Endocrine System

Disorders NCLEX
Challenge Exam (Quiz
#1: 25 Questions)
UPDATED ON OCTOBER 17, 2023
BY MATT VERA BSN, R.N.

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1 point(s)
1. Question
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, 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.

Incorrect
Correct Answer: 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. Patients
should be advised to wear a medical
alert bracelet and to carry a glucose
source like gel, candy, or tablets on
their person in case symptoms arise.
Option A: Ingesting only 2 to 5
g of a simple carbohydrate may
not raise the blood glucose level
sufficiently. Glucose is the
primary metabolic fuel for the
brain under physiologic
conditions. Unlike other tissues
of the body, the brain is very
limited in supplying its glucose.
Expectedly, the brain requires a
steady supply of arterial glucose
for adequate metabolic function.
Option C: Ingesting more than
15 g may raise it above normal,
causing hyperglycemia. For
conscious patients able to take
oral (PO) medications, readily
absorbable carbohydrate
sources (such as fruit juice)
should be given. For patients
unable to take oral agents, a 1-
mg intramuscular (IM) injection
of glucagon can be
administered.
Option D: Once the patient is
more awake, a complex
carbohydrate food source
should be given to the patient to
achieve sustained euglycemia.
More frequent blood glucose
monitoring should occur to rule
out further drops in blood sugar.

1 point(s)
2. Question
A female adult client with a history of chronic
hyperparathyroidism admits to being non-
compliant. Based on initial assessment
findings, the nurse 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?

A. Related to bone demineralization

resulting in pathologic fractures.

B. Related to exhaustion secondary

to an accelerated metabolic rate.

C. Related to edema and dry skin

secondary to fluid infiltration into the
interstitial spaces.

D. Related to tetany secondary to a

decreased serum calcium level.

Incorrect
Correct Answer: A. Related to bone
demineralization resulting in
pathologic fractures.
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 risk
for injury. Primary hyperparathyroidism
preferentially reduces cortical bone
density and increases fracture risk at
sites where cortical bone
predominates, such as the distal
forearm, with relative sparing of
trabecular bone. For this reason, those
with hyperparathyroidism should have
a dual-energy x-ray absorptiometry
that includes the distal third radius, a
site composed almost exclusively of
cortical bone, in addition to
measurements at the spine and hip.
Option B: Hyperparathyroidism
doesn’t accelerate the metabolic
rate. The physical examination
of a patient with primary
hyperparathyroidism is usually
normal. However, the physical
examination can be helpful in
finding abnormalities that could
suggest other etiologies of
hypercalcemia.
Option C: 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.
Patients with primary
hyperparathyroidism and other
causes of PTH-dependent
hypercalcemia often have
frankly elevated levels of PTH,
while some will have values that
fall within the reference range
for the general population. A
normal PTH in the presence of
hypercalcemia is considered
inappropriate and still consistent
with PTH-dependent
hypercalcemia.
Option D: Hyperparathyroidism
causes hypercalcemia, not
hypocalcemia; therefore, it isn’t
associated with tetany.
Parathyroid hormone activates
the parathyroid hormone
receptor increasing resorption of
calcium and phosphorus from
bone, enhancing the distal
tubular resorption of calcium,
and decreasing the renal tubular
reabsorption of phosphorus.

1 point(s)
3. Question
Nurse Joey 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:

A. Encourage the client to ask

questions about personal sexuality.

B. Provide time for privacy.

C. Provide support for the spouse

or significant other.

D. Suggest referral to a sex

counselor or other appropriate
professional.

Correct
Correct Answer: 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.
Erectile Dysfunction (ED) is common in
men with diabetes; these men tend to
present with more severe and
refractory ED compared to non-
diabetic peers. While ED is the best
established diabetes-related sexual
dysfunction, ejaculatory and sexual
desires issues may also occur in men.
Option A: The nurse doesn’t
normally provide sex counseling.
Diabetic neuropathy may impair
autonomic and somatic nerve
processes essential to erections.
Diabetes is also associated with
impaired relaxation of
cavernosal smooth muscle due
to endothelial-derived nitric
oxide, which may be a side
effect of glycosylation products.
Option B: It is recommended
that diabetic men be screened
for the presence of low
testosterone by checking serum
total testosterone; sex hormone
binding globulin and albumin
should also be tested to assess
for free and bioavailable
testosterone.
Option C: As with most aspects
of diabetes care, routine
exercise, careful monitoring of
glucose levels, and usage of
appropriate therapies to prevent
hyperglycemia are key to
preventing progression of
diabetes-induced sexual
problems. Weight management
and dietary prudence are also
critical in the management of
diabetes.

1 point(s)
4. Question
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?

