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MSN Exam for Cushing’s Syndrome (PM)*
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Question 1
The old woman told John that she has osteoporosis; Arthur knew that all of the following factors would contribute to osteoporosis except
A
Hypothyroidism
B
End stage renal disease
C
Cushing’s Disease
D
Taking Furosemide and Phenytoin.
Question 2
A female client with Cushing’s syndrome is admitted to the medical-surgical unit. During the admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem?
A
Depression
B
Neuropathy
C
Hypoglycemia
D
Hyperthyroidism
Question 2 Explanation:
Agitation, irritability, poor memory, loss of appetite, and neglect of one’s appearance may signal depression, which is common in clients with Cushing’s syndrome. Neuropathy affects clients with diabetes mellitus — not Cushing’s syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite.
Question 3
A Patient is being seen for complications due to corticosteriod therapy. Which are possible signs/symptoms of Cushing's Syndrome? (select all that apply)
A
Changes in recent memory
B
Sleep disturbances
C
Weakness
D
Fatique
E
Weight gain
F
Polydipsia
G
Hump between shoulder blades
Question 3 Explanation:
These are all clinical manifestations of increased glucocorticoid hormone which is increased in production in patients with Cushing's Syndrome(Sommers, 2011)
Question 4
Which of the following disorders is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?
A
Cushing’s syndrome
B
Addison’s disease
C
Graves’ disease
D
Hashimoto’s disease
Question 4 Explanation:
The patient with Cushing’s syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. In Addison’s disease, the patient experiences chronic adrenocortical insufficiency. In Graves’ disease, the patient experiences hyperthyroidism. The individual with Hashimoto’s disease demonstrates inflammation of the thyroid gland, resulting in hypothyroidism.
Question 5
Nurse Ronn is assessing a client with possible Cushing’s syndrome. In a client with Cushing’s syndrome, the nurse would expect to find:
A
Hypotension.
B
Thick, coarse skin.
C
Deposits of adipose tissue in the trunk and dorsocervical area.
D
Weight gain in arms and legs.
Question 5 Explanation:
Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.
Question 6
Which gland does Cushing's Syndrome originate in?
A
Pituitary
B
Pineal
C
Pancreas
D
Gonads
Question 7
Cushing's Disease and Cushing's Sydrome have the same cause.
A
True
B
False
Question 7 Explanation:
They have the same effect.
Disease is a pituitary cause
Syndrome is an adrenal cause
Question 8
A doctor is seeing a client in the clinic and suspects that the client has Cushing Syndrome. The nurse may suspect the doctor will order which of the following tests to aid him/her in making their diagnosis: (Select all that apply)
A
Blood chemistries for sodium, potassium, and glucose
B
CBC with WBC differential
C
CT scan and/or MRI
D
24-hour free cortisol test
Question 8 Explanation:
A CT scan and or/MRI may be ordered AFTER the diagnosis is made in the event the client needs surgery.
Question 9
Which of the following is NOT another name for Cushing's Syndrome?
A
Hypercorticism
B
Hyperadrenocorticism
C
Itsenko-Cushing syndrome
D
Fatty Disease
Question 10
Cushing's Syndrome is a hormone disorder caused by high levels of what?
A
Y Chromosomes
B
Fiber in the digestive tract
C
Cortisol in the blood
D
Unprotected sexual contact
Question 11
In a 29-year-old female client who is being successfully treated for Cushing’s syndrome, nurse Lyzette would expect a decline in:
A
Serum glucose level.
B
Hair loss.
C
Bone mineralization.
D
Menstrual flow.
Question 11 Explanation:
Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing’s syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in Cushing’s syndrome; therefore, with successful treatment, abnormal hair growth also declines. Osteoporosis occurs in Cushing’s syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing’s syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.
Question 12
Nurse Sugar is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?
A
Pitting edema of the legs
B
An irregular apical pulse
C
Dry mucous membranes
D
Frequent urination
Question 12 Explanation:
Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.
Question 13
You assess a patient with Cushing’s disease. For which finding will you notify the physician immediately?
A
Purple striae present on abdomen and thighs
B
Weight gain of 1 pound since the previous day
C
+1 dependent edema in ankles and calves
D
Crackles bilaterally in lower lobes of lungs
Question 13 Explanation:
The presence of crackles in the patient’s lungs indicate excess fluid volume doe to excess water and sodium reabsorption and may be a symptom of pulmonary edema, which must be treated rapidly. Striae (stretch marks), weight gain, and dependent edema are common findings in patients Cushing’s disease. These findings should be monitored, but are not urgent. Focus: Prioritization
Question 14
Which would a person with Cushing's Syndrome prefer to eat?
