ENDOCRINE DISORDERS

Prepared by: Professor Mike Chavez RN, USRN

1. The client is performing an admission assessment on a client who has been diagnosed
with, diabetes insipidus. Which of the following findings should the nurse expect to note
during the assessment?
Select all that applies:
a. Extreme polyuria
b. Excessive thirst
c. Elevated systolic blood pressure
d. Low urine specific gravity
e. Bradycardia
f. Elevated serum potassium level

2. A client with severe head trauma sustained in a car accident is admitted to the
intensive care unit. Thirty-six hours later, the client's urine output suddenly rises above
200 ml/hour, leading the nurse to suspect diabetes insipidus. Which laboratory findings
support the nurse's suspicion of diabetes insipidus?
a. Above-normal urine and serum osmolality levels
b. Below-normal urine and serum osmolality levels
c. Above-normal urine osmolality level, below-normal serum osmolality level
d. Below-normal urine osmolality level, above-normal serum osmolality level

3. In reviewing the assessment data of a client suspected of having diabetes insipidus,

the nurse expects which of the following after a water deprivation test?
a. Increased edema and weight gain
b. Unchanged urine specific gravity
c. Rapid protein excretion
d. Decreased blood potassium

4. Which of the following the nurse carry out first when taking care for a patient with
Diabetes Insipidus?
a. Monitor Intake and Output
b. Administer IV fluids
c. Administer Desmopressin
d. Check for urine specific gravity

5. A client with primary diabetes insipidus is ready for discharge on desmopressin

(DDAVP). Which instruction should the nurse provide?
a. “Administer desmopressin while the suspension is cold."
b. "Your condition isn't chronic, so you won't need to wear a medical identification
bracelet."
c. "You may not be able to use desmopressin nasally if you have nasal discharge or
blockage."
d. "You won't need to monitor your fluid intake and output after you start taking
desmopressin."
6. Which of the following outcomes would indicate successful treatment of diabetes
insipidus?
a. Fluid intake of less than 2,500 ml in 24 hours
b. Urine output of more than 200 ml/hour
c. Blood pressure of 90/50 mm Hg
d. Pulse rate of 126 beats/minute

7. Which of the following would indicate that a client has developed water intoxication
secondary to treatment for diabetes insipidus?
a. Confusion and seizures
b. Sunken eyeballs and spasticity
c. Flaccidity and thirst
d. Tetany and increased blood urea nitrogen (BUN) levels.

8. A client is admitted for treatment of the syndrome of inappropriate antidiuretic

hormone (SIADH). Which nursing intervention is appropriate?
a. Infusing I.V. fluids rapidly as ordered
b. Encouraging increased oral intake
c. Restricting fluids
d. Administering glucose-containing I.V. fluids as ordered

9. A client who suffered a brain injury after falling off a ladder has recently developed
syndrome of inappropriate antidiuretic hormone (SIADH). What findings are effective?
Select all that applies:
a. Decrease in body weight
b. Rise in blood pressure and drop in heart rate
c. Absence of wheezes in the lungs
d. Increase urine output
e. Decrease in urine osmolarity

10. A client is diagnosed with syndrome of inappropriate antidiuretic hormone

(SIADH). The nurse informs the client that the physician will prescribe diuretic therapy
and restrict fluid and sodium intake to treat the disorder. If the client does not comply
with the recommended treatment, which complication may arise?
a. Cerebral edema
b. Hypovolemic shock
c. Severe hyperkalemia
d. Tetany

11. Which of these signs suggests that a client with the syndrome of inappropriate
antidiuretic hormone (SIADH) secretion is experiencing complications?
a. Tetanic contractions
b. Neck vein distention
c. Weight loss
d. Polyuria

12. A client is diagnosed with the syndrome of inappropriate antidiuretic hormone

(SIADH). The nurse should anticipate which laboratory test result?
a. Decreased serum sodium level
b. Decreased serum creatinine level
c. Increased hematocrit
d. Increased blood urea nitrogen (BUN) level
13. The nurse is teaching a client with non-insulin dependent diabetes mellitus about
the prescribed diet. The nurse should teach the client to
a. Maintain previous calorie intake
b. Keep a candy bar available at all times
c. Reduce carbohydrates intake to 25% of total calories
d. Keep a regular schedule of meals and snacks

