NMNEC 2310 EXAM 1 QUESTIONS AND CORRECT
ANSWERS
The nurse instructs a patient with type 1 diabetes mellitus to avoid which of the following
drugs while taking insulin?
a.
Furosemide (Lasix)
b.
Dicumarol (Bishydroxycoumarin)
c.
Reserpine (Serpasil)
d.
Cimetidine (Tagamet) - Answers - ANS: A
Furosemide is a loop diuretic and can increase serum glucose levels; its use is
contraindicated with insulin. Dicumarol, an anticoagulant; reserpine, an anti-
hypertensive; and cimetidine, an H2 receptor antagonist, do not affect blood glucose
levels.
When a diabetic patient asks about maintaining adequate blood glucose levels, which of
the following statements by the nurse relates most directly to the necessity of
maintaining blood glucose levels no lower than about 74 mg/dL?
a.
"Glucose is the only type of fuel used by body cells to produce the energy needed for
physiologic activity."
b.
"The central nervous system cannot store glucose and needs a continuous supply of
glucose for fuel."
c.
"Without a minimum level of glucose circulating in the blood, erythrocytes cannot
produce ATP."
d.
"The presence of glucose in the blood counteracts the formation of lactic acid and
prevents acidosis." - Answers - ANS: B
The brain cannot synthesize or store significant amounts of glucose; thus a continuous
supply from the body's circulation is needed to meet the fuel demands of the central
nervous system.
The nurse associates which assessment finding in the diabetic patient with decreasing
renal function?
a.
Ketone bodies in the urine during acidosis
b.
Glucose in the urine during hyperglycemia
,c.
Protein in the urine during a random urinalysis
d.
White blood cells in the urine during a random urinalysis - Answers - ANS: C
Urine should not contain protein. Proteinuria in a diabetic heralds the beginning of renal
insufficiency or diabetic nephropathy with subsequent progression to end stage renal
disease. Chronic elevated blood glucose levels can cause renal hypertension and
excess kidney perfusion with leakage from the renal vasculature. This leaking allows
protein to be filtered into the urine.
What is the nurse's best response about developing diabetes to the patient whose
father has type 1 diabetes mellitus?
a.
"You have a greater susceptibility for development of the disease because of your
family history."
b.
"Your risk is the same as the general population, because there is no genetic risk for
development of type 1 diabetes."
c.
"Type 1 diabetes is inherited in an autosomal dominant pattern. Therefore the risk for
becoming diabetic is 50%."
d.
"Because you are a woman and your father is the parent with diabetes, your risk is not
increased for eventual development of the disease. However, your brothers will become
diabetic." - Answers - ANS: A
Even though type 1 diabetes does not follow a specific genetic pattern of inheritance,
those with one parent with type 1 diabetes are at an increased risk for development of
the disease.
The nurse recognizes which patient as having the greatest risk for undiagnosed
diabetes mellitus?
a.
Young white man
b.
Middle-aged African-American man
c.
Young African-American woman
d.
Middle-aged Native American woman - Answers - ANS: D
The highest incidence of diabetes in the United States occurs in Native Americans. With
age, the incidence of diabetes increases in all races and ethnic groups.
A diabetic patient is brought into the emergency department unresponsive. The arterial
pH is 7.28. Besides the blood pH, which clinical manifestation is seen in uncontrolled
diabetes mellitus and ketoacidosis?
a.
,Decreased hunger sensation
b.
Report of no urine output
c.
Increased respiratory rate
d.
Decreased thirst - Answers - ANS: C
Ketoacidosis decreases the pH of the blood, stimulating the respiratory control area of
the brain to buffer the effects of the increasing acidosis. The rate and depth of
respirations are increased (Kussmaul's respirations) to excrete more acids by
exhalation. Usually polydipsia (increased thirst), polyphagia (increased hunger), and
polyuria (increased urine output) are seen with hyperglycemia and ketoacidosis.
Which of the following would be included in the assessment of a patient with diabetes
mellitus who is experiencing a hypoglycemic reaction? (Select all that apply.)
a.
Tremors
b.
Nervousness
c.
Extreme thirst
d.
Flushed skin
e.
Profuse perspiration
f.
Constricted pupils - Answers - ANS: A, B, E
When hypoglycemia occurs, blood glucose levels fall, resulting in sympathetic nervous
system responses such as tremors, nervousness, and profuse perspiration. Dilated
pupils would also occur, not constricted pupils. Extreme thirst, flushed skin, and
constricted pupils are consistent with hyperglycemia.
