DI

1.) A patient is admitted to the hospital with a diagnosis of diabetes

insipidus (DI). The nurse should be aware of what primary characteristics
of DI?
a. Decreased urinary output and decreased plasma osmolality
b. Excretion of large quantities of urine with a very low specific gravity and
urine osmolality
c. Hypertension, weight gain, and bradycardia
d. Irritability and mental dullness
Answer: B
DI is associated with a deficiency of production of or secretion of ADH or
a decreased renal response to ADH. The decrease in ADH results in fluid
and electrolyte imbalances caused by increased urinary output and
increased plasma osmolality (Lewis et al., 2011, p. 1260).
2.) What is the priority action for the nurse to take in treating a patient with
central DI?
a. Fluid and hormone replacement
b. Restrict fluid intake
c. Low sodium diet and thiazide diuretics
d. Start patient on insulin drip
Answer:A
Primary treatment for central DI is fluid and hormone replacement. Fluids
are replaced orally or intravenously. In acute DI, hypotonic saline or
dextrose 5% in water is given intravenously and titrated to replace urinary
output. Desmopressin acetate (DDAVP), an analog of ADH, is the hormone
replacement of choice for central DI and can be given orally, intravenously,
subcutaneously, or as a nasal spray (Lewis et al., 2011, p. 1261).
3.) What test is usually done to confirm the diagnosis of central DI?
a. Fasting blood glucose
b. Urinalysis
c. Water restriction test
d. Chemistry panel
Answer: C
Water deprivation test measures the kidneys ability to concentrate urine
in light of an increased plasma osmolality and a low plasma vasopressin
level. It is a specialized test that must be performed in a controlled setting,
and the client should be observed constantly throughout the test
(Wissman, 2007, p.1017). The test is positive for diabetes insipidus if the
kidneys are unable to concentrate urine despite increased plasma
osmolality (Wissman, 2007, p.1017).


SIADH
1) Upon change of shift report, you are told a patient diagnosed with SIADH began to have seizures and
lab results showed serum sodium levels of 100mEq/L. You just received a new order from the physician
to start 7ml/hr of 3% NaCl IV stat. What type of osmolarity is the solution and how will this affect the
patients serum sodium level?

A) Isotonic, the solution will add more volume to the blood thus increasing the serum sodium level
B) Hypertonic, the solution will draw water from blood volume, thus increasing the serum sodium level
C) Hypotonic, the solution will add more volume to the blood, thus decreasing the serum sodium level
D) Hypertonic, the solution will draw water from blood volume, thus decreases the serum sodium level

2) A patient recently underwent brain surgery and developed SIADH. Which of the following symptoms
should the nurse anticipate finding?
A) weight gain
B) excessive urinary output
C) fluid loss and dehydration
D) low urine specific gravity
1) Answer: B
Rationale: The patient has a low serum sodium level and needs to recieve a solution that draws sodium
into the blood. 3% NaCl is considered to be hypertonic and works by drawing water from the intracellular
fluid into the blood. The sodium follows the water into the blood increasing the patient's serum sodium
level.

2) Answer: A
Rationale: SIADH results in abnormally high levels of ADH, which causes water retention as serum
sodium levels fall, leading weight gain. With fluid retention, urine output is decreased. Fluid intake is
restricted to prevent fluid overload rather than replace fluids. As a person's urine becomes more
concentrated, the urine specific gravity increases.











Online Nursing Practice Test/Exam about Endocrine (31-35)
Situation: Miss Eleanor is a 25 year old woman who is being treated in the endocrine clinic for adult-
onset Myxedema.

31. While taking a nursing history, the nurse should expect Miss Eleanor to assess:

a) facial puffiness
b) intolerance to heat
c) exopthalmus
d) heart palpitations

32. The physician has ordered serum thyroxine (T4) concentration and serum cholesterol test. Which
finding should the nurse expect?

a) decreased serum T4 and decreased serum cholesterol
b) decreased serum T4 and increased serum cholesterol
c) increased serum T4 and increased serum cholesterol
d) increased serum T4 and increased serum cholesterol

33. Which of the following manifestations does the nurse expect in a client with myxedema?
a) increased heart rate
b) edema
c) weight loss
d) intolerance to heat

34. Which of the following are most important to monitor in a client who had undergone total
thyroidectomy?

a) pulse and temperature
b) serum electrolyte levels
c) weight and food intake
d) hoarseness of the voice and ability to swallow

35. Which of the following should be included when giving health teachings to a client with
hyperthyroidism.

a) wear long-sleeved clothing
b) use artificial tears to the eyes as necessary
c) increase fibers in the diet
d) take medications with milk



