Deck 33: Endocrine Disorders and Therapeutic Management

Question 1

Which of the following nursing interventions should be initiated on all patients with SIADH?

A) Placing the patient on an air mattress
B) Forcing fluids
C) Initiating seizure precautions
D) Applying soft restraints

Answer 1

Initiating seizure precautions

Question 2

Patients with central DI are treated with

A) vasopressin.
B) insulin.
C) glucagon.
D) propylthiouracil.

Answer 2

vasopressin.

Question 3

A patient who has type 2 diabetes is on the unit after aneurysm repair.His serum glucose levels have been elevated for the past 2 days.He is concerned that he is becoming dependent on insulin.The best response for the nurse would be

A) "This surgery may have damaged your pancreas. We will have to do more evaluation."
B) "Perhaps your diabetes was more serious from the beginning."
C) "You will need to discuss this with your physician."
D) "The stress on your body has temporarily increased your blood sugar levels."

Answer 3

"The stress on your body has temporarily increased your blood sugar levels."

Question 4

A patient has a 10-year history of diabetes mellitus.The patient is admitted to the critical care unit with complaints of increased lethargy.Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA).Which of the following symptoms is most suggestive of DKA?

A) Irritability
B) Excessive thirst
C) Rapid weight gain
D) Peripheral edema

Question 5

A patient with diabetes in the critical care unit is at risk for developing diabetic ketoacidosis (DKA)secondary to

A) excess insulin administration.
B) inadequate food intake.
C) physiologic and psychologic stress.
D) increased release of antidiuretic hormone (ADH).

Question 6

The most common problem in the patient with type 2 diabetes is a(n)

A) lack of insulin production.
B) imbalance between insulin production and use.
C) overproduction of glucose.
D) increased uptake of glucose in the cells.

Question 7

A patient has a 10-year history of diabetes mellitus.The patient is admitted to the critical care unit with complaints of increased lethargy.Serum laboratory values validate the diagnosis of diabetic ketoacidosis (DKA).The treatment of DKA involves

A) extensive hydration.
B) oral hypoglycemic agents.
C) large doses of IV insulin.
D) limiting food and fluids.

Question 8

A patient is admitted to the unit with extreme fatigue,vomiting,and headache.This patient has type 1 diabetes but has been on an insulin pump for 6 months.He states,"I know it could not be my diabetes because my pump gives me 24-hour control." The nurse's best response would be

A) "You know a lot about your pump, and you are correct."
B) "You're right. This is probably a virus."
C) "We'll get an abdominal CT and see if your pancreas is inflamed."
D) "We'll check your serum blood glucose and ketones."

Question 9

A patient has a 10-year history of diabetes mellitus.The patient is admitted to the critical care unit with complaints of increased lethargy.Serum laboratory values validate the diagnosis of diabetic ketoacidosis.Which of the following statements best describes the rationale for administrating potassium supplements with the patient's insulin therapy?

A) Potassium replaces losses incurred with diuresis.
B) The patient has been in a long-term malnourished state.
C) IV potassium renders the infused solution isotonic.
D) Insulin drives the potassium back into the cells.

Question 10

The nurse knows that the dehydration in diabetic ketoacidosis stimulates catecholamine release,which results in

A) decreased glucose release.
B) increased insulin release.
C) decreased cardiac contractility.
D) increased gluconeogenesis.

Question 11

In the syndrome of inappropriate antidiuretic hormone (SIADH),the physiologic effect is

A) massive diuresis, leading to hemoconcentration.
B) dilutional hyponatremia, reducing sodium concentration to critically low levels.
C) hypokalemia from massive diuresis.
D) serum osmolality greater than 350 mOsm/kg.

Question 12

The nurse knows that the dehydration associated with diabetic ketoacidosis results from

A) increased serum osmolality and urea.
B) decreased serum osmolality and hyperglycemia.
C) ketones and potassium shifts.
D) acute renal failure.

Question 13

The primary intervention for hyperglycemic hyperosmolar syndrome (HHS)is

A) rapid rehydration.
B) monitoring vital signs.
C) high-dose intravenous (IV) insulin.
D) hourly urine sugar and acetone testing.

