Med Surg Study Guide Diabetes Mellitus & Endocrine Problems Flashcards


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1

In addition to promoting the transport of glucose from the blood into the cell, what does insulin do?

A) Enhances the breakdown of adipose tissue for energy

B) Stimulates hepatic glycogenolysis and gluconeogenesis

C) Prevents the transport of triglycerides into adipose tissue

D) Increases amino acid transport into cells and protein synthesis

Answer: D

2

Why are the hormones cortisol, glucagon, epinephrine, and growth hormone referred to as counter regulatory hormones?

A) Decrease glucose production

B) Stimulate glucose output by the liver

C) Increase glucose transport into the cells

D) Independently regulate glucose level in the blood

Answer: B

3

Which laboratory results would indicate that the patient has prediabetes?

A) Glucose tolerance result of 132 mg/dL (7.3 mmol/L)

B) Glucose tolerance result of 240 mg/dL (13.3 mmol/L)

C) Fasting blood glucose result of 80 mg/dL (4.4 mmol/L)

D) Fasting blood glucose result of 120 mg/dL (6.7 mmol/L)

Answer: D

4

In type 1 diabetes there is an osmotic effect of glucose when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose?

A) Fatigue

B) Polydipsia

C) Polyphagia

D) Recurrent infections

Answer: B

5

Which patient should the nurse plan to teach how to prevent or delay the development of diabetes?

A) An obese 40-yr-old Hispanic woman

B) A child whose father has type 1 diabetes

C) A 34-yr-old woman whose parents both have type 2 diabetes

D) A 12-yr-old boy whose father has maturity-onset diabetes of the young (MODY)

Answer: C

6

When caring for a patient with metabolic syndrome, the nurse should give the highest priority to teaching the patient about which treatment plan?

A) Achieving a normal weight

B) Performing daily aerobic exercise

C) Eliminating red meat from the diet

D) Monitoring the blood glucose periodically

Answer: A

7

The nurse determines that a patient with a 2-hour OGTT of 152 mg/dL has

A) diabetes.

B) elevated A1C.

C) impaired fasting glucose.

D) impaired glucose tolerance.

Answer: D

8

When teaching the patient with diabetes about insulin administration, the nurse should include which instruction for the patient?

A) Pull back on the plunger after inserting the needle to check for blood.

B) Consistently use the same size of insulin syringe to avoid dosing errors.

C) Clean the skin at the injection site with an alcohol swab before each injection.

D) Rotate injection sites from arms to thighs to abdomen with each injection to prevent lipodystrophies.

Answer: B

9

A patient with type 1 diabetes uses 20 U of Novolin 70/30 (NPH/regular) in the morning and at 6:00 PM. When teaching the patient about this regimen, what should the nurse emphasize?

A) Hypoglycemia is most likely to occur before the noon meal.

B) A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia.

C) Flexibility in food intake is possible because insulin is available 24 hours a day.

D) Premeal glucose checks are required to determine needed changes in daily dosing.

Answer: B

10

Lispro insulin (Humalog) with NPH (Humulin N) insulin is ordered for a patient with newly diagnosed type 1 diabetes. The nurse knows that when lispro insulin is used, when should it be administered?

A) Only once a day

B) 1 hour before meals

C) 30 to 45 minutes before meals

D) At mealtime or within 15 minutes of meals

Answer: D

11

A patient with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when the patient does what?

A) Withdraws the NPH dose into the syringe first

B) Injects air equal to the NPH dose into the NPH vial first

C) Removes any air bubbles after withdrawing the first insulin

D) Adds air equal to the insulin dose into the regular vial and withdraws the dose

Answer: A

12

The following interventions are planned for a patient with diabetes. Which intervention can the nurse delegate to unlicensed assistive personnel (UAP)?

A) Discuss complications of diabetes.

B) Check that the bath water is not too hot.

C) Check the patient's technique for drawing up insulin.

D) Teach the patient to use a meter for self-monitoring of blood glucose.

