Patho Test 3 - Endocrine Disorders and Diabetes

Which classification of medication does the nurse prepare to administer to the client with hyperthyroidism that will block the effects of the hyperthyroid state on sympathetic nervous system function?

Beta-adrenergic blocking agent.

Which gland is often referred to as the master gland because it secretes many hormones? a) Hypothalamus b) Pituitary c) Pancreas d) Thyroid

b) Pituitary The pituitary gland has been called the master gland because its hormones control the functions of many target glands and cells. That is not a term used to refer to the other options.

Impaired and delayed healing in a person with diabetes is caused by chronic complications that include: a) Ketoacidosis b) Somogyi effect c) Fluid imbalances d) Chronic neuropathies

d) Chronic neuropathies

Diabetics are at higher risk than are the majority of the population for injury to organ systems in the body. Which organs are most at risk? a) Kidneys and eyes b) Kidneys and liver c) Liver and eyes d) Pancreas and eyes

a) Kidneys and eyes Diabetic nephropathy is the leading cause of chronic kidney disease, accounting for 40% of new cases. Also, diabetes is the leading cause of acquired blindness in the United States. The liver and pancreas are not organs that diabetes attacks.

Tell whether the statement is true or false: Type 1 versus Type 2 can be categorized as insulin dependent and non-insulin dependent.

False Some people with type 2 diabetes may eventually have to be put on insulin.

The functions of the endocrine system are linked closely with which two systems?

Nervous system and immune system

Select the most appropriate intervention for the nurse to teach a client diagnosed with distal symmetric neuropathy related to diabetes. a) Inspect the feet for blisters daily b) Decrease daily walking activity c) Wear comfortable, open-toe shoes d) Rotate insulin injection sites once a week

a) Inspect the feet for blisters daily A client with neuropathy is at risk for damage to his or her feet, such as blisters or ulcers, as the clients are unable to feel this damage. Clients need to inspect their feet daily, where foot coverings (such as closed-toe shoes) to prevent injuries, and continue the exercise patterns to promote improved circulation.

A three year-old girl has just been diagnosed with type 1A diabetes. Her parents are currently receiving education from the diabetes education nurse. How can the nurse best explain to the parents the etiology (cause) of their daughter's diabetes? a) "The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin." b) "It's not known exactly why your daughter has completely stopped making insulin, and treatment will consist of your rigidly controlling her diet." c) "This tendency to produce insufficient amounts of insulin is likely something that she inherited." d) "Environmental and lifestyle factors are known to play a part in the fact that her pancreas secretes and withholds insulin at the wrong times."

a) "The problem that underlies her diabetes is that her own body has destroyed the cells in her pancreas that produce insulin." Type 1A, or immune-mediated, diabetes involves the autoimmune destruction of pancreatic beta cells and a consequent absolute lack of insulin.

Which of the following residents of a long-term facility is exhibiting signs and symptoms that are indicative of hypothyroidism? a) An 80-year-old woman who has uncharacteristically lost her appetite of late and often complains of feeling cold b) A 90-year-old woman with a history of atrial fibrillation whose arrhythmia has recently become more severe c) An 88-year-old man with a history of Alzheimer disease who has become increasingly agitated and is wandering more frequently d) A 91-year-old man with a chronic venous ulcer and a sacral ulcer who has developed sepsis

a) An 80-year-old woman who has uncharacteristically lost her appetite of late and often complains of feeling cold

The results of a 44-year-old obese mans recent diagnostic workup have culminated in a new diagnosis of type 2 diabetes. Which of the following pathophysiologic processes underlies the patients new diagnosis? a) Beta-cell exhaustion due to long-standing insulin resistance b) Destruction of beta cells that is not attributable to autoimmunity c) T-lymphocytemediated hypersensitivity reactions d) Actions of insulin autoantibodies (IAAs) and islet cell autoantibodies (ICAs)

a) Beta-cell exhaustion due to long-standing insulin resistance

A student nurse is taking a test on the endocrine system. From the following list of clinical manifestations, she needs to select the ones she would see in hypothyroidism. Which answers should she select? (Select all that apply) a) Coarse brittle hair b) Heat intolerance c) Puffy face with swollen eyelids d) Weight gain despite loss of appetite e) Nervousness with fine muscle tremors

