LA#3 (Endocrine) Chapters 50, 51, 52 in Med Surg

Question 1

When evaluating the laboratory findings of a patient with increased secretion of the anterior pituitary hormones, what would the nurse expect to find?

a. Increased urinary free cortisol
b. Decreased serum thyroxine (T4) levels
c. Low urinary excretion of catecholamines
d. Increased serum aldosterone levels

Answer 1

ANS: A
Increased secretion of adrenocorticotropic hormone by the anterior pituitary gland will lead to an increase in serum and urinary cortisol levels.

Question 2

When obtaining the health history, which of the following statements by a patient indicates that the nurse should assess further for a possible problem with the thyroid gland?

a. “I have noticed difficulty in swallowing.”
b. “I get up several times at night to urinate.”
c. “I have noticed my breasts are tender lately.”
d. “I drink about 6 L of water a day.”

Answer 2

ANS: A

Difficulty swallowing can occur with a goitre.

Question 3

What is the most common type of feedback system in the regulation of hormones?

a. Negative
b. Positive
c. Complex
d. Chemical

Answer 3

ANS: A
The most common type of feedback system is negative feedback, in which the gland responds by increasing or decreasing the secretion of a hormone on the basis of feedback from various factors (e.g., insulin).

Question 4

During a patient assessment, which of the following is a question the nurse can ask that addresses thyroid function?

a. “Do you have to get up at night to urinate?”
b. “Have you experienced any blurring or double vision?”
c. “Do you experience fatigue even if you have slept a long time?”
d. “Can you describe the amount of stress you have at home and work?”

Answer 4

ANS: C

Fatigue may be a sign of hypothyroidism.

Question 5

The physician has ordered a serum cortisol level to rule out adrenal dysfunction in a patient who is a night security guard who works from 2300 hours to 0700 hours and normally sleeps from 0800 hours to 1600 hours. To ensure the most reliable test results, when does the nurse arrange the blood specimen to be drawn?

a. At 0300 hours
b. At 2300 hours
c. In the early morning
d. In the late afternoon

Answer 5

ANS: D
Cortisol levels are usually drawn in the morning, when levels are highest. In a patient who sleeps during the day, the highest level would be soon after awakening in the late afternoon.

Question 6

A patient has a total serum calcium level of 3.3 mmol/L (13.3 mg/dL; 6.7 mEq/L). The nurse understands that this level of calcium normally does which of the following?

a. Indicates hypothyroidism
b. Stimulates the secretion of calcitonin
c. Occurs when the parathyroid gland is surgically removed
d. Can be caused by oversecretion of calcitonin from the thyroid gland

Answer 6

ANS: B

Calcitonin is secreted by the C cells of the thyroid gland in response to elevated blood calcium levels.

Question 7

Which action taken by a nursing student when caring for a patient with thyroiditis and a goitre requires that the supervising nurse intervene immediately?

a. The student nurse checks the blood pressure on both arms.
b. The student nurse lowers the thermostat to decrease the temperature in the room.
c. The student nurse palpates the neck to check thyroid size.
d. The student nurse orders nonmedicated eyedrops to lubricate the patient’s eyes.

Answer 7

ANS: C

Palpation can cause the release of thyroid hormones in a patient with an enlarged thyroid and should be avoided.

Question 8

During a physical examination, the nurse finds that a patient’s thyroid gland cannot be palpated. What does the nurse interpret this finding as?

a. A normal finding
b. Evidence of an atrophied thyroid gland
c. Insignificant in a patient with elevated triiodothyronine (T3) and T4 levels
d. Abnormal, and confirmation of the finding by another experienced health care provider is necessary

Answer 8

ANS: A

The thyroid is frequently nonpalpable. The nurse should simply document the finding.

Question 9

Which hormone is an example of positive feedback in the regulation of hormonal secretion?

a. Insulin
b. Oxytocin
c. Thyroid-stimulating hormone (TSH)
d. Thyroid-releasing hormone

Answer 9

ANS: B
An example of a positive-feedback hormone is oxytocin during the birth process. Insulin is an example of a negative-feedback hormone. Thyroid hormones are an example of complex feedback.

Question 10

When working with a patient who has diabetes mellitus, the nurse uses the results of testing for glycosylated hemoglobin to evaluate which of the following?

a. Glucose levels 2 hours after a meal
b. Glucose control over the past 3 months
c. Circulating, nonfasting glucose levels
d. Episodes of hypoglycemia in the past 2 months

Answer 10

ANS: B

Glycosylated hemoglobin testing measures glucose control over the last 3 months.

Question 11

Which of the following is an age-related change affecting the endocrine system?

a. Increase in TSH secretion
b. Decreased parathyroid secretion
c. Increased glucose intolerance
d. Decreased secretion of norepinephrine

Answer 11

ANS: C
A normal age-related change in assessment findings of the endocrine system is an increased glucose intolerance leading to a decreased sensitivity to insulin.

Question 12

A patient is scheduled for a growth hormone (GH) stimulation test. In preparation for the test, which of the following will the nurse obtain?

a. Vial of 50% dextrose solution
b. Vial of glargine insulin
c. Cardiac monitor
d. Basin of ice

Answer 12

ANS: A
Hypoglycemia is induced during the GH stimulation test, and the nurse should be ready to administer 50% dextrose immediately.

Question 13

To confirm the diagnosis of reactive hypoglycemia in a patient experiencing symptoms of the disorder, the nurse would expect the patient to be scheduled for which of the following tests?

a. Fasting blood glucose test
b. 2-hour glucose tolerance test
c. 5-hour glucose tolerance test
d. 24-hour urine test for glucose and ketones

Answer 13

ANS: C
Patients with reactive hypoglycemia have adrenergic symptoms and glucose levels less than 3.3 mmol/L with a 5-hour glucose tolerance test.

Question 14

Which of the following factors stimulates the secretion of insulin?

a. Decreased glucose levels
b. Increased somatostatin levels
c. Decreased amino acid levels
d. Increased vagal stimulation

Answer 14

ANS: D
Increased vagal stimulation is a factor that will stimulate the secretion of insulin. All of the others inhibit the secretion of insulin.

Question 15

When the nurse is describing the effects of insulin on the body to a patient newly diagnosed with diabetes mellitus, which of the following is the best explanation?

a. “Insulin promotes the breakdown of fatty tissue into triglycerides, which can be used for energy.”
b. “When proteins are taken into the body, insulin promotes their breakdown and conversion to fats.”
c. “Insulin stimulates the conversion of stored sugars into blood glucose and the conversion of proteins into glucose.”
d. “When carbohydrates, fats, and proteins are eaten, insulin promotes cellular transport and storage of all these nutrients.”

Answer 15

ANS: D
Insulin is an anabolic hormone that assists with the transport of nutrients into cells and their synthesis into glycogen, triglycerides, and proteins.

Question 16

Use of nursing interventions to decrease the patient’s physical and emotional stress is most important when the patient is undergoing which of the following tests?

a. A water deprivation test
b. Testing for serum T3 and T4 levels
c. A 24-hour urine test for free cortisol
d. A radioactive iodine uptake test

Answer 16

ANS: C
Physical and emotional stress can affect the results for the free cortisol test. The other tests are not impacted by stress.

Question 17

A patient is scheduled for a 24-hour urine collection for 17-ketosteroids. The nurse will plan to do which of the following?

a. Insert a retention catheter.
b. Keep the specimen on ice.
c. Have the patient void and save that specimen to start the collection.
d. Encourage the patient to drink 2 to 3 L of fluid during the 24 hours.

