Unit XIV

Endocrine Disorders

Critical Concepts

Definitions and Characteristics

Assessment & Pathophysiology
Diagnostic Procedures
Pituitary Gland Disorders
Thyroid Disorders
Parathyroid Disorders
Adrenal Gland Disorders
Diabetes mellitus
Pharmacology: Drugs Affecting the Endocrine System
Insulin and Oral Hypoglycemic Drugs

Identification

Identify what is described in each statement.

1. A hyperglycemic hormone produced by the beta-cells of the islets of Langerhans of the

pancreas. ______________________________

2. A term given to a child affected with hypothyroidism. _________

3. A chemical substance produced by glands that control metabolic activities of a cell.

________________________________________

4. It is also known as a thyroid storm. ________________________

5. Male sex hormones produced by the adrenal glands. ___________

6. The most common cause of Addison’s disease. _______________

7. A phenomenon seen among diabetic patients characterized by rebound hyperglycemia.

___________________________________

8. It is needed in the conversion of inactive vitamin D3 in the skin to its active form of
vitamin D. ________________________________

9. A complication of insulin therapy characterized by abnormal fat accumulation in tissues.

___________________________________

10. It is a hormone produced by the hypothalamus that stimulates secretion of

adrenocorticotropic hormone (ACTH). _____________
_______________________________________________________

True or False
Write T if the statement is true and F if it is false.

_____ 1. Thyroid stimulating hormone (TSH) is produced by the posterior pituitary gland.

_____ 2. Patients with Cushing’s syndrome are prone to fluid and electrolyte imbalances.

_____ 3. Vanillylmandelic acid (VMA) is a metabolite of epinephrine and is used in

diagnosing tumors of the adrenal cortex.

_____ 4. Goiter is a manifestation of hyperthyroidism.

_____ 5. Abrupt discontinuation of steroids after prolonged use predisposes to Addison’s

disease.

_____ 6. Under the normal biologic rhythm, blood sugar is usually higher in the evening than
early in the morning.

_____ 7. Type I diabetes mellitus is more prone to develop ketoacidosis.

_____ 8. Insulin may be administered intravenously.

_____ 9. Myocardial infarction is a microvascular complication of diabetes mellitus.

_____ 10.Cretinism is a form of hyperthyroidism.

Matching Type

Match Column A with Column B.

Set A. Hormones & Gland of Origin

Column A Column B
Hormone Gland of Origin

_____ 1. Glucocorticoids A. thyroid gland

_____ 2. Anti-diuretic hormone B. adrenal medulla
_____ 3. Epinephrine C. pancreas
_____ 4. Glucagon D. adrenal cortex
_____ 5. Calcitonin E. hypothalamus

Set B. Hormones and their Functions or Effects

Column A Column B
Hormone Function / Effect

_____ 1. InsulinA. promotes sodium and water retention

_____ 2. Aldosterone B. increases blood sugar levels
_____ 3. Thyroxine C. regulates basal metabolism
_____ 4. Glucagon D. facilitates entry of glucose into the cells
_____ 5. Parathormone E. regulates calcium homeostasis

Set C. Endocrine Disorder and Hormonal Imbalance

 Column A Column B
Diagnosis Hormonal Imbalance

_____ 1. Cushing’s disease A. low thyroxine levels

_____ 2. Addison’s disease
_____ 3. Hashimoto’s disease
_____ 4. Pheochromocytoma
_____ 5. Cushing’s syndrome
hormone
B. high cortisol levels
C. low aldosterone levels
D. high epinephrine level
E. high adreno corticotropic

Set D. Endocrine Disorders and Medical Treatment

Column A Column B
Diagnosis Medical Treatment

_____ 1. Grave’s disease A. Levothyroxine (Synthroid)

_____ 2. Diabetes mellitus B. Calcium gluconate
_____ 3. Addison’s disease C. Rosiglitazone (Avandia)
_____ 4. Hypothyroidism D. Hydrocortisone (Solu-medrol)
_____ 5. Hypoparathyroidism E. Methimazole (Tapazole)

Set E. Endocrine Disorders and Medical Treatment

Column A Column B
Diagnosis Medical Treatment

_____ 1. Hyperinsulinism A. DDAVP (Desmopressin)

_____ 2. Hyperparathyroidism B. Glucagon
_____ 3. Diabetes insipidus C. Metoprolol (Lopressor)
_____ 4. Pheochromocytoma D. Thyrocalcitonin
_____ 5. SIADH E. Fluid restriction

Set F . Pathophysiology: Diabetes Mellitus

Column A Column B
Manifestations Pathophysiology

_____ 1. Polyuria A. fat catabolism

_____ 2. Polyphagia B. osmotic diuresis due to hyperglycemia
_____ 3. Polydipsia C. protein catabolism
_____ 4. Weight loss D. compensatory increase in appetite
_____ 5. Ketoacidosis E. activation of thirst mechanism due to
polyuria

Set G. Pathophysiology: Thyroid Disorders

Column A Column B
Manifestations Pathophysiology

_____ 1. Constipation A. increased basal metabolic rate due to

_____ 2. Weight loss excessive thyroid hormone level
_____ 3. Cold intolerance B. decreased basal metabolic rate due to
_____ 4. Tachycardia inadequate hormone level
_____ 5. Edema
Set H. Pathophysiology: Adrenal Gland Disorders

Column A Column B
Manifestations Pathophysiology

_____ 1. Dehydration A. abnormal fat distribution

_____ 2. Buffalo’s hump B. excessive level of epinephrine
_____ 3. Frequent infections C. lack of aldosterone
_____ 4. Hypertension D. altered cellular integrity
_____ 5. Easy bruisability E. immunosuppression

Set I. Pathophysiology: Pituitary Disorders

Column A Column B
Manifestations Pathophysiology

_____ 1. Visual problems A. jaw enlargement r/t increased growth _____ 2. Prognathism
hormone
_____ 3. Hirsutism B. excessive hair growth r/t high steroid _____ 4. Gigantism
level
_____ 5. Galactorrhea C. rapid bone growth r/t high growth
hormone
D. pressure on the optic disc r/t growing
pituitary tumor
E. increased secretion of breast milk r/t
increased prolactin levels

* r/t means related to

Set J. Pathophysiology: Parathyroid Disorders

Column A Column B
Manifestations Pathophysiology

_____ 1. Trousseau’s sign A. facial muscle twitching r/t

_____ 2. Back pain
_____ 3. Epigastric pain
_____ 4. Fractures
_____ 5. Chvostek’s sign
hypercalcemia
hypercalcemia
parathyroid hormone level
hypocalcemia
B. carpo-pedal spasms r/t to
hypocalcemia
C. kidney stone formation r/t
D. increased gastric acids r/t
E. rapid bone resoprtion r/t high

Set K. Laboratory Results I

Column A Column B
Diagnosis Laboratory Results
_____ 1. Addison’s disease
_____ 2. Cushing’s syndrome
_____ 3. Diabetic ketoacidosis
_____ 4. Hypothyroidism
_____ 5. Hyperthyroidism
A. low TSH, high T3 & T4
B. high TSH, low T3 & T4
C. hypernatremia, hypokalemia
D. hyponatremia, hyperkalemia
E. hyperglycemia, ketonemia

Set L. Laboratory Results II

Column A Column B
Diagnosis Laboratory Results

_____ 1. Pheochromocytoma A. increased ACTH level

_____ 2. Diabetes insipidus B. hyperglycemia, glycosuria
_____ 3. Diabetes mellitus C. decreased urine specific gravity
_____ 4. Cushing’s disease D. increased vanillyl mandelic acid
_____ 5. Tetany E. reduced calcium level

Set M. Medical Terminology

Column A Column B
Medical Term Definition

_____ 1. ExophthalmosA. enlargement of the bones

_____ 2. Prognathism B. excessive hair growth
_____ 3. Hirsutism C. protrusion of the eyeballs
_____ 4. Catabolism D. protrusion of the jaw
_____ 5. Acromegaly E. breakdown to simpler substances

Multiple Choice

Choose the letter of the BEST answer.

_____ 1. Which of the following hormones is stored in the posterior pituitary gland?
A. follicle-stimulating hormone (FSH)
B. anti-diuretic hormone (ADH)
C. thyroid stimulating hormone (TSH)
D. corticotropin releasing factor (CRF)

_____2. A physiologic effect of luteinizing hormone (LH) is stimulation of

A. bone and muscle growth
B. sperm production in males
C. corpus luteum development
D. contraction of pregnant uterus

_____3. Hypofunctioning of the pituitary gland can lead to

A. syndrome of inappropriate diuretic hormone
B. acromegaly
 C. Cushing’s disease
D. diabetes insipidus

_____4. A patient prescribed of Bromocriptine, a dopamine antagonist, most probably has a

diagnosis of
A. thyroid tumors
B. tumor of the adrenal gland
C. pituitary tumor
D. pancreatic tumor

_____5. A patient is prepared for a fluid deprivation test. The nurse knows that this is used in
the diagnosis of
A. diabetes insipidus
B. Cushing’s syndrome
C. pheochromocytoma
D. syndrome of inappropriate anti-diuretic hormone

_____ 6. Which of the following data from a patient’s history is a risk factor of Type 1
diabetes mellitus? The patient
A. is 10 kilograms overweight.
B. loves to eat sweets.
C. has an active lifestyle.
D. has a previous Coxsackie virus infection

_____7. A patient asks the nurse how obesity is a risk for diabetes mellitus. The nurse
explains that obesity is a risk factor for non-insulin dependent diabetes mellitus because it:
A. reduces workload on the pancreatic cells
B. increases production of glucagon
C. leads to insulin resistance
D. enhances glucose utilization

_____8. The nurse conducts a diabetic teaching to a newly diagnosed patient and states that
the normal blood glucose level is:
A. 50-70 mg/dl
B. 70-110 mg/dl
C. 110-150 mg/dl
D. 150-180 mg/dl

