Chapter 50: Nursing Management: Endocrine Problems Test Bank

Chapter 50: Nursing Management: Endocrine Problems
Test Bank
MULTIPLE CHOICE
1. A 45-year-old male patient with suspected acromegaly is seen at the clinic. To assist in
making the diagnosis, which question should the nurse ask?
a. Have you had a recent head injury?
b. Do you have to wear larger shoes now?
c. Is there a family history of acromegaly?
d. Are you experiencing tremors or anxiety?
ANS: B
Acromegaly causes an enlargement of the hands and feet. Head injury and family history are
not risk factors for acromegaly. Tremors and anxiety are not clinical manifestations of
acromegaly.
DIF: Cognitive Level: Apply (application) REF: 1190

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
2. A 42-year-old female patient is scheduled for transsphenoidal hypophysectomy to treat a

pituitary adenoma. During preoperative teaching, the nurse instructs the patient about the need
to
a. cough and deep breathe every 2 hours postoperatively.
b. remain on bed rest for the first 48 hours after the surgery.
c. avoid brushing teeth for at least 10 days after the surgery.
d. be positioned flat with sandbags at the head postoperatively.
ANS: C
To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days
after surgery. It is not necessary to remain on bed rest after this surgery. Coughing is
discouraged because it may cause leakage of cerebrospinal fluid (CSF) from the suture line.
The head of the bed should be elevated 30 degrees to reduce pressure on the sella turcica and
decrease the risk for headaches.

TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
3. The nurse is planning postoperative care for a patient who is being admitted to the surgical
unit form the recovery room after transsphenoidal resection of a pituitary tumor. Which
nursing action should be included?
a. Palpate extremities for edema.
b. Measure urine volume every hour.
c. Check hematocrit every 2 hours for 8 hours.
d. Monitor continuous pulse oximetry for 24 hours.
ANS: B
After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema.
Monitoring of urine output and urine specific gravity is essential. Hemorrhage is not a
common problem. There is no need to check the hematocrit hourly. The patient is at risk for
dehydration, not volume overload. The patient is not at high risk for problems with
oxygenation, and continuous pulse oximetry is not needed.

TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity
4. The nurse is assessing a 41-year-old African American male patient diagnosed with a pituitary
tumor causing panhypopituitarism. Assessment findings consistent with panhypopituitarism
include
a. high blood pressure.
b. decreased facial hair.
c. elevated blood glucose.
d. tachycardia and cardiac palpitations.
ANS: B
Changes in male secondary sex characteristics such as decreased facial hair, testicular atrophy,
diminished spermatogenesis, loss of libido, impotence, and decreased muscle mass are
associated with decreases in follicle stimulating hormone (FSH) and luteinizing hormone
(LH). Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of
decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is likely due to
the decrease in thyroid stimulating hormone (TSH) and thyroid hormones associated with
panhypopituitarism.

5. Which information will the nurse include when teaching a 50-year-old male patient about
somatropin (Genotropin)?
a. The medication will be needed for 3 to 6 months.
b. Inject the medication subcutaneously every day.
c. Blood glucose levels may decrease when taking the medication.
d. Stop taking the medication if swelling of the hands or feet occurs.
ANS: B
Somatropin is injected subcutaneously on a daily basis, preferably in the evening. The patient
will need to continue on somatropin for life. If swelling or other common adverse effects
occur, the health care provider should be notified. Growth hormone will increase blood
glucose levels.

6. The nurse determines that demeclocycline (Declomycin) is effective for a patient with
syndrome of inappropriate antidiuretic hormone (SIADH) based on finding that the patients
a. weight has increased.
b. urinary output is increased.
c. peripheral edema is decreased.
d. urine specific gravity is increased.
ANS: B
Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and
increases urine output. An increase in weight or an increase in urine specific gravity indicates
that the SIADH is not corrected. Peripheral edema does not occur with SIADH. A sudden
weight gain without edema is a common clinical manifestation of this disorder.
DIF: Cognitive Level: Apply (application) REF: 1193-1194

TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity
7. The nurse determines that additional instruction is needed for a 60-year-old patient with
chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient says
which of the following?
a. I need to shop for foods low in sodium and avoid adding salt to food.
b. I should weigh myself daily and report any sudden weight loss or gain.
c. I need to limit my fluid intake to no more than 1 quart of liquids a day.
d. I will eat foods high in potassium because diuretics cause potassium loss.
ANS: A
Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be
prescribed. The other patient statements are correct and indicate successful teaching has
occurred.

