Endocrine Final Review
A patient with type two diabetes controls his blood glucose levels with oral hypoglycemics, diet, and exercise. During hospitalization for a knee replacement, He questions the nurse on why he is getting insulin injections when he does not take insulin at home. What should the nurse say?
"Stress like surgery and hospitalization requires an extra need for insulin - that is why you need insulin here but not at home."
A patient with hyperthyroidism is having a Radioactive Iodine Uptake test (RAIU) done. What should be ensured before starting this test?
- patient is not allergic to shellfish or iodine - patient signed consent form - HCP doing test or caring for patient is not pregnant & patient is not pregnant
A patient with thyroid storm should be monitored for
- s/s of pulmonary edema which can indicate HF
A patient's hypoglycemic agent is no longer working. What will the doctor order?
- try a different oral hypoglycemic - put client to insulin
A client with diabetes mellitus visits a health care clinic. The client's diabetes previously had been well controlled with glyburide (Diabeta), 5 mg PO daily, but recently the fasting blood glucose has been running 180-200mg/dl. Which medication, if added to the clients regimen, may have contributed to the hyperglycemia? A: Prednisone (Deltasone) B: Atenolol (Tenormin) C: Phenelzine (Nardil) D: Allopurinol (Zyloprim)
A
An external insulin pump is prescribed for a client with DM. The client asks the nurse about the functioning of the pump. The nurse bases the response on the information that the pump: A: Gives small continuous dose of regular insulin subcutaneously, and the client can self-administer a bolus with an additional dosage from the pump before each meal. B: Is timed to release programmed doses of regular or NPH insulin into the bloodstream at specific intervals. C: Is surgically attached to the pancreas and infuses regular insulin into the pancreas, which in turn releases the insulin into the bloodstream. D: Continuously infuses small amounts of NPH insulin into the bloodstream while regularly monitoring blood glucose levels.
A
Blood sugar is well controlled when Hemoglobin A1C is: A: Below 5.7% B: Between 12%-15% C: Less than 180 mg/dL D: Between 90 and 130 mg/dL
A
When caring for a male client with diabetes insipidus, nurse Juliet expects to administer: A: vasopressin (Pitressin Synthetic). B: furosemide (Lasix). C: regular insulin. D: 10% dextrose.
A
A female client has a serum calcium level of 7.2 mg/dl. During the physical examination, nurse Noah expects to assess: A: Trousseau's sign. B: Homans' sign. C: Hegar's sign. D: Goodell's sign.
A - Low calcium
A clinical feature that distinguishes a hypoglycemic reaction from a ketoacidosis reaction is: A: Blurred vision B: Diaphoresis C: Nausea D: Weakness
B
An agitated, confused female client arrives in the emergency department. Her history includes type 1 diabetes mellitus, hypertension, and angina pectoris. Assessment reveals pallor, diaphoresis, headache, and intense hunger. A stat blood glucose sample measures 42 mg/dl, and the client is treated for an acute hypoglycemic reaction. After recovery, the nurse teaches the client to treat hypoglycemia by ingesting: A: 2 to 5 g of a simple carbohydrate. B: 10 to 15 g of a simple carbohydrate. C: 18 to 20 g of a simple carbohydrate. D: 25 to 30 g of a simple carbohydrate.
