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Transcript
Chapter 11: Care of the Patient with an Endocrine Disorder
MULTIPLE CHOICE
1. The nurse explains that the negative feedback system controls hormone release by
communication between:
a. the pituitary and the target organ.
b. the thymus and the blood stream.
c. lymphatic system and the target organ.
d. central nervous system and the blood stream.
ANS: A
The amount of hormone released is controlled by a negative feedback system. When the level
of the particular hormone is appropriate, the target organ signals the pituitary to stop the
stimulation of the target organ.
DIF: Cognitive Level: Implementation
REF: Page 500
TOP: Anatomy
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
OBJ: 2
2. Which diagnostic test for diabetes mellitus provides a measure of glucose levels for the
previous 8 to 12 weeks?
a. Fasting blood sugar (FBS)
b. Oral glucose tolerance test (OGT)
c. Glycosylated hemoglobin (HbA1c)
d. Postprandial glucose test (PPBG)
ANS: C
Glycosylated hemoglobin (HbA1c)—This blood test measures the amount of glucose that has
become incorporated into the hemoglobin within an erythrocyte. Because glycosylation occurs
constantly during the 120-day life span of the erythrocyte, this test reveals the effectiveness of
diabetes therapy for the preceding 8 to 12 weeks.
DIF: Cognitive Level: Knowledge
REF: Page 539, Box 11-2
OBJ: 8
TOP: Glucose monitoring
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
3. Which test will furnish immediate feedback for a newly diagnosed diabetic who is not yet
under control?
a. Fasting blood sugar (FBS)
b. Glycosylated hemoglobin (HgbA1c)
c. Oral glucose tolerance test (OGTT)
d. Clinitest
ANS: A
Diabetics should do a fingerstick blood glucose level test before each meal and at bedtime
each day until their disease is under control. The HgbA1c serum test reveals the effectiveness
of diabetes therapy for the preceding 8 to 12 weeks.
DIF: Cognitive Level: Comprehension
REF: Page 539, Box 11-2
OBJ: 9
TOP: Diabetes mellitus
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
4. To which diet should a patient with Cushing syndrome adhere?
a. Less sodium
b. More calories
c. Less potassium
d. More carbohydrates
ANS: A
The diet should be lower in sodium to help decrease edema.
DIF: Cognitive Level: Analysis
REF: Page 524, Table 11-3
OBJ: 5
TOP: Cushing syndrome
KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
5. The patient is a 20-year-old college student who has type 1 diabetes and normally walks each
evening as part of an exercise regimen. The patient plans to enroll in a swimming class.
Which adjustment should be made based on this information?
a. Time the morning insulin injection so that the peak action will occur during
swimming class.
b. Delete normal walks on swimming class days.
c. Delay the meal before the swimming class until the session is over.
d. Monitor glucose level before, during, and after swimming to determine the need
for alterations in food or insulin.
ANS: D
Exercise can reduce insulin resistance and increase glucose uptake for as long as 72 hours, as
well as reducing blood pressure and lipid levels. However, exercise can carry some risks for
patients with diabetes, including hypoglycemia.
DIF: Cognitive Level: Analysis
TOP: Diabetes mellitus
MSC: NCLEX: Physiological Integrity
REF: Page 530
OBJ: 11
KEY: Nursing Process Step: Planning
6. What is a long-term complication of diabetes mellitus?
a. Diverticulitis
b. Renal failure
c. Hypothyroidism
d. Hyperglycemia
ANS: B
Long-term complications of diabetes include blindness, cardiovascular problems, and renal
failure.
DIF: Cognitive Level: Analysis
TOP: Diabetes mellitus
MSC: NCLEX: Physiological Integrity
REF: Page 538
OBJ: 15
KEY: Nursing Process Step: Assessment
7. A patient has returned to his room after a thyroidectomy with signs of thyroid crisis. During
thyroid crisis, exaggerated hyperthyroid manifestations may lead to the development of the
potentially lethal complication of:
a. severe nausea and vomiting.
b. bradycardia.
c. delirium with restlessness.
d. congestive heart failure.