14. The nurse has been teaching a client with Insulin Dependent Diabetes Mellitus.
Which statement by the client indicates a need for further teaching?
a. "I use a sliding scale to adjust regular insulin to my sugar level."
b. "Since my eyesight is so bad, I ask the nurse to fill several syringes."
c. "I keep my regular insulin bottle in the refrigerator."
d. "I always make sure to shake the NPH bottle hard to mix it well."

15. A client with a new diagnosis of diabetes mellitus is referred for home care. A
family member present expresses concern that the client seems depressed. The nurse
should initially focus assessment by using which approach?
a. The results of a standardized tool that measures depression
b. Observation of affect and behavior
c. Inquiry about use of alcohol
d. Family history of emotional problems or mental illness

16. At a senior citizens meeting a nurse talks with a client who has diabetes mellitus
Type 1. Which statement by the client during the conversation is most predictive of a
potential for impaired skin integrity?
a. "I give my insulin to myself in my thighs."
b. "Sometimes when I put my shoes on I don't know where my toes are."
c. "Here are my up and down glucose readings that I wrote on my calendar."
d. "If I bathe more than once a week my skin feels too dry."

17. During a class on exercise for diabetic clients, a client asks the nurse educator
how often to exercise. The nurse educator advises the clients to exercise how often to
meet the goals of planned exercise?
a. At least once a week
b. At least three times a week
c. At least five times a week
d. Every day

18. A client, age 23, is diagnosed with diabetes mellitus. The physician prescribes 15
U of U-100 regular insulin and 35 U of U-100 isophane insulin suspension (NPH) to be
taken before breakfast. The nurse checks the medication order, assembles equipment,
washes hands, rotates the NPH insulin vial, puts on disposable gloves, and cleans the
stoppers. To draw the two insulin doses into the single U-100 insulin syringe, which
sequence should the nurse use?
a. Inject 35 U air into NPH vial; inject 15 U air into regular insulin vial, withdraw 15
U regular insulin; withdraw 35 U NPH.
b. Inject 15 U air into regular insulin vial; inject 35 U air into NPH vial, withdraw 35
U of NPH; withdraw 15 U regular insulin.
c. Inject 15 U air into regular insulin vial, withdraw 15 units of regular insulin;
inject 35 U air into NPH vial and withdraw 35 U NPH.
 d. Inject 35 U air into NPH vial; inject 15 U air into regular insulin vial; withdraw 35
U NPH; withdraw 15 U regular insulin.

19. The nurse is assigned to care for a postoperative client who has diabetes
mellitus. During the assessment interview, the client reports that he's impotent and says
he's concerned about its effect on his marriage. In planning this client's care, the most
appropriate intervention would be to:
a. Encourage the client to ask questions about personal sexuality.
b. Provide time for privacy.
c. Provide support for the spouse or significant other.
d. Suggest referral to a sex counselor or other appropriate professional.

20. A client has just been diagnosed with type 1 diabetes mellitus. When teaching
the client and family how diet and exercise affect insulin requirements, the nurse should
include which guideline?
a. "You'll need more insulin when you exercise or increase your food intake."
b. "You'll need less insulin when you exercise or reduce your food intake."
c. "You'll need less insulin when you increase your food intake."
d. "You'll need more insulin when you exercise or decrease your food intake."

21. A client is evaluated for type 1 diabetes mellitus. Which client comment
correlates best with this disorder?
a. "I'm thirsty all the time. I just can't get enough to drink."
b. "It seems like I have no appetite. I have to make myself eat."
c. "I have a cough and cold that just won't go away."
d. "I notice pain when I urinate."

