ATI MED-SURG ENDOCRINE EXAM 2025/2026
Comprehensive Test Bank (200 Questions)
SECTION 1: Thyroid Disorders (Questions 1-35)
1. A nurse is assessing a client with Graves' disease. Which of the following findings should
the nurse expect?
A. Periorbital edema
B. Bradycardia
C. Weight gain
D. Cold intolerance
Answer: A. Periorbital edema
Rationale: Graves' disease is an autoimmune form of hyperthyroidism. Periorbital edema
(exophthalmos) is a classic finding due to lymphocytic infiltration and edema of the orbital
tissues. Bradycardia, weight gain, and cold intolerance are manifestations of hypothyroidism,
not hyperthyroidism.
2. A nurse is caring for a client who is 24 hours post-thyroidectomy. The client reports
muscle cramps and tingling in the fingers. Which of the following laboratory values should
the nurse check first?
A. Thyroid-stimulating hormone (TSH)
B. Serum calcium
C. Serum potassium
D. White blood cell count
Answer: B. Serum calcium
Rationale: Muscle cramps and tingling in the fingers (paresthesia) are early signs of
hypocalcemia, a potential complication following thyroidectomy due to accidental removal
or damage to the parathyroid glands. Hypocalcemia can lead to tetany and laryngeal stridor.
Checking serum calcium is the priority. TSH levels (A) assess thyroid function but do not
explain acute postoperative symptoms. Potassium (C) imbalances typically cause weakness
or cardiac dysrhythmias. WBC count (D) would assess for infection but not the described
neurological symptoms.
3. A nurse is teaching a client about levothyroxine therapy. Which of the following
statements indicates the client understands the teaching?
A. "I will take this medication on an empty stomach in the morning."
B. "I can stop taking this medication when my symptoms improve."
C. "I will take this medication with my evening meal."
D. "This medication will cure my hypothyroidism within 6 months."
Answer: A. "I will take this medication on an empty stomach in the morning."
,Rationale: Levothyroxine is best absorbed when taken consistently on an empty stomach,
typically 30-60 minutes before breakfast. It should not be stopped (B) even when symptoms
improve, as hypothyroidism is a lifelong condition requiring continuous replacement. Taking
with food (C) reduces absorption. The medication manages, not cures, the condition (D).
4. A nurse is assessing a client with myxedema coma. Which of the following findings is
the priority?
A. Hypothermia
B. Bradycardia
C. Hypotension
D. Decreased level of consciousness
Answer: D. Decreased level of consciousness
Rationale: Myxedema coma is a life-threatening complication of severe hypothyroidism.
While hypothermia, bradycardia, and hypotension are all present, decreased level of
consciousness indicates neurological compromise and is the priority finding as it reflects the
severity of the condition and risk for airway compromise. Using the ABCs (Airway, Breathing,
Circulation) and prioritizing the most life-threatening manifestation, altered mental status
poses the greatest immediate risk.
5. A nurse is preparing a client for a thyroid scan. Which of the following instructions
should the nurse provide?
A. "You will need to fast for 12 hours before the procedure."
B. "You will receive a radioactive iodine tracer intravenously."
C. "You should avoid taking thyroid medications for several weeks before the test."
D. "This test will measure the amount of thyroid hormone in your blood."
Answer: C. "You should avoid taking thyroid medications for several weeks before the
test."
Rationale: For a thyroid scan, clients are typically instructed to discontinue thyroid
medications (levothyroxine, antithyroid drugs) and avoid iodine-containing substances for
several weeks to ensure accurate uptake results. Fasting (A) is not typically required. The
tracer is usually oral, not IV (B). The test measures uptake and structure, not blood hormone
levels (D).
6. A nurse is monitoring a client who is receiving radioactive iodine therapy for
hyperthyroidism. Which of the following instructions should the nurse include?
A. "You should use a private bathroom and flush twice."
B. "You may share utensils with family members."
C. "You should avoid close contact with others for 1 hour."
D. "You do not need to use contraception after this treatment."
Answer: A. "You should use a private bathroom and flush twice."
