ENDOCRINE 1

1. The assessment of a client that would most indicative of diabetes insipidus is:
A. Increased blood glucose
B. Low urinary specific gravity
C. Elevation of blood pressure
D. Decreased serum osmolarity

Correct answer is B: Because water is not being reabsorbed, urine is dilute, resulting in a low specific gravity.
A. Diabetes Insipidus is not disorder of glucose metabolism; blood glucose levels are not affected
C. Loss of fluid may actually lower blood pressure
D. As fluid is lost from the vascular compartment, serum osmolarity increases

2. Normally the antidiuretic hormone (ADH) influences kidney function by stimulating the:
A. Nephron tubules to reabsorb water
B. Nephron tubules to reabsorb glucose
C. Glomerulus to withhold the proteins from the urine
D. Glomerulus to control the quantity of fluid passing through it

Correct answer is A: The antidiuretic hormone aids the body in retaining the fluid by causing the nephrons to reabsorb water.
B. Reabsorption of glucose is not affected, only the reabsorption of water
C. The glomeruli are not affected
D. Same as answer C.

3. The administration of corticosteroids to control the symptoms of one disease can cause infections. A rationale that does not support this concept is that corticosteroids:
A. Prevent the production of leukocytes
B. Stop antibody production in lymphatic tissue
C. Promote the growth and spread of enteric viruses
D. Interfere with the inflammatory response of the body.

Correct answer is C: These agents are classified as anti-inflammatory or immunosuppressive. Glucocorticoids interfere with the body’s response to microorganisms but do not directly promote the spread of enteroviruses
A. Immunosuppressant action causes bone marrow depression, which decreases the number of WBCs.
B. They interfere with antibody production
D. They interfere with the release of enzymes responsible for the inflammatory response.

4. The nurse knows that most of the hormones present in the body at any given time were secreted from the endocrine glands:
A. 24 hours ago
B. 4 to 6 hours ago
C. 8 to 12 hours ago
D. More than 72 hours ago

Correct answer is B: Endocrine gland secretions (hormones) are inactivated by the liver and other tissues fairly rapidly; continuous hormonal secretion by the endocrine glands is regulated by immediate feedback controls, and the body’s metabolism is always close to being suitable to the body’s immediate needs.
A. This time interval does not represent secretory patterns of the endocrine glands
C. same as answer A
D. same as answer A

5. After a head injury a client develops a deficiency of antidiuretic hormone (ADH). Normally secretion of ADH causes:
A. Serum osmolarity to increase
B. Urine concentration to decrease
C. Glomerular filtration to decrease
D. Tubular reabsorption of water to increase

Correct answer is D: Reabsorption of sodium and water in the kidney tubules decreases urinary output and retains body fluids.
A. The opposite is true
B. Same as answer A
C. There is no effect on filtration with ADH; ADH increases reabsorption in the tubules

6. A client who has acromegaly and diabetes mellitus undergoes a hypophysectomy. The nurse recognizes that further teaching about the hypophysectomy is necessary when the client states “I know I will:
A. Be sterile for the rest of my life”
B. Require larger doses of insulin than I did preoperatively”
C. Have to take thyroxine or a similar preparation for the rest of my life”
D. Have to take the cortisone or a similar preparation for the rest of my life”

Correct answer is B: The hypophysis (pituitary) does not directly regulate insulin release. This is controlled by serum glucose levels. Because somatotropin release will stop after the hypophysectomy any elevation of blood glucose caused by somatotropin will also stop.
A. This effects maybe expected after hypophysectomy because follicle-stimulating hormone and its releasing factor will no longer be present to stimulate spermatogenesis.
C. Thyroid-stimulating hormone will not be present; extrinsic thyroxine will have to be taken
D. ACTH, which stimulates glucocorticoids secretion by the adrenal glands, is absent and cortisone will have to be administered.

7. After a hypophysectomy the nurse specifically should observe the client for early signs of:
A. Urinary retention
B. Respiratory distress
C. Bleeding at the suture line
D. Increased intracranial pressure

Correct answer is D: Because the pituitary gland is located in the brain, edema after surgery may result in increased intracranial pressure.
A. This may follow any surgery because of the effects of anesthesia and is not a specific occurrence following cranial surgery
B. This is not an initial sign of increased ICP. This may be the result of pressure on the medulla caused by increased intracranial pressure.
C. This may occur with any surgery, not just a hypophysectomy.

8. In the emergency the rapid adjustments made by the body are associated with increased activity of the:
A. Thyroid gland
B. Adrenal gland
C. Pituitary gland
D. Pancreatic gland

Correct answer is B: The adrenal glands, stimulated by the sympathetic nervous system, secrete epinephrine during stressful situations. The ensuing alarm reaction involves rapid adjustment of the body to meet the emergency situation.
A. There maybe modification in secretion of hormones from this gland, but it is not directly related to meeting emergency situations.
C. same as answer A
D. same as answer A

9. One of the main differences between newly diagnosed type 1 and type 2 diabetes mellitus is that in type 1 diabetes:
A. The onset is slow
B. Clients are generally overweight
C, Treatment involves diet, exercise, and oral agents
D. Complications are not present at time of diagnosis

Correct answer is D: Clinical presentation of type 1 diabetes is characterized by acute onset and therefore there is no time to develop the long term complications that are common with long-standing disease; 20% of newly diagnosed clients with type 2 diabetes demonstrate complications because the diabetes has gone undetected for an extended period of time.


10. A client is scheduled for an adrenalectomy. The nurse should plan to:
A. Provide a high-protein diet
B. Administer steroid IM or IV
C. Collect a 24-hour urine specimen
D. Withhold all medication for 48 hours

Correct answer is B: Steroid therapy is usually instituted preoperatively and continued intraoperatively to prepare for the acute adrenal insufficiency the follows surgery.

11. A client with Cushing’s syndrome may manifest signs of diabetes mellitus because:
A. The cortical hormones stimulate rapid weight loss
B. Excessive ACTH secretion damages pancreatic tissue
C. Tissue catabolism results in a negative nitrogen balance
D. Glucocorticoids accelerate the process of gluconeogenesis

Correct answer is D: Excess glucocorticoids cause hyperglycemia and signs of diabetes mellitus may develop.