B
Early this morning, a female client had a subtotal thyroidectomy. During evening rounds, nurse Tina assesses the client, who now has nausea, a temperature of 105° F (40.5° C), tachycardia, and extreme restlessness. What is the most likely cause of these signs? A: Diabetic ketoacidosis B: Thyroid crisis C: Hypoglycemia D: Tetany
B
The insulin that has the most rapid onset of action would be: A: Lente B: Lispro C: Ultralente D: Humulin N
B
When a client is in diabetic ketoacidosis, the insulin that would be administered is: A: Human NPH insulin B: Human regular insulin C: Insulin lispro injection D: Insulin glargine injection
B
Which of the following diabetes drugs acts by decreasing the amount of glucose produced by the liver? A: Alpha-glucosidase inhibitors B: Biguanides C: Meglitinides D: Sulfonylureas
B
Which of the following if stated by the nurse is correct about Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)? A: This syndrome occurs mainly in people with Type I Diabetes B: It has a higher mortality rate than Diabetic Ketoacidosis C: The client with HHNS is in a state of over hydration D: This condition develops very rapidly
B
A female client with hypothyroidism (myxedema) is receiving levothyroxine (Synthroid), 25 mcg P.O. daily. Which finding should nurse Hans recognize as an adverse drug A: Dysuria B: Leg cramps C: Tachycardia D: Blurred vision
C
Clients with type 1 diabetes may require which of the following changes to their daily routine during periods of infection? A: No changes B: Less insulin C: More insulin D: Oral antidiabetic agents
C
Nurse Ronn is assessing a client with possible Cushing's syndrome. In a client with Cushing's syndrome, the nurse would expect to find: A: Hypotension. B: Thick, coarse skin. C: Deposits of adipose tissue in the trunk and dorsocervical area. D: Weight gain in arms and legs.
C
The nurse knows that glucagon may be given in the treatment of hypoglycemia because it: A: Inhibits gluconeogenesis B: Stimulates the release of insulin C: Increases blood glucose levels D: Provides more storage of glucose
C
When a client is first admitted with hyperglycemic hyperosmolar nonketotic syndrome (HHNS), the nurse's priority is to provide: A: Oxygen B: Carbohydrates C: Fluid replacement D: Dietary instruction
C
How is a DKA dx confirmed?
Elevated BG Decreased Plasma Bicarb Decreased pH
A patient with Type 2 diabetes has more acute, insidious onset of symptoms. T/F
False - Type 1 is more acute, insidious onset of symptoms Type 2 is asymptomatic and progressive in onset
A patient who is about to be discharge is non compliant with medication management. The nurse should
Get family/friend involvement
Which insulins should *never* be mixed?
Long-Acting
What is the treatment for the simple (Colloid) Goiter
Lugol's Solution
HHNS occurs only in people with Type 2 diabetes. T/F
True
A C-peptide level is increased or normal in
Type 2
When you administer calcium, you should also administer
Vitamin D
An example of a mineralocorticoid
aldosterone
Glucagon is released by
alpha cells in pancreas
What is Lugol's solution?
anti hyperthyroid medication (iodine product) to decrease or shrink thyroid gland
When doing a dressing change on a diabetic, you should always use
aspetic technique
When assessing a patient with simple goiter you should assess their diet because
most cases are caused by insufficient dietary intake of iodine leading to overgrowth of thyroid tissue
What is Trousseau's Sign? What is it an indicator of?
The hands get a posture when the BP cuff is inflated above the systolic pressure for 3 or more minutes. It indicates hypocalcemia
A 7 week old infant born with cretinism (congenital hypothyroidism) will need medication replacement. Why?
To avoid cognition impairment, hypothyroidism, physical defects
Why is it important to maintain blood glucose levels?
To prevent complications
A C-peptide level is decreased in
Type 1
a C-Peptide test indicates if new insulin is being created. This test can help a HCP determine if a newly dx diabetic is
Type 1 or 2
Insulin dependent diabetics (Type 1) should take their blood glucose levels (fingerstick) when?
- before meals - mid afternoon - at bedtime
When teaching a newly dx diabetic how to injection insulin at home, the nurse should include:
- do not aspirate - do not cleanse injection site with alcohol
What is the primary clinical manifestation of hyperparathyroidism? What does this do to the body?
- hypercalcemia - bones become demineralized causing bone pain and pathological fractures (oestoporosis) - kidney stones may form from excess calcium in blood
Fasting Blood Glucose (fbg) level that indicates DM
126 mg/dL or higher
What is priority for a patient with DKA?
1. Regular insulin IV (1st) 2. IV fluids NS 3. Potassium replacement 4. Correct Acidosis
After a glucose tolerance test, How long should levels take to return to normal for someone who is *not* diabetic?
2 hours
How should insulin sites be rotated?
2.5 cm (inch) apart, do not reuse same site for 2-3 weeks
What is the normal HbA1C level?
