Critical Thinking
Why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones? a. Decrease glucose production b. Independently regulate glucose level in the blood c. Increase glucose transport into the cells d. Stimulate glucose output by the liver
Answer: D
Your patient, Lucinda, was recently diagnosed with type 2 DM. Which of the following labs from the patient would support the diagnosis of type 2 DM? a. Fasting glucose 141 mg/dL b. HgbA1C 7.3% c. Random blood glucose of 113 mg/dL d. Answers A & B are correct e. Answers B & C are correct f. All of the above are correct g. None of the above are correct
Answer: D
You receive change of shift report on a patient. The patient was admitted with Graves disease. You understand that nursing considerations for the patient may include all of the following except: a. Provide frequent meals and snacks b. Provide patient with a warming blanket c. Provide patient with a cooling blanket d. Anticipate that patient may undergo thyroidectomy during their stay
Answer: B
A patient has a serum calcium (total) level of 13.4 mg/dL (3.35 mmol/L). Which disorder would the nurse suspect? a. Hyperphosphatemia b. Hyperparathyroidism c. Magnesium deficiency d. Type 2 diabetes mellitus
Answer: B Rationale: A normal serum calcium (total) is 8.6 to 10.2 mg/dL (2.15 to 2.55 mmol/L). The patient with a serum calcium level of 13.4 mg/dL has hypercalcemia. Serum calcium levels are increased in hyperparathyroidism.
Your patient requires insulin therapy for management of their type 1 DM. You educate the patient on all of the following except: a. You should ration your insulin if you are running low b. You should maintain a journal to keep track of your blood glucose levels before insulin injection c. Your insulin Glargine (Lantus) mimics the basal dose of insulin released by your pancreas d. Take your insulin as prescribed
Answer: A
Patient presents to the ED due to concern for development of purple stretch marks on her abdomen. Further examination reveals multiple bruises in various stages of healing, facial hair reported to be new, and reddened cheeks. Patient recently was hospitalized for severe asthma exacerbation that included use of steroids. Vital signs are stable, patient is A&O X4, and assessment is otherwise unremarkable. Which of the following would you expect to be ordered for the patient? a. 24 hr urine collection at home to determine cortisol levels b. BMP to determine hypokalemia to confirm Cushing's Syndrome c. Methylprednisolone order to help patient with symptom management d. Direct admission to ICU for emergent management for severe Cushing's Syndrome
Answer: A Patient is stable enough to return home and follow instructions for a 24 hr urine collection. Methylprednisolone is a steroid and would not be ordered when Cushing's is suspected. Patient is stable and does not require critical care at this time. Hypokalemia is not a definitive symptom to confirm Cushing's.
The nurse is caring for a patient with type 1 diabetes mellitus who is admitted for diabetic ketoacidosis. The nurse would expect which laboratory test result? a. Hypokalemia b. Fluid overload c. Hypoglycemia d. Hyperphosphatemia
Answer: A Rationale: Electrolytes are depleted in diabetic ketoacidosis. Osmotic diuresis occurs with depletion of sodium, potassium, chloride, magnesium, and phosphate levels. A patient with diabetic ketoacidosis will be dehydrated (fluid volume deficit), and blood glucose levels would be elevated (hyperglycemia). Additionally, polyuria and IV insulin can cause potassium to decrease.
The nurse administers corticosteroids to a patient with acute adrenal insufficiency. The nurse determines that treatment is effective if what is observed? a. The patient is alert and oriented. b. The patient's lung sounds are clear. c. The patient's urinary output decreases. d. The patient's potassium level is 5.7 mEq/L.
Answer: A Rationale: The patient in acute adrenal insufficiency will have the following clinical manifestations: hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, and confusion. Collaborative care will include administration of corticosteroids. An outcome that would indicate patient improvement would be improved level of consciousness (i.e., alert and oriented).
Patient is admitted to the unit for hypothyroid symptoms including hypotension and prolonged fatigue. On admission, patient explains that he changed his levothyroxine brand recently due to insurance coverage. Labs reveal suboptimal levels of T3 and T4. Which of the following assessment findings would be emergent and need to be reported immediately? Select All That Apply a. Severe periorbital and facial edema b. Thin, brittle nails c. Altered mental status d. Difficulty waking e. Cold intolerance
Answer: A, C, D, E The above assessment findings are suggestive of myxedema. Altered mental status and lethargy are findings that are typically reported to the provider. Because the patient is admitted for hypothyroid issues, the facial and periorbital edema must be reported in case level of care needs to be elevated.
