Endocrine - Adrenal

An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patient's daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority?

• Administration of antihypertensive medications

• Administering sodium bicarbonate intravenously

• Reversing acidosis by administering insulin

• Fluid and electrolyte replacement

• Administration of calcium gluconate

Tags

NGSS.HS-LS1-3

You are developing a care plan for a patient with Cushing syndrome. What nursing diagnosis would have the highest priority in this care plan?

• Risk for injury related to weakness

• Ineffective breathing pattern related to muscle weakness

• Risk for loneliness related to disturbed body image

• Autonomic dysreflexia related to neurologic changes

• Risk for disturbed sleep related to diurnal secretion of cortisol

The nurse is caring for a patient at risk for an addisonian crisis. For what associated signs and symptoms should the nurse monitor the patient? Select all that apply.

• Epistaxis

• Pallor

• Rapid respiratory rate

• Bounding pulse

• Hypotension

What is the correct way to administer insulin through an IV infusion set?

Which if the following is true regarding the administration of fludrocortisone acetate (Florinef) to a patient with adrenocortical insufficiency (Addison’s Disease)? Select all that apply.

• Side effects include HTN & pulmonary edema

• Can be taken PO daily in the PM or IM every 3 weeks

• Cannot be used simultaneously with a diet including increased calcium

• Usually needed if patient cannot maintain BP with modified diet

• Patient must maintain an increased sodium intake (3 Gm)

A patient with pheochromocytoma has been admitted for an adrenalectomy to be performed the following day. To prevent complications, the nurse should anticipate preoperative administration of which of the following?

• IV antibiotics

• Oral antihypertensives

• Parenteral nutrition

• IV corticosteroids

• IV fluids

A diabetic educator is discussing sick day rules with a newly diagnosed type 1 diabetic. The educator is aware that the patient will require further teaching when the patient states what? Select all that apply.

• I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours.

• If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day.

• I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea.

• I will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in my urine.

• If my ketones are +3 or higher, I will maintain an intake of liquids every 30 to 60 minutes to prevent dehydration.

The nurse is preparing to administer Regular insulin to a patient with a current diagnosis of HHS. The nurse understands that an IV bolus must be administered at a rate of ________ U/kg/hr.

A patient suspected of pheochromocytoma is receiving education from the nurse on how to prepare for a 24-hour urine collection for diagnosis. The nurse stresses that the patient must abstain from the following for 48-72 hours prior to the collection: (Select all that apply)

• Amphetamines

• Vanilla

• Banana

• Aspirin

• Bronchodilators

The nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve?

• Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3 hours

• Administration of dexamethasone IV, followed by an x-ray of the adrenal glands

• Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning

• Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after the drug is administered