Chapter 42: Coordinating Care for Patients with Adrenal Disorders
MULTIPLE CHOICE
1. A patient asks for a definition of adrenal insufficiency. Which response by the nurse is best?
1. Increased secretion of hormones from the adrenal cortex
2. Decreased secretion of hormones from the adrenal medulla
3. Increased secretion of hormones from the anterior pituitary gland
4. Decreased secretion of hormones from the anterior pituitary gland
ANS: 4
Chapter number and title: 42, Coordinating Care for Patients with Adrenal Disorders
Chapter learning objective: 2. Correlating clinical manifestations to pathophysiological
processes of: Adrenal cortex insufficiency
Chapter page reference: 933 - 934
Heading: Adrenal Cortical Insufficiency/Pathophysiology
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity/Physiological Adaptation
Cognitive Level: Application [Applying]
Concept: Metabolism
Difficulty: Moderate
Feedback
1 Adrenal insufficiency may be caused by decreased secretion of glucocorticoids
and mineralocorticoids from the adrenal cortex.
2 The hormones secreted by the adrenal medulla do not affect the development of
adrenal insufficiency.
3 Increased secretion of hormones from the anterior pituitary gland does not cause
adrenal insufficiency.
4 The pathophysiology of adrenal insufficiency may be related to decreased
secretion of corticotropin-releasing hormone (CRH) and decreased secretion of
ACTH, both from the anterior pituitary gland.
PTS: 1 CON: Metabolism
2. A patient has received doses of prednisone for treatment of rheumatoid arthritis for the past
3 months. If this medication is suddenly discontinued, the nurse assesses for which
complication?
1. Hypovolemia
2. Hypokalemia
3. Hypernatremia
4. Hyperglycemia
ANS: 1
Chapter number and title: 42, Coordinating Care for Patient with Adrenal Disorders
Chapter learning objective: 5. Explaining the presentation and management of adrenal crisis
Chapter page reference: 933 - 934
Heading: Adrenal insufficiency/Pathophysiology
Integrated Processes: Nursing Process: Analysis
Client Need: Physiological Integrity: Pharmacological and Parenteral Therapies
Feedback
1 Patients who are prescribed exogenous corticosteroids for longer than 2 weeks
are at risk for acute adrenal insufficiency if the medications are abruptly
discontinued. The loss of sodium and water places the patient at risk for
hypovolemia and hypotension.
2 Hyperkalemia is a clinical manifestation of the adrenal sufficiency that would
result from the abrupt withdrawal of exogenous corticosteroids.
3 The sodium does not increase with acute adrenal sufficiency that would result
from the abrupt withdrawal of exogenous corticosteroids. Because water is also
lost, the sodium may remain in the low to low-normal range.
4 Hypoglycemia is a clinical manifestation of the acute adrenal sufficiency that
would result from the abrupt withdrawal of exogenous corticosteroids.
PTS: 1 CON: Fluid and Electrolyte Balance
3. A patient with adrenal insufficiency asks why their skin looks so tan. What is the best
response by the nurse?
1. “The darker skin means the hormones from the hypothalamus are low.”
2. “The darker skin is caused by the destruction of the cells of the adrenal glands.”
3. “The darker skin means that you have too much of the hormones cortisol and
aldosterone.”
4. “The hormone causing the darker skin shares the same hormone as the one helping
to overcome the insufficiency.”
ANS: 4
Chapter number and title: 42, Coordinating Care for Patients with Adrenal Disorders
Chapter learning objective: 2. Correlating clinical manifestations to pathophysiological
processes of: Adrenal cortex insufficiency
Chapter page reference: 934
Heading: Adrenal Cortical Insufficiency/Clinical Manifestations
Integrated Processes: Nursing Process: Implementation
Client Need: Physiological Integrity/Physiological Adaptation
Cognitive Level: Application [Applying]
Concept: Metabolism
Difficulty: Moderate
Feedback
1 The darker skin does not mean that hormones from the hypothalamus are low.
2 The darker skin does not mean that the cells of the adrenal glands are being
destroyed.
3 The darker skin does not mean that the patient has increased levels of cortisol
and aldosterone.
4 As the circulating levels of cortisol and aldosterone fall, the hypothalamus and
, anterior pituitary gland increase secretion of corticotropin-releasing hormone
(CRH) and adrenocorticotropic hormone (ACTH), respectively. Because
melanocyte-stimulating hormone (MSH) and ACTH share a progenitor
(ancestor) hormone, there is an associated increase in secretion of MSH, leading
to a darkened, bronzed hyperpigmentation that accompanies the increased
secretion of ACTH.
PTS: 1 CON: Metabolism
4. A patient is prescribed to have a cortisol blood level drawn. At which time should this
sample be drawn?
1. Midnight
2. 0700
3. 1200
4. 2200
ANS: 2
Chapter number and title: 42, Coordinating Care for Patients with Adrenal Disorders
Chapter learning objective: 3. Describing the diagnostic results used to confirm the
diagnoses of adrenal disorders
Chapter page reference: 934 - 935
Heading: Adrenal Cortical Insufficiency/Medical Management/Diagnosis
Integrated Processes: Nursing Process: Planning
Client Need: Physiological Integrity/Reduction of Risk Potential
Cognitive Level: Comprehension [Understanding]
Concept: Assessment
Difficulty: Moderate
Feedback
1 Direct measurement of serum cortisol levels is collected in the morning because
they are highest between 6 a.m. and 8 a.m. (0600–0800).
2 Direct measurement of serum cortisol levels is collected in the morning because
of changes in levels associated with daily activities. Cortisol levels are highest in
the morning (between 6 a.m. and 8 a.m.).
3 Drawing the level at noon would provide incorrect results. Direct measurement
of serum cortisol levels is collected in the morning.
4 Drawing the level at 10 p.m. would provide incorrect results. Direct
measurement of serum cortisol levels is collected in the morning.
PTS: 1 CON: Assessment
5. The nurse provides care to a patient, diagnosed with adrenal insufficiency, who is scheduled
for an insulin tolerance test to evaluate the hypothalamic-pituitary axis. Which information
noted in the patient’s history requires an intervention by the nurse?
1. Epilepsy
2. Anorexia
3. Depression
4. Gastroesophageal reflux disease (GERD)
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