Question 1

A patient is reporting a headache,fatigue,abdominal pain,and blurred vision.The nurse knows that these signs may indicate the patient has what problem?

Accepted Answer

Because severe hyperglycemia affects a variety of body systems,all systems are assessed.The patient may complain of blurred vision,headache,weakness,fatigue,drowsiness,anorexia,nausea,and abdominal pain.

Question 2

A patient has been admitted with abdominal pain.The nurse notes that the patient's fasting blood glucose is 120 mg/dL.Which statement regarding this finding is accurate?

Accepted Answer

A normal fasting plasma glucose (FPG)level is between 70 and 110 mg/dL.An FPG level between 110 and 126 mg/dL identifies a person who is prediabetic.An FPG level of greater than 126 mg/dL (7 mmol/L)is diagnostic of diabetes.In nonurgent settings,the test is repeated on another day to make sure the result is accurate.

Question 3

A patient is admitted with diabetic ketoacidosis.The nurse requests the practitioner order a glycosylated hemoglobin (HbA₁C).What information does this test provide to the health care team?

Accepted Answer

The glycated hemoglobin test (also known as the glycosylated hemoglobin,or HbA₁C or A₁C)provides information about the average amount of glucose that has been present in the patient's bloodstream over the previous 3 to 4 months.During the 120-day life span of red blood cells (erythrocytes),the hemoglobin within each cell binds to the available blood glucose through a process known as glycosylation.

Question 4

A patient is admitted with hypernatremia secondary to neurogenic diabetes insipidus.The nurse notes that the patient's serum osmolality is 350 mOsm/kg.What does this finding indicate?

Accepted Answer

Values for serum osmolality in the bloodstream range from 275 to 295 mOsm/kg H₂O.Increased serum osmolality stimulates the release of antidiuretic hormone,which in turn reduces the amount of water lost through the kidney.

Question 5

The nurse is caring for a patient with a traumatic brain injury.Yesterday the patient weighed 62 kg and today the patient weighs 60 kg.How much fluid loss does this change in weight reflect?

Accepted Answer

Daily weight changes coincide with fluid retention and fluid loss.1 L of fluid lost or retained is equal to approximately 2.2 lb,or 1 kg,of weight gained or lost.This patient lost 2 kg of weight,which is equivalent to 2 L of fluid.

Question 6

A patient has been admitted with a brain mass.The practitioner suspects it might be a pituitary tumor and orders a computed tomography (CT)scan.What area of brain should be scanned to confirm this diagnosis?

Accepted Answer

Computed tomography (CT)of the base of the skull identifies pituitary tumors,blood clots,cysts,nodules,or other soft tissue masses.

Question 7

A patient is admitted with hypernatremia secondary to diabetes insipidus (DI).The practitioner suspects the patient has neurogenic DI.Which finding would confirm that diagnosis?

Accepted Answer

In cases of severe central diabetes insipidus (DI)d the urine osmolality shows a significant increase (becomes more concentrated).Test results in which urine osmolality remains unchanged indicate nephrogenic DI.

Question 8

A patient has been admitted with uncontrolled atrial fibrillation and muscle wasting.The practitioner suspects the patient may have a thyroid disorder.The nurse auscultates a bruit over the thyroid.What does this finding indicate?

Accepted Answer

Auscultation of the thyroid is accomplished by use of the bell portion of the stethoscope to identify a bruit or blowing noise from the circulation through the thyroid gland.The presence of a bruit indicates enlargement of the thyroid as evidenced by increased blood flow through the glandular tissue.

Question 9

A patient reports losing weight even though she eats "everything in sight." She also reports tremors and diarrhea.The nurse suspects the patient may have what problem?

Accepted Answer

Weight loss,increased appetite,tremors,insomnia,and diarrhea are symptoms of hyperthyroidism.

Question 10

A nurse is teaching a patient with diabetes mellitus.The patient asks the nurse what is an acceptable HbA₁c level for him.What should the nurse tell the patient?

Accepted Answer

A normal HbA₁C value is less than 5.4%,with an acceptable target level for patients with diabetes below 6.5%.

Question 11

A patient is being evaluated for thyroid dysfunction.The patient's medications include aspirin,digoxin,chlorothiazide,and insulin.The nurse knows that the laboratory work may be affected by which of these medications?

Accepted Answer

Several drugs increase the serum level of T₄ by displacing protein-bound T₄.Drugs that displace T₄,including heparin (both unfractionated and low-molecular-weight heparins),cause an increase in serum T₄ levels.Salicylates (aspirin)and furosemide (Lasix)also raise T₄ serum levels by the same mechanism.