a) Coarse brittle hair c) Puffy face with swollen eyelids d) Weight gain despite loss of appetite The hypometabolic state associated with hypothyroidism is characterized by a gradual onset of weakness and fatigue, a tendency to gain weight despite a loss of appetite, and cold intolerance. As the condition progresses, the skin becomes dry and rough and the hair becomes coarse and brittle. Reduced conversion of carotene to vitamin A and increased blood levels of carotene may give the skin a yellowish color. The face becomes puffy with edematous eyelids, and there is thinning of the outer third of the eyebrows. Nervousness with fine muscle tremors and heat intolerance are signs of hyperthyroidism.

Which of the following comorbidities represents the greatest risk for the development of foot ulcers in a diabetic patient? a) Distal symmetric neuropathy b) Previous incidents of diabetic ketoacidosis c) Diabetic nephropathy d) Autonomic neuropathy

a) Distal symmetric neuropathy

A 25-year-old female client exhibits exophthalmos (abnormal protrusion of the eyeballs) or eyeball of both eyes. The health care provider recognizes this as a manifestation of: a) Grave's disease b) Myxedema c) Hashimoto thyroiditis d) Acquired hypothyroidism

a) Grave's disease Graves disease is a state of hyperthyroidism in which opthalmopathies, such as exophthalmos, typically occur. The other conditions are states of hypothyroidism and are not associated with this abnormality.

When the nurse is performing a health history for a client who is being admitted for hyperthyroidism, what symptoms does the client report that the nurse would find associated with this disorder? a) Increase in appetite b) Constipation c) Weight gain d) Fatigue

a) Increase in appetite Thyroid hormone enhances gastrointestinal function, causing an increase in motility and production of GI secretions that often results in diarrhea. An increase in appetite and food intake accompanies the higher metabolic rate that occurs with increased thyroid hormone levels. At the same time, weight loss occurs because of the increased use of calories.

When calcium levels fall in the blood, PTH secretion: a) Increases b) Decreases c) Stays the same d) None of the above

a) Increases

A nurse is teaching a patient with newly diagnosed type 1 diabetes about the importance of blood glucose control to decrease the risk of which of the following potential chronic complications of diabetes? (Select all that apply) a) Nephropathy b) Gastroparesis c) Neuropathy d) Anxiety disorder e) Retinopathy

a) Nephropathy b) Gastroparesis c) Neuropathy e) Retinopathy There are many complications that result from consistent hyperglycemia. Damage to the retina leads to loss of vision. Damage to kidneys leads to renal failure. Neuropathies have many serious consequences including loss of feeling in the lower extremities, foot ulcers, and infections that go undetected and may result in amputation. Impaired gastrointestinal function includes the slowed gastric emptying of gastroparesis. Anxiety, although it is a possible consequence of a diagnosis of diabetes, is not directly attributable to elevated blood glucose levels.

A client with severe hypoglycemia is unconscious. Which method of providing glucose should be avoided? a) Orange juice orally b) Glucose gel in the buccal pocket c) IM glucagon injection d) Dextrose IV

a) Orange juice orally When clients are unconscious it is not safe to attempt to have them swallow liquids. Alternate routes that reduce the risk of choking such as buccal absorption, intramuscular or intravenous injections are preferred.

A client presents to the emergency room with fatigue, weakness, dehydration and thirst. What additional symptoms would correlate with a diagnosis of type 1 diabetes mellitus? (Select all that apply) a) Polyuria b) Blurred vision c) Joint pain d) Insomnia e) Recent weight loss

a) Polyuria b) Blurred vision e) Recent weight loss The cardinal manifestations of diabetes mellitus are the three "polys": polyuria, polydipsia, and polyphagia, and weight loss. Additional symptoms include fatigue and weakness, blurred vision, and skin infections.

