Geriatrics Test 4 Endocrine
Early diagnosis of diabetes in the elderly is often difficult because the classic symptoms of diabetes may be absent. What is the most reliable indicator of diabetes in the elderly? A) High blood glucose level B) Glaucoma C) High urinary glucose level D) Kidney failure
A Feedback: A high blood glucose level, as shown by a glucose tolerance test, is the most reliable indicator. Although glycosuria is evident in younger diabetic patients, it may not occur in the elderly, even when they have hyperglycemia. Glaucoma and kidney failure may result from diabetes eventually, but they can also have other causes.
Based on a 77-year-old client's signs and symptoms, the care team suspects an overactive thyroid gland. Which of the following components of assessment is most likely to yield information that is central to the diagnosis? A) A review of the client's medications, specifically the use of cardiac medications. B) Measurement of the patient's respiration rate, breath sounds, and oxygen saturation. C) Blood work that focuses on liver function. D) Assessment of renal function including a 24-hour urine.
A Feedback: Amiodarone is commonly implicated in cases of hyperthyroidism. Respiratory status and renal and liver function are not directly related to hyperthyroidism.
Which of the following statements best conveys the relationship between hyperglycemia and glycosuria in older adults? A) Older adults' kidneys tolerate higher glucose levels, so hyperglycemia does not necessarily result in glycosuria. B) Because older adults often display atypical signs and symptoms of diabetes, glycosuria coupled with hyperglycemia is considered the most accurate source of a definitive diagnosis. C) Decreased renal filtration capacity in older individuals causes their urine to normally contain more glucose than younger adults'. D) Glycosuria is considered a pathological finding in younger adults but a normal finding in older adults.
A Feedback: An increased renal threshold for glucose means that older adults with hyperglycemia will not necessarily have glycosuria. Hyperglycemia coupled with glycosuria is not, however, considered the most accurate source of diagnosis. Older adults' urine does not normally contain more glucose than younger people's and glycosuria is not considered a normal finding.
Patients with newly diagnosed diabetes are often fearful and nervous about coping with the disease. Only some of their fears are unfounded. Which of these concerns is undeniably true? A) "I will have to make lifestyle changes." B) "I can't learn to inject myself with insulin." C) "I will eventually have to enter a nursing home." D) "I can't afford a special diet."
A Feedback: Most people can adapt to injecting themselves with insulin, and some patients may be able to use oral hypoglycemic agents instead. If diabetes is well managed, patients can continue residing at home, working, and in general living their normal lives. The dietary changes do not need to be expensive, although they do require some planning. It is true, however, that if diabetes is to be managed successfully, the patient cannot continue life as usual. Diet, exercise, and medication all will be needed to keep the disease in check.
A 74-year-old has been diagnosed with type 2 diabetes based on the results of glucose tolerance test during a current hospital stay. The care team has prescribed oral glimepiride. Which of the following guidelines should the patient's nurse use in the administration of the new drug? A) Administer the drug 30 minutes before each meal, beginning the drug with a low dose. B) Give the glimepiride only if blood glucose exceeds 200 mg/dL (11.1 mmol/L). C) Drug levels will be required to determine the therapeutic serum concentration of the drug. D) Hold the drug if the patient exhibits signs and symptoms of hyperglycemia.
A Feedback: Sulfonylurea should be given half an hour before meals and should begin with a lower dose than among younger adults. Administration would not be held if blood glucose was less than 200 mg/dL and hyperglycemia would be an indication to withhold glimepiride. Drug levels are not required.
The elderly population has a high incidence of hyperglycemia. Compared with younger adults, what makes the elderly more vulnerable to this disorder? A) Glucose intolerance B) Improved diagnostic tests C) Diabetes prevalence D) Obesity prevalence
A Feedback: The physiologic deterioration of glucose tolerance with age increases the risk of hyperglycemia for the elderly. The other choices increase the risk for the population as a whole, including young people.
