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ASIAN DEVELOPMENT FOUNDATION COLLEGE

COLLEGES OF NURSING & MIDWIFERY


Tacloban City
DRILLS IN COMPETENCY APPRAISAL 2
(Endocrine Disorders)
Name: ______________________________________Year Level: _______________ Date: _______________________ Score: _______

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, the nurse 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, the nurse 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 Joey 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 lightheadedness 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.
26. Nurse Ronn is assessing a client with possible Cushings syndrome. In a client with Cushings
syndrome, the nurse would expect to find:
A. Hypotension.
B. Thick, coarse skin.
C. Deposits of adipose tissue in the trunk and dorsocervical area.
D. Weight gain in arms and legs.

27. A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which
instruction should nurse Lina provide?
A. Administer desmopressin while the suspension is cold.
B. Your condition isnt chronic, so you wont need to wear a medical identification bracelet.
C. You may not be able to use desmopressin nasally if you have nasal discharge or blockage.
D. You wont need to monitor your fluid intake and output after you start taking desmopressin.
28. Nurse Wayne is aware that a positive Chvosteks sign indicate?
A. Hypocalcemia
B. Hyponatremia
C. Hypokalemia
D. Hypermagnesemia
29. In a 29-year-old female client who is being successfully treated for Cushings syndrome, nurse
Lyzette would expect a decline in:
A. Serum glucose level.
B. Hair loss.
C. Bone mineralization.
D. Menstrual flow.
30. A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes
corticotropin (Acthar), 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of
corticotropin?
A. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target
organs.
B. It interacts with plasma membrane receptors to inhibit enzymatic actions.
C. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and
carbohydrate metabolism.
D. It regulates the threshold for water resorption in the kidneys.
31. Capillary glucose monitoring is being performed every 4 hours for a female client diagnosed with
diabetic ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results.
At 2 p.m., the client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin.
Nurse Vince should expect the doses:
A. Onset to be at 2 p.m. and its peak to be at 3 p.m.
B. Onset to be at 2:15 p.m. and its peak to be at 3 p.m.
C. Onset to be at 2:30 p.m. and its peak to be at 4 p.m.
D. Onset to be at 4 p.m. and its peak to be at 6 p.m.
32. A female client with Cushings syndrome is admitted to the medical-surgical unit. During the
admission assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory,
reports loss of appetite, and appears disheveled. These findings are consistent with which problem?
A. Depression
B. Neuropathy
C. Hypoglycemia
D. Hyperthyroidism
33. Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and
tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which
complication?

A. Tetany
B. Hemorrhage
C. Thyroid storm
D. Laryngeal nerve damage
34. After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith
prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the
preferred agent?
A. Primary hypothyroidism
B. Graves disease
C. Thyrotoxicosis
D. Euthyroidism
35. Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic
hormone (SIADH) secretion is experiencing complications?
A. Tetanic contractions
B. Neck vein distention
C. Weight loss
D. Polyuria
36. A female client with a history of pheochromocytoma is admitted to the hospital in an acute
hypertensive crisis. To reverse hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to
administer:
A. phentolamine (Regitine).
B. methyldopa (Aldomet).
C. mannitol (Osmitrol).
D. felodipine (Plendil).
37. A male client with a history of hypertension is diagnosed with primary hyperaldosteronism. This
diagnosis indicates that the clients hypertension is caused by excessive hormone secretion from which
of the following glands?
A. Adrenal cortex
B. Pancreas
C. Adrenal medulla
D. Parathyroid
38. Nurse Troy is aware that the most appropriate for a client with Addisons disease?
A. Risk for infection
B. Excessive fluid volume
C. Urinary retention
D. Hypothermia
39. Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2
diabetes mellitus. During discharge planning, nurse Pauleen would be aware of the clients need for
additional teaching when the client states:
A. If I have hypoglycemia, I should eat some sugar, not dextrose.
B. The drug makes my pancreas release more insulin.
C. I should never take insulin while Im taking this drug.
D. Its best if I take the drug with the first bite of a meal.

40. A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive
diagnostic workup. Test results reveal a pituitary tumor, which necessitates
a transsphenoidal hypophysectomy. The evening before the surgery, nurse Jacob reviews preoperative
and postoperative instructions given to the client earlier. Which postoperative instruction should the
nurse emphasize?
A. You must lie flat for 24 hours after surgery.
B. You must avoid coughing, sneezing, and blowing your nose.
C. You must restrict your fluid intake.
D. You must report ringing in your ears immediately.
41. Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2
diabetes mellitus who has been having trouble controlling the blood glucose level through diet and
exercise. Which medication instruction should the nurse provide?
A. Be sure to take glipizide 30 minutes before meals.
B. Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly.
C. You wont need to check your blood glucose level after you start taking glipizide.
D. Take glipizide after a meal to prevent heartburn.

42. For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing
change every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry
dressings used for this client?
A. They contain exudate and provide a moist wound environment.
B. They protect the wound from mechanical trauma and promote healing.
C. They debride the wound and promote healing by secondary intention.
D. They prevent the entrance of microorganisms and minimize wound discomfort.
43. When instructing the female client diagnosed with hyperparathyroidism about diet, nurse Gina
should stress the importance of which of the following?
A. Restricting fluids
B. Restricting sodium
C. Forcing fluids
D. Restricting potassium
44. Which nursing diagnosis takes highest priority for a female client with hyperthyroidism?
A. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
B. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing
C. Body image disturbance related to weight gain and edema
D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
45. A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide
(Tolinase). Which of the following is the most important laboratory test for confirming this disorder?
A. Serum potassium level
B. Serum sodium level

C. Arterial blood gas (ABG) values


D. Serum osmolarity
46. A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and
family how diet and exercise affect insulin requirements, Nurse Joy should include which guideline?
A. Youll need more insulin when you exercise or increase your food intake.
B. Youll need less insulin when you exercise or reduce your food intake.
C. Youll need less insulin when you increase your food intake.
D. Youll need more insulin when you exercise or decrease your food intake.
47. Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug
reactions and interactions. Which type of drug interacts adversely with glucagon?
A. Oral anticoagulants
B. Anabolic steroids
C. Beta-adrenergic blockers
D. Thiazide diuretics
48. Which instruction about insulin administration should nurse Kate give to a client?
A. Always follow the same order when drawing the different insulins into the syringe.
B. Shake the vials before withdrawing the insulin.
C. Store unopened vials of insulin in the freezer at temperatures well below freezing.
D. Discard the intermediate-acting insulin if it appears cloudy.
49. Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, lightheadedness, and aberrant behavior. The client is still conscious. The nurse should first administer:
A. I.M. or subcutaneous glucagon.
B. I.V. bolus of dextrose 50%.
C. 15 to 20 g of a fast-acting carbohydrate such as orange juice.
D. 10 U of fast-acting insulin.
50. For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for
Chvosteks sign and Trousseaus sign because they indicate which of the following?
A. Hypocalcemia
B. Hypercalcemia
C. Hypokalemia
D. Hyperkalemia

Prepared by:
Mr. Charlie C. Falguera, RN, MAN