Question 12

The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes.Which laboratory results would the nurse note confirming this diagnosis?

Accepted Answer

Ketone bodies are a byproduct of rapid fat breakdown.Ketone blood levels rise in acute illness,fasting,and with sustained elevation of blood glucose in type 1 diabetes in the absence of insulin.The patient would also have ketones in the urine,a hemoglobin A₁C greater than 6%,and a fasting glucose greater than 125 mg/dL.

Question 13

The nurse is caring for a patient with a traumatic brain injury.The nurse suspects the patient is developing diabetes insipidus.Which test or procedure would confirm this diagnosis?

Accepted Answer

Serum antidiuretic hormone (ADH)levels are compared with the blood and urine osmolality to differentiate syndrome of inappropriate antidiuretic hormone (SIADH)from central diabetes insipidus (DI).Increased ADH levels in the bloodstream compared with a low serum osmolality and elevated urine osmolality confirms the diagnosis of SIADH.Reduced levels of serum ADH in a patient with high serum osmolality,hypernatremia,and reduced urine concentration signal central DI.

Question 14

The nurse is caring for a patient who has been newly diagnosed with type 1 diabetes.The nurse notes that the patient is extremely dehydrated.To make this assessment,what did the nurse evaluate?

Accepted Answer

A hydration assessment includes observations of skin integrity,skin turgor,and buccal membrane moisture.Moist,shiny buccal membranes indicate satisfactory fluid balance.Skin turgor that is resilient and returns to its original position in less than 3 seconds after being pinched or lifted indicates adequate skin elasticity.Skin over the forehead,clavicle,and sternum is the most reliable for testing tissue turgor because it is less affected by aging and thus more easily assessed for changes related to fluid balance.

Question 15

A patient is admitted with severe hyperglycemia due to new-onset type 1 diabetes mellitus.The nurse notes a sweet-smelling odor on the patient's exhaled breath.What causes this phenomenon?

Accepted Answer

Ketoacidosis results in the patient's breathing becoming deep and rapid (Kussmaul respirations)and the patient's breath having a fruity odor.Metabolic alkalosis and dehydration do not cause this phenomenon.Glycosylation is when the hemoglobin within each cell binds to the available blood glucose.

Question 16

A patient is admitted with severe hyperglycemia due to new-onset type 1 diabetes mellitus.Which signs and symptoms obtained as part of the patient's history might indicate the presence of hyperglycemia?

Accepted Answer

The patient or family member may relay information about recent,unexplained changes in weight,thirst,hunger,and urination patterns.

Question 17

A patient has been admitted who is suspected of having thyrotoxicosis.Which laboratory findings would confirm this diagnosis?

Accepted Answer

Hyperthyroidism (thyrotoxicosis)is indicated by very low thyroid-stimulating hormone level,high serum T₄,and an increased T₃:T₄ ratio.

Question 18

A patient is admitted with hypernatremia secondary to diabetes insipidus (DI).Which test would help the practitioner differentiate between central and nephrogenic DI?

Accepted Answer

The antidiuretic hormone test is used to differentiate between neurogenic diabetes insipidus (DI)(central)and nephrogenic (kidney)DI.In severe central DI,in which the pituitary is affected,the urine osmolality shows a significant increase (becomes more concentrated),which indicates that the cell receptor sites on the kidney tubules are responsive to vasopressin.Test results in which urine osmolality remains unchanged indicate nephrogenic DI,suggesting kidney dysfunction because the kidneys are no longer responsive to antidiuretic hormone.

Question 19

A patient is admitted with hyponatremia.The practitioner suspects the patient may have syndrome of inappropriate secretion of antidiuretic hormone (SIADH)and orders a serum ADH level for the next morning.Which medications must be stopped or withheld at least 8 hours prior to the test?

Accepted Answer

To prepare the patient for the test,all drugs that may alter the release of antidiuretic hormone (ADH)are withheld for a minimum of 8 hours.Common medications that affect ADH levels include morphine sulfate,lithium carbonate,chlorothiazide,carbamazepine,oxytocin,nicotine,alcohol,and selective serotonin reuptake inhibitors.

Question 20

A patient has been admitted who is suspected of having thyrotoxicosis.Which symptom would support this diagnosis?

Accepted Answer

Signs and symptoms of thyrotoxicosis include tremors,insomnia,increased appetite,diarrhea,muscle weakness or wasting,and a change in menstruation.

Quiz 31: Endocrine Clinical Assessment and Diagnostic Procedures