MSN Client with Cushing’s Disease Quiz 1
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The nurse should tell the client to do which of the following when teaching the client about taking oral glucocorticoids?
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“Take your medication with a full glass of water.”
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“Take your medication on an empty stomach.”
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“Take your medication at bedtime to increase absorption.”
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“Take your medication with meals or with an antacid.”
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- 2.
Which of the following is the best indicator for determining whether a client with Addison’s disease is receiving the correct amount of glucocorticoid replacement?
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Skin turgor.
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Temperature.
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Thirst.
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Daily weight.
Correct Answer
A. Daily weight.Explanation
Measuring daily weight is a reliable, objective way to monitor fluid balance. Rapid variations in weight reflect changes in fluid volume, which suggests insufficient control of the disease and the need for more glucocorticoids in the client with Addison’s disease. Nurses should instruct clients taking oral steroids to weigh themselves daily and to report any unusual weight loss or gain. Skin turgor testing does supply information about fluid status, but daily weight monitoring is more reliable. Temperature is not a direct measurement of fluid balance. Thirst is a nonspecific and very late sign of weight loss.Rate this question:
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- 3.
Which of the following signs and symptoms would probably indicate that the client with Addison’s disease is receiving too much glucocorticoid replacement?
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Anorexia.
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Dizziness.
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Rapid weight gain.
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Poor skin turgor.
Correct Answer
A. Rapid weight gain.Explanation
Rapid weight gain, because it reflects excess fluids, is a warning sign that the client is receiving too much hormone replacement. It may be difficult to individualize the correct dosage for a client taking glucocorticoids, and the therapeutic range between underdosage and overdosage is narrow. Maintaining the client on the lowest dose that provides satisfactory clinical response is always the goal of pharmacotherapeutics. Fluid balance is an important indicator of the adequacy of hormone replacement. Anorexia is not present with glucocorticoid therapy because these drugs increase the
appetite. Dizziness is not specific to the effects of glucocorticoid therapy. Poor skin turgor is a late sign of fluid volume deficit.Rate this question:
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- 4.
Which of the following is a priority outcome for the client with Addison’s disease?
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Maintenance of medication compliance.
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Avoidance of normal activities with stress.
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Adherence to a 2-g sodium diet.
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Prevention of hypertensive episodes.
Correct Answer
A. Maintenance of medication compliance.Explanation
Medication compliance is an essential part of the self-care required to manage Addison’s disease.
The client must learn to adjust the glucocorticoid dose in response to the normal and unexpected
stresses of daily living. The nurse should instruct the client never to stop taking the drug without consulting the health care provider to avoid an addisonian crisis. Regularity in daily habits makes adjustment easier, but the client should not be encouraged to withdraw from normal activities to avoid stress. The client does not need to restrict sodium. The client is at risk for hyponatremia. Hypotension, not hypertension, is more common with Addison’s disease.Rate this question:
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- 5.
The client with Addison’s disease should anticipate the need for increased glucocorticoid supplementation in which of the following situations?
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Returning to work after a weekend.
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Going on vacation.
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Having oral surgery.
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Having a routine medical checkup.
Correct Answer
A. Having oral surgery.Explanation
Illness or surgery places tremendous stress on the body, necessitating increased glucocorticoid
dosage. Extreme emotional or psychological stress also necessitates dosage adjustment. Increased dosages are needed in times of stress to prevent drug induced adrenal insufficiency. Returning to work
after the weekend, going on a vacation, or having a routine checkup usually will not alter glucocorticoid dosage needs.Rate this question:
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- 6.
The nurse should teach the client with Addison’s disease that the adverse effect of bronze colored skin is thought to be caused by which of the following?
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Hypersensitivity to sun exposure.
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Increased serum bilirubin level.
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Adverse effects of the glucocorticoid therapy.
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Increased secretion of adrenocorticotropic hormone (ACTH).
Correct Answer
A. Increased secretion of adrenocorticotropic hormone (ACTH).Explanation
Bronzing, or general deepening of skin pigmentation, is a classic sign of Addison’s disease and
is caused by melanocyte-stimulating hormone produced in response to increased ACTH secretion. The
hyperpigmentation is typically found in the distal portion of extremities and in areas exposed to sun.
