Transcript Gastrointestinal Review

Endocrine Questions
Practice Questions
Ana Corona, MSN, FNP-C
Nursing Instructor
July 2007
Question 1
The nurse is caring for a client following removal of
the thyroid. Immediately post-op, the nurse
should:
A.
Maintain the client in a semi-Fowler's position
with the head and neck supported by pillows
B.
Encourage the client to turn her head side to
side, to promote drainage of oral secretions
C.
Maintain the client in a supine position with
sandbags placed on either side of the head and
neck
D.
Encourage the client to cough and breathe
deeply every 2 hours, with the neck in a flexed
position
1

Answer A is correct. Following a
thyroidectomy, the client should be placed in
semi-Fowler’s position to decrease swelling
that would place pressure on the airway.
Answers B, C, and D are incorrect because
they would increase the chances of postoperative complications that include bleeding,
swelling, and airway obstruction.
Question 2

A.
B.
C.
D.
A client with hypothyroidism frequently
complains of feeling cold. The nurse should
tell the client that she will be more
comfortable if she:
Uses an electric blanket at night
Dresses in extra layers of clothing
Applies a heating pad to her feet
Takes a hot bath morning and evening
2

Answer B is correct. Dressing in layers and using
extra covering will help decrease the
feeling of
being cold that is experienced by the client with
hypothyroidism. Decreased sensation and
decreased alertness are common in the client with
hypothyroidism; therefore, the use of electric
blankets and heating pads can result in burns,
making answers A and C incorrect. Answer D is
incorrect because the client with hypothyroidism has
dry skin, and a hot bath morning and evening would
make her condition worse.
Question 3

A.
B.
C.
D.
A client is admitted with acute adrenal crisis.
During the intake assessment, the nurse
can expect to find that the client has:
Low blood pressure
Slow, regular pulse
Warm, flushed skin
Increased urination
3

Answer A is correct. The client with acute
adrenal crisis has symptoms of hypovolemia
and shock; therefore, the blood pressure
would be low. Answer B is incorrect because
the pulse would be rapid and irregular.
Answer C is incorrect because the skin would
be cool and pale. Answer D is incorrect
because the urinary output would be
decreased.
Question 4

A.
B.
C.
D.
A client is admitted with a diagnosis of
hypothyroidism. An initial assessment of the
client would reveal:
Slow pulse rate, weight loss, diarrhea, and
cardiac failure
Weight gain, lethargy, slowed speech, and
decreased respiratory rate
Rapid pulse, constipation, and bulging eyes
Decreased body temperature, weight loss,
and increased respirations
4

Answer B is correct. Symptoms of
hypothyroidism include weight gain, lethargy,
slow speech, and decreased respirations.
Answers A and D do not describe symptoms
associated with myxedema; therefore, they
are incorrect. Answer C describes symptoms
associated with Graves’s disease; therefore,
it is incorrect.
Question 5

A.
B.
C.
D.
A client with hyperthyroidism is taking
lithium carbonate to inhibit thyroid hormone
release. Which complaint by the client
should alert the nurse to a problem with the
client's medication?
The client complains of blurred vision.
The client complains of increased thirst and
increased urination.
The client complains of increased weight
gain over the past year.
The client complains of ringing in the ears.
5

Answer B is correct. Increased thirst and
increased urination are signs of lithium
toxicity. Answers B and D do not relate to the
medication; therefore, they are incorrect.
Answer C is an expected side effect of the
medication; therefore, it is incorrect.
Question 6

A.
B.
C.
D.
The nurse is caring for a client with
acromegaly. Following a transphenoidal
hypophysectomy, the nurse should:
Monitor the client's blood sugar
Suction the mouth and pharynx every hour
Place the client in low Trendelenburg
position
Encourage the client to cough
6

