MSN Endocrine Quiz 2
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A female client is being treated with radioactive iodine (RAI) therapy for an enlarged thyroid gland. The client asks if there are any precautions that are needed during RAI therapy. Which is the nurse’s best response?
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“No precautions are necessary. You receive radiation in the form of a capsule that will target and destroy the thyroid tissue only.”
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“Though a pregnancy test has confirmed that you are not pregnant, use contraceptives or abstain from sexual intercourse to avoid conceiving during treatment.”
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“Because maximum effects may not be seen for 6 months, you will need to continue taking the antithyroid medication and propranolol until the effects of radiation become apparent.”
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“Although RAI is usually effective, a few individuals will need life-long thyroid hormone replacement due to posttreatment hypothyroidism.”
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- 2.
A nurse is teaching a client experiencing hypoparathyroidism resulting from a lack of parathyroid hormone (PTH) about foods to consume. Which should be included on a list of appropriate foods for a client experiencing hypoparathyroidism?
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Dark green vegetables, soybeans, and tofu
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Spinach, strawberries, and yogurt
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Whole grain bread, milk, and liver
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Rhubarb, yellow vegetables, and fish
Correct Answer
A. Dark green vegetables, soybeans, and tofuExplanation
Hypoparathyroidism from lack of PTH produces chronic hypocalcemia. Foods consumed should be high in calcium. Foods containing oxalic acid (spinach, rhubarb), and phytic acid (whole grains) reduce calcium absorption.Rate this question:
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- 3.
A nurse’s assessment of a client diagnosed with Cushing’s syndrome includes the following findings: 4+ pitting leg edema, blood glucose 140 mg/dL, irregular heart rate, and ecchymosis on the right arm. Which action should be taken by the nurse first?
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Weigh the client.
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Administer insulin.
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Notify the physician.
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Measure the client’s abdominal girth.
Correct Answer
A. Notify the physician.Explanation
Cushing’s syndrome causes overproduction of aldosterone, retention of sodium and water, and excretion of potassium. An irregular heart rate can occur from hypokalemia. The physician should be notified immediately to obtain serum laboratory studies and to treat the irregular heart rate and hypokalemia if present. The other actions are appropriate for the client with Cushing’s syndrome, but the first action addresses the major problem.Rate this question:
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- 4.
Which medication should a nurse plan to administer to a client admitted in Addisonian crisis?
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Regular insulin
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Ketoconazole (Nizoral®)
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Sodium nitroprusside (Nipride®)
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Hydrocortisone (Solu-Cortef®)
Correct Answer
A. Hydrocortisone (Solu-Cortef®)Explanation
Addisonian crisis results from insufficient secretion of glucocorticoids and mineralocorticoids from the adrenal cortex. Hydrocortisone is a corticosteroid used in the absence of sufficient glucocorticoid production. Hypoglycemia, not hyperglycemia, is associated with Addisonian crisis. Ketoconazole is a systemic antifungal that has an unlabeled use in treating Cushing’s syndrome as an adrenal enzyme inhibitor. Addisonian crisis produces severe hypotension; sodium nitroprusside is used to treat severe hypertension.Rate this question:
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- 5.
A nurse is caring for a client who is hospitalized with adrenocortical insufficiency. The nurse reviews the client’s serum laboratory values and immediately notifies the physician. Which serum laboratory value most likely prompted the nurse to notify the physician?
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WBC 11.0 K/μL
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Glucose 138 mg/dL
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Sodium 148 mEq/L
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Potassium 6.2 mEq/L
Correct Answer
A. Potassium 6.2 mEq/LExplanation
The normal range for serum potassium is 3.8 to 5.0 mEq/L. Adrenocortical insufficiency causes excessive potassium reabsorption producing hyperkalemia. Hyperkalemia can result in dysrhythmias and cardiac arrest if not treated promptly. An acute infection can precipitate Addisonian crisis, but the white blood cell (WBC) count is on the high side of normal. Hypoglycemia and hyponatremia, not hyperglycemia nor hypernatremia, are associated with adrenocortical insufficiency. Both values are elevated, but not alarmingly. Normal serum glucose is 70–110 mg/dL and serum sodium is 136–146 mEq/L.Rate this question:
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- 6.
Which clinical change should indicate to a nurse that the therapy for a client with Addisonian crisis is effective?
