VANGUARDIA’S ONLINE REVIEW | NURSING

ENDOCRINE SYSTEM DISORDERS (ANSWER KEY WITH RATIONALE)

1. A patient with type 1 diabetes has told the nurse that his most recent urine test for ketones was positive. What is
the nurses most plausible conclusion based on this assessment finding?
A. The patient should withhold his next scheduled dose of insulin.
B. The patient should promptly eat some protein and carbohydrates.
C. The patients insulin levels are inadequate.
D. The patient would benefit from a dose of metformin (Glucophage).

Ans: C
Ketones in the urine signal that there is a deficiency of insulin and that control of type 1 diabetes is deteriorating.
Withholding insulin or eating food would exacerbate the patients ketonuria. Metformin will not cause short-term
resolution of hyperglycemia.

2. A patient presents to the clinic complaining of symptoms that suggest diabetes. What criteria would support
checking blood levels for the diagnosis of diabetes?
A. Fasting plasma glucose greater than or equal to 126 mg/dL
B. Random plasma glucose greater than 150 mg/dL
C. Fasting plasma glucose greater than 116 mg/dL on 2 separate occasions
D. Random plasma glucose greater than 126 mg/dL

Ans: A
Criteria for the diagnosis of diabetes include symptoms of diabetes plus random plasma glucose greater than or
equal to 200 mg/dL, or a fasting plasma glucose greater than or equal to 126 mg/dL.

3. A nurse is providing health education to an adolescent newly diagnosed with type 1 diabetes mellitus and her
family. The nurse teaches the patient and family that which of the following nonpharmacologic measures will
decrease the bodys need for insulin?
A. Adequate sleep
B. Low stimulation
C. Exercise
D. Low-fat diet

Ans: C
Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels. Low
fat intake and low levels of stimulation do not reduce a patients need for insulin. Adequate sleep is beneficial in
reducing stress, but does not have an effect that is pronounced as that of exercise.

4. The nurses assessment of a patient with thyroidectomy suggests tetany and a review of the most recent blood
work corroborate this finding. The nurse should prepare to administer what intervention?
A. Oral calcium chloride and vitamin D
B. IV calcium gluconate
C. STAT levothyroxine
D. Administration of parathyroid hormone (PTH)

Ans: B
When hypocalcemia and tetany occur after a thyroidectomy, the immediate treatment is administration of IV calcium
gluconate. This has a much faster therapeutic effect than PO calcium or vitamin D supplements. PTH and
levothyroxine are not used to treat this complication.
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5. A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic agent
that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral
antidiabetic agent did the physician prescribe for this patient?
A. A sulfonylurea
B. A biguanide
C. A thiazolidinedione
D. An alpha glucosidase inhibitor

Ans: B
Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and therefore require a
functioning pancreas to be effective. Biguanides inhibit the production of glucose by the liver and are in used in type
2 diabetes to control blood glucose levels. Thiazolidinediones enhance insulin action at the receptor site without
increasing insulin secretion from the beta cells of the pancreas.
Alpha glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower
postprandial blood glucose level.

6. A diabetes nurse educator is teaching a group of patients with type 1 diabetes about sick day rules. What guideline
applies to periods of illness in a diabetic patient?
A) Do not eliminate insulin when nauseated and vomiting.
B) Report elevated glucose levels greater than 150 mg/dL.
C) Eat three substantial meals a day, if possible.
D) Reduce food intake and insulin doses in times of illness.

Ans: A
The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses when
nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, then
attempt to consume frequent, small portions of carbohydrates. In general, blood sugar levels will rise but should be
reported if they are greater than 300 mg/dL.

7. When assessing a client with a PTH deficiency, the nurse would expect abnormal serum levels of which
substances?
a. Sodium and chloride
b. Potassium and glucose
c. Urea and uric acid.
d. Calcium and phosphorous

Ans: D.
Decreased PTH reduces resorption of calcium from bone, reduces intestinal absorption of calcium, and reduces
reabsorption of calcium in the renal tubules. At the same time, it increases retention of phosphate in the renal
tubules. The net effect of these actions is that serum calcium is low and serum phosphate is high. Changes in serum
sodium, chloride, potassium, glucose, urea, or uric acid are not direct effects of PTH deficiency.

8. Following an addisonian crisis, a patients adrenal function has been gradually regained. The nurse should ensure
that the patient knows about the need for supplementary glucocorticoid therapy in which of the following
circumstances?
A) Episodes of high psychosocial stress
B) Periods of dehydration
C) Episodes of physical exertion
D) Administration of a vaccine

Ans: A
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During stressful procedures or significant illnesses, additional supplementary therapy with glucocorticoids is required
to prevent addisonian crisis. Physical activity, dehydration and vaccine administration would not normally be
sufficiently demanding such to require glucocorticoids.

