CH 42: ADRENAL CORTEX INSUFFICIENCY

CH 42: adrenal disorders. yellow: zoom review notes | purple: final study guide

A patient asks for a definition of adrenal insufficiency. Which response should the nurse make?

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

adrenal insufficiency is defined as (4) decreased secretion of homones from the anterior pituitary gland.

→ anterior pituitary gland: has a hormone called CRH that controls the release of ACTH

→ adrenal gland: releases ACTH. declined release of this is called “adrenal isnsufficiency”

→ anterior pituitary gland controsl the release of things from the adrenal gland.

TOPIC: definition of adrenal insufficiency

(2) A patient with adrenal insufficiency asks why the skin looks so tan. What should the nurse respond to this patient?

1) “The darker skin means the hormone from the hypothalamus is 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

4) darker skin is because of the same hormone that tries to help overcome insufficiency:

MSH (melanocyte stimulating hormone): is stimulated whenever the ACTH pathway is desparately triggered to be able to summon more of it. so while the body tried to trigger more hormones that are in the adrenal gland, ACTH drags MSH along with it.

(3) increased hormone cortisol and aldosterone: is is DECREASED ALDOSTERONE, cortisol is not connected

TOPICS:

(1) hyperpigmentation / increased MSH - ACTH

(2) body image disturbance form hyperpigmentation

(3) A patient is prescribed to have a cortisol blood level drawn. At which time should this sample be drawn?

1) Midnight

2) 0700 hours

3) 1200 hours

4) 2200 hours

ANS: 2

2) 0700 hours: cortisol levels (stress) are high in the morning

TOPIC: morning cortisol draw (0700)

The results of a patient’s MRI show evidence of enlarged adrenal glands. Which health problem is most likely causing this finding?

1) Cancer

2) Stenosis

3) Infection

4) Autoimmunity

ANS: 3

(3) infection: TB or fungal inflammation causes the swelling of the adrenal glands.

“enlarged” adrenal glands are seen in the MRI because it is swollen from being inflammed

TOPIC: MRI/CT adrenal gland assessment

(5) A patient being treated for adrenal insufficiency has a serum potassium level of 5.9 mEq/L. What should the nurse expect to be prescribed for this patient?

1) Kayexalate

2) Hydrocortisone

3) Dexamethasone

4) Dextrose 5% and 0.45% normal saline

ANS: 1

for a patient that has adrenal insufficiency, they usually have high potassium levels. the nurse would expect that this patiet would be given (1) kayexalate

(1) kayexalate: potassium binding resin

TOPIC: hyperkalemia treatment (kayexalate)

TOPIC:

(1) cortisol replacement medications (prednisone, dexamethasone, hydrocortisone)

(2) hyperkalemia treatment (“K-insulate”/kayexalate)

(6) A patient recovering from emergency surgery after a motor vehicle crash is demonstrating signs of adrenal insufficiency. What medication should the nurse expect to be prescribed for this patient?

1) Regular insulin 10 units

2) Potassium chloride 20 mEq

3) Intravenous infusion 0.9% normal saline

4) Hydrocortisone sodium succinate (Solu-Cortef)

ANS: 4

(4) hydrocortisone: replaces cortisol. this is a main treatment in crisis.

this patient already has a history of adrenal insufficiency. since the patient has a sudden period of stress (e.g., surgery, trauma, infection), adrenal crisis occurs.

so now, the body needs more of the cortisol levels to maintain the needs of the body. hydrocortisone helps with that.

→ adrenal glands = produces cortisol

TOPIC:

(1) IV glucocorticoids for adrenal crisis

(2) hormone replacement therapy

TOPIC:

(1) cortisol replacement medications (prednisone, dexamethasone, hydrocortisone)

(2) trauma/stress worsening adrenal insufficiency —> adrenal crisis

(7) The nurse notes that a patient with adrenal insufficiency has muscular weakness. To what should the nurse attribute this finding?

1) Infection

2) Inflammation

3) Hyperkalemia

4) Hypernatremia

ANS: 3

(3) hyperkalemia: affects muscle excitability. since adrenal insufficiency leads to high potassium, the muscle excitability needs becomes higher, making the muscles weaker.

