1.

A patient in the oliguric phase after an acute kidney injury has had a 250-mL urine output and
an emesis of 100 mL in the past 24 hours. What is the patient‘s fluid restriction for the next 24
hours?

ANS:
950 mL

The general rule for calculating fluid restrictions is to add all fluid losses for the previous 24
hours, plus 600 mL for insensible losses: (250 + 100 + 600 = 950 mL).

DIF:CognitiveLevel: Understand (Comprehension)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity
Chapter 52: Assessment: Endocrine System
Harding: Lewis’s Medical-Surgical Nursing, 12th Edition

MULTIPLE CHOICE

1. A young adult patient who is being seen in the clinic has excessive secretion of the anterior
pituitary hormones. Which laboratory test result would the nurse expect?
a. Increased urinary cortisol
b. Decreased serum thyroxine
c. Elevated serum aldosterone
d. Low urinary catecholamines
ANS: A
Increased secretion of adrenocorticotropic hormone (ACTH) by the anterior pituitary gland
will lead to an increase in serum and urinary cortisol levels. An increase, rather than a
decrease, in thyroxine level would be expected with increased secretion of thyroid-stimulating
hormone (TSH) by the anterior pituitary. The anterior pituitary does not control aldosterone
and catecholamine levels.

DIF:CognitiveLevel: Understand (Comprehension)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

2. Which statement made by a 50-yr-old female patient indicates to the nurse that further
assessment of thyroid function may be needed?
a. “I am so thirsty that I drink all day long.”
b. “I get up several times at night to urinate.”
c. “I feel a lump in my throat when I swallow.”
d. “I notice my breasts are always tender lately.”

ANS: C
An enlarged thyroid gland can cause problems swallowing or a change in neck size. Nocturia
is associated with diseases such as diabetes, diabetes insipidus, or chronic kidney disease.
Breast tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of
disease such as diabetes.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
3. A patient seen in the emergency department for severe headache and acute confusion has a
serum sodium level of 118 mEq/L. The nurse would anticipate the need for which diagnostic
test?
a. Urinary 17-ketosteroids
b. Antidiuretic hormone level
c. Growth hormone stimulation test
d. Adrenocorticotropic hormone level
ANS: B
Elevated levels of antidiuretic hormone will cause water retention and decrease serum sodium
levels. The other tests would not be helpful in determining the cause of the patient‘s
hyponatremia.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

4. Which question from the nurse during a patient interview would provide focused information
about a possible thyroid disorder?
a. “What methods do you use to help cope with stress?”
b. “Have you experienced any blurring or double vision?”
c. “Have you had a recent unplanned weight gain or loss?”
d. “Do you have to get up at night to empty your bladder?”

ANS: C
Because thyroid function affects metabolic rate, changes in weight may indicate hyperfunction
or hypofunction of the thyroid gland. Nocturia, visual difficulty, and changes in stress level
are associated with other endocrine disorders.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

5. A patient is scheduled in the outpatient clinic for blood cortisol testing. Which instruction
would the nurse provide?
a. “Avoid adding any salt to your foods for 24 hours before the test.”
b. “You will need to lie down for 30 minutes before the blood is drawn.”
c. “Come to the laboratory to have the blood drawn early in the morning.”
d. “Do not have anything to eat or drink before the blood test is obtained.”
ANS: C
Cortisol levels are usually drawn in the morning, when levels are highest. The other
instructions would be given to patients who were having other endocrine testing.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

6. A patient admitted with pneumonia has a total serum calcium level of 13.3 mg/dL. Which
serum level would the nurse anticipate will be tested next?
a. Calcitonin
b. Catecholamine
c. Thyroid hormone
d. Parathyroid hormone

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 ANS: D
Parathyroid hormone (PTH) is the major controller of blood calcium levels. Although
calcitonin secretion is a counter mechanism to PTH, it does not play a major role in calcium
balance. Catecholamine and thyroid hormone levels do not affect serum calcium level.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

7. During the physical examination, the nurse cannot feel the patient‘s thyroid gland. Which
action would the nurse take?
a. Palpate the patient‘s neck more deeply.
b. Document that the thyroid was nonpalpable.
c. Notify the health care provider immediately.
d. Teach the patient about thyroid hormone testing.
ANS: B
The thyroid is usually nonpalpable. The nurse would simply document the finding. Deep
palpation of the neck is not appropriate; do not press too hard or massage an enlarged thyroid
gland as this can cause a sudden release of thyroid hormone into an already overloaded
system. There is no need to notify the health care provider immediately about a normal
finding. There is no indication for thyroid-stimulating hormone (TSH) testing unless there is
evidence of thyroid dysfunction.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

8. Which laboratory value would the nurse review to determine whether a patient‘s
hypothyroidism is caused by a problem with the anterior pituitary gland?
a. Thyroxine (T4) level
b. Triiodothyronine (T3) level
c. Thyroid-stimulating hormone (TSH) level
d. Thyrotropin-releasing hormone (TRH) level

ANS: C
A low TSH level indicates that the patient‘s hypothyroidism is caused by decreased anterior
pituitary secretion of TSH. Low T3 and T4 levels are not diagnostic of the primary cause of the
hypothyroidism. TRH levels indicate the function of the hypothalamus.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

9. Which information will a patient‘s glycosylated hemoglobin (A1C) result provide to the
nurse?
a. Fasting preprandial glucose levels
b. Glucose levels 2 hours after a meal
c. Glucose control over the past 90 days
d. Hypoglycemic episodes in the past 3 months

ANS: C

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 Glycosylated hemoglobin testing measures glucose control over the last 3 months. Glucose
testing before/after a meal or random testing may reveal impaired glucose tolerance and
indicate prediabetes, but it is not done on patients who already have a diagnosis of diabetes.
There is no test to evaluate for hypoglycemic episodes in the past.

DIF:CognitiveLevel: Understand (Comprehension) TOP: NursingProcess: Evaluation

MSC:NCLEX: PhysiologicalIntegrity

10. A patient is taking a drug that blocks the action of aldosterone. Which additional effect of the
medication would the nurse monitor?
a. Increased serum sodium
b. Decreased urinary output
c. Elevated serum potassium
d. Evidence of fluid overload
ANS: C
Because aldosterone increases the excretion of potassium, a medication that blocks
aldosterone will tend to cause hyperkalemia. Aldosterone also promotes the reabsorption of
sodium and water in the renal tubules, so spironolactone will tend to cause increased urine
output, a decreased or normal serum sodium level, and signs of dehydration.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Evaluation

MSC:NCLEX: PhysiologicalIntegrity

11. A patient has been newly diagnosed with type 2 diabetes. Which information about the patient
will be most useful to the nurse who is helping the patient develop strategies for successful
adaptation to this disease?
a. Ideal weight
b. Value system
c. Activity level
d. Visual changes
ANS: B
When dealing with a patient with a chronic condition such as diabetes, identification of the
patient‘s values and beliefs can assist the interprofessional team in choosing strategies for
successful lifestyle change. The other information also will be useful but is not as important in
developing an individualized plan for the necessary lifestyle changes.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: Psychosocial Integrity

12. An 18-yr-old male patient with small stature is scheduled for a growth hormone stimulation
test. Which item would the nurse obtain in preparation for the test?
a. Ice in a basin
b. Glargine insulin
c. A cardiac monitor
d. 50% dextrose solution
ANS: D