Answer A is correct. Growth hormone levels
generally fall rapidly after a hypophysectomy,
allowing insulin levels to rise. The result is
hypoglycemia. Answer B is incorrect because
it traumatizes the oral mucosa. Answer C is
incorrect because the client’s head should be
elevated to reduce pressure on the operative
site. Answer D is incorrect because it
increases pressure on the operative site that
can lead to a leak of cerebral spinal fluid.
Question 7

A.
B.
C.
D.
A client newly diagnosed with diabetes is
started on Precose (acarbose). The nurse
should tell the client that the medication
should be taken:
1 hour before meals
30 minutes after meals
With the first bite of a meal
Daily at bedtime
7

Answer C is correct. Precose (acarbose) is
to be taken with the first bite of a meal.
Answers A, B, and D are incorrect because
they specify the wrong schedule for
medication administration.
Question 8

A.
B.
C.
D.
The glycosylated hemoglobin (hemoglobin
A1C) of a 40-year-old client with diabetes
mellitus is 5. The nurse understands that:
The client can have a higher-calorie diet.
The client has good control of her diabetes.
The client requires adjustment in her insulin
dose.
The client has poor control of her diabetes.
8

Answer B is correct. The client’s diabetes is
well under control. Answer A is incorrect
because it will lead to elevated glycosylated
hemoglobin. Answer C is incorrect because
the diet and insulin dose are appropriate for
the client. Answer D is incorrect because the
desired range for glycosylated hemoglobin in
the adult client is <6.
Question 9

A.
B.
C.
D.
The physician has discussed the need for
medication with the parents of an infant with
congenital hypothyroidism. The nurse can
reinforce the physician's teaching by telling the
parents that:
The medication will be needed only during
times of rapid growth.
The medication will be needed throughout the
child's lifetime.
The medication schedule can be arranged to
allow for drug holidays.
The medication is given one time daily every
other day.
9

Answer B is correct. The medication will be
needed throughout the child’s lifetime.
Answers A, C, and D contain inaccurate
statements; therefore, they are incorrect.
Question 10

A.
B.
C.
D.
A client with diabetes mellitus has a
prescription for Glucotrol XL (glipizide). The
client should be instructed to take the
medication:
At bedtime
With breakfast
Before lunch
After dinner
10

Answer B is correct. Glucotrol XL is given
once a day with breakfast. Answer A is
incorrect because the client would develop
hypoglycemia while sleeping. Answers C and
D are incorrect because the client would
develop hypoglycemia later in the day or
evening.
Question 11

A.
B.
C.
D.
A client with Type II diabetes has an order
for regular insulin (Novolog) 10 units SC
each morning. The client's breakfast should
be served within:
15 minutes
20 minutes
30 minutes
45 minutes
11


Answer A is correct.
Novalog insulin onsets very quickly, so food
should be available within 10–15 minutes of
taking the insulin.
Question 12
What is another name for primal adrenal
insufficiency?
A.
B.
C.
D.
Addison’s disease
hypoglycemia
Parkinson’s disease
leukemia
12

Answer A is correct. Addison’s disease is
also known as primal adrenal insufficiency
Question 13
Margaret O'Hara, a 30-year-old known diabetic, is brought to the
emergency department by ambulance. The paramedic team reports
symptoms of apparent hyperglycemia. Stat blood glucose is 640.
The nurse is aware that excess serum glucose acts to draw fluids
osmotically with resultant polyuria. In addition to increased urinary
output, the nurse should expect to observe which of the following
sets of symptoms in Margaret?
A.
B.
C.
D.
A.
B.
C.
D.
Polydipsia, diaphoresis, bradycardia
Thirst, dry mucous membranes, hot dry skin
Hypotension, bounding pulse, headache
Nervousness, rapid respirations, diarrhea
13

