Question 1

Which metabolic alteration characteristic might be associated with growth hormone deficiency?

Accepted Answer

Answer reason: When growth hormone is deficient, especially in infants and young children, decreased gluconeogenesis and reduced mobilization of alternative fuels can predispose to low serum glucose. This makes episodes of fasting intolerance and low blood sugar a recognized metabolic association of growth hormone deficiency. In contrast, hyperglycemia is more consistent with excess counter-regulatory hormones or diabetes rather than growth hormone deficiency.

Question 2

Thyroid radioactive iodine uptake and scan is usually performed on clients with an established diagnosis of?

Accepted Answer

Answer reason: Radioactive iodine uptake (RAIU) and scanning evaluate thyroid function and etiology by measuring how much iodine the gland traps and how it is distributed. This test is most useful in hyperthyroid states to distinguish causes such as Graves disease (diffusely increased uptake) versus thyroiditis or exogenous thyroid hormone use (low uptake). In severe acute presentations like thyroid storm, diagnosis and treatment are clinical and emergent, so imaging/uptake testing is not typically performed at that time. In hypothyroidism or myxedema, RAIU is generally not the usual diagnostic test because thyroid function tests and antibody studies are more direct.

Question 3

The nurse cares for a client with Addison’s disease. Which should the nurse expect to observe when assessing the client?

Accepted Answer

Answer reason: Primary adrenal insufficiency causes deficient cortisol and aldosterone, leading to chronic fatigue, weight loss, anorexia, and GI complaints (e.g., nausea). Decreased cortisol reduces appetite and contributes to unintended weight loss, making an undernourished or anorexic appearance a classic assessment finding. Edema is less likely because low aldosterone promotes sodium and water loss rather than retention. Tachycardia can occur secondary to hypovolemia or hypotension but is less characteristic as a defining expected baseline finding than weight loss/anorexia.

Question 4

The nurse suspects a client of having diabetic ketoacidosis. Which blood glucose value would be observed with this condition?

Accepted Answer

Answer reason: Blood glucose is typically significantly elevated (commonly >250 mg/dL) due to increased hepatic glucose output and reduced peripheral uptake. A value of 300 mg/dl fits this expected hyperglycemic range in DKA. By contrast, 50 and 90 mg/dl represent hypoglycemia/normal glucose and would not support DKA, while 150 mg/dl is only mildly elevated and less consistent with classic DKA.

Question 5

The nurse is caring for a client with an adrenal medulla tumor. Which of the following symptoms would the nurse expect to assess?

Accepted Answer

Answer reason: This drives peripheral vasoconstriction and increased cardiac output, making elevated blood pressure a hallmark expected finding. Hyperglycemia can also occur from catecholamine-induced glycogenolysis and insulin inhibition, but it is less characteristic as the primary presenting symptom than high blood pressure. Carpopedal spasm points more toward hypocalcemia, and “moon face” is typical of cortisol excess from adrenal cortex disorders such as Cushing syndrome.

Question 6

A nurse should recognize that exophthalmos (protruding eyeballs) may occur in children with which condition?

Accepted Answer

Answer reason: This process is linked to thyroid-stimulating immunoglobulins that drive hyperthyroidism and can produce eye findings independent of hormone level severity. Hypothyroidism more typically presents with fatigue, weight gain, cold intolerance, and bradycardia rather than proptosis. Parathyroid disorders primarily affect calcium and phosphorus balance (tetany, bone changes, renal stones) and do not typically cause protruding eyeballs.

Question 7

Which chronic complications are associated with diabetes mellitus?

Accepted Answer

Answer reason: Chronic hyperglycemia causes long-term microvascular injury and nerve ischemia/demyelination, leading to classic diabetic microvascular complications. Retinal capillary damage progresses to diabetic retinopathy with risk of vision loss, while peripheral and autonomic nerve damage produces diabetic neuropathy with sensory loss and pain. Angina and exertional dyspnea can occur from accelerated atherosclerosis in diabetes, but the option is less specific and not the hallmark paired chronic complications tested together. Fatigue, nausea, and dysrhythmias are more consistent with acute metabolic derangements or electrolyte shifts rather than defining chronic diabetic complications.

Question 8

A client asks the nurse what complications can occur from diabetes mellitus. What is the best response by the nurse?

Accepted Answer

Answer reason: This option best fits the question’s broad wording about complications by capturing a common, high-impact, ongoing risk rather than an acute metabolic crisis. The other diabetes-related choices are acute, episodic emergencies that can occur but do not represent the most general complication category asked for. Multiple sclerosis is unrelated to diabetes mellitus as a typical complication.

Question 9

The nurse admits a client whose initial laboratory tests reveal hyperphosphatemia and hypocalcemia. The nurse suspects which of the following disorders?

Accepted Answer

Answer reason: This lab pattern is classic for inadequate PTH effect and aligns most directly with parathyroid failure. Cushing’s syndrome is more associated with hyperglycemia and protein catabolism rather than this calcium-phosphate signature. Thyroid disorders (Graves’ or hypothyroidism) do not typically cause the paired finding of low calcium with high phosphate in the same characteristic way.

Question 10

The nurse is evaluating the long-term success of a child’s control of type 1 DM. Which laboratory test results should the nurse monitor?

Accepted Answer

Answer reason: Hemoglobin A1c reflects mean glycemia over roughly the prior 2–3 months because glucose irreversibly binds to hemoglobin for the lifespan of red blood cells. This makes it the standard lab used to evaluate overall diabetes control and risk for chronic microvascular complications. In contrast, blood glucose and urine glucose reflect short-term or threshold-based changes and can miss sustained hyperglycemia patterns, and insulin levels do not reliably indicate adequacy of control in type 1 diabetes managed with exogenous insulin.

Question 11

The nurse is assessing the 4-year-old child diagnosed with precocious puberty. Which physical assessment findings should the nurse expect?

Accepted Answer

Answer reason: A key expected physical finding is early appearance of androgen-mediated changes such as pubic and axillary hair. Advanced bone age can occur in precocious puberty but is typically confirmed by radiographic testing rather than being a direct bedside physical finding. A hypothalamic tumor is a possible underlying cause in some cases, but it is not itself a physical assessment finding, and short stature is more a potential long-term outcome from early epiphyseal closure than an expected initial finding.

Question 12

A client comes to the clinic complaining of sensitivity to cold, weight gain, and dry skin. The nurse recognizes that the client may be suffering from?

Accepted Answer

Answer reason: These symptoms reflect a decreased metabolic rate due to insufficient thyroid hormone. Reduced thermogenesis explains cold intolerance, while slowed metabolism contributes to weight gain and generalized skin changes such as dryness. Hyperthyroidism typically causes heat intolerance, weight loss, and diaphoresis rather than dry skin. Parathyroid disorders primarily affect calcium/phosphate balance and present with neuromuscular or bone/kidney manifestations, not classic metabolic slowing.

Question 13

Treatment for Cushing’s syndrome may involve removal of one of the adrenal glands, which could cause a temporary state of which condition?

Accepted Answer

Answer reason: In Cushing’s syndrome, endogenous ACTH drive is often suppressed by prolonged hypercortisolism, so postoperative steroid production may be inadequate for a period of time. This creates a transient adrenal insufficiency risk that may require glucocorticoid replacement and monitoring for hypotension, hypoglycemia, and fatigue. Hyperkalemia can occur with mineralocorticoid deficiency, but the broader and most test-relevant temporary postoperative state is adrenal insufficiency rather than an isolated electrolyte change.

Question 14

The nurse is admitting a client who is scheduled for a thyroidectomy. The initial serum laboratory tests indicate high levels of T3 and T4. The nurse expects to see which of the following related to levels of thyroid-stimulating hormone (TSH) for this client?

Accepted Answer

Answer reason: When circulating T3 and T4 are elevated, they suppress pituitary release of TSH to reduce further thyroid hormone production. This pattern is most consistent with primary hyperthyroidism, where the thyroid is overproducing hormone and pituitary TSH becomes suppressed. A common distractor is “High,” which would be expected in primary hypothyroidism (low T3/T4) rather than in a state of excess thyroid hormone.

Question 15

A client is diagnosed with a somatotrophin-secreting tumor that could lead to development of acromegaly, Cushing’s syndrome, and hypopituitarism. Which gland is related to this tumor?

Accepted Answer

Answer reason: Excess GH after epiphyseal closure causes acromegaly, matching the clinical consequence described. Pituitary adenomas can also compress normal pituitary tissue, leading to hypopituitarism. Additionally, pituitary tumors can alter ACTH secretion (or mass effect on pituitary regulation), which can contribute to a Cushingoid picture, making this gland the most directly related site.

Question 16

The nurse is caring for a client who is diagnosed with an unilateral pheochromocytoma and is scheduled for surgery to remove the left adrenal gland. The nurse is aware that the main manifestation of this disease process is which of the following?

Accepted Answer

Answer reason: The dominant clinical manifestation is elevated blood pressure due to intense alpha-adrenergic vasoconstriction, often accompanied by headaches, palpitations, and diaphoresis. Renal failure and heart failure can occur as complications of long-standing severe hypertension, but they are not the primary presenting manifestation. Hyponatremia is more characteristic of disorders like SIADH or adrenal insufficiency rather than catecholamine excess.

Question 17

The nurse is preparing to care for the stable client with Addison’s disease. Which skin appearance should the nurse expect when performing an assessment?

Accepted Answer

Answer reason: ACTH is derived from POMC, which also increases melanocyte-stimulating activity, leading to diffuse hyperpigmentation that can look “bronzed,” especially in skin creases, scars, and mucous membranes. This finding is characteristic of Addison’s disease and helps distinguish it from secondary adrenal insufficiency, where hyperpigmentation is typically absent. Other listed appearances point to different conditions (e.g., malar rash for lupus) rather than chronic adrenal insufficiency.

Question 18

The clinic nurse is reviewing the history of the client diagnosed with bacterial vaginosis (BV). Which identified disorder places the client at a higher risk of developing BV?

Accepted Answer

Answer reason: Diabetes is associated with higher rates of vaginitis and dysbiosis, making BV more likely compared with unrelated chronic conditions. In contrast, gastroesophageal reflux and cardiovascular disease do not directly change the vaginal environment or host defenses in a way that increases BV risk. Hypothyroidism also lacks a strong, direct link to BV development compared with the infection-prone state seen in diabetes.

Question 19

When reviewing the results of radiographic examinations of a child with hypopituitarism, which characteristic should the nurse expect to observe?

Accepted Answer

Answer reason: On radiographs this presents as a markedly delayed skeletal (bone) age compared with chronological age. Because overall skeletal development is broadly slowed, the retardation is typically more than just a subtle delay in epiphyseal changes. Options describing normal bone age or normal epiphyseal maturation contradict the expected effects of inadequate pituitary growth hormone on skeletal development.

Question 20

Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) can be differentiated from diabetic ketoacidosis (DK) by which physiologic finding?

Accepted Answer

Answer reason: HHNS typically has enough circulating insulin to prevent lipolysis and ketone production, so significant ketosis and metabolic acidosis are minimal or absent. In contrast, DKA features insulin deficiency leading to fat breakdown, ketone accumulation, and anion-gap metabolic acidosis. While both conditions can present with marked hyperglycemia and dehydration, that overlap makes hyperglycemia a poor differentiator. Increased serum osmolarity is prominent in HHNS but can also be elevated in severe DKA, so the clearest distinguishing physiologic finding is the lack of ketosis.

Question 21

A client presents with flushed skin, exophthalmos, and perspiration and states that he has been “irritable” and having palpitations. The nurse interprets these symptoms as indicating which disorder?

Accepted Answer

Answer reason: Palpitations, irritability, heat intolerance with sweating, and flushed warm skin are classic hyperthyroid manifestations. Exophthalmos is especially associated with Graves disease due to autoimmune inflammation and tissue expansion behind the eyes. Hypothyroidism would more typically cause cold intolerance, bradycardia, and weight gain, while hyperparathyroidism primarily presents with hypercalcemia-related bone, kidney, and GI symptoms rather than eye and sympathetic signs.

Question 22

The nurse is teaching a client with hypothyroidism about the thyroid gland. Which of the following statements by the nurse would be the most accurate about which gland controls the secretion of thyroid hormone?

Accepted Answer

Answer reason: The anterior pituitary releases TSH, which directly stimulates the thyroid gland to synthesize and secrete T3 and T4; therefore the controlling gland in this feedback loop is the pituitary. When circulating T3/T4 levels fall (as in hypothyroidism), pituitary TSH typically rises to drive more hormone production (unless there is central hypothyroidism). The parathyroids regulate calcium via PTH and the adrenal gland regulates corticosteroids/catecholamines, so they do not control thyroid hormone secretion.

Question 23

The nurse is caring for a client who is diagnosed with hyperparathyroidism. The client asks what conditions may contribute to the development of hyperparathyroidism. What is the most appropriate response by the nurse?

Accepted Answer

Answer reason: This persistent stimulation causes parathyroid hyperplasia and elevated PTH levels over time. In contrast, an elevated serum calcium level typically suppresses PTH via negative feedback, so it is more a consequence of primary hyperparathyroidism than a cause. Thyroidectomy is more associated with hypoparathyroidism if parathyroid tissue is damaged or removed, and chronic steroid use more commonly contributes to bone loss rather than directly causing hyperparathyroidism.

Question 24

The 10-year-old child is undergoing testing to diagnose possible Cushing’s syndrome. The nurse should plan to prepare the child and parents for which initial tests?

Accepted Answer

Answer reason: Late-night salivary cortisol and 24-hour urinary free cortisol reflect loss of normal circadian rhythm and increased cortisol burden, making them appropriate initial evaluations in suspected Cushing’s syndrome. The dexamethasone suppression test is also used, but it is typically part of confirmatory/etiologic evaluation after initial evidence of cortisol excess is obtained. GTT targets diabetes evaluation rather than diagnosing Cushing’s, and 17-hydroxyprogesterone is used to assess congenital adrenal hyperplasia, a different adrenal disorder.

Question 25

Which method is considered the definitive treatment for hypopituitarism due to growth hormone deficiency?

Accepted Answer

Answer reason: Recombinant (biosynthetic) human growth hormone directly addresses the underlying pituitary hormone deficit and is the standard therapy in pediatric hypopituitarism when GH is deficient. Desmopressin or ADH replacement is used for central diabetes insipidus, not isolated GH deficiency. Sex steroid therapy is reserved for pubertal induction/hypogonadism and does not correct impaired linear growth from GH deficiency.

Question 26

A client recently diagnosed with prediabetes asks the nurse about the risk factors for developing diabetes mellitus. The nurse is aware that the client’s greatest risk factor is which of the following?

Accepted Answer

Answer reason: Among the listed choices, obesity is the strongest and most modifiable predictor of developing diabetes. Japanese descent can increase risk, but it is not typically a larger independent risk than obesity in a person with prediabetes. A remote family history (great-grandparent) and history of delivering a macrosomic infant are risk factors, but they generally confer less overall risk than current obesity.

Question 27

The nurse is caring for a client with newly diagnosed Cushing’s disease. Which of the following signs and/or symptoms would the nurse expect to find on initial assessment?

Accepted Answer

Answer reason: Central (truncal) obesity is classic from cortisol-driven adipose redistribution, while petechiae (and easy bruising) occur due to protein catabolism leading to thin skin and fragile capillaries. Options featuring hypotension or weight loss conflict with cortisol’s typical effects, which include volume expansion and weight gain. Emaciation is more consistent with cortisol deficiency or other wasting states rather than hypercortisolism.

Question 28

A client exhibiting exophthalmos, weight loss, and tachycardia would be evaluated by checking the levels of which hormones?

Accepted Answer

Answer reason: The appropriate evaluation is thyroid function testing to quantify circulating thyroid hormones and the pituitary response. In hyperthyroidism, T3 and/or T4 are elevated, and TSH is typically suppressed from negative feedback (unless rare central causes). The other options reflect pancreatic enzymes, adrenal cortex hormones, or posterior pituitary hormones and do not explain the described constellation of findings.

Question 29

The nurse is caring for a client who is admitted with untreated hypothyroidism. Which of the following laboratory serum values will the nurse expect to see?

Accepted Answer

Answer reason: Reduced circulating thyroid hormone removes negative feedback inhibition on the pituitary and hypothalamus, so TSH increases in an attempt to stimulate the thyroid. This pattern (low T3/T4 with high TSH) is the classic untreated primary hypothyroidism lab profile. By contrast, low TSH with low T3/T4 would suggest central (pituitary/hypothalamic) hypothyroidism rather than the typical untreated presentation.

Question 30

The nurse is assessing a postmenopausal woman for evidence of heart disease- Which factor contributes to the client’s increased risk for heart disease after menopause?

Accepted Answer

Answer reason: This mechanism directly explains why heart disease risk rises after menopause. Progesterone does not rise postmenopause and is not the main driver of increased cardiovascular risk in this setting. While diet and physical activity influence cardiovascular risk, they are not the core physiologic menopause-related factor being tested here.