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 Hypoglycemia is induced during the growth hormone stimulation test, and the nurse should be
ready to administer 50% dextrose immediately. Regular insulin is used to induce
hypoglycemia. The patient does not need cardiac monitoring during the test. Although blood
samples for some tests must be kept on ice, this is not true for the growth hormone stimulation
test.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

13. In preparation for which test would the nurse teach the patient to minimize physical and
emotional stress?
a. A water deprivation test
b. A test for serum T3 and T4 levels
c. A 24-hour urine test for free cortisol
d. A radioactive iodine (I-131) uptake test
ANS: C
Physical and emotional stress can affect the results of the free cortisol test. Stress does not
impact the other tests.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

14. Which instruction would the nurse give to a patient who is scheduled to complete a 24-hour
urine collection for 17-ketosteroids?
a. Insert and maintain a retention catheter.
b. Keep the specimen refrigerated or on ice.
c. Drink at least 3 L of fluid during the 24 hours.
d. Void and save the specimen to start the collection.
ANS: B
The specimen must be kept on ice or refrigerated until the collection is finished. Voided or
catheterized specimens are acceptable for the test. The initial voided specimen is discarded.
There is no fluid intake requirement for the 24-hour collection.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

15. Which additional information would the nurse consider when reviewing the laboratory results
for a patient‘s total calcium level?
a. The blood glucose
b. The serum albumin
c. The phosphate level
d. The magnesium level

ANS: B
Part of the total calcium is bound to albumin, so hypoalbuminemia can lead to
misinterpretation of total calcium levels, while ionized calcium levels are unchanged by
inconsistent serum albumin levels. The other laboratory values will not affect total calcium
interpretation.

DIF:CognitiveLevel: Apply (Application)

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

16. A patient is admitted with tetany. Which laboratory value would the nurse plan to monitor?
a. Total protein
b. Blood glucose
c. Ionized calcium
d. Serum phosphate
ANS: C
Tetany is associated with hypocalcemia. The other values would not be useful for this patient.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

17. Which information about a patient who is scheduled for an oral glucose tolerance test would
the nurse consider in interpreting the test results?
a. The patient reports having occasional orthostatic dizziness.
b. The patient takes oral corticosteroids for rheumatoid arthritis.
c. The patient has had a 10 pound weight gain in the last month.
d. The patient drank several glasses of water an hour previously.

ANS: B
Corticosteroids can affect blood glucose results. The other information will not affect the
glucose test results.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

18. A nurse is caring for a patient with a goiter and possible hyperthyroidism. Which action by the
nurse has the potential for patient harm?
a. The nurse checks the blood pressure in both arms.
b. The nurse palpates the neck to assess thyroid size.
c. The nurse orders saline eye drops to lubricate the patient‘s bulging eyes.
d. The nurse lowers the thermostat to decrease the temperature in the room.
ANS: B
Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and
should be avoided. The other actions by the nurse are appropriate when caring for a patient
with an enlarged thyroid.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Evaluation

MSC:NCLEX: Safe and Effective Care Environment

19. The nurse is caring for a patient during a water deprivation test. Which finding is most
important for the nurse to communicate to the health care provider?
a. The patient reports intense thirst.
b. The patient has a 5-lb (2.3-kg) weight loss.
c. The patient feels dizzy when sitting on the bed.
d. The patient‘s urine osmolality does not increase.
ANS: B

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 A drop in the weight of more than 2 kg indicates severe dehydration, and the test should be
discontinued. The other assessment data are not unusual with this test.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

20. A patient with a possible pituitary adenoma is scheduled for a computed tomography (CT)
scan with contrast media. Which patient information is important for the nurse to
communicate to the health care provider before the test?
a. Bilateral poor peripheral vision
b. Allergies to iodine and shellfish
c. Recent weight loss of 20 pounds
d. Patient reports ongoing headaches
ANS: B
Because the usual contrast media is iodine-based, the health care provider will need to know
about the allergy before the CT scan. The other findings are common with any mass in the
brain such as a pituitary adenoma.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

21. The nurse is caring for a patient with a possible pituitary tumor who is scheduled for a
computed tomography scan with contrast. Which information about the patient is important
to discuss with the health care provider before the test?
a. Report of chronic headache
b. History of renal insufficiency
c. Recent bilateral visual field loss
d. Blood glucose level of 134 mg/dL
ANS: B
Because contrast media may cause acute kidney injury in patients with poor renal function,
the health care provider will need to prescribe therapies such as IV fluids to prevent this
complication. The other findings are consistent with the patient‘s diagnosis of a pituitary
tumor.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

MULTIPLE RESPONSE

1. Which instructions would the nurse include when teaching a patient who is scheduled for oral
glucose tolerance testing in the outpatient clinic? (Select all that apply.)
a. “You will need to avoid smoking before the test.”
b. “Exercise should be avoided until the testing is complete.”
c. “Several blood samples will be obtained during the testing.”
d. “You should follow a low-calorie diet the day before the test.”
e. “The test requires that you fast for at least 8 hours before testing.”
ANS: A, C, E

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 Smoking may affect the results of oral glucose tolerance tests. Blood samples are obtained at
baseline and at 30, 60, and 120 minutes. Accuracy requires that the patient be fasting before
the test. The patient should consume at least 1500 calories/day for 3 days before the test. The
patient should be ambulatory and active for accurate test results.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity
Chapter 53: Diabetes
Harding: Lewis’s Medical-Surgical Nursing, 12th Edition

MULTIPLE CHOICE

1. Which information provided by a nurse to a patient newly diagnosed with type 2 diabetes is
accurate?
a. Insulin is not used to control glucose in patients with type 2 diabetes.
b. Complications of type 2 diabetes are less serious than those of type 1 diabetes.
c. Changes in diet and exercise may control glucose levels with type 2 diabetes.
d. Type 2 diabetes is usually diagnosed when a patient is admitted in hyperglycemic
coma.
ANS: C
For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve glucose
control. Insulin is frequently used for type 2 diabetes, complications are equally serious as for
type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or
after a patient develops complications such as frequent infections.

DIF:CognitiveLevel: Understand (Comprehension)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

2. A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL
(6.7 mmol/L). Which information will the nurse plan to teach the patient?
a. Self-monitoring of glucose
b. Using small doses of regular insulin
c. Lifestyle changes to lower the glucose
d. Effects of oral hypoglycemic medications
ANS: C
The patient‘s impaired fasting glucose indicates prediabetes, and the patient would be
counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient
with prediabetes does not require insulin or oral hypoglycemics for glucose control and does
not need to self-monitor glucose.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

3. A 28-yr-old male patient with type 1 diabetes reports how he manages his exercise and
glucose control. Which behavior indicates a need for the nurse to implement additional
teaching?
a. The patient always carries hard candies when engaging in exercise.
b. The patient goes for a vigorous walk when his glucose is 200 mg/dL.

