Chapter 17: Metabolic Disorders My Nursing Test Banks

Chapter 17: Metabolic Disorders

Test Bank

MULTIPLE CHOICE

1. Which of the following statements is true about diabetes mellitus?

a.

Type 2 diabetes is the result of the failure of the pancreas to produce insulin.

b.

Diabetes is diagnosed after two fasting plasma glucose readings over 125 mg/dl.

c.

Noninsulin-dependent diabetes mellitus is another name for type 1 diabetes.

d.

The incidence of diabetes mellitus does not increase with age.

ANS: B

A fasting plasma glucose reading of over 125 mg/dl is considered diabetes, whereas a level between 110 mg/dl and 125 mg/dl is considered to be impaired fasting glucose (IFG). Type 2 diabetes is present when insulin is produced but does not lower the blood glucose level. Type 1 diabetes was formerly called insulin-dependent diabetes mellitus, whereas type 2 diabetes was formerly called noninsulin-dependent diabetes mellitus. In the United States, approximately 8.7% of all adults have diabetes, whereas 18.3% of persons older than 60 years have diabetes.

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TOP: Nursing Process: Assessment MSC: Physiological Integrity

2. Which laboratory results are goals for reducing a persons risk for diabetes and heart disease?

a.

Triglycerides over 150 mg/dl

b.

Cholesterol 250 mg/dl

c.

High-density lipoprotein (HDL) over 40 mg/d

d.

Fasting blood glucose under 150 mg/dl

ANS: C

To reduce the risk for diabetes and heart disease, the serum triglycerides value should be under 150 mg/dl. The cholesterol value should be under 200 mg/dl to reduce the risk for heart disease and diabetes. The HDL level should be over 40 mg/dl to reduce the risk for heart disease and diabetes. Fasting blood glucose value should be under 126 mg/dl.

PTS: 1 DIF: Remember REF: 4-14 TOP: Nursing Process: Planning

MSC: Physiological Integrity

3. When teaching a patient about foods that do not increase blood glucose, which should the nurse include?

a.

White bread

c.

Broccoli

b.

Baked beans

d.

Corn

ANS: C

Broccoli does not raise blood glucose levels. White bread quickly breaks down to glucose and therefore tends to cause a rapid, brief rise in the blood sugar level. Whole grains provide a more sustained release of glucose and are a better source of carbohydrates. The blood glucose level increases after eating baked beans, but the rise will occur more slowly, reaching a lower level of hyperglycemia and remaining for a longer period. Corn is a starchy vegetable and will raise the blood glucose level almost as much as sugar itself.

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TOP: Nursing Process: Assessment MSC: Physiological Integrity

4. Which of the following statements is true about medications taken by individuals with diabetes mellitus?

a.

Sitagliptin (Januvia) is indicated to treat type 1 diabetes mellitus.

b.

Nateglinide (Starlix) increases the secretion of insulin.

c.

Metformin (Glucophage) increases the secretion of insulin.

d.

Rosiglitazone (Avandia) decreases glucose absorption.

ANS: B

Meglitinides, such as nateglinide (Starlix), act by helping the pancreas release insulin. The use of sitagliptin (Januvia), a dipeptidyl-peptidase-4 inhibitor, is indicated for type 2 diabetes mellitus and acts by improving glucose-dependent insulin synthesis, lowering glucagon secretion and slowing gastric emptying. Metformin (Glucophage) acts by decreasing the release of glucose from the liver. Thiazolidinediones, such as rosiglitazone (Avandia), act by enhancing insulin sensitivity with hepatic glucose metabolism and by enhancing insulin-receptor kinase activity and phosphorylation.

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TOP: Nursing Process: Assessment MSC: Physiological Integrity

5. An older man with diabetes mellitus complains to the nurse that his feet feel like they are burning. Which of the following interventions should the nurse recommend to this older adult to reduce his discomfort?

a.

Wear well-fitting, leather shoes

b.

Wear knee-high nylon stockings

c.

Soak the feet in warm water

d.

Apply antifungal powder on the feet

ANS: A

The older adult is potentially experiencing a peripheral neuropathy from peripheral nerve damage from hyperglycemia. To prevent trauma to the feet, the nurse instructs him to wear comfortable, well-fitting, tie-on shoes with a broad toe space and low heels for protection. Nylon stockings for men tend to have restrictive ends that can inhibit tissue perfusion; because this patient is at risk for peripheral tissue damage, the constricted area can break down. The nurse also instructs him to avoid sitting with one leg crossed over the other or with both legs crossed at the knee; these positions restrict blood flow to the feet. Foot soaks can potentially cause excessive dryness. To maintain skin integrity, feet should be washed daily but not soaked. Irritating chemicals such as antifungal powder and corn or wart preparations should not be used on the feet of individuals with diabetes.

PTS: 1 DIF: Apply REF: 4-14 TOP: Teaching/Learning

MSC: Physiological Integrity

6. An older woman who has diabetes mellitus takes glipizide (Glucotrol) and tells the nurse that her blood sugar levels have been higher than normal since she began using a vaginal cream for hot flashes. Which one of the following interventions is the best for the nurse to implement?

a.

Ask the patient if she has had a fever or infection recently.

b.

Verify the expiration date of the medication.

c.

Review her diet for increased carbohydrates.

d.

Ascertain whether the vaginal cream contains estrogen.

ANS: D

Vaginal cream prescribed for hot flashes potentially contains estrogen as an active ingredient; estrogen is effective therapy to reduce hot flashes. Unfortunately, estrogen impairs the hypoglycemic effect of sulfonylurea hypoglycemic medications. If the estrogen therapy continues, then the nurse should assist this individual in adjusting her diet and exercise regimen in coordination with her antidiabetic medication to maintain stable blood sugar levels. Asking whether she has had a fever or infection recently is a reasonable question because infection increases the blood sugar of an individual with diabetes mellitus; however, because the hyperglycemia is associated with the vaginal cream, the most likely contributor to the problem is the vaginal cream, which is a good place to start the investigation. Verifying the expiration date of the medication is a reasonable task to implement; however, ineffective medication would not have the desired hypoglycemic effect. Reviewing her diet for increased carbohydrates is a reasonable task to implement because a glucose load will increase blood sugar levels.

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TOP: Nursing Process: Implementation MSC: Physiological Integrity

7. The older adult who has type 2 diabetes mellitus has a sensory impairment and unstable blood sugar levels. Which of the following alterations in sensory function does the nurse address in the plan of care for stabilizing the blood sugar?

a.

Requires reading glasses at 2.0 strength.

b.

Has difficulty hearing in crowded rooms.

c.

Enjoys spicy food more than bland food.

d.

Awakens with periodic left-foot numbness.

ANS: B

The nurse focuses on the hearing impairment to plan care for stabilizing this patients blood glucose level; hearing impairment is a factor that affects blood glucose control in older adults with diabetes mellitus. Reading glasses at 2.0 are medium-strength glasses, and the need for such glasses is common and not considered a visual impairment. A preference for spicy food does not indicate an impaired sense of taste. Although numbness is a sensory impairment, episodic numbness associated with sleeping is more likely to be due to a poorly positioned extremity.

PTS: 1 DIF: Apply REF: 23 Box 17-3 TOP: Nursing Process: Planning

MSC: Physiological Integrity

8. An older man comes to a primary care setting, and his reason for seeking health care is to get a prescription for sildenafil (Viagra). Which of the following laboratory reports can help explain why this individual needs sildenafil?

a.

Serum potassium 4.5 mEq/L

b.

Prothrombin time 13 seconds

c.

Alanine transferase (ALT) 50 units/L

d.

Glycosylated hemoglobin (Hgb A1c) over 8%

ANS: D

The Hgb A1c is an indicator of serum glucose control over the last 90 days. A Hgb A1c level over 8% indicates that this older adult had poor glucose control in that time frame. As a reliable indicator of hyperglycemia, it can indicate the reason this man experiences erectile dysfunction; hyperglycemia is associated with peripheral arterial disease. An erection occurs as the penile shaft becomes engorged with blood. This process can be impaired if the vessels are damaged from hyperglycemia because hyperglycemia damages the lining of blood vessels and leads to progressive occlusion of the damaged vessels. Many of the vessels involved in causing an erection are fine vessels and are among the first vessels occluded in arterial disease. The potassium level, the prothrombin time, and the ALT are all within normal limits.

PTS:1DIF:UnderstandREF:4-14

TOP: Nursing Process: Assessment MSC: Physiological Integrity

9. Which is the most important medication the nurse administers to a patient with diabetes mellitus to attenuate a metabolic disorder that is closely associated with diabetes mellitus and that accelerates the disease processes are associated with diabetes mellitus?

a.

Atorvastatin (Lipitor)

c.

Calcium citrate (Citracal)

b.

Colchicine (Colsalide)

d.

Aluminum hydroxide (Amphojel)

ANS: A

Hyperlipidemia is a metabolic disorder closely associated with diabetes mellitus, and it can be effectively treated with antilipid agents such as atorvastatin (Lipitor), exercise, and diet. Hyperlipidemia is associated with atherosclerosis. Colchicine (Colsalide) is prophylactic therapy for hyperuricemia, or gout, which is not commonly associated with diabetes mellitus; however, it is associated with coronary artery disease. Calcium citrate (Citracal) is used to treat osteoporosis and hypoparathyroidism and metabolic disorders of the bone and of the parathyroid gland; these metabolic disorders are not commonly associated with diabetes mellitus. Aluminum hydroxide (Amphojel) is given to bind with magnesium in chronic renal failure when the patient has hypermagnesemia.

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TOP: Nursing Process: Assessment MSC: Physiological Integrity

10. Which co-morbidity commonly associated with type 2 diabetes mellitus enhances the development of the microvascular complications of diabetes mellitus?

a.

Hyperlipidemia

c.

Venous insufficiency

b.

Hypothyroidism

d.

Chronic constipation

ANS: A

Hyperlipidemia, a condition commonly associated with type 2 diabetes mellitus, accelerates the development of microvascular complications of diabetes mellitus because high serum, low-density lipoproteins contribute to the formation of atherosclerotic plaque. The plaque first accumulates in the smallest arteries, causing complications of diabetes mellitus including peripheral arterial disease, retinopathy, and nephropathy. Hypothyroidism, venous insufficiency, and chronic constipation are not associated with type 2 diabetes mellitus.

PTS:1DIF:UnderstandREF:24 Box 17-4

TOP: Nursing Process: Assessment MSC: Physiological Integrity

11. The nurse assists an older man who has type 2 diabetes mellitus to improve his glucose control. Which of the following instructions does the nurse give to this individual when he plans to walk more than usual in one day?

a.

Omit antidiabetic medication.

c.

Supplement caloric intake.

b.

Wear sturdy open-toed shoes.

d.

Prepare to administer insulin.

ANS: C

Diabetes mellitus is controlled by balancing exercise, calories, and hypoglycemic medication; if one element of therapy is altered, then one or both of the remaining elements must be adjusted. When the patients activity is going to metabolize more calories, the medication has to be reduced or the calories have to increase. For a patient with type 2 diabetes mellitus, adjusting the medication can be difficult; therefore the nurse instructs this older adult to supplement his caloric intake, which can be accomplished by eating snacks during the walk or by increasing the glycemic load before walking. The patient ensures glucose control during these activities by testing his blood sugar levels. The nurse cannot tell the patient to omit medication because doing so is not within a nurses scope of practice. The nurse instructs the older adult to wear closed, well-fitting leather shoes to protect the feet from trauma. Although many individuals with type 2 diabetes mellitus periodically take insulin, insulin is administered to induce hypoglycemia. Because the individual plans to walk more than usual, more calories are needed to prevent hypoglycemia.

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TOP: Nursing Process: Implementation MSC: Physiological Integrity

12. Which is the best goal when planning nursing care for an older patient with diabetes mellitus?

a.

Stabilize the serum glucose.

c.

Set walking distance goals.

b.

Prevent disease progression.

d.

Plan for consistent exercise.

ANS: B

The most important goal for planning nursing care for a patient with diabetes mellitus is to prevent disease progression. Stabilizing the serum glucose, managing hyperlipidemia, controlling the blood pressure, preventing infection, maintaining a normal weight (if applicable), and obtaining regular medical evaluation will accomplish this goal. Stabilizing the serum glucose is a part of preventing disease progression. Setting goals for walking is part of a consistent walking regimen. Planning for consistent exercise is part of stabilizing the serum glucose.

PTS: 1 DIF: Understand REF: 4-14 TOP: Nursing Process: Planning

MSC: Physiological Integrity

13. An older man who is a non-Hispanic Caucasian has a fasting blood sugar level above 130 mg/dl. Which patient assessment does the nurse use to confirm a high risk for diabetes mellitus in this man?

a.

68 years of age

c.

Palpable peripheral pulses

b.

120/80 mm Hg

d.

Total cholesterol 198 mg/dl

ANS: A

Diabetes is significantly more prevalent among older Americans. This mans blood pressure is normal. Palpable peripheral pulses are a normal finding. A total cholesterol level below 200 mg/dl is normal and highly desirable for a man at risk for diabetes.

PTS: 1 DIF: Apply REF: 4-14 TOP: Nursing Process: Diagnosis

MSC: Physiological Integrity

MULTIPLE RESPONSE

1. The nurse teaches an older adult who has diabetes mellitus and takes metoprolol (Lopressor) to recognize clinical indicators of hypoglycemia. Which clinical indicators of hypoglycemia does the nurse include in patient teaching as the indicators this man is most likely to detect? (Select all that apply.)

a.

Shaking

b.

Dizziness

c.

Weakness

d.

Diaphoresis

e.

Tachycardia

f.

Impaired vision

ANS: B, C, F

Dizziness is a clinical indicator of moderate hypoglycemia. It is unlikely to be masked by the effects of metoprolol, a beta-adrenergic blocker, because beta-blockers effectively mask the early signs of hypoglycemia. Weakness is a clinical indicator of moderate hypoglycemia and is unlikely to be masked by the effects of metoprolol. Impaired vision is a clinical indicator of moderate hypoglycemia and is unlikely to be masked by the effects of metoprolol. Shaking is an early clinical indicator of hypoglycemia and likely to be masked by the action of a beta-adrenergic blocker such as metoprolol; beta-blockers oppose the surge of epinephrine in early hypoglycemia. Diaphoresis is an early clinical indicator of hypoglycemia, and it is likely to be masked by the action of a beta-adrenergic blocker such as metoprolol. Increased heart rate is an early clinical indicator of hypoglycemia and is likely to be masked by the action of a beta-adrenergic blocker such as metoprolol.

PTS: 1 DIF: Apply REF: 4-14 TOP: Teaching/Learning

MSC: Physiological Integrity

2. Which ethnic groups in the United States have higher rates of diabetes mellitus than non-Hispanic white people? (Select all that apply.)

a.

Pima Indians

b.

Alaskan Natives

c.

Cuban Americans

d.

Native Americans

e.

African Americans

f.

Mexican Americans

ANS: A, B, D, E, F

Pima Indians who live in southwestern United States have the highest incidence of diabetes mellitus in the world. Alaskan Natives have an incidence of diabetes mellitus of 14.2%. Native Americans have diabetes at a rate of 6% to 29.3%. African Americans are 1.8 times more likely to have diabetes mellitus. Mexican Americans have the highest incidence of diabetes mellitus in the United States. The rate of diabetes mellitus for non-Hispanic whites in the United States was 6.6% in 2007. Cuban Americans have the lowest rates of diabetes mellitus.

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TOP: Nursing Process: Assessment MSC: Physiological Integrity

3. The nurse recognizes which of the following signs and symptoms as an indication of hypothyroidism? (Select all that apply.)

a.

Decline in cognitive function

b.

Decrease in functional status

c.

Decrease in thyroid-stimulating hormone (TSH) and thyroxine (T4)

d.

Heat intolerance

ANS: A, B, D

A decline in cognitive function, functional status, and heat intolerance are all indicative of hypothyroidism. An elevated TSH and decrease in T4 indicates hypothyroidism.

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TOP: Nursing Process: Assessment MSC: Physiological Integrity

4. The nurse is caring for a patient diagnosed with hyperthyroidism. Which signs and symptoms indicate hyperthyroidism? (Select all that apply.)

a.

Atrial fibrillation

c.

Constipation

b.

Heart failure

d.

Heat intolerance

ANS: A, B, C

Compared with hypothyroidism, the onset of hyperthyroidism may be quite sudden. The signs and symptoms in the older adult include unexplained atrial fibrillation, heart failure, constipation, anorexia, muscle weakness, and other vague complaints. Symptoms of heart failure or angina may cloud the clinical presentation and prevent the correct diagnosis. The person may be misdiagnosed as being depressed or having dementia. On examination, the person is likely to have tachycardia, tremors, and weight loss. Heat intolerance is attributed to hyperthyroidism.

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TOP: Nursing Process: Assessment MSC: Physiological Integrity

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