Pathophysiology Exam 4 Practice Questions With Complete
Solutions
Nurse Ronn is assessing a client with possible Cushing's
syndrome. In a client with Cushing's syndrome, the nurse would
expect to find:
A. Hypotension.
B. Thick, coarse skin.
C. Deposits of adipose tissue in the trunk and dorsocervical area.
D. Weight gain in arms and legs.
Correct Answer: 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). Physical examination of the patient will
reveal increased fat deposits in the upper half of the body
leading to “Buffalo torso,” characteristic moon facies (earlobes
are not visible when viewed from the front), thin arms and legs,
acne, hirsutism, proximal muscle weakness of shoulder and hip
girdle muscles, paper-thin skin, abdominal pain due to gut
perforation in rare cases, and wide vertical purplish abdominal
striae.
Option A: Hypertension is caused by fluid retention. Patients
may also have a history of hypertension, peptic ulcer disease,
,and diabetes. Hypertension is a very common comorbidity in
patients with Cushing’s disease/syndrome, resulting from the
interplay of several pathophysiologic mechanisms, including
stimulation of mineralocorticoid and glucocorticoid receptors as
well as the associated insulin resistance, sleep apnea, and
overexpression of renin-angiotensin system.
Option B: Thinning of the skin and other mucous membranes:
the skin becomes dry and bruises easily. Cortisol causes the
breakdown of some dermal proteins along with the weakening
of small blood vessels. In fact, the skin may become so weak as
to develop a shiny, paper-thin quality which allows it to be torn
easily.
Option D: Muscle wasting causes muscle atrophy and thin
extremities. The effect of circulating levels of cortisol on the
muscles varies from slight to marked. Muscle wasting can be so
extensive that the condition stimulates muscular dystrophy.
Marked weakness of the quadriceps muscle often prevents
affected people from rising out of a chair unassisted.
In a 29-year-old female client who is being successfully
treated for Cushing’s syndrome, nurse Lyzette would expect a
decline in:
A. Serum glucose level
B. Hair loss
C. Bone mineralization
D. Menstrual flow
Correct Answer: 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. Cortisol is a
steroid hormone, and it directly affects the transcription and
translation of enzyme proteins involved in the metabolism of
fats, glycogen, proteins synthesis, and Kreb’s cycle. It promotes
the production of free glucose in the body, elevating glucose
levels, while simultaneously increasing insulin resistance.
Option B: Hirsutism is common in Cushing’s syndrome;
therefore, with successful treatment, abnormal hair growth also
declines. Cushing syndrome depends on adrenocorticotropic
hormone (ACTH). It can cause hirsutism, because of the
stimulating nature of ACTH on the reticulated area that can
cause excessive androgen secretion. The features of
hypercorticism are often in the foreground.
Option C: Osteoporosis occurs in Cushing’s syndrome;
therefore, with successful treatment, bone mineralization
increases. It has been well known that patients with Cushing’s
syndrome have frequently osteoporosis or bone loss due to
excess endogenous glucocorticoids and also osteopenia or
osteoporosis is commonly observed in patients with long-term
glucocorticoid therapy.
Option D: Amenorrhea develops in Cushing’s syndrome. With
successful treatment, the client experiences a return of menstrual
flow, not a decline in it. In Cushing’s disease, amenorrhea is
typically due to increased circulating androgens produced by the
, adrenal gland and cortisol can suppress GnRH and therefore LH
and FSH pulsatility.
Nurse Troy is aware that the most appropriate nursing
diagnosis for a patient with Addison’s disease is which of the
following?
A. Excessive fluid volume
B. Risk for infection
C. Urinary retention
D. Hypothermia
Correct Answer: B. Risk for infection
Addison’s disease decreases the production of all adrenal
hormones, compromising the body’s normal stress response and
increasing the risk of infection. Other appropriate nursing
diagnoses for a client with Addison’s disease include Deficient
fluid volume and Hyperthermia.
Option A: Assess skin turgor and mucous membranes for signs
of dehydration. The patient will have dry skin and mucous
membranes. Tenting of the skin will occur. The tongue may
have longitudinal furrows. A BP drop of more than 15 mm Hg
when changing from supine to sitting position, with a concurrent
elevation of 15 beats per min in HR, indicates reduced
circulating fluids.
