ENDOCRINE SYSTEMS

1. A patient is admitted to the medical unit with possible Graves disease (hyperthyroidism). Which assessment finding
supports this diagnosis?

a. Periorbital edema
b. Bradycardia
c. Exophthalmos
d. Hoarse voice


2. Which change in vital signs would you instruct a nursing assistant to report immediately for a patient with
hyperthyroidism?

a. Increased and rapid heart rate
b. Decrease systolic blood pressure
c. Increased respiratory rate
d. Decreased oral temperature


3. For the patient with hyperthyroidism, what intervention should you delegate to the experienced certified nursing
assistant?

a. Instruct the patient to report palpitations, dyspnea, vertigo, pr chest pain.
b. Check the apical pulse, blood pressure, and temperature every 4 hours.
c. Draw blood for thyroid-stimulating hormone, T3, and T4 levels.
d. Explain the side effects of propylthiouracil (PTU) to the patient.


4. As the shift begins, you are assigned these patients. Which patient should you assess first?

a. A 38-year-old patient with Graves disease and a heart rate of 94/minute
b. A 63-year-old patient with type 2 diabetes and fingerstick glucose of 137 mg/dL
c. A 58-year-old patient with hypothyroidism and heart rate of 48/minute
d. A 49-year-old patient with Cushings disease and +1 dependent edema


5. A patient is hospitalized with adrenocortical insufficiency. Which nursing activity should you delegate to the nursing
assistant?

a. Remind patient to change positions slowly.
b. Check the patient for muscle weakness
c. Teach the patient how to collect 24-hour urine
d. Plan nursing interventions to promote fluid balance

6. You assess a patient with Cushings disease. For which finding will you notify the physician immediately?

a. Purple striae present on abdomen and thighs
b. Weight gain of 1 pound since the previous day
c. +1 dependent edema in ankles and calves
d. Crackles bilaterally in lower lobes of lungs


7. The patient with pheochromocytoma had surgery to remove his adrenal glands. Which nursing intervention should
you delegate to the nursing assistant?

a. Add strategies to provide a calm and restful environment post-operatively to the care plan.
b. Warm the patient to avoid smoking and drinking caffeinated beverages
c. Monitor the patients skin and mucous membranes for signs of adequate hydration.
d. Monitor lying and standing blood pressure every 4 hours with cuff placed on same arm


8. For the patient with pheochromocytoma, what physical assessment technique should you instruct the LPN/LVN to
avoid?
________________________________________________________


9. The patient with adrenal insufficiency is to be discharged taking prednisone 10 mg orally each day. What will you
be sure to teach the patient?

a. Report excessive weigh gain or swelling to the physician.
b. Rapid changes of position may cause hypotension.
c. A diet with foods high in potassium may be beneficial.
d. Signs of hypoglycemia may occur while taking this drug.


10.You are caring for a patient who is post-hypophysectomy for hyperpituitarism. Which post-operative finding
requires immediate intervention?

a. Presence of glucose in nasal drainage
b. Nasal packing present in nares
c. Urine output of 40 50 mL per hour
d. Patient complaints of thirst


11.Which patients nursing care would be most appropriate for the charge nurse to assign to the LPN, under the
supervision of the RN team leader?

a. A 51-year-old patient with bilateral adrenalectomy just returned from the post-anesthesia care unit
b. An 83-year-old patient with type 2 diabetes and chronic obstructive pulmonary disease
c. A 38-year-old patient with myocardial infarction who is preparing for discharge
d. A 72-year-old patient admitted from long-term care with mental status changes


12.You are providing care for a patient who underwent thyroidectomy 2 days ago. Which laboratory value requires
close monitoring?

a. Calcium
b. Sodium
c. Potassium
d. White blood cells


13.You are preparing to review a teaching plan for a patient with type 2 diabetes. What will you check to determine
the patients level of compliance with his diabetic regimen?

a. Patients fasting glucose level
b. Patients oral glucose tolerance test results
c. Patients glycosylated hemoglobin assay
d. Patients fingerstick glucose check for 24 hours


14.The patient has newly diagnosed type 2 diabetes. Which task should you delegate to the nursing assistant?

a. Arrange consult with the dietician for patient.
b. Verify patients insulin injection technique.
c. Teach patient to use glucometer for monitoring glucose at home.
d. Remind patient to check glucose level prior to each meal.


15.A nursing diagnosis for the newly diagnosed diabetic patient is risk for Injury related to sensory alterations. Which
key points should you include in the teaching plan for this patient? (Choose all that apply).

a. Clean and inspect your feet every day.
b. Be sure that your shoes fit properly.
c. Nylon socks are best to prevent friction between toes and shoes.
d. Report any non-healing skin breaks to your doctor.


16.The diabetic patient has all of these assessment bindings. Which will you instruct the LPN/LVN to report
immediately?

a. Fingerstick glucose of 185 mg/dL
b. Numbness and tingling in both feet
c. Profuse perspiration
d. Bunion on left great toe


17.The plan of care for the diabetic patient includes all of the following interventions. Which intervention could you
delegate to the nursing assistant?

a. Check to make sure that the patients bath water is not too hot.
b. Discuss community resources for diabetic outpatient care.
c. Instruct the patient to perform daily foot inspections.
d. Check the patients technique for drawing insulin into a syringe.


18.You are precepting a nurse who has recently graduated and passes the NCLEX examination. The new nurse has
been on the unit for only 2 days. Which patient should you assign to the new nurse?

a. A 68-year-old diabetic who is experiencing signs of hyperglycemia including rapid, deep breathing and mental
status changes
b. A 58-year-old diabetic with peripheral neuropathy and cellulitis of the left ankle.
c. A 49-year-old diabetic who has just returned from post-anesthesia care unit (PACU) after a below-the-knee
amputation (BKA)
d. A 72-year-old diabetic with diabetic ketoacidosis (DKA) on an IV insulin drip


19.In the emergency department, during initial assessment of a new admission with diabetes, you discover all of the
following. Which information should you immediately report to the physician?

a. Hammertoe of the left second metatarsophalangeal joint
b. Rapid respiratory rate with deep inspirations
c. Numbness and tingling bilaterally in the feet and hands
d. Decreased sensitivity and swelling of the abdomen


20.You are caring for a diabetic patient who is developing DKA. Which delegated task is most appropriate?

a. Ask the unit clerk to page the physician to come to the unit.
b. Ask the LPN/LVN to administer IV insulin according to the sliding scale.
c. Ask the nursing assistant to check the patients level of consciousness.
d. Ask the nursing assistant to get the patient a cup of orange juice.


21.A diabetic patient presents with hot and dry skin, rapid and deep respirations, and a fruity odor to his breath. As
charge nurse, you observe the new graduate RN accomplishing all these patient tasks. Which one requires that you
intervene immediately?

a. The RN checks the patients fingerstick glucose.
b. The RN encourages the patient to drink orange juice.
c. The RN checks the patients order for sliding scale insulin.
d. The RN assess the patients vital signs every 15 minutes


22.You are preparing a 24-year-old patient with diabetes insipidus (DI) for discharge from the hospital. Which
statement indicates that the patient needs additional teaching?

a. I will drink fluids equal to the amount of my urine output.
b. I will weigh myself every day using the same scale.
c. I will wear my medical alert bracelet at all times.
d. I will gradually wean myself off the vasopressin.

1. ANSWER C Exophthalmos (abnormal protrusion of the eye) is characteristic of patients with hyperthyroidism
due to Graves disease. Periorbital edema, bradycardia, and hoarse voice are all characteristics of patients
with hypothyroidism. Focus: Prioritization

2. ANSWER A The cardiac problems associated with hyperthyroidism include tachycardia, increased systolic
blood pressure, and decreased diastolic blood pressure. Patients with hyperthyroidism also may have
increased body temperature related to increased metabolic rate. Focus: Delegation/supervision

3. ANSWER B Monitoring and recording vital signs are within the education scope of nursing assistants. An
experienced nursing assistant should have been taught how to monitor the apical pulse. However, the nurse
should observe the nursing assistant to be sure that she has mastered this skill. Instructing and teaching
patients, as well as performing venipuncture for laboratory samples, are more suited to the educational scope
of licensed nurses. In some facilities, an experienced nursing assistant may perform venipuncture, but only
after special training. Focus: Delegation/supervision

4. ANSWER C Although patients with hypothyroidism often have cardiac problems that include bradycardia,
a heart rate of 48/minute may have significant implications for cardiac output and hemodynamic stability.
Patients with Graves disease usually have a rapid heart rate, but 94/minute is within limits. The diabetic
patient may need sliding scale insulin. This is important but not urgent. Patients with Cushings disease
frequently have dependent edema. Focus: Prioritization

5. ANSWER A Patients with hypofunction of the adrenal glands often have hypotension and should be
instructed to change positions slowly. Once a patient has been instructed, it is appropriate for the nursing
assistant to remind the patient of those instructions. Assessing, teaching, and planning nursing care require
more education and should be done by licensed nurses. Focus: Delegation/supervision

6. ANSWER D The presence of crackles in the patients lungs indicate excess fluid volume doe to excess
water and sodium reabsorption and may be a symptom of pulmonary edema, which must be treated rapidly.
Striae (stretch marks), weight gain, and dependent edema are common findings in patients Cushings disease.
These findings should be monitored, but are not urgent. Focus: Prioritization

7. ANSWER D Monitoring vital signs is within the educational scope of the nursing assistant. The nurse
should be sure to instruct the nursing assistant that blood pressure measurements are to be done with the
cuff on the same arm. Revising the care plan and instructing and assessing patients are beyond the scope of
nursing assistants and fall within the purview of licensed nurses. Focus: Delegation/supervision

8. ANSWER: PALPATION OF THE ABDOMEN Palpating the abdomen can cause sudden release of
catecholamines and severe hypertension. Focus: Delegation/supervision

9. ANSWER A Rapid weight gain and edema are signs of excessive drug therapy, and the dose of the drug
needs to be adjusted. Hypertension, hyperkalemia, and hyperglycemia are common in patients with adrenal
hypofunction. Focus: Prioritization

10. ANSWER A The presence of glucose in nasal drainage indicates that the fluid is CSF (cerebrospinal fluid)
and suggests a CSF leak. Packing is normally inserted in the nares after the surgical incision is closed. Forty to
50 mL per hour is adequate urine output and patients may experience thirst post-operatively. When patients
are thirsty, nursing staff should encourage fluid intake. Thirst may be a sign of hypokalemia. The nurse should
assess the patients thirst and check the patients potassium level. This is not as urgent as the CSF leak.
Focus: Prioritization

11. ANSWER B The 83-year-old patient has no complicating factors at the moment. Providing care for stable
and uncomplicated patients is within the LPNs educational preparation and scope of practice, with the care
always being provided under the supervision and direction of the RN. The RN should assess the newly post-
operative patient and the new admission. The patient who is preparing for discharge after MI may need some
complex teaching. Focus: Delegation/supervision, assignment

12. ANSWER A The parathyroid glands are located on the back of the thyroid gland. The parathyroids are
important in maintaining calcium and phosphorus balance. The nurse should be attentive to all patient
laboratory values, but calcium and phosphorus are important to monitor after thyroidectomy. Focus:
Prioritization

13. ANSWER C The higher the blood glucose level is over time, the more elevated the glycosylated
hemoglobin becomes. Glycosylated hemoglobin is a good indicator of average blood glucose level over the
previous 120 days. Fasting glucose and oral glucose tolerance tests are important diagnostic tests. Fingerstick
blood glucose monitoring provides information that allows for adjustment of patients therapeutic regimen.
Focus: Prioritization

14. ANSWER D The nursing assistants role includes reminding patients about interventions that are already
part of the plan of care. Arranging for a diet consult is appropriate to delegate to the unit clerk. Teaching and
assessing require additional education and should be completed by licensed nurses. Focus:
Delegation/supervision, assignment

15. ANSWER A, B & E Sensory alterations are the major cause of foot complications in diabetic patients, and
patients should be taught to examine their feet on a daily basis. Properly fitted shoes protect the patient from
foot complications. Broken skin increases the risk of infection. Cotton socks are recommended to absorb
moisture. Patients, family, or health care providers may trim toenails. Focus: Prioritization

16. ANSWER C Profuse perspiration is a symptom of hypoglycemia, a complication of diabetes that needs
urgent treatment. A glucose level of 185 will need coverage with sliding-scale insulin, but this is not urgent.
Numbness, tingling, and bunions are related to the chronic nature of diabetes and are not urgent. Focus:
Prioritization

17. ANSWER A Checking the bath water temperature is part of assisting with activities of daily living and is
within the educational scope of the nursing assistant. Discussion of community resources and teaching and
assessing require a higher level of education and are appropriate to the scope of practice of licensed nurses.
Focus: Delegation

18. ANSWER B The new nurse is still orienting to the unit. Appropriate patient assignments at this time
include those who are stable and not complex. Focus: Assignment

19. ANSWER B Rapid, deep respirations (Kussmaul) are symptomatic of DKA. Hammertoe, as well as
numbness and tingling, are chronic complications associated with diabetes. Decreased sensitivity and swelling
(lipohypertrophy) occur at a site of repeated insulin injections, and treatment involves teaching the patient to
rotate injection sites. Focus: Prioritization

20. ANSWER A The nurse should not leave the patient. The scope of the unit clerks job includes calling and
paging physicians. LPN/LVNs generally do not administer IV push medication. IV fluid administration is not
within the scope of nursing assistants. Patients with DKA already have a high glucose level and do not need
orange juice. Focus: Delegation/supervision

21. ANSWER B The signs and symptoms the patient is exhibiting are consistent with hyperglycemia. The RN
should not give the patient additional glucose. All of the other interventions are appropriate for this patient.
The RN should also notify the physician at this time. Focus: Prioritization

22. ANSWER D The patient with permanent DI requires life-long vasopressin therapy. All of the other
statements are appropriate to the home care of this patient. Focus: Prioritization


II.

1. Which of the following hormones causes increased atrial pressure and decreases sodium reabsorption in the
kidneys?

A. Atrial natriuretic peptide
B. PTH
C. Aldosterone
D. Vasopressin


2. Angiotensin I is changed by which of the following into Angiotensin II?

A. ACE
B. AVT
C. Pepsin
D. Adenosine


3. Which of the following is not a cause of peripheral edema?

A. Increased capillary permeability
B. Reduced levels of plasma proteins
C. Heart failure
D. Decreased capillary output


4. Which of the following during an electrocardiogram is associated with hypokalemia?

A. QRS complex
B. U wave
C. PR segment
D. ST segment


5. Which of the following is not generally associated with a 2nd degree (Mobitz Type 1) AV block?

A. Usually asymptomatic
B. Nonsequential (P wave then QRS complex)
C. Increased PR segment/interval
D. 70% Fatal


6. An S3 heart sound is often associated with?

A. CHF
B. COPD
C. Atrial fib.
D. Ventricular fib.


7. Mean arterial pressure is the product of:

A. TPR x SV
B. TPR x CO
C. CO/SV
D. SV/EDV


8. During phase 3 of the myocardial action potential which ion is moving the most?

A. K+
B. Ca+
C. Na+
D. Ca2+


9. An ejection fraction can be calculated as:

A. SV/TPR
B. CO/TPR
C. SV/EDV
D. CO/EDV


10. Which of the following is not a bradykinin effect?

A. Elevated capillary permeability
B. Elevated pain levels
C. Elevated vasodilation response
D. Elevated prothrombin secretion


11. PAH is secreted in which of the following locations?

A. Distal tubule
B. Loop of Henle
C. Collecting tubule
D. Proximal tubule


12. Which of the following is not an anterior pituitary gland secretion?

A. TSH
B. GH
C. Vasopressin
D. Prolactin


13. Thyroid Hormone T3 does not have which of the following functions?

A. Stimulate bone development and growth
B. Create beta-adrenergic responses
C. Cause brain development
D. Decrease calcium re-absorption


14. Hypercalemia has not been linked with which of the following?

A. Paget's disease
B. Aldosterone
C. Sarcoidosis
D. Malignancy


15. Which of the following does not require the pre-cursor progesterone?

A. Cortisol
B. Testosterone
C. ACTH
D. Aldosterone


16. Which of the following is the source cell for the secretion Pepsinogen?

A. Chief cell
B. Plasma cell
C. G cell
D. Parietal cell


17. Which of the following is the primary activator of zymogen secretion?

A. Somatostatin
B. Secretin
C. Acetylcholine
D. Gastrin


18. Which of the following is not a function of Angiotensin II?

A. Causes release of aldosterone
B. Causes vasodilation
C. Causes increased posterior pituitary activation
D. Elevates blood pressure


19. Which of the following is not a function of Progesterone?

A. Causes increased body temperature.
B. Causes some smooth muscle relaxation.
C. Causes increased spiral artery growth
D. Causes activation of FSH


20. Which of the following is not a function of Estrogen?

A. Causes breast growth.
B. Causes inhibition of FSH
C. Increased follicle development
D. Decreased overall transport proteins

1. A
2. A
3. D
4. B
5. D
6. A
7. B
8. A
9. C
10. D
11. D
12. C
13. D
14. B
15. C
16. A
17. C
18. B
19. D
20. D

III.
1.) A client is receiving NPH insulin 20 units subq at 7:00 AM daily, at 3 PM how would the nurse finds if the client
were having a hypoglycemic reaction?

A.) Feel the client and bed for dampness
B.) Observe client kussmaul respirations
C.) Smell clients breathe for acetone odor
D.) Check clients pupils for dilation


2.) Postoperative thyroidectomy nursing care includes which measures?

A.) Have the client speak every 5-10 mins if hoarseness is present
B.) Provide a low calcium diet to prevent hypercalcemia
C.) Check the dressing all the back of the neck for bleeding
D.) Apply a soft cervical collar to restrict neck movement


3.) What would the nurse note as typical findings on the assessment of a client with acute pancreatitis?

A.) Steatorrhea, abd. Pain, fever
B.) Fever, hypoglycemia, DHN
C.) Melena, persistent vomiting, hyperactive bowel sounds
D.) Hypoactive bowel sounds, decreased amylase and lipase levels


4.) A client is found to be comatose and hypoglycemic with a blood suger level 50 mg/dl. What nursing action is
implemented first?

A.) Infuse 1000 ml of D5W over a 12-hour period
B.) Administer 50% glucose IV
C.) Check the clients urine for the presence of sugar and acetone
D.) Encourage the client to drink orange juice with added sugar


5.) Which medication will the nurse have available for the emergency treatment of tetany in the client who has had a
thyroidectomy?

A.) Calcium chloride
B.) Potassium chloride
C.) Magnesium sulfate
D.) Sodium bicarbonate


6.) What is the primary action of insulin in the body?

A.) Enhances the transport of glucose across cell walls
B.) Aids in the process of gluconeogenesis
C.) Stimulates the pancreatic beta cells
D.) Decreases the intestinal absorption of glucose

7.) What will the nurse teach the diabetic client regarding exercise in his /her treatment program?

A.) During exercise the body will use carbohydrates for energy production, which in turn will decrease the need for
insulin
B.) With an increase in activity the body will utilize more carbohydrates; therefore more insulin will be required.
C.) The increase in activity results in an increase in the utilization of insulin; therefore the client should decrease
his/her carbohydrate intake
D.) Exercise will improve pancreatic circulation and stimulate the islet of Langerhans to increase the production of
intrinsic insulin

8.) The nurse is caring for a client who has exophthalmos associated with her thyroid disease. What is the cause of
exophthalmos?

A.) Fluid edema in the retro-orbital tissues which force the eyes to protrude
B.) Impaired vision, which causes the client to squint in order to see
C.) Increased eye lubrication, which makes the client blink less
D.) Decrease in extraocular eye movements, which results in the thyroid stare.


9.) What is characteristic symptom of hypoglycemia that should alert nurse to an early insulin reaction?

A.) Diaphoresis
B.) Drowsiness
C.) Severe thirst
D.) Coma


10.) A client is scheduled for routine glycosylated hemoglobin (HbA1c) test. What is important for the nurse to tell the
client before this test?

A.) Drink only water after midnight and come to the clinic early in the morning
B.) Eat a normal breakfast and be at the clinic 2 hours because of the multiple blood draws
C.) Expect to be at the clinic for several hours because of the multiple blood draws
D.) Come to the clinic at the earliest convenience to have blood drawn


11.) A client has been inhalation vasopressin therapy. What will the nurse evaluate to determine the therapeutic
response to this medication?