Question 14

The major electrolyte disturbances that result from diuresis are

A) low calcium and high phosphorus levels.
B) low potassium and low sodium levels.
C) high sodium and low phosphorus levels.
D) low calcium and low potassium levels.

Question 15

The patient admitted in diabetic ketoacidosis has dry,cracked lips and is begging for something to drink.The nurse's best response would be to

A) keep the patient NPO.
B) allow the patient a cup of coffee.
C) allow the patient water.
D) allow the patient to drink anything he chooses.

Question 16

A patient weighs 140 kg and is 60 in.tall.The patient's blood sugar is being controlled by glipizide.As the nurse discusses discharge instructions,the primary treatment goal with this type 2 diabetes patient would be

A) signs of hypoglycemia.
B) proper injection technique.
C) weight loss.
D) increased caloric intake.

Question 17

Nursing management of a patient with thyrotoxic crisis includes

A) providing diversional stimuli.
B) restricting fluids.
C) maintaining a quiet, restful environment.
D) administering thyroid supplements at the same time each day.

Question 18

Patients with thyroid crisis are observed for symptoms of

A) tachycardia.
B) hypotension.
C) decreased appetite.
D) hypothermia.

Question 19

The hallmark of hyperglycemic hyperosmolar syndrome (HHS)is

A) hyperglycemia with low serum osmolality.
B) severe hyperglycemia with minimal or absent ketosis.
C) little or no ketosis in serum with rapidly escalating ketonuria.
D) hyperglycemia and ketosis.

Question 20

Characteristics of diabetes insipidus (DI)are

A) hyperglycemia and hyperosmolarity.
B) hyperglycemia and peripheral edema.
C) intense thirst and passage of excessively large quantities of dilute urine.
D) peripheral edema and pulmonary crackles.

Question 21

A patient was admitted with diabetic ketoacidosis 1 hour ago and is on an insulin drip.Suddenly,the nurse notices frequent premature ventricular contractions (PVCs)on the electrocardiogram.The expected intervention would be to

A) administer a lidocaine bolus.
B) administer a lidocaine drip.
C) synchronize cardioversion.
D) evaluate electrolytes.

Question 22

A patient with type 2 diabetes is admitted.He is very lethargic and hypotensive.A diagnosis of hyperglycemic hyperosmolar syndrome (HHS)is made based on laboratory values of

A) decreased serum glucose and increased serum ketones.
B) increased urine ketones and decreased serum osmolality.
C) increased serum osmolality and increased serum potassium.
D) increased serum osmolality and increased serum glucose.

Question 23

As a patient with diabetic ketoacidosis receives insulin and fluids,the nurse knows careful assessment must be given to which of the following electrolytes?

A) Potassium
B) Sodium
C) Phosphorus
D) Calcium

Question 24

A patient presenting with diabetes insipidus (DI)exhibits

A) hyperosmolality and hypernatremia.
B) hyperosmolality and hyponatremia.
C) hypo-osmolality and hypernatremia.
D) hypo-osmolality and hyponatremia.

Question 25

The onset of seizures in the patient with DI indicates

A) increased potassium levels.
B) hyperosmolality.
C) severe dehydration.
D) toxic ammonia levels.

Question 26

The most common maintenance dose of intravenous insulin for a patient with hyperglycemic hyperosmolar syndrome (HHS)would be

A) 0.1 U/kg/hr.
B) 1.0 U/kg/hr.
C) 2.0 U/kg/hr.
D) 5.0 U/kg/hr.

Question 27

The nurse knows that during the resuscitation of a patient with diabetic ketoacidosis,the IV line should be changed to a solution containing glucose when the

A) patient becomes more alert.
B) IV insulin has been infusing for 4 hours.
C) blood glucose drops to 200 mg/dL.
D) blood glucose drops to 100 mg/dL.

Question 28

When a patient in diabetic ketoacidosis (DKA)has insulin infusing intravenously,the nurse expects a drop in the serum levels of

A) sodium and potassium.
B) potassium and phosphate.
C) bicarbonate and calcium.
D) sodium and phosphate.

