Download TESTBANK Chapter Title: The History and Interviewing Process

TESTBANK Chapter Title: Endocrine Disorders and Therapeutic Management
Chapter #: Chapter 36
1. The diabetic patient in the critical care unit is at risk for developing diabetic ketoacidosis (DKA) secondary to:
1. excess insulin administration.
2. inadequate food intake.
3. physiologic and psychologic stress.
4. increased release of antidiuretic hormone (ADH).
2. The hallmark of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is:
1. hyperglycemia with low serum osmolality.
2. severe hyperglycemia with minimal or absent ketosis.
3. little or no ketosis in serum with rapidly escalating ketonuria.
4. hyperglycemia and ketosis.
3. The primary intervention for HHNS is:
1. rapid rehydration.
2. monitoring vital signs.
3. high-dose intravenous insulin.
4. hourly urine sugar and acetone testing.
4. Characteristics of diabetes insipidus are:
1. hyperglycemia and hyperosmolarity.
2. hyperglycemia and peripheral edema.
3. intense thirst and passage of excessively large quantities of dilute urine.
4. peripheral edema and pulmonary crackles.
5. Patients with primary and secondary diabetes insipidus are treated with:
1. vasopressin.
2. insulin.
3. glucagon.
4. propylthiouracil.
6. In the syndrome of inappropriate antidiuretic hormone (SIADH), the physiologic effect is:
1. massive diuresis, leading to hemoconcentration.
2. dilutional hyponatremia, reducing sodium concentration to critically low levels.
3. hypokalemia from massive diuresis.
4. serum osmolality greater than 350 mOsm/kg.
7. Which of the following nursing interventions should be initiated on all patients with SIADH?
1. Placing the patient on an air mattress
2. Forcing fluids
3. Initiating seizure precautions
4. Applying soft restraints
8. The patient with thyrotoxic crisis is observed for symptoms of:
1. tachydysrhythmia.
2. hypotension.
3. decreased appetite.
4. hypothermia.
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9. Nursing management of the patient with thyrotoxic crisis includes:
1. providing diversional stimuli.
2. restricting fluids.
3. maintaining a quiet, restful environment.
4. administering thyroid supplements at the same time each day.
Questions 10-12 refer to the following situation.
Mr. M. is a 25-year-old man with a 10-year history of diabetes mellitus. He is admitted to the critical care unit with complaints of
increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis.
10. Which of the following symptoms is most suggestive of DKA?
1. Irritability
2. Excessive thirst
3. Rapid weight gain
4. Peripheral edema
11. Which of the following statements best describes the rationale for administrating potassium supplements with Mr. M.’s insulin
therapy?
1. Potassium replaces losses incurred with diuresis.
2. The patient has been in a long-term malnourished state.
3. Intravenous potassium renders the infused solution isotonic.
4. Insulin drives the potassium back into the cells.
12. The treatment of diabetic ketoacidosis involves:
1. extensive hydration.
2. oral hypoglycemic agents.
3. large doses of IV insulin.
4. limiting food and fluids.
13. The most common problem in the patient with type 2 NIDDM is:
1. a lack of insulin production.
2. an imbalance between insulin production and use.
3. an overproduction of glucose.
4. an increased uptake of glucose in the cells.
14. The patient weighs 140 kilograms and is 60 inches tall. The patient’s blood sugar is being controlled by glipizide. As the nurse
discusses discharge instructions, the primary treatment goal with this NIDDM patient would be:
1. signs of hypoglycemia.
2. proper injection technique.
3. weight loss.
4. increased caloric intake.
15. The nurse knows that instructions on diabetic ketoacidosis need to be given to:
1. all diabetic patients.
2. patients taking oral hypoglycemics.
3. type 1 IDDM patients.
4. patients taking insulin.
16. The patient is admitted to the unit with extreme fatigue, vomiting, and headache. This patient has IDDM 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:
1. “You know a lot about your pump and you are correct.”
2. “You’re right. This is probably a virus.”
3. “We’ll get an abdominal CT and see if your pancreas is inflamed.”
4. “We’ll check your serum blood glucose and ketones.”
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17. A patient who has NIDDM is on the unit following 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:
1. “This surgery may have damaged your pancreas. We will have to do more evaluation.”
2. “Perhaps your diabetes was more serious from the beginning.”
3. “You will need to discuss this with your physician.”
4. “The stress on your body has temporarily increased your blood sugar levels.”
18. The nurse knows that the dehydration associated with diabetic ketoacidosis results from:
1. increased serum osmolality and urea.
2. decreased serum osmolality and hyperglycemia.
3. ketones and potassium shifts.
4. acute renal failure.
19. The nurse knows that the dehydration in DKA stimulates catecholamine release, which results in:
1. decreased glucose release.
2. increased insulin release.
3. decreased cardiac contractility.
4. increased gluconeogenesis.
20. The major electrolyte disturbances that result from diuresis are:
1. low calcium and high phosphorus levels.
