Chapter19 Endocrine

Question 1

The lab results for an older patient indicate a glycosylated hemoglobin (HbA1c) result of 6.5%. What is the nurse’s best response to the patient?

1. “Your blood sugar levels have been within normal limits for the past three months.”
2. “Your HbA1c level indicates a pattern of low blood glucose levels.”
3. “Your HbA1c indicates that you are anemic and will require a blood transfusion.”
4. “Your average blood glucose level averaged 126 mg/dl over the past 3 months, which is high.”

Answer 1

Answer: 4
Explanation: 1. An HbA1c of 6.5% is high and is not within normal limits.
2. Glycosylated hemoglobin of 6.5% indicates a pattern of high blood glucose, not low.
3. Glycosylated hemoglobin is not used to diagnose anemia.
4. Glycosylated hemoglobin estimates a patient’s blood glucose over the past 3 months by measuring how much glucose is attached to the hemoglobin in red blood cells, which have an average life span of about 4 months. An HbA1c of 6.5 relates to an average glucose level of 126 mg/dl. A normal glycosylated hemoglobin result is 5.0%.

Question 2

The nurse is planning interventions to achieve the goal of maintaining glycemic control for an older patient with type 2 diabetes mellitus. Which interventions will the nurse include in this patient’s plan of care? Select all that apply.

1. Teach to prevent hypoglycemia.
2. Emphasize the role of physical exercise.
3. Review the manifestations of complications.
4. Stress the importance of avoiding carbohydrates.
5. Instruct in self-monitoring of blood glucose levels.

Answer 2

Answer: 1, 2, 3, 5
Explanation: 1. The goals of managing diabetes mellitus in the older patient include achieving glycemic control through recognition, treatment, and prevention of hypoglycemia.
2. The goals of managing diabetes mellitus in the older patient include achieving glycemic control through regular physical activity.
3. The goals of managing diabetes mellitus in the older patient include achieving glycemic control through prevention, early detection, and treatment of chronic complications.
4. The goals of managing diabetes mellitus in the older patient do not include the achievement of glycemic control through restricting the intake of carbohydrates.
5. The goals of managing diabetes mellitus in the older patient include achieving glycemic control through self-management techniques such as self-monitoring of blood glucose levels.

Question 3

Why should the nurse counsel an older patient with a history of occasional high blood glucose levels to stop smoking?

1. To prevent need for HgA1C monitoring
2. To prevent rapid weight gain
3. To reduce the risk of developing type 2 diabetes mellitus
4. To reduce the risk of insulin dependence

Answer 3

Answer: 3
Explanation: 1. HgA1C would be required for a patient who has been diagnosed with diabetes. Smoking increases the risk of non-insulin dependent diabetes. Smoking cessation is one of five lifestyle factors that will reduce the risk of developing type 2 diabetes mellitus.
2. Smoking cessation techniques include healthy coping mechanisms such as exercise. Many smoke to lose weight and may have a slow weight gain with cessation.
3. Smoking cessation is one of five lifestyle factors that will reduce the risk of developing type 2 diabetes mellitus.
4. Smoking increases the risk of type 2 diabetes, which is non-insulin dependent. Smoking cessation is one of five lifestyle factors that will reduce the risk of developing type 2 diabetes mellitus.

Question 4

The nurse is caring for an older patient with type 2 diabetes mellitus. What is the teaching priority for this patient?

1. Provide written instructions in large print
2. Create a plan for hypoglycemic episodes
3. Provide instructions for good skin care
4. Educate regarding diabetic foot care

Answer 4

Answer: 2
Explanation: 1. Decreased vision acuity should be addressed with written materials in large print, but this is not the highest priority.
2. Glycemic control increases the risk of hypoglycemic episodes. Older people who live alone, those with cognitive or physical deficits, or those with serious underlying chronic illnesses are more likely to suffer serious consequences from hypoglycemic episodes. This is the priority.
3. Frequent skin infections could occur with blood glucose levels that are excessively elevated, but this is not a priority.
4. Foot ulcers could occur with blood glucose levels that are excessively elevated and instruction should be provided. However, this is not a priority.

Question 5

While conducting a health interview the nurse suspects an older patient might be experiencing diabetes. What comment did the patient make that could indicate this diagnosis?

1. “I sometimes have muscle aches in my upper legs at night.”
2. “I feel a bit tired by midafternoon and take a 30-minute nap most days.”
3. “I’ve been experiencing blurred vision frequently during the past month.”
4. “I’m slightly winded when I walk up a flight of stairs but it passes quickly.”

Answer 5

Answer: 3
Explanation: 1. Having some muscle aches at night may be within the normal functioning of a healthy older patient.
2. Fatigue that responds to a short nap may be within the normal functioning of a healthy older patient.
3. Blurred vision can be associated with high glucose levels and may be a symptom of undiagnosed diabetes mellitus.
4. Being slightly short of breath after walking up a flight of stairs with a quick recovery may be within the normal functioning of a healthy older patient.
Page Ref: 521

Question 6

Which dietary guideline would be important for the nurse to instruct a patient with diabetes mellitus?

1. Include foods rich in calcium at every meal.
2. Eliminate as much fat from the diet as possible.
3. Eat at regular times including meals and snacks.
4. Ingest the majority of daily caloric intake in the morning meal.

Answer 6

Answer: 3
Explanation: 1. Eating foods rich in calcium are generally healthy but are not related to blood glucose control.
2. Fats should not be eliminated but limited to less than 30% of the total caloric intake.
3. The patient with diabetes should be encouraged to eat meals and snacks at regular times throughout the day. This consistent food intake is a strategy to maintain the blood glucose levels near normal most of the time.
4. The caloric intake should be spread throughout the day. Patients who are planning to be physically active for a set period of time may want to increase their caloric intake prior to the activity to maintain proper glucose levels.
Page Ref: 527

Question 7

An older male patient with type 2 diabetes mellitus wants to know if he can have an alcoholic drink. What information should the nurse provide about alcohol intake with diabetes? Select all that apply.

1. Ingest alcohol with food.
2. Alcohol can interact with diabetes medications.
3. Consider calories from alcohol as being fat calories.
4. Limit consumption to no more than two drinks per day.
5. Double oral hypoglycemic medications when consuming alcohol.

Answer 7

Answer: 1, 2, 3, 4
Explanation: 1. Alcohol must be consumed with food to prevent hypoglycemia.
2. Alcohol can interact with diabetic medications.
3. Alcohol must be calculated as part of the total caloric intake and is best substituted for fat calories.
4. It is recommended that older adults with diabetes mellitus consume no more than two drinks per day for men.
5. Oral hypoglycemic agents should not be altered unless ordered by a physician.
Page Ref: 510

Question 8

The healthcare provider suggests that an older patient with type 2 diabetes mellitus begin a walking program. What should the nurse include when teaching the patient about this program? Select all that apply.

1. Dress in layers.
2. Wear shoes with thick flexible soles.
3. Walk at least three to five times a week.
4. Wear music headset to block noise distractions.
5. Perform warm-up exercises before walking.

Answer 8

Answer: 1, 2, 3, 5
Explanation: 1. The nurse should instruct the patient to wear clothes that are dry and comfortable and dress in layers to prevent overheating.
2. The nurse should instruct the patient to wear shoes with thick, flexible soles to cushion each step and absorb shock.
3. The nurse should instruct the patient to walk at least three to five times per week.
4. The nurse should instruct the patient to choose a safe place to walk and find a partner or exercise group at the same fitness level with whom to exercise. Blocking out noise would be harmful if walking outdoors for emergency alerts such as car horns or ambulance sirens would not be heard.
5. The nurse should instruct the patient to engage in warm-up exercises before walking.
Page Ref: 511-512

Question 9

) Metformin has been prescribed for an older patient with renal insufficiency and a new diagnosis of type 2 diabetes mellitus. What is the nurse’s priority action?

1. Begin instruction on a new medication regime.
2. Hold the Metformin and contact the healthcare provider.
3. Obtain a fasting blood sugar prior to administration.
4. Instruct the patient on subcutaneous injections.

Answer 9

Answer: 2
Explanation: 1. Metformin should not be used by older adults with renal insufficiency. Instruction should not begin.
2. Metformin should not be used by older adults with renal insufficiency. The medication should be held and the provider contacted.
3. Metformin should not be used by older adults with renal insufficiency, and a fasting blood glucose is not a priority.
4. Metformin is administered orally, not by injection, but it should not be used by older adults with renal insufficiency.
Page Ref: 514

Question 10

An older patient diagnosed with type 2 diabetes mellitus has been prescribed a combination of long and short-acting insulin. What should be included in the nurse’s medication instruction?

1. Mixtures of insulin preparations with different onsets and durations of action are often given in a single injection to simplify the dosing.
2. When medications are mixed together it is cost-effective, using only one syringe per administration time.
3. Insulin mixtures allow the medication to be distributed more deeply into the subcutaneous layer of tissue and allow for better absorption.
4. Insulin combinations reduce the incidence of complications to the patient and to the injection site.

Answer 10

Answer: 1
Explanation: 1. Mixtures of insulin preparations such as NPH and regular insulin may be combined in one syringe.
2. Mixtures of insulin preparations with different onsets and durations of action are often given in a single injection to simplify the dosing. The major advantage is only a single injection is required.
3. Insulin is injected into subcutaneous tissue regardless of whether it is a combination of insulins or a single type of insulin.
4. Mixtures of insulin preparations do not reduce the incidence of complications.
Page Ref: 515

Question 11

) The home health nurse assesses signs of hypoglycemia in an older patient. Which factors could cause this phenomenon? Select all that apply.

1. An illness
2. Poor sleep routine
3. Missing a meal
4. Unplanned exercise
5. Too much medication

Answer 11

Hypoglycemia can be caused by the onset of an illness that alters the patient’s metabolic needs.
2. Lack of sleep does not induce hypoglycemia.
3. Hypoglycemia can be caused by missing a meal and lack of nutritional intake.
4. Hypoglycemia can be caused by unplanned exercise that is uncompensated with nutritional intake increase.
5. Hypoglycemia can be caused by taking too much oral hypoglycemic medication.
Page Ref: 515

Question 12

The nurse is performing an admission assessment on an older patient with type 2 diabetes mellitus. Which assessment data is a risk factor for hypothyroidism? Select all that apply.

1. Taking oral furosemide (Lasix) for hypertension
2. Medical history of non-thyroid autoimmunity
3. Previous external radiation for neck cancer
4. Taking acetaminophen (Tylenol) routinely for arthritis pain
5. Compliance with 1800 calorie American Diabetes Association (ADA) diet

Answer 12

Answer: 1, 2, 3
Explanation: 1. Risk factors for the development of hypothyroidism include certain medications such as furosemide (Lasix).
2. Risk factors for the development of hypothyroidism include the diagnosis of non-thyroid autoimmune disease.
3. Risk factors for the development of hypothyroidism include treatment of neck cancer with external radiation.
4. Over-the-counter acetaminophen (Tylenol) does not increase the patient’s risk for developing hypothyroidism.
5. The diagnosis of type 2 diabetes mellitus that is diet controlled does not increase the patient’s risk for developing hypothyroidism.
Page Ref: 523

Question 13

An older patient has been diagnosed with hyperthyroidism. Which treatment will the nurse anticipate?

1. Partial thyroidectomy
2. Ingestion of radioactive sodium iodine
3. Combination treatment with Synthroid and amiodarone
4. Large doses of propylthiouracil (PTU) and intravenous propranolol

Answer 13

Answer: 2
Explanation: 1. Surgical removal is reserved for patients with symptoms too severe for treatment with radioactive iodine or nodules suspicious for malignancy.
2. The treatment of choice is ingestion of the radioactive iodine, which is picked up by the thyroid tissue and then destroys the tissue. This treatment avoids surgery, anesthesia, and hospitalization.
3. Treatment with Synthroid would worsen symptoms, and amiodarone is an antiarrhythmic drug that has induced hyperthyroidism in some patients.
4. Large doses of propylthiouracil (PTU) and intravenous propranolol are used to treat thyroid storm and not hyperthyroidism.
Page Ref: 526

Question 14

The healthcare provider has ordered a monofilament test on a patient with diabetes mellitus. What should be included in the nurse’s instruction?

