Answers and Rationales
By,
Kate, Anthony, Michelle, and Kelly
1) As a nurse, you are providing care to a client with myxedema coma. Priority
nursing care would include which of the following?
 (1) Measures to decrease body temperature
 (2) Measures to decrease heart rate
 (3) Measures to maintain airway, fluid and electrolyte balance, and
cardiovascular status
 (4) Measures to decrease blood pressure
Answer: 3
Rationale: Myxedema coma is a life-threatening crisis manifested by
hypothermia, hyponatremia, hypoglycemia, lactic acidosis,
cardiovascular collapse, and coma. Maintaining airway and circulation
are the priority interventions.
2) A client diagnosed with primary hyperparathyroidism demonstrates that she
understands the teaching plan when the client makes which of the following
statements?
 (1) “I know I must have surgery to remove my parathyroid gland.”
 (2) “I must take diuretics the rest of my life.”
 (3) “I must eat a diet low in potassium.”
 (4) “I must limit my daily fluid intake.”
Answer: 1
Rationale: The treatment for primary hyperparathyroidism is a
parathyroidectomy (surgical removal of parathyroid glands). Options 2,
3, and 4 are incorrect treatments for primary hyperparathyroidism.
3) The priority nursing diagnosis for a client with hypoparathyroidism would be
which of the following?
 (1) Risk for fluid volume excess
 (2) Risk for injury
 (3) Anxiety related to lack of knowledge
 (4) Knowledge deficit
Answer: 2
Rationale: Risk for injury related to hypocalcemia is the priority diagnosis
as injury may occur as a result of low calcium levels and tetany. The
client is at risk for fluid volume deficit, and anxiety and knowledge
deficit would not be a priority over injury.
4) A client with hypothyroidism is taking levothyroxine sodium (Synthroid), a
thyroid replacement hormone. Which of the following statements made by the
client would indicate additional teaching is required?
 (1) “I know I will be on this medication for the rest of my life.”
 (2) “I don’t eat excessive amounts of cabbage or spinach.”
 (3) “I take my Synthroid with food.”
 (4) “I take my Synthroid in the mornings.”
Answer: 3
Rationale: For best absorption, thyroid medications should be taken 1
hour before meals, or 2 hours after meals. Lifelong treatment of
hypothyroidism is necessary. Foods that inhibit thyroid hormone (TH)
synthesis, such as cabbage, spinach, and carrots should not be
consumed in excessive amounts. Thyroid medications should be taken
in the morning to reduce the possibility of insomnia.
5) In providing care for a client being admitted for hyperparathyroidism, the
nurse anticipates implementing which of the following aactions?
 (1) Administering intravenous calcium gluconate
 (2) Administering large amounts of intravenous saline
 (3) Maintaining strict fluid restriction
 (4) Monitoring for tetany
Answer: 2
Rationale: Hypercalcemia is the primary complication of
hyperparathyroidism, and the manifestations of the disorder are
directly related to the effects of hypercalcemia. Administering large
amounts of intravenous saline promotes renal excretion of calcium.
Calcium gluconate would increase serum calcium levels, and tetany is a
symptom of hypocalcemia
6) A client with exophthalmos as a result of Graves’ disease has expressed a desire
for the medications to “hurry up and work so that my eyes will go down.” The
nurse’s response to the client will be based on which of the following?
(1) Reversal of exophthalmos occurs after a therapeutic level of the antithyroid
medication is achieved.
(2) Reversal of exophthalmos occurs after treatment with ophthalmic
medications.
(3) Changes in the eyes as a result of Graves’ disease are not reversible, even
after treatment of the disease.
(4) Exophthalmos as a result of Graves’ disease is only a temporary symptom, and
should resolve spontaneously.
Answer: 3
Rationale: Exophthalmos occurs as a result of accumulation of fat deposits
and by-products in the retro-orbital tissues. Even with treatment of
Graves’ disease, these changes are not reversible. The client should
receive instructions on proper eye care.
7) A thirty five year old male has been an insulin-dependent diabetic for five years
and now is unable to urinate. Which of the following would you most likely
suspect?

 A. Atherosclerosis
 B. Diabetic nephropathy
 C. Autonomic neuropathy
 D. Somatic neuropathy
Answer: C
Rationale: Autonomic neuropathy is a group of symptoms that occur when
there is damage to nerves that regulate blood pressure, heart rate, bowel
and bladder emptying, digestion, and other body functions. Autonomic
neuropathy is associated with diabetic neuropathy.
8 . Which of the following clinical characteristics do not apply towards a patient
diagnosed with Type 2 DM?
A. Plasma hypoosmolality
B. Dehydration
C. Obesity
D. Fasting blood sugar greater than 200 mg/dl
Answer: A
Rationale: Patients with Type 2 DM present with plasma hyperosmolality.
9) You are treating a 45 year old male with diabetes who is being discharged after
having been treated for diabetic ketoacidosis. You determine that additional
discharge teaching is needed regarding the patient's care after you hear the patient's
spouse state the following:
A. He washes his feet daily, wears well fitted shoes, and inspects them with a mirror for
any blisters or sores.
B. He checks his fasting blood sugar daily and regularly takes his glucophage
(Metformin) when his blood sugar exceeds 125 mg/dl.
C. Rapid, labored breathing, with fruity smelly breath is an indication that the patient
is hyperglycemic and experiencing ketoacidosis.
D. Headaches, nausea, sweating, lethargy, confusion, and slurred speech and tingling
around the mouth may be an indication that too much insulin has been
administered.
Answer: B
Rationale: Glucophage is an oral hypoglycemic that lowers serum glucose levels
by inhibiting hepatic glucose production and increases the insulin
sensitivity of peripheral tissue. Glucophage is ineffective for insulin
dependent diabetes mellitus. You know that the patient is Type 1 IDDM
because he was admitted for diabetic ketoacidocis, which is rarely seen in
Type 2 NIDDM.
10) You are caring for a 65 year old women who has end stage renal disease as a result of
untreated Type 2 Diabetes Mellitus. The patient's 38 year old daughter is visiting
and she asks if her grandmother's condition is genetic and if she is at risk for kidney
failure. You respond appropriately by stating:
A. There is no genetic correlation with her mother's kidney failure, her kidneys have
failed due to complications with many years of high concentration of blood glucose,
which disrupts the kidney's ability to filter the blood.
B. Although Type 2 Diabetes has a genetic risk factor, the daughter is older than the
maximum age of onset (30).
C. Since her mother had the disease, the daughter is at risk for being
predisposed to diabetes and she should monitor for symptoms of frequent
urination as well as frequent hunger and thirst.
D. As long as the daughter restricts are diet with well managed meals, exercises to
maintain a recommended BMI under 30 she will eliminate her risk of inheriting her
mother's conditions.
Answer: C
Rationale: Type 2 diabetes has a strong genetic predisposition and children of
patients with type 2 NIDDM should be instructed to self-monitor for the
symptoms of NIDDM to ensure early treatment.
11) As a Clinical Nurse Leader, you meet regularly with the unit's nutritionist to
discuss the nutrition plans for patient's with Diabetes Mellitus. While
reviewing the nutritionist's discharge paperwork, you identify the following
error in the the patient nutrition information.
A. Patients with diabetes should consume a protein intake of 25-30% of
total daily calories.
B. Diabetic patients should have a daily carbohydrate intake of 130 g of
carbohydrates per day, with preferred carbohydrates sources being fruit,
vegetables, and whole grains.
C. Dietary fat, especially saturated and trans fatty acids should be restricted to
reduce the risk for cardiovascular disease.
D. Dietary sweeteners, such as sucrose, do not increase blood glucose levels.
Answer: A
Rationale: Patients with diabetes should consume a protein intake that is
15-20% of total daily calories, with some patients with kidney disease
requiring a further restriction of 10% total daily calories.
12) Which lab results indicate that fluid restrictions have been effective in treating
syndrome of inappropriate antidiuretic hormone (SIADH)?
a. Increased urine specific gravity
b. Increased serum sodium
c. Decreased serum osmolarity
d. Decreased hematocrit
Answer: b
Rationale: Increased serum sodium indicates effective therapy from fluid
restriction. Urine specific gravity increases and serum osmolarity
decreases when SIADH is not treated. Hemoconcentration is a result of
hypovolemic hyponatremia caused by diabetes insipidus.
13) When assessing a client with diabetes insipidus (DI), which of the following
signs and symptoms would you expect? (Circle all that apply.)






a. Polyuria
b. Increased thirst
c. Hypertension
d. Poor turgor
e. Bradycardia
f. Weak pulses
Answer: a, b, d, f
Rationale: Due to a deficiency in ADH, patients with DI excrete large
volumes of dilute urine. This massive water loss can cause dehydration
resulting in an increased sensation of thirst and poor skin turgor. This
state of hypovolemia also manifests as hypotension, weak pulse
pressure, and compensatory tachycardia.
