Cushing’s Syndrome and Addison’s Disease (10 Questions)

1. M. Jean-Claude Tremblay, 45 years old, has a history of Addison’s Disease (Primary Adrenal Insufficiency). He is brought to the Emergency Department after vomiting for 24 hours due to gastroenteritis. He is confused and extremely weak.

His vital signs are:
*BP: 80/50 mmHg
*HR: 125 bpm
*Temp: 38.2°C
*Glucose: 3.1 mmol/L

The physician orders STAT interventions.

Question:
What is the nurse’s priority intervention for this patient? *

Administer IV D50W to correct the hypoglycemia.

Administer IV Hydrocortisone (Solu-Cortef) and IV Normal Saline bolus.

Administer oral Fludrocortisone (Florinef) immediately.

Administer Gravol (Dimenhydrinate) IV to stop the vomiting.

2. Mme Ginette Gagnon, 60 years old, has been taking high-dose Prednisone for severe Rheumatoid Arthritis for 5 years. She presents to the clinic complaining of a "round face," weight gain in her midsection, and easy bruising. She tells the nurse, "I hate looking like this, so I stopped taking the Prednisone three days ago."

Question:
What is the nurse’s priority assessment based on the patient's statement? *

Assess for signs of hyperglycemia.

Assess for depressive symptoms related to body image.

Assess blood pressure and heart rate for orthostatic hypotension.

Assess the joints for returning arthritis pain.

3. M. Sylvain Roy, 50 years old, is admitted with Cushing’s Syndrome due to an adrenal tumor.

The nurse reviews his morning laboratory results.
*Sodium: 148 mmol/L
*Glucose: 10.5 mmol/L

Question:
Based on the pathophysiology of Cushing’s Syndrome, which other electrolyte imbalance should the nurse anticipate and monitor for cardiac complications? *

Hyperkalemia (High Potassium).

Hypokalemia (Low Potassium).

Hypercalcemia (High Calcium).

Hypomagnesemia (Low Magnesium).

4. Mme Lise Bernier, 32 years old, is being discharged with a new diagnosis of Addison’s Disease. She is prescribed Hydrocortisone and Fludrocortisone. The nurse is providing "Sick Day Rules" teaching.

Question:
Which statement by the patient indicates a correct understanding of the teaching? *

"If I have the flu and a fever, I should stop taking the pills until I feel better."

"I should drink plenty of water and take an extra dose of my medication if I am stressed or sick."

"I only need to take the medication when my skin starts turning bronze."

"I should decrease my salt intake to prevent high blood pressure."

5. M. Marc Lefebvre, 45 years old, is 12 hours post-op following a Transsphenoidal Hypophysectomy (removal of pituitary tumor) to treat Cushing’s Disease. The nurse notes clear fluid dripping from his nose. M. Lefebvre complains of a headache.

Question:
What is the nurse’s initial action? *

Encourge the patient to blow his nose to clear the passage.

Test the drainage for glucose.

Lower the head of the bed to flat.

Administer the prescribed opioid for the headache.

6. Mme Isabelle Bouchard, 28 years old, presents with severe fatigue, weight loss, and "salt cravings." On assessment, the nurse notes hyperpigmentation (bronze skin) on her elbows and knees.

Her vital signs are: BP 90/60 mmHg, HR 98 bpm.

Question:
The physician suspects Addison’s Disease. Which diagnostic test does the nurse prepare the patient for? *

A 24-hour urine collection for Vanillylmandelic acid (VMA).

An ACTH (Adrenocorticotropic Hormone) Stimulation Test.

A Dexamethasone Suppression Test.

A fasting blood glucose test.

7. M. Pierre Morin, 58 years old, has Cushing’s Syndrome. He is admitted to the hospital for a leg ulcer that is not healing.

Assessment:
*BP: 160/94 mmHg.
*Bilateral 2+ edema in ankles.
*Thin, fragile skin with bruising.

Question:
What is the primary priority problem in the Therapeutic Nursing Plan (TNP) for M. Morin regarding his skin? *

Risk for Infection related to immunosuppression and hyperglycemia.

Risk for Falls related to muscle wasting.

Disturbed Body Image related to moon face.

Fluid Volume Deficit related to polyuria.

8. Mme Claudette Dubé, 55 years old, is recovering from a bilateral adrenalectomy for Cushing’s Syndrome. She is on replacement steroid therapy. The nurse enters the room and finds the patient lethargic. BP is 85/52 mmHg.

Question:
The nurse interprets this hemodynamic change as a sign of what potential complication? *

Post-operative hemorrhage.

Adrenal Insufficiency.

Septic shock.

Fluid overload.

9. M. Luc Fortin, 62 years old, has Cushing’s Syndrome. The nurse is reviewing his diet tray. The patient asks, "What should I be eating to help with my condition?"

Question:
Which dietary selection is most appropriate for M. Fortin? *

High Sodium, Low Potassium, High Carbohydrate.

High Sodium, High Fat, Low Calcium, High Carbohydrate.

Low Sodium, High Potassium, High Protein, Low Carbohydrate.

Fluid restriction and low protein.

10. Mme Sophie Côté, 40 years old, has Addison’s Disease. She is admitted with hyperkalemia (K+ 6.2 mmol/L) and cardiac palpitations.

The physician orders:
*Cardiac Monitor.
*Sodium Polystyrene Sulfonate (Kayexalate) PO.
*Hydrocortisone IV.

Question:
The patient asks the nurse, "Why is my potassium so high?" *

"You likely ate too many bananas."

"Your kidneys are failing due to the low blood pressure."

"Because you lack the hormone aldosterone, your body throws away sodium and keeps potassium."

"The cortisol medication causes your body to hold onto potassium."