EVALUATIVE EXAM – ENDOCRINE SYSTEM

1. The nurse is caring for a client with type 1 diabetes mellitus who exhibits confusion,
light-headedness, and aberrant behavior. The client is still conscious. The nurse should first
administer:

a. 15 to 20 g of a fast-acting carbohydrate such as orange juice.

b. I.V. bolus of dextrose 50%.
c. I.M. or subcutaneous glucagon.
d. 10 U of fast-acting insulin.

SITUATION
Neil a fruit stand owner at Ayala Mall was diagnosed with congenital diabetes and was admitted to
the hospital of Granada for sudden loss of consciousness. He is ready for discharge after the
treatment and asks the nurse about his condition. The following questions refer to this situation:

2. For a client with hyperglycemia, which assessment finding best supports a nursing
diagnosis of Deficient fluid volume?

a. Hypertension
b. Hypotension
c. Bounding pulses
d. Distended neck veins

3. As a nurse you are teaching Neil to be aware of the possible signs of his condition.
Which of the following are considered signs of diabetes mellitus type 1 except?

a. Polyuria
b. Hypokalemia
c. Hot and dry skin
d. Weight gain

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

a. Give snacks prior to exercise to prevent hyperglycemia

b. Insulin injection after meals
c. Limit smoking
d. Maintain a well-balanced diet
5. Neil has a prescription for 5 U of U-100 regular insulin and 25 U of U-100 isophane
insulin suspension (NPH) to be taken before breakfast. Which of the following is true in
mixing 2 types of insulin?

a. Inject air first to Regular

b. Withdraw regular insulin the inject air to NPH
c. Need to inject twice daily in split mix
d. Withdraw regular insulin followed by intermediate insulin

6. On his next visit Neil has a highly elevated glycosylated hemoglobin (Hb) test result. In
discussing the result with Neil, the nurse would be most accurate in stating:

a. "The test needs to be repeated following a 12-hour fast."

b. "It tells us about your sugar control for the last 3 months."
c. "The higher the result of the test the better."
d. "This test is better than FBS to diagnose Diabetes."

7. Neil is asking the nurse how to self-administer insulin. The physician has prescribed 10
U of U-100 regular insulin. When teaching Neil how to manage his insulin maintenance, the
nurse should provide which instruction?

a. "Inject insulin into healthy tissue with large blood vessels and nerves."
b. "Rotate injection sites within the same anatomic region, not among different regions."
c. "Administer insulin into areas of scar tissue or hypotrophy whenever possible."
d. "Administer insulin into sites above muscles that you plan to exercise heavily later that day."

8. Agitated and confused Neil arrives in the emergency department. The client's history
includes type 1 diabetes mellitus, hypotension, and angina pectoris. Assessment reveals
acetone breath, metabolic acidosis and with a rapid and deep breathing. A stat blood
glucose sample measures 640 mg/dl, and the Neil is treated for diabetic ketoacidosis.
Which of the following should the medical team administer first? Arrange according to its
priority:

1. 0.9% NaCl to prevent hypovolemic shock

2. Insulin to correct the hyperglycemia

3. Oxygen to prevent coma

4. Pottasium to prevent arrhythmias

a. 3,2,1,4
b. 3,1,4,2
c. 3,1,2,4
d. 3,2,4,1

9. Ging Ging the wife of Neil finds him unconscious at home and administers glucagon, 0.5
mg S.C. Neil awakens in 5 minutes. Which of the following manifestation/s is/are consistent
with hypoglycemia?

a. The earliest sign of hypoglycemia is tremors

b. Cool and clammy skin is assessed to clients with hypoglycemia
c. It’s best to administer insulin to unconscious client with hypoglycemia
d. Hypoglycemia is less life-threatening than DKA

10. A client who was diagnosed with type 1 diabetes mellitus 14 years ago is admitted to
the medical-surgical unit with abdominal pain. On admission, the client's blood glucose
level is 470 mg/dl. Which finding is most likely to accompany this blood glucose level?

a. Cool, moist skin

b. Arm and leg trembling
c. Rapid, thready pulse
d. Slow, shallow respirations

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

a. use commercial preparations to remove corns

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

12. A client is diagnosed with diabetes mellitus. Which assessment finding best supports a
nursing diagnosis of Ineffective individual coping related to diabetes mellitus?

a. Recent weight gain of 20 lb

b. Failure to monitor blood glucose levels
c. Skipping insulin doses during illness
d. Crying whenever diabetes is mentioned
13. An obese Hispanic client, age 65, is diagnosed with type 2 diabetes mellitus. Which
statement about diabetes mellitus is true?

a. Nearly two-thirds of clients with diabetes mellitus are over age 60

b. Diabetes mellitus is three times more common in Hispanics than in Blacks or Whites.
c. Type 2 diabetes mellitus is less common than type 1 diabetes mellitus
d. Approximately one-half of the clients diagnosed with type 2 are obese

14. A client has type 1 diabetes. Her husband finds her unconscious at home and
administers glucagon, 0.5 mg S.C. She awakens in 5 minutes. Why should her husband offer
a complex carbohydrate snack to her as soon as possible?

a. To decrease the possibility of nausea and vomiting

b. To restore liver glycogen and prevent secondary hypoglycemia
c. To stimulate her appetite
d. To decrease the amount of glycogen in her system

15. The nurse is teaching a client with type 1 diabetes mellitus how to treat adverse
reactions to insulin. To reverse a hypoglycemic reaction, the client ideally should ingest an
oral carbohydrate. However, this treatment isn't always possible or safe. Therefore, the
nurse should advise the client to keep which alternate treatment on hand?

a. epinephrine
b. glucagon
c. 50% dextrose
d. hydrocortisone

16. A client with a serum glucose level of 618 mg/dl is admitted to the facility. He's awake
and oriented, has hot dry skin, and has the following vital signs: temperature of 100.6° F
(38.1° C), heart rate of 116 beats/minute, and blood pressure of 108/70 mm Hg. Based on
these assessment findings, which nursing diagnosis takes the highest priority?

a. Deficient fluid volume related to osmotic diuresis

b. Decreased cardiac output related to elevated heart rate
c. Imbalanced nutrition: Less than body requirements related to insulin deficiency
d. Ineffective thermoregulation related to dehydration
17. A client with newly diagnosed type 2 diabetes mellitus is admitted to the metabolic
unit. The primary goal for this admission is education. Which of the following goals should
the nurse incorporate into her teaching plan?

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

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

18. The physician prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a 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?

a. "Be sure to take glipizide 30 minutes before meals"

b. "Glipizide may cause a low serum sodium level, so make sure you have your sodium level
checked monthly"
c. "You won't need to check your blood glucose level after you start taking glipizide"
d. "Take glipizide after a meal to prevent heartburn"

19. The nurse is caring for a client with type 1 diabetes mellitus who exhibits confusion,
light-headedness, and aberrant behavior. The client is still conscious. The nurse should first
administer:

a. I.M. or subcutaneous glucagon.

b. I.V. bolus of dextrose 50%.
c. 15 to 20 g of a fast-acting carbohydrate such as orange juice.
d. 10 U of fast-acting insulin.

20. An agitated, confused client arrives in the emergency department. The client's 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, the
nurse teaches the client to treat hypoglycemia by ingesting:

a. 2 to 5 g of a simple carbohydrate.
b. 10 to 15 g of a simple carbohydrate.
c. 18 to 20 g of a simple carbohydrate.
d. 25 to 30 g of a simple carbohydrate.
21. The nurse is teaching the client about risk factors for diabetes mellitus. Which of the
following risk factors for diabetes mellitus is nonmodifiable?

a. Poor control of blood glucose levels

b. Inappropriate foot care
c. Current or recent foot trauma
d. Advanced age

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

a. prefers to take insulin orally

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

23. For a client with hyperglycemia, which assessment finding best supports a nursing
diagnosis of Deficient fluid volume?

a. Cool, clammy skin

b. Increased urine osmolarity
c. Distended neck veins
d. Decreased serum sodium level

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

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

25. A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs
and symptoms?

a. Coma, anxiety, confusion, headache, and cool, moist skin.

b. Kussmaul's respirations, dry skin, hypotension, and bradycardia.
c. Polyuria, polydipsia, hypotension, and hypernatremia.
d. Polyuria, polydipsia, polyphagia, and weight loss.
26. The nurse is caring for a client who's hypoglycemic. This client will have a blood
glucose level:

a. below 70 mg/dl
b. between 120 and 180 mg/dl
c. between 70 and 120 mg/dl
d. over 180 mg/dl
SITUATION
Erome a 32-year-old butcher with a history of Addison's disease manifested nausea and vomiting
over the past week is brought to the facility. When he awoke this morning, his wife noticed that he
acted confused and was extremely weak. The following questions refer to this situation:

27. Erome asks the nurse what is Addison’s disease all about. The nurse best explains it
by stating that Addison’s disease is an adrenal insufficiency of steroids cortex with the
following manifestation except?

a. Hypertension
b. Bronze-colored skin
c. Hyperkalemia
d. Risk for infection

28. The nursing care for the client in an Addisonian crisis should include which of the
following interventions?

a. Encouraging independence with activities of daily living

b. Allowing ambulation as tolerated
c. Offering extra blankets and raising the heat in the room to keep the client warm
d. Administration of IV hydrocortisone

SITUATION
Linda a 65-year-old widow was rushed to the emergency for severe headache and hypertension.
The endocrinologist diagnosed Linda with Cushing’s disease. The following questions refer to this
situation:

29. Which of the following is the primary cause of hyperaldosteronism?

a. Excessive sodium intake

b. A pituitary adenoma
c. Deficient potassium intake
d. An adrenal tumor
30. Which of the following manifestations should the nurse expect in a client with
Cushing’s disease just like with Linda except?

a. buffalo hump
b. moon face
c. truncal obesity
d. weight gain of the extremities

31. Linda asks the nurse what food she should eat to prevent complications brought by
her disease. The nurse would be correct in suggesting that Linda should consume the
following except:

a. apple and avoid potato chips

b. eggplant and avoid salted fish paste
c. grapes and avoid dried fish
d. canned goods and avoid raw foods

