ATI NURS 004

Global Rationale: The patient who received radioactive iodine treatment for hyperthyroidism is not at increased risk for Cushing syndrome. Patients receiving treatment for rheumatoid arthritis, patients with organ transplants, and patients receiving chemotherapy are frequently prescribed corticosteroids, which are a primary risk factor for Cushing syndrome. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Physiological Adaptation QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient centered care AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2. Compare and contrast the manifestations of disorders that result from hyperfunction and hypofunction of the thyroid, parathyroid, adrenal, and pituitary glands. MNL Learning Outcome: 10.3.1. Explain the causes, risk factors, incidence, and pathophysiology of adrenal gland disorders. Page Number: 489 Question 35 Type: MCMA A patient is prescribed prednisone (Dexasone) for a chronic health problem. The nurse instructs the patient to be alert for which signs that Cushing syndrome is developing? Standard Text: Select all that apply. 1. fat deposits in the abdominal and clavicle regions 2. muscle weakness and wasting in the extremities 3. delayed wound healing 4. development of varicose leg veins 5. hypotension Correct Answer: 1, 2, 3 Rationale 1: Symptoms of Cushing syndrome include obesity and a redistribution of body fat to the abdominal region (central obesity), the upper back, and under the clavicle. Rationale 2: Changes in protein metabolism cause muscle weakness and wasting, especially in the extremities. Rationale 3: Poor wound healing is common. Rationale 4: Varicose veins are not a manifestation of Cushing syndrome. Rationale 5: Hypotension is not a manifestation of Cushing syndrome. Global Rationale: Symptoms of Cushing syndrome include obesity and a redistribution of body fat to the abdominal region (central obesity), the upper back, and under the clavicle. Changes in protein metabolism cause muscle weakness and wasting, especially in the extremities. Poor wound healing is common. Varicose veins and hypotension are not manifestations of Cushing syndrome. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Pharmacological and Parenteral Therapies QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient centered care AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3. Explain the nursing implications for medications prescribed to treat disorders of the thyroid and adrenal glands. MNL Learning Outcome: 10.3.1. Explain the causes, risk factors, incidence, and pathophysiology of adrenal gland disorders. Page Number: 490 Question 36 Type: MCSA The nurse is assessing a patient with Cushing syndrome. Which findings should the nurse report for immediate follow-up? 1. serum potassium 2.5 mEq/L and blood pressure 150/90 2. serum sodium 145 mEq/L and reports of muscle weakness 3. serum calcium 11 mg/dL and reports of feelings of depression 4. serum phosphorus 3 mg/dL and hirsutism Correct Answer: 1 Rationale 1: Hypokalemia and hypertension occur with Cushing syndrome as potassium is lost and sodium is retained. Rationale 2: These findings do not need to be reported for immediate follow-up. Rationale 3: These findings do not need to be reported for immediate follow-up. Rationale 4: These findings do not need to be reported for immediate follow-up. Global Rationale: Hypokalemia and hypertension occur with Cushing syndrome as potassium is lost and sodium is retained. The other laboratory values and patient manifestations do not need to be reported for immediate follow-up. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient centered care AACN Essentials Competencies: IX.1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5. Use the nursing process as a framework for providing individualized care to patients with disorders of the thyroid, parathyroid, adrenal, and pituitary glands. MNL Learning Outcome: 10.3.1. Explain the causes, risk factors, incidence, and pathophysiology of adrenal gland disorders. Page Number: 490 Question 37 Type: MCSA A patient with suspected Cushing syndrome is prescribed a 24-hour urine collection. What should the nurse explain to the patient about the reason for this urine collection? 1. It measures the amount of cortisol in the urine over 24 hours. 2. At least 2,000 mL of urine is required to perform the test. 3. It identifies urine specific gravity changes over a 24-hour period. 4. The 24-hour timeline reduces unwanted effects of medications excreted in the urine. Correct Answer: 1 Rationale 1: If the dexamethasone test is positive, a test for urinary free cortisol is made. This measures the amount of cortisol in the urine over 24 hours. Rationale 2: The 24-hour urine collection is not performed because 2 L of urine is needed. Rationale 3: The 24-hour urine does not measure urine specific gravity changes. Rationale 4: The 24-hour urine is not performed to ensure medication excretion in the urine. Global Rationale: If the dexamethasone test is positive, a test for urinary free cortisol is made. This measures the amount of cortisol in the urine over 24 hours. The 24-hour urine collection is not performed because 2 L of urine is needed, to measure urine specific gravity, or to ensure medication excretion in the urine. Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient centered care AACN Essentials Competencies: IX.3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5. Use the nursing process as a framework for providing individualized care to patients with disorders of the thyroid, parathyroid, adrenal, and pituitary glands. MNL Learning Outcome: 10.3.3. Examine the diagnosis and treatment of adrenal gland disorders. Page Number: 490 Question 38 Type: MCSA A patient with a non-ACTH-producing adrenal cortex tumor is scheduled for a surgical procedure to remove the tumor. Which statement by the patient indicates that teaching about the procedure has been effective? 1. “The adrenal gland with the tumor will be removed.” 2. “I will need to take adrenal hormones for the rest of my life.” 3. “The tumor will be removed by the transsphenoidal route.” 4. “I will receive IV cortisol in preparation for the surgery.” Correct Answer: 1 Rationale 1: When Cushing syndrome is caused by a non-ACTH-producing adrenal cortex tumor, an adrenalectomy may be performed to remove the tumor and the affected adrenal gland. Rationale 2: Only one adrenal gland is usually involved. As there is a remaining adrenal gland, patients do not need lifetime adrenal hormone replacement. Rationale 3: Adrenal glands are not removed via the transsphenoidal route. Rationale 4: The patient with Cushing syndrome is already experiencing elevated cortisol levels; IV cortisol is not indicated prior to adrenalectomy. Global Rationale: When Cushing syndrome is caused by a non-ACTH-producing adrenal cortex tumor, an adrenalectomy may be performed to remove the tumor and the affected adrenal gland. Only one adrenal gland is usually involved. As there is a remaining adrenal gland, patients do not need lifetime adrenal hormone replacement. Adrenal glands are not removed via the transsphenoidal route. The patient with Cushing syndrome is already experiencing elevated cortisol levels; IV cortisol is not indicated prior to adrenalectomy. Cognitive Level: Analyzing Client Need: Physiological Integrity Client Need Sub: Reduction of Risk Potential QSEN Competencies: I.A.1. Integrate understanding of multiple dimensions of patient centered care AACN Essentials Competencies: IX.7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4. Provide appropriate nursing care for the patient before and after a subtotal thyroidectomy and an adrenalectomy. MNL Learning Outcome: 10.3.3. Examine the diagnosis and treatment of adrenal gland disorders. Page Number: 491 Question 39 Type: MCMA The nurse is preparing to assess a patient with Cushing syndrome. Which findings should the nurse expect to assess in this patient? Standard Text: Select all that apply. 1. weight gain 2. auscultatory lung crackles 3. jugular vein distention 4. peripheral edema 5. hypotension