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 c. The patient has a peanut butter sandwich before going for a bicycle ride.
d. The patient increases daily exercise when ketones are present in the urine.
ANS: D
When the patient is ketotic, exercise increase the glucose level; persons with type 1 diabetes
should be taught to avoid exercise when ketosis is present. Other recommendations include
(1) before exercise, if glucose 100 mg/dL, eat a 15-g carbohydrate snack. After 15 to 30 min,
recheck glucose levels. (2) Delay exercise if <100 mg/dL. Patients using drugs that place them
at risk for hypoglycemia should always carry a fast-acting source of carbohydrate, such as
glucose tablets or hard candies, when exercising. (3) Before exercise, if glucose 250 mg/dL
in a person with type 1 DM and ketones are present, delay vigorous activity until ketones are
gone. Drink fluids.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Evaluation

MSC:NCLEX: PhysiologicalIntegrity

4. The nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of type 1
diabetes. Which finding would the nurse anticipate?
a. Anorexia
b. Weight loss
c. Dark colored urine
d. Craving sugary drinks
ANS: B
Weight loss occurs because the body is no longer able to absorb glucose and starts to break
down protein and fat for energy. The patient is thirsty but does not necessarily crave
sugar-containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the
classic symptom of polyuria, urine will be very dilute.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

5. A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months
from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the
patient?
a. Fasting blood glucose
b. Glycosylated hemoglobin
c. Oral glucose tolerance test
d. Urine dipstick for glucose and ketones
ANS: B
The glycosylated hemoglobin (A1C) test shows the overall control of glucose over 90 to 120
days. A fasting level indicates only the glucose level at one time. Urine glucose testing is not
an accurate reflection of glucose level and does not reflect the glucose over a prolonged time.
Oral glucose tolerance testing is done to diagnose diabetes but is not used for monitoring
glucose control after diabetes has been diagnosed.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
6. The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass
index (BMI) of 32 kg/m2.Which goal in the plan of care is most important for this patient?
a. The patient will reach a glycosylated hemoglobin level of less than 7%.
b. The patient will follow a diet and exercise plan that results in weight loss.
c. The patient will choose a diet that distributes calories throughout the day.
d. The patient will state the reasons for eliminating simple sugars in the diet.
ANS: A
The complications of diabetes are related to elevated glucose and the most important patient
outcome is the reduction of glucose to near-normal levels. A BMI of 30.9/kg/m2 or above is
considered obese, so the other outcomes are appropriate but are not as high in priority.

DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

7. A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM. Which
advice would the clinic nurse plan to give the patient?
a. Increase the morning dose of NPH insulin (Novolin N).
b. Check glucose level before, during, and after swimming.
c. Time the morning insulin injection to peak while swimming.
d. Delay eating the noon meal until after finishing the swimming.
ANS: B
The exercise will affect glucose, and the patient will need to monitor glucose carefully to
determine the need for changes in diet and insulin administration. Because exercise tends to
decrease glucose, patients are advised to eat before exercising. Increasing the morning NPH or
timing the insulin to peak during exercise may lead to hypoglycemia, especially with the
increased exercise.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

8. Which statement by the person who has newly diagnosed type 1 diabetes indicates a need for
additional instruction from the nurse?
a. “I will need a bedtime snack because I take an evening dose of NPH insulin.”
b. “I can choose any foods, as long as I use enough insulin to cover the calories.”
c. “I can have an occasional beverage with alcohol if I include it in my meal plan.”
d. “I will eat something at meal times to prevent hypoglycemia, even if I am not
hungry.”
ANS: B
Planning to use additional insulin to “balance out” unhealthy diet choices is not effective for
glucose control or overall health. Patients who are using insulin therapy have considerable
flexibility in diet choices and can plan occasional alcohol beverages in their diet. Planning
snacks and meal intake to coordinate with insulin doses indicates good understanding of the
diet instruction.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Evaluation

MSC:NCLEX: PhysiologicalIntegrity

9. Which nursing action is most important in assisting an older patient who has diabetes to
engage in moderate daily exercise?

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 a. Determine what types of activities the patient enjoys.
b. Remind the patient that exercise improves self-esteem.
c. Teach the patient about the effects of exercise on glucose level.
d. Give the patient a list of activities that are moderate in intensity.
ANS: A
Because consistency with exercise is important, assessment for the types of exercise that the
patient finds enjoyable is the most important action by the nurse in ensuring adherence to an
exercise program. Reminding about the benefits of exercise, teaching about exercise effects on
glucose, and identifying moderate intensity exercises may be helpful but are not the most
important in improving adherence.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

10. Which patient statement to the nurse indicates a need for additional instruction in
administering insulin?
a. “I should inject the insulin into a muscle that I plan to exercise vigorously.”
b. “I can buy the 0.5-mL syringes because the line markings are easier to see.”
c. “I do not need to aspirate the plunger to check for blood before injecting insulin.”
d. “I should draw up the regular insulin first, after injecting air into the NPH bottle.”
ANS: A
Caution the patient about injecting into a site that will be exercised. For example, injecting
into the thigh and then going jogging could increase circulation and increase the rate of insulin
absorption, causing hypoglycemia. Patient statements about low-vision syringes, avoiding
aspiration, and the correct process for combining insulins are accurate and indicate that no
additional instruction is needed.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Evaluation

MSC:NCLEX: Health Promotion and Maintenance

11. Which patient action indicates accurate understanding of the nurse‘s teaching about
administration of aspart (NovoLog) insulin?
a. The patient cleans the skin with soap and water before the injection.
b. The patient avoids injecting the insulin into the upper abdominal area.
c. The patient stores the insulin in the freezer between prescribed doses.
d. The patient pushes the plunger down while removing the syringe from the
injection site.
ANS: A
Cleaning the skin with soap and water is acceptable. Insulin should not be frozen. The patient
should leave the syringe in place for about 5 seconds after injection to be sure that all the
insulin has been injected. The upper abdominal area is one of the preferred areas for insulin
injection.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Evaluation

MSC:NCLEX: PhysiologicalIntegrity

12. A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse
anticipate the highest risk for hypoglycemia?
a. 10:00 AM

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 b. 12:00 AM
c. 2:00 PM
d. 4:00 PM
ANS: A
The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for
hypoglycemia at the other listed times, although hypoglycemia may occur.

DIF:CognitiveLevel: Understand (Comprehension) TOP: NursingProcess: Evaluation

MSC:NCLEX: PhysiologicalIntegrity

13. Which patient action indicates an accurate understanding of the nurse‘s teaching about the use
of an insulin pump?
a. The patient programs the pump for an insulin bolus after eating.
b. The patient changes the location of the insertion site every week.
c. The patient takes the pump off at bedtime and restarts it each morning.
d. The patient plans a diet with more calories than usual when using the pump.
ANS: A
In addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a
bolus after each meal, with the dosage depending on the oral intake. The insertion site should
be changed every 2 or 3 days. The pump will deliver a basal insulin rate 24 hours a day. There
is more flexibility in diet and exercise when an insulin pump is used, but it does not provide
for consuming a higher calorie diet.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Evaluation

MSC:NCLEX: Health Promotion and Maintenance

14. A patient who has diabetes is starting on intensive insulin therapy. Which type of insulin will
the nurse explain for mealtime coverage?
a. Lispro (Humalog)
b. Glargine (Lantus)
c. Detemir (Levemir)
d. NPH (Humulin N)
ANS: A
Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive
insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

15. Which information about glyburide would the nurse include when teaching a patient who has
type 2 diabetes?
a. Glyburide decreases glucagon secretion from the pancreas.
b. Glyburide stimulates insulin production and release from the pancreas.
c. Glyburide should be taken even if the morning glucose level is low.
d. Glyburide should not be used for 48 hours after receiving IV contrast media.
ANS: B

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 The sulfonylureas stimulate the production and release of insulin from the pancreas. If the
glucose level is low, the patient should contact the health care provider before taking
glyburide because hypoglycemia can occur with this class of medication. Metformin should
be held for 48 hours after administration of IV contrast media, but this is not necessary for
glyburide. Glyburide does not affect glucagon secretion.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

16. The nurse has been teaching a patient who has type 2 diabetes about managing glucose levels
and taking glipizide (Glucotrol). Which patient statement indicates a need for additional
teaching?
a. “If I overeat at a meal, I will still take the usual dose of medication.”
b. “Other medications besides the Glucotrol may affect my blood sugar.”
c. “When I am ill, I may have to take insulin to control my blood sugar.”
d. “My diabetes won‘t cause complications because I don‘t need insulin.”

