Endocrine

A patient with Cushing's syndrome as a result of a pituitary tumor has been admitted to your unit for a transsphenoidal hypophysectomy. What would be important for the nurse to monitor before, during, and after surgery? A) Blood glucose B) Assessment of urine for blood C) Weight gain D) Exposure to others with infection

ANS: A Before, during, and after surgery, blood glucose monitoring and assessment of stools for blood are carried out to monitor for these complications. You would not assess for weight gain or exposure to infection.

An adolescent, newly diagnosed with type 1 diabetes, asks the nurse what caused the diabetes. What would be the nurse's best response? A) "Type 1 diabetes has a variety of causes that work together to cause the disease." B) "It is thought to be caused by environmental factors like a virus." C) "Part of the cause of diabetes is immunologic. That means your body is destroying itself." D) "The causes of type 1 diabetes are genetic, immunologic, and environmental."

ANS: D The etiology of type 1 diabetes mellitus includes genetic, immunologic, and environmental factors (eg, virus). Option C is not something you would say to a patient without further explanation. Options A and B are not complete answers to the patient's question.

A patient who has had a total parathyroidectomy has returned to the unit from the PACU. The nurse caring for the patient knows he should assess for what complication following this surgery? A) Tetany B) Hypercalcemia C) Brittle bones D) Fatigue

ANS: A Care of postoperative patients having a parathyroidectomy is directed toward detecting early signs of hypoparathyroidism and subsequent hypocalcemia and anticipating signs of tetany, seizures, and respiratory difficulties. Brittle bones and fatigue are not assessment parameters for parathyroidectomy.

A patient presents to the clinic complaining of symptoms that suggest diabetes mellitus. What criteria would support checking blood levels for the diagnosis of diabetes mellitus? A) Fasting plasma glucose greater than or equal to 126 mg/dL B) Random plasma glucose greater than 150 mg/dL C) Fasting plasma glucose greater than 100 mg/dL D) Random plasma glucose greater than 126 mg/dL

ANS: A Criteria for the diagnosis of diabetes mellitus include symptoms of diabetes plus random plasma glucose greater than or equal to 200 mg/dL, or a fasting plasma glucose greater than or equal to 126 mg/dL. Therefore options B, C, and D are incorrect.

What is another name for diabetic microvascular disease? A) Diabetic microangiopathy B) Diabetic microcapillary disease C) Diabetic microcellular disease D) Diabetic micromembranous disease

ANS: A Diabetic microvascular disease (or microangiopathy) is characterized by capillary basement membrane thickening. The basement membrane surrounds the endothelial cells of the capillary. Researchers believe that increased blood glucose levels react through a series of biochemical responses to thicken the basement membrane to several times its normal thickness. Two areas affected by these changes are the retina and the kidneys. Options B, C, and D are detractors for this question.

The nursing instructor is teaching his students about foot care for the diabetic patient. The instructor teaches the students what general guidelines regarding foot care? A) Wash feet in warm water. B) Rub a thin coat of lotion between the toes. C) Walk barefoot only at the beach. D) Do not wear socks to bed.

ANS: A Feet should be washed in warm water, and lotion should be applied to the tops and bottoms of the feet, but not between the toes. The patient should never walk barefoot. Patient may wear socks to bed if the feet are cold.

The nurse is teaching a newly diagnosed diabetic about his insulin regimen. When administering Humalog insulin the nurse should teach the patient what? A) Have the patient's meal tray available. B) Have the patient begin the meal tray 30 minutes following the injection. C) Feed the patient prior to administering the dose of insulin. D) Watch for symptoms of hyperglycemia.

ANS: A Humalog's onset of action is 10 to 15 minutes. Because of its rapid action, patients should be instructed not to wait the usual 30 minutes after injection to eat. You do not feed a patient before administering insulin. You always assess for symptoms of hyperglycemia.

The Diabetic Educator is teaching a class on complications of diabetes for newly diagnosed diabetic children and their parents. The diabetic Educator would define hypoglycemia as what blood glucose level? A) Below 60 mg/dL B) Between 60 and 120 mg/dL C) Between 120 and 180 mg/dL D) Above 180 mg/dL

ANS: A Hypoglycemia occurs when the blood glucose falls to less than 50 to 60 mg/dL (2.7 to 3.3 mmol/L), because of too much insulin or oral hypoglycemic agents, too little food, or excessive physical activity.

You are conducting a class on how to self-manage insulin regimens. A patient asks you how long a vial of insulin can be stored at room temperature before it "goes bad." What would be your best answer? A) If you are going to use up the vial within 1 month it can be kept at room temperature. B) If a vial of insulin will be used up within 21 days, it may be kept at room temperature. C) If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature. D) If a vial of insulin will be used up within 1 week, it may be kept at room temperature.

ANS: A If a vial of insulin will be used up within 1 month, it may be kept at room temperature.

You are caring for a newly diagnosed type 2 diabetic. The patient is 67 years old and has been found to have what long-term complication of diabetes mellitus? A) Cardiovascular disease B) Renal disease C) Retinal damage D) Hypertension

ANS: A Long-term complications are seen in both type 1 and type 2 diabetes but usually do not occur within the first 5 to 10 years after diagnosis. However, evidence of these complications may be present at the time of diagnosis of type 2 diabetes, because patients may have had undiagnosed diabetes for many years. Renal (microvascular) disease is more prevalent in patients with type 1 diabetes, and cardiovascular (macrovascular) complications are more prevalent in older patients with type 2 diabetes.

