Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas, Exams of Health sciences

Download Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas and more Exams Health sciences in PDF only on Docsity! Test Bank - Understanding Medical-Surgical Nursing 6e (Williams and Hopper) 1 Chapter 40. Nursing Care of Patients With Disorders of the Endocrine Pancreas Multiple Choice Identify the choice that best completes the statement or answers the question. 1. A patient is experiencing rapid deep breathing, fruity odor, lethargy, and weight loss. Laboratory results include a blood glucose of 720 mg/dL. Which symptom should indicate to the nurse that the patient has type 1 diabetes mellitus? a. Thirst b. Hunger c. Lethargy d. Fruity odor 2. The nurse is reviewing the causes for the development of type 1 diabetes mellitus with a patient who is newly diagnosed with the disorder. What major factor in the development of this disease should the nurse include? a. Obesity b. A high-fat diet c. An autoimmune response d. A diet high in concentrated carbohydrates 3. A patient with type 1 diabetes mellitus asks what caused the fruity odor that was present at diagnosis. How should the nurse respond? a. Excess sugar is excreted in the urine, which causes the fruity odor. b. The proteins in the blood are metabolized to a substance that has a fruity odor. c. The excess sugar in the blood is metabolized to fructose and excreted via the lungs. d. In the absence of available sugar, the body breaks down fat into ketones, which have a fruity odor. 4. A patient is newly diagnosed with type 1 diabetes mellitus. How should the nurse respond when the patient asks how long insulin injections will be necessary? a. You will need insulin injections for the rest of your life. b. Once your pancreas recovers, you may be able to discontinue the injections. c. If you follow your diet closely, your blood sugar may be controlled by just taking insulin pills. d. You may be able to stop the injections if you exercise regularly and adhere to the prescribed diet. 5. The nurse is assisting with nutrition teaching for a patient who voices concern over coping with a diabetic diet. What response about medical nutrition therapy is correct? a. You will have a well-balanced, individualized meal plan that will be healthy for your whole family. Test Bank - Understanding Medical-Surgical Nursing 6e (Williams and Hopper) 2 b. You will need to avoid sugars and fats, but the dietitian will assist you in finding acceptable alternatives. c. Your diabetes will require special foods, but many stores now stock a variety of choices for people with diabetes. d. Medical nutrition therapy stresses high protein and low carbohydrate intake, but most people readily adapt to these restrictions. 6. The nurse is providing care for a marathon runner who is newly diagnosed with diabetes mellitus. What explanation about exercise is best for the nurse to provide? a. You will need to avoid regular exercise since it will lower your blood sugar. b. You can still exercise, but running is too strenuous for someone with diabetes. c. You should always take some emergency glucose with you when you are running. d. Exercise is best done when insulin is peaking, so it is important to know the onset and peak of your type of insulin. 7. The nurse is reinforcing teaching for a patient who is on four injections of regular insulin daily. About how many hours after each injection of insulin should the nurse teach the patient to be alert for symptoms of hypoglycemia? a. 1/2 hour b. 3 hours c. 8 hours d. 12 hours 8. The nurse teaches a patient to self-administer insulin. How can the nurse best evaluate whether the patient understands the instructions? a. Observe as the patient prepares and injects a dose of insulin. b. Have the patient list the steps of the procedure for insulin administration. c. Ask the patient an open-ended question about feelings related to the procedure. d. Ask the patient to repeat the information in the insulin pamphlet that was provided. 9. The nurse is caring for a patient with diabetes. For which symptom should the nurse be the most concerned? a. Fatigue b. Heartburn c. Diaphoresis d. Muscle cramps 10. The nurse is assisting with a group class on complications of diabetes. Which information should the nurse include as factors that can precipitate hyperglycemia? Test Bank - Understanding Medical-Surgical Nursing 6e (Williams and Hopper) 5 c. Brain d. Blood vessels 21. A patient at home with type 1 diabetes has a glucose level of 324 mg/dL. It is usually less than 150 mg/dL. What should the patient do first? a. Call the physician. b. Have a glass of orange juice. c. Check the urine for ketones and drink water. d. Exercise and recheck glucose level in 2 hours. 