A.) Urine specific gravity
B.) Blood glucose
C.) Vital signs
D.) Oxygen saturation levels


12.) A client with diagnosis of type 2 diabetes has been ordered a course of prednisone for her severe arthritic pain.
An expected change that requires close monitoring by the nurse is;

A.) Increased blood glucose level
B.) Increased platelet aggregation
C.) Increased ceatinine clearance
D.) Increased ketone level in urine


13.) The nurse performing an assessment on a client who has been receiving long-term steroid therapy would expect
to find:

A.) Jaundice
B.) Flank pain
C.) Bulging eyes
D.) Central obesity


14.) A diabetic client receives a combination of regular and NPH insulin at 0700 hours. The nurse teaches the client to
be alert for signs of hypoglycemia at

A.) 1200 and 1300 hours
B.) 1100 and 1700 hours
C.) 1000 and 2200 hours
D.) 0800 and 1100 hours


15.) It is important for the nurse to teach the client that metformin (Glcucophage):

A.) May cause nocturia
B.) Should be taken at night
C.) Should be taken with meals
D.) May increase the effects of aspirin


16.) A nurse assessing a client with SIADH would expect to find laboratory values of:

A.) Serum Na= 150 mEq/L and low urine osmolality
B.) Serum K= 5 mEq/L and low serum osmolality
C.) Serum Na=120 mEq/L and low serum osmolality
D.) Serum K= 3 mEq/L and high serum osmolality


17.) A priority nursing diagnostic for a client admitted to the hospital with a diagnosis of diabetes insipidus is:

A.) Sleep pattern deprivation related nocturia
B.) Activity intolerance r/t muscle weakness
C.) Fluid volume excess r/t intake greater that output
D.) Risk for impaired skin integrity r/t generalized edema


18.) A client admitted with a pheochrocytoma returns from the operating room after adrenalectomy. The nurse should
carefully assess this client for:

A.) Hypokalemia
B.) Hyperglycemia
C.) Marked Na and water intake
D.) Marked fluctuations in BP


19.) When caring for client in thyroid crisis, the nurse would question an order for:

A.) IV fluid
B.) Propanolol (Inderal)
C.) Prophylthiouracil
D.) A hyperthermia blanket


20.) A client is prescribed levothyroxine (Synthroid) daily. The most important instruction to give the client for
administration of this drug is:

A.) Taper dose and discontinue if mental and emotional statuses stabilize
B.) Take it at bedtime to avoid the side effects of nausea and flatus
C.) Call the M.D. immediately at the onset of palpitations or nervousness
D.) Decrease intake of juices and fruits with high potassium and calcium contents
1. A
2. C
3. A
4. B
5. A
6. A
7. A
8. A
9. A
10. D
11. A
12. A
13. D
14. B
15. C
16. C
17. B
18. D
19. D
20. C

IV
26. Which of the following clinical characteristics is associated with Type 1 diabetes (previously referred
to as insulin-dependent diabetes mellitus [IDDM])?
a) Presence of islet cell antibodies
Individuals with Type 1 diabetes often have islet cell antibodies.
b) Obesity
Individuals with Type 1 diabetes are usually thin or demonstrate recent weight loss at the time of diagnosis
c) Rare ketosis
Individuals with Type 1 diabetes are ketosis-prone when insulin is absent.
d) Requirement for oral hypoglycemic agents
Individuals with Type 1 diabetes need insulin to preserve life.
27. Which of the following clinical characteristics is associated with Type 2 diabetes (previously referred
to as non-insulin-dependent diabetes mellitus [NIDDM])?
a) Can control blood glucose through diet and exercise
Oral hypoglycemic agents may improve blood glucose levels if dietary modification and exercise are
unsuccessful.
b) Usually thin at diagnosis
Individuals with Type 2 diabetes are usually obese at diagnosis.
c) Ketosis-prone
Individuals with Type 2 diabetes rarely demonstrate ketosis, except in stress or infection.
d) Demonstrate islet cell antibodies
Individuals with Type 2 diabetes do not demonstrate islet cell antibodies.
28. Of the following types of insulin, which is the most rapid acting?
a) Humalog
The onset of action of rapid-acting Humalog is within 10-15 minutes.
b) Regular
The onset of action of short-acting regular insulin is 30 minutes-1 hour.
c) NPH
The onset of action of intermediate acting NPH is 3-4 hours.
d) Ultralente
The onset of action of long-acting Ultralente is 6-8 hours.
29. Of the following categories of oral antidiabetic agents, which exert their primary action by directly
stimulating the pancreas to secrete insulin?
a) Sulfonylureas
Therefore, a functioning pancreas is necessary for sulfonylureas to be effective.
b) Thiazolidinediones
Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the
beta cells of the pancreas
c) Biguanides
Biguanides facilitate insulins action on peripheral receptor sites.
d) Alpha glucosidase inhibitors
Alpha glucosidase inhibitors delay the absorption of glucose in the intestinal system, resulting in a lower
postprandial blood glucose level.
30. The nurse teaches the patient about diabetes including which of the following statements?
a) Elevated blood glucose levels contribute to complications of diabetes, such as diminished vision.
When blood glucose levels are well controlled, the potential for complications of diabetes is reduced.
b) Sugar is found only in dessert foods.
Several types of foods contain sugar, including cereals, sauces, salad dressing, fruit, and fruit juices.
c) The only diet change needed in the treatment of diabetes is to stop eating sugar.
It is not feasible, nor is it advisable, to remove all sources of sugar from the diet.
d) Once insulin injections are started in the treatment of Type 2 diabetes, they can never be discontinued.
If the diabetes had been well controlled without insulin prior to the period of acute stress causing the need for insulin,
the patient may be able to resume previous methods for control of diabetes when the stress is resolved.


31. The nurse teaches the patient about glargine (Lantus), a peakless basal insulin including which of
the following statements?
a) Do not mix the drug with other insulins
Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this
would cause precipitation. When administering glargine (Lantus) insulin it is very important to read the label
carefully and to avoid mistaking Lantus insulin for Lente insulin and vice versa.
b) Administer the total daily dosage in two doses.
Glargine is absorbed very slowly over a 24-hour period and can be given once a day.
c) Draw up the drug first, then add regular insulin.
Because glargine is in a suspension with a pH of 4, it cannot be mixed with other insulins because this would
cause precipitation.
d) The drug is rapidly absorbed and has a fast onset of action
Glargine is a peakless basal insulin that is absorbed very slowly over a 24-hour period.
32. Which of the following disorders is characterized by a group of symptoms produced by an excess of
free circulating cortisol from the adrenal cortex?
a) Cushings syndrome
The patient with Cushings syndrome demonstrates truncal obesity, moon face, acne, abdominal striae, and
hypertension.
b) Addisons disease
In Addisons disease, the patient experiences chronic adrenocortical insufficiency.
c) Graves disease
In Graves disease, the patient experiences hyperthyroidism.
d) Hashimotos disease
The individual with Hashimotos disease demonstrates inflammation of the thyroid gland, resulting in
hypothyroidism.
33. Of the following disorders, which results from excessive secretion of somatotropin?
a) Acromegaly
The patient with acromegaly demonstrates progressive enlargement of peripheral body parts, most commonly
the face, head, hands, and feet.
b) Cretinism
Cretinism occurs as a result of congenital hypothyroidism.
c) Dwarfism
Dwarfism is caused by insufficient secretion of growth hormone during childhood.
d) Adrenogenital syndrome
Adrenogenital syndrome is the result of abnormal secretion of adrenocortical hormones, especially androgen.
34. Which of the following hormones is secreted by the posterior pituitary?
a) Vasopressin
Vasopressin causes contraction of smooth muscle, particularly blood vessels.
b) Calcitonin
Calcitonin is secreted by the parafollicular cells of the thyroid gland.
c) Corticosteroids
Corticosteroids are secreted by the adrenal cortex.
d) Somatostatin
Somatostatin is released by the anterior lobe of the pituitary.
35. Trousseaus sign is positive when
a) carpopedal spasm is induced by occluding the blood flow to the arm for 3 minutes with the use of a blood
pressure cuff.
A positive Trousseaus sign is suggestive of latent tetany.
b) a sharp tapping over the facial nerve just in front of the parotid gland and anterior to the ear causes
spasm or twitching of the mouth, nose, and eye.
A positive Chvosteks sign is demonstrated when a sharp tapping over the facial nerve just in front of the
parotid gland and anterior to the ear causes spasm or twitching of the mouth, nose, and eye.
c) after making a clenched fist, the palm remains blanched when pressure is placed over the radial artery.
A positive Allens test is demonstrated by the palm remaining blanched with the radial artery occluded. The
radial artery should not be used for an arterial puncture.
d) The patient complains of pain in the calf when his foot is dorsiflexed.
A positive Homans sign is demonstrated when the patient complains of pain in the calf when his foot is
dorsiflexed.
36. The digestion of carbohydrates is aided by
a) amylase.
Amylase is secreted by the exocrine pancreas.
b) lipase.
Lipase aids in the digestion of fats.
c) trypsin.
Trypsin aids in the digestion of proteins.
d) secretin.
Secretin is the major stimulus for increased bicarbonate secretion from the pancreas.
V.
1.) A client is receiving NPH insulin 20 units subq at 7:00 AM daily, at 3 PM how would the nurse finds if the client were
having a hypoglycemic reaction?
A.) Feel the client and bed for dampness
B.) Observe client kussmaul respirations
C.) Smell clients breathe for acetone odor
D.) Check clients pupils for dilation
2.) Postoperative thyroidectomy nursing care includes which measures?
A.) Have the client speak every 5-10 mins if hoarseness is present
B.) Provide a low calcium diet to prevent hypercalcemia
C.) Check the dressing all the back of the neck for bleeding
D.) Apply a soft cervical collar to restrict neck movement
3.) What would the nurse note as typical findings on the assessment of a client with acute pancreatitis?
A.) Steatorrhea, abd. Pain, fever
B.) Fever, hypoglycemia, DHN
C.) Melena, persistent vomiting, hyperactive bowel sounds
D.) Hypoactive bowel sounds, decreased amylase and lipase levels
4.) A client is found to be comatose and hypoglycemic with a blood suger level 50 mg/dl. What nursing action is
implemented first?
A.) Infuse 1000 ml of D5W over a 12-hour period
B.) Administer 50% glucose IV
C.) Check the clients urine for the presence of sugar and acetone
D.) Encourage the client to drink orange juice with added sugar
5.) Which medication will the nurse have available for the emergency treatment of tetany in the client who has had a
thyroidectomy?
A.) Calcium chloride
B.) Potassium chloride
C.) Magnesium sulfate
D.) Sodium bicarbonate
6.) What is the primary action of insulin in the body?
A.) Enhances the transport of glucose across cell walls
B.) Aids in the process of gluconeogenesis
C.) Stimulates the pancreatic beta cells
D.) Decreases the intestinal absorption of glucose
7.) What will the nurse teach the diabetic client regarding exercise in his /her treatment program?
A.) During exercise the body will use carbohydrates for energy production, which in turn will decrease the need for insulin
B.) With an increase in activity the body will utilize more carbohydrates; therefore more insulin will be required.
C.) The increase in activity results in an increase in the utilization of insulin; therefore the client should decrease his/her
carbohydrate intake
D.) Exercise will improve pancreatic circulation and stimulate the islet of Langerhans to increase the production of intrinsic
insulin
8.) The nurse is caring for a client who has exophthalmos associated with her thyroid disease. What is the cause of
exophthalmos?
A.) Fluid edema in the retro-orbital tissues which force the eyes to protrude
B.) Impaired vision, which causes the client to squint in order to see
C.) Increased eye lubrication, which makes the client blink less
D.) Decrease in extraocular eye movements, which results in the thyroid stare.
9.) What is characteristic symptom of hypoglycemia that should alert nurse to an early insulin reaction?
A.) Diaphoresis
B.) Drowsiness
C.) Severe thirst
D.) Coma
10.) A client is scheduled for routine glycosylated hemoglobin (HbA1c) test. What is important for the nurse to tell the
client before this test?
A.) Drink only water after midnight and come to the clinic early in the morning
B.) Eat a normal breakfast and be at the clinic 2 hours because of the multiple blood draws
C.) Expect to be at the clinic for several hours because of the multiple blood draws
D.) Come to the clinic at the earliest convenience to have blood drawn
11.) A client has been inhalation vasopressin therapy. What will the nurse evaluate to determine the therapeutic
response to this medication?
A.) Urine specific gravity
B.) Blood glucose
C.) Vital signs
D.) Oxygen saturation levels
12.) A client with diagnosis of type 2 diabetes has been ordered a course of prednisone for her severe arthritic pain. An
expected change that requires close monitoring by the nurse is;
A.) Increased blood glucose level
B.) Increased platelet aggregation
C.) Increased ceatinine clearance
D.) Increased ketone level in urine
13.) The nurse performing an assessment on a client who has been receiving long-term steroid therapy would expect to
find:
A.) Jaundice
B.) Flank pain
C.) Bulging eyes
D.) Central obesity
14.) A diabetic client receives a combination of regular and NPH insulin at 0700 hours. The nurse teaches the client to
be alert for signs of hypoglycemia at
A.) 1200 and 1300 hours
B.) 1100 and 1700 hours
C.) 1000 and 2200 hours
D.) 0800 and 1100 hours
15.) It is important for the nurse to teach the client that metformin (Glcucophage):
A.) May cause nocturia
B.) Should be taken at night
C.) Should be taken with meals
D.) May increase the effects of aspirin
16.) A nurse assessing a client with SIADH would expect to find laboratory values of:
A.) Serum Na= 150 mEq/L and low urine osmolality
B.) Serum K= 5 mEq/L and low serum osmolality
C.) Serum Na=120 mEq/L and low serum osmolality
D.) Serum K= 3 mEq/L and high serum osmolality
17.) A priority nursing diagnostic for a client admitted to the hospital with a diagnosis of diabetes insipidus is:
A.) Sleep pattern deprivation related nocturia
B.) Activity intolerance r/t muscle weakness
C.) Fluid volume excess r/t intake greater that output
D.) Risk for impaired skin integrity r/t generalized edema
18.) A client admitted with a pheochrocytoma returns from the operating room after adrenalectomy. The nurse should
carefully assess this client for:
A.) Hypokalemia
B.) Hyperglycemia
C.) Marked Na and water intake
D.) Marked fluctuations in BP
19.) When caring for client in thyroid crisis, the nurse would question an order for:
A.) IV fluid
B.) Propanolol (Inderal)
C.) Prophylthiouracil
D.) A hyperthermia blanket
20.) A client is prescribed levothyroxine (Synthroid) daily. The most important instruction to give the client for
administration of this drug is:
A.) Taper dose and discontinue if mental and emotional statuses stabilize
B.) Take it at bedtime to avoid the side effects of nausea and flatus
C.) Call the M.D. immediately at the onset of palpitations or nervousness
D.) Decrease intake of juices and fruits with high potassium and calcium contents

