MEDSURG 2 EXAM 1 ENDOCRINE NCLEX QUESTIONS
WITH ACCURATE ANSWERS
1. A pt with suspected acromegaly is seen at the clinic. To assist in making the
diagnosis, which question should the nurse ask?
a. "Have you had a recent head injury?"
b. "Do you have to wear larger shoes now?"
c. "Is there any family history of acromegaly?"
d. "Are you experiencing tremors or anxiety?" correct answer B
Rationale: 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.
(Cognitive Level: Application Text Reference: p. 1291
NProcess: Assessment NCLEX: Physiological Integrity)
2. During preoperative teaching for a patient scheduled for transsphenoidal
hypophysectomy for treatment of a pituitary adenoma, the nurse instructs the
patient about the need to
a. remain on bed rest for the first 48 hours after the surgery.
b. avoid brushing the teeth for at least 10 days after the surgery.
c. cough and deep-breathe every 2 hrs postoperatively.
d. be positioned flat with sandbags at the head postoperatively. correct answer B
R: 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.
,(Cognitive Level: Application Text Reference: p. 1293
NProcess: Implementation NCLEX: Physiological Integrity)
3. Following a transsphenoidal resection of a pituitary tumor, an important N
assessment is
a. monitoring hourly urine output.
b. checking the dressings for serous drainage.
c. palpating for dependent pitting edema.
d. obtaining continuous pulse oximetry. correct answer A
R: After pituitary surgery, the pt is at risk for diabetes insipidus caused by cerebral
edema and monitoring of urine output and urine specific gravity is essential.
There will be no dressing when transsphenoidal approach is used. The pt is at risk
for dehydration, not volume overload. The pt is not at high risk for problems with
oxygenation, and continuous pulse oximetry is not needed.
4. A pt is suspected of having a pituitary tumor causing panhypopituitarism.
During assessment of the pt, the nurse would expect to find
a. elevated blood glucose.
b. changes in secondary sex characteristics.
c. high blood pressure.
d. tachycardia and cardiac palpitations. correct answer B
Rationale: Changes in secondary sex characteristics are associated with decreases
in FSH and LH. Fasting hypoglycemia and hypotension occur in
panhypopituitarism as a result of decreases in ACTH and cortisol. Bradycardia is
likely due to the decrease in TSH and thyroid hormones associated with
panhypopituitarism.
(Cognitive Level: Application Text Reference: p. 1294
,NProcess: Assessment NCLEX: Physiological Integrity)
5. A pt seen at clinic for an upper respiratory infection reports receiving
subcutaneous somatotropin (Genotropin) when asked by the nurse about current
medications. The nurse questions the pt further about a hx of
a. adrenal disease.
b. untreated acromegaly.
c. a pituitary tumor.
d. diabetes insipidus (DI). correct answer C
R: Somatotropin is a recombinant growth hormone product used for adults with
growth hormone deficiency, such as that caused by a pituitary tumor. The med is
not used in adrenal disease or DI. The patient with untreated acromegaly will
have an excess of growth hormone.
6. A patient with an antidiuretic hormone (ADH)-secreting small-cell cancer of the
lung is treated with demeclocycline (Declomycin) to control the symptoms of
syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse
determines that the demeclocycline is effective upon finding that the
a. patient's daily weight is stable.
b. urine specific gravity is increased.
c. patient's urinary output is increased.
d. peripheral edema is decreased. correct answer C
R: Demeclocycline blocks the action of ADH on the renal tubules and increases
urine output. A stable body weight and an increase in urine specific gravity
indicate 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.
, 7. When teaching a patient with chronic SIADH about long-term management of
the disorder, the nurse determines that additional instruction is needed when the
patient says,
a. "I need to shop for foods that are low in sodium and avoid adding salt to
foods."
b. "I should weigh myself daily and report any sudden weight loss or gain."
c. "I need to limit my fluid intake to no more than 1 quart of liquids a day."
d. "I will eat foods high in potassium because the diuretics cause potassium loss."
correct answer A
Rationale: Pts with SIADH are at risk for hyponatremia, and a sodium supplement
may be prescribed. The other pt statements are correct and indicate successful
teaching has occurred.
8. A patient is hospitalized with possible SIADH. The patient is confused and
reports a headache, muscle cramps, and twitching. The nurse would expect the
initial laboratory results to include a
a. serum sodium of 125 mEq/L (125 mmol/L).
b. hematocrit of 52%.
c. blood urea nitrogen (BUN) of 22 mg/dl (11.5 mmol/L).
d. serum chloride of 110 mEq/L (110 mmol/L). correct answer A
R: When water is retained, the serum sodium level will drop below normal,
causing the CMs reported by the patient. The hematocrit will decrease because of
the dilution caused by water retention. The BUN is not helpful in diagnosis of
SIADH and this BUN value is increased. The serum chloride level will usually
decrease along with the sodium level. This chloride value is elevated.