8. A 56-year-old patient who is disoriented and reports a headache and muscle cramps is
hospitalized with possible syndrome of inappropriate antidiuretic hormone (SIADH). The
nurse would expect the initial laboratory results to include a(n)
a. elevated hematocrit.
b. decreased serum sodium.
c. low urine specific gravity.
d. increased serum chloride.
ANS: B
When water is retained, the serum sodium level will drop below normal, causing the clinical
manifestations reported by the patient. The hematocrit will decrease because of the dilution
caused by water retention. Urine will be more concentrated with a higher specific gravity. The
serum chloride level will usually decrease along with the sodium level.
DIF: Cognitive Level: Understand (comprehension) REF: 1193

9. An expected nursing diagnosis for a 30-year-old patient admitted to the hospital with
symptoms of diabetes insipidus is
a. excess fluid volume related to intake greater than output.
b. impaired gas exchange related to fluid retention in lungs.
c. sleep pattern disturbance related to frequent waking to void.
d. risk for impaired skin integrity related to generalized edema.
ANS: C
Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema, excess fluid
volume, and fluid retention are not expected.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity
10. Which information will the nurse teach a 48-year-old patient who has been newly diagnosed
with Graves disease?
a. Exercise is contraindicated to avoid increasing metabolic rate.
b. Restriction of iodine intake is needed to reduce thyroid activity.
c. Antithyroid medications may take several months for full effect.
d. Surgery will eventually be required to remove the thyroid gland.
ANS: C
Medications used to block the synthesis of thyroid hormones may take 2 to 3 months before
the full effect is seen. Large doses of iodine are used to inhibit the synthesis of thyroid
hormones. Exercise using large muscle groups is encouraged to decrease the irritability and
hyperactivity associated with high levels of thyroid hormones. Radioactive iodine is the most
common treatment for Graves disease although surgery may be used.

11. A patient who had a subtotal thyroidectomy earlier today develops laryngeal stridor and a
cramp in the right hand upon returning to the surgical nursing unit. Which collaborative action
will the nurse anticipate next?
a. Suction the patients airway.
b. Administer IV calcium gluconate.
c. Plan for emergency tracheostomy.
d. Prepare for endotracheal intubation.
ANS: B
The patients clinical manifestations of stridor and cramping are consistent with tetany caused
by hypocalcemia resulting from damage to the parathyroid glands during surgery.
Endotracheal intubation or tracheostomy may be needed if the calcium does not resolve the
stridor. Suctioning will not correct the stridor.

12. Which nursing action will be included in the plan of care for a 55-year-old patient with
Graves disease who has exophthalmos?
a. Place cold packs on the eyes to relieve pain and swelling.
b. Elevate the head of the patients bed to reduce periorbital fluid.
c. Apply alternating eye patches to protect the corneas from irritation.
d. Teach the patient to blink every few seconds to lubricate the corneas.
ANS: B
The patient should sit upright as much as possible to promote fluid drainage from the
periorbital area. With exophthalmos, the patient is unable to close the eyes completely to
blink. Lubrication of the eyes, rather than eye patches, will protect the eyes from developing
corneal scarring. The swelling of the eye is not caused by excessive blood flow to the eye, so
cold packs will not be helpful.

13. A 62-year-old patient with hyperthyroidism is to be treated with radioactive iodine (RAI). The
nurse instructs the patient
a. about radioactive precautions to take with all body secretions.
b. that symptoms of hyperthyroidism should be relieved in about a week.
c. that symptoms of hypothyroidism may occur as the RAI therapy takes effect.
d. to discontinue the antithyroid medications taken before the radioactive therapy.
ANS: C
There is a high incidence of postradiation hypothyroidism after RAI, and the patient should be
monitored for symptoms of hypothyroidism. RAI has a delayed response, with the maximum
effect not seen for 2 to 3 months, and the patient will continue to take antithyroid medications
during this time. The therapeutic dose of radioactive iodine is low enough that no radiation
safety precautions are needed.

14. Which nursing assessment of a 69-year-old patient is most important to make during initiation
of thyroid replacement with levothyroxine (Synthroid)?
a. Fluid balance
b. Apical pulse rate
c. Nutritional intake
d. Orientation and alertness
ANS: B
In older patients, initiation of levothyroxine therapy can increase myocardial oxygen demand
and cause angina or dysrhythmias. The medication also is expected to improve mental status
and fluid balance and will increase metabolic rate and nutritional needs, but these changes will
not result in potentially life-threatening complications.

15. An 82-year-old patient in a long-term care facility has several medications prescribed. After
the patient is newly diagnosed with hypothyroidism, the nurse will need to consult with the
health care provider before administering
a. docusate (Colace).
b. ibuprofen (Motrin).
c. diazepam (Valium).
d. cefoxitin (Mefoxin).
ANS: C
Worsening of mental status and myxedema coma can be precipitated by the use of sedatives,
especially in older adults. The nurse should discuss the use of diazepam with the health care
provider before administration. The other medications may be given safely to the patient.

16. A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is
improving and expected to be discharged in 2 days. Which teaching strategy will be best for
the nurse to use?
a. Provide written reminders of self-care information.
b. Offer multiple options for management of therapies.
c. Ensure privacy for teaching by asking visitors to leave.
d. Delay teaching until patient discharge date is confirmed.
ANS: A
Written instructions will be helpful to the patient because initially the hypothyroid patient may
be unable to remember to take medications and other aspects of self-care. Because the
treatment regimen is somewhat complex, teaching should be initiated well before discharge.
Family members or friends should be included in teaching because the hypothyroid patient is
likely to forget some aspects of the treatment plan. A simpler regimen will be easier to
understand until the patient is euthyroid.

17. A 63-year-old patient with primary hyperparathyroidism has a serum phosphorus level of 1.7
mg/dL (0.55 mmol/L) and calcium of 14 mg/dL (3.5 mmol/L). Which nursing action should
be included in the plan of care?
a. Restrict the patient to bed rest.
b. Encourage 4000 mL of fluids daily.
c. Institute routine seizure precautions.
d. Assess for positive Chvosteks sign.
ANS: B
The patient with hypercalcemia is at risk for kidney stones, which may be prevented by a high
fluid intake. Seizure precautions and monitoring for Chvosteks or Trousseaus sign are
appropriate for hypocalcemic patients. The patient should engage in weight-bearing exercise
to decrease calcium loss from bone.

18. A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy.
Which action should the nurse take first?
a. Administer the ordered muscle relaxant.
b. Give the ordered oral calcium supplement.
c. Have the patient rebreathe from a paper bag.
d. Start the PRN oxygen at 2 L/min per cannula.
ANS: C
The patients symptoms suggest mild hypocalcemia. The symptoms of hypocalcemia will be
temporarily reduced by having the patient breathe into a paper bag, which will raise the
PaCO2 and create a more acidic pH. The muscle relaxant will have no impact on the ionized
calcium level. Although severe hypocalcemia can cause laryngeal stridor, there is no
indication that this patient is experiencing laryngeal stridor or needs oxygen. Calcium
supplements will be given to normalize calcium levels quickly, but oral supplements will take
time to be absorbed.

