Endocrine System Disorders | NCLEX Quiz 93

1. A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack explains that these medications are only effective if the client:

Prefers to take insulin orally.

Has type 2 diabetes.

Has type 1 diabetes.

Is pregnant and has type 2 diabetes.

Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic agents aren’t effective in type 1 diabetes. Pregnant and lactating women aren’t prescribed oral antidiabetic agents because the effect on the fetus is uncertain.

Explanation

Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic agents aren’t effective in type 1 diabetes. Pregnant and lactating women aren’t prescribed oral antidiabetic agents because the effect on the fetus is uncertain.

2. An incoherent female client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia. hypoventilation. respiratory acidosis. bradycardia. hypotension. and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism. nurse Libby prepares to take emergency action to prevent the potential complication of:

Thyroid storm.

Cretinism.

Myxedema coma.

Hashimoto’s thyroiditis.

Severe hypothyroidism may result in myxedema coma. in which a drastic drop in the metabolic rate causes decreased vital signs. hypoventilation (possibly leading to respiratory acidosis). and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto’s thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.

Explanation

Severe hypothyroidism may result in myxedema coma. in which a drastic drop in the metabolic rate causes decreased vital signs. hypoventilation (possibly leading to respiratory acidosis). and nonpitting edema. Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in infants. Hashimoto’s thyroiditis is a common chronic inflammatory disease of the thyroid gland in which autoimmune factors play a prominent role.

3. Nurse Ronn is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome. the nurse would expect to find:

Hypotension.

Thick. coarse skin.

Deposits of adipose tissue in the trunk and dorsocervical area.

Weight gain in arms and legs.

Because of changes in fat distribution. adipose tissue accumulates in the trunk. face (moonface). and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

Explanation

Because of changes in fat distribution. adipose tissue accumulates in the trunk. face (moonface). and dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.

4. When caring for a male client with diabetes insipidus. nurse Juliet expects to administer:

Vasopressin (Pitressin Synthetic).

Furosemide (Lasix).

Regular insulin.

10% dextrose.

Chvostek’s sign is elicited by tapping the client’s face lightly over the facial nerve. just below the temple. If the client’s facial muscles twitch. it indicates hypocalcemia. Hyponatremia is indicated by weight loss. abdominal cramping. muscle weakness. headache. and postural hypotension. Hypokalemia causes paralytic ileus and muscle weakness. Clients with hypermagnesemia exhibit a loss of deep tendon reflexes. coma. or cardiac arrest.

Explanation

Chvostek’s sign is elicited by tapping the client’s face lightly over the facial nerve. just below the temple. If the client’s facial muscles twitch. it indicates hypocalcemia. Hyponatremia is indicated by weight loss. abdominal cramping. muscle weakness. headache. and postural hypotension. Hypokalemia causes paralytic ileus and muscle weakness. Clients with hypermagnesemia exhibit a loss of deep tendon reflexes. coma. or cardiac arrest.

5. During preoperative teaching for a female client who will undergo subtotal thyroidectomy. the nurse should include which statement?

“The head of your bed must remain flat for 24 hours after surgery.”

“You should avoid deep breathing and coughing after surgery.”

“You won’t be able to swallow for the first day or two.”

“You must avoid hyperextending your neck after surgery.”

To prevent undue pressure on the surgical incision after subtotal thyroidectomy. the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesn’t affect swallowing.

Explanation

To prevent undue pressure on the surgical incision after subtotal thyroidectomy. the nurse should advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesn’t affect swallowing.

6. A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should nurse Lina provide?

“Administer desmopressin while the suspension is cold.”

“Your condition isn’t chronic. so you won’t need to wear a medical identification bracelet.”

“You may not be able to use desmopressin nasally if you have nasal discharge or blockage.”

“You won’t need to monitor your fluid intake and output after you start taking desmopressin.”

Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable. the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and receive adequate fluid replacement.

