Question 1

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 (Lantus)and insulin aspart (NovoLog).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. B

Question 2

A patient presents to the emergency department ( ED )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 D

Question 3

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 A,C

Question 4

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 5

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 6

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 7

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 8

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

Accepted Answer

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

Question 9

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 10

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 11

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

Accepted Answer

A)   Heredity
B)   Medications, including phenytoin (Dilantin)  and lithium carbonate
C)   Meningitis
D)   Pituitary tumors
E)   Sickle cell disease

Question 12

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 13

The nurse is providing insulin education for an elderly patient with longstanding diabetes.An order has been written for the patient to take 20 units of insulin glargine (Lantus)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 14

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 15

An individual with type 2 diabetes who takes glipizide (Glucotrol)to control her blood glucose has begun a formal exercise program at a local gym.While exercising on the treadmill,she becomes pale,diaphoretic,and shaky.She has a headache and 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 16

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 17

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 50 to 75 mg/dL compared with admitting values.
D)   less than 200 mg/dL.

Question 18

The nurse is providing postoperative care to a patient who underwent a transsphenoidal hypophysectomy for a benign pituitary tumor.The nurse administers replacement hydrocortisone,thyroid hormone,and vasopressin.The nurse evaluates that the vasopressin replacement is effective when:

Accepted Answer

A)   the patient's blood glucose is 110 mg/dL.
B)   the patient maintains a core body temperature of 98.2° F ( 36.8° C ) .
C)   the patient's urine specific gravity decreases.
D)   2 liters of urine are produced in a 24-hour period.

Question 19

A 20-year-old female with a history of type 1diabetes and an eating disorder is found unconscious.In the emergency department,the following lab values are obtained: Glucose648 mg/dL
PH6)88
PaCO220 mm Hg
PaO295 mm Hg
HCO3-undetectable
Anion gap>31
Na+127 mEq/L
K+3.5 mEq/L
Creatinine1.8 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 20

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

Exam 18: Endocrine Alterations

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 (Lantus) and insulin aspart (NovoLog) .How should the nurse manage this transition in insulin delivery?