Answers and Rationale

Diabetic clients must exercise at least three times a week to

meet the goals of planned exercise lowering the blood

1. Answer: B. 10 to 15 g of a simple carbohydrate.

glucose level, reducing or maintaining the proper weight,

increasing the serum high-density lipoprotein level,

To reverse hypoglycemia, the American Diabetes

decreasing serum triglyceride levels, reducing blood

Association recommends ingesting 10 to 15 g of a simple

pressure, and minimizing stress. Exercising once a week

carbohydrate, such as three to five pieces of hard candy, two

wouldnt achieve these goals. Exercising more than three

to three packets of sugar (4 to 6 tsp), or 4 oz of fruit juice. If

times a week, although beneficial, would exceed the

necessary, this treatment can be repeated in 15 minutes.

minimum requirement.

Ingesting only 2 to 5 g of a simple carbohydrate may not

raise the blood glucose level sufficiently. Ingesting more than

5. Answer: B. Puffiness of the face and hands

15 g may raise it above normal, causing hyperglycemia.

Hypothyroidism (myxedema) causes facial puffiness,
2. Answer: A. Related to bone demineralization resulting

extremity edema, and weight gain. Signs and symptoms of

in pathologic fractures

hyperthyroidism (Graves disease) include an increased

appetite, weight loss, nervousness, tremors, and thyroid

Poorly controlled hyperparathyroidism may cause an

gland enlargement (goiter).

elevated serum calcium level. This, in turn, may diminish

calcium stores in the bone, causing bone demineralization

6. Answer: C. Tachycardia

and setting the stage for pathologic fractures and a risk for
injury. Hyperparathyroidism doesnt accelerate the metabolic
rate. A decreased thyroid hormone level, not an increased
parathyroid hormone level, may cause edema and dry skin
secondary to fluid infiltration into the interstitial spaces.
Hyperparathyroidism causes hypercalcemia, not
hypocalcemia; therefore, it isnt associated with tetany.

3. Answer: D. Suggest referral to a sex counselor or

other appropriate professional.

The nurse should refer this client to a sex counselor or other

professional. Making appropriate referrals is a valid part of
planning the clients care. The nurse doesnt normally
provide sex counseling.

4. Answer: B. At least three times a week

Levothyroxine, a synthetic thyroid hormone, is given to a

client with hypothyroidism to simulate the effects of thyroxine.
Adverse effects of this agent include tachycardia. The other
options arent associated with levothyroxine.

7. Answer: D. Hyperparathyroidism

Hyperparathyroidism is most common in older women and is

characterized by bone pain and weakness from excess
parathyroid hormone (PTH). Clients also exhibit
hypercaliuria-causing polyuria. While clients with diabetes
mellitus and diabetes insipidus also have polyuria, they dont
have bone pain and increased sleeping. Hypoparathyroidism
is characterized by urinary frequency rather than polyuria.

8. Answer: A. vasopressin (Pitressin Synthetic).

Because diabetes insipidus results from decreased

ADH is the hormone clients with diabetes insipidus lack. The

antidiuretic hormone (vasopressin) production, the nurse

clients TSH, FSH, and LH levels wont be affected.

should expect to administer synthetic vasopressin for

hormone replacement therapy. Furosemide, a diuretic, is
contraindicated because a client with diabetes insipidus
experiences polyuria. Insulin and dextrose are used to treat
diabetes mellitus and its complications, not diabetes
insipidus.

9. Answer: D. An adrenal adenoma

13. Answer: B. Thyroid crisis

Thyroid crisis usually occurs in the first 12 hours after

thyroidectomy and causes exaggerated signs of
hyperthyroidism, such as high fever, tachycardia, and
extreme restlessness. Diabetic ketoacidosis is more likely to
produce polyuria, polydipsia, and polyphagia; hypoglycemia,
to produce weakness, tremors, profuse perspiration, and

An autonomous aldosterone-producing adenoma is the most

hunger. Tetany typically causes uncontrollable muscle

common cause of hyperaldosteronism. Hyperplasia is the

spasms, stridor, cyanosis, and possibly asphyxia.

second most frequent cause. Aldosterone secretion is

independent of sodium and potassium intake as well as of
pituitary stimulation.

