Situation: Antonio, Age 52, was admitted to the hospital with acute adrenal insufficiency.

He has a history of Addison’s disease

for Which he has been taking hydrocortisone over the past week, he has flu like symptoms accompanied by nausea and vomiting,
extremely weak.

1. The nurse is performing an initial assessment on a client diagnosed with Addison's disease. Which assessment findings should
the nurse anticipate? Select all that apply.
a. Acanthosis nigricans
b. Hirsutism
c. Hyperpigmented skin
d. Truncal obesity
e. Weight loss

2. The nurse would assess for which of the following signs and symptoms for a client suffering from addisonian crisis?
A. Abdominal cramps, tetany
B. Buffalo hump, truncal obesity
C. tachycardia, tremors and weight gain
D. Hypotension, pallor, tachycardia

3. The nurse caring for a patient with cushing’s disease and anticipates that which of the following electrolyte imbalances will be
seen in the laboratory result?
a. Hyponatremia, Hyperkalemia
b. Hypernatremia, Hypokalemia
c. Hypernatremia, Hyperkalemia
d. Hyponatremia, Hypokalemia

4. The nurse is preparing a care plan for a patient with Cushing disease. Which abnormal laboratory values would the nurse
expect? Select all that apply.
1. Increased serum calcium level
2. Increased salivary cortisol level
3. Increased urinary cortisol level
4. Decreased serum glucose level
5. Decreased sodium level
6. Increased serum cortisol level

5. Assessment findings for a patient with Cushing disease include all of the following. For which finding would the nurse notify
the health care provider (HCP) immediately?
1. Purple striae present on the abdomen and thighs
2. Weight gain of 1 lb (0.5 kg) since the previous day
3. Dependent edema rated as + 1 in the ankles and calves
4. Crackles bilaterally in the lower lobes of the lungs

Situation: Antonio, Age 52, was admitted to the hospital with acute adrenal insufficiency. He has a history of Addison’s disease
for Which he has been taking hydrocortisone over the past week, he has flu like symptoms accompanied by nausea and vomiting,
extremely weak.

6. The nurse would assess for which of the following signs and symptoms for a client suffering from addisonian crisis?
A. Abdominal cramps, tetany
B. Buffalo hump, truncal obesity
C. tachycardia, tremors and weight gain
D. Hypotension, pallor, tachycardia

5. Antonio blood pressure is 90/58mmHg his heart rate is 116bpm and is temperature is 101F. The nurse should expect to start
and IV infusion of:
a. Insulin B. Hydrocortisone C. Mannitol D. Hypotonic Solution

6. Which is an appropriate measure for a patient with addisonian crisis?

a. IV fluid replacement C. Blood glucose management
b. IV corticosteroid D. All of the above

6. The second fasting blood glucose level was 131 mg/dl, and Rody asks what caused his diabetes, the nurse should reply that
type 2 diabetes is:

a. An autoimmune disease
b. Caused by decreased insulin levels
c. Caused by insulin resistance
d. Caused by eating too many sweets
7. A client with type I diabetes mellitus is brought to the emergency department by his wife. The client has fruity breath with
rapid, deep respirations at 36 breaths per minute, reports abdominal pain, and appears weak. The nurse should anticipate
implementation of which prescription(s)? Select all that apply.
A. Administer dextrose 50 mg intravenous (IV) push
B. Instruct client to breathe into a paper bag to treat hyperventilation
C. Perform a fingerstick and serum blood glucose test
D. Prepare to administer an IV infusion of regular insulin
E. Start an IV line and administer a bolus of normal saline

8. The nurse provides information to a client with diabetes mellitus who is taking insulin about the signs of hypoglycemia. Which
of the following signs should the nurse include in the infor- mation? Select all that apply.
1 Hunger r 2 Sweating r
1 Weakness r 4 Nervousness r
5 Cool clammy skin r 6 Increased urinary output

9. The nurse in an outpatient diabetes clinic is monitoring a client with type 1 diabetes melli- tus. Today’s blood work reveals a
glycosylated hemoglobin level of 10%. The nurse creates a teaching plan on the basis of the understanding that this result
indicates which of the following?
A.A normal value that indicates that the client is managing blood glucose control well
B. A value that does not offer information re- garding the client’s management of the disease
C. A low value that indicates that the client is not managing blood glucose control very well
D. A high value that indicates that the client is not managing blood glucose control very well

10. The nurse is caring for a client with type 1 dia- betes mellitus. Because the client is at risk for hypoglycemia, the nurse teaches
the client to:
a. Monitor the urine for acetone.
b. Report any feelings of drowsiness.
c. Keep glucose tablets and subcutaneous glucagon available.
d. Omit the evening dose of NPH insulin if the client has been exercising.