1. “A monofilament test is used to detect retinopathy in patients with diabetes.”
2. “A monofilament test will assess feeling and sensations in different parts of your feet.”
3. “A monofilament test will detect elevated blood glucose levels and ketones in the blood.”
4. “A monofilament test will indicate weak or absent peripheral pulses in your feet.”

Answer 14

Answer: 2
Explanation: 1. Retinopathy would be determined during an ophthalmic examination.
2. The monofilament test is used to assess a patient for the presence of protective sensation in the foot, which would alert the patient to the development of a blister or foot ulcer. Patients who can feel the filament at the designated sites are at reduced risk for developing foot ulcers.
3. Diabetic ketoacidosis is diagnosed by clinical picture, elevated blood glucose levels, and presence of ketones in the blood with acidosis.
4. Arterial insufficiency in the lower extremities is diagnosed by patient symptoms and weak or absent peripheral pulses on physical assessment.
Page Ref: 504

Question 15

An older patient with type 2 diabetes mellitus has a capillary blood glucose level of 44 mg/dL. What is the nurse’s priority action? What should the patient ingest to provide an immediate source of carbohydrate?

1. Provide four ounces of orange juice to the patient.
2. Glucose level is normal so no action is required.
3. Ask the patient when they last ate a meal.
4. Offer three to five pieces of sugar-free candy

Answer 15

Answer: 1
Explanation: 1. The best choice to treat the hypoglycemia is a concentrated carbohydrate source that can be taken quickly to raise the glucose to a safe level. Orange juice is the best option because it can be taken and absorbed quickly and is a good source of concentrated carbohydrate.
2. The blood glucose level is low and a concentrated carbohydrate source is needed.
3. Action needs to be taken immediately to increase the low blood sugar level.
4. There is no glucose available in sugar-free candy.
Page Ref: 517

Question 16

The nurse is preparing a teaching plan for a patient with type 2 diabetes mellitus regarding proper foot care. Which instructions should the nurse include in this plan? Select all that apply.

1. See a podiatrist for nail care.
2. Lubricate dry areas with lotion.
3. Dry moist areas between the toes.
4. Use an emery board to smooth toenails.
5. Soak feet in warm water to soften nails before clipping.

Answer 16

Answer: 1, 2, 3, 4
Explanation: 1. Foot care for the patient with type 2 diabetes mellitus is to include instructing to see a podiatrist for nail care. The patient should not cut toenails independently.
2. Foot care for the patient with type 2 diabetes mellitus is to include instructing to lubricate dry areas with lotion.
3. Foot care for the patient with type 2 diabetes mellitus is to include instructing to dry moist areas between the toes.
4. Foot care for the patient with type 2 diabetes mellitus is to include instructing to use an emery board to smooth toenails.
5. Soaking the feet should be avoided and the feet should be dried thoroughly. Diabetic toenails are not clipped, but filed.
Page Ref: 506

Question 17

The nurse is preparing discharge teaching for an older patient receiving insulin injections for diabetes. What should the nurse teach the patient about the insulin?

1. Always keep insulin refrigerated.
2. Systematically rotate insulin injection sites.
3. Increase the amount of insulin before exercise.
4. Ketones in the urine signify a need for less insulin.

Answer 17

Answer: 2
Explanation: 1. Insulin should be at room temperature when preparing an injection.
2. Insulin injection sites should be rotated to reduce the risk of lipodystrophy.
3. Insulin should not be adjusted prior to exercise.
4. Ketones in the urine may indicate a need for more insulin.
Page Ref: 533

Question 18

The nurse is performing a blood glucose test on an older patient with type 2 diabetes mellitus. Which are manifestations of hyperglycemia? Select all that apply.