_____9. A patient tells the nurse that she read an online journal about glucose being spilled
in the urine among diabetic patients. The nurse informs the patient that glucose is not excreted
by the kidneys unless it is higher than:
A. 110 mg/dl
B. 150 mg/dl
C. 180 mg/dl
D. 200 mg/dl

_____10. The nurse assessing a newly admitted patient notes for the cardinal signs of diabetes
mellitus which are:
A. polydipsia, polyuria, polyphagia
B. paralysis, pain, pallor
C. paresthesia, poikilothermia, pressure
D. paraplegia, pulselessness, ptosis

_____11. In a diabetic screening program, the public health nurse tells the outpatients that
diabetes is considered if they have a fasting blood sugar of more than:
 A. 70 mg.dl
B. 110 mg/dl
C. 126 mg/dl
D. 140 mg/dl

_____12. The nurse reviews the pathophysiology of diabetes mellitus and recalls that insulin
A. promotes cellular glucose uptake and utilization
B. facilitates the breakdown of fats and proteins to provide glucose
C. enhances the catabolism of glycogen from the liver and skeletal muscles
D. prevents excess glucose from forming into glycogen

_____13. A diabetic patient is found unconscious. The nurse notes that the patient’s skin is
flushed and dry, respirations are deep and rapid, and she can smell acetone on the patient’s
breath. The nurse anticipates for prompt management of
A. hypoglycemia
B. diabetic ketoacidosis
C. hyperosmolar hyperglycemic non-ketotic coma
D. Somogyi phenomenon

_____14. A novice nurse recalls that the most common route of insulin administration is:
A. oral
B. intramuscular
C. subcutaneous
D. intradermal

_____15. The patient is tired of receiving insulin injections and asks the nurse why she cannot
take insulin by mouth. The nurse’s correct response is:
A. “Insulin is best absorbed if given as an injection.”
B. “The acids in the stomach destroy insulin.”
C. “The physician’s order is to give it as an injection.”
D. “Insulin can cause nausea and vomiting if taken by mouth.”

_____16. Which of the following statements best describes type 2 diabetes mellitus?
A. It is also called insulin-dependent diabetes mellitus.
B. Most patients have an onset before the age of 40 years.
C. This type of diabetes is prone to ketoacidosis.
D. Diet and exercise are usually effective for this type of diabetes.

_____17. The nurse is making her assessments on a patient who received rapid-acting insulin
in the past 2 hours. The nurse notes that the patient is manifesting signs and symptoms of
hypoglycemia if the patient exhibits:
A. Tachycardia, acetone odor of the breath, Kussmaul’s respiration
B. Tremors, cold clammy skin, diaphoresis
C. Bradycardia, blurred vision, nervousness
D. Warm dry skin, tachycardia, confusion

_____18. A patient is on a sliding scale insulin. Which of the following medications is usually
given on a sliding scale?
A. Novolin 70/30
B. Regular
C. Humulin N
D. NPH

_____19. A patient is prescribed 15 units of Lispro q HS. The nurse knows that Lispro is an
example of which type of insulin?
 A. Intermediate-acting insulin
B. Long-acting insulin
C. Rapid-acting insulin
D. Short-acting insulin

_____20. A nursing intervention that can prevent the development of lipodystrophy is to:
A. Administer cold insulin
B. Rotate injection sites
C. Massage the injection site after giving insulin
D. Administer insulin in the morning

_____21. A patient is admitted to the ER with hyperosmolar, hyperglycemic non-ketotic

coma with a blood glucose level of 1,250 mg/dl. To treat severe hyperglycemia, the physician
orders insulin intravenously. The only type of insulin that can be given intravenously is
A. Semi-Lente
B. NPH
C. Isophane
D. Regular

_____22. A patient is prescribed NPH insulin 32 U SC and Regular insulin 8 U SC daily. In

preparing these, the nurse should use
A. Two separate insulin syringes
B. An insulin syringe, drawing regular insulin first
C. An insulin syringe, drawing NPH insulin first
D. A 1-cc syringe, drawing regular insulin first

_____23. The nurse is preparing to administer 30 units of Humulin 70/30. What does
Humulin 70/30 mean?
A. It has 70% Regular insulin and 30% NPH insulin
B. It has 70 units/mL of Regular and 30 units/mL of NPH
C. It has 70% NPH insulin and 30% regular insulin
D. It has 30 units of Regular and 70 units of NPH per vial.

