Chapter 19 My Nursing Test Banks

Tabloski Gerontological Nursing, 3/e
Chapter 19

Question 1

Type: MCSA

While reviewing laboratory results for an older patient the nurse notes that the glycosylated hemoglobin (HbA1c) result is 6.0%. What does this finding indicate to the nurse?

1. The patient needs a referral to a dietician.

2. The patient needs additional testing for anemia.

3. The patient has undiagnosed type 2 diabetes mellitus.

4. The patients average blood glucose level was 120 over the past 3 months.

Correct Answer: 4

Rationale 1: There is no need for a referral to a dietician for this laboratory value.
Reference: Page 522

Rationale 2: Glycosylated hemoglobin is not used to test for anemia.
Reference: Page 522

Rationale 3: Glycosylated hemoglobin is not used to diagnose type 2 diabetes mellitus.
Reference: Page 522

Rationale 4: Glycosylated hemoglobin estimates a patients blood glucose over the past 3 months by measuring how much glucose is attached to the hemoglobin in red blood cells, which have an average life span of about 4 months. An HbA1c of 6 relates to an average glucose level of 120. Ideally, the glycosylated hemoglobin should be less than 7.0%.
Reference: Page 522

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Understand unique presentations of diabetes and thyroid problems in the older person.

Question 2

Type: MCMA

The nurse is planning interventions to achieve the goal of maintaining glycemic control for an older patient with type 2 diabetes mellitus. Which interventions will the nurse include in this patients plan of care?

Standard Text: Select all that apply.

1. Teach to prevent hypoglycemia.

2. Emphasize the role of physical exercise.

3. Review the manifestations of complications.

4. Stress the importance of avoiding carbohydrates.

5. Instruct in self-monitoring of blood glucose levels.

Correct Answer: 1,2,3,5

Rationale 1: The goals of managing diabetes mellitus in the older patient include achieving glycemic control through recognition, treatment, and prevention of hypoglycemia.
Reference: Page 524

Rationale 2: The goals of managing diabetes mellitus in the older patient include achieving glycemic control through regular physical activity.
Reference: Page 524

Rationale 3: The goals of managing diabetes mellitus in the older patient include achieving glycemic control through prevention, early detection, and treatment of chronic complications.
Reference: Page 524

Rationale 4: The goals of managing diabetes mellitus in the older patient do not include the achievement of glycemic control through restricting the intake of carbohydrates.
Reference: Page 524

Rationale 5: The goals of managing diabetes mellitus in the older patient include achieving glycemic control through self-management techniques such as self-monitoring of blood glucose levels.
Reference: Page 524

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5. Apply appropriate nursing interventions directed toward assisting older adults with endocrine problems to develop self-care abilities.

Question 3

Type: MCSA

Why should the nurse counsel an older patient with a history of occasional high blood glucose levels to stop smoking?

1. To prevent insulin resistance

2. To prevent the loss of additional weight

3. To reduce the risk of developing type 2 diabetes mellitus

4. To ensure that blood glucose levels will remain within normal limits

Correct Answer: 3

Rationale 1: Smoking does not cause insulin resistance. Smoking is one of five lifestyle factors that will reduce the risk of developing type 2 diabetes mellitus.
Reference: Page 519

Rationale 2: Smoking cessation is not encouraged to prevent the loss of additional weight. Many smoke to lose weight.
Reference: Page 519

Rationale 3: Smoking is one of five lifestyle factors that will reduce the risk of developing type 2 diabetes mellitus.
Reference: Page 519

Rationale 4: Smoking does not influence blood glucose levels. It is one of five lifestyle factors that will reduce the risk of developing type 2 diabetes mellitus.
Reference: Page 519

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Identify risk factors to health for the older person with an endocrine problem.

Question 4

Type: MCSA

The healthcare provider has decided to not treat an older patient with type 2 diabetes mellitus aggressively. What would be a risk of aggressively treating this patient?

