Osborn Chapter 52: Osborn, Et Al., Test Item File For Medical-Surgical Nursing: Preparation For Practice

Osborn chapter 52
Learning Outcomes Number and Title

Learning Outcome 1
Describe the anatomic location and function of the endocrine
glands, including the physiological effects of the hormones that
each gland produces.
Learning Outcome 2
Compare the common pathophysiological syndromes caused by
under- and overproduction of hormones for each of the
endocrine glands, including the thyroid, parathyroid,
hypothalamus and pituitary, and adrenal glands.
Learning Outcome 3
Identify clinical manifestations, treatment, and nursing
interventions for hypo- and hypermetabolic conditions.
Learning Outcome 4
Describe the complex neurological and immunologic effects of
common glandular disorders.
Learning Outcome 5
Develop a plan of care for patients with each of the common
endocrine gland disorders, including the patient teaching and
discharge needs.
Learning Outcome 6
Describe the potential gerontological implications for each
glandular disorder.
Learning Outcome 7
Identify implications for nursing research when caring for
persons with glandular disorders.
Osborn, et al., Test Item File for Medical-Surgical Nursing: Preparation for Practice
Copyright 2010 by Pearson Education, Inc.
1. A nurse is obtaining a history of a female client during a routine physical exam. The client
indicates a past problem with endocrine gland functioning. The nurse is aware that this condition
could involve which of the following organs?
Select all that apply.
1.
2.
3.
4.
5.
Thyroid
Adrenals
Ovaries
Pancreas
Uterus
Correct Answer:
1. Thyroid
2. Adrenals
3. Ovaries
4. Pancreas
Rationale: Thyroid. The endocrine glands and organs include the thyroid.
Adrenals. The endocrine glands and organs include the adrenals. Ovaries. The
endocrine glands and organs include the ovaries. Pancreas. The endocrine glands
and organs include the pancreas. Uterus. The uterus is not considered part of the
function of the endocrine system.
Cognitive level: Application

Nursing Process: Planning
Client Need: Physiological Integrity
LO: 1
2. The nurse is caring for a client with dehydration. The clients blood pressure and blood
volume have stabilized after several hours of hypotension. The nurse understands that the
condition of the client has stabilized because of the bodys regulation of:
1. Aldosterone.
2. Adrenalin.
3. Dopamine.
4. Thyroxine.
Correct Answer: Aldosterone
Rationale: The adrenal gland and its hormone aldosterone stimulate the reabsorption of sodium
and passive reabsorption of water, thus increasing blood pressure. Adrenaline may increase blood
pressure, but in response to dehydration, aldosterone will be released by the adrenal gland to
cause the kidneys to hold on to sodium and water, and will increase blood pressure and blood
volume. Dopamine does not influence changes in blood volume. Thyroxine is a thyroid hormone
that does not affect blood pressure and blood volume.
Cognitive Level: Application
Nursing Process: Evaluation
LO: 1
3. The nurse is performing an assessment on a client and notes that the client has thin arms and
legs, purple striae on the abdomen, upper body obesity, and a round red face. The nurse would
suspect the client has a disturbance with the:
1. Adrenal gland.
2. Thyroid gland.
3. Parathyroid gland.
4. Hypothalamus.
Correct Answer: Adrenal gland.
Rationale: The assessment findings of this client indicate Cushings syndrome. Cushings
syndrome is a hypermetabolic disorder of the adrenal cortex. The assessment findings of the
client do not indicate associations with the thyroid gland, parathyroid gland, or hypothalamus.
Cognitive Level: Analysis
Nursing Process: Assessment
LO: 1
4. The nurse is caring for a client with a diagnosis of hypothyroidism. Which of the
following clinical manifestations would the nurse expect during the physical
assessment of the client?

1. Lethargy
2. Fatigue
3. Dry skin
4. Hair loss
5. Fever
Correct Answer:
1. Lethargy
2. Fatigue
3. Dry skin
4. Hair loss
Rationale: Lethargy. Lethargy is a clinical manifestation that indicates hypothyroidism. Fatigue.
Fatigue is a clinical manifestation that indicates hypothyroidism. Dry skin. Dry skin is a clinical
manifestation that indicates hypothyroidism. Hair loss. Hair loss is a clinical manifestation that
indicates hypothyroidism. Fever. Fever is not associated with hypothyroidism. Clients are
sensitive to changes in temperature, but fever is not associated with this condition.
Nursing Process: Assessment
LO: 2
5. Which of the following assessment parameters would the nurse implement as the
greatest priority for a client with severe hypothyroidism?
1.
2.
3.
4.
Heart rate
Temperature
Respiratory rate
Oxygen saturation
Correct Answer: Heart rate

Rationale: Clients with hypothyroidism have seriously decreased thyroid hormone levels, which
causes cardiac problems as evidenced by bradycardia. Temperature is a parameter that may
indicate that the client has a cold intolerance, but it is not the priority assessment parameter.
Respiratory rate and oxygen saturation are parameters that are not associated with potential
problems indicated with hypothyroidism.
Nursing Process: Implementation
LO: 2
6. When caring for a client with hypoparathyroidsim, the nurse would expect which
laboratory findings?

