Endocrine Test # 2

1. Nurse Ronn is assessing a client with possible Cushing’s syndrome. In a client with
Cushing’s syndrome, the nurse would expect to find:
a. Hypotension.
b. Thick, coarse skin.
c. Deposits of adipose tissue in the trunk and dorsocervical area.
d. Weight gain in arms and legs.

2. A male client with primary diabetes insipidus is ready for discharge on desmopressin
(DDAVP). Which instruction should nurse Lina provide?
a. “Administer desmopressin while the suspension is cold.”
b. “Your condition isn’t chronic, so you won’t need to wear a medical identification
bracelet.”
c. “You may not be able to use desmopressin nasally if you have nasal discharge or
blockage.”
d. “You won’t need to monitor your fluid intake and output after you start taking
desmopressin.”

3. Nurse Wayne is aware that a positive Chvostek’s sign indicate?

a. Hypocalcemia
b. Hyponatremia
c. Hypokalemia
d. Hypermagnesemia

4. In a 29-year-old female client who is being successfully treated for Cushing’s

syndrome, nurse Lyzette would expect a decline in:
a. Serum glucose level.
b. Hair loss.
c. Bone mineralization.
d. Menstrual flow.

5. A male client has recently undergone surgical removal of a pituitary tumor. Dr.
Wong prescribes corticotropin (Acthar), 20 units I.M. q.i.d. as a replacement therapy.
What is the mechanism of action of corticotropin?
a. It decreases cyclic adenosine monophosphate (cAMP) production and affects the
metabolic rate of target organs.
b. It interacts with plasma membrane receptors to inhibit enzymatic actions.
c. It interacts with plasma membrane receptors to produce enzymatic actions that affect
protein, fat, and carbohydrate metabolism.\
d. It regulates the threshold for water resorption in the kidneys.

6. Capillary glucose monitoring is being performed every 4 hours for a female client
diagnosed with diabetic ketoacidosis. Insulin is administered using a scale of regular
insulin according to glucose results. At 2 p.m., the client has a capillary glucose level of
250 mg/dl for which he receives 8 U of regular insulin. Nurse Vince should expect the
dose’s:
a. Onset to be at 2 p.m. and its peak to be at 3 p.m.
b. Onset to be at 2:15 p.m. and its peak to be at 3 p.m.
c. Onset to be at 2:30 p.m. and its peak to be at 4 p.m.
d. Onset to be at 4 p.m. and its peak to be at 6 p.m.

7. A female client with Cushing’s syndrome is admitted to the medical-surgical unit.

During the admission assessment, nurse Tyzz notes that the client is agitated and irritable,
has poor memory, reports loss of appetite, and appears disheveled. These findings are
consistent with which problem?
a. Depression
b. Neuropathy
c. Hypoglycemia
d. Hyperthyroidism

8. Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals

muscle twitching and tingling, along with numbness in the fingers, toes, and mouth area.
The nurse should suspect which complication?
a. Tetany
b. Hemorrhage
c. Thyroid storm
d. Laryngeal nerve damage

9. After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism.

Dr. Smith prescribes levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition
is levothyroxine the preferred agent?
a. Primary hypothyroidism
b. Graves’ disease
c. Thyrotoxicosis
d. Euthyroidism

10. Which of these signs suggests that a male client with the syndrome of inappropriate
antidiuretic hormone (SIADH) secretion is experiencing complications?
a. Tetanic contractions
b. Neck vein distention
c. Weight loss
d. Polyuria

11. A female client with a history of pheochromocytoma is admitted to the hospital in

an acute hypertensive crisis. To reverse hypertensive crisis caused by
pheochromocytoma, nurse Lyka expects to administer:
a. phentolamine (Regitine).
b. methyldopa (Aldomet).
c. mannitol (Osmitrol).
d. felodipine (Plendil).

