ch 35,36,37
The nurse explains that, when the target tissue signals that the need for a specific hormone is satisfied, the endocrine gland inhibits the secretion. This process is called _____________.
negative feedback
The nurse explains that the three cardinal signs of type 1 diabetes mellitus (DM) are __________, __________, and __________.
polydipsia, polyphagia, polyuria
Which factor(s) may cause diabetes mellitus (DM)? (select all that apply.) a. Genetic b. Microbiologic c. Metabolic d. Allogenic e. Immunologic
A, B, C, E Genetic, microbiologic, metabolic, and immunologic factors influence the development of diabetes mellitus. Allogenic refers to cells or tissues that are from different individuals in the same species.
Which action describes a function of aldosterone? a. Conserve water b. Excrete sodium c. Constrict blood vessels d. Excrete phosphorus
A Aldosterone is classified as a mineralocorticoid. It promotes conservation of water by acting on the kidneys to retain sodium in exchange for potassium, which is excreted in the urine.
The nurse is counseling an overweight, noncompliant, 30-year-old female with type 2 diabetes. Which change is most important for the nurse to suggest? a. Begin an exercise program and lose weight. b. Obtain annual eye examinations. c. Keep a food diary. d. Inspect feet daily.
A All of these changes are important, but exercise and weight loss are priority changes. In the type 2 diabetic, weight reduction and increased physical activity can restore blood glucose to normal levels and maintained it—hence the importance of diet and exercise in the management of type 2 diabetes. Annual eye examinations are important to detect onset of diabetic retinopathy. A food diary can help the patient to visualize food intake that may be subconscious otherwise. Diabetics are prone to foot problems and wounds and should inspect their feet daily.
The nurse is caring for a patient who is scheduled to have a thyroid panel drawn next week. After confirming with physician, which information is most important for the nurse to include in the patient instructions? a. Do not take aspirin for 2 days before the test. b. Take an OTC antacid 30 minutes before the test. c. Take the preprocedure diuretic 30 minutes before the test. d. Do not take any multivitamins for 2 days before the test.
A Aspirin, iodine-containing medications, contrast media, and other drugs may affect result. To ensure an accurate test result, aspirin should be avoided for 2 days before testing. Birth control pills also will alter the test results. Antacids, diuretics, and multivitamins do not affect the results of a thyroid panel.
A patient with central diabetes insipidus (DI) likely has which occurrence as part of his health history? a. Brain surgery to remove a tumor b. A kidney disorder c. Water addiction d. A thyroid disorder
A Central DI is caused by insult to the pituitary that results from a brain injury or invasive brain surgery. Kidney disorders, water addiction, and thyroid disorders do not cause central DI.
A nurse is teaching a patient with Addison disease who has a prescription for corticosteroids. Which statement is most important for the nurse to include in the teaching plan? a. Take the medication every day. b. Take the medication on an empty stomach. c. Stop the medication if gastrointestinal symptoms appear. d. Double the medication during stressful events.
A Corticosteroids should be taken every day. Corticosteroids should be administered with food. The medications should not be abruptly discontinued. To provide appropriate serum medication levels, they are not to be doubled or altered without physician consultation.
Which goal is the primary objective of a diabetic diet? a. Adequate nutrition with weight control b. Exclusion of all sweets c. Increased fat intake for greater energy d. Elimination of all fast foods
A Currently, the diabetic diet is much less stringent than diets of years past. The primary goal of the current diabetic diet includes adequate nutrition with weight and cholesterol control. The newer diets allow for some sweets and some fast foods. Fats are not adequate sources of energy. Fat intake should be limited to reduce complications related to weight gain and cardiovascular concerns.
The nurse is caring for a patient who struggles to maintain glycemic control at night and during early morning hours. Which statement correctly explains the reason for this problem? a. Counterregulatory hormones produce hyperglycemia. b. Hyperglycemia of dawn phenomenon does not react to insulin. c. Hypoglycemia quickly follows the dawn phenomenon. d. Food intake fails to change hyperglycemia of dawn phenomenon.
A Dawn phenomenon is produced in the morning by the circadian release of growth hormones, epinephrine, and glucagon during the night. Rebound hyperglycemia, also known as the Somogyi effect, follows a period of hypoglycemia, often during sleep. When hypoglycemia occurs, the body secretes glucagon, epinephrine, growth hormone, and cortisol to counteract the effects of low blood sugar. The patient may report nightmares and night sweats along with morning elevated serum glucose; if the patient increases the insulin dose, it worsens the problem. The dawn phenomenon is characterized by elevated blood glucose in the morning and is caused by release of growth hormone, glucagon, and epinephrine during the night, as part of the body's natural circadian rhythm. These hormones act to raise the body's blood sugar. The dawn phenomenon is the reason why most people with diabetes do not tolerate carbohydrates well in the morning. The treatment is an intermediate-acting insulin at night.
Which laboratory values are consistent with a patient in ketoacidosis? a. Blood urea nitrogen (BUN) of 35 mg/dL b. Carbon dioxide (CO2) of 40 mEq/L c. pH of 7.54 d. Blood glucose of 70 mg/dL
A Diabetic ketoacidosis results when the body attempts to metabolize protein and fats, which results in high BUN readings. The CO2 should be normal or low depending on the effectiveness of Kussmaul respirations. The arterial pH will be low, and there will be high glucose, which the diabetic patient cannot use.
