Metabolic and Endocrine Management
effect?
Endocrine Disorders 1 25 items
1. An agitated, confused female client arrives in the
emergency department. Her history includes type 1 diabetes
mellitus, hypertension, and angina pectoris. Assessment
reveals pallor, diaphoresis, headache, and intense hunger. A
stat blood glucose sample measures 42 mg/dl, and the client
is treated for an acute hypoglycemic reaction. After recovery,
nurse Lily teaches the client to treat hypoglycemia by
ingesting:
2 to 5 g of a simple carbohydrate.
10 to 15 g of a simple carbohydrate.
18 to 20 g of a simple carbohydrate.
25 to 30 g of a simple carbohydrate.
2. A female adult client with a history of chronic
hyperparathyroidism admits to being noncompliant. Based
on initial assessment findings, nurse Julia formulates the
nursing diagnosis of Risk for injury. To complete the nursing
diagnosis statement for this client, which “related-to” phrase
should the nurse add?
Related to bone demineralization resulting in pathologic
fractures
Related to exhaustion secondary to an accelerated metabolic
rate
Related to edema and dry skin secondary to fluid infiltration
into the interstitial spaces
Related to tetany secondary to a decreased serum calcium
level
3. Nurse John is assigned to care for a postoperative male
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:
Encourage the client to ask questions about personal
sexuality.
Provide time for privacy.
Provide support for the spouse or significant other.
Suggest referral to a sex counselor or other appropriate
professional.
4. During a class on exercise for diabetic clients, a female
client asks the nurse educator how often to exercise. The
nurse educator advises the clients to exercise how often to
meet the goals of planned exercise?
At least once a week
At least three times a week
At least five times a week
Every day
5. Nurse Oliver should expect a client with hypothyroidism to
report which health concerns?
Increased appetite and weight loss
Puffiness of the face and hands
Nervousness and tremors
Thyroid gland swelling
6. A female client with hypothyroidism (myxedema) is
receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which
finding should nurse Hans recognize as an adverse drug
Dysuria
Leg cramps
Tachycardia
Blurred vision
7. A 67-year-old male 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, nurse Richard
would suspect which of the following disorders?
Diabetes mellitus
Diabetes insipidus
Hypoparathyroidism
Hyperparathyroidism
8. When caring for a male client with diabetes insipidus,
nurse Juliet expects to administer:
vasopressin (Pitressin Synthetic).
furosemide (Lasix).
regular insulin.
10% dextrose.
9. The nurse is aware that the following is the most common
cause of hyperaldosteronism?
Excessive sodium intake
A pituitary adenoma
Deficient potassium intake
An adrenal adenoma
10. A male client with type 1 diabetes mellitus has a highly
elevated glycosylated hemoglobin (Hb) test result. In
discussing the result with the client, nurse Sharmaine would
be most accurate in stating:
“The test needs to be repeated following a 12-hour fast.”
“It looks like you aren’t following the prescribed diabetic
diet.”
“It tells us about your sugar control for the last 3 months.”
“Your insulin regimen needs to be altered significantly.”
11. Following a unilateral adrenalectomy, nurse Betty would
assess for hyperkalemia shown by which of the following?
Muscle weakness
Tremors
Diaphoresis
Constipation
12. Nurse Louie is developing a teaching plan for a male client
diagnosed with diabetes insipidus. The nurse should include
information about which hormone lacking in clients with
diabetes insipidus?
antidiuretic hormone (ADH).
thyroid-stimulating hormone (TSH).
follicle-stimulating hormone (FSH).
luteinizing hormone (LH).
13. Early this morning, a female client had a subtotal
thyroidectomy. During evening rounds, nurse Tina assesses
the client, who now has nausea, a temperature of 105° F
(40.5° C), tachycardia, and extreme restlessness. What is the
most likely cause of these signs?
Diabetic ketoacidosis
Thyroid crisis
Hypoglycemia
Tetany
14. For a male client with hyperglycemia, which assessment
finding best supports a nursing diagnosis of Deficient fluid
volume?
Cool, clammy skin
Distended neck veins
Increased urine osmolarity
Decreased serum sodium level
15. When assessing a male client with pheochromocytoma, a
tumor of the adrenal medulla that secretes excessive
catecholamine, nurse April is most likely to detect:
a blood pressure of 130/70 mm Hg.
a blood glucose level of 130 mg/dl.
bradycardia.
a blood pressure of 176/88 mm Hg.
16. A male client is admitted for treatment of the syndrome
of inappropriate antidiuretic hormone (SIADH). Which
nursing intervention is appropriate?
Infusing I.V. fluids rapidly as ordered
Encouraging increased oral intake
Restricting fluids
Administering glucose-containing I.V. fluids as ordered
17. A female client has a serum calcium level of 7.2 mg/dl.
During the physical examination, nurse Noah expects to
assess:
Trousseau’s sign.
Homans’ sign.
Hegar’s sign.
Goodell’s sign.
18. Which outcome indicates that treatment of a male client
with diabetes insipidus has been effective?
Fluid intake is less than 2,500 ml/day.
Urine output measures more than 200 ml/hour.
Blood pressure is 90/50 mm Hg.
The heart rate is 126 beats/minute.
19. Jemma, who weighs 210 lb (95 kg) and has been
diagnosed with hyperglycemia tells the nurse that her
husband sleeps in another room because her snoring keeps
him awake. The nurse notices that she has large hands and a
hoarse voice. Which of the following would the nurse suspect
as a possible cause of the client’s hyperglycemia?
Acromegaly
Type 1 diabetes mellitus
Hypothyroidism
Deficient growth hormone
20. Nurse Kate is providing dietary instructions to a male
client with hypoglycemia. To control hypoglycemic episodes,
the nurse should recommend:
Increasing saturated fat intake and fasting in the afternoon.
Increasing intake of vitamins B and D and taking iron
supplements.
Eating a candy bar if light-headedness occurs.
Consuming a low-carbohydrate, high-protein diet and
avoiding fasting.
21. An incoherent female 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, nurse Libby prepares to take
emergency action to prevent the potential complication of:
Thyroid storm.
Cretinism.
myxedema coma.
Hashimoto’s thyroiditis.
22. A male client with type 1 diabetes mellitus asks the nurse
about taking an oral antidiabetic agent. Nurse Jack explains
that these medications are only effective if the client:
prefers to take insulin orally.
has type 2 diabetes.
has type 1 diabetes.
is pregnant and has type 2 diabetes.
23. When caring for a female client with a history of
hypoglycemia, nurse Ruby should avoid administering a drug
that may potentiate hypoglycemia. Which drug fits this
description?
sulfisoxazole (Gantrisin)
mexiletine (Mexitil)
prednisone (Orasone)
lithium carbonate (Lithobid)
24. After taking glipizide (Glucotrol) for 9 months, a male
client experiences secondary failure. Which of the following
would the nurse expect the physician to do?
Initiate insulin therapy.
Switch the client to a different oral antidiabetic agent.
Prescribe an additional oral antidiabetic agent.
Restrict carbohydrate intake to less than 30% of the total
caloric intake.
25. During preoperative teaching for a female client who will
undergo subtotal thyroidectomy, the nurse should include
which statement?
“The head of your bed must remain flat for 24 hours after
surgery.”
“You should avoid deep breathing and coughing after
surgery.”
“You won’t be able to swallow for the first day or two.”
“You must avoid hyperextending your neck after surgery.”
Answers and Rationales
1. Answer B. To reverse hypoglycemia, the American
Diabetes Association recommends ingesting 10 to 15 g
of a simple carbohydrate, such as three to five pieces
of hard candy, two to three packets of sugar (4 to 6
tsp), or 4 oz of fruit juice. If necessary, this treatment
can be repeated in 15 minutes. Ingesting only 2 to 5 g
of a simple carbohydrate may not raise the blood
glucose level sufficiently. Ingesting more than 15 g may
raise it above normal, causing hyperglycemia.
2. Answer A. Poorly controlled hyperparathyroidism may
cause an elevated serum calcium level. This, in turn,
may diminish calcium stores in the bone, causing bone
demineralization and setting the stage for pathologic
fractures and a risk for injury. Hyperparathyroidism
doesn’t accelerate the metabolic rate. A decreased
thyroid hormone level, not an increased parathyroid
hormone level, may cause edema and dry skin
secondary to fluid infiltration into the interstitial
spaces. Hyperparathyroidism causes hypercalcemia,
not hypocalcemia; therefore, it isn’t associated with
tetany.
3. Answer 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.
4. Answer B. Diabetic clients must exercise at least three
times a week to meet the goals of planned exercise —
lowering the blood glucose level, reducing or
maintaining the proper weight, increasing the serum
high-density lipoprotein level, decreasing serum
triglyceride levels, reducing blood pressure, and
minimizing stress. Exercising once a week wouldn’t
achieve these goals. Exercising more than three times
a week, although beneficial, would exceed the
minimum requirement.
5. Answer B. Hypothyroidism (myxedema) causes facial
puffiness, extremity edema, and weight gain. Signs and
symptoms of hyperthyroidism (Graves’ disease)
include an increased appetite, weight loss,
nervousness, tremors, and thyroid gland enlargement
(goiter).
6. Answer C. Levothyroxine, a synthetic thyroid hormone,
is given to a client with hypothyroidism to simulate the
effects of thyroxine. Adverse effects of this agent
include tachycardia. The other options aren’t
associated with levothyroxine.
7. Answer 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.
8. Answer A. Because diabetes insipidus results from
decreased antidiuretic hormone (vasopressin)
production, the nurse should expect to administer
synthetic vasopressin for hormone replacement
therapy. Furosemide, a diuretic, is contraindicated
because a client with diabetes insipidus experiences
polyuria. Insulin and dextrose are used to treat
diabetes mellitus and its complications, not diabetes
insipidus.
9. Answer D. An autonomous aldosterone-producing
adenoma is the most common cause of
hyperaldosteronism. Hyperplasia is the second most
frequent cause. Aldosterone secretion is independent
of sodium and potassium intake as well as of pituitary
stimulation.
10. Answer C. The glycosylated Hb test provides an
objective measure of glycemic control over a 3-month
period. The test helps identify trends or practices that
impair glycemic control, and it doesn’t require a fasting
period before blood is drawn. The nurse can’t conclude
that the result occurs from poor dietary management
or inadequate insulin coverage.
11. Answer 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.
12. Answer A. ADH is the hormone clients with diabetes
insipidus lack. The client’s TSH, FSH, and LH levels
won’t be affected.
13. Answer B. Thyroid crisis usually occurs in the first 12
hours after thyroidectomy and causes exaggerated
signs of hyperthyroidism, such as high fever,
tachycardia, and extreme restlessness. Diabetic
ketoacidosis is more likely to produce polyuria,
polydipsia, and polyphagia; hypoglycemia, to produce
weakness, tremors, profuse perspiration, and hunger.
Tetany typically causes uncontrollable muscle spasms,
stridor, cyanosis, and possibly asphyxia.
14. Answer C. In hyperglycemia, urine osmolarity (the
measurement of dissolved particles in the urine)
increases as glucose particles move into the urine. The
client experiences glucosuria and polyuria, losing body
fluids and experiencing fluid volume deficit. Cool,
clammy skin; distended neck veins; and a decreased
serum sodium level are signs of fluid volume excess,
the opposite imbalance.
15. Answer D. Pheochromocytoma, a tumor of the adrenal
medulla that secretes excessive catecholamine, causes
hypertension, tachycardia, hyperglycemia,
hypermetabolism, and weight loss. It isn’t associated
with the other options.
16. Answer C. To reduce water retention in a client with
the SIADH, the nurse should restrict fluids.
Administering fluids by any route would further
increase the client’s already heightened fluid load.
17. Answer A. This client’s serum calcium level indicates
hypocalcemia, an electrolyte imbalance that causes
Trousseau’s sign (carpopedal spasm induced by
inflating the blood pressure cuff above systolic
pressure). Homans’ sign (pain on dorsiflexion of the
foot) indicates deep vein thrombosis. Hegar’s sign
(softening of the uterine isthmus) and Goodell’s sign
(cervical softening) are probable signs of pregnancy.
18. Answer A. Diabetes insipidus is characterized by
polyuria (up to 8 L/day), constant thirst, and an
unusually high oral intake of fluids. Treatment with the
appropriate drug should decrease both oral fluid
intake and urine output. A urine output of 200 ml/hour
indicates continuing polyuria. A blood pressure of
90/50 mm Hg and a heart rate of 126 beats/minute
indicate compensation for the continued fluid deficit,
suggesting that treatment hasn’t been effective.
19. Answer A. Acromegaly, which is caused by a pituitary
tumor that releases excessive growth hormone, is
associated with hyperglycemia, hypertension,
diaphoresis, peripheral neuropathy, and joint pain.
Enlarged hands and feet are related to lateral bone
 growth, which is seen in adults with this disorder. The
accompanying soft tissue swelling causes hoarseness
and often sleep apnea. Type 1 diabetes is usually seen
in children, and newly diagnosed persons are usually
very ill and thin. Hypothyroidism isn’t associated with
hyperglycemia, nor is growth hormone deficiency.
20. Answer D. To control hypoglycemic episodes, the nurse
should instruct the client to consume a low-
carbohydrate, high-protein diet, avoid fasting, and
avoid simple sugars. Increasing saturated fat intake
and increasing vitamin supplementation wouldn’t help
control hypoglycemia.
21. Answer 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.
22. Answer 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.
23. Answer A. Sulfisoxazole and other sulfonamides are
chemically related to oral antidiabetic agents and may
precipitate hypoglycemia. Mexiletine, an
antiarrhythmic, is used to treat refractory ventricular
arrhythmias; it doesn’t cause hypoglycemia.
Prednisone, a corticosteroid, is associated with
hyperglycemia. Lithium may cause transient
hyperglycemia, not hypoglycemia.
24. Answer B. Many clients (25% to 60%) with secondary
failure respond to a different oral antidiabetic agent.
Therefore, it wouldn’t be appropriate to initiate insulin
therapy at this time. However, if a new oral
antidiabetic agent is unsuccessful in keeping glucose
levels at an acceptable level, insulin may be used in
addition to the antidiabetic agent.
25. Answer D. To prevent undue pressure on the surgical
incision after subtotal thyroidectomy, the nurse should
advise the client to avoid hyperextending the neck.
The client may elevate the head of the bed as desired
and should perform deep breathing and coughing to
help prevent pneumonia. Subtotal thyroidectomy
doesn’t affect swallowing.
Endocrine Disorders 2 25 items
1. Nurse Ronn is assessing a client with possible Cushing’s
syndrome. In a client with Cushing’s syndrome, the nurse
would expect to find:
Hypotension.
Thick, coarse skin.
Deposits of adipose tissue in the trunk and dorsocervical
area.
Weight gain in arms and legs.
2. A male client with primary diabetes insipidus is ready for
discharge on desmopressin (DDAVP). Which instruction
should nurse Lina provide?
“Administer desmopressin while the suspension is cold.”
“Your condition isn’t chronic, so you won’t need to wear a
medical identification bracelet.”
“You may not be able to use desmopressin nasally if you have
nasal discharge or blockage.”
“You won’t need to monitor your fluid intake and output
after you start taking desmopressin.”
3. Nurse Frank is aware that a positive Chvostek’s sign
indicate?
Hypocalcemia
Hyponatremia
Hypokalemia
Hypermagnesemia
4. In a 29-year-old female client who is being successfully
treated for Cushing’s syndrome, nurse Lyzette would expect a
decline in:
Serum glucose level.
Hair loss.
Bone mineralization.
Menstrual flow.
5. A male client has recently undergone surgical removal of a
pituitary tumor. Dr. Wong prescribes corticotropin (Acthar),
20 units I.M. q.i.d. as a replacement therapy. What is the
mechanism of action of corticotropin?
It decreases cyclic adenosine monophosphate (cAMP)
production and affects the metabolic rate of target organs.
It interacts with plasma membrane receptors to inhibit
enzymatic actions.
It interacts with plasma membrane receptors to produce
enzymatic actions that affect protein, fat, and carbohydrate
metabolism.
It regulates the threshold for water resorption in the kidneys.
6. Capillary glucose monitoring is being performed every 4
hours for a female client diagnosed with diabetic
ketoacidosis. Insulin is administered using a scale of regular
insulin according to glucose results. At 2 p.m., the client has a
capillary glucose level of 250 mg/dl for which he receives 8 U
of regular insulin. Nurse Vince should expect the dose’s:
Onset to be at 2 p.m. and its peak to be at 3 p.m.
Onset to be at 2:15 p.m. and its peak to be at 3 p.m.
Onset to be at 2:30 p.m. and its peak to be at 4 p.m.
Onset to be at 4 p.m. and its peak to be at 6 p.m.
7. A female client with Cushing’s syndrome is admitted to the
medical-surgical unit. During the admission assessment,
nurse Tyzz 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?
Depression
Neuropathy
Hypoglycemia
Hyperthyroidism
8. Nurse Ruth 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?
Tetany
Hemorrhage
Thyroid storm
Laryngeal nerve damage
9. After undergoing a subtotal thyroidectomy, a female client
develops hypothyroidism. Dr. Smith prescribes levothyroxine
(Levothroid), 25 mcg P.O. daily. For which condition is
levothyroxine the preferred agent?
Primary hypothyroidism
Graves’ disease
Thyrotoxicosis
Euthyroidism
10. Which of these signs suggests that a male client with the
syndrome of inappropriate antidiuretic hormone (SIADH)
secretion is experiencing complications?
Tetanic contractions
Neck vein distention
Weight loss
Polyuria
11. A female client with a history of pheochromocytoma is
admitted to the hospital in an acute hypertensive crisis. To
reverse hypertensive crisis caused by pheochromocytoma,
nurse Lyka expects to administer:
phentolamine (Regitine).
methyldopa (Aldomet).
mannitol (Osmitrol).
felodipine (Plendil).
12. A male client with a history of hypertension is diagnosed
with primary hyperaldosteronism. This diagnosis indicates
that the client’s hypertension is caused by excessive hormone
secretion from which of the following glands?
Adrenal cortex
Pancreas
Adrenal medulla
Parathyroid
13. Nurse Troy is aware that the most appropriate for a client
with Addison’s disease?
Risk for infection
Excessive fluid volume
Urinary retention
Hypothermia
14. Acarbose (Precose), an alpha-glucosidase inhibitor, is
prescribed for a female client with type 2 diabetes mellitus.
During discharge planning, nurse Pauleen would be aware of
the client’s need for additional teaching when the client
states:
“If I have hypoglycemia, I should eat some sugar, not
dextrose.”
“The drug makes my pancreas release more insulin.”
“I should never take insulin while I’m taking this drug.”
“It’s best if I take the drug with the first bite of a meal.”
15. A female client whose physical findings suggest a
hyperpituitary condition undergoes an extensive diagnostic
workup. Test results reveal a pituitary tumor, which
necessitates a transphenoidal hypophysectomy. The evening
before the surgery, nurse Jacob reviews preoperative and
postoperative instructions given to the client earlier. Which
postoperative instruction should the nurse emphasize?
“You must lie flat for 24 hours after surgery.”
“You must avoid coughing, sneezing, and blowing your nose.”
“You must restrict your fluid intake.”
“You must report ringing in your ears immediately.”
16. Dr. Kennedy prescribes glipizide (Glucotrol), an oral
antidiabetic agent, for a male client with type 2 diabetes
mellitus who has been having trouble controlling the blood
glucose level through diet and exercise. Which medication
instruction should the nurse provide?
“Be sure to take glipizide 30 minutes before meals.”
“Glipizide may cause a low serum sodium level, so make sure
you have your sodium level checked monthly.”
“You won’t need to check your blood glucose level after you
start taking glipizide.”
“Take glipizide after a meal to prevent heartburn.”
17. For a diabetic male client with a foot ulcer, the physician
orders bed rest, a wet-to-dry dressing change every shift, and
blood glucose monitoring before meals and bedtime. Why
are wet-to-dry dressings used for this client?
They contain exudate and provide a moist wound
environment.
They protect the wound from mechanical trauma and
promote healing.
They debride the wound and promote healing by secondary
intention.
They prevent the entrance of microorganisms and minimize
wound discomfort.
18. When instructing the female client diagnosed with
hyperparathyroidism about diet, nurse Gina should stress the
importance of which of the following?
Restricting fluids
Restricting sodium
Forcing fluids
Restricting potassium
19. Which nursing diagnosis takes highest priority for a
female client with hyperthyroidism?
Risk for imbalanced nutrition: More than body requirements
related to thyroid hormone excess
Risk for impaired skin integrity related to edema, skin
fragility, and poor wound healing
Body image disturbance related to weight gain and edema
Imbalanced nutrition: Less than body requirements related to
thyroid hormone excess
20. A male client with a tentative diagnosis of hyperosmolar
hyperglycemic nonketotic syndrome (HHNS) has a history of
type 2 diabetes that is being controlled with an oral diabetic
agent, tolazamide (Tolinase). Which of the following is the
most important laboratory test for confirming this disorder?
Serum potassium level
Serum sodium level
Arterial blood gas (ABG) values
Serum osmolarity
21. A male client has just been diagnosed with type 1
diabetes mellitus. When teaching the client and family how
diet and exercise affect insulin requirements, Nurse Joy
should include which guideline?
“You’ll need more insulin when you exercise or increase your
food intake.”
“You’ll need less insulin when you exercise or reduce your
food intake.”
“You’ll need less insulin when you increase your food intake.”
“You’ll need more insulin when you exercise or decrease your
food intake.”
22. Nurse Noemi administers glucagon to her diabetic client,
then monitors the client for adverse drug reactions and
interactions. Which type of drug interacts adversely with
glucagon?
Oral anticoagulants
Anabolic steroids
Beta-adrenergic blockers
Thiazide diuretics
23. Which instruction about insulin administration should
nurse Kate give to a client?
“Always follow the same order when drawing the different
insulins into the syringe.”
“Shake the vials before withdrawing the insulin.”
“Store unopened vials of insulin in the freezer at
temperatures well below freezing.”
“Discard the intermediate-acting insulin if it appears cloudy.”
24. Nurse Perry is caring for a female client with type 1
diabetes mellitus who exhibits confusion, light-headedness,
and aberrant behavior. The client is still conscious. The nurse
should first administer:
I.M. or subcutaneous glucagon.
I.V. bolus of dextrose 50%.
15 to 20 g of a fast-acting carbohydrate such as orange juice.
10 U of fast-acting insulin.
25. For the first 72 hours after thyroidectomy surgery, nurse
Jamie would assess the female client for Chvostek’s sign and
Trousseau’s sign because they indicate which of the
following?
Hypocalcemia
Hypercalcemia
Hypokalemia
Hyperkalemia
Answers and Rationales
1. Answer C. Because of changes in fat distribution,
adipose tissue accumulates in the trunk, face
(moonface), and dorsocervical areas (buffalo hump).
Hypertension is caused by fluid retention. Skin
becomes thin and bruises easily because of a loss of
collagen. Muscle wasting causes muscle atrophy and
thin extremities.
2. Answer C. Desmopressin may not be absorbed if the
intranasal route is compromised. Although diabetes
insipidus is treatable, the client should wear medical
identification and carry medication at all times to alert
medical personnel in an emergency and ensure proper
treatment. The client must continue to monitor fluid
intake and output and receive adequate fluid
replacement.
3. Answer A. Chvostek’s sign is elicited by tapping the
client’s face lightly over the facial nerve, just below the
temple. If the client’s facial muscles twitch, it indicates
hypocalcemia. Hyponatremia is indicated by weight
loss, abdominal cramping, muscle weakness,
headache, and postural hypotension. Hypokalemia
causes paralytic ileus and muscle weakness. Clients
with hypermagnesemia exhibit a loss of deep tendon
reflexes, coma, or cardiac arrest.
4. Answer 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.
5. Answer C. Corticotropin interacts with plasma
membrane receptors to produce enzymatic actions
that affect protein, fat, and carbohydrate metabolism.
It doesn’t decrease cAMP production. The posterior
pituitary hormone, antidiuretic hormone, regulates the
threshold for water resorption in the kidneys.
6. Answer C. Regular insulin, which is a short-acting
insulin, has an onset of 15 to 30 minutes and a peak of
2 to 4 hours. Because the nurse gave the insulin at 2
p.m., the expected onset would be from 2:15 p.m. to
2:30 p.m. and the peak from 4 p.m. to 6 p.m.
7. Answer 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.
8. Answer 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.
9. Answer A. Levothyroxine is the preferred agent to
treat primary hypothyroidism and cretinism, although
it also may be used to treat secondary hypothyroidism.
It is contraindicated in Graves’ disease and
thyrotoxicosis because these conditions are forms of
hyperthyroidism. Euthyroidism, a term used to
describe normal thyroid function, wouldn’t require any
thyroid preparation.
10. Answer B. SIADH secretion causes antidiuretic
hormone overproduction, which leads to fluid
retention. Severe SIADH can cause such complications
as vascular fluid overload, signaled by neck vein
distention. This syndrome isn’t associated with tetanic
contractions. It may cause weight gain and fluid
retention (secondary to oliguria).
11. Answer A. Pheochromocytoma causes excessive
production of epinephrine and norepinephrine, natural
catecholamines that raise the blood pressure.
Phentolamine, an alpha-adrenergic blocking agent
given by I.V. bolus or drip, antagonizes the body’s
response to circulating epinephrine and
norepinephrine, reducing blood pressure quickly and
effectively. Although methyldopa is an
antihypertensive agent available in parenteral form, it
isn’t effective in treating hypertensive emergencies.
Mannitol, a diuretic, isn’t used to treat hypertensive
emergencies. Felodipine, an antihypertensive agent, is
available only in extended-release tablets and
therefore doesn’t reduce blood pressure quickly
enough to correct hypertensive crisis.
12. Answer A. Excessive secretion of aldosterone in the
adrenal cortex is responsible for the client’s
hypertension. This hormone acts on the renal tubule,
where it promotes reabsorption of sodium and
excretion of potassium and hydrogen ions. The
pancreas mainly secretes hormones involved in fuel
metabolism. The adrenal medulla secretes the
catecholamines — epinephrine and norepinephrine.
The parathyroids secrete parathyroid hormone.
13. Answer A. Addison’s disease decreases the production
of all adrenal hormones, compromising the body’s
normal stress response and increasing the risk of
infection. Other appropriate nursing diagnoses for a
client with Addison’s disease include Deficient fluid
volume and Hyperthermia. Urinary retention isn’t
appropriate because Addison’s disease causes
polyuria.
14. Answer A. Acarbose delays glucose absorption, so the
client should take an oral form of dextrose rather than
a product containing table sugar when treating
hypoglycemia. The alpha-glucosidase inhibitors work
by delaying the carbohydrate digestion and glucose
absorption. It’s safe to be on a regimen that includes
insulin and an alpha-glucosidase inhibitor. The client
should take the drug at the start of a meal, not 30
minutes to an hour before.
15. Answer B. After a transsphenoidal hypophysectomy,
the client must refrain from coughing, sneezing, and
blowing the nose for several days to avoid disturbing
the surgical graft used to close the wound. The head of
the bed must be elevated, not kept flat, to prevent
tension or pressure on the suture line. Within 24 hours
after a hypophysectomy, transient diabetes insipidus
commonly occurs; this calls for increased, not
restricted, fluid intake. Visual, not auditory, changes
are a potential complication of hypophysectomy.
16. Answer A. The client should take glipizide twice a day,
30 minutes before a meal, because food decreases its
absorption. The drug doesn’t cause hyponatremia and
therefore doesn’t necessitate monthly serum sodium
measurement. The client must continue to monitor the
blood glucose level during glipizide therapy.
17. Answer C. For this client, wet-to-dry dressings are most
appropriate because they clean the foot ulcer by
debriding exudate and necrotic tissue, thus promoting
healing by secondary intention. Moist, transparent
dressings contain exudate and provide a moist wound
environment. Hydrocolloid dressings prevent the
entrance of microorganisms and minimize wound
discomfort. Dry sterile dressings protect the wound
from mechanical trauma and promote healing.
18. Answer 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.
19. Answer 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.
20. Answer D. Serum osmolarity is the most important test
for confirming HHNS; it’s also used to guide treatment
strategies and determine evaluation criteria. A client
with HHNS typically has a serum osmolarity of more
than 350 mOsm/L. Serum potassium, serum sodium,
and ABG values are also measured, but they aren’t as
important as serum osmolarity for confirming a
diagnosis of HHNS. A client with HHNS typically has
hypernatremia and osmotic diuresis. ABG values reveal
acidosis, and the potassium level is variable.
21. Answer B. Exercise, reduced food intake,
hypothyroidism, and certain medications decrease the
insulin requirements. Growth, pregnancy, greater food
intake, stress, surgery, infection, illness, increased
insulin antibodies, and certain medications increase
the insulin requirements.
22. Answer A. As a normal body protein, glucagon only
interacts adversely with oral anticoagulants, increasing
the anticoagulant effects. It doesn’t interact adversely
with anabolic steroids, beta-adrenergic blockers, or
thiazide diuretics.
23. Answer A. The client should be instructed always to
follow the same order when drawing the different
insulins into the syringe. Insulin should never be
shaken because the resulting froth prevents
withdrawal of an accurate dose and may damage the
insulin protein molecules. Insulin also should never be
frozen because the insulin protein molecules may be
damaged. Intermediate-acting insulin is normally
cloudy.
24. Answer C. This client is having a hypoglycemic episode.
Because the client is conscious, the nurse should first
administer a fast-acting carbohydrate, such as orange
juice, hard candy, or honey. If the client has lost
consciousness, the nurse should administer either I.M.
 or subcutaneous glucagon or an I.V. bolus of dextrose
50%. The nurse shouldn’t administer insulin to a client
who’s hypoglycemic; this action will further
compromise the client’s condition.
25. Answer A. The client who has undergone a
thyroidectomy is at risk for developing hypocalcemia
from inadvertent removal or damage to the
parathyroid gland. The client with hypocalcemia will
exhibit a positive Chvostek’s sign (facial muscle
contraction when the facial nerve in front of the ear is
tapped) and a positive Trousseau’s sign (carpal spasm
when a blood pressure cuff is inflated for a few
minutes). These signs aren’t present with
hypercalcemia, hypokalemia, or hyperkalemia.
Endocrine Problems 22 items
1. A patient is admitted to the medical unit with possible
Graves’ disease (hyperthyroidism). Which assessment finding
supports this diagnosis?
Periorbital edema
Bradycardia
Exophthalmos
Hoarse voice
2. Which change in vital signs would you instruct a nursing
assistant to report immediately for a patient with
hyperthyroidism?
Increased and rapid heart rate
Decrease systolic blood pressure
Increased respiratory rate
Decreased oral temperature
3. For the patient with hyperthyroidism, what intervention
should you delegate to the experienced certified nursing
assistant?
Instruct the patient to report palpitations, dyspnea, vertigo,
pr chest pain.
Check the apical pulse, blood pressure, and temperature
every 4 hours.
Draw blood for thyroid-stimulating hormone, T3, and T4
levels.
Explain the side effects of propylthiouracil (PTU) to the
patient.
4. As the shift begins, you are assigned these patients. Which
patient should you assess first?
A 38-year-old patient with Graves’ disease and a heart rate of
94/minute
A 63-year-old patient with type 2 diabetes and fingerstick
glucose of 137 mg/dL
A 58-year-old patient with hypothyroidism and heart rate of
48/minute
A 49-year-old patient with Cushing’s disease and +1
dependent edema
5. A patient is hospitalized with adrenocortical insufficiency.
Which nursing activity should you delegate to the nursing
assistant?
Remind patient to change positions slowly.
Check the patient for muscle weakness
Teach the patient how to collect 24-hour urine
Plan nursing interventions to promote fluid balance
6. You assess a patient with Cushing’s disease. For which
finding will you notify the physician immediately?
Purple striae present on abdomen and thighs
Weight gain of 1 pound since the previous day
+1 dependent edema in ankles and calves
Crackles bilaterally in lower lobes of lungs
7. The patient with pheochromocytoma had surgery to
remove his adrenal glands. Which nursing intervention
should you delegate to the nursing assistant?
Add strategies to provide a calm and restful environment
post-operatively to the care plan.
Warm the patient to avoid smoking and drinking caffeinated
beverages
Monitor the patient’s skin and mucous membranes for signs
of adequate hydration.
Monitor lying and standing blood pressure every 4 hours with
cuff placed on same arm
8. For the patient with pheochromocytoma, what physical
assessment technique should you instruct the LPN/LVN to
avoid?
__________________________________________________
______
9. The patient with adrenal insufficiency is to be discharged
taking prednisone 10 mg orally each day. What will you be
sure to teach the patient?
Report excessive weigh gain or swelling to the physician.
Rapid changes of position may cause hypotension.
A diet with foods high in potassium may be beneficial.
Signs of hypoglycemia may occur while taking this drug.
10.You are caring for a patient who is post-hypophysectomy
for hyperpituitarism. Which post-operative finding requires
immediate intervention?
Presence of glucose in nasal drainage
Nasal packing present in nares
Urine output of 40 – 50 mL per hour
Patient complaints of thirst
11.Which patient’s nursing care would be most appropriate
for the charge nurse to assign to the LPN, under the
supervision of the RN team leader?
A 51-year-old patient with bilateral adrenalectomy just
returned from the post-anesthesia care unit
An 83-year-old patient with type 2 diabetes and chronic
obstructive pulmonary disease
A 38-year-old patient with myocardial infarction who is
preparing for discharge
A 72-year-old patient admitted from long-term care with
mental status changes
12.You are providing care for a patient who underwent
thyroidectomy 2 days ago. Which laboratory value requires
close monitoring?
Calcium
Sodium
Potassium
White blood cells
13.You are preparing to review a teaching plan for a patient
with type 2 diabetes. What will you check to determine the
patient’s level of compliance with his diabetic regimen?
Patient’s fasting glucose level
Patient’s oral glucose tolerance test results
Patient’s glycosylated hemoglobin assay
Patient’s fingerstick glucose check for 24 hours
14.The patient has newly diagnosed type 2 diabetes. Which
task should you delegate to the nursing assistant?
Arrange consult with the dietician for patient.
Verify patient’s insulin injection technique.
Teach patient to use glucometer for monitoring glucose at
home.
Remind patient to check glucose level prior to each meal.
15.A nursing diagnosis for the newly diagnosed diabetic
patient is risk for Injury related to sensory alterations. Which
key points should you include in the teaching plan for this
patient? (Choose all that apply).
Clean and inspect your feet every day.
Be sure that your shoes fit properly.
Nylon socks are best to prevent friction between toes and
shoes.
Report any non-healing skin breaks to your doctor.
16.The diabetic patient has all of these assessment bindings.
Which will you instruct the LPN/LVN to report immediately?
Fingerstick glucose of 185 mg/dL
Numbness and tingling in both feet
Profuse perspiration
Bunion on left great toe
17.The plan of care for the diabetic patient includes all of the
following interventions. Which intervention could you
delegate to the nursing assistant?
Check to make sure that the patient’s bath water is not too
hot.
Discuss community resources for diabetic outpatient care.
Instruct the patient to perform daily foot inspections.
Check the patient’s technique for drawing insulin into a
syringe.
18.You are precepting a nurse who has recently graduated
and passes the NCLEX examination. The new nurse has been
on the unit for only 2 days. Which patient should you assign
to the new nurse?
A 68-year-old diabetic who is experiencing signs of
hyperglycemia including rapid, deep breathing and mental
status changes
A 58-year-old diabetic with peripheral neuropathy and
cellulitis of the left ankle.
A 49-year-old diabetic who has just returned from post-
anesthesia care unit (PACU) after a below-the-knee
amputation (BKA)
A 72-year-old diabetic with diabetic ketoacidosis (DKA) on an
IV insulin drip
19.In the emergency department, during initial assessment of
a new admission with diabetes, you discover all of the
following. Which information should you immediately report
to the physician?
Hammertoe of the left second metatarsophalangeal joint
Rapid respiratory rate with deep inspirations
Numbness and tingling bilaterally in the feet and hands
Decreased sensitivity and swelling of the abdomen
20.You are caring for a diabetic patient who is developing
DKA. Which delegated task is most appropriate?
Ask the unit clerk to page the physician to come to the unit.
Ask the LPN/LVN to administer IV insulin according to the
sliding scale.
Ask the nursing assistant to check the patient’s level of
consciousness.
Ask the nursing assistant to get the patient a cup of orange
juice.
21.A diabetic patient presents with hot and dry skin, rapid
and deep respirations, and a fruity odor to his breath. As
charge nurse, you observe the new graduate RN
accomplishing all these patient tasks. Which one requires
that you intervene immediately?
The RN checks the patient’s fingerstick glucose.
The RN encourages the patient to drink orange juice.
The RN checks the patient’s order for sliding scale insulin.
The RN assess the patient’s vital signs every 15 minutes
22.You are preparing a 24-year-old patient with diabetes
insipidus (DI) for discharge from the hospital. Which
statement indicates that the patient needs additional
teaching?
“I will drink fluids equal to the amount of my urine output.”
“I will weigh myself every day using the same scale.”
“I will wear my medical alert bracelet at all times.”
“I will gradually wean myself off the vasopressin.”
Answers and Rationales
1. ANSWER C – Exophthalmos (abnormal protrusion of
the eye) is characteristic of patients with
hyperthyroidism due to Graves’ disease. Periorbital
edema, bradycardia, and hoarse voice are all
characteristics of patients with hypothyroidism. Focus:
Prioritization
2. ANSWER A – The cardiac problems associated with
hyperthyroidism include tachycardia, increased systolic
blood pressure, and decreased diastolic blood
pressure. Patients with hyperthyroidism also may have
increased body temperature related to increased
metabolic rate. Focus: Delegation/supervision
3. ANSWER B – Monitoring and recording vital signs are
within the education scope of nursing assistants. An
experienced nursing assistant should have been taught
how to monitor the apical pulse. However, the nurse
should observe the nursing assistant to be sure that
she has mastered this skill. Instructing and teaching
patients, as well as performing venipuncture for
laboratory samples, are more suited to the educational
scope of licensed nurses. In some facilities, an
experienced nursing assistant may perform
venipuncture, but only after special training. Focus:
Delegation/supervision
4. ANSWER C – Although patients with hypothyroidism
often have cardiac problems that include bradycardia,
a heart rate of 48/minute may have significant
implications for cardiac output and hemodynamic
 stability. Patients with Graves’ disease usually have a
rapid heart rate, but 94/minute is within limits. The
diabetic patient may need sliding scale insulin. This is
important but not urgent. Patients with Cushing’s
disease frequently have dependent edema. Focus:
Prioritization
5. ANSWER A – Patients with hypofunction of the adrenal
glands often have hypotension and should be
instructed to change positions slowly. Once a patient
has been instructed, it is appropriate for the nursing
assistant to remind the patient of those instructions.
Assessing, teaching, and planning nursing care require
more education and should be done by licensed
nurses. Focus: Delegation/supervision
6. ANSWER D – The presence of crackles in the patient’s
lungs indicate excess fluid volume doe to excess water
and sodium reabsorption and may be a symptom of
pulmonary edema, which must be treated rapidly.
Striae (stretch marks), weight gain, and dependent
edema are common findings in patients Cushing’s
disease. These findings should be monitored, but are
not urgent. Focus: Prioritization
7. ANSWER D – Monitoring vital signs is within the
educational scope of the nursing assistant. The nurse
should be sure to instruct the nursing assistant that
blood pressure measurements are to be done with the
cuff on the same arm. Revising the care plan and
instructing and assessing patients are beyond the
scope of nursing assistants and fall within the purview
of licensed nurses. Focus: Delegation/supervision
8. ANSWER: PALPATION OF THE ABDOMEN – Palpating
the abdomen can cause sudden release of
catecholamines and severe hypertension. Focus:
Delegation/supervision
9. ANSWER A – Rapid weight gain and edema are signs of
excessive drug therapy, and the dose of the drug needs
to be adjusted. Hypertension, hyperkalemia, and
hyperglycemia are common in patients with adrenal
hypofunction. Focus: Prioritization
10. ANSWER A – The presence of glucose in nasal drainage
indicates that the fluid is CSF (cerebrospinal fluid) and
suggests a CSF leak. Packing is normally inserted in the
nares after the surgical incision is closed. Forty to 50
mL per hour is adequate urine output and patients
may experience thirst post-operatively. When patients
are thirsty, nursing staff should encourage fluid intake.
Thirst may be a sign of hypokalemia. The nurse should
assess the patient’s thirst and check the patient’s
potassium level. This is not as urgent as the CSF leak.
Focus: Prioritization
11. ANSWER B – The 83-year-old patient has no
complicating factors at the moment. Providing care for
stable and uncomplicated patients is within the LPN’s
educational preparation and scope of practice, with
the care always being provided under the supervision
and direction of the RN. The RN should assess the
newly post-operative patient and the new admission.
The patient who is preparing for discharge after MI
may need some complex teaching. Focus:
Delegation/supervision, assignment
12. ANSWER A – The parathyroid glands are located on the
back of the thyroid gland. The parathyroids are
important in maintaining calcium and phosphorus
balance. The nurse should be attentive to all patient
laboratory values, but calcium and phosphorus are
important to monitor after thyroidectomy. Focus:
Prioritization
13. ANSWER C – The higher the blood glucose level is over
time, the more elevated the glycosylated hemoglobin
becomes. Glycosylated hemoglobin is a good indicator
of average blood glucose level over the previous 120
days. Fasting glucose and oral glucose tolerance tests
are important diagnostic tests. Fingerstick blood
glucose monitoring provides information that allows
for adjustment of patients’ therapeutic regimen.
Focus: Prioritization
14. ANSWER D – The nursing assistant’s role includes
reminding patients about interventions that are
already part of the plan of care. Arranging for a diet
consult is appropriate to delegate to the unit clerk.
Teaching and assessing require additional education
and should be completed by licensed nurses. Focus:
Delegation/supervision, assignment
15. ANSWER A, B & E – Sensory alterations are the major
cause of foot complications in diabetic patients, and
patients should be taught to examine their feet on a
daily basis. Properly fitted shoes protect the patient
from foot complications. Broken skin increases the risk
of infection. Cotton socks are recommended to absorb
moisture. Patients, family, or health care providers
may trim toenails. Focus: Prioritization
16. ANSWER C – Profuse perspiration is a symptom of
hypoglycemia, a complication of diabetes that needs
urgent treatment. A glucose level of 185 will need
coverage with sliding-scale insulin, but this is not
urgent. Numbness, tingling, and bunions are related to
the chronic nature of diabetes and are not urgent.
Focus: Prioritization
17. ANSWER A – Checking the bath water temperature is
part of assisting with activities of daily living and is
within the educational scope of the nursing assistant.
Discussion of community resources and teaching and
assessing require a higher level of education and are
appropriate to the scope of practice of licensed nurses.
Focus: Delegation
18. ANSWER B – The new nurse is still orienting to the
unit. Appropriate patient assignments at this time
include those who are stable and not complex. Focus:
Assignment
19. ANSWER B – Rapid, deep respirations (Kussmaul) are
symptomatic of DKA. Hammertoe, as well as numbness
and tingling, are chronic complications associated with
diabetes. Decreased sensitivity and swelling
(lipohypertrophy) occur at a site of repeated insulin
injections, and treatment involves teaching the patient
to rotate injection sites. Focus: Prioritization
20. ANSWER A – The nurse should not leave the patient.
The scope of the unit clerk’s job includes calling and
paging physicians. LPN/LVNs generally do not
administer IV push medication. IV fluid administration
is not within the scope of nursing assistants. Patients
with DKA already have a high glucose level and do not
need orange juice. Focus: Delegation/supervision
21. ANSWER B – The signs and symptoms the patient is
exhibiting are consistent with hyperglycemia. The RN
should not give the patient additional glucose. All of
 the other interventions are appropriate for this
patient. The RN should also notify the physician at this SV/TPR
time. Focus: Prioritization CO/TPR
22. ANSWER D – The patient with permanent DI requires SV/EDV
life-long vasopressin therapy. All of the other CO/EDV
statements are appropriate to the home care of this 10. Which of the following is not a bradykinin effect?
patient. Focus: Prioritization
Elevated capillary permeability
Endocrine System 20 items Elevated pain levels
1. Which of the following hormones causes increased atrial Elevated vasodilation response
pressure and decreases sodium reabsorption in the kidneys? Elevated prothrombin secretion
11. PAH is secreted in which of the following locations?
Atrial natriuretic peptide
PTH Distal tubule
Aldosterone Loop of Henle
Vasopressin Collecting tubule
2. Angiotensin I is changed by which of the following into Proximal tubule
Angiotensin II? 12. Which of the following is not an anterior pituitary gland
secretion?
ACE
AVT TSH
Pepsin GH
Adenosine Vasopressin
3. Which of the following is not a cause of peripheral edema? Prolactin
13. Thyroid Hormone T3 does not have which of the
Increased capillary permeability following functions?
Reduced levels of plasma proteins
Heart failure Stimulate bone development and growth
Decreased capillary output Create beta-adrenergic responses
4. Which of the following during an electrocardiogram is Cause brain development
associated with hypokalemia? Decrease calcium re-absorption
14. Hypercalemia has not been linked with which of the
QRS complex following?
U wave
PR segment Paget’s disease
ST segment Aldosterone
5. Which of the following is not generally associated with a Sarcoidosis
2nd degree (Mobitz Type 1) AV block? Malignancy
15. Which of the following does not require the pre-cursor
Usually asymptomatic progesterone?
Nonsequential (P wave then QRS complex)
Increased PR segment/interval Cortisol
70% Fatal Testosterone
6. An S3 heart sound is often associated with? ACTH
Aldosterone
CHF 16. Which of the following is the source cell for the secretion
COPD Pepsinogen?
Atrial fib.
Ventricular fib. Chief cell
7. Mean arterial pressure is the product of: Plasma cell
G cell
TPR x SV Parietal cell
TPR x CO 17. Which of the following is the primary activator of
CO/SV zymogen secretion?
SV/EDV
8. During phase 3 of the myocardial action potential which Somatostatin
ion is moving the most? Secretin
Acetylcholine
K+ Gastrin
Ca+ 18. Which of the following is not a function of Angiotensin II?
Na+
Ca2+ Causes release of aldosterone
9. An ejection fraction can be calculated as: Causes vasodilation
Causes increased posterior pituitary activation
Elevates blood pressure
19. Which of the following is not a function of Progesterone?
Causes increased body temperature.
Causes some smooth muscle relaxation.
Causes increased spiral artery growth
Causes activation of FSH
20. Which of the following is not a function of Estrogen?
Causes breast growth.
Causes inhibition of FSH
Increased follicle development
Decreased overall transport proteins
FALSE
6. Which of the following is not true about Type I DM?
May be linked to autoimmunity
Onset usually prior to age 20
Beta islet cells destroyed
Does not require insulin injections
7. Which of the following is not true about Type II DM?
Considered adult onset diabetes
Cause unknown may be due to genetics
Require insulin 80% of cases
May take a drug that sensitize cells or increase insulin release
8. Which of the following is not an effect of diabetes?