A. At least once a week

B. At least three times a week

C. At least five times a week

D. Every day

Incorrect
Correct Answer: 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.
Option A: Exercising once a
week wouldn’t achieve these
goals. Physical activity includes
all movement that increases
energy use, whereas exercise is
planned, structured physical
activity. Exercise improves blood
glucose control in type 2
diabetes, reduces
cardiovascular risk factors,
contributes to weight loss, and
improves well-being.
Option C: Exercising more than
three times a week, although
beneficial, would exceed the
minimum requirement. Regular
exercise may prevent or delay
type 2 diabetes development.
Regular exercise also has
considerable health benefits for
people with type 1 diabetes
(e.g., improved cardiovascular
fitness, muscle strength, insulin
sensitivity, etc.).
Option D: Daily exercise, or at
least not allowing more than 2
days to elapse between exercise
sessions, is recommended to
enhance insulin action. Adults
with type 2 diabetes should
ideally perform both aerobic and
resistance exercise training for
optimal glycemic and health
outcomes.

1 point(s)
5. Question
Nurse Oliver should expect a client with
hypothyroidism to report which health
concerns?

A. Increased appetite and weight

loss

B. Puffiness of the face and hands

C. Nervousness and tremors

D. Thyroid gland swelling

Incorrect
Correct Answer: 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).
Hypothyroidism results from low levels
of thyroid hormone with varied etiology
and manifestations. Untreated
hypothyroidism increases morbidity
and mortality.
Option A: Inquire about dry
skin, voice changes, hair loss,
constipation, fatigue, muscle
cramps, cold intolerance, sleep
disturbances, menstrual cycle
abnormalities, weight gain, and
galactorrhea. Also obtain a
complete medical, surgical,
medication, and family history.
Option C: It is important to
maintain a high index of
suspicion for hypothyroidism
since the signs and symptoms
can be mild and nonspecific and
different symptoms may be
present in different patients.
Typical features such as cold
intolerance, puffiness,
decreased sweating and skin
changes may not be present
always.
Option D: Autoimmune
thyroiditis causes an increase in
 the turnover of iodine and
impaired organification. Chronic
inflammation of the parenchyma
leads to predominant T-cell
lymphocytic infiltration. If this
persists, the initial lymphocytic
hyperplasia and vacuoles are
replaced by dense fibrosis and
atrophic thyroid follicles.

1 point(s)
6. Question
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 effect?

A. Dysuria

B. Leg cramps

C. Tachycardia

D. Blurred vision

Incorrect
Correct Answer: 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. Generally,
adverse events resulting from incorrect
dosing (excessive dosing) often form a
hyperthyroid-like picture or due to an
allergic reaction to the excipient of the
levothyroxine tablets. The other
options aren’t associated with
levothyroxine.
Option A: Adverse effects
(frequency undefined) include:
angina pectoris, tachycardia,
palpitations, arrhythmias,
myocardial infarction, dyspnea,
anxiety, fatigue, headache, heat
intolerance, insomnia, irritability,
diaphoresis, skin rash, alopecia,
goiter, weight loss, menstrual
irregularities, abdominal cramps,
diarrhea, emesis, reduced
fertility, and decreased bone
mineral density (a result of TSH
suppression).
Option B: In the initial stage of
overdose (6 to 12 hours post-
ingestion), the common signs of
toxicity would be tremulousness,
tachycardia, hypertension,
anxiety, and diarrhea. Rarely,
convulsions, thyroid storm,
acute psychosis, arrhythmias,
and acute myocardial infarction
may occur.
Option D: In adults, monitor
TSH levels approximately 6 to 8
weeks after initiating treatment
with levothyroxine. Upon
achieving the correct dosing of
levothyroxine, monitor TSH
levels 4 to 6 months after, and
then every 12 months after that.

1 point(s)
7. Question
A 67-year-old female client has been
complaining of sleeping more, increased
urination, anorexia, weakness, irritability,
depression, and bone pain that interferes with
her going outdoors. Based on these
assessment findings, the nurse would suspect
which of the following disorders?

