You catch glucose, thyroid, and steroid problems from the labs and symptoms in the stem. Five of the 15 questions include the correct answer and rationale. The other ten keep answers in the study hub. Continue with the Nursing textbooks exam guide or more Nursing textbooks practice questions.
Five endocrine questions with answers
Cover the key. Write the first action. Then open the rationale and name why the other choices fail.
Question 1
A diabetic educator is discussing sick day rules with a newly diagnosed type 1 diabetic. The educator is aware that the patient will require further teaching when the patient states what?
A. I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours.
B. If I cannot eat a meal, I will eat a soft food such as soup, gelatin, or pudding six to eight times a day.
C. I will call the doctor if I am not able to keep liquids in my body due to vomiting or diarrhea.
D. I will call the doctor if my blood sugar is over 300 mg/dL or if I have ketones in my urine.
Show answer and rationale
Correct answer: A — I will not take my insulin on the days when I am sick, but I will certainly check my blood sugar every 2 hours.
The nurse must explanation the sick day rules again to the patient who plans to stop taking insulin when sick. The nurse should emphasize that the patient should take insulin agents as usual and test ones blood sugar and urine ketones every 3 to 4 hours. In fact, insulin-requiring patients may need supplemental doses of regular insulin every 3 to 4 hours. The patient should report elevated glucose levels (greater than 300 mg/dL or as otherwise instructed) or urine ketones to the physician. If the patient is not able to eat normally, the patient should be instructed to substitute soft foods such a gelatin, soup, and pudding. If vomiting, diarrhea, or fever persists, the patient should have an intake of liquids every 30 to 60 minutes to prevent dehydration.
Question 2
A nurse is assigned to administer insulin glargine to a client at a health care facility. What precaution should the nurse take when administering this drug?
A. Administer glargine via IV route.
B. Avoid mixing glargine with other insulin.
C. Shake the vial vigorously before withdrawing insulin.
D. Be sure the insulin has been refrigerated.
Show answer and rationale
Correct answer: B — Avoid mixing glargine with other insulin.
When administering insulin glargine to the client, the nurse should avoid mixing it with other insulins or solutions. It will precipitate in the syringe when mixed. If glargine is mixed with another solution, it will lose glucose control, resulting in decreased effectiveness of the insulin. Glargine is administered via the subcutaneous route once daily at bedtime. The nurse should not shake the vial vigorously before withdrawing insulin. The vial should be gently rotated between the palms of the hands and tilted gently end to end immediately before withdrawing the insulin. The nurse administers insulin from vials at room temperature. Vials are stored in the refrigerator if they are to be stored for about 3 months for later use.
Question 3
A nurse is caring for a client with chronic lymphocytic thyroiditis. The physician has prescribed liothyronine to the client. The nurse understands that the drug is administered cautiously to clients with which of the following?
A. Upper respiratory tract infection
B. Diabetes
C. Elevated body temperature
D. Cardiac disease
Show answer and rationale
Correct answer: D — Cardiac disease
The nurse should be cautious about existing conditions such as cardiac disease and also cautious about factating clients before administering liothyronine to clients with chronic lymphocytic thyroiditis. The nurse need not be cautious about administering liothyronine to clients with an upper respiratory tract infection, diabetes, or elevated body temperature. The nurse should be cautious about clients contracting an upper respiratory tract infection on administrating antithyroid drugs. A client with diabetes may experience an increase in diabetes while undergoing thyroid hormone replacement therapy. The nurse should observe for elevated body temperature while managing the needs of a client administered thyroid hormones.
Question 4
The nurse is assessing a client in the clinic who appears restless, excitable, and agitated. The nurse observes that the client has exophthalmos and neck swelling. What diagnosis do these clinical manifestations correlate with?
A. Hypothyroidism
B. Hyperthyroidism
C. Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
D. Diabetes insipidus (DI)
Show answer and rationale
Correct answer: B — Hyperthyroidism
Clients with hyperthyroidism characteristically are restless despite feeling fatigued and weak, highly excitable, and constantly agitated. Fine tremors of the hand occur, causing unusual clumsiness. The client cannot tolerate heat and has an increased appetite but loses weight. Diarrhea also occurs. Visual changes, such as blurred or double vision, can develop. Exophthalmos, seen in clients with severe hyperthyroidism, results from enlarging muscle and fatty tissue surrounding the rear and sides of the eyeball. Hypothyroidism clinical manifestations are the opposite of what is seen in hyperthyroidism, and SIADH and DI clinical manifestations do not correlate with the symptoms manifested by the client.
Question 5
A physician has prescribed desiccated thyroid USP for thyroid-stimulating hormone suppression. The client is also taking serotonin reuptake inhibitors to overcome depression. The nurse would be alert to the development of which of the following due to the interaction of the two drugs?