Question 29

The top priority in the initial treatment of diabetic ketoacidosis (DKA)is

A) lowering the blood sugar.
B) giving fluids.
C) giving sodium bicarbonate to reverse the acidosis.
D) determining the reason for the DKA.

Question 30

A patient with diabetic ketoacidosis has an insulin drip infusing,and the nurse has just administered subcutaneous insulin.The nurse is alert for signs of hypoglycemia,which would include

A) Kussmaul respirations and flushed skin.
B) irritability and paresthesia.
C) abdominal cramps and nausea.
D) hypotension and itching.

Question 31

A patient with hyperglycemic hyperosmolar syndrome (HHS)has a serum glucose level of 400 mg/dL and a serum sodium level of 138 mEq/L.The intravenous fluid of choice would be

A) D5W.
B) 0.45% NS.
C) 0.9% NS.
D) D5/NS.

Question 32

An older patient presents with a serum glucose level of 900 mg/dL,hematocrit of 55%,and no serum ketones.Immediate attention must be given to

A) clotting factors.
B) rehydration.
C) administration of insulin.
D) sodium replacement.

Question 33

A patient in diabetic ketoacidosis has the following arterial blood gasses: pH 7.25; pCO? 30 mm Hg; HCO?? 16.The patient has rapid,regular respirations.The nurse's best response would be to

A) ask the patient to breathe into a paper bag to retain CO?.
B) administer sodium bicarbonate.
C) administer insulin and fluids intravenously.
D) prepare for intubation.

Question 34

A patient is admitted with a long history of mental illness.Her husband states she has been drinking up to 10 gallons of water each day for the past 2 days and refuses to eat.The patient is severely dehydrated and soaked with urine.The nurse suspects

A) central diabetes insipidus (DI).
B) nephrogenic DI.
C) psychogenic (dipsogenic) DI.
D) iatrogenic DI.

Question 35

A patient in diabetic ketoacidosis is comatose with a temperature of 102.2° F.The nurse would suspect

A) head injury.
B) infarct of the hypothalamus.
C) infection.
D) heat stroke.

Question 36

The nurse knows that three signs of effective fluid replacement include

A) elevated central venous pressure (CVP), increased heart rate, and elevated pulmonary artery pressure (PAP).
B) elevated CVP, decreased heart rate, and elevated PAP.
C) normal CVP, decreased heart rate, and normal PAP.
D) decreased CVP, increased heart rate, and decreased PAP.

Question 37

A patient in diabetic ketoacidosis is very lethargic and has a "funny" odor to his breath.The nurse would suspect this to be a result of

A) alcohol intoxication.
B) hyperglycemia.
C) hyperphosphatemia.
D) acetone.

Question 38

To assist the nurse in evaluating the patient's hydration status,assessment would include

A) orthostatic hypotension and neck vein filling.
B) pupil checks and Kernig sign.
C) Chvostek and Trousseau signs.
D) S4 gallop and edema.

Question 39

A nondiabetic patient presents ketoacidosis.Reasons may include

A) starvation and alcoholism.
B) drug overdose.
C) severe vomiting.
D) hyperaldosteronism.

Question 40

The nurse knows that the patient with DKA will need

A) subcutaneous insulin.
B) IV insulin.
C) subcutaneous and IV insulin.
D) combination 70%/30% insulin.

Question 41

An expected finding in the patient with hypothyroidism would be

A) increased T? .
B) anemia.
C) decreased thyroid stimulating hormone.
D) hyperglycemia.

Question 42

The patient at risk for developing SIADH may be taking

A) adenosine (Adenocard).
B) diltiazem (Cardizem).
C) heparin sodium.
D) acetaminophen.

Question 43

A patient has thyroid storm.The nurse is providing medication instruction for home.The patient asks "If I have a fever,should I take Tylenol or aspirin?" The best response for the nurse would be

A) "Either one is fine because they do not affect the antithyroid medication."
B) "Tylenol rather than aspirin because aspirin increases the amount of free thyroid hormone in circulation."
C) "Aspirin rather than Tylenol because Tylenol increases the amount of free thyroid hormone in circulation."
D) "They both prevent the antithyroid medication from working correctly. I would recommend an NSAID."

Question 44

Patients discharged with antithyroid medications are alerted to the potential side effect of

A) hyperthermia.
B) agranulocytosis.
C) tachypnea.
D) diaphoresis.

Question 45

Patients with myxedema are at high risk for any surgical procedure because of

A) decrease cardiac output.
B) overhydration.
C) thrombocytopenia.
D) respiratory failure.

Question 46

The neuroendocrine stress response produces which of the following?

A) Elevated blood pressure
B) Decreased gastric motility
C) Tachycardia
D) Heightened pain awareness
E) Increased glucose

Question 47

In evaluating the patient's hyponatremia,the nurse understands the problem is

A) increased cortisol release.
B) decreased aldosterone release.
C) increased glucocorticoid release.
D) decreased glucagon release.

Question 48

A patient with bronchogenic oat cell carcinoma has a drop in urine output.The laboratory reports a serum sodium level of 120 mEq/L,a serum osmolality level of 220 mOsm/kg,and urine specific gravity of 1.035.The nurse would suspect

A) diuresis.
B) DI.
C) SIADH.
D) hyperaldosteronism.

Question 49

A priority for patient education when discharged with long-term antidiuretic hormone deficiency is

A) daily intake and output.
B) attention to thirst.
C) a low-sodium diet.
D) daily weights.

Question 50

After a patient has been diagnosed with SIADH,the nurse would expect the first line of treatment to include

A) fluid restriction.
B) hypotonic intravenous fluid.
C) D5W.
D) fluid bolus.

Question 51

In caring for a patient with a thyrotoxic crisis,the nurse would expect neurologic symptoms such as

A) lethargy.
B) depression.
C) seizures.
D) agitation.

Question 52

A patient was admitted to the critical care unit with diabetic ketoacidosis (DKA).Glucose is 349 mg/dL,K? is 3.7 mEq/L,and pH is 7.10.Which of the following interventions would you expect?

A) NS 1.5 L IV fluid bolus
B) Insulin infusion at 5 units/hr
C) Sodium bicarbonate 50 mmol IV push
D) Vasopressin 10 units IM every 3 hr
E) Potassium 20 mEq/L of IV fluid

Question 53

During the first 24 hours when the nurse administers hypertonic saline in a patient with SIADH,the serum sodium should be raised no more than

A) 5 mEq/day.
B) 12 mEq/day.
C) 20 mEq/day.
D) 25 mEq/day.

Question 54

While a patient with SIADH is receiving hypertonic saline,the nurse assesses for signs that the saline must be stopped.These signs would include

A) decreased CVP and decreased PAP.
B) bradycardia and thirst.
C) hypotension and wheezing.
D) hypertension and lung crackles.

Question 55

A patient in myxedema coma has not had a bowel movement for 3 days.The nurse's best intervention would be to

A) administer a Fleet enema.
B) wait 1 more day.
C) administer a stool softener.
D) assess for rectal impaction.

Question 56

Patients who have sustained head trauma or have undergone resection of a pituitary tumor have an increased risk of developing

A) type 1 diabetes.
B) type 2 diabetes.
C) DI.
D) myxedema coma.

Question 57

The diagnosis of SIADH is made when which of the following conditions is present?

A) Decreased ADH level and hyperkalemia
B) Decreased ADH level and hypernatremia
C) Increased ADH level and serum ketones
D) Increased ADH level and low serum osmolality

Question 58

The patient's temperature is 93° F rectally.The most appropriate intervention with this patient would be to

A) give aggressive therapy that includes warm peritoneal lavage.
B) allow the patient to maintain this body temperature to decrease oxygen demands.
C) use warming blankets to slowly warm the patient.
D) wait until the patient shivers to start warming.

Question 59

Decreased urine osmolality is a sign of

A) hyperglycemia.
B) diabetes insipidus.
C) thyroid crisis.
D) SIADH.

Question 60

A patient is very lethargic.Vital signs include a blood pressure of 110/95 mm Hg and heart rate of 40 beats/min.The nurse would suspect

A) hypothyroidism.
B) Cushing syndrome.
C) Addison disease.
D) thyrotoxic crisis.