A. Diabetes mellitus

B. Diabetes insipidus

C. Hypoparathyroidism

D. Hyperparathyroidism

Incorrect
Correct Answer: 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 hypercalciuria-causing
polyuria. Patients should be asked
about any history of kidney stones,
bone pain, myalgias or muscle
weakness, symptoms of depression,
use of thiazide diuretics, calcium
products, vitamin D supplements, or
other symptoms associated with the
multiple etiologies of hypercalcemia.
While clients with diabetes mellitus and
diabetes insipidus also have polyuria,
they don’t have bone pain and
increased sleeping.
Option A: It often presents
asymptomatically, but when
symptoms develop, patients
usually present with polyuria,
polydipsia, and weight loss. On
physical examination of
someone with hyperglycemia,
one may see poor skin turgor
(from dehydration) and smell a
distinctive fruity odor on their
breath (in patients with ketosis).
Option B: The most common
findings in patients with
diabetes insipidus are
polydipsia, polyuria, and
nocturia. Polyuria is defined as a
urine output of more than 3
L/day in adults or 2 L/m2 in
children. In children, symptoms
can be nonspecific, and they
may present with severe
dehydration, constipation,
vomiting, fevers, irritability,
failure to thrive, and growth
retardation. In patients with
central nervous system (CNS)
tumors, headaches, and visual
defects may present in addition
to the classic symptoms.
Option C: Hypoparathyroidism
is characterized by urinary
frequency rather than polyuria.
Significant hypocalcemia can
cause numbness and
paresthesias, muscle cramps,
and carpopedal spasms. When
severe it can be life-threatening
with laryngospasm, tetany, and
seizures.

1 point(s)
8. Question
When caring for a male client with diabetes
insipidus, nurse Juliet expects to administer:

A. vasopressin (Pitressin
Synthetic).

B. furosemide (Lasix).

C. Regular insulin.

D. 10% dextrose.

Incorrect
Correct Answer: 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. DDAVP, an ADH analog, can
be administered orally, intranasally,
subcutaneously, or intravenously. In
adults, the dose is ten mcg by nasal
insufflation or 4 mcg subcutaneously
or intravenously.
Option B: Furosemide, a
diuretic, is contraindicated
because a client with diabetes
insipidus experiences polyuria.
Other treatment options for
central diabetes insipidus
include a low-solute diet (low
salt, low protein), thiazide
diuretics, chlorpropamide,
carbamazepine, and non-
steroidal anti-inflammatory
drugs (NSAID).
Option C: Insulin is used to treat
diabetes mellitus and its
complications, not diabetes
insipidus. Regular insulin is a
medication used in the
management of Diabetes
Mellitus and hyperglycemia of a
variety of etiologies. It is in the
short-acting insulin class of
drugs. Insulin, regular, which is
short-acting human insulin, is a
synthetic protein hormone,
which, just as the naturally
occurring endogenous insulin,
exerts a wide range of
physiologic effects. Clinical use
of insulin is mainly to its ability to
lower down serum glucose.
Option D: Clinicians should
avoid using crystalloids
containing dextrose (D5%W,
D10%W, D5% 0.45% NS, etc.) in
patients with hyperglycemia.
Crystalloid fluids function to
expand intravascular volume
without disturbing ion
concentration or causing
significant fluid shifts between
intracellular, intravascular, and
interstitial spaces.

1 point(s)
9. Question
The nurse is aware that the following is the
most common cause of hyperaldosteronism?

A. Excessive sodium intake

B. A pituitary adenoma

C. Deficient potassium intake

D. An adrenal adenoma

Correct
Correct Answer: D. An adrenal
adenoma
An autonomous aldosterone-producing
adenoma is the most common cause of
hyperaldosteronism. Hyperplasia is the
second most frequent cause. Excess
production of aldosterone is referred to
as hyperaldosteronism.
Hyperaldosteronism can initially
present as mild or severe to refractory
hypertension but can often go
undiagnosed. Aldosterone secretion is
independent of sodium and potassium
intake as well as of pituitary
stimulation.
Option A: Aldosterone is the
primary mineralocorticoid in the
body. Aldosterone acts on the
epithelial sodium channels
(ENaC) in the collecting tubules
and causes sodium
reabsorption. The increased
reabsorption of sodium leads to
hypertension and volume
expansion. Sodium
reabsorption, volume expansion,
and increased peripheral
vascular resistance are the
causative factors for
hypertension in aldosteronism.
Option B: Primary
hyperaldosteronism is due to the
excess production of the adrenal
gland, more specifically the
zona glomerulosa. It can present
more commonly as a primary
tumor in the gland known as
Conn syndrome or bilateral
adrenal hyperplasia.
Option C: Sodium reabsorption
creates a negative potential in
the tubular lumen and, in turn,
causes movement of cations
(primarily potassium and
hydrogen ions) into the tubular
lumen to maintain electrical
neutrality, resulting in
hypokalemia and metabolic
alkalosis. Symptoms are usually
due to moderate to severe high
blood pressure or secondary to
hypokalemia. High blood
pressure can cause headaches,
dizziness, vision problems,
chest pain, and dyspnea.

1 point(s)
10. Question
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:

A. “The test needs to be repeated

following a 12-hour fast.”

B. “It looks like you aren’t following

the prescribed diabetic diet.”

C. “It tells us about your sugar

control for the last 3 months.”

D. “Your insulin regimen needs to

be altered significantly.”