_____24. The nurse administered 6 units of Regular insulin before the patient took his
breakfast at 0800. At what time should the nurse assess for hypoglycemic reaction?
A. 0800-1000
B. 1000-1200
C. 1200-1400
D. 1400-1600

_____25. An unconscious diabetic patient is receiving continuous tube feeding at 45 cc/hr and
blood sugar checks q6h. At 0600, the patient’s blood sugar is 65 mg/dl. The nurse
observes that the patient is diaphoretic, tachycardic and has cold clammy skin. The nurse’s
action is appropriate if she
A. Administers 4 oz of orange juice orally
B. Mixes 4 oz of orange juice on her feeding bag
C. Gives 25 ml of Dextrose 50% intravenously
D. Administers regular insulin per sliding scale

_____26. The nurse doing a discharge teaching session for a diabetic patient explains that
insulin requirements decrease if the patient:
A. is pregnant
B. has an infection
C. is under stress
D. engages in exercise
_____27. A patient with type 2 diabetes is taking Glipizide (Glucotrol), a second generation
Sulfonylurea. Sulfonyureas decrease blood sugar by
A. Facilitating the entry of glucose into the cells
B. Promoting glucose uptake and utilization
C. Stimulating the pancreas to produce insulin
D. Decreasing glucose absorption in the intestines

_____28. A patient is experiencing hypoglycemia several hours after receiving insulin. Which
of the following medications is used in treating insulin- induced hypoglycemia?
A. Glucagon
B. Metformin (Glucophage)
C. Glyburide (DiaBeta)
D. Glipizide (Glucotrol)

_____29. Diabetic ketoacidosis (DKA) is one of the acute complications of diabetes mellitus.
Which of the following nursing actions is appropriate on a ketoacidotic patient?
A. Administer Regular insulin IV, as ordered.
B. Offer 4 oz of orange juice and check blood sugar in 15-30 minutes.
C. Administer Metformin (Glucophage) po, if ordered
D. Assess for hypoglycemia and rapid shallow breathing.

_____30. A nurse injects 40 units of NPH to a patient before breakfast at 0800. The nurse
knows that she will assess her patient for hypoglycemic reactions before
A. lunchtime
B. supper
C. bedtime
D. breakfast the following day

_____31. A diabetic patient is taking multiple medications for her other chronic medical
problems. Which of these medications may increase her blood sugar level?
A. Dexamethasone (Decadron)
B. Acetylsalicylic acid (Aspirin)
C. Metoprolol (Lopressor)
D. Chlorpropamide (Diabinese)

_____32. The nurse is correct in administering an insulin injection if she

A. uses a 1-ml syringe with a 25 gauge needle
B. injects the medication at a 45 degree angle
C. pulls the skin towards the side before giving the injection
D. massage the injection site vigorously after administering the injection

_____33. A patient is prescribed Pioglitazone (Actos). The nurse knows that this medication
is used in the management of:
A. hyperinsulinism
B. diabetes mellitus
C. ketoacidosis
D. hypoglycemia

_____34. A diabetic patient suddenly complains of blurred vision, becomes confused, has
tremors and cold clammy skin. This may be related to which of the following? The patient
A. has a blood sugar level of 55 mg/dl
B. has a urine output of 1,500 mL in the previous shift
C. took a slice of cake and a bottle of soft drinks with lunch
D. has a temperature of 37.4 C
_____35. Which of the following patient statements indicate the most risk for developing
diabetic ketoacidosis (DKA)?
A. “I’ve been in a lot of work-related stress lately.”
B. “I’m very susceptible to respiratory tract infections at this time of the year.”
C. “I usually forget if I have taken my insulin so I sometimes give myself an
extra dose to catch up with my schedule.”
D. “I don’t feel like eating when I wake up in the morning.”

_____36. A patient who has been diabetic for 15 years develops neuropathy. Which of the
following home care instructions will best prevent injury?
A. “Trim your toenails and in-growns every week to prevent toe infections.”
B. “Take hot shower on your own to promote self-care and independence.
C. “Make sure to clean the floor regularly before walking barefoot.”
D. “Inspect inside your shoes before wearing them.”

_____37. Kimmelsteil-Wilson syndrome is as a chronic micro vascular complication of

diabetes mellitus that affects the
A. glomerular basement membrane of the kidneys
B. small blood vessels of the eyes
C. peripheral and autonomic nerves
D. contractility of the myocardial fibers

_____38. Which statement made by the patient regarding insulin requirements in relation to
exercise needs further teaching?
A. “I may not need to take more insulin if I exercise.”
B. “I need less insulin if I remain active with my exercise regimen.”
C. “I need to take insulin before exercising.”
D. “I need to eat something before an active workout.”

_____39. The nurse in the community is planning a teaching session and incorporates
researches about conventional forms of diabetic management. Initial studies have shown that
which native food sources help reduce blood sugar?
A. ampalaya and tilapia
B. malunggay and milkfish (bangus)
C. alugbati and catfish (hito)
D. camote leaves and chicken

_____40. A patient is diagnosed of Grave’s disease. The nurse assesses for the hallmarks of
Grave’s disease which include:
A. hypertension, tachycardia and cardiomegaly
B. hyperthyroidism, goiter, exophthalmos
C. hypothyroidism, goiter, exophthalmos
D. hypermetabolism, myxedema, bradycardia

_____41. The nurse would expect that a patient with hyperthyroidism will exhibit
A. weight gain
B. constipation
C. hypotension
D. heat intolerance

_____42. The physician prescribes Propylthiouracil to a patient with hyperthyroidism. Which

of the following statements made by the patient needs clarification?
A. “This medicine blocks the synthesis of thyroid hormone.”
B. “I may be prone to develop infections while using this medication.”
 C. “I should expect my basal metabolism to increase with this
medication.”
D. “I hope my thyroid hormones will start to decrease as I take this
medicine.”