Answer: B

13

The home care nurse should intervene to correct a patient whose insulin
administration includes

A) warming a prefilled refrigerated syringe in the hands before administration.

B) storing syringes prefilled with NPH and regular insulin needle-up in the
refrigerator.

C) placing the insulin bottle currently in use in a small container on the bathroom countertop.

D) mixing an evening dose of regular insulin with insulin glargine in one syringe for administration.

Answer: D

14

When teaching the patient with type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump?

A) Tight glycemic control can be maintained.

B) Errors in insulin dosing are less likely to occur.

C) Complications of insulin therapy are prevented.

D) Frequent blood glucose monitoring is unnecessary.

Answer: A

15

A patient taking insulin has recorded fasting glucose levels above 200 mg/dL (11.1 mmol/L) on awakening for the last five mornings. What should the nurse advise the patient to do first?

A) Increase the evening insulin dose to prevent the dawn phenomenon.

B) Use a single-dose insulin regimen with an intermediate-acting insulin.

C) Monitor the glucose level at bedtime, between 2:00 AM and 4:00 AM, and on arising.

D) Decrease the evening insulin dosage to prevent night hypoglycemia and the
Somogyi effect.

Answer: C

16

Which class of oral glucose-lowering agents (OA) is most commonly used for people with type 2 diabetes because it reduces hepatic glucose production and enhances tissue uptake of glucose?

A) Insulin

B) Biguanide

C) Meglitinide

D) Sulfonylurea

Answer: B

17

The patient with type 2 diabetes has had trouble controlling his blood glucose with several OAs but wants to avoid the risks of insulin. The HCP told him a medication will be prescribed that will increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and slow gastric emptying. The nurse knows this is which medication that will have to be injected?

A) Dopamine receptor agonist, bromocriptine (Cycloset)

B) Dipeptidyl peptidase-4 (DPP-4) inhibitor, sitagliptin (Januvia)

C) Sodium-glucose co-transporter 2 (SGLT2) inhibitor, canagliflozin (Invokana)

D) Glucagon-like peptide-1 receptor agonist, exenatide extended release (Bydureon)

Answer: D

18

The nurse is assessing a newly admitted patient with diabetes. Which observation should be addressed as the priority by the nurse?

A) Bilateral numbness of both hands

B) Stage II pressure ulcer on the right heel

C) Rapid respirations with deep inspiration

D) Areas of lumps and dents on the abdomen

Answer: C

19

Individualized nutrition therapy for patients using conventional, fixed insulin regimens should include teaching the patient to

A) eat regular meals at regular times.

B) restrict calories to promote moderate weight loss.

C) eliminate sucrose and other simple sugars from the diet.

D) limit saturated fat intake to 30% of dietary calorie intake.

Answer: A

20

What should the goals of nutrition therapy for the patient with type 2 diabetes include?

A) Ideal body weight

B) Normal serum glucose and lipid levels

C) A special diabetic diet using dietetic foods

D) Five small meals per day with a bedtime snack

Answer: B

21

To prevent hyperglycemia or hypoglycemia related to exercise, what should the nurse teach the patient using glucose-lowering agents about the best time for exercise?

A) Plan activity and food intake related to blood glucose levels

B) When blood glucose is greater than 250 mg/dL and ketones are present

C) When glucose monitoring reveals that the blood glucose is in the normal range

D) When blood glucose levels are high, because exercise always has a hypoglycemic effect

Answer: A

22

The nurse assesses the technique of the patient with diabetes for self-monitoring of blood glucose (SMBG) 3 months after initial instruction. Which error in the performance of SMBG noted by the nurse requires intervention?

A) Doing the SMBG before and after exercising

B) Puncturing the finger on the side of the finger pad

C) Cleaning the puncture site with alcohol before the puncture

D) Holding the hand down for a few minutes before the puncture

Answer: C

23

A nurse working in an outpatient clinic plans a screening program for diabetes. What recommendations for screening should be included?

A) OGTT for all minority populations every year

B) FPG for all individuals at age 45 and then every 3 years

C) Testing people under the age of 21 for islet cell antibodies

D) Testing for type 2 diabetes in all overweight or obese individuals

Answer: B

24

Priority Decision: A patient with diabetes calls the clinic because she is
experiencing nausea and flu-like symptoms. Which advice from the nurse will be the best for this patient?

A) Administer the usual insulin dosage.

B) Hold fluid intake until the nausea subsides.

C) Come to the clinic immediately for evaluation and treatment.

D) Monitor the blood glucose every 1 to 2 hours and call if it rises over 150 mg/dL (8.3 mmol/L).

Answer: A

25

The nurse should observe the patient for symptoms of ketoacidosis when

A) illnesses causing nausea and vomiting lead to bicarbonate loss with body fluids.

B) glucose levels become so high that osmotic diuresis promotes fluid and electrolyte loss.

C) an insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy.

D) the patient skips meals after taking insulin, leading to rapid metabolism of glucose and breakdown of fats for energy.

Answer: C

26

What describes the primary difference in treatment for diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS)?

A) DKA requires administration of bicarbonate to correct acidosis.

B) Potassium replacement is not necessary in management of HHS.

C) HHS requires greater fluid replacement to correct the dehydration.

D) Administration of glucose is withheld in HHS until the blood glucose reaches a normal level.

Answer: C

27

A patient with diabetes is found unconscious at home and a family member calls the clinic. After determining that a glucometer is not available, what should the nurse advise the family member to do?

A) Have the patient drink some orange juice.

B) Administer 10 U of regular insulin subcutaneously.

C) Call for an ambulance to transport the patient to a medical facility.

D) Administer glucagon 1 mg intramuscularly (IM) or subcutaneously.

Answer: D

28

Priority Decision: Two days following a self-managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode have been between 80 and 90 mg/dL. Which is the best response by the nurse?

A) “That is a good range for your glucose levels.”

B) “You should call your healthcare provider because you need to have your insulin increased.”

C) “That level is too low in view of your recent hypoglycemia and you should increase your food intake.”

D) “You should take only half your insulin dosage for the next few days to get your glucose level back to normal.”

Answer: A

29

Which statement best describes atherosclerotic disease affecting the cerebrovascular, cardiovascular, and peripheral vascular systems in patients with diabetes?

A) It can be prevented by tight glucose control.

B) It occurs with a higher frequency and earlier onset than in the nondiabetic population.

C) It is caused by the hyperinsulinemia related to insulin resistance common in type 2 diabetes.

D) It cannot be modified by reduction of risk factors such as smoking, obesity, and high fat intake.

Answer: B

30

Following the teaching of foot care to a patient with diabetes, the nurse determines that additional instruction is needed when the patient makes which statement?

A) “I should wash my feet daily with soap and warm water.”

B) “I should always wear shoes to protect my feet from injury.”

C) “If my feet are cold, I should wear socks instead of using a heating pad.”

D) “I'll know if I have sores or lesions on my feet because they will be painful.”

Answer: D

31

A 72-year-old woman is diagnosed with diabetes. What does the nurse recognize about the management of diabetes in the older adult?

A) It is more difficult to achieve strict glucose control than in younger patients.

B) Treatment is not warranted unless the patient develops severe hyperglycemia.

C) It does not include treatment with insulin because of limited dexterity and vision.

D) It usually requires that a younger family member be responsible for care of the patient.

Answer: A

32

A patient with newly diagnosed type 2 diabetes has been given a prescription to start an oral hypoglycemic medication. The patient tells the nurse she would rather control her blood sugar with herbal therapy. Which action should the nurse take?

A) Teach the patient that herbal therapy is not safe and should not be used.

B) Advise the patient to discuss using herbal therapy with her HCP before using it.

C) Encourage the patient to give the prescriptive medication time to work before using herbal therapy.

D) Teach the patient that if she takes herbal therapy, she will have to monitor her blood sugar more often.