19. A patient who had radical neck surgery to remove a malignant tumor developed
hypoparathyroidism. The nurse should plan to teach the patient about
a. bisphosphonates to reduce bone demineralization.
b. calcium supplements to normalize serum calcium levels.
c. increasing fluid intake to decrease risk for nephrolithiasis.
d. including whole grains in the diet to prevent constipation.
ANS: B
Oral calcium supplements are used to maintain the serum calcium in normal range and
prevent the complications of hypocalcemia. Whole grain foods decrease calcium absorption
and will not be recommended. Bisphosphonates will lower serum calcium levels further by
preventing calcium from being reabsorbed from bone. Kidney stones are not a complication of
hypoparathyroidism and low calcium levels.

20. Which finding for a patient who has hypothyroidism and hypertension indicates that the nurse
should contact the health care provider before administering levothyroxine (Synthroid)?
a. Increased thyroxine (T4) level
b. Blood pressure 112/62 mm Hg
c. Distant and difficult to hear heart sounds
d. Elevated thyroid stimulating hormone level
ANS: A
An increased thyroxine level indicates the levothyroxine dose needs to be decreased. The
other data are consistent with hypothyroidism and the nurse should administer the
levothyroxine.

21. A 37-year-old patient is being admitted with a diagnosis of Cushing syndrome. Which
findings will the nurse expect during the assessment?
a. Chronically low blood pressure
b. Bronzed appearance of the skin
c. Purplish streaks on the abdomen
d. Decreased axillary and pubic hair
ANS: C
Purplish-red striae on the abdomen are a common clinical manifestation of Cushing
syndrome. Hypotension and bronzed-appearing skin are manifestations of Addisons disease.
Decreased axillary and pubic hair occur with androgen deficiency.

22. A 44-year-old female patient with Cushing syndrome is admitted for adrenalectomy. Which
intervention by the nurse will be most helpful for a nursing diagnosis of disturbed body image
related to changes in appearance?
a. Reassure the patient that the physical changes are very common in patients with
Cushing syndrome.
b. Discuss the use of diet and exercise in controlling the weight gain associated with
Cushing syndrome.
c. Teach the patient that the metabolic impact of Cushing syndrome is of more
importance than appearance.
d. Remind the patient that most of the physical changes caused by Cushing syndrome
will resolve after surgery.
ANS: D
The most reassuring communication to the patient is that the physical and emotional changes
caused by the Cushing syndrome will resolve after hormone levels return to normal
postoperatively. Reassurance that the physical changes are expected or that there are more
serious physiologic problems associated with Cushing syndrome are not therapeutic
responses. The patients physiological changes are caused by the high hormone levels, not by
the patients diet or exercise choices.

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
23. Which finding indicates to the nurse that the current therapies are effective for a patient with
acute adrenal insufficiency?
a. Increasing serum sodium levels
b. Decreasing blood glucose levels
c. Decreasing serum chloride levels
d. Increasing serum potassium levels
ANS: A
Clinical manifestations of Addisons disease include hyponatremia and an increase in sodium
level indicates improvement. The other values indicate that treatment has not been effective.

24. A 38-year-old male patient is admitted to the hospital in Addisonian crisis. Which patient
statement supports a nursing diagnosis of ineffective self-health management related to lack
of knowledge about management of Addisons disease?
a. I frequently eat at restaurants, and my food has a lot of added salt.
b. I had the stomach flu earlier this week, so I couldnt take the hydrocortisone.
c. I always double my dose of hydrocortisone on the days that I go for a long run.
d. I take twice as much hydrocortisone in the morning dose as I do in the afternoon.
ANS: B
The need for hydrocortisone replacement is increased with stressors such as illness, and the
patient needs to be taught to call the health care provider because medication and IV fluids
and electrolytes may need to be given. The other patient statements indicate appropriate
management of the Addisons disease.

TOP: Nursing Process: Diagnosis MSC: NCLEX: Physiological Integrity
25. A 29-year-old woman with systemic lupus erythematosus has been prescribed 2 weeks of
high-dose prednisone therapy. Which information about the prednisone is most important for
the nurse to include?
a. Weigh yourself daily to monitor for weight gain caused by increased appetite.
b. A weight-bearing exercise program will help minimize the risk for osteoporosis.
c. The prednisone dose should be decreased gradually rather than stopped
suddenly.
d. Call the health care provider if you experience mood alterations with the
prednisone.
ANS: C
Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped.
Mood alterations and weight gain are possible adverse effects of corticosteroid use, but these
are not life-threatening effects. Osteoporosis occurs when patients take corticosteroids for
longer periods.

26. A 56-year-old female patient has an adrenocortical adenoma, causing hyperaldosteronism.

The nurse providing care should
a. monitor the blood pressure every 4 hours.
b. elevate the patients legs to relieve edema.
c. monitor blood glucose level every 4 hours.
d. order the patient a potassium-restricted diet.
ANS: A
Hypertension caused by sodium retention is a common complication of hyperaldosteronism.
Hyperaldosteronism does not cause an elevation in blood glucose. The patient will be
hypokalemic and require potassium supplementation before surgery. Edema does not usually
occur with hyperaldosteronism.

27. The nurse will plan to monitor a patient diagnosed with a pheochromocytoma for
a. flushing.
b. headache.
c. bradycardia.
d. hypoglycemia.
ANS: B
The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia,
severe headache, diaphoresis, and abdominal or chest pain. Elevated blood glucose may also
occur because of sympathetic nervous system stimulation. Bradycardia and flushing would
not be expected.

28. After a 22-year-old female patient with a pituitary adenoma has had a hypophysectomy, the
nurse will teach about the need for
a. sodium restriction to prevent fluid retention.
b. insulin to maintain normal blood glucose levels.
c. oral corticosteroids to replace endogenous cortisol.
d. chemotherapy to prevent malignant tumor recurrence.
ANS: C
Antidiuretic hormone (ADH), cortisol, and thyroid hormone replacement will be needed for
life after hypophysectomy. Without the effects of adrenocorticotropic hormone (ACTH) and
cortisol, the blood glucose and serum sodium will be low unless cortisol is replaced. An
adenoma is a benign tumor, and chemotherapy will not be needed.

29. Which intervention will the nurse include in the plan of care for a 52-year-old male patient
with syndrome of inappropriate antidiuretic hormone (SIADH)?
a. Monitor for peripheral edema.
b. Offer patient hard candies to suck on.
c. Encourage fluids to 2 to 3 liters per day.
d. Keep head of bed elevated to 30 degrees.
ANS: B
Sucking on hard candies decreases thirst for a patient on fluid restriction. Patients with
SIADH are on fluid restrictions of 800 to 1000 mL/day. Peripheral edema is not seen with
SIADH. The head of the bed is elevated no more than 10 degrees to increase left atrial filling
pressure and decrease antidiuretic hormone (ADH) release.

30. A patient has just arrived on the unit after a thyroidectomy. Which action should the nurse
take first?
a. Observe the dressing for bleeding.
b. Check the blood pressure and pulse.
c. Assess the patients respiratory effort.
d. Support the patients head with pillows.
ANS: C
Airway obstruction is a possible complication after thyroidectomy because of swelling or
bleeding at the site or tetany. The priority nursing action is to assess the airway. The other
actions are also part of the standard nursing care postthyroidectomy but are not as high of a
priority.
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
31. The nurse is caring for a patient following an adrenalectomy. The highest priority in the
immediate postoperative period is to
a. protect the patients skin.
b. monitor for signs of infection.
c. balance fluids and electrolytes.
d. prevent emotional disturbances.
ANS: C
After adrenalectomy, the patient is at risk for circulatory instability caused by fluctuating
hormone levels, and the focus of care is to assess and maintain fluid and electrolyte status
through the use of IV fluids and corticosteroids. The other goals are also important for the
patient but are not as immediately life threatening as the circulatory collapse that can occur
with fluid and electrolyte disturbances.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
32. The nurse is caring for a patient admitted with diabetes insipidus (DI). Which information is
most important to report to the health care provider?
a. The patient is confused and lethargic.
b. The patient reports a recent head injury.
c. The patient has a urine output of 400 mL/hr.
d. The patients urine specific gravity is 1.003.
ANS: A
The patients confusion and lethargy may indicate hypernatremia and should be addressed
quickly. In addition, patients with DI compensate for fluid losses by drinking copious amounts
of fluids, but a patient who is lethargic will be unable to drink enough fluids and will become
hypovolemic. A high urine output, low urine specific gravity, and history of a recent head
injury are consistent with diabetes insipidus, but they do not require immediate nursing action
to avoid life-threatening complications.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Assessment
33. Which prescribed medication should the nurse administer first to a 60-year-old patient
admitted to the emergency department in thyroid storm?
a. Propranolol (Inderal)
b. Propylthiouracil (PTU)
c. Methimazole (Tapazole)
d. Iodine (Lugols solution)
ANS: A
-Adrenergic blockers work rapidly to decrease the cardiovascular manifestations of thyroid
storm. The other medications take days to weeks to have an impact on thyroid function.
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
34. Which assessment finding for a 33-year-old female patient admitted with Graves disease
requires the most rapid intervention by the nurse?
a. Bilateral exophthalmos
b. Heart rate 136 beats/minute
c. Temperature 103.8 F (40.4 C)
d. Blood pressure 166/100 mm Hg
ANS: C
The patients temperature indicates that the patient may have thyrotoxic crisis and that
interventions to lower the temperature are needed immediately. The other findings also
require intervention but do not indicate potentially life-threatening complications.
DIF: Cognitive Level: Apply (application) REF: 1196 | 1198

35. A 37-year-old patient has just arrived in the postanesthesia recovery unit (PACU) after a
thyroidectomy. Which information is most important to communicate to the surgeon?
a. The patient reports 7/10 incisional pain.
b. The patient has increasing neck swelling.
c. The patient is sleepy and difficult to arouse.
d. The patients cardiac rate is 112 beats/minute.
ANS: B
The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to
prevent airway obstruction. The incisional pain should be treated but is not unusual after
surgery. A heart rate of 112 is not unusual in a patient who has been hyperthyroid and has just
arrived in the PACU from surgery. Sleepiness in the immediate postoperative period is
expected.

36. Which assessment finding of a 42-year-old patient who had a bilateral adrenalectomy requires
the most rapid action by the nurse?
a. The blood glucose is 176 mg/dL.
b. The lungs have bibasilar crackles.
c. The blood pressure (BP) is 88/50 mm Hg.
d. The patient reports 5/10 incisional pain.
ANS: C
The decreased BP indicates possible adrenal insufficiency. The nurse should immediately
notify the health care provider so that corticosteroid medications can be administered. The
nurse should also address the elevated glucose, incisional pain, and crackles with appropriate
collaborative or nursing actions, but prevention and treatment of acute adrenal insufficiency is
the priority after adrenalectomy.
37. A 23-year-old patient is admitted with diabetes insipidus. Which action will be most
appropriate for the registered nurse (RN) to delegate to an experienced licensed
practical/vocational nurse (LPN/LVN)?
a. Titrate the infusion of 5% dextrose in water.
b. Teach the patient how to use desmopressin (DDAVP) nasal spray.
c. Assess the patients hydration status every 8 hours.
d. Administer subcutaneous DDAVP.
ANS: D
Administration of medications is included in LPN/LVN education and scope of practice.
Assessments, patient teaching, and titrating fluid infusions are more complex skills and should
be done by the RN.

OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
38. Which information is most important for the nurse to communicate rapidly to the health care
provider about a patient admitted with possible syndrome of inappropriate antidiuretic
hormone (SIADH)?
a. The patient has a recent weight gain of 9 lb.
b. The patient complains of dyspnea with activity.
c. The patient has a urine specific gravity of 1.025.
d. The patient has a serum sodium level of 118 mEq/L.
ANS: D
A serum sodium of less than 120 mEq/L increases the risk for complications such as seizures
and needs rapid correction. The other data are not unusual for a patient with SIADH and do
not indicate the need for rapid action.

39. After receiving change-of-shift report about the following four patients, which patient should
the nurse assess first?
a. A 31-year-old female with Cushing syndrome and a blood glucose level of 244
mg/dL
b. A 70-year-old female taking levothyroxine (Synthroid) who has an irregular pulse
of 134
c. A 53-year-old male who has Addisons disease and is due for a scheduled dose of
hydrocortisone (Solu-Cortef).
d. A 22-year-old male admitted with syndrome of inappropriate antidiuretic hormone
(SIADH) who has a serum sodium level of 130 mEq/L
ANS: B
Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias.
The patients high pulse rate needs rapid investigation by the nurse to assess for and intervene
with any cardiac problems. The other patients also require nursing assessment and/or actions
but are not at risk for life-threatening complications.
DIF: Cognitive Level: Analyze (analysis) REF: 1203

OBJ: Special Questions: Prioritization; Multiple Patients
TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment
40. Which question will the nurse in the endocrine clinic ask to help determine a patients risk
factors for goiter?
a. How much milk do you drink?
b. What medications are you taking?
c. Are your immunizations up to date?
d. Have you had any recent neck injuries?
ANS: B
Medications that contain thyroid-inhibiting substances can cause goiter. Milk intake, neck
injury, and immunization history are not risk factors for goiter.

41. Which finding by the nurse when assessing a patient with a large pituitary adenoma is most
important to report to the health care provider?
a. Changes in visual field
b. Milk leaking from breasts
c. Blood glucose 150 mg/dL
d. Nausea and projectile vomiting
ANS: D
Nausea and projectile vomiting may indicate increased intracranial pressure, which will
require rapid actions for diagnosis and treatment. Changes in the visual field, elevated blood
glucose, and galactorrhea are common with pituitary adenoma, but these do not require rapid
action to prevent life-threatening complications.

42. Which finding by the nurse when assessing a patient with Hashimotos thyroiditis and a goiter
will require the most immediate action?
a. New-onset changes in the patients voice
b. Apical pulse rate at rest 112 beats/minute
c. Elevation in the patients T3 and T4 levels
d. Bruit audible bilaterally over the thyroid gland
ANS: A
Changes in the patients voice indicate that the goiter is compressing the laryngeal nerve and
may lead to airway compression. The other findings will also be reported but are expected
with Hashimotos thyroiditis and do not require immediate action.
43. Which information obtained by the nurse in the endocrine clinic about a patient who has been
taking prednisone (Deltasone) 40 mg daily for 3 weeks is most important to report to the
health care provider?
a. Patients blood pressure is 148/94 mm Hg.
b. Patient has bilateral 2+ pitting ankle edema.
c. Patient stopped taking the medication 2 days ago.
d. Patient has not been taking the prescribed vitamin D.
ANS: C
Sudden cessation of corticosteroids after taking the medication for a week or more can lead to
adrenal insufficiency, with problems such as severe hypotension and hypoglycemia. The
patient will need immediate evaluation by the health care provider to prevent and/or treat
adrenal insufficiency. The other information will also be reported, but does not require rapid
treatment.

44. The cardiac telemetry unit charge nurse receives status reports from other nursing units about
four patients who need cardiac monitoring. Which patient should be transferred to the cardiac
unit first?
a. Patient with Hashimotos thyroiditis and a heart rate of 102
b. Patient with tetany who has a new order for IV calcium chloride
c. Patient with Cushing syndrome and a blood glucose of 140 mg/dL
d. Patient with Addisons disease who takes hydrocortisone twice daily
ANS: B
Emergency treatment of tetany requires IV administration of calcium; ECG monitoring will
be required because cardiac arrest may occur if high calcium levels result from too-rapid
administration. The information about the other patients indicates that they are more stable
than the patient with tetany.

