NLE

1. EXAMINATION CARVASCULAR SYSTEM AND ENDOCTINE SYSTEM
1. Which of the following arteries primarily feeds the anterior wall of the heart?
a. Circumflex artery
b. Internal mammary artery
c. Left anterior descending artery
d. Right coronary artery
2. When do coronary arteries primarily receive blood flow?
a. During inspiration
b. During diastole
c. During expiration
d. During systole
3. Which of the following illnesses is the leading cause of death in the US?
a. Cancer
b. Coronary artery disease
c. Liver failure
d. Renal failure
4. Which of the following conditions most commonly results in CAD?
a. Atherosclerosis
b. DM
c. MI
d. Renal failure
5. Atherosclerosis impedes coronary blood flow by which of the following mechanisms?
a. Plaques obstruct the vein
b. Plaques obstruct the artery
c. Blood clots form outside the vessel wall
d. Hardened vessels dilate to allow the blood to flow through
6. Which of the following risk factors for coronary artery disease cannot be corrected?
a. Cigarette smoking
b. DM
c. Heredity
d. HPN
7. Exceeding which of the following serum cholesterol levels significantly increases the risk of coronary artery
disease?
a. 100 mg/dl
b. 150 mg/dl
c. 175 mg/dl
d. 200 mg/dl
8. Which of the following actions is the first priority care for a client exhibiting signs and symptoms of coronary artery
disease?
a. Decrease anxiety
b. Enhance myocardial oxygenation
c. Administer sublingual nitroglycerin
d. Educate the client about his symptoms
9. Medical treatment of coronary artery disease includes which of the following procedures?
a. Cardiac catheterization
b. Coronary artery bypass surgery

2. c. Oral medication administration
d. Percutaneous transluminal coronary angioplasty
10. Prolonged occlusion of the right coronary artery produces an infarction in which of he following areas of the
heart?
a. Anterior
b. Apical
c. Inferior
d. Lateral
11. Which of the following is the most common symptom of myocardial infarction?
a. Chest pain
b. Dyspnea
c. Edema
d. Palpitations
12. Which of the following landmarks is the correct one for obtaining an apical pulse?
a. Left intercostal space, midaxillary line
b. Left fifth intercostal space, midclavicular line
c. Left second intercostal space, midclavicular line
d. Left seventh intercostal space, midclavicular line
13. Which of the following systems is the most likely origin of pain the client describes as knifelike chest pain that
increases in intensity with inspiration?
a. Cardiac
b. Gastrointestinal
c. Musculoskeletal
d. Pulmonary
14. A murmur is heard at the second left intercostal space along the left sternal border. Which valve area is this?
a. Aortic
b. Mitral
c. Pulmonic
d. Tricuspid
15. Which of the following blood tests is most indicative of cardiac damage?
a. Lactate dehydrogenase
b. Complete blood count
c. Troponin I
d. Creatine kinase
16. What is the primary reason for administering morphine to a client with myocardial infarction?
a. To sedate the client
b. To decrease the client’s pain
c. To decrease the client’s anxiety
d. To decrease oxygen demand on the client’s heart
17. Which of the following conditions is most commonly responsible for myocardial infarction?
a. Aneurysm
b. Heart failure
c. Coronary artery thrombosis
d. Renal failure
18. What supplemental medication is most frequently ordered in conjuction with furosemide (Lasix)?

3. a. Chloride
b. Digoxin
c. Potassium
d. Sodium
19. After myocardial infarction, serum glucose levels and free fatty acids are both increase. What type of physiologic
changes are these?
a. Electrophysiologic
b. Hematologic
c. Mechanical
d. Metabolic
20. Which of the following complications is indicated by a third heart sound (S3)?
a. Ventricular dilation
b. Systemic hypertension
c. Aortic valve malfunction
d. Increased atrial contractions
21. After an anterior wall myocardial infarction, which of the following problems is indicated by auscultation of
crackles in the lungs?
a. Left-sided heart failure
b. Pulmonic valve malfunction
c. Right-sided heart failure
d. Tricuspid valve malfunction
22. Which of the following diagnostic tools is most commonly used to determine the location of myocardial damage?
a. Cardiac catheterization
b. Cardiac enzymes
c. Echocardiogram
d. Electrocardiogram
23. What is the first intervention for a client experiencing myocardial infarction?
a. Administer morphine
b. Administer oxygen
c. Administer sublingual nitroglycerin
d. Obtain an electrocardiogram
24. What is the most appropriate nursing response to a myocardial infarction client who is fearful of dying?
a. “Tell me about your feeling right now.”
b. “When the doctor arrives, everything will be fine.”
c. “This is a bad situation, but you’ll feel better soon.”
d. “Please be assured we’re doing everything we can to make you feel better.”
25. Which of the following classes of medications protects the ischemic myocardium by blocking catecholamines and
sympathetic nerve stimulation?
a. Beta-adrenergic blockers
b. Calcium channel blockers
c. Narcotics
d. Nitrates
26. What is the most common complication of a myocardial infarction?
a. Cardiogenic shock
b. Heart failure
c. Arrhythmias
d. Pericarditis

4. 27. With which of the following disorders is jugular vein distention most prominent?
a. Abdominal aortic aneurysm
b. Heart failure
c. Myocardial infarction
d. Pneumothorax
28. What position should the nurse place the head of the bed in to obtain the most accurate reading of jugular vein
distention?
a. High-fowler’s
b. Raised 10 degrees
c. Raised 30 degrees
d. Supine position
29. Which of the following parameters should be checked before administering digoxin?
a. Apical pulse
b. Blood pressure
c. Radial pulse
d. Respiratory rate
30. Toxicity from which of the following medications may cause a client to see a green halo around lights?
a. Digoxin
b. Furosemide
c. Metoprolol
d. Enalapril
31. Which ofthe following symptoms is most commonly associated with left-sided heart failure?
a. Crackles
b. Arrhythmias
c. Hepatic engorgement
d. Hypotension
32. In which of the following disorders would the nurse expect to assess sacral edema in bedridden client?
a. DM
b. Pulmonary emboli
c. Renal failure
d. Right-sided heart failure
33. Which of the following symptoms might a client with right-sided heart failure exhibit?
a. Adequate urine output
b. Polyuria
c. Oliguria
d. Polydipsia
34. Which of the following classes of medications maximizes cardiac performance in clients with heat failure by
increasing ventricular contractility?
a. Beta-adrenergic blockers
b. Calcium channel blockers
c. Diuretics
d. Inotropic agents
35. Stimulation of the sympathetic nervous system produces which of the following responses?
a. Bradycardia
b. Tachycardia

5. c. Hypotension
d. Decreased myocardial contractility
36. Which of the following conditions is most closely associated with weight gain, nausea, and a decrease in urine
output?
a. Angina pectoris
b. Cardiomyopathy
c. Left-sided heart failure
d. Right-sided heart failure
37. What is the most common cause of abdominal aortic aneurysm?
a. Atherosclerosis
b. DM
c. HPN
d. Syphilis
38. In which of the following areas is an abdominal aortic aneurysm most commonly located?
a. Distal to the iliac arteries
b. Distal to the renal arteries
c. Adjacent to the aortic branch
d. Proximal to the renal arteries
39. A pulsating abdominal mass usually indicates which of the following conditions?
a. Abdominal aortic aneurysm
b. Enlarged spleen
c. Gastic distention
d. Gastritis
40. What is the most common symptom in a client with abdominal aortic aneurysm?
a. Abdominal pain
b. Diaphoresis
c. Headache
d. Upper back pain
41. Which of the following symptoms usually signifies rapid expansion and impending rupture of an abdominal aortic
aneurysm?
a. Abdominal pain
b. Absent pedal pulses
c. Angina
d. Lower back pain
42. What is the definitive test used to diagnose an abdominal aortic aneurysm?
a. Abdominal X-ray
b. Arteriogram
c. CT scan
d. Ultrasound
43. Which of the following complications is of greatest concern when caring for a preoperative abdominal aneurysm
client?
a. HPN
b. Aneurysm rupture
c. Cardiac arrhythmias
d. Diminished pedal pulses
44. Which of the following blood vessel layers may be damaged in a client with an aneurysm?