Syndrome of inappropriate antidiuretic hormone (SIADH) is associated with all of the following, except: a. Low serum sodium b. High serum sodium c. Low serum osmolality d. High urine osmolality
Answer: B
You are receiving change of shift report. After report, you anticipate you need to see which patient first? a. 22 year old male presenting with hypothyroidism and a heart rate of 53 b. 34 year old male presenting with a goiter complaining of difficulty swallowing and speaking c. 27 year old female with a low TSH complaining of insomnia d. 30 year old female with a high TSH complaining of constipation
Answer: B
A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmoL/L). Which statement by the nurse is best? a. "You will develop type 2 diabetes within 5 years." b. "You are at increased risk for developing diabetes." c. "The test is normal, and diabetes is not a problem." d. "The laboratory test result is positive for type 2 diabetes."
Answer: B Rationale: Impaired fasting glucose (fasting blood glucose level between 100 and 125 mg/dL) and impaired glucose tolerance (2-hour plasma glucose level between 140 and 199 mg/dL) represent an intermediate stage between normal glucose homeostasis and diabetes. This stage is called prediabetes, and patients are at increased risk for the development of type 2 diabetes.
A patient with thyroid nodules is to undergo a thyroid scan with oral radioactive isotopes. Which instructions, if given by the nurse, are appropriate? a. "The test cannot be completed if you have an allergy to iodine or shellfish." b. "It is important to drink at least 2 to 3 liters of liquids for the next 1 to 2 days." c. "Isolation is required for 24 hours until the radioactive substance is eliminated from the body." d. "Sedation is necessary to ensure that you do not move while the scanner moves over your neck."
Answer: B Rationale: Patients should drink increased amount of fluids for 24 to 48 hours unless this is contraindicated. No special precautions are needed. The radionuclide will be eliminated in 6 to 24 hours. Reaction to iodine in allergic patients is rare because the amount of iodine in preparation is minimal. Sedation is not necessary for this procedure.
A patient's arterial blood gas (ABG) results include the following: pH 7.32, PaO2 84 mm Hg, PaCO2 49 mm Hg, and SaO2 84%. For what should the nurse assess the patient? a. Tetany b. Tachypnea c. Pleural friction rub d. Kussmaul respirations
Answer: B Rationale: The arterial blood gas analysis indicates respiratory acidosis. Tachypnea is defined as a rapid respiratory rate and indicates respiratory distress. Tetany occurs in metabolic alkalosis. A pleural friction rub is a creaking or grating sound heard during auscultation of the lungs and indicates inflamed pleural surfaces that are rubbing together. Kussmaul respirations are commonly seen in metabolic acidosis and are abnormally deep, very rapid sighing respirations.
A patient learns from his A1C of 9.2 that he is prediabetic. Which of the following would be the most appropriate teaching for this patient prior to discharge? a. Teach the patient how to draw up insulin and how to use an insulin pen, then have him demonstrate to prove he can self-administer insulin at home b. Give the patient a picture of a well-balanced plate and explain how a balanced diet combined with exercise will aid with preventing the onset of Type 2 Diabetes c. Let the patient know that he needs to return for a lab draw in three months to confirm his new diabetic status d. Teach the patient about why his pancreas is no longer producing insulin so he can better understand his diagnosis
Answer: B The patient is not yet considered diabetic. Education should include how to eat appropriately and exercise to help him lower his A1C A and D contains education concerning insulin-dependent diabetics C offers no education or clarification of future steps for the patient to take. It is only an instruction.