A
Fat Free Yogurt
B
Salad
C
Bacon Grease
D
Fiber Bars
Question 15
Which is an obvious sign or sympton of Cushing's Syndrome?
A
Getting really, really fat.
B
Losing a lot of weight
C
Becoming constipated
D
Kidney Failure
Question 16
The nurse is assessing a postcraniotomy client and finds the urine output from a catheter is 1500 ml for the 1st hour and the same for the 2nd hour. The nurse should suspect:
A
Cushing’s syndrome
B
Diabetes mellitus
C
Adrenal crisis
D
Diabetes insipidus
Question 16 Explanation:
Diabetes insipidus is an abrupt onset of extreme polyuria that commonly occurs in clients after brain surgery. Cushing’s syndrome is excessive glucocorticoid secretion resulting in sodium and water retention. Diabetes mellitus is a hyperglycemic state marked by polyuria, polydipsia, and polyphagia. Adrenal crisis is undersecretion of glucocorticoids resulting in profound hypoglycemia, hypovolemia, and hypotension.
Question 17
Cushing Syndrome causes the anterior pituitary gland to secret an excess amount of which hormone?
A
CRH
B
cortisol
C
ACTH
D
GH
Question 17 Explanation:
In patients with Cushing Syndrome, the anterior pituitary secretes an excess of ACTH. The hypothalmus secretes CRH. ACTH stimulates the release of cortisol and other gluccortiods. Cushing Syndrome does not cause an excess of GH to be released by the anterior pitutary.
Question 18
Adrenocorticotropic hormone (ACTH) from the pituitary stimulates the __________ glands to release _________.
A
pineal, cortisol
B
adrenal, cortisol
C
pineal, TSH
D
adrenal, TSH
Question 19
Corticosteroids are potent suppressors of the body’s inflammatory response. Which of the following conditions or actions do they suppress?
A
Cushing syndrome.
B
Pain receptors.
C
Immune response.
D
Neural transmission.
Question 19 Explanation:
Corticosteroids suppress eosinophils, lymphocytes, and natural-killer cells, inhibiting the natural inflammatory process in an infected or injured part of the body. This helps resolve inflammation, stabilizes lysosomal membranes, decreases capillary permeability, and depresses phagocytosis of tissues by white blood cells, thus blocking the release of more inflammatory materials. Excessive corticosteroid therapy can lead to Cushing syndrome.
Question 20
The most common cause of Cushing's Disease is ____________.
A
Alcohol abuse
B
Steroid use
C
Genetic disposition
D
Adenoma (benign tumor)
Question 21
The nurse is planning room assignments for the day. Which client should be assigned to a private room if only one is available?
A
The client with Cushing’s disease
B
The client with diabetes
C
The client with acromegaly
D
The client with myxedema
Question 21 Explanation:
The client with Cushing’s disease has adrenocortical hypersecretion. This increase in the level of cortisone causes the client to be immune suppressed. In answer B, the client with diabetes poses no risk to other clients. The client in answer C has an increase in growth hormone and poses no risk to himself or others. The client in answer D has hyperthyroidism or myxedema and poses no risk to others or himself.
Question 22
Signs and/or symptoms of Cushing's Disease include: (check correct boxes)
A
moon face
B
fatty limbs
C
osteoporosis
D
acne
E
euphoria
Question 22 Explanation:
s/s include fatty abdomen and thinning limbs, euphoria is not a s/s
Question 23
As the shift begins, you are assigned these patients. Which patient should you assess first?
A
A 38-year-old patient with Graves’ disease and a heart rate of 94/minute
B
A 63-year-old patient with type 2 diabetes and fingerstick glucose of 137 mg/dL
C
A 58-year-old patient with hypothyroidism and heart rate of 48/minute
D
A 49-year-old patient with Cushing’s disease and +1 dependent edema
Question 23 Explanation:
Although patients with hypothyroidism often have cardiac problems that include bradycardia, a heart rate of 48/minute may have significant implications for cardiac output and hemodynamic stability. Patients with Graves’ disease usually have a rapid heart rate, but 94/minute is within limits. The diabetic patient may need sliding scale insulin. This is important but not urgent. Patients with Cushing’s disease frequently have dependent edema. Focus: Prioritization
Question 24
The pituitary gland is also known as the ____________.
