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?

A 40-year-old patient with Cushing syndrome and gynecomastia.

A 58-year-old patient with Addison's disease who is exhibiting confusion.

A 45-year-old patient with Graves' disease and exophthalmos.

A 47-year-old patient with hypothyroidism who is asking for a warm blanket.

Answer and Explanation

The Correct Answer is B

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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Correct Answer is B

Explanation

A. Hyperthermia: This is not commonly associated with hypothyroidism. Hypothyroidism is more likely to lead to a decreased metabolic rate and hypothermia rather than hyperthermia.
B. Hyperlipidemia: This is a common condition associated with hypothyroidism. Hypothyroidism can lead to increased levels of cholesterol and triglycerides due to decreased metabolism.
C. Agitation: Hypothyroidism typically presents with symptoms such as fatigue and depression rather than agitation. Agitation is more commonly associated with hyperthyroidism.
D. Insomnia: Insomnia is more often associated with hyperthyroidism. Hypothyroidism usually leads to symptoms like fatigue and sleepiness rather than insomnia.

A. It is important that you taper off of the corticosteroids you are taking which have caused this disorder. B. You will need to have your adrenal glands removed to reverse your symptoms. C. You will need to begin taking hydrocortisone, and increase your dose during times of stress. D. You will receive glucose checks and sliding-scale insulin until your hormone levels are corrected.

Correct Answer is B

Explanation

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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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client in a primary care provider's office has a new diagnosis of hypothyroidism. The nurse understands that the client should be screened for which of the following conditions common in people who have hypothyroidism?

Correct Answer is B

Explanation

Correct Answer is B

Explanation

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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?

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