The nurse assesses a group of older adults at a senior center for conditions related to an aging endocrine system. Which of the following assessment findings should the nurse prioritize and address first? A) Blood glucose of 300 in an 88-year-old person B) Metabolic syndrome in a 67-year-old person C) New onset of peripheral edema and constipation in a 72-year-old adult D) The presence of a Dupuytren contracture in a 78-year-old adult
A Feedback: While all are abnormal findings and need addressing, the elevated blood glucose is the priority before the patient develops other issues with the hyperglycemia.
The nurse educated the patient with newly diagnosed diabetes. Which of the learning outcomes would be appropriate? (Select all that apply.) A) To demonstrate the correct method of blood glucose testing B) To demonstrate the proper technique for administration of antidiabetic medication C) To lose 5 lb a week for the next 52 weeks D) To remain with heart rate within normal limits E) To verbalize understanding of diabetes and its management
A, B, E Feedback: Weight loss of 1 to 2 lb a week is suggested if indicated, and no direct cardiovascular effects are expected. Heart rate is not related to this learning outcome.
Which of the following statements by patients on a geriatric medicine unit would be considered suggestive of hypothyroidism? (Select all that apply.) A) "I've never been prone to constipation in the past, but lately I'm only having a bowel movement every 3 or 4 days." B) "I'm having a terrible time getting to sleep at night and I keep waking up early." C) "Lately I just can't manage to stay warm no matter how high I keep the thermostat." D) "I've always been a cheerful person but now I can't shake this blue feeling." E) "I feel like I just don't have the energy that I normally do."
A, C, D, E Feedback: Constipation, cold intolerance, depression, and fatigue are associated with hypothyroidism. Insomnia is more commonly present in cases of hyperthyroidism.
The nurse interviews the client at a yearly office visit. The client states "I don't really eat that much, I'm not that hungry, but I keep gaining weight. Just look at my fat face!" Which of the following conditions should the nurse suspect? A) Hyperlipidemia B) Hypothyroidism C) Diabetes D) Peripheral vascular disease
B Feedback: Anorexia, weight gain, and a puffy face are all characteristics of hypothyroidism.
The nurse plans care for residents of a nursing home with diabetes. Which of the following symptoms of hypoglycemia are characteristic of the elderly that the nurse should be attentive to? A) Tachycardia and restlessness B) Poor sleep patterns and slurred speech C) Perspiration and anxiety D) Anxiety and restlessness
B Feedback: Classic symptoms of hypoglycemia in younger people—tachycardia, restlessness, perspiration, and anxiety—may be missing in the elderly. Instead, the first indication of hypoglycemia in the elderly may be behavior disorders, convulsions, somnolence, confusion, disorientation, poor sleep patterns, nocturnal headache, slurred speech, or unconsciousness.
The nurse practitioner assesses an 84-year-old client, who talks about feeling tired and chilly, and having dry skin and coarse hair. Which of the following conditions should the nurse practitioner first consider? A) Hyperlipidemia B) Hypothyroidism C) Diabetes D) Peripheral vascular disease
B Feedback: Her symptoms are typical of hypothyroidism, although they occur in other disorders as well.
Which of the following older adults is most likely experiencing the effects of age-related changes to endocrine function? A) A 71-year-old whose circadian rhythms are disrupted due to decreased melatonin production by the pineal gland. B) A 78-year-old whose pancreas is releasing insufficient amounts of insulin, resulting in hyperglycemia. C) A 67-year-old who is experiencing hyperthermia and insomnia due to increased thyroid activity. D) A 69-year-old who has experienced decreased sexual responsiveness due to a large decline in testosterone production.
B Feedback: Insufficient insulin release is considered a common, age-related change, while melatonin levels are not noted to be affected by the aging process. Hyperthyroidism and a significant decline in testosterone production would constitute pathological findings.
The nurse assesses a 94-year-old resident of a nursing home who has diabetes mellitus. For which of the following signs and symptoms should the nurse perform a blood glucose test? A) Restlessness and postural hypotension B) Somnolence and slurred speech C) Perspiration and incontinence D) Numbness and weak pulses
B Feedback: Rather than the classic symptoms of hypoglycemia that one would anticipate in younger adults, older individuals instead may experience confusion, abnormal behavior, altered sleep patterns, nocturnal headache, and slurred speech. Uncorrected hypoglycemia can cause tachycardia, arrhythmias, myocardial infarctions, cerebrovascular accident, and death.