6. a. Externa
b. Interna
c. Media
d. Interna and Media
45. When assessing a client for an abdominal aortic aneurysm, which area of the abdomen is most commonly
palpated?
a. Right upper quadrant
b. Directly over the umbilicus
c. Middle lower abdomen to the left of the midline
d. Midline lower abdomen to the right of the midline
46. Which of the following conditions is linked to more than 50% of clients with abdominal aortic aneurysms?
a. DM
b. HPN
c. PVD
d. Syphilis
47. Which of the following sounds is distinctly heard on auscultation over the abdominal region of an abdominal
aortic aneurysm client?
a. Bruit
b. Crackles
c. Dullness
d. Friction rubs
48. Which of the following groups of symptoms indicated a ruptured abdominal aneurysm?
a. Lower back pain, increased BP, decreased RBC, increased WBC
b. Severe lower back pain, decreased BP, decreased RBC, increased WBC
c. Severe lower back pain, decreased BP, decreased RBC, decreased WBC
d. Intermittent lower back pain, decreased BP, decreased RBC, increased WBC
49. Which of the following complications of an abdominal aortic repair is indicated by detection of a hematoma in the
perineal area?
a. Hernia
b. Stage 1 pressure ulcer
c. Retroperitoneal rupture at the repair site
d. Rapid expansion of the aneurysm
50. Which hereditary disease is most closely linked to aneurysm?
a. Cystic fibrosis
b. Lupus erythematosus
c. Marfan’s syndrome
d. Myocardial infarction
51. Which of the following treatments is the definitive one for a ruptured aneurysm?
a. Antihypertensive medication administration
b. Aortogram
c. Beta-adrenergic blocker administration
d. Surgical intervention
52. Which of the following heart muscle diseases is unrelated to other cardiovascular disease?
a. Cardiomyopathy
b. Coronary artery disease
c. Myocardial infarction
d. Pericardial Effusion

7. 53. Which of the following types of cardiomyopathy can be associated with childbirth?
a. Dilated
b. Hypertrophic
c. Myocarditis
d. Restrictive
54. Septal involvement occurs in which type of cardiomyopathy?
a. Congestive
b. Dilated
c. Hypertrophic
d. Restrictive
55. Which of the following recurring conditions most commonly occurs in clients with cardiomyopathy?
a. Heart failure
b. DM
c. MI
d. Pericardial effusion
56. What is the term used to describe an enlargement of the heart muscle?
a. Cardiomegaly
b. Cardiomyopathy
c. Myocarditis
d. Pericarditis
57. Dyspnea, cough, expectoration, weakness, and edema are classic signs and symptoms of which of the following
conditions?
a. Pericarditis
b. Hypertension
c. Obliterative
d. Restrictive
58. Which of the following types of cardiomyopathy does not affect cardiac output?
a. Dilated
b. Hypertrophic
c. Restrictive
d. Obliterative
59. Which of the following cardiac conditions does a fourth heart sound (S4) indicate?
a. Dilated aorta
b. Normally functioning heart
c. Decreased myocardial contractility
d. Failure of the ventricle to eject all the blood during systole
60. Which of the following classes of drugs is most widely used in the treatment of cardiomyopathy?
a. Antihypertensive
b. Beta-adrenergic blockers
c. Calcium channel blockers
d. Nitrates
61. 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:

8. 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.
62. 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
63. Nurse Joey is assigned to care for a postoperative male client who has diabetes mellitus. During the
assessment interview, the client reports that he’s impotent and says he’s concerned about its effect on his
marriage. In planning this client’s care, the most appropriate intervention would be to:
A. Encourage the client to ask questions about personal sexuality.
B. Provide time for privacy.
C. Provide support for the spouse or significant other.
D. Suggest referral to a sex counselor or other appropriate professional.
64. During a class on exercise for diabetic clients, a female client asks the nurse educator how often to exercise.
The nurse educator advises the clients to exercise how often to meet the goals of planned exercise?
A. At least once a week
B. At least three times a week
C. At least five times a week
D. Every day
65. Nurse Oliver should expect a client with hypothyroidism to report which health concerns?
A. Increased appetite and weight loss
B. Puffiness of the face and hands
C. Nervousness and tremors
D. Thyroid gland swelling
66. A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily.
Which finding should nurse Hans recognize as an adverse drug effect?
A. Dysuria
B. Leg cramps
C. Tachycardia
D. Blurred vision

9. 67. A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness,
irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment
findings, nurse Richard would suspect which of the following disorders?
A. Diabetes mellitus
B. Diabetes insipidus
C. Hypoparathyroidism
D. Hyperparathyroidism
68. When caring for a male client with diabetes insipidus, nurse Juliet expects to administer:
A. vasopressin (Pitressin Synthetic).
B. furosemide (Lasix).
C. regular insulin.
D. 10% dextrose.
69. The nurse is aware that the following is the most common cause of hyperaldosteronism?
A. Excessive sodium intake
B. A pituitary adenoma
C. Deficient potassium intake
D. An adrenal adenoma
70. A male client with type 1 diabetes mellitus has a highly elevated glycosylated hemoglobin (Hb) test result. In
discussing the result with the client, nurse Sharmaine would be most accurate in stating:
A. “The test needs to be repeated following a 12-hour fast.”
B. “It looks like you aren’t following the prescribed diabetic diet.”
C. “It tells us about your sugar control for the last 3 months.”
D. “Your insulin regimen needs to be altered significantly.”
71. Following a unilateral adrenalectomy, nurse Betty would assess for hyperkalemia shown by which of the
following?
A. Muscle weakness
B. Tremors
C. Diaphoresis
D. Constipation
72. Nurse Louie is developing a teaching plan for a male client diagnosed with diabetes insipidus. The nurse
should include information about which hormone lacking in clients with diabetes insipidus?
A. antidiuretic hormone (ADH).
B. thyroid-stimulating hormone (TSH).
C. follicle-stimulating hormone (FSH).
D. luteinizing hormone (LH).

10. 73. Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses
the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What
is the most likely cause of these signs?
A. Diabetic ketoacidosis
B. Thyroid crisis
C. Hypoglycemia
D. Tetany
74. For a male client with hyperglycemia, which assessment finding best supports a nursing diagnosis of Deficient
fluid volume?
A. Cool, clammy skin
B. Distended neck veins
C. Increased urine osmolarity
D. Decreased serum sodium level
75. When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes
excessive catecholamine, nurse April is most likely to detect:
A. a blood pressure of 130/70 mm Hg.
B. a blood glucose level of 130 mg/dl.
C. bradycardia.
D. a blood pressure of 176/88 mm Hg.
76. A male client is admitted for treatment of the syndrome of inappropriate antidiuretic hormone (SIADH).
Which nursing intervention is appropriate?
A. Infusing I.V. fluids rapidly as ordered
B. Encouraging increased oral intake
C. Restricting fluids
D. Administering glucose-containing I.V. fluids as ordered
77. A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects
to assess:
A. Trousseau’s sign.
B. Homans’ sign.
C. Hegar’s sign.
D. Goodell’s sign.
78. Which outcome indicates that treatment of a male client with diabetes insipidus has been effective?
A. Fluid intake is less than 2,500 ml/day.
B. Urine output measures more than 200 ml/hour.
C. Blood pressure is 90/50 mm Hg.
D. The heart rate is 126 beats/minute.