Question 31

A client is admitted with an adrenal malfunction. The nurse demonstrates an understanding of the function of the adrenal gland by identifying which hormones as being released by the adrenal medulla?

Accepted Answer

Answer reason: It primarily releases epinephrine and norepinephrine into the bloodstream to increase heart rate, blood pressure, bronchodilation, and glucose availability. In contrast, glucocorticoids, mineralocorticoids, and androgens are produced by the adrenal cortex (zona fasciculata, glomerulosa, and reticularis). The other options describe hormones produced by the thyroid gland and pancreatic islet cells, not the adrenal gland.

Question 32

The nurse admits a client with a diagnosis of chronic adrenal insufficiency. The nurse is aware that adrenal insufficiency develops secondary to inadequate secretion of which pituitary hormone?

Accepted Answer

Answer reason: The anterior pituitary hormone that directly drives cortisol synthesis in the adrenal cortex is ACTH. When ACTH is deficient (e.g., pituitary disease or suppression after exogenous steroids), the adrenal glands underproduce glucocorticoids and may atrophy over time. ADH primarily regulates water balance, TSH targets the thyroid, and FSH regulates gonadal function, so they do not directly cause adrenal cortical hypofunction.

Question 33

The nurse is admitting a client who is suspected of having adrenal insufficiency, or Addison’s disease. An initial serum chemistry test is done. The nurse expects to see which of the following abnormalities?

Accepted Answer

Answer reason: Low aldosterone reduces renal sodium reabsorption and impairs potassium and hydrogen excretion, producing hyponatremia with hyperkalemia and often volume depletion. Cortisol deficiency can also contribute to low serum sodium via increased ADH and reduced free-water clearance. Options featuring hypernatremia/hypokalemia align more with excess mineralocorticoid effect, and hyperglycemia is less consistent because cortisol deficiency tends to lower glucose.

Question 34

The nurse is caring for a 47-year-old client admitted with joint pain and weakness. The client describes a gradual coarsening of facial features and enlargement of hands and feet over the past year. The nurse is aware that these are early clinical manifestations of which condition?

Accepted Answer

Answer reason: This leads to enlarged hands and feet, coarsened facial features, and musculoskeletal complaints such as joint pain and weakness from tissue overgrowth and arthropathy. Cushing’s syndrome is characterized by hypercortisolism findings (central obesity, striae, proximal muscle wasting) rather than acral enlargement and facial coarsening. Graves’ disease produces hyperthyroid symptoms and ophthalmopathy, and pheochromocytoma presents with episodic headaches, diaphoresis, and hypertension, not gradual somatic enlargement.

Question 35

A 37-year-old client complains of muscle weakness, anorexia, and darkening of his skin. The nurse reviews his laboratory data and notes findings of low serum sodium and high serum potassium levels. The nurse recognizes that these signs and symptoms are associated with which condition?

Accepted Answer

Answer reason: Aldosterone deficiency leads to renal sodium wasting (hyponatremia) and impaired potassium excretion (hyperkalemia), producing weakness and anorexia. Elevated ACTH occurs due to loss of negative feedback and increases melanocyte stimulation, explaining skin hyperpigmentation. In contrast, Cushing’s syndrome typically produces hypernatremia and hypokalemia from excess corticosteroid/mineralocorticoid effects, not the electrolyte pattern shown.

Question 36

The nurse is caring for a client who is diagnosed with Addison’s disease. While completing the initial assessment and reviewing serum laboratory test results, the nurse expects to find which of the following signs and symptoms?

Accepted Answer

Answer reason: Cortisol deficiency contributes to fatigue, while aldosterone deficiency can cause dehydration and electrolyte disturbances that worsen muscle weakness. By contrast, Addison’s classically presents with hypotension and hyponatremia (and often hyperkalemia), not hypertension and hypernatremia. It also tends toward weight loss and hyperpigmentation rather than weight gain and loss of skin pigment.

Question 37

The nurse is admitting a client who is diagnosed with untreated Cushing's syndrome. While performing the initial assessment, the nurse can expect to see which of the following signs and symptoms?

Accepted Answer

Answer reason: This produces centripetal (truncal) weight gain with facial rounding (“moon face”) and often a dorsocervical fat pad. Weight loss with heat intolerance is more consistent with hyperthyroidism, not Cushing’s. Polyuria can occur if steroid-induced hyperglycemia develops, but it is not as defining for initial recognition as the classic body habitus changes.

Question 38

The nurse is providing health maintenance education to a group of clients. As the nurse talks about thyroid disorders, one of the clients asks about risk factors for Graves’ disease. Which of the following would be most at risk for developing this disease?

Accepted Answer

Answer reason: The risk is highest in women roughly 20–40 years old, making this choice the best match to the classic epidemiology. Male sex is a relative protective factor compared with female sex, so both male options are less likely. While Graves’ can occur in adolescents, it is less common than in reproductive-age adults, so the teenage female is a weaker fit than the 30-year-old female.

Question 39

The nurse is providing education about the thyroid gland and aging to a group of nursing students. Which of the following would be appropriate to include in this discussion?

Accepted Answer

Answer reason: Aging is associated with a general decline in metabolic activity and lean body mass, leading to a lower basal metabolic rate even when thyroid function tests are normal. This statement accurately reflects a common physiologic change seen in older adults and helps explain age-related tendencies toward cold intolerance, weight gain, and reduced energy expenditure. In contrast, thyroid hormone secretion does not typically increase with age, and the thyroid gland more often shows atrophy/fibrosis rather than enlargement. Replacement therapy dosing in older adults is usually started lower and titrated cautiously due to cardiac sensitivity, not routinely increased.

Question 40

An unemployed client with no health insurance hasn’t filled his prescriptions for some time. According to his roommate, the client has been “getting sicker by the day.” Which problem suggests the client isn’t taking his prescribed levothyroxine (Synthroid)?

Accepted Answer

Answer reason: Temperature of 94° F (34.4° C) Untreated hypothyroidism lowers basal metabolic rate and heat production, so hypothermia and cold intolerance are hallmark findings when thyroid hormone replacement is missed. A low core temperature fits progressive thyroid hormone deficiency and can precede severe decompensation (myxedema coma). In contrast, rapid heart rate, warm flushed skin, and GI hypermotility symptoms are more consistent with excess thyroid hormone (hyperthyroidism) rather than lack of levothyroxine. Therefore, the low temperature most strongly indicates the client is not taking prescribed replacement therapy.

Question 41

A nonpregnant client tells the nurse that two recent fasting blood glucose results were 132 mg/dl and 146 mg/dl. The nurse should expect which of the following actions to occur?

Accepted Answer

Answer reason: Diabetes mellitus can be diagnosed with fasting plasma glucose values ≥ 126 mg/dL on two separate occasions in a nonpregnant adult. Both reported fasting results exceed this threshold, so the pattern is consistent with diabetes rather than normal or isolated impaired fasting glucose. The appropriate next step is confirmation/medical evaluation and initiation of diabetes care planning rather than dismissing the findings. While an HbA1c can be used as an additional diagnostic/monitoring test, the key expected action is follow-up for diabetes based on the already diagnostic fasting values.

Question 42

The nurse is teaching the parents of a neonate newly diagnosed with hypothyroidism about the condition. What is the most important information for the nurse to provide?

Accepted Answer

Answer reason:  Congenital hypothyroidism most commonly results from thyroid dysgenesis (absent, ectopic, or hypoplastic gland) or dyshormonogenesis, and the degree of hormone deficiency generally tracks with how much functional thyroid tissue exists. This is key teaching because it explains why some infants have profound hypothyroidism while others have milder disease that may be detected only by newborn screening. A large neonatal goiter can be clinically significant (e.g., airway compromise) and is not automatically benign. Also, neonates often have few or subtle early findings, so relying on “obvious signs” is unsafe and underscores the importance of screening and timely treatment.

Question 43

The nurse is obtaining the health history of a child with diabetes insipidus. The nurse expects the history to include which findings?

Accepted Answer

Answer reason: This results in large volumes of dilute urine with compensatory excessive thirst, and nighttime urination is common due to persistent high urine output. The presentation can appear relatively sudden to caregivers when the child begins voiding frequently and drinking constantly. A common distractor is diabetes mellitus, which can cause blurred vision and lethargy, but DI is defined by water balance symptoms rather than hyperglycemia-related findings.

Question 44

The nurse is admitting a client who is diagnosed with a new onset of type 1 diabetes mellitus. While performing the initial physical assessment and nursing history, the nurse expects to find which of the following signs/symptoms?