A
Hypophysis
B
Infundibulum
C
Hypothalamus
D
Neurohypophysis
Question 25
Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?
A
Tetany
B
Hemorrhage
C
Thyroid storm
D
Laryngeal nerve damage
Question 25 Explanation:
Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.
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MSN Exam for Cushing’s Syndrome (EM)*
Choose the letter of the correct answer. You got 25 minutes to finish the exam .Good luck!
Start
Congratulations - you have completed MSN Exam for Cushing’s Syndrome (EM)*.
You scored %%SCORE%% out of %%TOTAL%%.
Your performance has been rated as %%RATING%%
Your answers are highlighted below.
Question 1
Nurse Sugar is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately?
A
Pitting edema of the legs
B
An irregular apical pulse
C
Dry mucous membranes
D
Frequent urination
Question 1 Explanation:
Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.
Question 2
Adrenocorticotropic hormone (ACTH) from the pituitary stimulates the __________ glands to release _________.
A
pineal, cortisol
B
adrenal, cortisol
C
pineal, TSH
D
adrenal, TSH
Question 3
The most common cause of Cushing's Disease is ____________.
A
Alcohol abuse
B
Steroid use
C
Genetic disposition
D
Adenoma (benign tumor)
Question 4
Which gland does Cushing's Syndrome originate in?
A
Pituitary
B
Pineal
C
Pancreas
D
Gonads
Question 5
Nurse Ronn is assessing a client with possible Cushing’s syndrome. In a client with Cushing’s syndrome, the nurse would expect to find:
A
Hypotension.
B
Thick, coarse skin.
C
Deposits of adipose tissue in the trunk and dorsocervical area.
D
Weight gain in arms and legs.
Question 5 Explanation:
Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.
Question 6
Which of the following is NOT another name for Cushing's Syndrome?
A
Hypercorticism
B
Hyperadrenocorticism
C
Itsenko-Cushing syndrome
D
Fatty Disease
Question 7
Cushing's Syndrome is a hormone disorder caused by high levels of what?
A
Y Chromosomes
B
Fiber in the digestive tract
C
Cortisol in the blood
D
Unprotected sexual contact
Question 8
The old woman told John that she has osteoporosis; Arthur knew that all of the following factors would contribute to osteoporosis except
A
Hypothyroidism
B
End stage renal disease
C
Cushing’s Disease
D
Taking Furosemide and Phenytoin.
Question 9
Which would a person with Cushing's Syndrome prefer to eat?
A
Fat Free Yogurt
B
Salad
C
Bacon Grease
D
Fiber Bars
Question 10
A Patient is being seen for complications due to corticosteriod therapy. Which are possible signs/symptoms of Cushing's Syndrome? (select all that apply)
A
Changes in recent memory
B
Sleep disturbances
C
Weakness
D
Fatique
E
Weight gain
F
Polydipsia
G
Hump between shoulder blades
Question 10 Explanation:
These are all clinical manifestations of increased glucocorticoid hormone which is increased in production in patients with Cushing's Syndrome(Sommers, 2011)
Question 11
Which of the following disorders is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?
A
Cushing’s syndrome
B
Addison’s disease
C
Graves’ disease
D
Hashimoto’s disease
Question 11 Explanation:
The patient with Cushing’s syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. In Addison’s disease, the patient experiences chronic adrenocortical insufficiency. In Graves’ disease, the patient experiences hyperthyroidism. The individual with Hashimoto’s disease demonstrates inflammation of the thyroid gland, resulting in hypothyroidism.
Question 12
Which is an obvious sign or sympton of Cushing's Syndrome?
A
Getting really, really fat.
B
Losing a lot of weight
C
Becoming constipated
D
Kidney Failure
Question 13
Corticosteroids are potent suppressors of the body’s inflammatory response. Which of the following conditions or actions do they suppress?
A
Cushing syndrome.
B
Pain receptors.
C
Immune response.
D
Neural transmission.
Question 13 Explanation:
Corticosteroids suppress eosinophils, lymphocytes, and natural-killer cells, inhibiting the natural inflammatory process in an infected or injured part of the body. This helps resolve inflammation, stabilizes lysosomal membranes, decreases capillary permeability, and depresses phagocytosis of tissues by white blood cells, thus blocking the release of more inflammatory materials. Excessive corticosteroid therapy can lead to Cushing syndrome.