ANSWERS AND RATIONALE

31) A
- Hypothyroidism is due to absence or deficiency in thyroid hormone that causes a decline in the
metabolic rate. It is classified according to the time or life in which it occurs:
Cretinism - hypothyroidism in infants and young children
Hypothyroidism without myxedema - mild degree of thyroid failure in older children and adult
Hypothyroidism with myxedema - severe degree of thyroid failure or hypothyroidism in adults
Manifestations of hypothyroidism are associated with the slowing of the metabolic rate and include:
Patient's with myxedema exhibits nonpitting edema in connective tissues all over the body,
including the face which appears puffy and the tongue which is enlarged. The edema is due to
accumulation of mucoprotein and water retention.
Goiter - enlargement of the thyroid gland may or may not be present. Goiter occurs from
excessive stimulation of TSH from the pituitary because of continuous deficient or lack thyroxine.
Hypothyroidism caused by lack of TSH does not cause goiter.
Bradycardia, hypotension, dysrrhythmias, enlarged heart
Apathy, slow and slurred speech, lethargy
Decreased heat production-sensitivity to cold
Decreased nutrient requirements: poor appetite
Decreased sweat and sebaceous gland function: dry scaly skin
Altered protein, fat and carbohydrate metabolism: weight gain (edema) slow wound healing,
decreased blood glucose, hypoalbuminemia
Decreased erythropoietin production: anemia
32) B
- Hypothyroidism is due to deficient thyroxine hormone so naturally serum T4 will be below normal.

Thyroxine regulates fat or lipid metabolism. Deficiency in thyroxine will result in slow metabolic activity
resulting in slowing of lipid metabolism which increases serum cholesterol and triglyceride levels making
the patient at risk for atherosclerosis and cardiac disorders.

Management:

1. Prevention - prevention of iodine deficiency

2. Replacement therapy throughout life
a. Drugs used:
Sodium L-thyroxine/levothyroxine (Synthroid, Levoid)
Sodium L-triidothyroxine (Cytomel, Trionine)
Synthetic combination of T3 and T4 (Euthroid, thyrolar)
Natural combination of T3 and T4 extract
b. Major Side Effects:
Inadequate treatment - show recurrence/persistence of signs of hypothyroidism
Excessive treatment - show signs of hyperthyroidism
Too fast increase in drug dose - angina, palpitations, tachycardia
Bone loss and decreased bone density
c. During initiation of therapy - patient is seen by physician every 2-4 weeks until condition is stable and
then thyroid therapy is monitored annually.

3. Nursing Care:
Activity Intolerance - limit activity to patient's tolerance. If patient develops tachycardia or chest
pain, stop activity
Constipation - increase fiber and fluids
Hypothermia - maintain comfortable environmental temperature, use blankets as necessary
Use frequent stimulation at dusk and nightfall - use nightlights to prevent confusion
maintain safe environment
promote positive body image - educate about reversible body changes
4. Surgery - may be performed for large goiters especially if it causes dysphagia, chocking sensation,
inspiratory stridor, hoarseness and positive Pemberton's sign (elevation of arms results in dizziness and
syncope) caused by pressure on veins that venous return from the head.


33) B
- myxedema is manifested by hypothyroidism. (A, C, and D are manifestations of hyperthyroidism)

34) A
- thyroid crisis /storm/thyroidtoxicosis is the most life-threatening postop complication of thyroid surgery. It
is characterized by hyperthermia and tachycardia. Therefore it is necessary to monitor the client's pulse
and temperature.

35) B
- hyperthyroidism may cause exopthalmos. To prevent corneal ulceration, artificial tears will be instilled
into the eyes as necessary. The client usually develops diarrhea so, high fiber diet is not indicated. The
medication should not be taken with antacid. Antacid inhibits absorption of anti thyroid drugs.



















76. A client with a diagnosis of Cushing's syndrome is undergoing a dexamethasone suppression test.
The nurse plans to implement which steps during this test?

a ) collect a 24-hour urine specimen to measure serum cortisol levels
b) administer 1 mg of dexamethasone orally at night and obtain serum cortisol levels the next morning
c) draw blood samples before and after exercise to evaluate the effect of exercise on serum cortisol levels
d) administer an injection of adrenocorticotropic hormone (ACTH) 30 minutes before drawing blood to
measure serum cortisol levels


77. The nurse is caring for a client with type 1 diabetes mellitus. Which of the following laboratory results
would indicate a potential complication associated with this disorder?

a) ketonuria
b) potassium: 4.2 mEq
c) blood glucose: 112 mg/dL
d) blood urea nitrogen (BUN): 18 mg/dL

78. The nurse employed in a diabetes mellitus clinic is caring for a client on insulin pump therapy. Which
statement by the client indicates that a knowledge deficit exists regarding insulin pump therapy?

a) if my blood glucose is elevated, I can bolus myself with additional insulin as ordered
b) I'll need to check my blood glucose before meals in case I need a premeal insulin anymore
c) I still need to follow a diet and exercise plan even though I don't inject myself daily anymore
d) now that I have this pump, I don't have to worry about insulin reactions or ketoacidosis ever happening
again