14. Answer: C. Increased urine osmolarity

In hyperglycemia, urine osmolarity (the measurement of

10. Answer: C. It tells us about your sugar control for

dissolved particles in the urine) increases as glucose

the last 3 months.

particles move into the urine. The client experiences

glucosuria and polyuria, losing body fluids and

The glycosylated Hb test provides an objective measure of

experiencing fluid volume deficit. Cool, clammy skin;

glycemic control over a 3-month period. The test helps

distended neck veins; and a decreased serum sodium level

identify trends or practices that impair glycemic control, and

are signs of fluid volume excess, the opposite imbalance.

it doesnt require a fasting period before blood is drawn. The

nurse cant conclude that the result occurs from poor dietary
management or inadequate insulin coverage.

11. Answer: A. Muscle weakness

15. Answer: D. a blood pressure of 176/88 mm Hg.

Pheochromocytoma, a tumor of the adrenal medulla that

secretes excessive catecholamine, causes hypertension,
tachycardia, hyperglycemia, hypermetabolism, and weight

Muscle weakness, bradycardia, nausea, diarrhea, and

loss. It isnt associated with the other options.

paresthesia of the hands, feet, tongue, and face are findings

associated with hyperkalemia, which is transient and occurs
from transient hypoaldosteronism when the adenoma is
removed. Tremors, diaphoresis, and constipation arent seen
in hyperkalemia.

12. Answer: A. antidiuretic hormone (ADH).

16. Answer: C. Restricting fluids

To reduce water retention in a client with the SIADH, the

nurse should restrict fluids. Administering fluids by any route
would further increase the clients already heightened fluid
load.

17. Answer: A. Trousseaus sign.

To control hypoglycemic episodes, the nurse should instruct

the client to consume a low-carbohydrate, high-protein diet,

This clients serum calcium level indicates hypocalcemia, an

avoid fasting, and avoid simple sugars. Increasing saturated

electrolyte imbalance that causes Trousseaus sign

fat intake and increasing vitamin supplementation wouldnt

(carpopedal spasm induced by inflating the blood pressure

help control hypoglycemia.

cuff above systolic pressure). Homans sign (pain on

dorsiflexion of the foot) indicates deep vein thrombosis.

21. Answer: C. myxedema coma.

Hegars sign (softening of the uterine isthmus) and Goodells

sign (cervical softening) are probable signs of pregnancy.

Severe hypothyroidism may result in myxedema coma, in

which a drastic drop in the metabolic rate causes decreased

18. Answer: A. Fluid intake is less than 2,500 ml/day.

vital signs, hypoventilation (possibly leading to respiratory

acidosis), and nonpitting edema. Thyroid storm is an acute

Diabetes insipidus is characterized by polyuria (up to 8

complication of hyperthyroidism. Cretinism is a form

L/day), constant thirst, and an unusually high oral intake of

of hypothyroidism that occurs in infants. Hashimotos

fluids. Treatment with the appropriate drug should decrease

thyroiditis is a common chronic inflammatory disease of the

both oral fluid intake and urine output. A urine output of 200

thyroid gland in which autoimmune factors play a prominent

ml/hour indicates continuing polyuria. A blood pressure of

role.

90/50 mm Hg and a heart rate of 126 beats/minute indicate

compensation for the continued fluid deficit, suggesting that

22. Answer: B. has type 2 diabetes.

treatment hasnt been effective.

Oral antidiabetic agents are only effective in adult clients with
19. Answer: A. Acromegaly

type 2 diabetes. Oral antidiabetic agents arent effective in

type 1 diabetes. Pregnant and lactating women arent

Acromegaly, which is caused by a pituitary tumor that

prescribed oral antidiabetic agents because the effect on the

releases excessive growth hormone, is associated with

fetus is uncertain.

hyperglycemia, hypertension, diaphoresis, peripheral

neuropathy, and joint pain. Enlarged hands and feet are

23. Answer: A. sulfisoxazole (Gantrisin)

related to lateral bone growth, which is seen in adults with

this disorder. The accompanying soft tissue swelling causes

Sulfisoxazole and other sulfonamides are chemically related

hoarseness and often sleep apnea. Type 1 diabetes is

to oral antidiabetic agents and may precipitate hypoglycemia.

usually seen in children, and newly diagnosed persons are

Mexiletine, an antiarrhythmic, is used to treat refractory

usually very ill and thin. Hypothyroidism isnt associated with

ventricular arrhythmias; it doesnt cause hypoglycemia.

hyperglycemia, nor is growth hormone deficiency.

