectomy often causes nausea from surgical manipulation near the pituitary. Ondansetron controls postoperative nausea. Methimazole is for hyperthyroidism, omeprazole for gastric issues, and methylphenidate for attention disorders.
The nurse in the clinic is caring for a 32-year-old female client.
Item 6 of 6
Nurses' Notes
1559: Client reports to the outpatient clinic with reports of persistent fatigue, weakness, lethargy, and lower back pain over the last 8 months. She is also concerned because she has gained 24 pounds (10.9 kg) over the past 4 months. She stated that the weight gain has been so significant that she developed reddened streaks on her abdomen from the weight gain. The client is concerned because, over the past month, she has noticed she has been drinking more often and has had increased hunger. She has also noticed she is urinating more frequently. She went to urgent care one week ago and tested negative for urinary tract infection. She also noticed that her menstrual cycle has been irregular. She is not on birth control and took a home pregnancy test, which was negative. During the assessment, the client was fully alert and oriented. Clear lung sounds bilaterally. Skin was dry. Excessive facial hair was noted. 1+ pedal and ankle edema bilaterally. Peripheral pulses palpable, 2+, and regular. Body mass index (BMI) of 32. Vital signs: T 97.5° F (36.4° C), P 93, RR 18, BP 145/93, pulse oximetry reading 96% on room air. She is currently taking escitalopram for persistent depressive disorder.
Laboratory Results
Capillary Blood Glucose
1613: 254 mg/dL [70-110 mg/dL]
Orders
1714:
Arrange for a follow-up appointment in 3 days
Lab orders: serum complete blood count, complete metabolic panel, hemoglobin A1C
24-hour urinary cortisol excretion
Progress Notes
Follow-up appointment 3 days later
1544: Client presents for a 3-day follow-up. Laboratory findings confirm Cushing's disease with the 24-hour urine cortisol test at 125 mcg/24 hour [10 to 100 mcg/24]. CMP showed hyperglycemia, hypernatremia, and hypokalemia. Will refer to endocrinology for further evaluation and management. Will prescribe potassium supplementation.
For each of the statements made by the client, click to specify whether the statement indicates an understanding or requires follow-up of the discharge teaching provided on Cushing's disease.
- A. I should start using a salt substitute to season my foods.
- B. Exercise such as swimming is appropriate.
- C. I should start eating snacks high in sodium and potassium.
- D. I will limit my caffeine consumption.
- E. This condition requires me to avoid getting the seasonal influenza vaccine.
- F. I should notify my doctor if I start to develop constipation and muscle weakness.
Correct Answer: A, C, E
Rationale: Salt substitutes reduce sodium, appropriate for Cushing's-related hypertension. High sodium snacks are incorrect due to fluid retention risks. Limiting caffeine is good, and avoiding vaccines is wrong—immunizations are crucial. Notifying the doctor about weakness is correct.
The nurse is evaluating a client taking levothyroxine for hypothyroidism. Which findings indicate that the client is experiencing an adverse effect?
- A. Heat intolerance
- B. Palpitations
- C. Bradycardia
- D. Constipation
- E. Insomnia
- F. Weight gain
Correct Answer: A,B,E
Rationale: Heat intolerance, palpitations, and insomnia indicate hyperthyroidism, suggesting levothyroxine overdose. Bradycardia, constipation, and weight gain are hypothyroidism symptoms, not adverse effects of levothyroxine.