11. 79. Jemma, who weighs 210 lb (95 kg) and has been diagnosed with hyperglycemia tells the nurse that her
husband sleeps in another room because her snoring keeps him awake. The nurse notices that she has large
hands and a hoarse voice. Which of the following would the nurse suspect as a possible cause of the client’s
hyperglycemia?
A. Acromegaly
B. Type 1 diabetes mellitus
C. Hypothyroidism
D. Deficient growth hormone
80. Nurse Kate is providing dietary instructions to a male client with hypoglycemia. To control hypoglycemic
episodes, the nurse should recommend:
A. Increasing saturated fat intake and fasting in the afternoon.
B. Increasing intake of vitamins B and D and taking iron supplements.
C. Eating a candy bar if lightheadedness occurs.
D. Consuming a low-carbohydrate, high-protein diet and avoiding fasting.
81. An incoherent female client with a history of hypothyroidism is brought to the emergency department by the
rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis,
bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings
suggest severe hypothyroidism, nurse Libby prepares to take emergency action to prevent the potential
complication of:
A. Thyroid storm.
B. Cretinism.
C. myxedema coma.
D. Hashimoto’s thyroiditis.
82. A male client with type 1 diabetes mellitus asks the nurse about taking an oral antidiabetic agent. Nurse Jack
explains that these medications are only effective if the client:
A. prefers to take insulin orally.
B. has type 2 diabetes.
C. has type 1 diabetes.
D. is pregnant and has type 2 diabetes.
83. When caring for a female client with a history of hypoglycemia, nurse Ruby should avoid administering a
drug that may potentiate hypoglycemia. Which drug fits this description?
A. sulfisoxazole (Gantrisin)
B. mexiletine (Mexitil)
C. prednisone (Orasone)
D. lithium carbonate (Lithobid)
84. After taking glipizide (Glucotrol) for 9 months, a male client experiences secondary failure. Which of the
following would the nurse expect the physician to do?

12. A. Initiate insulin therapy.
B. Switch the client to a different oral antidiabetic agent.
C. Prescribe an additional oral antidiabetic agent.
D. Restrict carbohydrate intake to less than 30% of the total caloric intake.
85. During preoperative teaching for a female client who will undergo subtotal thyroidectomy, the nurse should
include which statement?
A. “The head of your bed must remain flat for 24 hours after surgery.”
B. “You should avoid deep breathing and coughing after surgery.”
C. “You won’t be able to swallow for the first day or two.”
D. “You must avoid hyperextending your neck after surgery.”
86. Nurse Ronn is assessing a client with possible Cushing’s syndrome. In a client with Cushing’s syndrome, the
nurse would expect to find:
A. Hypotension.
B. Thick, coarse skin.
C. Deposits of adipose tissue in the trunk and dorsocervical area.
D. Weight gain in arms and legs.
87. A male client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which
instruction should nurse Lina provide?
A. “Administer desmopressin while the suspension is cold.”
B. “Your condition isn’t chronic, so you won’t need to wear a medical identification bracelet.”
C. “You may not be able to use desmopressin nasally if you have nasal discharge or blockage.”
D. “You won’t need to monitor your fluid intake and output after you start taking desmopressin.”
88. Nurse Wayne is aware that a positive Chvostek’s sign indicate?
A. Hypocalcemia
B. Hyponatremia
C. Hypokalemia
D. Hypermagnesemia
89. In a 29-year-old female client who is being successfully treated for Cushing’s syndrome, nurse Lyzette would
expect a decline in:
A. Serum glucose level.
B. Hair loss.
C. Bone mineralization.
D. Menstrual flow.
90. A male client has recently undergone surgical removal of a pituitary tumor. Dr. Wong prescribes corticotropin
(Acthar), 20 units I.M. q.i.d. as a replacement therapy. What is the mechanism of action of corticotropin?

13. A. It decreases cyclic adenosine monophosphate (cAMP) production and affects the metabolic rate of target
organs.
B. It interacts with plasma membrane receptors to inhibit enzymatic actions.
C. It interacts with plasma membrane receptors to produce enzymatic actions that affect protein, fat, and
carbohydrate metabolism.
D. It regulates the threshold for water resorption in the kidneys.
91. Capillary glucose monitoring is being performed every 4 hours for a female client diagnosed with diabetic
ketoacidosis. Insulin is administered using a scale of regular insulin according to glucose results. At 2 p.m., the
client has a capillary glucose level of 250 mg/dl for which he receives 8 U of regular insulin. Nurse Vince should
expect the dose’s:
A. Onset to be at 2 p.m. and its peak to be at 3 p.m.
B. Onset to be at 2:15 p.m. and its peak to be at 3 p.m.
C. Onset to be at 2:30 p.m. and its peak to be at 4 p.m.
D. Onset to be at 4 p.m. and its peak to be at 6 p.m.
92. A female client with Cushing’s syndrome is admitted to the medical -surgical unit. During the admission
assessment, nurse Tyzz notes that the client is agitated and irritable, has poor memory, reports loss of appetite,
and appears disheveled. These findings are consistent with which problem?
A. Depression
B. Neuropathy
C. Hypoglycemia
D. Hyperthyroidism
93. Nurse Ruth is assessing a client after a thyroidectomy. The assessment reveals muscle twitching and tingling,
along with numbness in the fingers, toes, and mouth area. The nurse should suspect which complication?
A. Tetany
B. Hemorrhage
C. Thyroid storm
D. Laryngeal nerve damage
94. After undergoing a subtotal thyroidectomy, a female client develops hypothyroidism. Dr. Smith prescribes
levothyroxine (Levothroid), 25 mcg P.O. daily. For which condition is levothyroxine the preferred agent?
A. Primary hypothyroidism
B. Graves’ disease
C. Thyrotoxicosis
D. Euthyroidism
95. 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

14. 96. A female client with a history of pheochromocytoma is admitted to the hospital in an acute hypertensive
crisis. To reverse hypertensive crisis caused by pheochromocytoma, nurse Lyka expects to administer:
A. phentolamine (Regitine).
B. methyldopa (Aldomet).
C. mannitol (Osmitrol).
D. felodipine (Plendil).
97. A male client with a history of hypertension is diagnosed with primary hyperaldosteronism. This diagnosis
indicates that the client’s hypertension is caused by excessive hormone secretion from which of the following
glands?
A. Adrenal cortex
B. Pancreas
C. Adrenal medulla
D. Parathyroid
98. Nurse Troy is aware that the most appropriate for a client with Addison’s disease?
A. Risk for infection
B. Excessive fluid volume
C. Urinary retention
D. Hypothermia
99. Acarbose (Precose), an alpha-glucosidase inhibitor, is prescribed for a female client with type 2 diabetes
mellitus. During discharge planning, nurse Pauleen would be aware of the client’s need for additional teaching
when the client states:
A. “If I have hypoglycemia, I should eat some sugar, not dextrose.”
B. “The drug makes my pancreas release more insulin.”
C. “I should never take insulin while I’m taking this drug.”
D. “It’s best if I take the drug with the first bite of a meal.”
100. A female client whose physical findings suggest a hyperpituitary condition undergoes an extensive
diagnostic workup. Test results reveal a pituitary tumor, which necessitates a transsphenoidal hypophysectomy.
The evening before the surgery, nurse Jacob reviews preoperative and postoperative instructions given to the
client earlier. Which postoperative instruction should the nurse emphasize?
A. “You must lie flat for 24 hours after surgery.”
B. “You must avoid coughing, sneezing, and blowing your nose.”
C. “You must restrict your fluid intake.”
D. “You must report ringing in your ears immediately.”
101. Dr. Kennedy prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a male client with type 2
diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise.
Which medication instruction should the nurse provide?

15. A. “Be sure to take glipizide 30 minutes before meals.”
B. “Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly.”
C. “You won’t need to check your blood glucose level after you start taking glipizide.”
D. “Take glipizide after a meal to prevent heartburn.”
102. For a diabetic male client with a foot ulcer, the physician orders bed rest, a wet-to-dry dressing change
every shift, and blood glucose monitoring before meals and bedtime. Why are wet-to-dry dressings used for this
client?
A. They contain exudate and provide a moist wound environment.
B. They protect the wound from mechanical trauma and promote healing.
C. They debride the wound and promote healing by secondary intention.
D. They prevent the entrance of microorganisms and minimize wound discomfort.
103. When instructing the female client diagnosed with hyperparathyroidism about diet, nurse Gina should
stress the importance of which of the following?
A. Restricting fluids
B. Restricting sodium
C. Forcing fluids
D. Restricting potassium
104. Which nursing diagnosis takes highest priority for a female client with hyperthyroidism?
A. Risk for imbalanced nutrition: More than body requirements related to thyroid hormone excess
B. Risk for impaired skin integrity related to edema, skin fragility, and poor wound healing
C. Body image disturbance related to weight gain and edema
D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess
105. A male client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS) has a
history of type 2 diabetes that is being controlled with an oral diabetic agent, tolazamide (Tolinase). Which of
the following is the most important laboratory test for confirming this disorder?
A. Serum potassium level
B. Serum sodium level
C. Arterial blood gas (ABG) values
D. Serum osmolarity
106. A male client has just been diagnosed with type 1 diabetes mellitus. When teaching the client and family
how diet and exercise affect insulin requirements, Nurse Joy should include which guideline?
A. “You’ll need more insulin when you exercise or increase your food intake.”
B. “You’ll need less insulin when you exercise or reduce your food intake.”
C. “You’ll need less insulin when you increase your food intake.”
D. “You’ll need more insulin when you exercise or decrease your food intake.”

16. 107. Nurse Noemi administers glucagon to her diabetic client, then monitors the client for adverse drug
reactions and interactions. Which type of drug interacts adversely with glucagon?
A. Oral anticoagulants
B. Anabolic steroids
C. Beta-adrenergic blockers
D. Thiazide diuretics
108. Which instruction about insulin administration should nurse Kate give to a client?
A. “Always follow the same order when drawing the different insulins into the syringe.”
B. “Shake the vials before withdrawing the insulin.”
C. “Store unopened vials of insulin in the freezer at temperatures well below freezing.”
D. “Discard the intermediate-acting insulin if it appears cloudy.”
109. Nurse Perry is caring for a female client with type 1 diabetes mellitus who exhibits confusion, light -
headedness, and aberrant behavior. The client is still conscious. The nurse should first administer:
A. I.M. or subcutaneous glucagon.
B. I.V. bolus of dextrose 50%.
C. 15 to 20 g of a fast-acting carbohydrate such as orange juice.
D. 10 U of fast-acting insulin.
110. For the first 72 hours after thyroidectomy surgery, nurse Jamie would assess the female client for
Chvostek’s sign and Trousseau’s sign because they indicate which of the following?
A. Hypocalcemia
B. Hypercalcemia
C. Hypokalemia
D. Hyperkalemia

17. 1. c. Left anterior descending artery
The left anterior descending artery is the primary source of blood for the anterior wall of the heart. The circumflex
artery supplies the lateral wall, the internal mammary artery supplies the mammary, and the right coronary artery
supplies the inferior wall of the heart.
2. b. During diastole
Although the coronary arteries may receive a minute portion of blood during systole, most of the blood flow to
coronary arteries is supplied during diastole. Breathing patterns are irrelevant to blood flow
3. b. Coronary artery disease
Coronary artery disease accounts for over 50% of all deaths in the US. Cancer accounts for approximately 20%.
Liver failure and renal failure account for less than 10% of all deaths in the US.
4. a. Atherosclerosis
Atherosclerosis, or plaque formation, is the leading cause of CAD. DM is a risk factor for CAD but isn’t the most
common cause. Renal failure doesn’t cause CAD, but the two conditions are related. Myocardial infarction is
commonly a result of CAD.
5. b. Plaques obstruct the artery
Arteries, not veins, supply the coronary arteries with oxygen and other nutrients. Atherosclerosis is a direct result
of plaque formation in the artery. Hardened vessels can’t dilate properly and, therefore, constrict blood flow.
6. c. Heredity
Because “heredity” refers to our genetic makeup, it can’t be changed. Cigarette smoking cessation is a lifestyle
change that involves behavior modification. Diabetes mellitus is a risk factor that can be controlled with diet,
exercise, and medication. Altering one’s die t, exercise, and medication can correct hypertension.
7. d. 200 mg/dl
Cholesterol levels above 200 mg/dl are considered excessive. They require dietary restriction and perhaps
medication. Exercise also helps reduce cholesterol levels. The other levels listed are all below the nationally
accepted levels for cholesterol and carry a lesser risk for CAD.
8. b. Enhance myocardial oxygenation
Enhancing myocardial oxygenation is always the first priority when a client exhibits signs and symptoms of cardiac
compromise. Without adequate oxygen, the myocardium suffers damage. Sublingual nitroglycerin is administered
to treat acute angina, but its administration isn’t the first priority. Although educating the client and decreasing
anxiety are important in care delivery, nether are priorities when a client is compromised.
9. c. Oral medication administration
Oral medication administration is a noninvasive, medical treatment for coronary artery disease. Cardiac
catheterization isn’t a treatment but a diagnostic tool. Coronary artery bypass surgery and percutaneous
transluminal coronary angioplasty are invasive, surgical treatments.
10. c. Inferior
The right coronary artery supplies the right ventricle, or the inferior portion of the heart. Therefore, prolonged
occlusion could produce an infarction in that area. The right coronary artery doesn’t supply the anterior portion (
left ventricle ), lateral portion ( some of the left ventricle and the left atrium ), or the apical portion ( left ventricle )
of the heart.

18. 11. a. Chest pain
The most common symptom of an MI is chest pain, resulting from deprivation of oxygen to the heart. Dyspnea is
the second most common symptom, related to an increase in the metabolic needs of the body during an MI.
Edema is a later sign of heart failure, often seen after an MI. Palpitations may result from reduced cardiac output,
producing arrhythmias.
12. b. Left fifth intercostal space, midclavicular line
The correct landmark for obtaining an apical pulse is the left intercostal space in the mi dclavicular line. This is the
point of maximum impulse and the location of the left ventricular apex. The left second intercostal space in the
midclavicular line is where the pulmonic sounds are auscultated. Normally, heart sounds aren’t heard in the
midaxillary line or the seventh intercostal space in the midclavicular line.
13. d. Pulmonary
Pulmonary pain is generally described by these symptoms. Musculoskeletal pain only increase with movement.
Cardiac and GI pains don’t change with respiration.
14. c. Pulmonic
Abnormalities of the pulmonic valve are auscultated at the second left intercostal space along the left sternal
border. Aortic valve abnormalities are heard at the second intercostal space, to the right of the sternum. Mitral
valve abnormalities are heard at the fifth intercostal space in the midclavicular line. Tricuspid valve abnormalities
are heard at the third and fourth intercostal spaces along the sternal border.
15. c. Troponin I
Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I levels aren’t
detectable in people without cardiac injury. Lactate dehydrogenase is present in almost all body tissues and not
specific to heart muscle. LDH isoenzymes are useful in diagnosing cardiac injury. CBC is obtained to review blood
counts, and a complete chemistry is obtained to review electrolytes. Because CK levels may rise with skeletal
muscle injury, CK isoenzymes are required to detect cardiac injury.
16. d. To decrease oxygen demand on the client’s heart
Morphine is administered because it decreases myocardial oxygen demand. Morphine will also decrease pain and
anxiety while causing sedation, but isn’t primarily given for those reasons.
17. c. Coronary artery thrombosis
Coronary artery thrombosis causes occlusion of the artery, leading to myocardial death. An aneurysm is an
outpouching of a vessel and doesn’t cause an MI. Renal failure can be associated with MI but isn’t a direct cause.
Heart failure is usually the result of an MI.
18. c. Potassium
Supplemental potassium is given with furosemide because of the potassium loss that occurs as a result of this
diuretic. Chloride and sodium aren’t loss during diuresis. Digoxin acts to increase contractility but isn’t given
routinely with furosemide.
19. d. Metabolic
Both glucose and fatty acids are metabolites whose levels increase after a myocardial infarction. Mechanical
changes are those that affect the pumping action of the heart, and electrophysiologic changes affect conduction.
Hematologic changes would affect the blood.