A diabetic patient is post-op day 2 after elective knee replacement. Blood glucose check reveals 179 mg/dL. The patient normally takes an oral medication for glucose control, but it has not yet been reordered by the attending physician. Instead, insulin has been ordered to ensure the patient's blood glucose remains stable. All of the following interventions are appropriate EXCEPT: a. Administer insulin per MAR when the tray arrives to ensure patient will not become hypoglycemic b. Explain to the patient that he is now insulin-dependent because his blood sugars are not well controlled c. Explain to the patient that it is important to ensure blood glucose is controlled to prevent infection and delayed wound healing d. Explain how inflammation and stress from surgery can elevate blood sugar, which is why the doctor wants to use insulin while in the hospital to prevent complications
Answer: B The patient's blood sugar is not high enough to be considered poorly controlled. If the patient was now insulin dependent, it is the responsibility of the attending physician to explain this first, not the nurse.
Jimmy arrives to your clinic. Jimmy has previously been diagnosed with Addison's disease. You would anticipate Jimmy's labs to be: a. Na 140, K 4.0, Glucose 100 b. Na 128, K 5.2, Glucose 61 c. Na 153, K 3.1, Glucose 200 d. Na 130, K 2.9, Glucose 30
Answer: B You would expect hyponatremia, hyperkalemia, and hypoglycemia
Patient is admitted to the unit for suspected hyperaldosteronism. Labs show Na+ 159 K+ 2.9. Which of the following would you expect to see occurring in this patient? Select All That Apply a. Hypotension b. Hypertension c. Cardiac arrhythmias and EKG changes d. Headache e. Fatigue f. Tachypnea
Answer: B, C, D, E Patient has two electrolyte imbalances - sodium and potassium. This leads to headaches and hypertension for the elevated sodium, cardiac changes and fatigue for the lowered potassium levels
A 27 year old unresponsive female arrives to the emergency room. On physical examination, patient is cyanotic and cool to the touch. The patient is diagnosed with myxedema coma. You anticipate all of the following, except: a. Ensure patient has IV access b. The patient may require a warming blanket c. The patient will require an infusion of Methimazole (Tapazole) d. The patient may be intubated soon
Answer: C
Josephina, your 78 year old patient, had an episode of hypoglycemia overnight. You would take all of the following actions in regards to educating the patient about hypoglycemia, except: a. You can utilize the rule of 15s in treating hypoglycemia b. Hypoglycemia symptoms include tachycardia, diaphoresis, and altered mental status c. Hypoglycemia symptoms include bradycardia and thirst d. Hypoglycemia is defined as blood glucose less than 70 mg/dL
Answer: C
You receive change of shift report. Who would you prioritize visiting on morning rounds? a. 53 year old male with a blood sugar of 192 and complaints of bilateral lower extremity burning b. 34 year old male with a blood sugar of 214 and feels constipated c. 69 year old female with rapid and deep respirations and complaints of dehydration d. 21 year old female with a HgbA1C of 6.9% and abdominal pain
Answer: C
When teaching the patient with diabetes about insulin administration, the nurse should include which instruction for the patient? a. Mix long acting, moderate acting, and short acting insulins in the same syringe before injecting b. Clean the skin at the injection site with an alcohol swab before each injection c. Pull back on the plunger after inserting the needle to check for blood d. Rotate injection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies
Answer: D
Patient is admitted to the unit for hyperthyroidism. Handoff report indicated patient was stable with HR 105 at rest and mild tachypnea on exertion while ambulating to the bathroom. When the patient arrives to the unit, the following is found on assessment: HR 179 BP 190/85 RR 28, patient is angrily yelling at the transport team, then she begins to spontaneously vomit in bed. Fine tremors can be seen while the PCT is cleaning her up. Which of the following is the correct NEXT action? a. Page the doctor to assess the patient while increasing oxygen to help her breathe b. Place patient in restraints and page the doctor for medication c. Call rapid response for change in status and suspected thyrotoxicosis d. Administer beta blockers and call respiratory team to administer breathing treatment
Answer: C Patient is experiencing a thyroid storm. While beta blockers may be required, the change of status is a life-threatening emergency and requires immediate intervention.
An IV hydrocortisone infusion is started before a patient is taken to surgery for a bilateral adrenalectomy. Which explanation, if given by the nurse, is most appropriate? a. "The medication prevents sodium and water retention after surgery." b. "The drug prevent clots from forming in the legs during your recovery from surgery." c. "This medicine is given to help your body respond to stress after removal of the adrenal glands." d. "This drug stimulates your immune system and promotes wound healing."
