NCLEX Endocrine System Disorders Practice Exam Quiz
Which of the following is a classic symptom of hyperthyroidism?
A. Bradycardia
B. Cold intolerance
C. Heat intolerance
D. Weight gain
Which hormone is secreted by the adrenal cortex?
A. Insulin
B. Glucagon
C. Cortisol
D. Antidiuretic hormone
A patient with diabetes insipidus will typically present with which symptom?
A. Polyuria
B. Oliguria
C. Hyperglycemia
D. Hypertension
Which laboratory finding is indicative of hypothyroidism?
A. Elevated T3 and T4
B. Elevated TSH
C. Low TSH
D. Low blood calcium
Which endocrine disorder is caused by an excess of growth hormone in adults?
A. Cushing’s syndrome
B. Addison’s disease
C. Acromegaly
D. Gigantism
What is the primary treatment for myxedema coma?
A. Insulin administration
B. Intravenous levothyroxine
C. Oral corticosteroids
D. Antithyroid medications
What is the hallmark sign of pheochromocytoma?
A. Persistent hypotension
B. Severe hypertension
C. Polyuria and polydipsia
D. Hypoglycemia
Which condition is characterized by moon face, buffalo hump, and central obesity?
A. Cushing’s syndrome
B. Graves’ disease
C. Addison’s disease
D. Diabetes insipidus
A client with SIADH is likely to have which electrolyte imbalance?
A. Hypernatremia
B. Hyponatremia
C. Hypercalcemia
D. Hypokalemia
Which test is used to diagnose diabetes mellitus?
A. TSH levels
B. HbA1c test
C. ACTH stimulation test
D. Serum calcium test
Which medication is typically prescribed for hyperthyroidism?
A. Levothyroxine
B. Methimazole
C. Prednisone
D. Calcitonin
Which symptom is commonly associated with Addison’s disease?
A. Hyperpigmentation
B. Hypertension
C. Hypernatremia
D. Tachycardia
What is a priority nursing intervention for a patient in thyroid storm?
A. Administer aspirin for fever control
B. Administer IV fluids and beta-blockers
C. Administer levothyroxine
D. Encourage oral fluids
What dietary advice is important for a client with hypoparathyroidism?
A. Avoid dairy products
B. Increase calcium-rich foods
C. Decrease protein intake
D. Increase sodium-rich foods
Which lab value is critical to monitor for a patient receiving insulin therapy?
A. Sodium
B. Potassium
C. Calcium
D. Hemoglobin
Which is a complication of untreated diabetes mellitus?
A. Hepatic encephalopathy
B. Diabetic ketoacidosis (DKA)
C. Hyperthyroidism
D. Cushing’s syndrome
What is the primary cause of hyperparathyroidism?
A. Hypocalcemia
B. Adenoma of the parathyroid gland
C. Vitamin D deficiency
D. Chronic renal failure
A client with Cushing’s syndrome is at increased risk for which condition?
A. Osteoporosis
B. Hypotension
C. Hypoglycemia
D. Hyperkalemia
What symptom is most concerning in a patient with Graves’ disease?
A. Anxiety
B. Exophthalmos
C. Tachycardia
D. Thyroid storm
Which disorder involves an overproduction of ADH?
A. SIADH
B. Diabetes mellitus
C. Diabetes insipidus
D. Addison’s disease
Which is the preferred insulin for an emergency diabetic ketoacidosis (DKA)?
A. NPH insulin
B. Regular insulin
C. Glargine insulin
D. Detemir insulin
A priority for a patient with hypoglycemia is:
A. Administer IV fluids
B. Provide a carbohydrate-rich snack
C. Check blood pressure
D. Administer glucagon only if symptoms worsen
Which condition is associated with a goiter?
A. Addison’s disease
B. Hyperthyroidism
C. Diabetes insipidus
D. Cushing’s syndrome
What is the most important complication to monitor for after thyroidectomy?
A. Hypertension
B. Hypocalcemia
C. Hyperglycemia
D. Hyponatremia
Which test assesses long-term blood glucose control?
A. Fasting blood glucose test
B. Oral glucose tolerance test
C. HbA1c test
D. Random plasma glucose
Which electrolyte disturbance is associated with adrenal crisis?
A. Hyperkalemia
B. Hypokalemia
C. Hypernatremia
D. Hypercalcemia
Which is a late sign of hypoglycemia?
A. Diaphoresis
B. Shakiness
C. Seizures
D. Hunger
Which intervention is most important in managing a patient with diabetic ketoacidosis?
A. Administering potassium supplements
B. Initiating IV insulin therapy
C. Providing oxygen therapy
D. Administering corticosteroids
Which symptom is typical in hypothyroidism?
A. Tachycardia
B. Hair thinning
C. Weight loss
D. Nervousness
Which is a risk factor for type 2 diabetes?
A. Being underweight
B. Autoimmune conditions
C. Obesity
D. Hyperthyroidism
What is the primary cause of exophthalmos in Graves’ disease?
A. Increased secretion of TSH
B. Autoimmune inflammation of orbital tissue
C. Decreased secretion of thyroid hormones
D. Elevated calcitonin levels
A client with a history of Addison’s disease is admitted for severe hypotension and dehydration. What is the priority intervention?
A. Administer potassium supplements
B. Administer IV hydrocortisone
C. Provide oral fluids
D. Monitor blood glucose
Which medication is commonly prescribed for acromegaly to inhibit growth hormone release?
A. Levothyroxine
B. Octreotide
C. Metformin
D. Desmopressin
What is the key distinguishing symptom of diabetes insipidus compared to SIADH?
A. Hyponatremia
B. Polyuria
C. Edema
D. Weight gain
What is the most common cause of hyperthyroidism?
A. Hashimoto’s thyroiditis
B. Graves’ disease
C. Thyroid cancer
D. Iodine deficiency
A patient receiving long-term corticosteroid therapy is at risk for which complication?