ANS: D
The patient should understand that type 2 diabetes places the patient at risk for many
complications and that good glucose control is as important when taking oral agents as when
using insulin. Statements about maintaining a consistent dose of glipizide, the effects of other
medications on glucose, and possible needs for insulin during acute illness are accurate and
indicate good understanding of the use of glipizide.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Evaluation

MSC:NCLEX: PhysiologicalIntegrity

17. A patient who takes metformin (Glucophage) to manage type 2 diabetes developed an allergic
rash from an unknown cause and the health care provider prescribed prednisone. Which
change in the plan of care at would the nurse anticipate?
a. The patient may need a diet higher in calories while receiving prednisone.
b. The patient may develop acute hypoglycemia while taking the prednisone.
c. The patient may require administration of insulin while taking prednisone.
d. The patient may have rashes caused by metformin-prednisone interactions.
ANS: C
Glucose levels increase when patients are taking corticosteroids, and insulin may be required
to control glucose. Hypoglycemia is not a side effect of prednisone. Rashes are not an adverse
effect caused by taking metformin and prednisone simultaneously. The patient may have an
increased appetite when taking prednisone but will not need a diet that is higher in calories.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

18. A hospitalized patient who has diabetes received 38 U of NPH insulin at 7:00 AM. At 1:00
PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery
while awaiting a chest x-ray. Which nursing action would be the best way to prevent the
patient from experiencing hypoglycemia?
a. Plan to decrease the evening dose of insulin.
b. Save the lunch tray for the patient‘s later return.
c. Request that if testing is further delayed, the patient must eat lunch first.

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 d. Send a glass of orange juice to the patient in the diagnostic testing area.

ANS: C
The action of NPH insulin peaks 4 to 12 hours after injection, which can result in
hypoglycemia. Consistency for mealtimes assists with regulation of glucose, so the best
option is for the patient to have lunch at the usual time. Waiting to eat until after the procedure
is likely to cause hypoglycemia. Decreasing the insulin dose later that day will not prevent
hypoglycemia from the peak of the NPH dose. A glass of juice will keep the patient from
becoming hypoglycemic temporarily but will cause a rapid rise in glucose because of the
rapid absorption of the simple carbohydrate in these items.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

19. Which action by the patient who is self-monitoring blood glucose indicates a need for
additional teaching?
a. Washes the puncture site using warm water and soap.
b. Chooses a puncture site in the center of the finger pad.
c. Hangs the arm down for a minute before puncturing the site.
d. Says the result of 120 mg indicates “good blood sugar” control.
ANS: B
The patient is taught to choose a puncture site at the side of the finger pad because there are
fewer nerve endings along the side of the finger pad. The other patient actions indicate that
teaching has been effective.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Evaluation

MSC:NCLEX: Health Promotion and Maintenance

20. The nurse is preparing to teach a 43-yr-old man who is newly diagnosed with type 2 diabetes
about home management of the disease. Which action would the nurse take first?
a. Assess the patient‘s perception of what it means to have diabetes.
b. Ask the patient‘s family to participate in the diabetes education program.
c. Demonstrate how to check glucose using the patient‘s blood glucose monitor.
d. Discuss the need for the patient to actively participate in diabetes management.
ANS: A
Before planning teaching, the nurse would assess the patient‘s interest in and ability to
self-manage the diabetes. After assessing the patient, the other nursing actions may be
appropriate, but planning needs to be specific to each patient.

DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Planning

MSC:NCLEX: Health Promotion and Maintenance

21. An unresponsive patient who has type 2 diabetes is brought to the emergency department and
diagnosed with hyperosmolar hyperglycemia syndrome (HHS). Which action would the nurse
anticipate taking?
a. Giving 50% dextrose
b. Inserting an IV catheter
c. Initiating O2 by nasal cannula
d. Administering glargine (Lantus) insulin

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 ANS: B
HHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular
insulin is administered, not a long-acting insulin. There is no indication that the patient
requires O2. Concentrated dextrose solutions will increase the patient‘s glucose and would be
contraindicated.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

22. A 26-yr-old female who has type 1 diabetes develops a sore throat and runny nose after caring
for her sick toddler. The patient calls the clinic for advice about her symptoms and reports a
glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog)
insulin. Which action would the nurse advise the patient to take?
a. Use only the lispro insulin until the symptoms are resolved.
b. Limit intake of calories until the glucose is less than 120 mg/dL.
c. Monitor blood glucose every 4 hours and contact the clinic if it rises.
d. Decrease carbohydrates until glycosylated hemoglobin is less than 7%.
ANS: C
Infection and other stressors increase glucose levels and the patient will need to test glucose
frequently, treat elevations appropriately with lispro insulin, and call the health care provider
if glucose levels continue to be elevated. Discontinuing the glargine will contribute to
hyperglycemia and may lead to diabetic ketoacidosis (DKA). Decreasing carbohydrate or
caloric intake is not appropriate because the patient will need more calories when ill.
Glycosylated hemoglobin testing is not used to evaluate short-term alterations in glucose.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

23. The health care provider suspects the Somogyi effect in a 50-yr-old patient whose 6 AM
glucose is 230 mg/dL. Which action would the nurse teach the patient to take?
a. Check the glucose during the night.
b. Avoid snacking right before bedtime.
c. Increase the rapid-acting insulin dose.
d. Administer a larger dose of long-acting insulin.
ANS: A
If the Somogyi effect is causing the patient‘s increased morning glucose level, the patient will
experience hypoglycemia between 2:00 and 4:00 AM. The dose of insulin will be reduced,
rather than increased. A bedtime snack is used to prevent hypoglycemic episodes during the
night.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

24. Which action would the nurse take after a patient treated with intramuscular glucagon for
hypoglycemia regains consciousness?
a. Assess the patient for symptoms of hyperglycemia.
b. Give the patient a snack of peanut butter and crackers.
c. Have the patient drink a glass of orange juice or nonfat milk.
d. Administer a continuous infusion of 5% dextrose for 24 hours.

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 ANS: B
Rebound hypoglycemia can occur after glucagon administration, but having a meal containing
complex carbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and
nonfat milk will elevate glucose rapidly, but the cheese and crackers will stabilize glucose.
Administration of IV glucose might be used in patients who were unable to take in nutrition
orally. The patient should be assessed for symptoms of hypoglycemia after glucagon
administration.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

25. Which question during the assessment of a patient who has diabetes will help the nurse
identify autonomic neuropathy?
a. “Do you feel bloated after eating?”
b. “Have you seen any skin changes?”
c. “Do you need to increase your insulin dosage when you are stressed?”
d. “Have you noticed any painful new ulcerations or sores on your feet?”
ANS: A
Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling
for the patient. Asking about skin changes, insulin dosages, and foot lesions would not help in
identifying autonomic neuropathy.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

26. Which information would the nurse include in teaching a patient who has peripheral arterial
disease, type 2 diabetes, and sensory neuropathy of the feet and legs?
a. Choose flat-soled leather shoes.
b. Set heating pads on a low temperature.
c. Use a callus remover for corns or calluses.
d. Soak feet in warm water for an hour each day.
ANS: A
The patient is taught to avoid open-toe, open-heel, and high-heel shoes. Leather shoes are
preferred to plastic ones. The feet should be washed, but not soaked, in warm water daily.
Heating pad use should be avoided. Commercial callus and corn removers should be avoided.
The patient should see a specialist to treat these problems.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