Additionally, areas that may not be exposed to sun, such as the nipples, genitalia, tongue, and knuckles,
become bronze-colored. Treatment of Addison’s disease usually reverses the hyperpigmentation. Bilirubin level is not related to the pathophysiology of Addison’s disease. Hyperpigmentation is not
related to the effects of the glucocorticoid therapy.Rate this question:
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- 7.
A client reports that she has gained weight and that her face and body are “rounder,” while her legs and arms have become thinner. A tentative diagnosis of Cushing’s disease is made. When examining this client, the nurse would expect to find:
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Orthostatic hypotension.
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Muscle hypertrophy in the extremities.
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Bruised areas on the skin.
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Decreased body hair.
Correct Answer
A. Bruised areas on the skin.Explanation
Skin bruising from increased skin and blood vessel fragility is a classic sign of Cushing’s disease. Hyperpigmentation and bruising are caused by the hypersecretion of glucocorticoids. Fluid retention causes hypertension, not hypotension. Muscle wasting occurs in the extremities. Hair on the head thins, while body hair increases.Rate this question:
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- 8.
Signs and symptoms of Cushing’s disease include:
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Weight loss.
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Thin, fragile skin.
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Hypotension.
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Abdominal pain.
Correct Answer
A. Thin, fragile skin.Explanation
In Cushing’s disease, excessive cortisol secretion causes rapid protein catabolism, depleting the collagen support of the skin. The skin becomes thin and fragile and susceptible to easy bruising.
The typical “cushingoid” appearance of the client includes a moon face, buffalo hump, central obesity, and thin musculature. Weight gain, mood swings, and slow wound healing are other signs and symptoms of Cushing’s disease. Hypertension, not hypotension, is a sign of Cushing’s disease. Abdominal pain is not a symptom of Cushing’s disease.Rate this question:
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- 9.
Cushing’s disease is manifested by the excessive secretion of corticosteroids. The hormones involved are:
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Glucocorticoids and aldosterone.
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Adrenocorticotropic hormone (ACTH).
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Glucocorticoids, aldosterone, and androgens.
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Catecholamines.
Correct Answer
A. Glucocorticoids, aldosterone, and androgens.Explanation
Excessive levels of glucocorticoids, aldosterone, and androgens secreted from the adrenal cortex
result in the constellation of symptoms known as Cushing’s disease. Cushing’s disease can be caused by a tumor, overstimulation from the pituitary, or the use of prescription steroid drugs. Androgens are also secreted in excess. ACTH is only one hormone that is abnormal in Cushing’s disease. Excessive secretion of catecholamines accompanies pheochromocytoma, a disease of the adrenal medulla.Rate this question:
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- 10.
The nurse should monitor the client with Cushing’s disease for which of the following?
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Postprandial hypoglycemia.
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Hypokalemia.
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Hyponatremia.
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Decreased urine calcium level.
Correct Answer
A. Hypokalemia.Explanation
Sodium retention is typically accompanied by potassium depletion. Hypertension, hypokalemia,
edema, and heart failure may result from the hypersecretion of aldosterone. The client with Cushing’s disease exhibits postprandial or persistent hyperglycemia. Clients with Cushing’s disease have hypernatremia, not hyponatremia. Bone resorption of calcium increases the urine calcium level.Rate this question:
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- 11.
A client with Cushing’s disease tells the nurse that the physician said the morning serum cortisol level was within normal limits. The client asks, “How can that be? I’m not imagining all these symptoms!” The nurse’s response will be based on which of the following concepts?
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Some clients are very sensitive to the effects of cortisol and develop symptoms even with normal levels.
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A single random blood test cannot provide reliable information about endocrine levels.
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The excessive cortisol levels seen in Cushing’s disease commonly result from loss of the normal diurnal secretion pattern.
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Tumors tend to secrete hormones irregularly, and the hormones are generally not present in the blood.
