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3. The client has pink, frothy sputum and jugular vein distention. 4. The client has petechiae on the trunk and sclerosed veins. Answer: 2
Rationale:1. Shortness of breath and pale mucous membranes do not indicate long-term steroid use or Cushing’s syndrome. 2. A round face (moon face) indicates a redistribution of fat from steroid therapy. Multiple ecchymotic areas on the arms indicate a redistribution of subcutaneous fats away from the arm(thin extremities). Both are side effects of long-term steroid therapy. 3. Pink, frothy sputum and jugular vein distention are symptoms of congestive heart failure, not long-term steroid therapy. 4. Petechiae indicate a low platelet count, and sclerosed veins indicate the use of IV access for medication administration. These are not signs of steroid therapy. 38. The male client diagnosed with iatrogenic Cushing’s disease calls the clinic nurse and informs the nurse he has a temperature of 100.1°F. Which intervention should the nurse implement?1. Tell the client to take acetaminophen and drink liquids. 2. Instruct the client to come to the clinic for an antibiotic. 3. Have the client go to the nearest emergency department. 4. Encourage the client to discuss his feelings about the disease. Answer: 2Rationale:1. The client diagnosed with Cushing’s disease is at risk for infections because of the immune suppression that occurs as a result of excess cortisol production. This Client should be seen by the HCP.2. Clients diagnosed with Cushing’s disease are at risk for developing infections related to the excess production of cortisol by the adrenal glands. The client must be seen by an HCP and antibiotics must be initiated. 3. The client is not in an emergent situation; the client can go to an HCP office or clinic to be seen. 4. The client has a physiological problem, not a psychosocial problem. The client does not need therapeutic conversation. 39. The client diagnosed with Addison’s disease asks the nurse, “Why do I have to take fludrocortisone (Florinef), a mineral corticosteroid?” Which statement is the nurse’s best response?1. “It will keep you from getting high blood sugars.”2. “Florinef helps the body retain sodium.”3. “Florinef prevents muscle cramping.”4. “It stimulates the pituitary gland to secrete ACTH.”Answer: 2Rationale:1. Florinef is not an oral hypoglycemic medication. It is a steroid and may increase the blood glucose, notdecrease it. 2. Mineral corticosteroids help the body to maintain the correct serum sodium levels. Florinef is the preferred medication for Addison’s disease, primary hypoaldosteronism, and congenital adrenal hyperplasia when sodium wasting occurs. 3. Florinef does not prevent muscle cramps.If the Florinef dose is too high, then potassium wasting will occur, resulting in muscle cramping.
4. Florinef does not stimulate the pituitary gland. The pituitary gland produces hormones that stimulate the adrenal gland. The adrenal gland does not produce hormones that stimulate the pituitary gland.