Answer B is correct because these are all
symptoms associated with the dehydration that
occurs in hyperglycemia. Although polydypsia is
expected (response A), diaphoresis does not occur
in the body's effort to compensate by holding back
fluid. The patient would experience tachycardia as a
cardiac compensatory mechanism, causing a rapid,
thready pulse. Headache and nervousness
(responses C and D) are symptoms associated with
hypoglycemia.
Question 14
Loberta Jackson, a 21-year-old college student, is admitted to a
medical unit with diagnosis of uncontrolled diabetes, acute
hypoglycemic reaction.
Loberta explains to the admitting nurse that she had been feeling
"sick to my stomach, like I was coming down with the flu" for the
past 48 hours. She has continued to take her usual daily dosage
of insulin. Noting that Loberta has been admitted with a bloodglucose value of 46, which of the following assessment
questions would provide the most valuable information about
Loberta's status?
A.. "Have you been under a great deal of stress lately, Loberta?"
B. "Were you having difficulty sleeping after this illness started?"
C. "Have you eaten anything in the past 48 hours?"
D. "Did you take any medications for this illness other than your
insulin?"
14

Answer C is correct because it is highly probable
that Loberta, feeling "sick to her stomach," has not
taken in adequate foods and fluids, and coupled
with taking her usual dosage of daily insulin, has
brought about an acute hypoglycemic reaction.
(Higher than normal circulating levels of insulin
with insufficient food intake of essential nutrients
will result in acute decreased blood-glucose
levels). Response A, focusing on increased stress,
would more than likely stimulate a hyperglycemic
reaction, since stress causes elevations of blood
glucose. Response D, focusing on other
medications the patient has taken, would probably
not trigger a hypoglycemic reaction. Response B is
unrelated to her present status.
Question 15

23) A 7-year-old girl with insulin-dependent
diabetes (IDDM) has been home sick for several
days and is brought to the emergency department
by her parents. A diagnosis of ketoacidosis is
made. The nurse would expect to see which of the
following lab results for this client?
A.
Serum glucose 140 mg/dL
Serum creatine 5.2 mg/dL
Blood pH 7.28
Hematocrit 38%
B.
C.
D.
15

Answer B is correct. Explanation of
Answer: normal Blood pH is 7.35–7.45. A
level of 7.28 indicates acidosis.
Question 16





37) The nurse cares for a patient who has syndromes of
inappropriate antidiuretic hormone (SIADH). Which of the
following assessments would the nurse find consistent with this
diagnosis?
Urinary output of 2,500 cc/24 hours, sodium 122 mEq/L.
Urinary output of 800 cc/24 hours, sodium 156 mEq/L.
Urinary output of 2,700 cc/24 hours, sodium 164 mEq/L.
Urinary output of 500 cc/24 hours, sodium 118 mEq/L.
16

Answer D is correct. Explanation of
Answer: The patient would experience
decreased urine output, decreased serum
sodium, and hyponatremia with normal or
increased plasma volume
Question 17
The nurse explains to a client who has just
received the diagnosis of Noninsulin-Dependent
Diabetes Mellitus (NIDDM) that sulfonylureas,
one group of oral hypoglycemic agents, act by:
a. Stimulating the pancreas to produce or release
insulin
b. Making the insulin that is produced more
available for use
c. Lowering the blood sugar by facilitating the
uptake and utilization of glucose
d. Altering both fat and protein metabolism
17

Answer A is correct. Rationale:
Sulfonylurea drugs, Orinase for example,
lowers the blood sugar by stimulating the
beta cells of the pancreas to synthesize and
release insulin.
Question 18
A nursing assessment for initial signs of
Hypoglycemia will include:
A. Pallor, blurred vision, weakness, behavioral
changes
B. Frequent urination, flushed face, pleural
friction rub
C. Abdominal pain, diminished deep tendon
reflexes, double vision
D. Weakness, lassitude, irregular pulse, dilated
pupils
18

Answer A is correct: Rationale: Weakness,
fainting, blurred vision, pallor and perspiration
are all common symptoms when there is too
much insulin or too little food –
hypoglycemia. The signs and symptoms in
answers (b) and (c) are indicative of
hyperglycemia.
Question 19

Insulin inhibits the release of _______.
A.
Glucagon
ADH
Beta cells
Somatostatin
B.
C.
D.
19

