CH 47, 48, 49 (EXAM 4 study guide book)

4. What characterizes type 2 diabetes (select all that apply)? a. β-Cell exhaustion b. Insulin resistance c. Genetic predisposition d. Altered production of adipokines e. Inherited defect in insulin receptors f. Inappropriate glucose production by the liver

a, b, c, d, e, f. Type 2 diabetes is characterized by insulin resistance, β-cell exhaustion, altered production of adipokines, genetic predisposition, inherited defect in insulin receptors, and inappropriate glucose production by the liver. a. β-Cell exhaustion b. Insulin resistance c. Genetic predisposition d. Altered production of adipokines e. Inherited defect in insulin receptors f. Inappropriate glucose production by the liver

18.When teaching the patient with type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump? a. Tight glycemic control can be maintained. b. Errors in insulin dosing are less likely to occur. c. Complications of insulin therapy are prevented. d. Frequent blood glucose monitoring is unnecessary.

a. Tight glycemic control can be maintained -Insulin pumps provide tight glycemic control by continuous subcutaneous insulin infusion based on the patient's basal profile, with bolus doses at mealtime at the patient's discretion and related to blood glucose monitoring. Errors in insulin dosing and complications of insulin therapy are still potential risks with insulin pumps.

20. Which class of oral glucose-lowering agents is most commonly used for people with type 2 diabetes because it reduces hepatic glucose production and enhances tissue uptake of glucose? a. Insulin b. Biguanide c. Meglinitide d. Sulfonylurea

b. Biguanides (e.g., metformin [Glucophage]) are most commonly used with type 2 diabetes. They reduce glucose production by the liver and increase insulin sensitivity at the tissue level that improves glucose transport into the cells. Insulin is not taken orally, as it is ineffective. Meglitinides and sulfonylureas increase insulin production from the pancreas.

37.Which statement best describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes? a. It can be prevented by tight glucose control. b. It occurs with a higher frequency and earlier onset than in the nondiabetic population. c. It is caused by the hyperinsulinemia related to insulin resistance common in type 2 diabetes. d. It cannot be modified by reduction of risk factors such as smoking, obesity, and high fat intake.

b. It occurs with a higher frequency and earlier onset than in the nondiabetic population.

16.A patient is admitted to the hospital with thyrotoxicosis. On physical assessment of the patient, what should the nurse expect to find? a. Hoarseness and laryngeal stridor b. Bulging eyeballs and dysrhythmias c. Elevated temperature and signs of heart failure d. Lethargy progressing suddenly to impairment of consciousness

c. Elevated temperature and signs of heart failure

32.What describes the primary difference in treatment for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)? a. DKA requires administration of bicarbonate to correct acidosis. b. Potassium replacement is not necessary in management of HHS. c. HHS requires greater fluid replacement to correct the dehydration. d. Administration of glucose is withheld in HHS until the blood glucose reaches a normal level.

c. HHS requires greater fluid replacement to correct the dehydration.

13. A patient with type 1 diabetes uses 20U of 70/30 neutral protamine Hagedorn (NPH/regular) in the morning and at 6:00 pm. When teaching the patient about this regimen, what should the nurse emphasize? a. Hypoglycemia is most likely to occur before the noon meal. b. Flexibility in food intake is possible because insulin is available 24 hours a day. c. A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia. d. Premeal glucose checks are required to determine needed changes in daily dosing.

c. A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia.

13. What characteristic is related to Hashimoto's thyroiditis? a.Enlarged thyroid gland b. Viral-induced hyperthyroidism c. Bacterial or fungal infection of thyroid gland d. Chronic autoimmune thyroiditis with antibody destruction of thyroid tissue

d. Chronic autoimmune thyroiditis with antibody destruction of thyroid tissue

5. Which laboratory results would indicate that the patient has prediabetes? a. Glucose tolerance result of 132 mg/dL b. Glucose tolerance result of 240 mg/dL c. Fasting blood glucose result of 80 mg/dL d. Fasting blood glucose result of 120 mg/dL

d. Fasting blood glucose result of 120 mg/dL

11. The nurse determines that a patient with a 2-hour OGTT of 152mg/dL has a. diabetes b. elevated A1C. c. impaired fasting glucose d. impaired glucose tolerance.

d. impaired glucose tolerance.

21.When providing discharge instructions to a patient who had a subtotal thyroidectomy for hyperthyroidism, what should the nurse teach the patient? a.Never miss a daily dose of thyroid replacement therapy. b.Avoid regular exercise until thyroid function is normalized. c.Use warm saltwater gargles several times a day to relieve throat pain. d.Substantially reduce caloric intake compared to what was eaten before surgery.

d.Substantially reduce caloric intake compared to what was eaten before surgery.

36.A patient with mild iatrogenic Cushing syndrome is on an alternate-day regimen of corticosteroid therapy. What does the nurse explain to the patient about this regimen? a.It maintains normal adrenal hormone balance. b.It prevents ACTH release from the pituitary gland. c.It minimizes hypothalamic-pituitary-adrenal suppression. d. It provides a more effective therapeutic effect of the drug.

c.It minimizes hypothalamic-pituitary-adrenal suppression.

26. To prevent hyperglycemia or hypoglycemia related to exercise, what should the nurse teach the patient using glucose-lowering agents about the best time for exercise? a. Only after a 15-g carbohydrate snack is eaten b. About 1 hour after eating when blood glucose levels are rising c. When glucose monitoring reveals that the blood glucose is in the normal range d. When blood glucose levels are high, because exercise always has a hypoglycemic effect

b.

28.A nurse working in an outpatient clinic plans a screening program for diabetes. What recommendations for screening should be included? a. OGTT for all minority populations every year b. FPG for all individuals at age 45 and then every 3 years c. Testing people under the age of 21 for islet cell antibodies d. Testing for type 2 dia

b.

5. An African American woman with a history of breast cancer has panhypopituitarism from radiation therapy for primary pituitary tumors. Which medications should the nurse teach her about needing for the rest of her life (select all that apply)? a. Cortisol b. Vasopressin c. Sex hormones d. Levothyroxing (Synthyroid) e. Growth hormone (somatropin) f. Dopamine agonists (Parlodel)

a, b, d, e

34. The patient with diabetes has a blood glucose level of 248 mg/dL. Which manifestations in the patient would the nurse understand as being related to this blood glucose level (select all that apply)? a. Headache b. Unsteady gait c. Abdominal cramps d. Emotional changes e. Increase in urination f. Weakness and fatigue

a, c, e, f

6. The nurse is teaching the patient with prediabetes ways to prevent or delay the development of type 2 diabetes. What information should be included (select all that apply)? a. Maintain a healthy weight b. Exercise for 60 minutes each day c. Have blood pressure checked regularly d. Assess for visual changes on monthly basis e. Monitor for polyuria, polyphagia, and polydipsia.

a, e. a. Maintain a healthy weight e. Monitor for polyuria, polyphagia, and polydipsia. -To reduce the risk of developing diabetes, the patient with prediabetes should learn to monitor for symptoms of diabetes, have blood glucose and glycosylated hemoglobin (A1C) tested regularly, maintain a healthy weight, exercise regularly, and eat a healthy diet.

41. A 72-year-old woman is diagnosed with diabetes. What does the nurse recognize about the management of diabetes in the older adult? a. It is more difficult to achieve strict glucose control than in younger patients. b. It usually is not treated unless the patient becomes severely hyperglycemic. c. It does not include treatment with insulin because of limited dexterity and vision. d. It usually requires that a younger family member be responsible for care of the patient.

a. It is more difficult to achieve strict glucose control than in younger patients.

37.When caring for a patient with primary hyperaldosteronism, the nurse would question a health care provider's prescription for which drug? a. Lasix b. Amiloride (Midamor) c. Spironolactone (Aldactone) d. Aminoglutethimide (Cytadren)

a. Lasix

7. During care of the patient with SIADH, what should the nurse do? a. Monitor neurologic status at least every 2 hours. b. Teach the patient receiving treatment with diuretics to restrict sodium intake. c. Keep the head of the bed elevated to prevent antidiuretic hormone (ADH) release. d. Notify the health care provider if the patient's blood pressure decreases more than 20mm Hg from baseline.

a. Monitor neurologic status at least every 2 hours.

16.Delegation Decision: The following interventions are planned for a diabetic patient. Which intervention can the nurse delegate to unlicensed assistive personnel (UAP)? a. Discuss complications of diabetes. b. Check that the bath water is not too hot. c. Check the patient's technique for drawing up insulin. d. Teach the patient to use a meter for self-monitoring of blood glucose.

b. Checking the temperature of the bath water is part of assisting with activities of daily living (ADLs) and within the scope of care for unlicensed assistive personnel (UAP). This is important for the patient with neuropathy. Discussion of complications, teaching, and assessing learning are appropriate for RNs.

3. Why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones? a. Decrease glucose production b. Stimulate glucose output by the liver c. Increase glucose transport into the cells d. Independently regulate glucose level in the blood

b. Stimulate glucose output by the liver -The counter regulatory hormones have the opposite effect of insulin by stimulating glucose production and output by the liver and by decreasing glucose transport into the cells. The counter regulatory hormones and insulin together regulate the blood glucose level.

27.What is an appropriate nursing intervention for the patient with hyperparathyroidism? a. Pad side rails as a seizure precaution. b.Increase fluid intake to 3000 to 4000mL daily. c.Maintain bed rest to prevent pathologic fractures. d.Monitor the patient for Trousseau's and Chvostek's signs.

b.Increase fluid intake to 3000 to 4000mL daily.

23.The nurse has identified the nursing diagnosis of fatigue for a patient who is hypothyroid. What should the nurse do while caring for this patient? a.Monitor for changes in orientation, cognition, and behavior. b.Monitor for vital signs and cardiac rhythm response to activity. c.Monitor bowel movement frequency, consistency, shape, volume, and color. d.Assist in developing well-balanced meal plans consistent with level of energy expenditure.

b.Monitor for vital signs and cardiac rhythm response to activity.

25.A patient with hypothyroidism is treated with levothyroxine (Synthroid). What should the nurse include when teaching the patient about this therapy? a.Explain that alternate-day dosage may be used if side effects occur. b.Provide written instruction for all information related to the drug therapy. c.Assure the patient that a return to normal function will occur with replacement therapy. d.Inform the patient that the drug must be taken until the hormone balance is reestablished.

b.Provide written instruction for all information related to the drug therapy.