Answer: C Rationale: Hydrocortisone is administered IV during and after a bilateral adrenalectomy to ensure adequate responses to the stress of the procedure.
A patient with type 1 diabetes calls the clinic with complaints of nausea, vomiting, and diarrhea. It is most important that the nurse advise the patient to a. Withhold the regular dose of insulin. b. Drink cool fluids with high glucose content. c. Check the blood glucose level every 2 to 4 hours. until the illness resolves.
Answer: C Rationale: If a person with type 1 diabetes mellitus is ill, he or she should test blood glucose levels at least at 2- to 4-hour intervals to determine the effects of this stressor on the blood glucose level.
The nurse plans a class for patients who have newly diagnosed type 2 diabetes mellitus. Which goal is most appropriate? a. Make all patients responsible for the management of their disease. b. Involve the family and significant others in the care of these patients. c. Enable the patients to become active participants in the management of their disease. soon as possible to prevent complications.
Answer: C Rationale: The goal of diabetes education is to enable the patient to become the most active participant in his or her own care.
A patient with metabolic alkalosis has an SpO2 of 93% and a shift to the left in the oxygen-hemoglobin dissociation curve. Which action by the nurse is appropriate? a. Administer supplemental oxygen because less oxygen is dissolved in the blood. b. Discontinue supplemental oxygen because more oxygen is released to the tissues. c. Administer supplemental oxygen because oxygen is not readily released to the tissues. d. Discontinue supplemental oxygen because more oxygen is dissolved in the blood.
Answer: C Rationale: When the oxygen dissociation curve shifts to the left, blood picks up oxygen more readily in the lungs but delivers oxygen less readily to the tissues. Alkalosis can cause a shift to the left. Patients may be given higher concentrations of oxygen until alkalosis normalizes. This helps to compensate for decreased oxygen unloading in the tissues.
A 13 y/o girl presents to the ED with her mother who reports that the patient is lethargic, sweating, and weak. Labs reveal blood glucose levels are 758. Interviewing the mother, she reveals her daughter has been eating and drinking very often and has been using the bathroom often. BP 89/72, HR 110, RR 18, SpO2 91%, patient is tired but answering appropriately. After speaking with the doctor who places orders, which of the following interventions should be done FIRST? a. Give a large bolus of insulin to bring down the blood glucose levels until they reach 70 mg/dL b. Obtain the intubation tray while waiting for the anesthesiologist to intubate and place patient on a mechanical ventilator c. Establish IV access and begin fluid repletion d. Provide the patient food and oral fluids to help with maintaining energy levels
Answer: C The patient likely has Type 1 Diabetes based on the mother's interview. She needs IV fluids to replace what has been lost. There is no mention of the patient desaturating, and her blood glucose is already high. Feeding her wouldn't help because her body is not taking in the nutrients she already has circulating. The patient may need IV insulin, but it is important not to rapidly correct the problem.
Kimmy, a patient previously diagnosed with Cushing's syndrome, is coming to the clinic today. You would expect her labs to be: a. Na 156, K 5.6, Glucose 190 b. Na 129, K 5.4, Glucose 67 c. Na 150, K 3.2, Glucose 200 d. Na 140, K 4.0, Glucose 120
Answer: C You would expect hypokalemia and hyperglycemia
A patient taking insulin has recorded fasting glucose levels above 200 mg/dl (11.1 mmol/L) on awakening for the last 5 mornings. What should the nurse advise the patient to do first? a. Use a single-dose insulin regimen with an intermediate-acting insulin b. Increase the evening insulin dose to prevent the Dawn phenomenon c. Decrease the evening insulin dosage to prevent night hypoglycemia and the Somogyi effect d. Monitor the glucose level at bedtime, between 2:00 am and 4:00 am, and on arising
Answer: D
Felix presents to the clinic today to see the provider. He walks in and speaks with you, his nurse. You notice several distinctive features and draw the conclusion that Felix may have Cushing's syndrome. Which physical exam features may support your conclusion? a. Moon face b. Buffalo hump c. Purple striae on his abdomen d. All of the above are correct answers
Answer: D
George is your patient admitted for DKA. Your other patient, Jorge, is admitted for HHNKS (HHNS/HHS). During morning report, the labs of all of the patients were scrambled. How would you differentiate the labs between DKA and HHS? a. The urinalysis would be positive for ketones for the DKA patient b. The serum acetate would be negative in HHS c. The blood glucose is significantly higher in HHS than in DKA d. All of the above are correct e. None of the above are correct
Answer: D
The following interventions are planned for a diabetic patient. Which intervention can the nurse delegate to a CNA or PCT? a. Check the patient's technique for drawing up insulin b. Teach the patient to use a meter for self-monitoring of blood glucose c. Discuss complications of diabetes d. Check that the bath water is not too hot
Answer: D
The patient with newly diagnosed diabetes is displaying shakiness, confusion, irritability, and slurred speech. What should the nurse suspect is happening? a. DKA b. HHS c. Hyperglycemia d. Hypoglycemia
Answer: D
The nurse is caring for a patient who just returned to the surgical unit following a thyroidectomy. The nurse is most concerned if which is observed? a. The patient complains of increased thirst. b. The patient reports a sore throat when swallowing. c. The patient supports her head when moving in bed. breathing. d. The patient makes harsh, vibratory sounds when breathing.
Answer: D Rationale: After thyroid surgery, the patient may experience an airway obstruction related to excess swelling, hemorrhage, hematoma formation, or laryngeal stridor (harsh, vibratory sound). Emergency equipment should be at the bedside, including oxygen, suction equipment, and a tracheostomy tray.
The nurse would interpret an induration of 5 mm resulting from tuberculin skin testing as a positive finding in which patient? a. A patient with a history of illegal IV drug use b. A patient with diabetes and end-stage kidney disease c. A patient who immigrated from India 3 months ago d. A patient who is human immunodeficiency virus- infected
Answer: D Rationale: Induration of 5 mm in an HIV-infected person is considered a positive reaction.
A patient is exhibiting signs of hypothyroidism. Which diagnostic test will the nurse expect to be done first? a. Total thyroxine (T4) b. Thyroid antibodies (Ab) c. Free triiodothyronine (FT3) d. Thyroid-stimulating hormone (TSH)
Answer: D Rationale: The most sensitive and accurate laboratory test is measurement of TSH, and it is often recommended as a first diagnostic test for evaluation of thyroid function. If the TSH is abnormal, the other laboratory tests may be ordered.
Patient is in a myxedema coma following recent Covid illness. Which of the following treatments would you expect ordered? a. Oxygen support via nasal canula and standing respiratory therapy orders b. IV Thyroid hormone c. Fever reducers to keep patient's temperature low d. A and B
Answer: D With myxedema coma, patient's vital signs will be depressed instead of elevated, so antipyretics are not necessary. Patient needs support of vital functions and infusion of thyroid hormone to establish hemodynamic stability.
A diabetic patient orders her morning meal. The PCT checks the blood glucose levels to reveal 65 mg/dL. The threshold for hypoglycemia for your hospital is 70 mg/dL. Patient is AOx4, able to converse, but reports feeling lightheaded and sweaty. Which of the following interventions is appropriate for the patient? a. Call a rapid response before the patient loses consciousness, then prepare her for transfer to ICU b. Take a STAT glucose blood draw to confirm hypoglycemic status and stay with the patient because she is symptomatic c. Call the kitchen to have them bring her food immediately and stay with her to monitor symptoms d. Give the patient 4 oz of juice, stay nearby to monitor her symptoms, and retake her blood glucose in 15 min. Repeat the process while she is alert until her blood glucose rises above 70
Answer: D The patient is alert and able to follow commands, so giving her the juice will allow her to raise her blood glucose naturally rather than with invasive interventions. A: The patient is stable and does not require critical care B and C: These options require waiting to intervene, meaning the patient's blood glucose will drop further
Which of the following are true statements? a. A low TSH is associated with a diagnosis of primary hyperthyroidism b. A low TSH is associated with a diagnosis of primary hypothyroidism c. A high TSH is associated with a diagnosis of primary hypothyroidism d. A high TSH is associated with a diagnosis of primary hyperthyroidism e. Answers A & C are correct f. Answers B & D are correct
Answer: E
Your patient presents with the following: pH 7.19, HCO3 14, pCO2 40, Na 140, K 2.9, Ca 9.0. The urinalysis is +creatinine, +albumin, +ketones. The patient's symptoms include: rapid and deep respirations, altered mental status, and polyuria. The patient is diagnosed to be in diabetic ketoacidosis (DKA). Which actions would you as the nurse anticipate? a. Start an IV line b. Start the patient on 0.9% normal saline c. Start the patient on an insulin drip d. Start the patient on potassium chloride replacement IV e. Start the patient on telemetry (cardiac) monitoring f. Anticipate that the patient may be intubated g. All of the above are correct
Answer: G
In a patient with prolonged vomiting, the nurse monitors for fluid volume deficit because vomiting results in a. Fluid movement from the cells into the interstitial space and the blood vessels b. Excretion of large amounts of interstitial fluid with depletion of extracellular fluids c. An overload of extracellular fluid with a significant increase in intracellular fluid volume d. Fluid movement from the vascular system into the cells, causing cellular swelling and rupture
Answer: a Rationale: Fluid volume deficit occurs when there is loss of both sodium and water. Intracellular fluid moves into the interstitial spaces and blood vessels.
