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While assisting with the surgical removal of an adrenal tumor, the OR nurse is aware that the patients vital signs may change upon manipulation of the tumor. What vital sign changes would the nurse expect to see?
- A. Hyperthermia and tachypnea
- B. Hypertension and heart rate changes
- C. Hypotension and hypothermia
- D. Hyperthermia and bradycardia
Correct Answer: B
Rationale: Manipulation of the tumor during surgical excision may cause release of stored epinephrine and norepinephrine, with marked increases in BP and changes in heart rate. The use of sodium nitroprusside and alpha-adrenergic blocking agents may be required during and after surgery. While other vital sign changes may occur related to surgical complications, the most common changes are related to hypertension and changes in the heart rate.
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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.
A patient is undergoing testing for suspected adrenocortical insufficiency. The care team should ensure that the patient has been assessed for the most common cause of adrenocortical insufficiency. What is the most common cause of this health problem?
- A. Therapeutic use of corticosteroids
- B. Pheochromocytoma
- C. Inadequate secretion of ACTH
- D. Adrenal tumor
Correct Answer: A
Rationale: Therapeutic use of corticosteroids is the most common cause of adrenocortical insufficiency. The other options also cause adrenocortical insufficiency, but they are not the most common causes.
The nurse is caring for a patient with hyperparathyroidism. What level of activity would the nurse expect to promote?
- A. Complete bed rest
- B. Bed rest with bathroom privileges
- C. Out of bed (OOB) to the chair twice a day
- D. Ambulation and activity as tolerated
Correct Answer: D
Rationale: Mobility, with walking or use of a rocking chair for those with limited mobility, is encouraged as much as possible because bones subjected to normal stress give up less calcium. Best rest should be discouraged because it increases calcium excretion and the risk of renal calculi. Limiting the patient to getting out of bed only a few times a day also increases calcium excretion and the associated risks.
A patient with suspected adrenal insufficiency has been ordered an adrenocorticotropic hormone (ACTH) stimulation test. Administration of ACTH caused a marked increase in cortisol levels. How should the nurse interpret this finding?
- A. The patients pituitary function is compromised
- B. The patients adrenal insufficiency is not treatable
- C. The patient has insufficient hypothalamic function
- D. The patient would benefit from surgery
Correct Answer: A
Rationale: An adrenal response to the administration of a stimulating hormone suggests inadequate production of the stimulating hormone. In this case, ACTH is produced by the pituitary and, consequently, pituitary hypofunction is suggested. Hypothalamic function is not relevant to the physiology of this problem. Treatment exists, although surgery is not likely indicated.
The home care nurse is conducting patient teaching with a patient on corticosteroid therapy. To achieve consistency with the bodys natural secretion of cortisol, when would the home care nurse instruct the patient to take his or her corticosteroids?
- A. In the evening between 4 PM and 6 PM
- B. Prior to going to sleep at night
- C. At noon every day
- D. In the morning between 7 AM and 8 AM
Correct Answer: D
Rationale: In keeping with the natural secretion of cortisol, the best time of day for the total corticosteroid dose is in the morning from 7 to 8 AM. Large-dose therapy at 8 AM, when the adrenal gland is most active, produces maximal suppression of the gland. Also, a large 8 AM dose is more physiologic because it allows the body to escape effects of the steroids from 4 PM to 6 AM, when serum levels are normally low, thus minimizing cushingoid effects.