A 15-year-old child is brought to the emergency department with symptoms of hyperglycemia. A diagnosis of diabetes mellitus is made. What classification will be used to describe a 15-year-old child with diabetes who requires daily insulin injections? A) Type 1 diabetes B) Type 2 diabetes C) Juvenile diabetes D) Prediabetes

ANS: A Once classified as juvenile diabetes or juvenile-onset diabetes, the current classification for children with diabetes is type 1 diabetes. Type 2 diabetes is characterized by onset of the condition during adulthood and insulin may or may not be required. Prediabetes is characterized by normal glucose metabolism, but a previous history of hyperglycemia, often during illness or pregnancy.

The nursing instructor is quizzing one of her students who is caring for a diabetic in the clinical area. The instructor asks the student what is a contributing cause of ulcers to the foot in the diabetic patient. What should the student answer? A) Insensitive feet B) Arterial insufficiency C) Gout D) Smoking

ANS: A Patients with an insensitive foot do not feel injuries, which may be thermal (eg, from using heating pads, walking barefoot on hot concrete, testing bath water with the foot), chemical (eg, burning the foot while using caustic agents on calluses, corns, or bunions), or traumatic (eg, injuring skin while cutting nails, walking with an undetected foreign object in the shoe, or wearing ill-fitting shoes and socks). Arterial insufficiency, gout and smoking are not considered contributing causes of foot ulcers in the diabetic patient.

The nurse is caring for a patient diagnosed with Hashimoto's thyroiditis. When assessing this patient, what symptom would the nurse expect in a patient with hypothyroidism? A) Numbness and tingling in the fingers B) Bulging eyes C) Palpitations D) Flushed skin

ANS: A Symptoms of hypothyroidism include extreme fatigue, hair loss, brittle nails, dry skin, voice huskiness or hoarseness, menstrual disturbance, and numbness and tingling of the fingers. Bulging eyes, palpitations, and flushed skin would be signs and symptoms of hyperthyroidism.

The diabetic nurse is working for the summer at a camp for diabetic adolescents. When providing information on the prevention of hypoglycemia, what criteria would best help to prevent hypoglycemia? A) Always carry a form of fast-acting sugar. B) Exercise should be done prior to eating. C) Eat a meal or snack every 8 hours. D) Check blood sugar every 24 hours.

ANS: A The following should be included in information provided to the patient on how to prevent hypoglycemia: Always carry a form of fast-acting sugar, increase food prior to exercise, eat a meal or snack every 4 to 5 hours, and check blood sugar regularly.

The diabetic Nurse Educator is teaching a class for newly diagnosed diabetics and their families. In this class the Nurse Educator is teaching about "sick day rules." What guideline applies to periods of illness ("sick day rules") in a diabetic patient? A) Do not eliminate insulin when nauseated and vomiting. B) Report elevated glucose levels greater than 150 mg/dL. C) Eat three meals a day. D) If nauseated, do not eat solid foods.

ANS: A The most important issue to teach patients with diabetes who become ill is not to eliminate insulin doses when nausea and vomiting occur. Rather, they should take their usual insulin or oral hypoglycemic agent dose, and then attempt to consume frequent small portions of food. In general, blood sugar levels will rise but should be reported if they are greater than 300 mg/dL.

The nurse is caring for a patient with hyperthyroidism. What would the nurse closely monitor for? A) Thyroid storm B) Hypoxia C) Cardiac output D) Hypoglycemia

ANS: A The nurse closely monitors the patient with hyperthyroidism for signs and symptoms that may be indicative of thyroid storm. The nurse monitors for all of these things, but he or she monitors closely for thyroid storm.

The Diabetic Educator is discussing "sick day rules" with a newly diagnosed type 1 diabetic. The Educator is aware that the patient will require further teaching when the patient states what? A) "I will not take my insulin on the days when I am sick, but I will check my blood sugar every 2 hours." B) "If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day." C) "I will call the doctor, if I am not able to keep liquids in my body due to vomiting or diarrhea." D) "I will call the doctor if my blood sugar is over 300 (mg/dL) or if I have ketones in my urine."

ANS: A The nurse must explanation the "sick day rules" again to the patient. The nurse should emphasize that the patient should take insulin agents as usual and test their blood sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring patients may need supplemental doses of regular insulin every 3 to 4 hours. The patient should report elevated glucose levels (greater than 300 mg/dL or as otherwise instructed) or urine ketones to the physician. If the patient is not able to eat normally, the patient should be instructed to substitute soft foods such a gelatin, soup and pudding. If vomiting, diarrhea or fever persists, the patient should have an intake of liquids every 1/2 hour to hour to prevent dehydration. Fluid loss is dangerous and nausea, vomiting, and diarrhea should be reported to the physician. Patients with type 1 diabetes who cannot retain oral fluids may need hospitalization to avoid diabetic ketoacidosis and possibly coma.

You are developing a care plan for a patient with Cushing's syndrome. What nursing diagnosis would have the highest priority in this care plan? A) Risk for injury related to weakness B) Disturbed body image related to changes in physical appearance C) Risk for loneliness related to disturbed body image D) Fatigue related to sleep disturbances

ANS: A The nursing priority is to decrease the risk of injury by establishing a protective environment. The patient who is weak may require assistance from the nurse in ambulating to prevent falls or bumping corners or furniture. While the other nursing diagnoses are realistic and important to address, the nursing priority should focus on the patient's safety.

A patient presents at the walk in clinic complaining of diarrhea and vomiting. The patient has a history of adrenal insufficiency. Considering the patient's history and current symptoms, what would the nurse instruct the patient? A) Increase his intake of sodium until the gastrointestinal symptoms improve. B) Increase his intake of potassium until the gastrointestinal symptoms improve. C) Increase his intake of glucose until the gastrointestinal symptoms improve. D) Increase his intake of calcium until the gastrointestinal symptoms improve.