,Rationale: After radioactive iodine therapy, the client's body fluids are radioactive for several
days. Safety precautions include using a private bathroom, flushing twice, not sharing
utensils (B), avoiding close contact for several days to weeks (not 1 hour, C), and using
reliable contraception for at least 6-12 months (D) due to risk to fetus.
7. A nurse is assessing a client with hyperthyroidism. Which of the following findings is
consistent with this condition?
A. Constipation
B. Lethargy
C. Tachycardia
D. Weight gain
Answer: C. Tachycardia
Rationale: Hyperthyroidism causes a hypermetabolic state with increased sympathetic
nervous system activity, leading to tachycardia, palpitations, and hypertension. Constipation
(A), lethargy (B), and weight gain (D) are manifestations of hypothyroidism.
8. A nurse is providing discharge teaching to a client who had a thyroidectomy. The nurse
should instruct the client to report which of the following findings immediately?
A. Mild pain at the incision site
B. Difficulty swallowing
C. Hoarseness
D. Tingling around the mouth
Answer: D. Tingling around the mouth
Rationale: Tingling around the mouth (circumoral paresthesia) is an early sign of
hypocalcemia due to parathyroid damage or removal. This can progress to tetany, laryngeal
stridor, and respiratory arrest. This finding requires immediate reporting and intervention.
Mild incisional pain (A) is expected. Difficulty swallowing (B) and hoarseness (C) can occur
due to surgical trauma and inflammation but are not as immediately life-threatening as
hypocalcemia.
9. A nurse is assessing a client who has hypothyroidism. Which of the following findings
should the nurse expect?
A. Diarrhea
B. Insomnia
C. Dry skin
D. Palpitations
Answer: C. Dry skin
Rationale: Hypothyroidism results in decreased metabolic rate, leading to dry, coarse skin;
brittle hair; and cold intolerance. Diarrhea (A), insomnia (B), and palpitations (D) are
associated with hyperthyroidism.
, 10. A nurse is administering propylthiouracil (PTU) to a client with Graves' disease. The
nurse should monitor the client for which of the following adverse effects?
A. Hypoglycemia
B. Agranulocytosis
C. Hypertension
D. Weight gain
Answer: B. Agranulocytosis
Rationale: Propylthiouracil (PTU) is an antithyroid medication that can cause
agranulocytosis, a potentially fatal decrease in white blood cells. The nurse should monitor
for signs of infection such as sore throat, fever, and malaise. Hypoglycemia (A) is not a
common adverse effect. Hypertension (C) and weight gain (D) are not typical adverse effects
of PTU; weight gain may occur as hyperthyroidism is controlled.
11. A nurse is caring for a client following a thyroidectomy. The client's voice is hoarse.
Which of the following actions should the nurse take?
A. Reassure the client that this is expected and will resolve in 24 hours.
B. Assess the client's ability to swallow and cough effectively.
C. Notify the provider immediately.
D. Administer prescribed calcium gluconate.
Answer: B. Assess the client's ability to swallow and cough effectively.
Rationale: Hoarseness after thyroidectomy is often due to transient laryngeal nerve edema
or trauma. While it may be expected, the priority is to assess for airway protection by
evaluating the client's ability to swallow and cough effectively. Reassurance (A) may be
appropriate but assessment comes first. Notifying the provider (C) may be necessary but not
the immediate priority. Calcium gluconate (D) is for hypocalcemia, not hoarseness.
12. A nurse is teaching a client about the signs of thyroid storm. Which of the following
should be included?
A. Bradycardia and lethargy
B. Fever and delirium
C. Constipation and dry skin
D. Weight gain and cold intolerance
Answer: B. Fever and delirium
Rationale: Thyroid storm is a life-threatening exacerbation of hyperthyroidism characterized
by hyperpyrexia (fever), delirium or agitation, tachycardia, hypertension, and cardiovascular
collapse. Bradycardia (A), constipation (C), and weight gain with cold intolerance (D) are
manifestations of hypothyroidism.
13. A nurse is reviewing laboratory results for a client with suspected hyperthyroidism.
Which of the following findings is expected?