14. Lispro insulin (Humalog) with NPH insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, when should it be administered? a. Only once a day b. 1 hour before meals c. 30 to 45 minutes before meals d. At mealtime or within 15 minutes of meals

d. At mealtime or within 15 minutes of meals -Lispro is a rapid-acting insulin that has an onset of action of approximately 15 minutes and should be injected at the time of the meal to within 15 minutes of eating. Regular insulin is short acting with an onset of action in 30 to 60 minutes following administration and should be given 30 to 45 minutes before meals.

5.Which statement about the adrenal medulla hormones is accurate? a. overproduction of androgens may cause masculinization in women b. both the adrenal medulla and the thyroid gland have a negative feedback system to the hypothalamus c. cortisol levels would be altered in a person who normally works a night shift from 11 pm to 7 am and sleeps from 8am to 3pm d. Catecholamines are considered hormones when they are secreted by the adrenal medulla and neurotransmitters when they are secreted by nerve cells

d. Catecholamines are considered hormones when they are secreted by the adrenal medulla and neurotransmitters when they are secreted by nerve cells

24.Priority Decision: When replacement therapy is started for a patient with long-standing hypothyroidism, what is most important for the nurse to monitor the patient for? a. Insomnia b. Weight loss c. Nervousness d. Dysrhythmias

d. Dysrhythmias

20.The female patient is admitted with a new diagnosis of Cushing syndrome with elevated serum and urine cortisol levels. Which assessment findings should the nurse expect to see in this patient? a. Hair loss and moon face b. Decreased weight and hirsutism c. Decreased muscle mass and thick skin d. Elevated blood pressure and blood glucose

d. Elevated blood pressure and blood glucose

1. A patient suspected of having acromegaly has an elevated plasma growth hormone (GH) level. In acromegaly, what would the nurse also expect the patient's diagnostic results to indicate? a. Hyperinsulinemia b. Plasma glucose of <70mg/dL (3.9mmol/L) c. Decreased GH levels with an oral glucose challenge test d. Elevated levels of plasma insulin-like growth factor-1

d. Elevated levels of plasma insulin-like growth factor-1

30. The nurse should observe the patient for symptoms of ketoacidosis when a. illnesses causing nausea and vomiting lead to bicarbonate loss with body fluids. b. glucose levels become so high that osmotic diuresis promotes fluid and electrolyte loss. c. an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy. d. the patient skips meals after taking insulin, leading to rapid metabolism of glucose and breakdown of fats for energy

c. an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy.

14.Common nonspecific manifestations that may alert the nurse to endocrine dysfunction include a. goiter and alopecia. b. exophthalmos and tremors. c. weight loss, fatigue, and depression. d. polyuria, polydipsia, and polyphagia

c. weight loss, fatigue, and depression.

30.A patient with hypoparathyroidism resulting from surgical treatment of hyperparathyroidism is preparing for discharge. What should the nurse teach the patient? a.Milk and milk products should be increased in the diet. b.Parenteral replacement of parathyroid hormone will be required for life. c.Calcium supplements with vitamin D can effectively maintain calcium balance. d.Bran and whole-grain foods should be used to prevent GI effects of replacement therapy.

c.Calcium supplements with vitamin D can effectively maintain calcium balance.

32.A patient is scheduled for a bilateral adrenalectomy. During the postoperative period, what should the nurse expect related to the administration of corticosteroids? a.Reduced to promote wound healing b.Withheld until symptoms of hypocortisolism appear c.Increased to promote an adequate response to the stress of surgery d.Reduced because excessive hormones are released during surgical manipulation of adrenal glands

c.Increased to promote an adequate response to the stress of surgery

31. What are manifestations of diabetic ketoacidosis (DKA) (select all that apply)? a. Thirst b. Ketonuria c. Dehydration d. Metabolic acidosis e. Kussmaul respirations f. Sweet, fruity breath odor

a, b, c, d, e, f.

21.The patient with type 2 diabetes is being put on acarbose (Precose) and wants to know why she is taking it. What should the nurse include in this patient's teaching (select all that apply)? a. Take it with the first bite of each meal. b. It is not used in patients with heart failure. c. Endogenous glucose production is decreased. d. Effectiveness is measured by 2-hour postprandial glucose. e. It delays glucose absorption from the gastrointestinal (GI) tract.

a, d, e. Acarbose (Precose) is an α-glucosidase inhibitor that is taken with the first bite of each meal. The effectiveness is measured with 2-hour postprandial blood glucose testing, as it delays glucose absorption from the GI tract. The other options describe thiazolidinediones

2. Which hormones are secreted by the anterior pituitary gland (select all that apply)? a.Prolactin b. Melatonin c. Somatostatin d. Parathormone e. Growth hormone f. Gonadotropic hormone g. ADH h. Melanocyte-stimulating hormone i. TSH j. ACTH

a, e, f, h, i, j. prolactin growth hormone Gonadotropic hormone Melanocyte-stimulating hormone TSH ACTH The anterior pituitary gland secretes prolactin, growth hormone (GH), gonadotropic hormones, melanocyte-stimulating hormone, thyroid-stimulating hormone (TSH), and adrenocorticotropic hormone (ACTH). The pineal gland secretes melatonin. The delta cells of the islets of Langerhans secrete somatostatin. The parathyroid secretes parathormone. The posterior pituitary secretes antidiuretic hormone (ADH).

36. Priority Decision: Two days following a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80 and 90mg/dL. Which is the best response by the nurse? a. "That is a good range for your glucose levels." b. "You should call your health care provider because you need to have your insulin increased." c. "That level is too low in view of your recent hypoglycemia and you should increase your food intake." d. "You should take only half your insulin dosage for the

a. "That is a good range for your glucose levels."

10.What are two effects of hypokalemia on the endocrine system? a.Decreased insulin and aldosterone release b.Decreased glucagon and increased cortisol release c.Decreased release of atrial natriuretic factor and increased ADH release d.Decreased release of parathyroid hormone and increased calcitonin release

a. Decreased insulin and aldosterone release -Hypokalemia inhibits aldosterone release as well as insulin release.

12.In a patient with an elevated serum cortisol, what would the nurse expect other laboratory findings to reveal? a.Hypokalemia b.Hyponatremia c.Hypoglycemia d.Decreased serum triglycerides

a. Hypokalemia -Although cortisol is a glucocorticoid, it has action onmineralocorticoid receptors, which causes sodium retention and potassium excretion from the kidney, resulting in hypokalemia. Because water is reabsorbed with the sodium, serum sodium remains normal. In its effect on glucose and fat metabolism, cortisol causes an elevation in blood glucose as well as increases in free fatty acids and triglycerides.

31.A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, what should the nurse expect to find? a.Hypertension, peripheral edema, and petechiae b.Weight loss, buffalo hump, and moon face with acne c.Abdominal and buttock striae, truncal obesity, and hypotension d. Anorexia, signs of dehydration, and hyperpigmentation of the skin.

a.Hypertension, peripheral edema, and petechiae

17.What medication is used with thyrotoxicosis to block the effects of the sympathetic nervous stimulation of the thyroid hormones? a. Potassium iodide b. Atenolol c. Propylthiouracil (PTU) d. Radioactive iodine (RAI)

b. Atenolol

13.What manifestations of endocrine problems in the older adult are commonly attributed to the aging process? a. Tremors and paresthesias b. Fatigue and mental impairment c. Hyperpigmentation and oily skin d. Fluid retention and hypertension

b. Fatigue and mental impairment -Many symptoms of hypothyroidism, such as fatigue, mental impairment, dry skin, and constipation, that would be apparent in younger persons are attributed to general aging in the older adult; as a result, hypothyroidism goes unrecognized as a treatable condition.

34.During discharge teaching for the patient with Addison's disease, which statement by the patient indicates that the nurse needs to do additional teaching? a."I should always call the doctor if I develop vomiting or diarrhea." b."If my weight goes down, my dosage of steroid is probably too high." c."I should double or triple my steroid dose if I undergo rigorous physical exercise." d."I need to carry an emergency kit with injectable hydrocortisone in case I can't take my medication by mouth."

b."If my weight goes down, my dosage of steroid is probably too high."

7.The normal response to increased serum osmolality is the release of: a. aldosterone from the adrenal cortex, which stimulates sodium excretion by the kidney. b. ADH from the posterior pituitary gland, which stimulates the kidney to reabsorb water. c. mineralocorticoids from the adrenal gland, which stimulate the kidney to excrete potassium. d.calcitonin from the thyroid gland, which increases bone resorption and decreases serum calcium levels.

b.ADH from the posterior pituitary gland, which stimulates the kidney to reabsorb water.

33.A patient with Addison's disease comes to the emergency department with complaints of nausea, vomiting, diarrhea, and fever. What collaborative care should the nurse expect? a.IV administration of vasopressors b.IV administration of hydrocortisone c.IV administration of D5W with 20mEq KCl d.Parenteral injections of ACTH

b.IV administration of hydrocortisone

2. Which tissues require insulin to enable movement of glucose into the tissue cells (select all that apply)? a. Liver b. Brain c. Adipose d. Blood cells e. Skeletal muscle

c, e. c. Adipose e. Skeletal muscle Adipose tissue and skeletal muscle require insulin to allow the transport of glucose into the cells. Brain, liver, and blood cells require adequate glucose supply for normal function but do not depend directly on insulin for glucose transport.

18. To ensure accurate results of a fasting blood glucose analysis, the nurse instructs the patient to fast for at least how long? a. 2 hours b. 4 hours c. 8 hours d. 12 hours

c. 8 hours

35. A diabetic patient is found unconscious at home and a family member calls the clinic. After determining that a glucometer is not available, what should the nurse advise the family member to do? a. Have the patient drink some orange juice. b. Administer 10U of regular insulin subcutaneously. c. Call for an ambulance to transport the patient to a medical facility. d. Administer glucagon 1mg intramuscularly (IM) or subcutaneously.

d. Administer glucagon 1mg intramuscularly (IM) or subcutaneously.

22.What is a cause of primary hypothyroidism in adults? a.Malignant or benign thyroid nodules b.Surgical removal or failure of the pituitary gland c.Surgical removal or radiation of the thyroid gland d.Autoimmune-induced atrophy of the thyroid gland

d.Autoimmune-induced atrophy of the thyroid gland

22. the patient with type 2 diabetes has had trouble controlling his blood glucose with several OAs but wants to avoid the risks of insulin. The HCP told him a medication will be prescribed that will increase insulin synthesis and release from the pancreas, inhibit glucagon secretin, and slow gastric emptying. the nurse knows this is which medication that will have to be injected?

glucagon-like peptide-1 receptor agonist, exenatide extended release (Bydureon)

10. During routine health screening, a patient is found to have fasting plasma glucose (FPG) of 132mg/dL (7.33mmol/L). At a follow-up visit, a diagnosis of diabetes would be made based on which laboratory results (select all that apply)? a. A1C of 7.5% b. Glycosuria of 3+ c. FPG >126 mg/dL (7.0 mmol/L). d. Random blood glucose of 126mg/dL (7.0mmol/L) e. A 2-hour oral glucose tolerance test (OGTT) of 190mg/dL (10.5mmol/L)

a, c. a. A1C of 7.5% c. FPG >126 mg/dL (7.0 mmol/L). The patient has one prior test result that meets criteriafor a diagnosis of diabetes but this test must be confirmed on a subsequent day. The A1C is greater than 6.5% so it also indicates diabetes according to criteria for diabetes diagnosis. These criteria include a fasting plasma glucose (FPG) level ≥126 mg/dL (7.0 mmol/L), A1C ≥6.5%, or a 2-hour OGTT level ≥200 mg/dL (11.1 mmol/L), or in a patient with classic symptoms of hyperglycemia (polyuria, polydipsia, unexplained weight loss) or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.0 mmol/L).

18.Which characteristics describe the use of RAI (select all that apply)? a.Often causes hypothyroidism over time b.Decreases release of thyroid hormones c.Blocks peripheral conversion of T4 to T3 d.Treatment of choice in nonpregnant adults e.Decreases thyroid secretion by damaging thyroid gland f.Often used with iodine to produce euthyroid before surgery

a, d, e

29. Priority Decision: A patient with diabetes calls the clinic because she is experiencing nausea and flu-like symptoms. Which advice from the nurse will be the best for this patient? a. Administer the usual insulin dosage. b. Hold fluid intake until the nausea subsides. c. Come to the clinic immediately for evaluation and treatment. d. Monitor the blood glucose every 1 to 2 hours and call if it rises over 150mg/dL (8.3mmol/L).

a. During minor illnesses, the patient with diabetes should continue drug therapy and food intake. Insulin is important because counter regulatory hormones may increase blood glucose during the stress of illness. Food or a carbohydrate liquid substitution is important because during illness the body requires extra energy to deal with the stress of the illness. Blood glucose monitoring should be done every 4 hours and the health care provider should be notified if the level is greater than 240 mg/dL (13.9 mmol/L) or if fever, ketonuria, or nausea and vomiting occur.

3. A patient with acromegaly is treated with a transsphenoidal hypophysectomy. What should the nurse do postoperatively? a. Ensure that any clear nasal drainage is tested for glucose. b. Maintain the patient flat in bed to prevent cerebrospinal fluid (CSF) leakage. c. Assist the patient with toothbrushing every 4 hours to keep the surgical area clean. d. Encourage deep breathing, coughing, and turning to prevent respiratory complications.

a. Ensure that any clear nasal drainage is tested for glucose.

24. Individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to a. eat regular meals at regular times. b. restrict calories to promote moderate weight loss. c. eliminate sucrose and other simple sugars from the diet. d. limit saturated fat intake to 30% of dietary calorie intake.

a. The body requires food at regularly spaced intervals throughout the day and omission or delay of meals can result in hypoglycemia, especially for the patient using conventional insulin therapy or oral hypoglycemic agents. Weight loss may be recommended in type 2 diabetes if the individual is overweight but many patients with type 1 diabetes are thin and do not require a decrease in caloric intake. Fewer than 7% of total calories should be from saturated fats and simple sugar should be limited but moderate amounts can be used if counted as a part of total carbohydrate intake.

17.A patient has a low serum T3 level. The health care provider orders measurement of the TSH level. If the TSH level is elevated, what does this indicate? a. The cause of the low T3 level is most likely primary hypothyroidism. b. The negative feedback system is failing to stimulate the anterior pituitary gland. c. The patient has an underactive thyroid gland that is not receiving TSH stimulation. d. Most likely there is a tumor on the anterior pituitary gland that is causing increased production of TSH.

a. The cause of the low T3 level is most likely primary hypothyroidism.

12. When teaching the patient with diabetes about insulin administration, the nurse should include which instruction for the patient? a. Pull back on the plunger after inserting the needle to check for blood. b. Consistently use the same size of insulin syringe to avoid dosing errors. c. Clean the skin at the injection site with an alcohol swab before each injection. d. Rotate injection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies.

b .Consistently use the same size of insulin syringe to avoid dosing errors. -U100 insulin must be used with a U100 syringe but for those using low doses of insulin, syringes that have increments of 1 unit instead of 2 units are available. Errors can be made in dosing if patients switch back and forth between different sizes of syringes. Aspiration before injection of the insulin is not recommended, nor is the use of alcohol to clean the skin. Because the rate of peak serum concentration varies with the site selected for injection, injections should be rotated within a particular area, such as the abdomen, before changing to another area.

28.A patient has been diagnosed with hypoparathyroidism. What manifestations should the nurse expect to observe (select all that apply)? a.Skeletal pain b.Dry, scaly skin c.Personality changes d.Abdominal cramping e.Cardiac dysrhythmias f.Muscle spasms and stiffness

b, c, d, e, f

16.Which abnormal assessment findings are related to thyroid dysfunction (select all that apply)? a. Tetanic muscle spasms with hypofunction b. Heat intolerance caused by hyperfunction c. Exophthalmos associated with excessive secretion d. Hyperpigmentation associated with hypofunction e. A goiter with either hyperfunction or hypofunction f. Increase in hand and foot size associated with excessive secretion

b, c, e. b. Heat intolerance caused by hyperfunction c. Exophthalmos associated with excessive secretion e. A goiter with either hyperfunction or hypofunction -Heat intolerance, exophthalmos, and a goiter are all related to thyroid dysfunction. Tetanic muscle spasms are related to hypofunction of the parathyroid. Hyperpigmentation is related to hypofunction of the adrenal gland. Increased hand and foot size is related to excess growth hormone secretion.

38. What disorders and diseases are related to macrovascular complications of diabetes (select all that apply)? a. Chronic kidney disease b. Coronary artery disease c. Microaneurysms and destruction of retinal vessels d. Ulceration and amputation of the lower extremitiese.Capillary and arteriole membrane thickening specific to diabetes

b, d

19.A 30-year-old female patient was brought to the emergency department (ED) after a seizure at work. During the assessment she mentions hair loss and menstrual irregularities. What diagnostic tests would be helpful to determine if endocrine problems are a cause of her problem (select all that apply)? a. Thyroglobulin b. Luteinizing hormone (LH) c. Parathyroid hormone (PTH) d. Follicle-stimulating hormone (FSH) e. Magnetic resonance imaging (MRI) of the head f. Adrenal corticotropic hormone (ACTH) suppression

b, d, e. b. Luteinizing hormone (LH) d. Follicle-stimulating hormone (FSH) e. Magnetic resonance imaging (MRI) of the head --Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are used to distinguish gonad problems from pituitary insufficiency. LH and FSH are low in pituitary insufficiency and high in gonadal failure. The MRI would be used to identify tumors involving the pituitary gland or hypothalamus. Thyroglobulin is a tumor marker for thyroid cancer. Parathyroid hormone (PTH), along with calcium and phosphorus levels, are checked for parathyroid function. The ACTH suppression test assesses adrenal function, especially with hyperactivity.

39. The patient with diabetes has been diagnosed with autonomic neuropathy. What problems should the nurse expect to find in this patient (select all that apply)? a. Painless foot ulcers b. Erectile dysfunction c. Burning foot pain at night d. Loss of fine motor control e. Vomiting undigested food f. Painless myocardial infarction

b, e, f

29.When the patient with parathyroid disease experiences symptoms of hypocalcemia, what is a measure that can be used to temporarily raise serum calcium levels? a.Administer IV normal saline b. Have patient rebreathe in a paper bag c.Administer furosemide (Lasix) as ordered. d.Administer oral phosphorus supplements.

b. Have patient rebreathe in a paper bag

6. The patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What manifestation should the nurse expect to find? a. Decreased body weight b. Decreased urinary output c. Increased plasma osmolality d. Increased serum sodium levels

b. Decreased urinary output

38.Priority Decision: What is the priority nursing intervention during the management of the patient with pheochromocytoma? a. Administering IV fluids b. Monitoring blood pressure c. Administering B-adrenergic blockers d. Monitoring intake and output and daily weights

b. Monitoring blood pressure

7. In type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose? a. Fatigue b. Polydipsia c. Polyphagia d. Recurrent infections

b. Polydipsia

12. When caring for a patient with nephrogenic diabetes insipidus, what should the nurse expect the treatment to include? a. Fluid restriction b. Thiazide diurectics c. A high-sodium diet d. Chloropropamide (Diabinese)

b. Thiazide diurectics

4. Which endocrine gland secretes cortisol? a. Ovaries b. Thyroid c. Adrenal cortex d. Adrenal medulla

c. Adrenal cortex

35.A patient who is on corticosteroid therapy for treatment of an autoimmune disorder has the following additional drugs ordered. Which one is used to prevent corticosteroid-induced osteoporosis? a. Potassium b. Lasix c. Alendronate (Fosamax) d. Pantoprazole (Protonix)

c. Alendronate (Fosamax)

11. A patient with diabetes insipidus is treated with nasal desmopressin acetate (DDAVP). The nurse determines that the drug is not having an adequate therapeutic effect when the patient experiences a. headache and weight gain b. nasal irritation and nausea c. a urine SG of 1.002 d. an oral intake greater than urinary output

c. a urine SG of 1.002

3. From where is the hormone glucagon secreted? a. F cells of the islets of Langerhans b. β-Cells of the islets of Langerhans c. α-Cells of the islets of Langerhans d. Delta cells of the islets of Langerhans

c. The α-cells in the islets of Langerhans in the pancreas produce and secrete the hormone glucagon. The F cells secrete pancreatic polypeptide. The β-cells produce and secrete insulin and amylin. The delta cells produce and secrete somatostatin.