ANS: A The patient will need to supplement his dietary intake with added salt during episodes of gastrointestinal losses of fluid through vomiting and diarrhea to prevent the onset of Addisonian crisis. While the patient may experience the loss of other electrolytes, the major concern is the replacement of lost sodium.

A patient on your unit is in an addisonian crisis. You know the patient requires immediate treatment with what? A) Vasopressors B) Oral fluids C) Calcium channel blockers D) Antihypertensives

ANS: A The patient with addisonian crisis requires immediate treatment with IV administration of fluid, glucose, and electrolytes, especially sodium; replacement of missing steroid hormones; and vasopressors. Options B, C, and D are not emergency treatment drugs for addisonian crisis.

A patient you are caring for is undergoing a renin-aldosterone stimulation test. What drugs may be discontinued for up to 2 weeks before the rennin-aldosterone stimulation test? A) Antihypertensives B) Antibiotics C) Beta-Blockers D) Calcium channel blockers

ANS: A The renin-aldosterone stimulation test and bilateral adrenal venous sampling are useful in differentiating the cause of primary aldosteronism. Antihypertensive medication may be discontinued up to 2 weeks before testing. You would not stop antibiotics, beta-blockers, or calcium channel blockers before a rennin-aldosterone stimulation test.

What is the most common cause of adrenocortical insufficiency? A) Therapeutic use of corticosteroids B) Pheochromocytoma C) Inadequate secretion of ACTH D) Sudden cessation of exogenous adrenocortical hormonal therapy

ANS: A Therapeutic use of corticosteroids is the most common cause of adrenocortical insufficiency. The other options also cause adrenocortical insufficiency, but they are not the most common causes.

A patient with Cushing's syndrome has been hospitalized after a fall. The dietician is consulted and works with the patient to improve the nutritional intake of the patient. What foods should a patient with Cushing's syndrome eat to optimize health? (Mark all that apply.) A) Foods high in vitamin D B) Foods high in calories C) Foods high in protein D) Foods high in calcium E) Foods high in sodium

ANS: A, C, D Foods high in protein, calcium, and vitamin D are recommended to minimize muscle wasting and osteoporosis. Referral to a dietitian may assist the patient in selecting appropriate foods that are also low in sodium and calories. Options B and E are incorrect

The nursing instructor is talking with the nursing students about hyperthyroidism. The instructor breaks students into small groups and assigns them the task of creating meal plans for patients with hyperthyroidism. What would the instructor expect the student's meal plans to include? A) A clear liquid diet B) Small, frequent meals, high in protein and calories C) Three large, bland meals a day D) A diet high in fiber and fat

ANS: B A patient with hyperthyroidism has an increased appetite. The patient should be counseled to consume several well-balanced meals of small size. High-calorie, high-protein foods are encouraged. A clear liquid diet would not satisfy the patient's caloric or hunger needs. A diet rich in fiber and fat should be avoided as these foods may lead to gastrointestinal upset or increase peristalsis.

A diabetic patient calls the clinic complaining of having a "flu bug." The nurse tells him to take his regular dose of insulin. What else would the nurse tell the patient? A) Eat as you regularly would. B) Try drinking juice, regular soda, and eating gelatin frequently and in small portions. C) Check your blood glucose every hour. D) Check your urine ketones every 8 hours.

ANS: B For prevention of DKA related to illness, "sick day" rules for managing diabetes when ill (Chart 41-9) should be reviewed. The most important concept in this is to never eliminate insulin doses when nausea and vomiting occur. Instead, the patient should take the usual insulin dose (or previously prescribed special "sick day" doses) and then attempt to consume frequent small portions of carbohydrates (including foods usually avoided, such as juices, regular sodas, and gelatin). Drinking fluids every hour is important to prevent dehydration. Blood glucose and urine ketones must be assessed every 3 to 4 hours.

A patient with hypocalcemia is having carpopedal spasms. What is this called? A) Mendhelson's sign B) Trousseau's sign C) Chvostek's sign D) Jone's sign

ANS: B In overt tetany, the signs include bronchospasm, laryngeal spasm, carpopedal spasm (flexion of the elbows and wrists and extension of the carpophalangeal joints and dorsiflexion of the feet), dysphagia, photophobia, cardiac dysrhythmias, and seizures. A positive Trousseau's sign or a positive Chvostek's sign suggest latent tetany. Mendhelson's sign and Jone's sign are detractors for this question.

While assisting with the surgical removal of an adrenal tumor the operating room nurse is aware that the patient's vital signs may change upon manipulation of the tumor. What vital sign changes would the nurse expect to see? A) Hyperthermia and tachypnea B) Hypertension and heart rate changes C) Hypotension and hypothermia D) Hyperthermia and bradycardia

ANS: B Manipulation of the tumor during surgical excision may cause release of stored epinephrine and norepinephrine, with marked increases in blood pressure and changes in heart rate. The use of sodium nitroprusside and alpha-adrenergic blocking agents may be required during and after surgery. While other vital sign changes may occur related to surgical complications, the most common changes are related to hypertension and changes in the heart rate.

The student nurses are studying for a test on diabetes mellitus. What should the students know is a complication of diabetes termed "macrovascular"? A) Retinopathy B) Stroke C) Nephropathy D) Renal failure

ANS: B Myocardial infarction and stroke are considered macrovascular complications of diabetes mellitus, while peripheral neuropathy is related to the effects of elevated blood glucose levels over a period of years directly affecting the nerves. Microvascular complications include diabetic retinopathy and nephropathy.