Answer: B

33

A patient suspected of having acromegaly has an elevated plasma growth hormone (GH) level. In acromegaly, what would the nurse also expect the patient's diagnostic results to indicate?

A) Hyperinsulinemia

B) Plasma glucose of less than 70 mg/dL (3.9 mmol/L)

C) Decreased GH levels with an oral glucose challenge test

D) Elevated levels of plasma insulin-like growth factor-1 (IGF-1)

Answer: D

34

During assessment of the patient with acromegaly, what should the nurse expect the patient to report?

A) Infertility

B) Dry, irritated skin

C) Undesirable changes in appearance

D) An increase in height of 2 to 3 inches a year

Answer: C

35

Patient-Centered Care: A patient with acromegaly is treated with a transsphenoidal hypophysectomy. What should the nurse do postoperatively?

A) Ensure that any clear nasal drainage is tested for glucose and protein.

B) Maintain the patient flat in bed to prevent cerebrospinal fluid (CSF) leakage.

C) Assist the patient with tooth brushing every 4 hours to keep the surgical area clean.

D) Encourage deep breathing, coughing, and turning to prevent respiratory complications.

Answer: A

36

What findings are commonly found in a patient with a prolactinoma?

A) Gynecomastia in men

B) Profuse menstruation in women

C) Excess follicle-stimulating hormone (FSH) and luteinizing hormone (LH)

D) Signs of increased intracranial pressure, including headache, nausea, and vomiting

Answer: D

37

The patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What manifestation should the nurse expect to find?

A) Decreased body weight

B) Decreased urinary output

C) Increased plasma osmolality

D) Increased serum sodium levels

Answer: B

38

During care of the patient with SIADH, what should the nurse do?

A) Monitor neurologic status at least every 2 hours.

B) Teach the patient receiving treatment with diuretics to restrict sodium intake.

C) Keep the head of the bed elevated to prevent antidiuretic hormone (ADH) release.

D) Notify the HCP if the patient's blood pressure decreases more than 20 mm Hg from baseline.

Answer: A

39

A patient with SIADH is treated with water restriction. What does the patient experience when the nurse determines that treatment has been effective?

A) Increased urine output, decreased serum sodium, and increased urine specific gravity

B) Increased urine output, increased serum sodium, and decreased urine specific gravity

C) Decreased urine output, increased serum sodium, and decreased urine specific gravity

D) Decreased urine output, decreased serum sodium, and increased urine specific Gravity

Answer: B

40

The patient with diabetes insipidus is brought to the emergency department (ED) with confusion and dehydration after excretion of a large volume of urine today even though several liters of fluid were consumed. What is a diagnostic test that the nurse should expect to be done first to help make a diagnosis?

A) Blood glucose

B) Serum sodium level

C) CT scan of the head

D) Water deprivation test

Answer: D

41

In a patient with central diabetes insipidus, the administration of ADH during a water deprivation test will result in what?

A) Decrease in body weight

B) Increase in urinary output

C) Decrease in blood pressure

D) Increase in urine osmolality

Answer: D

42

Patient-Centered Care: A patient with diabetes insipidus is treated with nasal desmopressin acetate (DDAVP). The nurse determines that the drug is not having an adequate therapeutic effect when the patient experiences

A) headache and weight gain.

B) nasal irritation and nausea.

C) a urine specific gravity of 1.002.

D) an oral intake greater than urinary output.

Answer: C

43

When caring for a patient with nephrogenic diabetes insipidus, what should the nurse expect the treatment to include?

A) Fluid restriction

B) Thiazide diuretics

C) A high-sodium diet

D) metformin (Glucophage)

Answer: B

44

What characteristic is related to Hashimoto's thyroiditis?

A) Enlarged thyroid gland

B) Viral-induced hyperthyroidism

C) Bacterial or fungal infection of thyroid gland

D) Chronic autoimmune thyroiditis with antibody destruction of thyroid tissue

Answer: D

45

Which statement accurately describes Graves' disease?