1. Decreased vision acuity

2. Hypoglycemic episodes

3. Frequent skin infections

4. Development of foot ulcers

Correct Answer: 2

Rationale 1: Decreased vision acuity would not be a risk of treating a patient with type 2 diabetes mellitus aggressively.
Reference: Page 525

Rationale 2: Aggressive glycemic control increases the risk of hypoglycemic episodes. Older people who live alone, those with cognitive or physical deficits, or those with serious underlying chronic illnesses are more likely to suffer serious consequences from hypoglycemic episodes.
Reference: Page 525

Rationale 3: Aggressively treating type 2 diabetes mellitus will not predispose the older patient to develop frequent skin infections. Frequent skin infections could occur with blood glucose levels that are excessively elevated.
Reference: Page 525

Rationale 4: Aggressively treating type 2 diabetes mellitus will not predispose the older patient to develop foot ulcers. Foot ulcers could occur with blood glucose levels that are excessively elevated.
Reference: Page 525

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3. Identify risk factors to health for the older person with an endocrine problem.

Question 5

Type: MCSA

While conducting a health interview the nurse suspects an older patient might be experiencing diabetes. What comment did the patient make that could indicate this diagnosis?

1. I sometimes have muscle aches in my upper legs at night.

2. I feel a bit tired by midafternoon and take a 30-minute nap most days.

3. Ive been experiencing blurred vision frequently during the past month.

4. Im slightly winded when I walk up a flight of stairs but it passes quickly.

Correct Answer: 3

Rationale 1: Having some muscle aches at night may be within the normal functioning of a healthy older patient.
Reference: Page 521

Rationale 2: Fatigue that responds to a short nap may be within the normal functioning of a healthy older patient.
Reference: Page 521

Rationale 3: Blurred vision can be associated with high glucose levels and may be a symptom of undiagnosed diabetes mellitus.
Reference: Page 521

Rationale 4: Being slightly short of breath after walking up a flight of stairs with a quick recovery may be within the normal functioning of a healthy older patient.
Reference: Page 521

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Understand unique presentations of diabetes and thyroid problems in the older person.

Question 6

Type: MCSA

Which dietary guideline would be the most important for the nurse to instruct a patient with diabetes mellitus?

1. Include foods rich in calcium at every meal.

2. Eliminate as much fat from the diet as possible.

3. Eat at regular times including meals and snacks.

4. Ingest the majority of daily caloric intake in the morning meal.

Correct Answer: 3

Rationale 1: Eating foods rich in calcium are generally healthy but are not related to blood glucose control.
Reference: Page 527

Rationale 2: Fats should not be eliminated but limited to less than 30% of the total caloric intake.
Reference: Page 527

Rationale 3: The patient with diabetes should be encouraged to eat meals and snacks at regular times throughout the day. This consistent food intake is a strategy to maintain the blood glucose levels near normal most of the time.
Reference: Page 527

Rationale 4: The caloric intake should be spread throughout the day. Patients who are planning to be physically active for a set period of time may want to increase their caloric intake prior to the activity to maintain proper glucose levels.
Reference: Page 527

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Apply appropriate nursing interventions directed toward assisting older adults with endocrine problems to develop self-care abilities.

Question 7

Type: MCMA

An older male patient with type 2 diabetes mellitus wants to know if he can have an alcoholic drink. What information should the nurse provide about alcohol intake with diabetes?

Standard Text: Select all that apply.

1. Ingest alcohol with food.

2. Alcohol can interact with diabetes medications.

3. Consider calories from alcohol as being fat calories.

4. Limit consumption to no more than two drinks per day.

5. Take alcohol with carbohydrates because it enhances digestion.

Correct Answer: 1,2,3,4

Rationale 1: Alcohol must be consumed with food to prevent hypoglycemia.
Reference: Page 527

Rationale 2: Alcohol can interact with diabetic medications.
Reference: Page 527

Rationale 3: Alcohol must be calculated as part of the total caloric intake and are best substituted for fat calories.
Reference: Page 527

Rationale 4: It is recommended that older adults with diabetes mellitus consume no more than two drinks per day for men.
Reference: Page 527

Rationale 5: Alcohol should be consumed with food, however taking it with carbohydrates does not enhance digestion.
Reference: Page 527

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Apply appropriate nursing interventions directed toward assisting older adults with endocrine problems to develop self-care abilities.