_____43. Weeks prior to surgery for an enlarged thyroid gland (goiter), the physician orders
potassium iodide saturated solution (KISS) for which purpose?
A. to reduce the amount of circulating thyroid hormones
B. to stimulate production of thyroid hormones
C. to reduce the size and vascularity of the thyroid gland
D. to prevent hypersensitivity reaction to anesthesia

_____44. Which of the following information gathered in the patient’s history strongly
predisposes to goiter?
A. The patient’s mother has parathyroid hormone imbalance.
B. The patient is 5 kilograms underweight.
C. The patient lives in a remote village in the mountains.
D. The patient had a total thyroidectomy 10 years ago.

_____45. The nurse admitting a patient with hyperthyroidism should place the patient in
which of the following rooms?
A. a semi-private room near the nurse’ station
B. a private room at the end of the hallway
C. an open ward far from the nurse’s station
D. a private room near the nurse’s station

_____46. Which of the following types of diet should be planned for a patient with Grave’s
disease?
A. high-calorie, low-residue diet
B. high-calorie, high-residue diet
C. low-calorie, low-residue diet
D. low-calorie, high-residue diet

_____47. The nurse’s action is appropriate if she does which of the following to promote
comfort in a patient with hypothyroidism?
A. Place the patient’s bed near the opened windows.
B. Arrange to have an electric fan for the patient’s use.
C. Offer extra sheets or blankets to the patient.
D. Encourage the patient to take a bath twice a day.

_____48. The nurse taking care of a patient taking Propylthiouracil reviews the laboratory
results and should notify the physician of the presence of
A. agranulocytosis
B. leukocytosis
C. hemolysis
D. halitosis

_____49. The priority nursing diagnosis for a teenage patient with goiter will most likely be
A. Acute pain related to enlarged thyroid gland
B. Alteration in nutrition: less than body requirements related to
difficulty swallowing
C. Knowledge deficit: disease process related to developmental
stage
D. Altered elimination: diarrhea related to increased metabolism
_____50. Which of the following assessment findings would be inconsistent with the
diagnosis of hypothyroidism?
A. weight gain
B. constipation
C. generalized edema
D. hypertension

_____51. A patient with prolonged hyperthyroidism can develop which cardiovascular

complication?
A. coronary artery disease
B. heart failure
C. orthostatic hypotension
D. cardiomyopathy

_____52. The nurse taking care of a patient after thyroidectomy identifies the priority nursing
diagnosis as:
A. Altered tissue integrity related to surgical incision
B. Pain related to surgical incision
C. Ineffective airway clearance related to post-operative swelling
D. Altered nutrition: less than body requirements related to surgery

_____53. Which of the following observations will make the nurse suspect of bleeding
in a post-thyroidectomy patient?
A. The patient’s blood pressure increases and pulse rate decreases.
B. The surgical dressing has a scant amount of sero- sanguineous
drainage
C. The patient is swallowing frequently.
D. The patient is drowsy and has slow shallow respirations.

_____54. During the post-operative period for thyroidectomy, the nurse observes muscle
twitching on the patient’s arms as the blood pressure is being taken. This may likely be an
indication of:
A. hypocalcemia caused by accidental removal of the parathyroid
glands
B. hypothermia due to the temperature inside the recovery room
C. respiratory alkalosis due to inability to perform deep breathing
exercises
D. seizures related to effects of general anesthesia and narcotics

_____55. The nurse assesses for myxedema coma which can occur as a complication of:
A. hypothyroidism
B. hyperthyroidism
C. goiter
D. thyrotoxicosis

_____56. The nurse should question the physician if the hypothyroid patient is prescribed
which of the following medications?
A. Lorazepam (Ativan)
B. Acetaminophen (Tylenol)
C. Levothyroxine sodium (Synthroid)
D. Levostatin (Lipitor)

_____57. To reduce swelling on the post-operative site in a thyroidectomy patient, the most
appropriate independent nursing intervention is to:
A. provide cold drinks during the immediate post-operative period
 B. position the patient on semi-Fowler’s
C. administer corticosteroids
D. provide humidified oxygen

_____58. Metoprolol (Lopressor) 100 mg po bid is ordered to a patient with hyperthyroidism

for which purpose?
A. to treat tachycardia
B. to reduce thyroid hormone level
C. to slow down metabolism
D. to prevent corneal abrasions

_____59. To prevent eye injury in a patient with exophthalmos related to Grave’s disease, the
nurse should:
A. tape the eye shut with gauze
B. encourage the patient to blink frequently
C. apply ordered methylcellulose eye drops
D. offer the use of sunglasses at all times

_____60. The nurse asks the post-thyroidectomy patient to speak at 30-60 minute intervals
and notes voice quality. This is done to assess:
A. swelling in the throat
B. damage to the laryngeal nerve
C. airway obstruction
D. impending hemorrhage

_____61. The patient’s family asks the nurse the cause of Cushing’s disease. The nurse
responds by saying that Cushing’s disease is caused by:
A. stimulation of the adrenal cortex due to a pituitary tumor
B. overproduction of hormones caused by adrenal tumor
C. deficiency of glucocorticoids
D. hypofunctioning of the adrenal medulla

_____62. The nurse manager reviews a new nurse’s care plan for a patient with Cushing’s
syndrome. Which of the following nursing diagnosis formulated by the new nurse is
inconsistent with Cushing’s syndrome?
A. Fluid volume excess
B. Risk of blood glucose imbalance: hyperglycemia
C. Risk of infections and poor wound healing
D. Risk for electrolyte imbalance related to fluid loss

_____63. Which of the following sets of laboratory results is an expected electrolyte

imbalance among patients with Cushing’s syndrome ?
A. sodium-154, potassium-3.1, glucose-250
B. sodium-148; potassium-3.8; glucose - 150
C. sodium-129; potassium - 7.1; glucose - 200
D. sodium - 120; potassium - 3.4; glucose - 75

_____64. Appropriate nursing intervention for a patient with Cushing’s syndrome includes:
A. Monitor vital signs for the likelihood of hypotension.
B. Encourage to have adequate intake of high-calorie and potassium-rich
foods.
C. Provide adequate skin care and prevent exposure to persons with
infections.
D. Advise patient to take steroid medications as prescribed.
_____65. Patient’s with Cushing’s syndrome will most likely benefit from the administration
of
A. Aminoglutethemide
B. Fludrocortisone acetate
C. Calcium gluconate
D. Intravenous dextrose solution

_____66. The priority nursing diagnosis of a patient with Addison’s disease is

A. Altered nutrition: less than body requirements
B. Fluid volume deficit
C. Risk of blood glucose imbalance: hyperglycemia
D. Altered body image

_____67. The most common cause of Addison’s disease is

A. overuse of steroids
B. autoimmune
C. pituitary tumor
D. tumor of the adrenal gland

_____68. The nurse encourages a patient with Addison’s disease to have an adequate intake
of which types of diet?
A. high-sodium, high-calorie, low-potassium diet
B. low-sodium, high-calorie, high-potassium diet
C. high-sodium, low-calorie, high-potassium diet
D. low-sodium, low-calorie, low-potassium diet

_____69. A patients is rushed to the emergency department due to Addisonian crisis. A

priority intervention for this patient is to:
A. perform an emergency adrenalectomy
B. administer intravenous insulin
C. infuse large amounts of intravenous fluids
D. give medications for lower back pain

_____70. A patient with Addison’s disease undergoes laboratory test which involves the
administration of corticotropin-releasing factor (CRF) and observation on the response to the
test. A positive result if the patient has primary adrenal insufficiency is (Select all that apply):
A. an increase in cortisol level
B. no increase in cortical level
C. a decrease in cortical level
D. an increase in adrenocroticortopic hormone (ACTH)
E. a decrease in adrenocorticotropic hormone (ACTH)
F. no change in adrenocorticitropic hormone (ACTH)

_____71. Patients with Addison’s disease are most likely prescribed which of the following
medications except:
A. Prednisolone (Prednisone)
B. Hydrocortisone (Cortisol)
C. Desoxycorticosterone
D. Hydromorphone (Dilaudid)

_____72. When evaluating effectiveness of health teaching on a patient receiving medications

for treating Addison’s disease, which of the following nursing instructions verbalized by the
patient needs to be clarified?
A. “I need to take this pill on an empty stomach.”
B. “I will see my physician if I see blood in my stools.”
 C. “I need to stop the medication only as ordered and on a tapered dose.”
D. “I may experience elevations in my blood sugar while taking these
pills.”

_____73. A diabetic patient returns to the clinic to determine how well the blood sugar level
was maintained in the past 2-3 months. Which of the following blood sugar tests will achieve
that purpose?
A. Glycosylated hemoglobin (HA1C)
B. Fasting blood sugar (FBS)
C. Post-prandial blood sugar (PPBS)
D. Oral glucose tolerance test (OGTT)

_____74. A patient is admitted due to diabetic ketoacidosis (DKA). Which of the following
electrolyte imbalances is likely to occur?
A. hypernatremia
B. hyperkalemia
C. hypocalcaemia
D. hypokalemia

_____75. Patients on diabetic ketoacidosis (DKA) will more likely exhibit the
following changes in their arterial blood gases (ABG):
A. pH - 7.56, pCO2 - 60 mmHg, HCO3 - 35 meq/L
B. pH - 7.40, pCO2 - 44 mmHg, HCO3 - 24 meq/L
C. pH - 7.34, pCO2 - 50 mmHg, HCO3 - 22 meq/L
D. pH - 7.25, pCO2 - 30 mmHg, HCO3 - 19 meq/L

_____76. A pregnant mother has gestational diabetes mellitus (GDM). She asks the nurse
about the cause and effects of gestational diabetes to her pregnancy and its possible treatment.
The nurse is accurate if she responds:
A. “GDM usually stays even after pregnancy.”
B. “Patients with GDM has different set of manifestations compared to
patients with the regular type of diabetes.” C. “There is an urgent need to limit
nutritional intake to control your blood sugar during pregnancy.”
D. “Hormones produced during pregnancy counteracts the effects of
insulin.”

_____77. A baby is born from a diabetic mother. Which of the following findings made
during newborn assessment is consistent with the effects of diabetes to newborns? The baby
A. has an Apgar score of 8.
B. is macrosomic.
C. is alert and stares.
D. has increased amount of vernix caseosa.

_____78. A patient presents to the emergency department with pheochromocytoma. Which of

the following assessment findings is consistent with this diagnosis?
A. hypertension and hyperglycemia
B. hypotension and hypoglycemia
C. hypertension and hypoglycemia
D. hypotension and hyperglycemia

_____79. After an adrenalectomy to treat pheochromocytoma, the most important nursing

responsibility is to
A. monitor the patient’s vital signs every 15 minutes for at least an hour
B. offer medications to relieve severe pain as needed
C. accurately document urine output every hour
 D. perform blood glucose checks every hour

_____80. Laboratory results of a patient with pheochromocytoma will reveal:

A. high vanillylmandelic acid and epinephrine levels
B. elevated epinephrine and decreased blood glucose levels
C. decreased vanillylmandelic acid and epinephrine levels
D. decreased epinephrine and low blood sugar levels

_____81. A patient with a pituitary tumor underwent a transsphenoidal hypophysectomy. The

nurse cautiously monitors the patient’s urine output and urinary specific gravity (USG).
Which of the following assessment data alerts the nurse for an impending diabetes insipidus?
A. urine output of 240 cc for 8 hours, USG 1.015
B. urine output of 500 cc for 4 hours, USG of 1.010
C. urine output of 1000 cc for 12 hours, USG of 1.008
D. urine output of 2000 cc for 8 hours, USG of 1.002

_____82. The nurse recognizing the patient is at risk if diabetes insipidus should do which of
the following interventions?
A. Regulate the intravenous fluid at KVO rate.
B. Provide clear liquids at the bedside at all times.
C. Auscultate the lungs and listen for moist crackles.
D. Monitor the vital signs for any increase in blood pressure.

_____83. The nurse expects the physician to order which of the following medications for a
patient with diabetes insipidus?
A. Doxorubicin
B. Desmopressin acetate
C. Dexamethasone
D. Doxycycline

_____84. Which of the following discharge instructions would be most helpful to a patient
who underwent transnasal hypophysectomy?
A. “Blow your nose often to promote nasal drainage.”
B. “Always take your prescribed hormonal replacements.”
C. “Fever is expected and is normal after surgery.”
D. “Lifting objects is allowed to a maximum 10 kilograms.”

_____85. A patient with suspected pituitary tumor presents to a neurosurgeon at the early
stage of the disease. The patient is expected to have a chief complaint of:
A. changes in vision
B. confusion
C. hemorrhage
D. paraplegia

_____86.The nurse should monitor a patient with diabetes insipidus for the possible
development of
A. dehydration
B. hypertension
C. pulmonary edema
D. hemorrhage
_____87. A patient who underwent a major surgery is prone to develop syndrome of
inappropriate antiduretic hormone (SIADH). This condition occurs as a result of:
A. failure to produce anti-diuretic hormone
B. excessive release of anti-diuretic hormone
C. removal of the hypothalamus which produces the anti- diuretic hormone
 D. a negative feedback mechanism in response to fluid overload during
surgery

_____88. The nurse recalls that patients who have undergone cranial surgery may exhibit
syndrome of inappropriate anti diuretic hormone (SIADH) post-operatively. The nurse recalls
that the pathophysiology of SIADH involves an
A. increased sodium and water retention in the kidneys
B. increased water reabsorption from the renal tubules
C. decreased sodium and water excretion from the kidneys
D. decreased water reabsorption from the renal tubules

_____89. The priority nursing diagnosis of patients with syndrome of inappropriate anti-
diuretic hormone is:
A. Fluid volume excess
B. Fluid volume deficit
C. Risk for electrolyte imbalance: hypernatremia
D. Altered urinary elimination: frequency

_____90. A patient with increased levels of the hormone prolactin is expected to present with
A. hirsutism
B. galactorrhea
C. amenorrhea
D. menorrhagia

_____91. A nurse in the medical unit is assigned 4 patients. Which of the following patients
will the nurse assess first?
A. a 23-year old newly diagnosed of diabetes mellitus
B. a 34-year old scheduled for thyroidectomy in the morning
C. a 45-year old admitted for pheochromocytoma
D. a 54-year old for blood draw to assess Cushing’s disease

