A client complaining of weight gain and acne undergoes laboratory testing, which reveals elevated cortisol levels and hyperglycemia. The client has no prior medical history, and does not take any medications. After further testing and imaging to determine the cause of the elevated cortisol levels, the client is diagnosed with Cushing disease caused by a pituitary adenoma. Which of the following statements should the nurse include when teaching the client about this diagnosis?

It is important that you taper off of the corticosteroids you are taking which have caused this disorder.

You will need to have your adrenal glands removed to reverse your symptoms.

You will need to begin taking hydrocortisone, and increase your dose during times of stress.

You will receive glucose checks and sliding-scale insulin until your hormone levels are corrected.

Answer and Explanation

The Correct Answer is B

A. It is important that you taper off of the corticosteroids you are taking which have caused this disorder: This statement is not applicable because the client has a pituitary adenoma causing Cushing disease, not iatrogenic Cushing syndrome from corticosteroid use.
B. You will need to have your adrenal glands removed to reverse your symptoms: For Cushing disease caused by a pituitary adenoma, treatment typically involves surgical removal of the pituitary tumor, not the adrenal glands.
C. You will need to begin taking hydrocortisone, and increase your dose during times of stress: This is incorrect as hydrocortisone replacement is used for Addison's disease, not for managing Cushing disease.
D. You will receive glucose checks and sliding-scale insulin until your hormone levels are corrected: While glucose monitoring might be necessary due to hyperglycemia, the primary treatment for Cushing disease involves addressing the source of excess cortisol, which is the pituitary adenoma.

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Correct Answer is C

Explanation

A. Pain 7/10 at the surgical site: This level of pain is expected following major surgery, such as a bilateral adrenalectomy, and does not specifically indicate an Addisonian crisis.
B. Hyperglycemia: Although hyperglycemia can be associated with stress or corticosteroid treatment, it is not a hallmark of Addisonian crisis. Addisonian crisis is more related to adrenal insufficiency rather than hyperglycemia.
C. Blood pressure 92/50: Low blood pressure is a critical sign of an Addisonian crisis. This condition results from severe adrenal insufficiency where the body cannot maintain adequate blood pressure.
D. Sodium 152 mEq/L: High sodium levels are not characteristic of an Addisonian crisis. Addisonian crisis typically leads to hyponatremia (low sodium levels) due to inadequate aldosterone production.

A. "You may need to repeat this therapy again in three weeks if the first dose doesn't achieve optimal results." B. "Avoid being close to pregnant women and children for 7 days after your treatment." C. "You may need to begin corticosteroid replacement therapy after this treatment." D. "The purpose of this therapy is to increase your levels of thyroid hormone."

Correct Answer is B

Explanation

A. "You may need to repeat this therapy again in three weeks if the first dose doesn't achieve optimal results": Radioactive iodine therapy may require additional doses, but this is not determined by a set timeframe such as three weeks. The need for additional therapy is based on the individual’s response and thyroid function tests.
B. "Avoid being close to pregnant women and children for 7 days after your treatment": This is correct as radioactive iodine therapy can emit radiation, and avoiding close contact with vulnerable populations such as pregnant women and children helps minimize their exposure to radiation.
C. "You may need to begin corticosteroid replacement therapy after this treatment": This is incorrect because corticosteroid replacement is not typically required after radioactive iodine therapy for Graves' disease. The treatment primarily targets the thyroid gland.
D. "The purpose of this therapy is to increase your levels of thyroid hormone": This is incorrect. The purpose of radioactive iodine therapy is to reduce thyroid hormone production by destroying thyroid tissue, which helps to manage hyperthyroidism in Graves' disease.

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Naxlex Comprehensive Predictor Exams

The patient is returning to the unit after undergoing a bilateral adrenalectomy. Which clinical manifestation would indicate that the client is experiencing an Addisonian crisis?

Correct Answer is C

Explanation

A nurse is providing education to a client who has Graves' disease and who will be returning home after receiving their first dose of radioactive iodine therapy. Which of the following information should the nurse include?

Correct Answer is B

Explanation

A nurse is caring for a female client who has a diagnosis of Cushing syndrome. The client is embarrassed that she is experiencing hirsutism and severe acne. The nurse understands that these manifestations are caused by which of the following?

A client seen in the clinic with shortness of breath and fatigue is being evaluated for a possible diagnosis of heart failure. Which laboratory result will be the most useful for diagnosing heart failure?

A client is experiencing tachycardia and tremors. Lab values show elevated Free T4 and low thyroid stimulating hormone (TSH). Which diagnostic study will help the practitioner differentiate Graves' disease from other forms of hyperthyroidism?

A client with a history of hypothyroidism has accidentally been taking double her prescribed dose of levothyroxine. Which assessment findings would the nurse expect due to an excess of this medication?

A nurse is caring for a client after a subtotal thyroidectomy. Which of the following manifestations would lead the nurse to suspect that the procedure caused damage to the client's parathyroid glands?

A client seen in the clinic with shortness of breath and fatigue is being evaluated for a possible diagnosis of heart failure. Which laboratory result will be the most useful for diagnosing heart failure?

Which pharmacologic therapy does the nurse anticipate administering to a client who is experiencing acute thyrotoxicosis?

A 28-year-old female client who is in the first trimester of pregnancy is diagnosed with hyperthyroidism. Which of the following would be the preferred treatment for this client?