The nurse is teaching a client who has been newly diagnosed with hypothyroidism about the function of the thyroid. Which of these does the nurse explain to the client is the role of the thyroid gland? a) The thyroid gland is responsible for increasing the metabolic rate. b) The thyroid gland promotes development of secondary sex characteristics. c) The thyroid gland is responsible for regulating serum calcium levels. d) The thyroid gland releases neurotransmitters when the "flight or flight" mechanism is stimulated.

a) The thyroid gland is responsible for increasing the metabolic rate. The thyroid gland produces thyroid hormones, T3 and T4. These hormones increase the metabolic rate; increase protein and bone turnover; increase responsiveness to catecholamines; are necessary for fetal and infant growth and development. The parathyroid gland regulates calcium metabolism. The adrenal glands regulate flight or fight and the testes or ovaries regulate development of secondary sex characteristics.

The nurse is reviewing assessment data on four clients. Select the client at highest risk for developing type 2 diabetes. a) A 40-year-old male who has an active lifestyle b) A 45-year-old obese female with a sedentary lifestyle c) A 60-year-old female with a history of gestational diabetes d) A 10-year-old male whose grandmother has type 2 diabetes

b) A 45-year-old obese female with a sedentary lifestyle The person most at risk for developing type 2 diabetes is the 45-year-old obese female with a sedentary lifestyle. Other risk factors include family history, over age 40, and history of gestational diabetes. The 60-year-old would have developed it before age 60, if there were additional risk factors.

A hospital patient has been complaining of increasing fatigue for several hours and his nurse has entered his room to find him unarousable. The nurse immediately checked the patients blood glucose level, which is 22 mg/dL (1.2 mmol/L). The nurse should prepare to administer which of the following? a) A snack that combines simple sugars, protein, and complex carbohydrates b) A 50% glucose solution intravenously c) Infusion of rapid-acting insulin d) Oral solution containing glucagon and simple sugars

b) A 50% glucose solution intravenously You would not give anything by mouth because the patient is unconscious.

Where does a pheochromocytoma develop? a) Adrenal Cortex b) Adrenal Medulla c) Liver d) Gallbladder

b) Adrenal Medulla A pheochromocytoma is a tumor of adrenal medulla. It stimulates the nervous system via production of catecholamines (epinephrine and norepinephrine) which causes the patient to have very high blood pressure.

Diabetic ketoacidosis (DKA) more commonly occurs in patients with type 1 diabetes, when the lack of insulin leads to the mobilization of _____ that causes excess ketone production by the liver. a) Cortisol b) Fatty acids c) Potassium d) Bicarbonate

b) Fatty acids

When sensors detect a change in a hormone level, the hormonal response is regulated by _________ mechanisms that will return the level to within normal range. a) Metabolic b) Feedback c) Production d) Action potential

b) Feedback

Abnormal stimulation of the thyroid gland by TSH-receptor antibodies is implicated in cases of: a) Cushing syndrome b) Grave's disease c) Addison disease d) Cushing disease

b) Grave's disease

Diabetic retinopathy, the leading cause of acquired blindness in the United States, is characterized by retinal: a) Glaucoma b) Hemorrhages c) Dehydration d) Infections

b) Hemorrhages

The metabolic abnormalities that lead to type 2 diabetes include: a) Chronic overeating b) Insulin resistance c) Acute pancreatitis d) Recurrent hypoglycemia

b) Insulin resistance

A patient with distal symmetric polyneuropathy usually begins by complaining of: a) Painful cramps in their calves. b) Loss of feeling or touch in the feet. c) Seeping wounds in lower legs. d) Burning in the big toe.

b) Loss of feeling or touch in the feet. Peripheral neuropathy is often associated with the insensate foot. The loss of feeling, touch, sensation, and position sense increases the risk of falling, serious burns and injuries to the feet. Burning in big toe is usually associated with gout. Cramps in the legs may be electrolyte imbalances and seeping wounds in lower legs could be a result of obesity, lymphedema, or diabetes to name a few.

The hormone levels in the body need to be kept within an appropriate range. How is this accomplished for many of the hormones in the body? a) Positive feedback loop b) Negative feedback loop c) Regulated feedback loop d) Sensory feedback loop

b) Negative feedback loop

A client is brought to the emergency department with a suspected diagnosis of DKA (diabetic ketoacidosis). Select the assessment/diagnostic data to confirm the diagnosis. (Select all that apply) a) Hypoglycemia b) Positive urine ketones c) Low serum bicarbonate d) Negative serum ketones e) High arterial pH

b) Positive urine ketones c) Low serum bicarbonate The definitive diagnosis of DKA consists of hyperglycemia (blood glucose levels >250 mg/dL), low serum bicarbonate, low arterial pH, and positive urine and serum ketones.

