NSG 4100 Exam 2 – Adrenal Disorders &
Corticosteroid Therapy2026
1. The nurse is caring for someone with adrenal hyperfunction who screams at her spouse, bursts into
tears, and screams at the wall. The client tells the nurse, “I feel like I’m going crazy.” Which of the
following is the appropriate response for the nurse to make?
a) “You feel like this because of your hormone levels.”
b) “I will close the door to your room and restrict visitors.”
c) “I will bring you information about support groups.”
d) “I will ask your doctor about ordering a psychiatric consult.”
Correct answer: a
• a) Correct – Explaining that emotional lability is due to excess cortisol/adrenal hormones
normalizes the experience and reduces fear of “going crazy.”
• b) Incorrect – Restricting visitors and closing the door may increase isolation and fear; it does
not address the client’s understanding.
• c) Incorrect – Support groups are helpful long-term but not the immediate therapeutic response
to acute emotional distress with insight.
• d) Incorrect – A psychiatric consult may eventually be needed, but first the nurse should provide
education linking symptoms to the medical condition.
2. A client on high-dose corticosteroid therapy asks, “Why do I need to keep taking the steroids when I
no longer feel bad?” Which of the following is an appropriate response?
a) “You must decrease the steroids so that your hormones work again.”
b) “Once you start steroids you have to get weaned off of them.”
c) “It is possible for the inflammation to reoccur if you stop the drug.”
d) “The drug suppresses your immune system that needs to be built back up.”
Correct answer: b
• a) Incorrect – Abrupt decrease can cause adrenal crisis; this is not an accurate or safe
explanation.
• b) Correct – Corticosteroids suppress the HPA axis; tapering is needed to allow adrenal function
to recover.
, • c) Incorrect – While disease flare is possible, the main reason for tapering is physiological
dependence, not just inflammation recurrence.
• d) Incorrect – Immune suppression is a side effect, not the reason for gradual withdrawal.
3. A client with Cushing’s syndrome is being cared for by the nurse. Which intervention could the
nurse incorporate into the plan of care?
a) Assess abdominal girth at the same time each day.
b) Assess bony prominences every shift or as needed.
c) Initiate a fluid restriction with a low protein diet.
d) Place in a private room and initiate contact precautions.
Correct answer: a
• a) Correct – Abdominal girth monitoring helps detect progressive truncal obesity and possible
fluid shifts.
• b) Incorrect – Bony prominence assessment is more relevant for immobility; Cushing’s risk is skin
fragility and bruising, not pressure injury as primary focus.
• c) Incorrect – Fluid restriction is not indicated; clients may have hypertension but need protein
for tissue repair.
• d) Incorrect – Contact precautions are not needed; Cushing’s is not infectious.
4. The nurse preceptor is observing a newly hired nurse provide discharge instructions to a client with
Cushing’s syndrome. Which instruction requires intervention?
a) Avoid any unnecessary exposure to others who may be sick or have an infection.
b) Maintain moderate activity like walking with frequent rest periods.
c) Maintain a high carb diet and drink plenty of water throughout the day.
d) Be sure to wear a medical bracelet and carry a medical card with you every time.
Correct answer: c
• a) Incorrect – This is correct due to immunosuppression from hypercortisolism.
• b) Incorrect – Moderate activity with rest is appropriate to prevent muscle wasting and fatigue.
• c) Correct – High carb diet worsens hyperglycemia; clients need low carb, high protein, high
calcium.
• d) Incorrect – Medical alert jewelry is appropriate for adrenal insufficiency risk post-surgery or
taper.
5. The nurse has taught a client with Cushing’s syndrome about dietary changes. Which meal choice
indicates correct understanding?
a) Ham and bean soup, diet carbonated drink.
b) Fried fish and tartar sauce.
c) A BLT with wheat toast and apple juice.
d) Baked chicken breasts, beans, broccoli, and a glass of low fat milk.
,Correct answer: d
• a) Incorrect – Ham is high in sodium; Cushing’s requires low sodium due to fluid retention.
• b) Incorrect – Fried fish and tartar sauce add unhealthy fats and sodium.
• c) Incorrect – BLT has bacon (high sodium, fat) and apple juice is high sugar.
• d) Correct – Lean protein, fiber, low fat dairy (calcium for bone protection), low sodium.
6. A client with adrenal insufficiency is receiving hydrocortisone. Which finding indicates the therapy
is effective?
a) Weight gain of 4 lbs in 2 days.
b) Blood pressure 100/70 mmHg and stable.
c) Serum sodium 130 mEq/L.
d) Blood glucose 60 mg/dL.
Correct answer: b
• a) Incorrect – Rapid weight gain suggests fluid overload, not improvement.
• b) Correct – Adrenal insufficiency causes hypotension; stable normotension indicates
replacement is working.
• c) Incorrect – Hyponatremia is a sign of untreated adrenal insufficiency.
• d) Incorrect – Hypoglycemia indicates continued insufficiency.
7. Which nursing diagnosis has the highest priority for a client with Cushing’s syndrome?
a) Disturbed body image.
b) Risk for infection.
c) Impaired skin integrity.
d) Excessive fluid volume.