TOPIC:

(1) muscle weakness from hyperkalemia

(2) hyponatremia + hyperkalemia

(8) The nurse is reviewing data collected on a patient with adrenal insufficiency. Which finding suggests that the patient is experiencing dehydration?

1) Hematocrit 52%

2) Serumcortisol 11 mcg/dL

3) Serum sodium 134 mEq/L

4) Serum potassium 4.8 mEq/L

ANS: 1

(1) hematocrit 52%: FLUID LOSS = INCREASED HEMATOCRIT LEVELS

the volume of the plasma is lessened, increasing the hematocrit levels due to it becoming more concentrated.

TOPIC:

(1) dehydration/fluid deficit findings

(2) hyponatremia + hyperkalemia

TOPIC:

(1) low aldosterone causing fluid deficit/confusion

(2) sodium-water loss from low aldosterone

(9) The nurse is providing discharge instructions to a patient with adrenal insufficiency. Which statement indicates that additional teaching is required?

1) “I should obtain a MedicAlert bracelet.”

2) “I should report changes in urine output.”

3) “I should take my medication every day.”

4) “I should expect to gain weight every day.”

ANS: 4

(4) expect daily weight gain: do not expect WEIGHT GAIN. weight loss occurs during adrenal insufficiency.

TOPIC:

(1) patient teaching (MedicAlert, daily meds)

(13) The nurse plans to evaluate a patient for hypoglycemia and hypernatremia. Which medication did this patient most likely receive?

1) Dexamethasone

2) Potassium chloride

3) Aminoglutethimide

4) Spironolactone (Aldactone)

ANS: 3

(3) aminoglutethimide: this blocks cortisol production

→ aminoglutethimide: lowers cortisol production

→ cortisol + glucose: cortisol raises blood sugar. this helps with releasing more energy in relation to the stress hormone released.

→ hypoglycemia: is a sign that the cortisol is lowered.

TOPIC:

(1) hormone replacement therapy

(2) risk for unstable blood glucose

TOPIC:

(1) cortisol replacement medications (prednisone, dexamethasone, hydrocortisone)

(23) A patient is admitted to determine the cause for adrenal insufficiency. What body structures should the nurse expect to be examined in this patient? Select all that apply.

1) Ovaries

2) Thyroid

3) Hypothalamus

4) Adrenal glands

5) Anterior pituitary gland

ANS: 3,4,5

(3) hypothalamus: controls the anterior pituitary gland

(4) adrenal gland: mainly the ADRENAL CORTEX, abnormally gets increased cortisol and aldosterone

(5) anterior pituitary gland: decreased ACTH, which releases cortisol.v

TOPIC: causes of adrenal insufficiency

(24) The nurse is reviewing the medical history of a patient with adrenal insufficiency. What should the nurse identify as possible causes for the disorder in this patient? Select all that apply.

1) Cancer

2) Trauma

3) Infection

4) Medications

5) Autoimmune disorder

ANS: 1,2,3,5

WRONG

(4) medications: it TREATS THE DISEASE (e.g., blocks the cortisol for adrenal insufficiency diagnosis — specifically corticoids)

TOPIC:

(1) adrenal crisis findings/risk factors

(2) cause of adrenal insufficiency

TOPIC:

(1) trauma/stress worsening adrenal insufficiency —> adrenal crisis

(25) The nurse is visiting the home of a patient with adrenal insufficiency. Which observation indicates that the patient needs to be seen by the health-care provider immediately? Select all that apply.

1) Fatigue

2) Poor skin turgor

3) Skin hyperpigmentation

4) Dry mucous membranes

5) Blood pressure 90/50 mm Hg

ANS: 2,4,5

(2) poor skin turgor, (4) dry mucous membranes, (5) low BP are signs of an Adrenal crisis. these manifests when the body does not have sufficient CORTISOL (stimulates stress hormones) AND ALDOSTERONE (stimulates sodium retention)

WRONG:

(1) fatigue and (2) skin hyperpigmentation: are manifestations of adrenal insufficiency. they are NOT life-threatening

TOPIC:

(1) adrenal crisis findings/risk factors

(2) risk for fluid/electrolyte imbalance

TOPIC:

(1) trauma/stress worsening adrenal insufficiency —> adrenal crisis

(2) low aldosterone causing fluid deficit/confusion

(3) sodium-water loss from low aldosterone