22. A patient whose blood glucose level ranges between 150 to 200 mg/dL has an episode of hypoglycemia. Which patient activity most likely caused the hypoglycemia? a. Took a nap b. Took a bicycle ride c. Went to a birthday party d. Received news of a pay raise 23. A patient being treated with rosiglitazone (Avandia) for type 2 diabetes mellitus is receiving a routine follow-up assessment. In addition to hemoglobin A1c and a fasting plasma glucose test, which other laboratory test should the nurse expect to be monitored in this patient? a. Blood lipids b. Liver function tests c. Urine for microalbumin d. Complete blood count (CBC) 24. A patient is diagnosed with hypoglycemia. What glucose level should the nurse expect when monitoring the capillary blood glucose? a. 65 mg/dL b. 100 mg/dL c. 138 mg/dL d. 200 mg/dL 25. The nurse is reviewing goals for blood glucose monitoring with a patient newly diagnosed with type 2 diabetes mellitus. What pre-prandial blood glucose goal should the nurse instruct the patient to achieve? a. 50 to 100 mg/dL b. 60 to 100 mg/dL c. 70 to 130 mg/dL Test Bank - Understanding Medical-Surgical Nursing 6e (Williams and Hopper) 6 d. 80 to 150 mg/dL 26. The nurse is caring for a patient in the critical care unit. What should the nurse identify as a goal for this patients blood glucose levels? a. 50 to 100 mg/dL b. 100 to 150 mg/dL c. 140 to 180 mg/dL d. 180 to 240 mg/dL 27. A patient comes into the clinic with complaints of extreme thirst, extreme urination, and ongoing hunger. Which blood glucose level should the nurse use to determine if the patient has diabetes? a. 110 mg/dL b. 126 mg/dL c. 185 mg/dL d. 210 mg/dL Multiple Response Identify one or more choices that best complete the statement or answer the question. 28. The nurse is preparing to administer insulin to a patient with type 1 diabetes mellitus. Which sites should the nurse consider for this injection? (Select all that apply.) a. Forearm b. Buttocks c. Abdomen d. Anterior thigh e. Ventrogluteus f. Posterior aspect of the arm 29. The nurse is providing teaching to a patient with reactive hypoglycemia. Which instructions related to glucose monitoring should the nurse provide? (Select all that apply.) a. It is important to check your blood sugar at bedtime. b. It is important to check blood sugar 1 hour before meals. c. You will need to check your blood sugar 2 hours after meals. d. You should check your blood sugar when you get up in the morning. e. Two hours before each meal is the best time to check your blood sugar. f. Checking your blood sugar once a day, at the same time each day, is sufficient. Test Bank - Understanding Medical-Surgical Nursing 6e (Williams and Hopper) 7 30. A patient is diagnosed with diabetic ketoacidosis (DKA). Which manifestations should the nurse expect to observe in this patient? (Select all that apply.) a. Dehydration b. Hypertension c. Flulike symptoms d. Kussmauls respirations e. Cheyne-Stokes respirations f. Edema associated with fluid overload 31. The nurse is reviewing the goals and recommendations of the American Diabetes Association (ADA) prior to planning a patients care. What should the nurse keep in mind for this patient? (Select all that apply.) a. Aspirin therapy b. Yearly flu vaccine c. Hemoglobin A1c less than 7% d. Blood pressure less than 150/90 mm Hg e. Statin therapy for patients over 40 years old f. Peak postprandial capillary glucose less than 180 mg/dL 32. A patient with type 1 diabetes mellitus is prescribed insulin glargine (Lantus). What should the nurse instruct the patient about this medication? (Select all that apply.) a. It can be inhaled. b. It is not injectable. c. It has no peak action time. d. It has a duration of 24 hours. e. It cannot be mixed with other insulin. 33. A patient with type 2 diabetes mellitus is prescribed metformin (Glucophage). What should the nurse assess and monitor in this patient? (Select all that apply.) a. Weight gain b. Fluid retention c. Family history of glaucoma d. Presence of renal or hepatic disease e. Presence of congestive heart failure (CHF) f. Need for diagnostic tests involving use of contrast dyes Test Bank - Understanding Medical-Surgical Nursing 6e (Williams and Hopper) 10 will not recover. D. Patients with type 1 diabetes must have insulin to survive. C. Oral insulin is not available. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Pharmacological and Parenteral Therapies | Cognitive Level: Application 5. ANS: A Because all diabetic nutrition recommendations emphasize low fat intake and balanced intake of other food groups, it is healthy for the whole family. B. Patients with diabetes do not have to avoid all sugars and fats. D. High protein is not recommended; low protein may be necessary if nephropathy occurs. C. Special foods are not necessary. PTS: 1 DIF: Moderate KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application 6. ANS: C Persons with diabetes should always carry a quick source of sugar when exercising in case the blood glucose drops too low. D. Individuals on intermediate-acting insulin are taught to avoid exercising at the time of day when their blood glucose is at its lowest point (i.e., when insulin or medication is peaking) and to have a carbohydrate snack before exercising if blood glucose is less than 100 mg/dL. A. Exercising at similar times each day also helps prevent blood glucose fluctuations. B. Running is not too strenuous for someone who is used to doing it, but patients with neuropathy or foot problems should consult with a physician first. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Physiological Adaptation | Cognitive Level: Analysis 7. ANS: B Regular insulin peaks in 2 to 5 hours, so blood sugar will be lowest at this time. A. C. D. Onset is a half hour, and duration is 5 to 8 hours. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Pharmacological and Parenteral Therapies | Cognitive Level: Application 8. ANS: A Observing the patient as he or she demonstrates injection is the most objective measure. B. C. D. These are good additional steps, but they are not the best way to evaluate effectiveness of teaching. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Pharmacological and Parenteral Therapies | Cognitive Level: Evaluation 9. ANS: C Tremor and sweating are sympathetic symptoms of hypoglycemia. Treatment of hypoglycemia is more urgent than treatment of hyperglycemia. A. Thirst, fatigue, and glycosuria are symptoms of hyperglycemia. B. Heartburn is more commonly related to gastric acid secretion. D. Muscle cramps are more commonly related to electrolyte imbalances. PTS: 1 DIF: Moderate Test Bank - Understanding Medical-Surgical Nursing 6e (Williams and Hopper) 11 KEY: Client Need: Physiological Integrity, Reduction of Risk Potential | Cognitive Level: Analysis 10. ANS: B Stress or illness causes release of stress hormones, which are associated with hyperglycemia. A. Skipping meals causes hypoglycemia. C. D. Thirst and urination are symptoms of hyperglycemia, not causes. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Physiological Adaptation | Cognitive Level: Application 11. ANS: A Since the patient is oriented, there is time to check the blood glucose. B. Calling the laboratory takes too long and is unnecessary. D. Giving orange juice or another CHO (carbohydrate) source will be the next step, but adding sugar increases the risk of hyperglycemia. C. 50% dextrose is used if the patient is unable to take oral CHO. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Physiological Adaptation | Cognitive Level: Application 12. ANS: B Over time, chronic hyperglycemia causes a variety of serious complications in persons with diabetes. The Diabetes Control and Complications Trial showed that individuals with type 1 diabetes who maintain tight control of blood glucose experience fewer long-term complications than individuals who take traditional care of their diabetes. A. Feet should be inspected daily, but this is not the most important strategy to prevent complications. C. Fluids are only limited in patients who already have end-stage nephropathy. D. Orange juice (without sugar) is good to have on hand but will not prevent long-term complications. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Reduction of Risk Potential | Cognitive Level: Application 13. ANS: B Hyperosmolar hyperglycemia causes diuresis and dehydration. A. C. D. Dehydration and diuresis is more immediately life threatening than noncompliance, ineffective health management, or imbalanced nutrition. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Physiological Adaptation | Cognitive Level: Analysis 14. ANS: A The feet must be washed, dried, and inspected daily to recognize pressure points or red areas before they turn into problems. D. Soaking feet can macerate skin. C. Well-fitting shoes protect the feet. B. Lubricating lotion is a good idea but is only one way to protect the feet and is not as essential as daily washing and inspection for the patient with neuropathy. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Reduction of Risk Potential | Cognitive Level: Application 15. ANS: B Evaluation must address skin integrityassessing and documenting wound condition is the only response that Test Bank - Understanding Medical-Surgical Nursing 6e (Williams and Hopper) 12 does this. A. Monitoring glucose levels evaluates diabetes control, not skin integrity. C. D. Assessing the patients understanding or observing a dressing change evaluates the patients knowledge, not skin integrity. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Physiological Adaptation | Cognitive Level: Evaluation 16. ANS: A Rice and bread are both starches. C. D. Cottage cheese and custard are in the milk group. B. Juice is a fruit. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Basic Care and Comfort | Cognitive Level: Application 17. ANS: B A normal HbA1c is 4% to 6%. Glucose in the blood attaches to hemoglobin in the red blood cells, which live about 3 months. When the glucose that is attached to the hemoglobin is measured, it reflects the average blood glucose level for the previous 2 to 3 months. A. C. D. The result simply shows that glucose has been high, not the reason behind it. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Reduction of Risk Potential | Cognitive Level: Analysis 18. ANS: B According to the American Diabetes Association a normal plasma glucose level is less than 100 mg/dL. A. This is considered hypoglycemia. C. If the fasting plasma glucose is between 100 and 125 mg/dL, the patient has prediabetes. D. A value over 126 mg/dL is diabetes. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Reduction of Risk Potential | Cognitive Level: Analysis 19. ANS: A Sulfonylureas interact with alcohol and can make the patient very ill. B. This action should be taken for meglitinides and alpha-glucosidase inhibitors. D. This action should be taken for metformin. C. Glitazones may interfere with birth control. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Pharmacological and Parenteral Therapies | Cognitive Level: Application 20. ANS: D Most of the complications of diabetes involve either the large blood vessels in the body (macrovascular complications) or the tiny blood vessels, such as those in the eyes or kidneys (microvascular complications). A C. Damage to the blood vessels can affect the brain or heart. B. Liver complications are not common in diabetes. PTS: 1 DIF: Moderate KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application 21. ANS: C Test Bank - Understanding Medical-Surgical Nursing 6e (Williams and Hopper) 15 PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Pharmacological and Parenteral Therapies | Cognitive Level: Application 33. ANS: B, C, D, E, F Withhold if the patient is having tests involving contrast dye. It is contraindicated in renal and hepatic disease and CHF. Notify physician of early symptoms of lactic acidosis: hyperventilation, myalgia, and malaise. A. Glucophage may enhance weight loss, not gain. C. A family history of glaucoma is not a contraindication for this medication. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Pharmacological and Parenteral Therapies | Cognitive Level: Application 34. ANS: A, B, C, F The hemoglobin A1c is used to gather baseline data and to monitor progress of diabetes control. In 2009, the American Diabetes Association (ADA) also changed its guidelines to include the HbA1c as a diagnostic test for diabetes. It also assists in determining the degree of effectiveness of a patients treatment plan. Newer methods allow this test to be done in a physicians office while the patient waits. D. E. It reflects the average blood glucose level for the previous 2 to 3 months. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Reduction of Risk Potential | Cognitive Level: Analysis 35. ANS: A, D, E, F The Somogyi effect may be at fault when the patients blood glucose seems to be rising in spite of increasing insulin doses. If insulin levels are too high, the blood glucose may drop too low, stimulating release of counterregulatory hormones (epinephrine, glucagon, corticosteroids, growth hormone) that then elevate the blood glucose. The low glucose levels often occur during the night, and the patient may report night sweats or morning headaches. The high morning glucose is then interpreted as hyperglycemia, and the insulin dose may be further increased, compounding the problem. B. C. These are not manifestations of the Somogyi effect. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Reduction of Risk Potential | Cognitive Level: Analysis 36. ANS: A, C, D, E Heredity is responsible for up to 90% of cases of type 2 diabetes. Obesity is also a major contributing factor. Often the patient with a new diagnosis of type 2 diabetes is obese, relates a family history of diabetes, and has had a recent life stressor such as the death of a family member, illness, or loss of a job. B. Belonging to a book club would not increase this patients risk of developing type 2 diabetes mellitus. PTS: 1 DIF: Moderate KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application 37. ANS: A, B Those with prediabetes may be able to prevent the onset of diabetes with weight loss and exercise. C. Smoking does not influence the development of the disease. D. E. The patient should not be encouraged to eliminate a type or category of food. Test Bank - Understanding Medical-Surgical Nursing 6e (Williams and Hopper) 16 PTS: 1 DIF: Moderate KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Application 38. ANS: D, E Half the plate is filled with non-starchy vegetables. An 8 ounce glass of nonfat or low-fat milk completes the meal. B. When creating the plate, the place should be divided into one half and two quarters. C. One quarter is filled with starchy foods, such as whole grains and starchy vegetables. Fruit should be one serving A. The last quarter is used for meats and meat substitutes. PTS: 1 DIF: Moderate KEY: Client Need: Health Promotion and Maintenance | Cognitive Level: Analysis COMPLETION 39. ANS: 249 When using this equation, the patients average blood glucose level is calculated as being: 28.7 10.3 46.7 = 248.91. With rounding, it would be 249 mg/dL. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity, Reduction of Risk Potential | Cognitive Level: Application