Incorrect
Correct Answer: 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.
Option A: The hemoglobin A1c
(glycated hemoglobin,
glycosylated hemoglobin,
HbA1c, or A1c) test is used to
evaluate a person’s level of
glucose control. The test shows
an average of the blood sugar
level over the past 90 days and
represents a percentage. The
test can also be used to
diagnose diabetes.
Option B: The venous sample
A1c test may be used as a
diagnostic tool in clinical
practice when determining
diabetes risk or onset. Due to
the variability of capillary point
of care testing, any A1c done by
capillary sample should be
confirmed with a venous sample
before rendering the diagnosis.
Option D: There are several
conditions where the A1c test
can produce inaccurate results.
People diagnosed with sickle
cell anemia, thalassemia,
anemia, kidney failure, liver
disease, or patients receiving
blood transfusions can
experience altered results due to
the longevity of the red blood
cell. A1c tests in these patients
must be interpreted with caution
and should be confirmed with
plasma glucose samples to
diagnose diabetes.

1 point(s)
11. Question
Following a unilateral adrenalectomy, nurse
Betty would assess for hyperkalemia shown by
which of the following?

A. Muscle weakness

B. Tremors

C. Diaphoresis

D. Constipation

Incorrect
Correct Answer: A. Muscle
weakness
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.
Option B: Medications that may
predispose to the development
of hyperkalemia include digoxin,
potassium-sparing diuretics,
non-steroidal anti-inflammatory
drugs, ace-inhibitors, or recent
intravenous (IV) potassium, total
parenteral nutrition, potassium
penicillin, or succinylcholine.
Patients may complain of
weakness, fatigue, palpitations,
or syncope.
Option C: Most patients are
relatively asymptomatic with
mild and even moderate
hyperkalemia. Elevated
potassium is often discovered in
screening labs done in patients
with nonspecific complaints or
those with suspected electrolyte
abnormalities due to infection,
dehydration, or hypoperfusion.
Option D: Physical exam
findings may include
hypertension and edema in the
setting of renal disease. There
may also be signs of
hypoperfusion. Muscle
tenderness may be present in
patients with rhabdomyolysis.
Jaundice may be seen in
patients with hemolytic
conditions. Patients may have
muscle weakness, flaccid
paralysis, or depressed deep
tendon reflexes.

1 point(s)
12. Question
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?

A. Antidiuretic hormone (ADH).

B. Thyroid-stimulating hormone
(TSH).

C. Follicle-stimulating hormone
(FSH).

D. Luteinizing hormone (LH).

Incorrect
Correct Answer: 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. Diabetes insipidus (DI) is a
disease process that results in either
decreased release of antidiuretic
hormone (ADH, also known as
vasopressin or AVP) or decreased
response to ADH, causing electrolyte
imbalances. There are two types of
diabetes insipidus, central and
nephrogenic, and each has congenital
and acquired causes. There is a
passage of large volumes of dilute
urine (less than 300m Osm/kg) in all
cases.
Option B: Hypothyroidism
results from low levels of thyroid
hormone with varied etiology
and manifestations. Untreated
hypothyroidism increases
morbidity and mortality. In the
United States, autoimmune
thyroid disease (Hashimoto
thyroiditis) is the most common
cause of hypothyroidism, but
globally lack of iodine in the diet
is the most common cause.
Option C: A low FSH result is
generally associated with better
ovarian function. Higher levels
are associated with diminished
ovarian reserve, which makes
pregnancy difficult. Most women
have low FSH in their 20s, and
levels increase naturally as
women age.
Option D: Luteinizing hormone
(LH) is a glycoprotein hormone
secreted from the pituitary gland
in response to the pulsatile
release of gonadotropin-
releasing hormone (GnRH) from
the hypothalamus. Many
conditions can cause its
deficiency as a response to
maintain homeostasis and as a
response to hypothalamic-
pituitary-gonadal feedback
regulation.

1 point(s)
13. Question
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?

A. Diabetic ketoacidosis

B. Thyroid crisis
 C. Hypoglycemia

D. Tetany

Incorrect
Correct Answer: B. Thyroid crisis
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.
Presentation of thyroid storm is an
exaggerated manifestation of
hyperthyroidism, with the presence of
an acute precipitating factor. Fever,
cardiovascular involvement (including
tachycardia, heart failure, arrhythmia),
central nervous system (CNS)
manifestations, and gastrointestinal
symptoms are common.
Option A: Diabetic ketoacidosis
is more likely to produce
polyuria, polydipsia, and
polyphagia. The patient with
diabetic ketoacidosis may
present with a myriad of
symptoms and physical exam
findings. Patients may have
symptoms of hyperglycemia like
polyphagia, polyuria, or
polydipsia. As patients become
more volume-depleted, they
may experience decreased urine
output, dry mouth, or decreased
sweating indicative of
dehydration. They may complain
of many other symptoms,
including anorexia, nausea,
vomiting, abdominal pain, and
weight loss.
Option C: Hypoglycemia
produces weakness, tremors,
profuse perspiration, and
hunger. Neurogenic signs and
symptoms can either be
adrenergic (tremor, palpitations,
anxiety) or cholinergic (hunger,
diaphoresis, paresthesias).
Neurogenic symptoms and signs
arise from sympathoadrenal
involvement (either
norepinephrine or acetylcholine
release) in response to
perceived hypoglycemia.
Option D: Tetany typically
causes uncontrollable muscle
spasms, stridor, cyanosis, and
possibly asphyxia. Generally
induced by a rapid decline in
serum ionized calcium; tetany is
usually most dangerous and
most commonly seen in the
presence of respiratory alkalosis
causing hypocalcemia.

