60 91 Endocrine

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PITUITARY MECHANISMS
DISORDERS OF THE POSTERIOR PITUITARY GLAND
GROWTH HORMONE DISORDERS
DISORDERS OF THE THYROID GLAND
DISORDERS OF THE PARATHYROID GLAND

MEDULLA (PHEOCHROMOCYTOMA)
DISORDERS OF THE ADRENAL
DISORDERS OF THE ADRENAL CORTEX
DIABETES MELLITUS
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PITUITARY MECHANISMS
1.
Patient
Gardo
is
suspected
of
having
a
pituitary
tumor
causing
panhypopituitarism. During assessment, the nurse would expect to find which of the
following from Gardo?
a. Tachycardia and cardiac palpitations.
b. High blood pressure.
c. Changes in secondary sex characteristics.
d. Elevated blood glucose.
2. An upper respiratory infection is seen in one of the patients in the clinic. The
patient reports receiving subcutaneous somatotropin (Genotropin) when asked by the
nurse about current medications. Which of the following patients history will initiate
the nurse to ask for further information?
a. Diabetes insipidus (DI).
b. A pituitary tumor.
c. Untreated acromegaly.
d. Adrenal disease.
3. The nurse is evaluating the laboratory findings of a patient with increased
secretion of the anterior pituitary hormones. The nurse would expect to find:
a. Low urinary excretion of catecholamines.
b. Decreased serum thyroxine levels.
c. Elevated serum aldosterone levels.
d. An increase in urinary free cortisol.
4. Nurse Niguel is caring for a client after hypophysectomy. During bedside care, Niguel notices a
clear nasal drainage from the client's nostril. The nursing action that would be performed initially
by Nurse Niguel would be?
a. Lower the head of the bed.
b. Continue to observe the drainage.
c. Test the drainage for glucose.
d. Obtain a culture of the drainage.
5. Mrs. Georgia, a 35-year-old female client on oral contraceptives is prescribed steroid
therapy. Which of the following should be included by the nurse when teaching the
client about this medication?
a. Weigh daily
b. Avoid salt
c. Nothing
d. Consider adding another form of contraception
DISORDERS OF THE POSTERIOR PITUITARY GLAND
6. The medical surgical nurse has been teaching the clients with new onset of syndrome of
inappropriate antidiuretic hormone (SIADH) about the disorder. Which of the following
statements by the client best indicates that he/she correctly understand how to manage this
disease?
a. I should drink at least 3,000 cc or 10 glasses of water daily.
b. I should limit my fluid intake to approximately 800 cc or 4 glasses of water daily.
c. I should limit my sodium intake 2 grams daily.
d. I should report constipation or fatigue to the doctor.
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7. A water deprivation test is ordered by the physician for the patient. Results of the
test showed no changes in urine osmolality. The nurse realizes that this finding is
consistent with:
a. Diabetes insipidus.
b. Diabetes mellitus.
c. Syndrome of inappropriate antidiuretic hormone.
d. Nothing. No pathology is present.
8. Desmopressin acetate (DDAVP) is prescribed for the treatment of Mr. Lastimosa, a client
diagnosed with diabetes insipidus. Knowing the drugs effects and function, the nurse
administering the medication monitors the client for which therapeutic response?
a. Decreased urinary output
b. Decreased peripheral edema
c. Decreased blood pressure
d. Decreased blood glucose level
9. A client with diabetes insipidus is prescribed with Vasopressin (Pitressin). A nurse is
particularly cautious in monitoring the client receiving this medication if the client has which of
the following preexisting conditions?
a. Depression
b. Pheochromocytoma
c. Coronary artery disease
d. Endometriosis
10. The client went to the hospital complaining of increased urination and feeling of being weak.
After the initial assessment of the nurse, the physician confirms that the client may be suffering
from diabetes insipidus. As a competent nurse, you know that the assessment of a client that
would be most indicative of diabetes insipidus is
a. Decreased serum osmolarity.
b. Elevation of blood pressure
c. Low urinary specific gravity.
d. Increased blood glucose.
11. The nurse is discharging a client diagnosed with diabetes insipidus. Which statement made
by the client warrants further intervention?
a. I will keep a list of my medications in my wallet and wear a Medi bracelet.
b. I should take my medication in the morning and leave it refrigerated at home.
c. I should weigh myself every morning and record any weight gain.
d. If I develop tightness in my chest, I will call my health-care provider.
12. Nurse Gerald prepares discharge instructions for a patient with chronic syndrome of
inappropriate antidiuretic hormone (SIADH). Which statement indicates that the patient
understands these instructions?
a. I have to avoid too much sodium intake. I will read all food labels to make sure I dont get too
much of it in my diet.
b. I will weigh every day and I will log it in a notebook. I will call my physician whenever I gain 2
lbs or more in a day without changing my eating habits.
c. I will use a refractometer to check the specific gravity of my urine. If the result gradually rises,
I will consult my physician.
d. Ill check my pulse every morning and will contact my doctor if its rapid or irregular.
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13. Nurse Dennis is admitting a client diagnosed with syndrome of inappropriate antidiuretic
hormone (SIADH). Which clinical manifestations should be reported immediately to the health
care provider?
a. Serum potassium of 5.0 mEq/L and a heightened awareness.
b. Serum sodium of 112 mEq/L and a headache.
c. Serum magnesium of 1.2 mg/dL and large urinary output.
d. Serum calcium of 10 mg/dL and tented tissue turgor.
14. The client diagnosed with a pituitary tumor has developed syndrome of inappropriate
antidiuretic hormone (SIADH). The nurse would implement which of the following interventions?
a. Administer vasopressin IV and conduct a fluid deprivation test.
b. Monitor potassium levels and encourage fluid intake.
c. Assess for nausea and vomiting and weigh daily.
d. Assess for dehydration and monitor blood glucose levels.
15. The family of a client with syndrome of inappropriate antidiuretic hormone
(SIADH) asks the nurse if the water restriction is a punishment for the clients
uncooperative behavior. Which is the nurses best response?
a. "Limiting water intake prevents the client from losing too much fluid by vomiting."
b. "Limiting fluid intake decreases the risk of kidney failure."
c. "Limiting fluid decreases the clients sense of thirst and prevents him from drinking liquids
that contain an excess of sodium."
d. "Limiting fluid intake prevents the clients blood from becoming more dilute and
causing other complications."
GROWTH HORMONE DISORDERS
16. A nurse is caring for Dante, a 30 year old male client, who was admitted with an impression
of acromegaly. When developing the plan of care for Dante, which nursing diagnosis would be
given priority?
A. a. Activity intolerance.
B. b. Acute confusion.
C. c. Impaired speech.
D. d. Altered nutrition.
17. A client was diagnosed with acromegaly. The physician ordered bromocriptine therapy. After
a short course of Bromocriptine (Parodel) therapy to treat the acromegaly, which precautionary
instruction must the competent nurse give to the client?
a. Slowly rise from a sitting or lying position.
b. Have his blood pressure taken regularly.
c. Stay in bed for 30 minutes after intake of medication.
d. Avoid shower bath.
18. Archie is a client diagnosed with dwarfism. He asked the nurse what could be the reason of
his disease condition. As a nurse caring for Archie, you know that which of the following
metabolic alteration characteristics might be associated with growth hormone deficiency?
a. Galactosemia.
b. Homocystinuria.
c. Hypoglycemia.
d. Hyperglycemia.
DISORDERS OF THE THYROID GLAND
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19. A client with hyperthyroidism was admitted 2 hours ago. When caring for a client whose
being treated for hyperthyroidism, which nursing action is important?
a. Balancing the client's periods of activity and rest
b. Monitoring the client for signs of restlessness, sweating, and excessive weight loss during
thyroid replacement therapy
c. Providing extra blankets and clothing to keep the client warm
d. Encouraging the client to be active to prevent constipation
20. Ms. Rebecca has undergone thyroid surgery. During the first 24 hours after the operation,
which of the following should the nurse include in her care?
a. Encouraging the client to ventilate her feelings about the surgery.
b. Supporting the head during mild range of motion exercise.
c. Advising the client that she can resume her normal activities immediately.
d. Checking the back and sides of the operative dressing.
21. Clinical manifestations of hypothyroidism are seen in the client. To determine
whether the low thyroid level is caused by a problem with the anterior pituitary
gland, which value will the nurse check in the patients chart?
a. Triiodothyronine (T3) level
b. TSH level
c. Thyroxine (T4) level
d. Thyrotropin-releasing hormone (TRH) level
22. A client diagnosed with hyperthyroidism is receiving methimazole (Tapazole).
Which should be included in the clients education regarding the initiation of this
therapy?
a. "Take your pulse every day, as you were taught. If it is too fast, call your doctor."
b. This medication may cause dyspnea or vertigo. Call your doctor if this occurs.
c. "An increased need for sleep can occur with this drug. If it does, call your doctor."
d. "Nausea and vomiting are serious complication of the medication you are taking."
23. A client diagnosed with hyperparathyroidism is to undergo an operation for the removal of
parathyroid gland. Which foods would the licensed nurse discourage the client from eating prior
to a parathyroidectomy?
a. Green vegetables.
b. Milk products.
c. Poultry products.
d. Seafood.