9. A patient with symptoms of DI is admitted to the hospital for evaluation and
treatment of the condition. An appropriate nursing diagnosis for the patient is
WITH ACCURATE ANSWERS
1. A pt with suspected acromegaly is seen at the clinic. To assist in making the
diagnosis, which question should the nurse ask?
a. "Have you had a recent head injury?"
b. "Do you have to wear larger shoes now?"
c. "Is there any family history of acromegaly?"
d. "Are you experiencing tremors or anxiety?" correct answer B
Rationale: 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.
(Cognitive Level: Application Text Reference: p. 1291
NProcess: Assessment NCLEX: Physiological Integrity)
2. During preoperative teaching for a patient scheduled for transsphenoidal
hypophysectomy for treatment of a pituitary adenoma, the nurse instructs the
patient about the need to
a. remain on bed rest for the first 48 hours after the surgery.
b. avoid brushing the teeth for at least 10 days after the surgery.
c. cough and deep-breathe every 2 hrs postoperatively.
d. be positioned flat with sandbags at the head postoperatively. correct answer B
R: 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.
,(Cognitive Level: Application Text Reference: p. 1293
NProcess: Implementation NCLEX: Physiological Integrity)
3. Following a transsphenoidal resection of a pituitary tumor, an important N
assessment is
a. monitoring hourly urine output.
b. checking the dressings for serous drainage.
c. palpating for dependent pitting edema.
d. obtaining continuous pulse oximetry. correct answer A
R: After pituitary surgery, the pt is at risk for diabetes insipidus caused by cerebral
edema and monitoring of urine output and urine specific gravity is essential.
There will be no dressing when transsphenoidal approach is used. The pt is at risk
for dehydration, not volume overload. The pt is not at high risk for problems with
oxygenation, and continuous pulse oximetry is not needed.
4. A pt is suspected of having a pituitary tumor causing panhypopituitarism.
During assessment of the pt, the nurse would expect to find
a. elevated blood glucose.
b. changes in secondary sex characteristics.
c. high blood pressure.
d. tachycardia and cardiac palpitations. correct answer B
Rationale: Changes in secondary sex characteristics are associated with decreases
in FSH and LH. Fasting hypoglycemia and hypotension occur in
panhypopituitarism as a result of decreases in ACTH and cortisol. Bradycardia is
likely due to the decrease in TSH and thyroid hormones associated with
panhypopituitarism.
(Cognitive Level: Application Text Reference: p. 1294
,NProcess: Assessment NCLEX: Physiological Integrity)
5. A pt seen at clinic for an upper respiratory infection reports receiving
subcutaneous somatotropin (Genotropin) when asked by the nurse about current
medications. The nurse questions the pt further about a hx of
a. adrenal disease.
b. untreated acromegaly.
c. a pituitary tumor.
d. diabetes insipidus (DI). correct answer C
R: Somatotropin is a recombinant growth hormone product used for adults with
growth hormone deficiency, such as that caused by a pituitary tumor. The med is
not used in adrenal disease or DI. The patient with untreated acromegaly will
have an excess of growth hormone.
6. A patient with an antidiuretic hormone (ADH)-secreting small-cell cancer of the
lung is treated with demeclocycline (Declomycin) to control the symptoms of
syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The nurse
determines that the demeclocycline is effective upon finding that the
a. patient's daily weight is stable.
b. urine specific gravity is increased.
c. patient's urinary output is increased.
d. peripheral edema is decreased. correct answer C
R: Demeclocycline blocks the action of ADH on the renal tubules and increases
urine output. A stable body weight and an increase in urine specific gravity
indicate 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.
, 7. When teaching a patient with chronic SIADH about long-term management of
the disorder, the nurse determines that additional instruction is needed when the
patient says,
a. "I need to shop for foods that are low in sodium and avoid adding salt to
foods."
b. "I should weigh myself daily and report any sudden weight loss or gain."
c. "I need to limit my fluid intake to no more than 1 quart of liquids a day."
d. "I will eat foods high in potassium because the diuretics cause potassium loss."
correct answer A
Rationale: Pts with SIADH are at risk for hyponatremia, and a sodium supplement
may be prescribed. The other pt statements are correct and indicate successful
teaching has occurred.
8. A patient is hospitalized with possible SIADH. The patient is confused and
reports a headache, muscle cramps, and twitching. The nurse would expect the
initial laboratory results to include a
a. serum sodium of 125 mEq/L (125 mmol/L).
b. hematocrit of 52%.
c. blood urea nitrogen (BUN) of 22 mg/dl (11.5 mmol/L).
d. serum chloride of 110 mEq/L (110 mmol/L). correct answer A
R: When water is retained, the serum sodium level will drop below normal,
causing the CMs reported by the patient. The hematocrit will decrease because of
the dilution caused by water retention. The BUN is not helpful in diagnosis of
SIADH and this BUN value is increased. The serum chloride level will usually
decrease along with the sodium level. This chloride value is elevated.
9. A patient with symptoms of DI is admitted to the hospital for evaluation and
treatment of the condition. An appropriate nursing diagnosis for the patient is
