Deck 2: Endocrine

Question 1

JMM has been diagnosed with Hashimoto's disease, an autoimmune disorder. Which of the following signs and symptoms were most probably exhibited by the client that led to the diagnosis?

A)Increased appetite, weight loss, hyperdefecation
B)Increased urination, weight loss, increased thirst
C)Decreased appetite, weight gain, constipation
D)Increased urination, weight gain, and purplish red striae

Answer 1

Decreased appetite, weight gain, constipation

Question 2

Teasedale is to undergo a thyroidectomy. The nurse should be on the lookout for which electrolyte imbalance?

A)Hypokalemia
B)Hyperkalemia
C)Hypercalcemia
D)Hypocalcemia

Answer 2

Hypocalcemia

Question 3

The nurse is teaching Mrs. Jones, a known diabetic, to monitor her blood glucose using a glucometer. The nurse will know that Mrs. Jones is competent in performing her finger-stick to obtain blood when she:

A)Uses the ball of a finger as the puncture site
B)Uses the side of a fingertip as the puncture site
C)Avoids using the fingers of her dominant hand as puncture sites
D)Avoids using the thumbs as puncture sites

Answer 3

Uses the side of a fingertip as the puncture site

Question 4

Daniels, a 55-year-old mechanic, was diagnosed with adult-onset diabetes. The nurse will know that Mr. Daniels understand the symptoms of a hyperglycemic reaction if he verbalizes:

A)"I will experience thirst, always going to the bathroom to pee, and will also have decreased appetite."
B)"I may feel flushed cheeks, will have acetone breath, and increased thirst."
C)"I may experience nausea, even vomiting, and some episodes of diarrhea."
D)"I will experience weight gain, a normal breath, and constant thirst."

Question 5

The nurse in a day clinic is reviewing the laboratory results of clients who were examined for a possible diagnosis of diabetes mellitus. Which of the following individuals would the nurse believe to be diagnosed with diabetes mellitus?

A)Jack, 30 years old, with a fasting plasma glucose of 126 mg/dL
B)Penelope, 42 years old, with a random plasma glucose above 200 mg/dL and symptoms of diabetes
C)Cynthia, 25 years old, with a random plasma glucose less than 140 mg/dL
D)David, 51 years old, with a fasting plasma glucose between 110 mg/dL and 125 mg/dL

Question 6

Jena, age 32, visited a day clinic to report a sudden weight gain. She also reported to the nurse on duty that her abdomen is now bigger than before and her face looks "swollen" and rounded. Which additional assessment finding would lead the nurse to suspect that Jena has Cushing's syndrome rather than obesity?

A)Large thighs and upper arms
B)Pendulous abdomen and large hips
C)Abdominal striae and ankle enlargement
D)Posterior neck fat pad and thin extremities

Question 7

Ricky, age 18, is admitted with a decreased level of consciousness secondary to a closed head injury resulting from a fall while roller-skating. His urine output is 500cc from 6 AM to 11 AM, 1,000cc from 11 AM to 2 PM, and 350cc from 2 PM to 3 PM. Which of the following actions by the nurse is appropriate?

A)Realize that this is normal urine output and continue to monitor Ricky
B)Encourage Ricky to drink 8 to 10 glasses of fluid daily
C)Check the urine specific gravity and report any abnormality as well as the urine output
D)Decrease the IV rate from 100cc/hr to 25cc/hr, suspecting fluid excess

Question 8

Lisa, the nurse on duty, is preparing to discharge a client newly diagnosed with diabetes mellitus. The client states, "I should eat a candy bar or cup of ice cream every time I feel shaky, hungry, or nauseated." Which of the following is Lisa's best response?

A)"Yes. A candy bar or cup of ice cream is needed to treat the hypoglycemia."
B)"Yes. You should eat the snack and then have a meal as soon as possible."
C)"No. You should quickly eat a meal; the candy will cause hyperglycemia."
D)"No. These have too much sugar and fat, 5 Lifesavers candies or skim milk is better."