Question 14
The pituitary gland is also known as the ____________.
A
Hypophysis
B
Infundibulum
C
Hypothalamus
D
Neurohypophysis
Question 15
A doctor is seeing a client in the clinic and suspects that the client has Cushing Syndrome. The nurse may suspect the doctor will order which of the following tests to aid him/her in making their diagnosis: (Select all that apply)
A
Blood chemistries for sodium, potassium, and glucose
B
CBC with WBC differential
C
CT scan and/or MRI
D
24-hour free cortisol test
Question 15 Explanation:
A CT scan and or/MRI may be ordered AFTER the diagnosis is made in the event the client needs surgery.
Question 16
In a 29-year-old female client who is being successfully treated for Cushing’s syndrome, nurse Lyzette would expect a decline in:
A
Serum glucose level.
B
Hair loss.
C
Bone mineralization.
D
Menstrual flow.
Question 16 Explanation:
Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing’s syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in Cushing’s syndrome; therefore, with successful treatment, abnormal hair growth also declines. Osteoporosis occurs in Cushing’s syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing’s syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.
Question 17
As the shift begins, you are assigned these patients. Which patient should you assess first?
A
A 38-year-old patient with Graves’ disease and a heart rate of 94/minute
B
A 63-year-old patient with type 2 diabetes and fingerstick glucose of 137 mg/dL
C
A 58-year-old patient with hypothyroidism and heart rate of 48/minute
D
A 49-year-old patient with Cushing’s disease and +1 dependent edema
Question 17 Explanation:
Although patients with hypothyroidism often have cardiac problems that include bradycardia, a heart rate of 48/minute may have significant implications for cardiac output and hemodynamic stability. Patients with Graves’ disease usually have a rapid heart rate, but 94/minute is within limits. The diabetic patient may need sliding scale insulin. This is important but not urgent. Patients with Cushing’s disease frequently have dependent edema. Focus: Prioritization
Question 18
Cushing's Disease and Cushing's Sydrome have the same cause.
A
True
B
False
Question 18 Explanation:
They have the same effect.
Disease is a pituitary cause
Syndrome is an adrenal cause
Question 19
Cushing Syndrome causes the anterior pituitary gland to secret an excess amount of which hormone?
A
CRH
B
cortisol
C
ACTH
D
GH
Question 19 Explanation:
In patients with Cushing Syndrome, the anterior pituitary secretes an excess of ACTH. The hypothalmus secretes CRH. ACTH stimulates the release of cortisol and other gluccortiods. Cushing Syndrome does not cause an excess of GH to be released by the anterior pitutary.
Question 20
The nurse is planning room assignments for the day. Which client should be assigned to a private room if only one is available?
A
The client with Cushing’s disease
B
The client with diabetes
C
The client with acromegaly
D
The client with myxedema
Question 20 Explanation:
The client with Cushing’s disease has adrenocortical hypersecretion. This increase in the level of cortisone causes the client to be immune suppressed. In answer B, the client with diabetes poses no risk to other clients. The client in answer C has an increase in growth hormone and poses no risk to himself or others. The client in answer D has hyperthyroidism or myxedema and poses no risk to others or himself.
Question 21
A female client with Cushing’s syndrome is admitted to the medical-surgical unit. During the admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem?
A
Depression
B
Neuropathy
C
Hypoglycemia
D
Hyperthyroidism
Question 21 Explanation:
Agitation, irritability, poor memory, loss of appetite, and neglect of one’s appearance may signal depression, which is common in clients with Cushing’s syndrome. Neuropathy affects clients with diabetes mellitus — not Cushing’s syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite.
Question 22
Signs and/or symptoms of Cushing's Disease include: (check correct boxes)
A
moon face
B
fatty limbs
C
osteoporosis
D
acne
E
euphoria
Question 22 Explanation:
s/s include fatty abdomen and thinning limbs, euphoria is not a s/s
Question 23
The nurse is assessing a postcraniotomy client and finds the urine output from a catheter is 1500 ml for the 1st hour and the same for the 2nd hour. The nurse should suspect:
A
Cushing’s syndrome
B
Diabetes mellitus
C
Adrenal crisis
D
Diabetes insipidus
Question 23 Explanation:
Diabetes insipidus is an abrupt onset of extreme polyuria that commonly occurs in clients after brain surgery. Cushing’s syndrome is excessive glucocorticoid secretion resulting in sodium and water retention. Diabetes mellitus is a hyperglycemic state marked by polyuria, polydipsia, and polyphagia. Adrenal crisis is undersecretion of glucocorticoids resulting in profound hypoglycemia, hypovolemia, and hypotension.