Which statement accurately describes endocrine glands? a. Endocrine glands release secretions directly into the bloodstream. b. Endocrine glands release secretions via a duct into the bloodstream. c. Endocrine glands hold secretions in a reservoir until needed. d. Endocrine glands can produce constantly for body needs.
A Endocrine glands secrete directly into the bloodstream, whereas exocrine glands secrete via a duct.
The nurse notes that the HbA1c level of an assigned patient demonstrated a drop from 9.4% to 5.4%. What can the nurse infer from these findings? a. The patient's blood glucose control has improved over the last several months. b. The patient has been less compliant with the prescribed treatment regimen. c. The patient is experiencing a reduction in insulin sensitivity. d. The patient has less need for insulin.
A HbA1c is a diagnostic assessment used to review blood glucose levels retrospectively. A reduction in the value indicates improved glucose control by the patient. There is no evidence of insulin sensitivity. The need for insulin is not decreased in this patient.
If an endocrine gland begins to hypersecrete, it usually causes which result? a. Hyperplasia b. Activation of the inflammatory process c. An allergic response d. An autoimmune response
A Hyperplasia (increased cellular growth) is the usual cause of hypersecretion of an endocrine gland.
The nurse is reviewing the patient's prescribed insulin regimen. The nurse notes that the physician has ordered a long-lasting insulin. Which medication best meets this criteria? a. Lantus b. NovoLog c. Humalog d. Regular
A Lantus is a long-lasting insulin. It may be administered only one time per day. NovoLog and Humalog are both rapid-onset insulin preparations. Regular insulin is classified as a short-acting insulin.
Where in the body are mineralocorticoids and glucocorticoids produced? a. Adrenal cortex b. Adrenal medulla c. Pancreas d. Hypothalamus
A Mineralocorticoids and glucocorticoids are the products of the adrenal cortex.
A long-term diabetic patient reports that he has been diagnosed with early cardiovascular disease. How does diabetes predispose the patient to cardiovascular complications? a. Hyperglycemic periods cause thickening of the basement membrane in vessels, which causes atherosclerosis. b. Hypoglycemic periods increase cortisol release, which causes hypertension. c. Insulin constricts the cardiovascular vessels, which causes congestive heart failure. d. Diabetes decrease in the body's ability to digest fats by the pancreas, which leads to increased coronary artery blockage.
A Periods of hyperglycemia cause thickening of the vessels, chiefly the basement membrane (thin layer of connective tissue under the epithelium). The vessels of the retina, renal glomeruli, peripheral nerves, muscles, and skin are affected. Larger vessels are also affected, predisposing the patient to atherosclerosis and vascular occlusion. Two out of three people with diabetes die prematurely from heart attack or stroke.
The nurse is reviewing the health history of a patient. Which behavior is linked to increased probability of developing Grave disease? a. Smoking b. Long-term use of oral contraceptives c. Excessive alcohol consumption d. Use of St. John wort
A Primary hyperthyroidism is also known as Grave disease or toxic goiter. Medications containing iodine, such as amiodarone (an antidysrhythmic heart medication), can predispose to hyperthyroidism. In addition, it has been discovered recently that people who smoke have nearly twice the risk of developing hyperthyroidism when compared with nonsmokers.
The patient with hyperthyroidism is undergoing ablation therapy with radioactive iodine. Which precaution is most important for the nurse to employ? a. Take radioactive precautions with syringes and bedpans. b. Use Standard Precautions only. c. Enforce isolation for 3 days. d. Wear a mask and eye protectors when caring for patient.
A Radioactive iodine (131I) circulates in the blood and is excreted by the kidneys, so radioactive precautions should be taken with any equipment contaminated with blood or urine.
The nurse is educating a 50-year-old patient about diabetes monitoring. Which statement reinforces the American Diabetes Association's (ADA's) recommendation? a. Obtain regularly scheduled fasting blood glucose levels. b. Strictly adhere to weight reduction diets. c. Exercise regularly in intervals lasting a minimum of 30 minutes. d. Use stress reduction techniques.
A The ADA recommends screening with a fasting blood glucose. Adherence to a weight loss plan, regular exercise, and stress reduction techniques help control diabetes but do not monitor it.
Which gland secretes androgenic hormones? a. Adrenal cortex b. Hypothalamus c. Pancreas d. Pituitary
A The adrenal cortex secretes the androgenic hormones.
The nurse is educating the patient about the significance of islet cell antibodies. Which statement accurately describes islet cell antibodies? a. Islet cell antibodies cause beta cells to quit producing insulin and lead to type 1 diabetes mellitus (DM). b. Islet cell antibodies protect beta cells from viral attack. c. Islet cell antibodies increase production of insulin from beta cells. d. Islet cell antibodies decrease the size of the pancreas.
A The antibodies cause beta cells to quit production of insulin.
The nurse is caring for a patient undergoing the fluid deprivation test. This test is designed to confirm which condition? a. Diabetes insipidus b. Diabetes mellitus c. Hypothyroidism d. Hyperparathyroidism
A The fluid deprivation test is used to assess for the presence of diabetes insipidus.