A. Elevated TSH
Comprehensive Test Bank (200 Questions)
SECTION 1: Thyroid Disorders (Questions 1-35)
1. A nurse is assessing a client with Graves' disease. Which of the following findings should
the nurse expect?
A. Periorbital edema
B. Bradycardia
C. Weight gain
D. Cold intolerance
Answer: A. Periorbital edema
Rationale: Graves' disease is an autoimmune form of hyperthyroidism. Periorbital edema
(exophthalmos) is a classic finding due to lymphocytic infiltration and edema of the orbital
tissues. Bradycardia, weight gain, and cold intolerance are manifestations of hypothyroidism,
not hyperthyroidism.
2. A nurse is caring for a client who is 24 hours post-thyroidectomy. The client reports
muscle cramps and tingling in the fingers. Which of the following laboratory values should
the nurse check first?
A. Thyroid-stimulating hormone (TSH)
B. Serum calcium
C. Serum potassium
D. White blood cell count
Answer: B. Serum calcium
Rationale: Muscle cramps and tingling in the fingers (paresthesia) are early signs of
hypocalcemia, a potential complication following thyroidectomy due to accidental removal
or damage to the parathyroid glands. Hypocalcemia can lead to tetany and laryngeal stridor.
Checking serum calcium is the priority. TSH levels (A) assess thyroid function but do not
explain acute postoperative symptoms. Potassium (C) imbalances typically cause weakness
or cardiac dysrhythmias. WBC count (D) would assess for infection but not the described
neurological symptoms.
3. A nurse is teaching a client about levothyroxine therapy. Which of the following
statements indicates the client understands the teaching?
A. "I will take this medication on an empty stomach in the morning."
B. "I can stop taking this medication when my symptoms improve."
C. "I will take this medication with my evening meal."
D. "This medication will cure my hypothyroidism within 6 months."
Answer: A. "I will take this medication on an empty stomach in the morning."
,Rationale: Levothyroxine is best absorbed when taken consistently on an empty stomach,
typically 30-60 minutes before breakfast. It should not be stopped (B) even when symptoms
improve, as hypothyroidism is a lifelong condition requiring continuous replacement. Taking
with food (C) reduces absorption. The medication manages, not cures, the condition (D).
4. A nurse is assessing a client with myxedema coma. Which of the following findings is
the priority?
A. Hypothermia
B. Bradycardia
C. Hypotension
D. Decreased level of consciousness
Answer: D. Decreased level of consciousness
Rationale: Myxedema coma is a life-threatening complication of severe hypothyroidism.
While hypothermia, bradycardia, and hypotension are all present, decreased level of
consciousness indicates neurological compromise and is the priority finding as it reflects the
severity of the condition and risk for airway compromise. Using the ABCs (Airway, Breathing,
Circulation) and prioritizing the most life-threatening manifestation, altered mental status
poses the greatest immediate risk.
5. A nurse is preparing a client for a thyroid scan. Which of the following instructions
should the nurse provide?
A. "You will need to fast for 12 hours before the procedure."
B. "You will receive a radioactive iodine tracer intravenously."
C. "You should avoid taking thyroid medications for several weeks before the test."
D. "This test will measure the amount of thyroid hormone in your blood."
Answer: C. "You should avoid taking thyroid medications for several weeks before the
test."
Rationale: For a thyroid scan, clients are typically instructed to discontinue thyroid
medications (levothyroxine, antithyroid drugs) and avoid iodine-containing substances for
several weeks to ensure accurate uptake results. Fasting (A) is not typically required. The
tracer is usually oral, not IV (B). The test measures uptake and structure, not blood hormone
levels (D).
6. A nurse is monitoring a client who is receiving radioactive iodine therapy for
hyperthyroidism. Which of the following instructions should the nurse include?
A. "You should use a private bathroom and flush twice."
B. "You may share utensils with family members."
C. "You should avoid close contact with others for 1 hour."
D. "You do not need to use contraception after this treatment."
Answer: A. "You should use a private bathroom and flush twice."
