A client with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal hypophysectomy. What would be most important for the nurse to monitor before, during, and after surgery?

Oral temperature

Weight

Assessment of urine for blood

Blood glucose

Answer and Explanation

The Correct Answer is D

Reasoning:

Choice A reason: Oral temperature monitoring is important for detecting infection post-surgery but is not the primary concern in transsphenoidal hypophysectomy. Cushing’s syndrome causes hyperglycemia due to cortisol-induced insulin resistance, and surgical stress may exacerbate this, making glucose monitoring more critical than temperature in the perioperative period.

Choice B reason: Weight monitoring is relevant for long-term Cushing’s syndrome management due to fat redistribution, but it is not the most critical during surgery. Perioperative stress and fluid shifts have minimal immediate impact on weight, whereas glucose fluctuations from cortisol changes are more acute and require close monitoring.

Choice C reason: Assessing urine for blood is not a priority in transsphenoidal hypophysectomy. This surgery involves the pituitary gland, not the urinary tract, so hematuria is unlikely. Blood glucose fluctuations, driven by cortisol changes and surgical stress, are a more immediate concern requiring vigilant monitoring.

Choice D reason: Blood glucose monitoring is critical before, during, and after transsphenoidal hypophysectomy. Cushing’s syndrome causes hyperglycemia due to cortisol-induced insulin resistance. Surgery may alter cortisol levels, exacerbating glucose fluctuations, and postoperative adrenal insufficiency risk necessitates close glucose monitoring to manage metabolic complications effectively.

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Correct Answer is D

Explanation

Reasoning:

Choice A reason: A sodium level of 140 mEq/L is within the normal range and not diagnostic of Addison’s disease. This condition, caused by adrenal insufficiency, typically leads to hyponatremia due to reduced aldosterone, which decreases sodium reabsorption, making a normal sodium level uncharacteristic of the disease.

Choice B reason: A glucose level of 100 mg/dL is normal and not specific to Addison’s disease. Hypoglycemia is more common due to cortisol deficiency, which impairs gluconeogenesis. A normal glucose level does not support the diagnosis, as it does not reflect the metabolic disruptions of adrenal insufficiency.

Choice C reason: A blood pressure of 135/90 mm Hg is elevated but not diagnostic of Addison’s disease. The condition typically causes hypotension due to reduced aldosterone and cortisol, leading to low blood volume and vascular tone. Hypertension suggests another etiology, not adrenal insufficiency.

Choice D reason: A potassium level of 6.0 mEq/L indicates hyperkalemia, a diagnostic sign of Addison’s disease. Aldosterone deficiency reduces potassium excretion in the kidneys, leading to elevated serum potassium. This, combined with hyponatremia and hypotension, is a hallmark of adrenal insufficiency, making hyperkalemia a key diagnostic finding.

A. A blood pressure reading of 120/85 mm Hg B. Pitting edema in the lower extremities C. Normal skin turgor D. Moist mucous membranes

Correct Answer is D

Explanation

Reasoning:

Choice A reason: A blood pressure reading of 120/85 mm Hg is normal but not specific to SIADH. While fluid overload in SIADH may elevate blood pressure, this reading is not diagnostic. Hypertension is possible but not a consistent finding, as fluid retention primarily causes hyponatremia and other symptoms.

Choice B reason: Pitting edema in the lower extremities is uncommon in SIADH, as fluid retention is primarily intravascular, leading to dilutional hyponatremia rather than extravascular edema. Edema is more typical in conditions like heart failure or nephrotic syndrome, not the water retention mechanism of SIADH.

Choice C reason: Normal skin turgor is not typical in SIADH, as water retention can cause slight fluid overload, potentially leading to subtle tissue swelling. While not as pronounced as edema, skin turgor may be slightly increased due to excess fluid, making “normal” less accurate than moist mucous membranes.

Choice D reason: Moist mucous membranes are expected in SIADH due to excessive water retention from ADH overactivity. This leads to fluid overload, keeping mucosal tissues hydrated and moist, unlike the dehydration seen in diabetes insipidus, which causes dry mucous membranes due to water loss.

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A client with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal hypophysectomy. What would be most important for the nurse to monitor before, during, and after surgery?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse assesses a client who has been diagnosed with Addison's disease. Which of the following is a diagnostic sign of this disease?

Correct Answer is D

Explanation

A nurse is assessing a client admitted with SIADH. What finding would the nurse expect to assess in a client with SIADH?

Correct Answer is D

Explanation

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