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Comprehensive Diabetes & Thyroid problem
Practice Questions
1.A client asks the nurse why the provider bases his medication regimen on his HbA1C instead of his log of morning fasting blood glucose results. Which of the following is an appropriate response by the nurse? A. HB A1C measures how well insulin is regulating your blood glucose be- tween meals. B. HB A1 C indicates how well your blood glucose has been regulated over the past three months. C. A test of HB A1C is the first test to determine if an individual has diabetes. D. A test of HB A1C determines if the dosage of insulin needs to be adjusted.- : B. HB A1C measures the client's BC control over the past 2 to 4 months. 2.The nurse is reviewing the health record of a client who has syndrome of inappropriate antidiuretic hormone (SIADH). Which of the following laboratory findings should the nurse anticipate? Select all that apply. A. Low serum sodium B. High serum potassium C. Decreased urine osmolality D. High urine sodium E. Increased urine specific gravity: A, D, E SIADH results in water retention, causing a low serum sodium level. SIADH results in water retention, causing a high urine sodium level. SIADH results in water retention, causing an increase in urine specific gravity. 3.The nurse is assessing a client who has SIADH. Which of the following findings indicate the client is experiencing a complication? A. Decreased central venous pressure (CVP) B. Increased urine output C. Distended neck veins D. Extreme thirst: C. Distended neck veins are a manifestation of fluid overload, which can lead to pulmonary edema and heart failure. Decreased CVP is indicative of shock.
2 / Increased urine output is indicative of DI. Extreme thirst is indicative of DI. 4.A nurse in a providers office is reviewing the health record of a client who is being evaluated for Graves' disease. Which of the following is an expected laboratory finding for this client? A. Decreased thyrotropin receptor antibodies B. Decreased thyroid stimulating hormone C. Decreased free thyroxine index D. Decreased triiodothyronine: B. In the presence of Graves' disease, a low thyroid stimulating hormone (TSH) is an expected finding. The pituitary gland increases the production of TSH when thyroid hormone levels are elevated. 5.A nurse is reviewing the clinical manifestations of hyperthyroidism with the client. Which of the following findings should the nurse include? Select all that apply. A. Dry skin B. Heat intolerance C. Constipation D. Palpitations E. Weight loss F. Bradycardia: B, D, E Hyperthyroidism increases the client's metabolism. Therefore, heat intolerance, palpitations, and weight loss are expected findings. 6.A nurse is providing instructions to client who has Graves' disease and has a new prescription for propanolol (Inderal). Which of the following information should the nurse include? A. An adverse affects of this medication is jaundice. B. Take your pulse before each dose. C. The purpose of this medication is to decrease production of thyroid hor- mones. D.You should stop taking the medication if you have a sore throat.: B. Propanolol can cause bradycardia. The client should take his pulse before each dose. If there is a significant change, he should withhold the dose and consult his provider. 7.The nurse is preparing to receive a client from the PACU who is post operative following a thyroidectomy. The nurse should ensure that which of the following equipment is available? Select all that apply.
4 / A. Serum T4 10 mcg/dL B. Serum T3 200 ng/dL C. Hematocrit 34% D. Serum cholesterol 100 mg/dL: C. Hematocrit of 34% indicates anemia, which is an expected result for a client who has hypothyroidism. 11.A nurse is collecting an admission history from a female client who has hypothyroidism. Which of the following findings are expected with this condi- tion? Select all that apply. A. Diarrhea B. Menorrhagia C. Dry skin D. Increased libido E. Hoarseness: B, C, E Abnormal menstrual periods, including menorrhagia and amenorrhea, are clinical manifestations of hypothyroidism. Dry skin and hoarseness are clinical manifestations of hypothyroidism. 12.The nurse is reinforcing teaching with a client who has been prescribed levothyroxine (Synthroid) to treat hypothyroidism. Which of the following should the nurse include in the teaching? Select all that apply. A. Weight gain is expected while taking this medication. B. Medication should not be discontinued without the advice of the provider. C. Follow up serum TSH levels should be obtained. D. Take the medication on an empty stomach. E. Use fiber laxatives for constipation.: B, C, D The provider carefully titrate the dosage of this medication. It should be increased to slowly until the client reaches an euthyroid state. Therefore the client should not discontinue the medication unless directed by PCP. 13.A nurse in an intensive care unit is admitting a client who has myxedema coma. Which of the following should the nurse anticipate in caring for this client? Select all that apply. A. Observe cardiac monitor for inverted T-wave B. Observe evidence of urinary tract infection C. Initiate IV fluids using 0.9% sodium chloride D. Expect a prescription for levothyroxine IV bolus E. Provide warmth using a heating pad: A, B, C, D
5 / The client who has myxedema you may have a flat or inverted T- wave, as well as ST deviations; an infection such as a UTI, may precipitate myxedema coma; hyponatremia is a typical finding the presence of myxedema coma. Therefore,