A) Exophthalmos occurs in Graves' disease.

B) It is an uncommon form of hyperthyroidism.

C) Manifestations of hyperthyroidism occur from tissue desensitization to the sympathetic nervous system.

D) Diagnostic testing in the patient with Graves' disease will reveal an increased thyroid-stimulating hormone (TSH) level.

Answer: A

46

A patient with Graves' disease asks the nurse what caused the disorder. What is the best response by the nurse?

A) “The cause of Graves' disease is not known, although it is thought to be genetic.”

B) “It is usually associated with goiter formation from an iodine deficiency over a long period of time.”

C) “Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones.”

D) “In genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion.”

Answer: D

47

A patient is admitted to the hospital with acute thyrotoxicosis. On physical assessment of the patient, what should the nurse expect to find?

A) Hoarseness and laryngeal stridor

B) Bulging eyeballs and dysrhythmias

C) Elevated temperature and signs of heart failure

D) Lethargy progressing suddenly to impairment of consciousness

Answer: C

48

What medication is used with thyrotoxicosis to block the effects of the sympathetic nervous stimulation of the thyroid hormones?

A) Potassium iodine

B) Propylthiouracil

C) Propranolol (Inderal)

D) Radioactive iodine (RAI)

Answer: C

49

What preoperative instruction should the nurse give to the patient scheduled for a subtotal thyroidectomy?

A) How to support the head with the hands when turning in bed

B) Coughing should be avoided to prevent pressure on the incision

C) Head and neck will have to remain immobile until the incision heals

D) Any tingling around the lips or in the fingers after surgery is expected and temporary

Answer: A

50

Priority Decision: As a precaution for vocal cord paralysis from damage to the recurrent or superior laryngeal nerve during thyroidectomy surgery, what is the most important equipment to have in the room in case it is needed for this emergency situation?

A) Tracheostomy tray

B) Oxygen equipment

C) IV calcium gluconate

D) Paper and pencil for communication

Answer: A

51

When providing discharge instructions to a patient who had a subtotal thyroidectomy for hyperthyroidism, what should the nurse teach the patient?

A) Never miss a daily dose of thyroid replacement therapy.

B) Avoid regular exercise until thyroid function is normalized.

C) Use warm salt water gargles several times a day to relieve throat pain.

D) Substantially reduce caloric intake compared to what was eaten before surgery.

Answer: D

52

What is a cause of primary hypothyroidism in adults?

A) Malignant or benign thyroid nodules

B) Surgical removal or failure of the pituitary gland

C) Surgical removal or radiation of the thyroid gland

D) Autoimmune-induced atrophy of the thyroid gland

Answer: D

53

Patient-Centered Care: The nurse has identified the nursing diagnosis of fatigue for a patient who is hypothyroid. What should the nurse do while caring for this patient?

A) Monitor for changes in orientation, cognition, and behavior.

B) Monitor for vital signs and cardiac rhythm response to activity.

C) Monitor bowel movement frequency, consistency, shape, volume, and color.

D) Assist in developing well-balanced meal plans consistent with energy expenditurelevel.

Answer: B

54

Priority Decision: When replacement therapy is started for a patient with longstanding hypothyroidism, what is most important for the nurse to monitor for in the patient?

A) Insomnia

B) Weight loss

C) Nervousness

D) Dysrhythmias

Answer: D

55

A patient with hypothyroidism is treated with levothyroxine (Synthroid). What should the nurse include when teaching the patient about this therapy?

A) Explain that alternate-day dosage may be used if side effects occur.

B) Provide written instruction for all information related to the drug therapy.

C) Assure the patient that a return to normal function will occur with replacement therapy.

D) Inform the patient that the drug must be taken until the hormone balance is reestablished.

Answer: B

56

A patient who recently had a calcium oxalate renal stone had a bone density study, which showed a decrease in her bone density. What endocrine problem could this patient have?

A) SIADH

B) Hypothyroidism

C) Cushing syndrome

D) Hyperparathyroidism

Answer: D

57

What is an appropriate nursing intervention for the patient with hyperparathyroidism?

