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 D

Explanation

A. Radioactive iodine therapy: This is contraindicated during pregnancy as it can harm the fetus and affect thyroid function.
B. Levothyroxine: This is used for hypothyroidism, not hyperthyroidism. For hyperthyroidism, this medication would not be appropriate.
C. Ketoconazole: This is an antifungal and is not used to treat hyperthyroidism.
D. Propylthiouracil (PTU): PTU is the preferred treatment during the first trimester of pregnancy for hyperthyroidism. It inhibits thyroid hormone synthesis and is considered safer than methimazole during early pregnancy.

A. A 40-year-old patient with Cushing syndrome and gynecomastia. B. A 58-year-old patient with Addison's disease who is exhibiting confusion. C. A 45-year-old patient with Graves' disease and exophthalmos. D. A 47-year-old patient with hypothyroidism who is asking for a warm blanket. E. A 47-year-old patient with hypothyroidism who is asking for a warm blanket.

Correct Answer is B

Explanation

A. A 40-year-old patient with Cushing syndrome and gynecomastia: While Cushing syndrome requires ongoing management and monitoring, gynecomastia alone is not an urgent concern compared to the symptoms described in option B.
B. A 58-year-old patient with Addison's disease who is exhibiting confusion: Addison's disease can lead to adrenal insufficiency, and confusion could indicate an adrenal crisis or severe electrolyte imbalance. This is a critical situation requiring immediate assessment to prevent severe complications.
C. A 45-year-old patient with Graves' disease and exophthalmos: Graves' disease with exophthalmos is significant but does not typically represent an immediate life-threatening condition compared to the symptoms associated with Addison's disease.
D. A 47-year-old patient with hypothyroidism who is asking for a warm blanket: This patient’s request for a warm blanket suggests they might be experiencing symptoms related to hypothyroidism, such as feeling cold. However, this is less urgent compared to the confusion and potential crisis in option B.

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Naxlex Comprehensive Predictor Exams

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?

Correct Answer is D

Explanation

At the beginning of the shift, a nurse receives report on the following four patients. Which patient should the nurse place priority on assessing first?

Correct Answer is B

Explanation

A nurse is preparing to administer total parental nutrition (TPN) 1800 mL to infuse over 24 hr. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

A nurse is caring for a client who has hypokalemia, hyperglycemia, and hypertension. A diagnosis of Cushing syndrome is suspected. Which of the following tests would the nurse anticipate the health care provider will order to help confirm the diagnosis of Cushing syndrome?

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 nurse is admitting a client who is experiencing an Addisonian crisis. Which of the following should the nurse anticipate an order for?

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 nurse is caring for a client Exhibits Select the 3 interventions that the nurse should anticipate for this client.

A client who takes daily hormone replacement therapy for Addison's disease is scheduled for an outpatient surgical procedure. Which of the following instructions should the nurse include when providing discharge education to the client?

A client who has hypothyroidism will be undergoing surgery for a total knee replacement. When planning care for this client, the nurse understands which of the following to be true for people who have hypothyroidism?