ENDOCRINE SYSTEM

Prepared by: Prof. Mike Chavez RN, USRN

1. In a 28-year-old female client who is being successfully treated for Cushing's syndrome, the nurse would expect a
decline in:
A. serum glucose level.
B. hair loss.
C. bone mineralization.
D. menstrual flow.

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

A. Excessive sodium intake
B. A pituitary adenoma
C. Deficient potassium intake
D. An adrenal adenoma

3. The nurse is assessing a client with Cushing's syndrome. Which observation should the nurse report to the
physician immediately?
A. Pitting edema of the legs
B. An irregular apical pulse
C. Dry mucous membranes
D. Frequent urination

4. A client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding
should the nurse recognize as an adverse drug effect?
A. Dysuria
B. Leg cramps
C. Tachycardia
D. Blurred vision

5. The nurse explains to a client with thyroid disease that the thyroid gland normally produces:
A. iodine and thyroid-stimulating hormone (TSH).
B. thyrotropin-releasing hormone (TRH) and TSH.
C. TSH, T3, and calcitonin.
D. T3, T4, and calcitonin.

6. The client is being evaluated for hypothyroidism. During assessment, the nurse should stay alert for:
A. exophthalmos and conjunctival redness
B. flushed, warm, moist skin
C. systolic murmur at the left sternal border
D. decreased body temperature and cold intolerance

7. The nurse teaches a client with newly diagnosed hypothyroidism about the need for thyroid hormone replacement
therapy to restore normal thyroid function. Which thyroid preparation is the agent of choice for thyroid hormone
replacement therapy?
A. methimazole (Tapazole)
B. thyroid USP desiccated (Thyroid USP Enseals)
C. liothyronine (Cytomel)
D. levothyroxine (Synthroid)

8. Which important instruction concerning the administration of levothyroxine (Synthroid) should the nurse teach a
client?
A. "Take the drug on an empty stomach."
B. "Take the drug with meals."
C. "Take the drug in the evening."
D. "Take the drug whenever convenient."

9. The nurse 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

10. Which of the following laboratory test results would the nurse expect to find in a client diagnosed with
Hashimoto's thyroiditis?
A. Thyroxine (T4), 22 μg/dl; triiodothyronine (T3), 320 ng/dl; thyroid-stimulating hormone (TSH) undetectable
B. T4, 22 μg/dl; T3, 200 ng/dl; TSH 0.1 μIU/ml
C. T4, 2 μg/dl; T3, 200 ng/dl; TSH 5.9 μIU/ml
D. T4, 2 μg/dl; T3, 35 ng/dl; TSH 45 μIU/ml

11. Which of the following would the nurse expect to assess in an elderly client with Hashimoto's thyroiditis?
A. Weight loss, increased appetite, and hyperdefecation
B. Weight loss, increased urination, and increased thirst
C. Weight gain, decreased appetite, and constipation
D. Weight gain, increased urination, and purplish-red striae

12. An incoherent 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, the nurse prepares to take emergency action to prevent the potential complication of:
A. thyroid storm.
B. cretinism.
C. myxedema coma.
D. Hashimoto's thyroiditis.

13. Which of the following is the most critical intervention needed for a client with myxedema coma?
A. Administering an oral dose of levothyroxine (Synthroid)
B. Warming the client with a warming blanket
C. Measuring and recording accurate intake and output
D. Maintaining a patent airway

14. When caring for a client who's being treated for hyperthyroidism, it's important to:
A. provide extra blankets and clothing to keep the client warm.
B. monitor the client for signs of restlessness, sweating, and excessive weight loss during thyroid replacement
therapy.
C. balance the client's periods of activity and rest.
D. encourage the client to be active to prevent constipation.

15. A client visits the physician's office complaining of agitation, restlessness, and weight loss. The physical
examination reveals exophthalmos, a classic sign of Graves' disease. Based on history and physical findings, the
nurse suspects hyperthyroidism. Exophthalmos is characterized by:
A. dry, waxy swelling and abnormal mucin deposits in the skin.
B. protruding eyes and a fixed stare.
C. a wide, staggering gait.
D. more than 10 beats/minute difference between the apical and radial pulse rates.

