Chapter 19: Endocrine Alterations

Chapter 19: Endocrine Alterations

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

MULTIPLE CHOICE

1. A patient with type 1 diabetes who is receiving a continuous subcutaneous insulin infusion via an insulin pump contacts the clinic to report mechanical failure of the infusion pump. The nurse instructs the patient to begin monitoring for signs of:

ANS:   B

If the insulin pump fails, the patient with type 1 diabetes will have a complete interruption of insulin delivery; diabetic ketoacidosis will occur. Adrenal insufficiency would not result from insulin pump failure. Hyperosmolar, hyperglycemic state is a hyperglycemic complication associated with type 2 diabetes; this patient has type 1 diabetes. Interruption of insulin delivery in type 1 diabetes would result in hyperglycemia, not hypoglycemia.

DIF:    Cognitive Level: Apply/Application                                     REF:    p. 531 | Box 19-3

OBJ:    Formulate plans of care for patients with critical alterations in endocrine function.

TOP:    Nursing Process Step: Intervention

MSC:   NCLEX Client Needs Category: Physiological Integrity

2. Which of the following patients is at the highest risk for hyperosmolar hyperglycemic syndrome?

ANS:   D

Hyperosmolar hyperglycemic syndrome is more common in type 2 diabetes; influenza is a stressor that would result in further increases in blood sugar. Some individuals with advanced Alzheimer’s disease cannot communicate thirst needs and may be incontinent, making hypertonic fluid loss more difficult to estimate. Uncontrolled type 1 diabetes is associated with diabetic ketoacidosis. Interruption of insulin delivery related to a missed insulin dose in type 1 diabetes creates a situation of absolute insulin deficiency and is associated with diabetic ketoacidosis. A patient with type 2 diabetes who is new to insulin is at risk for hypoglycemia.

DIF:    Cognitive Level: Analyze/Analysis   REF:    p. 524

OBJ:    Describe the pathophysiology and systemic manifestations of disorders resulting from alterations in hormones secreted by the pancreas, adrenal, thyroid, and posterior pituitary glands.           TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

3. Which of the following laboratory values would be more common in patients with diabetic ketoacidosis?

ANS:   D

A pH of 7.24 is indicative of an acidotic state that may accompany diabetic ketoacidosis.

Glucose values of more than 1000 mg/dL are more commonly associated with hyperosmolar hyperglycemic syndrome. Diabetic ketoacidosis is associated with positive urine ketones and an increased anion gap.

DIF:    Cognitive Level: Understand/Comprehension

REF:    p. 526 | Figure 19-3

OBJ:    Describe the methods for assessing the endocrine system, including physical assessment, and interpretation of laboratory and other diagnostic tests.

TOP:    Nursing Process Step: Assessment

MSC:   NCLEX Client Needs Category: Physiological Integrity

4. Which of the following is a high-priority nursing diagnosis for both diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome?

ANS:   B

Both diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome result in dehydration and hypovolemia; therefore, fluid volume deficit is a priority nursing diagnosis. Even though activity intolerance is a potential nursing diagnosis related to the fatigue associated with metabolic changes in hyperglycemic conditions, it is not a first priority. Hyperthermia is associated with thyroid crisis. Although overweight and obesity are risk factors for type 2 diabetes, during metabolic crisis, the patient has inadequate energy available to tissues because of limited availability and poor utilization of insulin.

DIF:    Cognitive Level: Analyze/Analysis   REF:    p. 427 | Figure 19-3

OBJ:    Formulate plans of care for patients with critical alterations in endocrine function.

TOP:    Nursing Process Step: Planning

MSC:   NCLEX Client Needs Category: Safe and Effective Care Environment