Prednisone, a corticosteroid, is associated with

hyperglycemia. Lithium may cause transient hyperglycemia,

20. Answer: D. Consuming a low-carbohydrate, highprotein diet and avoiding fasting.

not hypoglycemia.

24. Answer: B. Switch the client to a different oral

medication at all times to alert medical personnel in an

antidiabetic agent.

emergency and ensure proper treatment. The client must

continue to monitor fluid intake and output and receive

Many clients (25% to 60%) with secondary failure respond to

adequate fluid replacement.

a different oral antidiabetic agent. Therefore, it wouldnt be

appropriate to initiate insulin therapy at this time. However, if

28. Answer: A. Hypocalcemia

a new oral antidiabetic agent is unsuccessful in keeping

glucose levels at an acceptable level, insulin may be used in

Chvosteks sign is elicited by tapping the clients face lightly

addition to the antidiabetic agent.

over the facial nerve, just below the temple. If the clients
facial muscles twitch, it indicates hypocalcemia.

25. Answer: D. You must avoid hyperextending your

Hyponatremia is indicated by weight loss, abdominal

neck after surgery.

cramping, muscle weakness, headache, and postural

hypotension. Hypokalemia causes paralytic ileus and muscle

To prevent undue pressure on the surgical incision after

weakness. Clients with hypermagnesemia exhibit a loss of

subtotal thyroidectomy, the nurse should advise the client to

deep tendon reflexes, coma, or cardiac arrest.

avoid hyperextending the neck. The client may elevate the

head of the bed as desired and should perform deep

29. Answer: A. Serum glucose level.

breathing and coughing to help prevent pneumonia. Subtotal

thyroidectomy doesnt affect swallowing.

Hyperglycemia, which develops from glucocorticoid excess,

is a manifestation of Cushings syndrome. With successful

26. Answer: C. Deposits of adipose tissue in the trunk

treatment of the disorder, serum glucose levels decline.

and dorsocervical area.

Hirsutism is common in Cushings syndrome; therefore, with

successful treatment, abnormal hair growth also declines.

Because of changes in fat distribution, adipose tissue

Osteoporosis occurs in Cushings syndrome; therefore, with

accumulates in the trunk, face (moonface), and

successful treatment, bone mineralization increases.

dorsocervical areas (buffalo hump). Hypertension is caused

Amenorrhea develops in Cushings syndrome. With

by fluid retention. Skin becomes thin and bruises easily

successful treatment, the client experiences a return of

because of a loss of collagen. Muscle wasting causes

menstrual flow, not a decline in it.

muscle atrophy and thin extremities.

30. Answer: C. It interacts with plasma membrane
27. Answer: C. You may not be able to use

receptors to produce enzymatic actions that affect

desmopressin nasally if you have nasal discharge or

protein, fat, and carbohydrate metabolism.

blockage.
Corticotropin interacts with plasma membrane receptors to
Desmopressin may not be absorbed if the intranasal route is

produce enzymatic actions that affect protein, fat, and

compromised. Although diabetes insipidus is treatable, the

carbohydrate metabolism. It doesnt decrease cAMP

client should wear medical identification and carry

production. The posterior pituitary hormone, antidiuretic

hormone, regulates the threshold for water resorption in the

Levothyroxine is the preferred agent to treat

kidneys.

primary hypothyroidism and cretinism, although it also may

be used to treat secondary hypothyroidism. It is

31. Answer: C. Onset to be at 2:30 p.m. and its peak to

be at 4 p.m.

Regular insulin, which is a short-acting insulin, has an onset

of 15 to 30 minutes and a peak of 2 to 4 hours. Because the
nurse gave the insulin at 2 p.m., the expected onset would

contraindicated in Graves disease and thyrotoxicosis

because these conditions are forms of hyperthyroidism.
Euthyroidism, a term used to describe normal thyroid
function, wouldnt require any thyroid preparation.