Question 8

Type: MCMA

The healthcare provider suggests that an older patient with type 2 diabetes mellitus begin a walking program. What should the nurse include when teaching the patient about this program?

Standard Text: Select all that apply.

1. Dress in layers.

2. Wear shoes with thick flexible soles.

3. Walk at least three to five times a week.

4. Walk alone to concentrate on the activity.

5. Perform warm-up exercises before walking.

Correct Answer: 1,2,3,5

Rationale 1: The nurse should instruct the patient to wear clothes that are dry and comfortable and dress in layers to prevent overheating.
Reference: Pages 529-530

Rationale 2: The nurse should instruct the patient to wear shoes with thick, flexible soles to cushion each step and absorb shock.
Reference: Pages 529-530

Rationale 3: The nurse should instruct the patient to walk at least three to five times per week.
Reference: Pages 529-530

Rationale 4: The nurse should instruct the patient to choose a safe place to walk and find a partner or exercise group at the same fitness level with whom to exercise.
Reference: Pages 529-530

Rationale 5: The nurse should instruct the patient to engage in warm-up exercises before walking.
Reference: Pages 529-530

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Apply appropriate nursing interventions directed toward assisting older adults with endocrine problems to develop self-care abilities.

Question 9

Type: MCSA

The nurse is reviewing the health history for an older patient newly diagnosed with type 2 diabetes mellitus. For which health problem would the medication metformin be contraindicated?

1. Heart failure

2. Hypertension

3. Osteoarthritis

4. Renal insufficiency

Correct Answer: 4

Rationale 1: Metformin should not be used by older adults with renal insufficiency. It can be taken by older adults with heart failure.
Reference: Page 532

Rationale 2: Metformin should not be used by older adults with renal insufficiency. It can be taken by older adults with hypertension.
Reference: Page 532

Rationale 3: Metformin should not be used by older adults with renal insufficiency. It can be taken by older adults with osteoarthritis.
Reference: Page 532

Rationale 4: Metformin should not be used by older adults with renal insufficiency.
Reference: Page 532

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Identify and implement appropriate nursing interventions to care for the older person with endocrine problems.

Question 10

Type: MCSA

An older patient diagnosed with type 2 diabetes mellitus has been prescribed insulin with different onsets and durations of action. Why would this type of insulin be prescribed for this patient?

1. It simplifies the dosing.

2. It can be refrigerated when not in use.

3. It can be injected into the thigh muscle.

4. It reduces the incidence of complications.

Correct Answer: 1

Rationale 1: Mixtures of insulin preparations with different onsets and durations of action are often given in a single injection to simplify the dosing.
Reference: Page 533

Rationale 2: Mixtures of insulin preparations with different onsets and durations of action are often given in a single injection to simplify the dosing. This type of insulin is not prescribed because it can be refrigerated when not in use.
Reference: Page 533

Rationale 3: Mixtures of insulin preparations with different onsets and durations of action are often given in a single injection to simplify the dosing. Insulin is injected into subcutaneous tissue.
Reference: Page 533

Rationale 4: Mixtures of insulin preparations with different onsets and durations of action are often given in a single injection to simplify the dosing. This type of insulin does not reduce the incidence of complications.
Reference: Page 533

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Identify and implement appropriate nursing interventions to care for the older person with endocrine problems.

Question 11

Type: MCMA

During a home visit an older patient demonstrates signs of hypoglycemia. For which situations should the nurse assess the patient?

Standard Text: Select all that apply.

1. An illness

2. Lack of sleep

3. Missing a meal

4. Unplanned exercise

5. Too much medication

Correct Answer: 1,3,4,5

Rationale 1: Hypoglycemia can be caused by the onset of an illness that alters the patients metabolic needs.
Reference: Page 535

Rationale 2: Hypoglycemia is not known to be caused by a lack of sleep.
Reference: Page 535

Rationale 3: Hypoglycemia can be caused by missing a meal.
Reference: Page 535

Rationale 4: Hypoglycemia can be caused by unplanned exercise.
Reference: Page 535

Rationale 5: Hypoglycemia can be caused by taking too much medication.
Reference: Page 535

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6. Identify and implement appropriate nursing interventions to care for the older person with endocrine problems.

