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NLN Practice Test about Endocrine Disorder: 1.

Which nursing diagnosis takes highest priority for a client with hyperthyroidism? a. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess b. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing c. Body image disturbance related to weight gain and edema d. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess 2. A client with long-standing type 1 diabetes mellitus is admitted to the hospital with unstable angina pectoris. After the client's condition stabilizes, the nurse evaluates the diabetes management regimen. The nurse learns that the client sees the physician every 4 weeks, injects insulin after breakfast and dinner, and measures blood glucose before breakfast and at bedtime. Consequently, the nurse should formulate a nursing diagnosis of: a. Impaired adjustment. b. Defensive coping. c. Deficient knowledge. d. Health-seeking behaviors. 3. A 62-year-old client diagnosed with pyelonephritis and possible septicemia has had five urinary tract infections over the past 2 years. She's fatigued from lack of sleep; urinates frequently, even during the night; and has lost weight recently. Tests reveal the following: sodium level 152 mEq/L, osmolarity 340 mOsm/L, glucose level 125 mg/dl, and potassium level 3.8 mEq/L. Which of the following nursing diagnoses is most appropriate for this client? a. Deficient fluid volume related to inability to conserve water b. Imbalanced nutrition: Less than body requirements related to hypermetabolic state c. Deficient fluid volume related to osmotic diuresis induced by hypernatremia d. Imbalanced nutrition: Less than body requirements related to catabolic effects of insulin deficiency 4. 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 5. Following a unilateral adrenalectomy, the nurse would assess for hyperkalemia shown by which of the following? a. Muscle weakness b. Tremors c. Diaphoresis d. Constipation

6. The nurse is assessing a client with hyperthyroidism. What findings should the nurse expect? a. Weight gain, constipation, and lethargy b. Weight loss, nervousness, and tachycardia c. Exophthalmos, diarrhea, and cold intolerance d. Diaphoresis, fever, and decreased sweating 7. Which important instruction concerning the administration of levothyroxine (Synthroid) should the nurse teach a client? a. "Take the drug on an empty stomach." b. "Take the drug with meals." c. "Take the drug in the evening." d. "Take the drug whenever convenient." 8. An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: a. thyroid storm. b. cretinism. c. myxedema coma. d. Hashimoto's thyroiditis. 9. 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 10. A client with Cushing's syndrome is admitted to the medical-surgical unit. During the admission assessment, the nurse notes that the client is agitated and irritable, has poor memory, reports loss of appetite, and appears disheveled. These findings are consistent with which problem? a. Depression b. Neuropathy c. Hypoglycemia d. Hyperthyroidism 11. A client is transferred to a rehabilitation center after being treated in the hospital for a cerebrovascular accident (CVA). Because the client has a history of Cushing's syndrome (hypercortisolism) and chronic obstructive pulmonary disease (COPD), the nurse formulates a nursing diagnosis of: a. Risk for imbalanced fluid volume related to excessive sodium loss. b. Risk for impaired skin integrity related to tissue catabolism secondary to cortisol hypersecretion. c. Ineffective health maintenance related to frequent hypoglycemic episodes secondary to Cushing's syndrome. d. Decreased cardiac output related to hypotension secondary to Cushing's syndrome.

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. Tetany and increased blood urea nitrogen (BUN) levels. No one in my family has ever had diabetes. exophthalmos and conjunctival redness b. The nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this disorder. the nurse should stress the importance of which of the following? a. Denial b. When instructing the client diagnosed with hyperparathyroidism about diet. flushed. 16. d. The nurse should state that the physician probably will prescribe daily supplements of calcium and: a. c. The nurse explains that these medications are only effective if the client: a. 13. folic acid. the nurse suspects the client is using which coping mechanism? a. b. vitamin D. "This must be a mistake. has type 2 diabetes. warm. prefers to take insulin orally. Resolution 14. systolic murmur at the left sternal border d. iron. Restricting fluids b. A client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. c. Restricting sodium c. is pregnant and has type 2 diabetes. A client becomes upset when the physician diagnoses diabetes mellitus as the cause of current signs and symptoms. During assessment. the nurse should stay alert for: a. decreased body temperature and cold intolerance 17. b. Flaccidity and thirst d. has type 1 diabetes.12. The client tells the nurse. d. moist skin c. Restricting potassium 15. potassium. The client is being evaluated for hypothyroidism. Withdrawal c." Based on this statement. Anger d. . Forcing fluids d.

Hypocalcemia b. Administering an oral dose of levothyroxine (Synthroid) b. c. b. a wide. and bone pain that interferes with her going outdoors. antidiuretic hormone (ADH). . Based on history and physical findings. Hyperphosphatemia d. b. and weight loss. The nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the physician immediately? a. Exophthalmos is characterized by: a. Diabetes mellitus b. Hypophosphaturia 20. Hyperparathyroidism 23. weakness. 19.18. more than 10 beats/minute difference between the apical and radial pulse rates. Hypercalcemia c. a classic sign of Graves' disease. the nurse would suspect which of the following disorders? a. Dry mucous membranes d. d. Measuring and recording accurate intake and output d. increased urination. Hypoparathyroidism d. Which of the following would the nurse expect to find in a client diagnosed with hyperparathyroidism? a. A 68-year-old client has been complaining of sleeping more. Warming the client with a warming blanket c. irritability. c. The physical examination reveals exophthalmos. Frequent urination 21. The nurse is developing a teaching plan for a client diagnosed with diabetes insipidus. The nurse should include information about which hormone lacking in clients with diabetes insipidus? a. Maintaining a patent airway 22. restlessness. depression. luteinizing hormone (LH). Diabetes insipidus c. Which of the following is the most critical intervention needed for a client with myxedema coma? a. An irregular apical pulse c. staggering gait. dry. Based on these assessment findings. Pitting edema of the legs b. thyroid-stimulating hormone (TSH). the nurse suspects hyperthyroidism. d. A client visits the physician's office complaining of agitation. follicle-stimulating hormone (FSH). anorexia. protruding eyes and a fixed stare. waxy swelling and abnormal mucin deposits in the skin.

