Chapter 50: Care of the Patient with an Endocrine Disorder

15. As the nurse is shaving a patient who is 2 days postoperative from a thyroidectomy, the patient has a spasm of the facial muscles. What should the nurse recognize this as? a. Chvostek sign b. Montgomery sign c. Trousseau sign d. Homans sign

ANS: A The spasm of facial muscles when stimulated is the Chvostek sign, an indication of hypocalcemic tetany. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1738 OBJ: 5 TOP: Chvostek sign KEY: Nursing Process Step: Assessment

49. Arrange the steps of drawing up a short-acting and a long-acting insulin in the same syringe. (Separate letters by a comma and space as follows: A, B, C, D) a. Draw up amount of shorter-acting insulin b. Check insulin dose with a second licensed nurse c. Inject the desired amount of air into the long-acting insulin d. Clean rubber stopper of both vials with alcohol e. Draw up desired amount of longer-acting insulin f. Inject the desired amount of air into the short-acting insulin

ANS: D, C, F, A, E, B When drawing up two different types of insulin, the two vials are prepared by cleansing the tops, air is injected in the longer-acting insulin, air is injected into the short-acting insulin, and the required dose is drawn up. Set the vial of short-acting insulin out of reach to prevent accidental reuse. Handing the plunger securely, insert the needle in the long-acting insulin and withdraw the dose very carefully. Check the dose with a licensed nurse before administering. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1759, Box 50-3 OBJ: 14 TOP: Mixing insulin KEY: Nursing Process Step: Implementation

48. Arrange the steps of the negative feedback system in the control of blood glucose in chronologic order. (Separate letters by a comma and space as follows: A, B, C, D): a. Elevation of blood glucose b. Decrease in blood glucose c. Beta cells repressed d. Beta cells of pancreas stimulated to excrete insulin e. Intake of nutrients

ANS: E, A, D, B, C After the intake of food the blood glucose increases, which stimulates the beta cells of the pancreas to excrete insulin. Insulin decreases the blood glucose and the negative feedback system represses the beta cells of the pancreas. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1728 OBJ: 2 TOP: Negative feedback system KEY: Nursing Process Step: N/A

46. is the term that describes a condition of normal thyroid function.

ANS: Euthyroid Euthyroid is the term that describes a condition of normal thyroid function. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1737 OBJ: 5 TOP: Euthyroid KEY: Nursing Process Step: N/A

42. The nurse is administering long-acting insulin once a day, which provides insulin coverage for 24 hours. This insulin is .

ANS: Lantus Lantus is a long-acting synthetic (recombinant DNA origin, human-made) human insulin. It is used once a day at bedtime and works around the clock for 24 hours. PTS: 1 DIF: Cognitive Level: Implementation REF: Page 1768, Table 50-5 OBJ: 3 TOP: Insulin KEY: Nursing Process Step: Planning

47. When the nurse inflates the sphygmomanometer cuff exceeding the systolic blood pressure and observes a carpal spasm, this is a(n) .

ANS: Trousseau sign Trousseau sign is a carpal spasm brought on by pressure of a cuff. This is an indicator for hypocalcemia and hypomagnesemia. PTS: 1 DIF: Cognitive Level: Application REF: Page 1738 OBJ: 6 TOP: Trousseau sign KEY: Nursing Process Step: Assessment

43. Another term for hyperglycemic reaction is .

ANS: diabetic ketoacidosis (DKA) diabetic ketoacidosis DKA Hyperglycemic reaction—the body eliminates the excess glucose by the kidneys releasing it in the urine. Diabetic ketoacidosis (DKA) (acidosis accompanied by an accumulation of ketones in the blood), formerly called diabetic coma, may develop and the patient could die. DKA is a severe metabolic disturbance caused by an acute insulin deficiency, decreased peripheral glucose use, and increased fat mobilization and ketogenesis. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1765, Table 50-6 OBJ: 10 TOP: Hyperglycemia KEY: Nursing Process Step: Assessment