19. 20. a. Ventricular dilation
Rapid filling of the ventricles causes vasodilation that is auscultated as S3. Increased atrial contraction or systemic
hypertension can result is a fourth heart sound. Aortic valve malfunction is heard as a murmur.
21. a. Left-sided heart failure
The left ventricle is responsible for the most of the cardiac output. An anterior wall MI may result in a decrease in
left ventricular function. When the left ventricle doesn’t function properly, resulting in left -sided heart failure, fluid
accumulates in the interstitial and alveolar spaces in the lungs and causes crackles. Pulmonic and tricuspid valve
malfunction causes right-sided heart failure.
22. d. Electrocardiogram
The ECG is the quickest, most accurate, and most widely used tool to determine the location of myocardial
infarction. Cardiac enzymes are used to diagnose MI but can’t determine the location. An echocardiogram is used
most widely to view myocardial wall function after an MI has been diagnosed. Cardiac catheter ization is an invasive
study for determining coronary artery disease and may also indicate the location of myocardial damage, but the
study may not be performed immediately.
23. b. Administer oxygen
Administering supplemental oxygen to the client is the fi rst priority of care. The myocardium is deprived of oxygen
during an infarction, so additional oxygen is administered to assist in oxygenation and prevent further damage.
Morphine and sublingual nitroglycerin are also used to treat MI, but they’re more commonly administered after
the oxygen. An ECG is the most common diagnostic tool used to evaluate MI.
24. a. “Tell me about your feeling right now.”
Validation of the client’s feelings is the most appropriate response. It gives the client a feeling of comfor t and
safety. The other three responses give the client false hope. No one can determine if a client experiencing MI will
feel or get better and therefore, these responses are inappropriate.
25. a. Beta-adrenergic blockers
Beta-adrenergic blockers work by blocking beta receptors in the myocardium, reducing the response to
catecholamines and sympathetic nerve stimulation. They protect the myocardium, helping to reduce the risk of
another infarction by decreasing the workload of the heart and decreasing myocardial oxygen demand. Calcium
channel blockers reduce the workload of the heart by decreasing the heart rate. Narcotics reduce myocardial
oxygen demand, promote vasodilation, and decreased anxiety. Nitrates reduce myocardial oxygen consumption by
decreasing left ventricular end-diastolic pressure (preload) and systemic vascular resistance (afterload).
26. c. Arrhythmias
Arrhythmias, caused by oxygen deprivation to the myocardium, are the most common complication of an MI.
cardiogenic shock, another complication of MI, is defined as the end stage of left ventricular dysfunction. The
condition occurs in approximately 15% of clients with MI. Because the pumping function of the heart is
compromised by an MI, heart failure is the second most common complication. Pericarditis most commonly results
from a bacterial of viral infection but may occur after MI.
27. b. Heart failure
Elevated venous pressure, exhibited as jugular vein distention, indicates a failure of the heart to pump. Jugular vein
distention isn’t a symptom of abdominal aortic aneurysm or pneumothorax. An MI, if severe enough, can progress
to heart failure; however, in and of itself, an MI doesn’t cause jugular vein distention.

20. 28. c. Raised 30 degrees
Jugular venous pressure is measured with a centimeter ruler to obtain the vertical distance between the sternal
angle and the point of highest pulsation with the head of the bed inclined between 15 and 30 degrees. Inclined
pressure can’t be seen when the client is supine or when the head of the bed is raise d 10 degrees because the
point that marks the pressure level is above the jaw (therefore, not visible). In high Fowler’s position, the veins
would be barely discernible above the clavicle.
29. a. Apical pulse
An apical pulse is essential or accurately assessing the client’s heart rate before administering digoxin. The apical
pulse is the most accurate point in the body. Blood pressure is usually only affected if the heart rate is too low, in
which case the nurse would withhold digoxin. The radial pulse can be affected by cardiac and vascular disease and
therefore, won’t always accurately depict the heart rate. Digoxin has no effect on respiratory function.
30. a. Digoxin
One of the most common signs of digoxin toxicity is the visual disturbance known as the green halo sign. The other
medications aren’t associated with such an effect.
31. a. Crackles
Crackles in the lungs are a classic sign of left-sided heart failure. These sounds are caused by fluid backing up into
the pulmonary system. Arrhythmias can be associated with both right and left-sided heart failure. Left-sided heart
failure causes hypertension secondary to an increased workload on the system.
32. d. Right-sided heart failure
The most accurate area on the body to assed dependent edema in a bedridden client is the sacral area. Sacral, or
dependent, edema is secondary to right-sided heart failure. Diabetes mellitus, pulmonary emboli, and renal disease
aren’t directly linked to sacral edema.
33. c. Oliguria
Inadequate deactivation of aldosterone by the liver after right-sided heart failure leads to fluid retention, which
causes oliguria. Adequate urine output, polyuria, and polydipsia aren’t associated with right -sided heart failure.
34. d. Inotropic agents
Inotropic agents are administered to increase the force of the heart’s contractions, thereby increasing ventricular
contractility and ultimately increasing cardiac output. Beta-adrenergic blockers and calcium channel blockers
decrease the heart rate and ultimately decrease the workload of the heart. Diuretics are administered to decrease
the overall vascular volume, also decreasing the workload of the heart.
35. b. Tachycardia
Stimulation of the sympathetic nervous system causes tachycardia and increased contractili ty. The other symptoms
listed are related to the parasympathetic nervous system, which is responsible for slowing the heart rate.
36. d. Right-sided heart failure
Weight gain, nausea, and a decrease in urine output are secondary effects of right -sided heart failure.
Cardiomyopathy is usually identified as a symptom of left-sided heart failure. Left-sided heart failure causes
primarily pulmonary symptoms rather than systemic ones. Angina pectoris doesn’t cause weight gain, nausea, or a
decrease in urine output.
37. a. Atherosclerosis
Atherosclerosis accounts for 75% of all abdominal aortic aneurysms. Plaques build up on the wall of the vessel and

21. weaken it, causing an aneurysm. Although the other conditions are related to the development of an aneurysm,
none is a direct cause.
38. b. Distal to the renal arteries
The portion of the aorta distal to the renal arteries is more prone to an aneurysm because the vessel isn’t
surrounded by stable structures, unlike the proximal portion of the aorta. Distal to the iliac arteries, the vessel is
again surrounded by stable vasculature, making this an uncommon site for an aneurysm. There is no area adjacent
to the aortic arch, which bends into the thoracic (descending) aorta.
39. a. Abdominal aortic aneurysm
The presence of a pulsating mass in the abdomen is an abnormal finding, usually indicating an outpouching in a
weakened vessel, as in abdominal aortic aneurysm. The finding, however, can be normal on a thin person. Neither
an enlarged spleen, gastritis, nor gastric distention cause pulsation.
40. a. Abdominal pain
Abdominal pain in a client with an abdominal aortic aneurysm results from the disruption of normal circulation in
the abdominal region. Lower back pain, not upper, is a common symptom, usually signifying expansi on and
impending rupture of the aneurysm. Headache and diaphoresis aren’t associated with abdominal aortic aneurysm.
41. d. Lower back pain
Lower back pain results from expansion of the aneurysm. The expansion applies pressure in the abdominal cavity,
and the pain is referred to the lower back. Abdominal pain is most common symptom resulting from impaired
circulation. Absent pedal pulses are a sign of no circulation and would occur after a ruptured aneurysm or in
peripheral vascular disease. Angina is associated with atherosclerosis of the coronary arteries.
42. b. Arteriogram
An arteriogram accurately and directly depicts the vasculature; therefore, it clearly delineates the vessels and any
abnormalities. An abdominal aneurysm would only be visible on an X-ray if it were calcified. CT scan and ultrasound
don’t give a direct view of the vessels and don’t yield as accurate a diagnosis as the arteriogram.
43. b. Aneurysm rupture
Rupture of the aneurysm is a life-threatening emergency and is of the greatest concern for the nurse caring for this
type of client. Hypertension should be avoided and controlled because it can cause the weakened vessel to
rupture. Diminished pedal pulses, a sign of poor circulation to the lower extremities, are associated with an
aneurysm but isn’t life threatening. Cardiac arrhythmias aren’t directly linked to an aneurysm.
44. c. Media
The factor common to all types of aneurysms is a damaged media. The media has more smooth muscle and less
elastic fibers, so it’s more capable of vasoconstriction and vasodilation. The interna and externa are generally no
damaged in an aneurysm.
45. c. Middle lower abdomen to the left of the midline
The aorta lies directly left of the umbilicus; therefore, any other region is inappropriate for palpation.
46. b. HPN
Continuous pressure on the vessel walls from hypertension causes the walls to weaken and an aneurysm to occur.
Atherosclerotic changes can occur with peripheral vascular diseases and are linked to aneurysms, but the link isn’t
as strong as it is with hypertension. Only 1% of clients with syphilis experience an aneurysm. Diabetes mellitus
doesn’t have direct link to aneurysm.