b. 29. Administer insulin at a 45-degree angle into the deltoid muscle. b. c. The nursing care for the client in addisonian crisis should include which of the following interventions? a. Which of the following instructions should be included in the teaching plan for a client requiring insulin? a. 28. Encouraging independence with activities of daily living (ADLs) b. Weigh the client.24. beta cells of the pancreas. provide time for privacy. The nurse is explaining the action of insulin to a newly diagnosed diabetic client. c. adenohypophysis. c. in a few days. c. Which of the following instructions should be included in the teaching plan for a client requiring insulin? b. the nurse reviews the process of insulin secretion in the body. The nurse is correct when stating that insulin is secreted from the: a. in 1 to 2 weeks. d. The nurse would expect the client's symptoms to subside: a. encourage the client to ask questions about personal sexuality. The nurse is assigned to care for a postoperative client who has diabetes mellitus. During the assessment interview. d. c. parafollicular cells of the thyroid. the client reports that he's impotent and says he's concerned about its effect on his marriage. Draw up clear insulin first when mixing two types of insulin in one syringe. During the teaching. suggest referral to a sex counselor or other appropriate professional. 26. provide support for the spouse or significant other. Assess vital signs. In planning this client's care. d. d. a client receives potassium iodide (Lugol's solution) and propylthiouracil (PTU). Allowing ambulation as tolerated c. Test urine for ketones. 27. Before undergoing a subtotal thyroidectomy. in 3 to 4 months. the most appropriate intervention would be to: a. alpha cells of the pancreas d. b. . Administer oral hydrocortisone. During the first 24 hours after a client is diagnosed with addisonian crisis. Placing the client in a private room 25. Shake the vial of insulin vigorously before withdrawing the medication. immediately. Offering extra blankets and raising the heat in the room to keep the client warm d. which of the following should the nurse perform frequently? a. b.

The nurse is assessing a client after a thyroidectomy.30. d. Maintaining room temperature in the low-normal range 34. a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. along with numbness in the fingers. c. and mouth area. use commercial preparations to remove corns. b. PTH maintains the balance between calcium and: a. b. phosphorus. walk barefoot at least once each day. magnesium. menstrual flow. Placing extra blankets on the client's bed c. cut the toenails by rounding edges. Smoking reduction but not complete cessation c. For a client with Graves' disease. the nurse would expect a decline in: a. The nurse should suspect which complication? a. The nurse is developing a teaching plan for a client with diabetes mellitus. Hemorrhage c. hair loss. . In a 28-year-old female client who is being successfully treated for Cushing's syndrome. toes. d. Restricting intake of oral fluids b. Exercise and a weight reduction diet 31. During a follow-up visit to the physician. wash and inspect the feet daily. Tetany b. A client with newly diagnosed type 2 diabetes mellitus is admitted to the metabolic unit. c. Thyroid storm d. c. 33. Laryngeal nerve damage 35. serum glucose level. Maintenance of blood glucose levels between 180 and 200 mg/dl b. which nursing intervention promotes comfort? a. sodium. A client with diabetes mellitus should: a. d. Which of the following goals should the nurse incorporate into her teaching plan? a. The primary goal for this admission is education. An eye examination every 2 years until age 50 d. 32. The nurse states that these glands produce parathyroid hormone (PTH). The assessment reveals muscle twitching and tingling. potassium. b. Limiting intake of high-carbohydrate foods d. bone mineralization.

A 42-year-old woman with a history of pernicious anemia comes to the physician complaining of increased anxiety. A 45-year-old man with type 2 diabetes mellitus undergoes a neurologic examination. Hypersecretion of this hormone can cause which of the following conditions? (A) Amenorrhea (B) Cold intolerance (C) Constipation (D) Hyperlipidemia 39. unexplained weight loss. Which of the following receptors is most likely affected in this patient? (A) Krause end bulbs (B) Meissner’s corpuscle (C) Merkel nerve endings (D) Pacinian corpuscle 41. A 34-year-old man with moderately severe ulcerative colitis has been taking oral prednisone for 4 months. dizziness. She says that she had been at a cocktail party when the symptoms began. and decreased renin activity. Her skin is notably flushed on physical examination. heart palpitations. a thyroid bruit. Which of the following is the most likely etiology of this patient’s disease? (A) Autoimmune stimulation of thyroid-stimulating hormone receptors (B) Idiopathic replacement of thyroid tissue with fibrous tissue (C) Thyroid adenoma (D) Thyroid hormone-producing ovarian teratoma 37. Which of the following symptoms is the most likely adverse effect of this drug? (A) Diabetes insipidus (B) Diabetes mellitus (C) Hyperpigmentation of the skin (D) Hypotension 40. A certain endocrine disorder can lead to an elevated blood pressure. blurry vision. and difficulty breathing. sodium and water retention. She has not had a period in 4 months. The physician reassures the mother that it is a common congenital ectopic anomaly that does not affect the function of the mass or the hormone it secretes. Which of the following medications is responsible for this reaction? . the patient is found to have a goiter. A 53-year-old woman with newly diagnosed type 2 diabetes presents to the emergency department complaining of vomiting. The patient is unable to sense the vibration produced by a tuning fork placed on his big toe. NLN Practice Test about a 5-year-old girl who is brought to the pediatrician by her mother because she has noticed a single soft.36. heat intolerance. decreased potassium levels. Laboratory studies show elevated triiodothyronine and free thyroxine levels. and mild exophthalmos.stimulating hormone. Which of the following is the most likely diagnosis? (A) Addison’s disease (B) Hyperthyroidism (C) Pheochromocytoma (D) Primary hyperaldosteronism 38. On physical examination. and multiple daily bowel movements. severe headache. nontender mass underneath her daughter’s tongue. and an undetectable thyroid.