27. Which finding indicates a need to contact the health care provider before the nurse administers
metformin (Glucophage)?
a. The patient‘s glucose level is 174 mg/dL.
b. The patient is scheduled for a chest x-ray in an hour.
c. The patient has gained 2 lb (0.9 kg) in the past 24 hours.
d. The patient‘s estimated glomerular filtration rate is 42 mL/min.
ANS: D

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 The glomerular filtration rate indicates possible renal impairment, and metformin should not
be used in patients with significant renal impairment. The other findings are not
contraindications to the use of metformin.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

28. A patient who has diabetes and reports burning foot pain at night receives a new prescription.
Which information would the nurse teach the patient about the purpose of amitriptyline?
a. Amitriptyline decreases the depression caused by your foot pain.
b. Amitriptyline helps prevent transmission of pain impulses to the brain.
c. Amitriptyline corrects some of the blood vessel changes that cause pain.
d. Amitriptyline improves sleep and makes you less aware of nighttime pain.
ANS: B
Tricyclic antidepressants (TCAs) decrease the transmission of pain impulses to the spinal cord
and brain. TCAs also improve sleep quality and are used for depression, but that is not the
major purpose for their use in diabetic neuropathy. TCAs do not affect the blood vessel
changes that contribute to neuropathy.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

29. A patient who has type 2 diabetes is being prepared for an elective coronary angiogram.
Which information would the nurse anticipate might lead to rescheduling the test?
a. The patient‘s glucose is 128 mg/dL.
b. The patient‘s most recent A1C was 7.5%.
c. The patient took the prescribed metformin today.
d. The patient took the prescribed enalapril 4 hours ago.
ANS: C
To avoid lactic acidosis, metformin should be discontinued a day or 2 before the coronary
angiogram and should not be used for 48 hours after IV contrast media are administered. The
other patient data do not indicate any need to reschedule the procedure.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

30. Which action by a patient indicates that the home health nurse‘s teaching about glargine and
regular insulin has been successful?
a. The patient administers the glargine 30 minutes before each meal.
b. The patient‘s family prefills the syringes with the mix of insulins weekly.
c. The patient discards the open vials of glargine and regular insulin after 4 weeks.
d. The patient draws up the regular insulin and then the glargine in the same syringe.
ANS: C
Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with
other insulins or prefilled and stored. Short-acting regular insulin is administered before
meals, and glargine is given once daily.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Evaluation

MSC:NCLEX: PhysiologicalIntegrity

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
31. A patient with diabetes rides a bicycle to and from work every day. Which site would the
nurse teach the patient to use to administer the morning insulin?
a. Thigh
b. Buttock
c. Abdomen
d. Upper arm
ANS: C
Patients should be taught not to administer insulin into a site that will be exercised vigorously
because exercise will increase the rate of absorption. The thigh, buttock, and arm are all
exercised by riding a bicycle.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

32. The nurse is interviewing a new patient with diabetes who takes rosiglitazone (Avandia).
Which information would the nurse anticipate resulting in the health care provider
discontinuing the medication?
a. The patient‘s blood pressure is 154/92.
b. The patient has a history of emphysema.
c. The patient reports chest pressure when walking.
d. The patient‘s morning glucose level is 96 mg/dL.
ANS: D
Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health
care provider and expect orders to discontinue the medication. A glucose level of 96 mg/dL
indicates a positive effect from the medication. Hypertension and a history of emphysema do
not contraindicate this medication.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

33. The nurse is taking a health history from a 29-yr-old patient at the first prenatal visit. The
patient reports that she has no personal history of diabetes, but her mother has diabetes. Which
action will the nurse plan to take?
a. Schedule the patient for a fasting glucose level.
b. Teach the patient about administering regular insulin.
c. Teach about an increased risk for fetal problems with gestational diabetes.
d. Schedule an oral glucose tolerance test for the twenty-fourth week of pregnancy.
ANS: A
Patients with a family history of diabetes are at high risk for gestational diabetes and should
be screened for diabetes on the initial prenatal visit. An oral glucose tolerance test may also be
used to check for diabetes, but it would be done before the twenty-fourth week. Teaching
plans would depend on the outcome of a fasting glucose test and other tests.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
34. A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of
732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health
care provider would the nurse implement first?
a. Place the patient on a cardiac monitor.
b. Administer IV potassium supplements.
c. Ask the patient about home insulin doses.
d. Start an insulin infusion at 0.1 units/kg/hr.
ANS: A
Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and
ventricular fibrillation, which would be detected with electrocardiogram (ECG) monitoring.
Because potassium must be infused over at least 1 hour, the nurse would initiate cardiac
monitoring before infusion of potassium. Insulin would not be administered without cardiac
monitoring because insulin infusion will further decrease potassium levels. Discussion of
home insulin and possible causes can wait until the patient is stabilized.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

35. A patient with diabetic ketoacidosis is brought to the emergency department. Which
prescribed action would the nurse implement first?
a. Infuse 1 L of normal saline rapidly.
b. Give sodium bicarbonate 50 mEq IV push.
c. Administer regular insulin 10 U by IV push.
d. Start a regular insulin infusion at 0.1 units/kg/hr.
ANS: A
The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis
(DKA), and the priority is to infuse IV fluids. Insulin can be given after the infusion of normal
saline is initiated. Sodium bicarbonate may be given for severe acidosis (pH <7.0) after fluids
are initiated.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

36. A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection
has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded
and sweaty. Which action would the nurse take first?
a. Infuse dextrose 50% by slow IV push.
b. Administer 1 mg glucagon subcutaneously.
c. Obtain a glucose reading using a finger stick.
d. Have the patient drink 4 ounces of orange juice.
ANS: C
The patient‘s clinical manifestations are consistent with hypoglycemia, and the initial action
should be to check the patient‘s glucose with a finger stick or order a stat glucose. If the
glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice.
Glucagon or dextrose 50% might be given if the patient‘s symptoms become worse or if the
patient is unconscious.

DIF:CognitiveLevel: Analyze (Analysis)

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

37. A female patient is scheduled for an oral glucose tolerance test. Which information from the
patient‘s health history is important for the nurse to communicate to the health care provider
regarding interpreting the result of this test?
a. The patient uses oral contraceptives.
b. The patient runs several days a week.
c. The patient has been pregnant three times.
d. The patient has a family history of diabetes.
ANS: A
Oral contraceptive use may falsely elevate oral glucose tolerance test (OGTT) values.
Exercise and a family history of diabetes both can affect glucose but will not lead to
misleading information from the OGTT. History of previous pregnancies may provide
informational about gestational glucose tolerance but will not lead to misleading information
from the OGTT.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

38. Which laboratory value reported by the assistive personnel (AP) indicates an urgent need for
the nurse to assess the patient?
a. Bedtime glucose of 140 mg/dL
b. Noon glucose of 52 mg/dL
c. Fasting glucose of 130 mg/dL
d. 2-hr postprandial glucose of 220 mg/dL
ANS: B
The nurse should assess the patient with a glucose level of 52 mg/dL for symptoms of
hypoglycemia and give the patient a carbohydrate-containing beverage such as orange juice.
The other values are within an acceptable range or not immediately dangerous for a patient
with diabetes.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