16. For a client with Graves' disease, which nursing intervention promotes comfort?
A. Restricting intake of oral fluids
B. Placing extra blankets on the client's bed
C. Limiting intake of high-carbohydrate foods
D. Maintaining room temperature in the low-normal range

17. The nurse is assessing a client with hyperthyroidism. What findings should the nurse expect?
A. Weight gain, constipation, and lethargy
B. Weight loss, nervousness, and tachycardia
C. Exophthalmos, diarrhea, and cold intolerance
D. Diaphoresis, fever, and decreased sweating

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

A. a thyroid hormone antagonist.
B. thyroid extract.
C. a synthetic thyroid hormone.
D. emollient lotions.

19. Hyperthyroidism is caused by increased levels of thyroxine in blood plasma. A client with this endocrine
dysfunction would experience:
A. heat intolerance and systolic hypertension.
B. weight gain and heat intolerance.
C. diastolic hypertension and widened pulse pressure.
D. anorexia and hyperexcitability.

20. A middle-age female complains of anxiety, insomnia, weight loss, the inability to concentrate, and eyes feeling
"gritty". Thyroid function tests reveal the following: thyroid-stimulating hormone (TSH) 0.02 U/ml, thyroxine 20
g/dl, and triiodothyronine 253 ng/dl. A 6-hr radioactive iodine uptake test showed a diffuse uptake of 85%. Based
on these assessment findings, the nurse would suspect which of the following?
A. Thyroiditis
B. Graves' disease
C. Hashimoto's thyroiditis
D. Multinodular goiter

21. A client is being returned to the room after a subtotal thyroidectomy. Which piece of equipment is most important
for the nurse to keep at the client's bedside?
A. Indwelling urinary catheter kit
B. Tracheostomy set
C. Cardiac monitor
D. Humidifier

22. Early this morning, a client had a subtotal thyroidectomy. During evening rounds, the nurse 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

23. A client has a serum calcium level of 7.2 mg/dl. During the physical examination, the nurse expects to assess:
A. Trousseau's sign.
B. Homans' sign.
C. Hegar's sign.
D. Goodell's sign.

24. Before undergoing a subtotal thyroidectomy, a client receives potassium iodide (Lugol's solution) and
propylthiouracil (PTU). The nurse would expect the client's symptoms to subside:
A. in a few days.
B. in 3 to 4 months.
C. immediately.
D. in 1 to 2 weeks.

25. During preoperative teaching for a 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."

26. The nurse is caring for a client who had a thyroidectomy and is at risk for hypocalcemia. What should the nurse
do?
A. Monitor laboratory values daily for an elevated thyroid-stimulating hormone.
B. Observe for swelling of the neck, tracheal deviation, and severe pain.
C. Evaluate the quality of the client's voice postoperatively, noting any drastic changes.
D. Observe for muscle twitching and numbness or tingling of the lips, fingers, and toes.

27. The nurse 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?
A. Tetany
B. Hemorrhage
C. Thyroid storm
D. Laryngeal nerve damage

28. For the first 72 hours after thyroidectomy surgery, the nurse would assess the client for Chvostek's sign and
Trousseau's sign because they indicate which of the following?
A. Hypocalcemia
B. Hypercalcemia
C. Hypokalemia
D. Hyperkalemia

29. After undergoing a subtotal thyroidectomy, a client develops hypothyroidism. The physician prescribes
levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?
A. Primary hypothyroidism
B. Graves' disease
C. Thyrotoxicosis
D. Euthyroidism

30. A client is admitted to an acute care facility with a tentative diagnosis of hypoparathyroidism. The nurse should
monitor the client closely for the related problem of:
A. severe hypotension.
B. excessive thirst.
C. profound neuromuscular irritability.
D. acute gastritis.