A 66-year-old man with chronic cough.5-cm mass in the head of the pancreas. and its secretion is tightly regulated via a feedback control system involving the hypothalamus. Which of the following is most likely to be elevated in this patient? . While awaiting CT. vomiting. and a 50-pack-year history of cigarette smoking comes to the clinic after noticing blood in his sputum. and increased fatigue. When probed for a deeper family history.(A) Acarbose (B) Glipizide (C) Glyburide (D) Tolbutamide 42. Surgical resection of this mass will necessitate ligation of branches from which of the following vascular structures? (A) The gastroduodenal and inferior mesenteric arteries (B) The gastroduodenal and superior mesenteric arteries (C) The left gastric and inferior mesenteric arteries (D) The left gastric and superior mesenteric arteries 43. the patient suffers a seizure and is rushed to the emergency department. he says that his mother and two cousins have had their thyroids removed. He appears visibly anxious and relates a recent history of sweats. NLN Practice Test about a 36-year-old woman who presents to the physician with amenorrhea. A 25-year-old man comes to the emergency department after experiencing tremors. Growth hormone is essential to normal human growth and development. He says he feels lethargic and has lost 18 kg (40 lb) over the past 3 months with no changes in diet or exercise. and lightheadedness. Which of the following is most appropriate for this patient? (A) Finasteride (B) Leuprolide (C) Octreotide (D) Recombinant growth hormone 44. dyspnea. Physical examination shows a blood pressure of 150/90 mm Hg and coarse facial features with mild macroglossia. and heart palpitations. Laboratory studies show a blood glucose level of 50 mg/dL. and the peripheral tissues. Which of the following is a stimulus for the secretion of growth hormone? (A) Hypoglycemia (B) Obesity (C) Pregnancy (D) Somatomedin excess 46. A 23-year-old man comes to the physician because of intermittent severe headaches. his uncle had similar symptoms. While he has no significant medical history. the pituitary gland. increased sweating. An abdominal CT scan shows a 1. She reports an increase in her ring and shoe sizes over the past year. Which of the following conditions most likely accounts for the clinical scenario? (A) Acromegaly (B) ACTH-secreting pituitary adenoma (C) Hyperparathyroidism (D) Pheochromocytoma 45. Laboratory studies show a serum sodium level of 120 mEq/L. nausea. anxiety.

thus decreasing the likelihood of renal osteodystrophy. Which of the following is the most common mode of inheritance of this patient’s disease? (A) Autosomal dominant (B) Autosomal recessive (C) Mitochondrial (D) X-linked dominant 48.9-lb) weight gain over the past 3 months. the patient indicates a recent history of polyuria. polydipsia. A 60-year-old woman with a history of type 2 diabetes mellitus comes to the clinic for a follow.up examination after being placed on a new agent to help her achieve tighter glycemic control. A 27-year-old woman presents to a new physician with muscle cramping and spasm. NLN Practice Test about a 43-year-old woman who presents with fatigue. a round face. the physician notes shortened fourth and fifth metacarpals and metatarsals. Which of the following is most likely to be elevated in this patient? (A) Cortisol (B) Glucagon (C) Growth hormone (D) Insulin 50. Her facial muscles twitched when her facial nerve was tapped. and weight gain. and concentration problems. and her wrist twitched with the use of a blood pressure cuff. X-ray of the spine shows an L4-L5 compression fracture. She states that she had some slight swelling of her lower neck several months ago.(A) ACTH (B) ADH (C) Parathyroid hormone (D) Renin 47. cold intolerance. coarse skin and bradycardia. and abnormal teeth. but a thyroid peroxidase antibody test is positive. which has become an embarrassing nuisance. adding that she has recently been experiencing increased flatulence. What other autoimmune diseases will this patient most likely have? (A) Graves’ disease and pernicious anemia (B) Osteoarthritis and Addison’s disease (C) Rheumatoid arthritis and vitiligo (D) Type 1 diabetes mellitus and celiac disease 49. hair loss. She complains that she has suffered occasional abdominal cramps and diarrhea. Results of antithyroglobulin antibody and antinuclear antibody tests are negative.5-kg (9. hypertension. Which of the following agents best accounts for this patient’s complaints? (A) Acarbose (B) Chlorpropamide (C) Glipizide (D) Metformin (E) Orlistat . A 45-year-old man comes to his primary care physician complaining of back pain. which resolved without treatment. On questioning. Physical examination is significant for dry. Laboratory studies show a decreased serum calcium level and a significantly elevated parathyroid hormone level. There is no evidence of renal disease. a 4. short stature. On physical examination.

