Glucose Regulation Flashcards
Which disorder is a result of excess cortisol?
- Cushing syndrome
- Marfan syndrome
- Hashimoto disease
The correct answer is: Cushing syndrome
The term Cushing syndrome refers to the manifestations of hypercortisolism from any cause.
Turner syndrome and Marfan syndrome are chromosomal disorders that affect height while Hashimoto disease is a thyroid disorder.
Which symptom, if found in the patient being treated for Cushing’s disease, indicates medication therapy is therapeutic?
- moon face
- Truncal obesity
- Osteoporosis
- Decreased peripheral edema
The correct answer is: Decreased peripheral edema
Decreased peripheral edema indicates the patient has decreased fluid retention.
The other assessments are symptoms of the disease, not improvements.
A nurse cares for a client who has secondary obesity. Which condition is the most likely to result in secondary obesity?
- Addison’s disease
- Grave’s disease
- Cushing’s disease
- Crohn’s disease
The correct answer is: Cushing’s disease
Cushing’s disease results from excess cortisol in the blood. This increases the risk of obesity.
The other diseases or conditions listed most likely cause weight loss, not weight gain.
Which patient should not receive ketoconazole (Nizoral) as ordered for Cushing’s disease?
- The patient with a headache
- The patient reporting fatigue
- the patient recently diagnosed with hepatitis C
- The patient with elevated liver function tests
The correct answer is: The patient with elevated liver function tests
The medication has a Black Box Warning: It can cause hepatotoxicity and should be given with caution to patients with known liver dysfunction.
The medication may cause a headache or fatigue; however, this is not a contraindication.
The patient recently diagnosed with hepatitis C needs to have liver function tests performed to see if liver function is an issue at this time.
A nurse should perform which intervention for a client with Cushing’s syndrome?
- Offer clothing or bedding that’s cool and comfortable
- Suggest a high-carbohydrate, low-protein diet
- Explain that the client’s physical changes are a result of excessive corticosteroids
- Explain the rationale for increasing salt and fluid intake in times of illness, increased stress, and very hot weather
The correct answer is: Explain that the client’s physical changes are a result of excessive corticosteroids.
The nurse should explain to the client that Cushing’s syndrome causes physical changes related to excessive corticosteroids.
Clients with hyperthyroidism, not Cushing’s syndrome, are heat intolerant and must have cool clothing and bedding.
Clients with Cushing’s syndrome should have a high-protein, not low-protein, diet.
Clients with Addison’s disease must increase sodium intake and fluid intake in times of stress to preventing hypotension.
The patient receiving ketoconazole (Nizoral) for Cushing’s disease reports a headache. What is the best advice for the nurse to give the patient?
- the headache is unrelated to the medication
- You can take Tylenol or another nonsteroidal anti-inflammatory drug
- this might be a reaction to the medication. Talk to your health care provider
- You might be getting migraines from the disease. You will need to be evaluated.
The correct answer is: “This might be a reaction to the medication. Talk to your health care provider.”
This might be a reaction to the medication. Headache is a common reaction to the medication. The best advice is talk to the health care provider.
Migraines have a typical presentation that the patient has not stated at this point.
Cushing’s disease doesn’t typically cause headaches.
The nurse administers mitotane (Lysodren) to the patient with Cushing’s disease. What is the desired therapeutic effect?
- Decreased ACTH
- Increased BP
- Increased Blood glucose levels
- Decreased cortisol levels
The correct answer is: Decreased cortisol levels
The patient with Cushing’s disease receives mitotane to stop the conversion of 11-deoxycortisol to cortisol, resulting in decreased cortisol levels.
Blood pressure should be decreased and blood glucose levels should be decreased.
ACTH would be increased as the blood cortisol levels decreased or stabilized.
A 51-year-old woman has been diagnosed with Cushing syndrome after a diagnostic workup that reveals cortisol hypersecretion. The nurse knows which assessment finding would be inconsistent with her diagnosis?
- Increased blood pressure and decreased potassium levels
- A protruding abdomen and a buffalo hump on the back
- Poor stress management and hyperpigmentation
- a moon face and muscle weakness
The correct answer is: Poor stress management and hyperpigmentation
Hyperpigmentation and a low tolerance for stress are associated with Addison disease and its consequent elevated levels of ACTH.
High blood pressure, hypokalemia, and “buffalo hump” and “moon face” are all characteristic of the elevated steroid levels that denote Cushing syndrome.
What dietary intervention will best help the patient being treated for Cushing’s disease?
