Addison and Cushions

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Sample questions from Addison and Cushions

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.The nurse in a long-term care facility is reviewing the morning laboratory results for an 82-year-old resident with chronic heart failure and a history of long-term prednisone use for rheumatoid arthritis. Which laboratory finding should the nurse report to the healthcare provider immediately?

   • A.Serum potassium 3.2 mEq/L
   • B.Blood urea nitrogen (BUN) 22 mg/dL
   • C.Random blood glucose 150 mg/dL
   • D.Serum sodium 136 mEq/L

   Rationale: Cushingoid effects from long-term corticosteroid use (prednisone) include sodium retention and potassium depletion. A potassium level of 3.2 mEq/L (normal 3.5-5.0 mEq/L) is critically relevant for a client with heart failure, as hypokalemia increases the risk of cardiac arrhythmias and digitalis toxicity. While glucose and BUN are slightly elevated, these are common side effects of steroids and age-related changes, respectively, and are not as immediately life-threatening as the electrolyte imbalance affecting cardiac stability.

2. 2.During a home health visit, a client with Addison's disease reports experiencing persistent nausea, abdominal pain, and extreme muscle weakness following a week of 'stomach flu.' Which action should the nurse take first?

   • A.Advise the client to increase intake of salty broths and water.
   • B.Instruct the client to take an extra dose of hydrocortisone.
   • C.Encourage the client to rest until the viral symptoms resolve.
   • D.Assess the client's current blood pressure and heart rate.

   Rationale: In Addison's disease, physical stress (like a viral infection) prevents the body from producing necessary cortisol, leading to a potential Addisonian crisis. Assessing vitals is important, but the priority 'first action' in a suspected crisis when the client is symptomatic is to stabilize the hormone levels. The client's symptoms (nausea, pain, weakness) indicate an urgent need for the 'stress dose' of steroids as previously taught in their emergency plan. If vitals indicate shock, EMS must be called, but the immediate physiological need is steroid replacement.

3. 3.A nurse is assigned to the following four clients. Which client should the nurse assess first after receiving the change-of-shift report?

   • A.A client with Cushing syndrome who has a 2+ pitting edema in the lower extremities.
   • B.A client with Addison's disease whose morning blood pressure is 105/62 mmHg.
   • C.A client with suspected Addisonian crisis who has become increasingly confused and has a thready pulse.
   • D.A client post-adrenalectomy who is reporting 7/10 incisional pain and has a heart rate of 105 bpm.

   Rationale: The client with suspected Addisonian crisis showing neurological changes (confusion) and signs of shock (thready pulse) is the most unstable and takes priority. Confusion indicates decreased cerebral perfusion or severe electrolyte imbalance (hyponatremia), both of which are life-threatening. Edema in Cushing's is expected, a BP of 105/62 in Addison's is relatively stable, and post-op pain/tachycardia is a priority but second to the circulatory collapse of a crisis.

4. 4.Refer to the client's chart. The nurse is preparing the 1000 medications. Which actions should the nurse take? Select all that apply.

   • A.Administer the prescribed spironolactone.
   • B.Verify the client's identity using two identifiers.
   • C.Monitor the client for signs of cardiac dysrhythmias.
   • D.Request a prescription for a stat potassium supplement.
   • E.Hold the scheduled dose of hydrocortisone.

   Answer and rationale are in the full material.

5. 5.A client is being discharged after a bilateral adrenalectomy. Which statement by the client indicates a need for further teaching regarding long-term management?

   • A.I will need to wear a medical alert bracelet at all times.
   • B.I can stop taking my prednisone once my surgical incision heals.
   • C.I will notify my doctor if I experience a high amount of emotional stress.
   • D.I should increase my salt intake if I am sweating excessively in hot weather.

   Answer and rationale are in the full material.