[Ex4] - C20 - AP

Question 1

20-1. Besides hyposecretion and hypersecretion, endocrine system dysfunction can result from:
a. abnormal receptor activity.
b. abnormal hormone levels.
c. increased synthesis of second messengers.
d. extracellular electrolyte alterations.

Answer 1

ANS: A
Dysfunction may result from abnormal cell receptor function or from altered intracellular
response to the hormone-receptor complex. Abnormal hormone levels can occur but are not
the cause of endocrine dysfunction. Intracellular storage of second-messenger hormones
would not lead to dysfunction; receptor function does. Extracellular electrolyte alterations
may result from dysfunction, but they are not a cause.

Question 2

20-2. What is the most common cause of elevated levels of antidiuretic hormone (ADH) secretion?
a. Autoimmune disease
b. Cancer
c. Pregnancy
d. Heart failure

Answer 2

ANS: B
The most common cause of elevated levels of ADH is cancer, not autoimmune disorders,
pregnancy, or heart failure.

Question 3

20-3. A 54-year-old patient with pulmonary tuberculosis is evaluated for syndrome of inappropriate
ADH secretion (SIADH). Which electrolyte imbalance would be expected in this patient?
a. Hyponatremia
b. Hyperkalemia
c. Hypernatremia
d. Hypokalemia

Answer 3

ANS: A
Hyponatremia occurs due to increased water reabsorption by kidneys. Hyperkalemia does not
occur due to increased water reabsorption. Sodium levels are lowered with hyponatremia; they
are not elevated. Hypokalemia does not occur; SIADH is a problem of sodium.

Question 4

20-4. A 44-year-old patient with pulmonary tuberculosis is evaluated for SIADH. Which
assessment finding would support this diagnosis?
a. Peripheral edema
b. Tachycardia
c. Low blood pressure
d. Concentrated urine

Answer 4

ANS: D

Clinical manifestations of SIADH include urine that is inappropriately concentrated with
respect to serum osmolarity. Symptomology of SIADH does not include peripheral edema,
tachycardia, or low blood pressure.

Question 5

20-5. A nurse is caring for a patient diagnosed with SIADH. What severe complication should the
nurse assess for?
a. Stroke
b. Diabetes insipidus
c. Neurologic damage
d. Renal failure

Answer 5

ANS: C
When the hyponatremia of SIADH becomes severe, 110–115 milliequivalents per liter,
confusion, lethargy, muscle twitching, convulsions, and severe and sometimes irreversible
neurologic damage may occur. Neither stroke, diabetes insipidus, nor renal failure is
associated with SIADH.

Question 6

20-6. A patient is admitted to the intensive care unit with a closed head injury sustained in a
motorcycle accident. The injury has caused severe damage to the posterior pituitary. Which of
the following complications should the nurse anticipate?
a. Dilutional hyponatremia
b. Dehydration from polyuria
c. Cardiac arrest from hyperkalemia
d. Metabolic acidosis

Answer 6

ANS: B
Diabetes insipidus is a well-recognized complication of closed head injury and is manifested
by polyuria leading to dehydration. The patient will experience hypernatremia, not
hyponatremia. Electrolytes other than sodium are typically not affected with diabetes
insipidus. Acidosis is not associated with diabetes insipidus.

Question 7

20-7. While planning care for a patient from general anesthesia, which principle should the nurse
remember? A side effect of some general anesthetic agents is _____ diabetes insipidus.
a. neurogenic
b. nephrogenic
c. psychogenic
d. allogenic

Answer 7

ANS: B
General anesthetics can lead to nephrogenic diabetes insipidus (DI). General anesthetics are
not associated with any of the other forms of DI.

Question 8

20-8. Diabetes insipidus, diabetes mellitus (DM), and SIADH share which of the following
assessment manifestations?
a. Polyuria
b. Edema
c. Vomiting
d. Thirst

Answer 8

ANS: D

All three share thirst as a common clinical manifestation. SIADH does not have polyuria as a
clinical manifestation. Diabetes insipidus does not have edema as a clinical manifestation.
SIADH is manifested by gastrointestinal symptoms; the other two are not.