12. A male client with a history of hypertension is diagnosed with primary

hyperaldosteronism. This diagnosis indicates that the client’s hypertension is caused by
excessive hormone secretion from which of the following glands?
a. Adrenal cortex
b. Pancreas
c. Adrenal medulla
d. Parathyroid

13. Nurse Troy is aware that the most appropriate for a client with Addison’s disease?
a. Risk for infection
b. Excessive fluid volume
c. Urinary retention
d. Hypothermia

14. Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client

with type 2 diabetes mellitus. During discharge planning, nurse Pauleen would be aware
of the client’s need for additional teaching when the client states:
a. “If I have hypoglycemia, I should eat some sugar, not dextrose.”
b. “The drug makes my pancreas release more insulin.”
c. “I should never take insulin while I’m taking this drug.”
d. “It’s best if I take the drug with the first bite of a meal.”

15. A female client whose physical findings suggest a hyperpituitary condition

undergoes an extensive diagnostic workup. Test results reveal a pituitary tumor, which
necessitates a transphenoidal hypophysectomy. The evening before the surgery, nurse
Jacob reviews preoperative and postoperative instructions given to the client earlier.
Which postoperative instruction should the nurse emphasize?
a. “You must lie flat for 24 hours after surgery.”
b. “You must avoid coughing, sneezing, and blowing your nose.”
c. “You must restrict your fluid intake.”
d. “You must report ringing in your ears immediately.”

16. Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male
client with type 2 diabetes mellitus who has been having trouble controlling the blood
glucose level through diet and exercise. Which medication instruction should the nurse
provide?
a. “Be sure to take glipizide 30 minutes before meals.”
b. “Glipizide may cause a low serum sodium level, so make sure you have your sodium
level checked monthly.”
c. “You won’t need to check your blood glucose level after you start taking glipizide.”
d. “Take glipizide after a meal to prevent heartburn.”
17. For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-
dry dressing change every shift, and blood glucose monitoring before meals and bedtime.
Why are wet-to-dry dressings used for this client?
a. They contain exudate and provide a moist wound environment.
b. They protect the wound from mechanical trauma and promote healing.
c. They debride the wound and promote healing by secondary intention.
d. They prevent the entrance of microorganisms and minimize wound discomfort.

18. When instructing the female client diagnosed with hyperparathyroidism about diet,
nurse Gina should stress the importance of which of the following?
a. Restricting fluids
b. Restricting sodium
c. Forcing fluids
d. Restricting potassium

19. Which nursing diagnosis takes highest priority for a female client with
hyperthyroidism?
a. Risk for imbalanced nutrition: More than body requirements related to thyroid
hormone excess
b. Risk for impaired skin integrity related to edema, skin fragility, and poor wound
healing
c. Body image disturbance related to weight gain and edema
d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

20. A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic

syndrome (HHNS) has a history of type 2 diabetes that is being controlled with an oral
diabetic agent, tolazamide (Tolinase). Which of the following is the most important
laboratory test for confirming this disorder?
a. Serum potassium level
b. Serum sodium level
c. Arterial blood gas (ABG) values
d. Serum osmolarity

21. A male client has just been diagnosed with type 1 diabetes mellitus. When
teaching the client and family how diet and exercise affect insulin requirements, Nurse
Joy should include which guideline?
a. “You’ll need more insulin when you exercise or increase your food intake.”
b. “You’ll need less insulin when you exercise or reduce your food intake.”
c. “You’ll need less insulin when you increase your food intake.”
d. “You’ll need more insulin when you exercise or decrease your food intake.”

22. Nurse Noemi administers glucagon to her diabetic client, then monitors the client
for adverse drug reactions and interactions. Which type of drug interacts adversely with
glucagon?
a. Oral anticoagulants
b. Anabolic steroids
c. Beta-adrenergic blockers
d. Thiazide diuretics

23. Which instruction about insulin administration should nurse Kate give to a client?
a. “Always follow the same order when drawing the different insulins into the syringe.”
b. “Shake the vials before withdrawing the insulin.”
c. “Store unopened vials of insulin in the freezer at temperatures well below freezing.”
d. “Discard the intermediate-acting insulin if it appears cloudy.”

24. Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits
confusion, light-headedness, and aberrant behavior. The client is still conscious. The
nurse should first administer:
a. I.M. or subcutaneous glucagon.
b. I.V. bolus of dextrose 50%.
c. 15 to 20 g of a fast-acting carbohydrate such as orange juice.
d. 10 U of fast-acting insulin.

25. For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the
female client for Chvostek’s sign and Trousseau’s sign because they indicate which of
the following?
a. Hypocalcemia
b. Hypercalcemia
c. Hypokalemia
d. Hyperkalemia

1. Answer C. 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. Answer C. Desmopressin may not be absorbed if the intranasal route is

compromised. Although diabetes insipidus is treatable, the client should wear medical
identification and carry medication at all times to alert medical personnel in an
emergency and ensure proper treatment. The client must continue to monitor fluid intake
and output and receive adequate fluid replacement.

3. Answer A. Chvostek’s sign is elicited by tapping the client’s face lightly over the
facial nerve, just below the temple. If the client’s facial muscles twitch, it indicates
hypocalcemia. Hyponatremia is indicated by weight loss, abdominal cramping, muscle
weakness, headache, and postural hypotension. Hypokalemia causes paralytic ileus and
muscle weakness. Clients with hypermagnesemia exhibit a loss of deep tendon reflexes,
coma, or cardiac arrest.

4. Answer 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.

5. Answer C. Corticotropin interacts with plasma membrane receptors to produce

enzymatic actions that affect protein, fat, and carbohydrate metabolism. It doesn’t
decrease cAMP production. The posterior pituitary hormone, antidiuretic hormone,
regulates the threshold for water resorption in the kidneys.

6. Answer C. 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.

7. Answer A. Agitation, irritability, poor memory, loss of appetite, and neglect of one’s
appearance may signal depression, which is common in clients with Cushing’s syndrome.
Neuropathy affects clients with diabetes mellitus — not Cushing’s syndrome. Although
hypoglycemia can cause irritability, it also produces increased appetite, rather than loss of
appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat
intolerance, and weight loss despite increased appetite.

8. Answer A. Tetany may result if the parathyroid glands are excised or damaged
during thyroid surgery. Hemorrhage is a potential complication after thyroid surgery but
is characterized by tachycardia, hypotension, frequent swallowing, feelings of fullness at
the incision site, choking, and bleeding. Thyroid storm is another term for severe
hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may
occur postoperatively, but its signs include a hoarse voice and, possibly, acute airway
obstruction.

9. Answer A. Levothyroxine is the preferred agent to treat primary hypothyroidism and

cretinism, although it also may be used to treat secondary hypothyroidism. It is
contraindicated in Graves’ disease and thyrotoxicosis because these conditions are forms
of hyperthyroidism. Euthyroidism, a term used to describe normal thyroid function,
wouldn’t require any thyroid preparation.

10. Answer B. SIADH secretion causes antidiuretic hormone overproduction, which

leads to fluid retention. Severe SIADH can cause such complications as vascular fluid
overload, signaled by neck vein distention. This syndrome isn’t associated with tetanic
contractions. It may cause weight gain and fluid retention (secondary to oliguria).

11. Answer A. Pheochromocytoma causes excessive production of epinephrine and

norepinephrine, natural catecholamines that raise the blood pressure. Phentolamine, an
alpha-adrenergic blocking agent given by I.V. bolus or drip, antagonizes the body’s
response to circulating epinephrine and norepinephrine, reducing blood pressure quickly
and effectively. Although methyldopa is an antihypertensive agent available in parenteral
form, it isn’t effective in treating hypertensive emergencies. Mannitol, a diuretic, isn’t
used to treat hypertensive emergencies. Felodipine, an antihypertensive agent, is
available only in extended-release tablets and therefore doesn’t reduce blood pressure
quickly enough to correct hypertensive crisis.