Question 24
Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?
A
Tetany
B
Hemorrhage
C
Thyroid storm
D
Laryngeal nerve damage
Question 24 Explanation:
Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.
Question 25
You assess a patient with Cushing’s disease. For which finding will you notify the physician immediately?
A
Purple striae present on abdomen and thighs
B
Weight gain of 1 pound since the previous day
C
+1 dependent edema in ankles and calves
D
Crackles bilaterally in lower lobes of lungs
Question 25 Explanation:
The presence of crackles in the patient’s lungs indicate excess fluid volume doe to excess water and sodium reabsorption and may be a symptom of pulmonary edema, which must be treated rapidly. Striae (stretch marks), weight gain, and dependent edema are common findings in patients Cushing’s disease. These findings should be monitored, but are not urgent. Focus: Prioritization
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1) Cushing’s Disease and Cushing’s Sydrome have the same cause.
True
False
2) You assess a patient with Cushing’s disease. For which finding will you notify the physician immediately?
Purple striae present on abdomen and thighs
Weight gain of 1 pound since the previous day
+1 dependent edema in ankles and calves
Crackles bilaterally in lower lobes of lungs
3) As the shift begins, you are assigned these patients. Which patient should you assess first?
A 38-year-old patient with Graves’ disease and a heart rate of 94/minute
A 63-year-old patient with type 2 diabetes and fingerstick glucose of 137 mg/dL
A 58-year-old patient with hypothyroidism and heart rate of 48/minute
A 49-year-old patient with Cushing’s disease and +1 dependent edema
4) Which is an obvious sign or sympton of Cushing’s Syndrome?
6) The nurse is assessing a postcraniotomy client and finds the urine output from a catheter is 1500 ml for the 1st hour and the same for the 2nd hour. The nurse should suspect:
Cushing’s syndrome
Diabetes mellitus
Adrenal crisis
Diabetes insipidus
7) Nurse Ronn is assessing a client with possible Cushing’s syndrome. In a client with Cushing’s syndrome, the nurse would expect to find:
Hypotension.
Thick, coarse skin.
Deposits of adipose tissue in the trunk and dorsocervical area.
Weight gain in arms and legs.
8) The pituitary gland is also known as the ____________.
Hypophysis
Infundibulum
Hypothalamus
Neurohypophysis
9) Which of the following disorders is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex?
Cushing’s syndrome
Addison’s disease
Graves’ disease
Hashimoto’s disease
10) Which gland does Cushing’s Syndrome originate in?
Pituitary
Pineal
Pancreas
Gonads
11) The most common cause of Cushing’s Disease is ____________.
Alcohol abuse
Steroid use
Genetic disposition
Adenoma (benign tumor)
12) A female client with Cushing’s syndrome is admitted to the medical-surgical unit. During the admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem?
Depression
Neuropathy
Hypoglycemia
Hyperthyroidism
13) Cushing’s Syndrome is a hormone disorder caused by high levels of what?
Y Chromosomes
Fiber in the digestive tract
Cortisol in the blood
Unprotected sexual contact
14) In a 29-year-old female client who is being successfully treated for Cushing’s syndrome, nurse Lyzette would expect a decline in:
Serum glucose level.
Hair loss.
Bone mineralization.
Menstrual flow.
15) Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?
Tetany
Hemorrhage
Thyroid storm
Laryngeal nerve damage
16) The old woman told John that she has osteoporosis; Arthur knew that all of the following factors would contribute to osteoporosis except
Hypothyroidism
End stage renal disease
Cushing’s Disease
Taking Furosemide and Phenytoin.
17) Which of the following is NOT another name for Cushing’s Syndrome?
Hypercorticism
Hyperadrenocorticism
Itsenko-Cushing syndrome
Fatty Disease
18) Corticosteroids are potent suppressors of the body’s inflammatory response. Which of the following conditions or actions do they suppress?
Cushing syndrome.
Pain receptors.
Immune response.
Neural transmission.