Question 9

20-9. A patient presents with polyuria and extreme thirst and is given exogenous ADH. For which
of the following conditions would this treatment be effective?
a. Neurogenic diabetes insipidus
b. Psychogenic diabetes insipidus
c. Nephrogenic diabetes insipidus
d. SIADH

Answer 9

ANS: A
Neurogenic diabetes insipidus is caused by the insufficient secretion of ADH; thus, exogenous
ADH would be useful in the treatment of this disorder. Psychogenic diabetes insipidus is due
to increased intake of water and would not respond to exogenous ADH. ADH is high in
nephrogenic diabetes insipidus; thus, exogenous ADH would be contraindicated. SIADH is
manifested by high levels of ADH; thus, exogenous administration of ADH would be
contraindicated.

Question 10

20-10. A patient presents with breast discharge, dysmenorrhea, and excessive excitability. Tests
reveal that all pituitary hormones are elevated. What does the nurse suspect as the most likely
cause for these assessment findings?
a. A pituitary adenoma
b. Hypothalamic hyposecretion
c. Hypothalamic inflammation
d. Pheochromocytoma

Answer 10

ANS: A
Hormonal effects of pituitary adenomas include hypersecretion from the adenoma itself and
hyposecretion from surrounding pituitary cells; in this case, prolactin would be elevated with
the manifestation of menstrual irregularities and secretion from the breast.
These symptoms are not indicative of hypothalamic inflammation, which would lead to
hyposecretion. Pheochromocytoma is a tumor of the adrenal gland and would be manifested
by elevated blood pressure.

Question 11

20-11. What common neurologic disturbances should the nurse assess for in a patient with a pituitary
adenoma?
a. Coma
b. Visual disturbances
c. Confused states
d. Breathing abnormalities

Answer 11

ANS: B
The clinical manifestations of pituitary adenomas are visual changes including visual field
impairments (often beginning in one eye and progressing to the other) and temporary
blindness. Coma, confusion, and breathing abnormalities are not associated with pituitary
adenomas.

Question 12

20-12. Which assessment result would the nurse expect to find associated with a patient diagnosed
with Graves disease?
a. High levels of circulating thyroid-stimulating autoantibodies
b. Ectopic secretion of thyroid-stimulating hormone (TSH)
c. Low circulating levels of thyroid hormones
d. Increased circulation of iodine

Answer 12

ANS: A
Graves disease results from a form of type II hypersensitivity in which there is stimulation of
the thyroid by autoantibodies directed against the TSH receptor. The thyroid-stimulating
antibodies stimulate TSH receptors; it is not an ectopic secretion. Graves disease is manifested
by elevated levels of thyroid hormones. Iodine deficiency leads to goiter but not Graves
disease.

Question 13

20-13. While checking the lab results for a patient diagnosed with Graves disease, the nurse would
expect the T3 level to be abnormally:
a. low.
b. high.
c. variable.
d. absent.

Answer 13

ANS: B
T3 levels are elevated in Graves disease.

Question 14

20-14. A patient diagnosed with Graves disease is admitted to a medical-surgical unit. Which of the
following symptoms would the nurse expect to find before treatment?
a. Weight gain, cold intolerance
b. Slow heart rate, rash
c. Skin hot and moist, rapid heart rate
d. Constipation, confusion

Answer 14

ANS: C
Symptoms of Graves disease include heat intolerance and increased tissue sensitivity to
stimulation by the sympathetic division of the autonomic nervous system. Weight loss, rather
than weight gain, and heat intolerance would result. Tachycardia, not slow heart rate, would
occur. Diarrhea would occur as opposed to constipation.

