Chapter 11 Endocrine Disorders

28. Which of the following statements best describes the Somogyi effect? A. Insulin-induced hypoglycemia triggers excess secretion of glucagon and cortisol, leading to hyperglycemia. B. Early morning elevated blood glucose levels result in part from growth hormone and cortisol-triggering hepatic glucose release. C. Late evening hyperglycemia is induced by inadequate insulin dose. D. Episodes of postprandial hypoglycemia occur as a result of inadequate food intake.

A. Insulin-induced hypoglycemia triggers excess secretion of glucagon and cortisol, leading to hyperglycemia.

2. Which of the following characteristics applies to type 2 DM? A. Major risk factors are heredity and obesity. B. Pear-shaped body type is commonly found. C. Exogenous insulin is needed for control of disease. D. Physical activity enhances IR.

A. Major risk factors are heredity and obesity.

1. Which of the following characteristics applies to type 1 diabetes mellitus (DM)? A. Significant hyperglycemia and ketoacidosis result from lack of insulin. B. This condition is commonly diagnosed on routine examination or workup for other health problems. C. Initial response to oral sulfonylureas is usually favorable. D. Insulin resistance (IR) is a significant part of the disease.

A. Significant hyperglycemia and ketoacidosis result from lack of insulin.

54. Which of the following is an unlikely consequence of untreated metabolic syndrome and IR in a woman of reproductive age? A. hyperovulation B. irregular menses C. acne D. hirsutism

A. hyperovulation

29. Intervention in microalbuminuria for a person with DM includes which of the following? (More than one can apply.) A. improved glycemic control B. strict dyslipidemia control C. use of an optimized dose of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) D. use of an ACEI with an ARB

A. improved glycemic control B. strict dyslipidemia control C. use of an optimized dose of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB)

4. After use, the onset of action of lispro (Humalog®) occurs in: A. less than 30 minutes. B. approximately 1 hour. C. 1 to 2 hours. D. 3 to 4 hours.

A. less than 30 minutes.

77. Which of the following is a possible consequence of obesity? (More than one can apply.) A. obstructive apnea B. steatohepatitis C. female infertility D. endometrial cancer

A. obstructive apnea B. steatohepatitis C. female infertility D. endometrial cancer

15. Clinical presentation of type 1 DM usually includes all of the following except: A. report of recent unintended weight gain. B. ketosis. C. persistent thirst. D. polyphagia.

A. report of recent unintended weight gain.

57. Possible adverse outcomes from heatstroke include: A. rhabdomyolysis. B. thrombocytopenia. C. hypernatremia. D. leukopenia.

A. rhabdomyolysis.

70. The use of which of the following medications is often associated with weight gain? A. risperidone (Risperdal®) B. topiramate (Topamax®) C. metformin (Glucophage®) D. sitagliptin (Januvia®)

A. risperidone (Risperdal®)

63. When advising a person who will be using orlistat (Xenical®, Alli®) as part of a weight loss program, the NP provides the following information about when to take the medication: A. within an hour of each meal that contains fat. B. before any food with high carbohydrate content. C. only in the morning, to avoid sleep disturbance. D. up to 3 hours after any meal, regardless of types of food eaten.

A. within an hour of each meal that contains fat.

11. Which of the following should be the goal measurement in treating a 45-year-old man with DM and hypertension? A. blood pressure less than 140 mm Hg systolic and less than 90 mm Hg diastolic B. hemoglobin A1c equal to or greater than 7% C. triglyceride 200 to 300 mg/dL (11.1 to 16.6 mmol/L) D. high-density lipoprotein (HDL) 35 to 40 mg/dL (0.9 to 1.03 mmol/L)

A. blood pressure less than 140 mm Hg systolic and less than 90 mm Hg diastolic

7. Generally, testing for type 2 DM in asymptomatic, undiagnosed individuals older than 45 years should be conducted every _____. A. year. B. 3 years C. 5 years D. 10 years

B. 3 years

60. Obesity is defined as having a body mass index (BMI) equal to or greater than _______ kg/m2. A. 25 B. 30 C. 35 D. 40

B. 30

39. In teaching a patient with type 2 diabetes mellitus and taking basal insulin such as degludec (Tresiba®) about using rapid-acting insulin such as aspart (Novolog®) to help with the management of postprandial hyperglycemia, the NP advises first starting an injection of _____ unit(s) prior to the largest meal. A. 1 B. 4 C. 8 D. 12

B. 4

49. Consideration should be given to setting A1c goal in a 22-year-old man with a 8-year history of type 1 diabetes mellitus who has no comorbid conditions equal to or at less than: A. 5.5%. B. 6%. C. 6.5%. D. 7%.