9. When assessing a client diagnosed with Graves’ disease, which finding would the nurse consider to be a hallmark
of the disease?
a. Low specific gravity of urine
b. Heat intolerance
c. Hirsutism
d. Dulled mentation

Ans: B.
Heat intolerance with diaphoresis when environmental temperature is comfortable to others is a classic sign of
hyperthyroidism or Graves’ disease. Low specific gravity
of urine is a classic sign of DI. Hirsutism accompanies hypersecretion of glucocorticoids from the adrenal glands.
Dulled mentation is a sign of hypothyroidism.

10. A client with thyroid cancer undergoes a thyroidectomy. After surgery, the client develops peripheral numbness,
tingling, and muscle twitching. Which type of medication should the nurse be prepared to administer?
a. Thyroid supplement
b. Antispasmodic
c. Barbiturate
d. Calcium replacement

Ans: D.
The parathyroid glands can be unintentionally removed along with the thyroid gland. If this occurs, hypocalcemic
tetany is a risk, the first signs of which include numbness and tingling in the extremities and muscle twitching. The
treatment of hypocalcemic tetany is IV calcium gluconate or calcium carbonate, which should be readily available at
the bedside.

11. A patient with hypofunction of the adrenal cortex has been admitted to the medical unit. What would the nurse
most likely find when assessing this patient?
A) Increased body temperature
B) Jaundice
C) Copious urine output
D) Decreased BP

Ans: D
Decreased BP may occur with hypofunction of the adrenal cortex. Decreased function of the adrenal cortex does not
affect the patients body temperature, urine output, or skin tone.

12. Which action helps to combat the Dawn phenomenon in a client with DM?
a. Eat a snack at bedtime
b. Inject evening intermediate-acting insulin at bedtime rather than dinnertime
c. Decrease evening dose of intermediate-acting insulin
d. Increase evening dose of long-acting insulin

Ans: B.
Inject evening intermediate-acting insulin at bedtime rather than dinnertime. Eating a snack at bedtime and
decreasing the evening dose of intermediate-acting insulin combat the Somogyi effect. Increasing the evening dose
of long-acting insulin helps combat insulin waning.
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13. The nurse is assessing a patient diagnosed with Graves disease. What physical characteristics of Graves
disease would the nurse expect to find?
A) Hair loss
B) Moon face
C) Bulging eyes
D) Fatigue

Ans: C
Clinical manifestations of the endocrine disorder Graves disease include exophthalmos (bulging eyes) and fine
tremor in the hands. Graves disease is not associated with hair loss, a moon face, or fatigue.

14. The physician has ordered a fluid deprivation test for a patient suspected of having diabetes insipidus. During the
test, the nurse should prioritize what assessments?
A) Temperature and oxygen saturation
B) Heart rate and BP
C) Breath sounds and bowel sounds
D) Color, warmth, movement, and sensation of extremities

Ans: B
The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is
lost. The patients condition needs to be monitored frequently during the test, and the test is terminated if tachycardia,
excessive weight loss, or hypotension develops. Consequently, BP and heart rate monitoring are priorities over the
other listed assessments.

15. When assessing a client during an acute episode of DI, on which problem would the nurse focus?
a. Imbalanced nutrition
b. Deficient fluid volume
c. Ineffective coping
d. Risk for impaired skin integrity

Ans: B.
During an acute episode of DI between 4 and 20 l of dilute urine is voided per 24 hours. With inadequate fluid
replacement, hypotension, tachycardia, and weight loss develop and ultimately shock from fluid loss can occur. Thus,
deficient fluid volume should be the focus of assessment. Imbalanced nutrition, ineffective coping, and risk for
impaired skin integrity may be problems but they are not the priority.

