While inspecting the neck, the nurse asks the patient to sip water, tilt the head back slightly and swallow. What is the purpose of this step?
To watch the gland rise and check for lumps or uneven movement
✓
To measure how quickly the patient can swallow liquids
To test the gag reflex, which the thyroid gland controls
To relax the neck so the trachea shifts to one side
Correct Answer
To watch the gland rise and check for lumps or uneven movement
The thyroid moves upward with swallowing, so watching the neck as the patient swallows shows whether the gland moves evenly and whether any lump or protrusion appears. To measure how quickly the patient can swallow liquids is part of a swallow screen, not a thyroid exam. To test the gag reflex, which the thyroid gland controls, is wrong because cranial nerves, not the thyroid, control the gag reflex. To relax the neck so the trachea shifts to one side is wrong because the trachea should stay midline, and deviation is an abnormal finding.
Category: Endocrine Anatomy and Physiology
Question 2
Which example describes negative feedback in the hypothalamic-pituitary-adrenal axis?
Rising cortisol levels increase ACTH release from the pituitary
Rising cortisol levels reduce hypothalamic and pituitary signaling
✓
Falling cortisol levels suppress ACTH release from the pituitary
Rising ACTH levels stop the adrenal cortex from releasing cortisol
Correct Answer
Rising cortisol levels reduce hypothalamic and pituitary signaling
In negative feedback, a rising hormone level shuts down the signals that produced it, so higher glucocorticoid levels reduce hypothalamic and pituitary signaling to the adrenal glands. Rising cortisol levels increase ACTH release from the pituitary describes positive feedback, which would drive levels ever higher. Falling cortisol levels suppress ACTH release from the pituitary is backward, because low cortisol increases ACTH. Rising ACTH levels stop the adrenal cortex from releasing cortisol is wrong because ACTH stimulates cortisol release.
Category: Endocrine Anatomy and Physiology
Question 3
A patient whose gestational diabetes resolved after delivery asks whether diabetes is still a concern. Which response by the nurse is accurate?
Your pancreas is now protected from developing diabetes
You will need insulin for the rest of your life
Your risk of developing type 2 diabetes later in life is higher
✓
You are now at high risk for developing type 1 diabetes
Correct Answer
Your risk of developing type 2 diabetes later in life is higher
Gestational diabetes usually resolves after delivery, but it raises the person's later risk of type 2 diabetes, so ongoing screening and healthy lifestyle habits matter. Your pancreas is now protected from developing diabetes is false reassurance. You will need insulin for the rest of your life is wrong because gestational diabetes usually resolves after birth. You are now at high risk for developing type 1 diabetes is wrong because type 1 diabetes is an autoimmune disease not linked to a history of gestational diabetes.
Category: Diabetes Mellitus
Question 4
An older adult with type 2 diabetes and pneumonia has extremely high blood glucose, severe dehydration and new confusion. Blood pH is normal and no ketones are found. Which complication do these findings indicate?
Diabetic ketoacidosis
Hypoglycemic reaction
Lactic acidosis
Hyperosmolar hyperglycemic state
✓
Correct Answer
Hyperosmolar hyperglycemic state
Hyperosmolar hyperglycemic state is more common in type 2 diabetes, is usually triggered by illness or infection, and causes extreme hyperglycemia with profound dehydration and neurologic changes but without ketones or acidosis. Diabetic ketoacidosis produces ketones and metabolic acidosis, which this patient does not have. Hypoglycemic reaction does not fit because the glucose is high, not low. Lactic acidosis lowers blood pH, which is normal here.
Category: Hyperglycemic Emergencies
Question 5
Where do the ketones in diabetic ketoacidosis come from?
Fat breakdown for fuel when cells cannot use glucose without insulin
✓
Protein digestion after a large high-protein meal
Failing kidneys that can no longer excrete acid
Excess insulin driving glucose into fat cells
Correct Answer
Fat breakdown for fuel when cells cannot use glucose without insulin
Without insulin, glucose cannot enter most cells, so the body breaks down fat for energy and the liver converts the fatty acids into ketones, acids that build up in the blood and spill into the urine. Protein digestion after a large high-protein meal does not produce the ketone buildup of this crisis. Failing kidneys that can no longer excrete acid cause a different form of metabolic acidosis, although kidney injury can occur as a complication. Excess insulin driving glucose into fat cells is the opposite of the problem, because ketoacidosis results from a lack of insulin.
