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).
Topic: Endocrine
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.
Topic: Endocrine
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.
Topic: Endocrine
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.
Topic: Endocrine
5. Patients with primary and secondary diabetes insipidus are
treated with:
1. vasopressin.
2. insulin.
3. glucagon.
4. propylthiouracil.
Topic: Endocrine
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.
Topic: Endocrine
Cognitive Level: Comprehension
Correct answer: 3
Rationale: Etiologic factors of diabetes insipidus are
numerous. Physiologic and psychologic stress can increase the
blood glucose, leading to diabetic ketoacidosis (DKA). Other
factors listed are hypoglycemic risks.
Text Reference: 853
Cognitive Level: Comprehension
Correct answer: 2
Rationale: The hallmarks of hyperglycemic hyperosmolar
nonketotic syndrome (HHNS) are extremely high levels of
plasma glucose with resulting elevations in serum
hyperosmolality and osmotic diuresis. The disorder occurs
mainly in patients with Type II diabetes.
Text Reference: 864
Cognitive Level: Application
Correct answer: 1
Rationale: Rapid rehydration is the primary intervention for
HHNS. Other interventions include electrolyte replacement,
restoration of the insulin/glucagon ratio, and
prevention/treatment of circulatory collapse.
Text Reference: 866
Cognitive Level: Comprehension
Correct answer: 3
Rationale: Characteristics of diabetes insipidus (DI) are
intense thirst and the passage of excessively large quantities of
very dilute urine.
Text Reference: 869
Cognitive Level: Comprehension
Correct answer: 1
Rationale: Patients with primary and secondary DI who are
unable to synthesize antidiuretic hormone (ADH) require
exogenous ADH (vasopressin) replacement therapy.
Text Reference: 872
Cognitive Level: Comprehension
Correct answer: 2
Rationale: In SIADH, profound fluid and electrolyte
disturbances result from the unsolicited, continuous release of
ADH into the bloodstream. Fluid is retained, resulting in
dilutional hyponatremia and a critically low sodium level.
Text Reference: 874
Copyright © 2003, Elsevier Science (USA). All rights reserved.
2
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
Topic: Endocrine
8. The patient with thyrotoxic crisis is observed for symptoms
of:
1. tachydysrhythmia.
2. hypotension.
3. decreased appetite.
4. hypothermia.
Topic: Endocrine
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.
Topic: Endocrine
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.
Topic: Endocrine
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.
Topic: Endocrine
Cognitive Level: Application
Correct answer: 3
Rationale: Seizure precautions for the patient with SIADH are
provided regardless of the degree of hyponatremia.
Text Reference: 876
Cognitive Level: Comprehension
Correct answer: 1
Rationale: Thyrotoxic crisis is a hypermetabolic state that
exhibits symptoms of tachydysrhythmia, fever, fatigue, and
increased appetite.
Text Reference: 877
Cognitive Level: Application
Correct answer: 3
Rationale: The patient in thyrotoxic crisis is agitated, anxious,
and unable to rest and thus requires intensive care that is quiet,
restful, and calm.
Text Reference: 882
Cognitive Level: Comprehension
Correct answer: 2
Rationale: Polydipsia, polyuria, and polyphagia are classic
symptoms of diabetic ketoacidosis. Other symptoms include
malaise, headache, nausea, vomiting, dehydration, and weight
loss.
Text Reference: 856
Topic: Endocrine
Cognitive Level: Comprehension
Correct answer: 4
Rationale: Hypokalemia may occur as insulin drives potassium
back into the cells.
Text Reference: 860
Topic: Endocrine
Cognitive Level: Application
Correct answer: 1
Rationale: Once diagnosed, DKA requires aggressive medical
and nursing management, including the replacement of fluid
loss from significant dehydration.
Text Reference: 860
Cognitive Level: Knowledge
Correct answer: 2
Rationale: In NIDDM the pancreatic B cells produce
ineffective or insufficient insulin.
Text Reference: 851
Copyright © 2003, Elsevier Science (USA). All rights reserved.
3
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.
Topic: Endocrine
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.”
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.
Topic: Endocrine
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.