The patient with Addison disease is receiving IV fluids for rehydration. The nurse should carefully monitor the patient for which potential problem? a. Hypotension b. Hyperglycemia c. Hypokalemia d. Hypernatremia
A The patient with Addison disease is at risk for an addisonian crisis. During an addisonian crisis, decreased levels of cortisol result in decreased sensitivity of the blood vessels to sympathetic stimulation. It is the sympathetic stimulation that maintains vascular tone. Lack of vascular tone causes vasodilation, producing hypotension. Addisonian crisis requires immediate fluid replacement therapy in order to prevent irreversible shock. Intravenous hydrocortisone is given along with sodium, fluids, and dextrose until blood pressure becomes stable. The hydrocortisone is then tapered off slowly. Hyperkalemia must also be addressed with insulin, Kayexalate, and loop diuretics, and by monitoring arrhythmias and the patient's intake and output. Hypoglycemia is treated with IV glucose and with glucagon as needed; blood glucose is monitored every hour.
Intake of which nutrients directly impacts thyroid hormone production? a. Protein and iodine b. Fats and vitamins c. Carbohydrates and minerals d. Sodium and potassium
A The production of thyroid hormone is dependent on the intake of protein and iodine.
Although thyroid hormone levels decrease with advancing age, which mechanism offsets this output reduction? a. Decreased rate of thyroid hormone breakdown b. Increased level of calcium c. Increased level of phosphorus d. Decreased mineralocorticoids
A The production of thyroid hormones decreases with age, but the decrease is offset by a matching decrease in the body's breakdown of the hormone. Changes in thyroid hormone levels are not affected by calcium, phosphorus, or mineralocorticoid levels.
A tumor of the pituitary has caused the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Which interventions should the nurse plan? (select all that apply.) a. Assist with activities of daily living. b. Record accurate urine. c. Weigh the patient daily. d. Assess for changes in level of consciousness. e. Assess stools for occult blood.
A, B, C, D The nurse should assist with activities of daily living because of weakness, record accurate urine output because of oliguria, weigh the patient daily to assess fluid volume status, and assess for changes in level of consciousness. There is no overt threat of a GI bleed with SIADH, so assessing stools for occult blood is not indicated.
In which body process(es) is/are the endocrine system involved? (select all that apply.) a. Regulation of metabolism b. Growth rate c. Physical development d. Sexual function e. Reproductive process
A, B, C, D, E All functions listed are affected or controlled by the pituitary gland.
Which manifestations occur with a benign pituitary adenoma? (select all that apply.) a. Gigantism in children b. Acromegaly in adults c. Muscle weakness d. Excessive hair growth e. Joint pain
A, B, C, E A benign pituitary adenoma may cause gigantism in children, acromegaly in adults, muscle weakness, and joint pain. A benign pituitary adenoma does not cause excessive hair growth (hirsutism).
The nurse is planning care for a patient with diabetes insipidus (DI). Which outcomes are important for the nurse to include? (select all that apply.) a. Maintain fluid therapy. b. Conserve energy. c. Supporting dietary choices to reduce diarrhea. d. Assess for bradycardia. e. Encouraging exercise to reduce weight.
A, B, D Goals for the patient with DI should include fluid therapy maintenance, energy conservation, and assessment for bradycardia. DI patients are often constipated and frail from weight loss.
The nurse is caring for a patient suspected of having ketoacidosis. Which manifestation(s) is/are characteristic with early ketoacidosis? (select all that apply.) a. Fruity breath b. Polyuria c. Nausea d. Thirst e. Sunken eyes
A, B, D Ketoacidosis is a complication associated with type 1 diabetes. Some of the earliest symptoms may be polyuria, fatigue, anorexia, abdominal pain, and a fruity smell to the breath. Later signs and symptoms include sunken eyes as a result of excessive dehydration. Nausea is not associated with ketoacidosis.
The nurse planning the postoperative instructions for the patient who will undergo a hypophysectomy. Which information is most important for the nurse to include? (select all that apply.) a. A drip pad will be placed under your nose. b. Avoid brushing your teeth. c. Avoid raising your arms above your head. d. Breathe through your mouth. e. Avoid blowing your nose.
A, B, D, E Removal of the pituitary gland is most often done microsurgically. The usual approach is transsphenoidal via the nose or at the junction of the gums and upper lip, and a nasal drip pad is placed. After surgery it is important that the patient not brush his teeth, cough, sneeze, blow his nose, or bend forward, as these may interfere with the healing process. The patient is allowed to raise his arms above his head.
Which hormone(s) does the anterior pituitary secrete? (select all that apply.) a. Growth hormone (GH) b. Thyroid-stimulating hormone (TSH) c. Antidiuretic hormone (ADH) d. Follicle-stimulating hormone (FSH) e. Luteinizing hormone (LH)
A, B, D, E The anterior pituitary secretes GH, TSH, FSH, and LH. The posterior pituitary secretes ADH.
The nurse is evaluating the laboratory results of a patient suspected of having hyperparathyroidism. Which finding(s) would be consistent with this condition? (select all that apply.) a. Anorexia b. Decreased serum phosphate levels c. Diarrhea d. Agitation e. Increased serum calcium levels
A, B, E Hyperparathyroidism would result in anorexia, low serum phosphate, and increased serum calcium. Hyperparathyroidism would cause constipation rather than diarrhea and lethargy rather than agitation.
Which statement(s) explain(s) a reason for weight loss in type 1 diabetics? (select all that apply.) a. Loss of body fluid b. Insulin intolerance c. Metabolization of body fats d. Stress of disease e. Altered diet
A, C Weight loss in type 1 diabetics can be attributed to loss of body fluids and metabolization of fats. Insulin intolerance, stress of the disease, and altered diet are not reasons for weight loss in type 1 diabetes.
