Deck 24: Endocrine Disorders and Therapeutic Management

Question 1

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

Answer 1

Excessive thirst

Question 2

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.

Answer 2

extensive hydration.

Question 3

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.

Answer 3

Insulin drives the potassium back into the cells.

Question 4

Patients with central DI are treated with

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

Question 5

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 6

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."

Question 7

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 8

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 9

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 10

A patient in diabetic ketoacidosis has the following arterial blood gasses: pH 7.25; pCO₂ 30 mm Hg; HCO₃^- 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 CO₂.
B) administer sodium bicarbonate.
C) administer insulin and fluids intravenously.
D) prepare for intubation.

Question 11

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 12

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 13

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 14

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 15

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

Question 16

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 17

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 18

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 19

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 20

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 21

The onset of seizures in the patient with DI indicates

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

Question 22

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 23

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 24

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 25

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 26

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 27

A nondiabetic patient presents ketoacidosis.Reasons may include

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

Question 28

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 29

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 30

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 31

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 32

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 33

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 34

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 35

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 36

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 37

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 38

The patient at risk for developing SIADH may be taking

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

Question 39

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 40

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 41

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 42

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 43

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 44

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 45

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 46

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 47

Decreased urine osmolality is a sign of

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

Question 48

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 49

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