22. A client is taking glyburide (DiaBeta), 1.25 mg P.O. daily, to treat type 2
diabetes mellitus. Which statement indicates the need for further client teaching about
treatment of this disease?
a. "I always carry hard candy to eat in case my blood sugar level drops."
b. "I avoid exposure to the sun as much as possible."
c. "I always wear my medical identification bracelet."
d. "I often skip lunch because I don't feel hungry."

23. For a client in addisonian crisis, it would be very risky for a nurse to administer:
a. potassium chloride.
b. normal saline solution.
c. hydrocortisone.
d. fludrocortisone.

24. The nurse is explaining the action of insulin to a newly diagnosed diabetic client.
During the teaching, the nurse reviews the hypoglycemic reaction of insulin after it is
injected in the morning. The nurse is correct when stating that NPH peak effect is with
in:
a. 7 in the morning
b. 10 in the morning
c. 5 in the afternoon
d. 7 in the evening
 25. A 55-year-old diabetic client is admitted with hypoglycemia. Which information
should the nurse include in her client teaching?
Select all that applies:
a. Hypoglycemia can result from excessive alcohol consumption
b. Skipping meals can cause hypoglycemia
c. Symptoms of hypoglycemia include thirst and excessive urinary output
d. Strenuous activity may result in hypoglycemia
e. Symptoms of hypoglycemia include shakiness, confusion, and headache
f. Hypoglycemia is relatively harmless situation.

26. The nurse teaches a diabetic client that diet plays a crucial role in managing
diabetes mellitus. When evaluating dietary intake, the nurse knows the client is eating
the right foods if total daily caloric intake consists of:
a. 30% to 35% carbohydrate, 40% fat, and 25% to 30% protein.
b. 40% to 45% carbohydrate, 40% fat, and 15% to 20% protein.
c. 50% to 55% carbohydrate, 35% fat, and 10% to 15% protein.
d. 55% to 60% carbohydrate, 30% fat, and 10% to 15% protein.

27. The nurse is performing a physical assessment on a client with insulin dependent
diabetes mellitus. Which client complaint calls for immediate nursing action?
a. Diaphoresis and shakiness
b. Reduced lower leg sensation
c. Intense thirst and hunger
d. Painful hematoma on thigh

28. Which serum blood finding with diabetic ketoacidosis alerts the nurse that
immediate action is required?
a. pH below 7.3
b. Potassium of 5.0
c. HCT of 60
d. Pa O2 of 79%

29. A client with type 2 diabetes mellitus needs instructions proper foot care. Which
of the following instructions should the nurse include in client teaching?
a. be sure to use scissors to trim toenails
b. wear cotton socks
c. apply foot powder after bathing
d. go barefoot only when you know your home environment
e. see a podiatrist regularly to have your feet checked
f. wear loose-fitting shoes

30. A 55-year-old diabetic client is admitted with hypoglycemia. Which information

should the nurse include in her client teaching?
a. Hypoglycemia can result from excessive alcohol consumption
b. Skipping meals can cause hypoglycemia
c. Symptoms of hypoglycemia include thirst and excessive urinary output
d. Strenuous of activity can result to hypoglycemia
e. Symptoms of hypoglycemia include shakiness, confusion, and headache
f. Hypoglycemia is a relatively harmless situation
31. The nursing assessment of a client recently diagnosed with hypothyroidism
reveals the most common clinical manifestations of hypothyroidism which are:
a. Increased body temperature, tachycardia, and fatigue
b. Increased sluggishness, increased cold intolerance, puffy eyelids, hands and feet
c. Nervousness, rapid pulse and increased perspiration
d. Progressive weight loss, changes in bowel function, bulging eyes

32. On an intake physical, the nurse questions the patient with diabetes insipidus
(DI) about the classic symptoms of that disease, which are:
a. tachycardia, extreme thirst and weakness.
b. massive diuresis, hypertension, and excitability.
c. stress incontinence, vomiting, and edema.
d. bradycardia, insomnia, and muscle cramps.

