Endocrine Questions

1. Endocrine Questions Practice Questions Ana Corona, MSN, FNP-C Nursing Instructor July 2007

2. Question 1 The nurse is caring for a client following removal of the thyroid. Immediately post-op, the nurse should: • Maintain the client in a semi-Fowler's position with the head and neck supported by pillows • Encourage the client to turn her head side to side, to promote drainage of oral secretions • Maintain the client in a supine position with sandbags placed on either side of the head and neck • Encourage the client to cough and breathe deeply every 2 hours, with the neck in a flexed position

3. 1 • Answer A is correct. Following a thyroidectomy, the client should be placed in semi-Fowler’s position to decrease swelling that would place pressure on the airway. Answers B, C, and D are incorrect because they would increase the chances of post-operative complications that include bleeding, swelling, and airway obstruction.

4. Question 2 • A client with hypothyroidism frequently complains of feeling cold. The nurse should tell the client that she will be more comfortable if she: • Uses an electric blanket at night • Dresses in extra layers of clothing • Applies a heating pad to her feet • Takes a hot bath morning and evening

5. 2 • Answer B is correct. Dressing in layers and using extra covering will help decrease the feeling of being cold that is experienced by the client with hypothyroidism. Decreased sensation and decreased alertness are common in the client with hypothyroidism; therefore, the use of electric blankets and heating pads can result in burns, making answers A and C incorrect. Answer D is incorrect because the client with hypothyroidism has dry skin, and a hot bath morning and evening would make her condition worse.

6. Question 3 • A client is admitted with acute adrenal crisis. During the intake assessment, the nurse can expect to find that the client has: • Low blood pressure • Slow, regular pulse • Warm, flushed skin • Increased urination

7. 3 • Answer A is correct. The client with acute adrenal crisis has symptoms of hypovolemia and shock; therefore, the blood pressure would be low. Answer B is incorrect because the pulse would be rapid and irregular. Answer C is incorrect because the skin would be cool and pale. Answer D is incorrect because the urinary output would be decreased.

8. Question 4 • A client is admitted with a diagnosis of hypothyroidism. An initial assessment of the client would reveal: • Slow pulse rate, weight loss, diarrhea, and cardiac failure • Weight gain, lethargy, slowed speech, and decreased respiratory rate • Rapid pulse, constipation, and bulging eyes • Decreased body temperature, weight loss, and increased respirations

9. 4 • Answer B is correct. Symptoms of hypothyroidism include weight gain, lethargy, slow speech, and decreased respirations. Answers A and D do not describe symptoms associated with myxedema; therefore, they are incorrect. Answer C describes symptoms associated with Graves’s disease; therefore, it is incorrect.

10. Question 5 • A client with hyperthyroidism is taking lithium carbonate to inhibit thyroid hormone release. Which complaint by the client should alert the nurse to a problem with the client's medication? • The client complains of blurred vision. • The client complains of increased thirst and increased urination. • The client complains of increased weight gain over the past year. • The client complains of ringing in the ears.

11. 5 • Answer B is correct. Increased thirst and increased urination are signs of lithium toxicity. Answers B and D do not relate to the medication; therefore, they are incorrect. Answer C is an expected side effect of the medication; therefore, it is incorrect.

12. Question 6 • The nurse is caring for a client with acromegaly. Following a transphenoidal hypophysectomy, the nurse should: • Monitor the client's blood sugar • Suction the mouth and pharynx every hour • Place the client in low Trendelenburg position • Encourage the client to cough

13. 6 • Answer A is correct. Growth hormone levels generally fall rapidly after a hypophysectomy, allowing insulin levels to rise. The result is hypoglycemia. Answer B is incorrect because it traumatizes the oral mucosa. Answer C is incorrect because the client’s head should be elevated to reduce pressure on the operative site. Answer D is incorrect because it increases pressure on the operative site that can lead to a leak of cerebral spinal fluid.

14. Question 7 • A client newly diagnosed with diabetes is started on Precose (acarbose). The nurse should tell the client that the medication should be taken: • 1 hour before meals • 30 minutes after meals • With the first bite of a meal • Daily at bedtime

15. 7 • Answer C is correct. Precose (acarbose) is to be taken with the first bite of a meal. Answers A, B, and D are incorrect because they specify the wrong schedule for medication administration.

