A nurse is assessing a client with Cushing's syndrome. The nurse is aware that an exogenous cause of Cushing's syndrome is which of the following?
Insufficient insulin production
Long term use of glucocorticoids
Adrenal insufficiency
Overproduction of growth hormones
The Correct Answer is B
A. Insufficient insulin production is related to diabetes mellitus, not Cushing's syndrome.
B. Long-term use of glucocorticoids is a well-known exogenous cause of Cushing's syndrome, as it leads to excess cortisol in the body.
C. Adrenal insufficiency refers to a deficiency of adrenal hormones and would not cause Cushing's syndrome, which is characterized by excess hormones.
D. Overproduction of growth hormones is associated with acromegaly or gigantism, not Cushing's syndrome, which primarily involves excess cortisol.
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Correct Answer is ["A","C","D"]
Explanation
A. Elevating the head of the bed to 30-45 degrees helps facilitate venous drainage from the brain, thereby reducing ICP.
B. Administering intravenous fluids rapidly is not appropriate, as it can lead to fluid overload and increase ICP.
C. Keeping the client in a calm and quiet environment minimizes stimulation, which can contribute to increased ICP.
D. Administering morphine sulfate as prescribed can provide pain relief, which may help decrease ICP since pain can contribute to increased intracranial pressure.
E. The Valsalva maneuver increases intrathoracic pressure and can lead to increased ICP, making it contraindicated in this scenario.
Correct Answer is D
Explanation
A. Encouraging deep breathing exercises may help with respiratory function but does not address the immediate risks associated with increased ICP.
B. Elevating the head of the bed can help reduce ICP; however, the priority intervention is to closely monitor ICP to identify any changes in the client's condition.
C. Administering a sedative may be appropriate, but it is not as critical as monitoring ICP in a client with Cushing's Triad, where altered consciousness and respiratory changes may be present.
D. Monitoring ICP is crucial in this situation, as Cushing's Triad indicates a potential increase in ICP, and timely interventions can prevent further complications.