Endocrine Practice Questions
15. In a 29-year-old female client who is being successfully treated for Cushing's syndrome, nurse Lyzette would expect a decline in which of these items? A. Serum glucose level. B. Hair loss. C. Bone mineralization. D. Menstrual flow.
a Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in Cushing's syndrome; therefore, with successful treatment, abnormal hair growth also declines. Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline in it.
26. A nurse is assessing a female client with Cushing syndrome. Which clinical findings can the nurse expect to identify? Select all that apply. A. Hirsutism B. Menorrhagia C. Buffalo hump D. Dependent edema E. Migraine headaches
a, c
32. A client arrived at the emergency department with a possible diagnosis of hyperparathyroidism. The nurse anticipates which serum electrolytes finding would be abnormal? Select all that apply A. Sodium B. Calcium C. Chloride D. Potassium E. Phosphorus
b,e A client with a parathormone deficiency has abnormal calcium and phosphorus values because parathormone regulates these two electrolytes.
30. What is the primary function of T3 and T4? A. Reduce blood glucose levels B. Release calcitonin C. Regulate bone growth D. Increase metabolic rate
d T3 and T4 are released throughout the body to direct the body's metabolism. They stimulate all cells within the body to increase metabolic rate.
46. The nurse is discussing sick day rules with a client with type 1 diabetes. Which interventions should the nurse include in the discussion? A. Take insulin even if unable to eat the normal diabetic diet B. Drink liquids equal to ½ the caloric usual intake C. It is not necessary to notify the primary provider if ketones are in the urine. D. Test the blood glucose and urine ketones and keep a record.
A Glucose levels increase with stress of illness.
49. The client diagnosed with Addison's disease is admitted to the ER after a day at the lake. The client is lethargic, forgetful and weak. Which intervention should the nurse implement? A. Start an IV with an 18 gauge needle and infuse normal saline rapidly B. Have the client wait until a bed is available in the waiting room. C. Obtain a consent for a blood transfusion D. Collect a urinalysis and blood samples for a CBC and calcium level
A There is a risk for dehydration.
44. The home health nurse is completing the admission assessment for a 76 year old client with type 2 diabetes controlled with 70/30 insulin. Which intervention should be included on the care plan? A. Assess the client's ability to read the fine print B. Monitor the client's prothrombin time C. Teach the client to perform a hemoglobin A1C test daily D. Instruct the client to assess the feet weekly
A aging changes and diabetic retinopathy cause the older client difficulty drawing up insulin.
7. Jemma. who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client's hyperglycemia? A. Acromegaly B. Type 1 diabetes mellitus C. Hypothyroidism D. Deficient growth hormone
Acromegaly. which is caused by a pituitary tumor that releases excessive growth hormone. is associated with hyperglycemia. hypertension. diaphoresis. peripheral neuropathy. and joint pain. Enlarged hands and feet are related to lateral bone growth. which is seen in adults with this disorder. The accompanying soft tissue swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children. and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn't associated with hyperglycemia. nor is growth hormone deficiency.
47. The client is admitted to the ICU diagnosed with diabetic ketoacidosis. Which interventions would the nurse implement? Select all that apply. A. Maintain adequate ventilation B. Assess fluid volume status C. Administer IV potassium D. Check for urine ketones E. Monitor intake and output
All of them
48.The client is admitted to rule out Cushing's syndrome. Which lab tests should the nurse anticipate being ordered? A. Plasma levels of potassium and phosporous B. Plasma levels of ACTH and cortisol C. A 24 hour urine for catecholamines D. Creatinine and white blood cell count
B ACTH comes from pituitary gland and stimulates secretion of cortisol.
43. Which electrolye replacement should the nurse anticipate being ordered by the primary provider in a client diagnosed with diabetic ketoacidosis? A. glucose B. Potassium C. Calcium D. Sodium
B Loses K with urine output and vomiting and acidosis state
9. Which of the following assessment findings characterize thyroid storm? A. increased body temperature, decreased pulse, and increased blood pressure B. increased body temperature, increased pulse, and increased blood pressure C. increased body temperature, decreased pulse, and decreased blood pressure D. increased body temperature, increased pulse, and decreased blood pressure
B Thyroid storm is characterized by SNS activation. Thyroid hormones potentiate effects of cathecolamines (epinephrine/norepinephrine). Therefore, all vital signs will be increased.