Correct Answer
A. The excessive cortisol levels seen in Cushing’s disease commonly result from loss of the normal diurnal secretion pattern.Explanation
Cushing’s disease is commonly caused by loss of the diurnal cortisol secretion pattern. The client’s random morning cortisol level may be within normal limits, but secretion continues at that level throughout the entire day. Cortisol levels should normally decrease after the morning peak. Analysis of a 24-hour urine specimen is often useful in identifying the cumulative excess. Clients will not have
symptoms with normal cortisol levels. Hormones are present in the blood.Rate this question:
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- 12.
The client with Cushing’s disease needs to modify dietary intake to control symptoms. In addition to increasing protein, which strategy would be most appropriate?
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Increase calories.
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Restrict sodium.
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Restrict potassium.
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Reduce fat to 10%.
Correct Answer
A. Restrict sodium.Explanation
A primary dietary intervention is to restrict sodium, thereby reducing fluid retention. Increased protein catabolism results in loss of muscle mass and necessitates supplemental protein intake. The client may be asked to restrict total calories to reduce weight. The client should be encouraged to eat potassium-rich foods because serum levels are typically depleted. Although reducing fat intake as
part of an overall plan to restrict calories is appropriate, fat intake of less than 20% of total calories is not recommended.Rate this question:
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- 13.
Bone resorption is a possible complication of Cushing’s disease. Which of the following interventions should the nurse recommend to help the client prevent this complication?
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Increase the amount of potassium in the diet.
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Maintain a regular program of weight-bearing exercise.
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Limit dietary vitamin D intake.
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Perform isometric exercises.
Correct Answer
A. Maintain a regular program of weight-bearing exercise.Explanation
Osteoporosis is a serious outcome of prolonged cortisol excess because calcium is resorbed out of the bone. Regular daily weight-bearing exercise (e.g., brisk walking) is an effective way to drive calcium back into the bones. The client should also be instructed to have a dietary or supplemental intake of calcium of 1,500 mg daily. Potassium levels are not relevant to prevention of bone resorption. Vitamin D is needed to aid in the absorption of calcium. Isometric exercises condition muscle tone but do not build bones.Rate this question:
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- 14.
A client has an adrenal tumor and is scheduled for a bilateral adrenalectomy. During prepoperative teaching, the nurse teaches the client how to do deep breathing exercises after surgery by telling the client to:
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“Sit in an upright position and take a deep breath.”
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“Hold your abdomen firmly with a pillow and take several deep breaths.”
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“Tighten your stomach muscles as you inhale and breathe normally.”
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“Raise your shoulders to expand your chest.”
Correct Answer
A. “Hold your abdomen firmly with a pillow and take several deep breaths.”Explanation
Effective splinting for a high incision reduces stress on the incision line, decreases pain, and increases the client’s ability to deep-breathe effectively. Deep breathing should be done hourly by the client after surgery. Sitting upright ignores the need to splint the incision to prevent pain. Tightening the stomach muscles is not an effective strategy for promoting deep breathing. Raising the shoulders is not a feature of deep-breathing
exercises.Rate this question:
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- 15.
A priority in the first 24 hours after a bilateral adrenalectomy is:
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Beginning oral nutrition.
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Promoting self-care activities.
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Preventing adrenal crisis.
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Ambulating in the hallway.
Correct Answer
A. Preventing adrenal crisis.Explanation
The priority in the first 24 hours after adrenalectomy is to identify and prevent adrenal crisis. Monitoring of vital signs is the most important evaluation measure. Hypotension, tachycardia, orthostatic hypotension, and arrhythmias can be indicators of pending vascular collapse and hypovolemic shock that can occur with adrenal crisis. Beginning oral nutrition is important, but not necessarily in the first 24 hours after surgery, and
it is not more important than preventing adrenal crisis. Promoting self-care activities is not as important as preventing adrenal crisis. Ambulating in the hallway is not a priority in the first 24 hours after adrenalectomy.Rate this question:
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Apr 09, 2025Quiz Edited by
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Apr 09, 2025Quiz Created by
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