A. Hyperthyroidism
B. Addisonian crisis
C. Osteoporosis
D. Hypoglycemia
Which electrolyte imbalance is a hallmark of hypoparathyroidism?
A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hypophosphatemia
What is the primary goal of treatment in a patient with diabetic ketoacidosis (DKA)?
A. Reduce serum potassium levels
B. Administer IV corticosteroids
C. Correct dehydration and acidosis
D. Increase insulin resistance
Which complication is associated with untreated hypothyroidism?
A. Thyroid storm
B. Myxedema coma
C. Addisonian crisis
D. Diabetic ketoacidosis
What is the expected outcome of administering calcitonin for hypercalcemia?
A. Decreased serum calcium levels
B. Increased bone resorption
C. Increased secretion of parathyroid hormone
D. Elevated blood glucose levels
Which test confirms the diagnosis of acromegaly?
A. Serum calcium levels
B. Serum insulin-like growth factor-1 (IGF-1)
C. TSH levels
D. Random glucose test
Which medication is commonly used to treat adrenal insufficiency?
A. Insulin
B. Hydrocortisone
C. Levothyroxine
D. Methimazole
What is the primary treatment for hypothyroidism?
A. Antithyroid drugs
B. Radioactive iodine therapy
C. Levothyroxine replacement therapy
D. Beta-blockers
A client with type 1 diabetes is found unconscious. What should the nurse administer first?
A. Oral glucose tablets
B. IV dextrose 50%
C. Subcutaneous insulin
D. Intravenous normal saline
Which symptom would indicate a patient is experiencing hyperglycemic hyperosmolar syndrome (HHS)?
A. Fruity-smelling breath
B. Severe hyperglycemia without ketosis
C. Kussmaul respirations
D. Hypoglycemia
A client with Cushing’s syndrome may exhibit which clinical feature?
A. Hypotension and hypoglycemia
B. Truncal obesity and moon face
C. Weight loss and muscle wasting
D. Exophthalmos and tachycardia
Which diagnostic test is most definitive for confirming pheochromocytoma?
A. 24-hour urine for catecholamines
B. Thyroid-stimulating hormone (TSH) level
C. Serum cortisol level
D. Serum glucose level
What is the primary effect of aldosterone in the body?
A. Regulation of blood glucose
B. Sodium and water retention
C. Stimulation of thyroid hormone production
D. Calcium resorption in bones
A client with hyperparathyroidism is at risk for which complication?
A. Hypocalcemia
B. Osteoporosis
C. SIADH
D. Addisonian crisis
What is the first-line treatment for thyroid storm?
A. IV hydrocortisone
B. Beta-blockers
C. Radioactive iodine
D. Oral calcium supplements
A client with diabetes mellitus reports burning sensations in their feet. What condition is most likely causing this symptom?
A. Peripheral neuropathy
B. Diabetic ketoacidosis
C. Hypoglycemia
D. Peripheral vascular disease
Which intervention is most appropriate for a client experiencing SIADH?
A. Administer desmopressin
B. Restrict fluid intake
C. Provide potassium supplements
D. Encourage a high-sodium diet
What is the hallmark feature of hyperosmolar hyperglycemic syndrome (HHS)?
A. Severe ketosis
B. Profound dehydration
C. Hypoglycemia
D. Kussmaul respirations
Which symptom is most concerning in a client with hypoglycemia?
A. Diaphoresis
B. Tachycardia
C. Confusion
D. Polyuria
A client presents with lethargy, weight gain, and cold intolerance. Which condition is most likely?
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing’s syndrome
D. Addison’s disease
Which electrolyte imbalance is associated with SIADH?
A. Hypercalcemia
B. Hyponatremia
C. Hyperkalemia
D. Hypophosphatemia
What is the purpose of an A1C test in diabetes management?
A. To diagnose type 1 diabetes
B. To evaluate long-term glucose control
C. To measure immediate blood sugar levels
D. To monitor for diabetic ketoacidosis
Which medication is used to treat severe hypoglycemia in unconscious clients?
A. Oral glucose
B. Glucagon injection
C. Insulin injection
D. IV potassium
What is the most common clinical manifestation of thyroid cancer?
A. Rapid heart rate
B. Palpable, painless nodule on the thyroid
C. Unexplained weight loss
D. Hypercalcemia
A client with Addison’s disease is prescribed fludrocortisone. What should the nurse monitor closely?
A. Blood glucose levels
B. Blood pressure and serum potassium
C. Calcium levels
D. White blood cell count
Which is a classic sign of hypoglycemia in a client with diabetes?
A. Polyuria
B. Blurred vision
C. Irritability
D. Fruity breath odor
Which lab finding is expected in a client with primary hypothyroidism?
A. Elevated TSH, low T3 and T4
B. Low TSH, elevated T3 and T4
C. Low TSH, low T3 and T4
D. Elevated TSH, elevated T3 and T4
A client with SIADH is likely to exhibit which finding?
A. Hyperkalemia
B. Increased urine output
C. Low serum sodium
D. Elevated serum osmolality
Which complication should the nurse monitor for in a client with hyperparathyroidism?
A. Tetany
B. Pathologic fractures
C. Hypernatremia
D. Hypokalemia
A nurse is educating a client on insulin therapy. Which insulin has the fastest onset?
A. NPH insulin
B. Regular insulin
C. Insulin glargine
D. Lispro insulin
What is the hallmark sign of myxedema coma?
A. Hyperglycemia
B. Severe bradycardia
C. Hypertension
D. Tachycardia
Which medication is most commonly used to manage hyperthyroidism?
A. Propylthiouracil (PTU)
B. Hydrocortisone
C. Levothyroxine
D. Octreotide
Which electrolyte imbalance is common in adrenal insufficiency?
A. Hypernatremia and hypokalemia
B. Hyponatremia and hyperkalemia
C. Hypocalcemia and hypokalemia
D. Hypercalcemia and hypernatremia
What is a characteristic feature of acromegaly?