45. A condition with a deficiency in growth hormone is called .

ANS: hypopituitary dwarfism A condition with a deficiency in growth hormone is called hypopituitary dwarfism. Most cases are idiopathic, but a small number can be attributed to an autosomal-recessive trait. In some cases there is also a lack of adrenocorticotropic hormone (ACTH), TSH, and the gonadotropins. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1731 OBJ: 5 TOP: Dwarfism KEY: Nursing Process Step: Assessment

44. Only insulin can be administered intravenously.

ANS: regular Insulin is given subcutaneously, although intravenous (IV) administration of regular insulin can be done when immediate onset of action is desired. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1768, Table 50-5 OBJ: 13 TOP: Insulin KEY: Nursing Process Step: Assessment

23. The nurse discovers the type 1 diabetic (IDDM) patient drowsy and tremulous, the skin is cool and moist, and the respirations are 32 and shallow. These are signs of: a. hypoglycemic reaction; give 6 oz of orange juice. b. hyperglycemic reaction; give ordered regular insulin. c. hyperglycemic hyperosmolar nonketotic reaction; squeeze glucagon gel in buccal cavity. d. hypoglycemic reaction; give ordered insulin.

ANS: A Hypoglycemic reaction is due to not enough food for the insulin. Quick acting carbohydrates—such as orange juice or longer acting foods such as milk, crackers, and cheese—are beneficial. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1765, Table 50-6 OBJ: 9 TOP: Diabetes mellitus complications KEY: Nursing Process Step: Assessment

8. In diabetes insipidus, a deficiency of which hormone causes clinical manifestations? a. antidiuretic hormone (ADH) b. follicle-stimulating hormone (FSH) c. thyroid-stimulating hormone (TSH) d. adrenocorticotropic hormone (ACTH)

ANS: A Diabetes insipidus is a transient or permanent metabolic disorder of the posterior pituitary in which ADH is deficient. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1732 OBJ: 5 TOP: Diabetes insipidus KEY: Nursing Process Step: Assessment

3. Which test will furnish immediate feedback for a newly diagnosed diabetic who is not yet under control? a. Fasting blood sugar (FBS) b. Glycosylated hemoglobin (HgbA1c) c. Oral glucose tolerance test (OGTT) d. Clinitest

ANS: A Diabetics should do a fingerstick blood glucose level test before each meal and at bedtime each day until their disease is under control. The HgbA1c serum test reveals the effectiveness of diabetes therapy for the preceding 8 to 12 weeks. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1764, Box 50-2 OBJ: 9 TOP: Diabetes mellitus KEY: Nursing Process Step: Planning

29. How should the nurse administer insulin to prevent lipohypertrophy? a. At room temperature b. At body temperature c. Straight from the refrigerator d. After rolling bottle between hands to warm

ANS: A In fact, it is now believed that insulin should be administered at room temperature, not straight from the refrigerator, to help prevent insulin lipohypertrophy. PTS: 1 DIF: Cognitive Level: Application REF: Page 1759 OBJ: 8 TOP: Diabetes mellitus KEY: Nursing Process Step: Implementation

18. What do the Chvostek sign and the Trousseau sign indicate? a. Low levels of serum calcium b. High levels of blood sugar c. Low levels of serum sodium d. High levels of serum aldosterone

ANS: A Low levels of blood calcium may cause the Chvostek sign and Trousseau sign. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1738 OBJ: 6 TOP: Chvostek sign KEY: Nursing Process Step: Assessment

1. The nurse explains that the negative feedback system controls hormone release by communication between: a. the pituitary and the target organ. b. the thymus and the blood stream. c. lymphatic system and the target organ. d. central nervous system and the blood stream.