Question 12

Type: MCMA

After completing a health history the nurse realizes that an older patient is at risk for developing hypothyroidism. What data did the nurse collect during the health history?

Standard Text: Select all that apply.

1. Prescribed furosemide (Lasix) for hypertension

2. Treatment for a non-thyroid autoimmune disease

3. Previous treatment of neck cancer with external radiation

4. Taking over-the-counter acetaminophen (Tylenol) for arthritis pain

5. Five year history of type 2 diabetes mellitus that is controlled by diet

Correct Answer: 1,2,3

Rationale 1: Risk factors for the development of hypothyroidism include certain medications such as furosemide (Lasix).
Reference: Page 542

Rationale 2: Risk factors for the development of hypothyroidism include the diagnosis of non-thyroid autoimmune disease.
Reference: Page 542

Rationale 3: Risk factors for the development of hypothyroidism include treatment of neck cancer with external radiation.
Reference: Page 542

Rationale 4: Over-the-counter acetaminophen (Tylenol) does not increase the patients risk for developing hypothyroidism.
Reference: Page 542

Rationale 5: The diagnosis of type 2 diabetes mellitus that is diet controlled does not increase the patients risk for developing hypothyroidism.
Reference: Page 542

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Identify risk factors to health for the older person with an endocrine problem.

Question 13

Type: MCSA

An older patient is prescribed the preferred treatment for hyperthyroidism. About which treatment will the nurse instruct the patient?

1. Partial thyroidectomy

2. Ingestion of radioactive sodium iodine 131I

3. Combination treatment with Synthroid and amiodarone

4. Large doses of propylthiouracil (PTU) and intravenous propranolol

Correct Answer: 2

Rationale 1: Surgical removal is reserved for patients with symptoms too severe for treatment with radioactive iodine or nodules suspicious for malignancy.
Reference: Page 546

Rationale 2: The treatment of choice is ingestion of the radioactive iodine, which is picked up by the thyroid tissue and then destroys the tissue. This treatment avoids surgery, anesthesia, and hospitalization.
Reference: Page 546

Rationale 3: Treatment with Synthroid would worsen symptoms, and amiodarone is an antiarrhythmic drug that has induced hyperthyroidism in some patients.
Reference: Page 546

Rationale 4: Large doses of propylthiouracil (PTU) and intravenous propranolol are used to treat thyroid storm and not hyperthyroidism.
Reference: Page 546

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6. Identify and implement appropriate nursing interventions to care for the older person with endocrine problems.

Question 14

Type: MCSA

For which complication of diabetes mellitus would the nurse use a monofilament test to determine a patients risk?

1. Retinopathy

2. Ulcer of the foot

3. Diabetic ketoacidosis

4. Arterial insufficiency of the lower extremities

Correct Answer: 2

Rationale 1: Retinopathy would be determined during an ophthalmic examination.
Reference: Page 522

Rationale 2: The monofilament test is used to assess a patient for the presence of protective sensation in the foot, which would alert the patient to the development of a blister or foot ulcer. Patients who can feel the filament at the designated sites are at reduced risk for developing foot ulcers.
Reference: Page 522

Rationale 3: Diabetic ketoacidosis is diagnosed by clinical picture, elevated blood glucose levels, and presence of ketones in the blood with acidosis.
Reference: Page 522

Rationale 4: Arterial insufficiency in the lower extremities is diagnosed by patient symptoms and weak or absent peripheral pulses on physical assessment.
Reference: Page 522

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Identify risk factors to health for the older person with an endocrine problem.

Question 15

Type: MCSA

An older patient with type 2 diabetes mellitus has a capillary blood glucose level of 44 mg/dL. What should the patient ingest to provide an immediate source of carbohydrate?

