Exam 1 Test Banks F&E

Question 1

A patient presents to the emergency room complaining of vomiting with severe back and leg pain. The patient’s home medications include daily oral corticosteroids. Vital signs reveal a low blood pressure and there are peaked T waves on the electrocardiogram. What is the nurse’s priority intervention?

a. Start an intravenous line
b. Collect urine specimen
c. Administer antiemetic
d. Administer narcotic analgesia

Answer 1

a. Start an intravenous line

Rationale: The patient is exhibiting signs of adrenal insufficiency (Addison disease) given the regular use of corticosteroids.
Cortisone, hydrocortisone (Cortef), prednisone, and fludrocortisone (Florinef) are used for the treatment of adrenocortical deficiency.
Treatment of Addisonian crisis includes the administration of hydrocortisone, saline solution, and sugar (dextrose) to correct the insufficiency.
The priority intervention is to start an intravenous line so that appropriate treatments may be administered. A urine
specimen may be collected but is not the priority intervention.
Since the patient is vomiting, administration of antiemetics or analgesia would be given through an intravenous line.
The nurse should also assess for changes in the level of consciousness; so the administration of analgesia may be contraindicated if any decrease in the level of consciousness occurs.

Question 2

Which important teaching point should the nurse include in the plan of care for a patient diagnosed with Cushing disease?

a. Daily weight using same scale
b. Wash hands frequently
c. Use exfoliating soaps when bathing
d. Avoid yearly influenza vaccine

Answer 2

b. Wash hands frequently

Rationale: Cushing syndrome is characterized by chronic excess glucocorticoid (cortisol) secretion from the adrenal cortex.
This is caused by the hypothalamus, or the anterior pituitary gland, or the adrenal cortex. Cushing syndrome can also be caused by taking corticosteroids in the form of medication (such as prednisone) over time—referred to as exogenous Cushing syndrome.
Regardless of the cause, excess secretion of cortisol has a systemic effect affecting immunity, metabolism, and fat distribution
(truncal obesity), reduced muscle mass, loss of bone density, hypertension, fragility to the microvasculature, as well as thinning of
the skin.
Washing hands is important because the patient’s immune system is suppressed due to the excess glucocorticoid level.
Daily weights are not indicated. Exfoliating soaps may damage thin skin. The patient should receive vaccinations due to being
immunocompromised.

Question 3

The nurse is caring for a patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What is the nurse’s best action?

a. Encourage increased fluid and water intake
b. Teach about risk for malignancies
c. Monitor for changes in Level Of Consciousness
d. Assess labwork for potassium level changes

Answer 3

c. Monitor for changes in Level Of Consciousness

Rationale: As the name suggests, SIADH is a condition in which antidiuretic hormone (ADH) is secreted despite normal or low plasma
osmolarity, resulting in water retention and dilutional hyponatremia.
In response to increased plasma volume, aldosterone secretion increases and further contributes to sodium loss.
Hyponatremia frequently manifests with changes in level of consciousness from confusion to coma.
A large number of clinical conditions can cause SIADH including malignancies,
pulmonary disorders, injury to the brain, and certain pharmacologic agents.
Malignancies often lead to SIADH versus SIADH causing malignant conditions. Water intoxication can lead to hyponatremia, therefore water intake is restricted.
The most affected electrolyte from SIADH is sodium versus potassium.

Question 4

Following a parathyroidectomy, which electrolyte should the nurse most closely monitor?

a. Potassium
b. Sodium
c. Magnesium
d. Calcium

Answer 4

d. Calcium

Rationale: Because the parathyroids are located on the thyroid gland, similar concerns for postoperative monitoring apply. Additionally, calcium levels are monitored to avoid hypocalcemic crisis.

Question 5

Radioactive iodine is indicated for the treatment of hyperthyroidism. Which item should the nurse include in the plan of care?

a. Isolation is required for 6–8 weeks.
b. Continued thyroid monitoring is required.
c. Thyroid replacement therapy is prescribed.
d. An overnight hospital stay is required.

Answer 5

b. Continued thyroid monitoring is required.

Rationale: Radioactive iodine (RAI) is indicated for the treatment of hyperthyroidism.
It is given as an oral preparation, usually as a single dose on an outpatient basis. The radioactive iodine makes its way to the thyroid gland where it destroys some of the cells that produce thyroid hormone.
The RAI is completely eliminated from the body after about 4 weeks. The extent of thyroid cell destruction is variable, thus the patient has ongoing monitoring of thyroid function.
If thyroid production remains too high a
second dose may be needed. The goal of this procedure is to destroy thyroid hormone producing cells; additional thyroid
hormone is not prescribed.

Question 6

The nurse is caring for a patient who has undergone a thyroidectomy. Which patient complaint is highest priority requiring further evaluation?

a. Pain at surgical site
b. Thirst
c. Hoarseness
d. Nausea

Answer 6

c. Hoarseness

Rationale: Thyroidectomy involves a surgical incision in the anterior neck. Hoarseness may be a sign of airway edema.
A patent airway is
always a priority of care for any post-operative patient.
General anesthesia is used for this surgery requiring the insertion of an
artificial airway, therefore throat irritation, and thirst is expected.
Nausea may be a side effect from anesthesia. Pain is expected at the surgical site.

Question 7

Which statement made by a student nurse indicates the need for additional teaching about pituitary insufficiency?

a. “Synthetic human growth hormone may be prescribed for children who are small for gestational age.”
b. “Testosterone supplements may be prescribed for women with gonadotropin deficiency.”
c. “Estrogen is known to regulate the action of growth hormone in men and women.”
d. “Chronic kidney disease treatment may include synthetic growth hormone replacement.”

Answer 7

b. “Testosterone supplements may be prescribed for women with gonadotropin
deficiency.”

Rationale: Synthetic human growth hormone (HGH) is used for growth hormone deficiencies caused by pituitary insufficiency, as well as other conditions such as Turner syndrome, chronic kidney disease, and children small for gestation age.
Testosterone is used as a supplement for men with gonadotropin deficiency. Estrogen and progesterone supplements, also referred to as hormone replacement therapy (HRT), are indicated for women with gonadotropin deficiency and for the relief of post-menopausal symptoms.
Estrogen is also known to regulate secretion and action of GH in men and women.

