Ch 54 Final exam 100 practice questions

Diabetes Insipidus (DI) is a disorder primarily characterized by a deficiency of which hormone or the kidney's resistance to it? A. Insulin B. Aldosterone C. Antidiuretic Hormone (ADH) D. Thyroid-stimulating hormone (TSH)

C

What are the two main clinical manifestations of Diabetes Insipidus due to the kidney's inability to concentrate urine? A. Hyperglycemia and polyphagia B. Polyuria and polydipsia C. Hypokalemia and hypotension D. Weight gain and fatigue

B

Which type of Diabetes Insipidus results from damage to the hypothalamus or posterior pituitary, leading to decreased ADH production or release? A. Nephrogenic DI B. Primary (Psychogenic) DI C. Central (Neurogenic) DI D. Iatrogenic DI

C

In which type of Diabetes Insipidus do the renal tubules not respond to ADH? A. Central DI B. Nephrogenic DI C. Primary DI D. Secondary DI

B

Excessive water intake, often associated with psychiatric disorders, can lead to which type of Diabetes Insipidus? A. Central DI B. Nephrogenic DI C. Primary (Psychogenic) DI D. Drug-induced DI

C

Which of the following is a common etiology or risk factor for Diabetes Insipidus? A. Type 2 Diabetes Mellitus B. Head injury or trauma C. Hyperthyroidism D. Adrenal insufficiency

B

Nephrotoxic drugs, such as lithium, are a known cause of which type of Diabetes Insipidus? A. Central DI B. Nephrogenic DI C. Primary DI D. Psychogenic DI

B

Neurosurgery, particularly transsphenoidal hypophysectomy, is a recognized risk factor for developing which type of DI? A. Primary DI B. Nephrogenic DI C. Central DI D. Drug-induced DI

C

The deficiency of or resistance to ADH in Diabetes Insipidus directly leads to what physiological change in the renal tubules? A. Increased water reabsorption B. Decreased water reabsorption C. Increased sodium reabsorption D. Decreased potassium excretion

B

What is the primary consequence of decreased water reabsorption in the renal tubules in a patient with Diabetes Insipidus? A. Decreased urine output B. Increased urine output C. Hypoglycemia D. Hyponatremia

B

A patient with Diabetes Insipidus would typically exhibit polyuria with an output range of: A. 0.5 – 1 liter/day B. 2 – 20 liters/day C. 20 – 40 liters/day D. Less than 400 mL/day

B

What characteristic finding would be expected in the urine specific gravity of a patient with Diabetes Insipidus? A. High urine specific gravity (> 1.025) B. Normal urine specific gravity (1.005-1.025) C. Low urine specific gravity (< 1.005) D. Highly variable urine specific gravity

C

A patient with DI is likely to have which of the following serum laboratory values? A. Low serum osmolality B. Low serum sodium C. High serum osmolality (> 295 mOsm/kg) D. Normal serum osmolality

C

Which electrolyte imbalance is characteristic of Diabetes Insipidus, often seen as a serum sodium level greater than 145 mEq/L? A. Hypokalemia B. Hypernatremia C. Hypocalcemia D. Hyperglycemia

B

Besides polyuria and polydipsia, what are common signs of dehydration that may be observed in a patient with DI? A. Bradycardia and moist mucous membranes B. Hypertension and fluid overload C. Dry mucous membranes, hypotension, and tachycardia D. Edema and weight gain

C

Which diagnostic test determines if kidneys can concentrate urine in response to dehydration and is positive in DI if dilute urine output continues despite fluid restriction? A. Desmopressin (DDAVP) Challenge Test B. Serum and Urine Labs C. Water Deprivation Test D. CT Scan of the pituitary gland

C

A patient undergoing a Desmopressin (DDAVP) Challenge Test shows decreased urine output and increased specific gravity. This result is indicative of which type of DI? A. Nephrogenic DI B. Primary DI C. Central DI D. Psychogenic DI

C

In a patient with suspected DI, serum and urine laboratory results would typically show: A. Decreased serum sodium and increased urine osmolality B. Increased serum sodium and decreased urine osmolality C. Normal serum sodium and normal urine osmolality D. Decreased serum osmolality and increased urine specific gravity

B

What is the primary medication used to manage Central (Neurogenic) DI? A. Thiazide diuretics B. Desmopressin (DDAVP) C. NSAIDs D. Lithium

B

In managing Central DI, what is an essential nursing intervention regarding fluid balance? A. Fluid restriction to prevent overhydration B. Administration of IV fluids for hydration C. Encouraging a low-sodium diet D. Monitoring for signs of water intoxication only

B

Which class of diuretics, surprisingly, helps to paradoxically decrease polyuria in Nephrogenic DI? A. Loop diuretics B. Potassium-sparing diuretics C. Osmotic diuretics D. Thiazide diuretics

D

Besides thiazide diuretics, what dietary recommendation is made for patients with Nephrogenic DI? A. High-protein diet B. Low-sodium diet C. High-carbohydrate diet D. Fluid restriction

B

What is a key component of management for Primary (Psychogenic) DI? A. Lifelong ADH replacement B. Thiazide diuretics C. Behavioral therapy and fluid restriction D. Surgical intervention

C

A crucial nursing intervention for a patient with DI is monitoring vital signs, especially watching for which changes? A. Hypertension and bradycardia B. Hypotension and tachycardia C. Normal blood pressure and heart rate D. Fluctuating blood pressure and stable heart rate

B

When educating a patient with Central DI about Desmopressin (DDAVP), what signs should they be taught to report, indicating potential overdose or water intoxication? A. Increased urine output and thirst B. Headache, confusion, and drowsiness C. Dry mucous membranes and hypotension D. Hypernatremia and high serum osmolality

B

What is a major complication of uncontrolled Diabetes Insipidus? A. Hypoglycemia B. Hyponatremia C. Dehydration D. Hypokalemia

C

In central DI, what serious complication can occur if Desmopressin (DDAVP) is overused? A. Hypovolemic shock B. Hypernatremia C. Water intoxication D. Renal failure

C

Addison's disease is characterized as primary adrenal insufficiency, involving a reduction in which hormones? A. Estrogen and progesterone B. Glucocorticoids, mineralocorticoids, and androgens C. Insulin and glucagon D. Thyroid hormones (T3, T4)

B

How does primary adrenal insufficiency (Addison's) differ from secondary adrenal insufficiency? A. Primary is caused by pituitary ACTH deficiency; secondary by adrenal destruction. B. Primary involves all three adrenal hormones; secondary primarily lacks glucocorticoids and androgens due to pituitary ACTH deficiency. C. Secondary adrenal insufficiency involves mineralocorticoid deficiency, unlike primary. D. Secondary adrenal insufficiency causes hyperpigmentation, unlike primary.

B

What accounts for 80% of Addison's disease cases, where antibodies destroy the adrenal cortex? A. Tuberculosis B. Fungal infections C. Autoimmune response (autoimmune adrenalitis) D. Adrenal hemorrhage

C

Addison's disease may co-occur with other endocrine conditions like Type 1 diabetes and autoimmune thyroid disease in a syndrome known as: A. Cushing Syndrome B. Autoimmune polyglandular syndrome C. Metabolic Syndrome D. Adrenal crisis

B

Iatrogenic Addison's disease can result from which of the following? A. Excessive cortisol intake B. Bilateral adrenalectomy C. Pituitary tumor D. Kidney failure

B

Which of the following is a common initial clinical manifestation of Addison's disease? A. Sudden weight gain and moon facies B. Hyperpigmentation over joints and on palms C. Hyperglycemia and polyuria D. Severe hypertension

B

A patient with Addison's disease might report which of the following symptoms related to electrolyte imbalance? A. Salt craving B. Palpitations C. Frequent urination D. Excessive thirst

A

What general symptoms often have an insidious onset in Addison's disease? A. Rapid weight gain, edema, and headache B. Anorexia, nausea, progressive weakness, fatigue, and weight loss C. Sudden severe abdominal pain and fever D. Increased appetite and energy

B

What is an Addisonian crisis? A. A chronic, mild form of adrenal insufficiency. B. An acute adrenal insufficiency, which is a life-threatening emergency. C. A condition caused by excessive hormone replacement. D. A state of hyperglycemia due to stress.