- Take antacids with all meals
- Increase fluids in the diet
- Maintain an American Diabetic Association diet
- Increase protein in the diet
The correct answer is: Maintain an American Diabetic Association diet.
The patient with Cushing’s disease has weight gain and hyperglycemia. It will help the patient to maintain a restricted-calorie diet while being treated for the disease.
Antacids may interfere with the medication.
Increasing fluids is not recommended because the patient is prone to hypervolemia.
Protein is not a concern, but calcium should be increased because the patient is prone to osteoporosis.
A young adult woman is reporting an unusual deposit of fat on her upper back, a rounded appearance to her face, increasing weakness, and development of “stretch marks.” The nurse should anticipate what treatment given these manifestations?
- Surgical removal of the client’s pituitary tumor
- Total thyroidectomy or hemithyroidectomy
- Administration of exogenous cortisol until symptoms are controlled
The correct answer is: Surgical removal of the client’s pituitary tumor
The client has signs and symptoms of Cushing disease; transsphenoidal removal of a pituitary adenoma, or a hemihypophysectomy, is the preferred method of treatment.
Cortisol would exacerbate her symptoms and surgery does not involve the adrenal gland itself.
The thyroid is uninvolved.
Which action indicates to the nurse that the patient with Cushing’s disease is adhering to teaching goals for medication therapy?
- The pt takes the medication every other day
- The pt takes the med in the evening daily
- The pt reports weight gain while on the med
- The pt has increased fluid intake to 2 L day
The correct answer is: The patient reports weight gain while on the medication.
The patient should report weight gain while on the medication therapy.
The medication is taken daily and in the morning.
Fluid intake should not be increased because the patient with Cushing’s disease is prone to retain fluid.
The nurse is caring for a client with Cushing’s disease. During a change of shift report, which assessment laboratory data would the nurse anticipate communicating? Select all that apply.
- Serum sodium level
- hemoglobin and hematocrit
- WBC count
- creatinine clearance total
- Serum K+ level
- Blood glucose level
The correct answers are: serum sodium level, serum potassium level, blood glucose level, white blood cell count
Cushing’s disease results in excess cortisol in the blood typically caused by a pituitary tumor secreting adrenocorticotropic hormone (ACTH). ACTH stimulates the adrenal glands to produce cortisol. Cortisol is important in controlling blood pressure and metabolism. Electrolyte disturbance is common for the nurse to report. Sodium retention is typically accompanied by potassium depletion. Clients exhibit frequent hyperglycemia. The white blood cell count is commonly elevated because of an increased number of neutrophils.
There is no impact of the hemoglobin or hematocrit or kidney function.
The nurse is caring for a new infant and notes on assessment the newborn is small for gestational age and also has indications for intrauterine growth restriction. Which assessments should the nurse prioritize for the mother as a potential cause for the infant’s condition?
- Previous smoking history
- Blood glucose levels
- Number of normal pregnancies
- Utilized food stamp program during pregnancy
The correct answer is: Blood glucose levels
Uncontrolled maternal diabetes can be a contributing factor for the infant with intrauterine growth restriction.
Smoking during pregnancy could be a contributing factor, but being a previous smoker would not affect this pregnancy.
Inadequate maternal nutrition is a contributing factor, but because this mother was on a food stamp program she was more likely to have had adequate nutrition during pregnancy.
Previous pregnancies with a history of IUGR or other poor pregnancy outcomes would be a possible contributing factor, but not normal pregnancies.
The nurse caring for a small for gestational age newborn in the special care nursery. What characteristics are commonly documented? Select all that apply
- poor skin turgor
- Tight and moist skin
- Sparse or absent hair
- Narrow skull sutures
- Diminished muscle tissue
- Increased fatty tissue
The correct answers are: Poor skin turgor, Sparse or absent hair and Diminished muscle tissue
Characteristics of the small for gestational age newborn include poor skin turgor, loose and dry skin, sparse or absent hair, wide skull sutures caused by inadequate bone growth, and diminished muscle and fatty tissue. Weight, length, and head circumference are below normal expectations as defined on growth charts.
The nursery nurse is providing shift handoff on a newborn documented as small for gestational age. Which clinical manifestations would be communicated? Select all that apply
- Sunken abdomen
- Narrow skulls sutures
- Increased subcutaneous fat stores
- Poor muscle tone over buttocks
- Dry or thin umbilical cord
The correct answers are: Sunken abdomen, Poor muscle tone over buttocks and Dry or thin umbilical cord
A small-for-gestational-age newborn typically has a sunken abdomen, wide skull sutures, decreased subcutaneous fat stores, poor muscle tone over buttocks and cheeks, and a thin umbilical cord.