The nurse is caring for a type 1 diabetic patient who is being discharged home tomorrow. Patient teaching includes assessing the patient's self-care skills to determine if further diabetes teaching is required. What is the best way to assess the patient's ability to prepare and give insulin? A) Ask the patient to describe the self-care skill B) Direct observation of the self-care skill C) Ask the family to describe the patient's ability to perform the self-care skill D) Consult the home health nurse to discuss self-care skills

ANS: B Nurses should assess the patient's ability to perform diabetes related self-care as soon as possible during the hospitalization or office visit to determine whether patients require further diabetes teaching. While consulting a home care nurse is beneficial, an initial assessment should be performed during the hospitalization or office visit. Nurses should directly observe the patient performing the skills such as insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the patient or family members about these skills without actually observing performance of the skill is not sufficient.

A 35-year-old female patient with type 1 diabetes has come to the clinic because she just doesn't feel well. The patient confides in the nurse that she is going through a divorce and a custody battle for her children ages 2 and 4. She has started drinking and has lost her job. What would the nurse suspect is causing this patient to feel poorly? A) Hypoglycemia B) Ketoacidosis C) Hypernatremia D) Fluid overload

ANS: B Patients with type 1 diabetes also risk developing ketoacidosis during periods of stress. The scenario describes a very stressful time in this patient's life. Hypoglycemia is a concern when the patient is undergoing surgery. Hypernatremia and fluid overload would not be a concern with a diabetic patient under stress.

You are writing a plan of care for your patient with Cushing's syndrome. What would be the priority nursing diagnosis for this patient? A) Hypertensive crisis B) Addisonian crisis C) Hypercalcemia D) Adrenocortical insufficiency

ANS: B Potential complications may include the following: Addisonian crisis; Adverse effects of adrenocortical activity. A potential complication of Cushing's syndrome is not a hypertensive crisis, hypercalcemia, or adrenocortical insufficiency.

A patient has just been diagnosed with type 2 diabetes. The physician has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the physician prescribe for this patient? A) Sulfonylurea B) Biguanide C) Thiazolidinedione D) Alpha glucosidase inhibitor

ANS: B Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Alpha glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

The nurse is caring for a patient with Addison's disease. The patient is scheduled for discharge in the morning. When teaching the patient about hormone replacement, the nurse instructs that too low a dose may be indicated by what? A) Weight gain B) Dizziness on standing C) Increase in systolic blood pressure D) Headache

ANS: B The development of edema or weight gain may signify too high a dose of hormone; postural hypotension (decrease in systolic blood pressure, light-headedness, dizziness on standing) and weight loss may indicate too low a dose.

The physician has ordered a fluid deprivation test on your patient. What is your patient being tested for? A) Hashimoto's thyroiditis B) Diabetes insipidus C) SIADH D) Hyperparathyroidism

ANS: B The fluid deprivation test is carried out by withholding fluids for 8 to 12 hours or until 3% to 5% of the body weight is lost. The patient is weighed frequently during the test. Plasma and urine osmolality studies are performed at the beginning and end of the test. The inability to increase the specific gravity and osmolality of the urine is characteristic of DI. Therefore options A, C, and D are incorrect.

An elderly patient comes to the clinic with her daughter. The patient is a diabetic and is concerned about foot care. The nurse goes over foot care with the patient and her daughter as the nurse realizes that foot care is extremely important. Why would the nurse feel that foot care is so important to this patient? A) An elderly patient with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy. B) Avoiding the complications associated with foot ulcers may mean the difference between institutionalization and continued independent living. C) Hypoglycemia is a dangerous situation and it may lead to unsteadiness of the feet and falls. D) Drugs that the patients are required to take for their diabetic condition often decrease circulation to the lower extremities.

ANS: B The nurse recognizes that providing information on the long-term complications, especially foot and eye problems, associated with diabetes is important. Avoiding amputation through early detection of foot ulcers may mean the difference between institutionalization and continued independent living for the elderly person with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation and may lead to falls, hypoglycemia is not directly connected to the importance of foot care. Patients with foot ulcers may not realize that they have a foot ulcer because the patient has diminished sensation due to diabetic polyneuropathy and pain is generally absent. The nurse is correct to recognize that patients with diabetes are at risk for decreased circulation to the lower extremities, but should understand that the decrease in circulation is related to vascular changes and is not associated with drugs administered for the condition.

What would be important to teach a patient on corticosteroid therapy to prevent adrenal insufficiency? A) Take the medication late in the day to mimic the body. B) Always have enough medication on hand to avoid running out. C) Refill prescriptions within one week of running out. D) It is okay to stop abruptly.

ANS: B The patient and family should be informed that acute adrenal insufficiency and underlying symptoms will recur if corticosteroid therapy is stopped abruptly without medical supervision. The patient should be instructed to always have an adequate supply of the corticosteroid medication to avoid running out

The Diabetic Educator is assessing a hospitalized patient to see if it is necessary to reinforce parts of the patient's knowledge of basic diabetic self-care skills. What would be an appropriate way for the Diabetic Educator to assess the patient's knowledge of nutritional therapy in diabetes mellitus? A) Ask the patient's roommate. B) Monitor the patient's daily food menus. C) Ask the patient's family what they eat at home. D) Ask the nursing staff what the patient is eating.

ANS: B The patient's knowledge about diet can be assessed with the help of a dietitian through direct questioning and review of the patient's menu choices.

A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on your unit. You are writing a care plan for this patient. The priority nursing diagnosis for a patient with this condition is what? A) Deficient fluid volume B) Excessive fluid volume C) Hypothermia D) Hyperthermia

ANS: B The priority nursing diagnosis for a patient with SIADH is excessive fluid volume, as the patient retains fluids and develops a sodium deficiency. Restricting fluid intake is a typical intervention for managing this syndrome. Temperature imbalances are not associated with SIADH, so hyperthermia and hypothermia are not priority nursing diagnoses.

A student nurse is caring for a patient with type 1 diabetes who also has glycosuria. The nursing instructor asks this student nurse what the patient's urine should look like. What would be the student's best response? A) Concentrated urine B) Dilute urine C) Elevated specific gravity D) Cloudy urine

ANS: B When excess glucose is excreted in the urine, it is accompanied by excessive loss of fluids and electrolytes. The urine will be dilute due to the osmotic diuresis. While the urine may be cloudy if the patient has a urinary tract infection, the best answer related to glycosuria is the excretion of dilute urine. A concentrated urine or urine with an elevated specific gravity occurs when the body is conserving fluid and is the opposite of diuresis

A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and is in HHNS. What are the components of HHNS? (Mark all that apply.) A) Too much insulin B) Glycosuria C) Dehydration D) Hyponatremia E) Hyperglycemia

ANS: B, C, E HHNS is a serious condition in which hyperosmolarity and hyperglycemia predominate, with alterations of the sensorium (sense of awareness). At the same time, ketosis is usually minimal or absent. The basic biochemical defect is lack of effective insulin (ie, insulin resistance). Persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity occur.

You are caring for a patient at risk for an addisonian crisis. What signs and symptoms would you monitor for? (Mark all that apply.) A) Extreme strength B) Pallor C) Rapid respiratory rate D) Bounding pulse E) Hypotension

ANS: B, C, E The patient at risk is monitored for signs and symptoms indicative of addisonian crisis, which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness. Extreme strength and a bounding pulse are not symptoms or signs of an addisonian crisis.

The Diabetic Nurse Educator is teaching a class for newly diagnosed diabetics and their families. The Nurse Educator is talking about "sick day" kits. What would the Nurse Educator tell the people attending the class to put in their "sick day" kits? Mark all that apply.) A) Concentrated proteins B) Urine test strips C) Nutritious pastries D) Baby orange juice E) Blood glucose test strips

ANS: B, D, E Patients are taught to have foods available for use on sick days. In addition, a supply of urine test strips (for ketone testing) and blood glucose test strips should be available. The patient must know how to contact his or her physician 24 hours a day. These materials should be assembled in a "sick day" kit. Concentrated proteins would not be included in the kit. Nutritious pastries is an oxymoron and would not be included in the kit.

A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance test. The patient asks the nurse what results indicate gestational diabetes. The nurse should respond that the minimum parameter for indication of gestational diabetes is a 2-hour blood glucose level greater than what? A) 120 mg/dL B) 150 mg/dL C) 200 mg/dL D) 250 mg/dL

ANS: C A glucose tolerance test indicates a diagnosis of gestational diabetes when the 2-hour blood glucose level is greater than 200 mg/dL. Confirmation occurs when at least one subsequent result is greater than 200 mg/dL. Options A and B are incorrect because they're below the minimum parameter; option D is incorrect because it's above the minimum parameter

The nurse is assessing a patient diagnosed with Graves' disease. What physical characteristics of Graves' disease would the nurse expect to find? A) Hair loss B) Moon face C) Bulging eyes D) Fatigue

ANS: C Clinical manifestations of the endocrine disorder Graves' disease include exophthalmos (bulging eyes) and fine tremor in the hands. Options A, B, and D are not symptoms of Graves' disease.

The nurse caring for a patient with Cushing's syndrome explains to her patient about the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve? A) Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3 hours B) Administration of dexamethasone intravenously, followed by an x-ray of the adrenal glands C) Administration of dexamethasone orally at 11 PM, and a plasma cortisol level at 8 AM the next morning D) Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after the drug is administered

ANS: C Dexamethasone (1 mg) is administered orally at 11 pm, and a plasma cortisol level is obtained at 8 AM the next morning. This test can be performed on an outpatient basis and is the most widely used and sensitive screening test for diagnosis of pituitary and adrenal causes of Cushing's syndrome. Options A, B and D are incorrect as they do not correctly describe the test.

The nurse is doing patient teaching with an adolescent newly diagnosed with type 1 diabetes mellitus and her family. The nurse teaches the patient and family that what will decrease the body's need for insulin? A) Sleep B) Stress C) Exercise D) Low-fat diet

ANS: C Exercise lowers blood glucose, increases levels of HDLs, and decreases total cholesterol and triglyceride levels. Stress increases the need for insulin. Insulin is generally taken to cover what is eaten at each meal. Sleep impacts the need for insulin because many patients forget to take their insulin dose prior to going to sleep.

A patient with type 1 diabetes mellitus is seeing the nurse to review foot care. What would be a priority instruction for the nurse to give the patient? A) Examine feet once per week for redness, blisters, and abrasions. B) Apply lotion to dry feet, especially between the toes. C) Avoid hot-water bottles and heating pads. D) Dry feet vigorously after each bath.

ANS: C High-risk behaviors, such as walking barefoot, using heating pads on the feet, wearing open-toed shoes, soaking the feet, and shaving calluses, should be avoided. Socks should be worn for warmth. Feet should be examined each day for cuts, blisters, swelling, redness, tenderness, and abrasions. Lotion should be applied to dry feet but never between the toes. After a bath, the patient should gently, not vigorously, pat feet dry to avoid injury.

A nurse works in a walk-in clinic. The nurse recognizes that certain patients are at higher risk for different disorders than other patients. What patient is at a greater risk for the development of hypothyroidism? A) A 75-year-old female B) A 50-year-old male C) A 45-year-old female D) A 25-year-old male

ANS: C Hypothyroidism affects women five times more frequently than men, and occurs most often between 30 and 60 years of age. The 45-year-old female has a greater risk for the development of hypothyroidism. Therefore options A, B, and D are incorrect.

A patient newly diagnosed with type 2 diabetes is attending a nutrition class specifically designed for type 2 diabetics. What general guideline would it be important to teach the patients at this class? A) Low fat generally indicates low sugar. B) Protein should constitute 35% of dietary intake. C) Control calorie intake to attain a reasonable body weight. D) Dietary fat should be eliminated from the diet.

ANS: C In general, calorie distribution recommended is higher in carbohydrates than in fat and protein, and all carbohydrates should be eaten in moderation to avoid high postprandial blood glucose levels. The most important objective in the dietary management of diabetes is control of total calorie intake to attain or maintain reasonable body weight. Low fat does not automatically mean low sugar. Dietary fat does not need to be eliminated from the diet. Protein intake needs to keep calories within a reasonable amount.

A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal? A) Hyponatremia B) Hypophosphatemia C) Hypocalcemia D) Hypokalemia

ANS: C Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as tetany and must be reported to the physician immediately, as laryngospasm may occur and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not an expected response to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may lead to hyperphosphatemia.

The Diabetic Educator is teaching a patient about type 2 diabetes. The Educator recognizes the patient understands the primary treatment for type 2 diabetes when the patient states what? A) "A pancreas transplant will provide a cure for my diabetes." B) "I will take my oral antidiabetic agents when my morning blood sugar is high." C) "I will follow the weight loss plan designed by the dietitian." D) "I will make sure I call the Diabetic Educator when I have questions about my insulin."

ANS: C Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss. Oral antidiabetic agents may be added if diet and exercise are not successful in controlling blood glucose levels. If maximum doses of a single category of oral agents fail to reduce glucose levels to satisfactory levels, additional oral agents may be used. Some patients may require insulin on an ongoing basis, or on a temporary basis during times of acute psychological stress. Pancreas transplantation is performed on a limited basis and is often performed in conjunction with kidney transplantation.

The nursing instructor is discussing diabetes mellitus with the junior nursing class. What would the instructor tell the class may develop in the patient when ketone bodies accumulate in excessive amounts? A) Hypovolemia B) Polyuria C) Diabetic ketoacidosis D) Blurred vision

ANS: C Ketone bodies are acids that disturb the acid-base balance of the body when they accumulate in excessive amounts. This will result in diabetic ketoacidosis. Signs and symptoms are abdominal pain, nausea, vomiting hyperventilation, fruity odor of breath, and if left untreated, possible death. Excessive amounts of ketone bodies do not cause hypovolemia, polyuria or blurred vision.

The nursing instructor is teaching the senior nursing class Addison's disease. What symptom would the instructor teach the student's is characteristic of Addison's disease? A) Truncal obesity B) Hypertension C) Muscle weakness D) "Moon" face

ANS: C Patients with Addison's disease demonstrate muscular weakness, anorexia, gastrointestinal symptoms, fatigue, emaciation, dark pigmentation of the skin, and hypotension. Patients with Cushing's syndrome demonstrate truncal obesity, "moon" face, acne, abdominal striae, and hypertension.

A nurse caring for a patient with diabetes insipidus is reviewing laboratory results. What is an expected urinalysis finding? A) Glucose in the urine B) Albumin in the urine C) Urine specific gravity of 1.001 to 1.005 D) Leukocytes in the urine

ANS: C Patients with diabetes insipidus produce an enormous daily output of very dilute, water-like urine with a specific gravity of 1.001 to 1.005. The urine contains no abnormal substances such as glucose or albumin. Leukocytes in the urine are not related to the condition of diabetes insipidus, but would indicate a urinary tract infection, if present in the urine.

In pharmacology class the student nurses are learning about oral antidiabetic agents. What category of oral antidiabetic agents would the students learn enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas? A) Sulfonylureas B) Biguanides C) Thiazolidinediones D) Alpha glucosidase inhibitors

ANS: C Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and therefore require a functioning pancreas to be effective. Biguanides facilitate insulin's action on peripheral receptor sites. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Alpha glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

The physician has explained to the patient that he has developed diabetic neuropathy in his right foot. Later that day the patient calls the nurse and asks what causes diabetic neuropathy. What would be the nurse's best response? A) "Research has shown that diabetic neuropathy is caused by hyperglycemia that has gone on for years." B) "The cause is not known for sure but it is thought to have something to do with ketoacidosis." C) "The cause is not known for sure but it is thought to involve elevated blood glucose levels over a period of years." D) "Research has shown that diabetic neuropathy is caused by a combination of elevated glucose levels and elevated ketone levels."

ANS: C The etiology of neuropathy may involve elevated blood glucose levels over a period of years.

11. The nurse is performing a shift assessment on a patient with aldosteronism. What would the nurse recognize that the kidney's response to this condition would lead to? A) Anuria B) Oliguria C) Polyuria D) Proteinuria

ANS: C The kidneys are unable to acidify or concentrate the urine in the presence of aldosteronism. Thus, the urine volume is excessive, leading to polyuria. Anuria is seen in renal failure; oliguria is seen in dehydration; proteinuria is seen in diabetes.

A patient with Cushing's syndrome is being followed by his family physician. What would be a major goal on the multidisciplinary plan of care for this patient? A) Increased risk of infection B) Increased risk of injury C) Improved mental function D) Decreased ability to carry out self-care activities.

ANS: C The major goals for the patient include decreased risk of injury, decreased risk of infection, increased ability to carry out self-care activities, improved skin integrity, improved body image, improved mental function, and absence of complications. Options A, B, and D are incorrect because these are nursing diagnoses, not goals of care.

You are teaching a patient about nutrition. You know that the body needs iodine for the thyroid to function. What food would be the best source of iodine for the body? A) Eggs B) Strawberries C) Table salt D) Red meat

ANS: C The major use of iodine in the body is by the thyroid. Iodized table salt is a source of iodine. Options A, B, and D are incorrect.