Option C: Urinary retention isn’t appropriate because
Addison’s disease causes polyuria. Assess color, concentration,
and amount of urine. Urine volume will decrease, urine specific
Solutions
Nurse Ronn is assessing a client with possible Cushing's
syndrome. In a client with Cushing's syndrome, the nurse would
expect to find:
A. Hypotension.
B. Thick, coarse skin.
C. Deposits of adipose tissue in the trunk and dorsocervical area.
D. Weight gain in arms and legs.
Correct Answer: 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). Physical examination of the patient will
reveal increased fat deposits in the upper half of the body
leading to “Buffalo torso,” characteristic moon facies (earlobes
are not visible when viewed from the front), thin arms and legs,
acne, hirsutism, proximal muscle weakness of shoulder and hip
girdle muscles, paper-thin skin, abdominal pain due to gut
perforation in rare cases, and wide vertical purplish abdominal
striae.
Option A: Hypertension is caused by fluid retention. Patients
may also have a history of hypertension, peptic ulcer disease,
,and diabetes. Hypertension is a very common comorbidity in
patients with Cushing’s disease/syndrome, resulting from the
interplay of several pathophysiologic mechanisms, including
stimulation of mineralocorticoid and glucocorticoid receptors as
well as the associated insulin resistance, sleep apnea, and
overexpression of renin-angiotensin system.
Option B: Thinning of the skin and other mucous membranes:
the skin becomes dry and bruises easily. Cortisol causes the
breakdown of some dermal proteins along with the weakening
of small blood vessels. In fact, the skin may become so weak as
to develop a shiny, paper-thin quality which allows it to be torn
easily.
Option D: Muscle wasting causes muscle atrophy and thin
extremities. The effect of circulating levels of cortisol on the
muscles varies from slight to marked. Muscle wasting can be so
extensive that the condition stimulates muscular dystrophy.
Marked weakness of the quadriceps muscle often prevents
affected people from rising out of a chair unassisted.
In a 29-year-old female client who is being successfully
treated for Cushing’s syndrome, nurse Lyzette would expect a
decline in:
A. Serum glucose level
B. Hair loss
C. Bone mineralization
D. Menstrual flow
Correct Answer: 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. Cortisol is a
steroid hormone, and it directly affects the transcription and
translation of enzyme proteins involved in the metabolism of
fats, glycogen, proteins synthesis, and Kreb’s cycle. It promotes
the production of free glucose in the body, elevating glucose
levels, while simultaneously increasing insulin resistance.
Option B: Hirsutism is common in Cushing’s syndrome;
therefore, with successful treatment, abnormal hair growth also
declines. Cushing syndrome depends on adrenocorticotropic
hormone (ACTH). It can cause hirsutism, because of the
stimulating nature of ACTH on the reticulated area that can
cause excessive androgen secretion. The features of
hypercorticism are often in the foreground.
Option C: Osteoporosis occurs in Cushing’s syndrome;
therefore, with successful treatment, bone mineralization
increases. It has been well known that patients with Cushing’s
syndrome have frequently osteoporosis or bone loss due to
excess endogenous glucocorticoids and also osteopenia or
osteoporosis is commonly observed in patients with long-term
glucocorticoid therapy.
Option D: Amenorrhea develops in Cushing’s syndrome. With
successful treatment, the client experiences a return of menstrual
flow, not a decline in it. In Cushing’s disease, amenorrhea is
typically due to increased circulating androgens produced by the
, adrenal gland and cortisol can suppress GnRH and therefore LH
and FSH pulsatility.
Nurse Troy is aware that the most appropriate nursing
diagnosis for a patient with Addison’s disease is which of the
following?
A. Excessive fluid volume
B. Risk for infection
C. Urinary retention
D. Hypothermia
Correct Answer: B. Risk for infection
Addison’s disease decreases the production of all adrenal
hormones, compromising the body’s normal stress response and
increasing the risk of infection. Other appropriate nursing
diagnoses for a client with Addison’s disease include Deficient
fluid volume and Hyperthermia.
Option A: Assess skin turgor and mucous membranes for signs
of dehydration. The patient will have dry skin and mucous
membranes. Tenting of the skin will occur. The tongue may
have longitudinal furrows. A BP drop of more than 15 mm Hg
when changing from supine to sitting position, with a concurrent
elevation of 15 beats per min in HR, indicates reduced
circulating fluids.
Option C: Urinary retention isn’t appropriate because
Addison’s disease causes polyuria. Assess color, concentration,
and amount of urine. Urine volume will decrease, urine specific