Tremors. This. feet. 4) A . 2) C . decreased glucose tolerance. and nonpitting edema. Hypovolemic shock results from severe fluid volume deficit. and diarrhea. hypoventilation (possibly leading to respiratory acidosis). fever. measuring blood glucose levels. therefore.Weight loss.Severe hypothyroidism may result in myxedema coma. and cold intolerance are signs of hypothyroidism. Weight gain. constipation. and face are findings associated with hyperkalemia. lethargy. 7) A . SIADH causes excessive fluid volume. not the client. This eliminates the nursing diagnoses of Impaired adjustment and Defensive coping. . Because the nurse. Options B and C may be appropriate for a client with hypothyroidism. This puts the client at risk for marked nutrient and calorie deficiency. dose. The major electrolyte disturbance in SIADH is dilutional hyponatremia. Hashimoto's thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role. in which a drastic drop in the metabolic rate causes decreased vital signs. probably caused by the failure of her renal tubules to respond to antidiuretic hormone as a consequence of pyelonephritis.m.Noncompliance with treatment for SIADH may lead to water intoxication from fluid retention caused by excessive antidiuretic hormone. the nursing diagnosis of Health-seeking behaviors isn't warranted.In the client with hyperthyroidism. questioned the client's health practices related to diabetes management. 6) B . nervousness. 3) A . nausea. diaphoresis. the client has demonstrated the ability and willingness to modify the lifestyle as needed to manage the disease. diaphoresis. the client has a knowledge deficit regarding when to administer insulin. severe hyperkalemia doesn't occur. which slows the metabolic rate. dose and 30 minutes before dinner for the p. Tetany results from hypocalcemia. and tachycardia are signs of hyperthyroidism. and fat mobilization and depletion.The nurse should instruct the client to take levothyroxine on an empty stomach (to promote regular absorption) in the morning (to help prevent insomnia and to mimic normal hormone release). in turn. an electrolyte disturbance not associated with SIADH. excessive thyroid hormone production leads to hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance. Other signs of hyperthyroidism include exophthalmos. and constipation aren't seen in hyperkalemia. diarrhea. decreased sweating. limits water excretion and increases the risk for cerebral edema. 8) C . increased protein synthesis and breakdown. Cretinism is a form of hypothyroidism that occurs in infants. Imbalanced nutrition related to hypermetabolic state or catabolic effect of insulin deficiency is an inappropriate nursing diagnosis for the client. potassium excretion remains normal. Therefore. The hypernatremia is secondary to her water loss. breakfast and dinner — 30 minutes before breakfast for the a. in contrast. Because SIADH doesn't alter renal function. bradycardia.The client has signs and symptoms of diabetes insipidus. which is transient and occurs from transient hypoaldosteronism when the adenoma is removed. tongue. not hyperkalemia. and seeing the physician regularly. and paresthesia of the hands. 5) A .The client should inject insulin before.NLN Practice Test: Answers and Rationale 1) D .m.Muscle weakness. not after. Thyroid storm is an acute complication of hyperthyroidism. By taking insulin. making Imbalanced nutrition: Less than body requirements the most important nursing diagnosis.

hypotension. . the hematocrit and BUN level decrease. In SIADH. after the client realizes the information is correct.9) A . it also produces increased appetite. 14) C . and resolution also are coping mechanisms. 10) A . constipation. This.In SIADH. and weight loss despite increased appetite.The client should be encouraged to force fluids to prevent renal calculi formation. along with immobility related to CVA. decreased intellectual function. Although hypoglycemia can cause irritability. they surface later in the readjustment period. Dry. such as a diagnosis of diabetes mellitus. poor memory. potassium. The other options are typical findings in a client with hyperthyroidism. eliminating Ineffective health maintenance related to frequent hypoglycemic episodes as an appropriate nursing diagnosis.Agitation. clients with hypoparathyroidism are prescribed daily supplements of vitamin D along with calcium because calcium absorption from the small intestine depends on vitamin D. loss of appetite. which decreases water excretion by the kidneys. 11) B . causing hyponatremia. and depression. many clients use denial to cope with unpleasant or shocking news. Therefore. Hypoparathyroidism doesn't cause a deficiency of folic acid. in turn. the client doesn't require daily supplements of these substances to maintain a normal serum calcium level. Although withdrawal. which is common in clients with Cushing's syndrome.Typically. in turn leading to edema and hypertension. Other signs and symptoms include dyspnea. or iron. A wide. 17) B . nervousness. Increased glucocorticoid activity also causes persistent hyperglycemia. anger. resulting in thinning skin and connective tissue loss. irritability. waxy swelling and abnormal mucin deposits in the skin typify myxedema. Oral antidiabetic agents aren't effective in type 1 diabetes. the serum creatinine level isn't affected by the client's fluid status and remains within normal limits. Hyperthyroidism typically causes such signs as goiter. hypoventilation. heat intolerance. Therefore. reduces the serum sodium level. rather than loss of appetite. these factors increase this client's risk for impaired skin integrity. staggering gait and a differential between the apical and radial pulse rates aren't specific signs of thyroid dysfunction. bradycardia. causing a reduced body temperature and cold intolerance. Neuropathy affects clients with diabetes mellitus — not Cushing's syndrome.Hypothyroidism markedly decreases the metabolic rate. a condition resulting from advanced hypothyroidism. Sodium should be encouraged to replace losses in urine.Oral antidiabetic agents are only effective in adult clients with type 2 diabetes.Cushing's syndrome causes tissue catabolism. anorexia. 16) D . Risk for imbalanced fluid volume and Decreased cardiac output are inappropriate nursing diagnoses. the posterior pituitary gland produces excess antidiuretic hormone (vasopressin). Restricting potassium isn't necessary in hyperparathyroidism. 12) B .Exophthalmos is characterized by protruding eyes and a fixed stare.Initially. 15) B . Typically. 13) A . and neglect of one's appearance may signal depression. The exaggerated glucocorticoid activity in Cushing's syndrome causes sodium and water retention. Pregnant and lactating women aren't prescribed oral antidiabetic agents because the effect on the fetus is uncertain.

23) A . they don't have bone pain and increased sleeping. PTU blocks the conversion of thyroxine to triiodothyronine. The client should be kept on bed rest. 24) D .Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness from excess parathyroid hormone (PTH). Thyroid replacement will be administered I. Hypoparathyroidism is characterized by urinary frequency rather than polyuria.Because Cushing's syndrome causes aldosterone overproduction.ADH is the hormone clients with diabetes insipidus lack. such as an irregular apical pulse. Although myxedema coma is associated with severe hypothermia.The client in addisonian crisis has a reduced ability to cope with stress due to an inability to produce corticosteroids.18) A . which plays a role in calcium metabolism. measures to raise the body temperature. these aren't critical interventions at this time. Compared to a multibed room. 22) D . such as extra blankets and turning up the heat.Potassium iodide reduces the vascularity of the thyroid gland and is used to prepare the gland for surgery. 21) D . the more biologically active thyroid hormone.Because respirations are depressed in myxedema coma. thirst. and decrease the risk of infection. Weight gain will also occur. Therefore. promote rest. and although intake and output are very important. and tetany are unrelated to water intoxication. and there will be increased urinary phosphate (hyperphosphaturia) because phosphate excretion is increased. prolactin. PTU effects are also seen in . which increases urinary potassium loss. a warming blanket shouldn't be used because it may cause vasodilation and shock. 19) B . The parafollicular cells of the thyroid secrete the hormone calcitonin. 26) D . Edema is an expected finding because aldosterone overproduction causes sodium and fluid retention. and temperature controlled. and LH levels won't be affected.The beta cells of the pancreas secrete insulin. Dry mucous membranes and frequent urination signal dehydration. While clients with diabetes mellitus and diabetes insipidus also have polyuria. dimly lit. The client's TSH. Clients also exhibit hypercaliuria-causing polyuria. Because extremes of temperature should be avoided.Hypercalcemia is the hallmark of excess parathyroid hormone levels. Gradual warming with blankets would be appropriate. which raises the blood glucose level. Also. Potassium iodide reaches its maximum effect in 1 to 2 weeks. thyroid-stimulating hormone. the nurse should immediately report signs and symptoms of hypokalemia. Ventilatory support is usually needed. FSH. to the physician. and increased BUN levels indicate fluid volume deficit. visitors can be limited to reduce noise.Classic signs of water intoxication include confusion and seizures. receiving total assistance with ADLs because ambulation isn't allowed. Spasticity. and luteinizing hormone. corticotropin. The alpha cells of the pancreas secrete glucagon. such as growth hormone. but not insulin. 20) B . both of which are caused by cerebral edema. a private room is easier to keep quiet. maintaining a patent airway is the most critical nursing intervention. Sunken eyeballs. flaccidity. The adenohypophysis or anterior pituitary gland secretes many hormones. should be avoided. which isn't associated with Cushing's syndrome. 25) B .V. folliclestimulating hormone. Serum phosphate will be low (hyperphosphatemia). the disorder may lead to hypokalemia.

Clients with diabetes mellitus should never walk barefoot.Because the client in addisonian crisis is unstable. Making appropriate referrals is a valid part of planning the client's care.A client with diabetes mellitus should wash and inspect his feet daily and should wear nonconstrictive shoes. To reduce heat intolerance and diaphoresis. choking. If cloudy. 27) D . 34) A . Oral hydrocortisone isn't administered during the first 24 hours in severe adrenal insufficiency. vital signs and fluid and electrolyte balance should be assessed every 30 minutes until he's stable. 31) D . or Humulin-N. and bleeding. diaphoresis. Weight reduction should be achieved by a healthy diet and exercise to increase carbohydrate metabolism. the nurse should encourage the client to eat high-carbohydrate foods. insulin must be administered. the client should draw the clear (regular) insulin into the syringe first. feelings of fullness at the incision site. 33) D .Graves' disease causes signs and symptoms of hypermetabolism. Blood glucose levels should be maintained within normal limits to prevent the development of diabetic complications. PTH doesn't affect sodium. Clients with type 1 or 2 diabetes shouldn't smoke because of the increased risk of cardiovascular disease. intake of oral fluids. Thyroid storm is another term .PTH increases the serum calcium level and decreases the serum phosphate level. potassium. Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia. frequent swallowing. such as heat intolerance. Daily weights are sufficient when assessing the client's condition. weight reduction may enhance the normalization of the blood glucose level. 32) C . and weight loss. not restrict. 28) D . To relieve symptoms of hyperthyroidism in the interim. hypotension. excessive thirst and appetite. To provide needed energy and calories. the nurse should encourage. To replace fluids lost via diaphoresis.The nurse should refer this client to a sex counselor or other professional. neutral protamine Hagedorn. The nurse doesn't normally provide sex counseling. therefore.Type 2 diabetes is often obesity-related. Nails should be filed straight across. The daily insulin dose typically is administered before the first meal of the day and at a 90-degree angle to fatty tissue. clients are usually given a betaadrenergic blocker such as propranolol. so there is no need to assess the urine for their presence. Corns should be treated by a podiatrist — not with commercial preparations. the nurse should keep the client's room temperature in the low-normal range.When mixing types of insulin. Placing extra blankets on the bed of a client with heat intolerance would cause discomfort. or magnesium regulation. the client should gently roll the vial between the palms of her hands before withdrawing the medication. The client shouldn't have ketones in his urine.1 to 2 weeks. A funduscopic examination should be done yearly to identify early signs of diabetic retinopathy. 29) C .Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. 30) D .

