A patient is scheduled for a bilateral adrenalectomy. During the postoperative period, what should the nurse expect related to the administration of corticosteroids?

Correct Answer: C

Rationale: In a patient undergoing bilateral adrenalectomy, the correct answer is C) Increased to promote an adequate response to the stress of surgery. Rationale: - The adrenal glands produce cortisol, a vital hormone for stress response and regulation of metabolism. Removal of both adrenal glands necessitates exogenous corticosteroid administration to prevent adrenal crisis. - Following adrenalectomy, the body lacks endogenous cortisol production, making exogenous corticosteroid replacement crucial to manage the body's response to stressors like surgery. - Increasing corticosteroid administration postoperatively is essential to mimic the body's natural stress response and prevent complications like hypotension, electrolyte imbalances, and shock. Incorrect options: - A) Reduced to promote wound healing: Incorrect because reducing corticosteroid administration postoperatively can lead to adrenal insufficiency and compromise stress response. - B) Withheld until symptoms of hypocortisolism appear: Incorrect as waiting for symptoms to appear delays necessary treatment, potentially leading to life-threatening adrenal crisis. - D) Reduced because excessive hormones are released during surgical manipulation of adrenal glands: Incorrect because surgery-induced hormone release underscores the need for increased corticosteroid replacement to manage stress response. Educational Context: Understanding the significance of corticosteroid administration post-bilateral adrenalectomy is crucial for nurses caring for these patients. This knowledge ensures appropriate care to prevent adrenal crisis and optimize patient outcomes. Nurses must monitor corticosteroid dosing closely, assess for signs of adrenal insufficiency, and educate patients on lifelong corticosteroid replacement therapy post-adrenalectomy.

Correct Answer: D

Rationale: In this scenario, the correct answer is D) An ear infection following swimming. This is the correct choice because individuals with diabetes are more prone to infections due to their compromised immune system. An ear infection following swimming can be a sign of a more serious issue, such as a fungal infection, which can worsen quickly in a diabetic patient. Option A) A weight loss of 2 lb may not be alarming in a general context, but for a newly diagnosed diabetic, unexpected weight loss can be a symptom of uncontrolled blood sugar levels or other underlying health issues that need immediate medical attention. Option B) Having an occasional alcoholic drink can be a concern for diabetic patients due to its impact on blood sugar levels, but it is not as urgent as reporting a potential infection. Option C) Planning to play in a tennis tournament is not an immediate concern unless it involves significant physical exertion that could affect blood sugar levels, which can be managed with appropriate adjustments to insulin or medication. Educationally, it is crucial for diabetic patients to understand the importance of promptly reporting any signs of infection or unusual symptoms to their physician to prevent complications and ensure timely treatment. Teaching patients to recognize and act on such warning signs is essential for their overall health management and well-being.

Correct Answer: B

Rationale: In the case of Mr. B, who has hypothyroidism and is starting thyroid hormone therapy, the indicator that the treatment is effective would be having normal serum thyroid hormone levels. This is the correct answer because the goal of thyroid hormone therapy in hypothyroidism is to restore the levels of thyroid hormones in the body to within the normal range. Normal serum thyroid hormone levels indicate that the therapy is successfully supplementing the deficient thyroid hormones in the body, thereby addressing the underlying cause of hypothyroidism. Option A, a decrease in weight, is not necessarily a direct indicator of effective treatment for hypothyroidism. While weight gain is a common symptom of hypothyroidism, weight loss may not be immediate or significant even with effective treatment. Option C, relief of fatigue, is a symptom of hypothyroidism that can improve with thyroid hormone therapy. However, it is a subjective measure and can be influenced by various factors other than the effectiveness of the treatment. Option D, increased appetite, is not a typical indicator of effective treatment for hypothyroidism. In fact, hypothyroidism is more commonly associated with a decreased appetite, so an increase in appetite would not necessarily indicate successful treatment. Educationally, understanding the rationale behind monitoring serum thyroid hormone levels in hypothyroidism is crucial for healthcare providers managing patients with this condition. It reinforces the importance of objective measures in assessing treatment efficacy and guides healthcare professionals in making informed decisions based on evidence-based practices.

Correct Answer: D

Rationale: The correct answer is D) Consulting a family member or the caregiver to confirm the drugs the client is taking. This is essential because older adults may have complex medication regimens, including over-the-counter medications and herbal supplements, which can have interactions or adverse effects during a diagnostic examination. By verifying the client's current medications with a family member or caregiver, the nurse can ensure accurate information and provide safe care. Option A) Consulting the physician is not the most appropriate choice in this scenario as the physician may not have immediate access to the client's complete medication history. It is more efficient to consult someone who is directly involved in the client's daily care. Option B) Consulting a family member or caregiver to confirm the client's diet history is not relevant to obtaining a drug history, which is the primary concern in this situation. Option C) Consulting the institution's procedure manual is not the best approach for obtaining an individual client's drug history, as this information is specific to the client and may not be documented in the manual. Relying on a manual could lead to inaccuracies in the medication information provided. In an educational context, this question highlights the importance of thorough medication reconciliation in older adults, emphasizing the need for healthcare providers to gather accurate and comprehensive information about a patient's medication regimen to ensure safe and effective care. It also underscores the significance of involving family members or caregivers in the care process to enhance communication and collaboration in managing the client's health.

Correct Answer: A

Rationale: Rationale: The correct answer is A) Eat a diet high in protein, low in refined carbohydrates. This is because individuals with Addison's disease have decreased cortisol production, which can lead to problems with blood sugar regulation. Eating a diet high in protein and low in refined carbohydrates can help stabilize blood sugar levels and prevent spikes and crashes. Protein is also crucial for muscle maintenance and repair, which can be important for individuals with Addison's disease who may experience muscle weakness. Option B) Consume two meals per day is incorrect because individuals with Addison's disease actually benefit from consuming multiple small meals throughout the day to help maintain stable blood sugar levels. Option C) Eat foods high in potassium is incorrect because individuals with Addison's disease are at risk of hyperkalemia (high potassium levels), so they should actually avoid foods high in potassium. Option D) Drink less than 1 L of fluid per day is incorrect because individuals with Addison's disease are often at risk of dehydration due to low aldosterone levels, so adequate fluid intake is important to prevent dehydration and maintain electrolyte balance. In an educational context, it is important for healthcare providers and nurses to understand the specific nutritional needs of individuals with Addison's disease to provide appropriate care and education. By understanding the rationale behind the correct nutrition instructions, healthcare professionals can help patients manage their condition effectively and improve their overall health outcomes.