1. Fatigue
2. Dizziness
3. Blurred vision
4. Abdominal pain
5. Excessive urination

Answer 18

Answer: 1, 3, 4, 5
Explanation: 1. Manifestations of hyperglycemia in a patient with type 2 diabetes mellitus include fatigue.
2. Dizziness is a manifestation of hypoglycemia in a patient with type 2 diabetes mellitus.
3. Manifestations of hyperglycemia in a patient with type 2 diabetes mellitus include blurred vision.
4. Manifestations of hyperglycemia in a patient with type 2 diabetes mellitus include abdominal pain.
5. Manifestations of hyperglycemia in a patient with type 2 diabetes mellitus include excessive urination or polyuria.
Page Ref: 503

Question 19

During a home visit the nurse learns that an older patient with type 2 diabetes mellitus and chronic renal failure is experiencing headache, polydipsia, and lethargy. What is the most important assessment that the nurse should make at this time?
1. Measure the patient’s latest urine output.
2. Assess the patient’s appetite and oral intake.
3. Measure the patient’s current capillary blood glucose level.
4. Determine the amount of fluid the patient has ingested over the last few hours.
Answer: 3
Explanation: 1. The patient has chronic renal failure and may have minimal, if any, urine output.
2. The patient’s appetite and oral intake will not help the nurse determine the cause of the patient’s current symptoms.
3. Measuring the patient’s capillary blood glucose level will help the nurse determine if the patient is developing hyperglycemic hyperosmolar nonketotic syndrome, a complication of type 2 diabetes mellitus.
4. Determining the amount of oral fluid intake the patient has had over the last few hours will not help the nurse determine the cause for the patient’s current symptoms.
Page Ref: 537

Answer 19

Answer: 3
Explanation: 1. The patient has chronic renal failure and may have minimal, if any, urine output.
2. The patient’s appetite and oral intake will not help the nurse determine the cause of the patient’s current symptoms.
3. Measuring the patient’s capillary blood glucose level will help the nurse determine if the patient is developing hyperglycemic hyperosmolar nonketotic syndrome, a complication of type 2 diabetes mellitus.
4. Determining the amount of oral fluid intake the patient has had over the last few hours will not help the nurse determine the cause for the patient’s current symptoms.
Page Ref: 537

Question 20

The nurse teaches an older patient with type 2 diabetes mellitus how to manage their diabetes when becoming acutely ill with a cold or other infection. Which statements indicate that instruction has been effective? Select all that apply.

1. “I should call the doctor if I have severe diarrhea.”
2. “My blood glucose levels will not change when I’m ill.”
3. “I should change my oral meds to insulin if I’m vomiting.”
4. “A large amount of ketones in my urine is to be expected.”
5. “I should not take my medication if I can’t eat and call the doctor.”

Answer 20

Answer: 1, 5
Explanation: 1. The patient with diabetes should notify the physician for any episodes of severe diarrhea. This statement indicates that teaching has been effective.
2. The patient with diabetes should monitor blood glucose levels closely since illness frequently alters them. This statement indicates that teaching has not been effective.
3. The patient with diabetes should notify the physician for any vomiting since medication dosages may need to be adjusted. Changing the route of administration is a physician order. This statement indicates that teaching has not been effective.
4. The patient with diabetes should notify the physician for large amounts of ketones in the urine. This statement indicates that teaching has not been effective.
5. The patient with diabetes should be instructed to not take medication if unable to eat since taking medication could cause hypoglycemia. This statement indicates that teaching has been effective.
Page Ref: 518

Question 21

The nurse is caring for an older patient with hypothyroidism. Which manifestations would the nurse anticipate? Select all that apply.

1. Dry skin
2. Weight loss
3. Vomiting
4. Bradycardia
5. Periorbital swelling

Answer 21

Answer: 1, 2, 4, 5
Explanation: 1. Dry skin will result if a patient has hypothyroidism.
2. Weight gain will occur in a patient with hypothyroidism.
3. Vomiting is not a symptom of hypothyroidism.
4. Bradycardia may manifest with hypothyroidism.
5. Periorbital swelling will occur in a patient diagnosed with hypothyroidism.
Page Ref: 524

Question 22

The nursing instructor asks a student to describe Graves disease. Which statement by the student indicates an accurate understanding of this disorder?