,Rationale: After radioactive iodine therapy, the client's body fluids are radioactive for several
days. Safety precautions include using a private bathroom, flushing twice, not sharing
utensils (B), avoiding close contact for several days to weeks (not 1 hour, C), and using
reliable contraception for at least 6-12 months (D) due to risk to fetus.
7. A nurse is assessing a client with hyperthyroidism. Which of the following findings is
consistent with this condition?
A. Constipation
B. Lethargy
C. Tachycardia
D. Weight gain
Answer: C. Tachycardia
Rationale: Hyperthyroidism causes a hypermetabolic state with increased sympathetic
nervous system activity, leading to tachycardia, palpitations, and hypertension. Constipation
(A), lethargy (B), and weight gain (D) are manifestations of hypothyroidism.
8. A nurse is providing discharge teaching to a client who had a thyroidectomy. The nurse
should instruct the client to report which of the following findings immediately?
A. Mild pain at the incision site
B. Difficulty swallowing
C. Hoarseness
D. Tingling around the mouth
Answer: D. Tingling around the mouth
Rationale: Tingling around the mouth (circumoral paresthesia) is an early sign of
hypocalcemia due to parathyroid damage or removal. This can progress to tetany, laryngeal
stridor, and respiratory arrest. This finding requires immediate reporting and intervention.
Mild incisional pain (A) is expected. Difficulty swallowing (B) and hoarseness (C) can occur
due to surgical trauma and inflammation but are not as immediately life-threatening as
hypocalcemia.
9. A nurse is assessing a client who has hypothyroidism. Which of the following findings
should the nurse expect?
A. Diarrhea
B. Insomnia
C. Dry skin
D. Palpitations
Answer: C. Dry skin
Rationale: Hypothyroidism results in decreased metabolic rate, leading to dry, coarse skin;
brittle hair; and cold intolerance. Diarrhea (A), insomnia (B), and palpitations (D) are
associated with hyperthyroidism.
, 10. A nurse is administering propylthiouracil (PTU) to a client with Graves' disease. The
nurse should monitor the client for which of the following adverse effects?
A. Hypoglycemia
B. Agranulocytosis
C. Hypertension
D. Weight gain
Answer: B. Agranulocytosis
Rationale: Propylthiouracil (PTU) is an antithyroid medication that can cause
agranulocytosis, a potentially fatal decrease in white blood cells. The nurse should monitor
for signs of infection such as sore throat, fever, and malaise. Hypoglycemia (A) is not a
common adverse effect. Hypertension (C) and weight gain (D) are not typical adverse effects
of PTU; weight gain may occur as hyperthyroidism is controlled.
11. A nurse is caring for a client following a thyroidectomy. The client's voice is hoarse.
Which of the following actions should the nurse take?
A. Reassure the client that this is expected and will resolve in 24 hours.
B. Assess the client's ability to swallow and cough effectively.
C. Notify the provider immediately.
D. Administer prescribed calcium gluconate.
Answer: B. Assess the client's ability to swallow and cough effectively.
Rationale: Hoarseness after thyroidectomy is often due to transient laryngeal nerve edema
or trauma. While it may be expected, the priority is to assess for airway protection by
evaluating the client's ability to swallow and cough effectively. Reassurance (A) may be
appropriate but assessment comes first. Notifying the provider (C) may be necessary but not
the immediate priority. Calcium gluconate (D) is for hypocalcemia, not hoarseness.
12. A nurse is teaching a client about the signs of thyroid storm. Which of the following
should be included?
A. Bradycardia and lethargy
B. Fever and delirium
C. Constipation and dry skin
D. Weight gain and cold intolerance
Answer: B. Fever and delirium
Rationale: Thyroid storm is a life-threatening exacerbation of hyperthyroidism characterized
by hyperpyrexia (fever), delirium or agitation, tachycardia, hypertension, and cardiovascular
collapse. Bradycardia (A), constipation (C), and weight gain with cold intolerance (D) are
manifestations of hypothyroidism.
13. A nurse is reviewing laboratory results for a client with suspected hyperthyroidism.
Which of the following findings is expected?
A. Elevated TSH