The nurse at the wellness center plans exercise treatment for the client with diabetes. Why should the nurse advise this patient who is being treated for diabetes to exercise with caution? A) The resting heart rate is lowered. B) Hypoglycemia may occur. C) The heart rate is temporarily increased. D) The absorption of insulin is lowered.
B Feedback: The absorption of insulin is increased during exercise, which can lead to hypoglycemia. The heart rate is temporarily increased during exercise, and the resting heart rate is lowered; these are both usually desirable outcomes.
With aging, the endocrine system experiences changes that can be diverse and interrelated. Which of the following statements accurately describes an effect of aging on the endocrine system and its hormones? A) The action of water-soluble hormones on body cells increases. B) The endocrine system's ability to regulate body activities decreases. C) The response of body cells to hormones increases. D) Hormones become more concentrated.
B Feedback: The endocrine system's ability to regulate body activities decreases with aging. Choices A, C, and D are not true statements about aging and the endocrine system.
The nurse practitioner interviews an 80-year-old client who reports that the long-term issue with constipation has stopped and the client now has normal bowel movements. Which of the following conditions should the nurse practitioner suspect that this patient has developed? A) Atrophy of the adrenal gland B) Diabetes C) Hyperthyroidism. D) Hyperlipidemia
C Feedback: Although the client may be pleased with her apparent improvement, following chronic constipation, it can be a danger signal. The primary care provider would most likely suspect hyperthyroidism based on the age and the unexplained change in the bowel habits; the other conditions are not related to increased bowel peristalsis.
The nurse admits a patient to the skilled care unit with symptoms of fatigue, weakness, and lethargy. Before the primary care provider completes a diagnosis of depression, which of the following laboratory tests should be completed? A) Estrogen and testosterone B) Random blood glucose C) T4 and TSH D) Triglyceride
C Feedback: Fatigue, weakness, lethargy, depression, and disinterest in activities are all characteristic of hypothyroidism. While fatigue and weakness may indicate hypoglycemia, a random blood glucose will not diagnose diabetes.
The nurse instructs the patient receiving treatment for hypothyroidism. Which of the following statements, if made by the patient, indicate the need for further teaching? A) "I will continue to take the stool softener until my constipation is better." B) "I will call the office if I have any chest palpitations." C) "I will not need to refill this prescription." D) "I will take one pill today, two tomorrow, and then three pills a day."
C Feedback: It is important that patients understand that thyroid replacement will most likely be a lifelong requirement. Initially, thyroid replacement is gradually increased under close supervision to prevent cardiac complications.
A 79-year-old in very good health has a lipid screening during a visit to the nurse practitioner. Which of the following values should the nurse interpret as desirable for him? A) Triglycerides 299 mg/dL B) Triglycerides 199 mg/dL C) Triglycerides 149 mg/dL D) Triglycerides 19 mg/dL
C Feedback: People with diabetes are at risk for metabolic syndrome, which includes elevated triglycerides. The American Diabetes Association recommends that people with diabetes maintain their triglyceride levels below 150 mg/dL. A level of 19 mg/dL would be unexpectedly low and may require further assessment.
A diabetes nurse is providing an educational in-service to nurses who provide care on a geriatric, subacute medical unit of hospital. Which of the following teaching points related to diagnosing diabetes in older adults should be included in the teaching? A) "Older adults with a new onset of diabetes will be hungry and thirsty with copious urine output." B) "Because of an absence of signs and symptoms in older adults with diabetes, diagnosis can be very difficult." C) "Older persons can often display signs and symptoms of diabetes that are more subtle than those in younger adults." D) "Pancreatic biopsy is often required in order to determine a definitive diagnosis of diabetes in the elderly."
C Feedback: Signs and symptoms of diabetes are often nonspecific, though not absent, in older adults. Pancreatic biopsy is not necessary for the diagnosis of diabetes.
