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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.
12. A client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. The nurse
explains that these medications are only effective if the client:

a. prefers to take insulin orally.


b. has type 2 diabetes.
c. has type 1 diabetes.
d. is pregnant and has type 2 diabetes.

13. A client becomes upset when the physician diagnoses diabetes mellitus as the cause of current signs
and symptoms. The client tells the nurse, "This must be a mistake. No one in my family has ever had
diabetes." Based on this statement, the nurse suspects the client is using which coping mechanism?

a. Denial
b. Withdrawal
c. Anger
d. Resolution

14. When instructing the client diagnosed with hyperparathyroidism about diet, the nurse should stress the
importance of which of the following?

a. Restricting fluids
b. Restricting sodium
c. Forcing fluids
d. Restricting potassium

15. The nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to
treat this disorder. The nurse should state that the physician probably will prescribe daily supplements of
calcium and:

a. folic acid.
b. vitamin D.
c. potassium.
d. iron.

16. The client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for:

a. exophthalmos and conjunctival redness


b. flushed, warm, moist skin
c. systolic murmur at the left sternal border
d. decreased body temperature and cold intolerance

17. 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.
18. A client visits the physician's office complaining of agitation, restlessness, and weight loss. The
physical examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and
physical findings, the nurse suspects hyperthyroidism. Exophthalmos is characterized by:

a. dry, waxy swelling and abnormal mucin deposits in the skin.


b. protruding eyes and a fixed stare.
c. a wide, staggering gait.
d. more than 10 beats/minute difference between the apical and radial pulse rates.

19. Which of the following would the nurse expect to find in a client diagnosed with
hyperparathyroidism?

a. Hypocalcemia
b. Hypercalcemia
c. Hyperphosphatemia
d. Hypophosphaturia

20. The nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to
the physician immediately?

a. Pitting edema of the legs


b. An irregular apical pulse
c. Dry mucous membranes
d. Frequent urination

21. Which of the following is the most critical intervention needed for a client with myxedema coma?

a. Administering an oral dose of levothyroxine (Synthroid)


b. Warming the client with a warming blanket
c. Measuring and recording accurate intake and output
d. Maintaining a patent airway

22. A 68-year-old client has been complaining of sleeping more, increased urination, anorexia, weakness,
irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment
findings, the nurse would suspect which of the following disorders?

a. Diabetes mellitus
b. Diabetes insipidus
c. Hypoparathyroidism
d. Hyperparathyroidism

23. 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. antidiuretic hormone (ADH).


b. thyroid-stimulating hormone (TSH).
c. follicle-stimulating hormone (FSH).
d. luteinizing hormone (LH).
24. The nursing care for the client in addisonian crisis should include which of the following
interventions?

a. Encouraging independence with activities of daily living (ADLs)


b. Allowing ambulation as tolerated
c. Offering extra blankets and raising the heat in the room to keep the client warm
d. Placing the client in a private room

25. The nurse is explaining the action of insulin to a newly diagnosed diabetic client. During the teaching,
the nurse reviews the process of insulin secretion in the body. The nurse is correct when stating that
insulin is secreted from the:

a. adenohypophysis.
b. beta cells of the pancreas.
c. alpha cells of the pancreas
d. parafollicular cells of the thyroid.

26. Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and
propylthiouracil (PTU). The nurse would expect the client's symptoms to subside:

a. in a few days.
b. in 3 to 4 months.
c. immediately.
d. in 1 to 2 weeks.

27. Which of the following instructions should be included in the teaching plan for a client requiring
insulin?

a. Which of the following instructions should be included in the teaching plan for a client requiring
insulin?
b. Administer insulin at a 45-degree angle into the deltoid muscle.
c. Shake the vial of insulin vigorously before withdrawing the medication.
d. Draw up clear insulin first when mixing two types of insulin in one syringe.

28. 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.

29. During the first 24 hours after a client is diagnosed with addisonian crisis, which of the following
should the nurse perform frequently?

a. Weigh the client.


b. Test urine for ketones.
c. Assess vital signs.
d. Administer oral hydrocortisone.
30. A client with newly diagnosed type 2 diabetes mellitus is admitted to the metabolic unit. The primary
goal for this admission is education. Which of the following goals should the nurse incorporate into her
teaching plan?

a. Maintenance of blood glucose levels between 180 and 200 mg/dl


b. Smoking reduction but not complete cessation
c. An eye examination every 2 years until age 50
d. Exercise and a weight reduction diet

31. During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain
the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone
(PTH). PTH maintains the balance between calcium and:

a. sodium.
b. potassium.
c. magnesium.
d. phosphorus.

32. The nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes
mellitus should:

a. use commercial preparations to remove corns.


b. cut the toenails by rounding edges.
c. wash and inspect the feet daily.
d. walk barefoot at least once each day.

33. For a client with Graves' disease, which nursing intervention promotes comfort?

a. Restricting intake of oral fluids


b. Placing extra blankets on the client's bed
c. Limiting intake of high-carbohydrate foods
d. Maintaining room temperature in the low-normal range

34. The nurse is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and
tingling, along with numbness in the fingers, toes, and mouth area. The nurse should suspect which
complication?

a. Tetany
b. Hemorrhage
c. Thyroid storm
d. Laryngeal nerve damage

35. In a 28-year-old female client who is being successfully treated for Cushing's syndrome, the nurse
would expect a decline in:

a. serum glucose level.


b. hair loss.
c. bone mineralization.
d. menstrual flow.
36. A 42-year-old woman with a history of pernicious anemia comes to the physician complaining of
increased anxiety, heart palpitations, heat intolerance, unexplained weight loss, and multiple daily bowel
movements. She has not had a period in 4 months. On physical examination, the patient is found to have a
goiter, a thyroid bruit, and mild exophthalmos. Laboratory studies show elevated triiodothyronine and
free thyroxine levels, and an undetectable thyroid- stimulating hormone. 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. A certain endocrine disorder can lead to an elevated blood pressure, decreased potassium levels,
sodium and water retention, and decreased renin activity. Which of the following is the most likely
diagnosis?

(A) Addison’s disease


(B) Hyperthyroidism
(C) Pheochromocytoma
(D) Primary hyperaldosteronism

38. 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, nontender mass underneath her daughter’s tongue. 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. Hypersecretion of this hormone can cause which of the following conditions?

(A) Amenorrhea
(B) Cold intolerance
(C) Constipation
(D) Hyperlipidemia

39. A 34-year-old man with moderately severe ulcerative colitis has been taking oral prednisone for 4
months. 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 45-year-old man with type 2 diabetes mellitus undergoes a neurologic examination. The patient is
unable to sense the vibration produced by a tuning fork placed on his big toe. 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 53-year-old woman with newly diagnosed type 2 diabetes presents to the emergency department
complaining of vomiting, severe headache, dizziness, blurry vision, and difficulty breathing. She says that
she had been at a cocktail party when the symptoms began. Her skin is notably flushed on physical
examination. Which of the following medications is responsible for this reaction?
(A) Acarbose
(B) Glipizide
(C) Glyburide
(D) Tolbutamide

42. A 25-year-old man comes to the emergency department after experiencing tremors. He appears
visibly anxious and relates a recent history of sweats, nausea, vomiting, and lightheadedness. Laboratory
studies show a blood glucose level of 50 mg/dL. An abdominal CT scan shows a 1.5-cm mass in the head
of the pancreas. 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. NLN Practice Test about a 36-year-old woman who presents to the physician with amenorrhea. She
reports an increase in her ring and shoe sizes over the past year, increased sweating, and increased
fatigue. Physical examination shows a blood pressure of 150/90 mm Hg and coarse facial features with
mild macroglossia. Which of the following is most appropriate for this patient?

(A) Finasteride
(B) Leuprolide
(C) Octreotide
(D) Recombinant growth hormone

44. A 23-year-old man comes to the physician because of intermittent severe headaches, anxiety, and
heart palpitations. While he has no significant medical history, his uncle had similar symptoms. When
probed for a deeper family history, he says that his mother and two cousins have had their thyroids
removed. Which of the following conditions most likely accounts for the clinical scenario?

(A) Acromegaly
(B) ACTH-secreting pituitary adenoma
(C) Hyperparathyroidism
(D) Pheochromocytoma

45. Growth hormone is essential to normal human growth and development, and its secretion is tightly
regulated via a feedback control system involving the hypothalamus, the pituitary gland, 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 66-year-old man with chronic cough, dyspnea, and a 50-pack-year history of cigarette smoking
comes to the clinic after noticing blood in his sputum. He says he feels lethargic and has lost 18 kg (40 lb)
over the past 3 months with no changes in diet or exercise. Laboratory studies show a serum sodium level
of 120 mEq/L. While awaiting CT, the patient suffers a seizure and is rushed to the emergency
department. Which of the following is most likely to be elevated in this patient?
(A) ACTH
(B) ADH
(C) Parathyroid hormone
(D) Renin

47. A 27-year-old woman presents to a new physician with muscle cramping and spasm. On physical
examination, the physician notes shortened fourth and fifth metacarpals and metatarsals, short stature, a
round face, and abnormal teeth. Her facial muscles twitched when her facial nerve was tapped, and her
wrist twitched with the use of a blood pressure cuff. Laboratory studies show a decreased serum calcium
level and a significantly elevated parathyroid hormone level. There is no evidence of renal disease, 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. NLN Practice Test about a 43-year-old woman who presents with fatigue, a 4.5-kg (9.9-lb) weight
gain over the past 3 months, cold intolerance, hair loss, and concentration problems. Physical examination
is significant for dry, coarse skin and bradycardia. She states that she had some slight swelling of her
lower neck several months ago, which resolved without treatment. Results of antithyroglobulin antibody
and antinuclear antibody tests are negative, but a thyroid peroxidase antibody test is positive. 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. A 45-year-old man comes to his primary care physician complaining of back pain. On questioning,
the patient indicates a recent history of polyuria, polydipsia, hypertension, and weight gain. X-ray of the
spine shows an L4-L5 compression fracture. Which of the following is most likely to be elevated in this
patient?