A hospital patient with a diagnosis of type 1 diabetes has been administered a scheduled dose of regular insulin. Which of the following effects will result from the action of insulin? a) Promotion of fat breakdown b) Promotion of glucose uptake by target cells c) Promotion of gluconeogenesis and protein synthesis d) Initiation of glycogenolysis

b) Promotion of glucose uptake by target cells

Release and synthesis of anterior pituitary hormones are mainly regulated by the inhibiting or releasing actions of the: a) Cell receptors b) Thymus gland c) Hypothalamus d) Adrenal gland

c) Hypothalamus

What is the most common mechanism of hormone control? a) Positive feedback b) Hypothalamic-pituitary-target cell feedback c) Negative feedback d) Hypothalamic-pituitary-adrenal axis

c) Negative feedback With negative feedback, the most common mechanism of hormone control, some feature of hormone action directly or indirectly inhibits further hormone secretion so that the hormone level returns to an ideal level or set point.

What are the hallmark signs of diabetes mellitus? a) Polyuria, polyphagia, and polycythemia b) Polycythemia, polydipsia, and pheochromocytoma c) Polyuria, polydipsia, and polyphagia d) Polyuria, polydipsia, and pheochromocytoma

c) Polyuria, polydipsia, and polyphagia The most commonly identified signs and symptoms of diabetes are referred to as the three polys: (1) polyuria (excessive urination), (2) polydipsia (excessive thirst), and (3) polyphagia (excessive hunger).

The nurse is teaching a client with diabetes and the family about the signs and symptoms of hypoglycemia. The client asks what produces signs and symptoms of headache, disturbed behavior, coma, and seizures. The best response would be: a) Hypoglycemia causes ketone breakdown. b) Hepatic glycogenolysis. c) The brain relies on blood glucose as its main energy source. d) Insulin produces a rebound hyperglycemia.

c) The brain relies on blood glucose as its main energy source. Because the brain relies on blood glucose as its main energy source, hypoglycemia produces behaviors related to altered cerebral function. Headache, difficulty in problem solving, disturbed or altered behavior, coma, and seizures may occur.

A patient is managing his type 2 diabetes with exercise and diet. He has a fasting blood sugar level (FBS) of 80 mg/dL and a hemoglobin A1C of 5%. Based on these findings, which of the following can the nurse assume? a) The patient is at risk for an insulin reaction. b) The patient is at risk for developing hyperglycemia. c) The patient is achieving normal glycemic control. d) The patient needs to modify his diet related to the low readings.

c) The patient is achieving normal glycemic control. The reading for the FBS is appropriate (<100 mg/dL is normal) and the hemoglobin A1C level (<5.7) shows good control of glucose levels over a 6- to 12-week period. This patient should continue his current exercise and diet routine, which is working well for him.

Which of the following assessment findings of a male patient constitutes a criterion for a diagnosis of metabolic syndrome? a) The patient states that he does less than 30 minutes of strenuous physical activity each week b) The patients resting heart rate is typically 85 to 95 beats per minute c) The patients blood pressure is consistently in the range of 140/90 mm Hg d) The patient has a family history of type 2 diabetes

c) The patients blood pressure is consistently in the range of 140/90 mm Hg

A patient with longstanding type 2 diabetes is surprised at his high blood sugar readings while recovering from an emergency surgery. Which of the following factors may have contributed to the patients inordinately elevated blood glucose levels? a) The tissue trauma of surgery resulted in gluconeogenesis b) Illness inhibited the release and uptake of glucagon c) The stress of the event caused the release of cortisol d) Sleep disruption in the hospital precipitated the dawn effect

c) The stress of the event caused the release of cortisol

A client is diagnosed with hyperthyroidism and is exhibiting weight loss, diarrhea, and tachycardia. What does the nurse understand that these clinical manifestations are related to? a) A decrease in the level of glucose b) A decrease in oxygen consumption c) A decrease in sympathetic nervous system activity d) A hypermetabolic state

d) A hypermetabolic state Many of the manifestations of hyperthyroidism are related to the increase in oxygen consumption and use of metabolic fuels associated with the hypermetabolic state, as well as to the increase in sympathetic nervous system activity that occurs.