A patient is prescribed corticosteroid therapy. What would be important information for the nurse to give the patient who is prescribed corticosteroid therapy? A) The patient's diet should be low protein with ample fat. B) There will be no change in appearance. C) The patient is at an increased risk for developing infection. D) The patient is at a decreased risk for development of thrombophlebitis and thromboembolism.

ANS: C The patient is at increased risk of infection and masking of signs of infection. The cardiovascular effects of corticosteroid therapy may result in development of thrombophlebitis or thromboembolism. Diet should be high in protein with limited fat. Changes in appearance usually disappear when therapy is no longer necessary.

You are caring for four patients, all diagnosed with type 1 diabetes. Based upon components of managing diabetes, which patient will likely have the greatest success in maintaining tight glucose control of type 1 diabetes? A) A patient who skips breakfast when his or her morning fingerstick glucose reading is greater than 220 mg/dL B) A patient who never deviates from his or her prescribed dose of insulin C) A patient who adheres to a meal plan and meal schedule D) A patient who eliminates carbohydrates from his or her daily intake

ANS: C The therapeutic goal for diabetes management is to achieve normal blood glucose levels without hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by patients. For patients who require insulin to help control blood glucose levels, maintaining consistency in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the approximate time intervals between meals, and the snacks, help maintain overall glucose control. Skipping meals is never advisable for an insulin-dependent diabetic.

An adolescent patient tells the nurse at school that he is feeling nervous and hungry. The school nurse assesses the patient and finds he has tachycardia and is diaphoretic. What should the school nurse administer? A) Non-diet soda, 1 oz B) Three hard candies (eg, Life Savers) C) Fruit juice, 4 to 6 oz D) Honey, 1 tsp

ANS: C The usual recommendation for treatment of hypoglycemia is for 10 to 15 g of a fast-acting, simple carbohydrate orally, such as three or four commercially prepared glucose tablets; 4 to 6 oz of fruit juice or regular soda; 6 to 10 Life Savers or other hard candies; or 2 to 3 tsp of sugar or honey. It is unnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar in juice contains enough simple carbohydrate to raise the blood glucose level and additional sugar may result in a sharp rise in blood sugar that will last for several hours

The PACU staff has brought a patient to the unit following a thyroidectomy. To promote comfort for this patient how would you position the patient? A) Side-lying (lateral) with one pillow under the head B) Head of the bed elevated 30 degrees and no pillows placed under the head C) Semi-Fowler's with the head supported on two pillows D) Flat, with a small roll supporting the neck

ANS: C When moving and turning the patient, the nurse carefully supports the patient's head and avoids tension on the sutures. The most comfortable position is the semi-Fowler's position, with the head elevated and supported by pillows. Therefore options A, B, and D are incorrect.

A patient with hyperparathyroidism would have what symptoms? (Mark all that apply.) A) Hypotension B) Diarrhea C) Cardiac dysrhythmias D) Irritability E) Apathy

ANS: C, D, E Psychological effects may vary from irritability and neurosis to psychoses caused by the direct action of calcium on the brain and nervous system. An increase in calcium produces a decrease in the excitation potential of nerve and muscle tissue.

A patient has returned to the unit after having a parathyroidectomy. What drug is kept at the bedside for emergency use? A) Digitalis B) Ergocalciferol C) Amphojel D) Calcium gluconate

ANS: D Calcium gluconate is kept at the bedside with equipment necessary for emergency IV administration. Digitalis is used to slow the ventricular rate; ergocalciferol is vitamin D; Amphojel is aluminum hydroxide gel; none of these are emergency drugs kept at the bedside for a patient who has had a parathyroidectomy.

A Diabetes Nurse Educator is providing a class on diabetes for the dieticians and staff nurses. The nurse educator discusses the American Diabetes Association (ADA) recommendations for levels of caloric intake. What do the ADA's recommendations include? A) 0% of calories from carbohydrates, 50% from fat, and the remaining 50% from protein B) 10% to 20% of calories from carbohydrates, 20% to 30% from fat, and the remaining 50% to 60% from protein C) 20% to 30% of calories from carbohydrates, 50% to 60% from fat and the remaining, 10% to 20% from protein D) 50% to 60% of calories from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein

ANS: D Currently, the ADA and the American Dietetic Association recommend that for all levels of caloric intake, 50% to 60% of calories come from carbohydrates, 20% to 30% from fat, and the remaining 10% to 20% from protein. These recommendations are also consistent with the American Heart Association, American Cancer Society, and the U.S. Department of Agriculture.

A patient with hypofunction of the adrenal cortex has been admitted to your unit. What would the nurse be likely to find when assessing the patient's vital signs? A) An increased body temperature B) A decreased body temperature C) An increased blood pressure D) A decreased blood pressure

ANS: D Decreased blood pressure may occur with hypofunction of the adrenal cortex. Decreased function of the adrenal cortex does not affect the patient's body temperature.

In what patients does hyperosmolar nonketotic syndrome occur? A) Patients with no known history of diabetes B) Patients with either type 1 diabetes or no known history of diabetes C) Adolescents with type 2 diabetes or no known history of diabetes D) Older people with either type 2 diabetes or no known history of diabetes

ANS: D HHNS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes. Therefore options A, B, and C are incorrect.

A patient with pheochromocytoma has been admitted for an adrenalectomy tomorrow. The patient is to start IV medication this evening to prevent adrenal insufficiency. What medication is the patient to start? A) Antibiotics B) Antihypertensives C) Parenteral nutrition D) Corticosteroids

ANS: D IV administration of corticosteroids (methylprednisolone sodium succinate [Solu-Medrol]) may begin on the evening before surgery and continue during the early postoperative period to prevent adrenal insufficiency. Antibiotics, antihypertensives, and parenteral nutrition do not prevent adrenal insufficiency.