45. The client diagnosed with type 1 diabetes has a glycosylated hemoglobin (A1C) of 8.1%. Which interpretation should the nurse make based on this result? A. This result is below normal levels. B. This result is within acceptable levels. C. This result is above recommended levels. D. This result is dangerously high.
C A1C blood test is a 3 month average glucose measurement for DM.
42.The client received 10 units of Humulin R, a fast acting insulin, at 0700. At 1030, the unlicensed personnel or aide tells the nurse the client has a headache and is really acting funny. Which intervention should the nurse instruct the aide to do first? A. Obtain a blood glucose B. Have the client drink 8 oz of orange juice C. Tell the aide that the nurse will assess the client for hypoglycemia D. Tell the client that the nurse will administer dextrose IV
C Regular insulin peaks in 2-4 hours.If the client is unstable, tasks should not be delegated to the aide.
50. The nurse is admitting a client diagnosed with Addison's disease. Which clinical manifestations would the nurse expect to assess? A. Moon face, buffalo hump and hyperglycemia B. Hirsutism, fever and irritability C. Bronze hyperpigmentation, hypotension and anorexia D. Tachycardia, bulging eyes, and goiter
C A & B are signs of Cushing's syndrome and D=hyperthyroidism.
31. What organ is responsible for storing and releasing the Antidiuretic hormone and oxytocin? A. Adrenal cortex B. Posterior pituitary gland C. Thyroid gland D. Pineal gland
b
22. Which hormones does the nurse state are released by the hypothalamus? Select all that apply. A. Follicle-stimulating hormone (FSH) B. Thyroid-stimulating hormone (TSH) C. Melanocyte-inhibiting hormone (MIH) D. Corticotropin-releasing hormone (CRH) E. Growth hormone-releasing hormone (GHRH)
c, d, e
24.A nurse identifies that the client is experiencing a hypoglycemic reaction. Which intervention should the nurse implement to relieve the symptoms associated with this reaction? A. Giving 4 oz (120 mL) of fruit juice B. Administering 5% dextrose solution intravenously (IV) C. Withholding a subsequent dose of insulin D. Providing a snack of cheese and dry crackers
a
12. When caring for a male client with diabetes insipidus, nurse Juliet expects to administer which of these medications? A. vasopressin (Pitressin Synthetic) B. furosemide (Lasix). C. regular insulin. D. 10% dextrose.
a Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production, the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat diabetes mellitus and its complications, not diabetes insipidus.
28. Which disease is caused by the deficiency of antidiuretic hormone? A. Acromegaly B. Diabetes insipidus C. Cushing's syndrome D. Syndrome of inappropriate antidiuretic hormone
b
21. fter recording the blood pressure of a client, the primary health care provider confirms a diagnosis of pheochromocytoma. What blood pressure may have helped confirm the diagnosis? A. 90/70 mmHg B. 80/60 mmHg C. 120/80 mmHg D. 190/90 mmHg
d
27. A primary healthcare provider prescribes a low-sodium, high-potassium diet for a client with Cushing syndrome. Which explanation should the nurse provide to the client about the need to follow this diet? A. "The use of salt probably contributed to the disease." B. "Excess weight will be gained if sodium is not limited." C. "The loss of excess sodium and potassium in the urine requires less renal stimulation." D. "Excessive aldosterone and cortisone cause retention of sodium and loss of potassium."
d
41. A nurse performs a physical assessment on a client with type 2 diabetes mellitus. Findings include fasting blood glucose of 120mg/dl, temperature of 101ºF, pulse of 88 bpm, respirations of 22 bpm, and a BP of 140/84 mmHg. Which finding would be of most concern to the nurse? A. Pulse B. Blood pressure C. Respiration D. Temperature
d An elevated temperature may indicate infection. Infection is a leading cause of hyperglycemic hyperosmolar nonketotic syndrome or diabetic ketoacidosis. Due to the possibility of an infectious trigger for DKA, the patient may be febrile or hypothermic. If there is a superimposed infection that triggered the episode of DKA, the patient may have other infectious symptoms like fever, cough, or other urinary symptoms.