2. low potassium and low sodium levels.
3. high sodium and low phosphorus levels.
4. low calcium and low potassium levels.
21. The patient admitted in DKA has dry, cracked lips and is begging for something to drink. The nurse’s best response would be
to:
1. keep the patient NPO.
2. allow the patient a cup of coffee.
3. allow the patient water
4. allow the patient to drink anything he chooses.
22. The patient in DKA has the following ABGs: pH 7.25; pCO2 30; HCO3- 16. The patient has rapid, regular respirations. The
nurse’s best response would be to:
1. ask the patient to breathe in a paper bag to retain CO2.
2. administer sodium bicarbonate.
3. administer insulin IV and fluids.
4. prepare for intubation.
23. The patient in DKA is very lethargic and has a “funny” odor to his breath. The nurse would suspect this to be a result of:
1. alcohol intoxication.
2. hyperglycemia.
3. hyperphosphatemia.
4. acetone.
24. The patient in DKA is comatose with a temperature of 102.2° F. The nurse would suspect:
1. head injury.
2. infarct of the hypothalamus.
3. infection.
4. heat stroke.
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25. The non-diabetic patient presents in ketoacidosis. Reasons may include:
1. starvation and alcoholism.
2. drug overdose.
3. severe vomiting.
4. hyperaldosteronism.
26. Dehydration in the DKA patient will be supported by the following laboratory evidence.
1. Decreased hematocrit and BUN
2. Low urine specific gravity and high serum osmolality
3. Increased hematocrit and BUN
4. High urine specific gravity and low white count
27. As the DKA patient receives insulin and fluids, the nurse knows careful assessment must be given to which of the following
electrolytes?
1. Potassium
2. Sodium
3. Phosphorus
4. Calcium
28. The top priority in the initial treatment of DKA is:
1. lowering the blood sugar.
2. giving fluids.
3. giving sodium bicarbonate to reverse the acidosis.
4. determining the reason for the DKA.
29. The nurse knows that during the resuscitation of the DKA patient, the IV should be changed to a solution containing glucose
when:
1. the patient becomes more alert.
2. the IV insulin has been infusing for 4 hours.
3. the blood glucose drops to 200 mg/dl.
4. the blood glucose drops to 100 mg/dl.
30. The nurse knows that the patient with DKA will need:
1. subcutaneous insulin.
2. intravenous insulin.
3. subcutaneous and intravenous insulin.
4. combination 70%/30% insulin.
31. Once the patient in DKA has insulin infusing intravenously, the nurse expects a drop in the serum levels of:
1. sodium and potassium.
2. potassium and phosphate.
3. bicarbonate and calcium.
4. sodium and phosphate.
32. The patient arrives in DKA with a grossly distended abdomen. His wife states that he has vomited twice. The nurse knows that
a priority would be:
1. endotracheal intubation.
2. stat CT scan.
3. antiemetics.
4. a nasogastric tube.
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33. To assist the nurse in evaluating the patient’s hydration status, assessment would include:
1. orthostatic hypotension and neck vein filling.
2. pupil checks and Kernig’s sign.
3. Chvostek’s and Trousseau’s sign.
4. S4 gallop and edema.
34. The nurse knows that three signs of effective fluid replacement include:
1. elevated CVP, increased heart rate, and elevated PAP.
2. elevated CVP, decreased heart rate, and elevated PAP.
3. normal CVP, decreased heart rate, and normal PAP.
4. decreased CVP, increased heart rate, and decreased PAP.
35. The patient with DKA has an insulin drip infusing and the nurse has just administered subcutaneous insulin. The nurse is alert
for signs of hypoglycemia, which would include:
1. Kussmaul’s respirations and flushed skin.
2. irritability and paresthesia.
3. abdominal cramps and nausea.
4. hypotension and itching.
36. The patient was admitted with DKA 1 hour ago and is on an insulin drip. Suddenly, the nurse notices frequent premature
ventricular contractions (PVCs) on the ECG. The expected intervention would be to:
1. administer lidocaine bolus.
2. administer lidocaine drip.
3. synchronize cardioversion.
4. evaluate electrolytes.
37. A patient with type II NIDDM is admitted. He is very lethargic and hypotensive. A diagnosis of HHNS is made based on
laboratory values of:
1. decreased serum glucose and increased serum ketones.
2. increased urine ketones and decreased serum osmolality.
3. increased serum osmolality and increased serum potassium.
4. increased serum osmolality and increased serum glucose.
38. The nurse identifies the nondiabetic patient at risk for HHNS as the patient receiving:
1. hyperalimentation.
2. aminoglycosides.
3. contrast for CT scan.
4. PEEP.
39. The elderly patient presents with a serum glucose of 900 mg/dl, hematocrit of 55%, and no serum ketones. Immediate attention
must be given to:
1. clotting factors.
2. rehydration.
3. administration of insulin.
4. sodium replacement
40. The patient with HHNS has a serum glucose of 400 mg/dl and a serum sodium of 138 mEq/L. The intravenous fluid of choice
would be:
1. D5W.
2. 0.45% NS.
