Chapter 23: Endocrine Function My Nursing Test Banks

Chapter 23: Endocrine Function

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. The nurse caring for an older adult with type 2 diabetes mellitus places importance on assessing the patient for:

a.

painful nodules on the fingers and toes.

b.

reddened rash and brittle nails on the hands.

c.

heartburn and flatus after meals.

d.

skin temperature and hair growth pattern on the legs.

ANS: D

Insulin resistance causes increased production of inflammatory cytokines correlating with the development of type 2 diabetes mellitus and atherosclerotic vascular disease, therefore skin temperature and hair growth pattern on the legs should be assessed.

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TOP: Nursing Process: Assessment MSC: Physiologic Integrity

2. The nurse recognizes that an older adult on both antihypertensive and antidepressant drug therapies has a specific need for:

a.

regular blood pressure monitoring.

b.

an effective history focusing on sexual function.

c.

an increase in daily fluid intake.

d.

frequent assessment of emotional stability.

ANS: B

Drugs such as oral contraceptives, hormone replacement, antihypertensives, antidepressants, or sedatives can cause a sexual arousal disorder as a side effect. In women this can manifest as female sexual dysfunction (FSD), and in men it can manifest as erectile dysfunction (ED).

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3. Aware that older adult patients often present with nonclassic symptoms of type 2 diabetes mellitus, the nurse is particularly suspicious of a patient reporting:

a.

bouts of diarrhea alternating with periods of constipation.

b.

recent problems reading and an infected sore on the toe that will not heal.

c.

periods of depression and severe indigestion after eating.

d.

dizziness when getting up too quickly and a red rash on the hands.

ANS: B

Often a newly diagnosed older individual will describe symptoms of fatigue, blurred vision, weight change (gain or loss), and infections. The other symptoms are not related.

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4. The nurse observes signs that a patient being assessed may have an underactive thyroid. The data supporting this suspicion includes:

a.

heat intolerance, low-grade fever, and patchy hair loss.

b.

polycythemia, tachycardia, and oral candidiasis.

c.

muscle cramps, fatigue, and cold intolerance.

d.

increased blood pressure, postural hypotension, and blurred vision.

ANS: C

Older patients are seen with complaints of fatigue, cold intolerance, weight gain, muscle cramps, paresthesias, and confusion, which are symptoms of hypothyroidism that are often attributed to old age. Heat intolerance is often associated with hyperthyroidism. The other options are not related to thyroid dysfunction.

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5. The nurse is preparing to provide an older, newly diagnosed diabetic patient with information regarding type 2 diabetes. The nurse initially:

a.

asks if the patient prefers a video or a pamphlet.

b.

invites the patients spouse to be present during the instruction.

c.

selects a quiet, well-lighted space for the class.

d.

ensures that the patient is pain-free and comfortably seated.

ANS: A

Cognitive function and learning styles vary, so knowing the patients preferred learning style facilitates education. Some individuals prefer to learn by visual methods, others by listening, and still others by experiencing contact in a hands-on approach. Controlling pain and ensuring the patient is comfortable will also facilitate learning, but it is more important to meet the patients preferred learning style. The other options are helpful but not as vital.

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6. Which documentation demonstrates that the nurse effectively assessed an older adult diabetic patients cardiac status?

a.

radial pulse: 88 and regular

b.

carotid pulses equal and strong

c.

BP 126/78 recumbent and 122/78 sitting

d.

nail beds pale in color

ANS: C

To assess circulation, the nurse should take an apical pulse, noting rate and rhythm; check pedal pulses bilaterally; and note the presence of hair on the lower extremities. The nurse should take blood pressure measurements with the patient in both recumbent and sitting positions, note any dizziness associated with a change of position, and assess the respiratory rate, depth, and chest sounds.

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7. The nurse teaching a 79-year-old with type 2 diabetes about the importance of regular exercise suggests that the patient:

a.

swim 10 laps in the community center pool three times a week.

b.

enroll in a daily lunch time aerobics class at the senior center.

c.

lift 5 pound weights in a routine of 10 repetitions in each arm.

d.

walk on the treadmill each morning for 30 minutes.

ANS: D

Older adults may derive the greatest benefit from morning exercise because that is the time of greatest insulin resistance. However, any exercise is better than no exercise at all. Aerobic exercise should be balanced with weight training.

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8. What assessment findings support an older patients diagnosis of hypothyroidism?

a.

A 2-cm wound noted on medial aspect of left foot

b.

An apical rate: 98/min

c.

A patient report that I always wear a sweater

d.