A. Sudden weight loss
B. Thickened facial features
C. Delayed puberty
D. Shortened limbs
Which condition is associated with low serum cortisol levels?
A. Addison’s disease
B. Cushing’s syndrome
C. Hyperthyroidism
D. Acromegaly
A nurse is caring for a client with diabetic ketoacidosis (DKA). Which lab finding is expected?
A. Hypokalemia
B. Metabolic acidosis
C. Elevated serum bicarbonate
D. Decreased blood glucose
Which hormone is deficient in diabetes insipidus?
A. Thyroid hormone
B. Antidiuretic hormone (ADH)
C. Growth hormone
D. Cortisol
A client with Grave’s disease is prescribed propranolol. What is the primary purpose of this medication?
A. To inhibit thyroid hormone production
B. To manage tachycardia and palpitations
C. To lower blood glucose levels
D. To reduce exophthalmos
Which intervention is a priority for a client with hyperosmolar hyperglycemic syndrome (HHS)?
A. Administering potassium
B. Correcting fluid deficits with IV fluids
C. Administering sodium bicarbonate
D. Administering glucagon
What is the most likely cause of hyperpigmentation in Addison’s disease?
A. Increased levels of ACTH
B. Elevated thyroid hormone levels
C. Increased cortisol production
D. Low levels of aldosterone
Which condition is most commonly associated with exophthalmos?
A. Hypothyroidism
B. Hyperthyroidism
C. Cushing’s syndrome
D. Addison’s disease
What dietary advice is appropriate for a client with hypoparathyroidism?
A. Increase foods rich in calcium and vitamin D
B. Limit intake of green leafy vegetables
C. Avoid dairy products
D. Focus on high-sodium foods
What is the primary action of calcitonin?
A. Lower blood calcium levels
B. Increase calcium absorption in the intestines
C. Increase bone resorption
D. Stimulate parathyroid hormone secretion
A client with diabetes insipidus is being treated with desmopressin. What is a sign of effective treatment?
A. Increased thirst
B. Decreased urine output
C. Increased blood glucose
D. Elevated serum sodium
Which lab result is consistent with diabetic ketoacidosis (DKA)?
A. Serum pH of 7.48
B. Elevated serum ketones
C. Decreased serum potassium
D. Low serum bicarbonate
A client is being evaluated for hyperthyroidism. Which symptom is most indicative of this condition?
A. Weight gain and lethargy
B. Cold intolerance and bradycardia
C. Weight loss and tachycardia
D. Constipation and dry skin
What is the primary concern in a client with acute hypoparathyroidism?
A. Hypercalcemia
B. Tetany and laryngospasm
C. Fluid volume overload
D. Hyperkalemia
Which test is most specific for diagnosing acromegaly?
A. Serum cortisol levels
B. Oral glucose tolerance test with growth hormone measurement
C. MRI of the thyroid gland
D. Fasting blood glucose test
Which medication is used to treat hypothyroidism?
A. Methimazole
B. Levothyroxine
C. Propylthiouracil (PTU)
D. Hydrocortisone
Which nursing intervention is a priority for a client with a thyroidectomy?
A. Encourage a high-calorie diet
B. Monitor for signs of hypocalcemia
C. Administer corticosteroids
D. Restrict fluid intake
A client with a pheochromocytoma is being prepared for surgery. Which preoperative intervention is critical?
A. Administering beta-blockers to control blood pressure
B. Restricting sodium in the diet
C. Monitoring for signs of hypoglycemia
D. Ensuring adequate calcium levels
What is a hallmark sign of Conn’s syndrome (primary hyperaldosteronism)?
A. Hyponatremia and hyperkalemia
B. Hypernatremia and hypokalemia
C. Hypercalcemia and hypophosphatemia
D. Hypoglycemia and hyponatremia
A client with Addison’s disease is prescribed corticosteroids. What is an important teaching point?
A. Take the medication at bedtime
B. Avoid foods high in potassium
C. Do not stop the medication abruptly
D. Increase salt intake only during illness
What is the most common cause of hyperthyroidism?
A. Hashimoto’s thyroiditis
B. Iodine deficiency
C. Grave’s disease
D. Pituitary adenoma
Which intervention is most appropriate for a client with hypoglycemia?
A. Administer regular insulin
B. Provide 15 grams of simple carbohydrates
C. Encourage increased fluid intake
D. Restrict food until symptoms subside
Which of the following is an expected finding in a client with Cushing’s syndrome?
A. Hyperkalemia and hypoglycemia
B. Hyperglycemia and moon face
C. Hypoglycemia and weight loss
D. Hyponatremia and hypotension
What is a priority nursing action for a client experiencing thyroid storm?
A. Administering levothyroxine
B. Cooling the client and administering beta-blockers
C. Encouraging increased fluid intake
D. Providing high-calorie meals
Which lab finding is consistent with syndrome of inappropriate antidiuretic hormone (SIADH)?
A. Hypernatremia
B. Elevated urine osmolality
C. Increased hematocrit
D. Decreased urine specific gravity
A client with diabetes mellitus is at risk for developing which of the following chronic complications?
A. Acute kidney injury
B. Retinopathy and neuropathy
C. Thyroid dysfunction
D. Pulmonary embolism
A nurse is caring for a client with Graves’ disease. Which intervention should be prioritized?
A. Monitor for signs of hypoglycemia
B. Provide a warm environment
C. Monitor for signs of thyroid storm
D. Administer levothyroxine as prescribed
Which medication is used to treat diabetes insipidus?
A. Hydrocortisone
B. Desmopressin
C. Levothyroxine
D. Methimazole
What is the primary function of parathyroid hormone (PTH)?
A. Regulate sodium balance
B. Lower blood glucose levels
C. Increase blood calcium levels
D. Stimulate thyroid hormone production
Which of the following is a clinical manifestation of Addisonian crisis?