Question 15

20-15. Visual disturbances are a common occurrence in patients with untreated Graves disease. The
endocrinologist explains to the patient that the main cause of these complications is:
a. decreased blood flow to the eye.
b. orbital edema and protrusion of the eyeball.
c. TSH neurotoxicity to retinal cells.
d. local lactic acidosis.

Answer 15

ANS: B
Visual disturbances with Graves disease include orbital fat accumulation, inflammation, and
edema of the orbital contents resulting in exophthalmos (protrusion of the eyeball), periorbital
edema, and extraocular muscle weakness leading to diplopia (double vision).
Blood flow to the eye is not an effect, but visual changes occur. Functional abilities of the eye
result from hyperactivity of the sympathetic system. Lactic acid is not involved with visual
changes in the eye.

Question 16

20-16. Palpation of the neck of a patient diagnosed with Graves disease would most likely reveal:
a. a normal-sized thyroid.
b. a small discrete thyroid nodule.
c. multiple discrete thyroid nodules.
d. diffuse thyroid enlargement.

Answer 16

ANS: D
A patient with Graves disease would reveal stimulation of the gland causing diffuse thyroid
enlargement. In Graves disease, the thyroid will not have nodules present.

Question 17

20-17. Which hypothyroid diagnosis is supported by low levels of TSH?
a. Primary
b. Secondary
c. Autoimmune
d. Atypical

Answer 17

ANS: B
Causes of secondary hypothyroidism are related to either pituitary or hypothalamic failure,
which would be evident by low levels of TSH. Primary and autoimmune hypothyroidism
would be evident by elevated levels of TSH. Atypical hypothyroidism would be evident by
normal or elevated TSH.

Question 18

20-18. When considering hypothyroidism, the basal metabolic rate is unusually:
a. high.
b. low.
c. steady.
d. variable.

Answer 18

ANS: B
The metabolic rate with hypothyroidism is low.

Question 19

20-19. A patient diagnosed with thyroid carcinoma would be expected to have T3 and T4 levels that
are:
a. high.
b. low.
c. normal.
d. variable.

Answer 19

ANS: C
Most individuals with thyroid carcinoma have normal T3 and T4 levels and are therefore
euthyroid.

Question 20

20-20. A 45 year old diagnosed with Graves disease underwent surgical removal of the thyroid gland.
During the postoperative period, the patient’s serum calcium is low. The most probable reason
for her low serum calcium is:
a. hyperparathyroidism secondary to Graves disease.
b. myxedema secondary to surgery.
c. hypoparathyroidism caused by surgical injury to the parathyroid glands.
d. hypothyroidism resulting from lack of thyroid replacement.

Answer 20

ANS: C
Hypoparathyroidism is most commonly caused by damage to the parathyroid glands during
thyroid surgery, not secondary to Graves disease, myxedema, or the lack of thyroid
replacement.

Question 21

20-21. A 30 year old diagnosed with Graves disease is admitted to a hospital unit for the surgical
removal of the thyroid gland. During the postoperative period, the nurse notes that the
patient’s serum calcium is low. The nurse should observe the patient for which of the
following signs/symptoms?
a. Muscle weakness and constipation
b. Laryngeal spasms and hyperreflexia
c. Abdominal pain and fever
d. Anorexia, nausea, and vomiting

Answer 21

ANS: B
Symptoms of low calcium are associated with tetany, a condition characterized by muscle
spasms, hyperreflexia, tonic-clonic convulsions, and laryngeal spasms. Symptoms of low
calcium are not associated with muscle weakness, constipation, abdominal pain, anorexia,
nausea, or vomiting.

Question 22

20-22. What is the most common cause of hypoparathyroidism?
a. Pituitary hyposecretion
b. Parathyroid adenoma
c. Parathyroid gland injury
d. Hypothalamic inactivity

Answer 22

ANS: C
Hypoparathyroidism is most commonly caused by damage to the parathyroid glands, not
pituitary hyposecretion, parathyroid adenoma, or inactivity of the hypothalamus.