Explanation

Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes insipidus is treatable. the client should wear medical identification and carry medication at all times to alert medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake and output and receive adequate fluid replacement.

7. In a 29-year-old female client who is being successfully treated for Cushing's syndrome. nurse Lyzette would expect a decline in:

Serum glucose level.

Hair loss.

Bone mineralization.

Menstrual flow.

Hyperglycemia. which develops from glucocorticoid excess. is a manifestation of Cushing’s syndrome. With successful treatment of the disorder. serum glucose levels decline. Hirsutism is common in Cushing’s syndrome; therefore. with successful treatment. abnormal hair growth also declines. Osteoporosis occurs in Cushing’s syndrome; therefore. with successful treatment. bone mineralization increases. Amenorrhea develops in Cushing’s syndrome. With successful treatment. the client experiences a return of menstrual flow. not a decline in it.

Explanation

Hyperglycemia. which develops from glucocorticoid excess. is a manifestation of Cushing’s syndrome. With successful treatment of the disorder. serum glucose levels decline. Hirsutism is common in Cushing’s syndrome; therefore. with successful treatment. abnormal hair growth also declines. Osteoporosis occurs in Cushing’s syndrome; therefore. with successful treatment. bone mineralization increases. Amenorrhea develops in Cushing’s syndrome. With successful treatment. the client experiences a return of menstrual flow. not a decline in it.

8. When caring for a female client with a history of hypoglycemia. nurse Ruby should avoid administering a drug that may potentiate hypoglycemia. Which drug fits this description?

Sulfisoxazole (Gantrisin)

Mexiletine (Mexitil)

Prednisone (Orasone)

Lithium carbonate (Lithobid)

Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine. an antiarrhythmic. is used to treat refractory ventricular arrhythmias; it doesn’t cause hypoglycemia. Prednisone. a corticosteroid. is associated with hyperglycemia. Lithium may cause transient hyperglycemia. not hypoglycemia.

Explanation

Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may precipitate hypoglycemia. Mexiletine. an antiarrhythmic. is used to treat refractory ventricular arrhythmias; it doesn’t cause hypoglycemia. Prednisone. a corticosteroid. is associated with hyperglycemia. Lithium may cause transient hyperglycemia. not hypoglycemia.

9. A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin (Acthar). 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin?

It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target organs.

It interacts with plasma membrane receptors to inhibit enzymatic actions.

It interacts with plasma membrane receptors to produce enzymatic actions that affect protein. fat. and carbohydrate metabolism.

It regulates the threshold for water resorption in the kidneys.

Corticotropin interacts with plasma membrane receptors to produce enzymatic actions that affect protein. fat. and carbohydrate metabolism. It doesn’t decrease cAMP production. The posterior pituitary hormone. antidiuretic hormone. regulates the threshold for water resorption in the kidneys.

Explanation

Corticotropin interacts with plasma membrane receptors to produce enzymatic actions that affect protein. fat. and carbohydrate metabolism. It doesn’t decrease cAMP production. The posterior pituitary hormone. antidiuretic hormone. regulates the threshold for water resorption in the kidneys.

10. After taking glipizide (Glucotrol) for 9 months. a male client experiences secondary failure. Which of the following would the nurse expect the physician to do?

Initiate insulin therapy.

Switch the client to a different oral antidiabetic agent.

Prescribe an additional oral antidiabetic agent.

Restrict carbohydrate intake to less than 30% of the total caloric intake.

Many clients (25% to 60%) with secondary failure respond to a different oral antidiabetic agent. Therefore. it wouldn’t be appropriate to initiate insulin therapy at this time. However. if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level. insulin may be used in addition to the antidiabetic agent.

Explanation

Many clients (25% to 60%) with secondary failure respond to a different oral antidiabetic agent. Therefore. it wouldn’t be appropriate to initiate insulin therapy at this time. However. if a new oral antidiabetic agent is unsuccessful in keeping glucose levels at an acceptable level. insulin may be used in addition to the antidiabetic agent.