Question 9

The non-insulin-dependent diabetic who is obese is best controlled by weight loss because obesity:

A)Reduces the number of insulin receptors
B)Causes pancreatic islet cell exhaustion
C)Reduces insulin binding at receptor sites
D)Reduces pancreatic insulin production

Question 10

The most accurate description a nurse could give a colleague about a thyroid scan is that it:

A)Assists in differentiating between primary and secondary hypothyroidism
B)Demonstrates increased uptake of radioactive iodine in areas of possible malignancy
C)Demonstrates decreased uptake of radioactive iodine in areas of possible malignancy
D)Measures the effect of TSH on thyroid function

Question 11

The nurse knows that acetonuria develops in diabetes due to:

A)Excessive oxidation of fatty acids for energy, which increases ketones in glomerular filtrate
B)Osmotic dieresis and accompanying elevation in serum glucose levels, which decreases exchange of electrolytes in renal tubules
C)Failure of sodium-hydrogen ion exchange mechanism in the renal tubules to secrete excess hydrogen ions
D)Increased volatile H+ ions and decreased nonvolatile H+ ions in the glomerular filtrate

Question 12

Matilda, 33 years old, was diagnosed with primary hypothyroidism. The doctor prescribed levothyroxine (Synthroid). Which statement should be included in the client education?

A)"You will need to take this medication until your symptoms are gone. Then your dose will be tapered off and discontinued."
B)"Symptoms such as tremors, nervousness, and insomnia may indicate that your dose is too high."
C)"You should begin to see your symptoms improve immediately after starting your medication."
D)"The reason for taking the drug is because the thyroid gland produces too much thyroxine."

Question 13

Chandler has trouble remembering to rotate his sites for insulin injections. In the past week he has self-injected into the right abdomen, left abdomen, right upper arm, left thigh, and right thigh. Into which site should he self-inject his insulin next?

A)Left ankle
B)Right abdomen
C)Left midback
D)Left upper arm

Question 14

You are a nurse who is discussing treatment involving insulin with Mrs. Christopher, who is newly diagnosed with type 1 diabetes mellitus. Mrs. Christopher asks, "Why can't I just take the pill like my friend who has diabetes?" After you give your explanation, which of the following responses by the patient would indicate that she understood your explanation?

A)"After I am on insulin for some time, then I can wean myself off insulin and take pills."
B)"With exercise twice a day and a 1,200-calorie diet, I should be able to avoid having to take insulin."
C)"Because my body does not produce insulin, I will need to take insulin by injection for the rest of my life."
D)"When my body starts to make insulin again, then I can stop the insulin injections and try pills."

Question 15

Jeckyll, a 46-year-old hotelier, has been diagnosed with type 2 diabetes and needs to begin daily medications and blood glucose monitoring. Mr. Jeckyll's response was, "This is not possible. How can I have diabetes when I'm not sick?" What is the most appropriate response by the nurse?

A)"Type 2 diabetes has a latent period when blood glucose levels are very high, but the body has not experienced enough deterioration to make you very ill."
B)"You are in denial, which is preventing you from experiencing many of the symptoms."
C)"Type 2 diabetes is often asymptomatic and the best way to understand the body's actual response to managing glucose is to monitor your blood sugar at home for a period of time."
D)"Patients with newly diagnosed diabetes are often very ill with nausea, vomiting, weight loss, and confusion, along with thirst and frequent urination. You should feel encouraged that you have few symptoms."

Question 16

Pitt is obese and unable to look directly at the bottoms of his feet to assess for skin problems related to his diabetes. What could you, as a nurse, suggest that might help Mr. Pitt complete his foot assessment?

A)Soaking the feet in water enlarges them and will make them easier to see
B)Use a mirror for better visualization
C)Foot assessment will be necessary only at his every 12-week diabetic clinic appointments
D)Wearing 100% cotton socks will eliminate any foot problems

Question 17

Situation: Jenny, 43 years old, has consulted her family physician because she has been experiencing chest pains, intolerance to heat, nervousness, dizziness, frequent headaches, and palpitations during the past three months. The doctor diagnosed her with pheochromocytoma. Jenny asked the nurse what her condition is all about. The nurse explains that:

A)It is caused by a benign tumor in the adrenal gland.
B)Her signs and symptoms are primarily caused by thyroid gland hyperactivity.
C)She has excess hormones.
D)Her adrenal gland is producing an insufficient amount of hormones.

