Question

A patient is admitted for treatment of Cushing's syndrome. The nurse correlates this disease process to which alteration in endocrine function?

Answer 1

Correct Answers:

Elevated glucocorticoid level

Rationale :

🔷 Cushing's syndrome results from excessive cortisol, a glucocorticoid hormone secreted by the adrenal cortex.

🔷 Elevated glucocorticoids lead to clinical features like central obesity, moon face, and buffalo hump.

🔷 Cortisol excess also causes hyperglycemia, muscle weakness, and immune suppression.

🔷 Cushing's syndrome may be due to exogenous steroid use or endogenous tumor secretion (e.g., pituitary adenoma).

🔷 The hallmark diagnostic indicator is elevated 24-hour urinary free cortisol or dexamethasone suppression test failure.

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Answer 2

Correct Answers:

Purplish streaks on the abdomen

Rationale :

💠 The purple striae (stretch marks) result from skin thinning and collagen breakdown due to prolonged cortisol elevation.

💠 This skin change is a distinctive sign of Cushing’s syndrome and typically appears over the abdomen, thighs, and breasts.

💠 Hyperpigmentation is not typical in Cushing’s but is seen in Addison’s disease.

💠 Patients may also exhibit truncal obesity, facial fullness, and easy bruising.

💠 The assessment should focus on Cushingoid features linked to long-term corticosteroid exposure.

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Answer 3

Correct Answers:

I will stop taking hydrocortisone when I feel better

Rationale :

♦️ After bilateral adrenalectomy, the body can no longer produce cortisol or aldosterone naturally.

♦️ Lifelong hormone replacement therapy is required; stopping hydrocortisone can lead to an adrenal crisis.

♦️ Adrenal crisis can cause hypotension, shock, and death if not promptly treated.

♦️ Patient education must emphasize the importance of compliance with daily steroid use.

♦️ Clients should also be taught emergency steroid injection techniques in case of illness or trauma.

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Answer 4

Correct Answers:

Eat 15 g of simple carbohydrates

Rationale :

🔶 The symptoms described (headache, anxiety, blurred vision) suggest hypoglycemia.

🔶 In the absence of a glucose monitor, the best action is the “15-15 rule”—15 g of fast-acting carbs, then recheck in 15 minutes.

🔶 Examples of simple carbs include glucose tablets, regular soda, juice, or hard candy.

🔶 Hypoglycemia should be treated immediately to avoid progression to seizures or loss of consciousness.

🔶 Administering insulin without a blood glucose reading is dangerous during suspected hypoglycemia.

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Answer 5

Correct Answers:

Weight gain

Rationale :

⬛ Type 1 diabetes often presents in children with polyphagia and weight loss, despite increased appetite.

⬛ The lack of insulin causes the body to burn fat and muscle for energy, leading to cachexia.

⬛ Other cardinal signs include polyuria, polydipsia, and nocturia.

⬛ Pediatric clients may appear thin, fatigued, and dehydrated at diagnosis.

⬛ Early identification of catabolic symptoms is key to preventing diabetic ketoacidosis (DKA).

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Answer 6

Correct Answers:

Glycosylated hemoglobin (Hemoglobin A1C)

Rationale :

🟢 The A1C test reflects average blood glucose over the previous 2-3 months.

🟢 It is used to evaluate long-term glycemic control in diabetic patients.

🟢 Unlike daily glucose tests, it does not require fasting and gives a broader view of treatment effectiveness.

🟢 Target A1C for most adults is below 7%, although this may vary based on age and comorbidities.

🟢 A1C testing is part of routine diabetic management and guides adjustments in therapy.

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Answer 7

Correct Answers:

Patient stopped taking the medication 2 days ago

Rationale :

🟣 Abrupt discontinuation of prednisone after prolonged use suppresses the hypothalamic-pituitary-adrenal axis, risking adrenal insufficiency.

🟣 Tapering is essential to allow the adrenal glands time to resume natural cortisol production.

🟣 Adrenal insufficiency can cause hypotension, weakness, nausea, and hypoglycemia.

🟣 Any sudden stop in steroid therapy after 2+ weeks should be reported immediately to the healthcare provider.

🟣 Symptoms may be subtle at first but can progress rapidly to life-threatening crisis.

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Answer 8

Correct Answers:

I will need to take medication by mouth until my blood sugar is within normal limits again

Rationale :

🔴 Type 1 diabetes requires lifelong insulin therapy, not oral agents.

🔴 It is an autoimmune destruction of pancreatic beta cells, resulting in absolute insulin deficiency.

🔴 Oral medications are typically ineffective in Type 1 and used for Type 2 diabetes only.

🔴 Misunderstanding this may result in severe hyperglycemia or DKA.

🔴 Patient education should emphasize insulin dependence, self-monitoring, and dietary adjustments.