A. Prolonged bleeding
B. Decreased effectiveness of the thyroid drug
C. Increased risk of paresthesias
D. Increased risk of hypoglycemia
Show answer and rationale
Correct answer: B — Decreased effectiveness of the thyroid drug
The nurse should monitor for a decreased effectiveness of the thyroid drug as the result of the interaction between desiccated thyroid USP and serotonin reuptake inhibitors. When the client is receiving desiccated thyroid USP with serotonin reuptake inhibitors, there is no increase in the risk of paresthesias, hypoglycemia, or prolonged bleeding. When the client is receiving oral anticoagulants with thyroid hormones, the client is at risk of prolonged bleeding. Increased risk of hypoglycemia occurs when oral hypoglycemics and insulin are administered with thyroid hormones to the client. The nurse should observe for paresthesias as one of the adverse reactions in a client receiving antithyroid drugs.
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Question 6
Which of the following patients with type 1 diabetes is most likely to experience adequate glucose control?
A. A patient who skips breakfast when his glucose reading is greater than 220 mg/dL
B. A patient who never deviates from her prescribed dose of insulin
C. A patient who adheres closely to a meal plan and meal schedule
D. A patient who eliminates carbohydrates from his daily intake
Correct answer:
The therapeutic goal for diabetes management is to achieve normal blood glucose levels without hypoglycemia. Therefore, diabetes management involves constant assessment and modification of the treatment plan by health professionals and daily adjustments in therapy (possibly including insulin) by patients. For patients who require insulin to help control blood glucose levels, maintaining consistency in the amount of calories and carbohydrates ingested at meals is essential. In addition, consistency in the approximate time intervals between meals, and the snacks, help maintain overall glucose control. Skipping meals is never advisable for person with type 1 diabetes.
A client is receiving glipizide at a health care facility. The client is also prescribed an anticoagulant. The nurse would be alert for which of the following related to the interaction of these two drugs?
A. Increased risk of lactic acidosis
B. Risk of acute renal failure
C. Increased risk for bleeding
D. Increased hypoglycemic effect
Correct answer:
The nurse should observe for increased hypoglycemic effect in the client as the effect of the interaction of sulfonylureas with the anticoagulants, chloramphenicol, clofibrate, fluconazole, histamine-2 antagonists, meth Methyldopa, monoamine oxidase inhibitors (MAOIs), salicylates, sulfonamides, and tricyclic antidepressants. Increased risk of lactic acidosis is an effect of the interaction of metformin with glucocorticoids. Increased risk for bleeding is an effect of the interaction of oral anticoagulants with anti-infective drugs. There is a risk of acute renal failure when iodinated contrast material used for radiologic studies is administered with metformin.
A nurse is caring for a patient with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the patients ability to prepare and self-administer insulin?
A. Ask the patient to describe the process in detail.
B. Observe the patient drawing up and administering the insulin.
C. Provide a health education session reviewing the main points of insulin delivery.
D. Review the patients first hemoglobin A1C result after discharge.
Correct answer:
Nurses should assess the patients ability to perform diabetes related self-care as soon as possible during the hospitalization or office visit to determine whether the patient requires further diabetes teaching. While consulting a home care nurse is beneficial, an initial assessment should be performed during the hospitalization or office visit. Nurses should directly observe the patient performing the skills such as insulin preparation and infection, blood glucose monitoring, and foot care. Simply questioning the patient about these skills without actually observing performance of the skill is not sufficient. Further education does not guarantee learning.
A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal?
A. Hyponatremia
B. Hypophosphatemia
C. Hypocalcemia
D. Hypokalemia
Correct answer:
Injury or removal of the parathyroid glands may produce a disturbance in calcium metabolism and result in a decline of calcium levels (hypocalcemia). As the blood calcium levels fall, hyperirritability of the nerves occurs, with spasms of the hands and feet and muscle twitching. This group of symptoms is known as tetany and must be reported to the physician immediately, because laryngospasm may occur and obstruct the airway. Hypophosphatemia, hyponatremia, and hypokalemia are not expected responses to parathyroid injury or removal. In fact, parathyroid removal or injury that results in hypocalcemia may lead to hyperphosphatemia.
The nurse is caring for a client who has syndrome of inappropriate antidiuretic hormone (SIADH). The nurse notices that the client has become confused and extremely short of breath, and crackles are heard when lungs are auscultated. What is the first action by the nurse?
A. Administer a diuretic.
B. Notify the physician.
C. Lay the client flat.
D. Suction the client.
Correct answer:
The nurse closely monitors fluid intake and output and vital signs. The nurse carefully assesses LOC and immediately reports any changes to the physician. The nurse checks closely for signs of fluid overload (confusion, dyspnea, pulmonary congestion, hypertension) and hyponatremia (weakness, muscle cramps, anorexia, nausea, diarrhea, irritability, headache, weight gain without edema). Laying the client flat would increase the shortness of breath and would deoxygenate the client. The nurse cannot administer a diuretic without the physician's order. Suctioning of the client will not clear the airway at this time.
