MEDICAL-SURGICAL NURSING COMPREHENSIVE
EXAMINATION
Specialty Focus: Endocrine Disorders (200 Clinical Questions with
Detailed Rationales)
Professional Nursing Board & Clinical Mastery Review
MODULE 1: HYPOTHALAMIC & PITUITARY DISORDERS (Q1
- Q35)
Question 1: A nurse is caring for a client immediately following a
transsphenoidal hypophysectomy for a pituitary adenoma. Which
assessment finding requires immediate nursing intervention?
A. Clear nasal drainage testing positive for glucose
B. Report of a mild headache relieved by analgesics
C. Dry mucous membranes and thirst
D. Numbness and tingling of the lips
Correct Answer: A
Rationale: Clear nasal drainage that tests positive for glucose
indicates cerebrospinal fluid (CSF) leakage, a serious complication
of transsphenoidal surgery placing the client at high risk for
meningitis. A mild headache is expected. Thirst and dry lips are
common due to mouth breathing from nasal packing. Numbness in
lips may relate to calcium or positioning but CSF leak is the most
critical emergency.
Question 2: A client with diabetes insipidus (DI) is prescribed
desmopressin (DDAVP). Which laboratory value should the nurse
monitor most closely during therapy?
A. Serum potassium and sodium
, B. Blood glucose levels
C. White blood cell differential
D. Prothrombin time and INR
Correct Answer: A
Rationale: Desmopressin is a synthetic analog of antidiuretic
hormone (ADH). In diabetes insipidus, excessive water loss leads to
severe hypernatremia and concentrated serum osmolality. Monitoring
serum sodium and potassium ensures fluid and electrolyte balance
and prevents water intoxication.
Question 3: The nurse is evaluating the fluid balance of a client
diagnosed with Syndrome of Inappropriate Antidiuretic Hormone
(SIADH). Which finding is consistent with this condition?
A. Serum sodium of 122 mEq/L and concentrated urine
B. Serum sodium of 152 mEq/L and dilute urine
C. Urine specific gravity of 1.002 and polyuria
D. Orthostatic hypotension and poor skin turgor
Correct Answer: A
Rationale: SIADH is characterized by excessive ADH release,
leading to water retention, dilutional hyponatremia (serum sodium <
135 mEq/L), low serum osmolality, and inappropriately concentrated
urine relative to serum osmolality. Options B, C, and D describe
diabetes insipidus.
Question 4: A client with acromegaly is scheduled for diagnostic
workup. Which clinical manifestation is the nurse most likely to assess?
A. Coarsening of facial features and enlargement of hands and feet
B. Rapid vertical linear growth and gigantism in adulthood
C. Severe weight loss and loss of muscle mass
D. Atrophy of soft tissues and premature epiphyseal plate fusion
, Correct Answer: A
Rationale: Acromegaly results from excess growth hormone (GH) in
adults after epiphyseal plate closure, causing enlargement of bones in
the hands, feet, face, and skull, along with soft tissue swelling.
Gigantism occurs when GH excess begins before epiphyseal closure
in children.
Question 5: A client is admitted with panhypopituitarism. Which
hormone replacement regimen is most critical for immediate life
support?
A. Thyroid hormone and corticosteroids
B. Insulin and oral hypoglycemics
C. Estrogen and progesterone
D. Melatonin and oxytocin
Correct Answer: A
Rationale: Panhypopituitarism involves deficiency of anterior
pituitary hormones. Loss of TSH and ACTH leads to secondary
hypothyroidism and secondary adrenal insufficiency, both of which
are life-threatening and require prompt replacement of
corticosteroids and thyroid hormone.
Question 6: Which nursing intervention is essential when administering
desmopressin intranasally to a client with central diabetes insipidus?
A. Inspect nasal passages for ulceration or irritation
B. Administer only when urine output drops below 30 mL/hr
C. Ensure the client maintains a high-sodium diet restriction
D. Refrigerate the medication vial after the first dose
Correct Answer: A
Rationale: Intranasal desmopressin can cause local nasal irritation,
edema, and ulceration. Assessing nasal mucosa is essential. It is
given based on urine output and specific gravity targets, not
, restricted sodium, and some formulations do not require refrigeration
once opened.
Question 7: A client with SIADH is placed on fluid restriction. Which
statement by the client indicates an understanding of the restriction?
A. I need to limit my total fluid intake to 800 mL to 1,000 mL per
day.
B. I should drink at least 3 liters of water daily to flush my kidneys.
C. I can drink as much water as long as I take salt tablets.
D. I should avoid all protein-rich foods in my diet.
Correct Answer: A
Rationale: Fluid restriction (typically 800 to 1,000 mL/24 hours) is
the cornerstone treatment for mild to moderate SIADH to prevent
further dilutional hyponatremia. High fluid intake would worsen
hyponatremia and cerebral edema.
Question 8: A client post-hypophysectomy complains of extreme thirst,
passing 450 mL of pale, dilute urine per hour with a specific gravity of
1.001. What is the nurse's priority action?
A. Notify the physician immediately and prepare to administer
vasopressin
B. Encourage oral water intake up to 3000 mL per day
C. Document the finding as expected post-operative diuresis
D. Administer prescribed IV furosemide immediately
Correct Answer: A
Rationale: Transient or permanent diabetes insipidus frequently
occurs following pituitary surgery due to trauma to the posterior
pituitary stalk, leading to abrupt ADH deficiency. Immediate medical
notification and vasopressin/desmopressin administration are vital to
prevent severe dehydration and shock.