4-6% of total
A client is in DKA, secondary to infection. As the condition progresses, which of the following symptoms might the nurse see? A: Kussmaul's respirations and a fruity odor on the breath B: Shallow respirations and severe abdominal pain C: Decreased respirations and increased urine output D: Cheyne-stokes respirations and foul-smelling urine
A
A client with DM has an above-knee amputation because of severe peripheral vascular disease, Two days following surgery, when preparing the client for dinner, it is the nurse's primary responsibility to: A:Check the client's serum glucose level B: Assist the client out of bed to the chair C:Place the client in a high-Fowlers position D: Ensure that the client's residual limb is elevated
A
A patient admitted to the unit with DKA was given regular insulin IV with NS. The nurse checks the blood sugar and now the blood sugar shows 250 mg/dL. What should the nurse do. Why?
Add 5% dextrose to IV fluids (D5W) to prevent hypoglycemia
A patient with hirsutism, amenorrhea, or enlarged hands and feet will have problems with what gland?
Anterior pituitary
A client is taking NPH insulin daily every morning. The nurse instructs the client that the most likely time for a hypoglycemic reaction to occur is: A: 2-4 hours after administration B: 6-14 hours after administration C: 16-18 hours after administration D: 18-24 hours after administration
B
The nurse is admitting a client with hypoglycemia. Identify the signs and symptoms the nurse should expect. Select all that apply. A: Thirst B: Palpitations C: Diaphoresis D: Slurred speech E: Hyperventilation
B,C,D
What is glycogenesis?
Glycogen synthesis - formed from extra unused glucose and stored in the liver as fat
What is found in the urine of a patient with DKA?
Glycosuria & Ketones
What are long term complications of DM?
Blindness, neuropathy, renal failure, PVD, infection, stroke
A 39-year-old company driver presents with shakiness, sweating, anxiety, and palpitations and tells the nurse he has Type I Diabetes Mellitus. Which of the follow actions should the nurse do first? A: Inject 1 mg of glucagon subcutaneously. B: Administer 50 mL of 50% glucose I.V. C: Give 4 to 6 oz (118 to 177 mL) of orange juice. D: Give the client four to six glucose tablets.
C
A patient received 6 units of regular insulin 3 hours ago. The nurse would be MOST concerned if which of the following was observed? A: kussmaul respirations and diaphoresis B: anorexia and lethargy C: diaphoresis and trembling D: headache and polyuria
C - s/s hypoglycemia
What dx test measures the *Amount of glucose in hemoglobin in a RBC*, and allows the HCP to see average blood glucose level over 120 days?
Glycosylated Hemoglobin (HbA1c)
What can increase blood glucose levels?
Cortisol Epinephrine Stress Prednisone Glucagon
A 67-year-old male client has been complaining of sleeping more, increased urination, anorexia, weakness, irritability, depression, and bone pain that interferes with her going outdoors. Based on these assessment findings, nurse Richard would suspect which of the following disorders? A: Diabetes mellitus B: Diabetes insipidus C: Hypoparathyroidism D: Hyperparathyroidism
D
During preoperative teaching for a female client who will undergo subtotal thyroidectomy, the nurse should include which statement? A: "The head of your bed must remain flat for 24 hours after surgery." B: "You should avoid deep breathing and coughing after surgery." C: "You won't be able to swallow for the first day or two." D: "You must avoid hyperextending your neck after surgery."
D
When assessing a male client with pheochromocytoma, a tumor of the adrenal medulla that secretes excessive catecholamine, nurse April is most likely to detect: A: a blood pressure of 130/70 mm Hg. B: a blood glucose level of 130 mg/dl. C: bradycardia. D: a blood pressure of 176/88 mm Hg.
D
Which of the following causes of HHNS is most common? A: Insulin overdose B: Removal of the adrenal gland C: Undiagnosed, untreated hyperpituitarism D: Undiagnosed, untreated diabetes mellitus
D
A nurse performs a physical assessment on a client with type 2 DM. Findings include a fasting blood glucose of 120mg/dl, temperature of 101, pulse of 88, respirations of 22, and a bp of 140/84. Which finding would be of most concern of the nurse? A: Pulse B: BP C: Respiration D: Temperature
D - high temp can indicate infection which is the leading cause of HHNS and DKA
Hypoparathyroidism shows many manifestations from
Hypocalcemia (Tetany)
What is the immediate treatment for hypoparathyroidism?