Answer 17

ANS: B

The specimen must be kept on ice or refrigerated until the collection is finished.

Question 18

When caring for a patient having a water deprivation test, which assessment obtained by the nurse will be of greatest concern?

a. The patient complains of intense thirst.
b. The patient has experienced a 2.5-kg weight loss.
c. The patient feels dizzy when sitting up on the edge of the bed.
d. The patient’s urine osmolality does not change after antidiuretic hormone is given.

Answer 18

ANS: B

A drop in the weight of more than 2 kg indicates severe dehydration, and the test should be discontinued.

Question 19

Which of the following is a common characteristic of most hormones?

a. Secretion at unpredictable rates
b. Circulation through the blood
c. Binding to receptors only on the cell membrane
d. Binding only to receptors within the cell

Answer 19

ANS: B
Most hormones have three common characteristics: secretion in small amounts at variable but predictable rates, circulation through the blood, and binding to specific receptors in the cell membrane or within the cell.

Question 20

A patient seeks care at the clinic because of increasing speech difficulties and hoarseness, telling the nurse his tongue has gotten so big that he can hardly talk. The physician suspects acromegaly. During the nursing history, which of the following should the nurse specifically ask the patient whether he has experienced?

a. A recent head injury
b. An increase in shoe size
c. A family history of endocrine problems
d. Symptoms of hypoglycemia, such as hunger and nervousness

Answer 20

ANS: B

Acromegaly causes an enlargement of the hands and feet.

Question 21

During preoperative teaching for a patient scheduled for transsphenoidal hypophysectomy for treatment of a pituitary adenoma, what should the nurse instruct the patient that she will have to do?

a. Take replacement growth hormone for the rest of her life
b. Not brush her teeth for at least 10 days after the surgery
c. Be expected to cough and breathe deeply every 2 hours postoperatively
d. Be positioned flat in bed with sandbags at her head to prevent head movement

Answer 21

ANS: B

To avoid disruption of the suture line, the patient should avoid brushing the teeth for 10 days after surgery.

Question 22

Following a transsphenoidal resection of a pituitary tumour, the nurse suspects that the patient has developed diabetes insipidus on finding which of the following data?

a. A urine specific gravity of 1.001
b. A consistent rise in blood pressure
c. Fluid retention with dependent edema
d. A serum sodium of 130 mmol/L

Answer 22

ANS: A
After pituitary surgery, the patient is at risk for diabetes insipidus caused by cerebral edema, and monitoring of urinary output and urine specific gravity is essential.

Question 23

A patient is suspected of having a pituitary tumour causing panhypopituitarism. During assessment of the patient, the nurse would expect to find which of the following changes?

a. Elevated plasma glucose levels and dyslipidemia
b. Changes in secondary sex characteristics and loss of libido
c. Hypertension resulting from increased water reabsorption in the kidney
d. Evidence of hypofunction of the adrenal, thyroid, and parathyroid glands

Answer 23

ANS: B
Changes in secondary sex characteristics are associated with decreases in follicle-stimulating hormone and luteinizing hormone. Fasting hypoglycemia and hypotension occur in panhypopituitarism as a result of decreases in adrenocorticotropic hormone and cortisol.

Question 24

Which of the following effects on the cardiovascular system would a patient with a hypofunction of the parathyroid gland most likely exhibit?

a. Hypertension
b. Increased cardiac output
c. Decreased contractility of heart muscle
d. Dysrhythmias

Answer 24

ANS: C
A patient with a hypofunction of their parathyroid gland would most likely exhibit a decrease in the contractibility of their heart muscle.

Question 25

A patient with an antidiuretic hormone (ADH)–secreting small cell cancer of the lung is treated to control the symptoms of syndrome of inappropriate ADH (SIADH). The nurse determines that treatment is effective on finding which of the following data?

a. The patient’s weight is stable.
b. The urine specific gravity is increased.
c. The patient’s urinary output is increased.
d. The patient’s edema is reduced.

Answer 25

ANS: C

Treatment is aimed at blocking the action of ADH on the renal tubules, causing an increase in urinary output.

Question 26

When teaching a patient with chronic SIADH about long-term management of the disorder, the nurse determines that additional instruction is needed when the patient gives which of the following responses?

a. “I need to maintain a sodium-restricted diet at home.”
b. “I should weigh myself daily and report a sudden loss or gain.”
c. “I need to limit my fluid intake to no more than 950 mL of liquids a day.”
d. “I will eat foods high in potassium because the diuretics cause potassium loss.”

Answer 26

ANS: A
Patients with SIADH are at risk for hyponatremia, and a sodium supplement may be prescribed; therefore, more teaching would be required to the patient who indicated that he or she would have to maintain a sodium-restricted diet.

Question 27

A 73-year-old woman is hospitalized with possible SIADH. She is confused and reports a headache, muscle cramps, and twitching. Initially, which of the following laboratory results would the nurse expect to find?

a. Hematocrit of 0.52 (52%)
b. Blood urea nitrogen of 7.9 mmol/L (22 mg/dL)
c. Serum sodium of 124 mmol/L
d. Serum chloride of 111 mmol/L

Answer 27

ANS: C
When water is retained, the serum sodium level will drop below normal, causing the clinical manifestations reported by the patient.

Question 28

A patient with symptoms of diabetes insipidus is admitted to the hospital for evaluation and treatment of the condition. What is an appropriate nursing diagnosis that the nurse would document for the patient based on an understanding of this condition?

a. Disturbed sleep pattern related to nocturia
b. Risk for impaired skin integrity related to edema
c. Excess fluid volume related to intake greater than output
d. Activity intolerance related to muscle cramps and weakness

Answer 28

ANS: A

Nocturia occurs as a result of the polyuria caused by diabetes insipidus, which leads to a disturbed sleep pattern.

Question 29

Which information obtained when caring for a patient who has just been admitted for evaluation of diabetes insipidus will be of greatest concern to the nurse?

a. Has a urinary output of 800 mL/hour
b. Has a urine specific gravity of 1.003
c. Had a recent head injury
d. Is confused and lethargic

Answer 29

ANS: D
Patients with diabetes insipidus compensate for fluid losses by drinking copious amounts of fluids, but a patient who is lethargic will be unable to drink enough fluids and will become hypovolemic.

Question 30

When teaching a patient newly diagnosed with Graves’ disease about the disorder, the nurse explains which of the following?

a. Restriction of iodine intake is needed to reduce thyroid activity.
b. Exercise is contraindicated to avoid increasing the metabolic rate.
c. Surgery will eventually be required to remove the thyroid gland.
d. Antithyroid medications may take several weeks to have an effect.

Answer 30

ANS: D

Improvement usually begins in 1 to 2 weeks, with good results at 4 to 8 weeks.

Question 31

Which one of the following effects on the integumentary system would a patient with a hyperfunction of the parathyroid gland most likely exhibit?

a. Lack of tooth enamel
b. Hair loss on scalp and body
c. Brittle nails
d. Moist skin

Answer 31

ANS: D
A patient with a hyperfunction of the parathyroid gland would most likely exhibit the integumentary change of moist skin and skin necrosis. The other choices are symptoms of hypofunction of the parathyroid gland.

Question 32

During the nursing assessment of a patient with Graves’ disease, the nurse notes a bounding, rapid pulse and systolic hypertension. What is an additional manifestation of the disorder that the nurse would expect to find?

a. Chest pain
b. Constipation
c. Decreased appetite
d. Muscle aches

Answer 32

ANS: A
Angina is a possible complication of Graves’ disease, especially for a patient with tachycardia and hypertension; therefore, the nurse would expect to assess the patient for chest pain.