Question 23

20-23. A 25-year-old male presents to his primary care provider reporting changes in facial features.
CT scan reveals a mass on the anterior pituitary, and lab tests reveal severely elevated growth
hormone (GH). Which of the following would the nurse also expect to find?
a. Decreased IGF-1
b. Hypotension
c. Muscular atrophy
d. Height increases

Answer 23

ANS: C
With elevated levels of GH, there is resulting bony and soft tissue overgrowth; nerve
entrapment occurs, leading to peripheral nerve damage manifested by weakness, muscular
atrophy, foot drop, and sensory changes in the hands. IGF-1 increases, and there is an
overgrowth of bone but not an increase in height or hypotension.

Question 24

20-24. A patient presents reporting visual disturbances. When CT reveals a pituitary tumor and lab
tests reveal elevated prolactin, the diagnosis of prolactinoma is made. Which intervention is
the treatment of choice for this condition?
a. Dopaminergic agonists
b. Calcium
c. Insulin
d. Radiation

Answer 24

ANS: A

Dopaminergic agonists (bromocriptine and cabergoline) are the treatment of choice for
prolactinomas. Calcium is used to treat parathyroid disease. Insulin is used to treat diabetes.
Radiation is not used to treat prolactionomas.

Question 25

20-25. What is the cause of type 1 diabetes mellitus (DM)?
a. A familial, autosomal dominant gene defect
b. Obesity and lack of exercise
c. Immune destruction of the pancreas
d. Hyperglycemia from eating too many sweets

Answer 25

ANS: C
The most common cause of type 1 DM is a slowly progressive autoimmune T-cell–mediated
disease that destroys the beta cells of the pancreas; it is not due to a gene defect. Although
obesity can contribute to diabetes, it doesn’t cause type 1 DM. Eating too many sweets may
contribute to the development of obesity.

Question 26

20-26. What is the purpose of the glycosylated hemoglobin (hemoglobin A1c) test?
a. Measuring fasting glucose levels
b. Monitoring long-term serum glucose control
c. Detecting acute complications of diabetes
d. Checking for hyperlipidemia

Answer 26

ANS: B
Glycosylated hemoglobin refers to the permanent attachment of glucose to hemoglobin
molecules and reflects the average plasma glucose exposure over the life of a red blood cell
(approximately 120 days). Glycosylated hemoglobin does not measure fasting, but rather
glucose control over time. Glycosylated hemoglobin does not identify complications but could
provide data if the patient is at risk. Glycosylated hemoglobin does not check for
hyperlipidemia.

Question 27

20-27. An 11 year old is newly diagnosed with type 1 DM. Which classic symptoms should the nurse
assess the patient for?
a. Recurrent infections, visual changes, fatigue, and paresthesia
b. Polydipsia, polyuria, polyphagia, and weight loss
c. Vomiting, abdominal pain, sweet, fruity breath, dehydration, and Kussmaul
breathing
d. Weakness, vomiting, hypotension, and mental confusion

Answer 27

ANS: B
Classic symptoms of type 1 DM include polydipsia, polyuria, polyphagia, and weight loss.
Recurrent infections and visual changes are complications of diabetes. Vomiting, abdominal
pain, and sweet breath are signs of diabetic ketoacidosis. Weakness, hypotension, and mental
confusion are signs of hypoglycemia.

Question 28

20-28. A 19-year-old female with type 1 DM was admitted to the hospital with the following lab
values: serum glucose 500 milligrams per deciliter (high), urine glucose and ketones 4+
(high), and arterial pH 7.20 (low). Her parents state that she has been sick with the “flu” for a
week. Which of the following statements best explains her acidotic state?
a. Increased insulin levels promote protein breakdown and ketone formation.
b. Her uncontrolled diabetes has led to renal failure.
c. Low serum insulin promotes lipid storage and a corresponding release of ketones.
d. Insulin deficiency promotes lipid metabolism and ketone formation.