A weight loss of 10 pounds over 6 weeks

ANS: C

Older patients are seen with complaints of fatigue, cold intolerance, weight gain, muscle cramps, paresthesias, and confusion. The other assessments are not related.

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9. Which assessment findings support the suspicion that an older patient has osteoporosis?

a.

The patients reports an allergy to dairy products.

b.

A lactase enzyme is a part of the patients drug regime.

c.

Bones in one of the patients lower legs are shorter than in the other.

d.

The patient is inch shorter than at his or her previous physical.

ANS: D

Dorsal kyphosis, chronic back pain, and loss of height are common signs of primary osteoporosis in older persons. The other signs do not relate to this disorder.

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10. An older patient has been diagnosed with metabolic syndrome. What action by the nurse takes priority?

a.

Educate the patient on medications.

b.

Teach lifestyle changes the patient can manage.

c.

Encourage 60 minutes of aerobic activity daily.

d.

Instruct the patient on a low-fat diet.

ANS: B

Lifestyle changes are the mainstay of treatment for this disorder. Nurses have the primary responsibility for teaching. The patient should be included in planning so that lifestyle changes are reasonable and doable for the older patient. Activity and diet are part of the changes needed, but activity does not need to be so extensive and diet should not be the only topic taught. Medications are not generally used.

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11. A patient has type 2 diabetes. The family reports the patient has become very forgetful. What response by the nurse is best?

a.

We should assess her for Alzheimer disease.

b.

Forgetfulness is a common sign in diabetes.

c.

Have her blood sugars been under good control?

d.

Does she recognize you and know your names?

ANS: B

Many diabetics report depression and memory problems, so the nurse explains this fact. Forgetfulness does not necessarily indicate dementia. Asking about blood glucose is appropriate, but not related. Not recognizing family is not the same as forgetfulness.

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12. The family of a patient who has type 2 diabetes calls the clinic to report a very small sore on the patients foot. What action by the nurse is best?

a.

Have the patient come to the clinic today.

b.

Have the family wash and bandage it.

c.

Tell the patient to check for a fever.

d.

Have the patient go to the emergency room.

ANS: A

Any ulcer or sore on a foot requires medical attention because on superficial inspection, the true degree of injury can be hidden. The patient should come to the clinic today. The family should not attempt to care for the wound and the patient does not need to take a temperature before coming in. The patient does not need to go to the emergency department at this time.

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13. A patient has been admitted with new atrial fibrillation. What additional diagnostic testing does the nurse anticipate?

a.

Thyroid hormones

b.

Platelet count

c.

Urinalysis

d.

Blood glucose

ANS: A

Hyperthyroidism is often seen with atrial fibrillation. Platelet count, urinalysis, and glucose are often done as part of admission, but they are not directly related to atrial fibrillation as is hyperthyroidism.

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14. An older patient has osteoporosis and is reluctant to exercise because I already have a bone problem, so how will it help? What response by the nurse is best?

a.

It can improve posture, balance, and reduce falls.

b.

It will give you heart-healthy benefits.

c.

Exercise will make you feel younger.

d.

If you join a gym, you can socialize with new people.

ANS: A

Exercise not only improves bone health but improves posture, balance, and reduces falls. The nurse should educate the patient on these benefits.

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15. A nurse is preparing to administer metoprolol (Toprol) to an older male patient. What action by the nurse is best regarding endocrine disorders?

a.

Administer the medication as ordered.

b.

Check the patients ID using two sources.

c.

Say, Many men experience ED with this drug.

d.

Tell the patient to discuss the side effects with his provider.

ANS: C

The nurse should instruct patients on side effects of medications. The nurse can assess if the patient wants to discuss this issue by opening the conversation with a normalizing statement, such as many men have ED on this drug. Is this something you would like to discuss? Although side effects do need to be brought up to the provider, the wording of this statement does not indicate a willingness of the nurse to engage in conversation. The other two options are correct but not related to endocrine dysfunction.

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TOP: Teaching-Learning MSC: Psychosocial Integrity

16. A type 2 diabetic patient is admitted to the hospital with a gastrointestinal illness and a blood glucose of 480 mg/dL. After stabilizing the patient, what action by the nurse is best?

a.

Educate the patient on safe food handling.

b.

Ask if the patient took the diabetic medication.

c.

Teach the patient ways to avoid dehydration

d.

Delegate frequent blood sugars to the aide.