13. Nurse Ronn is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find which of these clinical manifestations? A. Hypotension. B. Thick, coarse skin. C. Deposits of adipose tissue in the trunk and dorsocervical area. D. Weight gain in arms and legs.
d Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.
2. Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus? A. Antidiuretic hormone B. Thyroid stimulating hormone C. Insulin D. Luteinizing hormone
A ADH is the hormone clients with diabetes insipidus lack. The client's TSH. FSH. and LH levels won't be affected.
33. The nurse is admitting a patient diagnosed with type 2 diabetes mellitus. The nurse should expect the following symptoms during an assessment? Select all that apply. A. Hypoglycemia B. Frequent bruising C. Ketonuria D. Dry mouth
a Hypoglycemia does not occur in type 2 diabetes unless the patient is on insulin therapy or taking other diabetes medication. In T2DM, the response to insulin is diminished, and this is defined as insulin resistance. During this state, insulin is ineffective and is initially countered by an increase in insulin production to maintain glucose homeostasis, but over time, insulin production decreases, resulting in T2DM.
38. A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the ER. Which finding would a nurse expect to note as confirming this diagnosis? A. Elevated blood glucose level and a low plasma bicarbonate B. Decreased urine output C. Increased respiration and an increase in pH D. Comatose state
a In diabetic acidosis, the arterial pH is less than 7.35, plasma bicarbonate is less than 15mEq/L, and the blood glucose level is higher than 250mg/dl and ketones are present in the blood and urine. Diabetic ketoacidosis (DKA) is characterized by uncontrolled hyperglycemia, metabolic acidosis, and increased body ketone concentration.
39. A nurse is preparing a plan of care for a client with diabetes mellitus who has hyperglycemia. What would the priority nursing diagnosis be? A. High risk for deficient fluid volume B. Deficient knowledge: disease process and treatment C. Imbalanced nutrition: less than body requirements D. Disabled family coping: compromised
a Increased blood glucose will cause the kidneys to excrete the glucose on the urine. This glucose is accompanied by fluids and electrolytes, causing osmotic diuresis leading to dehydration. This fluid loss must be replaced when it becomes severe.
40. A nurse is caring for a client admitted to the ER with DKA. In the acute phase, what would the priority nursing action be? A. Administer regular insulin intravenously B. Administer 5% dextrose intravenously C. Correct the acidosis D. Apply an electrocardiogram monitor
a Lack (absolute or relative) of insulin is the primary cause of DK1. Intravenous insulin by continuous infusion is the standard of care. A more recent prospective randomized trial demonstrated that a bolus is not necessary if patients are given hourly insulin infusion at 0.14 U/kg/hr.
11. After thyroidectomy, which of the following is the priority assessment to observe laryngeal nerve damage? A. hoarseness of voice B. difficulty in swallowing C. tetany D. fever
a Laryngeal nerve damage is manifested by severe hoarseness of voice of "whispery voice".
20. A client who is started on metformin and glyburide would have initially presented with which symptoms? A. Polydispisa, polyuria, and weight loss B. weight gain, tiredness, & bradycardia C. irritability, diaphoresis, and tachycardia D. diarrhea, abdominal pain, and weight loss
a Polydispisa, polyuria, and weight loss"Symptoms of hyperglycemia include polydipsia, polyuria, and weight loss. Metformin and sulfonylureas are commonly ordered medications.
6. A female client has a serum calcium level of 7.2 mg/dl. During the physical examination. nurse Noah expects to do which of these tests? A. Trousseau's sign. B. Homans' sign. C. Hegar's sign. D. Goodell's sign.
a This client's serum calcium level indicates hypocalcemia. an electrolyte imbalance that causes Trousseau's sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans' sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar's sign (softening of the uterine isthmus) and Goodell's sign (cervical softening) are probable signs of pregnancy.
1. Following a unilateral adrenalectomy. nurse Betty would assess for hyperkalemia shown by which of the following? A. Muscle weakness B. Tremors C. Diaphoresis D. Constipation
a Muscle weakness. bradycardia. nausea. diarrhea. and paresthesia of the hands. feet. tongue. and face are findings associated with hyperkalemia. which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. Tremors. diaphoresis. and constipation aren't seen in hyperkalemia.