A. Hypertension and bradycardia
B. Severe hypotension and hyperkalemia
C. Hypoglycemia and weight gain
D. Increased appetite and hypernatremia
A nurse is educating a client with type 1 diabetes on insulin therapy. Which statement indicates understanding?
A. “I can skip a dose of insulin if I’m not eating.”
B. “I need to rotate injection sites to prevent lipodystrophy.”
C. “I should shake the insulin bottle vigorously before use.”
D. “I will only take insulin if my blood sugar is above 200 mg/dL.”
Which diagnostic test is most commonly used to confirm pheochromocytoma?
A. MRI of the adrenal glands
B. Serum calcium levels
C. Urinary catecholamine levels
D. Serum glucose levels
Which electrolyte imbalance is common in clients with diabetic ketoacidosis (DKA)?
A. Hyperkalemia
B. Hypocalcemia
C. Hypernatremia
D. Hypokalemia
Which dietary restriction is recommended for a client with hyperthyroidism?
A. Avoiding foods high in iodine
B. Limiting potassium-rich foods
C. Reducing carbohydrate intake
D. Avoiding fatty foods
What is the priority intervention for a client with myxedema coma?
A. Administering IV thyroid hormone replacement
B. Restricting fluid intake
C. Providing a high-protein diet
D. Encouraging ambulation
Which complication is most likely in a client with untreated hypothyroidism?
A. Thyroid storm
B. Myxedema coma
C. Adrenal crisis
D. Diabetic ketoacidosis
What is the hallmark symptom of hyperaldosteronism?
A. Hypertension and hypokalemia
B. Hypotension and hyperkalemia
C. Bradycardia and hyponatremia
D. Weight loss and tachycardia
Which hormone is deficient in a client with diabetes insipidus?
A. Insulin
B. Antidiuretic hormone (ADH)
C. Glucagon
D. Thyroxine (T4)
A nurse is caring for a client post-thyroidectomy. What is the priority assessment?
A. Monitoring for infection
B. Assessing for signs of tetany
C. Evaluating bowel sounds
D. Monitoring for bradycardia
What is the primary purpose of glucocorticoids?
A. Regulating blood glucose levels and reducing inflammation
B. Enhancing calcium absorption
C. Promoting sodium excretion
D. Increasing thyroid hormone production
Which lab value would you expect in a client with SIADH?
A. Low urine osmolality
B. Hypernatremia
C. Hyponatremia
D. High hematocrit
What is the expected effect of insulin on potassium levels?
A. Increases serum potassium levels
B. Decreases serum potassium levels
C. No effect on potassium levels
D. Causes potassium retention in the kidneys
Which symptom is most indicative of hypoglycemia?
A. Polyuria
B. Blurred vision
C. Diaphoresis and tremors
D. Fruity-smelling breath
A client with hypothyroidism complains of weight gain, fatigue, and cold intolerance. Which lab result is expected?
A. Elevated T3 and T4
B. Decreased T3 and T4, elevated TSH
C. Increased T3 and decreased TSH
D. Normal T3, T4, and TSH
What is the primary goal in the treatment of hyperparathyroidism?
A. Decrease calcium excretion in the urine
B. Lower serum calcium levels
C. Enhance phosphate absorption in the gut
D. Increase production of calcitonin
Which complication is most likely in a client with untreated acromegaly?
A. Hypoglycemia
B. Cardiovascular disease
C. Hypercalcemia
D. Addisonian crisis
Which intervention is critical for a client with Addison’s disease undergoing surgery?
A. Withholding all medications preoperatively
B. Administering supplemental corticosteroids
C. Monitoring for hypernatremia
D. Restricting fluid intake
What is the primary purpose of radioactive iodine therapy in hyperthyroidism?
A. Stimulate thyroid hormone production
B. Suppress pituitary TSH secretion
C. Destroy overactive thyroid cells
D. Reduce thyroid gland vascularity
Which finding is most concerning in a client with DKA?
A. Blood glucose of 350 mg/dL
B. Rapid, deep respirations
C. Blood pH of 7.30
D. Potassium level of 4.5 mEq/L
Which clinical manifestation suggests a diagnosis of hypoglycemia?
A. Fruity breath odor
B. Confusion and irritability
C. Excessive thirst
D. Frequent urination
Which intervention is critical in managing a client with myxedema coma?
A. Administering warm IV fluids
B. Initiating thyroid hormone replacement
C. Restricting fluid intake
D. Providing continuous oxygen therapy
What is the most common cause of secondary hyperparathyroidism?
A. Vitamin D toxicity
B. Chronic kidney disease
C. Parathyroid adenoma
D. Calcium deficiency
Which condition is most likely to develop in a client with long-term untreated hyperthyroidism?
A. Osteoporosis
B. Hypoglycemia
C. Cardiomyopathy
D. Myxedema coma
Which symptom is most characteristic of pheochromocytoma?
A. Persistent hypoglycemia
B. Severe episodic hypertension
C. Weight loss and diarrhea
D. Polyuria and polydipsia
What is the primary mechanism of action for metformin in type 2 diabetes management?
A. Stimulates insulin production from the pancreas
B. Decreases hepatic glucose production
C. Increases insulin receptor sensitivity in muscle tissue
D. Promotes glucagon release
Which electrolyte imbalance should the nurse monitor for in a client with hyperaldosteronism?
A. Hyperkalemia
B. Hypokalemia
C. Hyponatremia
D. Hypermagnesemia
Which of the following clinical signs is consistent with hypercalcemia caused by hyperparathyroidism?
A. Tetany
B. Chvostek’s sign
C. Constipation and muscle weakness
D. Increased deep tendon reflexes
Which of the following symptoms is most concerning in a client with Graves’ disease?
A. Heart rate of 110 bpm
B. Protruding eyeballs (exophthalmos)
C. Elevated blood pressure
D. Temperature of 103°F (39.4°C)
Which condition is associated with excessive growth hormone production in adults?