and hyperkalemia. heat intolerance with sweaty skin. Hirsutism is common in Cushing's syndrome. 36) A . but its signs include a hoarse voice and.Correct Rationale: This patient presents as a classic case of Graves’ disease.Hyperglycemia. B is Incorrect. dyspnea. chest pain/palpitations. The increased levels of aldosterone lead to hypertension. and secondary hyperaldosteronism. such as pernicious anemia or type 1 diabetes mellitus. Graves’ disease is the most common cause of thyrotoxicosis. which develops from glucocorticoid excess. hyperreflexia. abnormal hair growth also declines. hyperactivity. Increased blood pressure and aldosterone levels produce negative feedback to the kidneys. therefore. Rationale: Idiopathic replacement of thyroid and surrounding tissue with fibrous tissue is seen in Riedel’s thyroiditis. C is Incorrect. hyponatremia. therefore. Rationale: Addison’s disease results from adrenal atrophy and causes hypofunction of the adrenal glands. A is Incorrect. . tremor. Rationale: Most thyroid adenomas present as solitary nodules and are usually nonfunctional. resulting in a decreased level of serum renin. Laryngeal nerve damage may occur postoperatively. increased appetite. patients may present with dysphagia. Signs include diffuse goiter. possibly. increased sodium and water retention. It can also be found in patients with zona glomerulosa hyperplasia. diarrhea.Correct Rationale: Primary hyperaldosteronism is most commonly caused by an aldosterone. the client experiences a return of menstrual flow. proptosis. and frequently present with anxiety. is a manifestation of Cushing's syndrome. With successful treatment of the disorder. with increased aldosterone and decreased renin levels. Laboratory values reveal increased thyroid hormone levels and decreased TSH levels. and thickened skin on the lower extremities. although more than 50% of patients are euthyroid. but given the patient’s history of autoimmune disease. serum glucose levels decline. weight loss. 37) D . thyroidstimulating IgG antibodies bind to TSH receptors and lead to thyroid hormone production. B is Incorrect. fine hair. weight loss. diarrhea. and warm. including hypotension. and hypothyroidism. with increased aldosterone levels and increased renin levels. with successful treatment. fine hair. stridor. Osteoporosis occurs in Cushing's syndrome. Rationale: Thyroid hormoneproducing ovarian teratomas are known as struma ovarii. Graves’ disease is the better answer choice. Amenorrhea develops in Cushing's syndrome. Rationale: Patients with hyperthyroidism have heat intolerance.producing adenoma of the adrenal gland. which is high on the list of differential diagnoses for a patient with Riedel’s thyroiditis. tachycardia and cardiac palpitations. and the associated increase in excretion of potassium leading to hypokalemia. and amenorrhea or oligomenorrhea. With successful treatment. a tumor consisting of thyroid tissue. The disease can mimic thyroid carcinoma. These tumors can cause hyperthyroidism. moist skin. arrhythmias. bone mineralization increases. Serum renin levels help differentiate between primary hyperaldosteronism. irritability. acute airway obstruction. This causes glandular hyperplasia and enlargement characteristic of the goiter associated with Graves’ disease. Patients with this condition may have other autoimmune diseases. D is Incorrect. periorbital edema. 35) A . with successful treatment. not a decline in it. Patients with Addison’s disease display signs that are the opposite of those seen in hyperaldosteronism.for severe hyperthyroidism — not a complication of thyroidectomy. In Graves’ disease.

38) A . D is Incorrect. This side effect is due to the mineralocorticoid properties of steroids. Rationale: Hyperlipidemia is characteristic of hypothyroidism. Hypersecretion of T4 would cause heat intolerance. Rationale: Constipation is characteristic of hypothyroidism. which is a decreased secretion of T4 from the thyroid gland. which can be an adverse effect of chronic corticosteroid use owing to decreased glucose tolerance and the counterregulatory action of the hormone.. pressure. and skin hyperpigmentation should not occur. and joint capsules. Hypersecretion of thyroxine (T4) from the ectopic gland can result in menstrual abnormalities. ligaments. Hypersecretion of T4 is not associated with hyperlipidemia. Rationale: Diabetes mellitus.Correct NLN Practice Test Rationale: Usually. and tension are the large. which can lead to elevated blood pressure. Glucocorticoids increase the glucose production by the liver in part by stimulating gluconeogenesis. potassium. not hypotension. thus. Ectopic thyroid tissue may be found anywhere along the course of the duct. however. and also by stimulating proteolysis in the skeletal muscle and releasing glucogenic amino acids into the vasculature. Rationale: Patients with pheochromocytoma have increased levels of epinephrine and norepinephrine. Sheehan’s syndrome) or failure of kidneys to respond to circulating ADH (i. encapsulated pacinian corpuscles. This patient is receiving exogenous corticosteroids.Correct Rationale: This patient is at risk for prednisone-induced Cushing’s syndrome. owing to decreased glucose tolerance and the counterregulatory action of the hormone. is an adverse effect of corticosteroids.. including its place of origin: beneath the tongue. which are located in the deeper layers of the skin. They can be distinguished histologically by their onion like appearance on . is an adverse effect of corticosteroids. D is Incorrect. B is Incorrect. descends along the thyroglossal duct. Rationale: Hypertension. not cold. Cushing’s syndrome is associated with diabetes mellitus. This is a common congenital anomaly that does not affect thyroid function.Correct Rationale: The sensory receptors responsible for transducing the sensation of vibration. including amenorrhea and oligomenorrhea. his ACTH levels should be decreased from negative feedback inhibition.e. Hypersecretion of T4 is not associated with constipation.C is Incorrect. A is Incorrect. renal disease). C is Incorrect. which lead to increased sodium retention and hence to hypertension. which is a decreased secretion of T4 from the thyroid gland. Elevated ACTH can result in skin hyperpigmentation because of its melanocyte properties. and renin levels are not affected. and eventually resides anterior to the trachea in the neck. not diabetes insipidus. sodium. which is a decreased secretion of T4 from the thyroid gland. Rationale: Hyperpigmentation of the skin may develop in a patient with Cushing’s disease due to primary pituitary adenoma hypersecretion of ACTH.e. 39) B . C is Incorrect. and it should not be removed. Diabetes insipidus can develop due to either pituitary dysfunction (i. the thyroid gland develops beneath the tongue. 40) D . Rationale: Cold intolerance is characteristic of hypothyroidism.

