Cushings and Addisons

Free preview · Original latest version

Sample questions from Cushings and Addisons

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In the emergency department, a 46-year-old client with known Addison disease reports vomiting for 12 hours and profound weakness. BP is 78/42 mm Hg, HR 128/min, and glucose is 54 mg/dL. Which action should the nurse take first?

   • A.Obtain a urine specimen before starting treatment
   • B.Place the client on a low-sodium diet
   • C.Give oral fludrocortisone with a sip of water
   • D.Administer prescribed IV hydrocortisone and isotonic saline

   Rationale: The client has a likely adrenal crisis with shock and hypoglycemia, requiring immediate IV glucocorticoid and volume replacement. Oral medication is inappropriate during persistent vomiting and would not stabilize the client quickly. Diagnostic specimens and dietary changes must not delay emergency treatment.

2. 2.At change of shift on a medical-surgical unit, a 58-year-old client with Cushing syndrome has glucose 248 mg/dL, BP 168/94 mm Hg, and a new temperature of 38.1 C. Which client should the nurse assess first?

   • A.The client with Cushing syndrome and a new fever
   • B.A client awaiting discharge teaching about prednisone
   • C.A client with chronic back pain asking for an analgesic
   • D.A client with stable Addison disease requesting a meal

   Rationale: Cortisol excess suppresses immune responses, so a new fever may be the first sign of a serious infection. The other clients have needs that can be addressed after this potentially unstable change is assessed. Prioritize new signs of infection in a client with hypercortisolism.

3. 3.On a medical unit, a 63-year-old client with primary adrenal insufficiency is being discharged after stabilization of an adrenal crisis. Which instructions should the nurse include in the discharge plan? Select all that apply.

   • A.Do not stop prescribed glucocorticoids abruptly
   • B.Wear medical identification stating the diagnosis
   • C.Contact the prescriber for a plan to increase steroid dosing during significant illness
   • D.Keep an emergency injectable glucocorticoid available if prescribed
   • E.Restrict sodium intake to prevent fluid retention

   Rationale: Abrupt withdrawal can precipitate adrenal insufficiency, and medical identification helps others respond to an emergency. Significant illness may require a prescribed stress-dose plan, and an emergency injectable medication may be needed if oral dosing is not possible. Sodium restriction is not routine for primary adrenal insufficiency and may be harmful when sodium is low.

4. 4.In an outpatient endocrine clinic, a 39-year-old client taking hydrocortisone for Addison disease says, "I feel better, so I am going to stop the pills today." Which response is best?

   • A."Take the medication only on days when you feel weak."
   • B."Do not stop the medication suddenly; contact your prescriber to discuss any dose change."
   • C."Replace the medication with an over-the-counter salt supplement."
   • D."Stop it now and restart if nausea develops."

   Answer and rationale are in the full material.

5. 5.A client's potassium is 6.2 mEq/L and sodium is 126 mEq/L. The 51-year-old client with suspected Addison disease is on a telemetry unit and reports palpitations. Which action has priority?

   • A.Offer a potassium-rich snack
   • B.Recheck the laboratory values at the next scheduled visit
   • C.Initiate cardiac monitoring and promptly notify the provider
   • D.Encourage the client to ambulate to improve circulation

   Answer and rationale are in the full material.