Question 8

The nurse instructs a patient with type 1 diabetes mellitus to avoid which of the following drugs while taking insulin?

a. Aldactone (Spironolactone)
b. Dicumarol (Bishydroxycoumarin)
c. Reserpine (Serpasil)
d. Cimetidine (Tagamet)

Answer 8

a. Aldactone (Spironolactone)

Rationale: Aldactone is a loop potassium-sparing diuretic that can affect serum glucose levels and also lead to hypokalemia; its use is
contraindicated with insulin.
Dicumarol, an anticoagulant; reserpine, an anti-hypertensive; and cimetidine, an H2 receptor antagonist, do not affect blood glucose levels.

Question 9

When a diabetic patient asks about maintaining adequate blood glucose levels, which of the following statements by the nurse relates most directly to the necessity of maintaining blood glucose levels no lower than about 74 mg/dL?

a. “Glucose is the only type of fuel used by body cells to produce the energy needed for physiologic activity.”
b. “The central nervous system cannot store glucose and needs a continuous supply of glucose for fuel.”
c. “Without a minimum level of glucose circulating in the blood, erythrocytes cannot produce ATP.”
d. “The presence of glucose in the blood counteracts the formation of lactic acid and prevents acidosis.”

Answer 9

b. “The central nervous system cannot store glucose and needs a continuous supply
of glucose for fuel.”

Rationale: The brain cannot synthesize or store significant amounts of glucose; thus a continuous supply from the body’s circulation is needed to meet the fuel demands of the central nervous system.

Question 10

The nurse associates which assessment finding in the diabetic patient with decreasing renal function?

a. Ketone bodies in the urine during acidosis
b. Glucose in the urine during hyperglycemia
c. Protein in the urine during a random urinalysis
d. White blood cells in the urine during a random urinalysis

Answer 10

c. Protein in the urine during a random urinalysis

Rationale: Urine should not contain protein. Proteinuria in a diabetic heralds the beginning of renal insufficiency or diabetic nephropathy
with subsequent progression to end-stage renal disease.
Chronic elevated blood glucose levels can cause renal hypertension and excess kidney perfusion with leakage from the renal vasculature.
This leaking allows protein to be filtered into the urine.

Question 11

What is the nurse’s best response about developing diabetes to the patient whose father has type 1 diabetes mellitus?

a. “You have a greater susceptibility for development of the disease because of your family history.”
b. “Your risk is the same as the general population, because there is no genetic risk for development of type 1 diabetes.”
c. “Type 1 diabetes is inherited in an autosomal dominant pattern. Therefore the risk for becoming diabetic is 50%.”
d. “Because you are a woman and your father is the parent with diabetes, your risk is not increased for eventual development of the disease. However, your brothers
will become diabetic.”

Answer 11

a. “You have a greater susceptibility for development of the disease because of your family history.”

Rationale: Even though type 1 diabetes does not follow a specific genetic pattern of inheritance, those with one parent with type 1 diabetes are at an increased risk for development of the disease.

Question 12

The nurse recognizes which patient as having the greatest risk for undiagnosed diabetes mellitus?

a. Young white man
b. Middle-aged African-American man
c. Young African-American woman
d. Middle-aged Native American woman

Answer 12

d. Middle-aged Native American woman

Rationale: The highest incidence of diabetes in the United States occurs in Native Americans. With age, the incidence of diabetes increases
in all races and ethnic groups.

Question 13

A diabetic patient is brought into the emergency department unresponsive. The arterial pH is 7.28. Besides the blood pH, which clinical manifestation is seen in uncontrolled diabetes mellitus and ketoacidosis?

a. Decreased hunger sensation
b. Report of no urine output
c. Increased respiratory rate
d. Decreased thirst

Answer 13

c. Increased respiratory rate

Rationale: Ketoacidosis decreases the pH of the blood, stimulating the respiratory control area of the brain to buffer the effects of the
increasing acidosis.
The rate and depth of respirations are increased (Kussmaul respirations) to excrete more acids by exhalation.
Usually polydipsia (increased thirst), polyphagia (increased hunger), and polyuria (increased urine output) are seen with
hyperglycemia and ketoacidosis.

Question 14

Which of the following would be included in the assessment of a patient with diabetes mellitus who is experiencing a
hypoglycemic reaction? (Select all that apply.)

a. Tremors
b. Nervousness
c. Extreme thirst
d. Flushed skin
e. Profuse perspiration
f. Constricted pupils

Answer 14

a. Tremors
b. Nervousness
e. Profuse perspiration

Rationale: When hypoglycemia occurs, blood glucose levels fall, resulting in sympathetic nervous system responses such as tremors,
nervousness, and profuse perspiration. Dilated pupils would also occur, not constricted pupils. Extreme thirst, flushed skin, and constricted pupils are consistent with hyperglycemia.

Question 15

The nurse assesses an older client. What age-related physiologic changes would the nurse expect?

a. Heat intolerance
b. Rheumatoid arthritis
c. Dehydration
d. Increased appetite

Answer 15

c. Dehydration

Rationale: As people age, the many of the endocrine glands decrease hormone production, including a decrease in antidiuretic hormone production.
This change, in addition to less body fluid being present as one ages, can cause dehydration.
Older adults usually have cold intolerance and a decrease in appetite. Rheumatoid arthritis is not an age-related change; osteoarthritis causes primarily by aging.

Question 16

A client is scheduled to have a glycosylated hemoglobin (A1C) drawn and asks the nurse why she has to have it. How would the nurse respond?

a. “It measures your average blood glucose level for the past 3 months.”
b. “It determines what type of anemia you may have.”
c. “It measures the amount of liver glycogen you have.”
d. “It determines you have some type of leukemia or other blood cancer.”

Answer 16

a. “It measures your average blood glucose level for the past 3 months.”

