Question 1

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 2

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 3

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 4

A 32-year-old 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 5

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

Accepted Answer

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

Question 6

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

Question 7

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 8

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 9

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

Accepted Answer

A)  Administer levothyroxine ( Synthroid ) as ordered. 
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 10

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 11

The nurse is caring for a 27-year-old 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 12

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 13

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.

Question 14

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 15

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

Exam 18: Endocrine Alterations