Answers
1. A
2. C
3. A
4. B
5. A
6. A
7. A
8. A
9. A
10. D
11. A
12. A
13. D
14. B
15. C
16. C
17. B
18. D
19. D
20. C

1. Acromegaly is most frequently diagnosed in:
a. Middle-aged adults
b. Newborns
c. Children ages 2 to 5
d. Adults age 65 and older
2. Grave's disease is:
a. The most common cause of hypothyroidism
b. The most common cause of hyperparathyroidism
c. The most common cause of hyperthyroidism
d. The most common cause of adrenal insufficiency
3. Symptoms of Grave's ophthalmopathy include all of the following except:
a. Bulging eyeballs
b. Dry, irritated eyes and puffy eyelids
c. Cataracts
d. Light sensitivity
4. An ACTH stimulation test is commonly used to diagnose:
a. Grave's disease
b. Adrenal insufficiency and Addison's disease
c. Cystic fibrosis
d. Hashimoto's disease
5. All of the following are symptoms of Cushing's syndrome except:
a. Severe fatigue and weakness
b. Hypertension and elevated blood glucose
c. A protruding hump between the shoulders
d. Hair loss
6. Which of the following conditions is caused by long-term exposure to high levels of cortisol?
a. Addison's disease
b. Crohn's disease
c. Adrenal insufficiency
d. Cushing's syndrome
7. A "sweat test" or newborn screening may be used to detect:
a. Cystic fibrosis
b. Adrenal insufficiency
c. Grave's disease
d. Hypothyroidism
8. Hashimoto's disease is:
a. Chronic inflammation of the thyroid gland
b. Diagnosed most frequently in Asian-Americans and Pacific Islanders
c. A form of hyperthyroidism
d. A rare form of hypothyroidism
9. Persons at increased risk of developing Hashimoto's disease include all of the following except:
a. Persons with vitiligo
b. Asian-Americans
c. Persons with rheumatoid arthritis
d. Persons with Addison's disease
10. All of the following statements about Hashimoto's disease are true except:
a. Many patients are entirely asymptomatic
b. Not all patients become hypothyroid
c. Most cases of obesity are attributable to Hashimoto's disease
d. Hypothyroidism may be subclinical
11. The most common benign tumor of the pituitary gland is a:
a. Glioma
b Prolactinoma
c. Carcinoid tumor
d. Islet cell tumor
12. Symptoms of polycystic ovarian syndrome (PCOS) may include all of the following except:
a. Pelvic pain
b. Acne, oily skin, and dandruff
c. Infertility
d. Weight Loss
13. Women with PCOS are at increased risk for all of the following except:
a. Pregnancy
b. Diabetes
c. Cardiovascular disease
d. Metabolic syndrome
14. All of the following organs may be affected by multiple endocrine neoplasia type 1 except:
a. Parathyroid glands
b. Kidneys
c. Pancreas and Duodenum
d. Pituitary gland
15. What is the treatment for hyperparathyroidism?
a. Synthetic thyroid hormone
b. Desiccated thyroid hormone
c. Surgical removal of the glands
d. Calcium and phosphate
16. The most common causes of death in people with cystic fibrosis is:
a. Dehydration
b. Opportunistic infection
c. Lung cancer
d. Respiratory failure
17. Untreated hyperthyroidism during pregnancy may result in all of the following except:
a. Premature birth and miscarriage
b. Low birthweight
c. Autism
d. Preeclampsia
18. Short stature and undeveloped ovaries suggest which of the following disorders:
a. Polycystic ovarian syndrome
b. Prolactinoma
c. Grave's disease
d. Turner syndrome
19. Endocrine disorders may be triggered by all of the following except:
a. Stress
b. Infection
c. Chemicals in the food chain and environment
d. Cell phone use
20. An analysis of data from the Women's Health Initiative questioned the use of which therapy to prevent
heart disease?
a. Synthetic thyroid hormone
b. Oral contraceptives
c. Weight-loss drugs
d. Postmenopausal hormone replacement therapy
Answers and Explanations
1. A: Acromegaly results from benign tumors on the pituitary gland that produce excessive amounts of growth hormone.
Although symptoms may present at any age, the diagnosis generally occurs in middle-aged persons. Untreated, the consequences
of acromegaly include type 2 diabetes, hypertension and increased risk of cardiovascular disease, arthritis and colon polyps.
2. C: Grave's disease is an autoimmune disorder characterized by an enlarged thyroid gland and overproduction of thyroid
hormones producing symptoms of hyperthyroidism such as rapid heartbeat, heat intolerance, agitation or irritability, weight
loss, and trouble sleeping. It usually presents in persons age 20 to 40 and it is much more common in women than in men.
3. C: Grave's ophthalmopathy is an inflammation of tissue behind the eye causing the eyeballs to bulge. In addition to the above-
mentioned symptoms, Grave's ophthalmopathy may cause pressure or pain in the eyes, double vision, and trouble moving the
eyes. About one-quarter of persons with Grave's disease develop Grave's ophthalmopathy. The condition is frequently self-
limiting, resolving without treatment over the course of a year or two.
4. B: The ACTH stimulation test measures blood and urine cortisol before and after injection of ACTH. Persons with chronic
adrenal insufficiency or Addison's disease generally do not respond with the expected increase in cortisol levels. An abnormal
ACTH stimulation test may be followed with a CRH stimulation test to pinpoint the cause of adrenal insufficiency.
5. D: Cushing's syndrome also may cause fragile, thin skin prone to bruises and stretch marks on the abdomen and thighs as
well as excessive thirst and urination and mood changes such as depression and anxiety. Women who suffer from high levels of
cortisol often have irregular menstrual cycles or amenorrhea and present with hair on their faces, necks, chests, abdomens, and
thighs.
6. D: Cushing's syndrome is a form of hypercortisolism. Risk factors for Cushing's syndrome are obesity, diabetes, and
hypertension. Cushing's syndrome is most frequently diagnosed in persons ages 20 to 50 who have characteristic round faces,
upper body obesity, large necks, and relatively thin limbs.
7. A: Cystic fibrosis is the most common inherited fatal disease of children and young adults in the United States. Cystic fibrosis
is usually diagnosed by the time an affected child is three years old. Often, the only signs are a persistent cough, a large appetite
but poor weight gain, an extremely salty taste to the skin, and large, foul-smelling bowel movements. A simple sweat test is
currently the standard diagnostic test. The test measures the amount of salt in the sweat; abnormally high levels are the hallmark
of the disorder.
8. A: Hashimoto's disease is the most common cause of hypothyroidism. It is an autoimmune disease that produces chronic
inflammation of the thyroid gland. More women are affected than men and it is generally diagnosed in persons ages 40 to 60.
When treatment is indicated, synthetic T4 is administered.
9. B: Along with the above-mentioned groups, persons with type 1 diabetes and persons suffering from pernicious anemia
(insufficient vitamin b12) are at increased risk of developing Hashimoto's disease. Because it tends to run in families, there is
likely a genetic susceptibility as well. Environmental factors such as excessive iodine consumption and selected drugs also have
been implicated as potential risk factors.
10. C: Although weight gain may be a symptom of Hashimoto's disease, the majority of obese people have normal thyroid
function; rarely is thyroid disorder the sole cause of obesity. Other symptoms of Hashimoto's disease include fatigue, cold
intolerance, joint pain, myalgias, constipation, dry hair, skin and nails, impaired fertility, slow heart rate, and depression.
11. B: Prolactinomas can cause symptoms by releasing excessive amounts of prolactin into the blood or mechanically by pressing
on surrounding tissues. In women, symptoms may include menstrual irregularities and infertility; in men erectile dysfunction
and libido may be impaired.
12. D: In addition to the above-mentioned symptoms, PCOS may cause menstrual irregularities, thinning hair or male-pattern
baldness, thick skin or dark patches of skin and excessive hair growth on the face, chest, abdomen, thumbs and toes.
13. A: Women with PCOS produce excessive amounts of androgens and do not release ova during ovulation, which seriously
compromises their ability to conceive. Although women with PCOS can become pregnant, often by using assistive reproductive
technology, they are at increased risk for miscarriage.
14. B: Multiple endocrine neoplasia type 1, also known as Werner's syndrome, is a heritable disorder that causes tumors in
endocrine glands and the duodenum. Although the tumors associated with multiple endocrine neoplasia type 1 are generally
benign, they can produce symptoms chemically by releasing excessive amounts of hormones or mechanically by pressing on
adjacent tissue.
15. C: When hyperparathyroidism requires treatment, surgery is the treatment of choice and is considered curative for 95% of
cases. Because untreated hyperparathyroidism may elevate blood and urine levels of calcium and deplete phosphorus, bones and
teeth may lose the minerals needed to remain strong.
16. D: Declining pulmonary function is a hallmark of cystic fibrosis. Drugs such as Pulmozyme (dornase alfa) and Zithromax
(azithromycin) can slow the progression of lung disease and mechanical physical therapy devices help CF patients to breathe
more easily by loosening and dislodging mucus. For some patients with severe lung damage, lung transplantation is a treatment
option.
17. C: In addition to the above-mentioned complications of uncontrolled hyperthyroidism in pregnancy, expectant mothers may
suffer congestive heart failure and thyroid storm, which is life-threatening thyrotoxicosis with symptoms that include agitation,
confusion, tachycardia, shaking, sweating, diarrhea, fever, and restlessness.
18. D: Turner syndrome results from a chromosomal abnormality and occurs in an estimated 1 in 2,500 female births. It occurs
more frequently in preterm pregnancies. Affected women are shorter than average and are infertile because they lack ovarian
function. They also may have webbed necks, broad chests, arms that turn out from the elbow, lymphedema of the hands and feet
and skeletal, cardiac, and renal problems.
19. D: Endocrine function may be influenced by myriad factors. In addition to the above-mentioned, there is evidence that
exposure to naturally occurring and man-made endocrine disruptors such as tributyltin, certain bioaccumulating chlorinated
compounds, and phytoestrogens is widespread and in susceptible individuals, may trigger endocrine disorders.
20. D: The results of the Women's Health Initiative study prompted the U.S. Food and Drug Administration (FDA) to advise
against using hormone therapy (estrogen-alone or estrogen-plus-progestin) to prevent heart disease. When hormone
replacement therapy is used to treat moderate to severe hot flashes and symptoms of vulvar and vaginal atrophy it should used at
the lowest doses for the shortest duration needed to achieve treatment objectives.