Answers Small vessel occlusion

1. A. Atrial natriuretic peptide Necrosis of extremities
2. A. ACE Ketone Body production
3. D. Decreased capillary output Decreased fat metabolism
4. B. U wave 9. Which of the following is not an indicator of a
5. D. 70% Fatal hypoglycemic condition?
6. A. CHF
7. B. TPR x CO Fatigue
8. A. K+ Poor appetite
9. C. SV/EDV Tachycardia
10. D. Elevated prothrombin secretion Confusion
11. D. Proximal tubule 10. Which of the following is not an adverse effect of oral
12. C. Vasopressin hypoglycemics?
13. D. Decrease calcium re-absorption
14. B. Aldosterone Hypoglycemia
15. C. ACTH Headache
16. A. Chief cell Rashes
17. C. Acetylcholine Projectile vomiting
18. B. Causes vasodilation 11. Which of the following is not an adverse effect of
19. D. Causes activation of FSH glucagon?
20. D. Decreased overall transport proteins
Allergic reaction
Pancreatic Organ 20 items Vomiting
1. Insulin inhibits the release of _______. Nausea
Fever
Glucagon 12. Which of the following drugs may be given as an
ADH immunosuppressant soon after onset of Type I Diabetes?
Beta cells
Somatostatin Torsemide
2. Which of the following is caused by insulin release? Cyclosporine
Clofibrate
Increased breakdown of fats Ceftriaxone
Increase breakdown of proteins 13. Which of the following is not considered an endocrine
Decreased blood sugar hormone?
Causes glucose to be phosphorylated in kidney
3. Glucagon causes increased blood sugar and causes slow Renin
breakdown of glycogen in the liver. Insulin
Glucagon
TRUE Somatostatin
FALSE 14. What type of cells secrete glucagon?
4. As blood glucose decreases glucagon is inhibited.
Beta cells
TRUE Alpha cells
FALSE Plasma cells
5. Glucagon increases blood levels of glucose by causing liver Acinar cells
to breakdown glycogen. 15. What type of cells secrete insulin?

TRUE Beta cells

Alpha cells 1) A patient suspected of having acromegaly has an elevated
Plasma cells plasma growth hormone level. In acromegaly, the nurse
Acinar cells would also expect the patient’s diagnostic results to include
16. Which of the following would not be considered an acute
effect of diabetes mellitus? hyperinsulinemia
a plasma glucose of less than 70
Polyuria decreased growth hormone levels with an oral glucose
Weight gain challenge test
Polydipsia a serum sometomedin C (insulin-like growth-factor) of more
Polyphagia than 300
17. Which of the following is not an accurate test for 2) During assessment of the patient with acromegaly, the
diabetes? nurse would expect the patient to report

Glucose tolerance test infertility

HbA dry, irritated skin
Fasting serum glucose undesirable changes in appearance
Fasting glucagon test an increase in height of 2 to 3 inches per year
18. Which of the following is not an indicator of diabetic 3) The nurse is caring for a client with acromegaly. Following
ketoacidosis? a transphenoidal hypophysectomy, the nurse should:

Hyperthermia Monitor the client’s blood sugar

Nausea/Vomiting Suction the mouth and pharynx every hour
Slow and shallow breathing Place the client in low Trendelenburg position
Psychosis leading to dementia Encourage the client to cough
19. Which of the following is not related to a chronic diabetes 4) Of the following disorders, which results from excessive
mellitus condition? secretion of somatotropin?

Atherosclerosis Acromegaly
Neuropathy Cretinism
Glaucoma Dwarfism
Hypotension Adrenogenital syndrome
20. Which of the following conditions is not linked to diabetic 5) Jemma, who weighs 210 lb (95 kg) and has been diagnosed
ketoacidosis? with hyperglycemia tells the nurse that her husband sleeps in
another room because her snoring keeps him awake. The
Cerebral edema nurse notices that she has large hands and a hoarse voice.
Arrhythmias Which of the following would the nurse suspect as a possible
Peptic ulcers cause of the client’s hyperglycemia?
Mucormycosis
Acromegaly
Answers Type 1 diabetes mellitus
1. A. Glucagon Hypothyroidism
2. C. Decreased blood sugar Deficient growth hormone
3. B. FALSE 6) A patient with acromegaly is treated with a transphenoidal
4. B. FALSE hypophysectomy. Postoperatively, the nurse
5. A. TRUE
6. D. Does not require insulin injections ensures that any clear nasal drainage is tested for glucose
7. C. Require insulin 80% of cases maintains the patient flat in bed to prevent cerebrospinal
8. D. Decreased fat metabolism fluid leak
9. B. Poor appetite assists the patient with toothbrushing Q4H to keep the
10. D. Projectile vomiting surgical area clean
11. D. Fever encourages deep breathing and coughing to prevent
12. B. Cyclosporine respiratory complications
13. A. Renin 7) The nurse is planning room assignments for the day. Which
14. B. Alpha cells client should be assigned to a private room if only one is
15. A. Beta cells available?
16. B. Weight gain
17. D. Fasting glucagon test The client with Cushing’s disease
18. C. Slow and shallow breathing The client with diabetes
19. D. Hypotension The client with acromegaly
20. C. Peptic ulcers The client with myxedema

Acromegaly 7 items Answers and Rationales

1. D. a serum sometomedin C (insulin-like growth-factor) D has hyperthyroidism or myxedema and poses no risk
of more than 300. A normal response to growth to others or himself.
hormone secretion is stimulation of the liver to
produce somatomedin C which stimulates growth of Cushing’s Syndrome 22 items
bones and soft tissue. The increased levels of 1) Cushing’s Disease and Cushing’s Sydrome have the same
somatomedin C normally inhibit growth hormone, but cause.
in acromegaly the pituitary gland secretes GH despite
elevated somatomedin C levels.) True
2. C. undesirable changes in appearance . The increased False
production of growth hormone in acromegaly causes 2) You assess a patient with Cushing’s disease. For which
an increase in thickness and width of bones and finding will you notify the physician immediately?
enlargement of soft tissues, resulting in marked
changes in facial features, oily and coarse skin, and Purple striae present on abdomen and thighs
speech difficulties. Height is not increased in adults Weight gain of 1 pound since the previous day
with growth hormone excess because the epiphyses of +1 dependent edema in ankles and calves
the bones are closed, and infertility is not a common Crackles bilaterally in lower lobes of lungs
finding because growth hormone is usually the only 3) As the shift begins, you are assigned these patients. Which
pituitary hormone involved in acromegaly. patient should you assess first?
3. A. Monitor the client’s blood sugar. Growth hormone
levels generally fall rapidly after a hypophysectomy, A 38-year-old patient with Graves’ disease and a heart rate of
allowing insulin levels to rise. The result is 94/minute
hypoglycemia. A 63-year-old patient with type 2 diabetes and fingerstick
4. A. Acromegaly . The patient with acromegaly glucose of 137 mg/dL
demonstrates progressive enlargement of peripheral A 58-year-old patient with hypothyroidism and heart rate of
body parts, most commonly the face, head, hands, and 48/minute
feet. Cretinism occurs as a result of congenital A 49-year-old patient with Cushing’s disease and +1
hypothyroidism.Dwarfism is caused by insufficient dependent edema
secretion of growth hormone during childhood. 4) Which is an obvious sign or sympton of Cushing’s
Adrenogenital syndrome is the result of abnormal Syndrome?
secretion of adrenocortical hormones, especially
androgen. Getting really, really fat.
5. A. Acromegaly . Acromegaly, which is caused by a Losing a lot of weight
pituitary tumor that releases excessive growth Becoming constipated
hormone, is associated with hyperglycemia, Kidney Failure
hypertension, diaphoresis, peripheral neuropathy, and 5) Signs and/or symptoms of Cushing’s Disease include:
joint pain. Enlarged hands and feet are related to (check correct boxes)
lateral bone growth, which is seen in adults with this
disorder. The accompanying soft tissue swelling causes moon face
hoarseness and often sleep apnea. Type 1 diabetes is fatty limbs
usually seen in children, and newly diagnosed persons osteoporosis
are usually very ill and thin. Hypothyroidism isn’t acne
associated with hyperglycemia, nor is growth hormone euphoria
deficiency. 6) The nurse is assessing a postcraniotomy client and finds
6. A. ensures that any clear nasal drainage is tested for the urine output from a catheter is 1500 ml for the 1st hour
glucose. A transphenoidal hypophysectomy involves and the same for the 2nd hour. The nurse should suspect:
entry into the sella turcica through an incision in the
upper lip and gingiva into the floor of the nose and the Cushing’s syndrome
sphenoid sinuses. Postoperative clear nasal drainage Diabetes mellitus
with glucose content indicates CSF leakage from an Adrenal crisis
open connection to the brain, putting the patient at Diabetes insipidus
risk for meningitis. After surgery, the patient is 7) Nurse Ronn is assessing a client with possible Cushing’s
positioned with the head elevated to avoid pressure syndrome. In a client with Cushing’s syndrome, the nurse
on the sella turcica, coughing and straining are avoided would expect to find:
to prevent increased ICP and CSF leakage, and
although mouth care is required Q4H toothbrushing Hypotension.
should not be performed for 7-10post sx. Thick, coarse skin.
7. A. The client with Cushing’s disease. The client with Deposits of adipose tissue in the trunk and dorsocervical
Cushing’s disease has adrenocortical hypersecretion. area.
This increase in the level of cortisone causes the client Weight gain in arms and legs.
to be immune suppressed. In answer B, the client with 8) The pituitary gland is also known as the ____________.
diabetes poses no risk to other clients. The client in
answer C has an increase in growth hormone and Hypophysis
poses no risk to himself or others. The client in answer Infundibulum
Hypothalamus End stage renal disease
Neurohypophysis Cushing’s Disease
9) Which of the following disorders is characterized by a Taking Furosemide and Phenytoin.
group of symptoms produced by an excess of free circulating 17) Which of the following is NOT another name for Cushing’s
cortisol from the adrenal cortex? Syndrome?

Cushing’s syndrome Hypercorticism

Addison’s disease Hyperadrenocorticism
Graves’ disease Itsenko-Cushing syndrome
Hashimoto’s disease Fatty Disease
10) Which gland does Cushing’s Syndrome originate in? 18) Corticosteroids are potent suppressors of the body’s
inflammatory response. Which of the following conditions or
Pituitary actions do they suppress?
Pineal
Pancreas Cushing syndrome.
Gonads Pain receptors.
11) The most common cause of Cushing’s Disease is Immune response.
____________. Neural transmission.
19) Nurse Sugar is assessing a client with Cushing’s syndrome.
Alcohol abuse Which observation should the nurse report to the physician
Steroid use immediately?
Genetic disposition
Adenoma (benign tumor) Pitting edema of the legs
12) A female client with Cushing’s syndrome is admitted to An irregular apical pulse
the medical-surgical unit. During the admission assessment, Dry mucous membranes
nurse Tyzz notes that the client is agitated and irritable, has Frequent urination
poor memory, reports loss of appetite, and appears 20) The nurse is planning room assignments for the day.
disheveled. These findings are consistent with which Which client should be assigned to a private room if only one
problem? is available?

Depression The client with Cushing’s disease

Neuropathy The client with diabetes
Hypoglycemia The client with acromegaly
Hyperthyroidism The client with myxedema
13) Cushing’s Syndrome is a hormone disorder caused by 21) Which would a person with Cushing’s Syndrome prefer to
high levels of what? eat?