A. Glucagon
Question 20

A.
B.
C.
D.
Which of the following is caused by
insulin release?
Increased breakdown of fats
Increase breakdown of proteins
Decreased blood sugar
Causes glucose to be phosphorylated in
kidney
20

C. Decreased blood sugar.
Question 21

Glucagon causes increased blood sugar
and causes slow breakdown of glycogen
in the liver.
A.
TRUE
FALSE
B.
21

B. FALSE
Question 22

A.
B.
As blood glucose decreases glucagon is
inhibited.
TRUE
FALSE
22

B. FALSE
Question 23

A.
B.
Glucagon increases blood levels of glucose
by causing liver to breakdown glycogen.
TRUE
FALSE
23

A. TRUE
Question 24

A.
B.
C.
D.
Which of the following is not true about Type
I DM?
May be linked to autoimmunity
Onset usually prior to age 20
Beta islet cells destroyed
Does not require insulin injections
24

D. Does not require insulin injections.
Question 25

Which of the following is not true about Type
II DM?
A.
Considered adult onset diabetes
Cause unknown may be due to genetics
Require insulin 80% of cases
May take a drug that sensitize cells or
increase insulin release
B.
C.
D.
25

C. Require insulin 80% of cases.
Question 26

A.
B.
C.
D.
Which of the following is not an effect of
diabetes?
Small vessel occlusion
Necrosis of extremities
Ketone Body production
Decreased fat metabolism
26

D. Decreased fat metabolism
Question 27

A.
B.
C.
D.
Which of the following is not an indicator of
a hypoglycemic condition?
Fatigue
Poor appetite
Tachycardia
Confusion
27

B. Poor appetite.
Question 28

A.
B.
C.
D.
Which of the following is not an adverse
effect of oral hypoglycemics?
Hypoglycemia
Headache
Rashes
Projectile vomiting
28

C. Projectile vomiting.
Question 29

A.
B.
C.
D.
Which of the following is not an adverse
effect of glucagon?
Allergic reaction
Vomiting
Nausea
Fever
29

D. Fever.
Question 30

A.
B.
C.
D.
Which of the following drugs may be given
as an immunosuppressant soon after onset
of Type I Diabetes?
Torsemide
Cyclosporine
Clofibrate
Ceftriaxone
30

B. Cyclosporine.
Question 31

A.
B.
C.
D.
Which of the following is not considered an
endocrine hormone?
Renin
Insulin
Glucagon
Somatostatin
31

A. Renin.
Question 32

A.
B.
C.
D.
What type of cells secrete glucagon?
Beta cells
Alpha cells
Plasma cells
Acinar cells
32

B. Alpha cells.
Question 33

A.
B.
C.
D.
What type of cells secrete insulin?
Beta cells
Alpha cells
Plasma cells
Acinar cells
33

A. Beta cells
Question 34

A.
B.
C.
D.
Which of the following would not be
considered an acute effect of diabetes
mellitus?
Polyuria
Weight gain
Polydipsia
Polyphagia
34

B. Weight gain
Question 35

A.
B.
C.
D.
Which of the following is not an accurate
test for diabetes?
Glucose tolerance test
HbA1c
Fasting serum glucose
Fasting glucagon test
35

D. Fasting glucagon test.
Question 36

A.
B.
C.
D.
Which of the following is not an indicator of
diabetic ketoacidosis?
Hyperthermia
Nausea/Vomiting
Slow and shallow breathing
Psychosis leading to dementia
36

C. Slow and shallow breathing.
Question 37

A.
B.
C.
D.
Which of the following is not related to a
chronic diabetes mellitus condition?
Atherosclerosis
Neuropathy
Glaucoma
Hypotension
37

D. Hypotension.
Question 38

A.
B.
C.
D.
Which of the following conditions is not
linked to diabetic ketoacidosis?
Cerebral edema
Arrhythmias
Peptic ulcers
Mucormycosis
38

C. Peptic ulcers.