MCC Ch 8: Endocrine Disorders Comprehensive Exam

Question 1

The nurse is teaching a community class to people with type 2 diabetes mellitus. Which explanation explains the development of type 2 diabetes?

1. The islet cells in the pancreas stop producing insulin.
2. The client eats too many foods high in sugar.
3. The pituitary gland does not produce vasopressin.
4. The cells become resistant to the circulating insulin.

Answer 1

1. This is the cause of type 1 diabetes mellitus.
2. This may be a reason for obesity, which may lead to type 2 diabetes, but eating too much sugar does not cause diabetes.
3. This is the explanation for diabetes in- sipidus, which should not be confused with diabetes mellitus.
4. Normally insulin binds to special recep- tors sites on the cell and initiates a series of reactions involved in metabolism. In type 2 diabetes, these reactions are diminished primarily as a result of obesity and aging.

Question 2

The nurse is teaching the client diagnosed with type 2 diabetes mellitus about diet. Which diet selection indicates the client understands the teaching?

1. A submarine sandwich, potato chips, and diet cola.
2. Four (4) slices of a supreme thin-crust pizza and milk.
3. Smoked turkey sandwich, celery sticks, and unsweetened tea.
4. A roast beef sandwich, fried onion rings, and a cola.

Answer 2

1. A submarine sandwich is on a bun-type bread and is usually 6 to 12 inches long, and potato chips add fat and more carbohy- drates to the meal.
2. Four (4) slices of pizza contain excessive numbers of carbohydrates, plus cheese and meats, and whole milk is high in fat.
3. Turkey is a low-fat meat. A sandwich usually means normal slices of bread, and the client needs at least 50% carbo- hydrates in each meal. Celery sticks are not counted as carbohydrates.
4. The roast beef sandwich is high in carbohy- drates, fried onion rings are high in fat, and a regular coke is high in carbohydrates.

Question 3

The nurse is preparing to administer sliding-scale insulin to a client with type 2 diabetes. The Medication Administration Record is as follows:

At 1130, the client has a blood glucometer level of 322. Which intervention should the nurse implement?

1. Notify the health-care provider.
2. Administer 10 units of regular insulin.
3. Administer five (5) units of Humalog insulin.
4. Administer 10 units of intermediate-acting insulin.

Answer 3

1. The client’s blood glucose level does not warrant notifying the HCP.
2. According to the sliding scale, any blood glucose reading between 301 and 450 requires 10 units of regular insulin, which is fast-acting insulin.
3. Humalog is rapid-acting insulin, but the order reads regular insulin.
4. Intermediate-acting insulin, NPH or Humulin N, is not regular insulin.

Question 4

Which signs/symptoms should the nurse expect to assess in the 31-year-old client who has a sustained release of growth hormone (GH)?

1. An enlarged forehead, maxilla, and face.
2. A six (6)-inch increase in height of the client.
3. The client complaining of a severe headache.
4. A systolic blood pressure of 200 to 300 mm Hg.

Answer 4

1. Acromegaly (enlarged extremities) occurs when sustained GH hypersecretion begins during adulthood, most commonly because of a pituitary tumor.

2. Gigantism occurs when GH hypersecretion begins before puberty when the closure of the epiphyseal plates occurs. Note the age of the client.
3. A severe headache is not a symptom of acromegaly.
4. High blood pressure is a sign of pheochromocytoma.

Question 5

Which sign/symptom indicates to the nurse the client is experiencing hyperparathyroidism?

1. A negative Trousseau’s sign.
2. A positive Chvostek’s sign.
3. Nocturnal muscle cramps.
4. Tented skin turgor.

Answer 5

1. A carpopedal spasm occurs when the blood flow to the arm is decreased for three (3) minutes with a blood pressure cuff; a posi- tive Trousseau’s sign indicates hypocalcemia, which is a sign of hyperparathyroidism.
2. When a sharp tapping over the facial nerve elicits a spasm or twitching of the mouth, nose, or eyes, the client is hypocalcemic, which occurs in clients with hyperparathyroidism. This is known as a positive Chvostek’s sign.
3. Muscle cramps makes the nurse suspect hypokalemia (low potassium).
4. Tented skin turgor makes the nurse suspect dehydration, which occurs with hypernatremia.