16. The nurse is caring for a patient with hyperparathyroidism. What level of activity would the nurse expect to
promote?
A) Complete bed rest
B) Bed rest with bathroom privileges
C) Out of bed (OOB) to the chair twice a day
D) Ambulation and activity as tolerated

Ans: D
Mobility, with walking or use of a rocking chair for those with limited mobility, is encouraged as much as possible
because bones subjected to normal stress give up less calcium. Best rest should be discouraged because it
increases calcium excretion and the risk of renal calculi. Limiting the patient to getting out of bed only a few times a
day also increases calcium excretion and the associated risks.
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17. The nurse is caring for a patient diagnosed with hypothyroidism secondary to Hashimotos thyroiditis. When
assessing this patient, what sign or symptom would the nurse expect?
A) Fatigue
B) Bulging eyes
C) Palpitations
D) Flushed skin

Ans: A
Symptoms of hypothyroidism include extreme fatigue, hair loss, brittle nails, dry skin, voice huskiness or hoarseness,
menstrual disturbance, and numbness and tingling of the fingers. Bulging eyes, palpitations, and flushed skin would
be signs and symptoms of hyperthyroidism.

18. A patient with suspected adrenal insufficiency has been ordered an adrenocorticotropic hormone (ACTH)
stimulation test. Administration of ACTH caused a marked increase in cortisol levels. How should the nurse interpret
this finding?
A) The patients pituitary function is compromised.
B) The patients adrenal insufficiency is not treatable.
C) The patient has insufficient hypothalamic function.
D) The patient would benefit from surgery.

Ans: A
An adrenal response to the administration of a stimulating hormone suggests inadequate production of the
stimulating hormone. In this case, ACTH is produced by the pituitary and, consequently, pituitary hypofunction is
suggested. Hypothalamic function is not relevant to the physiology of this problem. Treatment exists, although
surgery is not likely indicated.

19. A patient has been admitted to the post-surgical unit following a thyroidectomy. To promote comfort and safety,
how should the nurse best position the patient?
A) Side-lying (lateral) with one pillow under the head
B) Head of the bed elevated 30 degrees and no pillows placed under the head
C) Semi-Fowlers with the head supported on two pillows
D) Supine, with a small roll supporting the neck

Ans: C
When moving and turning the patient, the nurse carefully supports the patients head and avoids tension on the
sutures. The most comfortable position is the semi-Fowlers position, with the head elevated and supported by
pillows.

20. While assisting with the surgical removal of an adrenal tumor, the OR nurse is aware that the patients vital signs
may change upon manipulation of the tumor. What vital sign changes would the nurse expect to see?
A) Hyperthermia and tachypnea
B) Hypertension and heart rate changes
C) Hypotension and hypothermia
D) Hyperthermia and bradycardia

Ans: B
Manipulation of the tumor during surgical excision may cause release of stored epinephrine and norepinephrine, with
marked increases in BP and changes in heart rate. The use of sodium nitroprusside and alpha-adrenergic blocking
agents may be required during and after surgery. While other vital sign changes may occur related to surgical
complications, the most common changes are related to hypertension and changes in the heart rate.
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21. A patient with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been
removed. The nurse caring for the patient should prioritize what question when addressing potential complications?
A) Do you feel any muscle twitches or spasms?
B) Do you feel flushed or sweaty?
C) Are you experiencing any dizziness or lightheadedness?
D) Are you having any pain that seems to be radiating from your bones?

Ans: A
As the blood calcium level falls, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle
twitching. This is characteristic of hypoparathyroidism. Flushing, diaphoresis, dizziness, and pain are atypical signs of
the resulting hypocalcemia.

22. The nurse is teaching a patient that the body needs iodine for the thyroid to function. What food would be the best
source of iodine for the body?
A) Eggs
B) Shellfish
C) Table salt
D) Red meat

Ans: C
The major use of iodine in the body is by the thyroid. Iodized table salt is the best source of iodine.

23. A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis
finding?
A) Glucose in the urine
B) Albumin in the urine
C) Highly dilute urine
D) Leukocytes in the urine

Ans: C
Patients with diabetes insipidus produce an enormous daily output of very dilute, water-like urine with a specific
gravity of 1.001 to 1.005. The urine contains no abnormal substances such as glucose or albumin. Leukocytes in the
urine are not related to the condition of diabetes insipidus, but would indicate a urinary tract infection, if present in the
urine.

24. A patient presents at the walk-in clinic complaining of diarrhea and vomiting. The patient has a documented
history of adrenal insufficiency. Considering the patients history and current symptoms, the nurse should anticipate
that the patient will be instructed to do which of the following?
A) Increase his intake of sodium until the GI symptoms improve.
B) Increase his intake of potassium until the GI symptoms improve.
C) Increase his intake of glucose until the GI symptoms improve.
D) Increase his intake of calcium until the GI symptoms improve.

Ans: A
The patient will need to supplement dietary intake with added salt during episodes of GI losses of fluid through
vomiting and diarrhea to prevent the onset of addisonian crisis. While the patient may experience the loss of other
electrolytes, the major concern is the replacement of lost sodium.
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25. Which of the following is a priority nursing diagnosis for the diabetic client who is taking insulin and has N&V from
a viral illness or influenza?
a. Imbalanced nutrition; less than body requirements
b. Impaired health maintenance related to ineffective coping skills
c. Risk for acute pain
d. Activity intolerance

Ans: A.
Imbalanced nutrition: less than body requirements.
Insulin and dietary intake must be in balance for hypoglycemia or hyperglycemia to be avoided. With decreased
intake from N&V, the need for insulin will be decreased placing the client at risk for hypoglycemia. Ineffective coping
skills and activity intolerance may be problems but are not life-threatening at the moment so are not the priority.
Acute pain is not an expected symptom.

26. A client presents in the emergency room with DKA. Which nursing diagnosis would be the priority problem?
a. Disturbed sleep pattern
b. Impaired health maintenance
c. Imbalanced nutrition; less than body requirements
d. Deficient fluid volume

Ans: D.
Deficient fluid volume occurs because insulin deficiency results in hyperglycemia as a result of the breakdown of
glycogen into glucose and accelerated gluconeogenesis.
The progressive hyperglycemia results in glycosuria, which acts as an osmotic diuretic and causes dehydration.
Initially, thirst increases fluid intake and dehydration is minimized but with progressive ketosis, N&V ensue and
dehydration becomes severe. Thus, deficient fluid volume that can lead to circulatory collapse and shock is the
priority diagnosis because it is immediately life-threatening; the other diagnoses are not.

27. When should the diabetic client who is taking insulin (Humalog) injections be advised to eat?
a. Within 20 minutes after the injection
b. 1 hour after the injection
c. At any time, because timing of meals with Humalog is unnecessary
d. 2 hours before the injection

Ans: A.
The onset of Humalog is in 10–15 minutes with a peak in 1 hour and a duration of 3 hours. It is typically taken before
meals to ensure a rapid reduction in glucose. In a few cases, it is taken after a meal as when a client with N&V waits
to make certain that the ingested food is going to stay down.

28. Which of the following is the priority for a client in addisonian crisis?
A. Controlling hypertension.
B. Preventing irreversible shock
C. Preventing infection
D. Relieving anxiety.

Ans: B.
Addison’s disease is caused by a deficiency of adrenal corticosteroids and can result in severe hypotension and
shock because of uncontrolled loss of sodium in the urine and impaired mineralocorticoid function. This results in loss
of extracellular
fluid and dangerously low blood volume. Glucocorticoids must be administered to reverse hypotension. Preventing
infection is not an appropriate goal of care in this life-threatening situation. Relieving anxiety is appropriate when the
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client’s condition is stabilized, but the calm, competent demeanor of the emergency department staff will be initially
reassuring.

29. After stabilization of Addison’s disease, the nurse teaches the client about stress management. The nurse should
instruct the client to:
A. Remove all sources of stress from daily life
B. Use relaxation techniques such as music
C. Take antianxiety drugs daily
D. Avoid discussing stressful experiences

Ans: B.
Finding alternative methods of dealing with stress, such as relaxation techniques, is a cornerstone of stress
management. Removing all sources of stress from one’s life is not possible. Antianxiety drugs are prescribed for
temporary management
during periods of major stress, and they are not an intervention in stress management classes. Avoiding discussion
of stressful situations will not necessarily reduce stress.

30. The nurse should assess a client with Addison’s disease for which of the following?
A. Weight gain
B. Hunger
C. Lethargy
D. Muscle spasms

Ans: C.
Although many of the disease signs and symptoms are vague and nonspecific, most clients experience lethargy and
depression as early symptoms. Other early signs and symptoms include mood changes, emotional lability, irritability,
weight loss, muscle weakness, fatigue, nausea, and vomiting. Most clients experience a loss of appetite. Muscles
become weak, not spastic, because of adrenocortical insufficiency.

31. Which of the following would be an expected finding in a client with adrenal crisis (addisonian crisis)?
A. Fluid retention
B. Pain
C. Peripheral edema
D. Hunger

Ans: B.
Adrenal hormone deficiency can cause profound physiologic changes. The client may experience severe pain
(headache, abdominal pain, back pain, or pain in the extremities). Inhibited gluconeogenesis commonly produces
hypoglycemia, and impaired sodium retention causes decreased, not increased, fl uid volume. Edema would not be
expected. Gastrointestinal disturbances, including nausea and vomiting, are expected findings in Addison’s disease,
not hunger.