B

Which of the following can trigger an Addisonian crisis? A. Adequate fluid intake B. Gradual withdrawal of corticosteroids C. Stressors such as infections or surgery D. Increased dietary salt

C

Manifestations of glucocorticoid and mineralocorticoid deficiencies during an Addisonian crisis include: A. Hypertension and bradycardia B. Hypernatremia and hypokalemia C. Hypotension, tachycardia, and dehydration D. Hyperglycemia and weight gain

C

Electrolyte imbalances characteristic of an Addisonian crisis include: A. Increased sodium, decreased potassium, increased glucose B. Decreased sodium, increased potassium, increased glucose C. Decreased sodium, increased potassium, decreased glucose D. Increased sodium, decreased potassium, increased glucose

C

What is the primary diagnostic test for Addison's disease where baseline cortisol and ACTH levels are taken, followed by synthetic ACTH injection? A. CRH stimulation test B. Dexamethasone suppression test C. ACTH stimulation test D. Water deprivation test

C

In an ACTH stimulation test, what result indicates Addison's disease? A. A significant increase in cortisol levels. B. Little or no increase in cortisol levels. C. Decreased ACTH levels. D. Normal cortisol and ACTH levels.

B

The CRH stimulation test is used if the ACTH test response is abnormal. In Addison's disease, what would the results typically show? A. Low ACTH levels with high cortisol. B. High ACTH levels with no cortisol. C. Normal ACTH levels with normal cortisol. D. Decreased ACTH and cortisol levels.

B

Which laboratory values are typically found in a patient with Addison's disease? A. Low potassium, high sodium, high glucose B. High potassium, low chloride, low sodium, low glucose C. Normal potassium, normal sodium, normal glucose D. High calcium, low BUN, low hemoglobin

B

Lifelong hormone therapy for Addison's disease typically includes: A. Insulin and glucagon B. Levothyroxine and desmopressin C. Hydrocortisone and fludrocortisone D. Estrogen and testosterone

C

What dietary recommendation is often made for patients with Addison's disease? A. Low-sodium diet B. High-carbohydrate diet C. Increase dietary salt intake D. Restrict potassium intake

C

How is an Addisonian crisis typically treated? A. Oral corticosteroids and fluid restriction B. Shock management, high-dose hydrocortisone replacement, and IV saline/dextrose solution C. Antidiuretic hormone and potassium-sparing diuretics D. Antibiotics and NSAIDs

B

In acute care for a patient with Addison's disease, frequent monitoring should include: A. Daily weights and temperature only B. Vital signs and neurological status C. Glucose and sodium levels every 8 hours D. Serum potassium and chloride levels every 12 hours

B

What should patients with Addison's disease be taught to carry at all times? A. A list of all their medications B. A sugary snack for hypoglycemia C. Identification and a medical ID bracelet D. A blood pressure cuff

C

A patient with Addison's disease should be taught to adjust their corticosteroid dosage during which times? A. When traveling B. During periods of stress C. After a large meal D. Before bedtime

B

What type of kit should a patient with Addison's disease have for emergencies? A. A kit for measuring blood glucose B. A kit for administering IM hydrocortisone C. A kit for fluid resuscitation D. A kit for electrolyte monitoring

B

Cushing Syndrome is caused by an excess of which hormones? A. Estrogen B. Corticosteroids C. Thyroid hormones D. Antidiuretic hormone (ADH)

B

What is the most common cause of Cushing Syndrome in a clinical setting, often observed in case studies like M.R.? A. Adrenal tumors B. ACTH-secreting pituitary adenoma C. Iatrogenic administration of exogenous corticosteroids D. Ectopic ACTH production by tumors