25. After assessing a client, the nurse anticipates that the client has hyperpituitarism. Which questions asked by the nurse helps confirm the diagnosis? Select all that apply. A. "Is there any change in your vision?" B. "Do you experience severe headaches?" C. "Are you suffering with frequent urination?" D. "Do you eat more than five times a day?" E. "Is there any change in your menstrual cycle?"
a, b, e
29. The following are the functions of the endocrine system? Select all that apply. A. Regulates immune system B. Controls reproductive function C. Regulate heart rate and blood pressure D. Water balance E. Direct blood flow
a,b,c,d The endocrine system helps control the production and function of the immune cells. The endocrine system helps controls the development and functions of the reproductive systems in males and females. The endocrine system helps regulate heart rate and blood pressure and helps prepare the body for physical exertion. The endocrine system regulates water balance by controlling the solute concentration of the blood.
10. The nurse is planning care for a client with hyperthyroidism. Which of the following nursing interventions are appropriate? Select all that apply A. instill isotonic eye drops as necessary B. provide several, small, well-balanced meals C. provide rest periods D. keep environment warm E. encourage frequent visitors and conversation F. weigh the client daily
a,b,c,f (b and f) The client experiences weight loss because of hypermetabolism. Several, small, well-balanced meals are given to improve nutritional status of the client and daily weights should be monitored. Weight is the most objective indicator of nutritional status. (c) The client is usually exhausted due to restlessness and agitation. Frequent rest periods help the client regain energy.
18. A client is admitted to the hospital with signs and symptoms of diabetes mellitus. Which findings is the nurse most likely to observe in this client? Select all that apply A. Excessive thirst B. Weight gain C. Constipation D. Excessive hunger E. Urine retention F. Frequent, high-volume urination
a,d,f Classic signs of diabetes mellitus include polydipsia (excessive thirst), polyphagia (excessive hunger), and polyuria (excessive urination). Because the body is starving from the lack of glucose the cells are using for energy, the client has weight loss, not weight gain. Clients with diabetes mellitus usually don't present with constipation. Urine retention is only a problem is the patient has another renal-related condition.
34. Glycosylated hemoglobin (HbA1C) test measures the average blood glucose control of an individual over the previous three months. Which of the following values is considered a diagnosis of pre-diabetes? A. 6.5-7% B. 5.7-6.4% C. 5-5.6% D. >5.6%
b Glycosylated hemoglobin levels between 5.7%-6.4% are considered as pre-diabetes. The hemoglobin A1c (glycated hemoglobin, glycosylated hemoglobin, HbA1c, or A1c) test is used to evaluate a person's level of glucose control. The test shows an average of the blood sugar level over the past 90 days and represents a percentage. Anyone with an HbA1c value of 5.7 % to 6.4 % is considered to be prediabetic.
19. A client is taking Humulin NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is when? A. 2-4 hours after administration B. 4-12 hours after administration C. 16-18 hours after administration D. 18-24 hours after administration
b Humulin is an intermediate acting insulin. The onset of action is 1.5 hours, it peaks in 4-12 hours, and its duration is 24 hours. Hypoglycemic reactions to insulin are most likely to occur during the peak time.
17. A 54-year-old patient admitted with type 2 diabetes, asks the nurse what "type 2" means. Which of the following is the most appropriate response by the nurse? A. ""With type 2 diabetes, the body of the pancreas becomes inflamed." B. "With type 2 diabetes, insulin secretion is decreased and insulin resistance is increased." C. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." D. "With type 2 diabetes, the body produces autoantibodies that destroy b-cells in the pancreas.""
b In type 2 diabetes mellitus, the secretion of insulin by the pancreas is reduced and/or the cells of the body become resistant to insulin."
16. A patient with newly diagnosed type 2 diabetes mellitus asks the nurse what ""type 2"" means in relation to diabetes. The nurse explains to the patient that type 2 diabetes differs from type 1 diabetes primarily in that with type 2 diabetes... Complete the sentence. A. the pt is totally dependent on an outside source of insulin B. there is a decreased insulin secretion and cellular resistance to insulin that is produced C. the immune system destroys the pancreatic insulin-producing cells D. the insulin precurosr that is secreted by the pancreas is not activated by the liver
b In type 2 diabetes, the pancreas produces insulin, but the insulin is insufficient for the body's needs or the cells do not respond to the insulin appropriately. The other information describes the physiology of type 1 diabetes.