16. Question 8 • The glycosylated hemoglobin (hemoglobin A1C) of a 40-year-old client with diabetes mellitus is 5. The nurse understands that: • The client can have a higher-calorie diet. • The client has good control of her diabetes. • The client requires adjustment in her insulin dose. • The client has poor control of her diabetes.

17. 8 • Answer B is correct. The client’s diabetes is well under control. Answer A is incorrect because it will lead to elevated glycosylated hemoglobin. Answer C is incorrect because the diet and insulin dose are appropriate for the client. Answer D is incorrect because the desired range for glycosylated hemoglobin in the adult client is <6.

18. Question 9 • The physician has discussed the need for medication with the parents of an infant with congenital hypothyroidism. The nurse can reinforce the physician's teaching by telling the parents that: • The medication will be needed only during times of rapid growth. • The medication will be needed throughout the child's lifetime. • The medication schedule can be arranged to allow for drug holidays. • The medication is given one time daily every other day.

19. 9 • Answer B is correct. The medication will be needed throughout the child’s lifetime. Answers A, C, and D contain inaccurate statements; therefore, they are incorrect.

20. Question 10 • A client with diabetes mellitus has a prescription for Glucotrol XL (glipizide). The client should be instructed to take the medication: • At bedtime • With breakfast • Before lunch • After dinner

21. 10 • Answer B is correct. Glucotrol XL is given once a day with breakfast. Answer A is incorrect because the client would develop hypoglycemia while sleeping. Answers C and D are incorrect because the client would develop hypoglycemia later in the day or evening.

22. Question 11 • A client with Type II diabetes has an order for regular insulin (Novolog) 10 units SC each morning. The client's breakfast should be served within: • 15 minutes • 20 minutes • 30 minutes • 45 minutes

23. 11 • Answer A is correct. • Novalog insulin onsets very quickly, so food should be available within 10–15 minutes of taking the insulin.

24. Question 12 What is another name for primal adrenal insufficiency? • Addison’s disease • hypoglycemia • Parkinson’s disease • leukemia

25. 12 • Answer A is correct. Addison’s disease is also known as primal adrenal insufficiency

26. Question 13 Margaret O'Hara, a 30-year-old known diabetic, is brought to the emergency department by ambulance. The paramedic team reports symptoms of apparent hyperglycemia. Stat blood glucose is 640. The nurse is aware that excess serum glucose acts to draw fluids osmotically with resultant polyuria. In addition to increased urinary output, the nurse should expect to observe which of the following sets of symptoms in Margaret? • A. Polydipsia, diaphoresis, bradycardia • B. Thirst, dry mucous membranes, hot dry skin • C. Hypotension, bounding pulse, headache • D. Nervousness, rapid respirations, diarrhea

27. 13 • Answer B is correct because these are all symptoms associated with the dehydration that occurs in hyperglycemia. Although polydypsia is expected (response A), diaphoresis does not occur in the body's effort to compensate by holding back fluid. The patient would experience tachycardia as a cardiac compensatory mechanism, causing a rapid, thready pulse. Headache and nervousness (responses C and D) are symptoms associated with hypoglycemia.

28. Question 14 Loberta Jackson, a 21-year-old college student, is admitted to a medical unit with diagnosis of uncontrolled diabetes, acute hypoglycemic reaction. Loberta explains to the admitting nurse that she had been feeling "sick to my stomach, like I was coming down with the flu" for the past 48 hours. She has continued to take her usual daily dosage of insulin. Noting that Loberta has been admitted with a blood-glucose value of 46, which of the following assessment questions would provide the most valuable information about Loberta's status? A.. "Have you been under a great deal of stress lately, Loberta?" B.  "Were you having difficulty sleeping after this illness started?" C.  "Have you eaten anything in the past 48 hours?" D.  "Did you take any medications for this illness other than your insulin?"