ANS: B

A frequent cause of hyperglycemia requiring hospitalization in diabetics is poor sick day management. The type 2 diabetic still makes insulin and so needs antihyperglycemic drugs even when ill. The nurse assesses the diabetics knowledge of sick day management. The other options are appropriate but not the priority. Better sick day management can possibly keep the patient from further, similar, hospitalizations.

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17. A nurse is reviewing possible first-line medications for a new, older type 2 diabetic. What contraindication does the nurse identify for metformin (Glucophage)?

a.

Patient drinks three to four alcoholic drinks/day

b.

Patients parents both took insulin

c.

Creatinine 0.9 mg/dL

d.

Potassium 3.8 mEq/dL

ANS: A

Patients with hepatic or renal dysfunction should not take metformin. A patient who drinks as much as three to four alcoholic drinks a day has a real risk of liver disease. The use of insulin by the parents is not related. Both kidney lab values are normal.

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MULTIPLE RESPONSE

1. The nurse is assessing an older patient with elevated plasma triglyceride levels. What other assessment finding leads the nurse to suspect metabolic syndrome? (Select all that apply.)

a.

Blood pressure of 148/90 mm Hg

b.

A fasting blood glucose of 109 mg/dL

c.

Reports of frequent urination

d.

Weight measurement of 50 inches

e.

HDL level of 52 mg/dL

ANS: A, B, D, E

The clinical criteria for metabolic syndrome includes increased waist circumference (population specific) plus any two of the following: (1) blood pressure greater than 129/84 mm Hg or taking hypertension medication, (2) plasma triglyceride levels over 149 mg/dL or taking triglyceride medication, (3) high-density lipid levels less than 40 mg/dL in men or less than 50 mg/dL in women or taking HDL-C medication, (4) fasting glucose greater than 99 mg/dL (including patients with diabetes).

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2. The nurse is teaching a newly diagnosed diabetic patient about metformin. What information does the nurse include? (Select all that apply.)

a.

Alcohol intake should be limited and taken with food.

b.

Overweight patients sometimes poorly tolerate metformin.

c.

Oral hypoglycemic agents can increase the risk of hyperglycemia.

d.

Metformin has been the cause of anorexia in older patients.

e.

Oral hypoglycemic agents affect vitamin D absorption.

ANS: A, D

Studies indicate that metformin, classified as a biguanide, may be the drug of choice for overweight patients. Side effects such as anorexia, nausea, and abdominal discomfort may, however, limit its use in older adults. Alcohol can decrease hypoglycemic awareness, so metformin should only be ingested with food. Alcohol use should also be limited.

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3. What assessment findings support a diagnosis of hyperthyroidism in the older adult? (Select all that apply.)

a.

Tremors

b.

Heat intolerance

c.

Tachycardia

d.

Palpable goiter

e.

Atrial fibrillation

ANS: A, D, E

The classic geriatric presentation of hyperthyroidism includes tachycardia, fatigue, tremors, and nervousness in contrast to tachycardia, heat intolerance, and fatigue in younger patients. An enlarged, palpable goiter is present in 60% of older adults with hyperthyroidism. The most common complication, occurring in 27% of geriatric hyperthyroid patients, is atrial fibrillation that does not convert back to sinus rhythm when a euthyroid state has been achieved.

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4. The nurse assessing patients for diabetes looks for the classic signs, including which of the following? (Select all that apply.)

a.

Polyuria

b.

Polycythemia

c.

Polydipsia

d.

Polyphagia

e.

Polyandrony

ANS: A, C, D

The classic signs of diabetes are polyuria, polydipsia, and polyphagia.

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5. When teaching an older patient about diet therapy, the nurse plans to assess for barriers to adherence, including which factors? (Select all that apply.)

a.

Lifelong habits

b.

Cultural influences

c.

Finances

d.

Dependency

e.

Inability to learn

ANS: A, B, C, D

Diet therapy can be problematic for older adults who have a lifetime of food habits, cultural influences on food, finances that may be limited, and dependency on others to buy or prepare food. Older adults are not unable to learn.

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TOP: Nursing Process: Assessment MSC: Health Promotion

6. The nurse teaches an older patient safety rules for exercising. What do these rules include? (Select all that apply.)

a.

Carry medical identification.

b.

Check blood glucose before exercising.

c.

Drink plenty of water.

d.

Have quick-acting glucose.

e.

Knowing signs of hyperglycemia.

ANS: A, B, C, D

Rules for safe exercise include all the above except the patient is more likely to experience hypoglycemia, so those signs and symptoms are important related to exercise.

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TOP: Teaching-Learning MSC: Health Promotion

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