Terms Definitions
A patient suspected of having
acromegaly has an elevated plasma
growth hormone level. In
acromegaly, the nurse would also
expect the patient's diagnostic
results to include
a. hyperinsulinemia
b. a plasma glucose of less than 70
c. decreased growth hormone levels
with an oral glucose challenge test
d. a serum sometomedin C (insulin-
like growth-factor) of more than 300
d. a serum somatomedin C (Insulin-like-growth-factor)
of more than 300
(rationale- a normal response to growth hormone
secretion is stimulation of the liver to produce
somatomedin C which stimulates growth of bones and
soft tissue. The increased levels of somatomedin C
normally inhibit growth hormone, but in acromegaly the
pituitary gland secretes GH despite elevated
somatomedin C levels.)
During assessment of the patient
with acromegaly, the nurse would
expect the patient to report
a. infertility
b. dry, irritated skin
c. undesirable changes in
appearance
d. an increase in height of 2 to 3
inches per year
c. undesirable changes in appearance
(Rationale- the increased production of growth hormone
in acromegaly causes an increase in thickness and width
of bones and enlargement of soft tissues, resulting in
marked changes in facial features, oily and coarse skin,
and speech difficulties. Height is not increased in adults
with growth hormone excess because the epiphyses of
the bones are closed, and infertility is not a common
finding because growth hormone is usually the only
pituitary hormone involved in acromegaly.)
A patient with acromegaly is treated
with a transphenoidal
hypophysectomy. Postoperatively,
the nurse
a. ensures that any clear nasal
drainage is tested for glucose
b. maintains the patient flat in bed
to prevent cerebrospinal fluid leak
c. assists the patient with
toothbrushing Q4H to keep the
surgical area clean
d. encourages deep breathing and
coughing to prevent respiratory
complications
a. ensures that any clear nasal drainage is tested for
glucose
(Rationale- a transphenoidal hypophysectomy involves
entry into the sella turcica through an incision in the
upper lip and gingiva into the floor of the nose and the
sphenoid sinuses. Postoperative clear nasal drainage
with glucose content indicates CSF leakage from an
open connection to the brain, putting the patient at risk
for meningitis. After surgery, the patient is positioned
with the head elevated to avoid pressure on the sella
turcica, coughing and straining are avoided to prevent
increased ICP and CSF leakage, and although mouth care
is required Q4H toothbrushing should not be performed
for 7-10post sx.)
During care of a patient with
syndrome of inappropriate ADH
a. monitor neurologic status Q2H or more often if
needed
(SIADH), the nurse should
a. monitor neurologic status Q2H or
more often if needed
b. keep the head of the bed elevated
to prevent ADH release
c. teach the patient receiving
treatment with diuretics to restrict
sodium intake
d. notify the physician if the patient's
blood pressure decreases more than
20mmHg from baseline
Rationale- the patient with SIADH has marked dilution
hyponatremia and should be monitored for decreased
neurologic function and convulsions every 2 hours. ADH
release is reduced by keeping the head of the bed flat to
increase left atrial filling pressure, and sodium intake is
supplemented because of hyponatremia and sodium
loss caused by diuretics. A reduction in blood pressure
indicates a reduction in total fluid volume and is an
expected outcome of treatment.)
A patient with SIADH is treated with
water restriction and administration
of IV fluids. The nurses evaluates
that treatment has been effective
when the patient experiences
a. increased urine output, decreased
serum sodium, and increased urine
specific gravity
b. increased urine output, increased
serum sodium, and decreased urine
specific gravity
c. decreased urine output, increased
serum sodium, and decreased urine
specific gravity
d. decreased urine output, decreased
serum sodium, and increased urine
specific gravity
b. increased urine output, increased serum sodium, and
decreased urine specific gravity
(rationale- the patient with SIADH has water retention
with hyponatremia, decreased urine output and
concentrated urine with high specific gravity.
improvement in the patient's condition reflected by
increased urine output, normalization of serum sodium,
and more water in the urine, decreasing the specific
gravity.)
In a patient with central diabetes
insipidus, administration of aqueous
vasopressin during a water
deprivation test will result in a
a. decrease in body weight
b. increase in urinary output
c. decrease in blood pressure
d. increase in urine osmolality
d. increase in urine osmolality
(rationale- a patient with DI has a deficiency of ADH with
excessive loss of water from the kidney, hypovolemia,
hypernatreamia, and dilute urine with a low specific
gravity. When vasopressin is administered, the
symptoms are reversed, with water retention, decreased
urinary output that increases urine osmolality, and an
increase in blood pressure.)
A patient with DI is treated with
nasal desmopression. The nurse
recognize that the drug is not having
an adequate therapeutic effect the
c. a urine specific gravity of 1.002
(rationale- normal urine specific gravity is 1.003 to
1.030, and urine with a specific gravity of 1.002 is very
dilute, indicating that there continues to be excessive
the patient experiences
a. headache and weight gain
b. nasal irritation and nausea
c. a urine specific gravity of 1.002
d. an oral intake greater than urinary
output
loss of water and that treatment of DI is inadequate.
H/A, weight gain, and oral intake greater the urinary
output are signs of volume excess that occur with
overmedication. Nasal irritation & nausea may also
indicate overmedication.)
When caring for a patient with
nephrogenic DI, the nurse would
expect treatment to include
a. fluid restriction
b. thiazide diuretics
c. a high-sodium diet
d. chlorpropamide (DIabinese)
b. thiazide diuretics
(Rationale- in nephrogenic Di the kidney is unable to
respond to ADH, so vasopressin or hormone analogs are
not effective. Thiazide diuretics slow the glomerular
filtration rate in the kidney and produce a decrease in
urine output. Low-sodium diets are also thought to
decrease urine output. Fluids are not restricted, because
the patient could become easily dehydrated.)
A patient with Grave's dz asks the
nurse what caused the disorder. The
best response by the nurse is
a. "The cause of Grave's disease is
not known, although it is thought to
be genetic."
b. "It is usually associated with
goiter formation from an iodine
deficiency over a long period of
time."
c. "Antibodies develop against
thyroid tissue and destroy it, causing
a deficiency of thyroid hormones"
d. "In genetically susceptible persons
antibodies form that attack thyroid
tissue and stimulate overproduction
of thyroid hormones."
d. "In genetically susceptible persons antibodies form
that attack thyroid tissue and stimulate overproduction
of thyroid hormones."
(rationale- The antibodies present in Graves' disease
that attack thyroid tissue cause hyperplasia of the gland
and stimulate TSH receptors on the thyroid and activate
the production of thyroid hormones, creating
hyperthyroidism. The disease is not directly genetic, but
individuals appear to have a genetic susceptibility to
become sensitized to develop autoimmune antibodies.
Goiter formation from insufficient iodine intake is
usually associated with hypothyroidism.)
A patient is admitted to the hospital
in thyrotoxic crisis. On physical
assessment of the patient, the nurse
would expect to find
a. hoarseness and laryngeal stridor
b. bulging eyeballs and arrhythmias
c. elevated temperature and signs of
heart failure
d. lethargy progressing suddenly to
c. elevated temperature and signs of heart failure
(rationale- a hyperthyroid crisis results in marked
manifestations of hyperthyroidism, with fever
tachycardia, heart failure, shock, hyperthermia,
agitation, N/V/D, delirium, and coma. Although
exophthalmos may be present in the patient with Gravs'
dz, it is not a significant factor in hyperthyroid crisis.
Hoarsness and laryngeal stridor are characteristic of the
tetany of hypoparathyroidism, and lethargy progressing
impairment of consciousness to coma is characteristic of myxedema coma, a
complication of hypothyroidism.
Preoperative instructions for the
patient scheduled for a subtotal
thyroidectomy includes teaching the
patient
a. how to support the head with the
hands when moving
b. that coughing should due avoided
to prevent pressure on the incision
c. that the head and neck will need
to remain immobile until the incision
heals
d. that any tingling around the lips
or in the fingers after surgery is
expected and temporary
a. how to support the head with the hands when moving
(rationale- to prevent strain on the suture line
postoperatively, the head must be manually supported
while turning and moving in bed, but range-of-motion
exercise for the head and neck are also taught
preoperatively to be gradually implemented after
surgery. There is no contraindication for coughing and
deep breathing, and they should be carrier out
postoperatively. Tingling around the lips or fingers is a
sign of hypocalcemia, which may occur if the
parathyroid glands are inadvertently removed during
surgery, and should be reported immediately.)
When providing discharge
instructions to a patient following a
subtotal thyroidectomy, the nurse
advises the patient to
a. never miss a daily dose of thyroid
replacement therapy
b. avoid regular exercise until
thyroid function is normalized
c. avoid eating foods such as
soybeans, turnips, and rutabagas
d. use warm salt water gargles
several times a day to relieve throat
pain
c. avoid eating foods such as soybeans, turnips, and
rutabagas
(Rationale- when a patient has had a subtotal
thyroidectomy, thyroid replacement therapy is not given,
because exogenous hormone inhibits pituitary
production of TSH and delays or prevents the restoration
of thyroid tissue regeneration. However, the patient
should avoid goitrogens, foods that inhibit thyroid, such
as soybeans, turnips, rutabagas, and peanut skins.
REgular exercise stimulates the thyroid gland and is
encourage. Salt water gargles are used for dryness and
irritation of the mouth and throat following radioactive
iodine therapy.)
Causes of primary hypothyroidism in
adults include
a. malignant or benign thyroid
nodules
b. surgical removal or failure of the
pituitary gland
c. surgical removal or radiation of
thyroid gland
d. autoimmune-induced atrophy of
the gland
d. autoimmune-induced atrophy of the gland
(rationale- both Graves disease and Hasimotos
thyroiditis are autoimmune disorders that eventually
destroy the thyroid gland, leading to primary
hypothyroidism. Thyroid tumors most often result in
hyperthyroidism. Secondary hypothyroidism occurs as a
result of pituitary failure, and iatrogenic hypothyroidism
results from thyroidectomy or radiation of the thyroid
gland.)
Physical changes of hypothyroidism
that must be monitored when
replacement therapy is started
include
a. achlorhydria and constipation
b. slowed mental processes and
lethargy
c. anemia and increased capillary
fragility
d. decreased cardiac contractility
and coronary atherosclerosis
d. decreased cardiac contractility and coronary
atherosclerosis
(rationale- hypothyroidism affects the heart in many
ways, causing cardiomyopathy, coronary atherosclerosis,
bradycardia, pericardial effusions, and weakened cardiac
contractility. when thyroid replacement therapy is
started, myocardial oxygen consumption is increased
and the resultant oxygen demand may cause angina,
cardiac arrhythmias, and heart failures. It is important to
monitor patients with compromised cardiac status when
starting replacement therapy.)
A patient with hypothyroidism is
treated with Synthroid. When
teaching the patient about the
therapy, the nurse
a. explains that caloric intake must
be reduced when drug therapy is
started
b. provides written instruction for all
information related to the
medication therapy
c. assures the patient that a return
to normal function will occur with
replacement therapy
d. informs the patient that
medications must be taken until
hormone balance is reestablished
b. provides written instruction for all information related
to the medication therapy
(rationale- because of the mental sluggishness,
inattentiveness, and memory loss that occur with
hypothyroidism, it is important to provide written
instructions and repeat information when teaching the
patient. Caloric intake can be increased when drug
therapy is started, because of an increased metabolic
rate, and replacement therapy must be taken for life.
Although most patients return to a normal state with
treatment, cardiovascular conditions and psychoses may
persist.)
An appropriate nursing intervention
for the patient with
hyperparathyroidism is to
a. pad side rails as a seizure
precaution
b. increase fluid intake to 3000 to
4000ml/day
c. maintain bed rest to prevent
pathologic fractures
d. monitor the patient for
Trousseau's phenomenon or
Chvostek's sign
b. increase fluid intake to 3000 to 4000ml/day
(Rationale-A high fluid intake is indicated in
hyperparathyroidism to dilute hypercalcemia and flush
the kidneys so that calcium stone formation is reduced.)
When the patient with parathyroid b. have the patient rebreathe in a paper bag
disease experiences symptoms of
hypocalcemia, a measure that can be
used to temporarily raise serum
calcium levels is to
a. administer IV normal saline
b. have the patient rebreathe in a
paper bag
c. administer Lasix as ordered
d. administer oral phosphorous
supplements
(rationale- rebreathing in a paper bag promotes carbon
dioxide retention in the blood, which lowers pH and
creates an acidosis. An academia enhances the solubility
and ionization of calcium, increasing the proportion of
total body calcium available in physiologically active
form and relieving the symptoms of hypocalcemia.
Saline promotes calcium excretion, as does Lasix.
Phosphate levels in the blood are reciprocal to calcium
and an increase in phosphate promotes calcium
excretion.)
A patient is admitted to the hospital
with a diagnosis of Cushing
syndrome. On physical assessment
of the patient, the nurse would
expect to find
a. HTN, peripheral edema, and
petechiae
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 hyper pigmentation of the skin
a. HTN, peripheral edema, and petechiae
(rationale- The effects of glucocorticoid excess include
weight gain from accumulation and redistribution of
adipose tissue, sodium and water retention, glucose
intolerance, protein wasting, loss of bone structure, loss
of collagen, and capillary fragility. Clinical
manifestations of corticosteroid deficiency include
hypotension, dehydration, weight loss, and
hyperpigmentation of the skin.)
To prevent complications in the
patient with Cushing syndrome, the
nurse monitors the patient for
a. hypotension
b. hypoglycemia
c. cardiac arrhythmias
d. decreased cardiac output
c. cardiac arrhythmias
(rationale- electrolyte changes that occur in Cushing
syndrome include sodium retention and potassium
excretion by the kidney, resulting in hypokalemia, which
may lead to cardiac arrhythmias or arrest. Hypotension,
hypoglycemia, and decreased cardiac strength and
output are characteristic of adrenal insufficiency.)
A patient is scheduled for bilateral
adrenalectomy. During the
postoperative period, the nurse
would expect administration of
corticosteroids to be
a. reduced to promote wound
healing
b. withheld until symptoms of
hypocortisolism appear
c. increased to promote an adequate
c. increased to promote an adequate response to the
stress of surgery
(rationale- although the patient with Cushing syndrome
has excess corticosteroids, removal of the glands and
the stress of surgery require that high doses of
cortisone be administered postoperatively for several
days. The nurse should monitor the patient
postoperatively to detect whether large amounts of
hormones were released during surgical manipulation
and to ensure the healing is satisfactory.)
response to the stress of surgery
d. reduced because excessive
hormones are released during
surgical manipulation of the glands
A patient with Addison's disease
comes to the emergency department
with complaints of N/V/D, and fever.
The nurse would expect
collaborative care to include
a. parenteral injections of ACTH
b. IV administration of vasopressors
c. IV administration of
hydrocortisone
d. IV administration of D5W with
20mEq of KCl
c. IV administration of hydrocortisone
(rationale- vomiting and diarrhea are early indicators of
addisonian crisis and fever indicates an infection, which
s causing additional stress for the patient. treatment of
a crisis requires immediate glucocorticoid replacement,
and IV hydrocortisone, fluids, sodium and glucose are
necessary for 24hours. Addison's disease is a primary
insufficiency of the adrenal gland, and ACTH is not
effective, nor would vasopressors be effective with the
fluid deficiency of Addison's. Potassium levels are
increased in Addison's dz, and KCl would be
contraindicated.)
The nurse determines that the
patient in acute adrenal insufficiency
is responding favorably to treatment
when
a. the patient appears alert and
oriented
b. the patient's urinary output has
increased
c. pulmonary edema is reduced as
evidenced by clear lung sounds
d. laboratory tests reveal serum
elevations of K and glucose and a
decrease in sodium
a. the patient appears alert and oriented
(rationale- confusion, irritability, disorientation, or
depressioni s often present in the patient with Addison's
dz, and a positive response to therapy would be
indicated by a return to alertness and orientation. Other
indication of response to therapy would be a decreased
urinary output, decreased serum potassium, and
increased serum sodium and glucose. The patient with
Addison's would be very dehydrated and volume-
depleted and would not have pulmonary edema.)
The most important nursing
intervention during the medical and
surgical treatment of the patient
with a pheochromocytoma is
a. administering IV fluids
b. monitoring blood pressure
c. monitoring I&O and daily weights
d. administering B-adrenergic
blocking agents
b. monitoring blood pressure38
(rationale- a pheochromocytoma is a catecholamine-
producing tumor of the adrenal medulla, which may
cause severe, episodic HTN; severe, pounding headache;
and profuse sweating. Monitoring for dangerously high
BP before surgery is critical, as is monitoring for BP
fluctuation during medical and surgical tx.)
When caring for a patient with a. Lasix37
primary hyperaldosteronism, the
nurse would question a physician's
order for the use of
a. Lasix
b. amiloride (midamor)
c. spironolactone (aldactone)
d. aminoglutethimide (cytadren)
(rationale- hyperaldosteronism is an excess of
aldosterone, which is manifested by sodium and water
retention and potassium excretion. Lasix is a
potassium-wasting diuretic that would increase the
potassium deficiency. Aminoglutethimide blocks
aldosterone synthesis; amiloride is apotassium-sparing
diuretic; and spironolactone blocks mineralocorticoid
receptors in the kidney, increasing secretion of sodium
and water and retention of potassium.)

The parathyroid glands play a major role in regulating which
substances?
A. Calcium and Phosphorus
B. Cholride and potassium
C. Potassium and calcium
D. Sodium and potassium
a. Calcium and Phosphorus
The primary function of insuln is to:
A. Lower blood glucose levels
B. Produce melanin
C. regulate the bodys metabolic rate
D. stimulate release of digestive enzymes
a. lower blood glucose levels
a client is admitted to the hospital with a medical DX of
hyerthyroidism. When taking a history which information would be
most significant?
A. edema, intolerance to cold, lethargy
b. peri-orbital edema, lethargy mask like face
c. weight loss, intolerance to cold, muscle wasting
d. weight loss, intolerance to heat, exophthalmos
d. weight loss, intolerance to heat, exophthalmos
Which nursing action is most appropriate for a client in
ketoacidosis?
a. admin of carbs
b. admin of IV fluids
c. applying cold compress
d. giving glucagon IV
b. admin of IV fluids
The nurse smells a sweet fruity odor on the breath of a client
admitted with DM. This odor may be associated with?
a. alcohol intoxication
b. insulin shock
c. ketoacidosis
d. macrovacular complications
c. ketoacidosis
A client asks what the purpose of the Hb A1c test is. The nurses
best explanation would be that the test measures the average:
a. blood sugar lvl's over a 6-10 week period
b. hemoglobin lvl's over a 6 - 10 week period
c. protien lvl over a 3 month period
d. vanillylmandelic acid lvl's
a. blood sugar lvl's over a 6-10 week period
which of the following would be a nursing priority for a client just
DX with Addison's disease?
a. avioding unnecessary activity
b. encouraging client to wear a med alert tag
c. ensuring the client is adequatly hydrated
c. ensuring the client is adequatly hydrated
d. explaining that the client will need life long hormone therapy
A nurse is caring for a client in the late stage of Ketoacidosis. The
nurse notices that the clients breath has a characteristic fruity
odor. Which of the following substances is responsible for the
fruity smell in the breath?
a. iodine
b. acetone
c.alcohol
d. glucose
b. acetone
A nurse is caring for a client with Addison's disease. Which of the
following mursing considerations shoul dbe employed when caring
for this client?
a. avoid sodium in the clients diet
b. monitor and protect skin integrity
c. document the specific gravity of urine
d. monitor increases in blood pressure
c. document the specific gravity of urine
A nurse is assigned to care for and monitor any complications in a
40 yr client with chronic diabetes. Which of the following is a
macrovascular complication of diabetes.
a. neuropathy
b. retinopathy
c. nephropathy
d. Arteriosclerosis
d. Arteriosclerosis
A nurse is instructing a 50yr diabetic client about the steps to be
followed for self admin of insulin. Which of the following
instructions should be included in te client teaching?
a. instruct client to aviod injections to the abdomen
b. encourage client to always inject insulin in the same site
c. inform client about the type of syringe to use
d. encourage client to do active exercise after injection
c. inform client about the type of syringe to use
A nurse is preparing a diet plan for a 50yr with simple goiter.
Which of the following should be included in teh clients diet to
decrease the enlargement of he thyroid gland?
a. iodine
b. sodium
c. potassium
d. calcium
a. iodine
A nurse is caring for a 60yr client affected with
hypoparathyroidism. When checking the lab report, the nurse finds
tht the clients calcium lvl was very low. Which of the following
vitamins regulates teh calcium lvl in the body?
a. A
b. D
c. E
d. K
b. D

1. An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus,
hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose
sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, nurse Lily teaches the client to
treat hypoglycemia by ingesting:
a. 2 to 5 g of a simple carbohydrate.
b. 10 to 15 g of a simple carbohydrate.
c. 18 to 20 g of a simple carbohydrate.
d. 25 to 30 g of a simple carbohydrate.
2. A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial assessment
findings, nurse Julia formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client,
which related-to phrase should the nurse add?
a. Related to bone demineralization resulting in pathologic fractures
b. Related to exhaustion secondary to an accelerated metabolic rate
c. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces
d. Related to tetany secondary to a decreased serum calcium level
3. Nurse John is assigned to care for a postoperative male client who has diabetes mellitus. During the assessment interview, the
client reports that hes impotent and says hes concerned about its effect on his marriage. In planning this clients care, the most
appropriate intervention would be to:
a. Encourage the client to ask questions about personal sexuality.
b. Provide time for privacy.
c. Provide support for the spouse or significant other.
d. Suggest referral to a sex counselor or other appropriate professional.
4. During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise. The nurse educator
advises the clients to exercise how often to meet the goals of planned exercise?
a. At least once a week
b. At least three times a week
c. At least five times a week
d. Every day
5. Nurse Oliver should expect a client with hypothyroidism to report which health concerns?
a. Increased appetite and weight loss
b. Puffiness of the face and hands
c. Nervousness and tremors
d. Thyroid gland swelling
6. A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should
nurse Hans recognize as an adverse drug effect?
a. Dysuria
b. Leg cramps
c. Tachycardia
d. Blurred vision
7. A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression,
and bone pain that interferes with her going outdoors. Based on these assessment findings, nurse Richard would suspect which of the
following disorders?
a. Diabetes mellitus
b. Diabetes insipidus
c. Hypoparathyroidism
d. Hyperparathyroidism
8. When caring for a male client with diabetes insipidus, nurse Juliet expects to administer:
a. vasopressin (Pitressin Synthetic).
b. furosemide (Lasix).
c. regular insulin.
d. 10% dextrose.
9. The nurse is aware that the following is the most common cause of hyperaldosteronism?
a. Excessive sodium intake
b. A pituitary adenoma
c. Deficient potassium intake
d. An adrenal adenoma
10. A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In discussing the result
with the client, nurse Sharmaine would be most accurate in stating:
a. The test needs to be repeated following a 12-hour fast.
b. It looks like you arent following the prescribed diabetic diet.
c. It tells us about your sugar control for the last 3 months.
d. Your insulin regimen needs to be altered significantly.
11. Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the following?
a. Muscle weakness
b. Tremors
c. Diaphoresis
d. Constipation
12. Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include
information about which hormone lacking in clients with diabetes insipidus?
a. antidiuretic hormone (ADH).
b. thyroid-stimulating hormone (TSH).
c. follicle-stimulating hormone (FSH).
d. luteinizing hormone (LH).
13. Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now
has nausea, a temperature of 105 F (40.5 C), tachycardia, and extreme restlessness. What is the most likely cause of these signs?
a. Diabetic ketoacidosis
b. Thyroid crisis
c. Hypoglycemia
d. Tetany
14. For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient fluid volume?
a. Cool, clammy skin
b. Distended neck veins
c. Increased urine osmolarity
d. Decreased serum sodium level
15. When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine,
nurse April is most likely to detect:
a. a blood pressure of 130/70 mm Hg.
b. a blood glucose level of 130 mg/dl.
c. bradycardia.
d. a blood pressure of 176/88 mm Hg.
16. A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention
is appropriate?
a. Infusing I.V. fluids rapidly as ordered
b. Encouraging increased oral intake
c. Restricting fluids
d. Administering glucose-containing I.V. fluids as ordered
17. A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects to assess:
a. Trousseaus sign.
b. Homans sign.
c. Hegars sign.
d. Goodells sign.
18. Which outcome indicates that treatment of a male client with diabetes insipidus has been effective?
a. Fluid intake is less than 2,500 ml/day.
b. Urine output measures more than 200 ml/hour.
c. Blood pressure is 90/50 mm Hg.
d. The heart rate is 126 beats/minute.
19. Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in
another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the
following would the nurse suspect as a possible cause of the clients hyperglycemia?
a. Acromegaly
b. Type 1 diabetes mellitus
c. Hypothyroidism
d. Deficient growth hormone
20. Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic episodes, the nurse
should recommend:
a. Increasing saturated fat intake and fasting in the afternoon.
b. Increasing intake of vitamins B and D and taking iron supplements.
c. Eating a candy bar if light-headedness occurs.
d. Consuming a low-carbohydrate, high-protein diet and avoiding fasting.
21. An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad.
Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting
edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take
emergency action to prevent the potential complication of:
a. Thyroid storm.
b. Cretinism.
c. myxedema coma.
d. Hashimotos thyroiditis.
22. A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these
medications are only effective if the client:
a. prefers to take insulin orally.
b. has type 2 diabetes.
c. has type 1 diabetes.
d. is pregnant and has type 2 diabetes.
23. When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a drug that may potentiate
hypoglycemia. Which drug fits this description?
a. sulfisoxazole (Gantrisin)
b. mexiletine (Mexitil)
c. prednisone (Orasone)
d. lithium carbonate (Lithobid)
24. After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. Which of the following would the nurse
expect the physician to do?
a. Initiate insulin therapy.
b. Switch the client to a different oral antidiabetic agent.
c. Prescribe an additional oral antidiabetic agent.
d. Restrict carbohydrate intake to less than 30% of the total caloric intake.
25. During preoperative teaching for a female client who will undergo subtotal thyroidectomy, the nurse should include which
statement?
a. The head of your bed must remain flat for 24 hours after surgery.
b. You should avoid deep breathing and coughing after surgery.
c. You wont be able to swallow for the first day or two.
d. You must avoid hyperextending your neck after surgery.
1. Answer B. To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a simple
carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary,
this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple carbohydrate may not raise the blood glucose level
sufficiently. Ingesting more than 15 g may raise it above normal, causing hyperglycemia.
2. Answer A. Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This, in turn, may diminish calcium
stores in the bone, causing bone demineralization and setting the stage for pathologic fractures and a risk for injury.
Hyperparathyroidism doesnt accelerate the metabolic rate. A decreased thyroid hormone level, not an increased parathyroid hormone
level, may cause edema and dry skin secondary to fluid infiltration into the interstitial spaces. Hyperparathyroidism causes
hypercalcemia, not hypocalcemia; therefore, it isnt associated with tetany.
3. Answer D. The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals is a vali d part of
planning the clients care. The nurse doesnt normally provide sex counseling.
4. Answer B. Diabetic clients must exercise at least three times a week to meet the goals of planned exercise lowering the blood
glucose level, reducing or maintaining the proper weight, increasing the serum high-density lipoprotein level, decreasing serum
triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once a week wouldnt achieve these goals. Exercising
more than three times a week, although beneficial, would exceed the minimum requirement.
5. Answer B. Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and symptoms of
hyperthyroidism (Graves disease) include an increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement
(goiter).
6. Answer C. Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the effects of thyroxine.
Adverse effects of this agent include tachycardia. The other options arent associated with levothyroxine.
7. Answer D. Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess
parathyroid hormone (PTH). Clients also exhibit hypercaliuria-causing polyuria. While clients with diabetesmellitus and diabetes
insipidus also have polyuria, they dont have bone pain and increased sleeping. Hypoparathyroidism is characterized by urinary
frequency rather than polyuria.
8. Answer A. Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should
expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a
client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not
diabetes insipidus.
9. Answer D. An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism. Hyperplasia is the
second most frequent cause. Aldosterone secretion is independent of sodium and potassium intake as well as of pituitary stimulation.
10. Answer C. The glycosylated Hb test provides an objective measure of glycemic control over a 3-month period. The test helps
identify trends or practices that impair glycemic control, and it doesnt require a fasting period before blood is drawn. The nurse cant
conclude that the result occurs from poor dietary management or inadequate insulin coverage.
11. Answer A. Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are findings
associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism when the adenoma is removed.
Tremors, diaphoresis, and constipation arent seen in hyperkalemia.
12. Answer A. ADH is the hormone clients with diabetes insipidus lack. The clients TSH, FSH, and LH levels wont be affected.
13. Answer B. Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroi dism,
such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria, polydipsia, and
polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration, and hunger. Tetany typically causes uncontrollable
muscle spasms, stridor, cyanosis, and possibly asphyxia.
14. Answer C. In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose parti cles
move into the urine. The client experiences glucosuria and polyuria, losing body fluids and experiencing fluid volume deficit. Cool,
clammy skin; distended neck veins; and a decreased serum sodium level are signs of fluid volume excess, the opposite imbalance.
15. Answer D. Pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, causes hypertension,
tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isnt associated with the other options.
16. Answer C. To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering fluids by any route
would further increase the clients already heightened fluid load.
17. Answer A. This clients serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes Trousseaus sign
(carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans sign (pain on dorsiflexion of the foot)
indicates deep vein thrombosis. Hegars sign (softening of the uterine isthmus) and Goodells sign (cervical softening) are probable
signs of pregnancy.
18. Answer A. Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high oral intake of
fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour
indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126 beats/minute indicate compensation for the
continued fluid deficit, suggesting that treatment hasnt been effective.
19. Answer A. Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is associated with
hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral bone
growth, which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea.
Type 1 diabetes is usually seen in children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isnt associated
with hyperglycemia, nor is growth hormone deficiency.
20. Answer D. To control hypoglycemic episodes, the nurse should instruct the client to consume a low-carbohydrate, high-protein
diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldnt help
control hypoglycemia.
21. Answer C. Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased
vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of
hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimotos thyroiditis is a common chronic inflammatory
disease of the thyroid gland in which autoimmune factors play a prominent role.
22. Answer B. Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic agents arent effective
in type 1 diabetes. Pregnant and lactating women arent prescribed oral antidiabetic agents because the effect on the fetus is uncertain.
23. Answer A. Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate
hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it doesnt cause hypoglycemia.
Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause transient hyperglycemia, not hypoglycemia.
24. Answer B. Many clients (25% to 60%) with secondary failure respond to a different oral antidiabetic agent. Therefore, it wouldnt
be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose levels
at an acceptable level, insulin may be used in addition to the antidiabetic agent.
25. Answer D. To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should advise the client to
avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and
coughing to help prevent pneumonia. Subtotal thyroidectomy doesnt affect swallowing.