39. When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action
can the nurse delegate to a licensed practical/vocational nurse (LPN/VN)?
a. Communicate the glucose level and insulin dose to the circulating nurse in surgery.
b. Discuss the reason for insulin therapy during the immediate postoperative period.
c. Administer the prescribed lispro (Humalog) insulin before transporting the patient
to surgery.
d. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the
postoperative period.
ANS: C
LPN/LVN education and scope of practice includes administration of insulin. Communication
about patient status with other departments, planning, and patient teaching are skills that
require RN education and scope of practice.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: Safe and Effective Care Environment

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
40. An active 32-yr-old male who has type 1 diabetes is being seen in the endocrine clinic. Which
finding indicates a need for the nurse to discuss a possible a change in therapy with the health
care provider?
a. Hemoglobin A1C level of 6.2%
b. Heart rate at rest of 58 beats/min
c. Blood pressure of 140/88 mmHg
d. High-density lipoprotein (HDL) level of 65 mg/dL
ANS: C
To decrease the incidence of macrovascular and microvascular problems in patients with
diabetes, the blood pressure should be kept in normal range. An A1C less than 6.5%, a low
resting heart rate (consistent with regular aerobic exercise in a young adult), and an HDL level
of 65 mg/dL all indicate that the patient‘s diabetes and risk factors for vascular disease are
well controlled.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

41. A 30-yr-old patient has a new diagnosis of type 2 diabetes. When would the nurse recommend
the patient schedule a dilated eye examination?
a. Every 2 years
b. Every 6 months
c. As soon as available
d. At the age of 39 years
ANS: C
Because many patients have some diabetic retinopathy when they are first diagnosed with
type 2 diabetes, a dilated eye examination is recommended at the time of diagnosis and
annually thereafter.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

42. Which patient statement indicates that the nurse‘s teaching about exenatide (Byetta) has been
effective?
a. “I may feel hungrier than usual when I take this medicine.”
b. “I will not need to worry about hypoglycemia with the Byetta.”
c. “I should take my daily aspirin at least an hour before the Byetta.”
d. “I will take the pill at the same time I eat breakfast in the morning.”
ANS: C
Because exenatide slows gastric emptying, oral medications would be taken at least 1 hour
before the exenatide to avoid slowing absorption. Exenatide is injected and increases feelings
of satiety. Hypoglycemia can occur with this medication.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Evaluation

MSC:NCLEX: PhysiologicalIntegrity

43. A few weeks after an 82-yr-old patient with a new diagnosis of type 2 diabetes has been
placed on metformin (Glucophage) therapy, the home health nurse makes a visit. Which
finding would the nurse promptly discuss with the health care provider?

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 a. Hemoglobin A1C level is 7.9%.
b. Glomerular filtration rate is decreased.
c. Last eye examination was 18 months ago.
d. Patient has questions about the prescribed diet.
ANS: B
The decrease in renal function may indicate a need to adjust the dose of metformin or change
to a different medication. In older patients, the goal for A1C may be higher in order to avoid
complications associated with hypoglycemia. The nurse will plan to schedule the patient for
an eye examination and address the questions about diet, but the area for prompt intervention
is the patient‘s decreased renal function.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

44. The nurse has administered 4 oz of orange juice to an alert patient whose glucose was 62
mg/dL. Fifteen minutes later, the glucose is 67 mg/dL. Which action would the nurse take
next?
a. Give the patient 4 to 6 oz more orange juice.
b. Administer the PRN glucagon (Glucagon) 1 mg IM.
c. Have the patient eat some peanut butter with crackers.
d. Notify the health care provider about the hypoglycemia.
ANS: A
The “rule of 15” indicates that administration of quickly acting carbohydrates should be done
two or three times for a conscious patient whose glucose remains less than 70 mg/dL before
notifying the health care provider. More complex carbohydrates and fats may be used after the
glucose has stabilized. Glucagon should be used if the patient‘s level of consciousness
decreases so that oral carbohydrates can no longer be given.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

45. Which nursing action can the nurse delegate to experienced assistive personnel (AP) who are
working in the diabetic clinic?
a. Measure the ankle-brachial index.
b. Check for changes in skin pigmentation.
c. Assess for unilateral or bilateral foot drop.
d. Ask the patient about symptoms of depression.
ANS: A
Checking systolic pressure at the ankle and brachial areas and calculating the ankle-brachial
index is a procedure that can be done by AP who have been trained in the procedure. The
other assessments should be done by the registered nurse (RN).

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: Safe and Effective Care Environment

46. After change-of-shift report, which patient will the nurse assess first?
a. A 19-yr-old patient with type 1 diabetes who was admitted with dawn
phenomenon
b. A 60-yr-old patient with type 1 diabetes whose most recent glucose reading was

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 230 mg/dL
c. A 68-yr-old patient with type 2 diabetes who has severe peripheral neuropathy and
reports burning foot pain
d. A 35-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor
skin turgor and dry oral mucosa
ANS: D
The patient‘s diagnosis of HHS and signs of dehydration indicate that the nurse should rapidly
assess for signs of shock and determine whether increased fluid infusion is needed. The other
patients also need assessment and intervention but do not have life-threatening complications.

DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Planning

MSC:NCLEX: Safe and Effective Care Environment

47. After change-of-shift report, which patient would the nurse assess first?
a. A 19-yr-old patient with type 1 diabetes who has a hemoglobin A1C of 12%
b. A 23-yr-old patient with type 1 diabetes who has a glucose of 40 mg/dL
c. A 50-yr-old patient who uses exenatide and is reporting acute abdominal pain
d. A 40-yr-old patient who is pregnant and whose oral glucose tolerance test is 202
mg/dL
ANS: B
Because the brain requires glucose to function, untreated hypoglycemia can cause
unconsciousness, seizures, and death. The nurse will rapidly assess and treat the patient with
low glucose. The other patients also have symptoms that require assessments or interventions,
but they are not at immediate risk for life-threatening complications.

DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Planning

MSC:NCLEX: Safe and Effective Care Environment

MULTIPLE RESPONSE

1. To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in
the diabetic clinic schedule at least annually? (Select all that apply.)
a. Chest x-ray
b. Blood pressure
c. Serum creatinine
d. Urine for microalbuminuria
e. Complete blood count (CBC)
f. Monofilament testing of the foot
ANS: B, C, D, F
Blood pressure, serum creatinine, urine testing for microalbuminuria, and monofilament
testing of the foot are recommended at least annually to screen for possible microvascular and
macrovascular complications of diabetes. Chest x-ray and CBC might be ordered if the patient
with diabetes presents with symptoms of respiratory or infectious problems but are not
routinely included in screening.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity
Chapter 54: Endocrine Problems

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
Harding: Lewis’s Medical-Surgical Nursing, 12th Edition

MULTIPLE CHOICE

1. A 40-year-old patient with suspected acromegaly is seen at the clinic. To assist in making the
diagnosis, which question would 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:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

2. A patient is scheduled for transsphenoidal hypophysectomy to treat a pituitary adenoma.

Which information would the nurse include in preoperative teaching?
a. Cough and deep breathe every 2 hours postoperatively.
b. Remain on bed rest for the first 48 hours postoperatively.
c. Avoid brushing teeth for at least 10 days after the surgery.
d. You will be positioned flat with a cervical collar after surgery.
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. A cervical collar is not needed.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

3. The nurse is planning postoperative care for a patient who is being admitted to the surgical
unit from the recovery room after transsphenoidal resection of a pituitary tumor. Which
nursing action would 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, so continuous pulse oximetry is not needed.