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Answer 9

Correct Answers:

Metabolic acidosis

Rationale :

⚫ A glucose level of 644 mg/dL in Type 1 diabetes suggests diabetic ketoacidosis (DKA).

⚫ DKA leads to accumulation of ketone bodies, which are acidic, lowering blood pH.

⚫ The acid-base imbalance in DKA is characterized by low pH and low HCO₃⁻, confirming metabolic acidosis.

⚫ Clinical signs include Kussmaul respirations, fruity breath, and confusion.

⚫ Early intervention with IV insulin and fluids is essential to correct acidosis and prevent complications.

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Answer 10

Correct Answers:

Patient states they are scheduled for a CT scan with contrast dye the next day

Rationale :

🟠 Metformin is contraindicated around contrast dye administration due to risk of lactic acidosis, a rare but fatal complication.

🟠 The provider must be notified to stop metformin 24–48 hours before and resume after renal function is confirmed.

🟠 Contrast-induced nephropathy can impair metformin clearance, increasing toxicity.

🟠 Patient safety protocols require pre-procedure medication reconciliation.

🟠 This scenario represents a medication safety issue, requiring prompt intervention.

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Indiana University Medical Surgical Nursing Exam 1

No.

1 :
A patient is admitted for treatment of Cushing's syndrome. The nurse correlates this disease process to which alteration in endocrine function?

2 :
A patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the nurse expect during the assessment?

3 :
Which patient statement indicates a need for further education regarding medications after a bilateral adrenalectomy?

4 :
A college student is newly diagnosed with type 1 diabetes. She now has a headache, changes in her vision, and is anxious, but does not have her portable blood glucose monitor with her. Which action should the campus nurse advise her to take?

5 :
The nurse may notice which clinical manifestation in the pediatric client diagnosed with type 1 diabetes mellitus?

6 :
A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient?

7 :
Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider?

8 :
Which patient statement indicates to the nurse the need for further teaching regarding the new diagnosis of type 1 diabetes mellitus (DM)?

9 :
Jo is a client with Type 1 Diabetes. Jo has a blood glucose level of 644 mg/dL. The nurse interprets that this client is most at risk of developing which type of acid-base imbalance?

10 :
A few weeks after an 82-year-old patient with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding should the nurse promptly discuss with the health care provider?

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Indiana University Medical Surgical Nursing Exam 1

No.

1 : A patient is admitted for treatment of Cushing's syndrome. The nurse correlates this disease process to which alteration in endocrine function?

2 : A patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the nurse expect during the assessment?

3 : Which patient statement indicates a need for further education regarding medications after a bilateral adrenalectomy?

4 : A college student is newly diagnosed with type 1 diabetes. She now has a headache, changes in her vision, and is anxious, but does not have her portable blood glucose monitor with her. Which action should the campus nurse advise her to take?

5 : The nurse may notice which clinical manifestation in the pediatric client diagnosed with type 1 diabetes mellitus?

6 : A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient?

7 : Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider?

8 : Which patient statement indicates to the nurse the need for further teaching regarding the new diagnosis of type 1 diabetes mellitus (DM)?

9 : Jo is a client with Type 1 Diabetes. Jo has a blood glucose level of 644 mg/dL. The nurse interprets that this client is most at risk of developing which type of acid-base imbalance?

10 : A few weeks after an 82-year-old patient with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding should the nurse promptly discuss with the health care provider?

1 :
A patient is admitted for treatment of Cushing's syndrome. The nurse correlates this disease process to which alteration in endocrine function?

2 :
A patient is being admitted with a diagnosis of Cushing syndrome. Which findings will the nurse expect during the assessment?

3 :
Which patient statement indicates a need for further education regarding medications after a bilateral adrenalectomy?

4 :
A college student is newly diagnosed with type 1 diabetes. She now has a headache, changes in her vision, and is anxious, but does not have her portable blood glucose monitor with her. Which action should the campus nurse advise her to take?

5 :
The nurse may notice which clinical manifestation in the pediatric client diagnosed with type 1 diabetes mellitus?

6 :
A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient?

7 :
Which information obtained by the nurse in the endocrine clinic about a patient who has been taking prednisone 40 mg daily for 3 weeks is most important to report to the health care provider?

8 :
Which patient statement indicates to the nurse the need for further teaching regarding the new diagnosis of type 1 diabetes mellitus (DM)?

9 :
Jo is a client with Type 1 Diabetes. Jo has a blood glucose level of 644 mg/dL. The nurse interprets that this client is most at risk of developing which type of acid-base imbalance?

10 :
A few weeks after an 82-year-old patient with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy and taught about appropriate diet and exercise, the home health nurse makes a visit. Which finding should the nurse promptly discuss with the health care provider?