1. “The antibodies in Graves disease bind to receptors on the thyroid cells and weaken them.”
2. “It is an autoimmune disorder associated with sustained thyroid overactivity.”
3. “It is an autoimmune disorder associated with severe thyroid underactivity.”
4. “It is associated with a tumor on the thyroid, which leads to thyroid overactivity”

Answer 22

Answer: 2
Explanation: 1. The antibodies in Graves disease bind to receptors on the thyroid cells and strengthen those cells.
2. Hyperthyroidism in the older patient is often due to Graves disease or toxic goiter, an autoimmune disorder associated with the production of immunoglobulins that attach to and stimulate the TSH receptor, leading to sustained thyroid overactivity.
3. This does not correctly explain the pathophysiology of Graves disease.
4. A tumor on the thyroid leading to thyroid overactivity may be a cause for hyperthyroidism but not Graves disease in particular.
Page Ref: 525

Question 23

The nurse is caring for an older patient experiencing new-onset atrial fibrillation. Which lab result is most concerning?
1. Hgb 13.8 g/dL
2. Hgb 11.0 g/dL
3. TSH 18 mU/mL
4. TSH 0.25 mU/mL
Answer: 4
Explanation: 1. This is a normal hemoglobin level and would not help determine the cause of atrial fibrillation.
2. This is a normal hemoglobin level and would not help determine the cause of atrial fibrillation.
3. This is an elevated TSH level, which is a diagnostic indicator of hypothyroidism.
4. This is an abnormally low TSH level, which is a diagnostic indicator of hyperthyroidism that could be the cause for the patient’s new-onset atrial fibrillation.

Answer 23

Answer: 4
Explanation: 1. This is a normal hemoglobin level and would not help determine the cause of atrial fibrillation.
2. This is a normal hemoglobin level and would not help determine the cause of atrial fibrillation.
3. This is an elevated TSH level, which is a diagnostic indicator of hypothyroidism.
4. This is an abnormally low TSH level, which is a diagnostic indicator of hyperthyroidism that could be the cause for the patient’s new-onset atrial fibrillation.
Page Ref: 526

Question 24

A 75-year-old patient is newly diagnosed with type 2 diabetes mellitus and asks why it developed late in life. What is the nurse’s best response?

1. “This disease is inevitable since everyone over 70 years will develop diabetes.”
2. “The pancreas becomes hardened and unable to produce insulin with aging.”
3. “The body loses the ability to digest carbohydrates as a normal part of aging.”
4. “The body gradually reduces the production of insulin as a normal part of aging.”

Answer 24

Answer: 4
Explanation: 1. The development of diabetes is not inevitable with aging. Everyone does not develop the disease.
2. Diabetes is not caused by a hardening of the pancreas. The body tissues become less receptive to insulin in the cells.
3. The body does not lose the ability to digest carbohydrates with aging.
4. With aging, the body gradually reduces the production of insulin.
Page Ref: 500

Question 25

The nurse is teaching management of type 2 diabetes mellitus to a group of older adults. Which participant statement indicates that additional instruction is needed?

1. “I will keep some hard candy with me at all times.”
2. “I will start a walking program with my neighbors.”
3. “If I’m sick, I will call my doctor to see if I should take my medicine.”
4. “If I start to feel nervous, sweaty, or shaky, I will drink a glass of water.”

Answer 25

Answer: 4
Explanation: 1. The older patient with type 2 diabetes mellitus should be instructed to have a source of glucose readily available at all times in the event symptoms of hypoglycemia develop.
2. The older patient with type 2 diabetes mellitus would benefit from regular exercise, which could include a walking program. Patients are instructed to walk with a partner or group with the same or similar stamina level.
3. The older patient with type 2 diabetes mellitus should talk with the physician about medication doses if unable to eat since taking the medication could cause an onset of hypoglycemia.
4. The older patient with type 2 diabetes mellitus should be instructed to recognize the manifestations of hypoglycemia, which include nervousness and diaphoresis so that a carbohydrate source can be ingested. Water will not provide needed carbohydrates.
Page Ref: 517