At the beginning of the shift, a nurse receives report on the following four patients. Which patient should the nurse place priority on assessing first?

A 40-year-old patient with Cushing syndrome and gynecomastia.

A 58-year-old patient with Addison's disease who is exhibiting confusion.

A 45-year-old patient with Graves' disease and exophthalmos.

A 47-year-old patient with hypothyroidism who is asking for a warm blanket.

Answer and Explanation

The Correct Answer is B

A. A 40-year-old patient with Cushing syndrome and gynecomastia: While Cushing syndrome requires ongoing management and monitoring, gynecomastia alone is not an urgent concern compared to the symptoms described in option B.
B. A 58-year-old patient with Addison's disease who is exhibiting confusion: Addison's disease can lead to adrenal insufficiency, and confusion could indicate an adrenal crisis or severe electrolyte imbalance. This is a critical situation requiring immediate assessment to prevent severe complications.
C. A 45-year-old patient with Graves' disease and exophthalmos: Graves' disease with exophthalmos is significant but does not typically represent an immediate life-threatening condition compared to the symptoms associated with Addison's disease.
D. A 47-year-old patient with hypothyroidism who is asking for a warm blanket: This patient’s request for a warm blanket suggests they might be experiencing symptoms related to hypothyroidism, such as feeling cold. However, this is less urgent compared to the confusion and potential crisis in option B.

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Correct Answer is C

Explanation

A. Pain 7/10 at the surgical site: This level of pain is expected following major surgery, such as a bilateral adrenalectomy, and does not specifically indicate an Addisonian crisis.
B. Hyperglycemia: Although hyperglycemia can be associated with stress or corticosteroid treatment, it is not a hallmark of Addisonian crisis. Addisonian crisis is more related to adrenal insufficiency rather than hyperglycemia.
C. Blood pressure 92/50: Low blood pressure is a critical sign of an Addisonian crisis. This condition results from severe adrenal insufficiency where the body cannot maintain adequate blood pressure.
D. Sodium 152 mEq/L: High sodium levels are not characteristic of an Addisonian crisis. Addisonian crisis typically leads to hyponatremia (low sodium levels) due to inadequate aldosterone production.

A. Excess mineralocorticoids B. Excess adrenal androgens C. Excess thyroid hormone D. Excess glucocorticoids

Correct Answer is B

Explanation

A. Excess mineralocorticoids: Mineralocorticoids primarily affect electrolyte and fluid balance. While excess mineralocorticoids can cause hypertension and fluid retention, they are not directly responsible for hirsutism or acne.
B. Excess adrenal androgens: Cushing syndrome can lead to elevated levels of adrenal androgens, which are responsible for hirsutism (excessive hair growth) and acne due to their androgenic effects.
C. Excess thyroid hormone: Thyroid hormone imbalances can affect various body systems, but they are not directly related to the development of hirsutism or acne seen in Cushing syndrome.
D. Excess glucocorticoids: While excess glucocorticoids are characteristic of Cushing syndrome and can cause a range of symptoms, hirsutism and acne are specifically due to excess adrenal androgens rather than glucocorticoids.

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At the beginning of the shift, a nurse receives report on the following four patients. Which patient should the nurse place priority on assessing first?

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Naxlex Comprehensive Predictor Exams

The patient is returning to the unit after undergoing a bilateral adrenalectomy. Which clinical manifestation would indicate that the client is experiencing an Addisonian crisis?

Correct Answer is C

Explanation

A nurse is caring for a female client who has a diagnosis of Cushing syndrome. The client is embarrassed that she is experiencing hirsutism and severe acne. The nurse understands that these manifestations are caused by which of the following?

Correct Answer is B

Explanation

A nurse is admitting a client who is experiencing an Addisonian crisis. Which of the following should the nurse anticipate an order for?

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