ANS: A The amount of hormone released is controlled by a negative feedback system. When the level of the particular hormone is appropriate, the target organ signals the pituitary to stop the stimulation of the target organ. PTS: 1 DIF: Cognitive Level: Implementation REF: Page 1725 OBJ: 2 TOP: Anatomy KEY: Nursing Process Step: Assessment

4. To which diet should a patient with Cushing syndrome adhere? a. Less sodium b. More calories c. Less potassium d. More carbohydrates

ANS: A The diet should be lower in sodium to help decrease edema. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1749, Table 50-3 OBJ: 5 TOP: Cushing syndrome KEY: Nursing Process Step: Planning

33. The patient being treated for hypothyroidism should be instructed to eat well-balanced meals including intake of iodine. Which of the following foods contains iodine? a. Eggs b. Pork c. White bread d. Skinless chicken

ANS: A The hypothyroid diet should be adequate in intake of iodine, in foods such as saltwater fish, milk, and eggs; fluids should be increased to help prevent constipation. PTS: 1 DIF: Cognitive Level: Application REF: Page 1740 OBJ: 8 TOP: Hypothyroidism KEY: Nursing Process Step: Assessment

24. A patient has come to the clinic because of enlarged hands and feet, amenorrhea, and increased hair growth. These symptoms most likely indicate problems with the: a. pituitary gland. b. adrenal glands. c. thyroid gland. d. pancreas.

ANS: A The pituitary gland may produce an overabundance of growth hormone. This overproduction of hormones may cause changes throughout the patient's body, including enlargement of the pituitary gland and hands and feet. Female patients may develop a deepened voice, increased facial hair growth, and amenorrhea. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1728 OBJ: 5 TOP: Acromegaly KEY: Nursing Process Step: Assessment

38. The adrenal cortex secretes glucocorticoids. The most important is cortisol. What is it involved in? (Select all that apply.) a. Glucose metabolism b. Releasing androgens and estrogens c. Providing extra reserve energy during stress d. Decreasing the level of potassium in the blood stream e. Increasing retention of sodium in the blood stream

ANS: A, C Cortisol is involved in glucose metabolism and provides extra reserve energy in times of stress. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1727 OBJ: 3 TOP: Adrenal cortex KEY: Nursing Process Step: Assessment

36. Which of the following are signs and symptoms of hypoglycemia? (Select all that apply.) a. Irritability b. Dry mouth c. Tremors d. Diaphoresis e. Fruity breath f. Deep respirations

ANS: A, C, D Hypoglycemic reaction: rapid shallow respirations, irritability, tremors, excessive perspiration, and possibly loss of consciousness. PTS: 1 DIF: Cognitive Level: Application REF: Page 1765, Table 50-6 OBJ: 9 TOP: Hypoglycemia KEY: Nursing Process Step: Assessment

37. What are the three major life-threatening complications postoperatively of a thyroidectomy? (Select all that apply.) a. Hemorrhaging b. Seizures c. Tetany d. Hypoglycemia e. Thyroid crisis (storm) f. SIADH

ANS: A, C, E The nurse must be alert for signs of internal or external bleeding. In addition to hemorrhage, two significant postoperative complications exist after thyroidectomy. The first is tetany. The second is thyroid crisis. Manipulation of the thyroid during surgery may cause the release of large amounts of thyroid hormones into the blood stream, creating a thyroid crisis (storm). PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1738 OBJ: 7 TOP: Thyroidectomy KEY: Nursing Process Step: Assessment

17. What should the nurse caution a type I diabetic about excessive exercise? a. It can increase the need for insulin and may result in hyperglycemia. b. It can decrease the need for insulin and may result in hypoglycemia. c. It can increase muscle bulk and may result in malabsorption of insulin. d. It can decrease metabolic demand and may result in metabolic acidosis.