A. Acromegaly
B. Gigantism
C. Dwarfism
D. Cushing’s syndrome
A client with hypothyroidism is prescribed levothyroxine. Which statement by the client indicates a need for further teaching?
A. “I should take the medication in the morning on an empty stomach.”
B. “I can stop the medication once my symptoms improve.”
C. “I should have my TSH levels monitored regularly.”
D. “It may take weeks to notice an improvement in my symptoms.”
Which clinical finding would most likely suggest Addison’s disease?
A. Hyperglycemia and hypertension
B. Hypoglycemia and hyperpigmentation
C. Hypernatremia and bradycardia
D. Hypokalemia and moon face
What is the recommended dietary adjustment for a client with hypoparathyroidism?
A. Low-calcium diet
B. High-calcium, low-phosphorus diet
C. Low-protein diet
D. High-sodium diet
Which clinical sign is an early indicator of thyroid storm?
A. Profound bradycardia
B. Sudden onset of high fever
C. Severe hypothermia
D. Decreased deep tendon reflexes
Which laboratory test result confirms the diagnosis of diabetes insipidus?
A. High urine specific gravity
B. Low serum sodium
C. Low urine osmolality
D. High serum potassium
Which intervention is most appropriate for a client with hypercalcemia due to hyperparathyroidism?
A. Administering IV calcium gluconate
B. Encouraging fluid intake to prevent kidney stones
C. Restricting vitamin D intake
D. Placing the client on a high-calcium diet
What is the priority nursing action for a client presenting with diabetic ketoacidosis (DKA)?
A. Administering subcutaneous insulin
B. Providing oral rehydration
C. Starting IV fluids and regular insulin infusion
D. Administering oral potassium supplements
Which hormone imbalance is responsible for the clinical manifestations of Cushing’s syndrome?
A. Decreased aldosterone levels
B. Increased cortisol levels
C. Reduced T3 and T4 hormones
D. Elevated epinephrine levels
A client with Addison’s disease is experiencing acute adrenal crisis. Which intervention should the nurse implement first?
A. Administer oral hydrocortisone
B. Prepare for an immediate ECG
C. Start an IV infusion of normal saline
D. Place the client on a low-sodium diet
Which clinical manifestation is expected in a client with untreated hyperthyroidism?
A. Cold intolerance
B. Weight gain and fatigue
C. Bradycardia and lethargy
D. Heat intolerance and weight loss
Which of the following would be a priority intervention for a client with hypoglycemia?
A. Administering 0.9% sodium chloride IV fluid
B. Administering insulin as prescribed
C. Providing a source of glucose, such as orange juice
D. Encouraging the client to rest in bed
Which symptom is most characteristic of diabetes insipidus (DI)?
A. Polyphagia
B. Excessive thirst and polyuria
C. Diaphoresis and tremors
D. Fruity-smelling breath
Which electrolyte imbalance should the nurse expect in a client with Cushing’s syndrome?
A. Hyperkalemia
B. Hyponatremia
C. Hypernatremia
D. Hypomagnesemia
What is a primary symptom of thyroid storm?
A. Increased blood pressure and fever
B. Rapid weight gain and fatigue
C. Weight loss and bradycardia
D. Slow deep respirations and hypothermia
Which of the following is an early indicator of hypoglycemia in a diabetic client?
A. Sweating and shaking
B. Deep and rapid breathing
C. Increased thirst and urination
D. Polyphagia and dry skin
A client with hyperparathyroidism is at risk for which of the following complications?
A. Renal stones
B. Severe dehydration
C. Diabetic ketoacidosis
D. Hypotension
Which laboratory finding is most indicative of diabetic ketoacidosis (DKA)?
A. Low blood glucose levels
B. Low pH and elevated ketones in urine
C. Decreased serum bicarbonate
D. High serum sodium and potassium levels
What is the most common cause of hypothyroidism in the United States?
A. Graves’ disease
B. Thyroidectomy
C. Hashimoto’s thyroiditis
D. Iodine deficiency
Which of the following is a common side effect of long-term corticosteroid therapy in a patient with Cushing’s syndrome?
A. Hyperkalemia
B. Osteoporosis
C. Hypoglycemia
D. Weight loss
Which clinical sign is most associated with a thyroid storm?
A. Severe hypotension
B. Severe hyperthermia
C. Decreased heart rate
D. Increased appetite
What is the priority nursing assessment in a client receiving insulin therapy for diabetes mellitus?
A. Assessing for signs of infection
B. Monitoring blood glucose levels
C. Assessing kidney function
D. Checking for signs of peripheral neuropathy
A client with acromegaly is prescribed octreotide. Which of the following is a therapeutic effect of this medication?
A. Decreasing cortisol production
B. Reducing growth hormone secretion
C. Enhancing thyroid hormone production
D. Promoting insulin secretion
What is the primary focus of care for a client with pheochromocytoma?
A. Promoting weight gain
B. Monitoring for hypertensive crises
C. Reducing blood glucose levels
D. Limiting fluid intake
A nurse is caring for a client with Addison’s disease. Which of the following symptoms should the nurse immediately report to the healthcare provider?
A. Fatigue and muscle weakness
B. Hyperpigmentation of the skin
C. Severe hypotension and tachycardia
D. Weight gain and increased appetite
A client with hyperthyroidism is prescribed methimazole. Which statement by the client indicates a need for further education about the medication?
A. “I will take this medication every day at the same time.”
B. “I should have my thyroid function tested regularly.”
C. “This medication may cause me to feel more tired.”
D. “I will stop taking this medication if I develop a sore throat.”
What is the most common initial sign of diabetic ketoacidosis (DKA)?
A. Dehydration
B. Kussmaul respirations
C. Fruity-smelling breath
D. Vomiting
A nurse is caring for a client with a goiter. Which of the following interventions is appropriate?
A. Administering radioactive iodine
B. Restricting sodium intake
C. Elevating the head of the bed
D. Encouraging increased fluid intake
Which of the following is a key characteristic of the early stages of diabetic neuropathy?