12. Answer A. Excessive secretion of aldosterone in the adrenal cortex is responsible

for the client’s hypertension. This hormone acts on the renal tubule, where it promotes
reabsorption of sodium and excretion of potassium and hydrogen ions. The pancreas
mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes the
catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid
hormone.

13. Answer A. Addison’s disease decreases the production of all adrenal hormones,
compromising the body’s normal stress response and increasing the risk of infection.
Other appropriate nursing diagnoses for a client with Addison’s disease include Deficient
fluid volume and Hyperthermia. Urinary retention isn’t appropriate because Addison’s
disease causes polyuria.

14. Answer A. Acarbose delays glucose absorption, so the client should take an oral
form of dextrose rather than a product containing table sugar when treating
hypoglycemia. The alpha-glucosidase inhibitors work by delaying the carbohydrate
digestion and glucose absorption. It’s safe to be on a regimen that includes insulin and an
alpha-glucosidase inhibitor. The client should take the drug at the start of a meal, not 30
minutes to an hour before.

15. Answer B. After a transsphenoidal hypophysectomy, the client must refrain from
coughing, sneezing, and blowing the nose for several days to avoid disturbing the
surgical graft used to close the wound. The head of the bed must be elevated, not kept
flat, to prevent tension or pressure on the suture line. Within 24 hours after a
hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased,
not restricted, fluid intake. Visual, not auditory, changes are a potential complication of
hypophysectomy.

16. Answer A. The client should take glipizide twice a day, 30 minutes before a meal,
because food decreases its absorption. The drug doesn’t cause hyponatremia and
therefore doesn’t necessitate monthly serum sodium measurement. The client must
continue to monitor the blood glucose level during glipizide therapy.

17. Answer C. For this client, wet-to-dry dressings are most appropriate because they
clean the foot ulcer by debriding exudate and necrotic tissue, thus promoting healing by
secondary intention. Moist, transparent dressings contain exudate and provide a moist
wound environment. Hydrocolloid dressings prevent the entrance of microorganisms and
minimize wound discomfort. Dry sterile dressings protect the wound from mechanical
trauma and promote healing.
18. Answer C. The client should be encouraged to force fluids to prevent renal calculi
formation. Sodium should be encouraged to replace losses in urine. Restricting potassium
isn’t necessary in hyperparathyroidism.

19. Answer D. In the client with hyperthyroidism, excessive thyroid hormone

production leads to hypermetabolism and increased nutrient metabolism. These
conditions may result in a negative nitrogen balance, increased protein synthesis and
breakdown, decreased glucose tolerance, and fat mobilization and depletion. This puts the
client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition:
Less than body requirements the most important nursing diagnosis. Options B and C may
be appropriate for a client with hypothyroidism, which slows the metabolic rate.

20. Answer D. Serum osmolarity is the most important test for confirming HHNS; it’s
also used to guide treatment strategies and determine evaluation criteria. A client with
HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum potassium,
serum sodium, and ABG values are also measured, but they aren’t as important as serum
osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has
hypernatremia and osmotic diuresis. ABG values reveal acidosis, and the potassium level
is variable.

21. Answer B. Exercise, reduced food intake, hypothyroidism, and certain medications
decrease the insulin requirements. Growth, pregnancy, greater food intake, stress,
surgery, infection, illness, increased insulin antibodies, and certain medications increase
the insulin requirements.

22. Answer A. As a normal body protein, glucagon only interacts adversely with oral
anticoagulants, increasing the anticoagulant effects. It doesn’t interact adversely with
anabolic steroids, beta-adrenergic blockers, or thiazide diuretics.

23. Answer A. The client should be instructed always to follow the same order when
drawing the different insulins into the syringe. Insulin should never be shaken because
the resulting froth prevents withdrawal of an accurate dose and may damage the insulin
protein molecules. Insulin also should never be frozen because the insulin protein
molecules may be damaged. Intermediate-acting insulin is normally cloudy.

24. Answer C. This client is having a hypoglycemic episode. Because the client is
conscious, the nurse should first administer a fast-acting carbohydrate, such as orange
juice, hard candy, or honey. If the client has lost consciousness, the nurse should
administer either I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%. The
nurse shouldn’t administer insulin to a client who’s hypoglycemic; this action will further
compromise the client’s condition.

25. Answer A. The client who has undergone a thyroidectomy is at risk for developing
hypocalcemia from inadvertent removal or damage to the parathyroid gland. The client
with hypocalcemia will exhibit a positive Chvostek’s sign (facial muscle contraction
when the facial nerve in front of the ear is tapped) and a positive Trousseau’s sign (carpal
spasm when a blood pressure cuff is inflated for a few minutes). These signs aren’t
present with hypercalcemia, hypokalemia, or hyperkalemia.

Endocrine

1. An agitated, confused female client arrives in the emergency department. Her history
includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals
pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures
42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery,
nurse Lily teaches the client to treat hypoglycemia by ingesting:
a. 2 to 5 g of a simple carbohydrate.
b. 10 to 15 g of a simple carbohydrate.
c. 18 to 20 g of a simple carbohydrate.
d. 25 to 30 g of a simple carbohydrate.

2. A female adult client with a history of chronic hyperparathyroidism admits to being

noncompliant. Based on initial assessment findings, nurse Julia formulates the nursing
diagnosis of Risk for injury. To complete the nursing diagnosis statement for this client,
which “related-to” phrase should the nurse add?
a. Related to bone demineralization resulting in pathologic fractures
b. Related to exhaustion secondary to an accelerated metabolic rate
c. Related to edema and dry skin secondary to fluid infiltration into the interstitial
spaces
d. Related to tetany secondary to a decreased serum calcium level

3. Nurse John is assigned to care for a postoperative male client who has diabetes
mellitus. During the assessment interview, the client reports that he’s impotent and says
he’s concerned about its effect on his marriage. In planning this client’s care, the most
appropriate intervention would be to:
a. Encourage the client to ask questions about personal sexuality.
b. Provide time for privacy.
c. Provide support for the spouse or significant other.
d. Suggest referral to a sex counselor or other appropriate professional.

4. During a class on exercise for diabetic clients, a female client asks the nurse educator
how often to exercise. The nurse educator advises the clients to exercise how often to
meet the goals of planned exercise?
a. At least once a week
b. At least three times a week
c. At least five times a week
d. Every day

5. Nurse Oliver should expect a client with hypothyroidism to report which health
concerns?
a. Increased appetite and weight loss
b. Puffiness of the face and hands
c. Nervousness and tremors
d. Thyroid gland swelling

6. A female client with hypothyroidism (myxedema) is receiving levothyroxine

(Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an
adverse drug effect?
a. Dysuria
b. Leg cramps
c. Tachycardia
d. Blurred vision

7. A 67-year-old male client has been complaining of sleeping more, increased

urination, anorexia, weakness, irritability, depression, and bone pain that interferes with
her going outdoors. Based on these assessment findings, nurse Richard would suspect
which of the following disorders?
a. Diabetes mellitus
b. Diabetes insipidus
c. Hypoparathyroidism
d. Hyperparathyroidism

8. When caring for a male client with diabetes insipidus, nurse Juliet expects to
administer:
a. vasopressin (Pitressin Synthetic).
b. furosemide (Lasix).
c. regular insulin.
d. 10% dextrose.

9. The nurse is aware that the following is the most common cause of
hyperaldosteronism?
a. Excessive sodium intake
b. A pituitary adenoma
c. Deficient potassium intake
d. An adrenal adenoma

10. A male client with type 1 diabetes mellitus has a highly elevated glycosylated
hemoglobin (Hb) test result. In discussing the result with the client, nurse Sharmaine
would be most accurate in stating:
a. “The test needs to be repeated following a 12-hour fast.”
b. “It looks like you aren’t following the prescribed diabetic diet.”
c. “It tells us about your sugar control for the last 3 months.”
d. “Your insulin regimen needs to be altered significantly.”

11. Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia
shown by which of the following?
a. Muscle weakness
b. Tremors
c. Diaphoresis
d. Constipation

12. Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes
insipidus. The nurse should include information about which hormone lacking in clients
with diabetes insipidus?
a. antidiuretic hormone (ADH).
b. thyroid-stimulating hormone (TSH).
c. follicle-stimulating hormone (FSH).
d. luteinizing hormone (LH).

13. Early this morning, a female client had a subtotal thyroidectomy. During evening
rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F
(40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these
signs?
a. Diabetic ketoacidosis
b. Thyroid crisis
c. Hypoglycemia
d. Tetany

14. For a male client with hyperglycemia, which assessment finding best supports a
nursing diagnosis of Deficient fluid volume?
a. Cool, clammy skin
b. Distended neck veins
c. Increased urine osmolarity
d. Decreased serum sodium level

15. When assessing a male client with pheochromocytoma, a tumor of the adrenal
medulla that secretes excessive catecholamine, nurse April is most likely to detect:
a. a blood pressure of 130/70 mm Hg.
b. a blood glucose level of 130 mg/dl.
c. bradycardia.
d. a blood pressure of 176/88 mm Hg.

16. A male client is admitted for treatment of the syndrome of inappropriate antidiuretic
hormone (SIADH). Which nursing intervention is appropriate?
a. Infusing I.V. fluids rapidly as ordered
b. Encouraging increased oral intake
c. Restricting fluids
d. Administering glucose-containing I.V. fluids as ordered

17. A female client has a serum calcium level of 7.2 mg/dl. During the physical
examination, nurse Noah expects to assess:
a. Trousseau’s sign.
b. Homans’ sign.
c. Hegar’s sign.
d. Goodell’s sign.

18. Which outcome indicates that treatment of a male client with diabetes insipidus has
been effective?
a. Fluid intake is less than 2,500 ml/day.
b. Urine output measures more than 200 ml/hour.
c. Blood pressure is 90/50 mm Hg.
d. The heart rate is 126 beats/minute.

19. Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia
tells the nurse that her husband sleeps in another room because her snoring keeps him
awake. The nurse notices that she has large hands and a hoarse voice. Which of the
following would the nurse suspect as a possible cause of the client’s hyperglycemia?
a. Acromegaly
b. Type 1 diabetes mellitus
c. Hypothyroidism
d. Deficient growth hormone

20. Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To
control hypoglycemic episodes, the nurse should recommend:
a. Increasing saturated fat intake and fasting in the afternoon.
b. Increasing intake of vitamins B and D and taking iron supplements.
c. Eating a candy bar if light-headedness occurs.
d. Consuming a low-carbohydrate, high-protein diet and avoiding fasting.

21. An incoherent female client with a history of hypothyroidism is brought to the

emergency department by the rescue squad. Physical and laboratory findings reveal
hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and
nonpitting edema of the face and pretibial area. Knowing that these findings suggest
severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the
potential complication of:
a. Thyroid storm.
b. Cretinism.
c. myxedema coma.
d. Hashimoto’s thyroiditis.

22. A male client with type 1 diabetes mellitus asks the nurse about taking an oral
antidiabetic agent. Nurse Jack explains that these medications are only effective if the
client:
a. prefers to take insulin orally.
b. has type 2 diabetes.
c. has type 1 diabetes.
d. is pregnant and has type 2 diabetes.
23. When caring for a female client with a history of hypoglycemia, nurse Ruby should
avoid administering a drug that may potentiate hypoglycemia. Which drug fits this
description?
a. sulfisoxazole (Gantrisin)
b. mexiletine (Mexitil)
c. prednisone (Orasone)
d. lithium carbonate (Lithobid)

24. After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary
failure. Which of the following would the nurse expect the physician to do?
a. Initiate insulin therapy.
b. Switch the client to a different oral antidiabetic agent.
c. Prescribe an additional oral antidiabetic agent.
d. Restrict carbohydrate intake to less than 30% of the total caloric intake.