ANS: B The patient with diabetes should exercise regularly. Exercise can reduce insulin resistance and increase glucose uptake for as long as 72 hours, as well as reducing blood pressure and lipid levels. However, exercise can carry some risks for patients with diabetes, including hypoglycemia. PTS: 1 DIF: Cognitive Level: Application REF: Page 1755 OBJ: 11 TOP: Diabetes mellitus KEY: Nursing Process Step: Implementation

27. A 27-year-old patient with hypothyroidism is referred to the dietitian for dietary consultation. What should nutritional interventions include? a. Frequent small meals high in carbohydrates b. Calorie-restricted meals c. Caffeine-rich beverages d. Fluid restrictions

ANS: B A high-protein, high-fiber, lower calorie diet is given. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1740 OBJ: 5 TOP: Hypothyroidism KEY: Nursing Process Step: Planning

6. What is a long-term complication of diabetes mellitus? a. Diverticulitis b. Renal failure c. Hypothyroidism d. Hyperglycemia

ANS: B Long-term complications of diabetes include blindness, cardiovascular problems, and renal failure. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1763 OBJ: 15 TOP: Diabetes mellitus KEY: Nursing Process Step: Assessment

13. What is the postoperative position for a person who has had a thyroidectomy? a. Prone b. Semi-Fowler c. Side-lying d. Supine

ANS: B Postoperative management of this patient includes keeping the bed in a semi-Fowler position, with pillows supporting the head and shoulders. There should be a suction apparatus and tracheotomy tray available for emergency use. PTS: 1 DIF: Cognitive Level: Application REF: Page 1738 OBJ: 7 TOP: Thyroidectomy KEY: Nursing Process Step: Implementation

25. What instructions should a nurse give to a diabetic patient to prevent injury to the feet? a. Soak feet in warm water every day. b. Avoid going barefoot and always wear shoes with soles. c. Use of commercial keratolytic agents to remove corns and calluses are preferred to cutting off corns and calluses. d. Use a heating pad to warm feet when they feel cool to the touch.

ANS: B Sturdy, properly fitting shoes should be worn. Use of corn removers and heating pads is not beneficial to preserve the health of a diabetic's feet. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1762 OBJ: 8 TOP: Foot care KEY: Nursing Process Step: Implementation

35. The nurse cautions the patient who is being instructed on self-medication with insulin to be aware that there are 25-, 30-, 50-, and 100-unit syringes. How is the 100-unit syringe marked? a. 1-unit increments b. 2-unitt increments c. 4-unit increments d. 5-unit increments

ANS: B The 100-unit syringe is marked in 2-unit increments while the smaller syringes are marked in 1-unit increments. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1759 OBJ: 14 TOP: Insulin administration KEY: Nursing Process Step: Implementation

14. What extra equipment should the nurse provide at the bedside of a new postoperative thyroidectomy patient? a. Large bandage scissors b. Tracheotomy tray c. Ventilator d. Water-sealed drainage system

ANS: B There should be a suction apparatus and tracheotomy tray available for emergency use. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1738 OBJ: 7 TOP: Thyroidectomy KEY: Nursing Process Step: Planning

41. The nurse would instruct a patient who is hypocalcemic from hypoparathyroidism about a diet that should include (select all that apply): a. High phosphorus foods b. Canned fish with the bones c. Cucumbers d. Tofu e. Bananas f. Vitamin D supplements

ANS: B, C, D, F The hypocalcemic patient should eat a high-calcium, low-phosphorus diet that includes canned fish, cucumbers, tofu, and vitamin D supplements as an aid to the absorption of the calcium. PTS: 1 DIF: Cognitive Level: Application REF: Page 1737 OBJ: 5 TOP: Diet for hypocalcaemia KEY: Nursing Process Step: Implementation

40. The nurse would instruct a patient with hyperthyroidism (Graves disease) to select which of the following nutritious foods because of the increased metabolism related to the disease. (Select all that apply.) a. Coffee with cream b. Lean meat c. White bread d. Leafy green vegetables e. Supplemental vitamin D

ANS: B, D, E Nutritious food sources, such as food high in protein (e.g., lean meat), sources of vitamin B (e.g., leafy green vegetables), and vitamin D supplements are helpful to meet the metabolic needs of the patient with hyperthyroidism. PTS: 1 DIF: Cognitive Level: Application REF: Page 1737 OBJ: 5 TOP: Diet for hyperthyroidism KEY: Nursing Process Step: Implementation

39. What should the nurse include in provisions for the postoperative care of the patient who had a thyroidectomy? (Select all that apply.) a. Assessing ability to speak by asking him or her to recite name and address every hour b. Maintaining anatomic position of the head when moving a patient c. Assisting a patient to hyperextend the head to assess for muscle damage d. Doing voice check every 2 hours e. Turning, coughing every hour f. Checking for bleeding at the sides and the back of the head

ANS: B, D, F The nurse should hold the head in an anatomic position when moving the patient to prevent tension on the suture line, do a voice check every 2 to 4 hours by asking the patient to say "ah"; the patient is not turned nor is coughing recommended immediately after a thyroidectomy. PTS: 1 DIF: Cognitive Level: Application REF: Page 1738 OBJ: 7 TOP: Postoperative thyroidectomy KEY: Nursing Process Step: Planning

26. The physician prescribes glyburide (Micronase, DiaBeta, Glynase) for a patient, age 57, when diet and exercise have not been able to control type 2 diabetes. What should the nurse include in the teaching plan about this medication? a. It is a substitute for insulin and acts by directly stimulating glucose uptake into the cell. b. It does not cause the hypoglycemic reactions that may occur with insulin use. c. It is thought to stimulate insulin production and increase sensitivity to insulin at receptor sites. d. It lowers blood sugar by inhibiting glucagon release from the liver, preventing gluconeogenesis.

ANS: C Oral hypoglycemics are compounds that stimulate the beta cells in the pancreas to increase insulin release. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1769, Table 50-7 OBJ: 8 TOP: Medications KEY: Nursing Process Step: Planning

19. A patient has undergone tests that indicate a deficiency of the parathyroid hormone secretion. She should be informed of which potential complication? a. Osteoporosis b. Lethargy c. Laryngeal spasms d. Kidney stones

ANS: C Decreased parathyroid hormone levels in the blood stream cause a decreased calcium level. Severe hypocalcemia may result in laryngeal spasm, stridor, cyanosis, and increased possibility of asphyxia. PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1745 OBJ: 5 TOP: Hypoparathyroidism KEY: Nursing Process Step: Implementation

2. Which diagnostic test for diabetes mellitus provides a measure of glucose levels for the previous 8 to 12 weeks? a. Fasting blood sugar (FBS) b. Oral glucose tolerance test (OGT) c. Glycosylated hemoglobin (HbA1c) d. Postprandial glucose test (PPBG)

ANS: C Glycosylated hemoglobin (HbA1c)—This blood test measures the amount of glucose that has become incorporated into the hemoglobin within an erythrocyte. Because glycosylation occurs constantly during the 120-day life span of the erythrocyte, this test reveals the effectiveness of diabetes therapy for the preceding 8 to 12 weeks. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1764, Box 50-2 OBJ: 8 TOP: Glucose monitoring KEY: Nursing Process Step: Assessment

16. The human insulin whose onset of action occurs within minutes is lispro (Humalog). a. 30 b. 60 c. 15 d. 45

ANS: C Humalog begins to take effect in less than half the time of regular, fast-acting insulin. The new formula can be injected 15 minutes before a meal. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1768, Table 50-5 OBJ: 13 TOP: Insulin KEY: Nursing Process Step: Planning

21. The physician orders an 1800-calorie diabetic diet and 40 units of (Humulin N) insulin U-100 subcutaneously daily for a patient with diabetes mellitus. Why would a mid-afternoon snack of milk and crackers be given? a. To improve nutrition b. To improve carbohydrate metabolism c. To prevent an insulin reaction d. To prevent diabetic coma