80. The nurse is completing a health history on a client with diabetes mellitus who has been taking insulin
for many years. At present the client states that he is experiencing periods of hypoglycemia followed by
periods of hyperglycemia. The most likely cause for this occurrence is which of following?

a) eating snacks between meals
b) initiating the use of the insulin pump
c) injecting insulin at a site of lipodystrophy
d) adjusting insulin according to blood glucose levels







Endocrine Practice Questions
Answers and Rationale

76) B
- The dexamethasone suppression test is performed to evaluate the function of the adrenal cortex. The
procedure for this test is to administer 1 mg of dexamethasone at 11:00 PM to suppress ACTH formation
and then to obtain 8:00 AM serum cortisol levels on the following day.

77) A
- Ketonuria is an abnormal finding in the client with diabetes mellitus indicating ketosis. Ketosis is a
metabolic effect from the lack of insulin on fat metabolism and occurs in type 1 diabetes mellitus. It is
associated with the severe complication of diabetic ketoacidosis (hyperglycemia, ketosis, and acidosis).
Options B, C, and D are all normal laboratory findings.

78) D
- Hypoglycemic reactions can occur if there is an error in calculating the insulin dose or if the pump
malfunctions. Ketoacidosis can occur if too little insulin is used or if there is an increase in metabolic
need. The pump does not have a built-in blood glucose monitoring feedback system, so the client is
subject to the usual complications associated with insulin administration without the use of a pump.
Options A, B, and C are accurate regarding the use of the insulin pump.

80) C
- Lipodystrophy, specifically lipohypertrophy, involves swelling of the fat at the site of repeated injections.
This can interfere with the absorption of insulin, resulting in erratic blood glucose levels. Because the
client has been on insulin for many years, this is the most likely cause of poor control. Options A, B, and
D are appropriate techniques to use in order to regulate blood glucose levels.


74. A client with Cushing's syndrome is being instructed by the nurse on follow-up care. Which statement
by the client would indicate a need for further instructions?
a) I should avoid contact sports
b) I should check my ankles for swelling
c) I need to avoid foods high in potassium
d) I need to check my blood glucose regularly
74) C
- Hypokalemia is a common characteristic of Cushing's syndrome, and the client is instructed to consume
foods high in potassium. Clients also experience activity intolerance, osteoporosis, and frequent bruising.
Excess fluid volume results from water and sodium retention. Hyperglycemia is caused by an increased
cortisol secretion.

61. A client with Cushing's disease is being admitted to the hospital after a stab wound to the abdomen.
The nurse places highest priority on which of the following nursing diagnoses developed for this client?

a) risk for infection
b) disturbed body image
c) ineffective health maintenance
d) risk for deficient fluid volume

62. A nurse is caring for a client with a diagnosis of Cushing's syndrome. The nurse plans which of these
measures to prevent complications from this medical condition?

a) monitoring glucose level
b) encouraging daily jogging
c) monitoring epinephrine levels
d) encouraging visits form friends
64. A client is admitted to the hospital with a diagnosis of Cushing's syndrome. The nurse monitors the
client for which of the following that is most likely to occur in this client?

a) hypovolemia
b) hypoglycemia
c) mood disturbances
d) deficient fluid volume

61) A
- The client with a stab wound has a break in the body's first line of defense against infection. The client
with Cushing's disease is at great risk for infection caused by excess cortisol secretion, subsequent
impaired antibody function, and decreased proliferation of lymphocytes. The client may also have an
Ineffective health maintenance and Disturbed body image, but these are not the highest priority at this
time. The client would be at risk for Excess fluid volume, not Deficient fluid volume, with Cushing's
disease.

62) A
- In the client with Cushing's syndrome, increased levels of glucocorticoids can result in hyperglycemia
and signs and symptoms of diabetes mellitus. Epinephrine levels are not affected. Clients experience
activity intolerance related to muscle weakness and fatigue, therefore option B is incorrect. Visitors should
be limited because of the client's impaired immune response.
64) C
- When Cushing's syndrome develops, the normal function of the glucocorticoids becomes exaggerated
and the classic picture of the syndrome emerges. This exaggerated physiological action can cause mood
disturbances, including memory loss, poor concentration and cognition, euphoria, and depression. It can
also cause persistent hyperglycemia along with sodium and water retention, producing edema and
hypertension.