25. During preoperative teaching for a female client who will undergo subtotal
thyroidectomy, the nurse should include which statement?
a. “The head of your bed must remain flat for 24 hours after surgery.”
b. “You should avoid deep breathing and coughing after surgery.”
c. “You won’t be able to swallow for the first day or two.”
d. “You must avoid hyperextending your neck after surgery

Answers

1. Answer B. To reverse hypoglycemia, the American Diabetes Association

recommends ingesting 10 to 15 g of a simple carbohydrate, such as three to five pieces of
hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If necessary,
this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple
carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g
may raise it above normal, causing hyperglycemia.

2. Answer A. Poorly controlled hyperparathyroidism may cause an elevated serum

calcium level. This, in turn, may diminish calcium stores in the bone, causing bone
demineralization and setting the stage for pathologic fractures and a risk for injury.
Hyperparathyroidism doesn’t accelerate the metabolic rate. A decreased thyroid hormone
level, not an increased parathyroid hormone level, may cause edema and dry skin
secondary to fluid infiltration into the interstitial spaces. Hyperparathyroidism causes
hypercalcemia, not hypocalcemia; therefore, it isn’t associated with tetany.

3. Answer D. The nurse should refer this client to a sex counselor or other professional.
Making appropriate referrals is a valid part of planning the client’s care. The nurse
doesn’t normally provide sex counseling.

4. Answer B. Diabetic clients must exercise at least three times a week to meet the
goals of planned exercise — lowering the blood glucose level, reducing or maintaining
the proper weight, increasing the serum high-density lipoprotein level, decreasing serum
triglyceride levels, reducing blood pressure, and minimizing stress. Exercising once a
week wouldn’t achieve these goals. Exercising more than three times a week, although
beneficial, would exceed the minimum requirement.

5. Answer B. Hypothyroidism (myxedema) causes facial puffiness, extremity edema,

and weight gain. Signs and symptoms of hyperthyroidism (Graves’ disease) include an
increased appetite, weight loss, nervousness, tremors, and thyroid gland enlargement
(goiter).

6. Answer C. Levothyroxine, a synthetic thyroid hormone, is given to a client with

hypothyroidism to simulate the effects of thyroxine. Adverse effects of this agent include
tachycardia. The other options aren’t associated with levothyroxine.

7. Answer D. Hyperparathyroidism is most common in older women and is

characterized by bone pain and weakness from excess parathyroid hormone (PTH).
Clients also exhibit hypercaliuria-causing polyuria. While clients with diabetes mellitus
and diabetes insipidus also have polyuria, they don’t have bone pain and increased
sleeping. Hypoparathyroidism is characterized by urinary frequency rather than polyuria.

8. Answer A. Because diabetes insipidus results from decreased antidiuretic hormone

(vasopressin) production, the nurse should expect to administer synthetic vasopressin for
hormone replacement therapy. Furosemide, a diuretic, is contraindicated because a client
with diabetes insipidus experiences polyuria. Insulin and dextrose are used to treat
diabetes mellitus and its complications, not diabetes insipidus.

9. Answer D. An autonomous aldosterone-producing adenoma is the most common

cause of hyperaldosteronism. Hyperplasia is the second most frequent cause. Aldosterone
secretion is independent of sodium and potassium intake as well as of pituitary
stimulation.

10. Answer C. The glycosylated Hb test provides an objective measure of glycemic

control over a 3-month period. The test helps identify trends or practices that impair
glycemic control, and it doesn’t require a fasting period before blood is drawn. The nurse
can’t conclude that the result occurs from poor dietary management or inadequate insulin
coverage.

11. Answer A. Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the
hands, feet, tongue, and face are findings associated with hyperkalemia, which is
transient and occurs from transient hypoaldosteronism when the adenoma is removed.
Tremors, diaphoresis, and constipation aren’t seen in hyperkalemia.

12. Answer A. ADH is the hormone clients with diabetes insipidus lack. The client’s
TSH, FSH, and LH levels won’t be affected.
13. Answer B. 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.

14. Answer C. In hyperglycemia, urine osmolarity (the measurement of dissolved

particles in the urine) increases as glucose particles move into the urine. The client
experiences glucosuria and polyuria, losing body fluids and experiencing fluid volume
deficit. Cool, clammy skin; distended neck veins; and a decreased serum sodium level are
signs of fluid volume excess, the opposite imbalance.

15. Answer D. Pheochromocytoma, a tumor of the adrenal medulla that secretes

excessive catecholamine, causes hypertension, tachycardia, hyperglycemia,
hypermetabolism, and weight loss. It isn’t associated with the other options.

16. Answer C. To reduce water retention in a client with the SIADH, the nurse should
restrict fluids. Administering fluids by any route would further increase the client’s
already heightened fluid load.

17. Answer 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.

18. Answer A. Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant

thirst, and an unusually high oral intake of fluids. Treatment with the appropriate drug
should decrease both oral fluid intake and urine output. A urine output of 200 ml/hour
indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of 126
beats/minute indicate compensation for the continued fluid deficit, suggesting that
treatment hasn’t been effective.

19. Answer A. Acromegaly, which is caused by a pituitary tumor that releases

excessive growth hormone, is associated with hyperglycemia, hypertension, diaphoresis,
peripheral neuropathy, and joint pain. Enlarged hands and feet are related to lateral
bone growth, which is seen in adults with this disorder. The accompanying soft tissue
swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in
children, and newly diagnosed persons are usually very ill and thin. Hypothyroidism isn’t
associated with hyperglycemia, nor is growth hormone deficiency.

20. Answer D. To control hypoglycemic episodes, the nurse should instruct the client to
consume a low-carbohydrate, high-protein diet, avoid fasting, and avoid simple sugars.
Increasing saturated fat intake and increasing vitamin supplementation wouldn’t help
control hypoglycemia.
21. Answer C. Severe hypothyroidism may result in myxedema coma, in which a
drastic drop in the metabolic rate causes decreased vital signs, hypoventilation (possibly
leading to respiratory acidosis), and nonpitting edema. Thyroid storm is an acute
complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in
infants. Hashimoto’s thyroiditis is a common chronic inflammatory disease of the thyroid
gland in which autoimmune factors play a prominent role.

22. Answer B. Oral antidiabetic agents are only effective in adult clients with type 2
diabetes. Oral antidiabetic agents aren’t effective in type 1 diabetes. Pregnant and
lactating women aren’t prescribed oral antidiabetic agents because the effect on the fetus
is uncertain.

23. Answer A. Sulfisoxazole and other sulfonamides are chemically related to oral
antidiabetic agents and may precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is
used to treat refractory ventricular arrhythmias; it doesn’t cause hypoglycemia.
Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause
transient hyperglycemia, not hypoglycemia.

24. Answer B. Many clients (25% to 60%) with secondary failure respond to a different
oral antidiabetic agent. Therefore, it wouldn’t be appropriate to initiate insulin therapy at
this time. However, if a new oral antidiabetic agent is unsuccessful in keeping glucose
levels at an acceptable level, insulin may be used in addition to the antidiabetic agent.

25. Answer D. To prevent undue pressure on the surgical incision after subtotal
thyroidectomy, the nurse should advise the client to avoid hyperextending the neck. The
client may elevate the head of the bed as desired and should perform deep breathing and
coughing to help prevent pneumonia. Subtotal thyroidectomy doesn’t affect swallowing.