EXAMINATION
Specialty Focus: Endocrine Disorders (200 Clinical Questions with
Detailed Rationales)
Professional Nursing Board & Clinical Mastery Review
MODULE 1: HYPOTHALAMIC & PITUITARY DISORDERS (Q1
- Q35)
Question 1: A nurse is caring for a client immediately following a
transsphenoidal hypophysectomy for a pituitary adenoma. Which
assessment finding requires immediate nursing intervention?
A. Clear nasal drainage testing positive for glucose
B. Report of a mild headache relieved by analgesics
C. Dry mucous membranes and thirst
D. Numbness and tingling of the lips
Correct Answer: A
Rationale: Clear nasal drainage that tests positive for glucose
indicates cerebrospinal fluid (CSF) leakage, a serious complication
of transsphenoidal surgery placing the client at high risk for
meningitis. A mild headache is expected. Thirst and dry lips are
common due to mouth breathing from nasal packing. Numbness in
lips may relate to calcium or positioning but CSF leak is the most
critical emergency.
Question 2: A client with diabetes insipidus (DI) is prescribed
desmopressin (DDAVP). Which laboratory value should the nurse
monitor most closely during therapy?
A. Serum potassium and sodium
, B. Blood glucose levels
C. White blood cell differential
D. Prothrombin time and INR
Correct Answer: A
Rationale: Desmopressin is a synthetic analog of antidiuretic
hormone (ADH). In diabetes insipidus, excessive water loss leads to
severe hypernatremia and concentrated serum osmolality. Monitoring
serum sodium and potassium ensures fluid and electrolyte balance
and prevents water intoxication.
Question 3: The nurse is evaluating the fluid balance of a client
diagnosed with Syndrome of Inappropriate Antidiuretic Hormone
(SIADH). Which finding is consistent with this condition?
A. Serum sodium of 122 mEq/L and concentrated urine
B. Serum sodium of 152 mEq/L and dilute urine
C. Urine specific gravity of 1.002 and polyuria
D. Orthostatic hypotension and poor skin turgor
Correct Answer: A
Rationale: SIADH is characterized by excessive ADH release,
leading to water retention, dilutional hyponatremia (serum sodium <
135 mEq/L), low serum osmolality, and inappropriately concentrated
urine relative to serum osmolality. Options B, C, and D describe
diabetes insipidus.
Question 4: A client with acromegaly is scheduled for diagnostic
workup. Which clinical manifestation is the nurse most likely to assess?
A. Coarsening of facial features and enlargement of hands and feet
B. Rapid vertical linear growth and gigantism in adulthood
C. Severe weight loss and loss of muscle mass
D. Atrophy of soft tissues and premature epiphyseal plate fusion
, Correct Answer: A
Rationale: Acromegaly results from excess growth hormone (GH) in
adults after epiphyseal plate closure, causing enlargement of bones in
the hands, feet, face, and skull, along with soft tissue swelling.
Gigantism occurs when GH excess begins before epiphyseal closure
in children.
Question 5: A client is admitted with panhypopituitarism. Which
hormone replacement regimen is most critical for immediate life
support?
A. Thyroid hormone and corticosteroids
B. Insulin and oral hypoglycemics
C. Estrogen and progesterone
D. Melatonin and oxytocin
Correct Answer: A
Rationale: Panhypopituitarism involves deficiency of anterior
pituitary hormones. Loss of TSH and ACTH leads to secondary
hypothyroidism and secondary adrenal insufficiency, both of which
are life-threatening and require prompt replacement of
corticosteroids and thyroid hormone.
Question 6: Which nursing intervention is essential when administering
desmopressin intranasally to a client with central diabetes insipidus?
A. Inspect nasal passages for ulceration or irritation
B. Administer only when urine output drops below 30 mL/hr
C. Ensure the client maintains a high-sodium diet restriction
D. Refrigerate the medication vial after the first dose
Correct Answer: A
Rationale: Intranasal desmopressin can cause local nasal irritation,
edema, and ulceration. Assessing nasal mucosa is essential. It is
given based on urine output and specific gravity targets, not
, restricted sodium, and some formulations do not require refrigeration
once opened.
Question 7: A client with SIADH is placed on fluid restriction. Which
statement by the client indicates an understanding of the restriction?
A. I need to limit my total fluid intake to 800 mL to 1,000 mL per
day.
B. I should drink at least 3 liters of water daily to flush my kidneys.
C. I can drink as much water as long as I take salt tablets.
D. I should avoid all protein-rich foods in my diet.
Correct Answer: A
Rationale: Fluid restriction (typically 800 to 1,000 mL/24 hours) is
the cornerstone treatment for mild to moderate SIADH to prevent
further dilutional hyponatremia. High fluid intake would worsen
hyponatremia and cerebral edema.
Question 8: A client post-hypophysectomy complains of extreme thirst,
passing 450 mL of pale, dilute urine per hour with a specific gravity of
1.001. What is the nurse's priority action?
A. Notify the physician immediately and prepare to administer
vasopressin
B. Encourage oral water intake up to 3000 mL per day
C. Document the finding as expected post-operative diuresis
D. Administer prescribed IV furosemide immediately
Correct Answer: A
Rationale: Transient or permanent diabetes insipidus frequently
occurs following pituitary surgery due to trauma to the posterior
pituitary stalk, leading to abrupt ADH deficiency. Immediate medical
notification and vasopressin/desmopressin administration are vital to
prevent severe dehydration and shock.