C

When Cushing Syndrome is caused by an ACTH-secreting pituitary adenoma, it is specifically referred to as: A. Addison's Disease B. Conn's Syndrome C. Cushing Disease D. Graves' Disease

C

Which of the following is a classic clinical manifestation of excess glucocorticoids in Cushing Syndrome? A. Hypoglycemia B. Weight loss C. Truncal obesity, supraclavicular fat pads, and moon facies D. Dry, thin skin

C

Due to the loss of bone matrix from excess glucocorticoids, patients with Cushing Syndrome are at risk for: A. Osteoporosis and back pain B. Bone density increase C. Joint fusion D. Muscle hypertrophy

A

What skin changes are often observed in Cushing Syndrome due to loss of collagen? A. Thick, firm skin B. Hyperpigmentation C. Thin skin, easily bruises D. Excessive sweating (diaphoresis)

C

Which of the following is a direct result of increased gluconeogenesis in Cushing Syndrome? A. Hypoglycemia B. Hyperglycemia C. Decreased insulin sensitivity D. Increased protein synthesis

B

What electrolyte imbalance is characteristic of mineralocorticoid excess in Cushing Syndrome? A. Hyperkalemia B. Hyponatremia C. Hypokalemia D. Hypercalcemia

C

Mineralocorticoid excess in Cushing Syndrome also commonly leads to which cardiovascular issue? A. Hypotension B. Tachycardia C. Hypertension D. Bradycardia

C

What manifestation is seen in women due to adrenal androgen excess in Cushing Syndrome? A. Severe acne and hirsutism B. Decreased libido C. Alopecia D. Breast enlargement

A

Which diagnostic test is used to confirm increased plasma cortisol levels, with levels greater than 100 mcg/24 hr indicating Cushing Syndrome? A. ACTH stimulation test B. 24-hour urine cortisol C. Serum aldosterone levels D. Fasting plasma glucose

B

When diagnosing Cushing Syndrome, what plasma ACTH level would be expected in a patient with a pituitary etiology (Cushing Disease)? A. Low or undetectable B. High or normal C. Absent D. Significantly fluctuating

B

Besides electrolyte imbalances, what other laboratory finding may be present in Cushing Syndrome due to mineralocorticoid excess? A. Metabolic acidosis B. Respiratory alkalosis C. Metabolic alkalosis D. Respiratory acidosis

C

For Cushing Syndrome caused by an ACTH-secreting pituitary adenoma, what is a primary treatment option? A. Medical management with antidiuretic hormone B. Surgical removal or irradiation of the pituitary adenoma C. Lifelong corticosteroid replacement D. Chemotherapy as first-line treatment

B

If Cushing Syndrome is caused by exogenous corticosteroid therapy, what is the recommended management approach? A. Abruptly discontinue the therapy. B. Increase the dose of corticosteroids. C. Gradually discontinue therapy, decrease the dose, or convert to an alternate-day dosing. D. Switch to a high-protein, low-carbohydrate diet.

C

What is a major risk factor for Cushing Syndrome that nurses should identify in health promotion? A. Long-term exogenous cortisol therapy B. High-sugar diet C. Genetic predisposition D. Exposure to environmental toxins

A

In acute care for Cushing Syndrome, monitoring for which complications is essential? A. Hypoglycemia and hypokalemia B. Inflammation/infection and VTE (venous thromboembolism) C. Hyponatremia and fluid deficit D. Bradycardia and hypotension

B

Before an adrenalectomy for Cushing Syndrome, what interventions are crucial to optimize the patient's physical condition? A. Restrict fluids and encourage low-protein diet. B. Control hypertension and hyperglycemia, correct hypokalemia, and provide a high-protein diet. C. Administer high-dose corticosteroids continuously. D. Initiate strict bed rest and avoid all physical activity.