ANS: D
In thyroid crisis, all the signs and symptoms of hyperthyroidism are exaggerated. The patient
may develop congestive heart failure and die.
DIF: Cognitive Level: Analysis
TOP: Thyroidectomy
MSC: NCLEX: Physiological Integrity
REF: Page 513
OBJ: 7
KEY: Nursing Process Step: Assessment
8. In diabetes insipidus, a deficiency of which hormone causes clinical manifestations?
a. antidiuretic hormone (ADH)
b. follicle-stimulating hormone (FSH)
c. thyroid-stimulating hormone (TSH)
d. adrenocorticotropic hormone (ACTH)
ANS: A
Diabetes insipidus is a transient or permanent metabolic disorder of the posterior pituitary in
which ADH is deficient.
DIF: Cognitive Level: Knowledge
TOP: Diabetes insipidus
MSC: NCLEX: Physiological Integrity
REF: Page 507
OBJ: 5
KEY: Nursing Process Step: Assessment
9. What is an appropriate nursing diagnosis for a patient who has recently been diagnosed with
acromegaly?
a. Ineffective coping
b. Activity intolerance
c. Risk for trauma
d. Chronic low self-esteem
ANS: C
Nursing interventions are mainly supportive. The presence of muscle weakness, joint pain, or
stiffness warrants assessment of the ability to perform activities of daily living (ADLs).
DIF: Cognitive Level: Analysis
REF: Page 503
TOP: Acromegaly KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment
OBJ: 5
10. The purpose of the use of radioactive iodine in the treatment of hyperthyroidism is to:
a. stimulate the thyroid gland.
b. depress the pituitary.
c. destroy some of the thyroid tissue.
d. alter the stimulus from the pituitary.
ANS: C
Radioactive iodine 131 destroys some of the hyperactive thyroid gland to produce a more
normally functioning gland.
DIF: Cognitive Level: Application
REF: Page 511, Box 11-1
OBJ: 5
TOP: Radioactive iodine 131
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
11. Which precaution(s) should the nurse take when caring for a patient who is being treated with
radioactive iodine 131 (RAIU)?
a. Initiate radioactive safety precautions
b. Avoid assigning any young woman to the patient
c. Wait three days after dose before assigning a pregnant nurse to care for this patient
d. Advise visitors to sit at least 10 feet away from the patient
ANS: C
The dose is patient specific and at a very low level. No radioactive safety precautions are
necessary and pregnant nurses can be assigned 3 days after the dose. RAIU is not harmful to
nonpregnant women.
DIF: Cognitive Level: Knowledge
REF: Page 511, Box 11-1
OBJ: 5
TOP: Thyroid disorders
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
12. Why would a patient with hyperthyroidism be prescribed the drug methimazole (Tapa-zole)?
a. To limit the effect of the pituitary on the thyroid
b. To destroy part of the hyperactive thyroid tissue
c. To stimulate the pineal gland
d. To block the production of thyroid hormones
ANS: D
Medical management for hyperthyroidism may include administration of drugs that block the
production of thyroid hormones, such as propylthiouracil or methimazole.
DIF:
OBJ:
KEY:
MSC:
Cognitive Level: Application
REF: Page 511, Table 11-2
5
TOP: Hyperthyroidism
Nursing Process Step: Implementation
NCLEX: Physiological Integrity
13. What is the postoperative position for a person who has had a thyroidectomy?
a. Prone
b. Semi-Fowler
c. Side-lying
d. Supine
ANS: B
Postoperative management of this patient includes keeping the bed in a semi-Fowler position,
with pillows supporting the head and shoulders. There should be a suction apparatus and
tracheotomy tray available for emergency use.