35. Answer: B. Neck vein distention

be from 2:15 p.m. to 2:30 p.m. and the peak from 4 p.m. to 6
p.m.

SIADH secretion causes antidiuretic hormone

overproduction, which leads to fluid retention. Severe SIADH

32. Answer: A. Depression

Agitation, irritability, poor memory, loss of appetite, and

neglect of ones appearance may signal depression, which is
common in clients with Cushings syndrome. Neuropathy
affects clients with diabetes mellitus not Cushings

can cause such complications as vascular fluid overload,

signaled by neck vein distention. This syndrome isnt
associated with tetanic contractions. It may cause weight
gain and fluid retention (secondary to oliguria).

36. Answer: A. phentolamine (Regitine).

syndrome. Although hypoglycemia can cause irritability, it

also produces increased appetite, rather than loss of

Pheochromocytoma causes excessive production of

appetite. Hyperthyroidism typically causes such signs as

epinephrine and norepinephrine, natural catecholamines that

goiter, nervousness, heat intolerance, and weight loss

raise the blood pressure. Phentolamine, an alpha-adrenergic

despite increased appetite.

blocking agent given by I.V. bolus or drip, antagonizes the

bodys response to circulating epinephrine and

33. Answer: A. Tetany

Tetany may result if the parathyroid glands are excised or

damaged during thyroid surgery. Hemorrhage is a potential
complication after thyroid surgery but is characterized by
tachycardia, hypotension, frequent swallowing, feelings of
fullness at the incision site, choking, and bleeding. Thyroid
storm is another term for severe hyperthyroidism not a
complication of thyroidectomy. Laryngeal nerve damage may
occur postoperatively, but its signs include a hoarse voice

norepinephrine, reducing blood pressure quickly and

effectively. Although methyldopa is an antihypertensive agent
available in parenteral form, it isnt effective in treating
hypertensive emergencies. Mannitol, a diuretic, isnt used to
treat hypertensive emergencies. Felodipine, an
antihypertensive agent, is available only in extended-release
tablets and therefore doesnt reduce blood pressure quickly
enough to correct hypertensive crisis.

37. Answer: A. Adrenal cortex

and, possibly, acute airway obstruction.

Excessive secretion of aldosterone in the adrenal cortex is
34. Answer: A. Primary hypothyroidism

responsible for the clients hypertension. This hormone acts

on the renal tubule, where it promotes reabsorption of

Within 24 hours after a hypophysectomy, transient diabetes

sodium and excretion of potassium and hydrogen ions. The

insipidus commonly occurs; this calls for increased, not

pancreas mainly secretes hormones involved in fuel

restricted, fluid intake. Visual, not auditory, changes are a

metabolism. The adrenal medulla secretes the

potential complication of hypophysectomy.

catecholamines epinephrine and norepinephrine. The

parathyroids secrete parathyroid hormone.

41. Answer: A. Be sure to take glipizide 30 minutes

before meals.

38. Answer: A. Risk for infection

The client should take glipizide twice a day, 30 minutes
Addisons disease decreases the production of all adrenal

before a meal, because food decreases its absorption. The

hormones, compromising the bodys normal stress response

drug doesnt cause hyponatremia and therefore doesnt

and increasing the risk of infection. Other appropriate

necessitate monthly serum sodium measurement. The client

nursing diagnoses for a client with Addisons disease

must continue to monitor the blood glucose level during

include Deficient fluid volume and Hyperthermia. Urinary

glipizide therapy.

retention isnt appropriate because Addisons disease

causes polyuria.

42. Answer: C. They debride the wound and promote

healing by secondary intention.

39. Answer: A. If I have hypoglycemia, I should eat

some sugar, not dextrose.