24. Nurse Vincent performs initial assessment and confers with the medical resident. Which of
the following will the nurse consider as the correct description of Graves disease?
a. Multiple thyroid nodules resulting in thyroid hyperfunction
b. Increase in thyroid secretion of T3; cause is unknown
c. Antibodies bind to TSH receptors causing increased thyroid hormone
d. Uncontrolled secretion of T3 and T4 from benign thyroid tumor
25. The client is ordered by the physician to undergo thyroid scan. Which is the best
instruction for the nurse to give to the client regarding the procedure?
a. "Your thyroid will be radioactive for weeks."
b. "Low-dose radiation is used and is excreted by the kidneys."
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c. "No radiation is used for this scan."
d. "You will have external beam radiation."
26. Mr. Gardo has undergone a complete thyroidectomy. Which statement by Gardo
indicates that further instruction is needed?
a. "After the surgery, I wont need to take any more thyroid medication."
b. "I may need calcium replacement."
c. "Ill need to take thyroid hormones for life."
d. "I can receive pain medication if I feel that I need it."
27. The nurse is making an initial assessment for the client suspected to have
thyroid problems admitted 2 hours ago. Which alteration in vital signs is most
indicative of hypothyroidism?
a. Apical rate of 50 beats/min
b. Respiratory rate of 16 breaths/min
c. Blood pressure of 118/70 mm/Hg
d. Temperature of 97.9F
28. Which of the following client statements should Nurse James report to the
physician prior to scheduling a radioactive iodine uptake and excretion test?
a. "Ive been taking over-the-counter cough medicine for the past two weeks."
b. "My husband and I are vegetarians."
c. "We like to drink a glass of wine with our meals."
d. "I take a baby aspirin every day since my heart attack last year."
29. Nurse Fifi is teaching a client experiencing hypoparathyroidism resulting from a lack of
parathyroid hormone (PTH) about foods to consume. Which should be included on a list of
appropriate foods for a client experiencing hypoparathyroidism?
a. Dark green vegetables, soybeans, and tofu
b. Spinach, strawberries, and yogurt
c. Whole grain bread, milk, and liver
d. Rhubarb, yellow vegetables, and fish
30. Mr. Popo, a client with hyperthyroidism is admitted. In what room would the registered nurse
place Mr. Popo?
a. Across from the RN's station.
b. A room with a client who had a cholecystectomy.
c. A private room.
d. A room with a client with the same diagnosis.
31. The nurse is caring for the client with hypothyroidism. Which of the following
interventions should the nurse perform in the plan of care for a client with
hypothyroidism?
a. Providing a cool temperature in the room.
b. Administering sedative.
c. Applying lotion for skin care.
d. Scheduling periods of rest.
32. A total thyroidectomy is ordered following the discovery of a cold nodule. In this case of
hyperthyroidism versus malignancy, the nurse anticipates that the client will have
a. A complete thyroidectomy also.
b. A partial thyroidectomy (approximately one-half of the thyroid is removed).
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c. A partial thyroidectomy (approximately five-sixths of the thyroid is removed).
d. Administration of additional thyroid hormone.
33. A 35 year old woman complains of anxiety, insomnia, weight loss, inability to concentrate,
and eyes feeling "gritty." Thyroid function tests reveal the following: thyroid-stimulating hormone
(TSH) 20 ml U/ml, thyroxine 20 mg/dl, and triiodothyronine 253 mg/dl. A 6-hour radioactive
iodine uptake test shows a diffuse uptake of 85%. Based on these assessment findings, the nurse
would suspect what?
a. Hashimoto's thyroiditis
b. Multinodular goiter
c. Thyroiditis
d. Graves' disease
34. A client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU) before
undergoing a subtotal thyroidectomy. The nurse would expect the maximum effect of both
agents to occur:
a. Immediately.
b. In 1 to 2 weeks.
c. In a few days.
d. In 3 to 4 months.
35. An elderly client, age 68 was diagnosed with Hashimoto's thyroiditis. As a knowledgeable
nurse taking care of the client, which signs and symptoms would you expect to assess?
a. Weight gain, decreased appetite, and constipation
b. Weight loss, increased urination, and increased thirst
c. Weight gain, increased urination, and purplish red striae
d. Weight loss, increased appetite, and hyperdefecation
36. A client diagnosed with Hashimoto's thyroiditis is admitted in the hospital ward. Which
laboratory test results would the nurse expect to find in a client experiencing this condition?
a. Thyroxine (T4), 22 mg/dl; triiodothyronine (T3), 320 ng/dl; thyroid-stimulating hormone (TSH),
undetectable
b. T4, 2 mg/dl; T3, 200 ng/dl; TSH, 5.9 mIU/ml
c. T4, 22 mg/dl; T3, 200 ng/dl; TSH, 0.1 mIU/ml
d. T4, 2 mg/dl; T3, 35 ng/dl; TSH, 45 mIU/ml
37. Nurse Kimmy is caring for a client diagnosed with myxedema coma. Which nursing
intervention is most crucial for a client with this condition?
a. Measuring and recording accurate intake and output
b. Administering an oral dose of levothyroxine (Synthroid)
c. Maintaining a patent airway
d. Warming the client with a warming blanket
38. Nurse Hyacint is monitoring a client with Graves disease for signs of thyrotoxic crisis (thyroid
storm). Which of the following signs and symptoms if noted in the client will alert the Nurse
Hyacint to the presence of this crisis?
a. Agitation and bradycardia
b. Restlessness and bradycardia
c. Fever and tachycardia
d. Pallor and tachycardia
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39. An adult, who is newly diagnosed with Graves disease, asks the nurse on duty, Why do I
need to take Propanolol (Inderal)? Based on the nurses understanding of the medication and
Graves disease, the best response to the clients question would be?
a. The medication will increase the synthesis of thyroid hormones.
b. The medication will block the cardiovascular symptoms of Graves disease.
c. The medication limit synthesis of the thyroid hormones.
d. The medication will limit thyroid hormone secretion.
40. Despite of thyroidectomy done for Graves Disease, Ms. Andreas exopthalmos still continues.
The nurse teaches her how to reduce discomfort and prevent corneal ulceration. The nurse
recognizes that the client understands the teaching when she says: I should:
a. Avoid excessive blinking.
b. Avoid using a sleeping mask at night.
c. Avoid moving my extra-ocular muscles.
d. Elevate the head of my bed at night.
41. Before a postthyroidectomy client returns to her private room from the operating room, the
nurse plans to set up emergency equipment, which should include:
a. A tracheostomy set and oxygen.
b. A crash cart with bed board.
c. Two ampules of sodium bicarbonate.
d. An airway and rebreathing mask.
42. Levothyroxine (Synthroid) is prescribed for a client diagnosed with hypothyroidism. The nurse
reviews the client's record and notes that the client is presently taking warfarin (Coumadin). The
nurse contacts the physician, anticipating that the physician will prescribe which of the
following?
a. An increased dosage of Coumadin.
b. A decreased dosage of Coumadin.
c. An increased dosage of Synthroid.
d. A decreased dosage of Synthroid.
43. A client with hypothyroidism is taking Synthroid (levothyroxine sodium) for 3 months. Which
evaluation would indicate a therapeutic response to this drug?
a. Weight loss of 5 lbs
b. Decreased diarrhea
c. Decreased appetite
d. Normal heart rate
DISORDERS OF THE PARATHYROID GLAND
44. Mrs. Sarah, a female adult client with a history of chronic hyperparathyroidism admits to
being disobedient to the health teachings given by the nurse. Based on initial assessment
findings, Nurse Archie 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 exhaustion secondary to an accelerated metabolic rate.
b. Related to bone demineralization resulting in pathologic fractures.
c. Related to tetany secondary to a decreased serum calcium level.
d. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces.
45. When instructing Ashlynn, diagnosed with hyperparathyroidism about diet, Nurse Marcus
should stress the importance of which of the following?
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a.
b.
c.
d.
Restricting sodium
Restricting fluids
Restricting potassium
Forcing fluids
46. While discussing the functions of the parathyroid hormone to a client who visited in the
clinic, you, as a nurse did not miss to mention that the parathyroid hormone (PTH) has which
effects on the bones and kidneys?
a. Increased absorption of vitamin D and excretion of vitamin E
b. Stimulation of phosphate resorption and calcium excretion
c. Stimulation of calcium resorption and phosphate excretion
d. Increased absorption of vitamin E and excretion of vitamin D
47. A nurse is caring for an adult male postoperative parathyroidectomy client. Which client
complaint would indicate that a serious, life-threatening complication may be developing,
requiring immediate notification of the physician?
a. Abdominal cramps
b. Laryngeal stridor
c. Mild to moderate incisional pain
d. Difficulty in voiding
48. The postoperative orders for a client who has a parathyroidectomy include using
Chvosteks sign to assess for signs of tetany. Which of the following is the appropriate
assessment technique the nurse should apply?
a. Listen for a crowing sound with inspirations.
b. Occlude the blood flow in the wrist.
c. Tap sharply over the facial nerves.
d. Observe respiratory rate and depth.