B. 6%.

47. Which of the following best describes ethnicity and insulin sensitivity? A. Little variation exists in insulin sensitivity among different ethnic groups. B. African Americans are typically less sensitive to the effects of insulin when compared with people of European ancestry. C. Mexican Americans are likely the most insulinsensitive ethnic group residing in North America. D. The degree of insulin sensitivity has little influence on insulin production.

B. African Americans are typically less sensitive to the effects of insulin when compared with people of European ancestry.

41. Mr. Samuels is a 58-year-old man with type 2 DM who is using a single 10 unit daily dose of the long-acting insulin glargine. His fasting blood glucose has been between 141 to 180 mg/dL (7.8 to 10 mmol/L). Which of the following best describes the next step in his therapy? A. Continue on the current glargine dose. B. Increase his glargine dose by 4 units per day. C. Increase his glargine dose by 1 unit per day. D. Increase his glargine dose by 6 units per day.

B. Increase his glargine dose by 4 units per day.

22 to 25. With an 8 a.m. dose of the following insulin forms, followed by an inadequate dietary intake and/or excessive energy use, at approximately what time would hypoglycemia be most likely to occur? 23. regular insulin _______________________

Approximately 10 to 11 a.m. (with peak of insulin dose)

22 to 25. With an 8 a.m. dose of the following insulin forms, followed by an inadequate dietary intake and/or excessive energy use, at approximately what time would hypoglycemia be most likely to occur? 24. NPH insulin ________________________

Approximately 2 to 10 p.m. (with peak of insulin dose)

22 to 25. With an 8 a.m. dose of the following insulin forms, followed by an inadequate dietary intake and/or excessive energy use, at approximately what time would hypoglycemia be most likely to occur? 22. lispro _____________________________

Approximately 8:30 to 9:30 a.m. (with peak of insulin dose)

69. When counseling about malabsorptive bariatric surgery, the NP provides the following information: A. Most people achieve ideal BMI postoperatively. B. The most dramatic weight losses are seen in the first few postoperative months. C. The death rate directly attributable to surgery is about 10%. D. Weight loss will continue for years postoperatively in most patients.

B. The most dramatic weight losses are seen in the first few postoperative months.

13. The mechanism of action of sulfonylureas is as: A. an antagonist of insulin receptor site activity. B. a product that enhances insulin release. C. a facilitator of renal glucose excretion. D. an agent that can reduce hepatic glucose production.

B. a product that enhances insulin release.

30. Hemoglobin A1c should be tested: A. at least annually for all patients. B. at least two times a year in patients who are meeting treatment goals and who have stable glycemic control. C. monthly in patients whose therapy has changed or who are not meeting glycemic goals. D. only via standardized laboratory testing because of inaccuracies associated with point-of-service testing.

B. at least two times a year in patients who are meeting treatment goals and who have stable glycemic control.

65. A pound of fat contains approximately _____ stored calories. A. 2500 B. 3000 C. 3500 D. 4000

C. 3500

44. In a healthy person, what percentage of the body's total daily physiological insulin secretion is released as basally? A. 10%-20% B. 25%-35% C. 50%-60% D. 75%-85%

C. 50%-60%

48. Recommended A1c goal in a 79-year-old woman with a 20-year history of type 2 diabetes mellitus who has difficulty ambulating, uses a walker, and has a cardiac ejection fraction of 35% and a history of heart failure should be equal to or less than: A. 7%. B. 7.5%. C. 8%. D. 8.5%.

C. 8%.

17. Which of the following should be periodically monitored with the use of a thiazolidinedione? A. CK B. ALP C. ALT D. Cr

C. ALT

26. The meglitinide analogues are particularly helpful adjuncts in type 2 DM care to minimize risk of: A. fasting hypoglycemia. B. nocturnal hyperglycemia. C. postprandial hyperglycemia. D. postprandial hypoglycemia.

C. postprandial hyperglycemia.

12. In caring for a patient with DM, microalbuminuria measurement should be obtained: A. annually if urine protein is present. B. periodically in relationship to glycemia control. C. yearly. D. with each office visit related to DM.

C. yearly.

6. The mechanism of action of metformin (Glucophage®) is as: A. an insulin-production enhancer. B. a product virtually identical in action to sulfonylureas. C. a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production. D. a facilitator of renal glucose excretion.