1. Low calcium
2. High phosphorous
3. High calcium
4. Low phosphorous
5. Low protein
Correct Answer:
1. Low calcium
2. High phosphorous
Rationale: Low calcium. When a deficient amount of parathyroid hormone is produced,
hypocalcemia results. High phosphorous. When a deficient amount of parathyroid hormone is
produced, results include high phosphorous levels. High calcium. When a deficient amount of
parathyroid hormone is produced, hypocalcemia results. Low phosphorous. When a deficient
amount of parathyroid hormone is produced, results include high phosphorous levels. Low
protein. Protein levels are not associated with hypoparathyroidism.
LO: 2
7. A client is beginning drug treatment for hypothyroidism and asks the nurse How do I know if
the drug is working? The nurse would respond by stating that:
1. You should notice less symptoms of the disorder.
2. You will need to have your thyroid levels monitored.
3. You will notice at least a 2-pound weight loss.
4. You should ask your doctor if the drug is working.
5. You will periodically notice a burst in your energy level.
Correct Answers:
1. You should notice less symptoms of the disorder.
2. You will need to have your thyroid levels monitored.
Rationale: You should notice less symptoms of the disorder. Symptoms of hypothyroidism
gradually fade over a period of 3 to 6 weeks as therapy is initiated. You will need to have your
thyroid levels monitored. Clients should be instructed to have their blood levels tested 6 to 8
weeks after therapy to determine if hormone levels have stabilized. You will notice at least a 2pound weight loss. The client may not experience a weight loss with this therapy. You should
ask your doctor if the drug is working. Asking the doctor does not provide the client
information on the effectiveness of the drug. You will periodically notice a burst in your
energy level. The client will not experience bursts of energy; although there may be increases
in the energy level in general, periodic bursts are not associated with this therapy.
LO: 3
8. The nurse is preparing to administer the synthetic hormone levothyroxine. The

nurse understands that to best facilitate absorption, the drug should be
administered:

1. On an empty stomach.
2. At least 4 hours before taking antacids.
3. With supplemental calcium.
4. With meals.
5. During the evening hours.
Correct answers
1. On an empty stomach.
2. At least 4 hours before taking antacids.
Rationale: On an empty stomach. Because the absorption of the synthetic thyroid hormone
levothyroxine is altered by food and selected drugs, herbs, vitamins, and minerals, the nurse
should administer the drug while the clients stomach is empty, usually as a single dose before
breakfast, and hold food intake for at least 1 hour. At least 4 hours before taking antacids. The
nurse should administer the medication at least 4 hours before taking antacids. With
supplemental calcium. The drug will suppress the TSH, which increases the risk of
osteoporosis, a side effect that can be avoided by the ingestion of calcium. However, the calcium
should not be administered with the drug because it can interfere with the absorption of the drug.
Therefore, calcium is incorrect because it should not be administered at the same time as the
levothyroxine. With meals. Taking levothyroxine with meals will interfere with the absorption
of the drug. During the evening hours. The best time for the administration of the drug is in the
early morning while the stomach is empty, not during the evening hours while the stomach is full
and its contents will alter absorption of the drug.
LO: 3
9. Which of the following nursing diagnoses would be incorporated into the plan of
care for a client with acute adrenal insufficiency?