22. 47. a. Bruit
A bruit, a vascular sound resembling heart murmur, suggests partial arterial occlusion. Crackles are indicative of
fluid in the lungs. Dullness is heard over solid organs, such as the liver. Friction rubs indicate inflammation of the
peritoneal surface.
48. b. Severe lower back pain, decreased BP, decreased RBC, increased WBC
Severe lower back pain indicates an aneurysm rupture, secondary to pressure being applied within the abdominal
cavity. When rupture occurs, the pain is constant because it can’t be alleviated until the aneurysm is repaired.
Blood pressure decreases due to the loss of blood. After the aneurysm ruptures, the vasculature is interrupted and
blood volume is lost, so blood pressure wouldn’t increase. For the same reason, the RBC count is decreased – not
increase. The WBC count increases as cells migrate to the site of injury.
49. c. Retroperitoneal rupture at the repair site
Blood collects in the retroperitoneal space and is exhibited as a hematoma in the perineal area. This rupture is
most commonly caused by leakage at the repair site. A hernia doesn’t cause vascular disturbances, nor does a
pressure ulcer. Because no bleeding occurs with rapid expansion of the aneurysm, a hematoma won’t form.
50. c. Marfan’s syndrome
Marfan’s syndrome results in the degeneration of the elastic fibers of the aortic media. Therefore, clients with the
syndrome are more likely to develop an aortic aneurysm. Although cystic fibrosis is hereditary, it hasn’t been linked
to aneurysms. Lupus erythematosus isn’t hereditary. Myocardial infarction is neither hereditary nor a disease.
51. d. Surgical intervention
When the vessel ruptures, surgery is the only intervention that can repair it. Administration of antihypertensive
medications and beta-adrenergic blockers can help control hypertension, reducing the risk of rupture. An
aortogram is a diagnostic tool used to detect an aneurysm.
52. a. Cardiomyopathy
Cardiomyopathy isn’t usually related to an underlying heart disease such as atherosclerosis. The etiology in most
cases is unknown. Coronary artery disease and myocardial infarction are directly related to atherosclerosis.
Pericardial effusion is the escape of fluid into the pericardial sac, a condition associated with pericarditis and
advanced heart failure.
53. a. Dilated
Although the cause isn’t entirely known, cardiac dilation and heart failure may develop during the last month of
pregnancy of the first few months after birth. The condition may result from a preexisting cardiomyopathy not
apparent prior to pregnancy. Hypertrophic cardiomyopathy is an abnormal symmetry of the ventricles that has an
unknown etiology but a strong familial tendency. Myocarditis isn’t specifically associated with childbirth. Restrictive
cardiomyopathy indicates constrictive pericarditis; the underlying cause is usually myocardial.
54. c. Hypertrophic
In hypertrophic cardiomyopathy, hypertrophy of the ventricular septum – not the ventricle chambers – is apparent.
This abnormality isn’t seen in other types of cardiomyopathy.
55. a. Heart failure
Because the structure and function of the heart muscle is affected, heart failure most commonly occurs in cli ents
with cardiomyopathy. Myocardial infarction results from prolonged myocardial ischemia due to reduced blood flow
through one of the coronary arteries. Pericardial effusion is most predominant in clients with percarditis. Diabetes
mellitus is unrelated to cardiomyopathy.

23. 56. a. Cardiomegaly
Cardiomegaly denotes an enlarged heart muscle. Cardiomyopathy is a heart muscle disease of unknown origin.
Myocarditis refers to inflammation of heart muscle. Pericarditis is an inflammation of the pericardium, the sac
surrounding the heart.
57. d. Restrictive
These are the classic symptoms of heart failure. Pericarditis is exhibited by a feeling of fullness in the chest and
auscultation of a pericardial friction rub. Hypertension is usually exhibited by headaches, visual disturbances and a
flushed face. Myocardial infarction causes heart failure but isn’t related to these symptoms.
58. b. Hypertrophic
Cardiac output isn’t affected by hypertrophic cardiomyopathy because the size of the ventricle remains relatively
unchanged. Dilated cardiomyopathy, and restrictive cardiomyopathy all decrease cardiac output.
59. d. Failure of the ventricle to eject all the blood during systole
An S4 occurs as a result of increased resistance to ventricular filling after atrial contraction. This increased
resistance is related to decrease compliance of the ventricle. A dilated aorta doesn’t cause an extra heart sound,
though it does cause a murmur. Decreased myocardial contractility is heard as a third heart sound. An s4 isn’t
heard in a normally functioning heart.
60. b. Beta-adrenergic blockers
By decreasing the heart rate and contractility, beta-adrenergic blockers improve myocardial filling and cardiac
output, which are primary goals in the treatment of cardiomyopathy. Antihypertensives aren’t usually indicated
because they would decrease cardiac output in clients who are often already hypotensive. Calcium channel
blockers are sometimes used for the same reasons as beta-adrenergic blockers; however, they aren’t as effective
as beta-adrenergic blockers and cause increase hypotension. Nitrates aren’t’ used because of their dilating effects,
which would further compromise the myocardium.
61. Answer B. To reverse hypoglycemia, the American Diabetes Association recommends ingesting 10 to 15 g of a
simple carbohydrate, such as three to five pieces of hard candy, two to three packets of sugar (4 to 6 tsp), or 4 oz of
fruit juice. If necessary, this treatment can be repeated in 15 minutes. Ingesting only 2 to 5 g of a simple
carbohydrate may not raise the blood glucose level sufficiently. Ingesting more than 15 g may raise it above
normal, causing hyperglycemia.
62. Answer A. Poorly controlled hyperparathyroidism may cause an elevated serum calcium level. This, in turn, may
diminish calcium stores in the bone, causing bone demineralization and setting the stage for pathologic fractures
and a risk for injury. Hyperparathyroidism doesn’t accelerate the metabolic rate. A decreased thyroid hormone
level, not an increased parathyroid hormone level, may cause edema and dry skin secondary to fluid infiltration
into the interstitial spaces. Hyperparathyroidism causes hypercalcemia, not hypocalcemia; therefore, it isn’t
associated with tetany.
63. Answer D. The nurse should refer this client to a sex counselor or other professional. Making appropriate
referrals is a valid part of planning the client’s care. The nurse doesn’t normally provide sex counseling.
64. Answer B. Diabetic clients must exercise at least three times a week to meet the goals of planned ex ercise —
lowering the blood glucose level, reducing or maintaining the proper weight, increasing the serum high-density
lipoprotein level, decreasing serum triglyceride levels, reducing blood pressure, and minimizing stress. Exercising
once a week wouldn’t achieve these goals. Exercising more than three times a week, although beneficial, would
exceed the minimum requirement.

