Endocrine Answers and Rationale
Question 1
Question 1
Question 1
Answer: C. Iatrogenic result of treating rheumatoid arthritis.
Rationale: Iatrogenic treatment of autoimmune disorders and diseases by use of corticosteroids is the most common cause of Cushing disease.
Adrenal adenoma is the cause of excess glucocorticoids secretion, mainly cortisol but not a common cause of Cushing syndrome.
Insufficient secretion of steroid hormones leads to Addison disease, the opposite of Cushing syndrome.
Question 2
Question 1
Question 1
Answer: B, C, F.
Rationale: A. Fatigue is a symptom of hypothyroidism
B. CORRECT - weight loss is a symptom of hyperthyroidism due to increased metabolism
C. CORRECT - nervousness and insomnia are seen due to the effect of thyroid hormone on the central nervous system.
D. Constipation is seen with hypothyroidism.
E. Facial edema and periorbital edema are symptoms of severe hypothyroidism (myxedema).
F. CORRECT - increased metabolism of body cells leads to increased sensitivity to heat.
Question 3
Question 1
Question 3
Answer: C. 1600
Rationale:
70/30 insulin is a premixed insulin made up of:
- 70% NPH insulin (intermediate-acting)
- 30% regular insulin (short-acting)
When given at 0800, the two components act as follows:
🔹 Regular insulin (30%):
- Onset: 30–60 minutes
- Peak: 2–4 hours
- Duration: 6–8 hours
✅ Peak around 1000–1200 — risk for early hypoglycemia
🔹 NPH insulin (70%):
- Onset: 1–2 hours
- Peak: 6–10 hours
- Duration: 12–16 hours
✅ Peak around 1400–1800 — highest risk for later hypoglycemia
Question 4
Question 3
Answer: B.
Rationale:
A positive Chvostek sign is a classic indication of hypocalcemia (low calcium levels), which can occur after a subtotal thyroidectomy if the parathyroid glands are accidentally damaged or removed.
- To test for Chvostek’s sign:
➤ Tap over the facial nerve (just in front of the ear).
➤ A positive response is twitching or spasm of the facial muscles, especially around the lips and cheek.
❌ Why not the others?
- A. Increased deep tendon reflexes on one side of the body
➤ Not specific to Chvostek sign; may indicate brain injury or stroke, increased reflexes seen on side opposite injury - C. Protrusion of the tongue when the client’s neck is stroked
➤ Not related to Chvostek sign or hypocalcemia.
- D. Spasm of the hand and lower muscles on one side of the body
➤ This more closely resembles Trousseau’s sign, another indicator of hypocalcemia (carpopedal spasm when BP cuff is inflated), but not Chvostek’s.
Question 5
Answer: B
Rationale:
This statement indicates possible cardiac complications from hyperthyroidism, such as: tachycardia, palpitations, atrial fibrillation, risk of heart failure, especially in older adults.
These symptoms can become life-threatening and must be reported to the nurse promptly for further assessment and possible intervention.
❌ Why not the others?
- A. "I noticed that my appetite was increased..."
➤ Common symptom of hyperthyroidism due to increased metabolism. - C. "My hair is thinner..."
➤ Also common in hyperthyroidism — hair may become fine, brittle, or fall out. - D. "My bowel movements are more frequent..."
➤ Another expected effect due to increased GI motility in hyperthyroidism.
Question 6
Answer: C.
Rationale:
An Addisonian crisis is a life-threatening emergency caused by a sudden and severe drop in cortisol and aldosterone levels in someone with Addison disease.
This may be triggered by:
stress (infection, trauma, surgery), sudden cessation of steroid therapy, illness or injury in someone with undiagnosed Addison disease.
Cortisol and aldosterone are hormones produced by the adrenal cortex that help regulate blood pressure, fluid and electrolyte balance, glucose metabolism, stress response.
A sudden drop causes:
hypotension, hyponatremia, hyperkalemia, hypoglycemia, shock
❌ Why not the others?
- A. Abnormally high secretion of thyroid hormone
➤ Refers to hyperthyroidism, not related to Addisonian crisis. - B. Sudden decrease in parathyroid hormone (PTH)
➤ Would affect calcium levels, not cortisol/aldosterone. - D. Development of ketoacidosis
➤ Common in type 1 diabetes, not Addison disease.
Question 7
Question 7
Question 7
Answer: C
Rationale: Give the client a simple carb like sugar to quickly treat their hypoglycemia symptoms. Repeat this action every 15 minutes until symptoms are gone and blood glucose is above 70 mg/dL. Cookies, cake or candy bars have fat and protein in them which slow the absorption of the carb. 4-6 ounces of juice is acceptable but mixed with 2 packets of sugar is a 30 gram carb load that will cause hyperglycemia. Diet soft drinks do not contain glucose needed by a hypoglycemic client. 4-6 ounces of non-diet soft drink would be appropriate.
Question 8
Question 7
Question 7
Answers: B. Dry mucous membranes
C. Poor skin turgor
D. Decreased pedal pulse strength
Rationale:
Diabetes insipidus (DI) is a disorder characterized by a deficiency of antidiuretic hormone (ADH) or the kidneys’ inability to respond to ADH. This leads to:
- Excessive water loss through urination (polyuria)
- Dehydration
- Dilute urine with low specific gravity
- Signs of fluid volume deficit
Option Review:
- A. Increased blood pressure ❌
- Incorrect. Hypotension (low blood pressure), not increased BP, is more likely due to fluid loss.
- B. Dry mucous membranes ✅
- Correct. A sign of dehydration from fluid loss.
- C. Poor skin turgor ✅
- Correct. Another classic sign of dehydration.
- D. Decreased pedal pulse strength ✅
- Correct. Due to reduced circulating volume, peripheral perfusion may be diminished.
- E. Increased urine specific gravity ❌
- Incorrect. In DI, urine is very dilute, so specific gravity is decreased, often <1.005.
Question 9
Question 10
Question 10
Answer: B. Diarrhea
Rationale:
Graves’ disease is an autoimmune disorder that leads to hyperthyroidism, where the thyroid gland overproduces thyroid hormones. This speeds up the body’s metabolism and leads to several characteristic symptoms.
- A. Bradycardia ❌
Incorrect. Graves’ disease causes tachycardia (fast heart rate), not bradycardia. - B. Diarrhea ✅
Correct. Increased metabolism stimulates gastrointestinal motility, leading to frequent bowel movements or diarrhea. - C. Fatigue ❌
Partially true. Fatigue can occur due to muscle weakness and insomnia, but it's not as specific as diarrhea in this context.
D. Weight gain ❌
Incorrect. Graves’ disease usually causes weight loss despite increased appetite, due to the hypermetabolic state.
Question 10
Question 10
Question 10
The correct answers are:
B. Increased thirst
C. Increased urine output
E. Increased appetite
Rationale:
When blood glucose is very high (hyperglycemia), the body experiences a range of symptoms due to the effects of excess glucose in the bloodstream:
Correct Answers:
- B. Increased thirst (polydipsia) ✅
- Excess glucose pulls water out of the cells, leading to dehydration and triggering intense thirst.
- Excess glucose pulls water out of the cells, leading to dehydration and triggering intense thirst.
- C. Increased urine output (polyuria) ✅
- The kidneys attempt to excrete the excess glucose, resulting in osmotic diuresis and frequent urination.
- The kidneys attempt to excrete the excess glucose, resulting in osmotic diuresis and frequent urination.
- E. Increased appetite (polyphagia) ✅
- Despite high glucose levels, cells are "starving" due to the lack of insulin or insulin resistance, leading to increased hunger.
- Despite high glucose levels, cells are "starving" due to the lack of insulin or insulin resistance, leading to increased hunger.
Incorrect Answers:
- A. Cold, clammy skin ❌
- This is typically associated with hypoglycemia, not hyperglycemia.
- This is typically associated with hypoglycemia, not hyperglycemia.
- D. Nervousness and tremors ❌
- These are signs of low blood sugar (hypoglycemia).
- These are signs of low blood sugar (hypoglycemia).
- F. Increased perspiration ❌
- Also more common in hypoglycemia, due to activation of the sympathetic nervous system.