B

Following an adrenalectomy, what is a significant risk that nurses must monitor for? A. Hypernatremia B. Increased risk of bleeding C. Hyperglycemia D. Fluid overload

B

What is a key sign of acute adrenal insufficiency to monitor for after an adrenalectomy? A. Weight gain, edema, and hyperglycemia B. Vomiting, weakness, dehydration, and hypotension C. Decreased urine output and increased serum sodium D. Normal vital signs and increased energy

B

What important instruction should be given to a patient discharged after treatment for Cushing Syndrome regarding identification? A. Carry a list of their allergies. B. Wear a Medic Alert bracelet. C. Keep a daily log of their food intake. D. Carry an emergency supply of antibiotics.

B

For a patient with Cushing Syndrome, emotional support is important. What reassurance can the nurse give regarding physical and emotional changes? A. They are permanent and irreversible. B. They will resolve with hormone normalization. C. They are not related to the disease. D. They can be managed with psychotherapy alone.

B

Hyperthyroidism is defined as a sustained increase in the synthesis and release of which hormones by the thyroid gland? A. Adrenaline and noradrenaline B. Cortisol and aldosterone C. Thyroid hormones (T3 and T4) D. Antidiuretic hormone

C

What is the most common form of hyperthyroidism? A. Toxic nodular goiter B. Thyroiditis C. Graves' disease D. Pituitary tumors

C

What is thyrotoxicosis? A. A condition of decreased circulating thyroid hormones. B. The physiologic effects and clinical syndrome of hypermetabolism resulting from increased circulating levels of T3, T4, or both. C. An autoimmune destruction of the thyroid gland. D. A state of low TSH and normal T3/T4 levels.

B

Graves' disease is characterized by what specific features? A. Nodular goiter and hyposecretion. B. Diffuse thyroid enlargement and excess thyroid hormone secretion. C. Thyroid atrophy and normal hormone levels. D. Single thyroid nodule and decreased TSH.

B

A patient with hyperthyroidism often describes themselves as: A. Always cold, gaining weight, and fatigued. B. Always hungry yet losing weight, always tired, and always warm, sweating a lot. C. Having decreased appetite and increased energy. D. Experiencing significant fluid retention and edema.

B

Which symptom is a characteristic eye manifestation of Graves' disease, caused by increased fat deposits and fluid forcing eyeballs outward? A. Cataracts B. Glaucoma C. Exophthalmos D. Nystagmus

C

What cardiovascular manifestations are common in hyperthyroidism? A. Bradycardia and hypotension B. Systolic hypertension, bounding, rapid pulse, and palpitations C. Decreased cardiac output and heart block D. Peripheral edema and normal heart rate

B

Nervous system manifestations in hyperthyroidism include: A. Decreased deep tendon reflexes and somnolence B. Hyperactive deep tendon reflexes, nervousness, and fine tremors C. Increased ability to concentrate and stable mood D. Muscle weakness and hyporeflexia

B

Acute thyrotoxicosis, also known as Thyroid Storm, is a life-threatening emergency characterized by: A. Mild tachycardia and slight fever B. Severe tachycardia, heart failure, shock, and hyperthermia (up to 106°F) C. Hypotension and hypoventilation D. Hypoglycemia and decreased metabolic rate

B

Which of the following is a common stressor that can trigger a thyroid storm? A. Gradual withdrawal of antithyroid medications B. Surgical removal of the thyroid (thyroidectomy) C. Adequate rest and nutrition D. Low iodine intake

B

What is the typical TSH level in a patient with overt hyperthyroidism? A. Increased TSH B. Normal TSH C. Low or undetectable TSH D. Highly fluctuating TSH

C

Radioactive iodine uptake (RAIU) is used to distinguish Graves' disease from other forms of thyroiditis based on what principle? A. Measures thyroid hormone levels in the blood. B. Assesses the thyroid gland's ability to take up iodine. C. Directly measures the size of the thyroid gland. D. Identifies circulating thyroid antibodies.