Topic: Endocrine
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.
Topic: Endocrine
Cognitive Level: Application
Correct answer: 3
Rationale: This patient weighs 308 pounds and is only 5 feet
tall. Diet management and exercise are interventions to
facilitate weight loss in the NIDDM patient.
Text Reference: 853
Topic: Endocrine
Cognitive Level: Application
Correct answer: 3
Rationale: In IDDM, the B cells no longer secrete insulin and
the cells must break down fatty acids for fuel.
Text Reference: 851
Cognitive Level: Comprehension
Correct answer: 4
Rationale: Subcutaneous insulin pumps can malfunction. It is
critical to assess glucose and ketone levels to evaluate for
diabetic ketoacidosis.
Text Reference: 851
Topic: Endocrine
Cognitive Level: Analysis
Correct answer: 4
Rationale: Adrenal hormones released during stress elevate
blood sugar by increasing insulin resistance and increasing
hepatic gluconeogenesis.
Text Reference: 851
Topic: Endocrine
Cognitive Level: Analysis
Correct answer: 1
Rationale: The hyperglycemia in DKA results in
hyperosmolality, which causes diuresis. The nitrogen waste
products in ketoacidosis are metabolized as urea, which also
increases the osmotic diuresis.
Text Reference: 853
Cognitive Level: Comprehension
Correct answer: 4
Rationale: The catecholamine release results in increased
glycogenolysis, lipolysis, gluconeogenesis, and ketogenesis.
Text Reference: 856
Cognitive Level: Comprehension
Correct answer: 2
Rationale: The major electrolytes lost in the diuresis are
sodium, potassium, and phosphorus.
Text Reference: 856
Copyright © 2003, Elsevier Science (USA). All rights reserved.
4
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.
Topic: Endocrine
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.
Topic: Endocrine
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.
Topic: Endocrine
25. The non-diabetic patient presents in ketoacidosis. Reasons
may include:
1. starvation and alcoholism.
2. drug overdose.
3. severe vomiting.
4. hyperaldosteronism.
Topic: Endocrine
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
Topic: Endocrine
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
Topic: Endocrine
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.
Topic: Endocrine
Cognitive Level: Application
Correct answer: 3
Rationale: The thirst sensation is the body’s attempt to correct
the fluid deficit. Water is the best replacement.
Text Reference: 856
Topic: Endocrine
Cognitive Level: Application
Correct answer: 3
Rationale: The metabolic acidosis is the result of inadequate
glucose to the cells. Insulin and fluids will correct the
underlying problem.
Text Reference: 856
Cognitive Level: Knowledge
Correct answer: 4
Rationale: The patient in DKA releases acetone in his breath to
compensate for the carbonic acid build-up. Acetone gives the
breath a “fruity” odor.
Text Reference: 857
Cognitive Level: Comprehension
Correct answer: 3
Rationale: Infection may be the cause of the DKA and is the
most common explanation for an elevated temperature.
Text Reference: 857
Cognitive Level: Comprehension
Correct answer: 1
Rationale: Starvation and alcoholism may result in a
ketoacidotic state.
Text Reference: 858
Cognitive Level: Analysis
Correct answer: 3
Rationale: The evaluation of hematocrit and BUN is a
measurement of the percent of particles in solution. When
patients are dehydrated, these values will be falsely elevated.
Text Reference: 858
Cognitive Level: Comprehension
Correct answer: 1
Rationale: Potassium shifts back into the cell as the acidosis is
corrected. Therefore the nurse must monitor the serum
potassium frequently during the resuscitation phase. IV insulin
will also push potassium into the cell.
Text Reference: 858
Cognitive Level: Evaluation
Correct answer: 2
Rationale: Giving fluids is a top priority to prevent
cardiovascular collapse.
Text Reference: 858
Copyright © 2003, Elsevier Science (USA). All rights reserved.
5
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.
Topic: Endocrine
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.
Topic: Endocrine
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.
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.
Topic: Endocrine
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.
Topic: Endocrine
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.