29. 14 • Answer Cis correct because it is highly probable that Loberta, feeling "sick to her stomach," has not taken in adequate foods and fluids, and coupled with taking her usual dosage of daily insulin, has brought about an acute hypoglycemic reaction. (Higher than normal circulating levels of insulin with insufficient food intake of essential nutrients will result in acute decreased blood-glucose levels). Response A, focusing on increased stress, would more than likely stimulate a hyperglycemic reaction, since stress causes elevations of blood glucose. Response D, focusing on other medications the patient has taken, would probably not trigger a hypoglycemic reaction. Response B is unrelated to her present status.

30. Question 15 • 23) A 7-year-old girl with insulin-dependent diabetes (IDDM) has been home sick for several days and is brought to the emergency department by her parents. A diagnosis of ketoacidosis is made. The nurse would expect to see which of the following lab results for this client? • Serum glucose 140 mg/dL • Serum creatine 5.2 mg/dL • Blood pH 7.28 • Hematocrit 38%

31. 15 • Answer B is correct. Explanation of Answer: normal Blood pH is 7.35–7.45. A level of 7.28 indicates acidosis.

32. Question 16 • 37) The nurse cares for a patient who has syndromes of inappropriate antidiuretic hormone (SIADH). Which of the following assessments would the nurse find consistent with this diagnosis? • Urinary output of 2,500 cc/24 hours, sodium 122 mEq/L. • Urinary output of 800 cc/24 hours, sodium 156 mEq/L. • Urinary output of 2,700 cc/24 hours, sodium 164 mEq/L. • Urinary output of 500 cc/24 hours, sodium 118 mEq/L.

33. 16 • Answer D is correct. Explanation of Answer: The patient would experience decreased urine output, decreased serum sodium, and hyponatremia with normal or increased plasma volume

34. Question 17 The nurse explains to a client who has just received the diagnosis of Noninsulin-Dependent Diabetes Mellitus (NIDDM) that sulfonylureas, one group of oral hypoglycemic agents, act by: a. Stimulating the pancreas to produce or release insulin b. Making the insulin that is produced more available for use c. Lowering the blood sugar by facilitating the uptake and utilization of glucose d. Altering both fat and protein metabolism

35. 17 • Answer A is correct. Rationale: Sulfonylurea drugs, Orinase for example, lowers the blood sugar by stimulating the beta cells of the pancreas to synthesize and release insulin.

36. Question 18 A nursing assessment for initial signs of Hypoglycemia will include: • Pallor, blurred vision, weakness, behavioral changes • Frequent urination, flushed face, pleural friction rub • Abdominal pain, diminished deep tendon reflexes, double vision • Weakness, lassitude, irregular pulse, dilated pupils

37. 18 • Answer A is correct: Rationale: Weakness, fainting, blurred vision, pallor and perspiration are all common symptoms when there is too much insulin or too little food – hypoglycemia. The signs and symptoms in answers (b) and (c) are indicative of hyperglycemia.

38. Question 19 • Insulin inhibits the release of _______. • Glucagon • ADH • Beta cells • Somatostatin

39. 19 • A. Glucagon

40. Question 20 • Which of the following is caused by insulin release? • Increased breakdown of fats • Increase breakdown of proteins • Decreased blood sugar • Causes glucose to be phosphorylated in kidney

41. 20 • C. Decreased blood sugar.

42. Question 21 • Glucagon causes increased blood sugar and causes slow breakdown of glycogen in the liver. • TRUE • FALSE

43. 21 • B. FALSE

44. Question 22 • As blood glucose decreases glucagon is inhibited. • TRUE • FALSE

45. 22 • B. FALSE

46. Question 23 • Glucagon increases blood levels of glucose by causing liver to breakdown glycogen. • TRUE • FALSE

47. 23 • A. TRUE

48. Question 24 • Which of the following is not true about Type I DM? • May be linked to autoimmunity • Onset usually prior to age 20 • Beta islet cells destroyed • Does not require insulin injections

49. 24 • D. Does not require insulin injections.

50. Question 25 • Which of the following is not true about Type II DM? • Considered adult onset diabetes • Cause unknown may be due to genetics • Require insulin 80% of cases • May take a drug that sensitize cells or increase insulin release