1 point(s)
14. Question
For a male client with hyperglycemia, which
assessment finding best supports a nursing
diagnosis of Deficient Fluid Volume?

A. Cool, clammy skin

B. Distended neck veins

C. Increased urine osmolarity

D. Decreased serum sodium level

Incorrect
Correct Answer: C. Increased urine
osmolarity
In hyperglycemia, urine osmolarity (the
measurement of dissolved particles in
the urine) increases as glucose
particles move into the urine. The client
experiences glycosuria 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.
Option A: The physical
examination can reveal signs of
hypovolemia like hypotension,
tachycardia, and dry mucous
membranes. When evaluating a
patient for hyperglycemia, the
focus should be on the patient’s
cardiorespiratory status, mental
status, and volume status.
Option B: Patients with diabetic
ketoacidosis may present with
nausea, vomiting, and
abdominal pain in addition to the
above symptoms. They also may
have a fruity odor to their breath
and have rapid shallow
respirations, reflecting
compensatory hyperventilation
for the acidosis.
Option D: Symptoms of severe
hyperglycemia include polyuria,
polydipsia, and weight loss. As
the patient’s blood glucose
increases, neurologic symptoms
can develop. The patient may
experience lethargy, focal
neurologic deficits, or altered
mental status. The patient can
progress to a comatose state.

1 point(s)
15. Question
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.

B. A blood glucose level of 130

mg/dl.

C. Bradycardia.

D. A blood pressure of 176/88 mm

Hg.

Incorrect
Correct Answer: D. A blood pressure
of 176/88 mm Hg.
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. Tumors secrete only
norepinephrine usually presents with
sustained hypertension.
Norepinephrine and epinephrine
secreting tumor present with
paroxysmal hypertension. Only
epinephrine can cause hypotension
instead of hypertension.
Option A: Pheochromocytoma
can be asymptomatic and
diagnosed by further workup of
an adrenal incidentaloma. It can
present with vague symptoms
like a headache (50%),
palpitations (60%), and
diaphoresis (50%) that can lead
to a paroxysmal hypertensive
crisis due to increased
catecholamine production.
Option B: Other associated
symptoms include pallor (40%),
nausea (40%), tremor,
trembling, fatigue (40%),
anxiety, fever, pain, and flushing
(20%). Characteristically, these
symptoms are paroxysmal and
may be precipitated by
abdominal exertion, such as
heavy lifting or performing the
Valsalva maneuver. Almost 90%
of the population with
pheochromocytoma has
hypertension.
Option C: Due to the release of
catecholamine, there is an
increase in heart rate, systemic
vascular resistance, inotropic
effect, and a decrease in venous
compliance. In
pheochromocytoma, there is
orthostatic hypotension as it is a
volume-depleted type of
hypertension.

1 point(s)
16. Question
A male client is admitted for treatment of the
syndrome of inappropriate antidiuretic
hormone (SIADH). Which nursing intervention
is appropriate?

A. Infusing I.V. fluids rapidly as

ordered.

B. Encouraging increased oral

intake.

C. Restricting fluids.

D. Administering glucose-
containing I.V. fluids as ordered.

Incorrect
Correct Answer: C. Restricting fluids
To reduce water retention in a client
with SIADH, the nurse should restrict
fluids. Administering fluids by any route
would further increase the client’s
already heightened fluid load.
Syndrome of inappropriate antidiuretic
hormone ADH release (SIADH) is a
condition defined by the unsuppressed
release of antidiuretic hormone (ADH)
from the pituitary gland or non-
pituitary sources or its continued
action on vasopressin receptors.
Option A: SIADH is
characterized by impaired water
excretion leading to
hyponatremia with hypervolemia
or euvolemia. SIADH treatment
involves correction and
maintenance of corrected
sodium levels and correction of
underlying abnormalities such
as hypothyroidism or pulmonary
or CNS infection. The goal of
sodium correction is more than
130 mEq/L.
Option B: In patients with mild
to moderate symptoms, the
mainstay of the treatment is the
restriction of oral water intake
with the goal of less than 800
mL/day. If hyponatremia is
persistent, sodium chloride in
the form of oral salt tablets or
intravenous saline can be given.
Option D: Loop diuretics such
as furosemide (20 mg twice
daily) can also be added to salt
tablets as it helps decrease the
urine concentration and thereby
increase water excretion,
particularly among the patients
whose urine osmolality is much
higher than serum osmolality
(greater than 500 mOsm/kg).