1.
2.
3.
4.
5.
Fluid-Volume Deficit
Hyponatremia
Risk for Ineffective Therapeutic Regimen
Knowledge Deficit
Fluid-Volume Excess
Correct Answer:
1. Fluid-Volume Deficit
2. Hyponatremia
3. Risk for Ineffective Therapeutic Regimen
4. Knowledge Deficit
Rationale: Fluid-Volume Deficit. Nurses play a key role in managing fluid replacement and
fluid intake and output. Hyponatremia. Hyponatremia is in the plan of care for this client
because it develops secondary to adrenal insufficiency. Risk for Ineffective Therapeutic
Regimen. A plan for client education and family education must be developed, and clients will
be at risk for ineffective therapeutic regimen. Knowledge Deficit. Clients will require instruction
on lifetime drug therapy and must adhere to the drug schedule. Clients are also advised to learn
how to administer intramuscular injections so that they can self-administer hydrocortisone if
unable to take medications by mouth due to nausea and vomiting. Fluid-Volume Excess.
Clients are dehydrated during this condition; therefore, fluid-volume excess is incorrect.
LO: 3
10. The nurse is developing a plan of care for a client with a diagnosis of
hyperparathyroidism. Nursing interventions for this client would include:
1.
2.
3.
4.
5.
Decrease environmental stimuli.

Promote comfort and rest.
Eliminate caffeine from the diet.
Monitor vital signs.
Liberally apply emollient skin lotion.
Correct Answer:
1. Decrease environmental stimuli.
2. Promote comfort and rest.
3. Eliminate caffeine from the diet.
4. Monitor vital signs.
Rationale: Decrease environmental stimuli. Decrease environmental stimuli because clients
experience insomnia and restlessness with this disorder. Promote comfort and rest. Promoting
comfort and rest will lessen the anxiety of the client. Eliminate caffeine from the diet.
Elimination of caffeine is recommended because caffeine will increase the hand tremors and
nervousness that occur with clients with this disorder. Monitor vital signs. Monitoring vital
signs is necessary to detect any early complications such as thyroid storm. Should thyroid storm
occur, the nurse would expect changes in the vital signs such as tachycardia and hyperpyrexia.
Liberally apply emollient skin lotion. Application of skin lotion is not indicated for this client.
LO: 4
11. A client with hypoparathyroidism has a low serum calcium level. In order to test
for the clinical manifestation consistent with this laboratory result, the nurse would:

1. Tap over the facial nerve of the client.
2. Place a tourniquet on the clients arm.
3. Have the client open and close both hands.
4. Ask the client to count backwards.
5. Press lightly on the clients shoulders.
Correct answers:
1. Tap over the facial nerve of the client.
2. Place a tourniquet on the clients arm.
Rationale: Tap over the facial nerve of the client. Tapping over the facial nerve will cause
spasm and twitching of the mouth, indicating hypocalcemia; this is referred to as the Chvosteks
sign. Place a tourniquet on the clients arm. Placing a tourniquet or BP cuff on the clients arm
to assess for carpopedal spasm can also indicate hypocalcemia. This is referred to as the
Trousseaus sign. Have the client open and close both hands. This is not a test for
hypocalcemia. Ask the client to count backwards. This is not a test for hypocalcemia. Press
lightly on the clients shoulders. This is not a test for hypocalcemia.
LO: 4
12. Following surgery for hyperpitutarism, a client complains of a supra-orbital

headache. The nurse suspects a possible CSF leak and would:

1.
2.
3.
4.
5.
Maintain bed rest.

Keep HOB elevated 30 degrees.
Administer antibiotics.
Medicate for pain.
Inform the client that headaches are expected.
Correct answers:
1. Maintain bed rest.
2. Keep HOB elevated 30 degrees.
3. Administer antibiotics.
4. Medicate for pain.
Rationale: Maintain bed rest. Postoperative care of clients with a CSK leak should include bed
rest. Keep HOB elevated 30 degrees. Postoperative care of clients with a CSK leak should
include continued elevation of the head of the bed. Administer antibiotics. Postoperative care of
clients with a CSK leak should include being placed on prophylactic antibiotics. Medicate for
pain. Mild analgesics will be prescribed for pain. Inform the client that headaches are
expected. Headaches are not expected after surgery and are a sign of a CSF leak.
LO: 4
13. The nurse is admitting a client with acute adrenal insufficiency. Which of the following
questions would the nurse ask to establish subjective data regarding this disease?
1. Have you been able to maintain your daily activities?
2. Have you noticed any food cravings lately?
3. Have you been sleeping well?
4. Have you experienced any stress or trauma recently?
5. Have experienced any numbness in your extremities?
Correct Answer:
1. Have you been able to maintain your daily activities?
2. Have you noticed any food cravings lately?
3. Have you been sleeping well?
4. Have you experienced any stress or trauma recently?
Rationale: Have you been able to maintain your daily activities? Clients
with this condition may not be mentally alert, and therefore may have difficulty in
maintaining activities of daily living. Have you noticed any food cravings
lately? Clients with this condition will experience food cravings. Have you been
sleeping well? Clients with this disorder may have sleep disturbances. Have
you experienced any stress or trauma recently? Stress and trauma can
cause adrenal insufficiency to progress into adrenal crisis. Have you
experienced any numbness in your extremities?These symptoms are not
associated with adrenal insufficiency or crisis.