ANS: C Humulin N insulin starts to peak in 4 hours. The nurse should be alert for signs of hypoglycemia (a less-than-normal amount of glucose in the blood, usually caused by administration of too much insulin, excessive secretion of insulin by the islet cells of the pancreas, or dietary deficiency) at the peak of action of whatever type of insulin the patient is taking. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1768, Table 50-5 OBJ: 13 TOP: Diabetes mellitus KEY: Nursing Process Step: Implementation

30. A patient with a history of Graves disease is admitted to the unit with shortness of breath. The nurse notes the patient's vital signs: T 103° F, P 160, R 24, BP 160/80. The nurse also notes distended neck veins. What does the patient most likely have? a. Pulmonary embolism b. Hypertensive crisis c. Thyroid storm d. Cushing crisis

ANS: C In a thyroid crisis, all the signs and symptoms of hyperthyroidism are exaggerated. Additionally, the patient may develop nausea, vomiting, severe tachycardia, severe hypertension, and occasionally hyperthermia up to 41° C (106° F). Extreme restlessness, cardiac arrhythmia, and delirium may also occur. The patient may develop heart failure and may die. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1738 OBJ: 8 TOP: Hyperthyroidism KEY: Nursing Process Step: Assessment

34. The nurse is caring for a patient who is receiving calcium gluconate for treatment of hypoparathyroid tetany. Which assessment would indicate an adverse reaction to the drug? a. Increase in heart rate b. Flushing of face and neck c. Drop in blood pressure d. Urticaria

ANS: C Indications of an adverse effect of calcium gluconate are dyspnea, bradycardia, and hypotension. PTS: 1 DIF: Cognitive Level: Application REF: Page 1745 OBJ: 5 TOP: Calcium gluconate for tetany KEY: Nursing Process Step: Assessment

32. What information should be obtained from the patient before an iodine-131 test? a. Presence of metal in the body b. Allergy to sulfa drugs c. Status of possible pregnancy d. Use of prescription drugs for hypertension

ANS: C Iodine-131 is not a radiation hazard to the nonpregnant patient but is absolutely contraindicated during pregnancy. Pregnant nurses should not care for this patient for several days. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1736 OBJ: 5 TOP: Iodine-131 KEY: Nursing Process Step: Assessment

9. What is an appropriate nursing diagnosis for a patient who has recently been diagnosed with acromegaly? a. Ineffective coping b. Activity intolerance c. Risk for trauma d. Chronic low self-esteem

ANS: C Nursing interventions are mainly supportive. The presence of muscle weakness, joint pain, or stiffness warrants assessment of the ability to perform activities of daily living (ADLs). PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1728 OBJ: 5 TOP: Acromegaly KEY: Nursing Process Step: Planning

10. The purpose of the use of radioactive iodine in the treatment of hyperthyroidism is to: a. stimulate the thyroid gland. b. depress the pituitary. c. destroy some of the thyroid tissue. d. alter the stimulus from the pituitary.

ANS: C Radioactive iodine 131 destroys some of the hyperactive thyroid gland to produce a more normally functioning gland. PTS: 1 DIF: Cognitive Level: Application REF: Page 1736, Box 50-1 OBJ: 5 TOP: Radioactive iodine 131 KEY: Nursing Process Step: Implementation

11. Which precaution(s) should the nurse take when caring for a patient who is being treated with radioactive iodine 131 (RAIU)? a. Initiate radioactive safety precautions b. Avoid assigning any young woman to the patient c. Wait three days after dose before assigning a pregnant nurse to care for this patient d. Advise visitors to sit at least 10 feet away from the patient

ANS: C The dose is patient specific and at a very low level. No radioactive safety precautions are necessary and pregnant nurses can be assigned 3 days after the dose. RAIU is not harmful to nonpregnant women. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1736, Box 50-1 OBJ: 5 TOP: Thyroid disorders KEY: Nursing Process Step: Assessment

20. The nurse caring for a 75-year-old man who has developed diabetes insipidus following a head injury will include in the plan of care provisions for: a. limiting fluids to 1500 mL a day. b. encouraging physical exercise. c. protecting patient from injury. d. discouraging daytime naps.

