NRSG 337 EXAM 4 QUESTIONS AND
CORRECT DETAILED ANSWERS
2025 NEWEST VERSION
An expected patient problem for a patient admitted to the hospital with symptoms of
diabetes insipidus is
A. excess fluid volume related to intake greater than output.
B. impaired gas exchange related to fluid retention in lungs.
C. risk for impaired skin integrity related to generalized edema.
D. sleep pattern disturbance related to frequent waking to void. - Answer-D
(Patients with DI have significantly increase urine output. All other responses describe
s/sx that would be expected with SIADH.)
A 56-yr-old patient who is disoriented and reports a headache and muscle cramps is
hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The
nurse would expect the initial laboratory results to include a(n)
A. Elevated hematocrit
B. Increased serum chloride
C. Decreased serum sodium
D. Low urine specific gravity - Answer-C
(Remember that the patient with SIADH is retaining too much water, resulting in low
urine output of concentrated urine (would have a high specific gravity). Water
resorption/retention will dilute RBCs (resulting in decreased hematocrit), dilute serum
chloride (the negative ion counterpart to positively charged sodium). Therefore, only "C"
is correct: sodium will decrease (become more diluted), too.)
If caused by exogenous cortisol (meds), what would you expect serum ACTH to be?
A. high
B. low - Answer-B
(Patient has excess glucocorticoid (cortisol) from the meds he is taking (imagine a
patient taking high doses for RA, etc.). His anterior pituitary recognizes there is plenty of
cortisol in the body (it doesn't care that it got there from meds) and decreases/stops
release of ACTH (similar to how a thermostat stops sending the "on" message to a
furnace once there is enough heat in the house). Note that - in the absence of this
,message - the patient's adrenal cortex does not secrete glucocorticoids either (the HPA
axis is on vacation); however, the patient still shows s/sx of Cushing's Syndrome due to
the high doses he is getting in his meds.)
If Cushing's Syndrome is caused by adrenal tumor, what would you expect serum
ACTH to be?
A. high
B. low - Answer-B
(This patient has Cushing's Syndrome (per the top of the slide). It is caused by tumor in
the adrenal gland itself, resulting in too much release of corticosteroids (likely all three
categories). His anterior pituitary recognizes there is plenty of corticosteroids in the
body and (similar to above) decreases/stops release of ACTH. Even though the healthy
adrenal tissue will not release corticosteroids in the absence of the message from the
anterior pituitary (ACTH), the tumor is dysfunctional tissue and keeps releasing the
corticosteroid anyway.)
If caused by a pituitary tumor (Cushing's disease), what would you expect serum ACTH
to be?
A. high
B. low - Answer-A
(This patient has Cushing's disease - a specific type of Cushing's Syndrome with it's
own pathophysiology (a tumor in the anterior pituitary that secretes too much ACTH and
doesn't follow the normal regulatory mechanisms). Consequently, this patient's ACTH
will be high.)
The client admitted for chronic obstructive pulmonary disease (COPD) has developed
Cushing's syndrome. What is the scientific rationale for the development of this
problem?
A. The client's chronic lack of oxygen has destroyed the adrenal glands.
B. The client has a pituitary tumor that causes an overproduction of cortisol.
C. The client has been taking steroid medications for an extended time.
D. It cannot be explained. - Answer-C
(patients with COPD often need corticosteroid medications to decrease respiratory
inflammation; this could lead to Cushing's syndrome from exogenous administration of
high doses)
A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical
assessment of the patient, what should the nurse expect to find?
A. Hypertension, abnormal hair growth, and easy bruising.
B. Weight loss, buffalo hump, and moon face with acne.
C. Abdominal and buttock striae, truncal obesity, and hypotension.
D. Anorexia, signs of dehydration, and hyperpigmentation of the skin. - Answer-A
, (HTN from excess mineralcorticoids; abnormal hair growth from excess androgens;
easy bruising from excess glucocorticoids)
B is not correct as we'd expect weight gain, not loss; C is not correct as we'd expect
hypertension, not hypotension; D is not correct as all listed s/sx are what we'd expect
with a lack of corticosteroids, not an excess.)
Primary adrenal insufficiency: caused by destruction of adrenal tissue (Addison's
disease). What would you expect serum ACTH to be?
A. high
B. low - Answer-A
(Patient's disease resulted in destruction of adrenal cortex tissue. The anterior pituitary
doesn't realize this (but knows levels of corticosteroids in the body are too low) and
keeps secreting more and more ACTH in hopes of activating the adrenal cortex to
action.)
Secondary adrenal insufficiency: caused by a pituitary problem. What would you expect
serum ACTH to be?
A. high
B. low - Answer-B
(The patient suffered damage to the anterior pituitary so it cannot release ACTH (levels
are low).)
The nurse is admitting a client who has been diagnosed with Addison's disease. Which
signs and symptoms support this diagnosis?
a. Bronze pigmentation, hypotension, and hyponatremia
b. Moon face, buffalo hump, and hyperglycemia
c. Hirsutism, fever, irritability
d. Tachycardia, bulging eyes, goiter - Answer-A
((bronze pigmentation from excess ACTH as the anterior pituitary tries to prompt the
adrenal cortex to release hormones; hypotension and hyponatremia from lack of mineral
corticoids)
B and C are not correct as almost all the s/sx are associated with Cushing syndrome
(excess corticosteroids); D is not correct as the s/sx would be expected with
hyperthyroid)
The nurse is caring for a client diagnosed with Addison's disease. Which nursing
interventions should be implemented?