7 / D. Age of 77 years E. No insulin production: A, B, C, D
8 / 17.A nurse is assessing a client who has DKA and ketones in the urine. Which of the following are expected findings? Select all that apply. A. Weight gain B. Fruity odor or breath C. Abdominal pain D. Kussmaul respirations E. Metabolic acidosis: B, C, D, E 18.The nurse is reviewing laboratory reports of a client who has HHS. Which of the following is an expected finding? A. Serum pH 7. B. Serum osmolarity 350 mOsm/L C. Serum potassium 3.8 mg/dL D. Serum creatinine 0.8 mg/dL: B 19.A nurse is preparing to administer IV fluids to client who has DKA. Which of the following is an appropriate nursing action? A. Administering IV infusion of regular insulin at 0.3 units per kilogram per hour B. Administer and IV infusion of 0.45% sodium chloride C. Rapidly administering IV infusion of 0.9% sodium chloride D. Add glucose to the IV infusion when serum glucose is 350 mg/dL: c 20.A nurse is providing discharge teaching to a client who experienced DKA. Which of the following should the nurse include in the teaching? Select all that apply. A. Drink 3 L of fluid daily B. Monitor blood glucose every 4 hrs when ill C. Administer insulin as prescribed when ill D. Notify provider when BG is 200 mg/dL E. Report ketones in the urine after 24 hours of illness: A, B, C, E 21.Which statement by the patient demonstrates an understanding of dis- charge instructions on the use of levothyroxine (Synthroid)? "I will take this medication in the morning so as not to interfere with sleep." "I will double my dose if I gain more than 1 pound per day." "I will stop the medication immediately if I lose more than 2 pounds in a week." "I can expect to see relief of my symptoms within 1 week.": "I will take this medication in the morning so as not to interfere with sleep."
10 / D. "Use a 23- to 25-gauge syringe with a 1-inch needle for maximum absorp-
11 / tion.": A. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." 27.The nurse would include which statement when teaching a patient about insulin glargine? A. "You should inject this insulin just before meals because it is very fast acting." B. "The duration of action for this insulin is approximately 8 to10 hours, so you will need to take it twice a day." C. "You can mix this insulin with NPH insulin to enhance its effects." D. "You cannot mix this insulin with regular insulin and thus will have to take two injections.": D. "You cannot mix this insulin with regular insulin and thus will have to take two injections." 28.The nurse will advise the patient to treat hypoglycemia with which drug? A. propranolol (Inderal) B. glucagon C. acarbose (Precose) D. bumetanide (Bumex): B. glucagon 29.When caring for a patient newly diagnosed with gestational diabetes, the nurse would question an order for which drug? A. insulin glargine (Lantus) B. glipizide (Glucotrol) C. insulin glulisine (Apidra) D. NPH insulin: B. glipizide (Glucotrol)
- Which information should be included in a teaching plan for patients taking oral hypoglycemic drugs? (Select all that apply.) A. Limit your alcohol consumption. B. Report symptoms of anorexia and fatigue. C. Take your medication only as needed. D. Notify your physician if blood glucose levels rise above the level set for you.: A. Limit your alcohol consumption. B. Report symptoms of anorexia and fatigue. D. Notify your physician if blood glucose levels rise above the level set for you. 31.Which actions describe the beneficial effects produced by sulfonylurea oral hypoglycemics? (Select all that apply.) A. Stimulate insulin secretion from beta cells B. Increase hepatic glucose production C. Enhance action of insulin in various tissues D. Inhibit breakdown of insulin by liver: A. Stimulate insulin secretion
13 / B. Enhance action of insulin in various tissues D. Inhibit breakdown of insulin by liver 32.The nurse is providing information to a teenager newly diagnosed with diabetes and his parents. The nurse teaches them that the signs of diabetic ketoacidosis (DKA) include: Standard Text: Select all that apply.
- Change in mental status.
- Tachycardia.
- Fruity breath odor.
- Rapid, shallow respirations.
- Abdominal pain.: Correct Answer: 1,3, Rationale 1: A change in mental state can be associated with DKA. Rationale 2: Tachycardia is not a typical symptom of DKA. Rationale 3: A fruity breath odor is common when the client is in a state of ketoaci- dosis. Rationale 4: Respirations are rapid, but deep (Kussmaul's breathing) in DKA. Rationale 5: Abdominal pain is commonly seen with DKA. 33.A child weighing 18.2 kg with a history of diabetes insipidus has been admitted to the hospital. Which of the physician's orders would the nurse question?
- Stat electrolytes
- Urine specific gravity with each void
- DDAVP (desmopressin) PO
- Restrict oral fluids to 500 mL every 24 hours.: Correct Answer: 4 Rationale 1: Stat electrolytes would be an appropriate order to check for hyperna- tremia. Rationale 2: Urine specific gravity is checked because it is often low. Rationale 3: DDAVP is the drug of choice for a child with DI. Rationale 4: Fluid replacement, not fluid restriction, is necessary for child with DI. 34.An adolescent female with untreated Graves' disease is admitted to the hospital. The nurse expects to find which signs and symptoms in this client?