Question 33

While assessing a patient who has just arrived in the postanaesthesia recovery unit after a thyroidectomy, the nurse obtains the following data. Which information is most important to communicate to the surgeon?

a. Complaining of level 7 incisional pain on a 10-point scale
b. Cardiac monitor showing a heart rate of 112 beats/min
c. Increasing swelling of the neck
d. A weak, hoarse voice

Answer 33

ANS: C

The neck swelling may lead to respiratory difficulty, and rapid intervention is needed to prevent airway obstruction.

Question 34

A few hours after returning to the surgical nursing unit, a patient who has undergone a subtotal thyroidectomy develops laryngeal stridor and a cramp in the right hand. What intervention would the nurse anticipate?

a. An immediate tracheostomy
b. Administration of intravenous morphine
c. Administration of intravenous calcium gluconate
d. Endotracheal intubation with mechanical ventilation

Answer 34

ANS: C
The patient’s clinical manifestations are consistent with tetany caused by hypocalcemia resulting from damage to the parathyroid glands during surgery

Question 35

The nurse identifies a nursing diagnosis of risk for injury: corneal ulceration related to inability to close the eyelids secondary to exophthalmos for a patient with Graves’ disease. What is an appropriate nursing intervention to prevent this problem?

a. Teach the patient to blink every few seconds to lubricate the cornea.
b. Elevate the head of the patient’s bed to reduce periorbital fluid.
c. Apply eye patches to protect the cornea from irritation.
d. Place cold packs on the eyes to relieve pain and swelling.

Answer 35

ANS: B

The patient should sit upright as much as possible to promote fluid drainage from the periorbital area.

Question 36

Which of the following is the first nursing action indicated when a patient returns to the surgical nursing unit after a thyroidectomy?

a. Check the back of the neck for hemorrhage.
b. Assess respiratory rate and effort.
c. Determine whether the patient can speak normally.
d. Ask the patient whether he or she experiences any tingling in the toes or fingers.

Answer 36

ANS: B
Airway obstruction is a possible complication after thyroidectomy because of swelling or bleeding at the site or tetany, and the priority nursing action is to assess the airway.

Question 37

A patient with hyperthyroidism is treated with radioactive iodine at a clinic. Before the patient is discharged, what should the nurse instruct the patient about?

a. Symptoms of hyperthyroidism should be relieved in about a week
b. Radioactive precautions to take with urine, stool, and other body secretions
c. Monitoring for symptoms of hypothyroidism, such as easy bruising and cold intolerance
d. Discontinuing the antithyroid medications and propranolol (Inderal) taken before the radioactive therapy

Answer 37

ANS: C
There is a high incidence of postradiation hypothyroidism after radioactive iodine, and the patient should be monitored for symptoms of hypothyroidism.

Question 38

After 5 years of experiencing depression, fatigue, and lethargy, an older adult woman is diagnosed with hypothyroidism, and levothyroxine (Synthroid) is prescribed. During initiation of thyroid replacement for the patient, it is most important for the nurse to assess which of the following functions?

a. Mental status
b. Nutritional status
c. Cardiovascular function
d. Fluid and electrolyte balance

Answer 38

ANS: C
In older adult patients, initiation of levothyroxine therapy can increase myocardial oxygen demand and cause angina or dysrhythmias.

Question 39

While a 68-year-old woman is hospitalized for a fractured femur, she is diagnosed with hypothyroidism. Which of the following medications ordered for the patient at the time of admission does the nurse recognize should not be administered without consulting the physician?

a. A stool softener
b. A sedative
c. An analgesic
d. An antibiotic

Answer 39

ANS: B
Worsening of mental status and myxedema coma can be precipitated in patients with hypothyroidism by the use of sedatives, especially in older adults.

Question 40

When teaching a patient with newly diagnosed hypothyroidism about management of the condition, the nurse should do which of the following?

a. Schedule daily home visits by home care nurses to repeat the necessary instructions.
b. Delay teaching about the condition until the patient has responded to replacement therapy.
c. Provide written handouts of all instructions for continued reference as the patient improves.
d. Designate a family member to teach the patient about the condition when forgetfulness has improved.

Answer 40

ANS: C
Written instructions will be helpful to the patient because, initially, the hypothyroid patient may be unable to remember to take medications and other aspects of self-care.

Question 41

When admitting a patient who has just recently fallen and broken his hip, the nurse notes hypertension, muscle wasting, and a large buffalo hump. The nurse knows that these findings are consistent with the patient having which following diagnosis?

a. Addison’s disease
b. SIADH
c. Cushing’s syndrome
d. Pheochromocytoma

Answer 41

ANS: C
These assessment findings are consistent with a diagnosis of Cushing’s syndrome—particularly the classic buffalo hump, which is visible as fat deposits on the back of the neck and on the shoulders.

Question 42

Following a thyroidectomy, a patient develops generalized muscle cramps and mild tetany. The patients’ calcium levels are decreased. Which nursing action is appropriate?

a. Administer the ordered muscle relaxant.
b. Have the patient rebreathe using a paper bag.
c. Start oxygen at 2 to 3 L/min per cannula.
d. Give the ordered oral calcium supplement.

Answer 42

ANS: B
Rebreathing may partially alleviate acute neuromuscular symptoms associated with hypocalcemia, such as generalized muscle cramps, or mild tetany. Patients who can cooperate should be instructed to breathe in and out of a paper bag or breathing mask. This reduces carbon dioxide excretion from the lungs, increases carbonic acid levels in the blood, and lowers the pH.

Question 43

Following a thyroidectomy, the patient develops hypoparathyroidism. The nurse teaches the patient that maintenance therapy for the hypoparathyroidism will include which of the following?

a. Calcium supplements
b. A diet high in oxalic acid
c. Phosphorus supplements
d. Parenteral parathyroid hormone

Answer 43

ANS: A
Oral calcium supplements are used to maintain the serum calcium in the normal range and prevent the complications of hypocalcemia.

Question 44

A patient with hypoparathyroidism receives instructions from the nurse regarding symptoms of hypo- and hypercalcemia. The nurse teaches the patient that if mild symptoms of hypocalcemia occur, the patient should do which of the following?

a. Increase the daily fluid intake to twice the usual amount.
b. Self-administer intramuscular calcium before calling the doctor.
c. Call an ambulance because the symptoms will progress to seizures.
d. Breathe in and out of a paper bag to temporarily relieve the symptoms, and then seek medical assistance.

Answer 44

ANS: D
Rebreathing may help alleviate mild symptoms, but it will only temporarily increase ionized calcium level, so the patient should call the physician.

Question 45

A nursing assessment of a patient with Cushing’s syndrome reveals that the patient has truncal obesity and thin arms and legs. What is an additional manifestation of Cushing’s syndrome that the nurse would expect to find?

a. Hypotension
b. Decreased axillary and pubic hair
c. Purplish red striae on the abdomen
d. Bronzed hyperpigmentation of the skin

Answer 45

ANS: C

Purplish red striae on the abdomen are a common clinical manifestation of Cushing’s syndrome.

Question 46

A patient with Cushing’s syndrome is admitted to the hospital in preparation for surgery to remove an adrenal tumour. During the admission assessment, the patient tells the nurse that she looks so awful she does not want anyone to be around her. What is the best response to the patient?

a. “Let me show you how to dress so that the changes are not so noticeable.”
b. “I do not think you look bad. Your appearance is just altered by your disease.”
c. “You really should not worry about how you look in the hospital. We see many worse things.”
d. “Most of the physical and mental changes caused by the disease will gradually improve after surgery.”