A. Pain in the feet and legs
B. Complete loss of sensation in the extremities
C. High blood sugar levels with severe fatigue
D. Difficulty swallowing and shortness of breath
What is the most important action for the nurse to take when caring for a client with thyroid storm?
A. Administering a sedative
B. Providing a cooling blanket
C. Restricting fluid intake
D. Encouraging high-calorie foods
Which of the following is a sign of severe hypercalcemia associated with hyperparathyroidism?
A. Hypertension
B. Nausea and vomiting
C. Bradycardia
D. Increased thirst and urination
A client with type 2 diabetes asks the nurse about insulin therapy. What is the nurse’s best response?
A. “You will need insulin only if your blood sugar is very high.”
B. “Insulin therapy is often used when diet and oral medications do not control blood sugar levels.”
C. “Insulin therapy is the first-line treatment for type 2 diabetes.”
D. “Insulin will cure your diabetes and help you manage your blood sugar better.”
Which of the following medications is commonly used to treat hyperkalemia in clients with Addison’s disease?
A. Furosemide
B. Spironolactone
C. Potassium chloride
D. Kayexalate
A client with Cushing’s syndrome is at risk for developing which of the following complications?
A. Hypotension and bradycardia
B. Hyperglycemia and delayed wound healing
C. Osteoporosis and weight gain
D. Tachycardia and increased potassium levels
Which condition is associated with a significant increase in the secretion of aldosterone?
A. Addison’s disease
B. Cushing’s syndrome
C. Hyperaldosteronism
D. Diabetes insipidus
A client with a history of hypothyroidism has been prescribed levothyroxine. Which of the following would indicate an adverse effect of the medication?
A. Increased heart rate and restlessness
B. Weight gain and increased energy
C. Decreased appetite and drowsiness
D. Improved skin turgor and moisture
Which of the following is the priority concern for a client with diabetes mellitus during the perioperative period?
A. Managing blood glucose levels
B. Promoting physical activity
C. Providing proper nutrition preoperatively
D. Monitoring for signs of dehydration
A client with pheochromocytoma is at risk for which of the following?
A. Hypotension and bradycardia
B. Hyperthyroidism and tachycardia
C. Severe hypertension and tachycardia
D. Hypoglycemia and tachypnea
Which of the following interventions should the nurse prioritize for a client with newly diagnosed type 1 diabetes mellitus?
A. Initiating insulin therapy and teaching about self-injection
B. Teaching the client about the importance of diet modification only
C. Discussing the potential for long-term complications
D. Starting oral hypoglycemic agents
Questions and Answers for Study Guide
Describe the pathophysiology, clinical manifestations, and nursing interventions for a client diagnosed with hyperthyroidism (Graves’ disease).
Answer:
Pathophysiology:
Hyperthyroidism, particularly Graves’ disease, is an autoimmune disorder where the body’s immune system produces antibodies (thyroid-stimulating immunoglobulins) that stimulate the thyroid gland to produce excess thyroid hormones (T3 and T4). This results in an accelerated metabolic rate, affecting many bodily systems, particularly the cardiovascular and nervous systems.
Clinical Manifestations:
Common symptoms include weight loss despite an increased appetite, nervousness, irritability, heat intolerance, excessive sweating, fatigue, and tremors. Cardiovascular symptoms include tachycardia, palpitations, and possibly atrial fibrillation. Patients may also present with bulging eyes (exophthalmos), goiter (enlarged thyroid), and increased bowel movements or diarrhea.
Nursing Interventions:
- Assessment: Monitor vital signs, particularly heart rate and blood pressure, as tachycardia is common. Assess for signs of exophthalmos and goiter.
- Medication management: Administer antithyroid medications such as methimazole or propylthiouracil to inhibit the production of thyroid hormones.
- Symptom management: Provide cooling measures for heat intolerance, and monitor for dehydration due to excessive sweating.
- Patient education: Teach the client about the importance of taking medications as prescribed and avoiding over-the-counter medications that may interfere with treatment. Encourage regular follow-ups to monitor thyroid hormone levels.
Explain the management and nursing care of a client experiencing diabetic ketoacidosis (DKA).
Answer:
Management:
Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, particularly type 1 diabetes, caused by severe insulin deficiency. The lack of insulin leads to hyperglycemia, ketone production, and acidosis.
Nursing Care:
- Initial Assessment: The nurse should assess vital signs, including blood pressure, heart rate, and respiratory rate (Kussmaul breathing is often present). A thorough assessment of blood glucose and ketone levels is essential.
- Fluid and Electrolyte Replacement: Administer intravenous (IV) fluids, typically starting with 0.9% saline to correct dehydration. After initial stabilization, fluids are switched to 0.45% saline to prevent a rapid decline in sodium levels. Potassium replacement may be necessary as insulin therapy is initiated, which shifts potassium into cells.
- Insulin Therapy: Administer regular insulin intravenously to lower blood glucose levels. The insulin drip is titrated based on blood glucose levels, typically aiming for a gradual decrease to avoid cerebral edema.
- Monitoring for Complications: Monitor for signs of fluid overload, hypokalemia, and hypoglycemia as blood glucose levels drop. Neurological status should be monitored to assess for signs of cerebral edema.
- Patient Education: Once stabilized, educate the client on the importance of managing blood glucose levels, understanding how to adjust insulin doses during illness, and preventing dehydration.
What are the nursing considerations for a client diagnosed with Cushing’s syndrome, and how does the condition affect the body?
Answer:
Pathophysiology:
Cushing’s syndrome results from prolonged exposure to high levels of cortisol, often due to the use of corticosteroid medications or a pituitary tumor (Cushing’s disease). High cortisol levels increase glucose production, reduce the immune response, and affect fat and protein metabolism, leading to several systemic changes.