(A) Cortisol
(B) Glucagon
(C) Growth hormone
(D) Insulin

50. 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. She
complains that she has suffered occasional abdominal cramps and diarrhea, adding that she has recently
been experiencing increased flatulence, which has become an embarrassing nuisance. Which of the
following agents best accounts for this patient’s complaints?

(A) Acarbose
(B) Chlorpropamide
(C) Glipizide
(D) Metformin (E) Orlistat
NLN Practice Test: Answers and Rationale

1) D
- In the client with hyperthyroidism, excessive thyroid hormone production leads to hypermetabolism and
increased nutrient metabolism. These conditions may result in a negative nitrogen balance, increased
protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This
puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than
body requirements the most important nursing diagnosis. Options B and C may be appropriate for a client
with hypothyroidism, which slows the metabolic rate.
2) C
- The client should inject insulin before, not after, breakfast and dinner — 30 minutes before breakfast for
the a.m. dose and 30 minutes before dinner for the p.m. dose. Therefore, the client has a knowledge
deficit regarding when to administer insulin. By taking insulin, measuring blood glucose levels, and
seeing the physician regularly, the client has demonstrated the ability and willingness to modify the
lifestyle as needed to manage the disease. This eliminates the nursing diagnoses of Impaired adjustment
and Defensive coping. Because the nurse, not the client, questioned the client's health practices related to
diabetes management, the nursing diagnosis of Health-seeking behaviors isn't warranted.
3) A
- The client has signs and symptoms of diabetes insipidus, probably caused by the failure of her renal
tubules to respond to antidiuretic hormone as a consequence of pyelonephritis. The hypernatremia is
secondary to her water loss. Imbalanced nutrition related to hypermetabolic state or catabolic effect of
insulin deficiency is an inappropriate nursing diagnosis for the client.
4) A
- Noncompliance with treatment for SIADH may lead to water intoxication from fluid retention caused by
excessive antidiuretic hormone. This, in turn, limits water excretion and increases the risk for cerebral
edema. Hypovolemic shock results from severe fluid volume deficit; in contrast, SIADH causes excessive
fluid volume. The major electrolyte disturbance in SIADH is dilutional hyponatremia, not hyperkalemia.
Because SIADH doesn't alter renal function, potassium excretion remains normal; therefore, severe
hyperkalemia doesn't occur. Tetany results from hypocalcemia, an electrolyte disturbance not associated
with SIADH.
5) A
- Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and face are
findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism
when the adenoma is removed. Tremors, diaphoresis, and constipation aren't seen in hyperkalemia.
6) B
- Weight loss, nervousness, and tachycardia are signs of hyperthyroidism. Other signs of hyperthyroidism
include exophthalmos, diaphoresis, fever, and diarrhea. Weight gain, constipation, lethargy, decreased
sweating, and cold intolerance are signs of hypothyroidism.
7) A
- 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).
8) C
- Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate
causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting
edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of
hypothyroidism that occurs in infants. Hashimoto's thyroiditis is a common chronic inflammatory disease
of the thyroid gland in which autoimmune factors play a prominent role.
9) A
- In SIADH, the posterior pituitary gland produces excess antidiuretic hormone (vasopressin), which
decreases water excretion by the kidneys. This, in turn, reduces the serum sodium level, causing
hyponatremia. In SIADH, the serum creatinine level isn't affected by the client's fluid status and remains
within normal limits. Typically, the hematocrit and BUN level decrease.
10) A
- Agitation, irritability, poor memory, loss of appetite, and neglect of one's appearance may signal
depression, which is common in clients with Cushing's syndrome. Neuropathy affects clients with
diabetes mellitus — not Cushing's syndrome. Although hypoglycemia can cause irritability, it also
produces increased appetite, rather than loss of appetite. Hyperthyroidism typically causes such signs as
goiter, nervousness, heat intolerance, and weight loss despite increased appetite.

11) B
- Cushing's syndrome causes tissue catabolism, resulting in thinning skin and connective tissue loss;
along with immobility related to CVA, these factors increase this client's risk for impaired skin integrity.
The exaggerated glucocorticoid activity in Cushing's syndrome causes sodium and water retention, in turn
leading to edema and hypertension. Therefore, Risk for imbalanced fluid volume and Decreased cardiac
output are inappropriate nursing diagnoses. Increased glucocorticoid activity also causes persistent
hyperglycemia, eliminating Ineffective health maintenance related to frequent hypoglycemic episodes as
an appropriate nursing diagnosis.
12) B
- Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic agents
aren't effective in type 1 diabetes. Pregnant and lactating women aren't prescribed oral antidiabetic agents
because the effect on the fetus is uncertain.
13) A
- Initially, many clients use denial to cope with unpleasant or shocking news, such as a diagnosis of
diabetes mellitus. Although withdrawal, anger, and resolution also are coping mechanisms, they surface
later in the readjustment period, after the client realizes the information is correct.
14) C
- The client should be encouraged to force fluids to prevent renal calculi formation. Sodium should be
encouraged to replace losses in urine. Restricting potassium isn't necessary in hyperparathyroidism.
15) B
- Typically, clients with hypoparathyroidism are prescribed daily supplements of vitamin D along with
calcium because calcium absorption from the small intestine depends on vitamin D. Hypoparathyroidism
doesn't cause a deficiency of folic acid, potassium, or iron. Therefore, the client doesn't require daily
supplements of these substances to maintain a normal serum calcium level.

16) D
- Hypothyroidism markedly decreases the metabolic rate, causing a reduced body temperature and cold
intolerance. Other signs and symptoms include dyspnea, hypoventilation, bradycardia, hypotension,
anorexia, constipation, decreased intellectual function, and depression. The other options are typical
findings in a client with hyperthyroidism.
17) B
- Exophthalmos is characterized by protruding eyes and a fixed stare. Dry, waxy swelling and abnormal
mucin deposits in the skin typify myxedema, a condition resulting from advanced hypothyroidism. A
wide, staggering gait and a differential between the apical and radial pulse rates aren't specific signs of
thyroid dysfunction.
18) A
- Classic signs of water intoxication include confusion and seizures, both of which are caused by cerebral
edema. Weight gain will also occur. Sunken eyeballs, thirst, and increased BUN levels indicate fluid
volume deficit. Spasticity, flaccidity, and tetany are unrelated to water intoxication.

19) B
- Hypercalcemia is the hallmark of excess parathyroid hormone levels. Serum phosphate will be low
(hyperphosphatemia), and there will be increased urinary phosphate (hyperphosphaturia) because
phosphate excretion is increased.

20) B
- Because Cushing's syndrome causes aldosterone overproduction, which increases urinary potassium
loss, the disorder may lead to hypokalemia. Therefore, the nurse should immediately report signs and
symptoms of hypokalemia, such as an irregular apical pulse, to the physician. Edema is an expected
finding because aldosterone overproduction causes sodium and fluid retention. Dry mucous membranes
and frequent urination signal dehydration, which isn't associated with Cushing's syndrome.

21) D
- Because respirations are depressed in myxedema coma, maintaining a patent airway is the most critical
nursing intervention. Ventilatory support is usually needed. Although myxedema coma is associated with
severe hypothermia, a warming blanket shouldn't be used because it may cause vasodilation and shock.
Gradual warming with blankets would be appropriate. Thyroid replacement will be administered I.V. and
although intake and output are very important, these aren't critical interventions at this time.
22) D
- Hyperparathyroidism is most common in older women and is characterized by bone pain and weakness
from excess parathyroid hormone (PTH). Clients also exhibit hypercaliuria-causing polyuria. While
clients with diabetes mellitus and diabetes insipidus also have polyuria, they don't have bone pain and
increased sleeping. Hypoparathyroidism is characterized by urinary frequency rather than polyuria.
23) A
- ADH is the hormone clients with diabetes insipidus lack. The client's TSH, FSH, and LH levels won't be
affected.
24) D
- The client in addisonian crisis has a reduced ability to cope with stress due to an inability to produce
corticosteroids. Compared to a multibed room, a private room is easier to keep quiet, dimly lit, and
temperature controlled. Also, visitors can be limited to reduce noise, promote rest, and decrease the risk
of infection. The client should be kept on bed rest, receiving total assistance with ADLs because
ambulation isn't allowed. Because extremes of temperature should be avoided, measures to raise the body
temperature, such as extra blankets and turning up the heat, should be avoided.

25) B
- The beta cells of the pancreas secrete insulin. The adenohypophysis or anterior pituitary gland secretes
many hormones, such as growth hormone, prolactin, thyroid-stimulating hormone, corticotropin, follicle-
stimulating hormone, and luteinizing hormone, but not insulin. The alpha cells of the pancreas secrete
glucagon, which raises the blood glucose level. The parafollicular cells of the thyroid secrete the hormone
calcitonin, which plays a role in calcium metabolism.

26) D
- Potassium iodide reduces the vascularity of the thyroid gland and is used to prepare the gland for
surgery. Potassium iodide reaches its maximum effect in 1 to 2 weeks. PTU blocks the conversion of
thyroxine to triiodothyronine, the more biologically active thyroid hormone. PTU effects are also seen in
1 to 2 weeks. To relieve symptoms of hyperthyroidism in the interim, clients are usually given a beta-
adrenergic blocker such as propranolol.

27) D
- When mixing types of insulin, the client should draw the clear (regular) insulin into the syringe first.
The daily insulin dose typically is administered before the first meal of the day and at a 90-degree angle
to fatty tissue. If cloudy, neutral protamine Hagedorn, or Humulin-N, insulin must be administered, the
client should gently roll the vial between the palms of her hands before withdrawing the medication.

28) D
- The nurse should refer this client to a sex counselor or other professional. Making appropriate referrals
is a valid part of planning the client's care. The nurse doesn't normally provide sex counseling.

29) C
- Because the client in addisonian crisis is unstable, vital signs and fluid and electrolyte balance should be
assessed every 30 minutes until he's stable. Daily weights are sufficient when assessing the client's
condition. The client shouldn't have ketones in his urine, so there is no need to assess the urine for their
presence. Oral hydrocortisone isn't administered during the first 24 hours in severe adrenal insufficiency.

30) D
- Type 2 diabetes is often obesity-related; therefore, weight reduction may enhance the normalization of
the blood glucose level. Weight reduction should be achieved by a healthy diet and exercise to increase
carbohydrate metabolism. Blood glucose levels should be maintained within normal limits to prevent the
development of diabetic complications. Clients with type 1 or 2 diabetes shouldn't smoke because of the
increased risk of cardiovascular disease. A funduscopic examination should be done yearly to identify
early signs of diabetic retinopathy.

31) D
- PTH increases the serum calcium level and decreases the serum phosphate level. PTH doesn't affect
sodium, potassium, or magnesium regulation.

32) C
- A client with diabetes mellitus should wash and inspect his feet daily and should wear nonconstrictive
shoes. Corns should be treated by a podiatrist — not with commercial preparations. Nails should be filed
straight across. Clients with diabetes mellitus should never walk barefoot.

33) D
- Graves' disease causes signs and symptoms of hypermetabolism, such as heat intolerance, diaphoresis,
excessive thirst and appetite, and weight loss. To reduce heat intolerance and diaphoresis, the nurse
should keep the client's room temperature in the low-normal range. To replace fluids lost via diaphoresis,
the nurse should encourage, not restrict, intake of oral fluids. Placing extra blankets on the bed of a client
with heat intolerance would cause discomfort. To provide needed energy and calories, the nurse should
encourage the client to eat high-carbohydrate foods.

34) A
- Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery. Hemorrhage
is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension, frequent
swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term
for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur
postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.

35) A
- Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing's syndrome.
With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in
Cushing's syndrome; therefore, with successful treatment, abnormal hair growth also declines.
Osteoporosis occurs in Cushing's syndrome; therefore, with successful treatment, bone mineralization
increases. Amenorrhea develops in Cushing's syndrome. With successful treatment, the client experiences
a return of menstrual flow, not a decline in it.

36) A - Correct
Rationale: This patient presents as a classic case of Graves’ disease. In Graves’ disease, thyroid-
stimulating IgG antibodies bind to TSH receptors and lead to thyroid hormone production. This causes
glandular hyperplasia and enlargement characteristic of the goiter associated with Graves’ disease.
Graves’ disease is the most common cause of thyrotoxicosis. Patients with this condition may have other
autoimmune diseases, such as pernicious anemia or type 1 diabetes mellitus, and frequently present with
anxiety, irritability, tremor, heat intolerance with sweaty skin, tachycardia and cardiac palpitations,
weight loss, increased appetite, fine hair, diarrhea, and amenorrhea or oligomenorrhea. Signs include
diffuse goiter, proptosis, periorbital edema, and thickened skin on the lower extremities. Laboratory
values reveal increased thyroid hormone levels and decreased TSH levels.
B is Incorrect.
Rationale: Idiopathic replacement of thyroid and surrounding tissue with fibrous tissue is seen in Riedel’s
thyroiditis; patients may present with dysphagia, stridor, dyspnea, and hypothyroidism, although more
than 50% of patients are euthyroid. The disease can mimic thyroid carcinoma, which is high on the list of
differential diagnoses for a patient with Riedel’s thyroiditis.
C is Incorrect.
Rationale: Most thyroid adenomas present as solitary nodules and are usually nonfunctional.
D is Incorrect.
Rationale: Thyroid hormoneproducing ovarian teratomas are known as struma ovarii, a tumor consisting
of thyroid tissue. These tumors can cause hyperthyroidism, but given the patient’s history of autoimmune
disease, Graves’ disease is the better answer choice.

37) D - Correct
Rationale: Primary hyperaldosteronism is most commonly caused by an aldosterone- producing adenoma
of the adrenal gland. It can also be found in patients with zona glomerulosa hyperplasia. The increased
levels of aldosterone lead to hypertension, increased sodium and water retention, and the associated
increase in excretion of potassium leading to hypokalemia. Increased blood pressure and aldosterone
levels produce negative feedback to the kidneys, resulting in a decreased level of serum renin. Serum
renin levels help differentiate between primary hyperaldosteronism, with increased aldosterone and
decreased renin levels, and secondary hyperaldosteronism, with increased aldosterone levels and
increased renin levels.

A is Incorrect.
Rationale: Addison’s disease results from adrenal atrophy and causes hypofunction of the adrenal glands.
Patients with Addison’s disease display signs that are the opposite of those seen in hyperaldosteronism,
including hypotension, hyponatremia, and hyperkalemia.

B is Incorrect.
Rationale: Patients with hyperthyroidism have heat intolerance, hyperactivity, weight loss, chest
pain/palpitations, arrhythmias, diarrhea, hyperreflexia, fine hair, and warm, moist skin.
C is Incorrect.
Rationale: Patients with pheochromocytoma have increased levels of epinephrine and norepinephrine,
which can lead to elevated blood pressure; however, sodium, potassium, and renin levels are not affected.

38) A - Correct
NLN Practice Test Rationale: Usually, the thyroid gland develops beneath the tongue, descends along the
thyroglossal duct, and eventually resides anterior to the trachea in the neck. Ectopic thyroid tissue may be
found anywhere along the course of the duct, including its place of origin: beneath the tongue. This is a
common congenital anomaly that does not affect thyroid function, and it should not be removed.
Hypersecretion of thyroxine (T4) from the ectopic gland can result in menstrual abnormalities, including
amenorrhea and oligomenorrhea.