_____92. The nurse in the general medicine ward is responsible for 4 patients in her shift.
Which of the following patients should be discharged first?
A. a 17-year old with juvenile diabetes in acute exacerbation with glucose of
250 mg/dl
B. a 24-year old who had a subtotal thyroidectomy the previous day
C. a 34-year old who returned to the unit after bilateral adrenalectomy
D. a 49-year old who had diabetes insipidus with a urine specific gravity of 1.015
two days after hypophysectomy

_____93. The charge nurse is making the day’s patient assignment using team nursing as a
mode of nursing care delivery. Which of the following activities can be delegated to the
nursing assistant?
A. Assess the level of consciousness of a patient who is admitted due to
myxedema coma.
B. Gather information regarding medications on a newly admitted patient
with goiter.
C. Reposition a patient who just had thyroidectomy.
D. Check the blood sugar of a diabetic patient.

_____94. The charge nurse will assign which of the following patients to the most
experienced medical-surgical nurse?
A. a 6-year old with diabetic ketoacidosis
B. a 24-year old with goiter scheduled for thyroidectomy
C. a 45-year old who had transsphenoidal hypophysectomy
 D. a 65-year old who needs diabetic foot care
_____95. A nurse plans for the diet of a patient with thyroid hormone deficiency. Which of
the following should be included since it is essential in the synthesis of thyroid hormones?
A. iodine
B. iron
C. vitamin D
D. zinc

______96. The nurse should assess a child diagnosed with a deficiency in thyroid hormone
for significant alterations in
A. bone growth
B. glucose metabolism
C. brain development
D. calcium metabolism

_____97. Which of the following reflects the function of parathyroid hormone?

A. reduced calcium absorption from the kidneys
B. increased calcium absorption from the digestive tract
C. decreased bone resorption
D. increased blood phosphorus level

_____98. A patient with hyperparathyroidism is at risk for

A. bone infections
B. seizures
C. renal stones
D. respiratory obstruction

_____99. The nurses assesses Chvostek’s sign in a patient with tetany by

A. tapping the facial muscle in front of the ears
B. occluding the arm with a blood pressure cuff
C. pressing the abdomen
D. checking deep tendon reflexes
_____100. The most appropriate management for hypercalcemic crisis in a patient with
hyperparathyroidism is
A. bed rest
B. hydration therapy
C. administration of calcium gluconate
D. nutritional counseling

_____101. Arrange the following steps, from numbers 1-5, to describe the proper technique
of insulin administration.
_____ Aspirate the plunger and observe for blood return.
_____ Grasp a fold of skin on the abdomen.
_____ Apply pressure on the injection site.
_____ Inject the medication at a 45-degree angle.
_____ Clean the skin with an alcohol pad.

_____102. The nurse preparing 2 insulin medications, 4 units of Regular insulin and 10 units
of NPH insulin, in 1 insulin syringe should perform the following steps in which sequence?
Arrange the steps from 1-4.
_____ Inject air into the clear vial.
_____ Aspirate 4 units of Regular insulin.
_____ Aspirate 10 units of NPH insulin.
_____ Inject air into the cloudy vial.
_____103. A patient on diabetic ketoacidosis is ordered fluid therapy of NS+20 KCl 1 liter to
run for 4 hours. How should the nurse regulate the intravenous fluid rate if the drop factor of
the IV set is 15 gtts/mL?
_____________________ gtts/min

_____104. The nurse carefully monitors a patient on insulin drip and checks the patient’s
blood sugar every
A. 15-30 minutes
B. 1-2 hours
C. 4-6 hours
D. 6-8 hours

_____105. Identify the letter that corresponds to the site that is most commonly used for
insulin administration.

_____106. A nurse is monitoring the patient’s vital signs after thyroidectomy. The nurse
should anticipate an order of which of the following medications at the bedside?
A. Potassium chloride
B. Calcium gluconate
C. Epinephrine hydrochloride
D. Heparin sodium

_____107. A nurse is doing a discharge teaching to a patient with hypothyroidism regarding

his home medication, Levothyroxine (Synthroid). The nurse should instruct the patient to
A. increase oral fluid intake
B. take the medication at night
C. monitor the pulse regularly
D. assess weight weekly

_____108. The nurse knows that a diabetic patient’s blood sugar has been in good control for
the past 3 months if she sees which of the following laboratory values?
A. Fasting blood sugar of 105 mg/dl
B. Post-prandial blood sugar of 140 mg/dl
C. Random blood glucose of 110 mg/dl
D. Glycosylated hemoglobin of 6%

_____109. The nurse giving discharge instructions to a patient with Cushing’s syndrome
should emphasize the need for a diet that is
A. high in calories
B. low in potassium
C. high in fiber
 D. low in sodium

_____110.A patient is admitted due to thyrotoxicosis. Which of the following assessments

support this diagnosis? The patient
A. has a serum cholesterol of >200 mg/dl
B. complains of increased sensitivity to cold
C. has a pulse rate of 145 beats per minute
D. is lethargic and confused