For this client, wet-to-dry dressings are most appropriate

because they clean the foot ulcer by debriding exudate and

Acarbose delays glucose absorption, so the client should

necrotic tissue, thus promoting healing by secondary

take an oral form of dextrose rather than a product

intention. Moist, transparent dressings contain exudate and

containing table sugar when treating hypoglycemia. The

provide a moist wound environment. Hydrocolloid dressings

alpha-glucosidase inhibitors work by delaying the

prevent the entrance of microorganisms and minimize wound

carbohydrate digestion and glucose absorption. Its safe to

discomfort. Dry sterile dressings protect the wound from

be on a regimen that includes insulin and an alpha-

mechanical trauma and promote healing.

glucosidase inhibitor. The client should take the drug at the

start of a meal, not 30 minutes to an hour before.

43. Answer: C. Forcing fluids

40. Answer: B. You must avoid coughing, sneezing, and

The client should be encouraged to force fluids to prevent

blowing your nose.

renal calculi formation. Sodium should be encouraged to

replace losses in urine. Restricting potassium isnt necessary

After a transsphenoidal hypophysectomy, the client must

in hyperparathyroidism.

refrain from coughing, sneezing, and blowing the nose for

several days to avoid disturbing the surgical graft used to
close the wound. The head of the bed must be elevated, not
kept flat, to prevent tension or pressure on the suture line.

44. Answer: D. Imbalanced nutrition: Less than body

requirements related to thyroid hormone excess

In the client with hyperthyroidism, excessive thyroid hormone

As a normal body protein, glucagon only interacts adversely

production leads to hypermetabolism and increased nutrient

with oral anticoagulants, increasing the anticoagulant effects.

metabolism. These conditions may result in a negative

It doesnt interact adversely with anabolic steroids, beta-

nitrogen balance, increased protein synthesis and

adrenergic blockers, or thiazide diuretics.

breakdown, decreased glucose tolerance, and fat

mobilization and depletion. This puts the client at risk for
marked nutrient and calorie deficiency, making Imbalanced
nutrition: Less than body requirements the most important
nursing diagnosis. Options B and C may be appropriate for a
client with hypothyroidism, which slows the metabolic rate.

45. Answer: D. Serum osmolarity

48. Answer: A. Always follow the same order when

drawing the different insulins into the syringe.

The client should be instructed always to follow the same

order when drawing the different insulins into the syringe.
Insulin should never be shaken because the resulting froth
prevents withdrawal of an accurate dose and may damage
the insulin protein molecules. Insulin also should never be

Serum osmolarity is the most important test for confirming

frozen because the insulin protein molecules may be

HHNS; its also used to guide treatment strategies and

damaged. Intermediate-acting insulin is normally cloudy.

determine evaluation criteria. A client with HHNS typically

has a serum osmolarity of more than 350 mOsm/L. Serum
potassium, serum sodium, and ABG values are also
measured, but they arent as important as serum osmolarity
for confirming a diagnosis of HHNS. A client with HHNS
typically has hypernatremia and osmotic diuresis. ABG
values reveal acidosis, and the potassium level is variable.

49. Answer: C. 15 to 20 g of a fast-acting carbohydrate

such as orange juice.

This client is having a hypoglycemic episode. Because the

client is conscious, the nurse should first administer a fastacting carbohydrate, such as orange juice, hard candy, or
honey. If the client has lost consciousness, the nurse should

46. Answer: B. Youll need less insulin when you

administer either I.M. or subcutaneous glucagon or an I.V.

exercise or reduce your food intake.

bolus of dextrose 50%. The nurse shouldnt administer

insulin to a client whos hypoglycemic; this action will further

Exercise, reduced food intake, hypothyroidism, and certain

compromise the clients condition.

medications decrease the insulin requirements. Growth,

pregnancy, greater food intake, stress, surgery, infection,
illness, increased insulin antibodies, and certain medications
increase the insulin requirements.

47. Answer: A. Oral anticoagulants

50. Answer: A. Hypocalcemia

The client who has undergone a thyroidectomy is at risk for

developing hypocalcemia from inadvertent removal or
damage to the parathyroid gland. The client with
hypocalcemia will exhibit a positive Chvosteks sign (facial
muscle contraction when the facial nerve in front of the ear is
tapped) and a positive Trousseaus sign (carpal spasm when
a blood pressure cuff is inflated for a few minutes). These

signs arent present with hypercalcemia, hypokalemia, or

hyperkalemia.