B is Incorrect.
Rationale: Cold intolerance is characteristic of hypothyroidism, which is a decreased secretion of T4 from
the thyroid gland. Hypersecretion of T4 would cause heat intolerance, not cold.

C is Incorrect.
Rationale: Constipation is characteristic of hypothyroidism, which is a decreased secretion of T4 from the
thyroid gland. Hypersecretion of T4 is not associated with constipation.

D is Incorrect.
Rationale: Hyperlipidemia is characteristic of hypothyroidism, which is a decreased secretion of T4 from
the thyroid gland. Hypersecretion of T4 is not associated with hyperlipidemia.

39) B - Correct
Rationale: This patient is at risk for prednisone-induced Cushing’s syndrome. Cushing’s syndrome is
associated with diabetes mellitus, which can be an adverse effect of chronic corticosteroid use owing to
decreased glucose tolerance and the counterregulatory action of the hormone. Glucocorticoids increase
the glucose production by the liver in part by stimulating gluconeogenesis, and also by stimulating
proteolysis in the skeletal muscle and releasing glucogenic amino acids into the vasculature.
A is Incorrect.
Rationale: Diabetes mellitus, not diabetes insipidus, is an adverse effect of corticosteroids, owing to
decreased glucose tolerance and the counterregulatory action of the hormone. Diabetes insipidus can
develop due to either pituitary dysfunction (i.e., Sheehan’s syndrome) or failure of kidneys to respond to
circulating ADH (i.e., renal disease).
C is Incorrect.
Rationale: Hyperpigmentation of the skin may develop in a patient with Cushing’s disease due to primary
pituitary adenoma hypersecretion of ACTH. Elevated ACTH can result in skin hyperpigmentation
because of its melanocyte properties. This patient is receiving exogenous corticosteroids; thus, his ACTH
levels should be decreased from negative feedback inhibition, and skin hyperpigmentation should not
occur.
D is Incorrect.
Rationale: Hypertension, not hypotension, is an adverse effect of corticosteroids. This side effect is due to
the mineralocorticoid properties of steroids, which lead to increased sodium retention and hence to
hypertension.

40) D - Correct
Rationale: The sensory receptors responsible for transducing the sensation of vibration, pressure, and
tension are the large, encapsulated pacinian corpuscles, which are located in the deeper layers of the skin,
ligaments, and joint capsules. They can be distinguished histologically by their onion like appearance on
cross section. This patient is presenting with one of the complications of diabetes, neuropathy, and since
pacinian corpuscles are responsible for transducing vibratory stimuli, it is these receptors that are
involved in this patient’s presentation.

A is Incorrect.
Rationale: Kraus end bulbs are sensory receptors found in the oropharynx and conjunctiva of the eye.

B is Incorrect.
Rationale: Meissner’s corpuscles, which are responsible for conveying the sensation of light touch, are
small encapsulated sensory receptors found just beneath the dermis of hairless skin, most prominently in
the fingertips, soles of the feet, and lips. Meissner’s corpuscles are involved in the reception of light
discriminatory touch, not vibratory sensation, as is being tested in this case.

C is Incorrect.
Rationale: Merkel nerve endings are nonencapsulated and found in all skin types (both hairy and hairless)
and, along with Meissner’s corpuscles, are believed to be responsible for discriminatory touch.

41) D - Correct

Rationale: This patient had a disulfiram like reaction after drinking alcohol at a cocktail party. Of the
diabetes medications listed, only tolbutamide is associated with causing a disulfiram like reaction after
alcohol consumption. Tolbutamide is a sulfonylurea antidiabetic agent. Sulfonylureas lower blood
glucose in patients with type 2 diabetes by directly stimulating the release of insulin from the pancreas.
They do islet cell, β this by binding to the sulfonylurea receptor on the leading to the inhibition of
potassium ion efflux, cell depolarization, subsequent opening of voltage gated calcium channels, and
calcium influx, which triggers the release of preformed insulin. Other drugs known to cause a disulfiram
like reaction include metronidazole, quinacrine, griseofulvin, and chloramphenicol, as well as some
cephalosporins including cefamandole and cefoperazone.

A is Incorrect.
-glucosidase inhibitor that may causeα Rationale: Acarbose is an gastrointestinal disturbances. It does
not cause disulfiram like -Glucosidases are attached to the intestinal brush borderα reactions. and
acarbose will reduce the postprandial digestion and absorption of starch and disaccharides.

B is Incorrect.
Rationale: Glipizide and glyburide are second-generation sulfonylureas that may cause hypoglycemia, but
they do not cause disulfiram like reactions.

C is Incorrect.
Rationale: Glyburide and glipizide are second-generation sulfonylureas that may cause hypoglycemia, but
they do not cause disulfiram like reactions. Glyburide and glipizide are second-generation sulfonylureas
that may cause hypoglycemia, but they do not cause disulfiram like reactions. The mechanism of action
of sulfonylureas is primarily to increase insulin release from the pancreas. However, two additional
mechanisms of action have been proposed (1) a reduction of serum glucagons and (2) closure of
potassium channels in extrapancreatic tissues.