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An increase of 25 mm Hg in the client’s systolic blood pressure
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A decrease of 25 mm Hg in the client’s systolic blood pressure
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An increase in the client’s serum potassium level from 3.4 to 4.8 mEq/dL
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An increase in the client’s total serum calcium level from 8.6 to 10.0 mg/dL
Correct Answer
A. An increase of 25 mm Hg in the client’s systolic blood pressureExplanation
An increase in blood pressure is indicative of effective therapy. Addisonian crisis is caused by adrenocortical insufficiency with disturbances of sodium and potassium metabolism resulting in hypernatremia and hyperkalemia. The depletion of sodium and water causes severe dehydration and hypotension. Effective therapy would lower potassium levels. A serum potassium level of 3.4 to 4.8 mEq/dL is within the normal range. The normal serum calcium level is 8.6 to 10.2 mg/dL.Rate this question:
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- 7.
What should be a nurse’s priority when admitting a client with suspected hyperaldosteronism?
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Preparing the client for a computed tomography (CT) scan
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Administering medications to treat headache
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Obtaining an electrocardiogram (ECG) to assess for cardiac dysrhythmias
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Protecting the client from falls due to muscle weakness
Correct Answer
A. Obtaining an electrocardiogram (ECG) to assess for cardiac dysrhythmiasExplanation
The excessive aldosterone secretion of hyperaldosteronism causes sodium retention and potassium and hydrogen ion excretion. The potassium-wasting produces hypokalemia, which can cause lifethreatening dysrhythmias. Assessing for life-threatening conditions is priority. Adenomas can be localized by a CT scan, but this is not priority. Headache occurs from hypertension, but this is not priority. Hypokalemia also produces generalized muscle weakness and fatigue which can predispose the client to falls.Rate this question:
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- 8.
A nurse is preparing to discharge a client following a unilateral adrenalectomy to treat hyperaldosteronism caused by an adenoma. Which instruction should be included in this client’s discharge teaching?
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Avoid foods high in potassium.
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Self-monitor the blood pressure.
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Discontinue medications taken prior to the adrenalectomy.
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Carry an emergency kit that includes epinephrine.
Correct Answer
A. Self-monitor the blood pressure.Explanation
The hallmark of hyperaldosteronism is hypertension. Unilateral adrenalectomy is successful in controlling hypertension in only 80% of clients with adenoma, so the client should continue to self-monitor the blood pressure. There are no dietary potassium restrictions. Maintenance therapy for hypertension may include the administration of spironolactone, a potassium-sparing diuretic. However, hyperaldosteronism causes excretion of potassium. The client may still need medications to treat hyperaldosteronism after adrenalectomy. Clients with Addison’s disease are instructed to carry an emergency kit with hydrocortisone.Rate this question:
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- 9.
A nurse is caring for a client who is experiencing symptoms associated with pheochromocytoma. Which intervention should be included in the care of this client?
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Offer distractions such as television or music.
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Encourage frequent intake of oral fluids.
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Assist with ambulation at least three times a day.
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Administer nicardipine (Cardene®) to control hypertension.
Correct Answer
A. Administer nicardipine (Cardene®) to control hypertension.Explanation
Pheochromocytoma is characterized by a tumor of the adrenal medulla that produces excessive catecholamines (epinephrine and norepinephrine). The increased catecholamines result in hypertension. Until the tumor can be surgically removed, calcium channel blockers are used to control blood pressure and other excess catecholamine symptoms. Noise can increase sympathetic nervous system stimulation and provoke a hypertensive and anxiety attack. A calm environment and reduced activity is needed to prevent hypertensive crisis prior to surgery.Rate this question:
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- 10.
A nurse understands that to modify the risk for early cardiovascular disease in children diagnosed with type 1 diabetes mellitus a child should:
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Exercise at least 30 minutes every day.
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Eat a diet that is low in fat and high in protein.
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Maintain optimal management of blood sugar levels.
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Have a cardiac workup at each visit for the diabetes.
Correct Answer
A. Maintain optimal management of blood sugar levels.Explanation
Research indicates that hyperglycemia is the primary mediator for atherosclerosis in children with type 1 diabetes. Since the risk is only modified, the child needs to avoid hyperglycemia. Exercise and a healthy diet are a part of any growing child’s needs. There is no need for a cardiac workup with each diabetes visit.Rate this question:
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- 11.
A 9-year-old child with a history of type 1 diabetes mellitus for the past 6 years is admitted with a diagnosis of diabetic ketoacidosis (DKA). In preparing for the child’s arrival to the nursing unit, the nurse should prepare to:
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Add sodium bicarbonate to the current IV fluids.
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Add potassium chloride to the current IV fluids.
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Use either 0.9% or 0.45% saline for the base IV fluid.
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Administer insulin by subcutaneous injection.