Question 6

Which laboratory data make the nurse suspect the client with primary hyperparathyroidism is experiencing a complication?

1. A serum creatinine level of 2.8 mg/dL.
2. A calcium level of 9.2 mg/dL.
3. A serum triglyceride level of 130 mg/dL.
4. A sodium level of 135 mEq/L.

Answer 6

1. A serum creatinine level of 2.8 mg/dL indicates the client is in renal failure, which is a complication of hyperparathy- roidism. The formation of stones in the kidneys related to the increased urinary excretion of calcium and phosphorus occurs in about 55% of clients with primary hyperparathyroidism and can lead to renal failure.
2. This calcium level is within the normal range of 9.0 to 10.5 mg/dL.
3. This serum triglyceride level is within the normal range of 40 to 150 mg/dL in males and 30 to 140 mg/dL for females.
4. This sodium level is within the normal range of 135 to 145 mEq/L.

Question 7

The nurse is assessing a client in an outpatient clinic. Which assessment data are a risk factor for developing pheochromocytoma?

1. A history of skin cancer.
2. A history of high blood pressure.
3. A family history of adrenal tumors.
4. A family history of migraine headaches.

Answer 7

1. A history of skin cancer is not a risk factor for pheochromocytoma.
2. A history of high blood pressure is a sign of this disease, not a risk factor for developing it.
3. There is a high incidence of pheochromocytomas in family members with adrenal tumors, and the von Hippel- Lindau gene is thought to be a primary cause.
4. Headaches are a symptom of this disease but not a risk factor for it

Question 8

The client is three (3) days postoperative unilateral adrenalectomy. Which discharge instructions should the nurse teach?

1. Discuss the need for lifelong steroid replacement.
2. Instruct the client on administration of vasopressin.
3. Teach the client to care for the suprapubic Foley catheter.
4. Tell the client to notify the HCP if the incision is inflamed.

Answer 8

1. Because the client has one adrenal gland remaining, the client may not need life- long supplemental steroids.
2. Vasopressin is administered to clients with diabetes insipidus.
3. The client does not have a suprapubic catheter during this procedure.
4. Any inflammation of the incision indicates an infection and the client will need to receive antibiotics, so the HCP must be notified.

Question 9

Which psychosocial problem should be included in the plan of care for a female client diagnosed with Cushing’s syndrome?

1. Altered glucose metabolism.
2. Body image disturbance.
3. Risk for suicide.
4. Impaired wound healing.

Answer 9

1. This is not a psychosocial problem; it is a physiological problem in clients diagnosed with Cushing’s syndrome.
2. The client with Cushing’s syndrome has body changes, including moon face, buffalo hump, truncal obesity, hirsutism, and striae and bruising, all of which affect the client’s body image.
3. This is a psychosocial problem, but it is not one which commonly occurs in clients diagnosed with Cushing’s syndrome.
4. This is not a psychosocial problem; it is a physiological problem which does occur in clients diagnosed with Cushing’s syndrome.

Question 10

The nurse is admitting a client to rule out aldosteronism. Which assessment data support the client’s diagnosis?

1. Temperature.
2. Pulse.
3. Respirations.
4. Blood pressure.

Answer 10

1. The temperature is not affected by aldosteronism.
2. The pulse is not affected by this disorder.
3. The respirations are not affected by this disorder.
4. Blood pressure is affected by aldosteronism, with hypertension being the most prominent and universal sign of aldosteronism.

Question 11

Which client history is most significant in the development of symptoms for a client who has iatrogenic Cushing’s disease?

1. Long-term use of anabolic steroids.
2. Extended use of inhaled steroids for asthma.
3. History of long-term glucocorticoid use.
4. Family history of increased cortisol production.

Answer 11

1. Anabolic steroids are used by individuals to build muscle mass. Long-term use can lead to psychosis or heart attacks.
2. Inhaled steroids do not have systemic effects, which is described by iatrogenic Cushing’s disease.
3. Iatrogenic Cushing’s disease is Cushing’s disease caused by medical treatment—in this case, by taking excessive steroids resulting in the symptoms of moon face, buffalo hump, and other associated symptoms.
4. Family history does not cause iatrogenic problems.

Question 12

The client is one (1) hour postoperative thyroidectomy. Which intervention should the nurse implement?

1. Check the posterior neck for bleeding.
2. Assess the client for the Chvostek’s sign.
3. Monitor the client’s serum calcium level.
4. Change the client’s surgical dressing.

Answer 12

1. The incision for a thyroidectomy allows the blood to drain dependently by gravity to the back of the client’s neck. Therefore, the nurse should check this area for hemorrhaging, which is a possible complication of any surgery.
2. The Chvostek’s sign indicates hypocal- cemia, which is too early to assess for in this client.
3. Accidental removal of or damage to the parathyroid glands will not decrease the calcium level for at least 24 hours.
4. Surgeons prefer to change the surgical dressing for the first time.

Question 13

Which signs/symptoms indicate the client with hypothyroidism is not taking enough thyroid hormone?

1. Complaints of weight loss and fine tremors.
2. Complaints of excessive thirst and urination.
3. Complaints of constipation and being cold.
4. Complaints of delayed wound healing and belching.

Answer 13

1. Weight loss and fine tremors make the nurse suspect the client is taking too much thyroid hormone because these are symptoms of hyperthyroidism.
2. Excessive thirst and urination are symptoms of diabetes.
3. If the client were not taking enough thyroid hormone, the client would exhibit symptoms of hypothyroidism such as constipation and being cold.
4. This indicates Cushing’s disease.

Question 14

Which client problem is the nurse’s priority concern for the client diagnosed with acute pancreatitis?

1. Impaired nutrition.
2. Skin integrity.
3. Anxiety.
4. Pain relief.

Answer 14

1. The client is NPO and can live without food for a number of days as long as he or she receives fluids.
2. The client is not on strict bedrest and can move about in the bed; therefore, skin integrity is not a priority problem. In pancreatitis, the tissue damage is internal.
3. The client may be anxious, but psychoso- cial problems are not priority.
4. The client with pancreatitis is in excru- ciating pain because the enzymes are autodigesting the pancreas; severe abdominal pain is the hallmark symptom of pancreatitis.

Question 15

Which laboratory data indicate to the nurse the client’s pancreatitis is improving?

1. The amylase and lipase serum levels are decreased.
2. The white blood cell count (WBC) is decreased.
3. The conjugated and unconjugated bilirubin levels are decreased.
4. The blood urea nitrogen (BUN) serum level is decreased.

Answer 15

1. These laboratory data are used to diagnose and monitor pancreatitis because amylase and lipase are the enzymes produced by the pancreas.
2. Pancreatitis is not an infection of the pancreas resulting from bacteria; such an infection causes an elevation in the WBCs.
3. Bilirubin is used to monitor liver problems.
4. BUN monitors kidney function.

Question 16

The client diagnosed with acute pancreatitis has a ruptured pseudocyst. Which procedure should the nurse anticipate the HCP prescribing?

1. Paracentesis.
2. Chest tube insertion.
3. Lumbar puncture.
4. Biopsy of the pancreas.

Answer 16

1. A paracentesis is used to remove fluid from the abdominal cavity.
2. The pancreas lies immediately below the diaphragm. When the cyst ruptures, alkaline substances in the abdomen cause fluid leaks at the esophageal diaphragmatic opening into the thorax. The fluid must be removed to prevent lung collapse.
3. Lumbar puncture is used to diagnose meningitis.
4. Biopsies are performed to confirm a diag- nosis; they are not used for treatment.

Question 17

Which signs/symptoms should the nurse expect to assess in the client diagnosed with an insulinoma?

1. Nervousness, jitteriness, and diaphoresis.
2. Flushed skin, dry mouth, and tented skin turgor.
3. Polyuria, polydipsia, and polyphagia.
4. Hypertension, tachycardia, and feeling hot.

Answer 17

1. Insulinoma is a tumor of the islet cells of the pancreas that produces insulin. The signs/symptoms of an insulinoma are signs of hypoglycemia.
2. These are signs/symptoms of hyperglycemia.
3. These are signs/symptoms of hyperglycemia.
4. These are signs/symptoms of hyperthyroidism.

Question 18

Which risk factor should the nurse expect to find in the client diagnosed with pancreatic cancer?

1. Chewing tobacco.
2. Low-fat diet.
3. Chronic alcoholism.
4. Exposure to industrial chemicals.

Answer 18

1. A history of smoking cigarettes is perti- nent, but a history of chewing tobacco is not.
2. A diet high in fat, not low in fat, is a risk factor.
3. Chronic alcoholism is not a risk factor, but chronic pancreatitis is a risk factor.
4. Exposure to industrial chemicals or environmental toxins is a risk factor for pancreatic cancer.

Question 19

The nurse is discussing the endocrine system with the client. Which endocrine gland secretes epinephrine and norepinephrine?

1. The pancreas.
2. The adrenal cortex.
3. The adrenal medulla.
4. The anterior pituitary gland.

Answer 19

1. The endocrine function of the pancreas is the secretion of insulin and amylin.
2. The adrenal cortex secretes mineralocorti- coids, glucocorticoids, and gonadotrophins.
3. The adrenal medulla secretes the catecholamines epinephrine and norepinephrine.
4. The anterior pituitary gland secretes the growth hormone.

Question 20

Which question should the nurse ask when assessing the client for an endocrine dysfunction?

1. “Have you noticed any pain in your legs when walking?”
2. “Have you had any unexplained weight loss?”
3. “Have you noticed any change in your bowel movements?”
4. “Have you experienced any joint pain or discomfort?”

Answer 20

1. Leg pain when walking indicates intermit- tent claudication, which occurs with peripheral vascular disease.
2. Weight loss with normal appetite may indicate hyperthyroidism.
3. Changes in bowel movements may indicate colon cancer.
4. Joint pain indicates a musculoskeletal or degenerative joint disease.

Question 21

Which nursing instruction should the nurse discuss with the client who is receiving glucocorticoids for Addison’s disease?

1. Discuss the importance of tapering medications when discontinuing medication.
2. Explain the dose may need to be increased during times of stress or infection.
3. Instruct the client to take medication on an empty stomach with a glass of water.
4. Encourage the client to wear clean white socks when wearing tennis shoes.

Answer 21

1. The client will have to receive this medication the rest of his or her life, so this should not be discussed with the client.
2. During times of stress, the medication may need to be increased to prevent adrenal insufficiency.
3. The medication should be taken with food to minimize its ulcerogenic effect.
4. Wearing white socks with tennis shoes is not an intervention pertinent to a client diagnosed with Addison’s disease.

Question 22

The client with chronic alcoholism has chronic pancreatitis and hypomagnesemia. Which data should the nurse assess when administering magnesium sulfate to the client?

1. Deep tendon reflexes.
2. Arterial blood gases.
3. Skin turgor.
4. Capillary refill time.

Answer 22

1. If deep tendon reflexes are hypoactive or absent, the nurse should hold the magnesium and notify the health-care provider.
2. The arterial blood gases are not affected by the serum magnesium level.
3. The client’s skin turgor will not be affected by the client’s serum magnesium level.
4. The client’s capillary refill time is not affected by the client’s serum magnesium level.

Question 23

Which endocrine disorder should the nurse assess for in the client who has a closed head injury with increased intracranial pressure?