24. 65. Answer B. Hypothyroidism (myxedema) causes facial puffiness, extremity edema, and weight gain. Signs and
symptoms of hyperthyroidism (Graves’ disease) include an increased appetite, weight loss, nervousness, tremors,
and thyroid gland enlargement (goiter).
66. Answer C. Levothyroxine, a synthetic thyroid hormone, is given to a client with hypothyroidism to simulate the
effects of thyroxine. Adverse effects of this agent include tachycardia. The other options aren’t associated with
levothyroxine.
67. Answer D. Hyperparathyroidism is most common in older women and is characterized by bone pain and
weakness from excess parathyroid hormone (PTH). Clients also exhibit hypercaliuria-causing polyuria. While clients
with diabetes mellitus and diabetes insipidus also have polyuria, they don’t have bone pain and increased sleeping.
Hypoparathyroidism is characterized by urinary frequency rather than polyuria.
68. Answer A. Because diabetes insipidus results from decreased antidiuretic hormone (vasopressin) production,
the nurse should expect to administer synthetic vasopressin for hormone replacement therapy. Furosemide, a
diuretic, is contraindicated because a client with diabetes insipidus experiences polyuria. Insulin and dextrose are
used to treat diabetes mellitus and its complications, not diabetes insipidus.
69. Answer D. An autonomous aldosterone-producing adenoma is the most common cause of hyperaldosteronism.
Hyperplasia is the second most frequent cause. Aldosterone secretion is independent of sodium and potassium
intake as well as of pituitary stimulation.
70. Answer C. The glycosylated Hb test provides an objective measure of glycemic control over a 3-month period.
The test helps identify trends or practices that impair glycemic control, and it doesn’t require a fasting period
before blood is drawn. The nurse can’t conclude that the result occurs from poor dietary management or
inadequate insulin coverage.
71. Answer A. Muscle weakness, bradycardia, nausea, diarrhea, and paresthesia of the hands, feet, tongue, and
face are findings associated with hyperkalemia, which is transient and occurs from transient hypoaldosteronism
when the adenoma is removed. Tremors, diaphoresis, and constipation aren’t seen in hyperkalemia.
72. Answer A. ADH is the hormone clients with diabetes insipidus lack. The client’s TSH, FSH, and LH levels won’t be
affected.
73. Answer B. Thyroid crisis usually occurs in the first 12 hours after thyroidectomy and causes exaggerated signs of
hyperthyroidism, such as high fever, tachycardia, and extreme restlessness. Diabetic ketoacidosis is more likely to
produce polyuria, polydipsia, and polyphagia; hypoglycemia, to produce weakness, tremors, profuse perspiration,
and hunger. Tetany typically causes uncontrollable muscle spasms, stridor, cyanosis, and possibly asphyxia.
74. Answer C. In hyperglycemia, urine osmolarity (the measurement of dissolved particles in the urine) i ncreases as
glucose particles move into the urine. The client experiences glucosuria and polyuria, losing body fluids and
experiencing fluid volume deficit. Cool, clammy skin; distended neck veins; and a decreased serum sodium level are
signs of fluid volume excess, the opposite imbalance.
75. Answer D. Pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, causes
hypertension, tachycardia, hyperglycemia, hypermetabolism, and weight loss. It isn’t associated with the other
options.

25. 76. Answer C. To reduce water retention in a client with the SIADH, the nurse should restrict fluids. Administering
fluids by any route would further increase the client’s already heightened fluid load.
77. Answer A. This client’s serum calcium level indicates hypocalcemia, an electrolyte imbalance that causes
Trousseau’s sign (carpopedal spasm induced by inflating the blood pressure cuff above systolic pressure). Homans’
sign (pain on dorsiflexion of the foot) indicates deep vein thrombosis. Hegar’ s sign (softening of the uterine
isthmus) and Goodell’s sign (cervical softening) are probable signs of pregnancy.
78. Answer A. Diabetes insipidus is characterized by polyuria (up to 8 L/day), constant thirst, and an unusually high
oral intake of fluids. Treatment with the appropriate drug should decrease both oral fluid intake and urine output.
A urine output of 200 ml/hour indicates continuing polyuria. A blood pressure of 90/50 mm Hg and a heart rate of
126 beats/minute indicate compensation for the continued fluid deficit, suggesting that treatment hasn’t been
effective.
79. Answer A. Acromegaly, which is caused by a pituitary tumor that releases excessive growth hormone, is
associated with hyperglycemia, hypertension, diaphoresis, peripheral neuropathy, and joint pain. Enlarged hands
and feet are related to lateral bone growth, which is seen in adults with this disorder. The accompanying soft tissue
swelling causes hoarseness and often sleep apnea. Type 1 diabetes is usually seen in children, and newly diagnosed
persons are usually very ill and thin. Hypothyroidism isn’t associated with hyperglycemia, nor is growth hormone
deficiency.
80. Answer D. To control hypoglycemic episodes, the nurse should instruct the client to consume a low-carbohydrate,
high-protein diet, avoid fasting, and avoid simple sugars. Increasing saturated fat intake and
increasing vitamin supplementation wouldn’t help control hypoglycemia.
81. Answer C. Severe hypothyroidism may result in myxedema coma, in which a drastic drop in the metabolic rate
causes decreased vital signs, hypoventilation (possibly leading to respiratory acidosis), and nonpitting edema.
Thyroid storm is an acute complication of hyperthyroidism. Cretinism is a form of hypothyroidism that occurs in
infants. Hashimoto’s thyroiditis is a common chronic inflammatory disease of the thyroid gland in which
autoimmune factors play a prominent role.
82. Answer B. Oral antidiabetic agents are only effective in adult clients with type 2 diabetes. Oral antidiabetic
agents aren’t effective in type 1 diabetes. Pregnant and lactating women aren’t prescribed oral antidiabetic agents
because the effect on the fetus is uncertain.
83. Answer A. Sulfisoxazole and other sulfonamides are chemically related to oral antidiabetic agents and may
precipitate hypoglycemia. Mexiletine, an antiarrhythmic, is used to treat refractory ventricular arrhythmias; it
doesn’t cause hypoglycemia. Prednisone, a corticosteroid, is associated with hyperglycemia. Lithium may cause
transient hyperglycemia, not hypoglycemia.
84. Answer B. Many clients (25% to 60%) with secondary failure respond to a different oral antidiabetic agent.
Therefore, it wouldn’t be appropriate to initiate insulin therapy at this time. However, if a new oral antidiabetic
agent is unsuccessful in keeping glucose levels at an acceptable level, insulin may be used in addition to the
antidiabetic agent.
85. Answer D. To prevent undue pressure on the surgical incision after subtotal thyroidectomy, the nurse should
advise the client to avoid hyperextending the neck. The client may elevate the head of the bed as desired and
should perform deep breathing and coughing to help prevent pneumonia. Subtotal thyroidectomy doesn’t affect
swallowing.

