,Maryville NURS 623 Exam 2 | Adult-Gerontology Health
Care II (2026) Q&A
1. Which laboratory pattern is most characteristic of primary adrenal insufficiency
(Addison disease)?
A) Increased cortisol, hypernatremia, hypokalemia
B) Decreased cortisol, hyponatremia, hyperkalemia
C) Increased cortisol, hyponatremia, hyperkalemia
D) Decreased cortisol, hypernatremia, hypokalemia
Correct Answer: Decreased cortisol, hyponatremia, hyperkalemia
Rationale: Primary adrenal insufficiency causes cortisol and aldosterone deficiency.
Aldosterone deficiency leads to sodium loss (hyponatremia) and potassium retention
(hyperkalemia), while cortisol is low. The pattern of increased cortisol with hypernatremia
and hypokalemia is seen in Cushing syndrome.
2. A 52-year-old female presents with central obesity, a rounded face, easy bruising, and a
dorsocervical fat pad. Which underlying mechanism best explains these findings?
A) Excess aldosterone secretion
B) Chronic exposure to excessive cortisol
C) Deficiency of parathyroid hormone
D) Excessive thyroid hormone production
Correct Answer: Chronic exposure to excessive cortisol
Rationale: The constellation of central obesity, moon facies, easy bruising, and a buffalo
hump is classic for Cushing syndrome, caused by chronic glucocorticoid excess. Aldosterone
,excess causes hypertension and hypokalemia, parathyroid hormone deficiency causes
hypocalcemia, and thyroid hormone excess causes weight loss and heat intolerance.
3. Which test is the most reliable screening test for Cushing syndrome when the diagnosis is
suspected?
A) Random serum cortisol
B) Overnight dexamethasone suppression test
C) Serum aldosterone level
D) Thyroid-stimulating hormone level
Correct Answer: Overnight dexamethasone suppression test
Rationale: The overnight dexamethasone suppression test is a standard screening test for
Cushing syndrome because it assesses the normal feedback suppression of cortisol. A
random cortisol level is not reliable due to diurnal variation, and aldosterone and TSH
assess different endocrine axes.
4. A patient with known Cushing disease is scheduled for transsphenoidal surgery. Which
preoperative teaching point is most important?
A) Lifelong hormone replacement will not be needed
B) Cortisol levels will fall after surgery and may require replacement
C) The surgery cures the condition immediately without further monitoring
D) Potassium levels will rise permanently after surgery
Correct Answer: Cortisol levels will fall after surgery and may require replacement
Rationale: After removal of an ACTH-secreting pituitary adenoma, cortisol levels fall
rapidly, and patients may require temporary or lifelong glucocorticoid replacement until
, the hypothalamic-pituitary-adrenal axis recovers. Lifelong replacement is not always
needed, cure is not immediate without monitoring, and potassium changes are variable.
5. Which finding is most consistent with primary hyperaldosteronism (Conn syndrome)?
A) Hypokalemia and hypertension
B) Hyperkalemia and hypotension
C) Hypernatremia and hypokalemia
D) Hypocalcemia and hypertension
Correct Answer: Hypokalemia and hypertension
Rationale: Primary hyperaldosteronism causes sodium retention and potassium
excretion, leading to hypertension and hypokalemia. Hyperkalemia with hypotension
suggests adrenal insufficiency, hypernatremia with hypokalemia can occur in Cushing
syndrome, and hypocalcemia with hypertension is not characteristic.
6. A patient with type 1 diabetes presents with nausea, vomiting, abdominal pain, and
Kussmaul respirations. Laboratory findings show glucose 520 mg/dL, pH 7.15, and
bicarbonate 10 mEq/L. Which is the priority intervention?
A) Administer subcutaneous insulin
B) Administer intravenous fluids and insulin
C) Administer oral glucose gel
D) Encourage a high-carbohydrate meal
Correct Answer: Administer intravenous fluids and insulin
Rationale: This presentation is consistent with diabetic ketoacidosis, which requires
aggressive intravenous fluid resuscitation and intravenous insulin as priority interventions.