A patient has the following ABG results: pH 7.48, PaO2 86 mm Hg, PaCO2 44 mm Hg, HCO3− 29 mEq/L. When assessing the patient, the nurse would expect the patient to have a. Muscle cramping b. Warm, flushed skin c. Respiratory rate of 36 d. Blood pressure of 94/52
Answer: a Rationale: The patient is experiencing metabolic alkalosis (elevated pH and elevated HCO3− ). Clinical manifestations of metabolic alkalosis include hypertonic muscles and cramping and reduced respiratory rate. Hypotension and warm, flushed skin may occur with respiratory acidosis.
A patient is admitted with renal failure and an arterial blood pH level of 7.29. Which lab result would the nurse expect? a. Serum sodium 138 mEq/L b. Serum glucose 145 mg/dL c. Serum potassium 5.9 mEq/L d. Serum magnesium 0.4 mg/dL
Answer: c Rationale: A common cause of acidosis (a pH below 7.35) is renal failure. Changes in pH (hydrogen ion concentration) affect potassium balance. In acidosis, hydrogen ions accumulate in the intracellular fluid (ICF) and potassium shifts out of the cell to the extracellular fluid to maintain a balance of cations across the cell membrane. Acidosis is associated with hyperkalemia (a serum potassium above 5.0 mEq/L).
The nurse is administering 3.0 % saline solution IV to a patient with severe hyponatremia. It is most important for the nurse to observe for what? a. Decreased heart rate and blood pressure b. Prolonged QT interval and facial flushing c. Shortness of breath and increased respiratory rate d. Increased urine output and decreased urine specific gravity
Answer: c Rationale: Hypertonic solutions such as 3.0% saline must be administered with extreme caution because they may cause dangerous intravascular volume overload and pulmonary edema. Signs and symptoms of volume overload and pulmonary edema include shortness of breath and increased respiratory rate.
A patient with an acid-base imbalance has an altered potassium level. The nurse recognizes that the potassium level is altered because a. Potassium is returned to extracellular fluid when metabolic acidosis is corrected. b. Hyperkalemia causes an alkalosis that results in potassium being shifted into the cells. c. Acidosis causes hydrogen ions in the blood to be exchanged for potassium from the cells. d. In alkalosis, potassium is shifted into extracellular fluid to bind excessive bicarbonate.
Answer: c Rationale: Changes in pH (hydrogen ion concentration) will affect potassium balance. In acidosis, hydrogen ions accumulate in the intracellular fluid (ICF), and potassium shifts out of the cell to the extracellular fluid to maintain a balance of cations across the cell membrane. In alkalosis, ICF levels of hydrogen diminish, and potassium shifts into the cell. If a deficit of H+ occurs in the extracellular fluid, potassium will shift into the cell. Acidosis is associated with hyperkalemia, and alkalosis is associated with hypokalemia.
True or false: The primary pharmacologic medication used in the treatment of primary hypothyroidism is Levothyroxine (Synthroid)?
True