33. The nurse explains to the patient admitted for the evaluation of SIADH
(syndrome of inappropriate antidiuretic hormone) that the medical treatment plan would
include:
a. strict enforcement of fluid restriction.
b. administration of vasopressin.
c. hypertonic IV solutions.
d. large doses of water-soluble vitamins.

34. The patient with Addison’s disease asks why she must take aldosterone. The
nurse clarifies that the drug will:
a. increase cardiac output.
b. regulate the excretion of potassium and sodium.
c. decrease the level of cortisol.
d. lower the blood sugar level.

35. The nurse caring for a patient with Addison’s disease suspects adrenal crisis
when the patient exhibits:
a. hypertension and abdominal pain.
b. confusion and tachycardia.
c. bradycardia and nausea.
d. widening pulse pressure and shortness of breath

36. The long-term asthmatic patient develops Cushing’s syndrome. The nurse
explains that this condition is probably the result of:
a. his taking corticosteroids for many years.
b. an abrupt withdrawal of cortisone therapy
c. the lack of adrenocorticotropic hormone related to his pituitary gland.
d. poorly functioning adrenal glands.

37. The hallmark findings that you would expect to see when assessing a patient
with Cushing’s syndrome would be:
a. edema of the trunk, extremities, and face and dark pigmentation of the skin
b. wasting of the abdomen with thick, calloused skin.
c. excess adipose tissue in the trunk, slender extremities, and “moon” face.
d. high levels of potassium and low levels of sodium, weakness, and wasting.
38. The nurse evaluates no need for further instruction for self-care for the patient
with Cushing’s syndrome who states:
a. “I know I should add salt to everything I eat.”
b. “I make a point to avoid excessive exposure to sun.”
c. “I avoid being exposed to anyone with an infection.”
d. “I am careful to wear well-fitting shoes.”

39. Discharge planning for a postoperative hypophysectomy patient would be

focused on:
a. finding a support group.
b. nutritional maintenance.
c. education on self-care.
d. self-image improvement.

40. The nurse making a care plan for a 10-year-old boy with hyperpituitarism
identifies a disturbed self-image. The nursing diagnosis she would add to the nursing
care plan would best be stated as “Disturbed self-image” related to:
a. lack of facial hair.
b. excessive height.
c. small genitalia.
d. skin eruptions on face.

41. A young woman makes an appointment to see a physician at the clinic. She
complains of tiredness, weight gain, muscle aches and pains, and constipation. The
physician will likely order:
a. T3 and T4 serum level laboratory tests.
b. glucose tolerance test.
c. cerebral computed tomography (CT) scan.
d. adrenocortical stimulating test.

42. The patient with hyperthyroidism complains of fatigue, but still cannot get to
sleep. The nurse suggests:
a. taking “cat naps” during the day.
b. adhering to a bedtime ritual.
c. drinking a cup of cocoa before bedtime.
d. mild pre-bedtime exercising.

43. The patient with Graves’ disease asks the nurse for additional information
regarding this disease. The nurse responds:
a. “Your thyroid gland is not sending out enough hormones, and so you will need
replacement hormones.”
b. “Your thyroid gland is overactive. There are ways to treat it—through medicine
or surgery.”
c. “It’s an autoimmune disorder—just the same as diabetes and multiple sclerosis.”
d. “Your doctor will be able to answer all your questions. It’s best to ask him.”

44. The nurse is caring for a client who just had a thyroidectomy and is at risk for
hypocalcemia. The nurse should:
a. Monitor laboratory values daily for an elevated thyroid-stimulating hormone.
b. Observe for swelling of the neck, tracheal deviation, and severe pain.
c. Evaluate the quality of the client's voice postoperatively, noting any drastic
changes.
 d. Observe for muscle twitching and numbness or tingling of the lips, fingers, and
toes.

45. The nurse would anticipate that the patient with hyperparathyroidism would
exhibit:
a. fatigue, hyperactive reflexes, muscle cramps, twitching.
b. poor muscle tone, bone pain, hypertension, fractures.
c. hunger, thirst, frequent urination.
d. tachycardia, air hunger, nervousness.