11. The initial treatment for Miguel is meal plan change, with a goal of modest weight loss and exercise. Modest weight loss and
exercise are used to treat type 2 diabetes because each will:
a. Enhance insulin sensitivity
b. Enhance insulin secretion
c. Make patients feel better
d. Prevent the progression of diabetes

12. . The blood test that reflects average blood glucose levels over a period of approximately 2-3 months is:

a. Fasting plasma glucose

b. Glycosylated hemoglobin
c. Urine glucose testing
d. Self monitoring of blood glucose

13. A patient is scheduled to take 10 units of Humulin N at 1100. When is the patient most susceptible
for hypoglycemia?
a. 1900

b. 1300

c. 1130

d. 1500

14. A patient has a blood glucose of 400. Which of the following medications could be the cause of this?
a. Glyburide

b. Atenolol
c. Bactrim

d. Prednisone
15. A 10 year old child with type 1 diabetes develops diabetic ketoacidosis and receives a continuous insulin infusion. Which
condition represents the greatest risk to this child?
A. Hypernatremia
B. Hypokalemia
C. Hyperphosphatemia
D. Hypercalcemia

16. What is the phenomenon wherein there is rebound hyperglycemia for patients with DM?
a. Insulin Waning
b. Dawn’s phenomena
c. Somogyi Effect
d. Insulin Effect

17. An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus,
hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood
glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse
teaches the client to treat hypoglycemia by ingesting:
a. 2 to 5 g of a simple carbohydrate.
b. 10 to 15 g of a simple carbohydrate.
c. 18 to 20 g of a simple carbohydrate.
d. 25 to 30 g of a simple carbohydrate.

18. The nurse is caring for an older patient with type 1 diabetes and diabetic retinopathy. What is the nurse's priority concern for
assessing this patient?
1. Assess ability to measure and inject insulin and to monitor blood glucose levels.
2. Assess for damage to motor fibers, which can result in muscle weakness.
3. Assess which modifiable risk factors can be reduced.
4. Assess for albuminuria, which may indicate kidney disease.

19. The nurse is preparing to review a teaching plan for a patient with type 2 diabetes mellitus. To determine the patient's level
of compliance with his prescribed diabetic regimen, which value would the nurse be sure to review?
1. Fasting glucose level
2. Oral glucose tolerance test results
3. Glycosylated hemoglobin (HgbA1c) level
4. Fingerstick glucose findings for 24 hours

20. A patient with newly diagnosed diabetes has peripheral neuropathy. Which key points should the nurse include in the
teaching plan for this patient? Select all that apply.
1. “Clean and inspect your feet every day.”
2. “Be sure that your shoes fit properly.”
3. “Nylon socks are best to prevent friction on your toes from shoes.”
4. “Only a podiatrist should trim your toenails.”
5. “Report any nonhealing skin breaks to your health care provider (HCP).”
6. “Use a thermometer to check the temperature of water before taking abath.”

21. In the emergency department, during initial assessment of a newly admitted patient with diabetes, the nurse discovers all of
these findings. Which finding should be reported to the health care provider immediately?
1. Hammer toe of the left second metatarsophalangeal joint
2. Rapid respiratory rate with deep inspirations
3. Numbness and tingling bilaterally in the feet and hands
4. Decreased sensitivity and swelling of the abdomen

22. A patient with type 1 diabetes reports feeling dizzy. What should the nurse do first?
1. Check the patient's blood pressure.
2. Give the patient some orange juice.
3. Give the patient's morning dose of insulin.
4. Use a glucometer to check the patient's glucose level.

23. A patient is scheduled to take 5 units of Humulin R and 10 units of NPH. What is the proper way of
mixing these insulins?
a. These insulins cannot be mixes, therefore should be drawn up in different syringes.
b. Draw-up the Humulin R insulin first and then the NPH insulin
c. Draw-up 2.5 units of NPH, then 10 units of Humulin R, and then finish drawing up 2.5 units of
NPH
d. Draw-up the NPH insulin first and then the Humulin R insulin.
24. Short acting insulin is given to the patient via IV at 8pm. At what time would the insulin cause hyperglycemia?
A. 10pm-11am
B. 12am – 2am
C. 3am – 4am
D. 5am-7am

25. A client is admitted to the hospital with a suspected diagnosis of Graves’ disease. Which symptom related to the client’s
menstrual cycle would the client likely report?

a. Amenorrhea
b. Menorrhagia
c. Metrorrhagia
d. Dysmenorrhea

26. The nurse is preparing to care for a client return- ing from the operating room after a subtotal thyroidectomy. The nurse
anticipates the need for which of the following items to be placed at the bedside?
A. Hypothermia blanket
B. Emergency tracheostomy kit
C. Magnesium sulfate in a ready-to-inject vial
D. Ampule of saturated solution of potassium iodide (SSKI)

27. Which of the following assessment would warrant the nurse that the patients is experiencing complication related to
thyroidectomy?
A. Hemorrhoids
B. lethargy and lack of coordination
C. kidney stones and constipation
D. Spasm and tingling sensation

28. A 40 year old female client with hyperthyroidism is taking propythiouracil ( PTU) for 6 months now. The nurse should
monitor the client for the most serious and toxic side effect of PTU, which is:
A. Autonomic dysfunction
B. Pruritus
C. Agranulocytosis
D. Constipation.