A. Place the client in contact isolation.
B. Administer intravenous and/or oral steroid medications as ordered
C. Provide a brightly lit room and recreational activities.
D. Consult with occupational therapy for work retraining. - Answer-B
CORRECT DETAILED ANSWERS
2025 NEWEST VERSION
An expected patient problem for a patient admitted to the hospital with symptoms of
diabetes insipidus is
A. excess fluid volume related to intake greater than output.
B. impaired gas exchange related to fluid retention in lungs.
C. risk for impaired skin integrity related to generalized edema.
D. sleep pattern disturbance related to frequent waking to void. - Answer-D
(Patients with DI have significantly increase urine output. All other responses describe
s/sx that would be expected with SIADH.)
A 56-yr-old patient who is disoriented and reports a headache and muscle cramps is
hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The
nurse would expect the initial laboratory results to include a(n)
A. Elevated hematocrit
B. Increased serum chloride
C. Decreased serum sodium
D. Low urine specific gravity - Answer-C
(Remember that the patient with SIADH is retaining too much water, resulting in low
urine output of concentrated urine (would have a high specific gravity). Water
resorption/retention will dilute RBCs (resulting in decreased hematocrit), dilute serum
chloride (the negative ion counterpart to positively charged sodium). Therefore, only "C"
is correct: sodium will decrease (become more diluted), too.)
If caused by exogenous cortisol (meds), what would you expect serum ACTH to be?
A. high
B. low - Answer-B
(Patient has excess glucocorticoid (cortisol) from the meds he is taking (imagine a
patient taking high doses for RA, etc.). His anterior pituitary recognizes there is plenty of
cortisol in the body (it doesn't care that it got there from meds) and decreases/stops
release of ACTH (similar to how a thermostat stops sending the "on" message to a
furnace once there is enough heat in the house). Note that - in the absence of this
,message - the patient's adrenal cortex does not secrete glucocorticoids either (the HPA
axis is on vacation); however, the patient still shows s/sx of Cushing's Syndrome due to
the high doses he is getting in his meds.)
If Cushing's Syndrome is caused by adrenal tumor, what would you expect serum
ACTH to be?
A. high
B. low - Answer-B
(This patient has Cushing's Syndrome (per the top of the slide). It is caused by tumor in
the adrenal gland itself, resulting in too much release of corticosteroids (likely all three
categories). His anterior pituitary recognizes there is plenty of corticosteroids in the
body and (similar to above) decreases/stops release of ACTH. Even though the healthy
adrenal tissue will not release corticosteroids in the absence of the message from the
anterior pituitary (ACTH), the tumor is dysfunctional tissue and keeps releasing the
corticosteroid anyway.)
If caused by a pituitary tumor (Cushing's disease), what would you expect serum ACTH
to be?
A. high
B. low - Answer-A
(This patient has Cushing's disease - a specific type of Cushing's Syndrome with it's
own pathophysiology (a tumor in the anterior pituitary that secretes too much ACTH and
doesn't follow the normal regulatory mechanisms). Consequently, this patient's ACTH
will be high.)
The client admitted for chronic obstructive pulmonary disease (COPD) has developed
Cushing's syndrome. What is the scientific rationale for the development of this
problem?
A. The client's chronic lack of oxygen has destroyed the adrenal glands.
B. The client has a pituitary tumor that causes an overproduction of cortisol.
C. The client has been taking steroid medications for an extended time.
D. It cannot be explained. - Answer-C
(patients with COPD often need corticosteroid medications to decrease respiratory
inflammation; this could lead to Cushing's syndrome from exogenous administration of
high doses)
A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical
assessment of the patient, what should the nurse expect to find?
A. Hypertension, abnormal hair growth, and easy bruising.
B. Weight loss, buffalo hump, and moon face with acne.
C. Abdominal and buttock striae, truncal obesity, and hypotension.
D. Anorexia, signs of dehydration, and hyperpigmentation of the skin. - Answer-A
, (HTN from excess mineralcorticoids; abnormal hair growth from excess androgens;
easy bruising from excess glucocorticoids)
B is not correct as we'd expect weight gain, not loss; C is not correct as we'd expect
hypertension, not hypotension; D is not correct as all listed s/sx are what we'd expect
with a lack of corticosteroids, not an excess.)
Primary adrenal insufficiency: caused by destruction of adrenal tissue (Addison's
disease). What would you expect serum ACTH to be?
A. high
B. low - Answer-A
(Patient's disease resulted in destruction of adrenal cortex tissue. The anterior pituitary
doesn't realize this (but knows levels of corticosteroids in the body are too low) and
keeps secreting more and more ACTH in hopes of activating the adrenal cortex to
action.)
Secondary adrenal insufficiency: caused by a pituitary problem. What would you expect
serum ACTH to be?
A. high
B. low - Answer-B
(The patient suffered damage to the anterior pituitary so it cannot release ACTH (levels
are low).)
The nurse is admitting a client who has been diagnosed with Addison's disease. Which
signs and symptoms support this diagnosis?
a. Bronze pigmentation, hypotension, and hyponatremia
b. Moon face, buffalo hump, and hyperglycemia
c. Hirsutism, fever, irritability
d. Tachycardia, bulging eyes, goiter - Answer-A
((bronze pigmentation from excess ACTH as the anterior pituitary tries to prompt the
adrenal cortex to release hormones; hypotension and hyponatremia from lack of mineral
corticoids)
B and C are not correct as almost all the s/sx are associated with Cushing syndrome
(excess corticosteroids); D is not correct as the s/sx would be expected with
hyperthyroid)
The nurse is caring for a client diagnosed with Addison's disease. Which nursing
interventions should be implemented?
A. Place the client in contact isolation.
B. Administer intravenous and/or oral steroid medications as ordered
C. Provide a brightly lit room and recreational activities.
D. Consult with occupational therapy for work retraining. - Answer-B