On the first postoperative day following a total thyroidectomy, which finding(s) would lead the nurse to suspect that the patient may be developing a thyroid storm? (select all that apply.) a. Temperature of 101.8° F b. Pulse of 58 beats/min c. Brief attention span d. Apprehension and restlessness e. Respiratory rate of 12 breaths/min
A, C, D Rising temperature, a brief attention span, and apprehension with restlessness would indicate a developing thyroid storm. Increasing pulse and respirations are other manifestations of thyroid storm.
Which classic signs and symptoms are manifestations of hyperthyroidism? (select all that apply.) a. Tremulousness b. Bradycardia c. Exertional dyspnea d. Scanty menstruation e. Increased thirst and urination
A, C, D, E Manifestations of hyperthyroidism include tremulousness, exertional dyspnea, scanty menstruation, and increased thirst and urination. Hyperthyroidism causes tachycardia.
When discussing exercise programs with the diabetic, which instruction(s) is/are important for the nurse to include? (select all that apply.) a. Delay exercise until glucose controlled. b. Check glucose immediately after exercising. c. Keep a quick source of glucose readily available while exercising. d. Begin slowly and build up to 30 to 45 minutes. e. Only use the abdominal injection site for insulin.
A, C, D, E The patient should delay exercise until glucose is controlled, keep a quick source of glucose readily available, begin slowly and build, and use the abdominal injection site for insulin. The patient should check the glucose level before exercising.
Which causative factor(s) may be responsible for primary endocrine disorders? (select all that apply.) a. Hormone overproduction b. Long periods of limited mobility c. Trauma d. Severe infection e. Effects of certain drugs
A, D Endocrine disorders are caused by an imbalance in the production of hormone or by an alteration in the body's ability to use the hormones produced. Primary endocrine dysfunction means that an endocrine gland is either oversecreting or undersecreting hormone(s). Tumor or hyperplasia of the endocrine gland may lead to hypersecretion. Infection, mechanical damage, or an autoimmune response may be an inflammatory response in a gland and lead to hyposecretion. Secondary endocrine dysfunction occurs from factors outside the gland itself. Medications, trauma, hormone therapy, and other factors may cause secondary dysfunction. Long periods of limited mobility do not cause endocrine disorders.
Which genetic factor(s) increase(s) the risk of a person developing diabetes mellitus (DM)? (select all that apply.) a. Number of relatives with DM b. Body mass index (BMI) c. Sedentary lifestyle d. Genetic closeness of relatives with DM e. Race
A, D, E Genetic factors that increase the risk of developing diabetes include the number and genetic closeness of relatives with diabetes, as well as race. BMI and sedentary lifestyle are not genetic factors.
Which statement accurately describes a subtotal thyroidectomy? a. It allows the patient to take minimum amounts of antithyroid drugs. b. It allows continued production and release of thyroid hormones from the remainder of the gland. c. It reduces exophthalmos. d. It poses less postoperative risk than a total thyroidectomy.
B Patients who do not respond well to antithyroid drug therapy, who are unable to take radioactive iodine, or who have greatly enlarged thyroid glands are candidates for a subtotal thyroidectomy. In the subtotal procedure, two thirds of the glandular mass is removed. The remaining portion of the gland is left intact so production and release of thyroid hormone can continue. There is no need for antithyroid drugs, and the operative risks are the same.
The patient comes to the emergency room complaining of abdominal pain. The nurse assesses dry, hot skin, fruity breath, and deep respirations. To which problem should the nurse attribute these findings? a. An insulin reaction b. Ketoacidosis c. Rebound hyperglycemia d. Hypoglycemia
B Abdominal pain with dry, hot skin, fruity breath, and deep respirations is characteristic of ketoacidosis. Manifestations of an insulin reaction, or hypoglycemia, include tremulousness, hunger, headache, pallor, sweating, palpitations, blurred vision, and weakness. Rebound hyperglycemia, or the Somogyi effect, follows a period of hypoglycemia, often during sleep. When hypoglycemia occurs, the body secretes glucagon, epinephrine, growth hormone, and cortisol to counteract the effects of low blood sugar. The patient may report nightmares and night sweats along with morning elevated serum glucose; if the patient increases the insulin dose, it worsens the problem.
The nurse is educating a patient who has a new prescription for methimazole (Tapazole). Which instruction is most important for the nurse to include? a. "Double the next medication dose if the previous dose is forgotten." b. "Take the medication on a strict schedule." c. "Ask the pharmacist for a less expensive generic substitute." d. "The medication is approved for use in pregnant women."
B All replacement hormone drugs should be taken on a strict schedule. Doubling up and taking a substitute drug interfere with the effectiveness of the therapy. Pregnant women should not take this drug because of risk for fetal damage.
The nurse is caring for a patient who is scheduled to undergo a glucose tolerance test next week. The patient's daily medications include an antihypertensive, oral contraceptives, and over-the-counter (OTC) vitamin C and calcium supplements. The nurse should instruct the patient to withhold which medication before the test? a. Antihypertensive agent b. Oral contraceptive c. Vitamin C d. Calcium supplement
B Birth control pills will affect the reliability of the glucose tolerance test and should be withheld. Antihypertensive agents, vitamin C, and calcium supplements do not affect the reliability of glucose screening tests.