ANS: C The patients need protection from injury because they are often exhausted from sleep deprivation and having to get up frequently at night. Fluids should not be limited and their energy should be preserved. PTS: 1 DIF: Cognitive Level: Application REF: Page 1733 OBJ: 5 TOP: Diabetes insipidus KEY: Nursing Process Step: Implementation

5. The patient is a 20-year-old college student who has type 1 diabetes and normally walks each evening as part of an exercise regimen. The patient plans to enroll in a swimming class. Which adjustment should be made based on this information? a. Time the morning insulin injection so that the peak action will occur during swimming class. b. Delete normal walks on swimming class days. c. Delay the meal before the swimming class until the session is over. d. Monitor glucose level before, during, and after swimming to determine the need for alterations in food or insulin.

ANS: D Exercise can reduce insulin resistance and increase glucose uptake for as long as 72 hours, as well as reducing blood pressure and lipid levels. However, exercise can carry some risks for patients with diabetes, including hypoglycemia. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1755 OBJ: 11 TOP: Diabetes mellitus KEY: Nursing Process Step: Planning

7. A patient has returned to his room after a thyroidectomy with signs of thyroid crisis. During thyroid crisis, exaggerated hyperthyroid manifestations may lead to the development of the potentially lethal complication of: a. severe nausea and vomiting. b. bradycardia. c. delirium with restlessness. d. congestive heart failure.

ANS: D In thyroid crisis, all the signs and symptoms of hyperthyroidism are exaggerated. The patient may develop congestive heart failure and die. PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1738 OBJ: 7 TOP: Thyroidectomy KEY: Nursing Process Step: Assessment

12. Why would a patient with hyperthyroidism be prescribed the drug methimazole (Tapa-zole)? a. To limit the effect of the pituitary on the thyroid b. To destroy part of the hyperactive thyroid tissue c. To stimulate the pineal gland d. To block the production of thyroid hormones

ANS: D Medical management for hyperthyroidism may include administration of drugs that block the production of thyroid hormones, such as propylthiouracil or methimazole. PTS: 1 DIF: Cognitive Level: Application REF: Page 1736, Table 50-2 OBJ: 5 TOP: Hyperthyroidism KEY: Nursing Process Step: Implementation

28. What instructions should be included in the discharge instructions for a 47-year-old patient with hypothyroidism? a. Taking medication whenever symptoms cause discomfort b. Decreasing fluid and fiber intake c. Consuming foods rich in iron d. Seeing the physician regularly for follow-up care

ANS: D Regular checkups are essential, because drug dosage may have to be adjusted from time to time. PTS: 1 DIF: Cognitive Level: Application REF: Page 1740 OBJ: 5 TOP: Hypothyroidism KEY: Nursing Process Step: Planning

22. The nurse teaching a patient with type 1 diabetes mellitus (IDDM) about early signs of insulin reaction would include information about: a. abdominal pain and nausea. b. dyspnea and pallor. c. flushing of the skin and headache. d. hunger and a trembling sensation.

ANS: D The patient should be instructed to notify a member of the nursing staff if any signs of hypoglycemic (low insulin) reaction occur: excessive perspiration or trembling. PTS: 1 DIF: Cognitive Level: Application REF: Page 1765, Table 50-6 OBJ: 9 TOP: Insulin reaction KEY: Nursing Process Step: Implementation

31. What is the master gland of the endocrine system? a. Thyroid b. Parathyroid c. Pancreas d. Pituitary

ANS: D The pituitary gland, located in the brain, is the master gland of the endocrine system. It has been called the "master gland" because through the negative feedback system, it exerts its control over the other endocrine glands. PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1725 OBJ: 1 TOP: Pituitary gland KEY: Nursing Process Step: Assessment