Clinical Manifestations:
Key signs include weight gain, particularly in the abdomen and face (moon face), and a buffalo hump (fat accumulation in the upper back). Muscle weakness and thinning of the skin are common due to protein breakdown. The client may also experience hyperglycemia, increased risk of infection, delayed wound healing, osteoporosis, and hypertension due to fluid retention and sodium retention.
Nursing Considerations:
- Assess for Signs and Symptoms: Monitor for weight gain, changes in skin appearance, and signs of infection or delayed wound healing.
- Medications: Administer medications to control cortisol levels, such as ketoconazole, and consider tapering corticosteroids if prescribed for other conditions.
- Monitoring Fluid and Electrolyte Balance: Assess for edema and electrolyte imbalances, especially hypokalemia and hypernatremia. Monitor blood pressure closely.
- Patient Education: Educate the client on the importance of avoiding infections, managing weight, and understanding the need for possible medication adjustments. Teach the client about gradual tapering of corticosteroids to prevent adrenal insufficiency.
What is the pathophysiology and nursing care for a client with Addison’s disease?
Answer:
Pathophysiology:
Addison’s disease, also known as primary adrenal insufficiency, occurs when the adrenal glands fail to produce sufficient amounts of cortisol and aldosterone. This often results from autoimmune destruction of the adrenal cortex, but can also occur due to tuberculosis or other causes. Insufficient cortisol leads to an impaired stress response, while a lack of aldosterone results in sodium and water loss, causing dehydration and hypotension.
Clinical Manifestations:
Symptoms include fatigue, weight loss, muscle weakness, hyperpigmentation (darkened skin), low blood pressure, and salt cravings due to sodium loss. Clients may also experience nausea, vomiting, and abdominal pain.
Nursing Care:
- Fluid and Electrolyte Balance: Monitor for dehydration and electrolyte imbalances, particularly hyponatremia and hyperkalemia. Administer IV fluids (e.g., normal saline) and electrolytes as needed.
- Corticosteroid Replacement: Administer hydrocortisone or prednisone as prescribed to replace deficient cortisol. It may be necessary to increase the dosage during periods of stress or illness.
- Education: Teach the client about lifelong corticosteroid therapy and how to adjust the dosage during stress or illness. Ensure the client understands the importance of wearing a medical alert bracelet and carrying emergency medication in case of adrenal crisis.
How would you care for a client with hypothyroidism, and what are the common signs and symptoms of this disorder?
Answer:
Pathophysiology:
Hypothyroidism occurs when the thyroid gland produces insufficient amounts of thyroid hormones (T3 and T4), leading to a slow metabolic rate. The most common cause in the United States is Hashimoto’s thyroiditis, an autoimmune disorder. Insufficient thyroid hormones lead to a variety of systemic effects, including slowed heart rate, weight gain, and cold intolerance.
Clinical Manifestations:
Symptoms include fatigue, cold intolerance, weight gain, dry skin, constipation, depression, and bradycardia. The client may also present with a goiter (enlarged thyroid gland) as the body attempts to compensate for low thyroid hormone levels.
Nursing Care:
- Medication Management: Administer levothyroxine to replace deficient thyroid hormones. Educate the client on taking the medication at the same time each day, preferably in the morning before food.
- Monitoring Vital Signs: Monitor heart rate and blood pressure, as clients with hypothyroidism may have bradycardia and hypotension. Also, assess for signs of myxedema coma in severe cases, which requires emergency treatment.
- Patient Education: Teach the client about the importance of regular follow-up appointments to monitor thyroid hormone levels, as well as signs of potential complications such as myxedema coma. Advise the client to report any new or worsening symptoms to their healthcare provider.
What are the causes, clinical manifestations, and nursing interventions for a patient with pheochromocytoma?
Answer:
Causes: Pheochromocytoma is a rare tumor of the adrenal medulla that causes the adrenal glands to produce excessive catecholamines (epinephrine and norepinephrine). This leads to severe hypertension, which is often episodic, and other related symptoms. The tumor can be unilateral or bilateral, and its exact cause is not always known, though it may be linked to genetic conditions like multiple endocrine neoplasia (MEN) type 2.
Clinical Manifestations: The hallmark signs of pheochromocytoma include severe, episodic hypertension, tachycardia, headache, sweating, palpitations, and tremors. Some clients may also experience anxiety, nausea, and weight loss. Hypertensive crises can lead to serious complications such as stroke or cardiac events.
Nursing Interventions:
- Assessment: Monitor vital signs, particularly blood pressure, as the patient may experience sudden spikes. Assess for signs of hypertensive crises, which include severe headaches, sweating, and anxiety.
- Medication Management: Administer alpha-blockers (e.g., phenoxybenzamine) to control blood pressure and beta-blockers (e.g., propranolol) to control tachycardia after adequate alpha blockade. Medications are typically started before surgery to control the symptoms.
- Pre-Operative Care: If surgery is indicated, pre-operative care involves stabilizing the patient with medications and managing blood pressure. Provide patient education about the procedure and potential risks.
- Post-Operative Care: After surgical removal of the tumor, the nurse should continue to monitor blood pressure and signs of a catecholamine surge. It is also important to educate the patient on the lifelong need for follow-up visits and possible complications of the surgery.
Discuss the pathophysiology, diagnostic tests, and nursing care for a client with diabetes insipidus.
Answer:
Pathophysiology:
Diabetes insipidus (DI) is a disorder of the posterior pituitary gland, resulting from either insufficient secretion of antidiuretic hormone (ADH) or the kidneys’ inability to respond to ADH. This leads to large volumes of dilute urine and extreme thirst (polydipsia). The two main types of DI are central DI (caused by insufficient ADH production) and nephrogenic DI (caused by the kidneys’ resistance to ADH).
Clinical Manifestations:
Symptoms of DI include polyuria (large volumes of urine output), polydipsia (excessive thirst), dehydration, and hypernatremia (elevated sodium levels). If not managed, these symptoms can lead to significant fluid and electrolyte imbalances, resulting in shock or organ failure.