32. Which of the following is the best indicator for determining whether a client with Addison’s disease is receiving the
correct amount of glucocorticoid replacement?
A. Skin turgor
B. Temperature
C. Thirst
D. Daily weight

Ans: D.
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Measuring daily weight is a reliable, objective way to monitor fluid balance. Rapid variations in weight reflect changes
in fluid volume, which suggests insufficient control of the disease and the need for more glucocorticoids in the client
with Addison’s disease. Nurses should instruct clients taking oral steroids to weigh themselves daily and to report any
unusual weight loss or gain. Skin turgor testing does supply information about fluid status, but daily weight monitoring
is more reliable. Temperature is not a direct measurement of fluid balance. Thirst is a nonspecific and very late sign
of weight loss.

33. A medical nurse is aware of the need to screen specific patients for their risk of hyperglycemic hyperosmolar
syndrome (HHS). In what patient population does hyperosmolar nonketotic syndrome most often occur?
A) Patients who are obese and who have no known history of diabetes
B) Patients with type 1 diabetes and poor dietary control
C) Adolescents with type 2 diabetes and sporadic use of antihyperglycemics
D) Middle-aged or older people with either type 2 diabetes or no known history of diabetes

Ans: D
HHS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have
type 2 diabetes.

34. A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the following
actions has the greatest potential to reduce an individuals risk for developing diabetes?
A) Have blood glucose levels checked annually.
B) Stop using tobacco in any form.
C) Undergo eye examinations regularly.
D) Lose weight, if obese.

Ans: D
Obesity is a major modifiable risk factor for diabetes. Smoking is not a direct risk factor for the disease. Eye
examinations are necessary for persons who have been diagnosed with diabetes, but they do not screen for the
disease or prevent it. Similarly, blood glucose checks do not prevent the diabetes.

35. The nurse is planning the care of a patient with hyperthyroidism. What should the nurse specify in the patients
meal plan?
A) A clear liquid diet, high in nutrients
B) Small, frequent meals, high in protein and calories
C) Three large, bland meals a day
D) A diet high in fiber and plant-sourced fat

Ans: B
A patient with hyperthyroidism has an increased appetite. The patient should be counseled to consume several
small, well-balanced meals. High-calorie, high-protein foods are encouraged. A clear liquid diet would not satisfy the
patients caloric or hunger needs. A diet rich in fiber and fat should be avoided because these foods may lead to GI
upset or increase peristalsis.

36. A patient with a recent diagnosis of hypothyroidism is being treated for an unrelated injury. When administering
medications to the patient, the nurse should know that the patients diminished thyroid function may have what effect?
A) Anaphylaxis
B) Nausea and vomiting
C) Increased risk of drug interactions
D) Prolonged duration of effect
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Ans: D
In all patients with hypothyroidism, the effects of analgesic agents, sedatives, and anesthetic agents are
prolonged. There is no direct increase in the risk of anaphylaxis, nausea, or drug interactions, although
these may potentially result from the prolonged half-life of drugs.

37. A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse is
explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe?
A) The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase.
B) Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough
insulin to control it.
C) The amount of glucose that your body makes overwhelms your pancreas and decreases your production of
insulin.
D) Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because
insulin normally breaks it down.

Ans: D
Type 1 diabetes is characterized by the destruction of pancreatic beta cells, resulting in decreased insulin production,
unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose derived from food cannot be
stored in the liver and remains circulating in the blood, which leads to postprandial hyperglycemia. Type 2 diabetes
involves insulin resistance and impaired insulin secretion. The body does not make glucose.

38. A nurse is caring for a patient newly diagnosed with type 1 diabetes. The nurse is educating the patient about
self-administration of insulin in the home setting. The nurse should teach the patient to do which of the following?
A) Avoid using the same injection site more than once in 2 to 3 weeks.
B) Avoid mixing more than one type of insulin in a syringe.
C) Cleanse the injection site thoroughly with alcohol prior to injecting.
D) Inject at a 45 angle.

Ans: A
To prevent lipodystrophy, the patient should try not to use the same site more than once in 2 to 3 weeks. Mixing
different types of insulin in a syringe is acceptable, within specific guidelines, and the needle is usually inserted at a
90 angle. Cleansing the injection site with alcohol is optional.

39. An occupational health nurse is screening a group of workers for diabetes. What statement should the nurse
interpret as suggestive of diabetes?
A) I’ve always been a fan of sweet foods, but lately I’m turned off by them.
B) Lately, I drink and drink and can’t seem to quench my thirst.
C) No matter how much sleep I get, it seems to take me hours to wake up.
D) When I went to the washroom the last few days, my urine smelled odd.

