,NURS 6560 Final Exam Advanced Practice Acute Care II Questions
And Answers 2026/2027 Walden University
Course: NURS 6560
University: Walden University
Assessment: Final Exam
Area: Advanced Practice Care of Adults in Acute Care Settings II
1.
A patient presents with progressive central obesity, proximal muscle
weakness, hypertension, purple abdominal striae, and easy bruising. Which
condition should be suspected?
A) Cushing syndrome
B) Addison disease
C) Hyperthyroidism
D) Primary hyperaldosteronism
Answer: A) Cushing syndrome
Rationale: The combination of central obesity, proximal muscle weakness,
hypertension, skin thinning, and violaceous striae is characteristic of cortisol
excess.
2.
Which initial test can be used to screen for endogenous Cushing syndrome?
A) Overnight dexamethasone suppression test
B) Serum sodium alone
C) TSH only
D) CBC only
Answer: A) Overnight dexamethasone suppression test
Rationale: The overnight low-dose dexamethasone suppression test is one
accepted screening approach for hypercortisolism.
3.
A patient with suspected Cushing syndrome has an elevated 24-hour urinary
free cortisol level. What does this finding indicate?
A) Hypercortisolism may be present
B) Primary adrenal insufficiency is confirmed
,C) Hypothyroidism is confirmed
D) Pheochromocytoma is excluded
Answer: A) Hypercortisolism may be present
Rationale: Elevated urinary free cortisol supports excessive cortisol
production but does not by itself determine the cause.
4.
A patient has confirmed hypercortisolism and a low ACTH level. Which source
is most likely?
A) Adrenal cortisol production
B) Pituitary ACTH-secreting adenoma
C) Ectopic ACTH production
D) Exogenous insulin therapy
Answer: A) Adrenal cortisol production
Rationale: Low ACTH in the presence of cortisol excess suggests an ACTH-
independent adrenal source or exogenous glucocorticoid exposure.
5.
Which finding is more consistent with primary adrenal insufficiency?
A) Hyperkalemia and hyponatremia
B) Hypokalemia and hypernatremia
C) Hypernatremia and metabolic alkalosis
D) Hyperglycemia with edema
Answer: A) Hyperkalemia and hyponatremia
Rationale: Mineralocorticoid deficiency in primary adrenal insufficiency
causes sodium loss and potassium retention.
6.
A patient with adrenal insufficiency develops severe vomiting, abdominal
pain, hypotension, and altered mental status. Which condition should be
suspected?
A) Adrenal crisis
B) Thyroid storm
C) HHS
D) SIADH
Answer: A) Adrenal crisis
, Rationale: Acute glucocorticoid deficiency can cause profound hypotension,
gastrointestinal symptoms, electrolyte abnormalities, and altered mentation.
7.
Which medication is essential in the acute management of adrenal crisis?
A) IV hydrocortisone
B) Methimazole
C) Metformin
D) Propranolol
Answer: A) IV hydrocortisone
Rationale: Prompt parenteral glucocorticoid replacement is central to
treatment.
8.
A patient has episodic severe hypertension, palpitations, diaphoresis, and
headaches. Which diagnosis should be considered?
A) Pheochromocytoma
B) Addison disease
C) Hypothyroidism
D) Diabetes insipidus
Answer: A) Pheochromocytoma
Rationale: Episodic catecholamine excess can cause hypertension,
headache, palpitations, sweating, and tremulousness.
9.
Which laboratory approach is useful when pheochromocytoma is suspected?
A) Plasma-free or urinary fractionated metanephrines
B) Serum TSH alone
C) CBC only
D) Troponin only
Answer: A) Plasma-free or urinary fractionated metanephrines
Rationale: Metanephrine testing is commonly used because catecholamine
metabolites are continuously produced by pheochromocytoma tissue.
10.
Which medication sequence is important in a patient with
pheochromocytoma who requires adrenergic blockade?
And Answers 2026/2027 Walden University
Course: NURS 6560
University: Walden University
Assessment: Final Exam
Area: Advanced Practice Care of Adults in Acute Care Settings II
1.
A patient presents with progressive central obesity, proximal muscle
weakness, hypertension, purple abdominal striae, and easy bruising. Which
condition should be suspected?
A) Cushing syndrome
B) Addison disease
C) Hyperthyroidism
D) Primary hyperaldosteronism
Answer: A) Cushing syndrome
Rationale: The combination of central obesity, proximal muscle weakness,
hypertension, skin thinning, and violaceous striae is characteristic of cortisol
excess.
2.
Which initial test can be used to screen for endogenous Cushing syndrome?
A) Overnight dexamethasone suppression test
B) Serum sodium alone
C) TSH only
D) CBC only
Answer: A) Overnight dexamethasone suppression test
Rationale: The overnight low-dose dexamethasone suppression test is one
accepted screening approach for hypercortisolism.
3.
A patient with suspected Cushing syndrome has an elevated 24-hour urinary
free cortisol level. What does this finding indicate?
A) Hypercortisolism may be present
B) Primary adrenal insufficiency is confirmed
,C) Hypothyroidism is confirmed
D) Pheochromocytoma is excluded
Answer: A) Hypercortisolism may be present
Rationale: Elevated urinary free cortisol supports excessive cortisol
production but does not by itself determine the cause.
4.
A patient has confirmed hypercortisolism and a low ACTH level. Which source
is most likely?
A) Adrenal cortisol production
B) Pituitary ACTH-secreting adenoma
C) Ectopic ACTH production
D) Exogenous insulin therapy
Answer: A) Adrenal cortisol production
Rationale: Low ACTH in the presence of cortisol excess suggests an ACTH-
independent adrenal source or exogenous glucocorticoid exposure.
5.
Which finding is more consistent with primary adrenal insufficiency?
A) Hyperkalemia and hyponatremia
B) Hypokalemia and hypernatremia
C) Hypernatremia and metabolic alkalosis
D) Hyperglycemia with edema
Answer: A) Hyperkalemia and hyponatremia
Rationale: Mineralocorticoid deficiency in primary adrenal insufficiency
causes sodium loss and potassium retention.
6.
A patient with adrenal insufficiency develops severe vomiting, abdominal
pain, hypotension, and altered mental status. Which condition should be
suspected?
A) Adrenal crisis
B) Thyroid storm
C) HHS
D) SIADH
Answer: A) Adrenal crisis
, Rationale: Acute glucocorticoid deficiency can cause profound hypotension,
gastrointestinal symptoms, electrolyte abnormalities, and altered mentation.
7.
Which medication is essential in the acute management of adrenal crisis?
A) IV hydrocortisone
B) Methimazole
C) Metformin
D) Propranolol
Answer: A) IV hydrocortisone
Rationale: Prompt parenteral glucocorticoid replacement is central to
treatment.
8.
A patient has episodic severe hypertension, palpitations, diaphoresis, and
headaches. Which diagnosis should be considered?
A) Pheochromocytoma
B) Addison disease
C) Hypothyroidism
D) Diabetes insipidus
Answer: A) Pheochromocytoma
Rationale: Episodic catecholamine excess can cause hypertension,
headache, palpitations, sweating, and tremulousness.
9.
Which laboratory approach is useful when pheochromocytoma is suspected?
A) Plasma-free or urinary fractionated metanephrines
B) Serum TSH alone
C) CBC only
D) Troponin only
Answer: A) Plasma-free or urinary fractionated metanephrines
Rationale: Metanephrine testing is commonly used because catecholamine
metabolites are continuously produced by pheochromocytoma tissue.
10.
Which medication sequence is important in a patient with
pheochromocytoma who requires adrenergic blockade?