A 77-year-old patient with hypothyroidism is undergoing right knee replacement surgery. The nurse caring for this patient knows that all patients with hypothyroidism have a prolonged reaction to what type of medication? A) Antibiotics B) Antihypertensive agents C) Anticholenergic agents D) Anesthetic agents

ANS: D In all patients with hypothyroidism, the effects of analgesic agents, sedatives, and anesthetic agents are prolonged; special caution is necessary in administering these agents to elderly patients because of concurrent changes in liver and renal function. This makes options A, B, and C incorrect.

The home care nurse is conducting patient teaching with a patient on corticosteroid therapy. To achieve consistency with the body's natural secretion of cortisol, when would the home care nurse instruct the patient to take his or her corticosteroid medication? A) In the evening between 4 PM and 6 PM B) Prior to going to sleep at night C) At noon every day D) In the early morning between 7 AM and 8 AM

ANS: D In keeping with the natural secretion of cortisol, the best time of day for the total corticosteroid dose is in the morning from 7 to 8 AM. Large-dose therapy at 8 AM, when the adrenal gland is most active, produces maximal suppression of the gland. Also, a large 8 AM dose is more physiologic because it allows the body to escape effects of the steroids from 4 PM to 6 AM, when serum levels are normally low, thus minimizing cushingoid effects.

You are teaching basic information to a newly diagnosed type 1 diabetic. What would the basic information include? A) Traveling B) "Sick day" kits C) Surgery and stress D) How to mix insulin

ANS: D Insulin injections are self-administered into the subcutaneous tissue with the use of special insulin syringes. Basic information includes explanations of the equipment, insulins, and syringes, and how to mix insulin. Therefore options A, B, and C are incorrect.

You are caring for a patient with hyperparathyroidism. What level of activity would you expect the physician to order? A) Complete bed rest B) Bed rest with bathroom privileges C) Out of bed (OOB) to the chair twice a day D) Ambulation and activity, as tolerated

ANS: D Mobility of the patient, with walking or use of a rocking chair for those with limited mobility, is encouraged as much as possible because bones subjected to normal stress give up less calcium. Best rest should be discouraged because it increases calcium excretion and the risk of renal calculi. Limiting the patient to getting out of bed only a few times a day also increases calcium excretion and the associated risks.

The school nurse is teaching the senior health class about risk factors for diabetes mellitus. What risk factor for diabetes mellitus cannot be modified by the patient? A) Poor control of blood glucose levels B) Inappropriate foot care C) Current or recent foot trauma D) Advanced age

ANS: D Nonmodifiable risk factors are ones that aren't in the patient's ability to change. Therefore, advanced age is the answer. The other choices are factors over which the patient can exert some control. Therefore options A, B, and C are incorrect.

You are a Family Nurse Practitioner performing a preoperative physical examination. The patient is a diabetic and you note a decrease in deep tendon reflexes in the right leg that make you suspect diabetic neuropathy. The patient has no history of diabetic neuropathies. What other indication of diabetic neuropathy might the Nurse Practitioner expect to find if the patient does have a diabetic neuropathy? A) Decreased sensation of dullness B) Lack of sensation of sharpness C) Increased sensation of pain D) Decreased vibratory sensation

ANS: D On physical examination, a decrease in deep tendon reflexes and vibratory sensation is found. For patients who have few or no symptoms of neuropathy, these physical findings may be the only indication of neuropathic changes. Options A, B, and C are incorrect. Patients with diabetic neuropathy do not have a sensation of pain or sharpness, and if they feel at all, everything feels dull.

A patient on corticosteroid therapy needs to be taught that a course of corticosteroids of 2 weeks duration can suppress the adrenal cortex for how long? A) Up to 3 months B) Up to 6 months C) Up to 9 months D) Up to 1 year

ANS: D Suppression of the adrenal cortex may persist up to 1 year after a course of corticosteroids of only 2 weeks' duration. Therefore options A, B, and C are incorrect.

An 88-year-old patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patient's daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is made. What nursing action would be a priority? A) Administration of anti-hypertensive medications B) Administering sodium bicarbonate intravenously for low bicarbonate levels C) Reversing acidosis by administering insulin D) Fluid and electrolyte replacement

ANS: D The overall approach to HHNS includes fluid replacement, correction of electrolyte imbalances and insulin administration. Insulin administration plays a less important role in the treatment of HHNS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA). Sodium bicarbonate is not administered to patients with HHNS, as their plasma bicarbonate level is usually normal. Also, anti-hypertensive medications are not indicated, as hypotension generally accompanies HHNS due to dehydration.

A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. The nurse is explaining to the patient the etiology of type 1 diabetes. Which of the following explanations is appropriate? A) "The tissues in the body are resistant to the action of insulin, making insulin less effective in the body." B) "The formation of an acidic substance when the liver breaks down fatty acids because of the lack of insulin in the body." C) "The secretion of placental hormones causes the body to be resistant to insulin." D) "Destruction of special cells in the pancreas causes a decrease in insulin production and the level of glucose (sugar) in the bloodstream increases because the body lacks insulin to break down the glucose."

D. Type 1 diabetes is characterized by the destruction of pancreatic beta cells resulting in decreased insulin production, unchecked glucose production by the liver, and fasting hyperglycemia. Also, glucose derived from food cannot be stored in the liver and remains circulating in the blood and leads to postprandial hyperglycemia. Type 2 diabetes involves insulin resistance and impaired insulin secretion. Gestational diabetes is defined as any degree of glucose intolerance with its onset during pregnancy and is caused by the secretion of placental hormones. Ketosis is the formation of a highly acidic substance when the liver breaks down free fatty acids in the absence of insulin.