35. Albert, a 35-year-old insulin-dependent diabetic, is admitted to the hospital with a diagnosis of pneumonia. He has been febrile since admission. His daily insulin requirement is 24 units of NPH. Every morning Albert is given NPH insulin at 0730. Meals are served at 0830, 1230, and 1830. The nurse expects that the NPH insulin will reach its maximum effect (peak) between the hours of: A. 1130 and 1330 B. 1330 and 1930 C. 1530 and 2130 D. 1730 and 2330
b The peak time of insulin is the time it is working the hardest to lower blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours.
36. A nurse is providing a bedtime snack for the patient. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of____. A. 6-8 hours B. 10-14 hours C. 14-18 hours D. 24-28 hours
b The peak time of insulin is the time it is working the hardest to lower blood glucose. NPH insulin is an intermediate-acting insulin that has an onset of 1 to 3 hours after injection, peaks 4 to 12 hours later, and is effective for about 12 to 16 hours.
5. A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH). Which nursing intervention is appropriate? A. Infusing I.V. fluids rapidly as ordered B. Encouraging increased oral intake C. Restricting fluids D. Administering glucose-containing I.V. fluids as ordered
c To reduce water retention in a client with the SIADH. the nurse should restrict fluids. Administering fluids by any route would further increase the client's already heightened fluid load.
23. After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). What manifestations are exhibited with excessive levels of antidiuretic hormone? A. Increased blood urea nitrogen (BUN) and hypotension B. Hyperkalemia and poor skin turgor C. Hyponatremia and decreased urine output D. Polyuria and increased specific gravity of urine
c
4. For a male client with hyperglycemia. which assessment finding best supports a nursing diagnosis of Deficient fluid volume? A. cool clammy skin B. distended neck veins C. increased urine osmolarity D. decreased sodium level
c In hyperglycemia. urine osmolarity (the measurement of dissolved particles in the urine) increases as glucose particles move into the urine. The client experiences glycosuria and polyuria. losing body fluids and experiencing fluid volume deficit. Cool. clammy skin; distended neck veins; and a decreased serum sodium level are signs of fluid volume excess. the opposite imbalance.
36. A nurse is providing a bedtime snack for the patient. This is based on the knowledge that intermediate-acting insulins are effective for an approximate duration of____. A. 6-8 hours B. 10-14 hours C. 14-18 hours D. 24-28 hours
c Intermediate-acting insulins include Humulin N and Novolin N. They have an onset of two to four hours, a peak of 4 to 12 hours, and a duration of 14 to 18 hours. They are absorbed more slowly, and last longer. They are also used to control the blood sugar overnight while fasting and between meals.
14. An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential complication of: A. Thyroid storm. B. Cretinism. C. Myxedema coma. D. Hashimoto's thyroiditis.
c Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.
8. Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic episodes. the nurse should recommend which of these interventions? A. Increasing saturated fat intake and fasting in the afternoon. B. Increasing intake of vitamins B and D and taking iron supplements. C. Eating a candy bar if lightheadedness occurs. D. Consuming a low-carbohydrate. high protein diet and avoiding fasting.
d To control hypoglycemic episodes. the nurse should instruct the client to consume a low-carbohydrate. high protein diet. avoid fasting. and avoid simple sugars. Increasing saturated fat intake and increasing vitamin supplementation wouldn't help control hypoglycemia.
3. Early this morning. a female client had a subtotal thyroidectomy. During evening rounds. nurse Tina assesses the client. who now has nausea. a temperature of 105° F (40.5° C). tachycardia. and extreme restlessness. What is the most likely cause of these signs? A. Diabetes Ketoacidosis B. Hypoglycemia C. Tetany D. Thyroid crisis
d Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of hyperthyroidism. such as high fever. tachycardia. and extreme restlessness. Diabetic ketoacidosis is more likely to produce polyuria. polydipsia. and polyphagia; hypoglycemia. to produce weakness. tremors. profuse perspiration. and hunger. Tetany typically causes uncontrollable muscle spasms. stridor. cyanosis. and possibly asphyxia.