42. B - Correct
Rationale: The head of the pancreas and the duodenum share a dual blood supply from the gastroduodenal
artery, a branch of the celiac trunk. This artery supplies the anterior and posterior superior
pancreaticoduodenal arteries as well as the superior mesenteric artery, which supplies the anterior and
posterior inferior pancreaticoduodenal arteries. Therefore, to resect any portion of the duodenum or the
head of the pancreas, branches from both the gastroduodenal and superior mesenteric arteries must be
ligated.

A is Incorrect.
Rationale: While the gastroduodenal artery is an important source of vascular supply to the head of the
pancreas, 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.

C is Incorrect.
Rationale: Neither the left gastric nor the inferior mesenteric arteries provide any significant arterial
supply to the head of the pancreas; thus no branches from either of these vessels would need to be ligated
to complete the resection.

D is Incorrect.
Rationale: While the superior mesenteric artery is an important source of vascular supply to the head of
the pancreas, 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.

43) C - Correct
NLN Practice Test Rationale: This patient presents with acromegaly, the clinical syndrome that is a result
of excessive growth hormone (GH) secretion in adults (after closure of the physes). Octreotide is a
somatostatin analog that acts at the anterior pituitary to suppress GH secretion, and is used in the
treatment of acromegaly. Surgical and radiotherapeutic approaches are also an option, depending on the
etiology. Somatostatin is normally secreted by the hypothalamus to help regulate basal GH secretion.

A is Incorrect.
-reductase inhibitor that suppresses theα Rationale: Finasteride is a 5- conversion of testosterone to
dihydrotestosterone and is used in the treatment of benign prostatic hypertrophy.

B is Incorrect.
Rationale: Leuprolide is a gonadotropin- releasing hormone analog that can exhibit both agonist and
antagonist actions, depending on the timing of administration. It is used to treat infertility, prostate cancer,
and uterine fibroids. Adverse effects include antiandrogen actions (e.g., gynecomastia, decreased libido),
nausea, and vomiting.

D is Incorrect.
Rationale: Like somatrem, recombinant GH is useful in the treatment of GH deficiency, but would
exacerbate the condition of a patient with acromegaly.

44) D - Correct
Rationale: The headache, anxiety, and palpitations suggest an excess of catecholamines stimulating the
sympathetic nervous system. A pheochromocytoma may be suspected, and since there appears to be
familial involvement, the related multiple endocrine neoplasia (MEN) syndromes should also be
considered. MEN type II (used to be called type 2a) consists of medullary thyroid carcinoma (MTC),
pheochromocytoma, and tumors of the parathyroid. MEN type III (used to be type 2b) usually includes
MTC, pheochromocytoma, and neuromas instead of parathyroid tumors. It is therefore likely that this
patient’s relatives had their thyroids removed due to MTC. One could further differentiate the two types
by looking for neuromas on the lips, tongue, or eyelids or in the gastrointestinal tract causing
constipation/diarrhea, or for hyperparathyroidism manifesting in bradycardia, hypotonia, fatigue, and
bone pain.
A is Incorrect.
Rationale: Acromegaly can lead to headaches; however, it does not commonly cause palpitations and is
not associated with multiple endocrine neoplasia. Clinical signs of acromegaly include coarse facies,
enlarged tongue, and increased size of hands and feet.

B is Incorrect.
Rationale: An ACTH-secreting pituitary adenoma, which defines Cushing’s disease, would cause
hypercortisolemia secondary to ACTH stimulation from the anterior pituitary, with elevated serum ACTH
levels. Clinical findings would include characteristic moon facies, striae, obesity, hypertension, weakness,
and hirsutism.

C is Incorrect.
Rationale: Up to 80% of patients with hyperparathyroidism are asymptomatic at diagnosis, and their
disease is caught by routine blood tests. Some have nonspecific symptoms such as fatigue, mild
depression, and anorexia.
If severe, metastatic calcification and osteoclastic bone lesions can occur.

45) A - Correct
Rationale: In addition to being necessary to normal human growth and development, GH is critical in the
stress response to starvation. GH is released in response to hypoglycemia and acts directly to decrease
glucose uptake by cells and increase lipolysis, resulting in an increase in blood sugar levels.

B is Incorrect.
Rationale: GH secretion is not stimulated by obesity, but rather is reduced by this condition.

C is Incorrect.
Rationale: Pregnancy is not a stimulus for GH secretion. Rather, GH secretion decreases in pregnancy.

