Question 1

Which of the following patients is at the highest risk for hyperosmolar hyperglycemic syndrome?

Accepted Answer

A)  An 18-year-old college student with type 1 diabetes who exercises excessively 
B)  A 45-year-old woman with type 1 diabetes who forgets to take her insulin in the morning 
C)  A 75-year-old man with type 2 diabetes and coronary artery disease who has recently started on insulin injections 
D)  An 83-year-old, long-term care resident with type 2 diabetes and advanced Alzheimer's disease who recently developed influenza

Question 2

In the management of diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome,when is an intravenous (IV)solution that contains dextrose started?

Accepted Answer

A)  Never; normal saline is the only appropriate solution in diabetes management 
B)  When the blood sugar reaches 70 mg/dL 
C)  When the blood sugar reaches 150 mg/dL 
D)  When the blood glucose reaches 250 mg/dL

Question 3

The nurse is caring for a patient who underwent pituitary surgery 12 hours ago.The nurse will give priority to monitoring the patient carefully for which of the following?

Accepted Answer

A)  Congestive heart failure 
B)  Hypovolemic shock 
C)  Infection 
D)  Volume overload

Question 4

A patient presents to the emergency department with suspected thyroid storm.The nurse should be alert to which of the following cardiac rhythms while providing care to this patient?

Accepted Answer

A)  Atrial fibrillation 
B)  Idioventricular rhythm 
C)  Junctional rhythm 
D)  Sinus bradycardia

Question 5

An individual with type 2 diabetes who takes glipizide has begun a formal exercise program at a local gym.While exercising on the treadmill,the individual becomes pale,diaphoretic,shaky,and has a headache.The individual feels as though she is going to pass out.What is the individual's priority action?

Accepted Answer

A)  Drink additional water to prevent dehydration. 
B)  Eat something with 15 g of simple carbohydrates. 
C)  Go to the first-aid station to have glucose checked. 
D)  Take another dose of the oral agent.

Question 6

The nurse is caring for a patient with a diagnosis of head trauma.The nurse notes that the patient's urine output has increased tremendously over the past 18 hours.The nurse suspects that the patient may be developing

Accepted Answer

A)  diabetes insipidus. 
B)  diabetic ketoacidosis. 
C)  hyperosmolar hyperglycemic syndrome. 
D)  syndrome of inappropriate secretion of antidiuretic hormone.

Question 7

The nurse is assigned to care for a patient who presented to the emergency department with diabetic ketoacidosis.A continuous insulin intravenous infusion is started,and hourly bedside glucose monitoring is ordered.The targeted blood glucose value after the first hour of therapy is

Accepted Answer

A)  70 to 120 mg/dL. 
B)  a decrease of 25 to 50 mg/dL compared with admitting values. 
C)  a decrease of 35 to 90 mg/dL compared with admitting values. 
D)  less than 200 mg/dL.

Question 8

The nurse is caring for a patient who suffered a head trauma following a fall.The patient's heart rate is 112 beats/min and blood pressure is 88/50 mm Hg.The patient has poor skin turgor and dry mucous membranes.The patient is confused and restless.The following laboratory values are reported: serum sodium is 115 mEq/L; blood urea nitrogen (BUN)50 mg/dL; and creatinine 1.8 mg/dL.The findings are consistent with which disorder?

Accepted Answer

A)  Cerebral salt wasting 
B)  Diabetes insipidus 
C)  Syndrome of inappropriate secretion of antidiuretic hormone 
D)  Thyroid storm

Question 9

In hyperosmolar hyperglycemic syndrome,the laboratory results are similar to those of diabetic ketoacidosis,with three major exceptions.What differences would you expect to see in patients with hyperosmolar hyperglycemic syndrome?

Accepted Answer

A)  Lower serum glucose, lower osmolality, and greater ketosis 
B)  Lower serum glucose, lower osmolality, and milder ketosis 
C)  Higher serum glucose, higher osmolality, and greater ketosis 
D)  Higher serum glucose, higher osmolality, and no ketosis

Question 10

A patient presents to the emergency department with the following clinical signs:
Pulse: 132 beats/min
Blood pressure: 88/50 mm Hg
Respiratory rate: 32 breaths/min
Temperature: 104.8°F
Chest x-ray: Findings consistent with congestive heart failure
Cardiac rhythm: Atrial fibrillation with rapid ventricular response
These signs are consistent with which disorder?

Accepted Answer

A)  Adrenal crisis 
B)  Myxedema coma 
C)  Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) 
D)  Thyroid storm

Question 11

A patient with newly diagnosed type 1 diabetes is being transitioned from an infusion of intravenous (IV)regular insulin to an intensive insulin therapy regimen of insulin glargine and insulin aspart.How should the nurse manage this transition in insulin delivery?

Accepted Answer

A)  Administer the insulin glargine and continue the IV insulin infusion for 24 hours. 
B)  Administer the insulin glargine and discontinue the IV infusion in several hours. 
C)  Discontinue the IV infusion and administer the insulin aspart with the next meal. 
D)  Discontinue the IV infusion and administer the Lantus insulin at bedtime.

Question 12

A patient is admitted to the critical care unit with a diagnosis of diabetic ketoacidosis.Following aggressive fluid resuscitation and intravenous (IV)insulin administration,the blood glucose begins to normalize.In addition to glucose monitoring,which of the following electrolytes requires close monitoring?

Accepted Answer

A)  Calcium 
B)  Chloride 
C)  Potassium 
D)  Sodium

Question 13

What psychosocial factors may potentially contribute to the development of diabetic ketoacidosis? (Select all that apply.)

Accepted Answer

A)  Altered sleep/rest patterns 
B)  Eating disorder 
C)  Exposure to influenza 
D)  High levels of stress 
E)  Lack of financial resources

Question 14

The most significant clinical finding of acute adrenal crisis associated with fluid and electrolyte imbalance is

Accepted Answer

A)  fluid volume excess. 
B)  hyperglycemia. 
C)  hyperkalemia 
D)  hypernatremia

Question 15

Mechanisms for development of diabetes insipidus include which of the following? (Select all that apply.)

Accepted Answer

A)  ADH deficiency 
B)  ADH excess 
C)  ADH insensitivity 
D)  ADH replacement therapy 
E)  Water deprivation

Exam 19: Endocrine Alterations