Answer 28

ANS: D
With insulin deficiency, lipolysis is enhanced, and there is an increase in the amount of
nonesterified fatty acids delivered to the liver. The consequence is increased glyconeogenesis
contributing to hyperglycemia and production of ketone bodies (acetoacetate,
hydroxybutyrate, and acetone) by the mitochondria of the liver at a rate that exceeds
peripheral use. Insulin levels are decreased. There is no evidence that the patient is in renal
failure. Insulin is low, but the ketones are the result of fatty acid breakdown due to lack of
insulin, not because of lipid storage.

Question 29

20-29. What causes the chronic microvascular and macrovascular complications of DM?
a. Pancreatic changes
b. Hyperglycemia
c. Ketone toxicity
d. Hyperinsulinemia

Answer 29

ANS: B
The underlying cause of the microvascular and macrovascular diseases is related to
hyperglycemia, not pancreatic changes, ketone toxicity, or hyperinsulinemia.

Question 30

20-30. Which condition is considered the ultimate cause of death in the patient with diabetes?
a. Renal disease
b. Stroke
c. Cardiovascular disease
d. Cancer

Answer 30

ANS: C
Cardiovascular disease, not renal disease, stroke, or cancer, is the ultimate cause of death in
up to 68% of people with diabetes.

Question 31

20-31. What is the earliest manifestation of diabetes-induced kidney dysfunction?
a. Polyuria
b. Glycosuria
c. Microalbuminuria
d. Decreased glomerular filtration

Answer 31

ANS: C
Polyuria occurs due to increased fluid in the vascular space, and microalbuminuria is the
earliest manifestation. While glycosuria occurs due to hyperglycemia, it is not the first sign of
kidney dysfunction. Decreased glomerular filtration and polyuria can occur due to changes,
but neither are initial manifestations.

Question 32

20-32. A patient is admitted to the medical unit for complications of long-term, poorly controlled
type 2 DM. Which of the following would the nurse expect to find in addition to elevated
glucose?
a. Atherosclerosis
b. Metabolic alkalosis
c. Elevated liver enzymes
d. Anemia

Answer 32

ANS: A

Macrovascular disease (lesions in large and medium-sized arteries) increases morbidity and
mortality and increases risk for accelerated atherosclerosis. Acidosis, rather than alkalosis,
would occur in this patient. Neither elevated liver enzymes nor anemia would be expected.

Question 33

20-33. A nurse checks lab results as both Cushing disease and Addison disease can manifest with
elevated levels of:
a. ADH.
b. estrogen.
c. adrenocorticotropic hormone (ACTH).
d. aldosterone.

Answer 33

ANS: C
Cushing disease and Addison disease are related to elevated levels of ACTH, not ADH,
estrogen, or aldosterone.

Question 34

20-34. Which of the following alterations would the nurse expect to find in a patient with untreated
Cushing disease or syndrome?
a. Bradycardia
b. Tachypnea
c. Hyperkalemia
d. Hypertension

Answer 34

ANS: D
With elevated cortisol levels, vascular sensitivity to catecholamines increases significantly,
leading to vasoconstriction and hypertension. Tachycardia is more likely than bradycardia due
to increased sensitivity to catecholamines. Tachypnea does not occur; the patient experiences
hypertension. Hypokalemia, not hyperkalemia, occurs.

Question 35

20-35. Which physical feature supports the diagnosis of Cushing syndrome?
a. Weight loss and muscle wasting
b. Truncal obesity and moon face
c. Pallor and swollen tongue
d. Depigmented skin and eyelid lag

Answer 35

ANS: B
Weight gain is the most common feature and results from the accumulation of adipose tissue
in the trunk, facial, and cervical areas. These characteristic patterns of fat deposition have
been described as “truncal obesity,” “moon face,” and “buffalo hump.”
Weight gain, not loss, is the most common feature of Cushing syndrome. Pallor is not
associated with Cushing syndrome. The skin of the patient with Cushing syndrome is bronze
in color.

Question 36

20-36. A 35-year-old female took corticosteroid therapy for several months. Which of the following
would the nurse expect to find?
a. Renal toxicity
b. Episodes of hypoglycemia
c. Hypotension
d. Type 2 DM

Answer 36

ANS: D
Overt DM develops in approximately 20% of individuals with hypercortisolism.
Diabetes develops not renal toxicity, but hyperglycemia and hypertension may occur.

Question 37

20-37. What is the most common cause of Addison disease?
a. An autoimmune reaction
b. Dietary deficiency of sodium and potassium
c. Cancer
d. Viral infection of the pituitary gland

Answer 37

ANS: A
Addison disease is caused by autoimmune mechanisms that destroy adrenal cortical cells and
is more common in women. Addison disease is not due to dietary deficiency, to cancer, or to a
viral infection.

Question 38

20-38. Which symptom would the nurse expect in a patient diagnosed with hyperaldosteronism?
a. Hypovolemia
b. Hypotension
c. Hypokalemia
d. Hyponatremia

Answer 38

ANS: C
Hypertension, hypokalemia, and neuromuscular manifestations are the hallmarks of primary
hyperaldosteronism. Neither hypovolemia nor hyponatremia is associated with
hyperaldosteronism.

Question 39

20-39. The body’s inability to conserve water and sodium when affected by Addison disease is
explained by which of the following conditions?
a. Elevated levels of cortisol
b. Decreased levels of ACTH
c. Hypersecretion of ADH
d. Aldosterone deficiency

Answer 39

ANS: D
The symptoms of Addison disease are primarily a result of hypocortisolism, elevated serum
ACTH, and hypoaldosteronism. ADH does not play a role in Addison disease.

Question 40

20-40. A patient diagnosed with Addison disease reports weakness and is easily fatigued. What is the
root of these symptoms?
a. Hyperkalemia
b. Hypoglycemia
c. Hypocortisolism
d. Metabolic acidosis

Answer 40

ANS: C
With mild-to-moderate hypocortisolism, symptoms usually begin with weakness and easy
fatigability. The weakness is not due to hyperkalemia, hypoglycemia, or metabolic acidosis.

Question 41

20-41. What is the cause of the hyperpigmentation seen in people with Cushing syndrome?
a. Abnormal levels of cortisol
b. Permissive effects of aldosterone when cortisol levels are altered
c. Elevated levels of ACTH
d. Hypersensitivity of melanocytes with sun exposure

Answer 41

ANS: C
Bronze or brownish hyperpigmentation of the skin, mucous membranes, and hair occurs when
there are very high levels of ACTH. The pigmentation changes associated with Cushing
syndrome and Addison disease are not due to increased levels of cortisol or hypersensitivity
of melanocytes. Aldosterone affects fluid balance.

Question 42

20-42. A 30 year old presents with hypertension, headache, tachycardia, impaired glucose tolerance,
and weight loss. Which of the following diagnoses is supported by this symptomology?
a. Addison disease
b. Conn disease
c. Cushing disease
d. Pheochromocytoma

Answer 42

ANS: D
Symptoms of pheochromocytoma include hypertension, palpitations, tachycardia, glucose
intolerance, excessive sweating, and constipation. Manifestations of Addison disease include
weakness, fatigability, hypoglycemia and related metabolic problems, lowered response to
stressors, hyperpigmentation, vitiligo, and manifestations of hypovolemia and hyperkalemia.
Hypertension and hypokalemia are the hallmarks of Conn disease. Weight gain is the most
common feature in Cushing disease and results from the accumulation of adipose tissue in the
trunk, facial, and cervical areas. These characteristic patterns of fat deposition have been
described as “truncal obesity,” “moon face,” and “buffalo hump.”