DIF: Cognitive Level: Application
TOP: Thyroidectomy
MSC: NCLEX: Physiological Integrity
REF: Page 513
OBJ: 7
KEY: Nursing Process Step: Implementation
14. What extra equipment should the nurse provide at the bedside of a new postoperative
thyroidectomy patient?
a. Large bandage scissors
b. Tracheotomy tray
c. Ventilator
d. Water-sealed drainage system
ANS: B
There should be a suction apparatus and tracheotomy tray available for emergency use.
DIF: Cognitive Level: Analysis
TOP: Thyroidectomy
MSC: NCLEX: Physiological Integrity
REF: Page 513
OBJ: 7
KEY: Nursing Process Step: Planning
15. As the nurse is shaving a patient who is 2 days postoperative from a thyroidectomy, the
patient has a spasm of the facial muscles. What should the nurse recognize this as?
a. Chvostek sign
b. Montgomery sign
c. Trousseau sign
d. Homans sign
ANS: A
The spasm of facial muscles when stimulated is the Chvostek sign, an indication of
hypocalcemic tetany.
DIF: Cognitive Level: Analysis
TOP: Chvostek sign
MSC: NCLEX: Psychosocial Integrity
REF: Page 513
OBJ: 5
KEY: Nursing Process Step: Assessment
16. The human insulin whose onset of action occurs within ____ minutes is lispro (Humalog).
a. 30
b. 60
c. 15
d. 45
ANS: C
Humalog begins to take effect in less than half the time of regular, fast-acting insulin. The
new formula can be injected 15 minutes before a meal.
DIF: Cognitive Level: Knowledge
OBJ: 13
TOP: Insulin
MSC: NCLEX: Physiological Integrity
REF: Page 533, Table 11-5
KEY: Nursing Process Step: Planning
17. What should the nurse caution a type I diabetic about excessive exercise?
a. It can increase the need for insulin and may result in hyperglycemia.
b. It can decrease the need for insulin and may result in hypoglycemia.
c. It can increase muscle bulk and may result in malabsorption of insulin.
d. It can decrease metabolic demand and may result in metabolic acidosis.
ANS: B
The patient with diabetes should exercise regularly. Exercise can reduce insulin resistance and
increase glucose uptake for as long as 72 hours, as well as reducing blood pressure and lipid
levels. However, exercise can carry some risks for patients with diabetes, including
hypoglycemia.
DIF: Cognitive Level: Application
TOP: Diabetes mellitus
MSC: NCLEX: Physiological Integrity
REF: Page 530
OBJ: 11
KEY: Nursing Process Step: Implementation
18. What do the Chvostek sign and the Trousseau sign indicate?
a. Low levels of serum calcium
b. High levels of blood sugar
c. Low levels of serum sodium
d. High levels of serum aldosterone
ANS: A
Low levels of blood calcium may cause the Chvostek sign and Trousseau sign.
DIF: Cognitive Level: Knowledge
TOP: Chvostek sign
MSC: NCLEX: Physiological Integrity
REF: Page 513
OBJ: 6
KEY: Nursing Process Step: Assessment
19. A patient has undergone tests that indicate a deficiency of the parathyroid hormone secretion.
She should be informed of which potential complication?
a. Osteoporosis
b. Lethargy
c. Laryngeal spasms
d. Kidney stones
ANS: C
Decreased parathyroid hormone levels in the blood stream cause a decreased calcium level.
Severe hypocalcemia may result in laryngeal spasm, stridor, cyanosis, and increased
possibility of asphyxia.
DIF: Cognitive Level: Comprehension
TOP: Hypoparathyroidism
MSC: NCLEX: Physiological Integrity
REF: Page 520
OBJ: 5
KEY: Nursing Process Step: Implementation
20. The nurse caring for a 75-year-old man who has developed diabetes insipidus following a
head injury will include in the plan of care provisions for:
a. limiting fluids to 1500 mL a day.
b. encouraging physical exercise.
c. protecting patient from injury.
d. discouraging daytime naps.
ANS: C
The patients need protection from injury because they are often exhausted from sleep
deprivation and having to get up frequently at night. Fluids should not be limited and their
energy should be preserved.
DIF: Cognitive Level: Application
REF: Page 508
OBJ: 5
TOP: Diabetes insipidus
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment
21. The physician orders an 1800-calorie diabetic diet and 40 units of (Humulin N) insulin U-100
subcutaneously daily for a patient with diabetes mellitus. Why would a mid-afternoon snack
of milk and crackers be given?
a.
b.
c.
d.
To improve nutrition
To improve carbohydrate metabolism
To prevent an insulin reaction
To prevent diabetic coma
ANS: C
Humulin N insulin starts to peak in 4 hours. The nurse should be alert for signs of
hypoglycemia (a less-than-normal amount of glucose in the blood, usually caused by
administration of too much insulin, excessive secretion of insulin by the islet cells of the
pancreas, or dietary deficiency) at the peak of action of whatever type of insulin the patient is
taking.
DIF:
OBJ:
KEY:
MSC:
Cognitive Level: Analysis
REF: Page 532, Table 11-5
13
TOP: Diabetes mellitus
Nursing Process Step: Implementation
NCLEX: Physiological Integrity
22. The nurse teaching a patient with type 1 diabetes mellitus (IDDM) about early signs of
insulin reaction would include information about:
a. abdominal pain and nausea.
b. dyspnea and pallor.
c. flushing of the skin and headache.
d. hunger and a trembling sensation.
ANS: D
The patient should be instructed to notify a member of the nursing staff if any signs of
hypoglycemic (low insulin) reaction occur: excessive perspiration or trembling.
DIF:
OBJ:
KEY:
MSC:
Cognitive Level: Application
REF: Page 540, Table 11-6
9
TOP: Insulin reaction
Nursing Process Step: Implementation
NCLEX: Physiological Integrity
23. The nurse discovers the type 1 diabetic (IDDM) patient drowsy and tremulous, the skin is cool
and moist, and the respirations are 32 and shallow. These are signs of:
a. hypoglycemic reaction; give 6 oz of orange juice.
b. hyperglycemic reaction; give ordered regular insulin.
c. hyperglycemic hyperosmolar nonketotic reaction; squeeze glucagon gel in buccal
cavity.
d. hypoglycemic reaction; give ordered insulin.
ANS: A
Hypoglycemic reaction is due to not enough food for the insulin. Quick acting
carbohydrates—such as orange juice or longer acting foods such as milk, crackers, and
cheese—are beneficial.
DIF: Cognitive Level: Comprehension
REF: Page 540, Table 11-6
OBJ: 9
TOP: Diabetes mellitus complications
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
24. A patient has come to the clinic because of enlarged hands and feet, amenorrhea, and
increased hair growth. These symptoms most likely indicate problems with the:
a.
b.
c.
d.
pituitary gland.
adrenal glands.
thyroid gland.
pancreas.
ANS: A
The pituitary gland may produce an overabundance of growth hormone. This overproduction
of hormones may cause changes throughout the patient’s body, including enlargement of the
pituitary gland and hands and feet. Female patients may develop a deepened voice, increased
facial hair growth, and amenorrhea.
DIF: Cognitive Level: Analysis
REF: Page 503
TOP: Acromegaly KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
OBJ: 5
25. What instructions should a nurse give to a diabetic patient to prevent injury to the feet?
a. Soak feet in warm water every day.
b. Avoid going barefoot and always wear shoes with soles.
c. Use of commercial keratolytic agents to remove corns and calluses are preferred to
cutting off corns and calluses.
d. Use a heating pad to warm feet when they feel cool to the touch.
ANS: B
Sturdy, properly fitting shoes should be worn. Use of corn removers and heating pads is not
beneficial to preserve the health of a diabetic’s feet.
DIF: Cognitive Level: Analysis
REF: Page 537
OBJ: 8
TOP: Foot care
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
26. The physician prescribes glyburide (Micronase, DiaBeta, Glynase) for a patient, age 57, when
diet and exercise have not been able to control type 2 diabetes. What should the nurse include
in the teaching plan about this medication?
a. It is a substitute for insulin and acts by directly stimulating glucose uptake into the
cell.
b. It does not cause the hypoglycemic reactions that may occur with insulin use.
c. It is thought to stimulate insulin production and increase sensitivity to insulin at
receptor sites.
d. It lowers blood sugar by inhibiting glucagon release from the liver, preventing
gluconeogenesis.
ANS: C
Oral hypoglycemics are compounds that stimulate the beta cells in the pancreas to increase
insulin release.
DIF: Cognitive Level: Analysis
OBJ: 8
TOP: Medications
MSC: NCLEX: Physiological Integrity
REF: Page 544, Table 11-7
KEY: Nursing Process Step: Planning
27. A 27-year-old patient with hypothyroidism is referred to the dietitian for dietary consultation.
What should nutritional interventions include?
a. Frequent small meals high in carbohydrates
b. Calorie-restricted meals
c. Caffeine-rich beverages
d. Fluid restrictions
ANS: B
A high-protein, high-fiber, lower calorie diet is given.
DIF: Cognitive Level: Analysis
TOP: Hypothyroidism
MSC: NCLEX: Physiological Integrity
REF: Page 515
OBJ: 5
KEY: Nursing Process Step: Planning
28. What instructions should be included in the discharge instructions for a 47-year-old patient
with hypothyroidism?
a. Taking medication whenever symptoms cause discomfort
b. Decreasing fluid and fiber intake
c. Consuming foods rich in iron
d. Seeing the physician regularly for follow-up care
ANS: D
Regular checkups are essential, because drug dosage may have to be adjusted from time to
time.
DIF: Cognitive Level: Application
REF: Page 515
OBJ: 5
TOP: Hypothyroidism
KEY: Nursing Process Step: Planning
MSC: NCLEX: Health Promotion and Maintenance
29. How should the nurse administer insulin to prevent lipohypertrophy?
a. At room temperature
b. At body temperature
c. Straight from the refrigerator
d. After rolling bottle between hands to warm
ANS: A
In fact, it is now believed that insulin should be administered at room temperature, not straight
from the refrigerator, to help prevent insulin lipohypertrophy.
DIF: Cognitive Level: Application
TOP: Diabetes mellitus
MSC: NCLEX: Physiological Integrity
REF: Page 534
OBJ: 8
KEY: Nursing Process Step: Implementation
30. A patient with a history of Graves disease is admitted to the unit with shortness of breath. The
nurse notes the patient’s vital signs: T 103° F, P 160, R 24, BP 160/80. The nurse also notes
distended neck veins. What does the patient most likely have?
a. Pulmonary embolism
b. Hypertensive crisis
c. Thyroid storm
d. Cushing crisis
ANS: C
In a thyroid crisis, all the signs and symptoms of hyperthyroidism are exaggerated.
Additionally, the patient may develop nausea, vomiting, severe tachycardia, severe
hypertension, and occasionally hyperthermia up to 41° C (106° F). Extreme restlessness,
cardiac arrhythmia, and delirium may also occur. The patient may develop heart failure and
may die.
DIF: Cognitive Level: Analysis
TOP: Hyperthyroidism
MSC: NCLEX: Physiological Integrity
REF: Page 513
OBJ: 8
KEY: Nursing Process Step: Assessment
31. What is the master gland of the endocrine system?
a. Thyroid
b. Parathyroid
c. Pancreas
d. Pituitary
ANS: D
The pituitary gland, located in the brain, is the master gland of the endocrine system. It has
been called the “master gland” because through the negative feedback system, it exerts its
control over the other endocrine glands.
DIF: Cognitive Level: Knowledge
TOP: Pituitary gland
MSC: NCLEX: Physiological Integrity
REF: Page 500
OBJ: 1
KEY: Nursing Process Step: Assessment
32. What information should be obtained from the patient before an iodine-131 test?
a. Presence of metal in the body
b. Allergy to sulfa drugs
c. Status of possible pregnancy
d. Use of prescription drugs for hypertension
ANS: C
Iodine-131 is not a radiation hazard to the nonpregnant patient but is absolutely
contraindicated during pregnancy. Pregnant nurses should not care for this patient for several
days.
DIF: Cognitive Level: Knowledge
REF: Page 511
TOP: Iodine-131
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
OBJ: 5
33. The patient being treated for hypothyroidism should be instructed to eat well-balanced meals
including intake of iodine. Which of the following foods contains iodine?
a. Eggs
b. Pork
c. White bread
d. Skinless chicken
ANS: A
The hypothyroid diet should be adequate in intake of iodine, in foods such as saltwater fish,
milk, and eggs; fluids should be increased to help prevent constipation.
DIF: Cognitive Level: Application
REF: Page 515
OBJ: 8
TOP: Hypothyroidism
MSC: NCLEX: Physiological Integrity
KEY: Nursing Process Step: Assessment
34. The nurse is caring for a patient who is receiving calcium gluconate for treatment of
hypoparathyroid tetany. Which assessment would indicate an adverse reaction to the drug?
a. Increase in heart rate
b. Flushing of face and neck
c. Drop in blood pressure
d. Urticaria
ANS: C
Indications of an adverse effect of calcium gluconate are dyspnea, bradycardia, and
hypotension.
DIF: Cognitive Level: Application
TOP: Calcium gluconate for tetany
MSC: NCLEX: Physiological Integrity
REF: Page 520
OBJ: 5
KEY: Nursing Process Step: Assessment
35. The nurse cautions the patient who is being instructed on self-medication with insulin to be
aware that there are 25-, 30-, 50-, and 100-unit syringes. How is the 100-unit syringe marked?
a. 1-unit increments
b. 2-unitt increments
c. 4-unit increments
d. 5-unit increments
ANS: B
The 100-unit syringe is marked in 2-unit increments while the smaller syringes are marked in
1-unit increments.
DIF: Cognitive Level: Knowledge
TOP: Insulin administration
MSC: NCLEX: Physiological Integrity
REF: Page 534
OBJ: 14
KEY: Nursing Process Step: Implementation
MULTIPLE RESPONSE
36. Which of the following are signs and symptoms of hypoglycemia? (Select all that apply.)
a. Irritability
b. Dry mouth
c. Tremors
d. Diaphoresis
e. Fruity breath
f. Deep respirations
ANS: A, C, D
Hypoglycemic reaction: rapid shallow respirations, irritability, tremors, excessive
perspiration, and possibly loss of consciousness.
DIF: Cognitive Level: Application
REF: Page 540, Table 11-6
OBJ: 9
TOP: Hypoglycemia
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
37. What are the three major life-threatening complications postoperatively of a thyroidectomy?
(Select all that apply.)
a. Hemorrhaging
b. Seizures
c. Tetany
d. Hypoglycemia
e. Thyroid crisis (storm)
f. SIADH
ANS: A, C, E
The nurse must be alert for signs of internal or external bleeding. In addition to hemorrhage,
two significant postoperative complications exist after thyroidectomy. The first is tetany. The
second is thyroid crisis. Manipulation of the thyroid during surgery may cause the release of
large amounts of thyroid hormones into the blood stream, creating a thyroid crisis (storm).
DIF: Cognitive Level: Comprehension
TOP: Thyroidectomy
MSC: NCLEX: Physiological Integrity
REF: Page 513
OBJ: 7
KEY: Nursing Process Step: Assessment
38. The adrenal cortex secretes glucocorticoids. The most important is cortisol. What is it
involved in? (Select all that apply.)
a. Glucose metabolism
b. Releasing androgens and estrogens
c. Providing extra reserve energy during stress
d. Decreasing the level of potassium in the blood stream
e. Increasing retention of sodium in the blood stream
ANS: A, C
Cortisol is involved in glucose metabolism and provides extra reserve energy in times of
stress.
DIF: Cognitive Level: Comprehension
TOP: Adrenal cortex
MSC: NCLEX: Physiological Integrity
REF: Page 502
OBJ: 3
KEY: Nursing Process Step: Assessment
39. What should the nurse include in provisions for the postoperative care of the patient who had
a thyroidectomy? (Select all that apply.)
a. Assessing ability to speak by asking him or her to recite name and address every
hour
b. Maintaining anatomic position of the head when moving a patient
c. Assisting a patient to hyperextend the head to assess for muscle damage
d. Doing voice check every 2 hours
e. Turning, coughing every hour
f. Checking for bleeding at the sides and the back of the head
ANS: B, D, F
The nurse should hold the head in an anatomic position when moving the patient to prevent
tension on the suture line, do a voice check every 2 to 4 hours by asking the patient to say
“ah”; the patient is not turned nor is coughing recommended immediately after a
thyroidectomy.
DIF: Cognitive Level: Application
REF: Page 513
OBJ: 7
TOP: Postoperative thyroidectomy
MSC: NCLEX: Physiological Integrity
KEY: Nursing Process Step: Planning
40. The nurse would instruct a patient with hyperthyroidism (Graves disease) to select which of
the following nutritious foods because of the increased metabolism related to the disease.
(Select all that apply.)
a. Coffee with cream
b. Lean meat
c. White bread
d. Leafy green vegetables
e. Supplemental vitamin D
ANS: B, D, E
Nutritious food sources, such as food high in protein (e.g., lean meat), sources of vitamin B
(e.g., leafy green vegetables), and vitamin D supplements are helpful to meet the metabolic
needs of the patient with hyperthyroidism.
DIF: Cognitive Level: Application
REF: Page 512
OBJ: 5
TOP: Diet for hyperthyroidism
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
41. The nurse would instruct a patient who is hypocalcemic from hypoparathyroidism about a diet
that should include (select all that apply):
a. High phosphorus foods
b. Canned fish with the bones
c. Cucumbers
d. Tofu
e. Bananas
f. Vitamin D supplements
ANS: B, C, D, F
The hypocalcemic patient should eat a high-calcium, low-phosphorus diet that includes
canned fish, cucumbers, tofu, and vitamin D supplements as an aid to the absorption of the
calcium.
DIF: Cognitive Level: Application
TOP: Diet for hypocalcaemia
MSC: NCLEX: Physiological Integrity
REF: Page 512
OBJ: 5
KEY: Nursing Process Step: Implementation
COMPLETION
42. The nurse is administering long-acting insulin once a day, which provides insulin coverage for
24 hours. This insulin is _________________.
ANS:
Lantus
Lantus is a long-acting synthetic (recombinant DNA origin, human-made) human insulin. It is
used once a day at bedtime and works around the clock for 24 hours.
DIF: Cognitive Level: Implementation
REF: Page 532, Table 11-5
OBJ: 3
TOP: Insulin
MSC: NCLEX: Physiological Integrity
KEY: Nursing Process Step: Planning
43. Another term for hyperglycemic reaction is ____________ ______________.
ANS:
diabetic ketoacidosis (DKA)
diabetic ketoacidosis
DKA
Hyperglycemic reaction—the body eliminates the excess glucose by the kidneys releasing it
in the urine. Diabetic ketoacidosis (DKA) (acidosis accompanied by an accumulation of
ketones in the blood), formerly called diabetic coma, may develop and the patient could die.
DKA is a severe metabolic disturbance caused by an acute insulin deficiency, decreased
peripheral glucose use, and increased fat mobilization and ketogenesis.
DIF: Cognitive Level: Knowledge
REF: Page 540, Table 11-6
OBJ: 10
TOP: Hyperglycemia
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
44. Only ________insulin can be administered intravenously.
ANS:
regular
Insulin is given subcutaneously, although intravenous (IV) administration of regular insulin
can be done when immediate onset of action is desired.
DIF: Cognitive Level: Knowledge
OBJ: 13
TOP: Insulin
MSC: NCLEX: Physiological Integrity
REF: Page 533, Table 11-5
KEY: Nursing Process Step: Assessment
45. A condition with a deficiency in growth hormone is called ________________.
ANS:
hypopituitary dwarfism
A condition with a deficiency in growth hormone is called hypopituitary dwarfism. Most
cases are idiopathic, but a small number can be attributed to an autosomal-recessive trait. In
some cases there is also a lack of adrenocorticotropic hormone (ACTH), TSH, and the
gonadotropins.
DIF: Cognitive Level: Knowledge
REF: Page 506
TOP: Dwarfism
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
OBJ: 5
46. ________________is the term that describes a condition of normal thyroid function.
ANS:
Euthyroid
Euthyroid is the term that describes a condition of normal thyroid function.
DIF: Cognitive Level: Knowledge
REF: Page 512
TOP: Euthyroid
KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiological Integrity
OBJ: 5
47. When the nurse inflates the sphygmomanometer cuff exceeding the systolic blood pressure
and observes a carpal spasm, this is a(n) __________ ____________.
ANS:
Trousseau sign
Trousseau sign is a carpal spasm brought on by pressure of a cuff. This is an indicator for
hypocalcemia and hypomagnesemia.
DIF: Cognitive Level: Application
TOP: Trousseau sign
MSC: NCLEX: Physiological Integrity
REF: Page 513
OBJ: 6
KEY: Nursing Process Step: Assessment
OTHER
48. Arrange the steps of the negative feedback system in the control of blood glucose in
chronologic order. (Separate letters by a comma and space as follows: A, B, C, D):
a. Elevation of blood glucose
b. Decrease in blood glucose
c. Beta cells repressed
d. Beta cells of pancreas stimulated to excrete insulin
e. Intake of nutrients
ANS:
E, A, D, B, C
After the intake of food the blood glucose increases, which stimulates the beta cells of the
pancreas to excrete insulin. Insulin decreases the blood glucose and the negative feedback
system represses the beta cells of the pancreas.
DIF: Cognitive Level: Analysis
TOP: Negative feedback system
MSC: NCLEX: Physiological Integrity
REF: Page 503
OBJ: 2
KEY: Nursing Process Step: N/A
49. Arrange the steps of drawing up a short-acting and a long-acting insulin in the same syringe.
(Separate letters by a comma and space as follows: A, B, C, D)
a. Draw up amount of shorter-acting insulin
b. Check insulin dose with a second licensed nurse
c. Inject the desired amount of air into the long-acting insulin
d. Clean rubber stopper of both vials with alcohol
e. Draw up desired amount of longer-acting insulin
f. Inject the desired amount of air into the short-acting insulin
ANS:
D, C, F, A, E, B
When drawing up two different types of insulin, the two vials are prepared by cleansing the
tops, air is injected in the longer-acting insulin, air is injected into the short-acting insulin,
and the required dose is drawn up. Set the vial of short-acting insulin out of reach to prevent
accidental reuse. Handing the plunger securely, insert the needle in the long-acting insulin and
withdraw the dose very carefully. Check the dose with a licensed nurse before administering.
DIF:
OBJ:
KEY:
MSC:
Cognitive Level: Analysis
REF: Page 534, Box 11-3
14
TOP: Mixing insulin
Nursing Process Step: Implementation
NCLEX: Physiological Integrity