Category: Hyperglycemic Emergencies
Question 6
An older adult is receiving intravenous fluids and insulin for a severe hyperglycemic crisis with profound dehydration. Which finding should the nurse report to the provider immediately?
Moist mucous membranes
Increasing drowsiness and difficulty waking
✓
Less thirst than on admission
Pale yellow urine in the drainage bag
Correct Answer
Increasing drowsiness and difficulty waking
Severe hyperglycemic crises, especially hyperosmolar hyperglycemic state in older adults, cause dehydration and neurologic changes that can progress to seizures and coma, so a falling level of consciousness signals worsening and needs immediate attention. Moist mucous membranes show that hydration is improving. Less thirst than on admission is also a sign that fluid replacement is working. Pale yellow urine in the drainage bag is not an urgent finding.
Category: Hyperglycemic Emergencies
Question 7
A hospitalized patient with diabetes has a low blood glucose episode that the nurse treats according to facility protocol. The patient recovers fully. What else should the nurse do?
Document it only if a second episode occurs
Hold all insulin until discharge without consulting the provider
Report the episode to the provider and include it in handoff
✓
Give the next insulin dose early to prevent a rebound
Correct Answer
Report the episode to the provider and include it in handoff
After treating hypoglycemia, the nurse reports it to the provider and the next nurse so the cause can be found and the treatment plan adjusted. Document it only if a second episode occurs would hide important information from the team. Hold all insulin until discharge without consulting the provider changes therapy without an order and risks severe hyperglycemia. Give the next insulin dose early to prevent a rebound would make another low blood glucose more likely.
Category: Diabetes Nursing Care
Question 8
A hospitalized patient with type 2 diabetes develops a fever from a urinary tract infection. How should the nurse adjust blood glucose monitoring?
Stop glucose checks until the fever breaks
Check the blood glucose only before breakfast
Rely on the patient's symptoms instead of glucose checks
Check the blood glucose more often than usual
✓
Correct Answer
Check the blood glucose more often than usual
Infection and physical stress raise glucose needs and can push blood glucose up, so the nurse checks it more often to catch hyperglycemia early. Stop glucose checks until the fever breaks removes monitoring when the risk is highest. Check the blood glucose only before breakfast would miss changes during the rest of the day. Rely on the patient's symptoms instead of glucose checks is unsafe because high or low glucose can be present before clear symptoms appear.
Category: Diabetes Nursing Care
Question 9
Which assessment finding in a patient with long-standing diabetes points to peripheral neuropathy?
Reduced sense of touch and temperature in both feet
✓
Weak pedal pulses with cool feet
Brisk, overactive ankle reflexes
Increased hair growth on the lower legs
Correct Answer
Reduced sense of touch and temperature in both feet
Diabetic neuropathy damages sensory nerves, so patients lose the ability to feel touch, temperature and pain in the feet, which makes unnoticed injuries and foot ulcers likely. Weak pedal pulses with cool feet point to reduced arterial blood flow rather than nerve damage. Brisk, overactive ankle reflexes are the opposite of the absent ankle reflexes seen with neuropathy. Increased hair growth on the lower legs is not a sign of neuropathy; hair loss on the legs is more typical of poor circulation.
Category: Diabetes Nursing Care
Question 10
A patient with untreated hyperthyroidism is restless, sweating heavily and says the room feels too warm. Which nursing action promotes comfort?
Add warm blankets to prevent chills
Keep the room cool and limit noise and activity
✓
Schedule several visitors to provide distraction
Encourage vigorous exercise to use up energy
Correct Answer
Keep the room cool and limit noise and activity
Excess thyroid hormone raises heat production and nervous system activity, so a cool, quiet, low-stimulation environment eases heat intolerance and restlessness and helps the patient rest. Add warm blankets to prevent chills would worsen heat intolerance. Schedule several visitors to provide distraction adds stimulation for a patient who is already agitated. Encourage vigorous exercise to use up energy raises the heart rate and metabolic demand further.
Category: Thyroid Disorders
Question 11
A patient has a newly found lump in the thyroid gland. Which history finding raises concern for thyroid cancer?
Regular aerobic exercise for many years
A history of kidney stones
Radiation exposure to the head and neck
✓
Daily use of a calcium supplement
Correct Answer
Radiation exposure to the head and neck
Radiation exposure, especially to the head and neck, is a known risk factor for thyroid cancer, along with a family history, obesity and a low-iodine diet; a suspicious nodule may be checked with ultrasound and a fine needle aspiration biopsy. Regular aerobic exercise for many years is not a risk factor. A history of kidney stones does not raise thyroid cancer risk. Daily use of a calcium supplement does not raise thyroid cancer risk either.
Category: Thyroid Disorders
Question 12
An older adult reports fatigue, feeling cold all the time, constipation and forgetfulness, and a family member says this is just normal aging. What should the nurse recognize?
These findings are expected with aging and need no workup
These findings point to hyperthyroidism and need evaluation
These findings suggest dehydration from low fluid intake
These findings may signal hypothyroidism and need evaluation
✓
Correct Answer
These findings may signal hypothyroidism and need evaluation
Hypothyroidism is more common in older adults, and its slowed metabolism, cold intolerance, constipation and memory problems are easily mistaken for aging, so a careful history and testing are needed. These findings are expected with aging and need no workup risks missing a treatable disorder. These findings point to hyperthyroidism and need evaluation is wrong because hyperthyroidism causes heat intolerance and diarrhea. These findings suggest dehydration from low fluid intake does not explain cold intolerance and slowed thinking together.
Category: Thyroid Disorders
Question 13
A patient with myxedema coma is admitted to the intensive care unit. Which assessment takes priority?
Rate and depth of respirations
✓
Condition of the skin and hair
Pattern of bowel elimination
Change in body weight since admission
Correct Answer
Rate and depth of respirations
Myxedema coma can depress breathing, so airway and breathing come first, along with monitoring for hypothermia, bradycardia and declining mental status. Condition of the skin and hair reflects hypothyroidism but is not life-threatening. Pattern of bowel elimination matters for comfort but is not an immediate threat. Change in body weight since admission is useful data but does not take priority over breathing.
Category: Thyroid Disorders
Question 14
A patient with hyperparathyroidism suddenly reports severe pain in the flank that spreads toward the groin. Which complication should the nurse suspect?
A bone fracture from muscle spasm
A kidney stone from excess calcium in the urine
✓
A gastric ulcer from excess acid
Pancreatitis from blocked bile flow
Correct Answer
A kidney stone from excess calcium in the urine
Excess parathyroid hormone pulls calcium out of bone, and the extra calcium filtered by the kidneys can form stones that cause sharp flank pain spreading to the groin. A bone fracture from muscle spasm does not match pain that radiates from the flank to the groin. A gastric ulcer from excess acid causes upper abdominal pain, not flank pain. Pancreatitis from blocked bile flow causes upper abdominal pain that radiates to the back.
Category: Parathyroid Disorders
Question 15
The evening after thyroid surgery, a patient with a low serum calcium level develops high-pitched, noisy breathing. What should the nurse do first?
Offer a calcium-rich snack such as yogurt
Teach coughing and deep-breathing exercises
Call the rapid response team for airway support
✓
Lower the head of the bed to a flat position
Correct Answer
Call the rapid response team for airway support
Severe hypocalcemia increases neuromuscular excitability and can cause laryngospasm, which threatens the airway, so the nurse summons emergency help and prepares for oxygen, suctioning or an artificial airway. Offer a calcium-rich snack such as yogurt is far too slow and unsafe with a narrowing airway. Teach coughing and deep-breathing exercises does not relieve spasm of the larynx. Lower the head of the bed to a flat position makes breathing harder for a patient in respiratory distress.
