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Which client history is most significant in the development of symptoms for a client who has iatrogenic Cushing's disease?
- A. Long-term use of anabolic steroids.
- B. Extended use of inhaled steroids for asthma.
- C. History of long-term glucocorticoid use.
- D. Family history of increased cortisol production.
Correct Answer: C
Rationale: Long-term glucocorticoid use causes iatrogenic Cushing’s by mimicking hypercortisolism. Anabolic/inhabited steroids and family history are less causative.
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The nurse is admitting a client diagnosed with primary adrenal cortex insufficiency (Addison's disease). Which clinical manifestations should the nurse expect to assess?
- A. Moon face, buffalo hump, and hyperglycemia.
- B. Hirsutism, fever, and irritability.
- C. Bronze pigmentation, hypotension, and anorexia.
- D. Tachycardia, bulging eyes, and goiter.
Correct Answer: C
Rationale: Addison’s causes cortisol and aldosterone deficiency, leading to bronze pigmentation, hypotension, and anorexia. Other options describe Cushing’s, hyperthyroidism, or unrelated symptoms.
The elderly client is admitted to the intensive care department diagnosed with severe HHNS. Which collaborative intervention should the nurse include in the plan of care?
- A. Infuse 0.9% normal saline intravenously.
- B. Administer intermediate-acting insulin.
- C. Perform blood glucometer checks daily.
- D. Monitor arterial blood gas (ABG) results.
Correct Answer: A
Rationale: IV normal saline corrects severe dehydration in HHNS, a priority collaborative intervention. Insulin is secondary, daily glucose checks are insufficient, and ABGs are less critical in HHNS.
The client with type 2 DM is scheduled for cardiac rehabilitation exercises (cardiac rehab). The nurse notes that the client's blood glucose level is 300 mg/dL and that the urine is positive for ketones. How should the nurse proceed?
- A. Send the client to cardiac rehab; exercise will lower the client's glucose level.
- B. Give insulin; send the client for exercises with a 15-gram carbohydrate snack.
- C. Delay cardiac rehab; blood glucose levels will decrease too much with exercise.
- D. Cancel cardiac rehab; blood glucose levels will increase further with exercise.
Correct Answer: D
Rationale: Exercising with blood glucose levels exceeding 250 mg/dL and ketonuria increases the secretion of glucagon, growth hormone, and catecholamines, causing the liver to release more glucose.
The nurse is performing discharge teaching for a client diagnosed with Cushing's disease. Which statement by the client demonstrates an understanding of the instructions?
- A. I will be sure to notify my health-care provider if I start to run a fever.
- B. Before I stop taking the prednisone, I will be taught how to taper it off.
- C. If I get weak and shaky, I need to eat some hard candy or drink some juice.
- D. It is fine if I continue to participate in weekend games of tackle football.
Correct Answer: B
Rationale: Tapering prednisone prevents adrenal crisis, indicating understanding. Fever notification is general, hypoglycemia is unrelated, and tackle football is unsafe.
Which statement provides the best evidence that the client understands the prescribed drug therapy?
- A. I must take this drug after meals.
- B. I'll need to take this drug life-long.
- C. I can skip a dose if I'm nauseated.
Correct Answer: B
Rationale: Levothyroxine for myxedema typically requires lifelong therapy to maintain thyroid hormone levels.