The nurse is caring for a client with hypoparathyroidism. When the nurse taps the client's facial nerve, the client's mouth twitches and the jaw tightens. What is this response documented as related to the low calcium levels?
A. Positive Chvostek sign
B. Positive Trousseau sign
C. Positive paresthesia
D. Positive Babinski sign
Correct answer:
If a nurse taps the client's facial nerve (which lies under the tissue in front of the ear), the client's mouth twitches and the jaw tightens. The response is identified as a positive Chvostek sign. A positive Trousseau sign is elicited by placing a BP cuff on the upper arm, inflating it between the systolic and diastolic BP, and waiting 3 minutes. The nurse observes the client for spasm of the hand (carpopedal spasm), which is evidenced by the hand flexing inward. Positive Babinski sign is elicited by stroking the sole of the foot. Paresthesia is not a symptom that can be elicited; it is felt by the client.
An elderly patient comes to the clinic with her daughter. The patient is a diabetic and is concerned about foot care. The nurse goes over foot care with the patient and her daughter as the nurse realizes that foot care is extremely important. Why would the nurse feel that foot care is so important to this patient?
A. An elderly patient with foot ulcers experiences severe foot pain due to the diabetic polyneuropathy.
B. Avoiding foot ulcers may mean the difference between institutionalization and continued independent living.
C. Hypoglycemia is linked with a risk for falls; this risk is elevated in older adults with diabetes.
D. Oral antihyperglycemics have the possible adverse effect of decreased circulation to the lower extremities.
Correct answer:
The nurse recognizes that providing information on the long-term complications especially foot and eye problems associated with diabetes is important. Avoiding amputation through early detection of foot ulcers may mean the difference between institutionalization and continued independent living for the elderly person with diabetes. While the nurse recognizes that hypoglycemia is a dangerous situation and may lead to falls, hypoglycemia is not directly connected to the importance of foot care. Decrease in circulation is related to vascular changes and is not associated with drugs administered for diabetes.
What life-threatening outcome should the nurse monitor for in a client who is not compliant with taking prescribed antithyroid medication?
A. Thyrotoxic crisis
B. Myxedema coma
C. Diabetes insipidus
D. Syndrome of inappropriate antidiuretic hormone secretion
Correct answer:
Thyrotoxic crisis, an abrupt and life-threatening form of hyperthyroidism, is thought to be triggered by extreme stress, infection, diabetic ketoacidosis, trauma, toxemia of pregnancy, or manipulation of a hyperactive thyroid gland during surgery or physical examination. Although rare, this condition may occur in clients with undiagnosed or inadequately treated hyperthyroidism. Myxedema coma is associated with hypothyroidism. Diabetes insipidus (DI) and syndrome of inappropriate antidiuretic hormone secretion (SIADH) clinical manifestations do not correlate with medication taken for hyperthyroidism.
A diabetes educator is teaching a patient about type 2 diabetes. The educator recognizes that the patient understands the primary treatment for type 2 diabetes when the patient states what?
A. I read that a pancreas transplant will provide a cure for my diabetes.
B. I will take my oral antidiabetic agents when my morning blood sugar is high.
C. I will make sure to follow the weight loss plan designed by the dietitian.
D. I will make sure I call the diabetes educator when I have questions about my insulin.
Correct answer:
Insulin resistance is associated with obesity; thus the primary treatment of type 2 diabetes is weight loss. Oral antidiabetic agents may be added if diet and exercise are not successful in controlling blood glucose levels. If maximum doses of a single category of oral agents fail to reduce glucose levels to satisfactory levels, additional oral agents may be used. Some patients may require insulin on an ongoing basis or on a temporary basis during times of acute psychological stress, but it is not the central component of type 2 treatment. Pancreas transplantation is associated with type 1 diabetes.
A student with diabetes tells the school nurse that he is feeling nervous and hungry. The nurse assesses the child and finds he has tachycardia and is diaphoretic with a blood glucose level of 50 mg/dL (2.8 mmol/L). What should the school nurse administer?
A. A combination of protein and carbohydrates, such as a small cup of yogurt
B. Two teaspoons of sugar dissolved in a cup of apple juice
C. Half of a cup of juice, followed by cheese and crackers
D. Half a sandwich with a protein-based filling
Correct answer:
Initial treatment for hypoglycemia is 15 g concentrated carbohydrate, such as two or three glucose tablets, 1 tube glucose gel, or 0.5 cup juice. After initial treatment, the nurse should follow with a snack including starch and protein, such as cheese and crackers, milk and crackers, or half of a sandwich. It is unnecessary to add sugar to juice, even it if is labeled as unsweetened juice, because the fruit sugar in juice contains enough simple carbohydrate to raise the blood glucose level and additional sugar may result in a sharp rise in blood sugar that will last for several hours.
Nursing textbooks endocrine practice questions for nursing students in the United States. Fifteen items. Five include answers and rationales in American English.
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