OBJ: Special Questions: Multiple Patients; Prioritization TOP: Nursing Process: Planning
MSC: NCLEX: Safe and Effective Care Environment
45. After obtaining the information shown in the accompanying figure regarding a patient with
Addisons disease, which prescribed action will the nurse take first?
a. Give 4 oz of fruit juice orally.

b. Recheck the blood glucose level.
c. Infuse 5% dextrose and 0.9% saline.
d. Administer oxygen therapy as needed.
ANS: C
The patients poor skin turgor, hypotension, and hyponatremia indicate an Addisonian crisis.
Immediate correction of the hypovolemia and hyponatremia is needed. The other actions may
also be needed but are not the initial action for the patient.

OBJ: Special Questions: Prioritization TOP: Nursing Process: Planning
SHORT ANSWER
1. A patient is to receive methylprednisolone (Solu-Medrol) 100 mg. The label on the

medication states: methylprednisolone 125 mg in 2 mL. How many milliliters will the nurse
administer?
ANS:
1.6
A concentration of 125 mg in 2 mL will result in 100 mg in 1.6 mL.


Chapter 50: Nursing Management: Endocrine Problems Test Bank

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Chapter 50: Nursing Management: Endocrine Problems

DIF: Cognitive Level: Apply (application) REF: 1190

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DIF: Cognitive Level: Apply (application) REF: 1191

DIF: Cognitive Level: Apply (application) REF: 1191

DIF: Cognitive Level: Apply (application) REF: 1192

DIF: Cognitive Level: Apply (application) REF: 1192

DIF: Cognitive Level: Apply (application) REF: 1193-1194

DIF: Cognitive Level: Apply (application) REF: 1194

DIF: Cognitive Level: Understand (comprehension) REF: 1193

DIF: Cognitive Level: Apply (application) REF: 1194

DIF: Cognitive Level: Apply (application) REF: 1199

DIF: Cognitive Level: Apply (application) REF: 1201

DIF: Cognitive Level: Apply (application) REF: 1200

DIF: Cognitive Level: Understand (comprehension) REF: 1199

DIF: Cognitive Level: Apply (application) REF: 1203

DIF: Cognitive Level: Apply (application) REF: 1203

DIF: Cognitive Level: Apply (application) REF: 1203

DIF: Cognitive Level: Apply (application) REF: 1206

DIF: Cognitive Level: Apply (application) REF: 1207

DIF: Cognitive Level: Apply (application) REF: 1207

DIF: Cognitive Level: Apply (application) REF: 1203

DIF: Cognitive Level: Understand (comprehension) REF: 1208

DIF: Cognitive Level: Apply (application) REF: 1210

DIF: Cognitive Level: Apply (application) REF: 1208

DIF: Cognitive Level: Apply (application) REF: 1212

DIF: Cognitive Level: Apply (application) REF: 1214

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DIF: Cognitive Level: Apply (application) REF: 1214

DIF: Cognitive Level: Apply (application) REF: 1215

DIF: Cognitive Level: Apply (application) REF: 1191

DIF: Cognitive Level: Apply (application) REF: 1194

DIF: Cognitive Level: Apply (application) REF: 1210-1211

DIF: Cognitive Level: Apply (application) REF: 1194-1195

DIF: Cognitive Level: Apply (application) REF: 1196 | 1198

DIF: Cognitive Level: Apply (application) REF: 1201

DIF: Cognitive Level: Apply (application) REF: 15-16

DIF: Cognitive Level: Apply (application) REF: 1193

DIF: Cognitive Level: Analyze (analysis) REF: 1203

DIF: Cognitive Level: Understand (comprehension) REF: 1195

DIF: Cognitive Level: Apply (application) REF: 1192

DIF: Cognitive Level: Apply (application) REF: 1210-1211

DIF: Cognitive Level: Analyze (analysis) REF: 1207

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DIF: Cognitive Level: Analyze (analysis) REF: 1211

1. A patient is to receive methylprednisolone (Solu-Medrol) 100 mg. The label on the

DIF: Cognitive Level: Apply (application) REF: 1212

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