Ans: B
Classic clinical manifestations of diabetes include the three Ps: polyuria, polydipsia, and polyphagia. Lack of interest
in sweet foods, fatigue, and foul-smelling urine are not suggestive of diabetes.

40. An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The patient
is found to have a blood glucose level of 623 mg/dL. The patients daughter reports that the patient recently had a
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gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar
syndrome (HHS) is made. What nursing action would be a priority?
A) Administration of antihypertensive medications
B) Administering sodium bicarbonate intravenously
C) Reversing acidosis by administering insulin
D) Fluid and electrolyte replacement

Ans: D
The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, and insulin
administration. Antihypertensive medications are not indicated, as hypotension generally accompanies HHS due to
dehydration. Sodium bicarbonate is not administered to patients with HHS, as their plasma bicarbonate level is
usually normal. Insulin administration plays a less important role in the treatment of HHS because it is not needed for
reversal of acidosis, as in diabetic ketoacidosis (DKA).

41. A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that
sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be
an early indication of parathyroid gland injury or removal?
A) Hyponatremia
B) Hypophosphatemia
C) Hypocalcemia
D) Hypokalemia

Ans: C
Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline
of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms
of the hands and feet and muscle twitching. This group of symptoms is known as tetany and must be reported to the
physician immediately, because laryngospasm may occur
and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not expected responses to
parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may lead to
hyperphosphatemia.

42. A patient with type 2 diabetes has been managing his blood glucose levels using diet and metformin
(Glucophage). Following an ordered increase in the patients daily dose of metformin, the nurse should prioritize
which of the following assessments?
A) Monitoring the patients neutrophil levels
B) Assessing the patient for signs of impaired liver function
C) Monitoring the patients level of consciousness and behavior
D) Reviewing the patients creatinine and BUN levels

Ans: D
Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the patients renal function.
This drug does not typically affect patients neutrophils, liver function, or cognition.

43. A 30 year-old female patient has been diagnosed with Cushing syndrome. What psychosocial nursing diagnosis
should the nurse most likely prioritize when planning the patients care?
A) Decisional conflict related to treatment options
B) Spiritual distress related to changes in cognitive function
C) Disturbed body image related to changes in physical appearance
D) Powerlessness related to disease progression
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Ans: C
Cushing syndrome causes characteristic physical changes that are likely to result in disturbed body
image. Decisional conflict and powerless may exist, but disturbed body image is more likely to be
present. Cognitive changes take place in patients with Cushing syndrome, but these may or may not
cause spiritual distress.

44. A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for
on the critical care unit. The priority nursing diagnosis for a patient with this condition is what?
A) Risk for peripheral neurovascular dysfunction
B) Excess fluid volume
C) Hypothermia
D) Ineffective airway clearance

Ans: B
The priority nursing diagnosis for a patient with SIADH is excess fluid volume, as the patient retains fluids and
develops a sodium deficiency. Restricting fluid intake is a typical intervention for managing this syndrome.
Temperature imbalances are not associated with SIADH. The patient is not at risk for neurovascular dysfunction or a
compromised airway.

45. Appropriate nursing diagnoses for a client with hypothyroidism would include which of the following?
A. Risk for injury (corneal abrasion) related to incomplete closure of the eyelid.
B. Imbalanced nutrition: Less than body requirements related to hypermetabolism.
C. Deficient fluid volume related to diarrhea.
D. Activity intolerance related to fatigue associated with the disorder.

Ans: D.
A major problem for the person with hypothyroidism is fatigue. Other signs and symptoms include lethargy,
personality changes, generalized edema, impaired memory, slowed speech, cold intolerance, dry skin, muscle
weakness, constipation,
weight gain, and hair loss. Incomplete closure of the eyelids, hypermetabolism, and diarrhea are associated with
hyperthyroidism.

46. A 57-year-old with diabetes insipidus is hospitalized for care. Which fi nding should the nurse report to the
physician?
A. Urine output of 350 mL in 8 hours.
B. Urine specific gravity of 1.001
C. Potassium of 4.0 mEq.
D. Weight gain.

Ans: B.
Diabetes insipidus is caused by a deficiency of antidiuretic hormone, which results in
excretion of a large volume of dilute urine. Therefore, a urine specific gravity of less than 1.005 should be reported.
Urine output should be 30 to 50 mL/hour; thus, 350 mL is a normal urinary output over 8 hours. The potassium level
is normal. Weight loss, not weight gain, should be monitored as a sign of dehydration.