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning
MSC:NCLEX: PhysiologicalIntegrity

4. The nurse is assessing a male patient diagnosed with a pituitary tumor causing
panhypopituitarism. Which assessment finding is consistent with panhypopituitarism?
a. High blood pressure
b. Decreased facial hair
c. Elevated blood glucose
d. Intermittent tachycardia
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 because of
decreases in adrenocorticotropic hormone (ACTH) and cortisol. Bradycardia is due to the
decrease in thyroid-stimulating hormone (TSH) and thyroid hormones associated with
panhypopituitarism.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

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 evening.
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 daily, 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.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

6. Which finding indicates to the nurse that demeclocycline has been effective for a patient with
syndrome of inappropriate antidiuretic hormone (SIADH)?
a. Weight has increased.
b. Urinary output has increased.
c. Peripheral edema has increased.
d. Urine specific gravity has increased.

ANS: B
Demeclocycline blocks the action of antidiuretic hormone (ADH) on the renal tubules and
increases urine output, producing more dilute urine. 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.

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Evaluation
MSC:NCLEX: PhysiologicalIntegrity

7. Which patient statement indicates to the nurse that further instruction is needed about chronic
syndrome of inappropriate antidiuretic hormone (SIADH)?
a. “I should weigh myself daily and report sudden weight loss or gain.”
b. “I need to shop for foods low in sodium and avoid adding salt to food.”
c. “I need to limit my fluid intake to no more than 1 quart of liquids a day.”
d. “I should eat foods high in potassium because diuretics cause potassium loss.”
ANS: B
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.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Evaluation

MSC:NCLEX: PhysiologicalIntegrity

8. A patient who is disoriented and reports a headache and muscle cramps is hospitalized with
syndrome of inappropriate antidiuretic hormone (SIADH). Which initial laboratory result
would the nurse expect?
a. Elevated hematocrit
b. Decreased serum sodium
c. Increased serum chloride
d. Low urine specific gravity
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:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

9. Which problem would the nurse anticipate for a patient admitted to the hospital with diabetes
insipidus?
a. Generalized edema
b. Respiratory distress
c. Fluid volume overload
d. Disturbed sleep pattern
ANS: D
Nocturia occurs because of the polyuria caused by diabetes insipidus. Edema, excess fluid
volume, and respiratory distress are not expected.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

10. Which information will the nurse teach a patient who has been newly diagnosed with Graves‘
disease?
a. Antithyroid medications may take months for full effect.

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 b. Restriction of iodine intake will help reduce thyroid activity.
c. Exercise is contraindicated to avoid increasing metabolic rate.
d. Surgery will eventually be required to remove the thyroid gland.
ANS: A
Medications used to block the synthesis of thyroid hormones may take 2 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.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

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. Plan for emergency tracheostomy.
b. Administer IV calcium gluconate.
c. Prepare for endotracheal intubation.
d. Begin thyroid hormone replacement.
ANS: B
The patient‘s 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. Thyroid hormone replacement may be needed eventually but will not improve the
symptoms of hypocalcemia.

DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

12. Which action will the nurse include in the plan of care for a 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 patient‘s 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.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

13. A patient who has hyperthyroidism is treated with radioactive iodine (RAI). What information
would the nurse include in discharge teaching?
a. Take radioactive precautions with all body secretions.

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 b. Symptoms of hyperthyroidism should be relieved in about a week.
c. Symptoms of hypothyroidism will occur as the RAI therapy takes effect.
d. Discontinue the antithyroid medications that were taken before the RAI therapy.
ANS: C
There is a high incidence of post radiation 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.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

14. Which nursing assessment of a 70-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.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

15. An 82-year-old patient in a long-term care facility is newly diagnosed with hypothyroidism.
Which prescribed drug would the nurse discuss with the health care provider?
a. Docusate (Colace)
b. Ibuprofen (Motrin)
c. Diazepam (Valium)
d. Cefoxitin (Mefoxin)
ANS: C
Worsening of mental status and myxedema coma can be precipitated using 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.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

16. A patient who was admitted with myxedema coma and diagnosed with hypothyroidism is
improving. Discharge is expected to occur in 2 days. Which teaching strategy is likely to
result in effective patient self-management at home?
a. Delay teaching until closer to discharge date.
b. Provide written reminders of information taught.
c. Offer multiple options for management of therapies.
d. Ensure privacy for teaching by asking the family to leave.

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 ANS: B
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 complex, teaching should be started 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.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

17. A patient develops carpopedal spasms and tingling of the lips following a parathyroidectomy.
Which action will provide the patient with rapid temporary relief from the symptoms?
a. Start the PRN O2 at 2 L/min per cannula.
b. Administer the prescribed muscle relaxant.
c. Have the patient rebreathe from a paper bag.
d. Stretch the muscles with passive range of motion.
ANS: C
The patient‘s 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. Applying as-needed O2, muscle relaxants, or stretching
will have no impact on the ionized calcium level.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

18. A patient who had radical neck surgery to remove a malignant tumor developed
hypoparathyroidism. Which topic would the nurse plan to teach the patient?
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.
Kidney stones are not a complication of hypoparathyroidism and low calcium levels.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

19. A patient who has hypothyroidism and hypertension is prescribed levothyroxine (Synthroid).
Which finding indicates that the nurse should contact the health care provider before
administering the medication?
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

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 ANS: A
An increased thyroxine level indicates the levothyroxine dose needs to be decreased. The
other data are consistent with hypothyroidism and the nurse would administer the
levothyroxine.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

20. A patient is being admitted with a diagnosis of Cushing syndrome. Which finding 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 Addison‘s disease.
Decreased axillary and pubic hair occur with androgen deficiency.

DIF:CognitiveLevel: Understand (Comprehension)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

21. A patient with Cushing syndrome is admitted for an adrenalectomy. Which information would
likely help the patient cope with a 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 and accurate 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 minimize the patient‘s
concerns. The patient‘s physiological changes are caused by the high hormone levels, not by
the patient‘s diet or exercise choices.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: Psychosocial Integrity

22. Which finding indicates to the nurse that the current therapies are effective for a patient who
has acute adrenal insufficiency?
a. Increasing serum sodium levels
b. Decreasing blood glucose levels
c. Decreasing serum chloride levels
d. Increasing serum potassium levels

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 ANS: A
Clinical manifestations of Addison‘s disease include hyponatremia and an increase in sodium
level indicates improvement. The other values indicate that treatment has not been effective.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Evaluation

MSC:NCLEX: PhysiologicalIntegrity

23. The nurse admits a patient to the hospital in Addisonian crisis. Which patient statement
supports the need to plan additional teaching?
a. “I frequently eat at restaurants, and my food has a lot of added salt.”
b. “I had the flu earlier this week, so I couldn‘t 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 Addison‘s disease.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

24. A patient 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.”
b. “The prednisone dose should be decreased gradually.”
c. “A weight-bearing exercise program will help minimize risk for osteoporosis.”
d. “Call the health care provider if you have mood changes with the prednisone.”

ANS: B
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.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

25. Which action would the nurse take when providing care for a patient who has an
adrenocortical adenoma causing hyperaldosteronism?
a. Check blood glucose level every 4 hours.
b. Monitor the blood pressure every 4 hours.
c. Elevate the patient‘s legs to prevent edema.
d. Order the patient a potassium-restricted diet.
ANS: B
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.