1. A half cup of orange juice

2. A half cup of diet soda pop

3. Half of an apple with the peel

4. Three to five pieces of sugar-free candy

Correct Answer: 1

Rationale 1: The best choice to treat the hypoglycemia is a concentrated carbohydrate source that can be taken quickly to raise the glucose to a safe level. Orange juice is the best option because it can be taken and absorbed quickly and is a good source of concentrated carbohydrate.
Reference: Page 536

Rationale 2: There is no glucose available in diet soda pop.
Reference: Page 536

Rationale 3: The apple would have to be chewed before the patient could get the appropriate carbohydrate amount.
Reference: Page 536

Rationale 4: There is no glucose available in sugar-free candy.
Reference: Page 536

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Apply appropriate nursing interventions directed toward assisting older adults with endocrine problems to develop self-care abilities.

Question 16

Type: MCMA

The nurse is preparing a teaching plan for a patient with type 2 diabetes mellitus regarding proper foot care. Which instructions should the nurse include in this plan?

Standard Text: Select all that apply.

1. See a podiatrist for nail care.

2. Lubricate dry areas with lotion.

3. Dry moist areas between the toes.

4. Use an emery board to smooth toe nails.

5. Soak feet in hot water and allow to air dry.

Correct Answer: 1,2,3,4

Rationale 1: Foot care for the patient with type 2 diabetes mellitus is to include instructing to see a podiatrist for nail care. The patient should not cut toe nails independently.
Reference: Page 524

Rationale 2: Foot care for the patient with type 2 diabetes mellitus is to include instructing to lubricate dry areas with lotion.
Reference: Page 524

Rationale 3: Foot care for the patient with type 2 diabetes mellitus is to include instructing to dry moist areas between the toes.
Reference: Page 524

Rationale 4: Foot care for the patient with type 2 diabetes mellitus is to include instructing to use an emery board to smooth toe nails.
Reference: Page 524

Rationale 5: Foot care for the patient with type 2 diabetes mellitus does not include soaking the feet in hot water and allowing to air dry. Soaking the feet should be avoided and the feet should be dried thoroughly.
Reference: Page 524

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5. Apply appropriate nursing interventions directed toward assisting older adults with endocrine problems to develop self-care abilities.

Question 17

Type: MCSA

The nurse is preparing discharge teaching for an older patient receiving insulin injections for diabetes. What should the nurse teach the patient about the insulin?

1. Always keep insulin refrigerated.

2. Systematically rotate insulin injection sites.

3. Increase the amount of insulin before exercise.

4. Ketones in the urine signify a need for less insulin.

Correct Answer: 2

Rationale 1: Insulin should be at room temperature when preparing an injection.
Reference: Page 533

Rationale 2: Insulin injection sites should be rotated to reduce the risk of lipodystrophy.
Reference: Page 533

Rationale 3: Insulin should not be adjusted prior to exercise.
Reference: Page 533

Rationale 4: Ketones in the urine may indicate a need for more insulin.
Reference: Page 533

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5. Apply appropriate nursing interventions directed toward assisting older adults with endocrine problems to develop self-care abilities.

Question 18

Type: MCMA

The nurse is concerned that an older patient with type 2 diabetes mellitus is demonstrating signs of hyperglycemia. What did the nurse assess in the patient?

Standard Text: Select all that apply.

1. Fatigue

2. Dizziness

3. Blurred vision

4. Abdominal pain

5. Excessive urination

Correct Answer: 1,3,4,5

Rationale 1: Manifestations of hyperglycemia in a patient with type 2 diabetes mellitus include fatigue.
Reference: Page 537

Rationale 2: Dizziness is a manifestation of hypoglycemia in a patient with type 2 diabetes mellitus.
Reference: Page 537

Rationale 3: Manifestations of hyperglycemia in a patient with type 2 diabetes mellitus include blurred vision.
Reference: Page 537

Rationale 4: Manifestations of hyperglycemia in a patient with type 2 diabetes mellitus include abdominal pain.
Reference: Page 537

Rationale 5: Manifestations of hyperglycemia in a patient with type 2 diabetes mellitus include excessive urination or polyuria.
Reference: Page 537

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Understand unique presentations of diabetes and thyroid problems in the older person.

Question 19

Type: MCSA

During a home visit the nurse learns that an older patient with type 2 diabetes mellitus and chronic renal failure is experiencing headache, polydipsia, and lethargy. What is the most important assessment that the nurse should make at this time?

1. Measure the patients latest urine output.

2. Assess the patients appetite and oral intake.

3. Measure the patients current capillary blood glucose level.

4. Determine the amount of fluid the patient has ingested over the last few hours.

Correct Answer: 3

Rationale 1: The patient has chronic renal failure and may have minimal, if any, urine output.
Reference: Page 537

Rationale 2: The patients appetite and oral intake will not help the nurse determine the cause of the patients current symptoms.
Reference: Page 537

Rationale 3: Measuring the patients capillary blood glucose level will help the nurse determine if the patient is developing hyperglycemic hyperosmolar nonketotic syndrome, a complication of type 2 diabetes mellitus.
Reference: Page 537

Rationale 4: Determining the amount of oral fluid intake the patient has had over the last few hours will not help the nurse determine the cause for the patients current symptoms.
Reference: Page 537

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Understand unique presentations of diabetes and thyroid problems in the older person.

Question 20

Type: MCMA

The nurse teaches an older patient with type 2 diabetes mellitus how to manage the disorder when becoming acutely ill with a cold or other infection. Which statements indicate that instruction has been effective?

Standard Text: Select all that apply.

1. I should call the doctor if I have severe diarrhea.

2. Difficulty breathing means I need to get some more rest.

3. I should continue to take my medication even if Im vomiting.

4. A large amount of ketones in my urine is nothing to worry about.

5. I should not take my medication if I cant eat and call the doctor.

Correct Answer: 1,5

Rationale 1: The patient with diabetes should notify the physician for any episodes of severe diarrhea. This statement indicates that teaching has been effective.
Reference: Page 537

Rationale 2: The patient with diabetes should notify the physician for any difficulty breathing because this does not mean that the patient needs additional rest. This statement indicates that teaching has not been effective.
Reference: Page 537

Rationale 3: The patient with diabetes should notify the physician for any vomiting since medication dosages may need to be adjusted. This statement indicates that teaching has not been effective.
Reference: Page 537

Rationale 4: The patient with diabetes should notify the physician for large amounts of ketones in the urine. This statement indicates that teaching has not been effective.
Reference: Page 537

Rationale 5: The patient with diabetes should be instructed to not take medication if unable to eat since taking medication could cause hypoglycemia. This statement indicates that teaching has been effective.
Reference: Page 537

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5. Apply appropriate nursing interventions directed toward assisting older adults with endocrine problems to develop self-care abilities.

Question 21

Type: MCMA

An older patient is being treated for hypothyroidism. Which manifestations will the nurse assess in this patient?

Standard Text: Select all that apply.

1. Dry skin

2. Hair loss

3. Vomiting

4. Bradycardia

5. Periorbital swelling

Correct Answer: 1,2,4,5

Rationale 1: Dry skin is a manifestation of hypothyroidism.
Reference: Page 543

Rationale 2: Hair loss is a manifestation of hypothyroidism.
Reference: Page 543

Rationale 3: Vomiting is not a manifestation of hypothyroidism.
Reference: Page 543

Rationale 4: Bradycardia is a manifestation of hypothyroidism.
Reference: Page 543

Rationale 5: Periorbital swelling is a manifestation of hypothyroidism.
Reference: Page 543

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Understand unique presentations of diabetes and thyroid problems in the older person.

Question 22

Type: MCSA

The nursing instructor asks a student to describe Graves disease. Which statement by the student indicates an accurate understanding of this disorder?