19) Nurse Sugar is assessing a client with Cushing’s syndrome. Which observation should the nurse report to the physician immediately?
Pitting edema of the legs
An irregular apical pulse
Dry mucous membranes
Frequent urination
20) The nurse is planning room assignments for the day. Which client should be assigned to a private room if only one is available?
The client with Cushing’s disease
The client with diabetes
The client with acromegaly
The client with myxedema
21) Which would a person with Cushing’s Syndrome prefer to eat?
Fat Free Yogurt
Salad
Bacon Grease
Fiber Bars
22) Adrenocorticotropic hormone (ACTH) from the pituitary stimulates the __________ glands to release _________.
pineal, cortisol
adrenal, cortisol
pineal, TSH
adrenal, TSH
Answers and Rationales
B. False . They have the same effect, Disease is a pituitary cause, Syndrome is an adrenal cause
D. Crackles bilaterally in lower lobes of lungs . The presence of crackles in the patient’s lungs indicate excess fluid volume doe to excess water and sodium reabsorption and may be a symptom of pulmonary edema, which must be treated rapidly. Striae (stretch marks), weight gain, and dependent edema are common findings in patients Cushing’s disease. These findings should be monitored, but are not urgent. Focus: Prioritization
C. A 58-year-old patient with hypothyroidism and heart rate of 48/minute . Although patients with hypothyroidism often have cardiac problems that include bradycardia, a heart rate of 48/minute may have significant implications for cardiac output and hemodynamic stability. Patients with Graves’ disease usually have a rapid heart rate, but 94/minute is within limits. The diabetic patient may need sliding scale insulin. This is important but not urgent. Patients with Cushing’s disease frequently have dependent edema. Focus: Prioritization
A. Getting really, really fat.
A. moon face , C. osteoporosis , D. acne . s/s include fatty abdomen and thinning limbs, euphoria is not a s/s
D. Diabetes insipidus . Diabetes insipidus is an abrupt onset of extreme polyuria that commonly occurs in clients after brain surgery. Cushing’s syndrome is excessive glucocorticoid secretion resulting in sodium and water retention. Diabetes mellitus is a hyperglycemic state marked by polyuria, polydipsia, and polyphagia. Adrenal crisis is undersecretion of glucocorticoids resulting in profound hypoglycemia, hypovolemia, and hypotension.
C. Deposits of adipose tissue in the trunk and dorsocervical area. Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.
A. Hypophysis
A. Cushing’s syndrome . The patient with Cushing’s syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and hypertension. In Addison’s disease, the patient experiences chronic adrenocortical insufficiency. In Graves’ disease, the patient experiences hyperthyroidism. The individual with Hashimoto’s disease demonstrates inflammation of the thyroid gland, resulting in hypothyroidism.
A. Pituitary
D. Adenoma (benign tumor)
A. Depression . Agitation, irritability, poor memory, loss of appetite, and neglect of one’s appearance may signal depression, which is common in clients with Cushing’s syndrome. Neuropathy affects clients with diabetes mellitus — not Cushing’s syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance, and weight loss despite increased appetite.
C. Cortisol in the blood
A. Serum glucose level. Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing’s syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in Cushing’s syndrome; therefore, with successful treatment, abnormal hair growth also declines. Osteoporosis occurs in Cushing’s syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing’s syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.
A. Tetany . Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.
A. Hypothyroidism
D. Fatty Disease
C. Immune response. Corticosteroids suppress eosinophils, lymphocytes, and natural-killer cells, inhibiting the natural inflammatory process in an infected or injured part of the body. This helps resolve inflammation, stabilizes lysosomal membranes, decreases capillary permeability, and depresses phagocytosis of tissues by white blood cells, thus blocking the release of more inflammatory materials. Excessive corticosteroid therapy can lead to Cushing syndrome.
B. An irregular apical pulse . Because Cushing’s syndrome causes aldosterone overproduction, which increases urinary potassium loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes and frequent urination signal dehydration, which isn’t associated with Cushing’s syndrome.
A. The client with Cushing’s disease . The client with Cushing’s disease has adrenocortical hypersecretion. This increase in the level of cortisone causes the client to be immune suppressed. In answer B, the client with diabetes poses no risk to other clients. The client in answer C has an increase in growth hormone and poses no risk to himself or others. The client in answer D has hyperthyroidism or myxedema and poses no risk to others or himself.