A) Pad side rails as a seizure precaution.

B) Increase fluid intake to 3000 to 4000 mL daily.

C) Maintain bed rest to prevent pathologic fractures.

D) Monitor the patient for Trousseau's and Chvostek's signs.

Answer: B

58

When the patient with parathyroid disease experiences symptoms of hypocalcemia, what is a measure that can be used to temporarily raise serum calcium levels?

A) Administer IV normal saline.

B) Have patient rebreathe in a paper bag.

C) Administer oral phosphorus supplements.

D) Administer furosemide (Lasix) as ordered.

Answer: B

59

A patient with hypoparathyroidism resulting from surgical treatment of hyperparathyroidism is preparing for discharge. What should the nurse teach the patient?

A) Milk and milk products should be increased in the diet.

B) Parenteral replacement of parathyroid hormone will be required for life.

C) Calcium supplements with vitamin D can effectively maintain calcium balance.

D) Bran and whole-grain foods should be used to prevent GI effects of replacement therapy.

Answer: C

60

A patient is admitted to the hospital with a diagnosis of Cushing syndrome. On physical assessment of the patient, what should the nurse expect to find?

A) Hypertension, peripheral edema, and petechiae

B) Weight loss, buffalo hump, and moon face with acne

C) Abdominal and buttock striae, truncal obesity, and hypotension

D) Anorexia, signs of dehydration, and hyperpigmentation of the skin

Answer: A

61

A patient is scheduled for a bilateral adrenalectomy. During the postoperative period, what should the nurse expect related to the administration of corticosteroids?

A) Reduced to promote wound healing

B) Withheld until symptoms of hypocortisolism appear

C) Increased to promote an adequate response to the stress of surgery

D) Reduced with excessive hormone release during surgical manipulation of adrenal glands

Answer: C

62

A patient with Addison's disease comes to the ED with complaints of nausea, vomiting, diarrhea, and fever. What interprofessional care should the nurse expect?

A) IV administration of vasopressors

B) IV administration of hydrocortisone

C) IV administration of D5W with 20 mEq KCl

D) Parenteral injections of adrenocorticotropic hormone (ACTH)

Answer: B

63

Patient-Centered Care: During discharge teaching for the patient with Addison's disease, which statement by the patient indicates that the nurse needs to do additional teaching?

A) “I should always call the doctor if I develop vomiting or diarrhea.”

B) “If my weight goes down, my dosage of steroid is probably too high.”

C) “I should double or triple my steroid dose if I undergo rigorous physical exercise.”

D) “I need to carry an emergency kit with injectable hydrocortisone in case I can't take my medication by mouth.”

Answer: B

64

A patient who is on corticosteroid therapy for treatment of an autoimmune disorder has the following additional drugs ordered. Which one is used to prevent
corticosteroid-induced osteoporosis?

A) Potassium

B) Furosemide (Lasix)

C) Alendronate (Fosamax)

D) Pantoprazole (Protonix)

Answer: C

65

A patient with mild iatrogenic Cushing syndrome is on an alternate-day regimen of corticosteroid therapy. What does the nurse explain to the patient about this regimen?

A) It maintains normal adrenal hormone balance.

B) It prevents ACTH release from the pituitary gland.

C) It minimizes hypothalamic-pituitary-adrenal suppression.

D) It provides a more effective therapeutic effect of the drug.

Answer: C

66

Patient-Centered Care: When caring for a patient with primary hyperaldosteronism, the nurse would question an HCP's prescription for which drug?

A) Ketoconazole

B) Furosemide (Lasix)

C) Eplerenone (Inspra)

D) Spironolactone (Aldactone)

Answer: B

67

Priority Decision: What is the priority nursing intervention during the management of the patient with pheochromocytoma?

A) Administering IV fluids

B) Monitoring blood pressure

C) Administering β-adrenergic blockers

D) Monitoring intake and output and daily weights

Answer: B