NSG 424 Endocrine Nursing Study Guide 2025 with Q/A
Each item below presents an NCLEX-style question, the correct answer, and a concise but thorough
rationale explaining the pathophysiology, nursing implications, and clinical reasoning.
Q1. 1. A client with hyperthyroidism is prescribed propranolol (Inderal). What is the
primary purpose of this medication?
Answer: To control tachycardia and tremors caused by excessive thyroid hormones (symptomatic
relief).
Rationale: Rationale: Propranolol is a nonselective beta-blocker that reduces adrenergic symptoms of thyrotoxicosis
such as palpitations, tachycardia, tremors, and anxiety. It does not lower thyroid hormone production itself
(antithyroid drugs do that) but provides symptomatic control while definitive therapy (radioactive iodine,
surgery, or antithyroid medications) takes effect. Beta-blockers also reduce peripheral conversion of T4 to T3
to a small extent.
Q2. 2. Which nursing intervention is most important after a thyroidectomy?
Answer: Keep a tracheostomy set and suction equipment at the bedside — risk of airway obstruction
due to edema.
Rationale: Rationale: Postoperative edema, hematoma formation, or vocal cord paralysis can rapidly compromise the
airway after thyroid surgery. Having suction and a tracheostomy or emergency airway kit immediately
available ensures rapid management of airway obstruction. Frequent monitoring of respiratory status, oxygen
saturation, and neck dressing is essential in the first 24 hours.
Q3. 3. A client presents with exophthalmos and weight loss despite increased appetite.
Which disorder is likely?
Answer: Graves’ disease (hyperthyroidism).
Rationale: Rationale: Graves’ disease is an autoimmune hyperthyroidism often presenting with weight loss, increased
appetite, heat intolerance, palpitations, and characteristic ophthalmopathy (exophthalmos). Exophthalmos
results from immune-mediated inflammation and increased orbital tissue volume. Recognizing systemic signs
helps differentiate from other causes of hyperthyroidism.
Q4. 4. When teaching a patient with hypothyroidism about levothyroxine (Synthroid), the
nurse should emphasize:
Answer: Take it on an empty stomach every morning; lifelong therapy is required.
Rationale: Rationale: Levothyroxine has better and more consistent absorption when taken on an empty stomach,
usually 30–60 minutes before breakfast. It is replacement therapy for thyroid hormone and often lifelong,
especially when hypothyroidism is primary. Patients must avoid taking calcium or iron within a few hours of
levothyroxine as these reduce absorption; dosing must be individualized and monitored with TSH levels.
Q5. 5. Which finding indicates Addison’s disease?
Answer: Hyperpigmentation, low sodium, high potassium, and low cortisol levels.
Rationale: Rationale: Primary adrenal insufficiency (Addison’s disease) results in decreased cortisol and aldosterone
leading to hyponatremia (sodium loss), hyperkalemia (reduced potassium excretion), hypotension, and often
hyperpigmentation due to elevated ACTH and melanocyte-stimulating activity. Recognizing the electrolyte
pattern and skin changes helps prompt diagnosis and prevent adrenal crisis.
, Q6. 6. A client with Addisonian crisis is treated with IV hydrocortisone. What other
interventions are vital?
Answer: Fluid resuscitation (NS/D5NS) and electrolyte correction (Na↑, K↓).
Rationale: Rationale: Adrenal crisis causes hypotension and hypovolemia from aldosterone deficiency. Rapid IV fluids
(normal saline, often with dextrose if hypoglycemic) restore circulating volume. Electrolyte correction
addresses hyponatremia and hyperkalemia; hydrocortisone provides necessary glucocorticoids and some
mineralocorticoid activity to stabilize hemodynamics.
Q7. 7. Which symptoms are consistent with Cushing’s syndrome?
Answer: Moon face, truncal obesity, buffalo hump, muscle weakness, thin skin, and hyperglycemia.
Rationale: Rationale: Cushing’s syndrome (chronic cortisol excess) causes characteristic fat redistribution (moon face,
buffalo hump, central obesity), skin thinning and easy bruising due to protein catabolism, muscle weakness,
osteoporosis risk, and glucose intolerance leading to hyperglycemia. These signs reflect cortisol’s metabolic
and catabolic effects and are important for nursing assessment and complication prevention.
Q8. 8. What nursing diagnosis is a priority for a client with Cushing’s syndrome?