66. The nurse is caring for a client who is scheduled for an adrenalectomy. The nurse plans to administer
which medication in the preoperative period to prevent Addison's crisis?

a) prednisone (deltasone)orally
b) fludrocortisone (Florinef) subcutaneously
c) spironolactone (Aldactone) intramuscularly
d) methiprednisolone sodium succinate (Solu-Medrol) intravenously
66) D
- A glucocorticoid preparation will be administered intravenously or intramuscularly in the immediate
preoperative period to a client scheduled for an adrenalectomy. Methylprednisolone sodium succinate
protects the client from developing acute adrenal insufficiency (Addison's crisis) that occurs as a result of
the adrenalectomy. Aldactone is a potassium-sparing diuretic. Prednisone is an oral corticosteroid.
Fludrocortisone is a mineralocorticoid.

5. A client with Addisons disease has a blood pressure of 65/60. The nurse understands
that decreased blood pressure of the client with Addisons disease involves a disturbance in
the production of:

A) Androgens
B) Glucocorticoids
C) Mineralocorticoids
D) Estrogen
5. C. Mineralocorticoids such as aldosterone cause the kidneys to retain sodium ions. With
sodium, water is also retained, elevating blood pressure. Absence of this hormone thus
causes hypotension.

38. A client with Addisons disease is scheduled for discharge. Before the discharge, the
physician prescribes hydrocortisone and fludrocortisone. The nurse expects the
hydrocortisone to:

A) Increase amounts of angiotensin II to raise the clients blood pressure.
B) Control excessive loss of potassium salts.
C) Prevent hypoglycemia and permit the client to respond to stress.
D) Decrease cardiac dysrhythmias and dyspnea.
38. C. Hydrocortisone is a glucocorticoid that has anti-inflammatory action and aids in
metabolism of carbohydrate, fat, and protein, causing elevation of blood glucose. Thus it
enables the body to adapt to stress.



DM
59. A client with diabetes mellitus has a blood glucose level of 644 mg/dL. The nurse interprets that this
client is most at risk of developing which type of acid-base imbalance?

a) metabolic acidosis
b) metabolic alkalosis
c) respiratory acidosis
d) respiratory alkalosis
59) A
- Diabetes mellitus can lead to metabolic acidosis. When the body does not have sufficient circulating
insulin, the blood glucose level rises. At the same time, the cells of the body use all available glucose.
The body then breaks down glycogen and fat for fuel. The by-products of fat metabolism are acidotic and
can lead to the condition known as diabetic ketoacidosis. Options B, C, and D are incorrect.

60. The home care nurse is developing a plan of care for an older client with diabetes mellitus who has
gastroenteritis. In order to maintain food and fluid intake to prevent dehydration, the nurse plans to:

a) offer water only until the client is able to tolerate solid foods
b) withhold all fluids until vomiting has ceased for at least 4 hours
c) encourage the client to take 8 to 12 ounces of fluid every hour while awake
d) maintain a clear liquid diet for at least 5 days before advancing to solids to allow inflammation of the
bowel to dissipate
60) C
- The client should be offered liquids containing both glucose and electrolytes. Small amounts of fluid may
be tolerated, even when vomiting is present. The diet should be advanced as tolerated and include a
minimum of 100 to 150 grams of carbohydrates daily. Offering water only and maintaining liquids for 5
days will not prevent dehydration but may promote it in this client.

47. A nurse teaches a client with diabetes mellitus about differentiating between hypoglycemia and
ketoacidosis. The client demonstrates an understanding of the teaching by stating that glucose will be
taken if which of the following symptoms develops?
a) polyuria
b) shakiness
c) blurred vision
d) fruity breath odor
47) B
- Shakiness is a sign of hypoglycemia and would indicate the need for food or glucose. A fruity breath
odor, blurred vision, and polyuria are signs of hyperglycemia.
48. A client with diabetes mellitus demonstrates acute anxiety when first admitted for the treatment of
hyperglycemia. The appropriate intervention to decrease the client's anxiety is to:

a) administer a sedative
b) convey empathy, trust, and respect toward the client
c) ignore the signs and symptoms of anxiety so that they will soon disappear
d) make sure that the client knows all the correct medical terms to understand what is happening
48) B
- The appropriate intervention is to address the clients feelings related to the anxiety. Administering a
sedative is not the most appropriate intervention. The nurse should not ignore the clients anxious
feelings. A client will not relate to medical terms, particularly when anxiety exists.

49. A nurse provides instructions to a client newly diagnosed with type 1 diabetes mellitus. The nurse
recognizes accurate understanding of measures to prevent diabetic ketoacidosis is when the client states:

a) I will stop taking my insulin if I'm too sick to eat
b) I will decrease my insulin dose during times of illness
c) I will adjust my insulin dose according to the level of glucose in my urine
d) I will notify my physician if my blood glucose level is higher than 250 mg/dL
49) D
- During illness, the client should monitor blood glucose levels and should notify the physician if the level
is higher than 250 mg/dL. Insulin should never be stopped. In fact, insulin may need to be increased
during times of illness. Doses should not be adjusted without the physicians advice and are usually
adjusted based on blood glucose levels, not urinary glucose readings.