Which of the following individuals is experiencing the effects of a primary endocrine disorder? a) A patient with adrenal cortical insufficiency due to pituitary hyposecretion of ACTH b) A patient who has hypothyroidism as a result of low TSH production c) A patient whose dysfunctional hypothalamus has resulted in endocrine imbalances d) A patient who has low calcium levels because of the loss of his parathyroid gland

d) A patient who has low calcium levels because of the loss of his parathyroid gland

Type 1 diabetes mellitus results from destruction of the pancreatic beta cells by two mechanisms. The mechanism for type 1A diabetes is _______ destruction. a) Genetic b) Resistant c) Idiopathic d) Autoimmune

d) Autoimmune

The pancreas is an endocrine organ that is composed of the acini and the islets of Langerhans. The islets of Langerhans have alpha, beta, and delta cells as well as the PP cell. Which cells secrete insulin? a) Alpha cells b) Delta cells c) PP cells d) Beta cells

d) Beta cells Each islet is composed of beta cells that secrete insulin and amylin, alpha cells that secrete glucagon, and delta cells that secrete somatostatin. In addition, at least one other type of cell, the PP cell, is present in small numbers in the islets and secrets a hormone of uncertain function called pancreatic polypeptide.

Diabetic ketoacidosis is a condition that mostly occurs in type 1 diabetics. What are the definitive diagnostic criteria for DKA? a) Blood glucose level greater than 350 mg/dL; bicarbonate less than 5 mEq/L and pH less than 7.4 b) Blood glucose level greater than 250 mg/dL; bicarbonate less than 25 mEq/L and pH less than 7.3 c) Blood glucose level greater than 350 mg/dL; bicarbonate less than 5 mEq/L and pH less than 7.4 d) Blood glucose level greater than 250 mg/dL; bicarbonate less than 15 mEq/L and pH less than 7.3

d) Blood glucose level greater than 250 mg/dL; bicarbonate less than 15 mEq/L and pH less than 7.3

Which of the following criteria about insulin would prompt a diagnosis of type 1 diabetes? a) Insulin not efficiently used b) Small amounts of insulin secreted c) Large amounts of insulin secreted d) Complete failure of insulin secretion

d) Complete failure of insulin secretion In type 1 diabetes there is an absolute lack of insulin due to complete failure of the pancreas. In type 2 diabetes some insulin is produced but may not be properly used (insulin resistance).

The nurse is caring for a client who received regular insulin at 7 am. Four hours later the nurse finds the client diaphoretic, cool, and clammy. Which of these interventions is the priority? a) Bathe the client with tepid water. b) Place the client in the supine position. c) Repeat the dose of insulin. d) Give the client a concentrated carbohydrate.

d) Give the client a concentrated carbohydrate. The client is displaying symptoms of hypoglycemia, which include headache, difficulty in problem solving, altered behavior, coma, and seizures. Hunger may occur. Activation of the sympathetic nervous system may cause anxiety, tachycardia, sweating, and cool and clammy skin.

Factors that contribute to the severe hyperglycemia that precipitates hyperglycemic hyperosmolar state (HHS) include: a) Fluid retention and edema b) Thromboembolism formation c) Insulin overdose d) Glycosuria and water loss

d) Glycosuria and water loss

Which test provides a way to monitor fluctuations of blood glucose levels over the previous 6 to 12 weeks? a) Glucose tolerance test b) Fasting blood glucose c) Capillary blood glucose d) Glycosylated hemoglobin (A1C)

d) Glycosylated hemoglobin (A1C)

Your patient has low levels of circulating thyroid hormone. How will the cells of the thyroid gland respond? a) No response b) Response will depend upon the levels of TSH c) Down-regulation d) Up-regulation

d) Up-regulation When there is diminished hormonal activity, cells have the ability to make more hormone receptors and increase the sensitivity of the existing receptors to the hormone. This is called up-regulation.

How does exercise affect blood glucose? a) Up-regulation b) Down-regulation c) Causes cells to be more sensitive to insulin d) Causes cells to be less sensitive to insulin e) A & C f) B & D

e) A & C