The nurse is educating an older adult patient with reduced cortisol levels. Which statement indicates that the patient accurately understands the nurse's teaching? a. "I should avoid crowds because low cortisol levels weaken my immune system." b. "I should keep stress to a minimum because low cortisol levels make it harder for my body to deal with stress." c. "I should avoid hot climates because low cortisol levels impact temperature regulation." d. "I should avoid salty foods because low cortisol levels keep my body from processing sodium."
B Cortisol is a mineralocorticoid produced by the adrenal glands. Cortisol acts to increase glucose levels in the blood. Cortisol also helps counteract the inflammatory response. The reduced production of cortisol hinders the older adult in dealing with stress.
Which corticoid counteracts the inflammatory response? a. Thyroxine b. Cortisol c. Insulin d. Norepinephrine
B Cortisol is the corticoid that counteracts the inflammatory process. Thyroxine is secreted by the thyroid gland. Insulin is secreted by the beta cells of the pancreas. It is responsible for regulation of blood glucose levels. Norepinephrine is secreted by the adrenal medulla in response to stimulation from the sympathetic nervous system. It functions as a pressor (causing blood vessel constriction) hormone to maintain blood pressure.
A patient who had a hypophysectomy 3 days ago begins to have 3000 mL of urine output every shift and complains of thirst and a dry mouth. Which problem does the nurse suspect? a. Overreaction to diuretics b. Diabetes insipidus (DI) c. Diabetes mellitus d. Glucose intolerance
B DI is a complication of a hypophysectomy. The posterior lobe of the pituitary gland controls urinary output; when this portion of the pituitary is removed or damaged, there is no secretion of antidiuretic hormone to stop excessive urine output.
The nurse is caring for patient who is 8 hours postoperative after a total thyroidectomy. The patient complains of muscle cramps, and the nurse assesses a positive Chvostek sign. The nurse correctly interprets that these findings indicate which complication? a. Imminent convulsions b. Hypoparathyroidism c. Hyperkalemia d. Thyroid storm
B Hypoparathyroidism results when the parathyroid glands are removed during a total thyroidectomy. Chvostek sign (muscle irritability when the facial nerve is gently tapped) is consistent with hypocalcemia that occurs secondary to the removal of the parathyroid glands.
The nurse is performing preoperative thyroidectomy instruction for a patient with Graves' disease. The patient begins to cry and says, "I am so nervous and can't listen to you. Just get out!" What should the nurse do next? a. Give the patient written preoperative instructions. b. Inform the charge nurse or surgeon of the patient's behavior. c. Remind the patient the preoperative information is important. d. Ask the family member to explain the preoperative instructions.
B Informing the charge nurse or surgeon will alert them to possible ineffective control of the thyroid, which can cause thyroid crisis postoperatively. The patient is not ready to read or listen to any instructions at this time, and instruction should not be deferred to a family member.
The nurse is discussing insulin administration with an assigned patient. The patient reports that she prefers to use only certain sites for insulin injections and questions the need to rotate sites. What response by the nurse is most appropriate? a. "Rotating injection sites helps reduce your risk of infection." b. "Rotating injection sites helps enhance insulin absorption." c. "Unsightly fatty tumors can develop when you do not adequately rotate injection sites." d. "Rotating injection sites decreases your risk of an insulin reaction."
B Insulin injections are rotated within one body area to enhance absorption. Patients are given charts showing the places on the arms, legs, buttocks, and abdomen where insulin can be injected. Patients should be encouraged to keep a daily record of injection sites to help remember which sites have been used and to avoid the problem of altered or erratic absorption, which is a complication associated with overuse of a single site. The most important way to reduce the incidence of infection is to wash the hands before insulin administration and to avoid reusing syringes. Fatty tumors are not complications of overuse of a single injection site. The term insulin reaction refers to hypoglycemia, and hypoglycemia is not directly associated with the failure to rotate injection sites.
Which change(s) in endocrine function can be attributed to age? (select all that apply.) a. Pituitary enlargement b. Declining metabolism c. Rising blood glucose levels d. Decreasing epinephrine levels e. Decreasing thyroxine levels
B, C, D, E Age-related endocrine functions include declining metabolism, rising blood glucose levels, and decreasing levels of epinephrine and thyroxine. Aging causes the pituitary gland to become smaller.
The nurse is caring for a patient with ketosis. Which statement indicates that the patient correctly understands the phenomenon? a. "I took too much insulin to decrease my body's glucose levels." b. "The condition resulted when my body tried to break down and use my stores of fats." c. "My blood glucose went over 150 mg/dL and caused this condition." d. "I exercised too much reduced my blood glucose level too dramatically."
B People with type 1 diabetes are more prone to a serious complication, ketosis, associated with an excess production of ketone bodies, leading to ketoacidosis (metabolic acidosis). When the glucose level gets too high, the body attempts to metabolize fats for energy, and the result is a buildup of ketone bodies.
A patient recently diagnosed with type 1 diabetes mellitus (DM) asks why she is experiencing increased thirst. Which explanation is most appropriate? a. Diabetes results in a lack of protein absorption that decreases amino acids and causes increased thirst. b. High glucose levels in the blood pull cellular water into circulating volume and increase thirst. c. Thirst results from the body's increased loss of fluids from frequent urination. d. Diabetes causes large amount of fluid to shut to the pancreas, which dehydrates the body.
B Polydipsia is stimulated by cellular dehydration from the hyperglycemia pulling intracellular fluid into the circulating volume.
The husband of a patient with Grave disease confides that he is frustrated with his wife's emotional outbursts and wide mood swings. How should the nurse respond? a. "I understand how you feel." b. "Antithyroid drugs usually help regulate mood swings after a few weeks." c. "I'm afraid this behavior will continue. How are you coping with it now?" d. "Have you told her how you feel?"
B Reassurance that the signs and symptoms will improve with medication is helpful. The nurse may or may not understand how the patient feels, and this dismisses the husband's concern. The behavior may or may not continue, and asking how the husband is coping or if he has shared his feelings are examples of nontherapeutic communication.
A patient asks the nurse if stress can be a potential cause of type 2 diabetes. Which response is most appropriate for the nurse to make? a. "Stress decreases the number of alpha cells in the pancreas, and increases the workload on the beta cells." b. "Periods of stress cause increases in glycogen production by the adrenal cortex." c. "Stress is directly associated with decreased insulin tolerance." d. "The inhibition of beta cells to glucose is increased in periods of stress."
B Stress stimulates the adrenal cortex to release glucocorticoids, which can cause hyperglycemia.
The nurse is caring for a patient who has orders for a 17-ketosteroid (17-KS) test. Which preparation is most important for the nurse to make? a. Keep the patient NPO after midnight the night before the test. b. Ensure adequate space for the specimen container is available in the refrigerator. c. Withhold the patient's metformin for 24 hours prior to the test. d. Request an order for an antacid.
B The 17-KS test is used to determine the amount of androgen metabolites in the urine and requires a 24-hour urine collection. The urine collection container must be kept chilled, so the nurse should ensure that adequate space is available in the specimen refrigerator. This test does not require the patient to fast. The nurse should consult with the physician and laboratory regarding the patient's medications but should not withhold any without orders. Antacids will not alter the test results.
The nurse is caring for an 80-year-old patient with a history of type 2 diabetes and hypothyroidism. The physician wants to evaluate the patient's blood glucose levels and orders a fructosamine assay. Which factor best explains why the physician chose this laboratory test instead a glycosylated hemoglobin (HbA1c) test? a. The patient's age b. Type 2 diabetes c. Hypothyroidism d. The tests' costs
B The fructosamine assay is a diagnostic test used to assess the degree of diabetic control of blood sugar over the preceding 2- to 3-week period. The fructosamine assay is a better tool for the older adult as it is less influenced by age. The fructosamine assay is not specific to type 1or type 2 diabetes. Its accuracy is not affected by hypothyroidism. While the fructosamine assay is simpler and cheaper than an HbA1c test, the accuracy of results for this patient takes priority.
The nurse is aware that the severe dehydration associated with diabetes insipidus (DI) can lead which serious electrolyte imbalance? a. Hypercalcemia b. Hypernatremia c. Hypocalcemia d. Hyperkalemia
B The loss of potassium in the large volume of urine depletes the compensatory mechanisms and hypernatremia results.
Which reason best explains why diabetics are prone to infection? a. High glucose levels provide an environment conducive to bacterial growth. b. Atherosclerotic vascular changes decrease blood supply to tissues. c. Diabetics display abnormal phagocyte function. d. Diabetics display decreased leukocyte function.
B The primary reason for increased risk of infection in diabetic patients is the hyperglycemic environment. Lesser risk factors include atherosclerotic vascular changes, abnormal phagocyte function, and decreased leukocyte function.
The nurse is caring for a patient with a goiter. The nurse correctly uses which technique to administer potassium iodide solution? a. Pour the solution over ice to increase palatability. b. Dilute the solution and administer it through a straw. c. Administer the solution on an empty stomach. d. Mix the solution with an antacid to reduce gastric irritation.
B The solution should be diluted and drunk through a straw to avoid staining of teeth.
Pituitary adenoma antagonizes insulin. This benign tumor results in which imbalance? a. Hyperinsulinism b. Hyperglycemia c. Hypopituitarism d. Hypoglycemia
B The tumor interferes with the effectiveness of insulin, resulting in hyperglycemia.
Which requirement(s) is/are part of the criteria for "tight control" of hyperglycemia? (select all that apply.) a. Perform glucose testing twice daily. b. Administer insulin injections three times a day based on glucometer readings. c. Maintain fasting glucose within normal limits. d. Maintain normal weight for height and age. e. Maintain cholesterol within normal limits.
B, C, D, E Patients attempting tight control follow an intensive therapy plan of blood glucose testing and insulin injections, three or more times a day, or they use an insulin pump. Maintaining a normal fasting glucose, weight for height and age, and cholesterol helps establish "tight control" of hyperglycemia.
Which interventions are indicated for the immediate postoperative care of a person after a thyroidectomy? (select all that apply.) a. Placing the patient in semi-Fowler position. b. Supporting the head with sandbags. c. Assess vital signs hourly. d. Assess the patient's ability to swallow. e. Assess for bleeding.
B, D, E Immediate postoperative care of a person who had a total thyroidectomy includes supporting the head with sandbags, and assessing the patient's ability to swallow, and monitoring for bleeding. The patient should be placed in high Fowler position and vital signs should be assessed every 15 minutes.
The nurse is caring for a patient who is scheduled to undergo a computed tomography (CT) scan with contrast within the hour. Which statement requires the nurse's immediate attention? a. "I forgot that I was not supposed to eat anything." b. "I left my potassium supplements off of my home medication list." c. "Did I tell you that I cannot eat lobster?" d. "I take my daily blood pressure medication at night."