Rationale: A1C measures the average blood glucose level to determine if the client is a diabetic or how controlled a diabetic client is.

Question 17

The nurse assesses a client who is scheduled to have a laboratory test to determine if the client’s adrenal glands are hypoactive. What type of testing would the client likely have?

a. Catecholamine testing
b. Suppression testing
c. Bone marrow testing
d. Provocative testing

Answer 17

d. Provocative testing

Rationale: Provocative testing is done to determine if an endocrine gland is capable of producing its normal level of hormone(s), especially when a client is suspected of having a hypoactive endocrine gland.

Question 18

A nurse assesses a client who is prescribed a medication that stimulates beta1 receptors. Which assessment finding would indicate that the medication is effective?

a. Heart rate of 92 beats/min
b. Respiratory rate of 18 breaths/min
c. Oxygenation saturation of 92%
d. Blood pressure of 144/69 mm Hg

Answer 18

a. Heart rate of 92 beats/min

Rationale: Stimulation of beta1 receptor sites in the heart has positive chronotropic and inotropic actions.
The nurse expects an increase in heart rate and increased cardiac output. The other vital signs are within normal limits and do not indicate any response to the medication.

Question 19

A nurse collaborates with assistive personnel (AP) to provide care for a client who is prescribed a 24-hour urine specimen
collection. Which statement would the nurse include when teaching the AP about this activity?

a. “Note the time of the client’s first void and collect urine for 24 hours.”
b. “Add the preservative to the container at the end of the test.”
c. “Start the collection by saving the first urine of the morning.”
d. “It is okay if one urine sample during the 24 hours is not collected.”

Answer 19

a. “Note the time of the client’s first void and collect urine for 24 hours.”

Rationale: The collection of a 24-hour urine specimen is often delegated to AP.
The nurse must ensure that the AP understands the proper process for collecting the urine.
The 24-hour urine collection specimen is started after the client’s first urination.
The first urine specimen is discarded because there is no way to know how long it has been in the bladder, but the time of the client’s first void is noted.
The client adds all urine voided after that first discarded specimen during the next 24 hours. When the 24-hour mark is reached, the client voids one last time and adds this specimen to the collection.
The preservative, if used, must be added to the container at the beginning of the collection. All urine samples need to be collected for the test results to be accurate.

Question 20

A nurse assesses a female client who presents with hirsutism. Which question would the nurse ask when assessing this client?

a. “How do you plan to pay for your treatments?”
b. “How do you feel about yourself?”
c. “What medications are you prescribed?”
d. “What are you doing to prevent this from happening?”

Answer 20

b. “How do you feel about yourself?”

Rationale: Hirsutism, or excessive hair growth on the face and body, can result from endocrine disorders.
This may cause a disruption in body
image, especially for female clients.
The nurse would inquire into the client’s body image and self-perception.
Asking about the client’s financial status or current medications does not address the client’s immediate problem.
The client is not doing anything to herself to cause the problem, nor can the client prevent it from happening.

Question 21

A nurse is caring for a patient who has excessive catecholamine release. Which assessment finding would the nurse correlate with this condition?

a. Decreased blood pressure
b. Increased pulse
c. Decreased respiratory rate
d. Increased urine output

Answer 21

b. Increased pulse

Rationale: Catecholamines are responsible for the fight-or-flight stress response. Activation of the sympathetic nervous system can be
correlated with tachycardia.
Catecholamines do not decrease blood pressure or respiratory rate, nor do they increase urine output.

Question 22

The nurse is teaching assistive personnel (AP) about hormones that are produced by the adrenal glands. Which hormone has the primary responsibility of maintaining fluid volume and electrolyte composition?

a. Sodium
b. Magnesium
c. Aldosterone
d. Renin

Answer 22

c. Aldosterone

Rationale: Aldosterone is a hormone secreted by the adrenal cortex that causes water and sodium absorption to maintain body fluid volume.
Renin is secreted by the kidney to trigger angiotensinogen converting angiotensin I to angiotensin II to help control blood pressure.
Magnesium and sodium are electrolytes and not hormones.

Question 23

The nurse reviews the function of thyroid gland hormones. What is the primary function of calcitonin?

a. Sodium and potassium balance
b. Magnesium balance
c. Norepinephrine balance
d. Calcium and phosphorus balance

Answer 23

d. Calcium and phosphorus balance

Rationale: Calcitonin is the primary body hormone that is secreted from the thyroid gland and is responsible for maintaining calcium and phosphorus balance.

Question 24

A nurse teaches an older woman who has a decreased production of estrogen. Which statement would the nurse include in this client’s teaching to decrease injury?

a. “Drink at least 2 quarts (2 L) of fluids each day.”
b. “Walk around the neighborhood for daily exercise.”
c. “Bathe your perineal area twice a day.”
d. “You should check your blood glucose before meals.”

Answer 24

b. “Walk around the neighborhood for daily exercise.”

Rationale: An older female with decreased production of estrogen is at risk for decreased bone density and fractures.
The nurse would encourage the client to participate in weight-bearing exercises such as walking.
Drinking fluids and performing perineal care will decrease vaginal drying but not injury. Older adults often have a decreased glucose tolerance, but this is not related to a decrease in estrogen.

Question 25

A nurse cares for a client with a hypofunctioning anterior pituitary gland. Which hormones would the nurse expect to be decreased as a result? (Select all that apply.)

a. Thyroid-stimulating hormone
b. Vasopressin
c. Follicle-stimulating hormone
d. Calcitonin
e. Growth hormone

Answer 25

a. Thyroid-stimulating hormone
c. Follicle-stimulating hormone
e. Growth hormone

Rationale: Thyroid-stimulating hormone, follicle-stimulating hormone, and growth hormone all are secreted by the anterior pituitary gland.
Vasopressin is secreted from the posterior pituitary gland. Calcitonin is secreted from the thyroid gland.

Question 26

A nurse assesses clients who have endocrine disorders. Which assessment findings are paired correctly with the endocrine
disorder? (Select all that apply.)

a. Excessive thyroid-stimulating hormone—increased bone formation
b. Excessive melanocyte-stimulating hormone—darkening of the skin
c. Excessive parathyroid hormone—synthesis and release of corticosteroids
d. Excessive antidiuretic hormone—increased urinary output
e. Excessive adrenocorticotropic hormone—increased bone resorption

Answer 26

a. Excessive thyroid-stimulating hormone—increased bone formation
b. Excessive melanocyte-stimulating hormone—darkening of the skin

Rationale: Thyroid-stimulating hormone targets thyroid tissue and stimulates the formation of bone.
Melanocyte-stimulating hormone
stimulates melanocytes and promotes pigmentation or the darkening of the skin. Parathyroid hormone stimulates bone resorption.
Antidiuretic hormone targets the kidney and promotes water reabsorption, causing a decrease in urinary output.
Adrenocorticotropic hormone targets the adrenal cortex and stimulates the synthesis and release of corticosteroids.

Question 27

When caring for an older client who has hypothyroidism, what assessment findings will the nurse expect? (Select all that apply.)

a. Lethargy
b. Diarrhea
c. Low body temperature
d. Tachycardia
e. Slowed speech
f. Weight gain

Answer 27

a. Lethargy
c. Low body temperature
e. Slowed speech
f. Weight gain

Rationale: A client who has an underactive thyroid gland has a decreased metabolic rate, resulting in lethargy and lack of energy, weight gain, slowed speech, and decreased vital signs like a lowered body temperature. The client also typically has constipation (instead of diarrhea) due to slower peristalsis and bradycardia (instead of tachycardia).

Question 28

A nurse assesses clients for potential endocrine dysfunction. Which client is at greatest risk for a deficiency of gonadotropin and growth hormone?

a. A 36-year-old female who has used oral contraceptives for 5 years
b. A 42-year-old male who experienced head trauma 3 years ago
c. A 55-year-old female with a severe allergy to shellfish and iodine
d. A 64-year-old male with adult-onset diabetes mellitus

Answer 28

b. A 42-year-old male who experienced head trauma 3 years ago

Rationale: Gonadotropin and growth hormone are anterior pituitary hormones. Head trauma is a common cause of anterior pituitary hypofunction. The other factors do not increase the risk of this condition.

Question 29

A nurse plans care for a client with a growth hormone deficiency. Which action would the nurse include in this client’s plan of care?

a. Avoid intramuscular medications.
b. Place the client in protective isolation.
c. Use a lift sheet to reposition the patient.
d. Assist the client to dangle before rising.

Answer 29

c. Use a lift sheet to reposition the patient.

Rationale: In adults, growth hormone is necessary to maintain bone density and strength.
Adults with growth hormone deficiency have thin, fragile bones. Avoiding IM medications, using protective isolation, and assisting the client as he or she moves from sitting to
standing will not serve as safety measures when the client is deficient in growth hormone.

Question 30

The nurse is caring for a client who has acromegaly. What physical change would the nurse expect to observe?

a. Large hands and face
b. Thin, dry skin
c. Short height
d. Truncal obesity

Answer 30

a. Large hands and face

Rationale: The client who has acromegaly has an excess of growth hormone as an adult and therefore has a large musculoskeletal structure that is readily observed.

Question 31

After teaching a client with acromegaly who is scheduled for open transsphenoidal hypophysectomy, the nurse assesses the client’s understanding. Which statement made by the client indicates a need for further teaching?

a. “I will no longer need to limit my fluid intake after surgery.”
b. “I am glad no visible incision will result from this surgery.”
c. “I hope I can go back to wearing size 8 shoes instead of size 12.”
d. “I will wear slip-on shoes after surgery to limit bending over.”

Answer 31

c. “I hope I can go back to wearing size 8 shoes instead of size 12.”

Rationale: Although removal of the tissue that is oversecreting hormones can relieve many symptoms of hyperpituitarism, skeletal changes and organ enlargement is not reversible.
It will be appropriate for the client to drink as needed postoperatively and avoid bending
over. The client can be reassured that the incision will not be visible.

Question 32

The nurse is caring for a client with acromegaly who is starting bromocriptine. What health teaching by the nurse about drug therapy will the nurse include?

a. “Take this drug on an empty stomach first thing in the morning.”
b. “You will be starting on a high dose of the drug to ensure it will work.”
c. “You might experience an increase in blood pressure in about a week.”
d. “Seek medical attention immediately if you have chest pain and dizziness.”

Answer 32

d. “Seek medical attention immediately if you have chest pain and dizziness.”

Rationale: Bromocriptine should be started on a low dose and taken with food.
The drug can cause decreased blood pressure, including orthostatic hypotension. Serious effects such as cardiac dysrhythmias, coronary artery spasms, and cerebrospinal leaks can occur.
Therefore, the nurse teaches the client should seek medical attention if he or she experiences chest pain, dizziness, and watery nasal discharge.

Question 33

After teaching a client who is recovering from an endoscopic transsphenoidal hypophysectomy, the nurse assesses the client’s understanding. Which statement made by the client indicates a correct understanding of the teaching?

a. “I will wear dark glasses to prevent sun exposure.”
b. “I’ll keep food on upper shelves so I do not have to bend over.”
c. “I must wash the incision with saline and redress it daily.”
d. “I should cough and deep breathe every 2 hours while I am awake.”

Answer 33

b. “I’ll keep food on upper shelves so I do not have to bend over.”

Rationale: After this surgery, the client must take care to avoid activities that can increase intracranial pressure.
The client should avoid bending from the waist and should not bear down, cough, or lie flat.
With this approach, there is no incision to clean and dress.
Protection from sun exposure is not necessary after this procedure.

Question 34

A nurse cares for a client who possibly has syndrome of inappropriate antidiuretic hormone (SIADH). The client’s serum sodium level is 114 mEq/L (114 mmol/L). What nursing action would be appropriate?

a. Consult with the dietitian about increased dietary sodium.
b. Restrict the client’s fluid intake to 600 mL/day.
c. Handle the client gently by using turn sheets for repositioning.
d. Instruct assistive personnel to measure intake and output.