It does not cause disulfiram like -Glucosidases are attached to the intestinal brush borderα reactions. are small encapsulated sensory receptors found just beneath the dermis of hairless skin. Rationale: Glyburide and glipizide are second-generation sulfonylureas that may cause hypoglycemia. and since pacinian corpuscles are responsible for transducing vibratory stimuli. and chloramphenicol. not vibratory sensation. only tolbutamide is associated with causing a disulfiram like reaction after alcohol consumption. Other drugs known to cause a disulfiram like reaction include metronidazole. B . griseofulvin. a branch of the celiac trunk. as is being tested in this case. neuropathy. which supplies the anterior and .Correct Rationale: This patient had a disulfiram like reaction after drinking alcohol at a cocktail party. quinacrine.cross section. most prominently in the fingertips. C is Incorrect. and acarbose will reduce the postprandial digestion and absorption of starch and disaccharides. soles of the feet. subsequent opening of voltage gated calcium channels. 42.Correct Rationale: The head of the pancreas and the duodenum share a dual blood supply from the gastroduodenal artery. B is Incorrect. C is Incorrect. A is Incorrect. are believed to be responsible for discriminatory touch. but they do not cause disulfiram like reactions. β this by binding to the sulfonylurea receptor on the leading to the inhibition of potassium ion efflux. which are responsible for conveying the sensation of light touch. This patient is presenting with one of the complications of diabetes. which triggers the release of preformed insulin. Of the diabetes medications listed. -glucosidase inhibitor that may causeα Rationale: Acarbose is an gastrointestinal disturbances. B is Incorrect. two additional mechanisms of action have been proposed (1) a reduction of serum glucagons and (2) closure of potassium channels in extrapancreatic tissues. Rationale: Merkel nerve endings are nonencapsulated and found in all skin types (both hairy and hairless) and. and lips. along with Meissner’s corpuscles. This artery supplies the anterior and posterior superior pancreaticoduodenal arteries as well as the superior mesenteric artery. as well as some cephalosporins including cefamandole and cefoperazone. Rationale: Glipizide and glyburide are second-generation sulfonylureas that may cause hypoglycemia. However. Tolbutamide is a sulfonylurea antidiabetic agent. but they do not cause disulfiram like reactions. Rationale: Kraus end bulbs are sensory receptors found in the oropharynx and conjunctiva of the eye. 41) D . A is Incorrect. Glyburide and glipizide are second-generation sulfonylureas that may cause hypoglycemia. but they do not cause disulfiram like reactions. They do islet cell. The mechanism of action of sulfonylureas is primarily to increase insulin release from the pancreas. Rationale: Meissner’s corpuscles. cell depolarization. and calcium influx. it is these receptors that are involved in this patient’s presentation. Meissner’s corpuscles are involved in the reception of light discriminatory touch. Sulfonylureas lower blood glucose in patients with type 2 diabetes by directly stimulating the release of insulin from the pancreas.

to resect any portion of the duodenum or the head of the pancreas. Rationale: Like somatrem. One could further differentiate the two types by looking for neuromas on the lips. Somatostatin is normally secreted by the hypothalamus to help regulate basal GH secretion. and bone pain. thus no branches from either of these vessels would need to be ligated to complete the resection. 43) C . and uterine fibroids. fatigue. . B is Incorrect. D is Incorrect. Rationale: While the gastroduodenal artery is an important source of vascular supply to the head of the pancreas. and vomiting.Correct Rationale: The headache. depending on the timing of administration. Surgical and radiotherapeutic approaches are also an option.Correct NLN Practice Test Rationale: This patient presents with acromegaly.posterior inferior pancreaticoduodenal arteries. pheochromocytoma. depending on the etiology. hypotonia. tongue. -reductase inhibitor that suppresses theα Rationale: Finasteride is a 5. gynecomastia. It is used to treat infertility. It is therefore likely that this patient’s relatives had their thyroids removed due to MTC. recombinant GH is useful in the treatment of GH deficiency. the related multiple endocrine neoplasia (MEN) syndromes should also be considered. Rationale: Neither the left gastric nor the inferior mesenteric arteries provide any significant arterial supply to the head of the pancreas. branches from both the gastroduodenal and superior mesenteric arteries must be ligated. prostate cancer. but would exacerbate the condition of a patient with acromegaly. and palpitations suggest an excess of catecholamines stimulating the sympathetic nervous system. anxiety. D is Incorrect. Rationale: Leuprolide is a gonadotropin.conversion of testosterone to dihydrotestosterone and is used in the treatment of benign prostatic hypertrophy. pheochromocytoma. decreased libido). Octreotide is a somatostatin analog that acts at the anterior pituitary to suppress GH secretion.g. and since there appears to be familial involvement. Rationale: While the superior mesenteric artery is an important source of vascular supply to the head of the pancreas. nausea. or eyelids or in the gastrointestinal tract causing constipation/diarrhea. 44) D . Adverse effects include antiandrogen actions (e. A is Incorrect.releasing hormone analog that can exhibit both agonist and antagonist actions. the clinical syndrome that is a result of excessive growth hormone (GH) secretion in adults (after closure of the physes). C is Incorrect. A pheochromocytoma may be suspected.. A is Incorrect. MEN type II (used to be called type 2a) consists of medullary thyroid carcinoma (MTC). MEN type III (used to be type 2b) usually includes MTC. and is used in the treatment of acromegaly. and neuromas instead of parathyroid tumors. or for hyperparathyroidism manifesting in bradycardia. the left gastric artery does not provide any vascular supply to this structure and thus provides no branches that would need to be ligated to remove the mass. and tumors of the parathyroid. the inferior mesenteric artery does not provide any vascular supply to this structure and thus provides no branches that would need to be ligated to remove the mass described in the question stem. Therefore.