A 22-year-old patient is being seen in the clinic with increased secretion of the anterior
pituitary hormones. The nurse would expect the laboratory results to show
a.
increased urinary cortisol.
b.
decreased serum thyroxine.
c.
elevated serum aldosterone levels.
d.
low urinary catecholamines excretion. - Answers - ANS: A
Increased secretion of adrenocorticotropic hormone (ACTH) by the anterior pituitary
gland will lead to an increase in serum and urinary cortisol levels. An increase, rather
than a decrease, in thyroxine level would be expected with increased secretion of
, thyroid stimulating hormone (TSH) by the anterior pituitary. Aldosterone and
catecholamine levels are not controlled by the anterior pituitary.
Which statement by a 50-year-old female patient indicates to the nurse that further
assessment of thyroid function may be necessary?
a.
"I notice my breasts are tender lately."
b.
"I am so thirsty that I drink all day long."
c.
"I get up several times at night to urinate."
d.
"I feel a lump in my throat when I swallow." - Answers - ANS: D
Difficulty in swallowing can occur with a goiter. Nocturia is associated with diseases
such as diabetes mellitus, diabetes insipidus, or chronic kidney disease. Breast
tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of
disease such as diabetes.
A 30-year-old patient seen in the emergency department for severe headache and
acute confusion is found to have a serum sodium level of 118 mEq/L. The nurse will
anticipate the need for which diagnostic test?
a.
Urinary 17-ketosteroids
b.
Antidiuretic hormone level
c.
Growth hormone stimulation test
d.
Adrenocorticotropic hormone level - Answers - ANS: B
Elevated levels of antidiuretic hormone will cause water retention and decrease serum
sodium levels. The other tests would not be helpful in determining possible causes of
the patient's hyponatremia.
Which question will provide the most useful information to a nurse who is interviewing a
patient about a possible thyroid disorder?
a.
"What methods do you use to help cope with stress?"
b.
"Have you experienced any blurring or double vision?"
c.
"Have you had a recent unplanned weight gain or loss?"
d.
"Do you have to get up at night to empty your bladder?" - Answers - ANS: C
Because thyroid function affects metabolic rate, changes in weight may indicate
hyperfunction or hypofunction of the thyroid gland. Nocturia, visual difficulty, and
changes in stress level are associated with other endocrine disorders.
ANSWERS
The nurse instructs a patient with type 1 diabetes mellitus to avoid which of the following
drugs while taking insulin?
a.
Furosemide (Lasix)
b.
Dicumarol (Bishydroxycoumarin)
c.
Reserpine (Serpasil)
d.
Cimetidine (Tagamet) - Answers - ANS: A
Furosemide is a loop diuretic and can increase serum glucose levels; its use is
contraindicated with insulin. Dicumarol, an anticoagulant; reserpine, an anti-
hypertensive; and cimetidine, an H2 receptor antagonist, do not affect blood glucose
levels.
When a diabetic patient asks about maintaining adequate blood glucose levels, which of
the following statements by the nurse relates most directly to the necessity of
maintaining blood glucose levels no lower than about 74 mg/dL?
a.
"Glucose is the only type of fuel used by body cells to produce the energy needed for
physiologic activity."
b.
"The central nervous system cannot store glucose and needs a continuous supply of
glucose for fuel."
c.
"Without a minimum level of glucose circulating in the blood, erythrocytes cannot
produce ATP."
d.
"The presence of glucose in the blood counteracts the formation of lactic acid and
prevents acidosis." - Answers - ANS: B
The brain cannot synthesize or store significant amounts of glucose; thus a continuous
supply from the body's circulation is needed to meet the fuel demands of the central
nervous system.
The nurse associates which assessment finding in the diabetic patient with decreasing
renal function?
a.
Ketone bodies in the urine during acidosis
b.
Glucose in the urine during hyperglycemia
,c.
Protein in the urine during a random urinalysis
d.
White blood cells in the urine during a random urinalysis - Answers - ANS: C
Urine should not contain protein. Proteinuria in a diabetic heralds the beginning of renal
insufficiency or diabetic nephropathy with subsequent progression to end stage renal
disease. Chronic elevated blood glucose levels can cause renal hypertension and
excess kidney perfusion with leakage from the renal vasculature. This leaking allows
protein to be filtered into the urine.
What is the nurse's best response about developing diabetes to the patient whose
father has type 1 diabetes mellitus?
a.
"You have a greater susceptibility for development of the disease because of your
family history."
b.
"Your risk is the same as the general population, because there is no genetic risk for
development of type 1 diabetes."
c.