Answer 34

b. Restrict the client’s fluid intake to 600 mL/day.

Rationale: With SIADH, clients often have dilutional hyponatremia. The client needs a fluid restriction, sometimes to as little as 500 to 600 mL/24 hr.
Adding sodium to the client’s diet will not help if he or she is retaining fluid and diluting the sodium.
The client is not at increased risk for fracture, so gentle handling is not an issue.
The client would be on intake and output; however, this will monitor only the client’s intake, so it is not the best answer.
Reducing fluid intake will help increase the client’s sodium.

Question 35

The nurse is caring for a client who is diagnosed with diabetes insipidus (DI). For what common complication will the nurse
monitor?

a. Hypertension
b. Bradycardia
c. Dehydration
d. Pulmonary embolus

Answer 35

c. Dehydration

Rationale: The client who has DI has fluid loss through excessive urination.
Decreased fluid volume, or dehydration, is manifested by tachycardia, hypotension, and possibly elevated temperature.
Pulmonary embolism (PE) could possible as a clot in the lower extremity (caused by dehydration) could fragment and travel to the lungs.

Question 36

A client is being treated for diabetes insipidus (DI) with synthetic vasopressin (desmopressin). What is the priority health teaching that the nurse provides regarding drug therapy?

a. The need to check the client’s urinary specific gravity.
b. The need to take blood pressure at least twice a day.
c. The need to monitor blood glucose every day.
d. The need to weigh every day and report weight gain.

Answer 36

d. The need to weigh every day and report weight gain.

Rationale: The client with DI who takes lifelong hormone replacement will need to report significant weight gain to monitor for water
toxicity. Water toxicity causes headache, vomiting, and acute confusion.

Question 37

A nurse cares for a client with adrenal hyperfunction. The client screams at her husband, bursts into tears, and throws her water pitcher against the wall. She then tells the nurse, “I feel like I am going crazy.” How would the nurse respond?

a. “I will ask your doctor to order a mental health consult for you.”
b. “You feel this way because of your hormone levels.”
c. “Can I bring you information about support groups?”
d. “I will close the door to your room and restrict visitors.”

Answer 37

b. “You feel this way because of your hormone levels.”

Rationale: Hypercortisolism can cause the client to have neurotic or psychotic behaviors. The client needs to know that these behavior
changes do not reflect a true mental or behavioral health disorder and will resolve when therapy results in lower and steadier blood cortisol levels.
The client needs to understand this effect and does not need a psychiatrist, support groups, or restricted visitors at this time.

Question 38

A nurse is reviewing care for a client who has syndrome of inappropriate antidiuretic hormone (SIADH) with assistive personnel.
What statement by the AP indicates understanding of this client’s care?

a. “I will weigh the client carefully before breakfast and compare with yesterday’s
weight.”
b. “I will encourage plenty of fluids to promote urination and prevent dehydration.”
c. “I will teach the client not to select high-sodium or salty foods on the menu.”
d. “I will assess the client’s mucous membranes and skin for signs of dehydration.”

Answer 38

a. “I will weigh the client carefully before breakfast and compare with yesterday’s weight.”

Rationale: The client with SIADH usually has a fluid restriction, not an increase in fluids.
It is the role of the RN rather than AP to perform assessments and provide health teaching. The AP needs to weigh the client daily and report a significant weight change.

Question 39

The nurse is preparing to give tolvaptan for a client who has syndrome of inappropriate antidiuretic hormone (SIADH). For which potentially life-threatening adverse effect would the nurse monitor?

a. Increased intracranial pressure
b. Myocardial infarction
c. Rapid-onset hypernatremia
d. Bowel perforation

Answer 39

c. Rapid-onset hypernatremia

Rationale: Tolvaptan has a black box warning that rapid increases in serum sodium levels have been associated with central nervous system demyelination that can lead to serious complications and death.

Question 40

The nurse is caring for a client with adrenal insufficiency. What priority physical assessment would the nurse perform?

a. Respiratory assessment
b. Skin assessment
c. Neurologic assessment
d. Cardiac assessment

Answer 40

d. Cardiac assessment

Rationale: The client who has adrenal insufficiency has hyperkalemia which can cause cardiac dysrhythmias.
Therefore, the nurse would monitor the client’s cardiovascular status through frequent assessments.

Question 41

A client is admitted with a possible diagnosis of diabetes insipidus (DI). What assessment findings would the nurse expect? (Select all that apply.)

a. Hypotension
b. Increased urinary output
c. Concentrated urine
d. Decreased thirst
e. Poor skin turgor
f. Bradycardia

Answer 41

a. Hypotension
b. Increased urinary output
e. Poor skin turgor

Rationale: The client who has DI has excessive urination and dehydration.
Clients who are dehydrated have decreased blood pressure, increased pulse (tachycardia), and poor skin turgor.
The urine is dilute with a low specific gravity.

Question 42

A nurse assesses a client who potentially has hyperaldosteronism. Which serum laboratory values would the nurse associate with
this disorder? (Select all that apply.)

a. Sodium: 150 mEq/L (150 mmol/L)
b. Sodium: 130 mEq/L (130 mmol/L)
c. Potassium: 2.5 mEq/L (2.5 mmol/L)
d. Potassium: 5.0 mEq/L (5.0 mmol/L)
e. pH 7.28
f. pH 7.50

Answer 42

a. Sodium: 150 mEq/L (150 mmol/L)
c. Potassium: 2.5 mEq/L (2.5 mmol/L)
e. pH 7.28

Rationale: Aldosterone increases reabsorption of sodium and excretion of potassium. Hyperaldosteronism causes hypernatremia, hypokalemia, and metabolic alkalosis. Hyponatremia, hyperkalemia, and acidosis are manifestations of adrenal insufficiency.