1. It is associated with long-term use of amiodarone, a cardiac medication.

2. It is an autoimmune disorder associated with sustained thyroid over activity.

3. It is an autoimmune disorder associated with sustained thyroid under activity.

4. It is associated with a tumor on the thyroid, which leads to thyroid over activity

Correct Answer: 2

Rationale 1: Hyperthyroidism may be medication induced as a result of taking amiodarone, a cardiac drug containing iodine that deposits in tissue and delivers iodine to the general circulation over long periods but this does not describe Graves disease.
Reference: Page 545

Rationale 2: Hyperthyroidism in the older patient is often due to Graves disease or toxic goiter, an autoimmune disorder associated with the production of immunoglobulins that attach to and stimulate the TSH receptor, leading to sustained thyroid over activity.
Reference: Page 545

Rationale 3: This does not correctly explain the pathophysiology of Graves disease.
Reference: Page 545

Rationale 4: A tumor on the thyroid leading to thyroid over activity could be a cause for hyperthyroidism but not Graves disease in particular.
Reference: Page 545

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4. Understand unique presentations of diabetes and thyroid problems in the older person.

Question 23

Type: MCSA

The nurse is reviewing the laboratory results for an older patient experiencing a new-onset of atrial fibrillation. On which laboratory value should the nurse focus as a potential cause for this diagnosis?

1. Hgb 13.8 g/dL

2. Hgb 11.0 g/dL

3. TSH 18 mU/mL

4. TSH 0.25 mU/mL

Correct Answer: 4

Rationale 1: This is a normal hemoglobin level and would not help determine the cause of atrial fibrillation.
Reference: Page 542

Rationale 2: This is a normal hemoglobin level and would not help determine the cause of atrial fibrillation.
Reference: Page 542

Rationale 3: This is an elevated TSH level which is a diagnostic indicator of hypothyroidism.
Reference: Page 542

Rationale 4: This is an abnormally low TSH level which is a diagnostic indicator of hyperthyroidism which could be the cause for the patients new-onset of atrial fibrillation.
Reference: Page 542

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4. Understand unique presentations of diabetes and thyroid problems in the older person.

Question 24

Type: MCSA

A 75-year-old patient newly diagnosed with type 2 diabetes mellitus asks how the disease developed since weight management and exercise have been practiced her entire life. Which response should the nurse make to this patient?

1. This disease is inevitable since everyone who ages will develop diabetes.

2. The pancreas becomes hardened and unable to produce insulin with aging.

3. The body loses the ability to digest carbohydrates as a normal part of aging.

4. The body gradually reduces the production of insulin as a normal part of aging.

Correct Answer: 4

Rationale 1: The development of diabetes is not inevitable with aging. Everyone does not develop the disease.
Reference: Page 516

Rationale 2: Diabetes is not caused by a hardening of the pancreas. The body tissues become less receptive to insulin in the cells.
Reference: Page 516

Rationale 3: The body does not lose the ability to digest carbohydrates with aging.
Reference: Page 516

Rationale 4: With aging the body gradually reduces the production of insulin.
Reference: Page 516

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1. Describe age-related changes that affect endocrine function.

Question 25

Type: MCSA

The nurse provides a program on self-management of diabetes for a group of senior citizens with type 2 diabetes mellitus. Which participant statement indicates that additional education is needed?

1. I will keep some hard candy with me at all times.

2. I will start a walking program with my neighbors.

3. If I cant eat, I will call my doctor to see if I should take my insulin.

4. If I start to feel nervous, sweaty, or shaky, I will lie down and take a nap.

Correct Answer: 4

Rationale 1: The older patient with type 2 diabetes mellitus should be instructed to have a source of glucose readily available at all times in the event symptoms of hypoglycemia develop.
Reference: Page 536

Rationale 2: The older patient with type 2 diabetes mellitus would benefit from regular exercise which could include a walking program. Patients are instructed to walk with a partner or group with the same or similar stamina level.
Reference: Page 536

Rationale 3: The older patient with type 2 diabetes mellitus should talk with the physician about medication doses if unable to eat since taking the medication could cause an onset of hypoglycemia.
Reference: Page 536

Rationale 4: The older patient with type 2 diabetes mellitus should be instructed to recognize the manifestations of hypoglycemia which include nervousness and diaphoresis so that a carbohydrate source can be ingested.
Reference: Page 536

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Reduction of Risk Potential

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5. Apply appropriate nursing interventions directed toward assisting older adults with endocrine problems to develop self-care abilities.

Leave a Reply