Answer 46

ANS: D
The most reassuring communication to the patient is that the physical and emotional changes caused by the Cushing’s syndrome will resolve after hormone levels return to normal postoperatively.

Question 47

When providing postoperative care for a patient who has had a bilateral adrenalectomy, which assessment information obtained by the nurse is most important to communicate to the physician?

a. The blood glucose is 8 mmol/L.
b. The patient’s blood pressure is 102/50 mm Hg.
c. The patient has level 6 incisional pain on a 10-point scale.
d. The lungs have bibasilar crackles.

Answer 47

ANS: B
During the immediate postoperative period, marked fluctuation in cortisol levels may occur, and the nurse must be alert for signs of acute adrenal insufficiency such as hypotension.

Question 48

A patient with Cushing’s syndrome returns to the surgical unit following an adrenalectomy. During the initial postoperative period, the nurse gives the highest priority to which of the following actions?

a. Monitoring for infection
b. Protecting the patient’s skin
c. Monitoring fluid and electrolyte status
d. Preventing severe emotional disturbances

Answer 48

ANS: C
After adrenalectomy, the patient is at risk for circulatory instability caused by fluctuating hormone levels, and the focus of care is to assess and maintain fluid and electrolyte status through the use of intravenous fluids and corticosteroids.

Question 49

A patient is hospitalized with acute adrenal insufficiency. Which of the following findings assists the nurse to determine that the patient is responding favourably to treatment?

a. Decreasing blood glucose
b. Increasing urinary output
c. Decreasing serum sodium
d. Decreasing serum potassium

Answer 49

ANS: D
Clinical manifestations of Addison’s disease include hyperkalemia, and a decrease in potassium level indicates improvement.

Question 50

A patient is admitted to the hospital in addisonian crisis 1 month following a diagnosis of Addison’s disease. The nurse documents the nursing diagnosis of ineffective therapeutic regimen management related to lack of knowledge of management of condition when the patient gives which of the following responses?

a. “I double my dose of hydrocortisone if I am experiencing moderate stress.”
b. “I had the stomach flu earlier this week and couldn’t take the hydrocortisone.”
c. “I frequently eat at restaurants, so my food has a lot of added salt.”
d. “I do yoga exercises almost every day to help me reduce stress and relax.”

Answer 50

ANS: B
The need for hydrocortisone replacement is increased with stressors such as illness, and the patient needs to be taught to call the physician because medication and intravenous fluids and electrolytes may have to be given.

Question 51

A patient who uses every-other-day prednisone therapy for rheumatoid arthritis complains of not feeling as well on the nonprednisone days and asks the nurse about taking prednisone daily instead. What is the best response to the patient?

a. An every-other-day schedule mimics the normal pattern of cortisol secretion from the adrenal gland.
b. Glucocorticoids are taken on a daily basis only when they are being used for replacement therapy.
c. If it improves the symptoms, it would be acceptable to take half the usual dose every day.
d. When prednisone is taken every other day, the effect on normal adrenal function is less.

Answer 51

ANS: D

An alternate-day regimen is given to minimize the impact of exogenous corticosteroids on adrenal gland function.

Question 52

A patient is taking high doses of prednisone to control the symptoms of an acute exacerbation of systemic lupus erythematosus. When teaching the patient about the use of prednisone, which information is most important for the nurse to include?

a. Call the doctor if you experience any mood alterations with the prednisone.
b. Do not stop taking the prednisone suddenly; it should be decreased gradually.
c. Weigh yourself daily to monitor for weight gain caused by water or increased fat.
d. Check your temperature daily because prednisone can hide signs of infection.

Answer 52

ANS: B

Acute adrenal insufficiency may occur if exogenous corticosteroids are suddenly stopped.

Question 53

A patient has an adenoma of the adrenal zona glomerulosa causing hyperaldosteronism and is scheduled for surgery to remove the affected gland. During care before surgery, the nurse should do which of the following?

a. Limit fluids to 1000 mL/day.
b. Provide a potassium-restricted diet.
c. Monitor the blood pressure every 4 hours.
d. Elevate the patient’s extremities to relieve edema.

Answer 53

ANS: C
Hypertension caused by sodium retention is a common complication of hyperaldosteronism; therefore, the blood pressure should be monitored frequently.

Question 54

A patient with a possible pheochromocytoma is admitted to the hospital for evaluation and diagnostic testing. During an attack, what would the nurse expect the patient to experience?

a. Persistent hypoglycemia
b. Severe bradycardia refractory to drug therapy
c. Severe hypotension with sympathoadrenal blockade
d. Severe, pounding headache, tachycardia, and profuse sweating

Answer 54

ANS: D
The classic clinical manifestations of pheochromocytoma are hypertension, tachycardia, severe headache, diaphoresis, and abdominal or chest pain.

Question 55

After a patient with a pituitary adenoma has had a hypophysectomy, the nurse will plan to do discharge teaching about the need for which of the following?

a. Insulin use to maintain blood glucose at normal levels
b. Sodium restriction to prevent fluid retention and hypertension
c. Oral corticosteroids to replace endogenous cortisol
d. Chemotherapy to prevent recurrence of the tumour

Answer 55

ANS: C

ADH, cortisol, and thyroid hormone replacement will be needed for life after hypophysectomy.

Question 56

A patient is admitted with possible SIADH. Which information obtained by the nurse is most important to communicate rapidly to the physician?

a. Complains of a severe headache
b. Complains of severe thirst
c. Has a urine specific gravity of 1.025
d. Has a serum sodium level of 119 mmol/L

Answer 56

ANS: D

A serum sodium of less than 120 mmol/L increases the risk for complications such as seizures and needs rapid correction.

Question 57

Which type of diabetes insipidus results from excessive water intake?

a. Central
b. Neurogenic
c. Nephrogenic
d. Primary

Answer 57

ANS: D

Primary diabetes insipidus results from excessive water intake.

Question 58

After receiving a change-of-shift report about the following four patients, which patient should the nurse assess first?

a. A 22-year-old patient admitted with SIADH who has a serum sodium level of 130 mmol/L
b. A 31-year-old patient who has iatrogenic Cushing’s syndrome with a capillary blood glucose level of 13.6 mmol/L (244 mg/dL)
c. A 53-year-old patient who has Addison’s disease and is due for a scheduled dose of hydrocortisone (Solu-Cortef)
d. A 70-year-old patient who recently started levothyroxine to treat hypothyroidism and has an irregular pulse of 134 beats/min

Answer 58

ANS: D

Initiation of thyroid replacement in older adults may cause angina and cardiac dysrhythmias.

Question 59

A patient with newly diagnosed type 2 diabetes asks the nurse what “type 2” means in relation to diabetes. Which of the following statements best explains to the patient how type 2 diabetes primarily differs from type 1 diabetes?

a. “With type 2 diabetes, the patient is totally dependent on an outside source of insulin.”
b. “With type 2 diabetes, decreased insulin secretion, cellular resistance to insulin, or both are produced.”
c. “With type 2 diabetes, islet cell antibodies and insulin autoantibodies destroy beta cells in the pancreas.”
d. “With type 2 diabetes, the C-peptide chain of proinsulin secreted by the pancreas cannot be removed by the liver, resulting in a lack of active insulin.”

Answer 59

ANS: B
In type 2 diabetes, the pancreas produces insulin, but the insulin is insufficient for the body’s needs or the cells do not respond to the insulin appropriately.

