A nurse receives hand-off report about a patient admitted with a diagnosis of Cushing syndrome.
Which findings would the nurse anticipate when the client is assessed?
Chronically low blood pressure and dehydration.
Decreased axillary and pubic hair.
Purplish-red abdominal striae and a "moon face.”.
Bulging of the eyes and intolerance to heat.
The Correct Answer is C
Choice A rationale
Chronically low blood pressure and dehydration are not characteristic of Cushing syndrome. Cushing syndrome is caused by prolonged exposure to high levels of cortisol. Cortisol, a glucocorticoid, increases sodium and water retention and potassium excretion. This fluid retention leads to increased blood volume and hypertension, not low blood pressure. The patient would typically have fluid overload, not dehydration.
Choice B rationale
Decreased axillary and pubic hair, known as sexual hair, is not a typical finding in Cushing syndrome. High cortisol levels can lead to excess androgen production, which in females may result in hirsutism, or excessive growth of male-pattern hair, including on the face, chest, and back. Decreased sexual hair is more commonly associated with conditions like Addison's disease or hypopituitarism, where there is a deficiency of adrenal hormones.
Choice C rationale
Purplish-red abdominal striae and a "moon face" are classic signs of Cushing syndrome. The high cortisol levels cause collagen breakdown, leading to thin, fragile skin that easily tears, forming these striae. The fat redistribution caused by cortisol excess leads to central obesity, a rounded or "moon" face, and a buffalo hump on the upper back. This combination of physical changes is pathognomonic for the condition.
Choice D rationale
Bulging of the eyes, or exophthalmos, and intolerance to heat are classic signs of hyperthyroidism, specifically Graves' disease. These symptoms are caused by an autoimmune process where antibodies stimulate the thyroid gland to produce excess thyroid hormones. They are not associated with Cushing syndrome, which is a disorder of the adrenal cortex and its regulation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Levothyroxine is a synthetic thyroid hormone used for replacement therapy in hypothyroidism, not to decrease overproduction of thyroxine. It mimics the effects of endogenous T4, which is deficient in this condition. The medication is dosed to restore a euthyroid state, which may take weeks, and it doesn't suppress thyroid function in a patient with a dysfunctional gland.
Choice B rationale
The therapeutic effects of levothyroxine are gradual, as it takes time to reach a steady state in the body and for cellular processes to normalize. Clinical improvement in symptoms such as fatigue and weight gain can take several weeks or even months of consistent therapy. Immediate improvement would suggest an alternative diagnosis or is not related to the medication itself.
Choice C rationale
Tremors, nervousness, and insomnia are classic signs and symptoms of hyperthyroidism, or thyrotoxicosis. When a patient on levothyroxine therapy exhibits these symptoms, it indicates that the prescribed dose may be too high, leading to an excess of circulating thyroid hormone. The normal TSH range is 0.4 to 4.0 mIU/L, and a dose that is too high would result in a suppressed TSH level.
Choice D rationale
Levothyroxine is a lifelong replacement therapy for patients with primary hypothyroidism. The thyroid gland's inability to produce sufficient hormone is a chronic condition that does not resolve. Discontinuing the medication would lead to a return of hypothyroid symptoms and a potential hypothyroid crisis. Patients must be taught the importance of continuous daily use.
Correct Answer is B
Explanation
Choice A rationale
Hypoglycemia is a low blood sugar level, which is the opposite of the metabolic changes seen in metabolic syndrome. Metabolic syndrome is characterized by insulin resistance, which can lead to hyperglycemia, not hypoglycemia. Therefore, hypoglycemia is not a risk factor for or a component of metabolic syndrome.
Choice B rationale
Abdominal obesity, defined by a large waist circumference, is a core component and significant risk factor for metabolic syndrome. Excess visceral fat releases inflammatory cytokines and free fatty acids, contributing to insulin resistance, dyslipidemia, and hypertension. This central adiposity is a key diagnostic criterion and a major driver of the condition's pathology.
Choice C rationale
Hyperthyroidism is a condition characterized by an overactive thyroid gland, leading to an increased metabolism. While it can affect glucose metabolism, it is not a primary risk factor or a defining criterion for metabolic syndrome, which is more directly linked to issues with insulin resistance, hypertension, dyslipidemia, and obesity.
Choice D rationale
Hypotension, or low blood pressure, is not a feature of metabolic syndrome. Instead, hypertension, or high blood pressure (systolic ≥130 mmHg or diastolic ≥85 mmHg), is one of the five key components used to diagnose this health condition. Hypotension can have various causes but is not a recognized risk factor.
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