32. Linda is scheduled for a surgical incision of the tumor that causes her overproduction
of steroids. The nurse should that the surgical procedure that should be done to Linda
could be:

a. Frontal boring hypophysectomy

b. hypophysectomy
c. Adrenalectomy
d. Transsphenoidal hypophysectomy

33. To prevent complications post-op the nurse should position Linda to:

a. Semi fowler’s
b. High fowler’s
c. flat in bed
d. Supine

34. The nurse should closely observe for common complications after the surgical incision
of the tumor except:

a. increase intracranial pressure

b. diabetes insipidus
c. tracheal compression
d. rhinorrhea
SITUATION
Lando a 44 male teacher, was admitted to Hospital ng Dumangas with anxiety, insomnia, weight
loss, the inability to concentrate, and eyes feeling "gritty". Thyroid function tests reveal the
following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20 g/dl, and triiodothyronine
253 ng/dl. A 6-hr radioactive iodine uptake test showed a diffuse uptake of 85%. Based on these
assessment findings, the nurse would suspect that Lando’s case could be hyperthyroidism. The
following questions refer to this situation:

35. Autoimmune type of hyperthyroidism is also known as:

a. Thyroiditis
b. Hashimoto's thyroiditis
c. Graves' disease
d. Multinodular goiter

36. The nurse explains to Lando with thyroid disease that the thyroid gland normally
produces except?

a. Tri-iodothyronine
b. Thyroid releasing hormone
c. Calcitonin
d. Thyroxine

37. Hyperthyroidism is caused by increased levels of thyroid hormones in blood plasma

which causes:

a. Increase oxygenation of cells and organs

b. Increase hydration of cells and organs
c. Decrease oxygenation of cells and organs
d. Decrease hydration of cells and organs

38. In assessing the condition of the thyroid gland, which of the following is not included?

a. Inspection
b. Percussion
c. Auscultation
d. Palpation
39. The nurse is assessing Lando. What findings should the nurse expect? SATA:

a. Weight gain

b. Constipation

c. Lethargy

d. Diarrhea

e. Fine tremors

f. Irritability

g. Heat intolerance

h. Hypertension

i. Exophthalmos

j. Cold intolerance

k. tachycardia

a. ABCD
b. GHIJ
c. ALL OF THE ABOVE
d. DEFGHIK

40. Based on history and physical findings, examination of Lando reveals exophthalmos, a
classic sign of Graves' disease. To prevent complications caused by exophthalmos the nurse
is aware that:

A. Patching both eyes during day time is necessary to protect them from UV rays
B. Sunglasses should be worn with day time activities
C. Applying topical steroids to prevent inflammation
D. Providing day time naps will help lessen eye irritation and itching
41. When caring for Lando who's being treated for hyperthyroidism, it's important to:

a. provide extra blankets and clothing to keep the client warm

b. monitor signs of restlessness, and excessive weight loss during thyroid replacement therapy
c. balance the client's periods of activity and rest
d. encourage the client to be active to prevent constipation

42. For a client with Hyperthyroidism, which nursing intervention promotes comfort?

a. Restricting intake of oral fluids and encouraging a caloric diet for weight loss
b. Placing extra blankets on the client's bed to provide comfort
c. Limiting intake of high-carbohydrate foods and increase fluid intake
d. Maintaining room temperature in the low-normal range

43. For a client with hyperthyroidism, treatment is most likely to include:

a. thyroid hormone antagonist

b. synthetic thyroid hormone
c. thyroid extract
d. emollient lotions

44. The endocrinologist prescribed PTU for Lando as part of his medical treatment. The
nurse understands that PTU’s mechanism of action is:

a. to decrease the vascularity of the thyroid gland

b. to promote euthyroidism
c. to prevent thyroid enlargement
d. to bind with TSH

45. If Lando’s blood pressure and heart rate rise continuously the nurse understands that
it may cause a fatal complication which is:

a. Seizures
b. Bleeding
c. increase ICP
d. Stroke
 46. To prevent complications caused by hypertension and tachycardia, the nurse expects
that the attending physician of Lando will prescribe:

a. Ace Inhibitors
b. Beta-adrenergic blocker
c. Calcium channel blocker
d. Diuretics

47. Saturated solution of potassium iodides was given to Lando, which of the following is
true about SSKI?

A. It should be given with meals to prevent stomach upset

B. Expect to notice its clinical response within 7-10 days
C. it will normalize the function of the thyroid gland
D. this medication will lessen goiter and possible bleeding

48. Lando is scheduled for thyroidectomy, the doctor explained to Lando that
thyroidectomy is to remove the tumor and:

a. It could partial or total removal of the thyroid gland

b. Only a part of the thyroid gland is removed
c. It includes removal of the para-thyroid gland
d. Thyroid gland and laryngeal nerves are removed

49. After thyroidectomy the nurse assigned to Lando, should position him to:

a. High fowlers
b. Semi fowler
c. Flat in bed
d. Prone position

50. Which of the following is not allowed after thyroidectomy?

a. Swallowing
b. Reading
c. hyperextending the neck
d. going to the bathroom