Question 43

A nurse teaches a client with Cushing’s disease. Which dietary requirements would the nurse include in this client’s health teaching? (Select all that apply.)

a. Low calcium
b. Low carbohydrate
c. Low protein
d. Low calories
e. Low sodium

Answer 43

b. Low carbohydrate
d. Low calories
e. Low sodium

Rationale: The client with Cushing’s disease has weight gain, muscle loss, hyperglycemia, and sodium retention.
Dietary modifications need to include a reduction of carbohydrates and total calories to prevent or reduce the degree of hyperglycemia.
Sodium retention causes water retention and hypertension. Clients are encouraged to restrict their sodium intake moderately. Clients often have bone density loss and need more calcium. Increased protein intake will help decrease muscle loss.

Question 44

A nurse assesses a client with Cushing’s disease. Which assessment findings would the nurse expect? (Select all that apply.)

a. Moon face
b. Weight loss
c. Hypotension
d. Petechiae
e. Muscle atrophy

Answer 44

a. Moon face
d. Petechiae
e. Muscle atrophy

Rationale: Clinical manifestations of Cushing disease include moon face, weight gain, hypertension, petechiae, and muscle atrophy.

Question 45

The nurse is planning health teaching for a client starting on levothyroxine. What health teaching about this drug would the nurse include?

a. The need to take the drug when the client feels fatigued and weak.
b. The need to report chest pain and dyspnea when starting the drug.
c. The need to check blood pressure and pulse every day.
d. The need to rotate injection sites when giving self the drug.

Answer 45

b. The need to report chest pain and dyspnea when starting the drug.

Rationale: Levothyroxine is a replacement hormone for clients who have hypothyroidism and is taken orally for life.
Vital signs do not have to be checked every day, but the client should report any chest pain and dyspnea when first starting the drug.

Question 46

A nurse assesses a client who is recovering from a subtotal thyroidectomy and observes the development of stridor. What is the priority action for the nurse to take?

a. Apply oxygen via nasal cannula at 2 L/min.
b. Document the finding and assess the client hourly.
c. Place the client in high-Fowler position in the bed.
d. Contact the Rapid Response Team and prepare for intubation.

Answer 46

d. Contact the Rapid Response Team and prepare for intubation.

Rationale: Stridor on exhalation is a hallmark of respiratory distress, usually caused by obstruction resulting from edema.
The nurse should prepare to assist with emergency intubation or tracheostomy while notifying the Rapid Response Team.
Stridor is an emergency situation; therefore, reassuring the client, documenting, and reassessing in an hour do not address the urgency of the situation.
Oxygen should be applied, but this action will not keep the airway open.

Question 47

A nurse assesses a client who is recovering from a subtotal thyroidectomy. On the first postoperative day before discharge, the client states, “I feel numbness and tingling around my mouth.” What action does the nurse take?

a. Offer mouth care.
b. Loosen the dressing.
c. Assess for muscle twitching.
d. Ask the client orientation questions.

Answer 47

c. Assess for muscle twitching.

Rationale: Numbness and tingling around the mouth or in the fingers and toes are manifestations of hypocalcemia, which could progress to cause tetany and seizure activity. The nurse would assess for muscle twitching and, if present, notify the surgeon or Rapid
Response Team to give calcium gluconate or other IV calcium replacement.
Mouth care, loosening the dressing, and orientation questions do not provide important information to prevent complications of low calcium levels.

Question 48

A nurse assesses a client on the medical-surgical unit. Which statement made by the client alerts the nurse to assess the patient for hypothyroidism?

a. “My sister has thyroid problems.”
b. “I seem to feel the heat more than other people.”
c. “Food just doesn’t taste good without a lot of salt.”
d. “I am always tired, even with 12 hours of sleep.”

Answer 48

d. “I am always tired, even with 12 hours of sleep.”

Rationale: Clients with hypothyroidism usually feel tired or weak despite getting many hours of sleep.
Most thyroid problems are not inherited, although they may occur in families.
Heat intolerance is indicative of hyperthyroidism.
Loss of taste is not a manifestation of hypothyroidism. The nurse would assess the client further for hypothyroidism.

Question 49

A nurse cares for a client who presents with bradycardia secondary to hypothyroidism. Which medication does the nurse prepare to administer?

a. Atropine sulfate
b. Levothyroxine
c. Propranolol
d. Epinephrine

Answer 49

b. Levothyroxine

Rationale: The treatment for bradycardia from hypothyroidism is to treat the hypothyroidism using levothyroxine. If the heart rate were so
slow that it became an emergency, then atropine or epinephrine might be an option for short-term management.
Propranolol is a beta blocker and would be contraindicated for a client with bradycardia.

Question 50

A nurse plans care for a client with hypothyroidism. Which priority problem does the nurse address first for this client?

a. Heat intolerance
b. Body image problems
c. Depression and withdrawal
d. Obesity and water retention

Answer 50

c. Depression and withdrawal

Rationale: Hypothyroidism causes many problems in psychosocial functioning. Depression is the most common reason for seeking medical attention.
Memory and attention span may be impaired. The client’s family may have great difficulty accepting and dealing with these changes.
The client is often unmotivated to participate in self-care.
Lapses in memory and attention require the nurse to ensure that the patient’s environment is safe.
Heat intolerance is seen in hyperthyroidism. Body image problems and weight issues
do not take priority over mental status and safety.

Question 51

A nurse assesses a client who is prescribed levothyroxine for hypothyroidism. Which assessment finding alerts the nurse that drug therapy is effective?

a. Thirst is recognized and fluid intake is appropriate.
b. Weight has been the same for 3 weeks.
c. Total white blood cell count is 6000 cells/mm3 (6 × 109/L).
d. Heart rate is 76 beats/min and regular.

Answer 51

d. Heart rate is 76 beats/min and regular.

Rationale: Hypothyroidism decreases body functioning and can result in effects such as bradycardia, confusion, and constipation.
If a client’s heart rate is bradycardic while on thyroid hormone replacement, this is an indicator that the replacement may not be adequate.
Conversely, a heart rate above 100 beats/min may indicate that the client is receiving too much of the thyroid hormone.
Thirst, fluid intake, weight, and white blood cell count do not represent a therapeutic response to this medication.