Situation - Nurse Thelma is on a duty at the Medical Private Wing. She admits Olive who is diagnosed with hypothyroidism. In
Nurse Thelma's assessment, she note tiredness, cold intolerance, constipation, and weight gain.
29. Which client statement alerts the nurse to the possibility of hypothyroidism?
a. “My sister has thyroid problems.”
b. “I seem to feel the heat more than other people.”
c. “Food just doesn’t taste good without a lot of salt.”
d. “I am always tired, even with 10 or 12 hours of sleep.”

30. What should Nurse Thelma anticipate to administer which of the following medication to Olive who is diagnosed to be
suffering from hypothyroidism?
a) Levophed
b) Lipitor
c) Levothyroxine
d) Lidocaine

31. The clinic nurse is taking vital signs on a client who reports being fatigued every day and gaining weight lately despite not
eating much. The nurse should also ask about which symptoms of hypothyroidism? Select all that apply.
A. Cold intolerance
B. Constipation
C. Fever
D. Menstrual irregularity
E. Night sweats
F. Tachycardia
 32. The physician prescribed Olive with hypothyroidismis to receive levothyroxine (Synthroid) daily. Which finding should nurse
Hans recognize as an adverse drug effect?
A. Dysuria
B. Leg cramps
C. Tachycardia
D. Blurred vision

33. A patient is diagnosed with hyperparathyroidism. Which of the following signs and symptoms would
you NOT find on this patient? Select all that apply.
1. Calcium level 6mg/dl
2. Bone fracture
3. Positive Trousseau’s sign
4. Tingling & numbness of lips & fingers
5. Calcium level of 15mg/dl
6. Renal Calculi
7. Anorexia
A. 3, 4, 8
B. 1, 3, 4
C. 2, 5, 6
D. 3, 4, 5

34. A nurse is conducting a health history on a client with hyperparathyroidism. Which of the following questions asked of the
client would elicit information about this condition?

a. “Do you have tremors in your hands?”

b. “Are you experiencing pain in your joints?”
c. “Have you had problems with diarrhea lately?”
d. “Do you notice any swelling in your legs at night?”

35. This medication is used to treat hyperparathyroidism in patients with chronic renal failure. It works
by inhibiting calcium loss from the bones. Which of the following medication does this describe
below?
A. Calcitonin
B. Fosamax
C. Lasix
D. Vit D

36. A female adult client with a history of chronic hyperparathyroidism admits to being noncompliant. Based on initial
assessment findings, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis
statement for this client, which “related-to” phrase should the nurse add?
A. Related to bone demineralization resulting in pathologic fractures.
B. Related to exhaustion secondary to an accelerated metabolic rate.
C. Related to edema and dry skin secondary to fluid infiltration into the interstitial spaces.
D. Related to tetany secondary to a decreased serum calcium level.

Situation: Mang Kanor was rushed in Kamogawa Medical Hospital at 10:12pm with chief complaint of Body malaise, decrease urine
output, accompanied by severe headache, he was later on diagnosed of having Syndrome of Inappropriate Antidiuretic Hormone
(SIADH) according to his medical history and diagnostic tests made.

37. Nurse Neri is caring for mang Kanor at the time of admission, the physician already checked mang Kanor’s condition and the
following orders are made. The nurse plans to execute which of the following nursing interventions except?
A. Encourage the patient to increase oral fluid intake to 2-3L/day.
B. Maintain the client on bed rest.
C. Administer diuretics as ordered.
D. Assess V/S at regular interval and weight daily.
38. Nurse Neri’s shift is about to end, she endorsed mang Kanor to Nurse Katrina for further management.
Which of the following Intravenous solution hooked to the patient will Nurse Katrina expect to see?

A. Hypertonic solution C. Isotonic solution

B. Hypotonic solution D. Isometric solution

39. Which of these signs suggests that a male client with the syndrome of inappropriate antidiuretic hormone
(SIADH) secretion is experiencing complications?

a. Tetanic contractions
b. Neck vein distention
c. Weight loss
d. Polyuria

40. As the shift begins, the nurse is assigned to care for the following patients. Which patient should the nurse
assess first?
1. A 38-year-old patient with Graves disease and a heart rate of 94 beats/min
2. A 63-year-old patient with type 2 diabetes and fingerstick glucose level of 137 mg/dL (7.6 mmol/L)
3. A 58-year-old patient with hypothyroidism and a heart rate of 48 beats/min
4. A 49-year-old patient with Cushing disease and dependent edema rated as + 1