Category: Parathyroid Disorders
Question 16
A patient with diabetes insipidus becomes confused, and the nurse finds that the patient has not been able to drink. Which complication is the nurse most concerned about?
Fluid overload from water retention
Hypoglycemia from poor oral intake
Hyperkalemia from failing kidneys
Hypovolemia from continued loss of dilute urine
✓
Correct Answer
Hypovolemia from continued loss of dilute urine
In diabetes insipidus the kidneys keep losing large amounts of dilute urine, so a patient who cannot drink quickly becomes dehydrated, which can progress to hypovolemic shock. Fluid overload from water retention does not fit, because diabetes insipidus causes water loss; water retention is the problem in the syndrome of inappropriate antidiuretic hormone release, the opposite disorder. Hypoglycemia from poor oral intake is not a feature of diabetes insipidus. Hyperkalemia from failing kidneys is not the expected problem; the concern is water and sodium balance.
Category: Pituitary Disorders
Question 17
A patient with the syndrome of inappropriate antidiuretic hormone release is on an oral fluid restriction and reports a dry mouth and strong thirst. Which nursing action is appropriate?
Provide frequent mouth care and sugar-free hard candy
✓
Offer ice chips freely, since they do not count as intake
Suspend the restriction for the rest of the shift
Give an extra glass of water with each medication
Correct Answer
Provide frequent mouth care and sugar-free hard candy
Fluid restriction is a key treatment because retained water dilutes the serum sodium, and frequent mouth care with sugar-free hard candy or gum eases thirst without adding much fluid. Offer ice chips freely, since they do not count as intake is wrong because melted ice is fluid and is counted in intake. Suspend the restriction for the rest of the shift changes the treatment plan without an order and worsens the dilution. Give an extra glass of water with each medication adds the fluid the restriction is meant to limit.
Category: Pituitary Disorders
Question 18
A patient with a long smoking history is diagnosed with the syndrome of inappropriate antidiuretic hormone release. Which underlying cause should the nurse expect to be ruled out with chest imaging?
Iron deficiency
Lung cancer
✓
Kidney stones
Osteoarthritis
Correct Answer
Lung cancer
Some cancers, especially of the lung, release a substance that acts like antidiuretic hormone, so a chest x-ray or CT is done for patients with a smoking history or lung symptoms. Iron deficiency does not cause antidiuretic hormone excess. Kidney stones are not detected by chest imaging and do not cause this syndrome. Osteoarthritis is a joint disease unrelated to water balance.
Category: Pituitary Disorders
Question 19
A patient with Addison disease reports dizziness when standing up. Which explanation fits this finding?
High cortisol causes the kidneys to retain sodium
Excess thyroid hormone raises the heart rate
Low aldosterone causes the kidneys to lose sodium and water
✓
Low insulin causes the cells to lose glucose
Correct Answer
Low aldosterone causes the kidneys to lose sodium and water
Destruction of the adrenal cortex lowers aldosterone, so the kidneys lose sodium and water, blood volume falls and blood pressure drops, especially on standing. High cortisol causes the kidneys to retain sodium describes Cushing syndrome, which causes fluid retention rather than low blood pressure. Excess thyroid hormone raises the heart rate describes hyperthyroidism, not adrenal insufficiency. Low insulin causes the cells to lose glucose describes diabetes and does not explain this finding.
Category: Adrenal Disorders
Question 20
A patient with Cushing syndrome is upset about a rounded face and a fat pad between the shoulders. Which response by the nurse is accurate?
These changes are permanent once they appear
These changes are caused by overeating
These changes can be reversed only with plastic surgery
These changes often lessen as cortisol levels return to normal
✓
Correct Answer
These changes often lessen as cortisol levels return to normal
The moon face and fat pad between the shoulders come from excess cortisol redistributing body fat, and they often fade as treatment brings cortisol back to normal; listening to the patient's body image concerns is part of care. These changes are permanent once they appear gives false information and takes away hope. These changes are caused by overeating blames the patient, when the cause is the hormone excess. These changes can be reversed only with plastic surgery is wrong because treating the cause usually lets them improve.
Category: Adrenal Disorders