46. The patient who is being treated for hyperparathyroidism is receiving calcitonin.
The action of this hormone is to:
a. promote excretion of calcium in the urine.
b. promote calcium absorption from the gastrointestinal (GI) tract.
c. inhibit release of calcium from the bones.
d. help in the excretion of kidney stones.

47. The nurse explains that type 1 diabetes mellitus is a disease in which the body
does not produce enough insulin so the blood glucose is elevated because of:
a. prolonged elevation of stress hormone levels (cortisol, epinephrine, glucagon,
growth hormone).
b. malfunction of the glycogen-storing capabilities of the liver.
c. destruction of the beta cells in the pancreas.
d. insulin resistance of the receptor cells of the muscle tissue.

48. When a newly diagnosed type 2 diabetes mellitus patient asks the nurse why she
has to take a pill instead of insulin, you reply that in type 2 diabetes, the body makes
insulinbut:
a. overweight and underactive people simply cannot use the insulin produced.
b. metabolism is slowed in some people so they have to take a pill to speed up
their metabolism.
c. sometimes the autoimmune system works against the action of the insulin.
d. the cells become resistant to the action of insulin. Pills are given to increase the
sensitivity.

49. A patient tells the nurse that she eats “huge” amounts of food but stays hungry
most of the time. The nurse explains that hunger experienced by persons with type 1
diabetes is caused by the:
a. excess amount of glucose
b. need for additional calories to correct the increased metabolism.
c. fact that the cells cannot use the blood glucose.
d. need for exercise to stimulate insulin secretion.

50. When the type 2 diabetic patient says, “Why in the world are they looking at my
hemoglobin? I thought my problem was with my blood sugar.” The nurse responds that
the level of hemoglobin A1c:
a. shows how a high glucose level can cause a significant drop in the hemoglobin
level.
b. shows what the glucose level has done for the last 3 months.
c. indicates a true picture of the patient’s nutritional state.
d. reflects the effect of high glucose levels on the ability to produce red blood cells.
51. The patient with type 2 diabetes shows a blood sugar reading of 72 at 6 a.m.
Based on the reading of 72, the nurse should:
a. Do nothing since this is normal
b. Give regular insulin per sliding scale.
c. Give him ½ cup of orange juice.
d. Administer the oral hyperglycemic tablet.

52. The nurse assigned to care for a patient with diabetic ketoacidosis (DKA) is
aware that this is a life-threatening condition that results in:
a. the inability of carbohydrates, fats, and proteins to be metabolized.
b. the storage of glycogen, so that there is a severe shortage of glucose in the
bloodstream.
c. dangerously elevated pH and bicarbonate levels in the blood.
d. severe hypoglycemia, which can result in coma and convulsions.

53. A patient has come into the emergency room with her friend. Her friend states
that she had been acting very strangely and confused. The friend states that the patient
has diabetes and takes insulin. The nurse knows that signs and symptoms of
hypoglycemia include:
a. slow pulse rate and low blood pressure.
b. irritability, anxiety, confusion, and dizziness.
c. flushing, anger, and forgetfulness.
d. sleepiness, edema, and sluggishness.

54. A patient has come to the doctor’s office after finding out that her blood glucose
level was 135 mg/dL. She states that she had not eaten before the test and was told to
come and see her doctor. She asks if she has diabetes. The nurse responds:
a. “Having a fasting serum glucose that high certainly indicates diabetes.”
b. “That test indicates that we need to do more tests that are specific for diabetes.”
c. “How do you feel? Do you have any other signs of diabetes?”
d. “Do you have a family history of diabetes, stroke, or heart disease? We need to
know before making a diagnosis.”

55. The type 1 diabetic patient has an insulin order for NPH insulin, 35 U, to be
given at 7 a.m. The patient is also NPO for laboratory work that will not be drawn until
10 AM. The nurse should:
a. Give the insulin as ordered.
b. Give the insulin with a small snack.
c. Inform the charge nurse.
d. Hold the insulin until after the blood draw.