Care II (2026) Q&A
1. Which laboratory pattern is most characteristic of primary adrenal insufficiency
(Addison disease)?
A) Increased cortisol, hypernatremia, hypokalemia
B) Decreased cortisol, hyponatremia, hyperkalemia
C) Increased cortisol, hyponatremia, hyperkalemia
D) Decreased cortisol, hypernatremia, hypokalemia
Correct Answer: Decreased cortisol, hyponatremia, hyperkalemia
Rationale: Primary adrenal insufficiency causes cortisol and aldosterone deficiency.
Aldosterone deficiency leads to sodium loss (hyponatremia) and potassium retention
(hyperkalemia), while cortisol is low. The pattern of increased cortisol with hypernatremia
and hypokalemia is seen in Cushing syndrome.
2. A 52-year-old female presents with central obesity, a rounded face, easy bruising, and a
dorsocervical fat pad. Which underlying mechanism best explains these findings?
A) Excess aldosterone secretion
B) Chronic exposure to excessive cortisol
C) Deficiency of parathyroid hormone
D) Excessive thyroid hormone production
Correct Answer: Chronic exposure to excessive cortisol
Rationale: The constellation of central obesity, moon facies, easy bruising, and a buffalo
hump is classic for Cushing syndrome, caused by chronic glucocorticoid excess. Aldosterone
,excess causes hypertension and hypokalemia, parathyroid hormone deficiency causes
hypocalcemia, and thyroid hormone excess causes weight loss and heat intolerance.
3. Which test is the most reliable screening test for Cushing syndrome when the diagnosis is
suspected?
A) Random serum cortisol
B) Overnight dexamethasone suppression test
C) Serum aldosterone level
D) Thyroid-stimulating hormone level
Correct Answer: Overnight dexamethasone suppression test
Rationale: The overnight dexamethasone suppression test is a standard screening test for
Cushing syndrome because it assesses the normal feedback suppression of cortisol. A
random cortisol level is not reliable due to diurnal variation, and aldosterone and TSH
assess different endocrine axes.
4. A patient with known Cushing disease is scheduled for transsphenoidal surgery. Which
preoperative teaching point is most important?
A) Lifelong hormone replacement will not be needed
B) Cortisol levels will fall after surgery and may require replacement
C) The surgery cures the condition immediately without further monitoring
D) Potassium levels will rise permanently after surgery
Correct Answer: Cortisol levels will fall after surgery and may require replacement
Rationale: After removal of an ACTH-secreting pituitary adenoma, cortisol levels fall
rapidly, and patients may require temporary or lifelong glucocorticoid replacement until
, the hypothalamic-pituitary-adrenal axis recovers. Lifelong replacement is not always
needed, cure is not immediate without monitoring, and potassium changes are variable.
5. Which finding is most consistent with primary hyperaldosteronism (Conn syndrome)?
A) Hypokalemia and hypertension
B) Hyperkalemia and hypotension
C) Hypernatremia and hypokalemia
D) Hypocalcemia and hypertension
Correct Answer: Hypokalemia and hypertension
Rationale: Primary hyperaldosteronism causes sodium retention and potassium
excretion, leading to hypertension and hypokalemia. Hyperkalemia with hypotension
suggests adrenal insufficiency, hypernatremia with hypokalemia can occur in Cushing
syndrome, and hypocalcemia with hypertension is not characteristic.
6. A patient with type 1 diabetes presents with nausea, vomiting, abdominal pain, and
Kussmaul respirations. Laboratory findings show glucose 520 mg/dL, pH 7.15, and
bicarbonate 10 mEq/L. Which is the priority intervention?
A) Administer subcutaneous insulin
B) Administer intravenous fluids and insulin
C) Administer oral glucose gel
D) Encourage a high-carbohydrate meal
Correct Answer: Administer intravenous fluids and insulin
Rationale: This presentation is consistent with diabetic ketoacidosis, which requires
aggressive intravenous fluid resuscitation and intravenous insulin as priority interventions.