Correct answer: b
• a) Incorrect – Important but not life-threatening.
• b) Correct – Hypercortisolism suppresses immunity; infection risk is high priority.
• c) Incorrect – Skin integrity is a concern but secondary to infection risk.
• d) Incorrect – Fluid volume excess occurs but is managed with sodium restriction and diuretics.
8. A client with Cushing’s syndrome has a round, flushed face and a buffalo hump. The nurse explains
these changes are due to:
a) Androgen excess.
b) Mineralocorticoid excess.
c) Cortisol excess.
d) Aldosterone deficiency.
Correct answer: c
, • a) Incorrect – Androgen excess causes hirsutism, not moon facies or buffalo hump.
• b) Incorrect – Mineralocorticoid excess causes hypertension and hypokalemia, not fat
redistribution.
• c) Correct – Cortisol causes central obesity, moon face, buffalo hump.
• d) Incorrect – Aldosterone deficiency causes hypotension and hyperkalemia.
9. The nurse is assessing a client who has been taking prednisone 40 mg daily for 3 months. Which
finding requires immediate notification of the healthcare provider?
a) Moon face and acne.
b) Blood glucose 160 mg/dL.
c) Temperature 101.5°F (38.6°C).
d) Bruising on forearms.
Correct answer: c
• a) Incorrect – Common side effects, not emergent.
• b) Incorrect – Hyperglycemia is expected but not immediately dangerous.
• c) Correct – Fever with immunosuppression suggests serious infection; steroids mask symptoms.
• d) Incorrect – Skin fragility/bruising is expected.
10. A client with Addison’s disease is being discharged on fludrocortisone. Which statement indicates
understanding?
a) “I will stop taking this if I gain weight.”
b) “I will report dizziness when standing up.”
c) “I can take this with grapefruit juice.”
d) “I will take this only when I feel tired.”
Correct answer: b
• a) Incorrect – Weight gain may be expected; stopping causes adrenal crisis.
• b) Correct – Dizziness indicates orthostatic hypotension from low mineralocorticoid effect.
• c) Incorrect – Grapefruit juice affects metabolism of many drugs; not recommended without
checking.
• d) Incorrect – Fludrocortisone must be taken regularly, not PRN.
11. A client with Cushing’s syndrome has a potassium level of 3.0 mEq/L. What should the nurse do
first?
a) Administer oral potassium supplement.
b) Notify the healthcare provider.
c) Check the magnesium level.
d) Place the client on a cardiac monitor.
Correct answer: d
Corticosteroid Therapy2026
1. The nurse is caring for someone with adrenal hyperfunction who screams at her spouse, bursts into
tears, and screams at the wall. The client tells the nurse, “I feel like I’m going crazy.” Which of the
following is the appropriate response for the nurse to make?
a) “You feel like this because of your hormone levels.”
b) “I will close the door to your room and restrict visitors.”
c) “I will bring you information about support groups.”
d) “I will ask your doctor about ordering a psychiatric consult.”
Correct answer: a
• a) Correct – Explaining that emotional lability is due to excess cortisol/adrenal hormones
normalizes the experience and reduces fear of “going crazy.”
• b) Incorrect – Restricting visitors and closing the door may increase isolation and fear; it does
not address the client’s understanding.
• c) Incorrect – Support groups are helpful long-term but not the immediate therapeutic response
to acute emotional distress with insight.
• d) Incorrect – A psychiatric consult may eventually be needed, but first the nurse should provide
education linking symptoms to the medical condition.
2. A client on high-dose corticosteroid therapy asks, “Why do I need to keep taking the steroids when I
no longer feel bad?” Which of the following is an appropriate response?
a) “You must decrease the steroids so that your hormones work again.”
b) “Once you start steroids you have to get weaned off of them.”
c) “It is possible for the inflammation to reoccur if you stop the drug.”
d) “The drug suppresses your immune system that needs to be built back up.”
Correct answer: b
• a) Incorrect – Abrupt decrease can cause adrenal crisis; this is not an accurate or safe
explanation.
• b) Correct – Corticosteroids suppress the HPA axis; tapering is needed to allow adrenal function
to recover.
, • c) Incorrect – While disease flare is possible, the main reason for tapering is physiological
dependence, not just inflammation recurrence.
• d) Incorrect – Immune suppression is a side effect, not the reason for gradual withdrawal.
3. A client with Cushing’s syndrome is being cared for by the nurse. Which intervention could the
nurse incorporate into the plan of care?
a) Assess abdominal girth at the same time each day.
b) Assess bony prominences every shift or as needed.
c) Initiate a fluid restriction with a low protein diet.
d) Place in a private room and initiate contact precautions.
Correct answer: a
• a) Correct – Abdominal girth monitoring helps detect progressive truncal obesity and possible
fluid shifts.
• b) Incorrect – Bony prominence assessment is more relevant for immobility; Cushing’s risk is skin
fragility and bruising, not pressure injury as primary focus.