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 DIF:CognitiveLevel: Apply (Application)
TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

26. Which finding would the nurse plan to assess for in a patient diagnosed with a
pheochromocytoma?
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 occur
because of sympathetic nervous system stimulation. Bradycardia and flushing would not be
expected.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

27. Which topic would the nurse teach a patient who had a hypophysectomy to remove a pituitary
adenoma?
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.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

28. Which intervention will the nurse include in the plan of care for a patient with syndrome of
inappropriate antidiuretic hormone (SIADH)?
a. Encourage fluids to 2 to 3 L/day.
b. Offer the patient sugarless gum to chew.
c. Monitor for increasing peripheral edema.
d. Keep head of bed elevated to 30 degrees.
ANS: B
Chewing on sugarless gum 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.

DIF:CognitiveLevel: Apply (Application) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
29. A patient has just arrived on the unit after a thyroidectomy. Which action would the nurse take
first?
a. Observe the dressing for bleeding.
b. Check the blood pressure and pulse.
c. Assess the patient‘s respiratory effort.
d. Support the patient‘s 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.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

30. The nurse is caring for a patient following an adrenalectomy. Which goal is the highest
priority in the immediate postoperative period?
a. Protecting the patient‘s skin
b. Monitoring for signs of infection
c. Balancing fluids and electrolytes
d. Preventing 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.

DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

31. 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 patient‘s urine specific gravity is 1.003.
ANS: A
The patient‘s confusion and lethargy may indicate hypernatremia and would 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.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
32. Which prescribed medication would the nurse expect will have the most rapid effect on a
patient admitted to the emergency department in thyroid storm?
a. Iodine
b. Methimazole
c. Propylthiouracil
d. Propranolol (Inderal)
ANS: D
-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.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity

33. Which assessment finding for an adult admitted with Graves‘ disease requires the most rapid
intervention by the nurse?
a. Heart rate 136 beats/min
b. Severe bilateral exophthalmos
c. Temperature 103.8F (40.4C)
d. Blood pressure 166/100 mm Hg
ANS: C
The patient‘s 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:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

34. A patient has just arrived in the postanesthesia recovery unit (PACU) after a thyroidectomy.
Which information about the patient is most important to communicate to the surgeon?
a. Difficult to awaken
b. Increasing neck swelling
c. Reports 7/10 incisional pain
d. Cardiac rate 112 beats/min

ANS: B
The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to
prevent airway obstruction. The incisional pain would be treated but is not unusual after
surgery. A heart rate of 112 beats/min 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.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

35. Which assessment finding in a patient who had a bilateral adrenalectomy requires the most
rapid action by the nurse?
a. The blood glucose is 192 mg/dL.
b. The lungs have bibasilar crackles.
c. The patient reports 6/10 incisional pain.

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 d. The blood pressure (BP) is 88/50 mm Hg.

ANS: D
The decreased BP indicates possible adrenal insufficiency. The nurse would immediately
notify the health care provider so that corticosteroid medications can be administered. The
nurse would also address the elevated glucose, incisional pain, and crackles with appropriate
collaborative or nursing actions, but prevention and treatment of acute adrenal insufficiency
are the priorities after adrenalectomy.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

36. A patient is admitted with diabetes insipidus. Which action will be appropriate for the
registered nurse (RN) to delegate to an experienced licensed practical/vocational nurse
(LPN/VN)?
a. Titrate the infusion of 5% dextrose in water.
b. Administer prescribed subcutaneous DDAVP.
c. Assess the patient‘s overall hydration status every 8 hours.
d. Teach the patient to use desmopressin (DDAVP) nasal spray.
ANS: B
Administration of medications is included in LPN/VN education and scope of practice.
Assessments, patient teaching, and titrating fluid infusions are more complex skills and would
be done by the RN.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: Safe and Effective Care Environment

37. 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 weight gain of 9 pounds.
b. The patient reports some 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.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

38. After receiving change-of-shift report about the following four patients, which patient would
the nurse assess first?
a. A 31-year-old female patient with Cushing syndrome and a blood glucose level of
244 mg/dL
b. A 70-year-old female patient taking levothyroxine (Synthroid) who has an
irregular pulse of 134
c. A 53-year-old male patient who has Addison‘s disease and is due for a prescribed
dose of hydrocortisone (Solu-Cortef)

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 d. A 22-year-old male patient 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 patient‘s 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:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: Safe and Effective Care Environment

39. Which question will the nurse in the endocrine clinic ask to help determine a patient‘s risk
factors for goiter?
a. “How much milk do you drink?”
b. “What medications are you taking?”
c. “Have you had a recent neck injury?”
d. “Are your immunizations up to date?”
ANS: B
Medications that contain thyroid-inhibiting substances can cause goiter. Milk intake, neck
injury, and immunization history are not risk factors for goiter.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

40. 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.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

41. Which finding by the nurse when assessing a patient with Hashimoto‘s thyroiditis and a goiter
will require the most immediate action?
a. New-onset changes in the patient‘s voice
b. Elevation in the patient‘s T3 and T4 levels
c. Resting apical pulse rate 112 beats/min
d. Bruit audible bilaterally over the thyroid gland
ANS: A

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 Changes in the patient‘s 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 Hashimoto‘s thyroiditis and do not require immediate action.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

42. Which information obtained by the nurse in the clinic about a patient who has been taking
prednisone 40 mg daily for 3 weeks is most important to report to the health care provider?
a. Patient‘s 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 or treat adrenal
insufficiency. The other information will also be reported but does not require rapid treatment.

DIF:CognitiveLevel: Analyze (Analysis)

TOP: NursingProcess: Assessment MSC:NCLEX: PhysiologicalIntegrity

43. The cardiac telemetry unit charge nurse receives status reports from other nursing units about
four patients who need cardiac monitoring. Which patient would be transferred to the cardiac
unit first?
a. Patient with Hashimoto‘s 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 Addison‘s disease who takes IV hydrocortisone twice daily

ANS: B
Emergency treatment of tetany requires IV administration of calcium; electrocardiographic
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.

DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Planning

MSC:NCLEX: Safe and Effective Care Environment

44. After obtaining the information shown in the accompanying figure regarding a patient with
Addison‘s disease, which prescribed action will the nurse take first?

a. Give 4 oz of fruit juice orally.

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!
 b. Recheck the blood glucose level.
c. Administer O2 therapy as needed.
d. Infuse 5% dextrose and 0.9% saline.
ANS: D
The patient‘s 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 most crucial action for maintaining perfusion in the patient.

DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

45. A 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 Chvostek‘s 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 Chvostek‘s or Trousseau‘s sign are
appropriate for hypocalcemic patients. The patient should engage in weight-bearing exercise
to decrease calcium loss from bone.

DIF:CognitiveLevel: Analyze (Analysis) TOP: NursingProcess: Planning

MSC:NCLEX: PhysiologicalIntegrity

COMPLETION

1. A patient is to receive methylprednisolone 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.

DIF:CognitiveLevel: Apply (Application)

TOP: NursingProcess: Implementation MSC:NCLEX: PhysiologicalIntegrity
Chapter 55: Assessment: Reproductive System
Harding: Lewis’s Medical-Surgical Nursing, 12th Edition

MULTIPLE CHOICE

1. Which question would the nurse ask when assessing a 60-year-old patient who has a history of
benign prostatic hyperplasia (BPH)?
a. “Have you noticed any unusual discharge from your penis?”

Discover more educational resources and start earning by selling your own documents at Schootex.com
Join our community and turn your knowledge into income!