3. 0.9% NS.
4. D5/NS.
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41. The most common maintenance dose of intravenous insulin would be:
1. 0.1 U/kg/hour.
2. 1.0 U/kg/hour.
3. 2.0 U/kg/hour.
4. 5.0 U/kg/hour.
42. The 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:
1. central diabetes insipidus.
2. cephrogenic diabetes insipidus.
3. psychogenic diabetes insipidus.
4. iatrogenic diabetes insipidus.
43. The patient presenting with diabetes insipidus will exhibit:
1. hyperosmolality and hypernatremia.
2. hyperosmolality and hyponatremia.
3. hypoosmolality and hypernatremia.
4. hypoosmolality and hyponatremia.
44. The onset of seizures in the patient with DI indicates:
1. increased potassium levels.
2. hyperosmolality.
3. severe dehydration.
4. toxic ammonia levels.
45. The patient with DI has a blood pressure of 80/60. The nurse is administering Pitressin intravenously. The nurse recognizes
that the next step to correct the blood pressure would be to:
1. stop the Pitressin.
2. start dopamine.
3. increase the Pitressin.
4. give a fluid bolus.
46. A priority for patient education when discharged with long-term ADH deficiency is:
1. daily intake and output.
2. attention to thirst.
3. a low sodium diet.
4. daily weights.
47. The patient with bronchogenic oat cell carcinoma has a drop in urine output. The laboratory reports a serum sodium of 120
mEq/l, a serum osmolality of 220 mOsm/kg, and urine specific gravity of 1.035. The nurse would suspect:
1. diuresis.
2. diabetes insipidus.
3. syndrome of inappropriate ADH.
4. hyperaldosteronism.
48. The patient at risk for developing SIADH may be taking:
1. adenosine (Adenocard).
2. diltiazem (Cardizem).
3. heparin sodium.
4. acetaminophen.
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49. In evaluating the patient’s hyponatremia, the nurse understands the problem is:
1. increased cortisol release.
2. decreased aldosterone release.
3. increased glucocorticoid release.
4. decreased glucagon release.
50. Once the patient has been diagnosed with SIADH, the nurse would expect treatment to include:
1. fluid restriction.
2. hypotonic intravenous fluid.
3. D5W.
4. fluid bolus.
51. During the first 24 hours when the nurse administers hypertonic saline in the SIADH patient, the serum sodium should be
raised no more than:
1. 5 mEq/day.
2. 12 mEq/day.
3. 20 mEq/day.
4. 25 mEq/day.
52. While the patient with SIADH is receiving hypertonic saline, the nurse assesses for signs that the saline must be stopped. These
signs would include:
1. decreased CVP and decreased PAP.
2. bradycardia and thirst.
3. hypotension and wheezing.
4. hypertension and lung crackles.
53. The patient who is tachycardic and febrile should be monitored closely if prescribed:
1. digitalis (Lanoxin).
2. acetaminophen (Tylenol).
3. amiodarone (Cordarone).
4. hydralazine (Apresoline).
54. In treating the patient with thyrotoxic crisis, the nurse must be alert for:
1. myxedema coma and bradycardia.
2. hyponatremia, pericardial effusion, and hypoventilation.
3. prolonged QT interval and hypoglycemia.
4. dehydration, metabolic acidosis, and heart failure.
55. The patient with thyrotoxic crisis has a heart rate of 140 and is ordered metoprolol (Lopressor). The nurse must monitor closely
for:
1. hypertension.
2. hypotension.
3. atrial fibrillation
4. PVCs.
56. In caring for the patient with a thyrotoxic crisis, the nurse would expect neurologic symptoms such as:
1. lethargy.
2. depression.
3. seizures.
4. agitation.
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57. On discharge, the nurse must warn the patient taking antithyroid drugs of the potential side effect of:
1. thrombocytopenia.
2. diplopia.
3. bronchospasm.
4. agranulocytosis.
58. An elderly lady was found in her cold apartment. She is very lethargic. Her blood pressure is 110/95 and her heart rate is 40.
The nurse would suspect:
1. hypothyroidism.
2. Cushing’s syndrome.
3. Addison’s disease.
4. thyrotoxic crisis.
59. An expected finding in the patient with hypothyroidism would be:
1. increased T4.
2. anemia.
3. decreased TSH
4. hyperglycemia.
60. The patient’s temperature is 93° F, rectally. The most appropriate intervention with this patient would be:
1. aggressive therapy that includes warm peritoneal lavage.
2. to allow the patient to maintain this body temperature to decrease oxygen demands.
3. to use passive warming blankets to slowly warm the patient.
4. to wait until the patient shivers to start warming.
61. The patient in myxedema coma has not had a bowel movement for 3 days. The nurse’s best intervention would be:
1. to administer a Fleets enema.
2. to wait 1 more day.
3. to administer a stool softener.
4. to assess for rectal impaction.
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