47. Which of the following conditions is the most significant risk factor for the development of type 2 diabetes
mellitus?
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A. Cigarette smoking.
B. High-cholesterol diet.
C. Obesity.
D. Hypertension.

Ans : C.
The most important factor predisposing to the development of type 2 diabetes mellitus is obesity. Insulin resistance
increases with obesity. Cigarette smoking is not a predisposing factor, but it is a risk factor that increases
complications of diabetes mellitus. A high-cholesterol diet does not necessarily predispose to diabetes mellitus, but it
may contribute to obesity and hyperlipidemia. Hypertension is not a predisposing factor, but it is a risk factor for
developing complications of diabetes mellitus.

48. Cushing’s disease is manifested by the excessive secretion of corticosteroids. The hormones involved are:
A. Glucocorticoids and aldosterone.
B. Adrenocorticotropic hormone (ACTH).
C. Glucocorticoids, aldosterone, and androgens.
D. Catecholamines.

Ans: C.
Excessive levels of glucocorticoids, aldosterone, and androgens secreted from the adrenal cortex result in the
constellation of symptoms known as Cushing’s disease. Cushing’s disease can be caused by a tumor,
overstimulation from the pituitary, or the
use of prescription steroid drugs. Androgens are also secreted in excess. ACTH is only one hormone that is
abnormal in Cushing’s disease. Excessive secretion of catecholamines accompanies pheochromocytoma, a disease
of the adrenal medulla.

49. In the early postoperative period after a bilateral adrenalectomy, the client has an increased temperature. The
nurse should assess the client further for signs of:
A. Dehydration.
B. Poor lung expansion.
C. Wound infection.
D. Urinary tract infection.

Ans: B.
Poor lung expansion from bed rest, pain, and retained anesthesia is a common cause of slight postoperative
temperature elevation. Nursing care includes turning the client and having the client cough and deep-breathe every 1
to 2 hours, or more
frequently as ordered. The client will have postoperative I.V. fluid replacement ordered to prevent dehydration.
Wound infections typically appear 4 to 7 days after surgery. Urinary tract infections would not be typical with this
surgery.

50. Because of steroid excess after a bilateral adrenalectomy, the nurse should assess the client for:
A. Postoperative confusion.
B. Delayed wound healing.
C. Emboli.
D. Malnutrition
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Ans: B.
Persistent cortisol excess undermines the collagen matrix of the skin, impairing wound
healing. It also carries an increased risk of infection and of bleeding. The wound should be observed and
documentation performed regarding the status of healing. Confusion and emboli are not expected complications after
adrenalectomy. Malnutrition also is not an expected complication after adrenalectomy.
Nutritional status should be regained postoperatively.

51. When teaching a diabetic client, which symptom should the nurse identify as most commonly indicative of
hypoglycemia?
a. Nervousness
b. Anorexia
c. Kussmaul’s respirations
d. Bradycardia

Ans: A.
Nervousness along with shakiness, weakness, trembling, pallor, diaphoresis, tachycardia, irritability, and palpitations
are all adrenergic symptoms associated with hypoglycemia. Headache, mental confusion, circumoral paresthesia,
fatigue double vision, incoherent speech, seizures, and coma are neuroglycopenic symptoms. Kussmaul’s
respirations are a symptom of hyperglycemia.

52. Which of the following patients with type 1 diabetes is most likely to experience adequate glucose control?
A) A patient who skips breakfast when his glucose reading is greater than 220 mg/dL
B) A patient who never deviates from her prescribed dose of insulin
C) A patient who adheres closely to a meal plan and meal schedule
D) A patient who eliminates carbohydrates from his daily intake

Ans: C
The therapeutic goal for diabetes management is to achieve normal blood glucose levels without hypoglycemia.
Therefore, diabetes management involves constant assessment and modification of the treatment plan by health
professionals and daily adjustments in therapy (possibly including insulin) by patients. For patients who require
insulin to help control blood glucose levels, maintaining consistency in the amount of calories and carbohydrates
ingested at meals is essential. In addition, consistency in the
approximate time intervals between meals, and the snacks, help maintain overall glucose control. Skipping meals is
never advisable for person with type 1 diabetes.

53. A patient is prescribed corticosteroid therapy. What would be priority information for the nurse to give the patient
who is prescribed long-term corticosteroid therapy?
A) The patients diet should be low protein with ample fat.
B) The patient may experience short-term changes in cognition.
C) The patient is at an increased risk for developing infection.
D) The patient is at a decreased risk for development of thrombophlebitis and thromboembolism.