Y Chromosomes Fat Free Yogurt

Fiber in the digestive tract Salad
Cortisol in the blood Bacon Grease
Unprotected sexual contact Fiber Bars
14) In a 29-year-old female client who is being successfully 22) Adrenocorticotropic hormone (ACTH) from the pituitary
treated for Cushing’s syndrome, nurse Lyzette would expect a stimulates the __________ glands to release _________.
decline in:
pineal, cortisol
Serum glucose level. adrenal, cortisol
Hair loss. pineal, TSH
Bone mineralization. adrenal, TSH
Menstrual flow.
15) Nurse Ruth is assessing a client after a thyroidectomy. Answers and Rationales
The assessment reveals muscle twitching and tingling, along 1. B. False . They have the same effect, Disease is a
with numbness in the fingers, toes, and mouth area. The pituitary cause, Syndrome is an adrenal cause
nurse should suspect which complication? 2. D. Crackles bilaterally in lower lobes of lungs . The
presence of crackles in the patient’s lungs indicate
Tetany excess fluid volume doe to excess water and sodium
Hemorrhage reabsorption and may be a symptom of pulmonary
Thyroid storm edema, which must be treated rapidly. Striae (stretch
Laryngeal nerve damage marks), weight gain, and dependent edema are
16) The old woman told John that she has osteoporosis; common findings in patients Cushing’s disease. These
Arthur knew that all of the following factors would contribute findings should be monitored, but are not urgent.
to osteoporosis except Focus: Prioritization
3. C. A 58-year-old patient with hypothyroidism and
Hypothyroidism heart rate of 48/minute . Although patients with
 hypothyroidism often have cardiac problems that
include bradycardia, a heart rate of 48/minute may
have significant implications for cardiac output and
hemodynamic stability. Patients with Graves’ disease
usually have a rapid heart rate, but 94/minute is
within limits. The diabetic patient may need sliding
scale insulin. This is important but not urgent. Patients
with Cushing’s disease frequently have dependent
edema. Focus: Prioritization
4. A. Getting really, really fat.
5. A. moon face , C. osteoporosis , D. acne . s/s include
fatty abdomen and thinning limbs, euphoria is not a
s/s
6. D. Diabetes insipidus . Diabetes insipidus is an abrupt
onset of extreme polyuria that commonly occurs in
clients after brain surgery. Cushing’s syndrome is
excessive glucocorticoid secretion resulting in sodium
and water retention. Diabetes mellitus is a
hyperglycemic state marked by polyuria, polydipsia,
and polyphagia. Adrenal crisis is undersecretion of
glucocorticoids resulting in profound hypoglycemia,
hypovolemia, and hypotension.
7. C. Deposits of adipose tissue in the trunk and
dorsocervical area. Because of changes in fat
distribution, adipose tissue accumulates in the trunk,
face (moonface), and dorsocervical areas (buffalo
hump). Hypertension is caused by fluid retention. Skin
becomes thin and bruises easily because of a loss of
collagen. Muscle wasting causes muscle atrophy and
thin extremities.
8. A. Hypophysis
9. A. Cushing’s syndrome . The patient with Cushing’s
syndrome demonstrates truncal obesity, moon face,
acne, abdominal striae, and hypertension. In Addison’s
disease, the patient experiences chronic adrenocortical
insufficiency. In Graves’ disease, the patient
experiences hyperthyroidism. The individual with
Hashimoto’s disease demonstrates inflammation of
the thyroid gland, resulting in hypothyroidism.
10. A. Pituitary
11. D. Adenoma (benign tumor)
12. A. Depression . 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.
13. C. Cortisol in the blood
14. A. Serum glucose level. 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.
15. A. Tetany . 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.
16. A. Hypothyroidism
17. D. Fatty Disease
18. C. Immune response. Corticosteroids suppress
eosinophils, lymphocytes, and natural-killer cells,
inhibiting the natural inflammatory process in an
infected or injured part of the body. This helps resolve
inflammation, stabilizes lysosomal membranes,
decreases capillary permeability, and depresses
phagocytosis of tissues by white blood cells, thus
blocking the release of more inflammatory materials.
Excessive corticosteroid therapy can lead to Cushing
syndrome.
19. B. An irregular apical pulse . 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.
20. A. The client with Cushing’s disease . The client with
Cushing’s disease has adrenocortical hypersecretion.
This increase in the level of cortisone causes the client
to be immune suppressed. In answer B, the client with
diabetes poses no risk to other clients. The client in
answer C has an increase in growth hormone and
poses no risk to himself or others. The client in answer
D has hyperthyroidism or myxedema and poses no risk
to others or himself.
21. C. Bacon Grease
22. B. adrenal, cortisol
Diabetes Insipidus 20 items
1) Cyrill with severe head trauma sustained in a car accident
is admitted to the intensive care unit. Thirty-six hours later,
the client’s urine output suddenly rises above 200 ml/hour,
leading the nurse to suspect diabetes insipidus. Which
laboratory findings support the nurse’s suspicion of diabetes
insipidus?
Above-normal urine and serum osmolality levels
Below-normal urine and serum osmolality levels
Above-normal urine osmolality level, below-normal serum
osmolality level
Below-normal urine osmolality level, above-normal serum
osmolality level
2) The drug of choice for central diabetes insipidus is
desmopressin (DDAVP). What isthis drug’s mechanism of
action?
Mimics vasopressin and increases kidney water reabsorption
Blocks vasopressin and increases kidney water reabsorption
Mimics vasopressin and increases kidney salt excretion
Blocks vasopressin and increases kidney salt excretion
3) The nurse is assessing a postcraniotomy client and finds
the urine output from a catheter is 1500 ml for the 1st hour
and the same for the 2nd hour. The nurse should suspect:
Cushing’s syndrome
Diabetes mellitus
Adrenal crisis
Diabetes insipidus
4) A 67-year-old male 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, nurse Richard
would suspect which of the following disorders?
Diabetes mellitus
Diabetes insipidus
Hypoparathyroidism
Hyperparathyroidism
5) What drugs antagonize the effects of ADH on the renal
tubules, and thus could causenephrogenic diabetes insipidus?
Bromocryptine and cabergoline
Hydrochlorothiazide and furosemide
Cimetidine and verapamil
Lithium and demeclocycline
Acetaminophen and isoniazid
6) Damage to what organ would cause central diabetes
insipidus?
Kidneys
Hypothalamus
Thyroid
Parathyroid
Pituitary
7) To confirm central diabetes insipidus, post-injection
(desmopressin) urine osmolarityshould be what percentage
of pre-injection osmolarity?
< 50%
< 75%
100% (equal)
> 125%
> 150%
8) A priority nursing diagnostic for a client admitted to the
hospital with a diagnosis of diabetes insipidus is:
Sleep pattern deprivation related nocturia
Activity intolerance r/t muscle weakness
Fluid volume excess r/t intake greater that output
Risk for impaired skin integrity r/t generalized edema
9) What are the typical presenting signs of diabetes
insipidus?
Hyperglycemia and polyuria
Periorbital ecchymosis and blurred vision
Polyuria and polydipsia
Oliguria and hypoglycemia
Weight gain and malaise
10) What electrolyte abnormalities can cause diabetes
insipidus?
Hypercalcemia and hyperkalemia
Hypercalcemia and hypokalemia
Hypocalcemia and hyperkalemia
Hypocalcemia and hypokalemia
11) Nurse Louie is developing a teaching plan for a male
client diagnosed with diabetes insipidus. The nurse should
include information about which hormone lacking in clients
with diabetes insipidus?
antidiuretic hormone (ADH).
thyroid-stimulating hormone (TSH).
follicle-stimulating hormone (FSH).
luteinizing hormone (LH).
12) A male client with primary diabetes insipidus is ready for
discharge on desmopressin (DDAVP). Which instruction
should nurse Lina provide?
“Administer desmopressin while the suspension is cold.”
“Your condition isn’t chronic, so you won’t need to wear a
medical identification bracelet.”
“You may not be able to use desmopressin nasally if you have
nasal discharge or blockage.”
“You won’t need to monitor your fluid intake and output
after you start taking desmopressin.”
13) You are preparing a 24-year-old patient with diabetes
insipidus (DI) for discharge from the hospital. Which
statement indicates that the patient needs additional
teaching?
“I will drink fluids equal to the amount of my urine output.”
“I will weigh myself every day using the same scale.”
“I will wear my medical alert bracelet at all times.”
“I will gradually wean myself off the vasopressin.”
14) Which of the following is most suggestive of psychogenic
polydipsia, not diabetesinsipidus?
Nocturia
Constant symptoms
24-hour urine output > 18L
Plasma osmolarity > 295mOsm/kg
Plasma osmolarity < 280mOsm/kg after a water deprivation
test
15) A client is suspected of developing diabetes insipidus.
Which of the following is the most effective assessment?
Taking vital signs every 4 hours
Monitoring blood glucose
Assessing ABG values every other day
Measuring urine output hourly
16) A client with diabetes insipidus is taking Desmopressin
acetate (DDAVP). To determine if the drug is effective, the
nurse should monitor the client’s:
Arterial blood pH
Pulse rate
Serum glucose
Intake and output
17) Which outcome indicates that treatment of a male client
with diabetes insipidus has been effective?
Fluid intake is less than 2,500 ml/day.
Urine output measures more than 200 ml/hour.
Blood pressure is 90/50 mm Hg.
The heart rate is 126 beats/minute.
18) Adequate fluid replacement and vasopressin replacement
are objectives of therapy for which of the following disease
processes?
Diabetes mellitus.
Diabetes insipidus.
Diabetic ketoacidosis.
Syndrome of inappropriate antidiuretic hormone secretion
(SIADH).
19) The client with a history of diabetes insipidus is admitted
with polyuria, polydipsia, and mental confusion. The priority
intervention for this client is:
Measure the urinary output
Check the vital signs
Encourage increased fluid intake
Weigh the client
20) When caring for a male client with diabetes insipidus,
nurse Juliet expects to administer:
vasopressin (Pitressin Synthetic).
furosemide (Lasix).
regular insulin.
10% dextrose.
Answers and Rationales
1. D. Below-normal urine osmolality level, above-normal
serum osmolality level. In diabetes insipidus, excessive
polyuria causes dilute urine, resulting in a below-
normal urine osmolality level. At the same time,
polyuria depletes the body of water, causing
dehydration that leads to an above-normal serum
osmolality level. For the same reasons, diabetes
insipidus doesn’t cause above-normal urine osmolality
or below-normal serum osmolality levels.
2. A. Mimics vasopressin and increases kidney water
reabsorption
3. D. Diabetes insipidus. Diabetes insipidus is an abrupt
onset of extreme polyuria that commonly occurs in
clients after brain surgery. Cushing’s syndrome is
excessive glucocorticoid secretion resulting in sodium
and water retention. Diabetes mellitus is a
hyperglycemic state marked by polyuria, polydipsia,
and polyphagia. Adrenal crisis is undersecretion of
glucocorticoids resulting in profound hypoglycemia,
hypovolemia, and hypotension.
4. D. Hyperparathyroidism. 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.
5. D. Lithium and demeclocycline
6. E. Pituitary
7. E. > 150%
8. B. Activity intolerance r/t muscle weakness
9. A. Hyperglycemia and polyuria
10. B. Hypercalcemia and hypokalemia
11. A. antidiuretic hormone (ADH). ADH is the hormone
clients with diabetes insipidus lack. The client’s TSH,
FSH, and LH levels won’t be affected.
12. C. “You may not be able to use desmopressin nasally if
you have nasal discharge or blockage.” Desmopressin
may not be absorbed if the intranasal route is
compromised. Although diabetes insipidus is treatable,
the client should wear medical identification and carry
medication at all times to alert medical personnel in an
emergency and ensure proper treatment. The client
must continue to monitor fluid intake and output and
receive adequate fluid replacement.
13. D. “I will gradually wean myself off the vasopressin.”
The patient with permanent DI requires life-long
vasopressin therapy. All of the other statements are
appropriate to the home care of this patient. Focus:
Prioritization
14. C. 24-hour urine output > 18L
15. D. Measuring urine output hourly. Measuring the urine
output to detect excess amount and checking the
specific gravity of urine samples to determine urine
concentration are appropriate measures to determine
the onset of diabetes insipidus.
16. D. Intake and output . DDAVP replaces the ADH,
facilitating reabsorption of water and consequent
return of normal urine output and thirst.
17. A. Fluid intake is less than 2,500 ml/day. Diabetes
insipidus is characterized by polyuria (up to 8 L/day),
constant thirst, and an unusually high oral intake of
fluids. Treatment with the appropriate drug should
decrease both oral fluid intake and urine output. A
urine output of 200 ml/hour indicates continuing
polyuria. A blood pressure of 90/50 mm Hg and a heart
rate of 126 beats/minute indicate compensation for
the continued fluid deficit, suggesting that treatment
hasn’t been effective.
18. B. Diabetes insipidus. Maintaining adequate fluid and
replacing vasopressin are the main objectives in
treating diabetes insipidus. An excess of antidiuretic
hormone leads to SIADH, causing the patient to retain
fluid. Diabetic ketoacidosis is a result of severe insulin
insufficiency.
19. B. Check the vital signs . The large amount of fluid loss
can cause fluid and electrolyte imbalance that should
be corrected. The loss of electrolytes would be
reflected in the vital signs. Measuring the urinary
output is important, but the stem already says that the
client has polyuria. Encouraging fluid intake will not
correct the problem, .Weighing the client is not
necessary at this time.
20. A. vasopressin (Pitressin Synthetic). Because diabetes
insipidus results from decreased antidiuretic hormone
(vasopressin) production, the nurse should expect to
administer synthetic vasopressin for hormone
replacement therapy. Furosemide, a diuretic, is
contraindicated because a client with diabetes
insipidus experiences polyuria. Insulin and dextrose
 are used to treat diabetes mellitus and its Glomuerular injury
complications, not diabetes insipidus. Bleeding of retinal caplillaries
Numbness of feet
Diabetes Mellitus 70 items Impotence
1) Nurse Perry is caring for a female client with type 1 9) What is the number one complication of diabetes?
diabetes mellitus who exhibits confusion, light-headedness,
and aberrant behavior. The client is still conscious. The nurse Diabetic ketoacidosis
should first administer: Obesity
Hypertension
I.M. or subcutaneous glucagon. Cardiovascular disease
I.V. bolus of dextrose 50%. 10) Nurse Noemi administers glucagon to her diabetic client,
15 to 20 g of a fast-acting carbohydrate such as orange juice. then monitors the client for adverse drug reactions and
10 U of fast-acting insulin. interactions. Which type of drug interacts adversely with
2) A client with diabetes mellitus has a prescription for glucagon?
Glucotrol XL (glipizide). The client should be instructed to
take the medication: Oral anticoagulants
Anabolic steroids
At bedtime Beta-adrenergic blockers
With breakfast Thiazide diuretics
Before lunch 11) The newly diagnosed diabetic patient asks the nurse why
After dinner he needs to check his feet every day. The nurse’s best
3) The glycosylated hemoglobin of a 40-year-old client with response is….
diabetes mellitus is 2.5%. The nurse understands that:
To prevent leg amputation.
The client can have a higher-calorie diet. To check for any cuts, sores, or dry cracked skin so they can
The client has good control of her diabetes. be treated early to prevent infection or gangrene.
The client requires adjustment in her insulin dose. To see if they hurt.
The client has poor control of her diabetes. You just need to do it.
4) A patient with severe hypoglycemia arrives at the ED 12) What type of cells secrete glucagon?
unconscious by ambulance. The nurse would first…
Beta cells
Give regular insulin by IV Alpha cells
Give NPH by IV Plasma cells
Give 10-15 g CHO or Orange juice Acinar cells
Give 1 mg glucagon 13) Nurse John is assigned to care for a postoperative male
5) A male client with type 1 diabetes mellitus asks the nurse client who has diabetes mellitus. During the assessment
about taking an oral antidiabetic agent. Nurse Jack explains interview, the client reports that he’s impotent and says he’s
that these medications are only effective if the client: concerned about its effect on his marriage. In planning this
client’s care, the most appropriate intervention would be to:
prefers to take insulin orally.
has type 2 diabetes. Encourage the client to ask questions about personal
has type 1 diabetes. sexuality.
is pregnant and has type 2 diabetes. Provide time for privacy.
6) Which of the following conditions is not linked to diabetic Provide support for the spouse or significant other.
ketoacidosis? Suggest referral to a sex counselor or other appropriate
professional.
Cerebral edema 14) Which are potential complications of diabetes? (Choose
Arrhythmias all that applies)
Peptic ulcers
Mucormycosis Amputations (BKA)
7) Which of the following clinical characteristics is associated Cardiovascular disease
with Type 1 diabetes (previously referred to as insulin- Edema
dependent diabetes mellitus [IDDM])? Peripheral neuropathy
Hyperthyroidism
Presence of islet cell antibodies Retinopathy
Obesity Cardio neuropathy
Rare ketosis Coma
Requirement for oral hypoglycemic agents Nephropathy
8) What are the micro vascular complications of uncontrolled Arteriosclerosis
diabetes? Hypertension
Obesity
Delayed gastric emptying Infections
Diarrhea 15) Which of the following is not an effect of diabetes?

Small vessel occlusion
Necrosis of extremities
Ketone Body production
Decreased fat metabolism
16) Which of the following is not an indicator of diabetic
ketoacidosis?
Hyperthermia
Nausea/Vomiting
Slow and shallow breathing
Psychosis leading to dementia
17) Dr. Kennedy prescribes glipizide (Glucotrol), an oral
antidiabetic agent, for a male client with type 2 diabetes
mellitus who has been having trouble controlling the blood
glucose level through diet and exercise. Which medication
instruction should the nurse provide?
“Be sure to take glipizide 30 minutes before meals.”
“Glipizide may cause a low serum sodium level, so make sure
you have your sodium level checked monthly.”
“You won’t need to check your blood glucose level after you
start taking glipizide.”
“Take glipizide after a meal to prevent heartburn.”
18) What type of cells secrete insulin?
Beta cells
Alpha cells
Plasma cells
Acinar cells
19) A 65-year-old female who has diabetes mellitus and has
sustained a large laceration on her left wrist asks the nurse,
“How long will it take for my scars to disappear?” which
statement would be the nurse’s best response?
“The contraction phase of wound healing can take 2 to 3
years.”
“Wound healing is very individual but within 4 months the
scar should fade.”
“With your history and the type of location of the injury, it’s
hard to say.”
“If you don’t develop an infection, the wound should heal any
time between 1 and 3 years from now.”
20) The nurse enters a patient’s room and sees the patient
breathing rapidly with a fruity breath smell. This is known
as…
Trousseau’s
Cullen’s
Kussmaul’s
Bitot’s
21) The nurse is performing wound care on a foot ulcer in a
client with type 1 diabetes mellitus. Which technique
demonstrates surgical asepsis?
Putting on sterile gloves then opening a container of sterile
saline.
Cleaning the wound with a circular motion, moving from
outer circles toward the center.
Changing the sterile field after sterile water is spilled on it.
Placing a sterile dressing ½” (1.3 cm) from the edge of the
sterile field.
22) A male client with type 1 diabetes mellitus has a highly
elevated glycosylated hemoglobin (Hb) test result. In
discussing the result with the client, nurse Sharmaine would
be most accurate in stating:
“The test needs to be repeated following a 12-hour fast.”
“It looks like you aren’t following the prescribed diabetic
diet.”
“It tells us about your sugar control for the last 3 months.”
“Your insulin regimen needs to be altered significantly.”
23) A male client has just been diagnosed with type 1
diabetes mellitus. When teaching the client and family how
diet and exercise affect insulin requirements, Nurse Joy
should include which guideline?
“You’ll need more insulin when you exercise or increase your
food intake.”
“You’ll need less insulin when you exercise or reduce your
food intake.”
“You’ll need less insulin when you increase your food intake.”
“You’ll need more insulin when you exercise or decrease your
food intake.”
24) An agitated, confused female client arrives in the
emergency department. Her history includes type 1 diabetes
mellitus, hypertension, and angina pectoris. Assessment
reveals pallor, diaphoresis, headache, and intense hunger. A
stat blood glucose sample measures 42 mg/dl, and the client
is treated for an acute hypoglycemic reaction. After recovery,
nurse Lily teaches the client to treat hypoglycemia by
ingesting:
2 to 5 g of a simple carbohydrate.
10 to 15 g of a simple carbohydrate.
18 to 20 g of a simple carbohydrate.
25 to 30 g of a simple carbohydrate.
25) Acarbose (Precose), an alpha-glucosidase inhibitor, is
prescribed for a female client with type 2 diabetes mellitus.
During discharge planning, nurse Pauleen would be aware of
the client’s need for additional teaching when the client
states:
“If I have hypoglycemia, I should eat some sugar, not
dextrose.”
“The drug makes my pancreas release more insulin.”
“I should never take insulin while I’m taking this drug.”
“It’s best if I take the drug with the first bite of a meal.”
26) Which of the following is not true about Type I DM?
May be linked to autoimmunity
Onset usually prior to age 20
Beta islet cells destroyed
Does not require insulin injections
27) Which of the following is caused by insulin release?
Increased breakdown of fats
Increase breakdown of proteins
Decreased blood sugar
Causes glucose to be phosphorylated in kidney
28) The physician has prescribed NPH insulin for a client with
diabetes mellitus. Which statement indicates that the client
knows when the peak action of the insulin occurs?
“I will make sure I eat breakfast within 2 hours of taking my
insulin.” appendectomy
“I will need to carry candy or some form of sugar with me all pernicious anemia
the time.” diabetes mellitus
“I will eat a snack around three o’clock each afternoon.” valve replacement
“I can save my dessert from supper for a bedtime snack.” 37) Of the following types of insulin, which is the most rapid
29) Which of the following is not an accurate test for acting?
diabetes?
Humalog
Glucose tolerance test Regular
HbA NPH
Fasting glucagon test Ultralente
30) A home health nurse is at the home of a client with 38) The nurse’s first action upon finding a patient with mild
diabetes and arthritis. The client has difficulty drawing up hypoglycemia is to…
insulin. It would be most appropriate for the nurse to refer
the client to Call the rapid response team
Give 1 mg of glucagon
A social worker from the local hospital Give 10-15 g of CHO or Orange juice
An occupational therapist from the community center Give insulin
A physical therapist from the rehabilitation agency 39) After taking glipizide (Glucotrol) for 9 months, a male
Another client with diabetes mellitus and takes insulin client experiences secondary failure. Which of the following
31) Which of the following is not true about Type II DM? would the nurse expect the physician to do?

Considered adult onset diabetes Initiate insulin therapy.

Cause unknown may be due to genetics
Require insulin 80% of cases
May take a drug that sensitize cells or increase insulin release
32) Which of the following is not an indicator of a
hypoglycemic condition?
Fatigue
Poor appetite
Tachycardia
Confusion
33) Glucagon increases blood levels of glucose by causing
liver to breakdown glycogen.
TRUE
FALSE
34) A patient with a history of diabetes mellitus is in the
second post-operative day following cholecystectomy. She
has complained of nausea and isn’t able to eat solid foods.
The nurse enters the room to find the patient confused and
shaky. Which of the following is the most likely explanation
for the patient’s symptoms?
Anesthesia reaction.
Hyperglycemia.
Hypoglycemia.
Diabetic ketoacidosis.
35) A urine test in an undiagnosed diabetic may show……..
glucose and ketones in the urine
glucose and high amounts of bilirubin in the urine
ketones in the urine
ketones and adrenaline in the urine
36) A client has a medical history of rheumatic fever, type 1
(insulin dependent) diabetes mellitus, hypertension,
pernicious anemia, and appendectomy. She’s admitted to the
hospital and undergoes mitral valve replacement surgery.
After discharge, the client is scheduled for a tooth extraction.
Which history finding is a major risk factor for infective
endocarditis?
Switch the client to a different oral antidiabetic agent.
Prescribe an additional oral antidiabetic agent.
Restrict carbohydrate intake to less than 30% of the total
caloric intake.
40) When caring for a female client with a history of
hypoglycemia, nurse Ruby should avoid administering a drug
that may potentiate hypoglycemia. Which drug fits this
description?
sulfisoxazole (Gantrisin)
mexiletine (Mexitil)
prednisone (Orasone)
lithium carbonate (Lithobid)
41) A male client with diabetes mellitus is receiving insulin.
Which statement correctly describes an insulin unit?
It’s a common measurement in the metric system.
It’s the basis for solids in the avoirdupois system.
It’s the smallest measurement in the apothecary system.
It’s a measure of effect, not a standard measure of weight or
quantity.
42) The physician has prescribed Novalog insulin for a client
with diabetes mellitus. Which statement indicates that the
client knows when the peak action of the insulin occurs?
“I will make sure I eat breakfast within 10 minutes of taking
my insulin.”
“I will need to carry candy or some form of sugar with me all
the time.”
“I will eat a snack around three o’clock each afternoon.”
“I can save my dessert from supper for a bedtime snack.”
43) Which of the following would not be considered an acute
effect of diabetes mellitus?
Polyuria
Weight gain
Polydipsia
Polyphagia
44) Which instruction about insulin administration should
nurse Kate give to a client?
“Always follow the same order when drawing the different
insulins into the syringe.”
“Shake the vials before withdrawing the insulin.”
“Store unopened vials of insulin in the freezer at
temperatures well below freezing.”
“Discard the intermediate-acting insulin if it appears cloudy.”
45) Which of the following drugs may be given as an
immunosuppressant soon after onset of Type I Diabetes?
Torsemide
Cyclosporine
Clofibrate
Ceftriaxone
46) As blood glucose decreases glucagon is inhibited.
TRUE
FALSE
47) Of the following categories of oral antidiabetic agents,
which exert their primary action by directly stimulating the
pancreas to secrete insulin?
Sulfonylureas
Thiazolidinediones
Biguanides
Alpha glucosidase inhibitors
48) The nurse enters a diabetic patient’s room at 11:30 and
notices that the patient is diaphoretic, tachycardic, anxious,
states she is hungry, and doesn’t remember where she is.
This patient is most likely showing signs of what?
hyperglycemic
hypoglycemic
diabetic ketoacidosis
hyperosmolar hyperglycemic noketotic coma
49) A client with type 1 diabetes mellitus who’s a
multigravida visits the clinic at 27 weeks gestation. The nurse
should instruct the client that for most pregnant women with
type 1 diabetes mellitus:
Weekly fetal movement counts are made by the mother.
Contraction stress testing is performed weekly.
Induction of labor is begun at 34 weeks’ gestation.
Nonstress testing is performed weekly until 32 weeks’
gestation
50) The diabetic patient’s lab work comes back with a pH of
7.4, serum blood sugar of 950, serum osmolarity of 460,
pCO2 of 35, HCO3 of 25. The patient is confused and
dehydrated. This patient is showing signs and symptoms of….
Diabetic ketoacidosis
hyperosmolar hyperglycemic noketotic coma
Hypoglycemia
diabetic neuropathy
51) The nurse teaches the patient about glargine (Lantus), a
“peakless” basal insulin including which of the following
statements?
Do not mix the drug with other insulins
Administer the total daily dosage in two doses.
Draw up the drug first, then add regular insulin.
The drug is rapidly absorbed and has a fast onset of action
52) Which of the following is not related to a chronic diabetes
mellitus condition?
Atherosclerosis
Neuropathy
Glaucoma
Hypotension
53) During a class on exercise for diabetic clients, a female
client asks the nurse educator how often to exercise. The
nurse educator advises the clients to exercise how often to
meet the goals of planned exercise?
At least once a week
At least three times a week
At least five times a week
Every day
54) For a diabetic male client with a foot ulcer, the physician
orders bed rest, a wet-to-dry dressing change every shift, and
blood glucose monitoring before meals and bedtime. Why
are wet-to-dry dressings used for this client?
They contain exudate and provide a moist wound
environment.
They protect the wound from mechanical trauma and
promote healing.
They debride the wound and promote healing by secondary
intention.
They prevent the entrance of microorganisms and minimize
wound discomfort.
55) A client with type 1 diabetes mellitus has been on a
regimen of multiple daily injection therapy. He’s being
converted to continuous subcutaneous insulin therapy. While
teaching the client bout continuous subcutaneous insulin
therapy, the nurse would be accurate in telling him the
regimen includes the use of:
intermediate and long-acting insulins
short and long-acting insulins
short-acting only
short and intermediate-acting insulins
56) Patients with Type 1 diabetes mellitus may require which
of the following changes to their daily routine during periods
of infection?
No changes.
Less insulin.
More insulin.
Oral diabetic agents.
57) At a senior citizens meeting a nurse talks with a client
who has diabetes mellitus Type 1. Which statement by the
client during the conversation is most predictive of a
potential for impaired skin integrity?
“I give my insulin to myself in my thighs.”
“Sometimes when I put my shoes on I don’t know where my
toes are.”
“Here are my up and down glucose readings that I wrote on
my calendar.”
“If I bathe more than once a week my skin feels too dry.”
58) Which of the following is not considered an endocrine
hormone?
Renin
Insulin
Glucagon
Somatostatin
59) A patient arrives at the ED with a blood sugar of 578,
serum osmolarity of 300, pH of 7.3, severe thirst,
dehydration, and confusion. The patient is breathing rapidly
and has a fruity breath smell. This patient has symptoms
of……
Diabetic ketoacidosis
hyperosmolar hyperglycemic noketotic coma
Hypoglycemia
diabetic neuropathy
60) A 27-year-old woman has Type I diabetes mellitus. She
and her husband want to have a child so they consulted her
diabetologist, who gave her information on pregnancy and
diabetes. Of primary importance for the diabetic woman who
is considering pregnancy should be
a review of the dietary modifications that will be necessary.
early prenatal medical care.
adoption instead of conception.
understanding that this is a major health risk to the mother.
61) Clients with diabetes mellitus require frequent vision
assessment. The nurse should instruct the client about which
of the following eye problems most likely to be associated
with diabetes mellitus?
Cataracts
Retinopathy
Astigmatism
Glaucoma
62) Which of the following is not an adverse effect of
glucagon?
Allergic reaction
Vomiting
Nausea
Fever
63) Which of the following is not an adverse effect of oral
hypoglycemics?
Hypoglycemia
Headache
Rashes
Projectile vomiting
64) A 25-year-old woman is in her fifth month of pregnancy.
She has been taking 20 units of NPH insulin for diabetes
mellitus daily for six years. Her diabetes has been well
controlled with this dosage. She has been coming for routine
prenatal visits, during which diabetic teaching has been
implemented. Which of the following statements indicates
that the woman understands the teaching regarding her
insulin needs during her pregnancy?
“Are you sure all this insulin won’t hurt my baby?”
“I’ll probably need my daily insulin dose raised.”
“I will continue to take my regular dose of insulin.”
“These finger sticks make my hand sore. Can I do them less
frequently?”
65) A nurse assigned to care for a postoperative male client
who has diabetes mellitus. During the assessment interview,
the client reports that he’s impotent and says that he’s
concerned about its effect on his marriage. In planning this
client’s care, the most appropriate intervention would be to:
Encourage the client to ask questions about personal
sexuality
Provide time for privacy
Provide support for the spouse or significant other
Suggest referral to a sex counselor or other appropriate
professional
66) Patricia a 20 year old college student with diabetes
mellitus requests additional information about the
advantages of using a pen like insulin deliverydevices. The
nurse explains that the advantages of these devices over
syringes includes:
Accurate dose delivery
Shorter injection time
Lower cost with reusable insulin cartridges
Use of smaller gauge needle.
67) Which of the following clinical characteristics is
associated with Type 2 diabetes (previously referred to as
non-insulin-dependent diabetes mellitus [NIDDM])?
Can control blood glucose through diet and exercise
Usually thin at diagnosis
Ketosis-prone
Demonstrate islet cell antibodies
68) The nurse teaches the patient about diabetes including
which of the following statements?
Elevated blood glucose levels contribute to complications of
diabetes, such as diminished vision.
Sugar is found only in dessert foods.
The only diet change needed in the treatment of diabetes is
to stop eating sugar.
Once insulin injections are started in the treatment of Type 2
diabetes, they can never be discontinued.
69) Glucagon causes increased blood sugar and causes slow
breakdown of glycogen in the liver.
TRUE
FALSE
70) Insulin inhibits the release of _______.
Glucagon
ADH
Beta cells
Somatostatin
Answers and Rationales
1. C. 15 to 20 g of a fast-acting carbohydrate such as
orange juice. This client is having a hypoglycemic
episode. Because the client is conscious, the nurse
should first administer a fast-acting carbohydrate, such
as orange juice, hard candy, or honey. If the client has
lost consciousness, the nurse should administer either
I.M. or subcutaneous glucagon or an I.V. bolus of
dextrose 50%. The nurse shouldn’t administer insulin
to a client who’s hypoglycemic; this action will further
compromise the client’s condition.
2. B. With breakfast. Glucotrol XL is given once a day with
breakfast. Answer A is incorrect because the client
 would develop hypoglycemia while sleeping. Answers
C and D are incorrect because the client would develop
hypoglycemia later in the day or evening.
3. B. The client has good control of her diabetes. The
client’s diabetes is well under control. Answer A is
incorrect because it will lead to elevated glycosylated
hemoglobin. Answer C is incorrect because the diet
and insulin dose are appropriate for the client. Answer
D is incorrect because the desired range for
glycosylated hemoglobin in the adult client is 2.5%–
5.9%
4. D. Give 1 mg glucagon
5. B. has type 2 diabetes. 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.
6. C. Peptic ulcers
7. A. Presence of islet cell antibodies . Individuals with
Type 1 diabetes often have islet cell antibodies.
Individuals with Type 1 diabetes are usually thin or
demonstrate recent weight loss at the time of
diagnosis. Individuals with Type 1 diabetes are ketosis-
prone when insulin is absent. Individuals with Type 1
diabetes need insulin to preserve life.
8. A. Delayed gastric emptying, C. Glomuerular injury D.
Bleeding of retinal caplillaries , F. Impotence
9. D. Cardiovascular disease
10. A. Oral anticoagulants . As a normal body protein,
glucagon only interacts adversely with oral
anticoagulants, increasing the anticoagulant effects. It
doesn’t interact adversely with anabolic steroids, beta-
adrenergic blockers, or thiazide diuretics.
11. B. To check for any cuts, sores, or dry cracked skin so
they can be treated early to prevent infection or
gangrene.
12. B. Alpha cells
13. D. Suggest referral to a sex counselor or other
appropriate professional. 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.
14. A. Amputations (BKA) , B. Cardiovascular disease , D.
Peripheral neuropathy, F. Retinopathy , G. Cardio
neuropathy , H. Coma, I. Nephropathy, J.
Arteriosclerosis , M. Infections
15. D. Decreased fat metabolism
16. C. Slow and shallow breathing
17. A. “Be sure to take glipizide 30 minutes before
meals.”The client should take glipizide twice a day, 30
minutes before a meal, because food decreases its
absorption. The drug doesn’t cause hyponatremia and
therefore doesn’t necessitate monthly serum sodium
measurement. The client must continue to monitor the
blood glucose level during glipizide therapy.
18. A. Beta cells
19. C. “With your history and the type of location of the
injury, it’s hard to say.”. Wound healing in a client with
diabetes will be delayed. Providing the client with a
time frame could give the client false information.
20. C. Kussmaul’s
21. C. Changing the sterile field after sterile water is spilled
on it. A sterile field is considered contaminated when it
becomes wet. Moisture can act as a wick, allowing
microorganisms to contaminate the field. The outside
of containers, such as sterile saline bottles, aren’t
sterile. The containers should be opened before sterile
gloves are put on and the solution poured over the
sterile dressings placed in a sterile basin. Wounds
should be cleaned from the most contaminated area to
the least contaminated area—for example, from the
center outward. The outer inch of a sterile field
shouldn’t be considered sterile.
22. C. “It tells us about your sugar control for the last 3
months.” The glycosylated Hb test provides an
objective measure of glycemic control over a 3-month
period. The test helps identify trends or practices that
impair glycemic control, and it doesn’t require a fasting
period before blood is drawn. The nurse can’t conclude
that the result occurs from poor dietary management
or inadequate insulin coverage.
23. B. “You’ll need less insulin when you exercise or
reduce your food intake.” Exercise, reduced food
intake, hypothyroidism, and certain medications
decrease the insulin requirements. Growth, pregnancy,
greater food intake, stress, surgery, infection, illness,
increased insulin antibodies, and certain medications
increase the insulin requirements.
24. B. 10 to 15 g of a simple carbohydrate. To reverse
hypoglycemia, the American Diabetes Association
recommends ingesting 10 to 15 g of a simple
carbohydrate, such as three to five pieces of hard
candy, two to three packets of sugar (4 to 6 tsp), or 4
oz of fruit juice. If necessary, this treatment can be
repeated in 15 minutes. Ingesting only 2 to 5 g of a
simple carbohydrate may not raise the blood glucose
level sufficiently. Ingesting more than 15 g may raise it
above normal, causing hyperglycemia.
25. A. “If I have hypoglycemia, I should eat some sugar,
not dextrose.”Acarbose delays glucose absorption, so
the client should take an oral form of dextrose rather
than a product containing table sugar when treating
hypoglycemia. The alpha-glucosidase inhibitors work
by delaying the carbohydrate digestion and glucose
absorption. It’s safe to be on a regimen that includes
insulin and an alpha-glucosidase inhibitor. The client
should take the drug at the start of a meal, not 30
minutes to an hour before.
26. D. Does not require insulin injections
27. C. Decreased blood sugar
28. C. “I will eat a snack around three o’clock each
afternoon.” NPH insulin peaks in 8–12 hours, so a
snack should be offered at that time. NPH insulin
onsets in 90–120 minutes, so answer A is incorrect.
Answer B is untrue because NPH insulin is time
released and does not usually cause sudden
hypoglycemia.
29. C. Fasting glucagon test
30. B. An occupational therapist from the community
center. An occupational therapist can assist a client to
improve the fine motor skills needed to prepare an
insulin injection.
31. C. Require insulin 80% of cases
32. B. Poor appetite
33. A. TRUE
34. C. Hypoglycemia. A post-operative diabetic patient
who is unable to eat is likely to be suffering from
hypoglycemia. Confusion and shakiness are common
symptoms. An anesthesia reaction would not occur on
the second post-operative day. Hyperglycemia and
ketoacidosis do not cause confusion and shakiness.
35. A. glucose and ketones in the urine
36. D. valve replacement. A heart valve prosthesis, such as
a mitral valve replacement, is a major risk factor for
infective endocarditis. Other risk factors include a
history of heart disease (especially mitral valve
prolapse), chronic debilitating disease, IV drug abuse,
and immunosuppression. Although diabetes mellitus
may predispose a person to cardiovascular disease, it
isn’t a major risk factor for infective endocarditis, nor
is an appendectomy or pernicious anemia.
37. A. Humalog . The onset of action of rapid-acting
Humalog is within 10-15 minutes. The onset of action
of short-acting regular insulin is 30 minutes-1 hour.
The onset of action of intermediate acting NPH is 3-4
hours. The onset of action of long-acting Ultralente is
6-8 hours.
38. C. Give 10-15 g of CHO or Orange juice
39. B. Switch the client to a different oral antidiabetic
agent. Many clients (25% to 60%) with secondary
failure respond to a different oral antidiabetic agent.
Therefore, it wouldn’t be appropriate to initiate insulin
therapy at this time. However, if a new oral
antidiabetic agent is unsuccessful in keeping glucose
levels at an acceptable level, insulin may be used in
addition to the antidiabetic agent.
40. A. sulfisoxazole (Gantrisin). Sulfisoxazole and other
sulfonamides are chemically related to oral
antidiabetic agents and may precipitate hypoglycemia.
Mexiletine, an antiarrhythmic, is used to treat
refractory ventricular arrhythmias; it doesn’t cause
hypoglycemia. Prednisone, a corticosteroid, is
associated with hyperglycemia. Lithium may cause
transient hyperglycemia, not hypoglycemia.
41. D. It’s a measure of effect, not a standard measure of
weight or quantity. An insulin unit is a measure of
effect, not a standard measure of weight or quantity.
Different drugs measured in units may have no
relationship to one another in quality or quantity.
42. A. “I will make sure I eat breakfast within 10 minutes
of taking my insulin.” Novalog insulin onsets very
quickly, so food should be available within 10–15
minutes of taking the insulin. Answer B does not
address a particular type of insulin, so it is incorrect.
NPH insulin peaks in 8–12 hours, so a snack should be
eaten at the expected peak time. It may not be 3 p.m.
as stated in answer C. Answer D is incorrect because
there is no need to save the dessert until bedtime.
43. B. Weight gain
44. A. “Always follow the same order when drawing the
different insulins into the syringe.” The client should
be instructed always to follow the same order when
drawing the different insulins into the syringe. Insulin
should never be shaken because the resulting froth
prevents withdrawal of an accurate dose and may
damage the insulin protein molecules. Insulin also
should never be frozen because the insulin protein
molecules may be damaged. Intermediate-acting
insulin is normally cloudy.
45. B. Cyclosporine
46. B. FALSE
47. A. Sulfonylureas . A functioning pancreas is necessary
for sulfonylureas to be effective.
48. B. hypoglycemic
49. D. Nonstress testing is performed weekly until 32
weeks’ gestation. For most clients with type 1 diabetes
mellitus, nonstress testing is done weekly until 32
weeks’ gestation and twice a week to assess fetal well-
being.
50. B. hyperosmolar hyperglycemic noketotic coma
51. A. Do not mix the drug with other insulins . Because
glargine is in a suspension with a pH of 4, it cannot be
mixed with other insulins because this would cause
precipitation. When administering glargine (Lantus)
insulin it is very important to read the label carefully
and to avoid mistaking Lantus insulin for Lente insulin
and vice versa.
52. D. Hypotension
53. B. At least three times a week . Diabetic clients must
exercise at least three times a week to meet the goals
of planned exercise — lowering the blood glucose
level, reducing or maintaining the proper weight,
increasing the serum high-density lipoprotein level,
decreasing serum triglyceride levels, reducing blood
pressure, and minimizing stress. Exercising once a
week wouldn’t achieve these goals. Exercising more
than three times a week, although beneficial, would
exceed the minimum requirement.
54. C. They debride the wound and promote healing by
secondary intention. For this client, wet-to-dry
dressings are most appropriate because they clean the
foot ulcer by debriding exudate and necrotic tissue,
thus promoting healing by secondary intention. Moist,
transparent dressings contain exudate and provide a
moist wound environment. Hydrocolloid dressings
prevent the entrance of microorganisms and minimize
wound discomfort. Dry sterile dressings protect the
wound from mechanical trauma and promote healing.
55. C. short-acting only. Continuous subcutaneous insulin
regimen uses a basal rate and boluses of short-acting
insulin. Multiple daily injection therapy uses a
combination of short-acting and intermediate or long-
acting insulins.
56. C. More insulin. During periods of infection or illness,
patients with Type 1 diabetes may need even more
insulin to compensate for increased blood glucose
levels.
57. B. “Sometimes when I put my shoes on I don’t know
where my toes are.” Peripheral neuropathy can lead to
lack of sensation in the lower extremities. Clients do
not feel pressure and/or pain and are at high risk for
skin impairment.
58. A. Renin
59. A. Diabetic ketoacidosis
60. B. early prenatal medical care. A review of dietary
modifications is important once the woman is
pregnant. However, it is not of primary importance
when considering pregnancy. Pregnancy makes
metabolic control of diabetes more difficult. It is
essential that the client start prenatal care early so
 that potential complications can be controlled or 2. Clinical manifestations associated with a diagnosis of type
minimized by the efforts of the client and health care 1 DM include all of the following except:
team. The alternative of adoption is not necessary just
because the client is a diabetic. Many diabetic women Hypoglycemia
have pregnancies with successful outcomes if they Hyponatremia
receive good care. While there is some risk to the Ketonuria
pregnant diabetic woman, it is not considered a major Polyphagia
health risk. The greater risk is to the fetus. 3. The lowest fasting plasma glucose level suggestive of a
61. B. Retinopathy diagnosis of DM is:
62. D. Fever
63. D. Projectile vomiting 90mg/dl
64. B. “I’ll probably need my daily insulin dose raised.” The 115mg/dl
client starts to need increased insulin in the second 126mg/dl
trimester. This statement indicates a lack of 180mg/dl
understanding. As a result of placental maturation and 4. Rotation sites for insulin injection should be separated
placental production of lactogen, insulin requirements from one another by 2.5 cm (1 inch) and should be used only
begin increasing in the second trimester and may every:
double or quadruple by the end of pregnancy. The
client starts to need increased insulin in the second Third day
trimester. This statement indicates a lack of Week
understanding. Insulin doses depend on blood glucose 2-3 weeks
levels. Finger sticks for glucose levels must be 2-4 weeks
continued. 5. A clinical feature that distinguishes a hypoglycemic
65. D. Suggest referral to a sex counselor or other reaction from a ketoacidosis reaction is:
appropriate professional. The nurse should refer this
client to a sex counselor or other professional. Making Blurred vision
appropriate referrals is a valid part of planning the Diaphoresing
client’s care. The nurse doesn’t normally provide sex Nausea
counseling. Therefore, providing time for privacy and Weakness
providing support for the spouse or significant other 6. Clinical nursing assessment for a patient with
are important, but not as important as referring the microangiopathy who has manifested impaired peripheral
client to a sex counselor. arterial circulation includes all of the following except:
66. A. Accurate dose delivery. These devices are more
accurate because they are easily to used and have Integumentary inspection for the presence of brown spots on
improved adherence in insulin regimens by young the lower extremities
people because the medication can be administered Observation for paleness of the lower extremities
discreetly. Observation for blanching of the feet after the legs are
67. A. Can control blood glucose through diet and elevated for 60 seconds
exercise . Oral hypoglycemic agents may improve Palpation for increased pulse volume in the arteries of the
blood glucose levels if dietary modification and lower extremities
exercise are unsuccessful. Individuals with Type 2 7. The nurse expects that a type 1 diabetic may receive ____
diabetes are usually obese at diagnosis. Individuals of his or her morning dose of insulin preoperatively:
with Type 2 diabetes rarely demonstrate ketosis,
except in stress or infection. Individuals with Type 2 10-20%
diabetes do not demonstrate islet cell antibodies. 25-40%
68. A. Elevated blood glucose levels contribute to 50-60%
complications of diabetes, such as diminished vision. 85-90%
When blood glucose levels are well controlled, the 8. Albert, a 35-year-old insulin dependent diabetic, is
potential for complications of diabetes is reduced. admitted to the hospital with a diagnosis of pneumonia. He
69. B. FALSE has been febrile since admission. His daily insulin
70. A. Glucagon requirement is 24 units of NPH. Every morning Albert is given
NPH insulin at 0730. Meals are served at 0830, 1230, and
Diabetes Mellitus 2 95 items 1830. The nurse expects that the NPH insulin will reach its
1. Knowing that gluconeogenesis helps to maintain blood maximum effect (peak) between the hours of:
levels, a nurse should:
1130 and 1330
Document weight changes because of fatty acid mobilization 1330 and 1930
Evaluate the patient’s sensitivity to low room temperatures 1530 and 2130
because of decreased adipose tissue insulation 1730 and 2330
Protect the patient from sources of infection because of 9. A bedtime snack is provided for Albert. This is based on the
decreased cellular protein deposits knowledge that intermediate-acting insulins are effective for
Do all of the above an approximate duration of:
6-8 hours
10-14 hours
16-20 hours
24-28 hours
10. Albert refuses his bedtime snack. This should alert the
nurse to assess for:
Elevated serum bicarbonate and a decreased blood pH.
Signs of hypoglycemia earlier than expected.
Symptoms of hyperglycemia during the peak time of NPH
insulin.
Sugar in the urine
11. A client is taking NPH insulin daily every morning. The
nurse instructs the client that the most likely time for a
hypoglycemic reaction to occur is:
2-4 hours after administration
6-14 hours after administration
16-18 hours after administration
18-24 hours after administration
12. An external insulin pump is prescribed for a client with
DM. The client asks the nurse about the functioning of the
pump. The nurse bases the response on the information that
the pump:
Gives small continuous dose of regular insulin
subcutaneously, and the client can self-administer a bolus
with an additional dosage from the pump before each meal.
Is timed to release programmed doses of regular or NPH
insulin into the bloodstream at specific intervals.
Is surgically attached to the pancreas and infuses regular
insulin into the pancreas, which in turn releases the insulin
into the bloodstream.
Continuously infuses small amounts of NPH insulin into the
bloodstream while regularly monitoring blood glucose levels.
13. A client with a diagnosis of diabetic ketoacidosis (DKA) is
being treated in the ER. Which finding would a nurse expect
to note as confirming this diagnosis?
Elevated blood glucose level and a low plasma bicarbonate
Decreased urine output
Increased respirations and an increase in pH
Comatose state
14. A client with DM demonstrates acute anxiety when first
admitted for the treatment of hyperglycemia. The most
appropriate intervention to decrease the client’s anxiety
would be to:
Administer a sedative
Make sure the client knows all the correct medical terms to
understand what is happening.
Ignore the signs and symptoms of anxiety so that they will
soon disappear
Convey empathy, trust, and respect toward the client.
15. A nurse is preparing a plan of care for a client with DM
who has hyperglycemia. The priority nursing diagnosis would
be:
High risk for deficient fluid volume
Deficient knowledge: disease process and treatment
Imbalanced nutrition: less than body requirements
Disabled family coping: compromised.
16. A nurse is caring for a client admitted to the ER with DKA.
In the acute phase the priority nursing action is to prepare to:
Administer regular insulin intravenously
Administer 5% dextrose intravenously
Correct the acidosis
Apply an electrocardiogram monitor.
17. A nurse performs a physical assessment on a client with
type 2 DM. Findings include a fasting blood glucose of
120mg/dl, temperature of 101, pulse of 88, respirations of
22, and a bp of 140/84. Which finding would be of most
concern of the nurse?
Pulse
BP
Respiration
Temperature
18. A client with type 1 DM calls the nurse to report recurrent
episodes of hypoglycemia with exercise. Which statement by
the client indicated an inadequate understanding of the peak
action of NPH insulin and exercise?
“The best time for me to exercise is every afternoon.”
“The best time for me to exercise is right after I eat.”
“The best time for me to exercise is after breakfast.”
“The best time for me to exercise is after my morning snack.”
19. A client with diabetes mellitus visits a health care clinic.
The client’s diabetes previously had been well controlled with
glyburide (Diabeta), 5 mg PO daily, but recently the fasting
blood glucose has been running 180-200mg/dl. Which
medication, if added to the clients regimen, may have
contributed to the hyperglycemia?
Prednisone (Deltasone)
Atenolol (Tenormin)
Phenelzine (Nardil)
Allopurinol (Zyloprim)
20. Glucose is an important molecule in a cell because this
molecule is primarily used for:
Extraction of energy
Synthesis of protein
Building of genetic material
Formation of cell membranes.
21. When a client is first admitted with hyperglycemic
hyperosmolar nonketotic syndrome (HHNS), the nurse’s
priority is to provide:
Oxygen
Carbohydrates
Fluid replacement
Dietary instruction
22. The nurse is admitting a client with hypoglycemia. Identify
the signs and symptoms the nurse should expect. Select all
that apply.
Thirst
Palpitations
Diaphoresis
Slurred speech
Hyperventilation
23. When a client is in diabetic ketoacidosis, the insulin that
would be administered is:
 Humulin N
Human NPH insulin 31. A client with DM states, “I cannot eat big meals; I prefer
Human regular insulin to snack throughout the day.” The nurse should carefully
Insulin lispro injection explain that the:
Insulin glargine injection
24. The nurse recognizes that additional teaching is necessary Regulated food intake is basic to control
when the client who is learning alternative site testing (AST) Salt and sugar restriction is the main concern
for glucose monitoring says: Small, frequent meals are better for digestion
Large meals can contribute to a weight problem
“I need to rub my forearm vigorously until warm before 32. A client with DM has an above-knee amputation because
testing at this site.” of severe peripheral vascular disease, Two days following
“The fingertip is preferred for glucose monitoring if surgery, when preparing the client for dinner, it is the nurse’s
hyperglycemia is suspected.” primary responsibility to:
“I have to make sure that my current glucose monitor can be
used at an alternate site.” Check the client’s serum glucose level
“Alternate site testing is unsafe if I am experiencing a rapid Assist the client out of bed to the chair
change in glucose levels.” Place the client in a high-fowlers position
25. Which adaptations should the nurse caring for a client Ensure that the client’s residual limb is elevated.
with diabetic ketoacidosis expect the client to exhibit? Select 33. Which of the following nursing interventions should be
all that apply: taken for a client who complains of nausea and vomits one
hour after taking his glyburide (DiaBeta)?
Sweating
Low PCO2 Give glyburide again
Retinopathy Give subcutaneous insulin and monitor blood glucose
Acetone breath Monitor blood glucose closely, and look for signs of
Elevated serum bicarbonate hypoglycemia.
26. A client’s blood gases reflect diabetic acidosis. The nurse Monitor blood glucose, and assess for signs of hyperglycemia.
should expect: 34. Which of the following chronic complications is
associated with diabetes?
Increased pH
Decreased PO2 Dizziness, dyspnea on exertion, and coronary artery disease.
Increased PCO2 Retinopathy, neuropathy, and coronary artery disease
Decreased HCO3 Leg ulcers, cerebral ischemic events, and pulmonary infarcts
27. The nurse knows that glucagon may be given in the Fatigue, nausea, vomiting, muscle weakness, and cardiac
treatment of hypoglycemia because it: arrhythmia’s
35. Rotating injection sites when administering insulin
Inhibits gluconeogenesis prevents which of the following complications?
Stimulates the release of insulin
Increases blood glucose levels Insulin edema
Provides more storage of glucose. Insulin lipodystrophy
28. A client with type 1 DM has a fingerstick glucose level of Insulin resistance
258mg/dl at bedtime. An order for sliding scale insulin exists. Systemic allergic reactions
The nurse should: 36. Which of the following methods of insulin administration
would be used in the initial treatment of hyperglycemia in a
Call the physician client with diabetic ketoacidosis?
Encourage the intake of fluids
Administer the insulin as ordered Subcutaneous
Give the client ½ c. of orange juice Intramuscular
29. The physician orders 36 units of NPH and 12 units of IV bolus only
regular insulin. The nurse plans to administer these drugs in 1 IV bolus, followed by continuous infusion.
syringe. Identify the steps in this procedure by listing them in 37. Insulin forces which of the following electrolytes out of
priority order. the plasma and into the cells?