- Hyperglycemia, ketonuria, and glucosuria
- Weight gain, hirsutism, and muscle weakness
- Tachycardia, fatigue, and heat intolerance
- Dehydration, metabolic acidosis, and hypertension: Correct Answer: 3 Rationale 1: Hyperglycemia, ketonuria, and glucosuria are signs of diabetes. Rationale 2: Weight gain, hirsutism, and muscle weakness
14 / are seen in clients with Cushing's disease. Rationale 3: Clinical manifestations of Graves' disease are tachycardia, fatigue, and
16 / hypoglycemia. Rationale 3: Dry mucous membranes, blurred vision, and weakness are seen with hyperglycemia.
17 / Rationale 4: Dry skin and dehydration are signs of hyperglycemia, but shallow breathing is a sign of hypoglycemia. 38.A 12-year-old has been selected to be a cheerleader for her middle school. This child has been recently diagnosed with type 1 diabetes. In teaching this child's mother about care for her child, the nurse wants the mother to understand that with increased physical activity, the child will need:
- Decreased food intake.
- Increased doses of insulin.
- Increased food intake.
- Decreased doses of insulin.: Correct Answer: 3 Rationale 1: Decreased food intake would increase the chance of hypoglycemia. Rationale 2: Increased dose of insulin would cause hypoglycemia. Exercise causes insulin to be used more efficiently by the body, so an increase in insulin would not be needed. Rationale 3: An increase in physical activity requires an increase in caloric intake to prevent hypoglycemia. Rationale 4: A decreased dose of insulin would not allow the sugar to enter the cells where it is needed during exercise.
- The nurse is teaching a teenage client newly diagnosed with type 1diabetes about complications of the disease. The nurse explains that clients with type 1 diabetes can avoid lipoatrophy by:
- Rotating injection sites.
- Checking blood sugars at mealtime and bedtime.
- Using a sliding scale for additional coverage.
- Administration of insulin via insulin pump.: Correct Answer: 1 Rationale 1: Lipoatrophy is caused by using the same insulin injection site. Rationale 2: Checking blood sugars does not influence lipoatrophy. Rationale 3: A sliding scale does not influence lipoatrophy. Rationale 4: Insulin administration via pump doesn't influence lipoatrophy. 40.The nurse is teaching the caregiver of a child who is newly diagnosed with type 1 diabetes mellitus how to minimize pain with insulin injections. Which interventions to minimize pain will the nurse include in the teaching? Standard Text: Select all that apply.
- Do not reuse needles.
- Remove all bubbles from the syringe before injecting.
- Have the child flex the muscle during injection.
- Inject insulin when it is cold.
19 / Rationale 1: Reusing needles leads to more pain on injection. Rationale 2: Removing bubbles from the syringe minimizes pain. Rationale 3: Flexing or tensing muscles during injection causes more discomfort. Rationale 4: Insulin should be injected when it is at room temperature to minimize pain. Rationale 5: Keeping the direction of the syringe constant will minimize pain. 41.The nurse is caring for a hospitalized three-year-old admitted with a history of syndrome of inappropriate antidiuretic hormone (SIADH). He has just re- ceived his breakfast tray. Which food should the nurse remove from his tray?
- Oatmeal
- Yogurt
- Biscuit
- Cantaloupe: Correct Answer: 4 Rationale 1: A child with SAIDH may have carbohydrates and fiber, such as in oatmeal. Rationale 2: A child with SIADH may have dairy products, such as yogurt. Rationale 3: A child with SIADH may have carbohydrates, such as in a biscuit. Rationale 4: A child with SIADH is on a fluid restriction. Cantaloupe contains significant fluid volume, so it would not be a good food for this child to consume. 42.Mandatory testing in the newborn nursery determines that the infant has hypothyroidism. When discussing the treatment with the new mother, the mother states that she doesn't believe in taking medications. The nurse would explain that failure to treat the infant with the appropriate medication will result in:
- Heart disease.
- Mental retardation.
- Renal failure.
- Thyroid storm.: Correct Answer: 2 Rationale 1: If the hypothyroidism is left untreated, the child will experience brady- cardia but will not develop heart disease. Rationale 2: Untreated hypothyroidism will lead to mental retardation. Rationale 3: Untreated hypothyroidism does not lead to renal failure. Rationale 4: Thyroid storm is a complication of hyperthyroidism, not hypothyroidism.
20 / 43.The school nurse has noticed an increase in the number of children in the school being diagnosed with type 2 diabetes. Which changes could the nurse implement at school to help reduce students' risk for developing type 2 diabetes? Standard Text: Select all that apply.
- Increase the amount of daily physical activity.