LO: 5
14. A nurse is providing discharge instructions to a newly diagnosed client with

hyperthyroidism. The nurse would instruct the client to avoid:

1.
2.
3.
4.
5.
Stress.
Infections.
Crowds.
Contact sports.
Driving.
Correct Answer:
1. Stress.
2. Infections.
Rationale: Stress. Clients should be instructed to avoid additional stress, which can lead to
complications of the disease. This should be done until the disease is under control. Infections.
Clients should be instructed to avoid infections, which can lead to complications of the disease.
This should be done until the disease is under control. Crowds. Avoiding crowds is not necessary
with hyperthyroid disorders. Contact sports. Avoiding contact sports is not necessary with
hyperthyroid disorders. Driving. Avoiding driving is not necessary with hyperthyroid disorders.
LO: 5
15. Which of the following nursing diagnoses would the nurse include as the highest
priority in the discharge teaching for a client with hypoparathyroidism?
1.
2.
3.
4.
Risk for Injury

Altered Nutrition
Impaired Mobility
Risk for Infection
Correct Answer: Risk for Injury

Rationale: Discharge priorities for patients with parathyroid disease are focused on safety related
to falls and fracture prevention. Follow-up home visits are warranted to assess how the client has
modified the environment to enhance safety. Altered nutrition is included because the client will
need to be instructed on the intake of vitamin D in the diet, but it is not the priority. Mobility is
not affected with this disorder unless the client develops bone fractures related to the low levels
of calcium; the question does not imply that the client has bone fractures. Risk for infection is
not the priority for these clients.
LO: 5
16. An elderly client has a decline in the function of the endocrine system. The
nurse would alert the client to notify the health care provider under which
conditions?

1.
2.
3.
4.
5.
Infection
Trauma
Surgery
Stress
Slowed metabolism
Correct answers:
1. Infection
2. Trauma
3. Surgery
4. Stress
Rationale: Infection. The elderly client should notify the health care provider of infection
because this condition may quickly destabilize older clients; the aging body is less capable of
responding to either internal or external stressors. Trauma. The elderly client should notify the
health care provider of trauma because this condition may quickly destabilize older clients; the
aging body is less capable of responding to either internal or external stressors. Surgery. The
elderly client should notify the health care provider of surgery because this condition may
quickly destabilize older clients; the aging body is less capable of responding to either internal or
external stressors. Stress. The elderly client should notify the health care provider of stress
because this condition may quickly destabilize older clients; the aging body is less capable of
responding to either internal or external stressors. Slowed metabolism. The elderly client may
not be able to determine if metabolism has slowed, and elderly clients already have a slower
metabolism.
LO: 6
17. An elderly client has been diagnosed with a pituitary tumor that cannot be entirely surgically
removed. The nurse would:
1.
2.
3.
4.
5.
Provide clear instructions on the medications and side effects.

Refer the client to the local support group for pituitary tumors.
Refer the client to the hospital chaplain.
Provide emotional support for the concerns of the client.
Ask the family if the client has advance directives.
Correct Answer:
1. Provide clear instructions on the medications and side effects.
2. Refer the client to the local support group for pituitary tumors.
3. Refer the client to the hospital chaplain.
4. Provide emotional support for the concerns of the client.
Rationale: Provide clear instructions on the medications and side effects. Medication will
have to be used when a pituitary tumor cannot be entirely removed. Older patients will need
simple but clear instructions on medications that they will be receiving along with the potential
side effects. Refer the client to the local support group for pituitary tumors. Referring the
client to a support group is appropriate for this condition. Refer the client to the hospital
chaplain. The client may need emotional/religious support. Provide emotional support for the
concerns of the client. The nurse should provide emotional support to the client. Ask the family
if the client has advance directives. The nurse should ask the client rather than the family about
advance directives. This is something that should be asked when the client is admitted to the
hospital, not after the client has been informed of his condition.
LO: 6
18. Which of following nursing diagnoses would the nurse include in the plan of
care for an elderly client with a pituitary adenoma?