1 point(s)
17. Question
A female client has a serum calcium level of
7.2 mg/dl. During the physical examination,
nurse Noah expects to assess:

A. Trousseau’s sign.

B. Homans’ sign.

C. Hegar’s sign.

D. Goodell’s sign.

Incorrect
Correct Answer: A. Trousseau’s
sign.
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). Trousseau’s sign for
latent tetany is most commonly
positive in the setting of hypocalcemia.
The sign is observable as a carpopedal
spasm induced by ischemia secondary
to the inflation of a
sphygmomanometer cuff, commonly
on an individual’s arm, to 20 mmHg
over their systolic blood pressure for 3
minutes. The carpopedal spasm is
visualized as flexion of the wrist,
thumb, and metacarpophalangeal
joints with hyperextension of the
fingers.
Option B: Homans’ sign (pain
on dorsiflexion of the foot)
indicates deep vein thrombosis.
A positive Homan’s sign (calf
pain at dorsiflexion of the foot)
is thought to be associated with
the presence of thrombosis.
However, Homans’s sign has a
very poor predictive value for
the presence or absence of
deep vein thrombosis, like any
other symptom or clinical sign of
this disease.
Option C: Hegar’s sign is the
softening of the uterine isthmus.
Hegar’s sign is a non-sensitive
indication of pregnancy in
women — its absence does not
exclude pregnancy. It pertains to
the features of the cervix and
the uterine isthmus. It is
demonstrated as a softening in
the consistency of the uterus,
and the uterus and cervix seem
to be two separate regions.
Option D: Goodell’s sign
(cervical softening) is a probable
sign of pregnancy. In medicine,
the Goodell sign is an indication
of pregnancy. It is a significant
softening of the vaginal portion
of the cervix from increased
vascularization. This
vascularization is a result of
hypertrophy and engorgement
of the vessels below the growing
uterus. This sign occurs at
approximately four weeks’
gestation.

1 point(s)
18. Question
Which outcome indicates that treatment of a
male client with diabetes insipidus has been
effective?

A. Fluid intake is less than 2,500

ml/day.

B. Urine output measures more

than 200 ml/hour.

C. Blood pressure is 90/50 mm Hg.

D. The heart rate is 126

beats/minute.

Correct
Correct Answer: 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. It is essential
to replete fluid losses in diabetes
insipidus, as some patients may have
thirst impairment and will not respond
adequately to water intake.
Option B: A urine output of 200
ml/hour indicates continuing
polyuria. The preferred therapy
is DDAVP. Typically, therapy is
maintained for the duration of
central diabetes insipidus, which
varies depending on the cause.
The minimum dose should be
administered to control polyuria
adequately.
Option C: 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.
The prognosis for most patients
with DI is excellent as long as
the underlying primary cause
can be treated. Lithium
discontinuation can restore
normal kidney function, but the
nephrogenic DI may be
permanent in some patients.
Option D: It is important to
monitor hyponatremia, as water
retention can lead to sodium
concentration changes that may
cause brain injury. The patients
and families should be educated
to observe for symptoms of
nausea, vomiting, lethargy,
headaches, confusion, seizures,
and coma.

1 point(s)
19. Question
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?

A. Acromegaly

B. Type 1 diabetes mellitus

C. Hypothyroidism

D. Deficient growth hormone

Incorrect
Correct Answer: A. Acromegaly
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.
Option B: Type 1 diabetes is
usually seen in children, and
newly diagnosed persons are
usually very ill and thin. At
presentation, children usually
have a history of polyuria,
polydipsia, and weight loss for
days to months. If the diagnosis
is delayed, there may be
vomiting, lethargy, altered
mental status, dehydration, and
acidosis.
Option C: Hypothyroidism isn’t
associated with hyperglycemia.
Patients with severe
hyperglycemia should be
assessed for clinical stability
including mentation and
hydration. Diabetic ketoacidosis
and hyperglycemic
hyperosmolar state are acute,
severe disorders related to
hyperglycemia.
Option D: Hypothyroidism isn’t
associated with growth hormone
deficiency. Countless studies
have shown that untreated
hyperglycemia shortens lifespan
and worsens the quality of life.
Thus, an aggressive lowering of
hyperglycemia must be initiated,
and patients must be closely
followed.

1 point(s)
20. Question
Nurse Kate is providing dietary instructions to
a male client with hypoglycemia. To control
hypoglycemic episodes, the nurse should
recommend:

A. Increasing saturated fat intake

and fasting in the afternoon.