During patient education of a 71-year-old who has a recent diagnosis of diabetes, the nurse has emphasized the importance of consistently maintaining blood glucose levels within the normal range rather than simply reacting to high or low levels. Which of the following tests is most likely to gauge the consistency of the patient's blood sugar control over time? A) Random blood glucose B) Triglyceride monitoring C) Hemoglobin A1c D) Glucose tolerance test (GTT)
C Feedback: The hemoglobin A1c test determines an individual's effectiveness of blood sugar control over the previous 6- to 12-week period. Random glucose testing, triglyceride tests, and the GTT do not achieve this result.
Older people are subject to a long list of complications from diabetes, so the disease must be strictly managed. Which of the following statements is true about diabetes and its complications? A) Hyperglycemia is associated with anxiety and insomnia. B) Unmanaged hyperglycemia can cause tachycardia and heart arrhythmias. C) Ketoacidosis can cause gangrene in the limbs and lead to eventual amputation. D) Diabetes can eventually damage nearly every body system.
D Feedback: By affecting metabolism and the elimination of toxic compounds from the body, diabetes eventually can damage every body system.
The home care nurse regularly performs visits to a client's apartment. This client asks about ways that exercise might be able to control his type 2 diabetes. How should the nurse respond to the client's query? A) "Exercise is very beneficial for diabetes control, but if it's too vigorous it can lead to rebound hyperglycemia that is dangerous." B) "Confirm with your doctor, but it's likely best to maintain a low activity levels to keep your glucose levels within normal range." C) "Exercise can be an excellent substitute for oral antihyperglycemic medications." D) "It's important to have an exercise plan that is appropriate specifically for you, because you don't want to bring on hypoglycemia by exercising too hard."
D Feedback: Exercise is therapeutic for older adults, but vigorous physical activity can heighten the use of glucose and result in hypoglycemia, not hyperglycemia. Exercise is beneficial, but not a substitute for medication.
The nurse administers the initial dose of levothyroxine sodium (Synthroid) to a 76-year-old. Which of the following signs would indicate a complication? A) Anorexia B) Cold intolerance C) Constipation D) Tachycardia
D Feedback: Initially, thyroid replacement is prescribed at a low dose and gradually increased under close supervision to prevent cardiac complications. Anorexia, cold intolerance, and constipation are all symptoms of hypothyroidism, the condition which this medicine is to treat.
Before having a blood sugar test, a patient must avoid drugs that affect blood glucose level. In analyzing a patient's blood glucose level, the nurse should be aware of any drugs the patient is taking. Which of the following drugs may lower a patient's blood sugar level? A) Nicotinic acid B) Estrogen C) Diuretics D) Monoamine oxidase inhibitors
D Feedback: Monoamine oxidase inhibitors lower blood glucose level. Nicotinic acid, estrogen, and diuretics raise blood glucose level.
The nurse educates the older adult regarding a new diagnosis of diabetes mellitus. Which of the following educational materials should the nurse consider as appropriate? A) A commercial pamphlet with pictures and font size 12 B) An audio recording. C) Online interactive presentation D) Printed handouts on white paper with font size 16
D Feedback: Original handmade aids suited for the individual's unique needs may have a value equal to or greater than commercially prepared ones. Audio recording is of little benefit to the older person with a hearing problem. A computer presentation may overwhelm the older learner. The print on a commercial pamphlet may appear minute to older eyes.
The nurse presents at a seminar on "Aging of the Endocrine Glands" at a senior center. Which of the following should the nurse include in the presentation? A) Blood tests are necessary for initial assessment of endocrine system decline. B) Endocrine function decline can be prevented with exercise and vitamins. C) Glands that secrete hormones decline at a predetermined prescribed rate. D) The thyroid, pancreas, and adrenal glands are at risk for dysfunction in the older adult.
D Feedback: With age, the thyroid gland progressively atrophies, the adrenal gland reduces the secretion of hormones, and there is insufficient release of insulin by the pancreas and reduced tissue sensitivity to circulating insulin.