2. Ineffective Coping
3. Risk for Injury
4. Disturbed Body Image
5. Ineffective Breathing Patterns
Correct Answer:
2. Ineffective Coping
3. Risk for Injury
4. Disturbed Body Image
Rationale: Knowledge Deficit. Clients will need instructions on the medications that may have
to be used to inhibit hormone production. Older patients may need simple but clear instructions
on the medications and the side effects. Ineffective Coping. Ineffective coping is appropriate
because the client may have a change in physical appearance that may be disheartening for the
client and lead to depression. Risk for Injury. Patients may experience difficulty with vision,
which places them at risk for injury. Disturbed Body Image. Clients may have a disturbed body
image because of the changes in physical appearance with this disorder. Ineffective Breathing
Patterns. Ineffective breathing patterns are not associated with this disorder.
LO: 6
19. A client is concerned about passing on her endocrine disorder to her children.
The nurse responds by discussing which of the following significant promises for the
future in endocrinology?

1.
2.
3.
4.
5.
Genetic etiology
Genetic counseling
Gene therapy
Genetic screening of infants
Immunizations
Correct Answer:
1. Genetic etiology
2. Genetic counseling
3. Gene therapy
4. Genetic screening of infants
Rationale: Genetic etiology. The field of genetics holds significant promise in endocrinology in
the future. Genetic counseling. The field of genetic counseling holds significant promise in
endocrinology in the future. Gene therapy. The field of gene therapy holds significant promise
in endocrinology in the future. Genetic screening of infants. The field of genetic screening of
infants holds significant promise in endocrinology in the future. Immunizations. Immunizations
have not been an aspect considered in the research on this topic.
LO: 7
20. The nurse is aware that advances have been made in the diagnosis and treatment of endocrine
disorders in recent years due to the development of:
1.
2.
3.
4.
5.
New diagnostic imaging technologies.

An immunoassay test of hormones.
Improved laboratory techniques for genetic studies.
New synthetic hormones.
Hormone agonists.
Correct Answer:
1. New diagnostic imaging technologies.
2. An immunoassay test of hormones.
3. Improved laboratory techniques for genetic studies.
4. New synthetic hormones.
5. Hormone agonists.
Rationale: New diagnostic imaging technologies. Significant advances have been made in
research in the diagnosis and treatment of endocrine disorders in recent years due to the
development of new diagnostic imaging technologies. An immunoassay test of hormones.
Significant advances have been made in research in the diagnosis and treatment of endocrine
disorders in recent years due to the development of an immunoassay test of hormones. Improved
laboratory techniques for genetic studies. Significant advances have been made in research in
the diagnosis and treatment of endocrine disorders in recent years due to improved laboratory
techniques for genetic studies. New synthetic hormones. Significant advances have been made
in research in the diagnosis and treatment of endocrine disorders in recent years due to the
development of new synthetic hormones and hormone agonists. Hormone agonists. Significant
advances have been made in research in the diagnosis and treatment of endocrine disorders in
recent years due to the development of new synthetic hormones and hormone agonists.
LO: 7
21. Which of the following advances offer hope for a cure in patient with endocrine
problems?

1.
2.
3.
4.
5.
Biochemistry
Technology
Genetics
Pharmacology
Diet therapy
Correct Answer:
1. Biochemistry
2. Technology
3. Genetics
4. Pharmacology
Rationale: Biochemistry. Advances in biochemistry offer hope in the search for cures and care of
the patient with endocrine problems. Technology. Advances in technology offer hope in the
search for cures and care of the patient with endocrine problems. Genetics. Advances in genetics
offer hope in the search for cures and care of the patient with endocrine problems.
Pharmacology. Advances in pharmacology offer hope in the search for cures and care of the
patient with endocrine problems. Diet therapy. Diet therapy has not been associated with a cure
in this area.
LO: 7

Osborn Chapter 52: Osborn, Et Al., Test Item File For Medical-Surgical Nursing: Preparation For Practice

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Osborn chapter 52

Learning Outcomes Number and Title

Cognitive level: Application

Select all that apply.

Correct Answer: Heart rate

Select all that apply.

8. The nurse is preparing to administer the synthetic hormone levothyroxine. The

Select all that apply.

Select all that apply.

Decrease environmental stimuli.

Select all that apply.

12. Following surgery for hyperpitutarism, a client complains of a supra-orbital

Select all that apply.

Maintain bed rest.

Cognitive Level: Application

14. A nurse is providing discharge instructions to a newly diagnosed client with

Select all that apply.

Risk for Injury

Correct Answer: Risk for Injury

Select all that apply.

Provide clear instructions on the medications and side effects.

Select all that apply.

Select all that apply.

New diagnostic imaging technologies.

Select all that apply.

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