Ans: C
The patient is at increased risk of infection and masking of signs of infection. The cardiovascular effects of
corticosteroid therapy may result in development of thrombophlebitis or thromboembolism. Diet should be high in
protein with limited fat. Changes in appearance usually disappear when therapy is no longer necessary. Cognitive
changes are not common adverse effects.
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54. A nurse works in a walk-in clinic. The nurse recognizes that certain patients are at higher risk for different
disorders than other patients. What patient is at a greater risk for the development of hypothyroidism?
A) A 75-year-old female patient with osteoporosis
B) A 50-year-old male patient who is obese
C) A 45-year-old female patient who used oral contraceptives
D) A 25-year-old male patient who uses recreational drugs

Ans: A
Even though osteoporosis is not a risk factor for hypothyroidism, the condition occurs most frequently in older
women.

55. You are developing a care plan for a patient with Cushing syndrome. What nursing diagnosis would have the
highest priority in this care plan?
A) Risk for injury related to weakness
B) Ineffective breathing pattern related to muscle weakness
C) Risk for loneliness related to disturbed body image
D) Autonomic dysreflexia related to neurologic changes

Ans: A
The nursing priority is to decrease the risk of injury by establishing a protective environment. The patient who is weak
may require assistance from the nurse in ambulating to prevent falls or bumping corners or furniture. The patients
breathing will not be affected and autonomic dysreflexia is not a plausible risk. Loneliness may or may not be an
issue for the patient, but safety is a priority.

56. A patient with a longstanding diagnosis of type 1 diabetes has a history of poor glycemic control. The nurse
recognizes the need to assess the patient for signs and symptoms of peripheral neuropathy. Peripheral neuropathy
constitutes a risk for what nursing diagnosis?
A) Infection
B) Acute pain
C) Acute confusion
D) Impaired urinary elimination

Ans: A
Decreased sensations of pain and temperature place patients with neuropathy at increased risk for injury and
undetected foot infections. The neurologic changes associated with peripheral neuropathy do not normally result in
pain, confusion, or impairments in urinary function.

57. A patient has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent
adrenal insufficiency, the nurse should ensure that the patient knows to do which of the following?
A) Take the drug concurrent with levothyroxine (Synthroid).
B) Take each dose of prednisone with a dose of calcium chloride.
C) Gradually replace the prednisone with an OTC alternative.
D) Slowly taper down the dose of prednisone, as ordered.

Ans: D
Corticosteroid dosages are reduced gradually (tapered) to allow normal adrenal function to return and to prevent
steroid-induced adrenal insufficiency. There are no OTC substitutes for prednisone and neither calcium chloride nor
levothyroxine addresses the risk of adrenal insufficiency
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58. The nurse is providing care for an older adult patient whose current medication regimen includes levothyroxine
(Synthroid). As a result, the nurse should be aware of the heightened risk of adverse effects when administering an
IV dose of what medication?
A) A fluoroquinalone antibiotic
B) A loop diuretic
C) A proton pump inhibitor (PPI)
D) A benzodiazepine

Ans: D
Oral thyroid hormones interact with many other medications. Even in small IV doses, hypnotic and sedative agents
may induce profound somnolence, lasting far longer than anticipated and leading to narcosis (stupor like condition).
Furthermore, they are likely to cause respiratory depression, which can easily be fatal because of decreased
respiratory reserve and alveolar hypoventilation. Antibiotics, PPIs and diuretics do not cause the same risk.

59. A patient with Cushing syndrome as a result of a pituitary tumor has been admitted for a transsphenoidal
hypophysectomy. What would be most important for the nurse to monitor before, during, and after surgery?
A) Blood glucose
B) Assessment of urine for blood
C) Weight
D) Oral temperature

Ans: A
Before, during, and after this surgery, blood glucose monitoring and assessment of stools for blood are carried out.
The patients blood sugar is more likely to be volatile than body weight or temperature. Hematuria is not a common
complication.

60. A patient who has been taking corticosteroids for several months has been experiencing muscle wasting. The
patient has asked the nurse for suggestions to address this adverse effect. What should the nurse recommend?
A) Activity limitation to conserve energy
B) Consumption of a high-protein diet
C) Use of OTC vitamin D and calcium supplements
D) Passive range-of-motion exercises

Ans: B
Muscle wasting can be partly addressed through increased protein intake. Passive ROM exercises maintain
flexibility, but do not build muscle mass. Vitamin D and calcium supplements do not decrease muscle wasting.
Activity limitation would exacerbate the problem.