Question 52

A nurse cares for a client who has hypothyroidism as a result of Hashimoto’s thyroiditis. The client asks, “How long will I need to take this thyroid medication?” How would the nurse respond?

a. “You will need to take the thyroid medication until the goiter is completely
gone.”
b. “Thyroiditis is cured with antibiotics. Then you won’t need thyroid medication.”
c. “You’ll need thyroid pills for life because your thyroid won’t start working again.”
d. “When blood tests indicate normal thyroid function, you can stop the medication.”

Answer 52

c. “You’ll need thyroid pills for life because your thyroid won’t start working again.”

Rationale: Hashimoto thyroiditis results in a permanent loss of thyroid function.
The client will need lifelong thyroid replacement therapy and will not be able to stop taking the medication.

Question 53

The nurse is caring for a client who is starting on propylthiouracil for hyperthyroidism. What statement by the client indicates a need for further teaching?

a. “I will let my provider know if I have weight gain and cold intolerance.”
b. “I will let my provider know if I have a metallic taste or stomach upset.”
c. “I will avoid crowds and other people who have infection.”
d. “I am aware that if the drug changes the color of my urine, I should stop it.”

Answer 53

b. “I will let my provider know if I have a metallic taste or stomach upset.”

Rationale: If the client’s urine turns dark and/or the skin has a yellow appearance, the client may have possible liver toxicity from the drug.
This is a serious adverse effect and needs to be reported to the primary health care provider after stopping the drug.
If weight gain and cold intolerance occurs, then the client may need a lower dose of the drug.
The drug should not cause GI distress or a metallic taste in his or her mouth.

Question 54

A nurse plans care for a client with hyperparathyroidism. Which intervention does the nurse include in this client’s plan of care?

a. Use a lift sheet to assist the client with position changes in bed.
b. Ask the client to ambulate in the hallway twice a day.
c. Provide the client with a soft-bristled toothbrush for oral care.
d. Instruct the assistive personnel to strain the patient’s urine for stones.

Answer 54

a. Use a lift sheet to assist the client with position changes in bed.

Rationale: Hyperparathyroidism causes increased resorption of calcium from the bones, increasing the risk for pathologic fractures.
Using a lift sheet when moving or positioning the client, instead of pulling on the client, reduces the risk of bone injury.
Hyperparathyroidism can cause kidney stones, but not every client will need to have urine strained.
The priority is preventing injury. Ambulating in the hall and using a soft toothbrush are not specific interventions for this patient.

Question 55

While assessing a client with Graves disease, the nurse notes that the client’s temperature has risen 1° F (1° C). What does the nurse do first?

a. Turn the lights down and shut the patient’s door.
b. Call for an immediate electrocardiogram (ECG).
c. Calculate the client’s apical-radial pulse deficit.
d. Administer a dose of acetaminophen.

Answer 55

a. Turn the lights down and shut the patient’s door.

Rationale: A temperature increase of 1° F (5/9° C) may indicate the development of thyroid storm, and the primary health care provider or RRT needs to be notified.
But before notifying the provider, the nurse should first take measures to reduce environmental stimuli that increase the risk of cardiac complications.
The nurse can then call for an ECG. The apical-radial pulse deficit would not be necessary, and acetaminophen is not needed because the temperature increase is due to thyroid activity.

Question 56

Preconception counseling is critical to the outcome of diabetic pregnancies because poor glycemic control before and during early pregnancy is associated with

a. frequent episodes of maternal hypoglycemia.
b. congenital anomalies in the fetus.
c. polyhydramnios.
d. hyperemesis gravidarum.

Answer 56

b. congenital anomalies in the fetus.

Rationale: Preconception counseling is particularly important because strict metabolic control before conception and in the early weeks of gestation is instrumental in decreasing the risks of congenital anomalies. Frequent episodes of maternal hypoglycemia may occur during the first trimester (not before conception) as a result of hormone changes and the effects on insulin production and usage.
Hydramnios occurs about 10 times more often in diabetic pregnancies than in nondiabetic pregnancies.
Typically, it is seen in the third trimester of pregnancy.
Hyperemesis gravidarum may exacerbate hypoglycemic events as the decreased food intake by the mother and glucose transfer to the fetus contribute to hypoglycemia.

Question 57

In assessing the knowledge of a pregestational woman with type 1 diabetes concerning changing insulin needs during pregnancy, the nurse recognizes that further teaching is warranted when the patient states

a. “I will need to increase my insulin dosage during the first 3 months of pregnancy.”
b. “Insulin dosage will likely need to be increased during the second and third
trimesters.”
c. “Episodes of hypoglycemia are more likely to occur during the first 3 months.”
d. “Insulin needs should return to normal within 7 to 10 days after birth if I am bottle feeding.”

Answer 57

a. “I will need to increase my insulin dosage during the first 3 months of pregnancy.”

Rationale: Insulin needs are reduced in the first trimester due to increased insulin production by the pancreas and increased peripheral sensitivity to insulin.
Also the woman may be experiencing nausea, vomiting, and anorexia that would decrease her insulin needs.
The other statements show good understanding of this topic.

Question 58

Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at the greatest risk for

a. macrosomia.
b. congenital anomalies of the central nervous system.
c. preterm birth.
d. low birth weight.

Answer 58

a. macrosomia.

Rationale: Poor glycemic control later in pregnancy increases the rate of fetal macrosomia.
Poor glycemic control during the preconception time frame and into the early weeks of the pregnancy is associated with congenital anomalies.
Preterm labor or birth is more likely to occur with severe diabetes and is the greatest risk in women with pregestational diabetes. Increased weight, or macrosomia, is the greatest risk factor for this woman.

Question 59

In terms of the incidence and classification of diabetes, maternity nurses should know that

a. type 1 diabetes is most common.
b. type 2 diabetes often goes undiagnosed.
c. there is only one type of gestational diabetes.
d. type 1 diabetes may become type 2 during pregnancy.

Answer 59

b. type 2 diabetes often goes undiagnosed.