Topic: Endocrine
Cognitive Level: Analysis
Correct answer: 3
Rationale: Once the blood glucose drops to 200 mg/dl,
dextrose should be added to avoid hypoglycemia.
Text Reference: 858
Topic: Endocrine
Cognitive Level: Knowledge
Correct answer: 3
Rationale: The patient needs IV insulin for rapid onset but will
also need subcutaneous insulin about 1 hour before the IV
insulin is discontinued.
Text Reference: 858-859
Cognitive Level: Application
Correct answer: 2
Rationale: Insulin promotes the return of potassium and
phosphate into the cell.
Text Reference: 860
Cognitive Level: Application
Correct answer: 4
Rationale: A nasogastric tube will decompress the stomach
contents, prevent aspiration, and improve ventilation.
Text Reference: 860
Topic: Endocrine
Cognitive Level: Knowledge
Correct answer: 1
Rationale: Assessment for orthostatic hypotension and neck
vein filling are important ways to evaluate hydration status.
Text Reference: 860
Cognitive Level: Analysis
Correct answer: 3
Rationale: Central venous pressure and pulmonary artery
pressure should return to normal, and the heart rate should
decrease as cardiac output returns to normal.
Text Reference: 861
Cognitive Level: Knowledge
Correct answer: 2
Rationale: Irritability and paresthesia are seen in
hypoglycemia.
Text Reference: 861
Topic: Endocrine
Cognitive Level: Analysis
Correct answer: 4
Rationale: It is common for the potassium to drop as insulin
pushes it into the cell; this can result in ventricular irritability.
The patient needs potassium supplements.
Text Reference: 862
Copyright © 2003, Elsevier Science (USA). All rights reserved.
6
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.
Topic: Endocrine
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
Topic: Endocrine
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.
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.
Topic: Endocrine
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.
Topic: Endocrine
Cognitive Level: Comprehension
Correct answer: 4
Rationale: HHNS is characterized by extremely high levels of
serum glucose, which lead to high serum osmolality.
Text Reference: 864
Topic: Endocrine
Cognitive Level: Application
Correct answer: 1
Rationale: Hyperalimentation contains large amounts of
dextrose that may not be handled properly by the pancreas,
resulting in hyperglycemia and hyperosmolality.
Text Reference: 864
Cognitive Level: Synthesis
Correct answer: 2
Rationale: The laboratory values indicate HHNS. The
extremely high serum glucose results in hyperosmolality,
which can lead to cardiovascular collapse.
Text Reference: 865
Cognitive Level: Analysis
Correct answer: 3
Rationale: Normal saline is isotonic and would be the most
appropriate fluid to correct the dehydration.
Text Reference: 866
Topic: Endocrine
Cognitive Level: Comprehension
Correct answer: 1
Rationale: 0.1 U/kg/hour most closely mimics the physiologic
secretion of 30 U/day with increases at mealtime.
Text Reference: 867
Cognitive Level: Knowledge
Correct answer: 3
Rationale: This is a rare form of the disease that occurs with
compulsive drinking of water.
Text Reference: 869
Topic: Endocrine
Cognitive Level: Application
Correct answer: 1
Rationale: Diabetes insipidus is the result of a deficiency in
antidiuretic hormone and results in a loss of free water. The loss
of free water causes an increased serum osmolality and serum
sodium.
Text Reference: 869
Copyright © 2003, Elsevier Science (USA). All rights reserved.
7
44. The onset of seizures in the patient with DI indicates:
1. increased potassium levels.
2. hyperosmolality.
3. severe dehydration.
4. toxic ammonia levels.
Topic: Endocrine
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.
Topic: Endocrine
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.
Topic: Endocrine
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.
Topic: Endocrine
48. The patient at risk for developing SIADH may be taking:
1. adenosine (Adenocard).
2. diltiazem (Cardizem).
3. heparin sodium.
4. acetaminophen.
Topic: Endocrine
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.
Topic: Endocrine
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.
Topic: Endocrine
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.
Topic: Endocrine
Cognitive Level: Analysis
Correct answer: 3
Rationale: The lack of ADH leads to severe dehydration,
which can lead to decreased perfusion to the brain and seizures.