C. a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production.

37. All the following medications are recommended as possible first-line medications for treatment of concomitant hypertension when seen with type 2 DM in a 48-year-old man of European ancestry except: A. thiazide diuretic. B. calcium channel blocker. C. alpha-adrenergic receptor antagonist. D. angiotensin receptor blocker.

C. alpha-adrenergic receptor antagonist

10. The mechanism of action of pioglitazone is as: A. an insulin-production enhancer. B. a reducer of pancreatic glucose output. C. an insulin sensitizer. D. a facilitator of renal glucose excretion.

C. an insulin sensitizer.

8. You are seeing 17-year-old Amanda. As part of the visit, you consider her risk factors for type 2 DM would likely include all of the following except: A. obesity. B. Native American ancestry. C. family history of type 1 DM. D. personal history of polycystic ovary syndrome.

C. family history of type 1 DM.

14. When caring for a patient with DM, hypertension, and persistent proteinuria, the nurse practitioner (NP) prioritizes the choice of antihypertension and prescribes: A. furosemide. B. methyldopa. C. fosinopril. D. nifedipine.

C. fosinopril.

5. Which of the following medications should be used with caution in a person with severe sulfa allergy? A. metformin B. glyburide C. rosiglitazone D. NPH insulin

B. glyburide

51. The International Diabetes Federation's diagnostic criteria for metabolic syndrome include: A. an obligatory finding of persistent hyperglycemia. B. notation of ethnic-specific waist circumference measurements. C. documentation of microalbuminuria. D. a family history of type 2 DM.

B. notation of ethnic-specific waist circumference measurements.

45. Five years or more after type 2 diabetes mellitus diagnosis, which of the following medications is less likely to be effective in controlling plasma glucose? A. metformin B. pioglitazone C. glipizide D. insulin

C. glipizide

53. Cardiovascular effects of hyperinsulinemia include: A. decreased renal sodium reabsorption. B. constricted circulating volume. C. greater responsiveness to angiotensin II. D. diminished sympathetic activation.

C. greater responsiveness to angiotensin II

50. The use of GLP-1 agonist has been associated with the development of: A. leukopenia. B. pancreatitis. C. lymphoma. D. vitiligo.

B. pancreatitis.

59. The most commonly utilized intervention for patients with heatstroke is: A. total body ice packing. B. rehydration. C. management of hyperammonemia. D. electrolyte supplementation.

B. rehydration.

22 to 25. With an 8 a.m. dose of the following insulin forms, followed by an inadequate dietary intake and/or excessive energy use, at approximately what time would hypoglycemia be most likely to occur? 25. insulin glargine (Toujeo®, Lantus®) _______

Because insulin glargine (Toujeo®, Lantus®) has no peak, an episode of hypoglycemia is unlikely. If hypoglycemia were to occur, the episode could be protracted if left untreated because of the protracted duration of activity of the medication.

36. Metformin should be discontinued for the day of and up to 48 hours after surgery because of increased risk of: A. hypoglycemia. B. hepatic impairment. C. lactic acidosis. D. interaction with most anesthetic agents.

C. lactic acidosis.

56. Risk factors for heatstroke include all of the following except: A. obesity. B. use of beta-adrenergic antagonists. C. excessive activity. D. use of a vasodilator.

D. use of a vasodilator.

20. Hemoglobin A1c best provides information on glucose control over the past: A. 21 to 47. B. 48 to 68. C. 69 to 89. D. 90 to 120.

D. 90 to 120.

21. Which of the following statements is not true concerning the effects of exercise and IR? A. Approximately 80% of the body's insulin-mediated glucose uptake occurs in skeletal muscle. B. With regular aerobic exercise, IR is reduced by approximately 40%. C. The IR-reducing effects of exercise persist for 48 hours after the activity. D. Hyperglycemia can occur as a result of aerobic exercise.

D. Hyperglycemia can occur as a result of aerobic exercise.

34. The use of a thiazolidinedione is not recommended in all of the following clinical scenarios except: A. a 57-year-old man who is taking a nitrate. B. a 62-year-old woman with heart failure. C. a 45-year-old man who is using insulin. D. a 35-year-old patient with newly diagnosed type 2 DM.