"Type 1 diabetes is inherited in an autosomal dominant pattern. Therefore the risk for
becoming diabetic is 50%."
d.
"Because you are a woman and your father is the parent with diabetes, your risk is not
increased for eventual development of the disease. However, your brothers will become
diabetic." - Answers - ANS: A
Even though type 1 diabetes does not follow a specific genetic pattern of inheritance,
those with one parent with type 1 diabetes are at an increased risk for development of
the disease.
The nurse recognizes which patient as having the greatest risk for undiagnosed
diabetes mellitus?
a.
Young white man
b.
Middle-aged African-American man
c.
Young African-American woman
d.
Middle-aged Native American woman - Answers - ANS: D
The highest incidence of diabetes in the United States occurs in Native Americans. With
age, the incidence of diabetes increases in all races and ethnic groups.
A diabetic patient is brought into the emergency department unresponsive. The arterial
pH is 7.28. Besides the blood pH, which clinical manifestation is seen in uncontrolled
diabetes mellitus and ketoacidosis?
a.
,Decreased hunger sensation
b.
Report of no urine output
c.
Increased respiratory rate
d.
Decreased thirst - Answers - ANS: C
Ketoacidosis decreases the pH of the blood, stimulating the respiratory control area of
the brain to buffer the effects of the increasing acidosis. The rate and depth of
respirations are increased (Kussmaul's respirations) to excrete more acids by
exhalation. Usually polydipsia (increased thirst), polyphagia (increased hunger), and
polyuria (increased urine output) are seen with hyperglycemia and ketoacidosis.
Which of the following would be included in the assessment of a patient with diabetes
mellitus who is experiencing a hypoglycemic reaction? (Select all that apply.)
a.
Tremors
b.
Nervousness
c.
Extreme thirst
d.
Flushed skin
e.
Profuse perspiration
f.
Constricted pupils - Answers - ANS: A, B, E
When hypoglycemia occurs, blood glucose levels fall, resulting in sympathetic nervous
system responses such as tremors, nervousness, and profuse perspiration. Dilated
pupils would also occur, not constricted pupils. Extreme thirst, flushed skin, and
constricted pupils are consistent with hyperglycemia.
A 22-year-old patient is being seen in the clinic with increased secretion of the anterior
pituitary hormones. The nurse would expect the laboratory results to show
a.
increased urinary cortisol.
b.
decreased serum thyroxine.
c.
elevated serum aldosterone levels.
d.
low urinary catecholamines excretion. - Answers - ANS: A
Increased secretion of adrenocorticotropic hormone (ACTH) by the anterior pituitary
gland will lead to an increase in serum and urinary cortisol levels. An increase, rather
than a decrease, in thyroxine level would be expected with increased secretion of
, thyroid stimulating hormone (TSH) by the anterior pituitary. Aldosterone and
catecholamine levels are not controlled by the anterior pituitary.
Which statement by a 50-year-old female patient indicates to the nurse that further
assessment of thyroid function may be necessary?
a.
"I notice my breasts are tender lately."
b.
"I am so thirsty that I drink all day long."
c.
"I get up several times at night to urinate."
d.
"I feel a lump in my throat when I swallow." - Answers - ANS: D
Difficulty in swallowing can occur with a goiter. Nocturia is associated with diseases
such as diabetes mellitus, diabetes insipidus, or chronic kidney disease. Breast
tenderness would occur with excessive gonadal hormone levels. Thirst is a sign of
disease such as diabetes.
A 30-year-old patient seen in the emergency department for severe headache and
acute confusion is found to have a serum sodium level of 118 mEq/L. The nurse will
anticipate the need for which diagnostic test?
a.
Urinary 17-ketosteroids
b.
Antidiuretic hormone level
c.
Growth hormone stimulation test
d.
Adrenocorticotropic hormone level - Answers - ANS: B
Elevated levels of antidiuretic hormone will cause water retention and decrease serum
sodium levels. The other tests would not be helpful in determining possible causes of
the patient's hyponatremia.
Which question will provide the most useful information to a nurse who is interviewing a
patient about a possible thyroid disorder?
a.
"What methods do you use to help cope with stress?"
b.
"Have you experienced any blurring or double vision?"
c.
"Have you had a recent unplanned weight gain or loss?"
d.
"Do you have to get up at night to empty your bladder?" - Answers - ANS: C
Because thyroid function affects metabolic rate, changes in weight may indicate
hyperfunction or hypofunction of the thyroid gland. Nocturia, visual difficulty, and
changes in stress level are associated with other endocrine disorders.
