Addison's vs. Cushing's: A Clinical Quiz

A patient presents with hyperpigmentation, hypotension, and fatigue. Based on these findings, which diagnostic test result would most strongly support a diagnosis of Addison’s disease rather than Cushing’s syndrome?

• Elevated serum cortisol levels

• Decreased serum cortisol levels

• Elevated serum sodium levels

• Decreased ACTH levels

Answer explanation

Decreased serum cortisol levels indicate adrenal insufficiency, supporting Addison's disease. In contrast, Cushing's syndrome typically presents with elevated cortisol levels.

A nurse is planning care for a patient with Cushing’s syndrome. Which intervention should be prioritized to address the patient’s increased risk for infection?

• Encourage a high-protein diet

• Monitor blood glucose levels

• Implement strict hand hygiene protocols

• Restrict visitors

Answer explanation

Implementing strict hand hygiene protocols is crucial for patients with Cushing’s syndrome due to their increased susceptibility to infections from immunosuppression. This intervention directly addresses their heightened infection risk.

A patient with Addison’s disease is admitted with an Addisonian crisis. Which combination of symptoms would require immediate intervention?

• Hypertension, bradycardia, and hyperglycemia

• Hypotension, tachycardia, and hyponatremia

• Edema, moon face, and hypernatremia

• Polyuria, polydipsia, and hyperkalemia

Answer explanation

The combination of hypotension, tachycardia, and hyponatremia indicates severe adrenal insufficiency and requires immediate intervention to prevent shock and restore hemodynamic stability.

A nurse is teaching a patient with Addison’s disease about medication management. Which statement best demonstrates the patient’s understanding of steroid therapy?

• “I should take my medication only when I feel symptoms.”

• “I need to take my medication daily and never stop abruptly.”

• “I can double my dose if I miss a day.”

• “I should avoid taking my medication with food.”

Answer explanation

The correct statement emphasizes the importance of daily medication adherence and the dangers of abrupt discontinuation, which is crucial for managing Addison's disease effectively.

A patient with Cushing’s syndrome is experiencing muscle weakness and osteoporosis. Which nursing intervention is most appropriate to prevent further complications?

• Encourage weight-bearing exercises

• Restrict calcium intake

• Increase sodium in the diet

• Limit physical activity

Answer explanation

Encouraging weight-bearing exercises helps strengthen bones and muscles, counteracting the effects of osteoporosis and muscle weakness in Cushing’s syndrome, thus preventing further complications.

A nurse is planning discharge teaching for a patient with Addison’s disease. Which instruction is most important to prevent an Addisonian crisis?

• Avoid strenuous exercise

• Increase salt intake during hot weather

• Take extra insulin during illness

• Limit fluid intake

Answer explanation

Increasing salt intake during hot weather is crucial for patients with Addison's disease to prevent an Addisonian crisis, as they have impaired ability to retain sodium and may experience low blood pressure and dehydration.

A patient with Cushing’s syndrome is at risk for impaired skin integrity. Which nursing action demonstrates strategic planning to minimize this risk?

• Use adhesive tape for all dressings

• Reposition the patient every 2 hours

• Limit bathing to once a week

• Apply heat packs to pressure areas

Answer explanation

Repositioning the patient every 2 hours helps prevent pressure ulcers and maintains skin integrity, which is crucial for patients with Cushing’s syndrome who are at higher risk for skin issues.

A nurse is reviewing lab results for a patient with suspected Addison’s disease. Which finding would require further investigation to confirm the diagnosis?

• Hyperglycemia

• Hyponatremia

• Hypernatremia

• Hypokalemia

Answer explanation

Hyponatremia is a key indicator of adrenal insufficiency in Addison's disease, as it reflects low aldosterone levels. Further investigation is needed to confirm the diagnosis, unlike hyperglycemia or hypokalemia, which are less specific.

A patient with Cushing’s syndrome asks about the cause of their symptoms. Which explanation best uses evidence to compare and contrast Cushing’s and Addison’s disease?

• “Both conditions are caused by low cortisol levels.”

• “Cushing’s is due to excess cortisol, while Addison’s is due to insufficient cortisol.”

• “Addison’s causes high blood sugar, while Cushing’s causes low blood sugar.”

• “Both conditions result in low sodium levels.”

Answer explanation

The correct choice highlights that Cushing’s syndrome is characterized by excess cortisol production, while Addison’s disease results from insufficient cortisol levels, clearly contrasting the two conditions.

A nurse is developing a care plan for a patient with Addison’s disease. Which intervention is most strategic in preventing hypoglycemia?

• Administer insulin as ordered

• Provide frequent small meals and snacks

• Restrict carbohydrate intake

• Encourage fasting

Answer explanation

Providing frequent small meals and snacks helps maintain stable blood glucose levels, which is crucial for patients with Addison's disease to prevent hypoglycemia. Other options may worsen glucose control.