26. 86. Answer C. Because of changes in fat distribution, adipose tissue accumulates in the trunk, face (moonface), and
dorsocervical areas (buffalo hump). Hypertension is caused by fluid retention. Skin becomes thin and bruises easily
because of a loss of collagen. Muscle wasting causes muscle atrophy and thin extremities.
87. Answer C. Desmopressin may not be absorbed if the intranasal route is compromised. Although diabetes
insipidus is treatable, the client should wear medical identification and carry medication at all times to alert
medical personnel in an emergency and ensure proper treatment. The client must continue to monitor fluid intake
and output and receive adequate fluid replacement.
88. Answer A. Chvostek’s sign is elicited by tapping the client’s face lightly over the facial nerve, just below the
temple. If the client’s facial muscles twitch, it indicates hypocalcemia. Hyponatremia is indicated by weight loss,
abdominal cramping, muscle weakness, headache, and postural hypotension. Hypokalemia causes paralytic ileus
and muscle weakness. Clients with hypermagnesemia exhibit a loss of deep tendon reflexes, coma, or cardiac
arrest.
89. Answer A. Hyperglycemia, which develops from glucocorticoid excess, is a manifestation of Cushing’s
syndrome. With successful treatment of the disorder, serum glucose levels decline. Hirsutism is common in
Cushing’s syndrome; therefore, with successful treatment, abnormal hair growth also declines. Osteoporosis oc curs
in Cushing’s syndrome; therefore, with successful treatment, bone mineralization increases. Amenorrhea develops
in Cushing’s syndrome. With successful treatment, the client experiences a return of menstrual flow, not a decline
in it.
90. Answer C. Corticotropin interacts with plasma membrane receptors to produce enzymatic actions that affect
protein, fat, and carbohydrate metabolism. It doesn’t decrease cAMP production. The posterior pituitary hormone,
antidiuretic hormone, regulates the threshold for water resorption in the kidneys.
91. Answer C. Regular insulin, which is a short-acting insulin, has an onset of 15 to 30 minutes and a peak of 2 to 4
hours. Because the nurse gave the insulin at 2 p.m., the expected onset would be from 2:15 p.m. to 2:30 p.m. and
the peak from 4 p.m. to 6 p.m.
92. Answer A. Agitation, irritability, poor memory, loss of appetite, and neglect of one’s appearance may signal
depression, which is common in clients with Cushing’s syndrome. Neuropathy affects clients with diabetes mellitus
— not Cushing’s syndrome. Although hypoglycemia can cause irritability, it also produces increased appetite,
rather than loss of appetite. Hyperthyroidism typically causes such signs as goiter, nervousness, heat intolerance,
and weight loss despite increased appetite.
93. Answer A. Tetany may result if the parathyroid glands are excised or damaged during thyroid surgery.
Hemorrhage is a potential complication after thyroid surgery but is characterized by tachycardia, hypotension,
frequent swallowing, feelings of fullness at the incision site, choking, and bleeding. Thyroid storm is another term
for severe hyperthyroidism — not a complication of thyroidectomy. Laryngeal nerve damage may occur
postoperatively, but its signs include a hoarse voice and, possibly, acute airway obstruction.
94. Answer A. Levothyroxine is the preferred agent to treat primary hypothyroidism and cretinism, although it also
may be used to treat secondary hypothyroidism. It is contraindicated in Graves’ disease and thyrotoxico sis because
these conditions are forms of hyperthyroidism. Euthyroidism, a term used to describe normal thyroid function,
wouldn’t require any thyroid preparation.

27. 95. Answer B. SIADH secretion causes antidiuretic hormone overproduction, which leads to fluid retention. Severe
SIADH can cause such complications as vascular fluid overload, signaled by neck vein distention. This syndrome
isn’t associated with tetanic contractions. It may cause weight gain and fluid retention (secondary to oliguria).
96. Answer A. Pheochromocytoma causes excessive production of epinephrine and norepinephrine, natural
catecholamines that raise the blood pressure. Phentolamine, an alpha-adrenergic blocking agent given by I.V. bolus
or drip, antagonizes the body’s response to circulating epinephrine and norepinephrine, reducing blood pressure
quickly and effectively. Although methyldopa is an antihypertensive agent available in parenteral form, it isn’t
effective in treating hypertensive emergencies. Mannitol, a diuretic, isn’t used to treat hypertensive emergencies.
Felodipine, an antihypertensive agent, is available only in extended-release tablets and therefore doesn’t reduce
blood pressure quickly enough to correct hypertensive crisis.
97. Answer A. Excessive secretion of aldosterone in the adrenal cortex is responsible for the client’s hypertension.
This hormone acts on the renal tubule, where it promotes reabsorption of sodium and excretion of potassium and
hydrogen ions. The pancreas mainly secretes hormones involved in fuel metabolism. The adrenal medulla secretes
the catecholamines — epinephrine and norepinephrine. The parathyroids secrete parathyroid hormone.
98. Answer A. Addison’s disease decreases the production of all adrenal hormones, compromising the body’s
normal stress response and increasing the risk of infection. Other appropriate nursing diagnoses for a client with
Addison’s disease include Deficient fluid volume and Hyperthermia. Urinary retention isn’t appropriate because
Addison’s disease causes polyuria.
99. Answer A. Acarbose delays glucose absorption, so the client should take an oral form of dextrose rather than a
product containing table sugar when treating hypoglycemia. The alpha-glucosidase inhibitors work by delaying the
carbohydrate digestion and glucose absorption. It’s safe to be on a regimen that includes insulin and an alpha-glucosidase
inhibitor. The client should take the drug at the start of a meal, not 30 minutes to an hour before.
100. Answer B. After a transsphenoidal hypophysectomy, the client must refrain from coughing, sneezing, and
blowing the nose for several days to avoid disturbing the surgical graft used to close the wound. The head of the
bed must be elevated, not kept flat, to prevent tension or pressure on the suture line. Within 24 hou rs after a
hypophysectomy, transient diabetes insipidus commonly occurs; this calls for increased, not restricted, fluid intake.
Visual, not auditory, changes are a potential complication of hypophysectomy.
101. Answer A. The client should take glipizide twice a day, 30 minutes before a meal, because food decreases its
absorption. The drug doesn’t cause hyponatremia and therefore doesn’t necessitate monthly serum sodium
measurement. The client must continue to monitor the blood glucose level during glipizide therapy.
102. Answer C. For this client, wet-to-dry dressings are most appropriate because they clean the foot ulcer by
debriding exudate and necrotic tissue, thus promoting healing by secondary intention. Moist, transparent dressings
contain exudate and provide a moist wound environment. Hydrocolloid dressings prevent the entrance of
microorganisms and minimize wound discomfort. Dry sterile dressings protect the wound from mechanical trauma
and promote healing.
103. Answer C. The client should be encouraged to force fluids to prevent renal calculi formation. Sodium should
be encouraged to replace losses in urine. Restricting potassium isn’t necessary in hyperparathyroidism.
104. Answer D. In the client with hyperthyroidism, excessive thyroid hormone production leads to
hypermetabolism and increased nutrient metabolism. These conditions may result in a negative nitrogen balance,
increased protein synthesis and breakdown, decreased glucose tolerance, and fat mobilization and depletion. This

28. puts the client at risk for marked nutrient and calorie deficiency, making Imbalanced nutrition: Less than body
requirements the most important nursing diagnosis. Options B and C may be appropriate for a client with
hypothyroidism, which slows the metabolic rate.
105. Answer D. Serum osmolarity is the most important test for confirming HHNS; it’s also used to guide treatment
strategies and determine evaluation criteria. A client with HHNS typically has a serum osmolarity of more than 350
mOsm/L. Serum potassium, serum sodium, and ABG values are also measured, but they aren’t as important as
serum osmolarity for confirming a diagnosis of HHNS. A client with HHNS typically has hypernatremia and osmotic
diuresis. ABG values reveal acidosis, and the potassium level is variable.
106. Answer B. Exercise, reduced food intake, hypothyroidism, and certain medications decrease the insulin
requirements. Growth, pregnancy, greater food intake, stress, surgery, infection, illness, increased insulin
antibodies, and certain medications increase the insulin requirements.
107. Answer A. As a normal body protein, glucagon only interacts adversely with oral anticoagulants, increasing the
anticoagulant effects. It doesn’t interact adversely with anabolic steroids, beta-adrenergic blockers, or thiazide
diuretics.
108. Answer A. The client should be instructed always to follow the same order when drawing the different insulins
into the syringe. Insulin should never be shaken because the resulting froth prevents withdrawal of an accurate
dose and may damage the insulin protein molecules. Insulin also should never be frozen because the insulin
protein molecules may be damaged. Intermediate-acting insulin is normally cloudy.
109. Answer C. This client is having a hypoglycemic episode. Because the client is conscious, the nurse should first
administer a fast-acting carbohydrate, such as orange juice, hard candy, or honey. If the client has lost
consciousness, the nurse should administer either I.M. or subcutaneous glucagon or an I.V. bolus of dextrose 50%.
The nurse shouldn’t administer insulin to a client who’s hypoglycemic; this action will further compromise the
client’s condition.
110. Answer A. The client who has undergone a thyroidectomy is at risk for developing hypocalcemia from
inadvertent removal or damage to the parathyroid gland. The client with hypocalcemia will exhibit a positive
Chvostek’s sign (facial muscle contraction when the facial nerve in front of the ear is tapped) and a positive
Trousseau’s sign (carpal spasm when a blood pressure cuff is inflated for a few minutes). These signs aren’t present
with hypercalcemia, hypokalemia, or hyperkalemia.