• c) Incorrect – Fluid restriction is not indicated; clients may have hypertension but need protein
for tissue repair.
• d) Incorrect – Contact precautions are not needed; Cushing’s is not infectious.
4. The nurse preceptor is observing a newly hired nurse provide discharge instructions to a client with
Cushing’s syndrome. Which instruction requires intervention?
a) Avoid any unnecessary exposure to others who may be sick or have an infection.
b) Maintain moderate activity like walking with frequent rest periods.
c) Maintain a high carb diet and drink plenty of water throughout the day.
d) Be sure to wear a medical bracelet and carry a medical card with you every time.
Correct answer: c
• a) Incorrect – This is correct due to immunosuppression from hypercortisolism.
• b) Incorrect – Moderate activity with rest is appropriate to prevent muscle wasting and fatigue.
• c) Correct – High carb diet worsens hyperglycemia; clients need low carb, high protein, high
calcium.
• d) Incorrect – Medical alert jewelry is appropriate for adrenal insufficiency risk post-surgery or
taper.
5. The nurse has taught a client with Cushing’s syndrome about dietary changes. Which meal choice
indicates correct understanding?
a) Ham and bean soup, diet carbonated drink.
b) Fried fish and tartar sauce.
c) A BLT with wheat toast and apple juice.
d) Baked chicken breasts, beans, broccoli, and a glass of low fat milk.
,Correct answer: d
• a) Incorrect – Ham is high in sodium; Cushing’s requires low sodium due to fluid retention.
• b) Incorrect – Fried fish and tartar sauce add unhealthy fats and sodium.
• c) Incorrect – BLT has bacon (high sodium, fat) and apple juice is high sugar.
• d) Correct – Lean protein, fiber, low fat dairy (calcium for bone protection), low sodium.
6. A client with adrenal insufficiency is receiving hydrocortisone. Which finding indicates the therapy
is effective?
a) Weight gain of 4 lbs in 2 days.
b) Blood pressure 100/70 mmHg and stable.
c) Serum sodium 130 mEq/L.
d) Blood glucose 60 mg/dL.
Correct answer: b
• a) Incorrect – Rapid weight gain suggests fluid overload, not improvement.
• b) Correct – Adrenal insufficiency causes hypotension; stable normotension indicates
replacement is working.
• c) Incorrect – Hyponatremia is a sign of untreated adrenal insufficiency.
• d) Incorrect – Hypoglycemia indicates continued insufficiency.
7. Which nursing diagnosis has the highest priority for a client with Cushing’s syndrome?
a) Disturbed body image.
b) Risk for infection.
c) Impaired skin integrity.
d) Excessive fluid volume.
Correct answer: b
• a) Incorrect – Important but not life-threatening.
• b) Correct – Hypercortisolism suppresses immunity; infection risk is high priority.
• c) Incorrect – Skin integrity is a concern but secondary to infection risk.
• d) Incorrect – Fluid volume excess occurs but is managed with sodium restriction and diuretics.
8. A client with Cushing’s syndrome has a round, flushed face and a buffalo hump. The nurse explains
these changes are due to:
a) Androgen excess.
b) Mineralocorticoid excess.
c) Cortisol excess.
d) Aldosterone deficiency.
Correct answer: c
, • a) Incorrect – Androgen excess causes hirsutism, not moon facies or buffalo hump.
• b) Incorrect – Mineralocorticoid excess causes hypertension and hypokalemia, not fat
redistribution.
• c) Correct – Cortisol causes central obesity, moon face, buffalo hump.
• d) Incorrect – Aldosterone deficiency causes hypotension and hyperkalemia.
9. The nurse is assessing a client who has been taking prednisone 40 mg daily for 3 months. Which
finding requires immediate notification of the healthcare provider?
a) Moon face and acne.
b) Blood glucose 160 mg/dL.
c) Temperature 101.5°F (38.6°C).
d) Bruising on forearms.
Correct answer: c
• a) Incorrect – Common side effects, not emergent.
• b) Incorrect – Hyperglycemia is expected but not immediately dangerous.
• c) Correct – Fever with immunosuppression suggests serious infection; steroids mask symptoms.
• d) Incorrect – Skin fragility/bruising is expected.
10. A client with Addison’s disease is being discharged on fludrocortisone. Which statement indicates
understanding?
a) “I will stop taking this if I gain weight.”
b) “I will report dizziness when standing up.”
c) “I can take this with grapefruit juice.”
d) “I will take this only when I feel tired.”
Correct answer: b
• a) Incorrect – Weight gain may be expected; stopping causes adrenal crisis.
• b) Correct – Dizziness indicates orthostatic hypotension from low mineralocorticoid effect.
• c) Incorrect – Grapefruit juice affects metabolism of many drugs; not recommended without
checking.
• d) Incorrect – Fludrocortisone must be taken regularly, not PRN.
11. A client with Cushing’s syndrome has a potassium level of 3.0 mEq/L. What should the nurse do
first?
a) Administer oral potassium supplement.
b) Notify the healthcare provider.
c) Check the magnesium level.
d) Place the client on a cardiac monitor.
Correct answer: d