D. a 35-year-old patient with newly diagnosed type 2 DM.

40. Which of the following patients has prediabetes? A. a 70-year-old man with a fasting glucose of 99 mg/dL (6.05 mmol/L) B. an 84-year-old woman with a 1-hour postprandial glucose of 98 mg/dL (5.44 mmol/L) C. a 33-year-old man with a hemoglobin A1c of 5.4% D. a 58-year-old woman with a 2-hour postprandial glucose of 152 mg/dL (8.44 mmol/L)

D. a 58-year-old woman with a 2-hour postprandial glucose of 152 mg/dL (8.44 mmol/L)

9. Criteria for the diagnosis of type 2 DM include: A. classic symptoms regardless of fasting plasma glucose measurement. B. plasma glucose level of 126 mg/dL (7 mmol/L) as a random measurement. C. a 2-hour glucose measurement of 156 mg/dL (8.6 mmol/L) after a 75 g anhydrous glucose load. D. a plasma glucose level of 126 mg/dL (7 mmol/L) or greater after an 8 hour or greater fast on more than one occasion.

D. a plasma glucose level of 126 mg/dL (7 mmol/L) or greater after an 8 hour or greater fast on more than one occasion.

46. The use of which of the following medications has the potential for causing the greatest reduction in HbA1c? A. a biguanide B. a thiazolidinedione C. a sulfonylurea D. an insulin form

D. an insulin form

42. Which of the following classes of medications is commonly recommended as part of first-line therapy in the newly diagnosed person with type 2 diabetes? A. alpha-glucosidase inhibitor B. meglitinide C. thiazolidinedione D. biguanide

D. biguanide

16. Which of the following should be periodically monitored with the use of a biguanide? A. creatine kinase (CK) B. alkaline phosphatase (ALP) C. alanine aminotransferase (ALT) D. creatinine (Cr)

D. creatinine (Cr)

55. Acanthosis nigricans is commonly noted in all of the following areas except: A. groin folds. B. axilla. C. nape of the neck. D. face.

D. face.

18. All of the following are risks for lactic acidosis in individuals taking metformin except: A. presence of chronic renal insufficiency. B. acute dehydration. C. recent radiographic contrast dye use. D. history of allergic reaction to sulfonamides.

D. history of allergic reaction to sulfonamides.

52. Metformin has all of the following effects except: A. improved insulin-mediated glucose uptake. B. modest weight loss with initial use. C. enhanced fibrinolysis. D. increased low-density lipoprotein (LDL) cholesterol production.

D. increased low-density lipoprotein (LDL) cholesterol production.

35. In an older adult with type 2 DM with gastroparesis, the use of which of the following medications should be avoided? A. insulin glargine (Toujeo®, Lantus®) B. insulin aspart (NovoLog®) C. glimepiride (Amaryl®) D. liraglutide (Victoza®)

D. liraglutide (Victoza®)

19. Secondary causes of hyperglycemia potentially include the use of all of the following medications except: A. high-dose niacin. B. systemic corticosteroids. C. high-dose thiazide diuretics. D. low-dose angiotensin receptor blockers.

D. low-dose angiotensin receptor blockers.

64. The action of which of the following is believed to be most responsible for the sensation of satiety? A. norepinephrine B. epinephrine C. dopamine D. serotonin

D. serotonin

72 to 76. Weight loss medications: True or false? ____ 74. Phentermine's mechanism of action in weight loss is as a product that reduces gastrointestinal (GI) motility.

False

61. Which of the following is an example of an appropriate question to pose to a person with obesity who is in the precontemplation change stage? A. "How do you feel about your weight?" B. "What are barriers you see to losing weight?" C. "What is your personal goal for weight loss?" D. "How do you envision my helping you meet your weight loss goal?"

A. "How do you feel about your weight?"

71. You are counseling a patient who is considering gastric bypass surgery for weight loss. You advise the following. (More than one can apply.) A. Calcium absorption will be reduced. B. Rapid weight loss after obesity surgery can contribute to the development of gallstones. C. Chronic constipation is a common postoperative adverse effect. D. Lifelong vitamin B12 supplementation is recommended.

A. Calcium absorption will be reduced. B. Rapid weight loss after obesity surgery can contribute to the development of gallstones. D. Lifelong vitamin B12 supplementation is recommended.