2. During assessment of the patient with acromegaly, what should the nurse expect the patient to report? a. Infertility b. Dry, irritated skin c. Undesirable changes in appearance d. An increase in height of 2 to 3 inches a year

c. Undesirable changes in appearance

9. The patient with diabetes insipidus is brought to the emergency department with confusion and dehydration after excretion of a large volume of urine today even though several liters of fluid were drunk. What is a diagnostic test that the nurse should expect to be done to help make a diagnosis? a. Blood glucose b. Serum sodium level c. Urine SG d. CT of the head

c. Urine SG

1. In addition to promoting the transport of glucose from the blood into the cell, what does insulin do? a. Enhances the breakdown of adipose tissue for energy b. Stimulates hepatic glycogenolysis and gluconeogenesis c. Prevents the transport of triglycerides into adipose tissue d. Accelerates the transport of amino acids into cells and their synthesis into protein -"increases amino acid transport into cells and protein synthesis"

d. Accelerates the transport of amino acids into cells and their synthesis into protein -"increases amino acid transport into cells and protein synthesis"

9. How do hormones respond following the ingestion of a high-protein, carbohydrate-free meal? a. Both insulin and glucagon are inhibited because blood glucose levels are unchanged. b. Insulin is inhibited by low glucose levels and glucagon is released to promote gluconeogenesis. c. Insulin is released to facilitate the breakdown of amino acids into glucose and glucagon is inhibited. d. Glucagon is released to promote gluconeogenesis and insulin is released to facilitate movement of amino acids into muscle cells.

d. Glucagon is released to promote gluconeogenesis and insulin is released to facilitate movement of amino acids into muscle cells. -Usually insulin and glucagon function in a reciprocal manner, except after a high-protein, carbohydrate-free meal, in which both hormones are secreted. Glucagon increases gluconeogenesis and insulin facilitates transport of amino acids across muscle membranes for protein synthesis.

21. The patient with type 1 diabetes mellitus is in the clinic to check his long-term glycemic control. Which test should be used? a. Water deprivation test b. Fasting blood glucose test c. Oral glucose tolerance test d. Glycosylated hemoglobin (A1C)

d. Glycosylated hemoglobin (A1C)

26.A patient who recently had a calcium oxalate renal stone had a bone density study, which showed a decrease in her bone density. What endocrine problem could this patient have? a. SIADH b. Hypothyroidism c. Cushing syndrome d. Hyperparathyroidism

d. Hyperparathyroidism

10. In a patient with central diabetes insipidus, what will the administration of ADH during a water deprivation test result in? a. Decrease in body weight b. Increase in urinary output c. Decrease in blood pressure d. Increase in urine osmolality

d. Increase in urine osmolality

8. What accurately demonstrates that hormones of one gland influence the function of hormones of another gland? a.Increased insulin levels inhibit the secretion of glucagon. b.Increased cortisol levels stimulate the secretion of insulin. c.Increased testosterone levels inhibit the release of estrogen. d.Increased atrial natriuretic peptide (ANP) levels inhibit the secretion of aldosterone.

d. Increased atrial natriuretic peptide (ANP) levels inhibit the secretion of aldosterone. -Atrial natriuretic peptide (ANP) is secreted in response to high blood volume and high serum sodium levels and has an inhibiting effect on ADH and the renin-angiotensin-aldosterone system, the effects of which would make the blood volume even higher. The relationship between cortisol and insulin is indirect; cortisol raises blood glucose levels and insulin secretion is stimulated by high glucose levels. Glucagon secretion inhibits insulin secretion but insulin does not inhibit glucagon. Testosterone and estrogen have no reciprocal action and both are secreted by the body in response to tropic hormones.

20.As a precaution for vocal cord paralysis from damage to the recurrent laryngeal nerve during thyroidectomy surgery, what equipment should be in the room in case it is needed for this emergency situation? a. Tracheostomy tray b. Oxygen equipment c. IV calcium gluconate d. Paper and pencil for communication

a. Tracheostomy tray

15. A patient with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when the patient does what? a. Withdraws the NPH dose into the syringe first b. Injects air equal to the NPH dose into the NPH vial first c. Removes any air bubbles after withdrawing the first insulin d. Adds air equal to the insulin dose into the regular vial and withdraws the dose

a. Withdraws the NPH dose into the syringe first -When mixing regular and intermediate-acting insulin, regular insulin should always be drawn into the syringe first to prevent contamination of the regular insulin vial with intermediate-acting insulin additives. Air is added to the neutral protamine Hagedorn (NPH) vial. Then air is added to the regular vial and the regular insulin is withdrawn, bubbles are removed, and the dose of NPH is withdrawn.

9. Priority Decision: When caring for a patient with metabolic syndrome, the nurse should give the highest priority ti teaching the patient about which treatment plan? a. Achieving a normal weight b. Performing daily aerobic exercise c. Eliminating red meat from the diet d. Monitoring the blood glucose periodically

a.Achieving a normal weight

14.Which statement accurately describes Graves' disease? a.Exophthalmos occurs in Graves' disease. b.It is an uncommon form of hyperthyroidism. c.Manifestations of hyperthyroidism occur from tissue desensitization to the sympathetic nervous system. d.Diagnostic testing in the patient with Graves' disease will reveal an increased thyroid-stimulating hormone (TSH) level.

a.Exophthalmos occurs in Graves' disease.

19.What preoperative instruction should the nurse give to the patient scheduled for a subtotal thyroidectomy? a.How to support the head with the hands when turning in bed b.Coughing should be avoided to prevent pressure on the incision c.Head and neck will need to remain immobile until the incision heals d.Any tingling around the lips or in the fingers after surgery is expected and temporary

a.How to support the head with the hands when turning in bed

25. What should the goals of nutrition therapy for the patient with type 2 diabetes include? a. Ideal body weight b. Normal serum glucose and lipid levels c. A special diabetic diet using dietetic foods d. Five small meals per day with a bedtime snack

b.

8. A patient with SIADH is treated with water restriction. What does the patient experience when the nurse determines that treatment has been effective? a. Increased urine output, decreased serum sodium, and increased urine specific gravity b. Increased urine output, increased serum sodium, and decreased urine specific gravity c. Decreased urine output, increased serum sodium, and decreased urine specific gravity d. Decreased urine output, decreased serum sodium, and increased urine specific gravity

b. Increased urine output, increased serum sodium, and decreased urine specific gravity

8.Which patient should the nurse plan to teach how to prevent or delay the development of diabetes? a. An obese 50-year-old Hispanic woman b. A child whose father has type 1 diabetes c. A 34-year-old woman whose parents both have type 2 diabetes d. A 12-year-old boy whose father has maturity onset diabetes of the young (MODY)

c. 34-year-old woman whose parents both have type 2 diabetes

27. The nurse assesses the diabetic patient's technique of self-monitoring of blood glucose (SMBG) 3 months after initial instruction. Which error in the performance of SMBG noted by the nurse requires intervention? a. Doing the SMBG before and after exercising b. Puncturing the finger on the side of the finger pad c. Cleaning the puncture site with alcohol before the puncture d. Holding the hand down for a few minutes before the puncture

c. Cleaning the puncture site with alcohol is not necessary and may interfere with test results and lead to drying and splitting of the fingertips. Washing the hands with warm water is adequate cleaning and promotes blood flow to the fingers. Blood flow is also increased by holding the hand down. Punctures on the side of the finger pad are less painful. Self-monitored blood glucose (SMBG) should be performed before and after exercise.

33. The patient with newly diagnosed diabetes is displaying shakiness, confusion, irritability, and slurred speech. What should the nurse suspect is happening? a. DKA b. HHS c. Hypoglycemia d. Hyperglycemia

c. Hypoglycemia

19. Priority Decision: A patient taking insulin has recorded fasting glucose levels above 200mg/dL (11.1mmol/L) on awakening for the last five mornings. What should the nurse advise the patient to do first? a. Increase the evening insulin dose to prevent the dawn phenomenon. b. Use a single-dose insulin regimen with an intermediate-acting insulin. c. Monitor the glucose level at bedtime, between 2:00 am and 4:00 am, and on arising. d. Decrease the evening insulin dosage to prevent night hypoglycemia and the Somogyi effect

c. Monitor the glucose level at bedtime, between 2:00 am and 4:00 am, and on arising.

23. Priority Decision: The nurse is assessing a newly admitted diabetic patient. Which observation should be addressed as the priority by the nurse? a. Bilateral numbness of both hands b. Stage II pressure ulcer on the right heel c. Rapid respirations with deep inspiration d. Areas of lumps and dents on the abdomen

c. Rapid deep respirations are symptoms of diabetic ketoacidosis (DKA), so this is the priority of care. Stage II pressure ulcers and bilateral numbness are chronic complications of diabetes. The lumps and dents on the abdomen indicate a need to teach the patient about site rotation.

15.What is a potential adverse effect of palpation of an enlarged thyroid gland? a. Carotid artery obstruction b. Damage to the cricoid cartilage c. Release of excessive thyroid hormone into circulation d. Hoarseness from pressure on the recurrent laryngeal nerve

c. Release of excessive thyroid hormone into circulation

40. Following the teaching of foot care to a diabetic patient, the nurse determines that additional instruction is needed when the patient makes which statement? a. "I should wash my feet daily with soap and warm water." b. "I should always wear shoes to protect my feet from injury." c. "If my feet are cold, I should wear socks instead of using a heating pad." d. "I'll know if I have sores or lesions on my feet because they will be painful."

d. "I'll know if I have sores or lesions on my feet because they will be painful."

4. What findings are commonly found in a patient with a prolactinoma? a. Gynecomastia in men b. Profuse menstruation in women c. Excess follicle-stimulating hormone (FSH) and luteinizing hormone (LH) d. Signs of increased intracranial pressure, including headache, nausea, and vomiting

d. Signs of increased intracranial pressure, including headache, nausea, and vomiting

17. The home care nurse should intervene to correct a patient whose insulin administration includes a. warming a prefilled refrigerated syringe in the hands before administration. b. storing syringes prefilled with NPH and regular insulin needle-up in the refrigerator. c. placing the insulin bottle currently in use in a small container on the bathroom countertop. d. mixing an evening dose of regular insulin with insulin glargine in one syringe for administration.

d. mixing an evening dose of regular insulin with insulin glargine in one syringe for administration.

15.A patient with Graves' disease asks the nurse what caused the disorder. What is the best response by the nurse? a."The cause of Graves' disease is not known, although it is thought to be genetic." b."It is usually associated with goiter formation from an iodine deficiency over a long period of time." c."Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones." d."In genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion."

d."In genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion."