Chapter 16. Endocrine/Metabolic Problems
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____1.A patient is 66 inches in height, weighing 200 pounds, and newly diagnosed with type 2 diabetes mellitus (DM). Her fasting plasma glucose level is 215 mg/dL. What is the best initial treatment?
a.No treatment at this time
b.Diet and exercise for 6-week trial
c.Diet, exercise, and oral medication
d.Diet, exercise, and exogenous insulin
____2.The clinician suspects that a client seen in the office has hyperthyroidism. Which of the following tests should the clinician order on the initial visit?
a.High sensitivity thyroid-stimulating hormone (TSH) and free T4
b.Free T4 and serum calcium
c.Free T3 and T4
d.TSH and thyroxin antibodies
____3.A patient with type 2 diabetes asks the clinician why she needs to exercise. In order to answer her, the clinician must understand that exercise has what effect on the patient with type 2 diabetes?
a.Reduces postprandial blood glucose
b.Reduces triglycerides and increases high-density lipoprotein (HDL)
c.Reduces total cholesterol
d.All of the above
____4.A patient with type 1 diabetes comes to the clinic complaining of feeling nervous and clammy. He states that he took his insulin this morning but was late for work and did not eat breakfast. Which action should the clinician take first?
a.Check his blood sugar.
b.Have him drink 4 ounces of juice.
c.Call 911.
d.Ask him about his usual eating habits.
____5.A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine. Which of the following conditions that the patient also has would be a contraindication to taking metformin?
a.Ketoacidosis
b.Cirrhosis
c.Hypoglycemic episodes
d.All of the above
____6.A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices a sinus bradycardia; muscular stiffness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes. Which of the following tests should be ordered next?
a.Serum calcium
b.TSH c.Electrolytes
d.Urine specific gravity
____7.The clinician has been doing diabetic teaching for a patient with type 1 diabetes. Which of the following statements by the patient would indicate that teaching has been effective?
a.“As long as I don’t need glasses, I don’t have to worry about going blind.”
b.“I know I need to have my eyes checked every year.”
c.“My optometrist checks my eyes.”
d.“I will see my eye doctor when my vision gets blurry.”
____8.A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of “my feet feel like
they are on fire.” He has a loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left
heel. Which of the following would be an appropriate treatment?
a.Tricyclic antidepressants
b.Capsaicin cream
c.Vitamin B12 injections
d.Insulin
____9.After removing a tack from a type 2 diabetic’s heel and evaluating the site for infection, what is the best plan for this patient?
a.Suggest she use a heating pad to improve circulation.
b.Refer to a podiatrist for a foot care treatment plan.
c.Send her for acupuncture treatments.
d.All of the above
____10.Joyce is seen in the clinic complaining of vague symptoms of nervousness and irritability. She says that her hair will not hold a permanent wave anymore. On physical examination, the clinician finds an irregular heartbeat and brisk reflexes. The differential diagnosis should include which of the following conditions?
a.Myxedema
b.Thyrotoxicosis
c.Cushing’s syndrome
d.Pan-hypopituitarism
____11.The patient is prescribed radioactive iodine (RAI) and asks the clinician how this drug works. The clinician’s response should include which of the following data?
a.RAI prevents the peripheral conversion of T4 to T3.
b.RAI binds free T4.
c.RAI destroys thyroid tissue.
d.RAI reduces freely circulating iodine.
____12.A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram changes should the clinician expect as a manifestation of the disease?
a.Sinus bradycardia
b.Atrial fibrillation
c.Supraventricular tachycardia
d.U waves ____13.After 6 months of Synthroid therapy, the clinician should expect which of the following in the repeat
thyroid studies?
a.Elevated TSH
b.Normal TSH
c.Low TSH
d.Undetectable TSH
____14.Which of the following laboratory findings should the clinician expect in a patient with untreated Graves’ disease?
a.Elevated TSH
b.Elevated T4
c.Elevated thyrotropin-releasing hormone (TRH)
d.All of the above
____15.The clinician prescribes glipizide (Glucotrol) for a diabetic patient. Which statement made by the patient would indicate that your teaching has been effective?
a.“I’ll take my pill at least 30 minutes before breakfast.”
b.“I’ll take my Glucotrol before bedtime.”
c.“It is important to take my medication right after I eat.”
d.“Since I only like to eat two meals a day, I can take the pill between my meals.”
____16.A diabetic patient asks the clinician why he needs to check his blood sugar at home even when he feels good. Which of the following responses would be most appropriate?
a.“Control of glucose will help postpone or delay complications.”
b.“Regularly checking blood sugar will help establish a routine.”
c.“Monitoring glucose will promote a sense of control.”
d.All of the above
____17.How often should the clinician examine the feet of a person with diabetes?
a.Once a year
b.Every 6 months
c.Every 3 months
d.Every visit
____18.The clinician sees a patient who is 5 feet tall and weighs 150 pounds. How would the clinician classify this patient?
a.Overweight
b.Mild obesity
c.Moderate obesity
d.Morbid obesity
____19.Mr. S presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe. The clinician suspects acute gout. Which of the following should the clinician expect in the initial test results for this patient?
a.Elevated uric acid level
b.Elevated blood urea nitrogen
c.Decreased urine pH
d.Decreased C-reactive protein
Multiple Choice
Identify the choice that best completes the statement or answers the question.
____1.A patient is 66 inches in height, weighing 200 pounds, and newly diagnosed with type 2 diabetes mellitus (DM). Her fasting plasma glucose level is 215 mg/dL. What is the best initial treatment?
a.No treatment at this time
b.Diet and exercise for 6-week trial
c.Diet, exercise, and oral medication
d.Diet, exercise, and exogenous insulin
____2.The clinician suspects that a client seen in the office has hyperthyroidism. Which of the following tests should the clinician order on the initial visit?
a.High sensitivity thyroid-stimulating hormone (TSH) and free T4
b.Free T4 and serum calcium
c.Free T3 and T4
d.TSH and thyroxin antibodies
____3.A patient with type 2 diabetes asks the clinician why she needs to exercise. In order to answer her, the clinician must understand that exercise has what effect on the patient with type 2 diabetes?
a.Reduces postprandial blood glucose
b.Reduces triglycerides and increases high-density lipoprotein (HDL)
c.Reduces total cholesterol
d.All of the above
____4.A patient with type 1 diabetes comes to the clinic complaining of feeling nervous and clammy. He states that he took his insulin this morning but was late for work and did not eat breakfast. Which action should the clinician take first?
a.Check his blood sugar.
b.Have him drink 4 ounces of juice.
c.Call 911.
d.Ask him about his usual eating habits.
____5.A patient with type 2 diabetes comes to the clinic after reading about metformin in a magazine. Which of the following conditions that the patient also has would be a contraindication to taking metformin?
a.Ketoacidosis
b.Cirrhosis
c.Hypoglycemic episodes
d.All of the above
____6.A 25-year-old patient presents to the clinic with fatigue, cold intolerance, weight gain, and constipation for the past 3 months. On physical examination, the clinician notices a sinus bradycardia; muscular stiffness; coarse, dry hair; and a delay in relaxation in deep tendon reflexes. Which of the following tests should be ordered next?
a.Serum calcium
b.TSH c.Electrolytes
d.Urine specific gravity
____7.The clinician has been doing diabetic teaching for a patient with type 1 diabetes. Which of the following statements by the patient would indicate that teaching has been effective?
a.“As long as I don’t need glasses, I don’t have to worry about going blind.”
b.“I know I need to have my eyes checked every year.”
c.“My optometrist checks my eyes.”
d.“I will see my eye doctor when my vision gets blurry.”
____8.A 64-year-old man with type 2 diabetes presents to the clinic with the complaint of “my feet feel like
they are on fire.” He has a loss of vibratory sense, +1 Achilles reflex, and a tack embedded in his left
heel. Which of the following would be an appropriate treatment?
a.Tricyclic antidepressants
b.Capsaicin cream
c.Vitamin B12 injections
d.Insulin
____9.After removing a tack from a type 2 diabetic’s heel and evaluating the site for infection, what is the best plan for this patient?
a.Suggest she use a heating pad to improve circulation.
b.Refer to a podiatrist for a foot care treatment plan.
c.Send her for acupuncture treatments.
d.All of the above
____10.Joyce is seen in the clinic complaining of vague symptoms of nervousness and irritability. She says that her hair will not hold a permanent wave anymore. On physical examination, the clinician finds an irregular heartbeat and brisk reflexes. The differential diagnosis should include which of the following conditions?
a.Myxedema
b.Thyrotoxicosis
c.Cushing’s syndrome
d.Pan-hypopituitarism
____11.The patient is prescribed radioactive iodine (RAI) and asks the clinician how this drug works. The clinician’s response should include which of the following data?
a.RAI prevents the peripheral conversion of T4 to T3.
b.RAI binds free T4.
c.RAI destroys thyroid tissue.
d.RAI reduces freely circulating iodine.
____12.A patient is diagnosed with hypothyroidism. Which of the following electrocardiogram changes should the clinician expect as a manifestation of the disease?
a.Sinus bradycardia
b.Atrial fibrillation
c.Supraventricular tachycardia
d.U waves ____13.After 6 months of Synthroid therapy, the clinician should expect which of the following in the repeat
thyroid studies?
a.Elevated TSH
b.Normal TSH
c.Low TSH
d.Undetectable TSH
____14.Which of the following laboratory findings should the clinician expect in a patient with untreated Graves’ disease?
a.Elevated TSH
b.Elevated T4
c.Elevated thyrotropin-releasing hormone (TRH)
d.All of the above
____15.The clinician prescribes glipizide (Glucotrol) for a diabetic patient. Which statement made by the patient would indicate that your teaching has been effective?
a.“I’ll take my pill at least 30 minutes before breakfast.”
b.“I’ll take my Glucotrol before bedtime.”
c.“It is important to take my medication right after I eat.”
d.“Since I only like to eat two meals a day, I can take the pill between my meals.”
____16.A diabetic patient asks the clinician why he needs to check his blood sugar at home even when he feels good. Which of the following responses would be most appropriate?
a.“Control of glucose will help postpone or delay complications.”
b.“Regularly checking blood sugar will help establish a routine.”
c.“Monitoring glucose will promote a sense of control.”
d.All of the above
____17.How often should the clinician examine the feet of a person with diabetes?
a.Once a year
b.Every 6 months
c.Every 3 months
d.Every visit
____18.The clinician sees a patient who is 5 feet tall and weighs 150 pounds. How would the clinician classify this patient?
a.Overweight
b.Mild obesity
c.Moderate obesity
d.Morbid obesity
____19.Mr. S presents in the clinic with pain, tenderness, erythema, and swelling of his left great toe. The clinician suspects acute gout. Which of the following should the clinician expect in the initial test results for this patient?
a.Elevated uric acid level
b.Elevated blood urea nitrogen
c.Decreased urine pH
d.Decreased C-reactive protein