C Before administering tests that involve contrast media, the nurse must ask about allergies to iodine or shellfish. An allergy to either of these may indicate that an individual is hypersensitive to contrast media.
The physician has ordered cortisol level testing for a patient. Which statement indicates that the patient accurately understands the nurse's teaching? a. "I should not eat or drink 6 hours before the procedure." b. "I should exercise for at least 10 minutes during the test." c. "I will have blood samples collected during the day and night." d. "I should limit salty foods the day before the test."
C Cortisol levels are collected during both the day and night to take into account alterations associated with circadian rhythms. The laboratory test does not require the patient to be fasting. Increases in activity levels may promote stress and alter the test results. Dietary intake will not affect the test results.
The patient takes his NovoLog 70/30 at 0700. When should the nurse suggest that the patient schedule exercise? a. 0730. b. 1000. c. 1300. d. Scheduling exercise is unnecessary.
C Exercise should occur after peak action time to prevent hypoglycemia. NovoLog is a rapid-acting insulin that peaks 1 to 3 hours after administration. Since the insulin is administered at 70/30, scheduling exercise for 1300 would mean that it occurs after the peak insulin action.
The nurse is educating a patient with gestational diabetes. Which statement indicates that the patient needs additional teaching? a. "Gestational diabetes happens because of the hormonal changes of pregnancy." b. "I should exercise regularly and lose weight to reduce my risk of becoming a diabetic." c. "This problem goes away completely once I give birth." d. "The baby will have to be monitored for hypoglycemia during my pregnancy."
C Giving birth does not automatically resolve gestational diabetes. Of the women who have gestational diabetes, 5% to 10% go on to develop type 2 diabetes. The patient correctly understands that gestational diabetes occurs because of hormonal changes in pregnancy, proper diet and regular exercise may help decrease the likelihood of developing type 2 diabetes, and the baby will require monitoring for hypoglycemia throughout the patient's pregnancy.
The nurse is caring for an older adult patient who is diabetic. The nurse cautions against the technique of "tight control" of hyperglycemia. Which statement explains why this management method is not recommended? a. Older adults may not accurately test and administer sliding-scale insulin. b. Older adults possess lower risk for hyperglycemia. c. Older adults may experience cardiovascular problems from hypoglycemia. d. Older adults possess an unstable metabolic rate.
C One complication of the "tight control" method includes hypoglycemia. Older adults experience hypoglycemia more quickly than do younger people, and older adults are more prone to hypoglycemic episodes. The older adult may progress to dangerously low levels of blood glucose before signs and symptoms are obvious. Severe hypoglycemia in the older adult can precipitate myocardial infarction, angina, stroke, or seizures. For this reason, "tight control" may not be the best thing for the older adult. Older adults can accurately test and administer insulin, possess a higher risk for hypoglycemia, and do not possess an unstable metabolic rate.
Which actual structural unit secretes insulin? a. Pancreas b. Islets of Langerhans c. Beta cell d. Alpha cell
C The actual structural unit that secretes insulin is the beta cell. Beta cells are found on the islets of Langerhans, which are in the pancreas.
Which gland is the only gland that is both an endocrine gland and an exocrine gland? a. Thyroid b. Hypothalamus c. Pancreas d. Parathyroid
C The pancreas acts as an endocrine gland, secreting insulin directly into the bloodstream, and an exocrine gland, secreting digestive enzymes through ducts.
The nurse is caring for a patient with type 1 diabetes who is diaphoretic and clammy. The patient complains of hunger but denies pain. The nurse performs a bedside blood glucose check. What should the nurse do next? a. Administer insulin as scheduled. b. Notify the charge nurse. c. Give 6 ounces of orange juice. d. Document the findings.
C These findings are consistent with hypoglycemia; manifestations of hypoglycemia include tremulousness, hunger, headache, pallor, sweating, palpitations, blurred vision, and weakness. Management includes providing a source of quick-acting carbohydrate/glucose such as orange juice. The nurse should withhold the patient's scheduled insulin at this time. The nurse should document the findings and then notify the charge nurse.
The nurse watches a patient perform an insulin injection. Which observation(s) indicate(s) that the patient needs additional instruction? (select all that apply.) a. The patient uses a 90-degree angle to administer the injection. b. The patient cleans the injection site with alcohol before the injection. c. The patient rubs the injection site after administration of the insulin injection. d. The patient draws up the cloudy insulin and then the clear insulin. e. The patient shakes the insulin bottle before administration.
C, D, E The patient should not rub the injection site because it could alter absorption. When mixing two types of insulin, in order to prevent contamination of the second vial, the patient should withdraw clear insulin into the syringe first. Shaking the bottle can damage the solution; the patient should gently roll the bottle between the palms of the hands. Administering the injection at a 90-degree angle and cleaning the injection site prior to injection describe appropriate technique.
The nurse is caring for a patient who reports abruptly discontinuing his prescribed levothyroxine. The nurse should carefully monitor the patient for which complication? a. Seizures b. Extreme diarrhea c. Sudden hypertension d. Respiratory distress
D Abruptly stopping hormone replacement can cause the patient to go into myxedema coma. Signs and symptoms of myxedema coma include dizziness, respiratory distress, low blood sugar, or hypothermia. Discontinuation of levothyroxine should not cause seizures, diarrhea, or sudden hypertension.