49. The diet arranged for a client with hypoparathyroidism should be high in calcium
and low in phosphorus. The nurse instructs the client to eat which of the following
foods basing from the ordered diet by the physician?
a. Milk
b. Cheese
c. Cauliflower
d. Green leafy vegetables
50. Nurse Jayvee is completing an assessment on a client who is being admitted for a diagnostic
workup for primary hyperparathyroidism. Which client complaint would be characteristic of this
disorder?
a. Polyuria
b. Diarrhea
c. Weight gain
d. Polyphagia
DISORDERS OF THE ADRENAL MEDULLA (PHEOCHROMOCYTOMA)
51. The nursing coordinator calls the intensive care unit (ICU) to advise them that a client with a
suspected pheochromocytoma will be admitted from the emergency department. The
knowledgeable nurse should prepare to administer which drug to the client?
a. nitroprusside
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b. lidocaine
c. insulin
d. dopamine (Inotropin)
52. Mr. Caloi is diagnosed with pheochromocytoma. A nurse prepares a nursing care plan for the
client. While planning, the nurse understands that pheochromocytoma is a condition that
a. Is not curable and is treated symptomatically.
b. Causes the release of excessive amounts of catecholamines.
c. Causes profound hypotension.
d. Is manifested by severe hypoglycemia.
53. Nurse James collects urine specimens for testing of catecholamines from a client with
suspected pheochromocytoma. The results of the catecholamine test are reported as 20
mcg/100 mL urine. The nurse analyzes these results as:
a. Normal
b. Insignificant and unrelated to pheochromocytoma
c. Higher than normal, indicating pheochromocytoma
d. Lower than normal, ruling out pheochromocytoma
54. Nurse Archie is caring for a male client with pheochromocytoma. The client asks for a snack
and something warm to drink. Which of the following would be the most appropriate choice for
this client to meet his nutritional needs?
a. Graham crackers and warm milk
b. Crackers with cheese and tea
c. Vanilla wafers and coffee with cream and sugar
d. Toast with peanut butter and cocoa
55. Mr. Denver, the patient with pheochromocytoma is scheduled for surgical resection of the
tumor in the adrenal medulla. The nurse monitors the patient postoperatively for which of the
following potential complications?
a. Hemorrhage.
b. Hypertensive crisis.
c. Hypoglycemia.
d. Postural hypotension.
56. You are discussing the possible treatment regimens with clients diagnosed with
pheochromocytoma. As a nurse you would discuss that which of the following therapeutic
classes of drugs is used to treat tachycardia and angina in patients with pheochromocytoma?
a. Calcium channel blockers.
b. -blockers.
c. ACE inhibitors.
d. Diuretics.
DISORDERS OF THE ADRENAL CORTEX
57. The patient with Addisons disease must be taught and informed by the nurse that the side
effect of bronze-colored skin is thought to be caused by which of the following?
a. Increased secretion of ACTH.
b. Hypersensitivity to sun exposure.
c. Side effects of the glucocorticoid therapy.
d. Increased serum bilirubin level.
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58. Nurse Brent is teaching diet restrictions for a client with Addison's disease. The client would
indicate an understanding of the diet by stating
a. "I will increase sodium and fluids and restrict potassium."
b. "I will increase potassium and sodium and restrict fluids."
c. "I will increase sodium, potassium and fluids."
d. "I will increase fluids and restrict sodium and potassium."
59. The health care provider has ordered a serum cortisol level to rule out adrenal
dysfunction in a patient who works at night from 11:00 PM to 7:00 AM and normally
sleeps from 8:00 AM to 4:00 PM. To ensure the most consistent test results, the nurse
arranges the blood specimen to be drawn
a. In the early morning.
b. At 11:00 PM.
c. At 3:00 AM.
d. In the late afternoon.
60. A 45 year old female client comes into the private clinic to be seen for fatigue and
a cold that "won't go away" that began when she got a new job and her father moved
in with her family. The nurse realizes that this client might be experiencing:
a. A drop in mineralocorticoid secretion.
b. A reduction in norepinephrine secretion.
c. An increase in glucocorticoid secretion.
d. An increase in epinephrine secretion.
61. Warren, a client with Cushing's syndrome tells the nurse on duty, "I seem to catch
a cold every couple of weeks." Which of the following nursing actions would be
appropriate for Warren?
a. Encourage daily weights.
b. Assess for protein and vitamin intake.
c. Review coping strategies.
d. Plan for frequent rest periods.
62. A nurse is taking care of Manong Buboy, a client recently diagnosed with Addisons disease.
Which of the following is a priority outcome for Mang Buboy who suffers from Addisons disease?
a. Maintenance of medication compliance.
b. Prevention of hypertensive episodes.
c. Adherence to a 2-g sodium diet.
d. Avoidance of normal activities with stress.
63. In the medical ward, a client expresses to the nurse, "I am seldom outside in the
sun and I'm getting such a tan!" Which of the following should the nurse assess in
this client?
a. Ask the client what time of day they are outdoors.
b. Ask if the client is still taking the prescribed steroid for her Addison's disease.
c. Palpate the client's thyroid gland.
d. Auscultate the client's lung sounds.
64. Which statement made by Manong Ondoy indicates a correct understanding of steroid
therapy for Addisons Disease?
a. "Ill take the medicine in the morning because if I take it at night, it might keep me awake."
b. "Ill take the same amount from now on."
c. "Ill increase my potassium by eating more bananas."
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d. "This medicine probably wont affect my blood pressure."
65. Which clinical change should indicate to a nurse that the treatment for Pipoy, a client with
Addisonian crisis is effective?
a. An increase of 25 mm Hg in the clients systolic blood pressure
b. A decrease of 25 mm Hg in the clients systolic blood pressure
c. An increase in the clients serum potassium level from 4.8 to 6.0 mEq/dL
d. A decrease in the clients total serum calcium level from 8.6 to 7.0 mg/dL
66. Nurse Archie is caring for a client identified as having Addisons disease. Archie is monitoring
the client for signs of Addisonian crisis. Being the nurse on duty, Archie should assess the client
for which manifestation that would be associated with this crisis?
a. Agitation
b. Diaphoresis
c. Severe abdominal pain
d. Restlessness
67. When admitting a client with suspected hyperaldosteronism, a nurses priority would be?
a. Administering medications to treat headache
b. Preparing the client for a computed tomography (CT) scan
c. Protecting the client from falls due to muscle weakness
d. Obtaining an electrocardiogram (ECG) to assess for cardiac dysrhythmias
68. After unilateral adrenalectomy to treat hyperaldosteronism caused by an adenoma, the nurse
is preparing to discharge the client. As a knowledgeable nurse, which instruction should be
included in this clients discharge teaching?
a. Carry an emergency kit that includes hydrocortisone.
b. Discontinue medications taken prior to the adrenalectomy.
c. Self-monitor the blood pressure.
d. Avoid foods high in potassium.
69. A 40-year-old woman who complains of weight gain, facial hair, sudden absence of
menstruation, frequent bruising, and acne is diagnosed with Cushing's disease. Cushing's
disease is most likely caused by
a. an inborn error of metabolism.
b. a corticotropin-secreting pituitary adenoma.
c. adrenal carcinoma.
d. an ectopic corticotropin-secreting tumor.
70. Nurse Grace admitted a 6-year-old patient with Cushing's syndrome to be prepared for
surgical removal of an adrenal tumor. Nurse Grace understands that the manifestations observed
on the patient is due to which of the following?
a. Decreased adrenocorticotropic hormone
b. Oversecretion of glucocorticoids
c. Deficiency of corticosteroids
d. Decreased secretion of mineralocorticoids
71. The client has developed iatrogenic Cushings disease. Which is a scientific rationale for the
development of this problem?
a. The client has a pituitary gland tumor that causes the adrenal glands to produce too much
cortisol.
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b. The client has developed an adrenal gland problem for which the health care provider does
not have an explanation.
c. The client has an autoimmune problem that causes the destruction of the adrenal cortex.
d. The client has been taking steroid medications for an extended period for another disease
process.
72. You are taking care of a client recently diagnosed with Cushings syndrome. In planning care
for the client with Cushings syndrome, which nursing action would be of highest priority?
a. prevent skin breakdown
b. prevent infections
c. teach client signs and symptoms of hyperglycemia
d. prevent fluid overload.
73. At the weight loss clinic, the nurse assesses a client who has a large abdomen and a rounded
face. Which additional assessment finding would lead the nurse to suspect that the client has
Cushings syndrome rather than obesity?
a. posterior neck fat pad and thin extremities
b. abdominal striae and ankle enlargement
c. large thighs and upper arms
d. pendulous abdomen and large hips
74. Nurse Carl Jade is assigned to a client who is 48 hours post adrenalectomy. The client is
receiving IV therapy at 125 cc/hr. The urinary output is 200 cc over the past 8 hours, with BP
80/60, pulse 120, and respiration 24. Nurse Carl Jade reports these findings to the surgeon and
associates these data with
a. Cardiac complications.
b. Decreased circulating blood volume.
c. Renal insufficiency.
d. Incisional pain.
75. A client undergoing bilateral adrenalectomy has postoperative orders for hydromorphone
hydrochloride (Dilaudil) 2 mg to be given subcutaneously every 4 hours PRN for pain. This drug is
administered in relatively small doses primarily because it is
a. less irritating to subcutaneous tissues in small doses.
b. less likely to cause dependency in small doses.
c. as potent as most other analgesics in larger doses.
d. excreted before accumulating in toxic amounts in the body.
DIABETES MELLITUS
76. Clyde has just been diagnosed with type 1 diabetes mellitus. When teaching Clyde and his
family how diet and exercise affect insulin requirements, Nurse Alvin should include which
guideline?
a.
b.
c.
d.
Youll need less insulin when you exercise or reduce your food intake.
Youll need more insulin when you exercise or increase your food intake.
Youll need more insulin when you exercise or decrease your food intake.
Youll need less insulin when you increase your food intake.
77. In teaching the brother of a diabetic client about the proper use of a glucometer in
determining the blood sugar level of the client, the nurse is focusing in which domain of learning
according to Bloom?
a. Cognitive
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b. Affective
c. Psychomotor
d. Affiliative
78. Capillary blood glucose monitoring is being performed every 4 hours for Kris, 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 Regine should expect the doses
a.
b.
c.
d.
Onset to be at 4 p.m. and its peak to be at 6 p.m.

Onset to be at 2:30 p.m. and its peak to be at 4 p.m.
Onset to be at 2:15 p.m. and its peak to be at 3 p.m.
Onset to be at 2 p.m. and its peak to be at 3 p.m.
79. Before breakfast, a 10 year old child with juvenile diabetes mellitus (Type 1) passed out on
the kitchen floor after taking his morning insulin dose. The nurse's best response is based on
which concept?
a. A child with a viral infection can have hypoglycemia.
b. Children with diabetes may act out to get attention.
c. Insulin shouldnt be taken until 30-60 minutes after breakfast
d. The morning dose caused hypoglycemia before the child ate.
80. Taguro, a patient with D
diabetes mellitus was prescribed by the physician to use insulin. His physician has ordered shortand long-acting insulin. When administering two types of insulin, the proficient nurse would
a. Withdraw long-acting insulin, inject air into the regular insulin, and withdraw insulin.
b. Withdraw the short-acting insulin into the syringe before the long-acting insulin.
c. Withdraw the long-acting insulin into the syringes before the shortacting insulin.
d. Draw up in two syringes, and then combine into one syringe.
81. The nurse is having difficulty obtaining a capillary blood sample from a client's finger to
measure blood glucose using a blood glucose monitor. Which procedure will increase the blood
flow to the area to ensure an adequate specimen?
a. Pierce the skin with the lancet in the middle of the finger pad.
b. Raise the hand on a pillow to increase venous flow.
c. Pierce the skin at a 45-degree angle.
d. Wrap the finger in a warm cloth for 30-60 seconds.
82. The most important condition for diabetic client to learn how to control their diet is which of
the following?
a. Use of pamphlets and effective teaching devices during health instruction
b. Motivation to be symptom free
c. Language and appropriateness of the instruction
d. Ability of the client to understand teaching instruction
83. A 17 year old female with newly diagnosed diabetes is being discharged. Before discharge,
you as a nurse provided health teachings to the client. During your evaluation, which client
statement indicates an accurate understanding of insulin?
a. The onset action for Humulin R insulin is 1 1-1/2 hours.
b. The peak action for Semilente insulin is 2-3 hours.
c. The peak action for Humulin N insulin is 5-10 hours.
d. Ultra Lente insulin is effective for 8 12 hours.
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84. A diabetic male client with a foot ulcer has the following physician orders; bed rest, a wet-todry dressing change every shift, and blood glucose monitoring before meals and bedtime. The
male client asked the nurse, Why wet-to-dry dressings are used for my foot ulcer? The correct
answer of the nurse would be?
a. They debrid the wound and promote healing by secondary intention.
b. They protect the wound from mechanical trauma and promote healing.
c. They contain exudates and provide a moist wound environment.
d. They prevent the entrance of microorganisms and minimize wound discomfort.
85. The physician ordered screening the client for diabetes mellitus. The screening includes a
measurement of postprandial blood glucose. The nurse is correct in explaining that blood will be
drawn at which approximate time?
a. 2 hours after sleep
b. 2 hours before exercise.
c. 2 hours after meal.
d. 2 hours after fasting.
86. Diet is one of the most important concepts a nurse must teach to a diabetic client. Nurse
Cyndy knows that the diabetic client understands that lite or light in food products is a
categorizing term that means which of the following?
a. The item contains one third fewer calories than a similar unaltered item.
b. The product is compressed to lesser weight but the same caloric content.
c. A food item has reduced water content.
d. The product is calculated specifically for diabetic client assumption.
87. A diabetic client, controlled with oral anti-hyperglycemic agents, questions the need for
postoperative subcutaneous insulin injections. What is the most accurate explanation the nurse
would give the client for the injections?
a. Being NPO inhibits normal blood sugar control.
b. Tissue injury after surgery decreases blood sugar.
c. Surgery often leads to insulin dependency.
d. Anesthesia acts to increase glycogen store.
88. Jamaica experiences Somogyis effect. To prevent this complication, the competent nurse
should instruct Jamaica to
a. Take insulin every day at 2:00 pm
b. Eat a snack before bedtime
c. Increase the amount of regular insulin
d. Engage in physical activity daily
89. Nurse James and Nurse Archie is caring for a client with type 2 diabetes on a telemetry unit.
The client is scheduled for cardiac rehabilitation exercises (cardiac rehab). Nurse James notes
that the clients blood glucose level is 300 mg/dL and the urine is positive for ketones. Nurse
Archie asks Nurse James, which nursing action should be included in their nurses' care plan?
a. Send the client to cardiac rehab because exercise will lower the clients blood glucose level.
b. Administer insulin and then send the client to cardiac rehab with a 15-gram carbohydrate
snack.
c. Delay the cardiac rehab because blood glucose levels will decrease too much with exercise.
d. Cancel the cardiac rehab because blood glucose levels will increase further with exercise.
90. What actions would the RN take when a client's blood sugar is 310 mg/dL and pH is 7.32,
with ketonuria and considered in the early stages of diabetic ketoacidosis (DKA)?
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a. Give 0.9 percent saline IV with regular insulin.
b. Give nasal O2 at 2 L/min.
c. Start an IV of Ringer's lactate with 20 mEq of KCl.
d. Insert a Foley catheter.
91. A 75-year-old client with type 2 diabetes is rushed in the emergency department with signs
of hyperglycemic, hyperosmolar nonketotic (HHNK) coma. What assessment finding would the
registered nurse expect?
a. Profuse sweating.
b. Rapid, deep respirations.
c. Severe dehydration.
d. Fruity odor to the breath.
92. Mr. Gary has new onset type I diabetes mellitus (DM). He asks you why he needs to check his
blood glucose level so frequently. As a competent nurse, you explain that frequent monitoring of
insulin is done to keep his blood glucose level between 80 and 155 mg/dl is important for which
of the following reasons?
a. Chronic elevated blood glucose levels damage cells and cause multiple organ damage.
b. Carbohydrates are constantly being converted to glucose and transported in the blood by
insulin.
c. High glucose levels cause the body to use proteins for energy, causing lactic acidosis.
d. Early identification of hypoglycemia before the onset of symptoms is easier to treat.
93. Jennifer, age 58, who is diabetic, is for debridement of wound incision. When the circulating
nurse checked the present I.V Fluid, she found out that there is no insulin incorporated as
ordered. What should the circulating nurse do?
a. Communicate with the client to verify if insulin was incorporated
b. Incorporate insulin as ordered
c. Double check the doctors order and call the attending MD
d. Communicate with the ward nurse to verify if insulin was incorporated or not
94. Self-monitoring of blood glucose (SMBG) is recommended for diabetic clients use. You will
recommend this technology in the following diabetic patients, EXCEPT:
a. Unstable diabetes
b. Hypoglycemia without warning
c. Client with proliferative retinopathy
d. Abdominal renal glucose threshold
95. At a senior citizens meeting, Nurse Angelica talks with a client who has diabetes mellitus
Type 1. Which statement by the client during the conversation is most projecting for a potential
risk
of
impaired
skin
integrity?
a. "Sometimes when I put my shoes on I don't know where my toes are."
b. "I give my insulin to myself in my thighs."
c. "If I bathe more than once a week my skin feels too dry."
d. "Here are my up and down glucose readings that I wrote on my calendar."
96. The nurse is providing health teachings to a client prescribed with insulin therapy. What is
the best reason for the nurse in educating the client to rotate injection sites for insulin
administration?
a. Injection sites can never be reused
b. Lipodystrophy can result and is extremely painful
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c. Poor rotation technique can cause superficial hemorrhaging
d. Lipodystrophic areas can result, causing erratic insulin absorption rates
97. The nurse is teaching ways to prevent diabetic ketoacidosis with the client diagnosed with
diabetes type I. Which instruction would be most crucial for the nurse to discuss with the client?
a. Be sure to get your annual flu and pneumonia vaccines.
b. Take the prescribed insulin even when unable to eat if you have an illness.
c. Do not take any over-the-counter medications.
d. Refer the client to the American Diabetes Association.
98. The nurse is discussing the importance of exercising to a client diagnosed with Type 2
diabetes whose diabetes is well controlled with diet and exercise. Which information should the
nurse include in the teaching about diabetes?
a. Perform warm-up and cool down exercises.
b. Encourage the client to walk 20 minutes 3 times a week.
c. Carry peanut butter crackers when exercising.
d. Eat a simple carbohydrate snack before exercising.
99. The client diagnosed with Type 1 diabetes has glycosylated hemoglobin of 8.1%. Which
interpretation should the nurse make based on this result?
a. This result is dangerously high.
b. This result is above recommended levels.
c. This result is within acceptable levels.
d. This result is below normal levels.
100. A patient with type I diabetes mellitus was immediately rushed to the emergency room last
night because of diabetic ketoacidosis. Which arterial blood gas would the nurse expect in the
client diagnosed with diabetic ketoacidosis?
a. pH 7.34, PaO2 99, PaCO2 48, HCO3 24.
b. pH 7.46, PaO2 85, PaCO2 30, HCO3 26.
c. pH 7.38, PaO2 95, PaCO2 40, HCO3 22.
d. pH 7.30, PaO2 90, PaCO2 30, HCO3 18.
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ANSWERS AND CONCEPT ILLUMINATIONS
79
1. Answer: C.
CONCEPT ILLUMINATION
Changes in secondary sex characteristics are usually seen in people who suffer from
panhypopituitarism. The changes in secondary sex characteristics are associated with
decrease in FSH and LH. Fasting hypoglycemia and hypotension occur in
panhypopituitarism as a result of a decrease in ACTH and cortisol. Bradycardia is likely
due to the decrease in TSH and thyroid hormones associated with panhypopituitarism.
2. Answer: B.
A history of pituitary tumor must be evaluated further by the nurse. Somatotropin
(Genotropin) is a recombinant growth hormone product used for adults with growth
hormone deficiency, such as that caused by a pituitary tumor. The medication is not
used in adrenal disease or DI therefore asking for further information about it will be
unlikely. The patient with untreated acromegaly will have an excess of growth
hormone which means the use of somatotropins will be implausible or unrelated.
3. Answer: D.
Increased secretion of ACTH by the anterior pituitary gland will lead to an increase in
serum and urinary cortisol levels. An increase, rather than a decrease, in thyroxine
level would be expected with increased secretion of TSH by the anterior pituitary
gland. Aldosterone and catecholamine levels are not controlled by the anterior
pituitary.
4. Answer: C.
After hypophysectomy, the client should be monitored for rhinorrhea, which could indicate a
cerebrospinal fluid leak (CSF leak). If this occurs, the drainage should be collected and tested for
the presence of glucose. If glucose is present in the drainage, the secretion would be regarded as
positive CSF leakage. The head of the bed should not be lowered to prevent increased
intracranial pressure. Clear nasal drainage would not indicate the need for a culture. Continuing
to observe the drainage without taking action could result in a serious complication.
5. Answer: D.
The intake of corticosteroids (steroid therapy) may impair the effectiveness of oral
contraceptives; therefore the health teachings by the nurse must include encouraging
the client to consider adding another form of contraception. Avoiding excess salt and
monitoring weight daily may assist the client in limiting the adverse effects of the
steroids that some experience; however, the need to ensure adequate methods of
contraception takes precedence. The nurse must fulfill their role as an educator. As an
education taking action is paramount.
6. ANSWER: B.
In SIADH there is an excess secretion of antidiuretic hormone (ADH) that causes fluid retention,
dilutes the plasma causing suppression of aldosterone and increases the renal excretion of
sodium. Water then moves from the plasma into the cells and interstitial spaces causing cellular
edema. The correct management for this condition is fluid restriction and hypertonic saline
infusion. Other options are the opposite of the standard treatment and are therefore incorrect.
7. Answer: D.
If there is no change in urine and plasma osmolality in the water deprivation test, the
patients result will be labeled as No pathology present." Diabetes insipidus and
syndrome of inappropriate antidiuretic hormone would result in changes in urine
osmolality. Water deprivation test is not used to detect diabetes mellitus.
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8. Answer: A.
The therapeutic effect of this medication would be manifested by a decreased urine output.
Desmopressin stimulates renal conservation of water. The hormone carries out this action by
acting on the collecting ducts of the kidneys to increase their permeability to water, which
results in increased water reabsorption.
9. Answer: C.
Vasopressin can cause adverse cardiovascular effects mainly because of its powerful
vasoconstrictor actions. By constricting arteries of the heart, vasopressin can cause angina
pectoris and even myocardial infarction, especially if administered to clients with coronary artery
disease. In addition, vasopressin may cause vascular problems by decreasing blood flow in the
peripheries.
10. ANSWER: C.
Diabetes insipidus is a disorder of the posterior lobe of the pituitary gland characterized by a
deficiency of the antidiuretic hormone (ADH) or vasopressin. Without the action of ADH, an
enormous daily output of urine which is very dilute and has a specific gravity of 1.001-1.005
occurs. Usually, patients with diabetes insipidus has low urinary specific gravity or low urine
concentration because their urine is diluted.
11. ANSWER B.
I should take my medication in the morning and leave it refrigerated at home. This statement
by the client would warrant the nurse to provide further teachings and interventions. Medication
taken for DI is usually every 812 hours, depending on the client. The client should keep the
medication close at hand and must not be left at home. The client should always keep a list of
medication being taken and wear a Medic Alert bracelet in cases of emergency. The client is at
risk for fluid shifts, thus weighing every morning allows the client to follow the fluid shifts. Weight
gain could indicate too much medication. Tightness in the chest could be an indicator that the
medication is not being tolerated; if this occurs the client should call the health care provider.
12. Answer: B.
Weighing everyday is the most accurate means in monitoring the hydration status of the patient.
If a client with SIADH gains 2 pounds or more in a day without changing eating habits, the health
care provider must be notified because this may indicate fluid retention and edema.
13. Answer: B.
A serum sodium level of 112 mEq/L is dangerously low, and the client is at risk for seizures
therefore the physician must be immediately notified. Headache is one of the early symptoms of
a low sodium level.
14. Answer: C.
Early signs and symptoms of pituitary tumor growth include nausea and vomiting due to
increased intracranial pressure. The client has also developed syndrome of the inappropriate
secretion of the antidiuretic (against allowing the body to urinate) hormone secondary to the
pituitary tumor. In other words, the client is producing a hormone that will not allow the client to
urinate therefore the client is at risk for water retention. Because of the clients risk of retaining
water inside the body, weighing daily is very important in monitoring the progression of the
disease.
15. ANSWER: D.
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The increased water reabsorption that occurs with SIADH causes a fluid overload and
can dilute serum electrolytes, especially sodium, to dangerously low levels.
Appropriate therapy aims to reduce the overhydration by limiting fluids and
increasing urine output.
16. ANSWER: A.
Patients with acromegaly commonly experiences arthralgia (joint pain), backache due to bone
changes and decreased mobility, therefore a diagnosis of activity intolerance would be given
priority.
17. ANSWER: A.
Bromocriptine (Parlodel) reduces growth hormone production and decreases tumor size. Side
effects of this drug may include orthostatic hypotension, gastric irritation, headaches, and
abdominal cramps. Therefore an important instruction to be given with patients taking this drug
is slowly rising from a sitting or lying position to prevent orthostatic hypotension which could
cause falls, injuries, dizziness and lightheadedness.
18. ANSWER: C.
Hypoglycemia is a characteristic finding related to growth hormone deficiency (Dwarfism).
Dwarfism is a condition which is caused by hyposecretion of growth hormones resulting in failure
to grow in height. This condition is commonly associated with hypoglycemia.
19. ANSWER A:
Many clients with hyperthyroidism are hyperactive and therefore need to be encouraged to
balance periods of activity and rest. They also complain of heat intolerance. Consequently,
keeping the environment cool and teaching the client how to manage his physical reactions to
heat is important. Clients with hypothyroidism, not hyperthyroidism, complain of being cold and
need warm clothing and blankets to maintain a comfortable temperature. Clients with
hypothyroidism receive thyroid replacement therapy, often feel lethargic and sluggish, and are
prone to constipation. Therefore, the nurse should encourage clients with hypothyroidism, not
hyperthyroidism, to be more active to prevent constipation.
20. Answer: D.
Bleeding is a potential complication following surgery of the thyroid gland. This can best be
assessed by checking the back and the sides of the operative dressing as the blood may flow
towards the side and back leaving the front dry and clear of drainage.
21. Answer: B.
A low TSH level indicates that the patients hypothyroidism is caused by decreased
anterior pituitary secretion of TSH. Low T3 and T4 levels are not diagnostic results of
the primary cause of the hypothyroidism. TRH levels indicate the function of the
hypothalamus.
22. ANSWER: C.
Antithyroid medication may result in hypothyroidism, which is manifested by
sleepiness and cold intolerance. The client must be closely monitored for signs of
hypothyroidism to determine the need for drug regimen changes and adjustments.
23. ANSWER: B.
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A low calcium diet is recommended preoperatively in clients who will undergo
parathyroidectomy. Therefore the nurse must discourage milk and cheese products because
these foods contain high calcium.
24. ANSWER: C.
Excessive output of thyroid hormone caused by abnormal stimulation of thyroid gland by
circulating immunoglobulins best describes Graves disease. Graves disease is characterized by
excessive release of thyroid hormones and also known as thyrotoxicosis (toxic diffuse goiter).
25. ANSWER: B.
The radioactive iodine used in thyroid scans is of low intensity and has such a short
half-life that the client is not considered to be a radiation hazard. Thus, no radiation
precautions are necessary.
26. ANSWER: A.
The nurse must inform the client that he or she still needs to take thyroid medication
even after thyroidectomy. After the client undergoes a thyroidectomy, the client must
be given thyroid replacement medication for life. He or she may also need calcium if
the parathyroid is damaged during surgery, and can receive pain medication
postoperatively.
27. ANSWER: A.
The heart rate is commonly affected when a client develops hypothyroidism. A heart
rate of less than 60 beats per minute is associated with hypothyroidism because of
slowed metabolism and body functions. Therefore an apical rate of 50 beats/ min is
the most indicative sign of hypothyroidism among the given choices.