31. Parathyroid hormone (PTH) has which of the following effects on the kidney?
A. Stimulation of calcium reabsorption and phosphate excretion
B. Stimulation of phosphate reabsorption and calcium excretion
C. Increased absorption of vitamin D and excretion of vitamin E
D. Increased absorption of vitamin E and excretion of vitamin D

32. The nurse is instructing a client with newly diagnosed hypoparathyroidism about the regimen used to treat this
disorder. The nurse should state that the physician probably will prescribe daily supplements of calcium and:
A. folic acid.
B. vitamin D.
C. potassium.
D. iron.

33. A client with a history of chronic hyperparathyroidism admits to being noncompliant. 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
34. When instructing the client diagnosed with hyperparathyroidism about diet, the nurse should stress the
importance of which of the following?
A. Restricting fluids
B. Restricting sodium
C. Forcing fluids
D. Restricting potassium

35. Which of the following would the nurse expect to find in a client diagnosed with hyperparathyroidism?
A. Hypocalcemia
B. Hypercalcemia
C. Hyperphosphatemia
D. Hypophosphaturia

36. A 68-year-old 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

37. During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the
physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH
maintains the balance between calcium and:
A. sodium.
B. potassium.
C. magnesium.
D. phosphorus.

38. A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen
and progesterone. Which of the following instructions would be most important to include in the client's teaching
plan?
A. Weight bearing exercises.
B. Rest as much as possible.
C. Lose weight.
D. Jog at least 2 miles per day.

39. Which of the following outcomes would indicate successful treatment of diabetes insipidus?
A. Fluid intake of less than 2,500 ml in 24 hours
B. Urine output of more than 200 ml/hour
C. Blood pressure of 90/50 mm Hg
D. Pulse rate of 126 beats/minute

40. The nurse is developing a teaching plan for a 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).

41. After surgery to remove a pituitary tumor, a client develops diabetes insipidus. Which of the following drugs would
the nurse expect to administer?
A. Vasopressin (Pitressin)
B. Furosemide (Lasix)
C. Regular insulin (Humulin-R)
D. Dextrose 10% in water
42. A client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should
the nurse provide?
A. "Administer desmopressin while the suspension is cold."
B. "Your condition isn't chronic, so you won't need to wear a medical identification bracelet."
C. "You may not be able to use desmopressin nasally if you have nasal discharge or blockage."
D. "You won't need to monitor your fluid intake and output after you start taking desmopressin."

43. Which of the following would indicate that a client has developed water intoxication secondary to treatment for
diabetes insipidus?
A. Confusion and seizures
B. Sunken eyeballs and spasticity
C. Flaccidity and thirst
D. Tetany and increased blood urea nitrogen (BUN) levels.

44. A client is diagnosed with the syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should
anticipate which laboratory test result?
A. Decreased serum sodium level
B. Decreased serum creatinine level
C. Increased hematocrit
D. Increased blood urea nitrogen (BUN) level

45. Which of these signs suggests that a client with the syndrome of inappropriate antidiuretic hormone (SIADH)
secretion is experiencing complications?
A. Tetanic contractions
B. Neck vein distention
C. Weight loss
D. Polyuria

46. A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client
that the physician will prescribe diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the
client does not comply with the recommended treatment, which complication may arise?
A. Cerebral edema
B. Hypovolemic shock
C. Severe hyperkalemia
D. Tetany
47. When assessing a client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive
catecholamine, the nurse is most likely to detect:
A. 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.

48. A female client 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

49. A client whose physical findings suggest a hyperpituitary condition undergoes an extensive diagnostic workup.
Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy. The evening before
the surgery, the nurse reviews preoperative and postoperative instructions given to the client earlier. Which
postoperative instruction should the nurse emphasize?
A. "You must lie flat for 24 hours after surgery."
B. "You must avoid coughing, sneezing, and blowing your nose."
C. "You must restrict your fluid intake."
D. "You must report ringing in your ears immediately."

50. A client is scheduled for a transsphenoidal hypophysectomy to remove a pituitary tumor. Preoperatively, the nurse
should assess for potential complications by doing which of the following?
A. Testing for ketones in the urine
B. Testing urine specific gravity
C. Checking temperature every 4 hours
D. Performing capillary glucose testing every 4 hours