MSN Exam for Cushing’s Syndrome

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1) Cushing’s Disease and Cushing’s Sydrome have the same cause.

1. True
2. False

2) You assess a patient with Cushing’s disease. For which finding will you notify the physician immediately?

1. Purple striae present on abdomen and thighs
2. Weight gain of 1 pound since the previous day
3. +1 dependent edema in ankles and calves
4. Crackles bilaterally in lower lobes of lungs

3) As the shift begins, you are assigned these patients. Which patient should you assess first?

1. A 38-year-old patient with Graves’ disease and a heart rate of 94/minute
2. A 63-year-old patient with type 2 diabetes and fingerstick glucose of 137 mg/dL
3. A 58-year-old patient with hypothyroidism and heart rate of 48/minute
4. 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?

1. Getting really, really fat.
2. Losing a lot of weight
3. Becoming constipated
4. Kidney Failure

5) Signs and/or symptoms of Cushing’s Disease include: (check correct boxes)

1. moon face
2. fatty limbs
3. osteoporosis
4. acne
5. euphoria

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:

1. Cushing’s syndrome
2. Diabetes mellitus
3. Adrenal crisis
4. 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:

1. Hypotension.
2. Thick, coarse skin.
3. Deposits of adipose tissue in the trunk and dorsocervical area.
4. Weight gain in arms and legs.

8) The pituitary gland is also known as the ____________.

1. Hypophysis
2. Infundibulum
3. Hypothalamus
4. 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?

1. Cushing’s syndrome
2. Addison’s disease
3. Graves’ disease
4. Hashimoto’s disease

10) Which gland does Cushing’s Syndrome originate in?

1. Pituitary
2. Pineal
3. Pancreas
4. Gonads

11) The most common cause of Cushing’s Disease is ____________.

1. Alcohol abuse
2. Steroid use
3. Genetic disposition
4. 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?

1. Depression
2. Neuropathy
3. Hypoglycemia
4. Hyperthyroidism

13) Cushing’s Syndrome is a hormone disorder caused by high levels of what?

1. Y Chromosomes
2. Fiber in the digestive tract
3. Cortisol in the blood
4. 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:

1. Serum glucose level.
2. Hair loss.
3. Bone mineralization.
4. 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?

1. Tetany
2. Hemorrhage
3. Thyroid storm
4. 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

1. Hypothyroidism
2. End stage renal disease
3. Cushing’s Disease
4. Taking Furosemide and Phenytoin.

17) Which of the following is NOT another name for Cushing’s Syndrome?

1. Hypercorticism
2. Hyperadrenocorticism
3. Itsenko-Cushing syndrome
4. Fatty Disease

18) Corticosteroids are potent suppressors of the body’s inflammatory response. Which of the following conditions or actions do they suppress?

1. Cushing syndrome.
2. Pain receptors.
3. Immune response.
4. Neural transmission.

19) Nurse Sugar is assessing a client with Cushing’s syndrome. Which observation should the nurse report to the physician immediately?

1. Pitting edema of the legs
2. An irregular apical pulse
3. Dry mucous membranes
4. 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?

1. The client with Cushing’s disease
2. The client with diabetes
3. The client with acromegaly
4. The client with myxedema

21) Which would a person with Cushing’s Syndrome prefer to eat?

1. Fat Free Yogurt
2. Salad
3. Bacon Grease
4. Fiber Bars

22) Adrenocorticotropic hormone (ACTH) from the pituitary stimulates the __________ glands to release _________.

1. pineal, cortisol
2. adrenal, cortisol
3. pineal, TSH
4. adrenal, TSH

Answers and Rationales

1. B. False . They have the same effect, Disease is a pituitary cause, Syndrome is an adrenal cause
2. 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
3. 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
4. A. Getting really, really fat. 
5. A. moon face , C. osteoporosis , D. acne . s/s include fatty abdomen and thinning limbs, euphoria is not a s/s
6. 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.
7. 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.
8. A. Hypophysis 
9. 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.
10. A. Pituitary 
11. D. Adenoma (benign tumor) 
12. 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.
13. C. Cortisol in the blood 
14. 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.
15. 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.
16. A. Hypothyroidism 
17. D. Fatty Disease
18. 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.
19. 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.
20. 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.
21. C. Bacon Grease 
22. B. adrenal, cortisol