A client with a pituitary defect is being treated for Addison disease with supplemental corticosteroids. The client develops signs and symptoms of Cushing syndrome. The nurse recognizes that this reaction is a result of the failure of normal:
1. chemical messengers.
2. feedback mechanisms.
3. receptor sensitivity.
4. ACTH formation.
Correct Answer: 2
Rationale 1: There is no problem with the chemical messengers that are present.
Rationale 2: When corticosteroid levels increase too much, the adrenal glands send a negative feedback message to the hypothalamus. The hypothalamus decreases its output of the hormone that tells the anterior pituitary to make less ACTH. In this case, the pituitary is defective and cannot act on the hypothalamic message. If the dose of corticosteroid is not decreased, the client will continue to develop Cushing syndrome.
Rationale 3: There is no problem with the receptors that are present.
Rationale 4: ACTH is not formed, but that is because there is no pituitary activity.
Global Rationale: When corticosteroid levels increase too much, the adrenal glands send a negative feedback message to the hypothalamus. The hypothalamus decreases its output of the hormone that tells the anterior pituitary to make less ACTH. In this case, the pituitary is defective and cannot act on the hypothalamic message. If the dose of corticosteroid is not decreased, the client will continue to develop Cushing syndrome. There is likely no problem with either the chemical messengers or receptors. ACTH is not formed if there is no pituitary activity.
You might also like to view...
The nurse caring for a patient with breast cancer recalls that a breast tumor of any size with direct extension to the breast wall, any regional lymph node involvement, and signs of metastatic disease would be categorized as:
A) Stage I B) Stage IIB C) Stage IIIA D) Stage IV
A nurse is reviewing a patient's medical record before administering a medication. Which factors can alter the patient's physiologic response to the drug? (Select all that apply.)
a. Ability to swallow pills b. Age c. Genetic factors d. Gender e. Height
The nurse is assessing a wound using the technique shown in this picture. How would the nurse document this assessment?
1. The wound is macerated.
2. The wound is tunneled.
3. The wound is deep.
4. The wound is filled with exudate.
A UAP reports to you that a pt with acute kidney failure has had a urine output of 350ml over the past 24 hrs after receiving furosemide 40mg IV push. The UAP asks you how this can happen. What is your best response?
a. during the oliguric phase of acute kidney failure, pts often don't respond well to either fluid challenges or diuretics b. there must be some sort of error. Someone must have failed to record the urine output c. a pt with acute kidney failure retains sodium and water, which counteracts the action of the furosemide d. the gradual accumulation of nitrogenous waste products results in the retention of water and sodium