D is Incorrect.
Rationale: Somatomedins, or insulin- like growth factors, are secreted by the liver in response to GH and
mediate the metabolic changes necessary for growth and development. These intermediaries also act on
the hypothalamus and the anterior pituitary via a negative feedback mechanism to reduce GH secretion.
46) B - Correct
Rationale: This vignette is most consistent with a syndrome of inappropriate secretion of ADH due to a
lung neoplasm. ADH is secreted by the posterior pituitary and stimulates the expression of aquaporins in
the renal collecting ducts, resulting in transport of water into the renal medulla from the ductal lumen and
hence water retention in the kidneys. When levels of this hormone are inappropriately elevated, excessive
water retention results in hyponatremia, which can lead to seizures. ADH can be produced ectopically in
the setting of malignancy, classically by small cell lung cancer.
A is Incorrect.
Rationale: ACTH can be produced ectopically in the setting of malignancy, especially small cell lung
cancer. However, excessive levels of ACTH would result in Cushing’s syndrome, and the vignette
provides no symptoms or signs that would be consistent with this condition.
C is Incorrect.
Rationale: Parathyroid hormone (PTH) can be produced ectopically in the setting of malignancy and is
associated with a variety of neoplasia, including squamous celllung cancer, breast cancer, and multiple
myeloma. However, excessive levels of PTH would result in hypercalcemia, and the vignette does not
provide any indication that would be most consistent with this condition. Note that these symptoms can
also occur in the setting of malignancy due to production of PTH-related peptide by tumor cells.
D is Incorrect.
Rationale: Hyperreninemia does not typically occur as paraneoplastic syndrome and would generally
cause hyperaldosteronism, resulting in hypernatremia and hypokalemia. While seizures can be a
consequence of severe hypernatremia, the vignette does not mention any signs or symptoms of
hypokalemia (nausea, vomiting, muscle weakness, cardiac dysrhythmias).

47) A - Correct
Rationale: This patient had pseudohypoparathyroidism. In all forms of pseudohypoparathyroidism, there
is a defect in the peripheral organ response to PTH, leading to increased PTH levels. There are several
types of pseudohypoparathyroidism, which vary in clinical presentation. This is an autosomal dominant
disease, and penetrance is variable. Pseudohypothyroidism is caused by kidney unresponsiveness to PTH.

B is incorrect.
Rationale: Pseudohypoparathyroidism is an autosomal dominant disease, and penetrance is variable.

C is Incorrect.
Rationale: Pseudohypoparathyroidism is an autosomal dominant disease, and penetrance is variable.

D is Incorrect.
Rationale: Pseudohypoparathyroidism is an autosomal dominant disease, and penetrance is variable.

48) D - Correct
NLN Practice Test Rationale: This patient has Hashimoto’s thyroiditis, an autoimmune disorder in which
patients have antibodies attacking thyroglobulin, thyroid peroxidase, 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.

A is Incorrect.
Rationale: This patient has Hashimoto’s thyroiditis. She would not have Graves’ disease as well.

B is Incorrect.
Rationale: Addison’s disease does have a high prevalence in patients with Hashimoto’s thyroiditis.
However, osteoarthritis is not an autoimmune disease.

C is Incorrect.
Rationale: Rheumatoid arthritis and vitiligo are both autoimmune diseases, but they do not have as high
of an association with Hashimoto’s thyroiditis as do type 1 diabetes mellitus and celiac disease.

49) A - Correct
Rationale: This patient’s recent history of hyperglycemic symptoms, hypertension, and weight gain are all
consistent with a diagnosis of Cushing’s syndrome, which is characterized by hypercortisolemia. This
leads to exaggeration of the physiologic effects of cortisol, such as hyperglycemia and insulin resistance,
immune suppression, and hypertension (a consequence of salt retention due to secondary elevation of
aldosterone). One result of this syndrome is osteoporosis, which is caused by increased bone resorption in
response to an elevated serum cortisol level. Vertebral compression fractures are common manifestations
of osteoporosis.

B is Incorrect.
Rationale: Glucagon can account for hyperglycemia via its anti-insulin physiologic effects, but it has no
known physiologic effects on bone metabolism.
C is Incorrect.
Rationale: GH can cause hyperglycemia and insulin resistance but cannot account for increased bone
resorption resulting in osteoporosis. Rather, GH stimulates increased bone growth that results in linear
growth; it is responsible for the pubertal growth spurt.

D is Incorrect.
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.

50) A - Correct
Rationale: -glucosidase inhibitor that decreases the hydrolysis andα Acarbose is an absorption of
disaccharides and polysaccharides at the intestinal brush border, thereby reducing postprandial
hyperglycemia. This drug can be used as monotherapy or in combination with oral hypoglycemic
medications in the management of type 2 diabetes mellitus. Acarbose commonly causes gastrointestinal
adverse effects that include abdominal cramps, diarrhea, and flatulence.

B is Incorrect.
Rationale: Chlorpropamide is a sulfonylurea that acts via stimulation of insulin secretion by the pancreas.
Hypoglycemia is the most important adverse effect of this drug, but chlorpropamide can also cause
disulfiram-like adverse effects. This agent is generally not known to cause signifi cant gastrointestinal
disturbances.

C is Incorrect.
Rationale: Glipizide is a sulfonylurea that acts via stimulation of insulin secretion by the pancreas.
Hypoglycemia is the most important side effect of this drug. Glipizide is generally not known to cause
signifi cant gastrointestinal disturbances.

D is Incorrect.
Rationale: Metformin inhibits gluconeogenesis, thus reducing blood sugar levels. The most important side
effect of this agent is lactic acidosis. Metformin can sometimes cause loose bowel movements but is
generally not associated with increased flatulence.