Question 18

Situation: Jenny, 43 years old, has consulted her family physician because she has been experiencing chest pains, intolerance to heat, nervousness, dizziness, frequent headaches, and palpitations during the past three months. The doctor diagnosed her with pheochromocytoma. The most important assessment that the nurse should carry out with regards to Jenny's condition is:

A)Urine output
B)Blood pressure
C)Respiratory rate
D)Temperature

Question 19

Situation: Jenny, 43 years old, has consulted her family physician because she has been experiencing chest pains, intolerance to heat, nervousness, dizziness, frequent headaches, and palpitations during the past three months. The doctor diagnosed her with pheochromocytoma. Diagnostic tests for Jenny would reveal:

A)Elevated vanillylmandelic acid (VMA)
B)Hypoglycemia
C)Hypercalcemia
D)Deficient epinephrine levels

Question 20

A person who is diabetic is brought into the Emergency Department by a friend who found him on the floor unconscious. The first nursing action would be to:

A)Ask the friend what happened and how long the client was unconscious
B)Assess the client for signs of head trauma when he collapsed
C)Obtain a blood sugar level and start an IV infusion
D)Contact the client's immediate family to come to the hospital

Question 21

For which complication of thyroidectomy would the nurse monitor?

A)Hypercalcemia
B)Respiratory obstruction
C)Elevated serum T4
D)Paralytic ileus

Question 22

Maia Clarins, 24 years old, was diagnosed with hypopituitarism. When performing the history and physical exam, which of the following findings should the nurse anticipate?

A)Increased cardiac output
B)Truncal obesity
C)Increased blood pressure
D)Hyperactivity or increased energy levels

Question 23

Vasopressin (Pitressin) is ordered for a client with diabetes insipidus in order to do which of the following?

A)Stimulate the pancreas to secrete insulin
B)Slow the absorption of glucose in the intestine
C)Increase the reabsorption of water in the tubules
D)Increase blood pressure

Question 24

The client with Addison's disease is ordered glucocorticoid therapy. Which of the following statements indicates that the client has a correct understanding of the medication regimen?

A)"Dosage adjustments in my medication dosages may be needed."
B)"On days I feel good, I will not need to take the medication."
C)""I will adjust my dosages based on my home blood glucose test results."
D)"I am on an every-other-day dosing regimen."

Question 25

The nurse administers a dose of six units of regular insulin (Humulin R) to a patient at 8:00 AM. Knowing the action of regular insulin, when would the nurse anticipate that a hypoglycemia reaction could occur?

A)Between 8:00 AM and 10:00 AM
B)Between 10:00 AM and 12:00 PM
C)Between 2:00 PM and 10:00 PM
D)Between 10:00 PM and 8:00 AM the next day

Question 26

The nurse is working with a client who is just beginning to use a new external insulin pump. Which statement made by the client indicates a need for more teaching regarding the use of the pump?

A)"I will change my tubing and site every three days."
B)"I will use only regular insulin (buffered) in my pump."
C)"My pump delivers a continuous (basal) rate of insulin and I will use it to deliver additional (bolus) insulin with meals."
D)"When I disconnect the pump overnight, I will use the sterile cap to cover the end of the tubing."

Question 27

The client is admitted with metabolic acidosis secondary to diabetic ketoacidosis (DKA). Understanding metabolic acidosis, the nurse should choose which of the following as the priority nursing diagnosis?

A)Decreased urinary elimination related to reduced output and muscle function.
B)Decreased cardiac output related to fluid and electrolyte imbalance.
C)Ineffective breathing pattern related to hyperventilation.
D)Anxiety related to fears of long-term outcomes and discomfort.

Question 28

Keller is an elderly client with dry flaky skin and activity intolerance secondary to myxedema. She was admitted to the progressive care unit to improve her activity intolerance and gain independence in self-care. For hygiene care the nursing order is two total baths per week on Saturday and Wednesday, with partial baths on the remaining days of the week. Which of the following would be the desired outcome of this intervention?

A)Client is able to sleep through the night and stay awake most of the day.
B)Gradual increase in ambulation ability over the first month.
C)Increased energy by the end of the first week of paced rest and activity.
D)Intact elastic moist warm skin by the end of first week.

Question 29

Davidson is 8 hours post partial thyroidectomy for Grave's disease. What is the best documentation by the nurse of evaluation outcome criteria for the nursing diagnosis risk for effective airway clearance?

A)Dressing is clean dry and intact, pain minimal and controlled, alert, and oriented
B)Vital signs stable; client supports neck with hand during change of position
C)No tracheal stridor, speaks clearly, and denies numbness or tingling
D)Balanced intake and output, vital signs stable, and alert and oriented

Question 30

Marcus Pinel, 43-years-old, is brought back to the nursing unit following a thyroidectomy. Which of the following methods should the nurse use to assess for bleeding?

A)Inspect the dressing for signs of hemorrhage
B)Change the dressing applied in the operating room
C)Check the latest hemoglobin to determine if there has been a drop in value
D)Palpate the back of the neck and shoulders for evidence of bleeding

Question 31

Diaz, a 56-year-old candle maker, developed diabetic ketoacidosis (DKA) and is given intravenous normal saline infusion and regular insulin. In addition to hourly blood glucose monitoring, what assessment data are early signs of clinical improvement?

A)Respiratory rate of 12 to 15 and normal BP in the standing position
B)Temperature and pulse in normal range
C)Improved level of consciousness and decreasing urine output
D)Client eats a full meal and respiratory rate is normal

Question 32

Joshua Caine, age 48 years old, had a bilateral adrenalectomy for Cushing's syndrome. He is being sent home with a new prescription for hydrocortisone. The best statement indicating understanding of the drug and associated risk is:

A)"I am taking this drug to replace the hormones usually secreted by the adrenal medulla."
B)"I should take this pill every morning before breakfast."
C)"This pill may cause weight gain so I should exercise and eat less."
D)"I should call the doctor if I think I am starting a cold and I should not take aspirin."

Question 33

Following a hypophysectomy, the client complains of clear nasal drainage. What is the most appropriate initial action for the nurse?

A)Notify the surgeon immediately
B)Encourage the client to blow his nose to clear the sinuses
C)Check the nasal drainage for glucose
D)Place the client in Trendelenburg position

Question 34

Thomas, newly admitted to your unit this morning, presents with lipodystrophy on both upper thighs. It would be most important to assess which of the following?

A)Whether Mrs. Thomas aspirates before administering the insulin
B)Whether Mrs. Thomas administers the insulin at a 45° angle
C)Whether Mrs. Thomas cleanses the site with alcohol before each injection
D)Whether Mrs. Thomas rotates injection sites using sites other than the thighs

Question 35

Which of the following tests is used to diagnose Cushing's syndrome?

A)Fluid deprivation test
B)Glucose tolerance test
C)Low-dose dexamethasone suppression test
D)Thallium stress test

Question 36

Which of the following nursing considerations must be taken into account for a client with type 1 diabetes mellitus on the morning of surgery?

A)The client should take half of his usual daily insulin.
B)The client should receive an oral antidiabetic agent.
C)The client should receive an I.V. insulin infusion.
D)The client should take his full daily insulin dose with no dextrose infusion.

Question 37

A nurse is caring for a client with type 1 diabetes mellitus. Because the client is at risk for hypoglycemia, the nurse teaches the client which of the following?

A)Glucose tablets and subcutaneous glucagon should be made available.
B)If the client is exercising, the evening dose of NPH insulin can be discontinued.
C)Urine should be monitored for presence of acetone.
D)Assess for signs of coma and drowsiness.

Question 38

Donna has Addison's disease and is receiving fludrocortisone acetate. The nurse knows that the therapeutic effect of this is to:

A)Stimulate thyroid gland production
B)Activate parathyroid production
C)Maintain electrolyte imbalance
D)Activate the immune response

Question 39

The nurse receives notification from the laboratory that the client, who is diabetic, has an HgbA1c of 6%. The best action by the nurse would be to:

A)Counsel the client on the need for better glycemic control
B)Document the results in the client record
C)Encourage a diet with more red meat and green leafy vegetables
D)Acknowledge the client's successful glycemic control

Question 40

Which of the following chronic complications is associated with diabetes mellitus?

A)Dizziness, dyspnea on exertion, and angina
B)Retinopathy, neuropathy, and coronary artery disease
C)Leg ulcers, cerebral ischemic events, and pulmonary infarcts
D)Fatigue, nausea, vomiting, muscle weakness, and cardiac arrhythmias