# Situation: A 44-year-old woman has a rounded face, a fat pad at the back of the neck, purple abdominal striae, and bruises on her forearms. Her blood pressure is 162/98 mmHg. A computed tomography (CT) scan shows a 3-cm mass in the left adrenal gland. She has never taken corticosteroid medicines. The nurse helps her choose meals while she is in the hospital. Which lunch BEST fits the diet usually advised for her condition?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630506  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 44-year-old woman has a rounded face, a fat pad at the back of the neck, purple abdominal striae, and bruises on her forearms. Her blood pressure is 162/98 mmHg. A computed tomography (CT) scan shows a 3-cm mass in the left adrenal gland. She has never taken corticosteroid medicines.

The nurse helps her choose meals while she is in the hospital. Which lunch BEST fits the diet usually advised for her condition?

## 보기

1. Canned meat loaf with rice and a mango
2. Instant noodles with an egg and a banana
3. Grilled fish, boiled squash and a banana **✔ 정답**
4. White rice, fried chicken and soft drink

**정답: 3**

## 해설

Cortisol excess causes sodium retention, hypertension, hyperglycemia, muscle wasting, and potassium loss, so the diet is low in sodium and calories and high in protein and potassium. Grilled fish with a vegetable and a banana meets these goals.

## 심화 해설

What the diet aims to correct
Cortisol excess produces several metabolic effects that diet can help manage. It causes sodium and water retention, contributing to her blood pressure of 162/98 mmHg; hyperglycemia and weight gain; muscle wasting from protein breakdown; and potassium loss in the urine. The diet usually advised is therefore low in sodium, low in calories and simple sugars, high in protein, and rich in potassium. Grilled fish, boiled squash, and a banana provide lean protein, a vegetable, and potassium with little sodium or fat.

Why grilled fish, squash, and banana fit
Grilled fish is a lean protein that helps counter muscle wasting without adding much fat. Boiled squash is a low-calorie vegetable that adds fiber and nutrients without salt from processing. A banana is a familiar potassium-rich fruit that helps replace potassium lost because of cortisol's mineralocorticoid effect. The meal is simply prepared, which keeps sodium low, and it has moderate carbohydrate, which helps glucose control.

| Lunch | Main problem |
| --- | --- |
| Canned meat loaf, rice, mango | Canned meat is high in sodium and fat |
| Instant noodles, egg, banana | Instant noodles are very high in sodium |
| Grilled fish, boiled squash, banana | Fits: lean protein, vegetable, potassium, low sodium |
| White rice, fried chicken, soft drink | Fried food, refined starch, and sugar worsen weight and glucose |

Why the other meals do not fit
Canned meat products are preserved with large amounts of salt and are often high in fat. Instant noodles, a common convenience food, contain very high sodium, especially in the seasoning packet, which worsens fluid retention and hypertension even though the banana adds potassium. White rice with fried chicken and a sugared soft drink provides excess calories, fat, and simple sugar that aggravate weight gain and hyperglycemia. Watch out! An option can include one good item, such as a banana, and still be wrong because the main dish is high in sodium.

Exam takeaway
Diet questions in endocrine disorders test whether you can link each metabolic effect of the hormone to a dietary goal. Key point! For cortisol excess, choose meals low in sodium and calories and high in protein and potassium. Calcium and vitamin D intake are also important because cortisol excess weakens bone.

## 임상 시나리오

Diet in Cortisol ExcessLow sodium, high protein and potassium
Cortisol excess causes sodium retention, hypertension, hyperglycemia, muscle wasting, and potassium loss.

The diet is low in sodium and calories, high in protein, and rich in potassium. Grilled fish, boiled squash, and a banana meet these goals.

Avoid canned meats, instant noodles, fried foods, refined starch, and sugared drinks.

## 핵심 개념

- **Sodium retention** — Holding of sodium and water by the kidneys, which raises blood pressure and causes edema.
- **Muscle wasting** — Loss of muscle mass from protein breakdown, a feature of prolonged cortisol excess.
- **Mineralocorticoid effect** — Action that promotes sodium retention and potassium loss by the kidneys, seen with high cortisol levels.

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