Endocrine (Chapter 27)
A
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.
C
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
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."
A
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.
D
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
C
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)
A
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
D
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.
A
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
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
D
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
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
C
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
B
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
A
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
B
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.
A, B, E
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
D
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
C
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."
B
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
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
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
C
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
D
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.
B
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.
A
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, C, D, E
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."
B
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.
