A 35-year-old woman reports lethargy, difficulty remembering ...

[daltonest1984]

A 35-year-old woman reports lethargy, difficulty remembering things, facial edema, dry skin, and cessation of menses. The nurse notes a heart rate of 60 beats per minute and a weight increase of 5 pounds from a previous visit.
 
  The nurse will notify the provider of which possible condition?
  a. Cretinism
  b. Early menopause
  c. Hyperthyroidism
  d. Myxedema

Question 2

The nurse administers intravenous corticotropin (Acthar) to a patient. A serum cortisol level drawn 60 minutes later shows no change in serum cortisol levels from prior to the dose. What is the nurse's first action?
 
  a. Notify the provider to discuss a possible non-functioning adrenal gland.
  b. Recognize the need for an increased dose to treat pituitary insufficiency.
  c. Request an order for a second dose of corticotropin to treat cortisone deficiency.
  d. Request an order to repeat the serum cortisol level in 1 to 2 hours.

[gabrielle_lawrence]

Answer to Question 1

ANS: D
Myxedema is severe hypothyroidism characterized by this woman's symptoms. Cretinism is congenital hypothyroidism. Early menopause is not characterized by memory loss, facial edema, dry skin, or bradycardia. Hyperthyroidism would include tachycardia and weight loss.

Answer to Question 2

ANS: A
Corticotropin is given to diagnose adrenal gland disorders as well as to treat adrenal gland insufficiency. When given intravenously, the serum cortisol level should increase within 30 to 60 minutes if the adrenal gland is functioning. The nurse should report adrenal gland dysfunction. The provider will determine how to treat. Since the levels should increase in 30 to 60 minutes, there is no need to repeat the test in 1 to 2 hours.

[daltonest1984]

Excellent

[diana chang]

TYSM