NCLEX : Identifying Endocrine Conditions

Study concepts, example questions & explanations for NCLEX

varsity tutors app store varsity tutors android store

Example Questions

← Previous 1

Example Question #1 : Identifying Endocrine Conditions

Most pituitary adenomas are non functional (incidentalomas). Of the functional adenomas, which are the most common?

Possible Answers:

Prolactinomas

Somatotrophic adenomas

Null cell adenoma

Gonadotrophic adenomas

Correct answer:

Prolactinomas

Explanation:

Prolactinomas (prolactin-secreting) make up 30% of functional pituitary adenomas. The second most common type are somatotrophic (growth hormone-secreting) adenomas, which make up 15%, followed by gonadotrophic (gonadotrophin-releasing) adenomas, which make up 10% of reported cases. Null cell adenomas are non functional (they do not secrete hormones).

Example Question #2 : Identifying Endocrine Conditions

Which of the following are common cardiac signs with hyperthyroidism? 

Possible Answers:

Premature ventricular contractions and low cardiac output

High cardiac output, tachycardia, and atrial fibrillation

Atrial stenosis and tachycardia

Diastolic murmurs and low cardiac output

Correct answer:

High cardiac output, tachycardia, and atrial fibrillation

Explanation:

A cardiac workup on a patient with hyperthyroidism will often reveal high cardiac output, tachycardia, atrial fibrillation, a prominent (fourth heart sound) S4, and flow murmurs. This condition is not associated with low cardiac output and while it may be seen with murmurs it is not specifically associated with atrial stenosis.

Example Question #3 : Endocrine Conditions

What HbA1c level is diagnostic for type II diabetes?

Possible Answers:

Greater than 

Greater than 

Greater than 

Greater than 

Correct answer:

Greater than 

Explanation:

A hemoglobin A1c level of 6.5% or greater is considered diagnostic of type II diabetes. A HgA1c level of less than 6.5% does not exclude a diagnosis of diabetes, however, and should be looked at alongside fasting blood glucose and oral glucose tolerance testing.

Example Question #3 : Identifying Endocrine Conditions

What is the most common cause of hyperthyroidism?

Possible Answers:

Hashimoto's thyroiditis 

Toxic nodular goiter

Graves' disease

Thyroid storm

Correct answer:

Graves' disease

Explanation:

Graves' disease is the most common cause of hyperthyroidism. Graves disease is an autoimmune condition in which antibody is produced against the thyroid-stimulating hormone (TSH) receptor, which binds to receptors, resulting in continuous stimulation of the gland to synthesize and secrete excess quantities of the thyroid hormones T4 and T3. Thyroid storm and toxic nodular goiter are less common causes of elevated thyroid hormone levels. Hashimoto's thyroiditis is the most common cause of hypothyroidism. 

Example Question #4 : Identifying Endocrine Conditions

What is the most common sign of primary hyperparathyroidism?

Possible Answers:

Depressed serum potassium

Elevated serum phosphorous

Depressed serum calcium

Elevated serum calcium

Correct answer:

Elevated serum calcium

Explanation:

The most common manifestation of primary hyperparathyroidism is elevated serum calcium. Parathyroid hormone (PTH) activates osteoclasts, which mobilize calcium and phosphate from bone. PTH also increases renal tubular absorption of calcium and inhibits the reabsorption of phosphate, resulting in elevated blood calcium levels while maintaining normal phosphate levels. High PTH has no significant direct effect on potassium levels.

Example Question #6 : Endocrine Conditions

A male client presents to the outpatient clinic for care for recently diagnosed hyperparathyroidism. He has been undergoing care for this condition. The nurse recognizes this patient will be at risk for several clinical manifestations.

All of the following are signs and symptoms associated with hyperparathyroidism except __________.

Possible Answers:

delirium and confusion

kidney stones and urinary tract infections

shortened QT interval on ECG

painful muscle cramps and tremors

skeletal pain and backaches

Correct answer:

painful muscle cramps and tremors

Explanation:

Painful muscle cramps and tremors are associated with low calcium levels which is indicative of hypoparathyroidism. All the other choices are associated with high calcium levels and therefore are symptoms associated with hyperparathyroidism.

Example Question #7 : Endocrine Conditions

A 35-year-old male client presents to the emergency department after wife found him unresponsive at home. The wife informs the nurse her husband is a diabetic, and had not taken his insulin for the past two days. The client appears flushed, breathing is rapid and deep, and has a fruity smell on the breath.

The nurse suspects this presentation is diabetic ketoacidosis, which diagnostic finding would confirm this pathology?

Possible Answers:

Blood pH of 7.26

Elevated blood urea nitrogen (BUN)

Decreased serum osmolality

Blood glucose 

Serum bicarbonate of 

Correct answer:

Blood pH of 7.26

Explanation:

The acidic pH is what is most consistent with the diagnosis of diabetic ketoacidosis (DKA). A pH of less than 7.30 is what is seen in DKA. The blood glucose will be elevated but the nurse may also see a similar elevation in hyperosmolar hyperglycemic syndrome as well. The serum bicarbonte will be low and the serum osmolality would be elevated, yet both findings are not specific for DKA. Elevated BUN (blood urea nitrogen) is not specific for DKA as well. 