Answer: Risk for infection related to immunosuppression from excess corticosteroids.
Rationale: Rationale: Elevated cortisol suppresses immune function, increasing susceptibility to infection. Skin
breakdown from thin skin and poor wound healing compounds this risk. Nursing care focuses on infection
prevention, monitoring for subtle signs of infection (fever may be blunted), and patient education about
avoidance of exposure.
Q9. 9. A client with SIADH is likely to exhibit which laboratory values?
Answer: Low serum sodium (hyponatremia) and decreased serum osmolality.
Rationale: Rationale: SIADH causes inappropriate ADH release leading to water retention and dilutional hyponatremia,
low serum osmolality, and concentrated urine (high urine osmolality). Monitoring sodium and osmolality guides
fluid restriction and hypertonic saline therapy decisions for severe symptoms.
Q10. 10. What is the best nursing intervention for SIADH?
Answer: Fluid restriction and administration of hypertonic saline (3% NaCl) as prescribed.
Rationale: Rationale: Fluid restriction is the cornerstone of SIADH management to reduce water excess. In severe
symptomatic hyponatremia (confusion, seizures), carefully administered hypertonic saline corrects sodium
while avoiding rapid shifts that risk central pontine myelinolysis. Monitor neuro status, I&O;, daily weights, and
serum sodium frequently.
Q11. 11. What is a key finding in Diabetes Insipidus (DI)?
Answer: Excessive urination (polyuria) and dilute urine with low specific gravity (<1.005).
Rationale: Rationale: DI (central or nephrogenic) is characterized by inability to concentrate urine due to ADH
deficiency or renal insensitivity, leading to large volumes of dilute urine, polydipsia, and risk of dehydration
and hypernatremia. Specific gravity and serum sodium help differentiate DI from other causes of polyuria.
Q12. 12. Which medication treats central DI?
Answer: Desmopressin (DDAVP) — synthetic ADH replacement.
Rationale: Rationale: Desmopressin is a synthetic analog of ADH effective for central DI by reducing urine output and
increasing urine osmolality. It is given intranasally, orally, or parenterally depending on severity. Nephrogenic
DI requires different management (thiazide diuretics, low-salt diet) since ADH receptors are impaired.
Each item below presents an NCLEX-style question, the correct answer, and a concise but thorough
rationale explaining the pathophysiology, nursing implications, and clinical reasoning.
Q1. 1. A client with hyperthyroidism is prescribed propranolol (Inderal). What is the
primary purpose of this medication?
Answer: To control tachycardia and tremors caused by excessive thyroid hormones (symptomatic
relief).
Rationale: Rationale: Propranolol is a nonselective beta-blocker that reduces adrenergic symptoms of thyrotoxicosis
such as palpitations, tachycardia, tremors, and anxiety. It does not lower thyroid hormone production itself
(antithyroid drugs do that) but provides symptomatic control while definitive therapy (radioactive iodine,
surgery, or antithyroid medications) takes effect. Beta-blockers also reduce peripheral conversion of T4 to T3
to a small extent.
Q2. 2. Which nursing intervention is most important after a thyroidectomy?
Answer: Keep a tracheostomy set and suction equipment at the bedside — risk of airway obstruction
due to edema.
Rationale: Rationale: Postoperative edema, hematoma formation, or vocal cord paralysis can rapidly compromise the
airway after thyroid surgery. Having suction and a tracheostomy or emergency airway kit immediately
available ensures rapid management of airway obstruction. Frequent monitoring of respiratory status, oxygen
saturation, and neck dressing is essential in the first 24 hours.
Q3. 3. A client presents with exophthalmos and weight loss despite increased appetite.
Which disorder is likely?
Answer: Graves’ disease (hyperthyroidism).
Rationale: Rationale: Graves’ disease is an autoimmune hyperthyroidism often presenting with weight loss, increased
appetite, heat intolerance, palpitations, and characteristic ophthalmopathy (exophthalmos). Exophthalmos
results from immune-mediated inflammation and increased orbital tissue volume. Recognizing systemic signs
helps differentiate from other causes of hyperthyroidism.
Q4. 4. When teaching a patient with hypothyroidism about levothyroxine (Synthroid), the
nurse should emphasize:
Answer: Take it on an empty stomach every morning; lifelong therapy is required.