14) The nurse is teaching a client about how to monitor for therapy effectiveness
for SIADH. For which sign indicating effective management does the nurse
instruct the client to look?
 a. Dry mucous membranes
 b. Muscle twitching
 c. Increasing heart rate
 d. Daily weight gain less than 2 pounds
Answer: d
Rationale: Monitoring daily weights assesses the degree of fluid restriction
needed. A weight gain of 2 pounds for more daily or a gradual increase
over several days is cause for concern. Dry mucous membranes are a sign
of dehydration. Muscle twitching indicates a change in the client's
neurological status, which could lead to seizures and coma if left
unchecked. An increased heart rate indicates increased fluid retention.
15) Which order would you question when taking care of a patient with DI?
 a. Strict I's and O's
 b. Record daily weight
 c. NPO
 d. Desmopressin acetate (DDAVP) 0.2mg PO BID
Answer: c
Rationale: The patient should be strongly encouraged to drink fluids so as
to maintain adequate hydration and prevent dehydration. Accurate
measurement of intake and output and daily weight measurement help
assess hydration and effectiveness of treatment. Desmopressin acetate
is a synthetic form of vasopressin which is deficient in patients with
diabetes insipidus.
16) The nurse is providing discharge instructions to the SIADH client on
spironolactone therapy. Which comment by the client indicates a need for
further teaching?
 a. "This drug will help control my blood pressure."
 b. "I should eat a banana every day."
 c. "I must call the doctor if I have increased thirst and am more tired than
usual."
 d. "I need to increase my salt intake.“
Answer: b
Rationale: Spironolactone increases potassium levels, so potassium
supplements and foods rich in potassium should be avoided to prevent
hyperkalemia. As a potassium-sparing diuretic and aldosterone
antagonist, spironolactone does not control blood pressure. While
taking this drug, any symptoms of hyponatremia, such as dryness of the
mouth, thirst, lethargy, or drowsiness, must be reported. Increased
dietary sodium intake may be necessary.
17) A patient who has been diagnosed with Addison’s disease is admitted to the
hospital. You are informed that the patient is in an Addisonian crisis. The most
severe complication of an Addisionian crisis that you should closely monitor
for is
 a.
 b.
 c.
 d.
Paralytic ileus
Respiratory distress
Shock
Pulmonary Embolism
Answer: c
Rationale: Addisonian crisis or acute adrenal crisis occurs when there
is acute insufficiency of adrenocorticoids. It results in a decrease in
the production of cortisone and aldosterone. Both cortisol and
aldosterone play an important role in maintaining blood pressure. A
decrease in both hormones can cause hypotension and potentially
shock if it’s not treated early.
18) The spouse of the patient with Addison’s disease gives you a brief medical
history of the patient. Which statements provided by the patient’s spouse
provide information to the nurse as to possible precipating factors of the crisis?
Choose All that apply
 a. Client stopped taking their prescribed hydrocortisone
 b. Client has type 1 diabetes mellitus
 c. Client is taking fludrocortisones (Florinef)
 d. Client was recently in a severe car accident
Answer: a and d
Rationale: An abrupt withdrawal of hydrocortisone can cause the crisis.
Also major stressors such as surgery, infections and trauma (ie. accident)
can induce a Addisonian crisis. Since the patient is still taking Florinef
there shouldn’t be any problems and DM1 has not been shown to
influence an Addisonian crisis.
19) Which laboratory results support a patient’s new diagnosis of Cushings
disease
 a.
 b.
 c.
 d.
Increased serum calcium levels
Decreased serum sodium levels
Increased serum cortisol levels
Decreased serum glucose levels
Answer: c
Rationale: Cushings disease is characterized by an increase in cortisol.
It can be caused by an adrenal tumor, disorders of the pituitary or
hypothalamus, which causes an increase in the release of ACTH. It
can also be caused from long-term use of glucorticoid therapy, which
results in excess cortisol levels. In addition to an increase in cortisol,
other signs are an increase in sodium and an increase in glucose
(opposite of the other answer options). Cushings does not have a
direct effect on Calcium.
20) A patient is admitted to the hospital with Conn’s disease (hyperaldosterone).
The nurse knows that they need to closely monitor for which fluid/electrolyte
problem?
 a.
 b.
 c.
 d.
Hyperkalemia
Hyponatremia
Excess fluid volume
Deficient fluid volume
Answer: c
Rationale: Hyperaldosterone leads to sodium retention (hypernatremia),
which increases fluid volume and blood pressure. Hypokalemia is also a
common sign of Conn’s disease (not hyperkalemia).
21) Moon face, “buffalo” hump, purple striae, and truncal obesity are classic
symptoms of which endorcrine disorder
 a.
 b.
 c.
 d.
Addison’s Disease
Cushing’s Disease
Grave’s Disease
Hashimoto’s Disease
Answer: b
Rationale: Moon face, “buffalo” hump, purple striae, and truncal obesity
are all classic signs of Cushings due to an increase in cortisol levels.