1. Pheochromocytoma.
2. Diabetes insipidus.
3. Hashimoto’s thyroiditis.
4. Gynecomastia.

Answer 23

1. This is a tumor of the adrenal medulla.
2. Diabetes insipidus can be caused by brain tumors or infections, pituitary surgery, cerebrovascular accidents, or renal and organ failure, or it may be a complication of a closed head injury with increased intracranial pressure. Diabetes insipidus is a result of antidiuretic hormone (ADH) insufficiency.
3. Hashimoto’s thyroiditis causes hypothyroidism.
4. Gynecomastia is abnormal enlargement of breast tissue in men.

Question 24

Which sign/symptom should the nurse expect in the client diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)?

1. Excessive thirst.
2. Orthopnea.
3. Ascites.
4. Concentrated urine output.

Answer 24

1. Excessive thirst is a symptom of diabetes insipidus, which is a deficiency of antidi- uretic (ADH) hormone.
2. Orthopnea is difficulty breathing when in the supine position, which is not a sign/ symptom of SIADH.
3. Ascites is excess fluid in the peritoneal cavity, which is not a sign/symptom of SIADH.
4. Excess antidiuretic hormone (ADH) causes SIADH, which causes increased water reabsorption and leads to increased fluid volume and scant, concentrated urine.

Question 25

In which area should the nurse administer the regular insulin to ensure the best absorption of the medication?

1. A
2. B
3. C
4. D

Answer 25

1. The anterior thigh is an appropriate area, but it does not provide the best absorption.
2. The abdominal area allows for the most rapid absorption of insulin and is the recommended site.
3. The deltoid is an appropriate area, but it does not provide the most rapid absorption.
4. The gluteal buttocks area is primarily the best area for intramuscular injections.

Question 26

The client diagnosed with type 1 diabetes mellitus received regular insulin
two (2) hours ago. The client is complaining of being jittery and nervous. Which interventions should the nurse implement? List in order of priority.

1. Call the laboratory to confirm blood glucose level.
2. Administer a quick-acting carbohydrate.
3. Have the client eat a bologna sandwich.
4. Check the client’s blood glucose level at the bedside.
5. Determine if the client has had anything to eat.

Answer 26

In order of performance: 5, 2, 4, 1, 3.

5. Regular insulin peaks in 2 to 4 hours; therefore, the nurse should suspect a hypoglycemic reaction if the client has not eaten anything.
6. The antidote for insulin is glucose; therefore, the nurse should give the client some type of quick-acting food source.
7. The nurse should obtain the client’s blood glucose level as soon as possible; this can be done with a glucometer at the bedside.
8. Most hospitals require a confirmatory serum blood glucose level. Do not wait for results to give food.
9. A source of long-acting carbohydrate and protein should be given to prevent a reoccurrence of hypoglycemia.

Question 27

The nurse in the intensive care unit is caring for a client 20 hours postoperative Whipple’s procedure for cancer of the pancreas who has two intravenous lines running via a central catheter and one unit of packed red blood cells in a peripheral line. The client’s intake and output record from the previous day is as follows:

Based on these findings, which action should the nurse implement?

1. Slow down the intravenous rates and notify the HCP immediately.
2. Assess the client for change in sensorium daily and stay in the room.
3. Continue to assess intake and output every one (1) hour.
4. Increase the blood rate to infuse rapidly and crossmatch for two (2) more units.

Answer 27

1. The IV rates are preventing the client from developing hypovolemic shock due to third spacing after a major abdominal surgery. The ICU nurse must be vigilant for third spacing and fluid shifts following major trauma to the body.
2. The sensorium must be assessed more frequently than daily, and the nurse does not have to remain with the client continuously.
3. The intake and output should be assessed hourly to determine kidney perfusion and to determine when the fluids have stopped shifting to the surgical area.
4. There is no evidence that the client has begun to bleed and requires faster infusion and another crossmatch.