28. ANSWER: A.
Over-the-counter cough medicines may contain iodide which could affect the results
of a radioactive iodine test and therefore must be reported to the physician prior to
the test. Always remember that medications and foods containing iodine may alter
the results of radioactive iodine tests. A vegetarian diet and wine are not food sources
of iodine. Aspirin is not a medicinal source of iodine.
29. ANSWER: A.
Hypoparathyroidism resulting from lack of PTH produces chronic hypocalcemia. Foods consumed
should be high in calcium. Foods containing oxalic acid (spinach, rhubarb), and phytic acid
(whole grains) reduce calcium absorption and therefore must be avoided with
hypoparathyroidism.
30. ANSWER: C.
The client with hyperthyroidism is typically nervous and often has insomnia and emotional
lability. A calm, subdued environment with reduced stimuli and sensory input would be beneficial
thus a private room is encouraged. There is a great deal of activity at the RN's station; therefore
this is not a suitable room for a client with hyperthyroidism. A room with a client who had a
cholecystectomy is also not compatible with the client with hyperthyroidism because the client's
insomnia or nervousness due to hyperthyroidism would prevent the client who is postoperative
from obtaining sufficient rest. A room with the same diagnosis of hyperthyroidism is not also
recommended because having two clients with nervousness or insomnia would be too much
stimuli for either client.
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31. ANSWER: C.
The client with hypothyroidism has decreased metabolism, which results in a slowing
of all body processes. Characteristically, the skin of clients with hypothyroidsm is very
dry and thickened thus requires lubrication. With a decrease in metabolic rate, the
client will be cold and will be prone to constipation. These clients are very lethargic
and sleep most of the time and therefore need to be encouraged to participate in
activities to the greatest extent possible.
32. ANSWER: C.
Surgical treatment of hyperthyroidism involves a subtotal thyroidectomy in which approximately
five-sixths of the thyroid tissue is removed. Whereas this procedure does not cure
hyperthyroidism, it reduces the amount of circulating thyroid hormone by reducing the amount
of functioning tissue. A complete or total thyroidectomy is rarely done for hyperthyroidism today,
because of its various possible complications. Removal of half of the thyroid would leave enough
functioning hyperactive tissue to prevent reduction of symptoms in the client. The client with
hyperthyroidism needs no additional thyroid hormone; he or she receives antithyroid
medications such as propylthiouracil (PRU) or methimazole (Tapazole) to reduce both circulating
and stored thyroid hormone.
33. ANSWER: D.
Graves' disease is an autoimmune disease causing hyperthyroidism, is most prevalent in females
ages 20 to 40. In thyroiditis, there's a low (12%) level of radioactive iodine uptake. In
Hashimoto's thyroiditis, the most common form of hypothyroidism, TSH levels would be high and
thyroid hormone levels are low. Multinodular goiter will show radioactive iodine uptake in the
high-normal range (3% to 10%).
34. ANSWER: B.
Potassium iodide reduces the vascularity of the thyroid gland and is used to prepare the gland
for surgery. Potassium iodide reaches its maximum effect in 1 to 2 weeks. PTU blocks the
conversion of thyroxine to triiodothyronine, the more biologically active thyroid hormone. PTU
effects are also seen in 1 to 2 weeks. To relieve symptoms of hyperthyroidism temporarily,
clients are usually given a beta-adrenergic blocker such as propranolol.
35. ANSWER: A.
Hashimoto's thyroiditis, an autoimmune disorder, is the most common cause of hypothyroidism.
It is seen most frequently in women over age 40. Weight gain, decreased appetite, depression,
constipation, lethargy, brittle nails, coarse hair, muscle cramps, weakness, sleep apnea, and dry,
cool skin are symptoms of Hashimoto's thyroiditis. Weight loss, increased urination, and
increased thirst are characteristic of uncontrolled diabetes mellitus. Weight gain, increased
urination, and purplish red striae are characteristic of hypercortisolism. Weight loss, increased
appetite, and hyperdefecation are characteristic of hyperthyroidism.
36. ANSWER: D.
Normal thyroid function tests are as follows: T4 (5 to 12 mg/dl); T3 (65 to 195 ng/dl); TSH (0.3 to
5.4 mIU/ml). With Hashimoto's thyroiditis, T4 and T3 levels are typically subnormal and TSH is
elevated. With primary hyperthyroidism, T4 and T3 levels are elevated and TSH is subnormal.
With hypothyroidism, T4 is subnormal and T3 and TSH levels are elevated.
37. ANSWER: C.
In myxedema coma, respirations are gravely depressed, therefore maintaining a patent airway is
the most critical nursing intervention. Ventilatory support is usually needed. Thyroid replacement
84
will be administered I.V. Although myxedema coma is associated with severe hypothermia, a
warming blanket shouldn't be used because it may cause vasodilation and shock (cardiovascular
collapse). Gradual warming with blankets rather than warming blankets would be appropriate.
Intake and output are very important but aren't critical interventions at this time.
38. Answer: C.
Thyrotoxic crisis (thyroid storm) is an acute, potentially life-threatening state of extreme thyroid
activity that represents a breakdown in the bodys tolerance to a chronic excess of thyroid
hormones. The clinical manifestations include fever with temperatures greater than 100F,
severe tachycardia, flushing and sweating and marked agitation and restlessness. Delirium and
coma can occur with thyroid storm thus it is considered a medical emergency.
39. Answer: B.
Propranolol (Inderal) is a beta-adrenergic blocker that controls the cardiovascular manifestations
brought about by increased secretion of the thyroid hormone in Graves disease.
40. Answer: B.
A patient with exophthalmos must avoid using a sleeping mask at night. The mask may irritate
or scratch the eye if the client turns and lies on it during the night. Elevating the head of the bed
at night might help reduce the intraocular pressure exerted on the eyes, but it will not help
prevent ulceration.
41. Answer: A.
A tracheostomy and oxygen set must be prepared by the nurse for the client postthyroidectomy. Because of edema, subcutaneous bleeding that presses on the trachea, nerve
damage, or tetany, acute respiratory obstruction in the post-operative period may occur, thus a
bedside tracheostomy set and oxygen must be prepared by the nurse to maintain the clients
airway in the moment of emergency.
42. Answer: B.
Levothyroxine (Synthroid) accelerates the degradation of vitamin K-dependent clotting factors.
As a result, the effects of warfarin (Coumadin) are enhanced. Therefore, if thyroid hormone
replacement therapy is instituted in a client who has been taking warfarin, the dosage of
warfarin should be reduced.
43. ANSWER: D.
Synthroid is given for hypothyroidism. Clients with hypothyroidism usually has bradycardia. By
taking a thyroid drug, heart rate should return to normal. Decreased appetite and constipation
are signs of hypothyroidism. Excessive weight loss could indicate side effects of hyperthyroidism.
44. ANSWER: B.
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.
45. ANSWER: D.
The client with hyperparathyroidism should be encouraged to force fluids to prevent renal calculi
formation. Sodium should be encouraged to replace losses in urine. Potassium restriction isnt
necessary in hyperparathyroidism.
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46. ANSWER: C.
PTH stimulates calcium resorption from the bones and triggers the kidneys to reabsorb calcium
and excrete phosphate, and converts vitamin D to its active form-1, 25-dihydroxyvitamin D. PTH
doesn't play a role in the metabolism of vitamin E.
47. Answer: B.
During the postoperative period, the nurse must carefully observe the client for signs of
hemorrhage, which causes swelling and compression of adjacent tissue. Laryngeal stridor is a
harsh, high-pitched sound heard on inspiration and expiration; stridor is caused by compression
of the trachea, leading to respiratory distress. Stridor is an acute emergency situation that
requires immediate attention to avoid complete obstruction of the airway. Also, after
parathyroidectomy the client might be at risk for hypocalcemia which could trigger laryngeal
spasms and stridor.
48. ANSWER: C.
Tetany is neuromuscular irritability characterized by spasms and tremors. Chvosteks
sign is accomplished by tapping sharply over the facial nerves and is considered
positive if it causes twitching or spasms in the region of the eyes, nose, and mouth.
Occluding the blood flow in the wrist is Trousseaus sign, which can be done by a BP
cuff. Assessing for respiratory obstruction and laryngeal spasm are important
measures to detect impending tetany but are not Chvosteks sign.
49. ANSWER: D.
Milk and cheese products are high in calcium but also high in phosphorus. Green leafy
vegetables have higher calcium and lower phosphorus ratio but note that spinach is
an exemption and should be avoided as it contains oxalate, which forms insoluble
calcium substances. Cauliflower has high phosphorus and calcium content.
50. Answer: A.
Hypercalcemia is considered to be the hallmark of hyperparathyroidism. Elevated serum calcium
levels produce osmotic diuresis thereby causing polyuria (excessive urination). This diuresis
leads to dehydration (weight loss rather than weight gain). Gastrointestinal symptoms are not
associated with primary hyperthyroidism such as diarrhea and polyphagia.
51. ANSWER: A.
Pheochromocytoma is characterized by excess catecholamine release, causing hypertension.
The nurse should prepare to administer nitroprusside to control the hypertension until the client
undergoes adrenalectomy to remove the tumor. Dopamine is used to treat hypotension, which
isn't associated with pheochromocytoma. Lidocaine is sometimes used to treat ventricular
arrhythmias, which aren't related with pheochromocytoma. Pheochromocytoma doesn't affect
blood glucose level, so insulin isn't indicated for this client unless there's an underlying diagnosis
of diabetes mellitus.
52. Answer: B.
Pheochromocytoma is characterized by a catecholamine-producing tumor which causes
secretion of excessive amounts of epinephrine and norepinephrine. The principal manifestation
of the condition is hypertension accompanied by pounding headaches. The excessive release of
catecholamines also results in excessive conversion of glycogen into glucose in the liver.
Consequently, hyperglycemia and glucosuria can occur during attacks. Pheochromocytoma is
considered curable. The primary treatment is surgical removal of one or both of the adrenal
glands, depending on whether the tumor is unilateral or bilateral.
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53. Answer: C.
Assays of catecholamines are performed on single-voided urine specimens, 2- to 4-hour
specimens, and 24-hour urine specimens. The normal range of urinary catecholamines is up to
14 mcg/100 mL of urine, higher levels may indicate pheochromocytoma.
54. Answer: A.
The diet of a client with pheochromocytoma needs to be high in vitamins, minerals, and calories.
Of particular importance are the foods or beverages that contain caffeine, such as cocoa, coffee,
tea, or colas. These foods are prohibited and must be avoided because they can precipitate
hypertensive crisis.
55. ANSWER: B.
Postoperative management is directed at maintaining a normal blood pressure, because the
client may be hypertensive immediately after surgery. Alpha- adrenergic agents are sometimes
prescribed by the physician to control the clients hypertension.
56. ANSWER: B.
Pheochromocytoma is a disease condition that releases both catecholamines (epinephrine and
norepinephrine). A -blocker such as propanolol is usually prescribed and administered to block
the cardiac-stimulating effects of epinephrine thereby preventing the occurrence of angina or
tachycardia.
57. ANSWER: A.
Addisons disease is characterized by a decrease in adrenal cortex hormones (Glucocorticoid,
mineralocorticoid and sex hormones). To compensate for the decrease in the adrenal cortex
hormones, adrenocorticotropic hormone (ACTH) from the anterior pituitary gland is increased
(negative feedback). Bronzing, or general deepening of skin pigmentation, is a classic sign of
Addisons disease and is caused by melanocytes- stimulating hormone produced in response to
increased ACTH secretion. The hyperpigmentation is typically found in the distal portion of
extremities and in areas exposed to sun.
58. ANSWER: A.
CONCEPT
ILLUMINATION
Addison's disease is characterized by mineralocorticoid deficiency resulting from renal sodium
wasting (decrease in sodium) and potassium retention (increase in potassium). Signs and
symptoms include dehydration, hypotension, hyponatremia, hyperkalemia and acidosis.
Therefore increasing sodium and fluid intake plus limiting potassium would be crucial in the
clients diet.
59. Answer: D.
Cortisol levels are usually drawn in the morning, when levels are highest. In a patient
who sleeps during the day (example 8am to 4pm), the highest level would be soon
after awakening in the late afternoon. The other listed times would not give accurate
information about adrenal function.
60. Answer: C.
The glucocorticoids include cortisol and cortisone. These hormones affect carbohydrate
metabolism and are released in times of stress. An excess of glucocorticoids in the
body depresses the inflammatory response and inhibits the effectiveness of the
immune system. Alteration in epinephrine, norepinephrine, or mineralocorticoids
87
would have an influence on cardiovascular function and fluid and electrolyte balance,
but would not influence immune response as much as an increase in glucocorticoid
secretion.
61. Answer: B.
Due to the overproduction of glucocorticoids, the client with Cushing's syndrome is at
high risk for infection. In relation to the clients risk, the nurse should teach the
importance of increasing intake of protein and vitamins C and A, which are all
important to support and repair body tissues. Rest periods and daily weights are
encouraged in the care of a client with Cushing's, but neither will directly address the
problem of frequent infections as much as the dietary changes. There is no indication
of a need to review or change coping strategies.
62. ANSWER: A.
In managing Addisons disease, maintenance of medication compliance is very essential. The
client must learn to adjust the glucocorticoid dose in response to the normal and unexpected
stresses of daily living and activities.
63. Answer: B.
Addison's disease (failure of the adrenal glands to produce adrenal cortex hormones)
could be aggravated if a client abruptly stops taking the recommended steroids. One
symptom of this disease process is hyperpigmentation or a bronze-colored skin. In
Caucasian clients, the skin looks deeply tanned in both exposed and unexposed areas.
Auscultation of lung sounds and palpation of the thyroid gland would not help in
determining the cause of the changes in the clients skin. The client has already
reported limited time being spent outdoors; therefore asking it again would unlikely.
64. ANSWER: A.
Sleeplessness is one of the usual side effects of steroid use. If the client takes the drug at night,
it may cause difficulty of sleeping. Steroid intake is encouraged to be taken during daytime to
avoid disruption of clients sleep at night. Taking the steroid at same amounts is incorrect,
because the dosage has to be adjusted according to stress. Increasing potassium intake is
incorrect because the client with Addisons disease already has hyperkalemia. Steroid use can
cause fluid retention which can increase and affect the blood pressure.
65. ANSWER: A.
An increase in blood pressure is indicative of effective therapy. Addisonian crisis is caused by
adrenocortical insufficiency with disturbances of sodium and potassium metabolism resulting in
hyponatremia and hyperkalemia. The depletion of sodium and water causes severe dehydration
and hypotension, therefore the treatment must aim to increase the blood pressure and alleviate
dehydration. Effective therapy should lower potassium levels. A serum potassium level of 6.0
mEq/dL indicates hyperkalemia, meaning the clients condition has worsened. The normal serum
calcium level is 8.6 to 10.2 mg/dL; therefore a value of 7.0mg/dL indicates aggravation of
hypocalcemia experienced by a patient in Addisonian crisis.
66. ANSWER: C.
Addisonian crisis is a serious, life-threatening response to acute adrenal insufficiency that most
commonly is precipitated by a major stressor. The client in addisonian crisis may demonstrate
any of the signs and symptoms of Addisons disease, but the primary problems are sudden
profound weakness, severe abdominal, back and leg pain. Agitation, diaphoresis and
restlessness are clinical manifestations not related to Addisonian crisis.
67. ANSWER: D.
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The excessive aldosterone secretion of hyperaldosteronism causes sodium retention and
potassium and hydrogen ion excretion thereby producing hypokalemia. Hypokalemia can cause
life-threatening dysrhythmias. As a nurse, assessing for life-threatening conditions is priority.
Adenomas can be localized by a CT scan and headache occurs because of hypertension, but this
is not the priority by this time. Hypokalemia also produces generalized muscle weakness and
fatigue which can predispose the client to falls however this is not life threatening as cardiac
dysrhythmias.
68. ANSWER: C.
The hallmark sign of hyperaldosteronism is hypertension therefore teaching the client about selfmonitoring the blood pressure is of utmost importance. Take note that unilateral adrenalectomy
is successful in controlling hypertension in only 80% of clients with adenoma, so the client should
be taught to self-monitor the blood pressure. Maintenance therapy for hypertension may include
the administration of spironolactone, a potassium-sparing diuretic because hyperaldosteronism
causes excretion of potassium; however dietary potassium restriction is not needed by the client.
The client may still need medications to treat hyperaldosteronism after adrenalectomy thus
discontinuing medications taken prior to the operation is not encouraged. Clients with Addisons
disease are instructed to carry an emergency kit with hydrocortisone and not clients with
hyperaldosteronism.
69. ANSWER: B.
A corticotropin-secreting pituitary adenoma (usually a benign pituitary adenoma) is the most
common cause of Cushing's disease in women ages 20 to 40. Ectopic corticotropin-secreting
tumors are more common in older men rather than women and are often associated with weight
loss not weight gain. Adrenal carcinoma isn't usually accompanied by hirsutism (abnormal
presence of body hair especially in women). A female with an inborn error of metabolism would
never have begun menstruating.
70. ANSWER: B.
Cushing's syndrome describes the signs and symptoms linked with prolonged exposure to
inappropriately high levels of the hormone cortisol. This can be caused by prolonged taking of
glucocorticoid drugs, diseases that result in excess cortisol and adrenocorticotropic hormone
(ACTH). As a result of excess ACTH stimulation, over secretion of glucocorticoids,
mineralocorticoids and sex hormones occur (adrenal cortex hormones). Take note that Cushings
syndrome affects the glucocorticoids the greatest rather than mineralocorticoids or sex
hormones.
71. Answer: D.
Iatrogenic means that a problem has been produced by a medical treatment or procedure - in
this case, treatment with steroids for another problem. Clients taking steroids over a period of
time develop the clinical manifestations of Cushings disease. Disease processes for which longterm steroids are prescribed include chronic obstructive pulmonary disease, cancer, and arthritis.
72. ANSWER: D.
Clients with Cushings syndrome are prone to fluid overload and congestive heart failure due to
sodium and water retention. Fluid overload can affect the lungs causing difficulty of breathing.
Always remember airway receives the highest priority. Clients with Cushings syndrome are
susceptible to skin breakdown and infections but these are not the priority actions at this time,
prevention of fluid overload still takes precedence.
73. Answer: A.
89
Posterior neck fat pad and thin extremities are signs associated with Cushings syndrome.
Buffalo hump is the accumulation of fat pads over the upper back and posterior neck. Fat may
also accumulate on the face. There is truncal obesity but the extremities are noticeably thin. All
these are seen in a client suffering from Cushings syndrome.
74. ANSWER: B.
The patient may be suffering from fluid volume deficit as evidence by signs of hypovolemia such
as hypotension, tachycardia and tachypnea. A urine output of 200 cc over 8 hours is also
abnormal because the normal urine output per hour is 30 cc. This represents that the body is
trying to conserve its remaining fluid to avoid hypovolemic shock. There is no information
regarding the client's pain therefore associating it with incisional pain is unlikely. Also, to
diagnose renal insufficiency, lab tests and other diagnostic tests (intravenous pyelogram) would
be necessary. High serum creatinine, potassium, and BUN would point to renal dysfunction.
There are no data to indicate cardiac complications. Cardiac problems would be indicated by
specific findings, for example, irregular pulse, chest pain, tachycardia, or bradycardia.
75. ANSWER: C.
Hydromorphone hydrochloride is about five times more potent than morphine sulfate, from
which it is prepared. Therefore, it is administered only in small doses. This drug can cause
dependency in any dose.
76. ANSWER: A.
Exercise, reduced food intake, and certain medications decrease the insulin requirements. In
clients with diabetes mellitus it is important for the nurse to teach the client about compliance to
the therapeutic regimen. Some of the important pointers that the nurse must teach the clients
with DM include medication, exercise and diet (M-E-D).
77. ANSWER: C.
The psychomotor domain according to Bloom, involves the principle of psycho for intelligence,
and motor for movement. This domain explains that during teaching, the most effective indicator
of learning is that the client understands the teaching and at the same time, can perform return
demonstration correctly. This domain is commonly applied to clients being taught about glucose
monitoring using the glucometer.
78. ANSWER: B.
Regular insulin, which is a short-acting insulin, has an onset of 15 to 30 minutes and a peak of 2
to 4 hours. Because the nurse gave the insulin at 2 p.m., the expected onset would be from 2:15
p.m. to 2:30 p.m. and the peak from 4 p.m. to 6 p.m.
79. ANSWER: D.
When children become distracted and fail to eat after a dose of insulin, hypoglycemia can easily
occur. Viral infections result in hyperglycemia not hypoglycemia and there is no indication the
child has an infection. Insulin should be taken before meals not 30-60 minutes after meals.
80. ANSWER: B.
The short acting (regular) insulin which is clear should be withdrawn first before the long acting
(cloudy). By withdrawing the clear insulin first followed by the cloudy insulin, contamination of
the clear insulin is prevented. If the cloudy insulin is first withdrawn, it may contaminate the
clear one making it cloudy also. Therefore, the clear insulin (regular) is withdrawn first before the
cloudy (long acting).
90
81. ANSWER: D.
To increase blood flow to the area, the nurse must wrap the finger in a warm cloth for
approximately 30-60 seconds causing vasodilation thereby increasing and enhancing blood flow
to the area. The hand is also lowered to increase venous flow. The finger is pierced lateral to the
middle of the pad perpendicular to the skin surface. These methods will help the nurse to obtain
the
adequate
specimen
needed
for
the
capillary
blood
glucose
test.
82. ANSWER: B.
The most important condition for a client to comply with the treatment regimen and to control
their diet is the personal motivation to be symptom free. If the clients motivation comes from
within, the degree of discipline and compliance to control the signs and symptoms of the disease
condition is maximized.
83. ANSWER: C.
Humulin N, intermediate acting insulin, has a peak action of 512 hours. Semilente, rapid acting
insulin, peaks between 8 10 hours not 2-3 hours. Ultra Lente, long acting insulin, is effective for
36+ hours. Onset of action for regular insulin is between to 1 hour.
84. ANSWER: A.
For this client, wet-to-dry dressings are most appropriate because they clean the foot ulcer by
debriding exudates and necrotic tissue plus closing the wound with granulation, thus promoting
healing by secondary intention. Healing by first intention is described as union or restoration of
continuity occurs directly, without intervention of granulations. In contrast with healing by
secondary intention, there is union by closure of a wound with granulations.
85. ANSWER: C.
Postprandial blood glucose is usually done 2 hours after meals. The client will first eat and 2
hours after eating the blood glucose will be tested. The normal level of postprandial blood
glucose is less than 200mg.
86. ANSWER: A.
The label LITE or LIGHT is a term which means having lesser substance and weight with
fewer calories than something else. Food groups labeled with LITE are not specifically made for
diabetic client consumption.
87. ANSWER: A.
The inability to control diabetes mellitus by diet and oral agents, together with surgically induced
metabolic changes, being NPO both prior to and after surgery, necessitates temporary control by
insulin.
88. ANSWER: B.
Somogyi effect/phenomenon is characterized by a drop in glucose level during the early morning
around 2:00 3:00 a.m., followed by a false elevation. Eating a snack before sleeping prevents
the hypoglycemia and rebound elevation.
89. ANSWER: D.
Exercising with blood glucose levels exceeding 250 mg/dL and ketonuria increases the secretion
of glucagon, growth hormone, and catecholamines, causing the liver to release more glucose.
Exercise in the presence of hyperglycemia does not lower the blood glucose level. Administering
insulin may be an option, but the blood glucose level should be known before sending the client
91
to cardiac rehab.
90. ANSWER: C.
The client with diabetic ketoacidosis (DKA) is usually dehydrated from the polyuria due to
hyperglycemia thus 0.9 percent saline and regular insulin is given. Saline is given to alleviate
cellular dehydration due to polyuria and regular insulin to help decrease hyperglycemia. Initial
fluid replacement with insulin is aggressive in order to correct the fluid volume deficit, acid-base
imbalance, and electrolyte imbalance. The client in this initial stage of metabolic acidosis is
hyperkalemic, not hypokalemic. The Ringer's lactate alone would help neutralize the acidosis.
The client does not need the KCl. A client with DKA is not usually hypoxic; no O2 is needed.
Although urinary output is essential information, fluid replacement is the priority.
91. ANSWER: C.
There is severe dehydration with warm, dry skin in HHNK. Hyperglycemia and hyperosmolality in
Hyperglycemic Hyperosmolar Nonketotic diabetes mellitus (serum glucose greater than 600
mg/dL) causes osmotic diuresis for days to weeks. The client becomes severely dehydrated, with
hypovolemia and changes in level of consciousness. Remember there is no ketosis or acidosis in
HHNK therefore there would be no compensatory kussmauls respiration (rapid deep
respirations) and no fruity acetone breath.
92. ANSWER: A.
Research demonstrates a strong correlation between chronic hyperglycemia and complications
of retinopathy, nephropathy and neuropathy. Thus, there is damage to the eyes, kidneys and
peripheral nerves respectively. Chronic diabetes is also associated with multiple organ failure
such as renal failure, cardiac arrest and liver cirrhosis. Lactic acidosis occurs with diabetic
ketoacidosis (DKA). Insulin is needed to carry glucose across the cell membrane into the cell, not
to be transported to the blood.
93. ANSWER: D.
Before doing any action, the OR nurse must first communicate with the ward nurse to verify the
administration of the medication. It is the nurses responsibility to have proper communication
with the medical team, especially the endorsements from other nurses. Verification if the insulin
was incorporated with the ward nurse is crucial for the safety of the client involve. The MD will
not know if the order had been carried out, therefore it is unlikely for the OR nurse to call the
attending physician.
94. ANSWER: C.
It is a requirement to have fine motor skills and good eye sight when doing self-monitoring of
blood glucose (SMBG). A patient with proliferative retinopathy have impaired vision hence cannot
perform the test properly.
95. ANSWER: A.
Peripheral neuropathy, which is a chronic complication of diabetes mellitus especially in
elderlies, can lead to lack of sensation in the lower extremities. Clients do not feel pressure and
pain thereby putting them at high risk for skin impairment. Clients with retinopathy must wear
properly fitting closed shoes to prevent injury of the feet.
96. Answer: D.
Lipodystrophy is the development of fibrofatty masses at the injection site caused by frequent
use of an injection site. Injecting insulin into these scarred and damaged areas can cause the
insulin to be poorly absorbed and lead to erratic reactions.
92
97. Answer: B.
Illness triggers the liver to increase blood glucose levels; therefore the client must take insulin
and drink high-carbohydrate fluids such as regular Jell-O, regular popsicles, and orange juice to
prevent diabetic ketoacidosis.
98. Answer: A.
All clients who exercise should perform warm-up and cool down exercises to help prevent muscle
strain and injury. The diabetic client who also exercises must eat complex carbohydrate plus
protein before exercising to avoid hypoglycemic episodes.
99. Answer: B.
This result parallels a serum blood glucose level of approximately 180 to 200 mg/dL.
Glycosylated hemoglobin is a blood test that reflects average blood glucose levels over a period
of 23 months; clients with elevated blood glucose levels are at risk for developing long-term
complications. Glycosylated hemoglobin is also the best test for patients compliance on the
therapeutic regimen.
100. Answer: D.
This ABG indicates metabolic acidosis, which is an expected result in a client with diabetic
ketoacidosis (DKA). Normal ABG values are pH: 7.357.45; PaO2: 80100; PaCO2: 3545; HCO3:
2226.
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60

DISORDERS OF THE POSTERIOR PITUITARY GLAND

GROWTH HORMONE DISORDERS

DISORDERS OF THE THYROID GLAND

DISORDERS OF THE PARATHYROID GLAND

DISORDERS OF THE ADRENAL

DISORDERS OF THE ADRENAL CORTEX

Onset to be at 4 p.m. and its peak to be at 6 p.m.

ANSWERS AND CONCEPT ILLUMINATIONS

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