Question 60

A patient screened for diabetes at a clinic has a fasting plasma glucose of 6.7 mmol/L (120 mg/dL). What will the nurse plan to teach the patient about?

a. Use of low doses of regular insulin
b. Self-monitoring of blood glucose
c. Oral hypoglycemic medications
d. Maintenance of a healthy weight

Answer 60

ANS: D
The patient’s impaired fasting glucose indicates prediabetes, and the patient should be counselled about lifestyle changes, for example, a healthy weight, to prevent the development of type 2 diabetes.

Question 61

During a diabetes screening program, a young woman tells the nurse that her mother died of complications of diabetes and asks whether she will inherit the disease. After determining that the woman’s mother most likely had type 2 diabetes, what should the nurse explain?

a. Her 60% chance of developing type 2 diabetes can be prevented by maintaining a normal weight and a low-carbohydrate diet.
b. The patient has a higher familial risk for developing type 2 diabetes than for type 1 diabetes, and she should have her glucose level tested periodically.
c. She would have a higher risk for developing diabetes if her father, rather than her mother, had diabetes, but she should still be tested periodically.
d. Although there is a familial tendency for children or siblings of individuals with type 2 diabetes to develop diabetes, the inherited risk is not as high as it is for type 1 diabetes.

Answer 61

ANS: B

The offspring of people with type 2 diabetes are at higher risk for developing type 2 diabetes.

Question 62

A program of weight loss and exercise is recommended for a patient with insulin resistance syndrome. When the patient asks why these measures are necessary when she really does not have diabetes, what should the nurse explain?

a. The high insulin levels associated with this syndrome damage the lining of blood vessels and cause osmotic diuresis.
b. Although her fasting plasma glucose levels do not indicate diabetes, she has impaired glucose tolerance, which is characteristic of the syndrome.
c. The liver is inappropriately producing glucose, which will eventually exhaust the ability of the pancreas to produce insulin, and exercise will normalize glucose production.
d. She has a variety of abnormalities associated with diabetes, which indicate a very high risk for cardiovascular disease, and the onset of diabetes can be delayed or prevented by weight loss and exercise.

Answer 62

ANS: D
The patient with impaired fasting glucose is at risk for developing type 2 diabetes, but this risk can be decreased with lifestyle changes.

Question 63

When assessing the patient experiencing the onset of type 1 diabetes, which question should the nurse ask?

a. “Have you lost any weight lately?”
b. “Do you crave fluids containing sugar?”
c. “How long have you felt anorexic?”
d. “Is your urine unusually dark-coloured?”

Answer 63

ANS: A
Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy.

Question 64

During a clinic visit 3 months following a diagnosis of type 2 diabetes, the patient reports that she has been following her reduced-calorie diet, but she has not lost any weight, and she has neglected to bring her record of glucose monitoring results. What does the nurse recognize as the best indicator of the patient’s control of her diabetes since her initial diagnosis and instruction?

a. A fasting glucose level
b. Analysis for microalbuminuria
c. A glycosylated hemoglobin (HbA1C) level
d. The patient’s verbal report of her symptoms

Answer 64

ANS: C

The HbA1C test shows the overall control of glucose over 90 to 120 days.

Question 65

A patient is diagnosed with type 2 diabetes at the clinic. A nursing assessment of the patient reveals vital signs of blood pressure 158/96 mm Hg, heart rate 88 beats/min, respiration 18 breaths/min, temperature 37.1°C, height 160 cm, and weight 82 kg. The physician prescribes a 1200-calorie diet with a daily exercise program as initial therapy for the patient. The nurse refers the patient to the dietitian for initial diet planning and teaching with the knowledge that which of the following is the primary goal of nutritional therapy for the patient?

a. Control of dietary intake to achieve ideal body weight
b. Elimination of simple sugars in exchange for complex carbohydrate in the diet
c. Reduction in dietary calories and fat to normalize glucose, lipid, and blood pressure levels
d. Maintenance of equal distribution of carbohydrate throughout the day with strict adherence to consistency in daily intake

Answer 65

ANS: C
A nutritionally adequate meal plan with a reduction in total fat (especially saturated fats), an increase in fibre, and a decrease in simple sugars can bring about decreased calorie and carbohydrate consumption.

Question 66

A 20-year-old university student who has type 1 diabetes normally walks each evening as part of her exercise regimen. She now plans to enroll in a swimming class to meet her physical education requirement. What should the nurse teach the patient that adjustments to her treatment plan should include?

a. Delaying the normal meal before the swimming class until the session is over
b. Adding 10 units of regular insulin to her usual morning dose on the days she plans to swim
c. Timing her morning insulin injection so that the peak action will occur during her swimming class
d. Monitoring her glucose level before, during, and after swimming to determine the need for alterations in food or insulin

Answer 66

ANS: D
The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration.

Question 67

A patient with type 1 diabetes has received diet instruction as part of his treatment plan. The nurse determines a need for additional instruction when the patient makes which one of the following comments?

a. “I may have an occasional alcoholic drink if I include it in my meal plan.”
b. “I will need a bedtime snack because I take an evening dose of NPH insulin.”
c. “I may eat whatever I want as long as I cover the calories with sufficient insulin.”
d. “I should eat meals as scheduled, even if I am not hungry, to prevent hypoglycemia.”

Answer 67

ANS: C
Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are using intensified insulin therapy have considerable flexibility in diet choices but still should restrict dietary intake of items such as fat, protein, and alcohol.

Question 68

A 1200-calorie diet and exercise are prescribed for a patient with newly diagnosed type 2 diabetes. The patient tells the nurse that she hates to exercise and asks whether just following her diet would control her diabetes. What primary reason should the nurse stress to the patient for planning a pleasant, regular exercise routine?

a. It will give her increased energy and a sense of well-being.
b. It will facilitate weight loss, which will decrease peripheral insulin resistance.
c. It will improve cardiovascular and respiratory fitness, which is important for all individuals.
d. It will set a pattern for the other routines of dietary changes and meal scheduling necessary for diabetes control.

Answer 68

ANS: B

Exercise is essential to decrease insulin resistance and improve blood glucose control.

Question 69

The nurse has been teaching the patient to administer a dose of 10 units regular insulin and 28 units Lente insulin. Which of the following statements by the patient indicates a need for additional instruction?

a. “I should rotate injection sites among my arms, legs, and abdomen each day.”
b. “I may reuse my insulin syringes for more injections if I recap them after use.”
c. “I should draw up the regular insulin first after injecting air into the Lente bottle.”
d. “I do not have to pull back on the plunger to check for blood before I inject the insulin.”

Answer 69

ANS: A
Rotating sites is no longer necessary because all insulin is now purified human insulin, and the risk for lipodystrophy is low.

Question 70

What should the nurse emphasize when teaching a patient with type 1 diabetes about the Somogyi effect and dawn phenomenon?

a. The Somogyi effect occurs early at night, and the dawn phenomenon occurs on arising.
b. The Somogyi effect is characterized by hyperglycemia and the dawn phenomenon by hypoglycemia.
c. The Somogyi effect occurs when the patient is asleep, and the dawn phenomenon occurs after the patient awakens.
d. In the Somogyi effect, hyperglycemia results from too much insulin, and the dawn phenomenon results from too little insulin.

Answer 70

ANS: D
In the Somogyi effect, hyperglycemia results from too much insulin, and the dawn phenomenon results from too little insulin.

Question 71

A patient receives a daily injection of 70/30 NPH/regular insulin premix at 0700 hours. The nurse expects that a hypoglycemic reaction is most likely to occur between which of the following times?

a. 0800 and 1000 hours
b. 1600 and 1800 hours
c. 1900 and 2100 hours
d. 2200 and 2400 hours

Answer 71

ANS: B

The greatest insulin effect with this combination occurs in midafternoon.

Question 72

A patient using a split mixed-dose insulin regimen tells the nurse that he is interested in using intensive insulin therapy because he has read that it promotes fewer and less severe complications of diabetes. In response to the patient’s comment, what should the nurse explain?

a. Intensive insulin therapy requires three or more injections a day in addition to an injection of a basal long-acting insulin.
b. Intensive insulin therapy is indicated only for patients who have recently received a diagnosis of type 1 diabetes and who have never experienced ketoacidosis.
c. Studies have shown that intensive insulin therapy is most effective in preventing the macrovascular complications characteristic of type 2 diabetes.
d. The use of an insulin pump does not require as much attention as intensive insulin therapy and offers the same protection against long-term complications.

Answer 72

ANS: A
Patients using intensive insulin therapy must check their glucose level four to six times daily and administer insulin accordingly.

Question 73

When intensive insulin therapy is used for control of diabetes, the nurse recognizes that which of the following types of insulin is preferred for mealtime coverage?

a. NPH insulin
b. Lispro insulin
c. Lente insulin
d. Insulin glargine

Answer 73

ANS: B

Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive insulin therapy.

Question 74

Glyburide (Diabeta) is prescribed for a patient when her type 2 diabetes has not been controlled with diet and exercise. When teaching the patient about glyburide, what should the nurse explain?

a. Glyburide is thought to stimulate insulin production and release from the pancreas.
b. Glyburide is a substitute for insulin and acts by directly stimulating glucose uptake into the cell.
c. Glyburide, like all oral antidiabetes agents, does not cause the hypoglycemic reactions that may occur with insulin use.
d. Glyburide and other sulphonylureas lower blood sugar by decreasing the rate of hepatic glucose production, preventing gluconeogenesis.

Answer 74

ANS: A

The sulphonylureas stimulate the production and release of insulin from the pancreas.

Question 75

When teaching a patient with type 2 diabetes about taking an oral antihyperglycemic medication, the nurse determines that additional teaching about the medication is needed when the patient gives which of the following responses?

a. “If I overeat at a meal, I should not take an extra dose of my medication.”
b. “If I become ill or especially stressed, I may have to take insulin to control my blood sugar.”
c. “Given that I can take oral drugs rather than insulin, my diabetes is not serious and won’t cause many complications.”
d. “I should check with my doctor before taking any other medications because there are many that will affect glucose levels.”

Answer 75

ANS: C
The patient should understand that type 2 diabetes places the patient at risk for many complications and that good glucose control is as important when taking oral agents, as when using insulin.

Question 76

A patient with type 2 diabetes that is controlled with diet and metformin (Glucophage) also has severe rheumatoid arthritis. During an acute exacerbation of the patient’s arthritis, the physician prescribes prednisone (Deltasone) to control inflammation. What will the nurse anticipate?

a. Administration of insulin while taking prednisone
b. Development of acute hypoglycemia during the rheumatoid arthritis exacerbation
c. Evidence of rashes caused by metformin–prednisone interactions
d. Requirement of a diet higher in calories while receiving prednisone

Answer 76

ANS: A

Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose.

Question 77

A hospitalized patient with diabetes receives 12 units of regular insulin mixed with 34 units of NPH insulin at 0700 hours. The patient is away from the nursing unit for diagnostic testing at noon, when lunch trays are distributed. What is the most appropriate nursing action?

a. Save the lunch tray to be provided on the patient’s return to the unit.
b. Call the diagnostic testing area, and ask the physician to start an intravenous (IV) line of 5% dextrose solution.
c. Ensure that the patient drinks a glass of milk or orange juice at noon in the diagnostic testing area.
d. Request that the patient be returned to the unit to eat lunch if testing will not be completed promptly.

Answer 77

ANS: D
Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient to have lunch at the usual time.

Question 78

A patient with type 1 diabetes has been using self-capillary blood glucose monitoring (CBGM) as part of his diabetes management. During evaluation of his technique of CBGM, the nurse identifies a need for additional teaching when the patient does which of the following actions?

a. Chooses a puncture site in the centre of the finger pad
b. Washes his hands with soap and water to cleanse the puncture site
c. Tells the nurse that the result of 130 mg indicates good control of his diabetes
d. Hangs his arm down before a second puncture site attempt for an adequate drop of blood

Answer 78

ANS: A

The patient is taught to choose a puncture site at the side of the finger pad.

Question 79

The nurse is preparing a mixed insulin dose for administration. After injecting air into both vials, what would be the immediate next step?

a. Gently rotate the NPH insulin bottle.
b. Invert and draw up regular insulin.
c. Swab the tops of both vials with alcohol sponge or swab.
d. Invert and draw up NPH insulin.

Answer 79

ANS: B
After the nurse has injected air into both vials, the next action is to invert the regular insulin vial and withdraw the ordered amount.

Question 80

A patient with type 1 diabetes is found unresponsive in the morning by his wife and is admitted to the emergency department. On admission, the patient is unresponsive to stimuli and has fruity, sweet breath with Kussmaul’s respirations. Laboratory results include arterial blood gases of pH 7.32, PCO2 34 mm Hg, and HCO3− 11 mmol/L, and a plasma glucose of 28.8 mmol/L (518 mg/dL). Which of the following interventions does the nurse anticipate will be prescribed initially for the patient?

a. IV fluid and electrolyte replacement therapy
b. Administration of an IV bolus of regular insulin
c. Low-dose insulin infusion in a normal saline solution
d. IV administration of sodium bicarbonate to replace bicarbonate and reverse the acidosis

Answer 80

ANS: A

The priority action is to administer IV fluid and electrolyte replacement therapy.

Question 81

Cardiac monitoring is initiated for a patient in diabetic ketoacidosis. The nurse recognizes that this measure is important to identify which of the following complications?

a. Electrocardiogram (ECG) changes and dysrhythmias related to hypokalemia
b. Fluid overload resulting from aggressive fluid replacement
c. The presence of hypovolemic shock related to osmotic diuresis
d. Cardiovascular collapse resulting from the effects of excess glucose on cardiac muscle

Answer 81

ANS: A
The hypokalemia associated with metabolic acidosis can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with ECG monitoring.

Question 82

A patient with diabetes is admitted with ketoacidosis, and the physician writes all of the following orders. Which order should the nurse implement first?

a. Start an infusion of regular insulin at 50 units/hour.
b. Give sodium bicarbonate 50 mmol/L IV push.
c. Infuse 1 L of normal saline per hour.
d. Administer regular IV insulin 30 units.

Answer 82

ANS: C
The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis, and the priority is to infuse IV fluids.

Question 83

Which of the following is a common side effect of metformin?

a. Nausea and diarrhea
b. Edema and weight gain
c. Upper respiratory tract infections
d. Hypoglycemia

Answer 83

ANS: A
Nausea and diarrhea are common side effects of metformin; others include upset stomach, less weight gain than with sulphonylureas, no hypoglycemia, and potential lactic acidosis in renal or hepatic impairment.

Question 84

A patient with type 1 diabetes develops a sore throat, cough, and fever. He calls the clinic when he finds his blood glucose level to be 11.67 mmol/L (210 mg/dL) with his monitor. What should the nurse advise the patient to do?

a. Hold all food and insulin until his fever is relieved.
b. Measure his urinary output, and test his urine for ketones.
c. Reduce his carbohydrate intake until his glucose level is about 8.33 mmol/L (150 mg/dL).
d. Monitor his blood glucose every 4 hours, and notify the clinic if it continues to rise.

Answer 84

ANS: D
Infection and other stressors increase blood glucose levels, and the patient will need to test blood glucose frequently, treat elevations appropriately with insulin, and call the physician if glucose levels continue to be elevated.

Question 85

While hospitalized and recovering from an episode of diabetic ketoacidosis, the patient calls the nurse and reports feeling anxious, nervous, and sweaty. Based on the patient’s report, what should the nurse do?

a. Obtain a glucose reading using a finger stick.
b. Administer 1 mg glucagon subcutaneously.
c. Have the patient eat a chocolate bar.
d. Have the patient drink 113 g of orange juice.

Answer 85

ANS: A
The patient’s clinical manifestations are consistent with hypoglycemia, and the initial action should be to check the patient’s glucose with a finger stick or order an immediate blood glucose test.

Question 86

A patient recovering from diabetic ketoacidosis asks the nurse how acidosis occurs. What is the best response?

a. Excess glucose in the blood is metabolized by the liver into acetone, which is acidic in nature.
b. An insulin deficit promotes metabolism of fat stores, which produces large amounts of acidic ketones.
c. Insufficient insulin leads to cellular starvation, and as cells rupture, they release organic acids into the blood.
d. When an insulin deficit causes hyperglycemia, then proteins are deaminated by the liver, causing acidic by-products.

Answer 86

ANS: B

Ketoacidosis is caused by the breakdown of fat stores when glucose is not available for intracellular metabolism.

Question 87

Intramuscular glucagon is administered to an unresponsive patient for treatment of hypoglycemia. Which action should the nurse take after the patient regains consciousness?

a. Give the patient a snack of cheese and crackers.
b. Have the patient drink a glass of orange juice or nonfat milk.
c. Administer a continuous infusion of 5% dextrose for 24 hours.
d. Assess the patient for symptoms of hyperglycemia.

Answer 87

ANS: A
Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat, such as cheese and crackers, will help prevent hypoglycemia.

Question 88

A patient with diabetes was admitted to the emergency department when he was found unresponsive at his desk at work. A capillary blood glucose level was 2.2 mmol/L (38 mg/dL), and he was treated for hypoglycemia. When he recovers, he tells the nurse that he had no warning of the hypoglycemia. Which of the following questions will help identify a possible reason for the patient’s hypoglycemic unawareness?

a. “Do you use any calcium channel–blocking drugs for blood pressure?”
b. “Have you observed any recent skin changes?”
c. “Do you notice any bloating feeling after eating?”
d. “Have you noticed any painful new ulcerations or sores on your feet?”

Answer 88

ANS: C
Hypoglycemic unawareness is caused by autonomic neuropathy, which would also cause delayed gastric emptying, making the patient feel bloated after eating.

Question 89

A patient with type 2 diabetes has sensory neuropathy of the feet and legs and peripheral vascular disease evidenced by decreased peripheral pulses and dependent rubor. What will the nurse teach the patient?

a. The feet should be soaked in warm water on a daily basis.
b. Flat-soled leather shoes are the best choice to protect the feet from injury.
c. Heating pads should always be set at a very low temperature.
d. Over-the-counter callus remover may be used to remove calluses and prevent pressure.

Answer 89

ANS: B

The patient is taught to avoid high heels and that leather shoes are preferred.

Question 90

A patient newly diagnosed with type 1 diabetes likes to run 5 km several mornings a week. Which teaching will the nurse implement about exercise for this patient?

a. “You should not take the morning NPH insulin before you run.”
b. “Plan to eat breakfast about an hour before your run.”
c. “Afternoon running is less likely to cause hypoglycemia.”
d. “You may want to run a little farther if your glucose is very high.”

Answer 90

ANS: B

Blood sugar increases after meals, so this will be the best time to exercise.

Question 91

Amitriptyline (Elavil) is prescribed for a patient with diabetes with peripheral neuropathy who has burning foot pain occurring mostly at night. Which information should the nurse include when teaching the patient about the new medication?

a. Amitriptyline will help prevent the transmission of pain impulses to the brain.
b. Amitriptyline will improve sleep and make you less aware of nighttime pain.
c. Amitriptyline will decrease the depression caused by the pain.
d. Amitriptyline will correct some of the blood vessel changes that cause pain.

Answer 91

ANS: A
Tricyclic antidepressants decrease the transmission of pain impulses to the spinal cord and brain. Tricyclic antidepressants are also moderately effective in treating the symptoms of diabetic neuropathy. They work by inhibiting the reuptake of norepinephrine and serotonin, which are neurotransmitters that are believed to play a role in the transmission of pain through the spinal cord.

Question 92

A patient with type 2 diabetes is scheduled for an outpatient coronary arteriogram. Which information obtained by the nurse when admitting the patient indicates a need for a change in the patient’s regimen?

a. The patient’s most recent HbA1C result was 6%.
b. The patient takes metformin every morning.
c. The patient uses captopril (Capoten) for hypertension.
d. The patient’s admission blood glucose is 7.1 mmol/L (128 mg/dL).

Answer 92

ANS: B

To avoid lactic acidosis, metformin should not be used for 48 hours after IV contrast medium is administered.

Question 93

Which of the following is true of type 2 diabetes?

a. Diet modifications and insulin are required for glucose control.
b. Uniform timing of meals is crucial.
c. Reduction in caloric intake is desirable to control weight.
d. Intermeal and bedtime snacks are frequently necessary.

Answer 93

ANS: C
Reduction in caloric intake is desirable for the patient with type 2 diabetes to control weight, whereas in type 1 diabetes, total calories may be increased to achieve a desirable body weight and restore body tissues.

Question 94

Which of these laboratory values noted by the nurse when reviewing the chart of a patient with diabetes indicates the need for further assessment of the patient?

a. Fasting blood glucose of 6.5 mmol/L
b. Noon blood glucose of 2.6 mmol/L
c. HbA1C of 6.9%
d. HbA1C of 5.8%

Answer 94

ANS: B
The nurse should assess the patient with a blood glucose level of 2.6 mmol/L for symptoms of hypoglycemia and give the patient a carbohydrate-containing beverage such as orange juice.

Question 95

Which of the following is a characteristic of type 1 diabetes?

a. Incidence in young people is increasing
b. Insidious onset
c. Absent islet-cell antibodies
d. Patient prone to ketosis at onset

Answer 95

ANS: D
Patients are prone to ketosis at onset in type 1 diabetes but in type 2 diabetes are resistant except during infections or stress.

Question 96

Which of the following is an example of a short-acting insulin?

a. Lispro (Humalog)
b. Glulisine (Apidra)
c. Regular (Novolin)
d. Detemir (Levemir)

Answer 96

ANS: C

Regular insulin is a short-acting insulin.

Question 97

What is the name of the process that reduces the number of primordial follicles from 2 to 4 million at birth to approximately 300,000 to 400,000 at menarche?

a. Phagocytosis
b. Pinocytosis
c. Atresia
d. Active transport

Answer 97

ANS: C
Atresia is the name of the process that reduces the number of primordial follicles from 2 to 4 million at birth to approximately 300,000 to 400,000 at menarche.

Question 98

Because of the location of the prostate gland in the male reproductive system, when caring for a patient with prostate problems, the nurse should monitor the patient for which of the following?

a. Constipation
b. Low back pain
c. Penile discharge
d. Urinary symptoms

Answer 98

ANS: D

Enlargement of the prostate blocks the urethra, leading to urinary retention and difficulty initiating a urinary stream.

Question 99

What is the range of length of a menstrual cycle?

a. 5 to 7 days
b. 21 to 28 days
c. 20 to 40 days
d. 21 to 35 days

Answer 99

ANS: C

The range of length of the menstrual cycle is 20 to 40 days, the average being 28 days.

Question 100

A patient with a possible ovarian cyst is scheduled for ultrasonography. The nurse will teach the patient which of the following?

a. She should not eat or drink for 4 hours before the procedure.
b. She will experience minimal discomfort during the procedure.
c. She should discontinue taking aspirin before the procedure.
d. She will receive intravenous contrast solution during the procedure.

Answer 100

ANS: B
Ultrasonography measures high-frequency sound waves as they pass through various tissues and should cause very little discomfort.

Question 101

During the nursing assessment of a 62-year-old man, the patient tells the nurse that he does not respond to sexual stimulation the way he did when he was younger. What is the best response to the patient’s comment?

a. “Erectile dysfunction is a common problem with older men.”
b. “Tell me more about how your response has changed.”
c. “Interest in sex frequently decreases as men get older.”
d. “Many men need more sexual stimulation with aging.”

Answer 101

ANS: B
The nurse’s initial response should be further assessment of the problem. The other statements are accurate but might not respond to the patient’s concerns.

Question 102

When the nurse obtains a health history from a patient, the patient reports that she had cryosurgery 1 year ago. What does the nurse anticipate that the patient most likely has a history of?

a. Obstructed fallopian tubes
b. Abnormal menstrual cycles
c. Abnormal cells detected by a Pap smear
d. A protrusion of the urinary bladder through the vaginal wall

Answer 102

ANS: C

Cryosurgery is done to destroy abnormal cells, such as might be found in a Pap smear.

Question 103

A patient considering a vasectomy as a means of contraception asks the nurse what is involved in the procedure. The nurse explains that which of the following structures is partially removed?

a. Epididymis
b. Spermatic cord
c. Ductus deferens
d. Ejaculatory duct

Answer 103

ANS: C

A vasectomy involves partial removal of the vas deferens or ductus deferens.

Question 104

When scheduling a patient for a pelvic examination and Pap smear, what should the nurse instruct the patient to do?

a. The patient should not douche for 24 hours before the examination.
b. The patient should not have sexual intercourse for 2 days before the examination.
c. The patient should schedule the examination for the first day of her menstrual period.
d. The patient should shower before the examination but avoid tub baths the day before the examination.

Answer 104

ANS: A

The results of a Pap smear may be affected by douching, so the patient should not douche before the examination.

Question 105

When is menopause usually considered to be complete?

a. Cessation of menses for a period of 1 year
b. Once a woman turns 55 years of age
c. When estrogen levels drop 10% below normal
d. Once ovulation has ceased for a period of 2 years

Answer 105

ANS: A

Menopause is usually considered complete after 1 year of amenorrhea.

Question 106

When the nurse is performing a physical assessment of a male patient’s reproductive system, which of the following findings does the nurse identify as abnormal?

a. Absence of a prepuce
b. Clear penile discharge
c. One testis descended lower than the other
d. Ability to palpate the abdominal wall along the inguinal canal

Answer 106

ANS: B

Clear penile discharge may be indicative of a sexually transmitted infection.

Question 107

Which of the following is an age-related change in male sexual functioning?

a. Increased force of ejaculation
b. Increased rigidity of erection
c. Increased interest in sex
d. Decreased libido

Answer 107

ANS: D
An age-related change in sexual functioning for the male includes requiring an increase in stimulation for an erection, decreased force of ejaculation, decreased ability to attain erection, decreased size and rigidity of the penis at full erection, and a decreased libido and interest in sex.

Question 108

During the physical assessment of a 68-year-old woman, which of the following is a finding that the nurse considers abnormal?

a. Pendulous breasts
b. Nonpalpable ovaries
c. Serous nipple drainage
d. Atrophy of vaginal tissue

Answer 108

ANS: C

Serous drainage may indicate an intraductal papilloma and should be investigated further.

Question 109

A woman calls the clinic because she is having an unusually heavy menstrual flow. She tells the nurse that she has saturated two pads in the past 2 hours. At which of the following approximate amounts does the nurse estimate the amount of blood loss?

a. 10 to 20 mL
b. 20 to 30 mL
c. 30 to 40 mL
d. 40 to 60 mL

Answer 109

ANS: D

The average pad absorbs 20 to 30 mL, so two pads would indicate 40 to 60 mL.

Question 110

When preparing a patient for colposcopy with a cervical biopsy, what should the nurse explain to the patient about the procedure?

a. It requires surgical anaesthesia and overnight hospitalization.
b. It involves dilation of the cervix and biopsy of the tissue lining the uterus.
c. It is similar to a speculum examination of the cervix and should result in little or no pain.
d. It is a surgical procedure that permits visualization of the uterus, ovaries, and fallopian tubes.

Answer 110

ANS: C

Colposcopy involves visualization of the cervix with a binocular microscope and is similar to a speculum examination.

Question 111

A couple who has not been able to conceive is scheduled for a Huhner test for infertility. In preparation for the test, what should the nurse inform the couple to do?

a. Refrain from sexual intercourse for 1 week before the test to allow sperm counts to increase.
b. Have intercourse at the estimated time of ovulation and come to the health clinic 2 to 8 hours after intercourse.
c. Expect to have sexual intercourse at the clinic so that sperm evaluation can be made immediately following intercourse.
d. Bring the man’s semen specimen no older than 2 hours to be implanted into the woman’s cervix at the clinic.

Answer 111

ANS: B
For the Huhner test, the couple should have intercourse at the estimated time of conception and then arrive for the test 2 to 8 hours after intercourse.

Question 112

A young man is suspected of having syphilis. Which of the following tests does the nurse recognize as the one most commonly used for initial screening for syphilis as it yields information in the fastest way possible?

a. Venereal Disease Research Laboratory (VDRL) testing for antibodies
b. A blood culture of the microorganism
c. A dark-field microscopy direct examination culture of a specimen of drainage from an active chancre
d. Fluorescent treponemal antibody absorption (FTA-Abs) testing for antibodies to treponema

Answer 112

ANS: C
If the patient has an active chancre, the Treponema pallidum bacteria can be visualized. The VDRL, rapid plasma regain (blood culture of the microorganism), and FTA-Abs tests will take longer.

Question 113

Before a woman uses oral contraceptives, the nurse should question the patient about a history of which one of the following disorders?

a. Rubella
b. Anemia
c. Mumps
d. Cholecystitis

Answer 113

ANS: D

Cholecystitis is aggravated by oral contraceptives.

Question 114

A 42-year-old man tells the nurse that he has not been able to function sexually for about the last year. The nurse asks the patient specifically about medications he is taking, with the knowledge that erectile dysfunction may occur with the use of which of the following drugs?

a. Antilipemics
b. Antihypertensives
c. Oral hypoglycemic agents
d. H2-receptor blocking agents

Answer 114

ANS: B
Some antihypertensives may cause erectile dysfunction, and the nurse should anticipate a change in antihypertensive therapy.

Question 115

The nurse’s best response to the patient who asks “what is a varicocelectomy” is which one of the following?

a. Removal of part of the ductus deferens
b. Correction of axial rotation of the spermatic cord
c. Repair of a varicose vein of the scrotum
d. Skin graft to repair an injury to the testicle

Answer 115

ANS: C

A varicocelectomy is the repair of varicose veins of the scrotum.