Diagnostic Tests:
- Urine Specific Gravity: The urine specific gravity is typically low (<1.005) due to the dilute nature of the urine.
- Water Deprivation Test: A test where the client is deprived of water for a certain period, and urine osmolality is measured. In DI, the kidneys will continue to excrete large amounts of dilute urine despite dehydration.
- ADH Level: Central DI is diagnosed with low ADH levels, while nephrogenic DI has normal or high ADH levels, indicating a renal resistance to the hormone.
Nursing Care:
- Fluid and Electrolyte Monitoring: Ensure the patient is adequately hydrated and monitor electrolytes, particularly sodium levels, as hypernatremia is a concern. Administer IV fluids if necessary.
- Medications: In central DI, desmopressin (DDAVP) is administered to replace ADH. In nephrogenic DI, thiazide diuretics or nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to reduce urine output.
- Patient Education: Educate the client on the importance of fluid intake and the need for lifelong treatment. If taking desmopressin, teach the patient how to administer the medication correctly and recognize symptoms of overhydration.
Describe the nursing interventions and management of a client with hypothalamic-pituitary disorders leading to acromegaly.
Answer:
Pathophysiology:
Acromegaly is caused by the excessive secretion of growth hormone (GH) from the anterior pituitary gland, typically due to a benign pituitary tumor (pituitary adenoma). The overproduction of GH leads to excessive growth of bones and soft tissues, especially in the hands, feet, and face. The condition is usually insidious in onset, and symptoms may not become apparent until years after GH overproduction begins.
Clinical Manifestations:
Symptoms of acromegaly include enlarged hands and feet, coarse facial features (e.g., protruding jaw, enlarged nose), joint pain, and thickened skin. Other systemic effects include sleep apnea, hypertension, and increased risk for diabetes mellitus due to insulin resistance. The client may also develop cardiovascular and respiratory issues as the condition progresses.
Nursing Interventions and Management:
- Monitoring Vital Signs: Regular monitoring of blood pressure, heart rate, and respiratory status is essential. Acromegaly can cause hypertension, left ventricular hypertrophy, and sleep apnea, all of which require management.
- Medications: Medications such as somatostatin analogs (e.g., octreotide) are used to inhibit GH secretion. Dopamine agonists like cabergoline or pegvisomant may also be used. For pituitary tumors, radiation therapy may be required.
- Pre-Operative Care for Surgery: If surgery is indicated to remove the pituitary tumor, the nurse should provide education regarding the procedure, possible risks (e.g., pituitary hormone deficiencies), and the need for hormone replacement post-operatively.
- Post-Operative Care: After surgery, monitor for signs of hypopituitarism, including decreased hormone levels. Regular follow-up care is necessary to monitor for tumor recurrence and manage hormone replacement therapy.
What are the pathophysiology, symptoms, and nursing interventions for a client with syndrome of inappropriate antidiuretic hormone (SIADH)?
Answer:
Pathophysiology:
Syndrome of inappropriate antidiuretic hormone (SIADH) is a condition where excessive release of antidiuretic hormone (ADH) leads to water retention, dilutional hyponatremia, and concentrated urine. This condition can result from various causes, including brain injury, tumors, pulmonary disorders, and medications (e.g., certain antidepressants, antipsychotics).
Clinical Manifestations:
Symptoms include nausea, vomiting, headache, confusion, and weakness, all due to hyponatremia (low sodium levels). Severe cases can lead to seizures, coma, and death. The client may present with concentrated urine output despite normal fluid intake.
Nursing Interventions:
- Monitor Fluid and Electrolyte Balance: Assess for signs of fluid overload, such as edema, and monitor sodium levels regularly. The priority nursing action is to correct hyponatremia slowly to prevent rapid changes in serum sodium, which can cause cerebral edema.
- Fluid Restriction: Limit fluid intake as prescribed to prevent further dilution of sodium. Usually, fluid intake is restricted to 800-1000 mL/day.
- Medications: Administer diuretics (e.g., furosemide) to promote water excretion and vasopressin receptor antagonists (e.g., tolvaptan) to block the effects of excess ADH.
- Education: Educate the patient about the need for fluid restriction, monitoring for symptoms of hyponatremia, and when to seek help if symptoms worsen.
Explain the diagnostic tests, treatment options, and nursing care for a client with primary hyperparathyroidism.
Answer:
Pathophysiology:
Primary hyperparathyroidism is characterized by overproduction of parathyroid hormone (PTH) from one or more of the parathyroid glands, often due to a benign tumor or hyperplasia. Elevated PTH levels increase calcium release from bones, causing hypercalcemia, which affects multiple systems in the body.
Clinical Manifestations:
Symptoms of primary hyperparathyroidism include hypercalcemia, which can cause symptoms such as fatigue, weakness, bone pain, kidney stones, abdominal pain, and psychiatric disturbances (e.g., depression, confusion). Osteoporosis and fractures may occur due to calcium resorption from bones.
Diagnostic Tests:
- Serum Calcium and PTH Levels: Elevated calcium and PTH levels are the primary diagnostic markers.
- Bone Density Scan: A DEXA scan may be performed to assess for bone loss or osteoporosis.
- Urine Calcium Excretion: A 24-hour urine collection may show increased calcium excretion.
Treatment and Nursing Care:
- Surgical Treatment: Parathyroidectomy is the definitive treatment for primary hyperparathyroidism, particularly if a parathyroid tumor is identified. Preoperative care includes monitoring calcium and renal function.
- Medications: In some cases, bisphosphonates (e.g., zoledronic acid) or calcimimetics (e.g., cinacalcet) may be used to manage hypercalcemia if surgery is not an option.
- Nursing Interventions: Monitor vital signs, particularly for signs of hypercalcemia (e.g., confusion, muscle weakness). Encourage fluid intake to prevent kidney stones and educate the patient about lifestyle modifications to manage bone health. Post-operative care includes monitoring for hypocalcemia after surgery.