Example Question #8 : Endocrine Conditions

The nurse cares for a patient with a history of diabetes mellitus after a cholecystectomy. He has reported nausea and cannot have solid foods. Upon assessment, the patient appears disoriented and confused. Based on these observations, which of the following is the most likely explanation for the patient’s condition?

Possible Answers:

Hyperglycemia

Diabetic ketoacidosis

Insulin resistance syndrome

Diabetic hyperglycemic hyperosmolar syndrome

Hypoglycemia

Correct answer:

Hypoglycemia

Explanation:

A patient status-post surgery is often unable to eat due to nausea. A diabetic patient is likely to be suffering from hypoglycemia because of this; confusion, disorientation, and shakiness are common manifestations of hypoglycemia as well. Hyperglycemia may present with blurry vision, frequent urination, headaches, and fatigue. Diabetic ketoacidosis can manifest with thirst, frequent urination, weakness, and fruity-scented breath and occurs in patients with diabetes mellitus (DM) type 1. Diabetic hyperglycemic hyperosmolar syndrome may also present with the same symptoms of diabetic ketoacidosis but occurs in patients with DM type 2. Insulin resistance syndrome (also known as metabolic syndrome or prediabetes) usually does not present with manifestations, but people with severe insulin resistance syndrome may present with dark patches of skin on the back of the neck, elbows, knees, and/or armpits.

Example Question #9 : Endocrine Conditions

You are taking care of a 66-year old female who complains of weight gain, lethargy, dry skin, hair loss, constipation, and increased cold sensitivity. Based upon this assessment, you feel that the most likely diagnosis is which of the following?

Possible Answers:

Diabetic ketoacidosis

Thyroid storm

Diabetes insipidus

Hypothyroidism

Hyperthyroidism

Correct answer:

Hypothyroidism

Explanation:

This patient's constellation of symptoms is most consistent with hypothyroidism

In hypothyroidism, which may occur for a handful of reasons, the patient typically does not produce significant levels of thyroid hormone (T3/T4), and therefore, a variety of functions that are modulated by thyroid hormone are impaired. Common symptoms associated with hypothyroidism are weight gain, lethargy, hair loss/brittle hair, dry skin, constipation, depression, cold sensitivity, bradycardia, and brittle nails, among other symptoms. On exam, the patient's thyroid may feel enlarged. Characteristic lab findings would be an elevated TSH level with low or low/normal T3/T4 levels. 

The other choices are incorrect for the following reasons:

1) Hyperthyroidism would be characterized by opposite symptoms from those seen in this patients. Patients with hyperthyroidism would be tachycardic, anxious, have poor heat tolerance, diaphoretic, may have diarrhea, and weight loss among, other symptoms. 

2) Thyroid storm is a severe, life-threatening condition that is essentially an acute, severe manifestation of excess levels of thyroid hormone (also known as thyrotoxicosis), and presents with very pronounced, severe signs of hyperthyroidism.

3) Diabetic ketoacidosis is almost exclusively seen in patients with diabetes (which is not noted in this patient) and often presents with diffuse abdominal pain, rapid shallow breathing, altered mental status, and a fruity odor on the breath.

4) Diabetes insipidus would present with increased frequency of urination of dilute urine, fatigue, enuresis, dehydration, and/or electrolyte abnormalities. 

Example Question #10 : Endocrine Conditions

You are the nurse taking care of a 23-year old patient who complains of anxiety, diaphoresis, palpitations, diarrhea, weight loss, and tremors. When examining them you notice exophthalmos and eyelid lag. The most likely diagnosis in your patient is which of the following?

Possible Answers:

Hypothyroidism

Graves' disease

Glucagonoma

Diabetes insipidus

Diabetes mellitus

Correct answer:

Graves' disease

Explanation:

The most likely diagnosis in this patient is Graves' Disease, which is a form of hyperthyroidism

Graves' Disease is an autoimmune condition in which the patient produces autoantibodies to the thyrotropin receptor, which overstimulates the release of T4 and T3, resulting in hyperthyroidism and its associated clinical manifestations (anxiety, palpitations, weight loss, diaphoresis, diarrhea, tremors, etc...). Further, in Graves' Disease, patients may have exophthalmos and/or lid lag, which are findings that are more specific to Graves' Disease than other causes of hyperthyroidism. This patient's constellation of symptoms is highly consistent with Graves' Disease. 

Hypothyroidism is not correct, as this patient is experiencing symptoms opposite those of hypothyroidism. In hypothyroidism, one would expect the patient to feel lethargic, weak, experience weight gain, dry skin, constipation, and potentially have depression.

Diabetes insipidus would present with increased frequency of urination of dilute urine, fatigue, enuresis, dehydration, and/or electrolyte abnormalities. 

Diabetes mellitus would not likely present in this manner. Patients are often asymptomatic at the time of diagnosis, and it would be discovered by elevated glucose or HbA1c readings on routine laboratory work. Occasionally, increased urinary frequency and dehydration, or more severe manifestations like hyperglycemic hyperosmolar nonketotic coma (HHNK) or diabetic ketoacidosis (DKA) would be a presenting scenario. 

A glucagonoma would present with necrolytic migratory erythema, most commonly, as well as severely elevated glucose concentrations.

← Previous 1
Learning Tools by Varsity Tutors

Incompatible Browser

Please upgrade or download one of the following browsers to use Instant Tutoring: