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MedSurg 2 Exam 1 Endocrine NCLEX
Questions With Complete 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?" 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. 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. 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.
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,CLASSROOM CLASSROOM CLASSROOM
c. high blood pressure.
d. tachycardia and cardiac palpitations. 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). 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. 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."
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).
CLASSROOM CLASSROOM CLASSROOM
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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). 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
a. insomnia related to waking at night to void.
b. risk for impaired skin integrity related to generalized edema.
c. excess fluid volume related to intake greater than output.
d. activity intolerance related to muscle cramps and weakness. Answer- A
R: Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema
will not be expected because dehydration is a concern with polyuria. The pt drinks
large amnts of fluid to compensate for losses experienced from diuresis. The pt's
fluid and electrolyte status remain normal as long as the patient's oral intake can
keep up w fluid losses, muscle cramps and weakness arent concerns.
10. Which information obtained when caring for a pt who has just been admitted for
evaluation of DI will be of greatest concern to the nurse?
a. The patient has a urine output of 800 ml/hr.
b. The patient's urine specific gravity is 1.003.
c. The patient had a recent head injury.
d. The patient is confused and lethargic. Answer- D
R: Pts with diabetes insipidus 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 DI, but they do not require
immediate nursing action to avoid life-threatening complications.
11. When teaching a patient newly diagnosed with Graves' disease about the
disorder, the nurse explains that
a. restriction of iodine intake is needed to reduce thyroid activity.
b. exercise is contraindicated to avoid increasing metabolic rate.
c. surgery will eventually be required to remove the thyroid gland.
d. antithyroid medications may take several weeks to have an effect. Answer- D
R: Improvement usually begins in 1-2 wks w good results at 4-6 weeks. Large doses
of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large
muscle groups is encouraged to decrease irritability and hyperactivity associated
with high levels of thyroid hormones. Radioactive iodine is the most common trtmt for
Graves' disease, although surgery may be used.
12. A patient with Graves' disease is prepared for surgery with drug therapy
consisting of 4 weeks of propylthiouracil (PTU) and 10 days of iodine before surgery.
When teaching the patient about the drugs, the nurse explains that the drugs are
given preoperatively to
a. eliminate the risk for tetany during the postoperative period.
CLASSROOM CLASSROOM CLASSROOM
MedSurg 2 Exam 1 Endocrine NCLEX
Questions With Complete 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?" 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. 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. 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.
CLASSROOM CLASSROOM CLASSROOM
,CLASSROOM CLASSROOM CLASSROOM
c. high blood pressure.
d. tachycardia and cardiac palpitations. 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). 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. 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."
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).
CLASSROOM CLASSROOM CLASSROOM
, CLASSROOM CLASSROOM CLASSROOM
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). 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
a. insomnia related to waking at night to void.
b. risk for impaired skin integrity related to generalized edema.
c. excess fluid volume related to intake greater than output.
d. activity intolerance related to muscle cramps and weakness. Answer- A
R: Nocturia occurs as a result of the polyuria caused by diabetes insipidus. Edema
will not be expected because dehydration is a concern with polyuria. The pt drinks
large amnts of fluid to compensate for losses experienced from diuresis. The pt's
fluid and electrolyte status remain normal as long as the patient's oral intake can
keep up w fluid losses, muscle cramps and weakness arent concerns.
10. Which information obtained when caring for a pt who has just been admitted for
evaluation of DI will be of greatest concern to the nurse?
a. The patient has a urine output of 800 ml/hr.
b. The patient's urine specific gravity is 1.003.
c. The patient had a recent head injury.
d. The patient is confused and lethargic. Answer- D
R: Pts with diabetes insipidus 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 DI, but they do not require
immediate nursing action to avoid life-threatening complications.
11. When teaching a patient newly diagnosed with Graves' disease about the
disorder, the nurse explains that
a. restriction of iodine intake is needed to reduce thyroid activity.
b. exercise is contraindicated to avoid increasing metabolic rate.
c. surgery will eventually be required to remove the thyroid gland.
d. antithyroid medications may take several weeks to have an effect. Answer- D
R: Improvement usually begins in 1-2 wks w good results at 4-6 weeks. Large doses
of iodine are used to inhibit the synthesis of thyroid hormones. Exercise using large
muscle groups is encouraged to decrease irritability and hyperactivity associated
with high levels of thyroid hormones. Radioactive iodine is the most common trtmt for
Graves' disease, although surgery may be used.
12. A patient with Graves' disease is prepared for surgery with drug therapy
consisting of 4 weeks of propylthiouracil (PTU) and 10 days of iodine before surgery.
When teaching the patient about the drugs, the nurse explains that the drugs are
given preoperatively to
a. eliminate the risk for tetany during the postoperative period.
CLASSROOM CLASSROOM CLASSROOM