B. Increasing intake of vitamins B

and D and taking iron supplements.

C. Eating a candy bar if

lightheadedness occurs.

D. Consuming a low-
carbohydrate, high protein diet and
avoiding fasting.

Correct
Correct Answer: D. Consuming a
low-carbohydrate, high protein diet
and avoiding fasting.
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. A person experiencing a
minor case of low blood sugar can
consume 15–20 grams (g) of fast-
acting carbohydrates, such as a small
glass of fruit juice or a few crackers.
Option A: Lunch should be a
small meal but packed with
protein, healthful fats, and
complex carbohydrates that will
continue to release energy
slowly. It is necessary for a
 person with hypoglycemia to be
aware of the glycemic index or
GI of the foods they eat. Some
foods that appear to be healthful
may have a high GI. Fortunately,
there is often an alternative that
has a lower GI.
Option B: People with
hypoglycemia should try to
include small, nutritious snacks
in between meals to keep blood
sugar levels constant and
ensure they are having enough
vitamins, minerals, healthy fats,
proteins, and fibrous
carbohydrates in their diet. It is
important to remember that
people who exercise regularly
may need to eat more
frequently, as strenuous or
sustained physical activity can
cause blood sugar levels to
drop.
Option C: It is advisable to limit
intake of fruit juices in the
morning and stick to juices that
do not have added sugar, as
these may cause blood sugar
levels to become unstable.
Cinnamon is thought to help
reduce blood sugar levels and
can be sprinkled on many
breakfast foods.

1 point(s)
21. Question
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:

A. Thyroid storm.

B. Cretinism.

C. Myxedema coma.

D. Hashimoto’s thyroiditis.

Incorrect
Correct Answer: 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.
Patients are most commonly
presenting for emergency services with
altered mental status and hypothermia,
below 35.5 degrees C (95.9 degrees
F). The lower the body temperature,
the worst is the prognosis. The
absence of mild diastolic hypertension
in severely hypothyroid patients is a
warning sign of impending myxedema
coma.
Option A: Thyroid storm is an
acute complication of
hyperthyroidism. Thyroid storm,
also known as thyrotoxic crisis,
is an acute, life-threatening
complication of hyperthyroidism.
It is an exaggerated presentation
of thyrotoxicosis. It comes with
sudden multisystem
involvement.
Option B: Cretinism is a form of
hypothyroidism that occurs in
infants. Congenital
hypothyroidism (CH) is defined
as thyroid hormone deficiency
present at birth. CH must be
diagnosed promptly because
delay in treatment can lead to
irreversible neurological deficits.
Before the newborn screening
program, CH was one of the
most common preventable
causes of intellectual disability.
Option D: Hashimoto’s
thyroiditis is a common chronic
inflammatory disease of the
thyroid gland in which
autoimmune factors play a
prominent role. Hashimoto
thyroiditis is an autoimmune
disease that destroys thyroid
cells by cell and antibody-
mediated immune processes. It
is the most common cause of
hypothyroidism in developed
countries. This disease is also
known as chronic autoimmune
thyroiditis and chronic
lymphocytic thyroiditis. The
pathology of the disease
involves the formation of
antithyroid antibodies that
attack the thyroid tissue,
causing progressive fibrosis.

1 point(s)
22. Question
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:

A. Prefers to take insulin orally.

B. Has type 2 diabetes.

C. Has type 1 diabetes.

D. Is pregnant and has type 2

diabetes.

Incorrect
Correct Answer: B. Has type 2
diabetes.
Oral antidiabetic agents are only
effective in adult clients with type 2
diabetes. Antidiabetic drugs (with the
exception of insulin are all
pharmacological agents that have been
approved for hyperglycemic treatment
in type 2 diabetes mellitus (DM). If
lifestyle modifications (weight loss,
dietary modification, and exercise) do
not sufficiently reduce A1C levels
(target level: ? 7%), pharmacological
treatment with antidiabetic drugs
should be initiated.
Option A: These drugs may be
classified according to their
mechanism of action as
insulinotropic or non-
insulinotropic. They are available
as monotherapy or combination
therapies, with the latter
involving two (or, less
commonly, three) antidiabetic
drugs and/or insulin. The drug of
choice for all type 2 diabetic
patients is metformin. This drug
has beneficial effects on
glucose metabolism and
promotes weight loss or at least
weight stabilization.
Option C: Oral antidiabetic
agents aren’t effective in type 1
diabetes. All patients with T1DM
require insulin therapy. Multiple
daily insulin injections (MDI)
using a basal/bolus insulin
regimen or continuous
subcutaneous insulin infusion
through an insulin pump are the
preferred treatment.
Option D: Pregnant and
lactating women aren’t
prescribed oral antidiabetic
agents because the effect on
the fetus is uncertain. Most
antidiabetic drugs are not
recommended or should be
used with caution in patients
with moderate or severe renal
failure or other significant
comorbidities. Oral antidiabetic
drugs are not recommended
during pregnancy or
breastfeeding.