IV calcium gluconate or calcium chloride
Why should insulin not be injected cold?
It is painful and can cause lipohypertrophy
What does insulin do to potassium in the circulatory system?
It pushes it out of the plasma into the cells - causing *hypokalemia*
A patient with HHNC will have glycosuria but not
Ketonuria
Which two insulins are peakless?
Levemir (Determir) & Lantus
S/S of a patient with a thyroid storm
N/V, severe tachycardia, severe HTN, hyperthermia (up to 106F), restlessness, dysrhythmias, delirium
A patient with DM is scheduled to have surgery. They have an IV fusion of D5W. Will the nurse hold the insulin?
No
Is insulin required for a Type 2 diabetic?
No
Opposite of epinephrine
Norepinephrine
When administering insulin you should always monitor which lab?
Potassium - insulin can cause hypokalemia
What kind of insulin can be given IV?
Regular (Novolin R & Humulin R)
What is the treatment for acromegaly?
Surgery & Radiation of anterior pituitary
What is a common symptom of hypoparathyroidism?
Tetany - from lack of calcium in blood
Which injection site gives the fastest absorption for insulin?
The abdomen
Chronic Hyperparathyroidism can cause bone demineralization resulting in fractures, why?
The parathyroid is releasing excessive PTH, which is causing the serum calcium level to increase and calcium to be depleted in the bones
Before exercising, Robert measures his blood glucose. It shows 97 mg/dL. Before starting his exercise Robert should eat
a snack with carbs like cheese and crackers
How is a Postprandial (After meal) blood glucose (PPBG) done?
administer a carbohydrate solution orally to a fasting patient. Draw a blood sample *2 hours* after meal is complete.
Insulin is released by
beta cells in pancreas
A thyroid storm can lead to
cardiovascular collapse and death
After menopause, a spontaneous fracture r/t osteoporosis is due to
decreased estrogen release
A child who is deficient in growth hormone will have
dwarfism
Acromegaly clinical manifestations are most often seen as
enlargement of the facial features, hands and feet
Fight or flight hormone
epinephrine
Hypoglycemic reaction is caused by
excess insulin or inadequate glucose
s/s of hypoglycemia
faintness, weakness, diaphoresis, irritability, palpitations, trembling, drowsiness, hunger
Why does IV calcium gluconate or calcium chloride need to be infused very slowly?
hypotension, serious cardiac dysrhythmias or cardiac arrest can occur
A common side effect of a patient with hyperthyroidism being treated with PTU
hypothyroidism
DKA is caused by
inadequate amounts of insulin
What are s/s of hypoparathyroidism?
laryngeal spasm, stridor, cyanosis, spastic movements, Chvostek Sign, Trousseau Sign, decreased cardiac output
Glucagon should be administered IM or IV if a patient
loses consciousness
What is simple goiter caused by?
low iodine levels and low level of T3 in the blood. The T3 level is too low to signal the thyroid to stop secreting TSH which results in increasing formation of thyroid gland tissue (colloid)
A patient with Cushings Disease should have what type of diet?
low sodium, high potassium, controlled carbs and calories
S/S simple goiter
mass on neck, dysphagia, hoarseness, dyspnea, voice changes
Biguanides include
metformin
After administering Glucagon IM, *the patient regains consciousness*. The patient should be given
oral protein and carb - ex. milk and crackers
A PPBG plasma glucose over 160 mg/dL indicates
patient has diabetes
Two medications that block the production of thyroid hormones
propylthiouracil (PTU) and methimazole (Tapazole)
What is the Chvostek sign? What is it an indicator of?
sign of nerve hyper excitability of the facial nerve. When you tap the face, the same side of the face will contract momentarily. This indicates hypocalcemia
What are s/s that a patient is undergoing a thyroid crisis?
temp of 106f, tachycardia, restlessness, HTN, delirium, dehydration
What is the primary function of oral hypoglycemic agents?
to lower blood sugar by stimulating pancreas beta cells to release insulin