However. striae. especially small cell lung cancer. If severe. and anorexia. Rationale: Parathyroid hormone (PTH) can be produced ectopically in the setting of malignancy and is associated with a variety of neoplasia. and their disease is caught by routine blood tests. Rationale: ACTH can be produced ectopically in the setting of malignancy. D is Incorrect. Rationale: Up to 80% of patients with hyperparathyroidism are asymptomatic at diagnosis. 45) A . with elevated serum ACTH levels. are secreted by the liver in response to GH and mediate the metabolic changes necessary for growth and development. A is Incorrect. Rather. Rationale: Acromegaly can lead to growth factors. Note that these symptoms can also occur in the setting of malignancy due to production of PTH-related peptide by tumor cells. which can lead to seizures. Rationale: An ACTH-secreting pituitary adenoma. These intermediaries also act on the hypothalamus and the anterior pituitary via a negative feedback mechanism to reduce GH secretion. metastatic calcification and osteoclastic bone lesions can occur. however. which defines Cushing’s disease. GH secretion decreases in pregnancy. C is Incorrect. breast cancer. Some have nonspecific symptoms such as fatigue. weakness. and increased size of hands and feet. and the vignette provides no symptoms or signs that would be consistent with this condition. excessive levels of PTH would result in hypercalcemia. 46) B .A is Incorrect. B is Incorrect. and the vignette does not provide any indication that would be most consistent with this condition. Rationale: Somatomedins. Clinical signs of acromegaly include coarse facies. and multiple myeloma. GH is critical in the stress response to starvation. B is Incorrect.Correct Rationale: In addition to being necessary to normal human growth and development. Rationale: Pregnancy is not a stimulus for GH secretion. mild depression. excessive water retention results in hyponatremia. including squamous celllung cancer. hypertension. but rather is reduced by this condition.Correct Rationale: This vignette is most consistent with a syndrome of inappropriate secretion of ADH due to a lung neoplasm. and hirsutism. obesity. ADH is secreted by the posterior pituitary and stimulates the expression of aquaporins in the renal collecting ducts. excessive levels of ACTH would result in Cushing’s syndrome. When levels of this hormone are inappropriately elevated. . resulting in transport of water into the renal medulla from the ductal lumen and hence water retention in the kidneys. ADH can be produced ectopically in the setting of malignancy. GH is released in response to hypoglycemia and acts directly to decrease glucose uptake by cells and increase lipolysis. would cause hypercortisolemia secondary to ACTH stimulation from the anterior pituitary. However. classically by small cell lung cancer. C is Incorrect. or insulin. it does not commonly cause palpitations and is not associated with multiple endocrine neoplasia. C is Incorrect. enlarged tongue. resulting in an increase in blood sugar levels. Rationale: GH secretion is not stimulated by obesity. Clinical findings would include characteristic moon facies.

which is characterized by hypercortisolemia. A is Incorrect. B is incorrect. However.Correct Rationale: This patient’s recent history of hyperglycemic symptoms. cardiac dysrhythmias). Vertebral compression fractures are common manifestations of osteoporosis. there is a defect in the peripheral organ response to PTH. Rationale: Pseudohypoparathyroidism is an autosomal dominant disease. immune suppression. In all forms of pseudohypoparathyroidism. 48) D . B is Incorrect.D is Incorrect. Rationale: This patient has Hashimoto’s thyroiditis. One result of this syndrome is osteoporosis. Rationale: Addison’s disease does have a high prevalence in patients with Hashimoto’s thyroiditis. and penetrance is variable. but they do not have as high of an association with Hashimoto’s thyroiditis as do type 1 diabetes mellitus and celiac disease. She would not have Graves’ disease as well. and penetrance is variable. Rationale: Glucagon can account for hyperglycemia via its anti-insulin physiologic effects. but it has no known physiologic effects on bone metabolism. resulting in hypernatremia and hypokalemia. C is Incorrect. the vignette does not mention any signs or symptoms of hypokalemia (nausea. There are several types of pseudohypoparathyroidism. osteoarthritis is not an autoimmune disease. Rationale: Pseudohypoparathyroidism is an autosomal dominant disease. D is Incorrect. Rationale: Rheumatoid arthritis and vitiligo are both autoimmune diseases. or another part of the thyroid gland or thyroid hormonesynthesis pathway. Patients with Hashimoto’s thyroiditis have a 20 times greater prevalence of celiac disease and type 1 diabetes mellitus than the general population. . such as hyperglycemia and insulin resistance. hypertension. an autoimmune disorder in which patients have antibodies attacking thyroglobulin.Correct NLN Practice Test Rationale: This patient has Hashimoto’s thyroiditis. thyroid peroxidase. While seizures can be a consequence of severe hypernatremia. This leads to exaggeration of the physiologic effects of cortisol. 47) A . which vary in clinical presentation. This is an autosomal dominant disease. and penetrance is variable. vomiting. and weight gain are all consistent with a diagnosis of Cushing’s syndrome. muscle weakness. Pseudohypothyroidism is caused by kidney unresponsiveness to PTH. B is Incorrect. 49) A .Correct Rationale: This patient had pseudohypoparathyroidism. Rationale: Pseudohypoparathyroidism is an autosomal dominant disease. Rationale: Hyperreninemia does not typically occur as paraneoplastic syndrome and would generally cause hyperaldosteronism. leading to increased PTH levels. which is caused by increased bone resorption in response to an elevated serum cortisol level. C is Incorrect. and penetrance is variable. and hypertension (a consequence of salt retention due to secondary elevation of aldosterone).

Hypoglycemia is the most important side effect of this drug.Correct Rationale: -glucosidase inhibitor that decreases the hydrolysis andα Acarbose is an absorption of disaccharides and polysaccharides at the intestinal brush border. The most important side effect of this agent is lactic acidosis. Rationale: Metformin inhibits gluconeogenesis. Acarbose commonly causes gastrointestinal adverse effects that include abdominal cramps. Rationale: Chlorpropamide is a sulfonylurea that acts via stimulation of insulin secretion by the pancreas. it is responsible for the pubertal growth spurt. GH stimulates increased bone growth that results in linear growth. but chlorpropamide can also cause disulfiram-like adverse effects. diarrhea. Metformin can sometimes cause loose bowel movements but is generally not associated with increased flatulence. B is Incorrect. . D is Incorrect. Glipizide is generally not known to cause signifi cant gastrointestinal disturbances. D is Incorrect. thereby reducing postprandial hyperglycemia. Rationale: Insulin causes hypoglycemia rather than hyperglycemia and does not exert any physiologic effects on bone metabolism that may be exaggerated and thus manifested as pathology in the setting of insulin excess. and flatulence. This drug can be used as monotherapy or in combination with oral hypoglycemic medications in the management of type 2 diabetes mellitus. Hypoglycemia is the most important adverse effect of this drug. Rather. 50) A .C is Incorrect. Rationale: GH can cause hyperglycemia and insulin resistance but cannot account for increased bone resorption resulting in osteoporosis. C is Incorrect. This agent is generally not known to cause signifi cant gastrointestinal disturbances. Rationale: Glipizide is a sulfonylurea that acts via stimulation of insulin secretion by the pancreas. thus reducing blood sugar levels.