Accepted Answer

Answer reason: Glucose spilling into the urine pulls water with it, causing frequent urination and dehydration that triggers excessive thirst. Because cells cannot effectively use glucose without insulin, the body breaks down fat and muscle for energy, producing unintended weight loss. A common distractor is adrenergic symptoms like diaphoresis and tachycardia, which more strongly suggest hypoglycemia rather than new-onset untreated hyperglycemia.

Question 45

The 10-year-old child with a 6-year history of type 1 DM has been seen in a clinic for enuresis over the past 2 weeks. Which conclusion by the nurse regarding the likely cause of the enuresis is correct?

Accepted Answer

Answer reason: In a child with type 1 diabetes, new enuresis over 2 weeks is most consistent with inadequate glycemic control producing excessive urine output during sleep. Hypoglycemia does not produce osmotic diuresis and is more associated with adrenergic/neuroglycopenic symptoms. SIADH causes water retention and concentrated urine rather than increased urine volume, making it an unlikely cause of bedwetting here.

Question 46

A child has been brought to a pediatrician’s office for concerns about growth. The physician suspects hypopituitarism. The mother asks the nurse which test will be done to determine the diagnosis. Which response by the nurse would be appropriate?

Accepted Answer

Answer reason: Diagnostic evaluation commonly uses stimulation testing to assess pituitary growth hormone reserve because random levels are pulsatile and unreliable. A reduced response/low reserve on stimulation supports the diagnosis of growth hormone deficiency from pituitary dysfunction. Thyroid hormone excess would suggest hyperthyroidism rather than pituitary failure, and ADH deficiency is a posterior pituitary problem that presents primarily as diabetes insipidus rather than growth delay.

Question 47

A 40-year-old client is curious about visible appearance changes related to menopause. In general, menopausal clients experience?

Accepted Answer

Answer reason: Declining estrogen during the menopausal transition contributes to unfavorable body composition changes, including decreased lean muscle mass and a relative increase in adiposity. Clinically this often appears as weight redistribution and central fat accumulation, making it a “visible appearance” change. Improved skin turgor is inconsistent with menopause, as estrogen loss tends to reduce collagen and skin elasticity. Bone loss can occur, but fractures are not a typical early visible appearance change compared with shifts in muscle and fat.

Question 48

The nurse is caring for a middle-aged athletic client with hyperparathyroidism. The client has been further diagnosed with kidney stones. The client is currently showing signs of apathy and depression, and despite the client’s athleticism, the nurse’s assessment finds flabby musculature. Based on the diagnosis and signs and symptoms, the nurse suspects which of the following conditions?

Accepted Answer

Answer reason: Elevated calcium commonly causes renal calculi from hypercalciuria and is classically associated with neuropsychiatric changes such as lethargy, apathy, and depression. Proximal muscle weakness with decreased muscle tone can present as “flabby” musculature, fitting the neuromuscular effects of high calcium. In contrast, hypocalcemia more typically produces neuromuscular excitability (tetany, paresthesias, Chvostek/Trousseau) rather than stones and depressive/apathic features.

Question 49

The parents of a child who’s going through testing for hypopituitarism ask the nurse what type of test results they should expect. The nurse’s response should be based on which factor?

Accepted Answer

Answer reason: Growth hormone secretion is pulsatile and strongly linked to slow-wave sleep, so random daytime levels can be misleading when evaluating suspected deficiency. The most reliable physiologic rises occur shortly after sleep onset, which explains why testing strategies may incorporate overnight sampling or stimulation paradigms rather than a single baseline value. Strenuous exercise typically increases, not decreases, growth hormone secretion, making that distractor physiologically incorrect. Overnight urinary growth hormone is not expected to be increased in hypopituitarism and is not a core rationale for interpreting results compared with sleep-related pulsatility.

Question 50

A client newly diagnosed with diabetic ketoacidosis has a serum glucose level of 485 mg/dl. After treatment, the serum glucose level drops to 185 mg/dl, and the cardiac monitor starts to show ventricular ectopic beats. Which factor is the most probable cause factor in arrhythmia?

Accepted Answer

Answer reason: Hypokalemia increases myocardial irritability and is a classic precipitant of ventricular ectopy and more dangerous ventricular dysrhythmias. A rapid glucose drop itself does not directly cause ventricular ectopic beats in the way potassium shifts do. Chloride and sodium abnormalities are less directly arrhythmogenic than low potassium in this clinical context.

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