NCLEX Practice Exam for Endocrine Disorders 2

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:

  1. Hypotension.
  2. Thick, coarse skin.
  3. Deposits of adipose tissue in the trunk and dorsocervical area.
  4.  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?

  1. “Administer desmopressin while the suspension is cold.”
  2.  “Your condition isn’t chronic, so you won’t need to wear a medical identification bracelet.”
  3. “You may not be able to use desmopressin nasally if you have nasal discharge or blockage.”
  4. “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?

  1. Hypocalcemia
  2. Hyponatremia
  3. Hypokalemia
  4. 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:

  1. Serum glucose level.
  2. Hair loss.
  3. Bone mineralization.
  4. 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?

  1. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs.
  2. It interacts with plasma membrane receptors to inhibit enzymatic actions.
  3. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and carbohydrate metabolism.
  4. 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:

  1. Onset to be at 2 p.m. and its peak to be at 3 p.m.
  2. Onset to be at 2:15 p.m. and its peak to be at 3 p.m.
  3. Onset to be at 2:30 p.m. and its peak to be at 4 p.m.
  4. 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?

  1. Depression
  2. Neuropathy
  3. Hypoglycemia
  4. 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?

  1. Tetany
  2. Hemorrhage
  3. Thyroid storm
  4. 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?

  1. Primary hypothyroidism
  2. Graves’ disease
  3.  Thyrotoxicosis
  4. Euthyroidism

10. Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is experiencing complications?

  1. Tetanic contractions
  2. Neck vein distention
  3. Weight loss
  4. 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:

  1. phentolamine (Regitine).
  2. methyldopa (Aldomet).
  3. mannitol (Osmitrol).
  4. 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?

  1. Adrenal cortex
  2. Pancreas
  3. Adrenal medulla
  4. Parathyroid

13. Nurse Troy is aware that the most appropriate for a client with Addison’s disease?

  1. Risk for infection
  2. Excessive fluid volume
  3. Urinary retention
  4. 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:

  1. “If I have hypoglycemia, I should eat some sugar, not dextrose.”
  2. “The drug makes my pancreas release more insulin.”
  3.  “I should never take insulin while I’m taking this drug.”
  4.  “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?

  1. “You must lie flat for 24 hours after surgery.”
  2. “You must avoid coughing, sneezing, and blowing your nose.”
  3. “You must restrict your fluid intake.”
  4.  “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?

  1. “Be sure to take glipizide 30 minutes before meals.”
  2. “Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly.”
  3. “You won’t need to check your blood glucose level after you start taking glipizide.”
  4. “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?

  1. They contain exudate and provide a moist wound environment.
  2. They protect the wound from mechanical trauma and promote healing.
  3. They debride the wound and promote healing by secondary intention.
  4. 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?

  1. Restricting fluids
  2. Restricting sodium
  3. Forcing fluids
  4. Restricting potassium

19. Which nursing diagnosis takes highest priority for a female client with hyperthyroidism?

  1. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
  2. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing
  3. Body image disturbance related to weight gain and edema
  4. 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?

  1. Serum potassium level
  2. Serum sodium level
  3. Arterial blood gas (ABG) values
  4. 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?

  1. “You’ll need more insulin when you exercise or increase your food intake.”
  2. “You’ll need less insulin when you exercise or reduce your food intake.”
  3. “You’ll need less insulin when you increase your food intake.”
  4. “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?

  1. Oral anticoagulants
  2. Anabolic steroids
  3. Beta-adrenergic blockers
  4. Thiazide diuretics

23. Which instruction about insulin administration should nurse Kate give to a client?

  1. “Always follow the same order when drawing the different insulins into the syringe.”
  2. “Shake the vials before withdrawing the insulin.”
  3. “Store unopened vials of insulin in the freezer at temperatures well below freezing.”
  4. “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:

  1. I.M. or subcutaneous glucagon.
  2. I.V. bolus of dextrose 50%.
  3. 15 to 20 g of a fast-acting carbohydrate such as orange juice.
  4. 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?

  1. Hypocalcemia
  2. Hypercalcemia
  3. Hypokalemia
  4. 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.