Inject air equal to NPH dose into NPH vial Calcium

Invert regular insulin bottle and withdraw regular insulin dose Magnesium
Inject air equal to regular dose into regular dose Phosphorus
Invert NPH vial and withdraw NPH dose. Potassium
30. The insulin that has the most rapid onset of action would 38. Which of the following causes of HHNS is most common?
be:
Insulin overdose
Lente Removal of the adrenal gland
Lispro Undiagnosed, untreated hyperpituitarism
Ultralente Undiagnosed, untreated diabetes mellitus
39. A client is in DKA, secondary to infection. As the condition
progresses, which of the following symptoms might the nurse
see?
Kussmaul’s respirations and a fruity odor on the breath
Shallow respirations and severe abdominal pain
Decreased respirations and increased urine output.
Cheyne-stokes respirations and foul-smelling urine
40. Clients with type 1 diabetes may require which of the
following changes to their daily routine during periods of
infection?
No changes
Less insulin
More insulin
Oral antidiabetic agents
41. Marlisa has been diagnosed with diabetes mellitus type 1.
She asks Nurse Errol what this means. What is the best
response by the nurse? Select all that apply.
“Your alpha cells should be able to secrete insulin, but
cannot.”
“The exocrine function of your pancreas is to secrete insulin.”
“Without insulin, you will develop ketoacidosis (DKA).”
“The endocrine function of your pancreas is to secrete
insulin.”
“It means your pancreas cannot secrete insulin.”
42. Dr. Shrunk orders intravenous (IV) insulin for Rita, a client
with a blood sugar of 563. Nurse AJ administers insulin lispro
(Humalog) intravenously (IV). What does the best evaluation
of the nurse reveal? Select all that apply.
The nurse could have given the insulin subcutaneously.
The nurse should have contacted the physician.
The nurse should have used regular insulin (Humulin R).
The nurse used the correct insulin.
43. Ben injects his insulin as prescribed, but then gets busy
and forgets to eat. What will the best assessment of the
nurse reveal?
The client will be very tasty.
The client will complain of nausea.
The client will need to urinate.
The client will have moist skin.
44. A clinical instructor teaches a class for the public about
diabetes mellitus. Which individual does the nurse assess as
being at highest risk for developing diabetes?
The 50-year-old client who does not get any physical exercise
The 56-year-old client who drinks three glasses of wine each
evening
The 42 year-old client who is 50 pounds overweight
The 38 year-old client who smokes one pack of cigarettes per
day
45. Steven John has type 1 diabetes mellitus and receives
insulin. Which laboratory test will the nurse assess?
Potassium
AST (aspartate aminotransferase)
Serum amylase
Sodium
46. Jansen receives metformin (Glucophage). What will the
best plan of the nurse include with regard to patient
education with this drug? Select all that apply.
It stimulates the pancreas to produce more insulin.
It must be taken with meals.
It decreases sugar production in the liver.
It inhibits absorption of carbohydrates.
It reduces insulin resistance.
47. Serafica who has diabetes mellitus type 1 is found
unresponsive in the clinical setting. Which nursing action is a
priority? arrange from 1 to 4.
Treat the client for hypoglycemia.
Call the physician STAT.
Assess the vital signs.
Call a code.
1, 2, 3, 4
1, 3, 2, 4
3, 1, 2, 4
4, 3, 2, 1
48. Serge who has diabetes mellitus is taking oral agents, and
is scheduled for a diagnostic test that requires him to be
NPO. What is the best plan of the nurse with regard to giving
the client his oral medications?
Administer the oral agents immediately after the test.
Notify the the diagnostic department and request orders.
Notify the physician and request orders.
Administer the oral agents with a sip of water before the test.
49. A client diagnosed with type 1 diabetes receives insulin.
He asks the nurse why he can’t just take pills instead. What is
the best response by the nurse?
“Insulin must be injected because it needs to work quickly.”
“Insulin can’t be in a pill because it is destroyed in stomach
acid.”
“Have you talked to your doctor about taking pills instead?”
“I know it is tough, but you will get used to the shots soon.”
50. Nurse Andy has finished teaching a client with diabetes
mellitus how to administer insulin. He evaluates the learning
has occurred when the client makes which statement?
“I should check my blood sugar immediately prior to the
administration.”
“I should provide direct pressure over the site following the
injection.”
“I should use the abdominal area only for insulin injections.”
“I should only use calibrated insulin syringe for the
injections.”
51. Genevieve has diabetes type 1 and receives insulin for
glycemic control. She tells the nurse that she likes to have a
glass of wine with dinner. What will the best plan of the
nurse for client education include?
The alcohol could cause pancreatic disease.
The alcohol could cause serious liver disease.
The alcohol could predispose you to hypoglycemia.
The alcohol could predispose you to hyperglycemia.
52. Dr. Wijangco orders insulin lispro (Humalog) 10 units for
Alicia, a client with diabetes mellitus. When will the nurse
administer this medication?
When the client is eating
Thirty minutes before meals
fifteen minutes before meals
When the meal trays arrive on the floor
53. Nurse Matt makes a home visit to the client with diabetes
mellitus. During the visit, Nurse Matt notes the client’s
additional insulin vials are not refrigerated. What is the best
action by the nurse at this time?
Instruct the client to label each vial with the date when
opened.
Tell the client there is no need to keep additional vials.
Have the client place the insulin vials in the refrigerator.
Have the client discard the vials.
54. During the morning rounds, Nurse AJ accompanied the
physician in every patient’s room. The physician writes orders
for the client with diabetes mellitus. Which order would the
nurse validate with the physician?
Use Humalog insulin for sliding scale coverage.
Metformin (Glucophage) 1000 mg per day in divided doses.
Administer regular insulin 30 minutes prior to meals.
Lantus insulin 20U BID.
55. Gary has diabetes type 2. Nurse Martha has taught him
about the illness and evaluates learning has occurred when
the client makes which statement?
“My cells have increased their receptors, but there is enough
insulin.”
“My peripheral cells have increased sensitivity to insulin.”
“My beta cells cannot produce enough insulin for my cells.”
“My cells cannot use the insulin my pancreas makes.”
56. The principal goals of therapy for older patients who have
poor glycemic control are:
Enhancing quality of life.
Decreasing the chance of complications.
Improving self-care through education.
All of the above.
57. Which of the following is accurate pertaining to physical
exercise and type 1 diabetes mellitus?
Physical exercise can slow the progression of diabetes
mellitus.
Strenuous exercise is beneficial when the blood glucose is
high.
Patients who take insulin and engage in strenuous physical
exercise might experience hyperglycemia.
Adjusting insulin regimen allows for safe participation in all
forms of exercise.
58. Harry is a diabetic patient who is experiencing a reaction
of alternating periods of nocturnal hypoglycemia and
hyperglycemia. The patient might be manifesting which of
the following?
Uncontrolled diabetes
Somogyi phenomenon
Brittle diabetes
Diabetes insipidus
59. Dr. Hugo has prescribed sulfonylureas for Rebecca in the
management of diabetes mellitus type 2. As a nurse, you
know that the primary purpose of sulfonylureas, such as
long-acting glyburide (Micronase), is to:
Induce hypoglycemia by decreasing insulin sensitivity.
Improve insulin sensitivity and decrease hyperglycemia.
Stimulate the beta cells of the pancreas to secrete insulin.
Decrease insulin sensitivity by enhancing glucose uptake.
60. Rosemary has been taking Glargine (Lantus) to treat her
condition. One of the benefits of Glargine (Lantus) insulin is
its ability to:
Release insulin rapidly throughout the day to help control
basal glucose.
Release insulin evenly throughout the day and control basal
glucose levels.
Simplify the dosing and better control blood glucose levels
during the day.
Cause hypoglycemia with other manifestation of other
adverse reactions.
61. A 50-year-old widower is admitted to the hospital with a
diagnosis of diabetes mellitus and complaints of rapid-onset
weight loss, elevated blood glucose levels, and polyphagia,
the gerontology nurse should anticipate which of the
following secondary medical diagnoses?
Impaired glucose tolerance
Gestational diabetes mellitus
Pituitary tumor
Pancreatic tumor
62. An older woman with diabetes mellitus visits the clinic
concerning her condition. Of which of the following
symptoms might an older woman with diabetes mellitus
complain?
Anorexia
Pain intolerance
Weight loss
Perineal itching
63. Gregory is a 52-year-old man identified as high-risk for
diabetes mellitus. Which laboratory test should a nurse
anticipate a physician would order for him? (Select all that
apply.)
Fasting Plasma Glucose (FPG)
Two-hour Oral Glucose Tolerance Test (OGTT)
Glycosylated hemoglobin (HbA1C)
Finger stick glucose three times daily
64. According to the National Diabetes Statistics Report,
diabetes remains as one of the leading causes of death in the
United States since 2010. Which of the following factors are
risks for the development of diabetes mellitus? (Select all
that apply.)
Age over 45 years
Overweight with a waist/hip ratio >1
Having a consistent HDL level above 40 mg/dl
Maintaining a sedentary lifestyle
65. During a visit in the hospital, the student nurses are asked
which of the following persons would most likely be
diagnosed with diabetes mellitus. They are correct if they
answered a 44-year-old:
Caucasian woman.
Asian woman.
African-American woman.
Hispanic male.
66. An ailing 70-year-old woman with a diagnosis of type 2
diabetes mellitus has been ill with pneumonia. The client’s
intake has been very poor, and she is admitted to the hospital
for observation and management as needed. What is the
most likely problem with this patient?
Insulin resistance has developed.
Diabetic ketoacidosis is occurring.
Hypoglycemia unawareness is developing.
Hyperglycemic hyperosmolar non-ketotic coma.
67. Daniel is diagnosed of having hyperthyroidism (Graves’
disease). Which of the following is a drug of choice for his
condition?
Furosemide (Lasix)
Digoxin (Lanoxin)
Propranolol (Inderal)
Propylthiouracil (PTU)
68. Which of the following medications are most likely to
cause hypothyroidism? (Select all that apply.)
Acetylsalicylic acid (aspirin)
Furosemide (Lasix)
Docusate sodium (Colace)
Rifampin (Rifadin)
69. After visiting the physician, Angela found out that she has
a thyroid problem. In line with her condition, which of the
following diagnostic studies is done to determine the size and
composition of the thyroid gland?
Thyroid scan with RAI 123I
Electrocardiography
Ultrasonography
Venous duplex Doppler study
70. Nurse Gil is caring for a patient with a diagnosis of
hypothyroidism. Which nursing diagnosis should the nurse
most seriously consider when analyzing the needs of the
patient?
High risk for aspiration related to severe vomiting
Diarrhea related to increased peristalsis
Hypothermia related to slowed metabolic rate
Oral mucous membrane, altered related to disease process
71. During lecture, the clinical instructor tells the students
that 50% to 60% of daily calories should come from
carbohydrates. What should the nurse say about the types of
carbohydrates that can be eaten?
Try to limit simple sugars to between 10% and 20% of daily
calories.
Simple carbohydrates are absorbed more rapidly than
complex carbohydrates.
Simple sugars cause rapid spike in glucose levels and should
be avoided.
Simple sugars should never be consumed by someone with
diabetes.
72. At the time Cherrie Ann found out that the symptoms of
diabetes were caused by high levels of blood glucose, she
decided to break the habit of eating carbohydrates. With this,
the nurse would be aware that the client might develop what
complication?
retinopathy
atherosclerosis
glycosuria
acidosis
73. Joko has recently been diagnosed with Type I diabetes
and asks Nurse Jessica for help formulating a nutrition plan.
Which of the following recommendations would the nurse
make to help the client increase calorie consumption to
offset absorption problems?
Eat small meals with two or three snacks throughout the day
to keep blood glucose levels steady
Increase consumption of simple carbohydrates
Eating small meals with two or three snacks may be more
helpful in maintaining blood glucose levels than three large
meals.
Skip meals to help lose weight
74. Billy is being asked concerning his health in the
emergency department. When obtaining a health history
from a patient with acute pancreatitis, the nurse asks the
patient specifically about a history of
alcohol use.
cigarette smoking.
diabetes mellitus.
high-protein diet.
75. Nurse Shey is educating a pregnant client who has
gestational diabetes. Which of the following statements
should the nurse make to the client? Select all that apply.
Cakes, candies, cookies, and regular soft drinks should be
avoided.
Gestational diabetes increases the risk that the mother will
develop diabetes later in life.
Gestational diabetes usually resolves after the baby is born.
Insulin injections may be necessary.
The baby will likely be born with diabetes
The mother should strive to gain no more weight during the
pregnancy.
76. The goal for pre-prandial blood glucose for those with
Type 1 diabetes mellitus is:
<80 mg/dl
<130 mg/dl
<180 mg/dl
<6%
77. The guidelines for Carbohydrate Counting as medical
nutrition therapy for diabetes mellitus includes all of the
following EXCEPT:
Flexibility in types and amounts of foods consumed
Unlimited intake of total fat, saturated fat and cholesterol
Including adequate servings of fruits, vegetables and the
dairy group
Applicable to with either Type 1 or Type 2 diabetes mellitus
78. The nurse working in the physician’s office is reviewing
lab results on the clients seen that day. One of the clients
who has classic diabetic symptoms had an eight-hour fasting
plasma glucose (FPG) test done. The nurse realizes that
diagnostic criteria developed by the American Diabetes
Association for diabetes include classic diabetic symptoms
plus which of the following fasting plasma glucose levels?
Higher than 106 mg/dl
Higher than 126 mg/dl
Higher than 140 mg/dl
Higher than 160 mg/dl
79. When taking a health history, the nurse screens for
manifestations suggestive of Diabetes Type I. Which of the
following manifestations are considered the primary
manifestations of Diabetes Type I and would be most
suggestive and require follow-up investigation?
Excessive intake of calories, rapid weight gain, and difficulty
losing weight
An increase in three areas: thirst, intake of fluids, and hunger
Poor circulation, wound healing, and leg ulcers,
Lack of energy, weight gain, and depression
80. The nurse is working with an overweight client who has a
high-stress job and smokes. This client has just received a
diagnosis of Type II Diabetes and has just been started on an
oral hypoglycemic agent. Which of the following goals for the
client which if met, would be most likely to lead to an
improvement in insulin efficiency to the point the client
would no longer require oral hypoglycemic agents?
Comply with medication regimen 100% for 6 months
Quit the use of any tobacco products by the end of three
months
Lose a pound a week until weight is in normal range for
height and exercise 30 minutes daily
Practice relaxation techniques for at least five minutes five
times a day for at least five months
81. During a visit in a community, the nurse will recommend
routine screening for diabetes when the person has one or
more of seven risk criteria. Which of the following persons
that the nurse comes in contact with most needs to be
screened for diabetes based on the seven risk criteria?
A client with an HDL cholesterol level of 40 mg/dl and a
triglyceride level of 300 mg/dl
A woman who is at 90% of standard body weight after
delivering an eight-pound baby
A middle-aged Caucasian male
An older client who is hypotensive
82. During the admission of a client with diabetic
ketoacidosis, Nurse Kendra will anticipate the physician
ordering which of the following types of intravenous solution
if the client cannot take fluids orally?
Lactated Ringer’s solution
0.9 normal saline solution
5% dextrose in water (D5W)
0.45% normal saline solution
83. You are doing some teaching with a client who is starting
on a sulfonylurea antidiabetic agent. The client mentions that
he usually has a couple of beers each night and takes an
aspirin each day to prevent heart attack and/or strokes.
Which of the following responses would be best on the part
of the nurse?
As long as you only drink two beers and take one aspirin, this
should not be a problem
The aspirin is alright but you need to give up drinking any
alcoholic beverages
Taking alcohol and/or aspirin with a sulfonylurea drug can
cause development of hypoglycemia
Aspirin and alcohol will cause the stomach to bleed more
when on a sulfonylurea drug
84. Which of the following if stated by the nurse is correct
about Hyperglycemic Hyperosmolar Nonketotic Syndrome
(HHNS)?
This syndrome occurs mainly in people with Type I Diabetes
It has a higher mortality rate than Diabetic Ketoacidosis
The client with HHNS is in a state of overhydration
This condition develops very rapidly
85. Nurse Robedee is teaching a thin client about the proper
methods/techniques when giving insulin. Which one of the
following is proper?
Pinch the skin up and use a 90 degree angle
Use a 45 degree angle with the skin pinched up
Massage the area of injection after injecting the insulin
Warm the skin with a warmed towel or washcloth prior to
the injection
86. Nurse Pira is explaining to the client about Type II
Diabetes. Risk factors of such condition include all of the
following except:
Advanced age
Physical inactivity
Obesity
Smoking
87. Blood sugar is well controlled when Hemoglobin A1C is:
Below 5.7%
Between 12%-15%
Less than 180 mg/dL
Between 90 and 130 mg/dL
88. Which of the following diabetes drugs acts by decreasing
the amount of glucose produced by the liver?
Alpha-glucosidase inhibitors
Biguanides
Meglitinides
Sulfonylureas
89. A 39-year-old company driver presents with shakiness,
sweating, anxiety, and palpitations and tells the nurse he has
Type I Diabetes Mellitus. Which of the follow actions should
the nurse do first?
Inject 1 mg of glucagon subcutaneously.
Administer 50 mL of 50% glucose I.V.
Give 4 to 6 oz (118 to 177 mL) of orange juice.
Give the client four to six glucose tablets.
90. An external insulin pump is prescribed for a client with
diabetes mellitus and the client asks the nurse about the
functioning of the pump. The nurse bases the response on
the information that the pump:
is timed to release programmed doses of regular or NPH
insulin into the bloodstream at specific intervals
gives a small continuously dose of regular insulin
subcutaneously, and the client can self-administer a bolus
with an additional dose from the pump before each meal
continuously infuses small amounts of NPH insulin into the
bloodstream while regularly monitoring blood glucose levels
 is surgically attached to the pancreas and infuses regular
insulin into the pancreas, which in turn releases the insulin
into the bloodstream
91. Which of the following persons would most likely be
diagnosed with Diabetes Mellitus? A 44-year-old:
Caucasian woman.
Asian woman.
African-American woman.
Hispanic male.
92. Which of the following factors are risks for the
development of Diabetes Mellitus? Select all that apply.
Age over 45 years
Overweight with a waist/hip ratio >1
Having a consistent HDL level above 40 mg/dl
Maintaining a sedentary lifestyle
93. Anton brought his grandfather to the clinic to confirm his
blood sugar levels. Which laboratory test should a nurse
anticipate a physician would order when an older person is
identified as high-risk for Diabetes Mellitus? Select all that
apply.
Fasting Plasma Glucose (FPG)
Two-hour Oral Glucose Tolerance Test (OGTT)
Glycosylated hemoglobin (HbA1C)
Finger stick glucose three times daily
94. A patient received 6 units of regular insulin 3 hours ago.
The nurse would be MOST concerned if which of the
following was observed?
kussmaul respirations and diaphoresis
anorexia and lethargy
diaphoresis and trembling
headache and polyuria
95. Mr. Wesley is newly diagnosed with Type I DM and is
being seen by the home health nurse. The doctors orders
include: 1200 calorie ADA diet, 15 units NPH insulin before
breakfast, and check blood sugar qid. When the nurse visits
the patient at 5 pm, the nurse observes the man performing
blood sugar analysis. The result is 50 mg/dL. The nurse would
expect the patient to be
confused with cold, clammy skin and pulse of 110
lethargic with hot dry skin and rapid deep respirations
alert and cooperative with BP of 130/80 and respirations of
12
short of breath, with distended neck veins and bounding
pulse of 96.
Answers and Rationales
1. Answer: D.
2. Answer: A.
3. Answer: C.
4. Answer: C.
5. Answer: B.
6. Answer: D.
7. Answer: C.
8. Answer: B.
9. Answer: C.
10. Answer: B.
11. Answer: B. NPH is intermediate acting insulin. The
onset of action is 1-2 hours, it peaks in 6-14 hours, and
it’s duration of action is 24 hours. Hypoglycemic
reactions most likely occur during peak time.
12. Answer: A. An insulin pump provides a small
continuous dose of regular insulin subcutaneously
throughout the day and night, and the client can self-
administer a bolus with additional dosage from the
pump before each meal as neede4. Regular insulin is
used in an insulin pump. An external pump is not
attached surgically to the pancreas.
13. Answer: A. In diabetic acidiosis the arterial pH is less
than 7.35. plasma bicarbonate is less than 15mEq/L,
and the blood glucose level is higher than 250mg/dl
and ketones are present in the blood and urine. The
client would be experiencing polyuria, and Kussmauls
respirations would be present. A comatose state may
occur if DKA is not treated, but coma would not
confirm the diagnosis
14. Answer: D. The most appropriate intervention is to
address the client’s feelings related to the anxiety.
Administering a sedative is not the most appropriate
intervention. The nurse should not ignore the client’s
anxious feelings. A client will not relate to medical
terms, particularly when anxiety exists.
15. Answer: A. Increased blood glucose will cause the
kidneys to excrete the glucose on the urine. This
glucose is accompanied by fluids and electrolytes,
causing osmotic diuresis leading to dehydration. This
fluid loss must be replaced when it becomes severe.
Options B, C, and D are not related specifically to the
issue of the question.
16. Answer: A. lack (absolute or relative) of insulin is the
primary cause of DK1. Treatment consists of insulin
administration (regular insulin), IV fluid administration
(normal saline initially), and potassium replacement,
followed by correcting acidosis. Applying an
electrocardiogram monitor is not a priority action.
17. Answer: D. An elevated temperature may indicate
infection. Infection is a leading cause of hyperglycemic
hyperosmolar nonketotic syndrome or diabetic
ketoacidosis.
18. Answer: A. A hypoglycemic reaction may occur in the
response to increased exercise. Clients should avoid
exercise during the peak time of insulin. NPH insulin
peaks at 6-14 hours; therefore afternoon exercise will
occur during the peak of the medication. Options B, C,
and D do not address peak action times.
19. Answer: A. Prednisone may decrease the effect of oral
hypoglycemics, insulin, diuretics, and potassium
supplements.
20. Answer: A. Glucose catabolism is the main pathway for
cellular energy production.
21. Answer: C. As a result of osmotic pressures created by
increased serum glucose, the cells become dehydrated;
the client must receive fluid and then insulin.
22. Answer: B, C, D. Palpitations, an adrenergic symptom,
occur as the glucose levels fall; the sympathetic
nervous system is activated and epinephrine and
norepinephrine are secreted causing this response.
Diaphoresis is a sympathetic nervous system response
that occurs as epinephrine and norepinephrine are
released. Slurred speech is a neuroglycopenic
symptom; as the brain receives insufficient glucose,
the activity of the CNS becomes depressed.
23. Answer: B. Regular insulin (Humulin R) is a short-acting
insulin and is administered via IV with an initial dose of
0.3 units/kg, followed by 0.2 units/kg 1 hour later,
followed by 0.2 units/kg every 2 hours until blood
glucose becomes <13.9 mmol/L (<250 mg/dL). At this
point, insulin dose should be decreased by half, to 0.1
units/kg every 2 hours, until the resolution of DKA.
24. Answer: B. The fingertip is preferred for glucose
monitoring if hypoglycemia, not hyperglycemia, is
suspected.
25. Answer: B, C. Metabolic acidosis initiates respiratory
compensation in the form of Kussmaul respirations to
counteract the effects of ketone buildup, resulting in a
lowered PCO2. A fruity odor to the breath (acetone
breath) occurs when the ketone level is elevated in
ketoacidosis.
26. Answer: D. The bicarbonate-carbonic acid buffer
system helps maintain the pH of the body fluids; in
metabolic acidosis there is a decrease in bicarbonate
because of an increase of metabolic acids.
27. Answer: C. Glucagon, an insulin antagonist produced
by the alpha cells in the islets of langerhans, leads to
the conversion of glycogen to glucose in the liver.
28. Answer: C. A value of 258mg/dl is above the expected
range of 70-105 mg/dl; the nurse should administer
the insulin as ordered.
29. Answer: 1, 3, 2, 4.
30. Answer: B. Lispro has an immediate onset, a peak of
30-90 minutes, and duration of 2-4 hours.
31. Answer: A. An understanding of the diet is imperative
for compliance. A balance of carbohydrates, proteins,
and fats usually apportioned over three main meals
and two-between meals snacks needs to be tailored to
the client’s specific needs, with due regard for activity,
diet, and therapy.
32. Answer: A. Because the client has diabetes, it is
essential that the blood glucose level be determined
before meals to evaluate the success of control of
diabetes and the possible need for insulin coverage.
33. Answer: C. When a client who has taken an oral
antidiabetic agent vomits, the nurse would monitor
glucose and assess him frequently for signs of
hypoglycemic. Most of the medication has probably
been absorbed. Therefore, repeating the dose would
further lower glucose levels later in the day. Giving
insulin would also lower the glucose levels, causing
hypoglycemic. The client wouldn’t have hyperglycemia
if the glyburide was absorbed.
34. Answer: B. These are all chronic complications of
diabetes. Dizziness, dyspnea on exertion, and coronary
artery disease are symptoms of aortic valve stenosis.
Fatigue, nausea, vomiting, muscle weakness, and
cardiac arrhythmias are symptoms of
hyperparathyroidism. Leg ulcers, cerebral ischemic
events, and pulmonary infarcts are complications of
sickle cell anemia.
35. Answer: B. Insulin lipodystrophy produces fatty masses
at the injection sites, causing unpredictable absorption
of insulin injected into these sites.
36. Answer: D. An IV bolus of insulin is given initially to
control the hyperglycemia; followed by a continuous
infusion, titrated to control blood glucose. After the
client is stabilized, subcutaneous insulin is given.
Insulin is never given intramuscularly.
37. Answer: D. Insulin forces potassium out of the plasma,
back into the cells, causing hypokalemia. Potassium is
needed to help transport glucose and insulin into the
cells. Calcium, magnesium, and phosphorus aren’t
affected by insulin.
38. Answer: D. Undiagnosed, untreated DM is one of the
most common causes of HHNS.
39. Answer: A. Coma and severe acidosis are ushered in
with Kussmaul’s respirations (very deep but not
labored respirations) and a fruity odor on the breath
(academia).
40. Answer: C. During periods of infection or illness,
diabetics may need even more insulin to compensate
for increased blood glucose levels.
41. Answer: C, D, E. One function of your pancreas is to
secrete insulin. The endocrine function of the pancreas
is to secrete insulin. The endocrine, not the exocrine,
function of the pancreas is to secrete insulin. Insulin is
secreted by the beta, not the alpha, cells of the
pancreas. A consequence of diabetes mellitus type 1 is
that without insulin, severe metabolic disturbances,
such as ketoacidosis (DKA) will result.
42. Answer: B, C. Regular insulin is the only insulin that can
be given intravenously (IV). The nurse did not use
correct insulin as it was not regular insulin. Contact the
provider to clarify the order, regular insulin is the only
insulin that can be given intravenously (IV). The nurse
cannot give the insulin subcutaneously when it is
ordered to be given intravenously (IV).
43. Answer: D. The client will have moist skin. Moist skin is
the sign of hypoglycemia, which the client would
experience if he injected himself with insulin and did
not eat. Thirst, nausea, and and increased urination
are signs of hyperglycemia.
44. Answer: C. The 42 year-old client who is 50 pounds
overweight. Obesity increases the likelihood of
developing diabetes mellitus due to over stimulation
of the endocrine system. Exercise is important, but lack
of exercise is not as big a risk factor as obesity.
Smoking is a serious health concern, but is not a
specific risk factor for diabetes. Consuming alcohol is
associated with liver disease but is not as high a risk
factor for diabetes as obesity.
45. Answer: A. Potassium. Insulin causes potassium to
move into the cell and may cause hypokalemia. There
is no need to monitor the sodium, serum amylase, and
AST levels.
46. Answer: B, C, E. Metformin (Glucophage) reduces
insulin resistance, decreases sugar production in the
liver, and should be taken with meals for the best
absorption and effect. It does not stimulate the
pancreas to produce more insulin and does not inhibit
the absorption of carbohydrates.
47. Answer: A. 1, 2, 3, 4. When a patient with diabetes
mellitus type 1 is unresponsive, the the nurse should
focus on and treat for hypoglycemia, as this is more
likely than hyperglycemia. This is an emergency
situation where the nurse must act before calling the
physician. Vital signs should be taken after the client is
treated for hypoglycemia. Assessment for ABCs should
 precede calling a code; there is no information that the
client is not breathing.
48. Answer: C. Notify the physician and request orders. It
is best to notify the client’s physician and request
orders. The client should not receive the medication
during NPO status unless directed by the physician.
The medications should not be given upon return
unless the physician orders this; the client may still
need to be NPO. The radiologist in the diagnostic
department might give orders, but it would be best to
check with the client’s physician first.
49. Answer: B. “Insulin can’t be in a pill because it is
destroyed in stomach acid.” Insulin must be injected
because it is destroyed in the stomach acid if taken
orally. Telling he will get used to shots does not
answer his question and is condescending. Insulin must
be injected because it is destroyed in stomach acid if
taken orally; the onset of action is not the issue here.
The nurse should answer the client’s question, not
refer him back to the physician.
50. Answer: D. “I should only use calibrated insulin syringe
for the injections.” To ensure the correct insulin dose,
a calibrated insulin syringe must be used. Insulin
injections should be rotated to the arm and thigh, not
just the abdominal area. There is no need to apply
direct pressure over the site following an insulin
injection. There is no need to check blood glucose
immediately prior to the injection.
51. Answer: C. The alcohol could predispose you to
hypoglycemia. Alcohol can potentiate hypoglycemic,
not hypoglycemic, effects in the client. Alcohol can
cause pancreatic disease, but the client’s pancreas is
not producing any insulin currently. Alcohol can cause
liver disease, but the more immediate concern is
hypoglycemia.
52. Answer: A. When the client is eating. The onset action
for the insulin lispro (Humalog) is 10 to 15 minutes so it
must be given when the client is eating to prevent
hypoglycemia. It must be given when the client is
eating, not when the meal trays arrive on the floor and
not thirty minutes before meals.
53. Answer: C. Have the client place the insulin vials in the
refrigerator. Vials not in use should be refrigerated to
preserve drug potency. There is no need to discard the
vials. The client should always have additional vials of
insulin available. Writing the date of opening on the
vial is good practice, but does not address the need to
refrigerate additional vials.
54. Answer: D. Lantus insulin 20U BID. Lantus insulin is
usually prescribed once-a-day so an order for BID
dosing should be validated with the physician.
Humalog insulin can be prescribed for sliding scale
coverage. Regular insulin is administered 30 minutes
before meals. Metformin (Glucophage) is often
prescribed in divided doses of 1000 mg per day.
55. Answer: D. “My cells cannot use the insulin my
pancreas makes.” With type 2 diabetes mellitus, the
pancreas produces insulin, but the cells cannot use it.
Peripheral cells have a decreased, not an increased,
sensitivity to insulin. The beta cells continue to
produce insulin with type 2 diabetes. There is a
decrease, not an increase, in receptor sites with type 2
diabetes.
56. Answer: D. All of the above. The principal goals of
therapy for older persons with diabetes mellitus and
poor glycemic control are enhancing quality of life,
decreasing the chance of complications, improving
self-care through education, and maintaining or
improving general health status.
57. Answer: A. Physical exercise can slow the progression
of diabetes mellitus. Physical exercise slows the
progression of diabetes mellitus, because exercise has
beneficial effects on carbohydrate metabolism and
insulin sensitivity. Strenuous exercise can cause retinal
damage, and can cause hypoglycemia. Insulin and
foods both must be adjusted to allow safe
participation in exercise.
58. Answer: B. Somogyi phenomenon. Somogyi
phenomenon manifests itself with nocturnal
hypoglycemia, followed by a marked increase in
glucose and increase in ketones.
59. Answer: C. Stimulate the beta cells of the pancreas to
secrete insulin. Sulfonylureas such as glyburide are
used only with patients who have some remaining
pancreatic-beta cell function. These drugs stimulate
insulin secretion, which reduces liver glucose output
and increases cell uptake of glucose, enhancing the
number of and sensitivity of cell receptor sites for
interaction with insulin.
60. Answer: B. Release insulin evenly throughout the day
and control basal glucose levels. Glargine (Lantus)
insulin is designed to release insulin evenly throughout
the day and control basal glucose levels.
61. Answer: D. Pancreatic tumor. The onset of
hyperglycemia in the older adult can occur more
slowly. When the older adult reports rapid-onset
weight loss, elevated blood glucose levels, and
polyphagia, the healthcare provider should consider
pancreatic tumor.
62. Answer: D. Perineal itching. Older women might
complain of perineal itching due to vaginal candidiasis.
63. Answer: A, B. When an older person is identified as
high-risk for diabetes, appropriate testing would
include FPG and OGTT. A FPG greater than 140 mg/dL
usually indicates diabetes. The OGTT is to determine
how the body responds to the ingestion of
carbohydrates in a meal. HbA1C evaluates long-term
glucose control. A finger stick glucose three times daily
spot-checks blood glucose levels.
64. Answer: A, B, D. Aging results in reduced ability of beta
cells to respond with insulin effectively. Overweight
with waist/hip ratio increase is part of the metabolic
syndrome of DM II. There is an increase in
atherosclerosis with DM due to the metabolic
syndrome and sedentary lifestyle.
65. Answer: C. African-American woman. Age-specific
prevalence of diagnosed diabetes mellitus (DM) is
higher for African-Americans and Hispanics than for
Caucasians. Among those younger than 75, black
women had the highest incidence.
66. Answer: D. Hyperglycemic hyperosmolar non-ketotic
coma.Illness, especially with the frail elderly patient
whose appetite is poor, can result in dehydration and
HHNC. Insulin resistance usually is indicated by a daily
insulin requirement of 200 units or more. Diabetic
ketoacidosis, an acute metabolic condition, usually is
 caused by absent or markedly decreased amounts of
insulin.
67. Answer: D. Propylthiouracil (PTU). Propylthiouracil
(PTU) initially is given in divided doses, and functions
to block thyroid hormone synthesis.
68. Answer: A, B, D. Acetylsalicylic acid (aspirin),
Furosemide (Lasix), and Rifampin (Rifadin) are most
likely to cause hypothyroidism.
69. Answer: C. Ultrasonography. Although thyroid scans
frequently are done to evaluate the thyroid gland, I
123 is used to destroy overactive thyroid cells such as
are seen in thyroid cancer. Ultrasonography can be
used early in the evaluation process to rule out Graves’
disease, nodular goiter, or other thyroid dysfunction.
70. Answer: C. Hypothermia related to slowed metabolic
rate. Thyroid hormone deficiency results in reduction
in the metabolic rate, resulting in hypothermia, and
does predispose the older adult to a host of other
health-related issues. One quarter of affected elderly
experience constipation.
71. Answer: A. Try to limit simple sugars to between 10%
and 20% of daily calories. It is recommended that
carbohydrates provide 50% to 60% of the daily
calories. Approximately 40% to 50% should be from
complex carbohydrates. The remaining 10% to 20 % of
carbohydrates could be from simple sugars. Studies
give no evidence that carbohydrates from simple
sugars are digested and absorbed more rapidly that
are complex carbohydrates, and they do not appear to
affect blood sugar control.
72. Answer: D. acidosis. When a client’s carbohydrate
consumption is inadequate, ketones are produced
from the breakdown of fat. These ketones lower the
pH of the blood, potentially causing acidosis that can
lead to a diabetic coma.
73. Answer: C. Eating small meals with two or three snacks
may be more helpful in maintaining blood glucose
levels than three large meals. Eating small meals with
two or three snacks may be more helpful in
maintaining blood glucose levels than three large
meals.
74. Answer: A. alcohol use. Alcohol use is one of the most
common risk factors for pancreatitis in the United
States.
75. Answer: A, B, C, D. Gestational diabetes can occur
between the 16th and 28th week of pregnancy. If not
responsive to diet and exercise, insulin injections may
be necessary. Concentrated sugars should be avoided.
Weight gain should continue, but not in excessive
amounts. Usually, gestational diabetes disappears
after the infant is born. However, diabetes can develop
5 to 10 years after the pregnancy.
76. Answer: B. <130 mg/dl. The goal for pre-prandial blood
glucose for those with Type 1 diabetes mellitus is <130
mg/dl.
77. Answer: B. Unlimited intake of total fat, saturated fat
and cholesterol. The guidelines for Carbohydrate
Counting as medical nutrition therapy for diabetes
mellitus includes all of the following EXCEPT option B,
unlimited intake of total fat, saturated fat and
cholesterol.
78. Answer: B. Higher than 126 mg/dl. Diabetes is
diagnosed at fasting blood glucose of greater than or
equal to 126 mg/dl.
79. Answer: B. An increase in three areas: thirst, intake of
fluids, and hunger. The primary manifestations of
diabetes type I are polyuria (increased urine output),
polydipsia (increased thirst), polyphagia (increased
hunger).
80. Answer: C. Lose a pound a week until weight is in
normal range for height and exercise 30 minutes daily.
When Type II diabetics lose weight through diet and
exercise they sometimes have an improvement in
insulin efficiency sufficient to the degree they no
longer require oral hypoglycemic agents.
81. Answer: A. A client with an HDL cholesterol level of 40
mg/dl and a triglyceride level of 300 mg/dl. The seven
risk criteria include: greater than 120% of standard
body weight, Certain races but not including Caucasian,
delivery of a baby weighing more than 9 pounds or a
diagnosis of gestational diabetes, hypertensive, HDL
greater than 35 mg/dl or triglyceride level greater than
250 or a triglyceride level of greater than 250 mg/dl,
and, lastly, impaired glucose tolerance or impaired
fasting glucose on prior testing.
82. Answer: D. 0.45% normal saline solution. 0.45% normal
saline solution is recommended.
83. Answer: C. Taking alcohol and/or aspirin with a
sulfonylurea drug can cause development of
hypoglycemia. Alcohol and/or aspirin taken with a
sulfonylurea can cause development of hypoglycemia.
84. Answer: B. It has a higher mortality rate than Diabetic
Ketoacidosis. HHNS occurs only in people with Type II
Diabetes. It is a medical emergency and has a higher
mortality rate than Diabetic Ketoacidosis. This
condition develops very slowly over hours or days.
85. Answer: A. Pinch the skin up and use a 90 degree
angle. The best angle for a thin person is 90 degrees
with the skin pinched up. The area is not massaged and
it is not necessary to warm it.
86. Answer: D. Smoking. Additional risk factors for type 2
diabetes are a family history of diabetes, impaired
glucose metabolism, history of gestational diabetes,
and race/ethnicity. African-Americans,
Hispanics/Latinos, Asian Americans, Native Hawaiians,
Pacific Islanders, and Native Americans are at greater
risk of developing diabetes than whites.
87. Answer: A. Below 5.7%. A1c measures the percentage
of hemoglobin that is glycated and determines average
blood glucose during the 2 to 3 months prior to testing.
Used as a diagnostic tool, A1C levels of 6.5% or higher
on two tests indicate diabetes. A1C of 6% to 6.5% is
considered prediabetes.
88. Answer: B. Biguanides. Biguanides, such as metformin,
lower blood glucose by reducing the amount of glucose
produced by the liver. Sulfonylureas and Meglitinides
stimulate the beta cells of the pancreas to produce
more insulin. Alpha-glucosidase inhibitors block the
breakdown of starches and some sugars, which helps
to reduce blood glucose levels
89. Answer: C. Give 4 to 6 oz (118 to 177 mL) of orange
juice. Because the client is awake and complaining of
symptoms, the nurse should first give him 15 grams of
carbohydrate to treat hypoglycemia. This could be 4 to
 6 oz of fruit juice, five to six hard candies such as
Lifesavers, or 1 tablespoon of sugar. When a client has
worsening symptoms of hypoglycemia or is
unconscious, treatment includes 1 mg of glucagon
subcutaneously or intramuscularly, or 50 mL of 50%
glucose I.V. The nurse may also give two to three
glucose tablets for a hypoglycemic reaction.
90. Answer: B. gives a small continuously dose of regular
insulin subcutaneously, and the client can self-
administer a bolus with an additional dose from the
pump before each meal. An insulin pump provides a
small continuous dose of regular insulin
subcutaneously throughout the day and night, and the
client can self-administer a bolus with an additional
dose from the pump before each meal as needed.
Regular insulin is used in an insulin pump. An external
pump is not attached surgically to the pancreas.
91. Answer: C. African-American woman. Age-specific
prevalence of diagnosed diabetes mellitus (DM) is
higher for African-Americans and Hispanics than for
Caucasians. Among those younger than 75, black
women had the highest incidence.
92. Answer: A, B, D. Aging results in reduced ability of beta
cells to respond with insulin effectively. Overweight
with waist/hip ratio increase is part of the metabolic
syndrome of DM II. There is an increase in
atherosclerosis with DM due to the metabolic
syndrome and sedentary lifestyle.
93. Answer: A, B. When an older person is identified as
high-risk for diabetes, appropriate testing would
include FPG and OGTT. A FPG greater than 126 mg/dL
usually indicates diabetes. The OGTT is to determine
how the body responds to the ingestion of
carbohydrates in a meal. HbA1C evaluates long-term
glucose control. A finger stick glucose three times daily
spot-checks blood glucose levels.
94. Answer: C. diaphoresis and trembling. Diaphoresis and
trembling indicates hypoglycemia.
95. Answer: A. confused with cold, clammy skin and pulse
of 110. Confused with cold, clammy skin and pulse of
110 indicate hypoglycemia.
Hyperthyroidism 15 items
1) Which change in vital signs would you instruct a nursing
assistant to report immediately for a patient with
hyperthyroidism?
Increased and rapid heart rate
Decrease systolic blood pressure
Increased respiratory rate
Decreased oral temperature
2) For the patient with hyperthyroidism, what intervention
should you delegate to the experienced certified nursing
assistant?
Instruct the patient to report palpitations, dyspnea, vertigo,
pr chest pain.
Check the apical pulse, blood pressure, and temperature
every 4 hours.
Draw blood for thyroid-stimulating hormone, T3, and T4
levels.
Explain the side effects of propylthiouracil (PTU) to the
patient.
3) Which nursing diagnosis takes highest priority for a client
with hyperthyroidism?
Risk for imbalanced nutrition: More than body requirements
related to thyroid hormone excess
Risk for impaired skin integrity related to edema, skin
fragility, and poor wound healing
Body image disturbance related to weight gain and edema
Imbalanced nutrition: Less than body requirements related to
thyroid hormone excess
4) A 38 year old woman returns from a subtotal
thryroidectomy for the treatment of hyperthyroidism. Upon
assessment, the immediate priority that the nurse would
include is:
Assess for pain
Assess for neurological status
Assess fluid volume status
Assess for respiratory distress
5) Which of the following nursing assessment is the most
important in the patient with hyperthyroidism and risk for
thyrotoxic crisis or thyroid storm?
Intake and output
Heart sounds
Bowel sounds
Vital signs
6) A client with hyperthyroidism is taking lithium carbonate
to inhibit thyroid hormone release. Which complaint by the
client should alert the nurse to a problem with the client’s
medication?
The client complains of blurred vision.
The client complains of increased thirst and increased
urination.
The client complains of increased weight gain over the past
year.
The client complains of ringing in the ears.
7) Untreated hyperthyroidism during pregnancy may result in
all of the following except:
Premature birth and miscarriage
Low birthweight
Autism
Preeclampsia
8) The physician orders laboratory tests to confirm
hyperthyroidism in a female client with classic signs and
symptoms of this disorder. Which test result would confirm
the diagnosis?
No increase in the thyroid-stimulating hormone (TSH) level
after 30 minutes during the TSH stimulation test
A decreased TSH level
An increase in the TSH level after 30 minutes during the TSH
stimulation test
Below-normal levels of serum triiodothyronine (T3) and
serum thyroxine (T4) as detected by radioimmunoassay
9) A client is being returned after subtotal thyroidectomy.
Which piece of equipment is most important for the nurse to
keep at the client’s bedside?
Orange juice and hard candy
Tracheostomy set
Cardiac monitor and oxygen tank
Indwelling catheter tray
10) Which medication will the nurse have available for
emergency treatment of tetany in the client who has had
thyroidectomy?
Calcium chloride
Potassium chloride
Magnesium chloride
Sodium bicarbonate
11) Matilda, with hyperthyroidism is to receive Lugol’s iodine
solution before a subtotal thyroidectomy is performed. The
nurse is aware that this medication is given to:
Decrease the total basal metabolic rate.
Maintain the function of the parathyroid glands.
Block the formation of thyroxine by the thyroid gland.
Decrease the size and vascularity of the thyroid gland.
12) Which nursing diagnosis takes highest priority for a
female client with hyperthyroidism?
Risk for imbalanced nutrition: More than body requirements
related to thyroid hormone excess
Risk for impaired skin integrity related to edema, skin
fragility, and poor wound healing
Body image disturbance related to weight gain and edema
Imbalanced nutrition: Less than body requirements related to
thyroid hormone excess
13) Ms.Clark has hyperthyroidism and is scheduled for a
thyroidectomy. The physician has ordered Lugol’s solution for
the client. The nurse understands that the primary reason for
giving Lugol’s solution preoperatively is to:
decrease the risk of agranulocytosis postoperatively.
prevent tetany while the client is under general anesthesia.
reduce the size and vascularity of the thyroid and prevent
hemorrhage.
potentiate the effect of the other preoperative medication so
less medicine can be given while the client is under
anesthesia.
14) What are the functions of T3 and T4?
Retention of salt and water
Maintenance of blood sugar
Maintenance of blood pressure
Regulation of energy production
15) A patient is admitted to the medical unit with possible
Graves’ disease (hyperthyroidism). Which assessment finding
supports this diagnosis?
Periorbital edema
Bradycardia
Exophthalmos
Hoarse voice
Answers and Rationales
1. A. Increased and rapid heart rate . The cardiac
problems associated with hyperthyroidism include
tachycardia, increased systolic blood pressure, and
decreased diastolic blood pressure. Patients with
hyperthyroidism also may have increased body
temperature related to increased metabolic rate.
Focus: Delegation/supervision
2. B. Check the apical pulse, blood pressure, and
temperature every 4 hours. Monitoring and recording
vital signs are within the education scope of nursing
assistants. An experienced nursing assistant should
have been taught how to monitor the apical pulse.
However, the nurse should observe the nursing
assistant to be sure that she has mastered this skill.
Instructing and teaching patients, as well as
performing venipuncture for laboratory samples, are
more suited to the educational scope of licensed
nurses. In some facilities, an experienced nursing
assistant may perform venipuncture, but only after
special training. Focus: Delegation/supervision
3. D. Imbalanced nutrition: Less than body requirements
related to thyroid hormone excess . 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.
4. D. Assess for respiratory distress . Though fluid volume
status, neurological status and pain are all important
assessment, the immediate priority for postoperative
is the airway management. Respiratory distress may
result from hemorrhage, edema, laryngeal damage or
tetany.
5. D. Vital signs
6. B. The client complains of increased thirst and
increased urination. Increased thirst and increased
urination are signs of lithium toxicity.
7. C. Autism . In addition to the above-mentioned
complications of uncontrolled hyperthyroidism in
pregnancy, expectant mothers may suffer congestive
heart failure and thyroid storm, which is life-
threatening thyrotoxicosis with symptoms that include
agitation, confusion, tachycardia, shaking, sweating,
diarrhea, fever, and restlessness.
8. A. No increase in the thyroid-stimulating hormone
(TSH) level after 30 minutes during the TSH stimulation
test . In the TSH test, failure of the TSH level to rise
after 30 minutes confirms hyperthyroidism. A
decreased TSH level indicates a pituitary deficiency of
this hormone. Below-normal levels of T3 and T4, as
detected by radioimmunoassay, signal
hypothyroidism. A below-normal T4 level also occurs
in malnutrition and liver disease and may result from
administration of phenytoin and certain other drugs.
9. B. Tracheostomy set . After subtotal thyroidectomy,
swelling of the surgical site ( the tracheal area) may
obstruct the airway. Therefore tracheostomy set
should be at the bedside in case of respiratory
emergency.
10. B. Potassium chloride
11. D. Decrease the size and vascularity of the thyroid
gland. Lugol’s solution provides iodine, which aids in
decreasing the vascularity of the thyroid gland, which
limits the risk of hemorrhage when surgery is
performed.
12. D. Imbalanced nutrition: Less than body requirements
related to thyroid hormone excess . 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.
13. C. reduce the size and vascularity of the thyroid and
prevent hemorrhage. Doses of over 30 mg/day may
increase the risk of agranulocytosis. Lugol’s solution
does not act to prevent tetany. Calcium is used to treat
tetany. The client may receive iodine solution (Lugol’s
solution) for 10 to 14 days before surgery to decrease
vascularity of the thyroid and thus prevent excess
bleeding. Lugol’s solution does not potentiate any
other preoperative medication.
14. D. Regulation of energy production
15. C. Exophthalmos . Exophthalmos (abnormal protrusion
of the eye) is characteristic of patients with
hyperthyroidism due to Graves’ disease. Periorbital
edema, bradycardia, and hoarse voice are all
characteristics of patients with hypothyroidism. Focus:
Prioritization
Hypothyroidism 30 items
1) A 32-year-old mother of three is brought to the clinic. Her
pulse is 52, there is a weight gain of 30 pounds in 4 months,
and the client is wearing two sweaters. The client is
diagnosed with hypothyroidism. Which of the following
nursing diagnoses is of highest priority?
Impaired physical mobility related to decreased endurance
Hypothermia r/t decreased metabolic rate
Disturbed thought processes r/t interstitial edema
Decreased cardiac output r/t bradycardia
2) Despite the availability of a wide array of thyroid hormone
products, it is clear that ___________ is the treatment of
choice for almost all patients with hypothyroidism.
Liothyronine (Cytomel)
Liotrix (Thryolar)
Synthetic levothyroxine (LT4)
Desiccared Thyroid (Armour, etc)
None of the above
3) High TSH but low FT4 suggests…Hint: TSH and FT4 levels
going in opposite directions is usually what we expect to see,
generally indicating a problem on the level of the thyroid.
Primary hyperthyroidism
Primary hypothyroidism
Pituitary hyperthyroidism
Pituitary hypothyroidism
Hypothalamus hypothyroidism
4) A radioactive iodide uptake test helps determine intrinsic
thyroid function. A thyroid scan can help distinguish etiology
(such as cancer). A TRH stimulation test helps determine
thyroid and ________ function.
liver
pituitary
intestinal
none of the above
5) A nurse gets back results on a pt who may have
hyperthyroidism. What lab values might the nurse expect?
decreased T3 and Increased T4
Decreased TSH and Increased T3 and T4
Increased TSH and decreased T3 and T4
Increased T3 and Decreased T4
6) The physician has discussed the need for medication with
the parents of an infant with congenital hypothyroidism. The
nurse can reinforce the physician’s teaching by telling the
parents that:
The medication will be needed only during times of rapid
growth.
The medication will be needed throughout the child’s
lifetime.
The medication schedule can be arranged to allow for drug
holidays.
The medication is given one time daily every other day.
7) A client has been newly diagnosed with hypothyroidism
and will take levothyroxine (Synthroid) 50 mcg/day by
mouth. As part of the teaching plan, the nurse emphasizes
that this medication:
Should be taken in the morning
May decrease the client’s energy level
Must be stored in a dark container
Will decrease the client’s heart rate
8) Iodine’s main function in therapy is to:
Rapidly inhibits the synthesis/release of T3 & T4
Blocks conversion of T4 to T3
Damages or destroys thyroid tissue
Decreases HR, BP, CO2, and O2 requirements
9) A nurse gets back results on a pt who may have
hypothyroidism. What lab values might the nurse expect?
decreased T3 and Increased T4
increased TSH and Increased T3 and T4
Increased TSH and decreased T3 and T4
Increased T3 and Decreased T4
10) On discharge, the nurse teaches the patient to observe
for signs of surgically induced hypothyroidism. The nurse
would know that the patient understands the teaching when
she states she should notify the MD if she develops:
Intolerance to heat
Dry skin and fatigue
Progressive weight gain
Insomnia and excitability
11) Which of the following potentially serious complications
could occur with therapy for hypothyroidism?
Acute hemolytic reaction.
Angina or cardiac arrhythmia.
Retinopathy.
Thrombocytopenia.
12) Some causes of hypothyroidism include iatrogenic causes,
drugs (such as amiodarone and lithium), and this (also known
as autoimmune thyroiditis)….
 Damages or destroys thyroid tissue
Grave’s Decreases HR, BP, CO2, and O2 requirements
Hashimoto’s 21) Michael comes into the ED. His HR is 150 and has a fever
Silent thyroiditis of 104.5. He is confused and anxious. What could be
Hypothalamic disease Michael’s problem?
Pituitary disease
13) A client with hypothyroidism asks the nurse if she will still Thyroid infection.
need to take thyroid medication during the pregnancy. The Thyroid Fire
nurse’s response is based on the knowledge that: Thyroid Storm
Thyroid Shut Down.
There is no need to take thyroid medication because the 22) After undergoing a subtotal thyroidectomy, a female
fetus’s thyroid produces a thyroid-stimulating hormone. client develops hypothyroidism. Dr. Smith prescribes
Regulation of thyroid medication is more difficult because the levothyroxine (Levothroid), 25 mcg P.O. daily. For which
thyroid gland increases in size during pregnancy. condition is levothyroxine the preferred agent?
It is more difficult to maintain thyroid regulation during
pregnancy due to a slowing of metabolism. Primary hypothyroidism
Fetal growth is arrested if thyroid medication is continued Graves’ disease
during pregnancy. Thyrotoxicosis
14) A nurse understands calcitonin and parathormone when Euthyroidism
the nurse states: 23) A client is admitted with a diagnosis of hypothyroidism.
An initial assessment of the client would reveal:
They work separately on calcium balance.
They work together for blood clotting. Slow pulse rate, weight loss, diarrhea, and cardiac failure
They work together on bone growth. Weight gain, lethargy, slowed speech, and decreased
Calcitonin works on cellular function while parathormone respiratory rate
works on neuromuscular function. Rapid pulse, constipation, and bulging eyes
15) Mrs. Gilmour is complaining of being hot all the time, Decreased body temperature, weight loss, and increased
sweating, being thirsty, and losing hair. What could her respirations
symptoms indicate? 24) A 58 year old woman has newly diagnosed with
hypothyroidism. The nurse is aware that the signs and
Hypothyroidsim symptoms of hypothyroidism include:
Hyperthyroidism
Graves disease Diarrhea
16) Thyrotoxicosis is understood when the nurse states: Vomiting
Tachycardia
Hypermetabolism from decrease in T3 and T4. Weight gain
Hypometabolism from decrease in T3 and T4. 25) A pt is given radioactive iodine for a thyroid scan. How
Hypermetabolism from increase in T3 and T4. often are the tests taken?
Hypometabolism from increase in T3 and T4.
17) T3 and T4 are produced in which type of cell? one hour after ingestion
4-8-24 hours
Follicle 2-4-24 hours
Squamous 2-6-24 hours
Epithelial 26) T3 and T4 are similar, but different produced in equal
Glandular amounts?
18) A newborn has been diagnosed with hypothyroidism. In
discussing the condition and treatment with the family, the True
nurse should emphasize False
27) A client with hypothyroidism frequently complains of
They can expect the child will be mentally retarded feeling cold. The nurse should tell the client that she will be
Administration of thyroid hormone will prevent problems more comfortable if she:
This rare problem is always hereditary
Physical growth/development will be delayed Uses an electric blanket at night
19) What does tyrosine combine with to make T3 and T4? Dresses in extra layers of clothing
Applies a heating pad to her feet
Serum K Takes a hot bath morning and evening
Serum Na 28) A female client with hypothyroidism (myxedema) is
Serum Iodine receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which
Serum Phosphoruse finding should nurse Hans recognize as an adverse drug
20) Radioactive Iodine’s main function in therapy is to: effect?

Rapidly inhibits the synthesis/release of T3 & T4 Dysuria

Blocks conversion of T4 to T3 Leg cramps
Tachycardia
Blurred vision
29) Nurse Oliver should expect a client with hypothyroidism
to report which health concerns?
Increased appetite and weight loss
Puffiness of the face and hands
Nervousness and tremors
Thyroid gland swelling
30) An incoherent female 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, nurse Libby prepares to take
emergency action to prevent the potential complication of:
Thyroid storm.
Cretinism.
myxedema coma.
Hashimoto’s thyroiditis.
31) A 3-month-old client is in the pediatric unit. During
assessment, the nurse is suspecting that the baby may have
hypothyroidism when mother states that her baby does not:
Sit up.
Pick up and hold a rattle.
Roll over.
Hold the head up.
Answers and Rationales
1. D. Decreased cardiac output r/t bradycardia . The
decrease in pulse can affect the cardiac output and
lead to shock, which would take precedence over the
other choices
2. C. Synthetic levothyroxine (LT4)
3. B. Primary hypothyroidism
4. B. pituitary
5. B. Decreased TSH and Increased T3 and T4
6. B. The medication will be needed throughout the
child’s lifetime. The medication will be needed
throughout the child’s lifetime. Answers A, C, and D
contain inaccurate statements; therefore, they are
incorrect.
7. A. Should be taken in the morning . Should be taken in
the morning Thyroid supplement should be taken in
the morning to minimize the side effects of insomnia
8. A. Rapidly inhibits the synthesis/release of T3 & T4
9. C. Increased TSH and decreased T3 and T4
10. C. Progressive weight gain . Hypothyroidism, a
decrease in thyroid hormone production, is
characterized by hypometabolism that manifests itself
with weight gain
11. B. Angina or cardiac arrhythmia. Precipitation of
angina or cardiac arrhythmia is a potentially serious
complication of hypothyroidism treatment. Acute
hemolytic reaction is a complication of blood
transfusions. Retinopathy typically is a complication of
diabetes mellitus. Thrombocytopenia doesn’t result
from treating hypothyroidism.
12. B. Hashimoto’s
13. B. Regulation of thyroid medication is more difficult
because the thyroid gland increases in size during
pregnancy. During pregnancy, the thyroid gland triples
in size. This makes it more difficult to regulate thyroid
medication.
14. B. They work together for blood clotting. , C. They work
together on bone growth.
15. B. Hyperthyroidism
16. C. Hypermetabolism from increase in T3 and T4.
17. A. Follicle
18. B. Administration of thyroid hormone will prevent
problems . Early identification and continued
treatment with hormone replacement corrects this
condition.
19. C. Serum Iodine
20. C. Damages or destroys thyroid tissue
21. C. Thyroid Storm
22. A. Primary hypothyroidism. Levothyroxine is the
preferred agent to treat primary hypothyroidism and
cretinism, although it also may be used to treat
secondary hypothyroidism. It is contraindicated in
Graves’ disease and thyrotoxicosis because these
conditions are forms of hyperthyroidism.
Euthyroidism, a term used to describe normal thyroid
function, wouldn’t require any thyroid preparation.
23. B. Weight gain, lethargy, slowed speech, and
decreased respiratory rate . Symptoms of
hypothyroidism include weight gain, lethargy, slow
speech, and decreased respirations.
24. D. Weight gain . Typical signs of hypothyroidism
includes weight gain, fatigue, decreased energy,
apathy, brittle nails, dry skin, cold intolerance,
constipation and numbness.
25. D. 2-6-24 hours
26. B. False. T3 and T4 are similar, but they are produced
in different amounts.
27. B. Dresses in extra layers of clothing. Dressing in layers
and using extra covering will help decrease the feeling
of being cold that is experienced by the client with
hypothyroidism. Decreased sensation and decreased
alertness are common in the client with
hypothyroidism; therefore, the use of electric blankets
and heating pads can result in burns,
28. C. Tachycardia . Levothyroxine, a synthetic thyroid
hormone, is given to a client with hypothyroidism to
simulate the effects of thyroxine. Adverse effects of
this agent include tachycardia. The other options
aren’t associated with levothyroxine.
29. B. Puffiness of the face and hands . Hypothyroidism
(myxedema) causes facial puffiness, extremity edema,
and weight gain. Signs and symptoms of
hyperthyroidism (Graves’ disease) include an increased
appetite, weight loss, nervousness, tremors, and
thyroid gland enlargement (goiter).
30. C. myxedema coma. 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.
31. D. Hold the head up. Development normally proceeds
cephalocaudally; so the first major developmental
milestone that the infant achieves is the ability to hold
the head up within the first 8-12 weeks of life. In
hypothyroidism, the infant’s muscle tone would be
poor and the infant would not be able to achieve this
milestone.