A patient with type 1 diabetes mellitus (DM) is preparing for a moderate 30-minute exercise period. Which action best indicates that the patient understands condition management? a. The patient reduces insulin use during days when exercise periods are planned. b. The patient administers insulin after exercise rather than before exercise. c. The patient eats a high-carbohydrate snack before the exercise period. d. The patient consumes a simple carbohydrate snack after 30 minutes of activity.
D During moderate exercise (such as brisk walking, bowling, or vacuuming), 5 g of simple carbohydrate should be consumed at the end of 30 minutes and at 30-minute intervals during the continued activity. (A food example with 5 g of simple carbohydrate is 1 tsp honey.)
The nurse is explaining the underlying pathophysiology of type 1 diabetes to a newly diagnosed patient. Which information accurately explains why the type 1 diabetic does not produce adequate insulin? a. A pituitary disorder inhibits beta cells. b. An allergic response alters beta cell responses to hyperglycemia. c. Alpha cells proliferated in the islets of Langerhans. d. The body's immune system destroyed beta cells.
D In type 1 diabetes mellitus (DM), the beta cells on the islets of Langerhans are destroyed by an autoimmune reaction
The nurse is caring for a patient scheduled for a thyroidectomy. Which instruction should be included in the preoperative care? a. Avoid salt for 2 weeks prior to surgery. b. Preoperative medications will include drugs to increase the vascularity of the gland. c. Keep a food diary for 2 weeks prior to surgery. d. Preoperative medications will be given 2 weeks before surgery to reduce the vascularity of the gland.
D Iodine preparations may be given for a period of 10 to 14 days before surgery of the thyroid to reduce the vascularity of the gland, minimizing the danger of releasing large amounts of thyroid hormone into the bloodstream during surgery, and to decrease the risk of hemorrhage.
The nurse is caring for a patient who has been experiencing infertility. Which statement indicates that the patient understands the impact of inadequate luteinizing hormone (LH) levels? a. "Since luteinizing hormone maintains my secondary sex characteristics, low levels explain my small breasts." b. "Low levels of luteinizing hormone cause the swelling I experience during my menstrual cycle." c. "Low levels of luteinizing hormone cause my menstrual cycle irregularities." d. "Since luteinizing hormone stimulates ovulation and progesterone production, low levels could cause infertility."
D LH is produced by the anterior pituitary gland. It targets the ovaries. LH stimulates ovulation and production of progesterone. LH does not affect maintenance of secondary sex characteristics, fluid retention, or menstrual cycle regularity.
Which hormone acts on bone to release calcium into the blood? a. Thyroxine (T4) b. Thyrocalcitonin c. Triiodothyronine (T3) d. Parathormone
D Parathormone, or parathyroid hormone, is produced and secreted by the parathyroid glands. Low calcium levels will stimulate release of parathormone, which increases the plasma level of calcium. Parathormone acts on the renal tubules to increase the excretion of phosphorus in the urine and to stimulate the reabsorption of calcium. Parathormone also acts on bone, causing the release of calcium from the bone into the bloodstream.
Which gland secretes epinephrine and norepinephrine? a. Thyroid b. Pituitary c. Pancreas d. Adrenal medulla
D The adrenal medulla secretes epinephrine and norepinephrine.
The nurse is caring for a long-term diabetic patient with a glycosylated hemoglobin (HbA1c) level of 5%. Which statement indicates that the patient understands this laboratory result? a. "My hemoglobin A levels are excellent." b. "I am anemic and may need a blood transfusion." c. "I should meet with the dietician to discuss better food choices." d. "My glucose control has been excellent for the last few weeks."
D The hemoglobin A1c (A1C) test (formerly called the glycosylated hemoglobin test) measures blood glucose over a period of many weeks. Glucose in the bloodstream attaches itself to the hemoglobin A (red blood cell) molecule and remains there for the life span of the red blood cell. Physicians use A1C test results to prescribe adjustments to a patient's treatment program for managing diabetes. Results of 4.9% to 6.7% are considered excellent results. Good results are between 7.6% and 8.5%. Fair results are between 9.4% and 10.0%. Poor control is considered between 12.1% and 13.0%.
The nurse is educating a patient with a simple goiter. Which statement indicates that the patient needs additional instruction? a. "The lump on my throat is my enlarged thyroid." b. "Treatment stops enlargement of the goiter." c. "I am aware this goiter could develop into cancer." d. "I'm glad my treatment will make this thing go away."
D Treatment usually arrests the growth of the goiter but usually does not diminish the size of the growth unless diagnosis is made early in the disease before growth has become excessive.
Type 2 diabetes cases compose approximately what percentage of all known cases of diabetes? a. 70% b. 75% c. 80% d. 95%
D Type 2 diabetics comprise 90% to 95% of all known cases.
The nurse is preparing a patient to undergo a dexamethasone suppression test. Which action is most appropriate? a. Instruct the patient to be NPO 6 hours before the test. b. Instruct the patient that urine levels will be assessed after a 24-hour collection period. c. Administer a steroid the morning of the test. d. Instruct the patient that a blood specimen will be collected in the morning.
D When assessing for Cushing disease cortisol levels are evaluated. If elevated cortisol levels are noted, a dexamethasone suppression test should be ordered. In preparation for the test, the patient is given a steroid at night, and blood and urine cortisol levels are then measured in the morning.
The nurse's major contribution to the care of a patient with Cushing syndrome is that of __________ and __________.
education; support