Correct Answer
A. Use either 0.9% or 0.45% saline for the base IV fluid.Explanation
Both water and sodium are depleted in DKA, thus the child will require intravenous saline. Research has shown no benefit to giving sodium bicarbonate to children with DKA to reverse metabolic acidosis. Potassium is added only after laboratory studies have confirmed that the plasma potassium is low. Usually there is not a drop in plasma potassium. Insulin is always given IV in DKA for rapid effect and close monitoring. Insulin onset by subcutaneous route is 15 to 30 minutes and can cause hypoglycemia from potential excessive dosing when attempting to reduce the hyperglycemia.Rate this question:
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- 12.
A pediatric nurse is administering metformin (Glucophage®) to a child at risk for developing type 2 diabetes mellitus. The nurse understands that an important use of metformin in children is to:
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Delay the development of type 2 diabetes mellitus in high-risk children.
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Restore fertility in adolescent females.
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Reduce blood sugars in children who have type 1 diabetes mellitus.
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Restore renal function in children who have type 1 diabetes mellitus.
Correct Answer
A. Delay the development of type 2 diabetes mellitus in high-risk children.Explanation
When a family member has been diagnosed with type 2 diabetes melli- tus, children in the family who are overweight will often be given met- formin and placed on a weight-reduction diet.Rate this question:
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- 13.
The parents of a 7-year-old child diagnosed with type 1 diabetes mellitus are planning to drive 1,200 miles for a vacation at the beach. They question the nurse about insulin storage for the trip. Which response by the nurse is most accurate?
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“Because insulin must be refrigerated, you will need to obtain the medication from a pharmacy at your destination.”
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“Freeze the insulin before you leave home and take it in a cooler; it should be thawed by the time you get to the beach.”
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Keep the insulin in a cooler with an ice pack and out of direct heat and sunlight for the trip. Store unopened insulin in the refrigerator at your destination.”
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“Because it is illegal to transport needles and syringes across most state lines, you will need to obtain a prescription from your doctor and purchase the insulin and the syringes at your destination.”
Correct Answer
A. Keep the insulin in a cooler with an ice pack and out of direct heat and sunlight for the trip. Store unopened insulin in the refrigerator at your destination.”Explanation
Because insulin should be kept out of direct sunlight and extreme heat, it should be transported in a cooler with an ice pack. Insulin is destroyed when frozen. Although it is not illegal to transport needles and syringes, the child should have a prescription to identify the medication and justify the syringes. The prescription also provides a means to obtain additional supplies if needed.Rate this question:
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- 14.
A nurse explains to a parent who has a child with type 1 diabetes mellitus that the most important reason for counting the child’s grams of carbohydrate intake is to:
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Lower blood glucose levels.
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Supply energy for growth and development.
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Provide consistent glucose to prevent hypoglycemia.
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Attain metabolic control of glucose and lipid levels.
Correct Answer
A. Attain metabolic control of glucose and lipid levels.Explanation
Children need energy for growth and development. A child who has type 1 diabetes mellitus needs a consistent intake of carbohydrate; but the overall goal of nutritional management is to achieve and maintain
control of glucose and lipids metabolism. The other alternatives are only a partial answer to the question.Rate this question:
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- 15.
An adolescent client is taught how to use a continuous subcutaneous insulin infusion pump for tight glucose control of type 1 diabetes mellitus. Which statement by the client indicates the need for additional teaching?
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“I can put in the number of carbohydrates that I consume, and the insulin pump will calculate the bolus insulin dose that I will receive.”
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“I must still check my blood glucose levels with meals and snacks and calculate the amount of carbohydrates I consume to ensure I get the correct bolus dose of insulin.”
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“As my blood glucose control improves with the use of the insulin pump, I should see a drop in the weight that I have gained.”
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“Every 2 to 4 days, I will need to change the syringe, catheter, and site moving the site away at least 1 inch from the last site.”
Correct Answer
A. “As my blood glucose control improves with the use of the insulin pump, I should see a drop in the weight that I have gained.”Explanation
Weight gain, and not weight loss, commonly occurs as blood glucose control improves. Newer pumps calculate bolus insulin dose to the carbohydrates consumed. Monitoring blood glucose levels and carbohydrates consumed is still necessary with an insulin pump. About every 2 to 4 days when a syringe is empty, a new syringe and tubing is attached to the pump along with a new skin setup. The site is also changed to prevent lipoatrophy.Rate this question:
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Current Version
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Apr 08, 2025Quiz Edited by
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Apr 08, 2025Quiz Created by
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