This results from an iodine-deficient diet, which causes a hyperplasia or overgrowth of the thyroid gland.....
A.
Goiter
B.
Cretinism
C.
Tetany

Results from a deficiency of insulin; the person becomes hyperglycemic and glucosuric.
A.

Addison's Disease
B.

Diabetes Mellitus
C.

Cretinism

Condition that is due to a deficiency of adrenal cortical steroids.
A.Addison's Disease*
B.Pheochromocytoma
C.Giantism

Results from a deficiency of ADH that causes the person to urinate up to 25 liters of pale urine per day...
A.Acromegaly
B.Myxedema
C.Diabetes Insipidus(Your Answer)

Condtiton that is treated with replacement doses of insulin....
A.Diabetes Insipidus
B.Diabetes Mellatus(Your Answer)
C.Grave's Disease

The adult form of hypothyroidism that is treated with thyroid hormone....
A.Myxedema(Your Answer)
B.Tetany
C.Acromegaly

Antithyroid drugs and surgery are used to treat this form of hyperthyroidism....
A.Addison's Disease
B.Pheochromocytoma
C.Grave's Disease(Your Answer)

An infant born with a deficiency of thyroid hormones develops this condition, characterized by a severe delay in both
physical and mental development...
A.Acromegaly
B.Cretinism(Your Answer)
C.Giantism

A deficiency of parathyroid hormone causes this life-threatening hypocalcemic condition...
A.Tetany(Correct Answer)
B.Exophthalmos
C.Phenochromocytoma

Condition that is caused by a hypersecretion of growth hormone in an adult (after fusion of the epiphyseal discs)
A.Giantism
B.Acromegaly(Your Answer)
C.Cretinism

Condition that is caused by a hypersecretion of somatotropic hormone in a child....
A.Myxedema
B.Dwarfism
C.Giantism(Your Answer)

Condition that is caused by hyposecretion of somatotropic hormone in a child...
A.Giantism
B.Dwarfism(Your Answer)
C.Acromegaly

Condition that results from a tumor of the adrenal medulla, which causes a very high (and dangerous) blood
pressure....
A.Grave's Disease
B.Pheochromocytoma(Your Answer)
C.Cushing's Syndrome

Describes the bulging or protruding eyes that characterize hyperthyroidism....
A.Exophthalmos(Your Answer)
B.Goiter
C.Acromegaly

A person who takes high doses of steroids over an extended period of time will develop this group of signs and
symptoms...
A.Cushing's Syndrome(Your Answer)
B.Diabetes mellitus
C.Diabetes insipidus

If untreated, this deficiency disease will progress to adrenal shock...
A.Cushing's Syndrome
B.Grave's Disease
C.Addison's Disease(Your Answer)

If untreated this condition progresses to ketoacidosis...
A.Diabetes Mellitus(Your Answer)
B.Grave's Disease
C.Acromegaly

Characterized by sustained muscle contraction and an inability to ventilate (breathe)...
A.Cretinism
B.Myxedema
C.Tetany(Your Answer)

Requires replacement doses of steroids, especially mineralocorticoid....
A.Addison's Disease(Your Answer)
B.Cushing's Syndrome
C.Grave's Disease

Requires replacement doses of T3 and T4.....
A.Myxedema and Dwarfism
B.Myxedema and Cretinism(Your Answer)
C.Myxedema and Tetany

A client is
admitted for
removal of a
goiter. Which
nursing
intervention
should receive
priority during
the post-
operative period?
A
.
Maintainin
g fluid
and
electrolyte
balance
B
.
Assessing
the
clients
airway
C. Providing
needed
nutrition
and fluids
D
.
Providing
pain relief
with
narcotic
analgesics

2. A client is admitted for treatment of hypoparathyroidism. Based on the clients diagnosis, the
nurse would anticipate an order for:
A. Potassium
B. Magnesium
C. Calcium
D. Iron

3. A client with Addisons disease will most likely exhibit which symptom?
A. Hypertension
B. Bronze pigmentation
C. Hirsutism
D. Purple striae

4. A client with Cushings syndrome should be instructed to:
A. Avoid alcoholic beverages
B. Limit the sodium in her diet
C. Increase servings of dark green vegetables
D. Limit the amount of protein in her diet

5. The client with a suspected pituitary tumor will most likely exhibit symptoms of:
A. Alteration in visual acuity
B. Frequent diarrhea
C. Alterations in blood glucose
D. Urticaria

6. A diabetic client has been maintained on Glucophage (metformin) for regulation of his blood
glucose levels. Which teaching should be included in the plan of care?
A. Report changes in urinary pattern.
B. Allow six weeks for optimal effects.
C. Increase the amount of carbohydrates in your diet.
D. Use lotions to treat itching.

7. A client with diabetes experiences Somogyis effect. To prevent this complication, the nurse
should instruct the client to:
A. Take his insulin each day at 1400 hours
B. Engage in physical activity daily
C. Increase the amount of regular insulin
D. Eat a protein and carbohydrate snack at bedtime

8. Which item should be kept at the bedside of a client who has just returned from having a
thyroidectomy?
A. A padded tongue
B. An endotracheal tube
C. An airway
D. A tracheostomy set

9. Which vitamin is directly involved in the metabolism of the hormones secreted by the
parathyroid?
A. Vitamin C
B. Vitamin D
C. Vitamin K
D. Vitamin B9

10. A client with acromegaly will most likely experience which symptom?
A. Bone pain
B. Frequent infections
C. Fatigue
D. Weight loss

11. A diabetic client is taking Lantus insulin for regulation of his blood glucose levels. The nurse
should know that this insulin will most likely be administered:
A. Prior to each meal
B. At night
C. Midday
D. Prior to the evening meal

12. A client with polyuria, polydipsia, and polyphagia is diagnosed with diabetes mellitus. The nurse
would expect that these symptoms are related to
A. Hypoglycemia
B. Hyperglycemia
C. Hyperparathyroidism
D. Hyperthyroidism

13. Which laboratory test conducted on the client with diabetes mellitus indicates compliance?
A. Fasting blood glucose
B. Two-hour post-prandial
C. Hgb A-1C
D. Dextrostix

Answer Rationales
1. Answer B is correct. A goiter is hyperplasia of the thyroid gland. Removal of a goiter can result in laryngeal
spasms and airway occlusion. The other answers are lesser in priority.
2. Answer C is correct. The parathyroid is responsible for calcium and phosphorus absorption. Clients with
hypoparathyroidism have hypocalcemia. Answers A, B, and D are not associated with hypoparathyroidism
therefore they are incorrect.
3. Answer B is correct. Answer B is correct because a bronze pigmentation is a sign of Addisons disease.
Answers A, C, and D are symptoms of Cushings syndrome, making them incorrect.
4. Answer B is correct. A client with Cushings syndrome has adrenocortical hypersecretion, so she retains
sodium and water. The client may drink alcohol in moderation, so answer A is incorrect, and there is no
need to eat more green vegetables or limit protein, so answers C and D are incorrect.
5. Answer A is correct. The pituitary is located in the middle of the skull adjacent to the optic nerve and brain.
Pressure on the optic nerve can cause an increase in intracranial pressure. Clients frequently complain of
headache, nausea, vomiting, and decreasing visual acuity as the intracranial pressure increases. B, C, and
D are incorrect because they are not associated with a pituitary tumor.
6. Answer A is correct. Glucophage (metformin) can cause renal complications. The client should be monitored
for changes in renal function. In answer B, the medication begins working immediately, so it is incorrect. In
answer C, the amount of carbohydrates should be regulated with a diabetic diet, so it is incorrect. The use
of lotions in answer D is unnecessary, so it is incorrect.
7. Answer D is correct. Somogyis is characterized by a drop in glucose levels at approximately 2 a.m. or 3
a.m. followed by a false elevation. Eating a protein and carbohydrate snack before retiring prevents the
hypoglycemia and rebound elevation. Answers A, B, and C are incorrect because they do not prevent
Somogyis effect.
8. Answer D is correct. Laryngeal swelling is not uncommon in clients following a thyroidectomy. A
tracheostomy tray should be kept available. The ventilator is not necessary, so answer A is incorrect. The
endotracheal tube is very difficult, if not impossible, to intubate if swelling has already occurred, so answer
B is incorrect. The airway will do no good because the swelling is in the trachea, so answer C is incorrect.
9. Answer B is correct. Vitamin D is related to absorption of calcium and phosphorus. A, C, and D are incorrect
because they are not related to the absorption of calcium and phosphorus.
10. Answer A is correct. Acromegaly is an increase in secretion of growth hormone. The growth hormones
cause expansion and elongation of the bones. Answers B, C, and D are not directly associated with
acromegaly, so they are incorrect.
11. Answer B is correct. This insulin, unlike others, is most frequently administered at night. Its duration is 24
36 hours. A, C, and D are incorrect they are incorrect times to administer Lantus insulin.
12. Answer B is correct. The client with hyperglycemia will exhibit polyuria, polydipsia, or increased thirst, and
polyphagia, or increased hunger. A, C, and D are incorrect because they are not signs of hypoglycemia.
13. Answer C is correct. The Hgb A-1C indicates that the client has been compliant for approximately three
months. Answers A, B, and D tell the nurse the clients blood glucose at the time of the test, so they are
incorrect.