Text Reference: 870
Cognitive Level: Evaluation
Correct answer: 4
Rationale: Pitressin is a synthetic ADH that may correct the
fluid loss. However, a fluid bolus is indicated to correct the
hypovolemia associated with DI before starting a vasopressor
such as dopamine.
Text Reference: 872
Cognitive Level: Application
Correct answer: 4
Rationale: Daily weights on the same scale are an excellent
assessment of fluid status. A weight gain/loss of 1 kilogram (2.2
pounds) is equal to 1 liter of fluid.
Text Reference: 872
Cognitive Level: Synthesis
Correct answer: 3
Rationale: A decreased urine output, hyponatremia,
hypoosmolality, and high urine specific gravity are classic signs
of SIADH. Oat cell carcinoma is a precipitating factor for
SIADH.
Text Reference: 874
Cognitive Level: Comprehension
Correct answer: 4
Rationale: Tylenol increases the release of ADH.
Text Reference: 875
Cognitive Level: Analysis
Correct answer: 2
Rationale: Low sodium levels normally trigger the release of
aldosterone, which retains sodium at the kidney tubules.
However, in SIADH, aldosterone is suppressed.
Text Reference: 874
Cognitive Level: Evaluation
Correct answer: 1
Rationale: Fluid restriction is a successful intervention for the
water intoxication.
Text Reference: 876
Cognitive Level: Knowledge
Correct answer: 2
Rationale: To avoid neurologic complications, the serum
sodium should be raised no more than 12 mEq/day.
Text Reference: 876
Copyright © 2003, Elsevier Science (USA). All rights reserved.
8
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.
Topic: Endocrine
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).
Topic: Endocrine
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.
Topic: Endocrine
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.
Topic: Endocrine
56. In caring for the patient with a thyrotoxic crisis, the nurse
Topic: Endocrine
Cognitive Level: Knowledge
Correct answer: 4
Rationale: Agitation and the inability to rest are often found
would expect neurologic symptoms such as:
1. lethargy.
2. depression.
3. seizures.
4. agitation.
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.
Cognitive Level: Evaluation
Correct answer: 4
Rationale: Hypertension and lung crackles are signs of fluid
overload. The hypertonic solution may pull fluid out of cells
and tissues.
Text Reference: 877
Cognitive Level: Synthesis
Correct answer: 3
Rationale: Amiodarone has been identified as causing thyroid
dysfunction and may precipitate thyrotoxicosis.
Text Reference: 877
Cognitive Level: Analysis
Correct answer: 4
Rationale: The hypermetabolic effects on the body result in
dehydration, metabolic acidosis, and heart failure.
Text Reference: 879
Cognitive Level: Analysis
Correct answer: 2
Rationale: Hypotension is a common side effect of
beta-blockers.
Text Reference: 880
in the patient with thyrotoxic crisis.
Text Reference: 881
Topic: Endocrine
Cognitive Level: Analysis
Correct answer: 4
Rationale: Agranulocytosis is a common side effect of
antithyroid drugs, particularly propylthiouracil and
methimazole. Symptoms include sudden cough, fever, rash, and
inflammation.
Text Reference: 881
Topic: Endocrine
Cognitive Level: Synthesis
Correct answer: 1
Rationale: These are all signs of a decrease in the metabolic
rate. The systolic BP is decreased and the diastolic is increased,
resulting in a narrowed pulse pressure.
Text Reference: 881
Topic: Endocrine
Cognitive Level: Comprehension
Correct answer: 2
Rationale: Anemia is a common finding in hypothyroidism
because of the decrease in normal iron absorption.
Text Reference: 881
Copyright © 2003, Elsevier Science (USA). All rights reserved.
9
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.
Topic: Endocrine
Cognitive Level: Evaluation
Correct answer: 3
Rationale: Passive warming will minimize heat loss without
shocking the system.
Text Reference: 881
Topic: Endocrine
Cognitive Level: Analysis
Correct answer: 3
Rationale: A stool softener is the safest intervention for
constipation.
Text Reference: 886
Copyright © 2003, Elsevier Science (USA). All rights reserved.