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

Accepted Answer

Decreased appetite, weight gain, and constipation are indications that the client is having Hashimoto's disease, which is the most common cause of hypothyroidism. Other signs and symptoms to watch for are lethargy, brittle nails, coarse hair, muscle cramps, weakness, and apnea. Choice A includes signs of hyperthyroidism. Symptoms presented in Choice B are characteristic of uncontrolled diabetes mellitus. Symptoms presented in Choice D are characteristic of hypercortisolism.

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

Accepted Answer

The nurse should monitor the client for hypocalcemia. Symptoms like numbness or tingling of toes, extremities, and lips; muscle twitches; Chvostek's; and Trousseau signs are all indicative of tetany, which develops after the thyroid gland is surgically removed.

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

Accepted Answer

Using the side of a fingertip as the puncture site confirms that the client understands the health teaching on blood glucose monitoring using a glucometer. The sides of the fingertips have fewer nerve endings than do the balls of the finger, so less discomfort will result from selecting the sides as puncture sites. Both hands, including the thumbs, can be used as puncture sites.

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."

Accepted Answer

"I may feel flushed cheeks, will have acetone breath, and increased thirst" is the statement that shows that the client understands the manifestations of a hyperglycemic reaction. All the other choices have one wrong answer or symptom: (A) hunger, not decreased appetite; (C) pain in abdomen, not diarrhea; (D) breath odor of acetone, not normal. Answers such as this are tricky, because you have to pick out the wrong answers from among several right answers.

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

Accepted Answer

Penelope, 42 years old, with a random plasma glucose above 200 mg/dL and symptoms of diabetes, meets the criteria for a diagnosis of diabetes. Other criteria for the diagnosis of diabetes are a fasting plasma glucose of 126 mg/dL or above on two occasions or a plasma glucose value equal to or above 200mg/dL in the 2-hour sample on a glucose tolerance test. A random plasma glucose of 140mg/dL or less is normoglycemic. A fasting plasma glucose of 110mg/dL to 125 mg/dL is considered impaired fasting plasma glucose (IPFG) and represents an increased risk for diabetes and a need for lifestyle changes to prevent the onset of diabetes.

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

Accepted Answer

Posterior neck fat pad and thin extremities are also noted in a client with Cushing's syndrome. "Buffalo hump" is the accumulation of fat pads over the upper back and neck. Fat may also accumulate on the face, which suggests a "swollen" and rounded face. There is truncal obesity, but the extremities are thin.

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

Accepted Answer

Check the urine specific gravity and report any abnormality, as well as the urine output. Since the urine output of the client is excessive (i.e., 350cc/hr or more), this marks a classic sign of Diabetes insipidus (DI). Diabetes insipidus can develop with head injury, tumors, and other conditions that cause increased intracranial pressure. The specific gravity provides valuable information about renal function and response to antidiuretic hormone (ADH).

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."

Accepted Answer

The candy bar and ice cream may have too much glucose and fat, potentially leading to hyperglycemia. In addition, the fat may delay glucose absorption. Immediate absorption of glucose is needed in hypoglycemia.

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

Accepted Answer

Obesity causes a reduce insulin binding at receptor sites and this leads to pancreatic hypersecretion of insulin and eventual pancreatic cell exhaustion.

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

Accepted Answer

A thyroid scan utilizes the uptake of radioactive iodine by the thyroid gland to determine the size, shape, and function of the gland. Also identified are areas of increased uptake (hot areas), indicating increased metabolic function, as in hyperthyroidism, not malignancy (choice B) and areas of decreased or no uptake (cold areas), which are associated with malignancy. Choices A and D both describe the TSH stimulation test.

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

Accepted Answer

When excessive quantities of fatty acids are oxidized, blood buffer systems may become exhausted. Ketoacidosis develops and acetone bodies are excreted in the urine. In an emergency room situation, diabetic acidosis can be recognized not only by increased rate and depth of respirations (Kussmaul's respirations) but also by the odor of acetone on the breath. Neither osmotic diuresis (Choice B) nor failure in the sodium-hydrogen ion exchange (Choice C) causes acetonuria. In the latter case, failure to excrete excess hydrogen ions would decrease urinary acids. Volatile hydrogen ions (CO₂) are excreted by the lungs; a decrease in nonvolatile hydrogen ions in the glomerular filtrate (Choice D) would move the pH of the urine toward the alkaline side.

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."

Accepted Answer

Levothyroxine is a synthetic preparation of the thyroid hormone thyroxine (T4). Tremors, nervousness, and insomnia may indicate an overdose of the medication. The client should be instructed to contact the prescriber if she experiences these symptoms.

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

Accepted Answer

He is due for an injection in the left upper arm owing to the site rotation.

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."

Accepted Answer

"Because my body does not produce insulin, I will need to take insulin by injection for the rest of my life." In diabetes, the beta cells do not produce insulin, so the patient needs lifelong insulin therapy.

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."

Accepted Answer

"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." Type 2 diabetes results in hyperglycemia from a combination of insulin resistance and impaired insulin secretion by pancreatic beta cells. Type 2 diabetes has a slower onset than type 1 diabetes and is often asymptomatic owing to the gradual increase in blood sugar levels. This problem is often detected during routine medical visits. Because type 2 diabetes can result from insulin resistance as well as impaired insulin secretion, one of the best ways to manage glucose is to monitor blood sugar at home via the use of glucometer.

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

Accepted Answer

Using a mirror can help a person look at the underside, as well as sides, of his feet.

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.

Accepted Answer

Pheochromocytoma is an endocrine disorder, affecting mostly females between 40 to 50 years old, caused by a benign adrenal tumor that secretes excessive catecholamines, which results in an increased metabolism and hypertensive crisis.

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

Accepted Answer

Pheochromocytoma is a tumor of the adrenal medulla that causes an increase secretion of catecholamines that can elevate the blood pressure.

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

Accepted Answer

Elevated urinary levels of VMA, the by-product of catecholamines, would be manifested by a client with pheochromocytoma.

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

Accepted Answer

The first action is to measure the glucose level, start an IV, and prepare to give glucose or insulin. A dangerously low blood sugar level is life-threatening and must be corrected immediately. Choices A, B, and D are not incorrect nursing actions; however, they are not the first priority.

Quiz 2: Endocrine

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?

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

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:

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:

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?

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?

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

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

The nurse knows that acetonuria develops in diabetes due to:

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

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?

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?

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 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: