ENDOCRINE SYSTEM COMPREHENSIVE EXAMINATION
ANSWERS AND RATIONALES
1. 1. This is a false statement, and the nurse
should investigate any type of alternative
treatment before making this statement.
2. Licorice is a flavoring for candy, but it
is also used as an herbal medication in
tablet, tea, or tincture form. Licorice
increases the aldosterone effect, which
helps treat Addison’s disease.
3. This is an aggressive-type judgmental ques-
tion, and the client does not owe the nurse
an explanation.
4. Licorice is used to treat mouth ulcers; it
does not cause them.
MEDICATION MEMORY JOGGER: Some
herbal preparations are effective, some
are not, and a few can be harmful or even
deadly. If a client is taking an herbal sup-
plement and a conventional medicine, the
nurse should investigate to determine if the
herbal preparation will cause harm to the
client. The nurse should always be the cli-
ent’s advocate.
2. 1. Spironolactone (Aldactone) is a potas-
sium-sparing diuretic. Hyperaldoste-
ronism causes hypokalemia, metabolic
alkalosis, and hypertension. Spirono-
lactone, a potassium-sparing diuretic,
normalizes potassium levels in clients
with hyperaldosteronism within 2 weeks;
therefore, a normal potassium level,
which is 4.2 mEq/L, indicates the medi-
cation is effective.
2. The urinary output is not used to determine
the effectiveness of this medication in a
client with hyperaldosteronism.
3. The client does have hypertension, but this
blood pressure is above normal limits and
does not indicate the medication is effective.
4. The serum sodium level is not used to
determine the effectiveness of this medica-
tion in a client with hyperaldosteronism.
MEDICATION MEMORY JOGGER: The nurse
determines the effectiveness of a medi-
cation by assessing for the symptoms, or
lack thereof, for which the medication was
prescribed.
3. 1. The major symptom with DI is polyuria
resulting in polydipsia (extreme thirst);
therefore, the client not being thirsty indi-
cates the medication is effective.
2. The client being able to sleep through the
night indicates that he or she is not getting
6924_Ch06_157-186.indd 183
up to urinate because of polyuria and, thus,
that the medication is effective.
3. Desmopressin (DDAVP) is the pituitary
antidiuretic hormone. A weight gain of
4.4 pounds indicates the client is experi-
encing water intoxication, which indicates
the client is receiving too much medica-
tion and the HCP should be notified.
4. The client urinating 20 to 30 times a day
indicates the medication is ineffective;
therefore, the nurse should notify the
HCP.
5. The client is well hydrated; therefore, this
data does not warrant intervention.
MEDICATION MEMORY JOGGER: If the
client verbalizes a symptom, if the nurse
assesses data, or if laboratory data indicates
an adverse effect secondary to a medication,
the nurse must intervene. The nurse must
implement an independent intervention or
notify the HCP because medications can
result in serious or even life-threatening
complications.
4. 1. Mucolytic medications are administered
to help liquefy thick, tenacious secre-
tions characteristic of CF.
2. Postural drainage and chest percussion
help cough up mucus from the lungs.
3. The child would not receive cough suppres-
sants (antitussives) because the thick, tena-
cious secretions need to be expectorated,
not suppressed.
4. Eventually the beta cells will become
clogged as a result of the thick, tenacious
secretions in the pancreas, but this would
not be a problem in the initial stage after
diagnosis.
5. The thick, tenacious secretions clog the
pancreatic ducts, resulting in a decrease
of the pancreatic enzymes amylase
and lipase in the small intestines. The
mother must administer these enzymes
with every meal or snack to ensure
digestion of carbohydrates and fats.
5. 1. This is not an expected side effect and is
caused by the conjugated estrogen tab-
lets (Premarin), an estrogen replacement
hormone stimulating the hypothalamus to
produce prolactin. The estrogen dosage
must be adjusted or discontinued.
2. Abdominal cramping is a symptom asso-
ciated with menses and the client does
183
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 184 PHARMACOLOGY SUCCESS
not have a uterus; therefore, this is not an
appropriate question.
3. The breast discharge is unrelated to sexual
intercourse.
4. Conjugated estrogen tablets (Premarin)
is an estrogen replacement hormone.
The medication should be stopped until
the HCP can be seen because this war-
rants a dosage adjustment or permanent
discontinuation. The estrogen stimulates
the hypothalamus to produce prolactin,
which causes the breast milk.
6. 1. The child has grown a little more than
1 inch (2.54 cm equals 1 inch). Because
the child has been prescribed the growth
hormone to increase growth, this would
indicate that the medication is effective and
no intervention on the part of the nurse is
needed.
2. These are side effects of steroid therapy, not
growth hormones.
3. Somatropin (Humatrope) is a human
growth hormone. Growth hormone is
diabetogenic; therefore, any signs of dia-
betes mellitus, such as polyuria, polydip-
sia, and polyphagia, should be reported
to the HCP immediately. These are the
three Ps of diabetes mellitus.
4. The nurse must know the normal parame-
ters for children (T 97.5°F to 98.6°F), so a
temperature of 99.4°F would not warrant
notification of the HCP. Normal pulse rate
is 70 to 110 bpm, respiratory rate is 16 to 22,
systolic blood pressure is 83 to 121, and dia-
stolic blood pressure is 43 to 79. These vital
signs do not warrant notifying the HCP.
7. 1. Thyroid hormones, not ACTH, would
increase the client’s metabolism.
2. Adrenocorticotropic hormone (ACTH/
Acthar), a pituitary hormone, is admin-
istered as an adrenal stimulant when the
pituitary gland is unable to perform this
function. This medication will cause the
absorption of sodium and cause edema;
therefore, the client should decrease salt
intake.
3. This medication may decrease the client’s
growth.
4. This medication causes abnormal menses.
8. 1. Levothyroxine (Synthroid) is a thyroid
hormone. If the thyroid medication is
effective, the client’s metabolism should
be within normal limits, and this pulse
and blood pressure support this.
2. These vital signs are subnormal, indicating
hypothyroidism.
6924_Ch06_157-186.indd 184
3. A stool every 4 days indicates constipation
and constipation is a sign of hypothyroid-
ism. This indicates the medication is not
effective.
4. Six to eight hours of sleep would be normal.
Three hours would indicate hyperactivity,
which is a sign of hyperthyroidism. Perhaps
a dosage adjustment in the medication is
needed.
9. 1. Glyburide (Micronase) is a sulfonylurea.
The sulfonylureas stimulate beta-cell
production of insulin. Clients diagnosed
with type 1 diabetes have no function-
ing beta cells; therefore, they cannot be
stimulated. The nurse should question
administering this medication.
2. Furosemide (Lasix) is a loop diuretic. The
client with syndrome of inappropriate antid-
iuretic hormone secretion (SIADH) would
be receiving a loop diuretic to decrease
excess fluid volume.
3. Morphine is a narcotic analgesic. Clients
diagnosed with pancreatitis have a great
deal of pain from the auto-digestion of their
pancreas.
4. A client with type 2 diabetes is often pre-
scribed insulin during times of stress or
illness.
MEDICATION MEMORY JOGGER: The nurse
must be knowledgeable about accepted
standards of practice for disease processes
and conditions. If the nurse administers a
medication the HCP has prescribed and it
harms the client, the nurse could be held
accountable. Remember, the nurse is a
client advocate.
10. 1. Because the client is NPO for the test, the
insulin should be held.
2. Because the client is NPO for the test,
the insulin should be held. In addition,
the nurse cannot prescribe medication or
change the dosage.
3. Metformin (Glucophage), a biguanide,
has a potential side effect of producing
lactic acid. When it is administered
simultaneously or within a close time
span of the contrast dye used for the
CT scan, lactic acidosis could result. It
is recommended to hold the medication
prior to and up to 48 hours after the
scan. The HCP should obtain blood
urea nitrogen (BUN) and creatinine
levels to determine kidney function
prior to restarting Glucophage.
7/11/18 4:35 PM

4. Insulin should be held when the client
is NPO, and Glucophage will be held
because of the contrast dye.
MEDICATION MEMORY JOGGER: Any time
the client is having a diagnostic test the
nurse should question administering any
medication.
11. 1. Constipation does not determine the effec-
tiveness of Pancrease.
2. Pancreas enzymes (Pancrease) are
replacements for the enzymes normally
produced by the pancreas. Steatorrhea
(fatty, frothy, foul-smelling stools) or
diarrhea indicate a lack of pancreatic
enzymes in the small intestines. This
would indicate the dosage is too small
and needs to be increased.
3. Urine output does not determine effective-
ness of Pancrease.
4. An increase in midepigastric pain is a
symptom of peptic ulcer disease (PUD) or
GERD and does not indicate the effective-
ness of the pancreatic enzyme. The client
with chronic pancreatitis may have abdom-
inal pain, but the pancreatic enzymes are
administered for digestion of food, not to
alleviate pain.
12. 1. Prednisone is a glucocorticoid medica-
tion, which affects the glucose metabo-
lism; therefore, the nurse should expect
the glucose level to be altered.
2. Sodium is not affected by prednisone.
3. Calcium is not affected by prednisone.
4. Creatinine is not affected by prednisone.
13. 1. Prednisone is very irritating to the
stomach and must be taken with food
to avoid gastritis or peptic ulcer disease.
2. To avoid adrenal insufficiency or Addi-
sonian crisis, the client must taper the
medication.
3. Prednisone does not cause photosensitivity.
4. Because the prednisone is used short term
for treating poison ivy, the blood glucose
level would not need to be monitored.
5. Green, leafy vegetables are high in vitamin
K and would be contraindicated in antico-
agulant treatment with Coumadin, but not
with prednisone treatment.
14. 1. PTU is an antithyroid medication and the
client has had the thyroid gland removed.
2. The client must take the thyroid hormone
daily or the client will experience signs of
hypothyroidism.
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CHAPTER 6 ENDOCRINE SYSTEM 185
3. Because the client’s thyroid has been
removed, the client now has hypo-
thyroidism and must take a thyroid
replacement daily for the rest of his or
her life.
4. The thyroid level is checked by a veni-
puncture test every few months.
5. Diarrhea is a sign of hyperthyroidism
and the client should report it to the
doctor to determine if it is a need to
decrease thyroid hormone or if it is
secondary to gastroenteritis.
15. 4, 1, 2, 3, 5
4. These are symptoms of a hypoglycemic
reaction and the nurse should assess
the client immediately; therefore, this
is the first intervention.
1. Because the nurse is assessing the cli-
ent in the room, the UAP can take the
glucometer reading. The nurse cannot
delegate care of an unstable client, but
can delegate a task because the nurse is
in the room with the client.
2. The treatment of choice for a conscious
client experiencing a hypoglycemic reac-
tion is to administer food or a source
of glucose. Orange juice is a source of
glucose, and the UAP can get it.
3. The nurse should check the MAR to
determine when the last dose of insulin
or oral hypoglycemic medication was
administered.
5. When the client has been stabilized,
then the linens should be changed to
make the client comfortable.
16. 1. The regular insulin adheres to the lin-
ing of the plastic IV tubing; therefore,
the nurse should flush the tubing with
at least 50 mL of the insulin solution
so that insulin will adhere to the tubing
before the prescribed dosage is admin-
istered to the client. If this is not done,
the client will not receive the correct
dose of insulin during the first few
hours of administration.
2. To monitor serum glucose, the nurse would
need to perform an hourly venipuncture.
This is painful, is more expensive, and takes
a longer time to provide glucose results;
therefore, a capillary (fingerstick) bedside
glucometer will be used to monitor the
client’s blood glucose level every hour.
3. The nurse does not draw ABGs. This is
done by the respiratory therapist or the
HCP.
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 186 PHARMACOLOGY SUCCESS
4. A regular insulin drip must be adminis-
tered by an infusion-controlled device
(IV pump). It may not be given via gravity
because it is a very dangerous medication
and could kill the client if not administered
correctly.
17. 1. According to the sliding scale, blood
glucose results should be verified when less
than 60 or greater than 400.
2. The HCP does not need to be notified
unless the blood glucose is greater than 400.
3. The client’s reading is 310; therefore,
the nurse should administer eight units
of regular insulin as per the HCP’s
order.
4. There is no reason for the nurse to
recheck the results.
18. 1. Sitagliptin (Januvia) is a Dipeotide-
peptidase-4 inhibitor (DPP-4I) and is an
oral medication.
2. Side effects with sitagliptin are pancre-
atitis (pain on the left side) and Stevens
Johnson Syndrome (painful blisters and
skin rashes).
3. Sitagliptin slows gastric emptying so that
when taken with insulin the client could
experience hypoglycemic reactions.
4. Sitagliptin is not a type of insulin.
19. 1. The insulin degludec (Tresiba), an
ultralong acting insulin analog, is in
the same classification as glargine and
detemir. Any medication remaining
after 30 days should be discarded to
6924_Ch06_157-186.indd 186
assure that the medication has the same
potency as when it was first opened.
2. The needle should be removed from the
pen when storing the medication in the
refrigerator because some medicine may
leak from the degludec pen or air bubbles
may form in the cartridge.
3. The degludec pen should not be used after
the expiration date printed on the label.
4. Degludec can be used with metformin
(Glucophage) or other types of antidia-
betic medicine.
20. 1. The administration of any insulin can
cause hypoglycemia when it is com-
bined with medications that act to
decrease appetite, then the patient
has an even greater risk of develop-
ing hypoglycemia. Insulin degludec
(Tresiba) and liraglutide (Victoza or
Saxenda), incretin mimetics, increase
glycemia by lowering the blood glucose
level and the appetite.
2. The medication does work to control
blood glucose levels and by providing
continuous insulin release and decreasing
appetite. It is injected once daily.
3. This is insulin, and the client is still subject
to hypoglycemia and hyperglycemia. This
statement indicates the client understands
the medication regimen.
4. If the client cannot eat and retain the
food, the HCP should be notified to make
certain that the client does not develop
complications.
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