Rationale: Rationale: Levothyroxine has better and more consistent absorption when taken on an empty stomach,
usually 30–60 minutes before breakfast. It is replacement therapy for thyroid hormone and often lifelong,
especially when hypothyroidism is primary. Patients must avoid taking calcium or iron within a few hours of
levothyroxine as these reduce absorption; dosing must be individualized and monitored with TSH levels.
Q5. 5. Which finding indicates Addison’s disease?
Answer: Hyperpigmentation, low sodium, high potassium, and low cortisol levels.
Rationale: Rationale: Primary adrenal insufficiency (Addison’s disease) results in decreased cortisol and aldosterone
leading to hyponatremia (sodium loss), hyperkalemia (reduced potassium excretion), hypotension, and often
hyperpigmentation due to elevated ACTH and melanocyte-stimulating activity. Recognizing the electrolyte
pattern and skin changes helps prompt diagnosis and prevent adrenal crisis.
, Q6. 6. A client with Addisonian crisis is treated with IV hydrocortisone. What other
interventions are vital?
Answer: Fluid resuscitation (NS/D5NS) and electrolyte correction (Na↑, K↓).
Rationale: Rationale: Adrenal crisis causes hypotension and hypovolemia from aldosterone deficiency. Rapid IV fluids
(normal saline, often with dextrose if hypoglycemic) restore circulating volume. Electrolyte correction
addresses hyponatremia and hyperkalemia; hydrocortisone provides necessary glucocorticoids and some
mineralocorticoid activity to stabilize hemodynamics.
Q7. 7. Which symptoms are consistent with Cushing’s syndrome?
Answer: Moon face, truncal obesity, buffalo hump, muscle weakness, thin skin, and hyperglycemia.
Rationale: Rationale: Cushing’s syndrome (chronic cortisol excess) causes characteristic fat redistribution (moon face,
buffalo hump, central obesity), skin thinning and easy bruising due to protein catabolism, muscle weakness,
osteoporosis risk, and glucose intolerance leading to hyperglycemia. These signs reflect cortisol’s metabolic
and catabolic effects and are important for nursing assessment and complication prevention.
Q8. 8. What nursing diagnosis is a priority for a client with Cushing’s syndrome?
Answer: Risk for infection related to immunosuppression from excess corticosteroids.
Rationale: Rationale: Elevated cortisol suppresses immune function, increasing susceptibility to infection. Skin
breakdown from thin skin and poor wound healing compounds this risk. Nursing care focuses on infection
prevention, monitoring for subtle signs of infection (fever may be blunted), and patient education about
avoidance of exposure.
Q9. 9. A client with SIADH is likely to exhibit which laboratory values?
Answer: Low serum sodium (hyponatremia) and decreased serum osmolality.
Rationale: Rationale: SIADH causes inappropriate ADH release leading to water retention and dilutional hyponatremia,
low serum osmolality, and concentrated urine (high urine osmolality). Monitoring sodium and osmolality guides
fluid restriction and hypertonic saline therapy decisions for severe symptoms.
Q10. 10. What is the best nursing intervention for SIADH?
Answer: Fluid restriction and administration of hypertonic saline (3% NaCl) as prescribed.
Rationale: Rationale: Fluid restriction is the cornerstone of SIADH management to reduce water excess. In severe
symptomatic hyponatremia (confusion, seizures), carefully administered hypertonic saline corrects sodium
while avoiding rapid shifts that risk central pontine myelinolysis. Monitor neuro status, I&O;, daily weights, and
serum sodium frequently.
Q11. 11. What is a key finding in Diabetes Insipidus (DI)?
Answer: Excessive urination (polyuria) and dilute urine with low specific gravity (<1.005).
Rationale: Rationale: DI (central or nephrogenic) is characterized by inability to concentrate urine due to ADH
deficiency or renal insensitivity, leading to large volumes of dilute urine, polydipsia, and risk of dehydration
and hypernatremia. Specific gravity and serum sodium help differentiate DI from other causes of polyuria.
Q12. 12. Which medication treats central DI?
Answer: Desmopressin (DDAVP) — synthetic ADH replacement.
Rationale: Rationale: Desmopressin is a synthetic analog of ADH effective for central DI by reducing urine output and
increasing urine osmolality. It is given intranasally, orally, or parenterally depending on severity. Nephrogenic
DI requires different management (thiazide diuretics, low-salt diet) since ADH receptors are impaired.