B

Which antithyroid drug inhibits thyroid hormone synthesis and is commonly used for hyperthyroidism treatment? A. Levothyroxine B. Propylthiouracil and methimazole (Tapazole) C. Iodine (Lugol's solution) D. Propranolol (Inderal)

B

Beta-adrenergic blockers like Propranolol (Inderal) are used in hyperthyroidism to: A. Directly inhibit thyroid hormone synthesis. B. Block the release of T3 and T4. C. Provide symptomatic relief by blocking sympathetic nervous stimulation effects (e.g., decrease tachycardia, nervousness). D. Damage and destroy thyroid tissue.

C

What is considered the treatment of choice for most non-pregnant adults with hyperthyroidism? A. Antithyroid medications B. Subtotal thyroidectomy C. Radioactive Iodine Therapy (RAI) D. High-calorie diet

C

Patients undergoing RAI therapy are typically treated with antithyroid drugs and β-blockers for how long before and during the initial treatment period? A. 1-2 days B. 1-2 weeks C. First 3 months D. 6-12 months

C

What is the preferred surgical procedure for hyperthyroidism, involving removal of 90% of the thyroid? A. Total thyroidectomy B. Subtotal thyroidectomy C. Lobectomy D. Tracheal resection

B

What are common indications for surgical therapy (thyroidectomy) in hyperthyroidism? A. Responsiveness to antithyroid therapy B. Small goiter with no compression C. Large goiter causing tracheal compression, unresponsiveness to antithyroid therapy, or thyroid cancer. D. Mild symptoms and normal thyroid function tests.

C

For a patient with exophthalmos due to hyperthyroidism, nursing care includes: A. Encouraging a high-sodium diet B. Keeping the head of the bed flat C. Applying artificial tears and elevating the head of bed D. Avoiding dark glasses

C

After a thyroidectomy, what equipment should be kept at the bedside to ensure a patent airway, anticipating potential complications like laryngeal stridor? A. Cardiac monitor and defibrillator B. Oxygen, suction equipment, and tracheostomy tray C. IV fluids and antibiotics D. Blood pressure cuff and pulse oximeter

B

What electrolyte imbalance should the nurse monitor for after thyroidectomy, specifically watching for signs of tetany, and have IV calcium readily available? A. Hypernatremia B. Hyperkalemia C. Hypocalcemia D. Hypomagnesemia

C

Hypothyroidism is defined as a deficiency of thyroid hormone, leading to a general slowing of what body process? A. Immune response B. Metabolic rate C. Glucose absorption D. Red blood cell production

B

What distinguishes primary hypothyroidism from secondary hypothyroidism? A. Primary is due to pituitary disease; secondary is due to thyroid tissue destruction. B. Primary is due to defective hormone synthesis or thyroid tissue destruction; secondary is due to pituitary or hypothalamic dysfunction. C. Secondary hypothyroidism has normal TSH levels, unlike primary. D. Primary hypothyroidism is caused by iodine deficiency; secondary is not.

B

Which of the following is a common etiology for primary hypothyroidism? A. Excess iodine intake B. Atrophy of the gland, such as in Hashimoto's thyroiditis C. Pituitary tumors D. Genetic predisposition only

B

A patient with hypothyroidism often reports: A. Increased energy, weight loss, and heat intolerance. B. Tiredness, lethargy, weight gain, and cold intolerance. C. Rapid speech and increased initiative. D. Increased appetite and rapid heart rate.

B

What skin and hair changes are commonly observed in hypothyroidism? A. Warm, moist skin and fine, silky hair. B. Dry, thick, inelastic, cold skin, and dry, sparse, coarse hair. C. Hyperpigmentation and thin nails. D. Petechiae and purpura.

B

What is Myxedema Coma? A. A mild, chronic form of hypothyroidism. B. A life-threatening complication precipitated by infection, drugs, cold, or trauma. C. A condition treated with oral thyroid hormone. D. A state of hyperthyroidism with impaired consciousness

B

How is Myxedema Coma typically treated? A. Oral antithyroid medications B. Fluid restriction and diuretics C. IV thyroid hormone D. Cooling blankets and sedatives

C