Rationale: Type 2 often goes undiagnosed, because hyperglycemia develops gradually and often is not severe.
Type 2, previously called adult onset diabetes, is the most common. There are 2 subgroups of gestational diabetes.
Type GDM A1 is diet-controlled whereas type GDM A2 is controlled by insulin and diet. People do not go back and forth between type 1 and type 2 diabetes.

Question 60

A nurse in labor and delivery learns about metabolic changes that occur throughout pregnancy in diabetes. What information does the nurse know?

a. Insulin crosses the placenta to the fetus only in the first trimester, after which the
fetus secretes its own.
b. Women with insulin-dependent diabetes are prone to hyperglycemia during the
first trimester, because they are consuming more sugar.
c. During the second and third trimesters, pregnancy exerts a diabetogenic effect
that ensures an abundant supply of glucose for the fetus.
d. Maternal insulin requirements steadily decline during pregnancy.

Answer 60

c. During the second and third trimesters, pregnancy exerts a diabetogenic effect
that ensures an abundant supply of glucose for the fetus.

Rationale: Pregnant women develop increased insulin resistance during the second and third trimesters.
Insulin never crosses the placenta; the fetus starts making its own around the tenth week. As a result of normal metabolic changes during pregnancy, insulin-dependent women are prone to hypoglycemia.
Maternal insulin requirements may double or quadruple by the end of pregnancy.

Question 61

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother?

a. Hypoglycemia
b. Hypercalcemia
c. Hyperbilirubinemia
d. Hypoinsulinemia

Answer 61

a. Hypoglycemia

Rationale: The neonate is at highest risk for hypoglycemia because fetal insulin production is accelerated during pregnancy to metabolize excessive glucose from the mother.
At birth, the maternal glucose supply stops and the neonatal insulin exceeds the available glucose, leading to hypoglycemia. Hypocalcemia is associated with preterm birth, birth trauma, and asphyxia, all common problems of the infant of a diabetic mother. Excess erythrocytes are broken down after birth, releasing large amounts of bilirubin into the neonate’s circulation, which results in hyperbilirubinemia.
Because fetal insulin production is accelerated during pregnancy, the neonate shows hyperinsulinemia.

Question 62

Which factor is known to increase the risk of gestational diabetes mellitus?

a. Underweight before pregnancy
b. Maternal age younger than 25 years
c. Previous birth of a large infant
d. Previous diagnosis of type 2 diabetes mellitus

Answer 62

c. Previous birth of a large infant

Rationale: Previous birth of a large infant suggests gestational diabetes mellitus. Obesity (BMI of 30 or greater) creates a higher risk for gestational diabetes.
A woman younger than 25 generally is not at risk for gestational diabetes mellitus.
The person with type 2 diabetes mellitus already is a diabetic and will continue to be so during and after pregnancy.

Question 63

Glucose metabolism is profoundly affected during pregnancy because

a. pancreatic function in the islets of Langerhans is affected by pregnancy.
b. the pregnant woman uses glucose at a more rapid rate than the nonpregnant woman.
c. the pregnant woman increases her dietary intake significantly.
d. placental hormones are antagonistic to insulin, resulting in insulin resistance.

Answer 63

d. placental hormones are antagonistic to insulin, resulting in insulin resistance.

Rationale: Placental hormones, estrogen, progesterone, and human placental lactogen (HPL) create insulin resistance.
Insulin also is broken down more quickly by the enzyme placental insulinase.
Pancreatic functioning is not affected by pregnancy.
The glucose requirements differ because of the growing fetus.
The pregnant woman should increase her intake by 200 calories a day.

Question 64

To manage her diabetes appropriately and ensure a good fetal outcome, the pregnant woman with diabetes will need to alter her diet by doing which of the following?

a. Eating six small equal meals per day
b. Reducing carbohydrates in her diet
c. Eating her meals and snacks on a fixed schedule
d. Increasing her consumption of protein

Answer 64

c. Eating her meals and snacks on a fixed schedule

Rationale: Having a fixed meal schedule will provide the woman and the fetus with a steadier blood sugar level, provide better balance with insulin administration, and help prevent complications.
It is more important to have a fixed meal schedule than equal division of food intake or increased protein intake.
Approximately 45% of the food eaten should be in the form of carbohydrates.

Question 65

A pregnant diabetic woman is in the hospital and her blood glucose reading is 42 mg/dL. What action by the nurse is best?

a. Provide her with 15 grams of oral carbohydrate if she can swallow.
b. Administer a bolus of rapid-acting insulin.
c. Order the woman a meal tray from the cafeteria.
d. Notify the provider immediately.

Answer 65

a. Provide her with 15 grams of oral carbohydrate if she can swallow.

Rationale: This woman has hypoglycemia and needs to injest 15 grams of carbohydrate if she is able to swallow.
Insulin would make the problem worse. The meal tray is a good idea but not as the first response as it will take too long.
The provider should be notified but only after the nurse takes corrective action.

Question 66

Nursing intervention for the pregnant diabetic is based on the knowledge that the need for insulin

a. increases throughout pregnancy and the postpartum period.
b. decreases throughout pregnancy and the postpartum period.
c. varies depending on the stage of gestation.
d. should not change because the fetus produces its own insulin.

Answer 66

c. varies depending on the stage of gestation.

Rationale: Insulin needs decrease during the first trimester, when nausea, vomiting, and anorexia are a factor.
They increase during the second and third trimesters, when the hormones of pregnancy create insulin resistance in maternal cells.

Question 67

With regard to the association of maternal diabetes and other risk situations affecting mother and fetus, nurses should be aware that

a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.
b. Hydramnios rarely occurs in diabetic pregnancies.
c. Infections occur about as often and are considered about as serious in diabetic and
nondiabetic pregnancies.
d. Women should not use insulin pumps during pregnancy.

Answer 67

a. Diabetic ketoacidosis (DKA) can lead to fetal death at any time during pregnancy.

Rationale: Prompt treatment of DKA is necessary to save the fetus and the mother. Hydramnios is a potential complication for the diabetic pregnancy. Infections are more common and more serious in pregnant women with diabetes.
Women who were treated with an insulin pump before pregnancy can continue this therapy.