1 point(s)
23. Question
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?

A. sulfisoxazole (Gantrisin)

B. mexiletine (Mexitil)

C. prednisone (Orasone)

D. lithium carbonate (Lithobid)

Incorrect
Correct Answer: A. sulfisoxazole
(Gantrisin)
Sulfisoxazole and other sulfonamides
are chemically related to oral
antidiabetic agents and may precipitate
hypoglycemia. The cause of the
interaction is not known. When these
two medicines are taken together, the
body may not process the diabetes
medicine properly. An increase in the
effects of diabetes medicine may occur
and may cause low blood sugar levels.
Option B: Mexiletine, an
antiarrhythmic, is used to treat
refractory ventricular
arrhythmias; it doesn’t cause
hypoglycemia. Mexiletine is
largely used to suppress
ventricular arrhythmias but also
has a role in peripheral
neuropathy and chronic pain,
although the use for either is
limited and seldom given its
extensive side effect profile.
Option C: Prednisone, a
corticosteroid, is associated
with hyperglycemia. Prednisone
is a synthetic, anti-inflammatory
glucocorticoid that derives from
cortisone. It is biologically inert
and converted to prednisolone
in the liver. Prednisone is an
FDA-approved, delayed-release
corticosteroid indicated as an
anti-inflammatory or
immunosuppressive agent to
treat a broad range of diseases.
Option D: Lithium may cause
transient hyperglycemia, not
hypoglycemia. Lithium was the
first mood stabilizer and is still
the first-line treatment option,
but is underutilized because it is
an older drug. Lithium is a
commonly prescribed drug for a
manic episode in bipolar
disorder as well as maintenance
therapy of bipolar disorder in a
patient with a history of a manic
episode. The primary target
symptoms of lithium are mania
and unstable mood.

1 point(s)
24. Question
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?

A. Initiate insulin therapy.

B. Switch the client to a different

oral antidiabetic agent.

C. Prescribe an additional oral

antidiabetic agent.

D. Restrict carbohydrate intake to

less than 30% of the total caloric intake.

Incorrect
Correct Answer: 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.
Option A: Glipizide can be used
concomitantly with insulin, but
the dose of glipizide will
typically need to be at the lower
end of the dose range to prevent
hypoglycemia. If discontinuation
of insulin becomes necessary,
then the patient’s urine and
blood sugars should be
monitored at least three times a
day.
Option C: Second-generation
sulfonylureas are considered to
be more potent by weight when
compared to the first-generation
agents. Sulfonylureas were
discovered in 1942 and have
enjoyed extensive use in type 2
diabetes mellitus treatment
since the 1960s.
Option D: Other drug classes
used in the treatment of
diabetes mellitus type 2 include
alpha-glucosidase inhibitors,
biguanides, dipeptidyl
peptidase-4 (DPP-4) inhibitors,
glucagon-like peptide-1 (GLP-1)
receptor agonists, glinides, and
thiazolidinediones.

1 point(s)
25. Question
During preoperative teaching for a female
client who will undergo subtotal
thyroidectomy, the nurse should include which
statement?

A. “The head of your bed must

remain flat for 24 hours after surgery.”

B. “You should avoid deep

breathing and coughing after surgery.”

C. “You won’t be able to swallow for

the first day or two.”

D. “You must avoid hyperextending

your neck after surgery.”

Incorrect
Correct Answer: D. “You must avoid
hyperextending your neck after
surgery.”
To prevent undue pressure on the
surgical incision after subtotal
thyroidectomy, the nurse should advise
the client to avoid hyperextending the
neck. Caution patient to avoid bending
neck; support head with pillows.
Reduces the likelihood of tension on
the surgical wound.
Option A: The client may
elevate the head of the bed as
desired. Keep side rails raised
and padded, bed in a low
position, and airway at the
bedside. Avoid the use of
restraints. Reduces the potential
for injury if seizures occur.
Option B: The client should
perform deep breathing and
coughing to help prevent
pneumonia. Assist with
repositioning, deep breathing
exercises, and/or coughing as
indicated. Maintains clear airway
and ventilation. Although
“routine” coughing is not
encouraged and may be painful,
it may be needed to clear
secretions.
Option C: Investigate reports of
difficulty swallowing, drooling of
oral secretions. May indicate
edema or sequestered bleeding
in tissues surrounding the
operative site. Check dressing
frequently, especially the
posterior portion. If bleeding
occurs, the anterior dressing
may appear dry because blood
pools dependently.

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