Question 1

Which of the following would be seen in a patient with myxedema coma?

Accepted Answer

A)   Decreased reflexes
B)   Hyperthermia
C)   Hyperventilation
D)   Tachycardia A

Question 2

Which of the following statements is true about the medical management of diabetic ketoacidosis?

Accepted Answer

A)   Serum lactate levels are used to guide insulin administration.
B)   Sodium bicarbonate is a first-line medication for treatment.
C)   The degree of acidosis is assessed through continuous pulse oximetry.
D)   Volume replacement and insulin infusion often correct the acidosis. D

Question 3

Factors associated with the development of nephrogenic diabetes insipidus include which of the following? (Select all that apply.)

Accepted Answer

A)   Heredity
B)   Medications
C)   Meningitis
D)   Pituitary tumors
E)   Sickle cell disease A,B,E

Question 4

A patient is receiving hydrocortisone sodium succinate for adrenal crisis.What other medication does the nurse prepare to administer?

Accepted Answer

A)   Regular insulin
B)   A proton pump inhibitor
C)   Canagliflozin
D)   Propranolol

Question 5

Which of the following are appropriate nursing interventions for the patient in myxedema coma? (Select all that apply.)

Accepted Answer

A)   Administer levothyroxine as prescribed.
B)   Encourage the intake of foods high in sodium.
C)   Initiate passive rewarming interventions.
D)   Monitor airway and respiratory effort.
E)   Monitor urine osmolality.

Question 6

The nurse is providing insulin education for an elderly patient with long-standing diabetes.A prescription has been written for the patient to take 20 units of insulin glargine at 10 PM nightly.The nurse should instruct the patient that the peak of the insulin action for this agent is

Accepted Answer

A)   0200.
B)   0400.
C)   0800.
D)   peakless.

Question 7

An elderly female patient has presented to the emergency department with altered mental status,hypothermia,and clinical signs of heart failure.Myxedema is suspected.Which of the following laboratory findings support this diagnosis?

Accepted Answer

A)   Elevated adrenocorticotropic hormone
B)   Elevated cortisol levels
C)   Elevated T3 and T4
D)   Elevated thyroid-stimulating hormone

Question 8

A patient is admitted to the oncology unit with a small-cell lung carcinoma.During the admission,the patient is noted to have a significant decrease in urine output accompanied by shortness of breath,edema,and mental status changes.The nurse is aware that this clinical presentation is consistent with

Accepted Answer

A)   adrenal crisis.
B)   diabetes insipidus.
C)   myxedema coma.
D)   syndrome of inappropriate secretion of antidiuretic hormone (SIADH) .

Question 9

A patient with a history of type 1 diabetes and an eating disorder is found unconscious.In the emergency department,the following lab values are obtained:
Glucose: 648 mg/dL
PH: 6.88
PaCO2: 20 mm Hg
PaO2: 95 mm Hg
HCO3-: undetectable
Anion gap: >31
Na+: 127 mEq/L
K+: 3.5 mEq/L
Creatinine: 1.8 mg/dL
After the patient's airway and ventilation have been established,the next priority for this patient is:

Accepted Answer

A)   administration of a 1-L normal saline fluid bolus.
B)   administration of 0.1 unit of regular insulin IV push followed by an insulin infusion.
C)   administration of 20 mEq KCl in 100 mL.
D)   IV push administration of 1 amp of sodium bicarbonate.

Question 10

A patient with long-standing type 1 diabetes presents to the emergency department with a loss of consciousness and seizure activity.The patient has a history of renal insufficiency,gastroparesis,and peripheral diabetic neuropathy.Emergency personnel reported a blood glucose of 32 mg/dL on scene.When providing discharge teaching for this patient and family,the nurse instructs on the need to do which of the following? (Select all that apply.)

Accepted Answer

A)   Administer glucagon 1 mg intramuscularly any time the blood glucose is less than 70 mg/dL.
B)   Administer 15 grams of carbohydrate orally for severe episodes of hypoglycemia.
C)   Discontinue the insulin pump by removing the infusion set catheter.
D)   Increase home blood glucose monitoring and report patterns of hypoglycemia to the provider.
E)   Perform blood glucose monitoring before exercising and driving.

Question 11

The nurse has been assigned the following patients.Which patients require assessment of blood glucose control as a nursing priority? (Select all that apply.)

Accepted Answer

A)   18-year-old male who has undergone surgical correction of a fractured femur
B)   29-year-old female who is undergoing evaluation for pheochromocytoma
C)   43-year-old male with acute pancreatitis who is receiving total parenteral nutrition ( TPN ) 
D)   62-year-old morbidly obese female who underwent a hysterectomy for ovarian cancer
E)   72-year-old female who is receiving intravenous ( IV )  steroids for an exacerbation of chronic obstructive pulmonary disease ( COPD )

Question 12

Which of the following laboratory values would be more common in patients with diabetic ketoacidosis?

Accepted Answer

A)   Blood glucose >1000 mg/dL
B)   Negative ketones in the urine
C)   Normal anion gap
D)   pH 7.24

Question 13

A patient with pancreatic cancer has been admitted to the critical care unit with clinical signs consistent with syndrome of inappropriate secretion of antidiuretic hormone.The nurse anticipates that clinical management of this condition will include

Accepted Answer

A)   administration of 3% normal saline.
B)   administration of exogenous vasopressin.
C)   fluid restriction.
D)   low sodium diet.

Question 14

A patient has been on daily,high-dose glucocorticoid therapy for the treatment of rheumatoid arthritis.His prescription runs out before his next appointment with his physician.Because he is asymptomatic,he thinks it is all right to withhold the medication for 3 days.What is likely to happen to this patient?

Accepted Answer

A)   He will go into adrenal crisis.
B)   He will go into thyroid storm.
C)   His autoimmune disease will go into remission.
D)   Nothing; it is appropriate to stop the medication for 3 days.

Question 15

A college student was admitted to the emergency department after being found unconscious by a roommate.The roommate informs emergency medical personnel that the student has diabetes and has been experiencing flulike symptoms,including vomiting,since yesterday.The patient had been up all night studying for exams.The patient used the last diabetes testing supplies 3 days ago and has not had time to go to the pharmacy to refill prescription supplies.Based upon the history,which laboratory findings would be anticipated in this client? (Select all that apply.)

Accepted Answer

A)   Blood glucose: 43 mg/dL
B)   Blood glucose: 524 mg/dL
C)   HCO3-: 10 mEq/L
D)   PaCO2: 37 mm Hg
E)   pH: 7.23

Question 16

Which of the following laboratory values would be found in a patient with syndrome of inappropriate secretion of antidiuretic hormone?

Accepted Answer

A)   Fasting blood glucose 156 mg/dL
B)   Serum potassium 5.8 mEq/L
C)   Serum sodium 115 mEq/L
D)   Serum sodium 152 mEq/L

Question 17

A patient with type 1 diabetes who is receiving a continuous subcutaneous insulin infusion via an insulin pump contacts the clinic to report mechanical failure of the infusion pump.The nurse instructs the patient to begin monitoring for signs of:

Accepted Answer

A)   adrenal insufficiency.
B)   diabetic ketoacidosis.
C)   hyperosmolar, hyperglycemic state.
D)   hypoglycemia.

Question 18

The nurse is caring for a patient with head trauma who was admitted to the surgical intensive care unit following a motorcycle crash.What is an important assessment that will assist the nurse in early identification of an endocrine disorder commonly associated with this condition?

Accepted Answer

A)   Daily weight
B)   Fingerstick glucose
C)   Lung sound auscultation
D)   Urine osmolality

Question 19

Acute adrenal crisis is caused by

Accepted Answer

A)   acute renal failure.
B)   deficiency of corticosteroids.
C)   high doses of corticosteroids.
D)   overdose of testosterone.

Question 20

Which of the following is a high-priority nursing diagnosis for both diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome?

Accepted Answer

A)   Activity intolerance
B)   Fluid volume deficient
C)   Hyperthermia
D)   Impaired nutrition, more than body requirements

Exam 19: Endocrine Alterations