33. You see an obese 25-year-old man with acanthosis nigricans and consider ordering: A. FBS. B. LFT. C. RPR. D. ESR.

A. FBS.

38. Which of the following best describes the physical activity recommendations such as brisk walking for a 55-year-old woman with newly diagnosed type 2 diabetes mellitus? (More than one can apply.) A. The goal should be for a total increased physical activity of 150 min per week or more. B. Increased physical activity is recommended at least three times per week with no more than 48 hours without exercise C. Some form of resistance exercise such as lifting dumbbells or using an exercise band should be included at least two times per week. D. Vigorous aerobic or resistance activity is potentially contraindicated in the presence of proliferative or severe nonproliferative retinopathy because of the possible risk of vitreous hemorrhage or retinal detachment.

A. The goal should be for a total increased physical activity of 150 min per week or more. B. Increased physical activity is recommended at least three times per week with no more than 48 hours without exercise C. Some form of resistance exercise such as lifting dumbbells or using an exercise band should be included at least two times per week. D. Vigorous aerobic or resistance activity is potentially contraindicated in the presence of proliferative or severe nonproliferative retinopathy because of the possible risk of vitreous hemorrhage or retinal detachment.

43. Pertaining to the use of sliding-scale insulin in response to elevated blood glucose, which of the following best describes current best practice? A. The use of this type of sliding-scale insulin therapy is discouraged as this method treats hyperglycemia after it has already occurred. B. Sliding-scale insulin in response to elevated glucose is a safe and helpful method of treating hyperglycemia. C. Delivering insulin in this manner is acceptable within the acute care hospital setting only. D. The use of the sliding insulin scale is appropriate in the treatment of type 1 DM only.

A. The use of this type of sliding-scale insulin therapy is discouraged as this method treats hyperglycemia after it has already occurred.

31. The mechanism of action of the DPP-4 inhibitors is as: A. a drug that increases levels of incretin, increasing synthesis and release of insulin from pancreatic beta cells. B. a product virtually identical in action to sulfonylureas. C. a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production. D. a facilitator of renal glucose excretion.

A. a drug that increases levels of incretin, increasing synthesis and release of insulin from pancreatic beta cells.

32. The mechanism of action of a GLP-1 agonist such as exenatide (Byetta®) is as: A. a drug that stimulates insulin production in response to an increase in plasma glucose. B. a product virtually identical in action to sulfonylureas. C. a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production. D. a facilitator of renal glucose excretion.

A. a drug that stimulates insulin production in response to an increase in plasma glucose.

58. Laboratory findings in heatstroke usually include: A. elevated total creatine kinase. B. anemia. C. metabolic alkalosis. D. hypokalemia.

A. elevated total creatine kinase.

3. You consider prescribing insulin glargine (Toujeo®, Lantus®) because of its: A. extended duration of action. B. rapid onset of action. C. ability to prevent diabetic end-organ damage. D. ability to preserve pancreatic function.

A. extended duration of action.

27. What is the most common adverse effect noted with alpha-glucosidase inhibitor use? A. gastrointestinal upset B. hepatotoxicity C. renal impairment D. symptomatic hypoglycemia

A. gastrointestinal upset

68. In a person with obesity, weight loss of _______ % or more yields an immediate reduction in death rates from cardiovascular and cerebrovascular disease. A. 5 B. 10 C. 15 D. 20

B. 10

67. With the use of weight loss medications, if the patient has not achieved a 5% weight loss by week ______ of treatment, the therapy should be discontinued. A. 6 B. 12 C. 18 D. 24

B. 12

62. Which of the following is an example of an appropriate question to pose to a person with obesity who is in the contemplation change stage? A. "How do you feel about your weight?" B. "What are barriers you see to losing weight?" C. "What is your personal goal for weight loss?" D. "How do you envision my helping you meet your weight loss goal?"

B. "What are barriers you see to losing weight?"

66. The commonly recommended physical activity level of 10,000 steps per day is roughly the equivalent of walking ____ miles. A. 1 to 2 B. 2 to 3 C. 3 to 4 D. 4 to 5

D. 4 to 5

72 to 76. Weight loss medications: True or false? ____ 76. Use of naltrexone/bupropion (Contrave®) is associated with increased risk of suicidal ideation.

True

72 to 76. Weight loss medications: True or false? ____ 72. Lorcaserin (Belviq®) should not be used with medications that have a serotonergic effect.

True

72 to 76. Weight loss medications: True or false? ____ 73. Phentermine/topiramate (Qsymia®) carries a warning about potential teratogenic effects.

True

72 to 76. Weight loss medications: True or false? ____ 75. In general, weight lost post-gastric bypass is significantly more when compared with the postoperative course of a restrictive procedure such as adjustable gastric band or gastric sleeve.

True