Medical-Surgical Nursing: Med Surg 2 Test 3: Cushing's Flashcards


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Cushings
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1

new book

giddens 2nd ed

2

Which important teaching point should the nurse include in the plan of care for a patient diagnosed with Cushing’s disease?

a. Daily weight using same scale

b. Wash hands frequently

c. Use exfoliating soaps when bathing

d. Avoid yearly influenza vaccine

ANS: B

Cushing’s syndrome is characterized by chronic excess glucocorticoid (cortisol) secretion from the adrenal cortex. This is caused by the hypothalamus, or the anterior pituitary gland, or the adrenal cortex. Cushing’s syndrome can also be caused by taking corticosteroids in the form of medication (such as prednisone) over time – referred to as exogenous Cushing syndrome. Regardless of the cause, excess secretion of cortisol has a systemic affect affecting immunity, metabolism, and fat distribution (truncal obesity), reduced muscle mass, loss of bone density, hypertension, fragility to microvasculature, as well as thinning of the skin. Washing hands is important because the patient’s immune system is suppressed due to the excess glucocorticoid level. Daily weights are not indicated. Exfoliating soaps may damage thin skin. The patient should receive vaccinations due to being immunocompromised.

REF: Page 131

OBJ: NCLEX® Client Needs Category: Physiological Integrity: Physiological Adaptation

3

New Book

Brunner Suddarth 14th ed

4

The nurse is caring for a patient with a diagnosis of Addisons disease. What sign or symptom is most
closely associated with this health problem?
A) Truncal obesity
B) Hypertension
C) Muscle weakness
D) Moon face

Ans: C
Feedback:
Patients with Addisons disease demonstrate muscular weakness, anorexia, gastrointestinal symptoms,
fatigue, emaciation, dark pigmentation of the skin, and hypotension. Patients with Cushing syndrome
demonstrate truncal obesity, moon face, acne, abdominal striae, and hypertension.

5

The nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test
scheduled for tomorrow. What does the nurse explain that this test will involve?
A) Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3
hours
B) Administration of dexamethasone IV, followed by an x-ray of the adrenal glands
C) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next
morning
D) Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after
the drug is administered

Ans: C
Feedback:
Dexamethasone (1 mg) is administered orally at 11 PM, and a plasma cortisol level is obtained at 8 AM
the next morning. This test can be performed on an outpatient basis and is the most widely used and
sensitive screening test for diagnosis of pituitary and adrenal causes of Cushing syndrome.

6

You are developing a care plan for a patient with Cushing syndrome. What nursing diagnosis would
have the highest priority in this care plan?
A) Risk for injury related to weakness
B) Ineffective breathing pattern related to muscle weakness
C) Risk for loneliness related to disturbed body image
D) Autonomic dysreflexia related to neurologic changes

Ans: A
Feedback:
The nursing priority is to decrease the risk of injury by establishing a protective environment. The
patient who is weak may require assistance from the nurse in ambulating to prevent falls or bumping
corners or furniture. The patients breathing will not be affected and autonomic dysreflexia is not a
plausible risk. Loneliness may or may not be an issue for the patient, but safety is a priority.

7

A 30 year-old female patient has been diagnosed with Cushing syndrome. What psychosocial nursing
diagnosis should the nurse most likely prioritize when planning the patients care?
A) Decisional conflict related to treatment options
B) Spiritual distress related to changes in cognitive function
C) Disturbed body image related to changes in physical appearance
D) Powerlessness related to disease progression

Ans: C
Feedback:
Cushing syndrome causes characteristic physical changes that are likely to result in disturbed body
image. Decisional conflict and powerless may exist, but disturbed body image is more likely to be
present. Cognitive changes take place in patients with Cushing syndrome, but these may or may not
cause spiritual distress.

8

The nurse providing care for a patient with Cushing syndrome has identified the nursing diagnosis of
risk for injury related to weakness. How should the nurse best reduce this risk?
A) Establish falls prevention measures.
B) Encourage bed rest whenever possible.
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 992
C) Encourage the use of assistive devices.
D) Provide constant supervision.

Ans: A
Feedback:
The nurse should take action to prevent the patients risk for falls. Bed rest carries too many harmful
effects, however, and assistive devices may or may not be necessary. Constant supervision is not
normally required or practicable.

9

A patient with Cushing syndrome has been hospitalized after a fall. The dietician consulted works with
the patient to improve the patients nutritional intake. What foods should a patient with Cushing
syndrome eat to optimize health? Select all that apply.
A) Foods high in vitamin D
B) Foods high in calories
C) Foods high in protein
D) Foods high in calcium
E) Foods high in sodium

Ans: A, C, D
Feedback:
Foods high in vitamin D, protein, and calcium are recommended to minimize muscle wasting and
osteoporosis. Referral to a dietitian may assist the patient in selecting appropriate foods that are also low
in sodium and calories.

10

A patient with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal
hypophysectomy. What would be most important for the nurse to monitor before, during, and after
surgery?
A) Blood glucose
B) Assessment of urine for blood
C) Weight
D) Oral temperature

Ans: A
Feedback:
Before, during, and after this surgery, blood glucose monitoring and assessment of stools for blood are
carried out. The patients blood sugar is more likely to be volatile than body weight or temperature.
Hematuria is not a common complication.

11

A nurse is working with a patient who has a diagnosis of Cushing syndrome. When completing a
physical assessment, the nurse should specifically observe for what integumentary manifestation?
A) Alopecia
B) Yellowish skin tone
C) Patchy, bronze pigmentation
D) Hirsutism

Ans: D
Feedback:
Cushing syndrome causes excessive hair growth, especially in women. Alopecia is hair loss from the
scalp and other parts of the body. Jaundice causes a yellow discoloration in light-skinned patients, but
this does not accompany Cushing syndrome. Patients that have Addisons disease exhibit a bronze
discoloration to their skin due to increased melanin production.

12

What should the nurse suspect when hourly assessment of urine output on a patient postcraniotomy
exhibits a urine output from a catheter of 1,500 mL for two consecutive hours?
A) Cushing syndrome
B) Syndrome of inappropriate antidiuretic hormone (SIADH)
C) Adrenal crisis
D) Diabetes insipidus

Ans: D
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1248
Feedback:
Diabetes insipidus is an abrupt onset of extreme polyuria that commonly occurs in patients after brain
surgery. Cushing syndrome is excessive glucocorticoid secretion resulting in sodium and water
retention. SIADH is the result of increased secretion of ADH; the patient becomes volume-overloaded,
urine output diminishes, and serum sodium concentration becomes dilute. Adrenal crisis is
undersecretion of glucocorticoids resulting in profound hypoglycemia, hypovolemia, and hypotension.

13

The nurse caring for a patient with Cushing syndrome is describing the dexamethasone suppression test
scheduled for tomorrow. What does the nurse explain that this test will involve?
A) Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3
hours
B) Administration of dexamethasone IV, followed by an x-ray of the adrenal glands
C) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next
morning
D) Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after
the drug is administered

Ans: C
Feedback:
Dexamethasone (1 mg) is administered orally at 11 PM, and a plasma cortisol level is obtained at 8 AM
the next morning. This test can be performed on an outpatient basis and is the most widely used and
sensitive screening test for diagnosis of pituitary and adrenal causes of Cushing syndrome.

14

You are developing a care plan for a patient with Cushing syndrome. What nursing diagnosis would
have the highest priority in this care plan?
A) Risk for injury related to weakness
B) Ineffective breathing pattern related to muscle weakness
C) Risk for loneliness related to disturbed body image
D) Autonomic dysreflexia related to neurologic changes

Ans: A
Feedback:
The nursing priority is to decrease the risk of injury by establishing a protective environment. The
patient who is weak may require assistance from the nurse in ambulating to prevent falls or bumping
corners or furniture. The patients breathing will not be affected and autonomic dysreflexia is not a
plausible risk. Loneliness may or may not be an issue for the patient, but safety is a priority.

15

What should the nurse suspect when hourly assessment of urine output on a patient postcraniotomy
exhibits a urine output from a catheter of 1,500 mL for two consecutive hours?
A) Cushing syndrome
B) Syndrome of inappropriate antidiuretic hormone (SIADH)
C) Adrenal crisis
D) Diabetes insipidus

Ans: D
Test Bank - Brunner & Suddarth's Textbook of Medical-Surgical Nursing 14e (Hinkle 2017) 1248
Feedback:
Diabetes insipidus is an abrupt onset of extreme polyuria that commonly occurs in patients after brain
surgery. Cushing syndrome is excessive glucocorticoid secretion resulting in sodium and water
retention. SIADH is the result of increased secretion of ADH; the patient becomes volume-overloaded,
urine output diminishes, and serum sodium concentration becomes dilute. Adrenal crisis is
undersecretion of glucocorticoids resulting in profound hypoglycemia, hypovolemia, and hypotension.

16

NEW BOOK

IGNATAVICIUS 9TH

17

A client has a traumatic brain injury. The nurse assesses the following: pulse change from 82 to 60
beats/min, pulse pressure increase from 26 to 40 mm Hg, and respiratory irregularities. What action by the
nurse takes priority?
a. Call the provider or Rapid Response Team.
b. Increase the rate of the IV fluid administration.
c. Notify respiratory therapy for a breathing treatment.
d. Prepare to give IV pain medication.

ANS: A
These manifestations indicate Cushings syndrome, a potentially life-threatening increase in intracranial
pressure (ICP), which is an emergency. Immediate medical attention is necessary, so the nurse notifies the
provider or the Rapid Response Team. Increasing fluids would increase the ICP. The client does not need a
breathing treatment or pain medication.
DIF: Applying/Application REF: 949
KEY: Neurologic disorders| Rapid Response Team| critical rescue
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

18

A nurse plans care for a client with Cushings disease. Which action should the nurse include in this clients
plan of care to prevent injury?
a. Pad the siderails of the clients bed.
b. Assist the client to change positions slowly.
c. Use a lift sheet to change the clients position.
d. Keep suctioning equipment at the clients bedside.

ANS: C
Cushings syndrome or disease greatly increases the serum levels of cortisol, which contributes to excessive
bone demineralization and increases the risk for pathologic bone fracture. Padding the siderails and assisting
the client to change position may be effective, but these measures will not protect him or her as much as using
a lift sheet. The client should not require suctioning.
DIF: Applying/Application REF: 1257
KEY: Adrenal gland disorder| safety
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

19

A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for
hypopituitarism? (Select all that apply.)
a. A 20-year-old female with benign pituitary tumors
b. A 32-year-old male with diplopia
c. A 41-year-old female with anorexia nervosa
d. A 55-year-old male with hypertension
e. A 60-year-old female who is experiencing shock
f. A 68-year-old male who has gained weight recently

ANS: A, C, D, E
Pituitary tumors, anorexia nervosa, hypertension, and shock are all conditions that can cause hypopituitarism.
Diplopia is a manifestation of hypopituitarism, and weight gain is a manifestation of Cushings disease and
syndrome of inappropriate antidiuretic hormone. They are not risk factors for hypopituitarism.
DIF: Remembering/Knowledge REF: 1246
KEY: Pituitary disorder| health screening
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

20

A nurse teaches a client with Cushings disease. Which dietary requirements should the nurse include in this
clients teaching? (Select all that apply.)
a. Low calcium
b. Low carbohydrate
c. Low protein
d. Low calories
e. Low sodium

ANS: B, D, E
The client with Cushings disease has weight gain, muscle loss, hyperglycemia, and sodium retention. Dietary
modifications need to include reduction of carbohydrates and total calories to prevent or reduce the degree of
hyperglycemia. Sodium retention causes water retention and hypertension. Clients are encouraged to restrict
their sodium intake moderately. Clients often have bone density loss and need more calcium. Increased protein
intake will help decrease muscle loss.
DIF: Applying/Application REF: 1258
KEY: Adrenal gland disorder| laboratory values
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

21

A nurse assesses clients with potential endocrine disorders. Which clients are at high risk for adrenal
insufficiency? (Select all that apply.)
a. A 22-year-old female with metastatic cancer
b. A 43-year-old male with tuberculosis
c. A 51-year-old female with asthma
d. A 65-year-old male with gram-negative sepsis
e. A 70-year-old female with hypertension

ANS: A, B, D
Metastatic cancer, tuberculosis, and gram-negative sepsis are primary causes of adrenal insufficiency. Active
tuberculosis is a contributing factor for syndrome of inappropriate antidiuretic hormone. Hypertension is a key
manifestation of Cushings disease. These are not risk factors for adrenal insufficiency.
DIF: Remembering/Knowledge REF: 1248
KEY: Adrenal gland disorder| health screening
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

22

A nurse assesses a client with Cushings disease. Which assessment findings should the nurse correlate with
this disorder? (Select all that apply.)
Test Bank - Medical-Surgical Nursing: Concepts for Interprofessional Collaborative Care 9e 518
a. Moon face
b. Weight loss
c. Hypotension
d. Petechiae
e. Muscle atrophy

ANS: A, D, E
Clinical manifestations of Cushings disease include moon face, weight gain, hypertension, petechiae, and
muscle atrophy.
DIF: Remembering/Knowledge REF: 1257
KEY: Adrenal gland disorder| assessment/diagnostic examination
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

23

NEW BOOK

LEWIS 9TH ED

24

A 37-year-old patient is being admitted with a diagnosis of Cushing syndrome. Which
findings will the nurse expect during the assessment?
a. Chronically low blood pressure
b. Bronzed appearance of the skin
c. Purplish streaks on the abdomen
d. Decreased axillary and pubic hair

ANS: C
Purplish-red striae on the abdomen are a common clinical manifestation of Cushing syndrome.
Hypotension and bronzed-appearing skin are manifestations of Addison’s disease. Decreased axillary and
pubic hair occur with androgen deficiency.
DIF: Cognitive Level: Understand (comprehension) REF: 1208
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity

25

A 44-year-old female patient with Cushing syndrome is admitted for adrenalectomy.
Which intervention by the nurse will be most helpful for a nursing diagnosis of disturbed body
image related to changes in appearance?
a. Reassure the patient that the physical changes are very common in patients with
Cushing syndrome.
b. Discuss the use of diet and exercise in controlling the weight gain associated with
Cushing syndrome.
c. Teach the patient that the metabolic impact of Cushing syndrome is of more
importance than appearance.
d. Remind the patient that most of the physical changes caused by Cushing syndrome
will resolve after surgery.

ANS: D
The most reassuring communication to the patient is that the physical and emotional changes caused by
the Cushing syndrome will resolve after hormone levels return to normal postoperatively. Reassurance
that the physical changes are expected or that there are more serious physiologic problems associated with
Cushing syndrome are not therapeutic responses. The patient’s physiological changes are caused by the
high hormone levels, not by the patient’s diet or exercise choices.
DIF: Cognitive Level: Apply (application) REF: 1210
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

26

After receiving change-of-shift report about the following four patients, which patient
should the nurse assess first?
a. A 31-year-old female with Cushing syndrome and a blood glucose level of 244
mg/dL
b. A 70-year-old female taking levothyroxine (Synthroid) who has an irregular pulse
of 134
c. A 53-year-old male who has Addison’s disease and is due for a scheduled dose of
hydrocortisone (Solu-Cortef).
d. A 22-year-old male admitted with syndrome of inappropriate antidiuretic hormone
(SIADH) who has a serum sodium level of 130 mEq/L

ANS: B
Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias. The
patient’s high pulse rate needs rapid investigation by the nurse to assess for and intervene with any
cardiac problems. The other patients also require nursing assessment and/or actions but are not at risk for
life-threatening complications.
DIF: Cognitive Level: Analyze (analysis) REF: 1203
OBJ: Special Questions: Prioritization; Multiple Patients
TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

27

The cardiac telemetry unit charge nurse receives status reports from other nursing units
about four patients who need cardiac monitoring. Which patient should be transferred to the cardiac
unit first?
a. Patient with Hashimoto’s thyroiditis and a heart rate of 102
b. Patient with tetany who has a new order for IV calcium chloride
c. Patient with Cushing syndrome and a blood glucose of 140 mg/dL
d. Patient with Addison’s disease who takes hydrocortisone twice daily

ANS: B
Emergency treatment of tetany requires IV administration of calcium; ECG monitoring will be required
because cardiac arrest may occur if high calcium levels result from too-rapid administration. The
information about the other patients indicates that they are more stable than the patient with tetany.
DIF: Cognitive Level: Analyze (analysis) REF: 1207
OBJ: Special Questions: Multiple Patients; Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment