Endocrine (CC Final, 34, 35, 36)
3 (The endocrine system controls and communicates by the distribution of potent hormones throughout the body.)
The
... [Show More] endocrine system helps maintain equilibrium throughout the body via:
1. control of smooth muscle.
2. control of skeletal muscle.
3. hormones.
4. neuronal control.
3 (Insulin is a potent anabolic hormone that produces hypoglycemia and also augments the transport of potassium into the cells. With potassium driven into the cells, serum potassium may decrease, resulting in hypokalemia.)
Insulin produces hypoglycemia. What other physiologic effect may occur when insulin is given?
1. Polyuria
2. Hypercalcemia
3. Hypokalemia
4. Cellular dehydration
3 (A normal blood glucose level is maintained by the insulin/glucagon ratio. When the blood glucose level is high, insulin is released and glucagon is inhibited. When blood glucose levels are low, glucagon rather than insulin is released.)
In the healthy body, a normal blood glucose level is maintained by:
1. insulin secretion.
2. cellular metabolism.
3. insulin/glucagon ratio.
4. insulin/thyroxine ratio.
1 (Decreased insulin/increased glucagon results in increased glycogenolysis.)
Decreased insulin/increased glucagon results in:
1. increased glycogenolysis.
2. decreased fat mobilization.
3. decreased ketosis.
4. increased glycogen storage.
3 (Somatostatin inhibits the release of insulin and glucagon.)
Which of the following best describes the effects of somatostatin?
1. It stimulates the release of antidiuretic hormone and oxytocin.
2. It suppresses the release of pancreatic polypeptide.
3. It inhibits the release of insulin and glucagon.
4. It inhibits the release of thyroid-stimulating hormone and thyroid hormone.
1 (The pituitary gland is known as the "master gland" because of the major influence it has over all areas of body functioning.)
The gland called the "master gland" that has the most influence over all areas of body functioning is the:
1. pituitary.
2. pancreas.
3. thyroid.
4. hypothalamus.
2 (Antidiuretic hormone has been identified as the single most important hormone responsible for regulating fluid balance within the body.)
Ms. E. is admitted to the critical care unit after sustaining a head injury. Based on the injury, it is determined that her level of antidiuretic hormone is decreased.
The major role of antidiuretic hormone is to regulate:
1. blood pressure.
2. fluid balance.
3. potassium.
4. equilibrium.
2 (Suppression of antidiuretic hormone renders the kidney tubules impermeable to water and causes an increase in the amount of water excreted by the kidneys.)
Ms. E. is admitted to the critical care unit after sustaining a head injury. Based on the injury, it is determined that her level of antidiuretic hormone is decreased. The symptom that would alert the medical team to a possible decrease in antidiuretic hormone is:
1. rapidly escalating hypertension.
2. massive diuresis.
3. pulmonary edema.
4. hyperkalemia.
1 (The alpha cells are responsible for the secretion of glucagons.)
The alpha cells of the pancreas secrete:
1. glucagon.
2. insulin.
3. somatostatin.
4. pancreatic polypeptide hormone.
2 (The hepatic cells store glycogen for use as fuel.)
Excess glucose is stored as glycogen in the:
1. pancreas.
2. hepatic cells.
3. gallbladder.
4. stomach.
4 (Exercise stimulates the release of glucose.)
Glucose is released in response to:
1. increases in circulating insulin.
2. decreases in blood amino acids.
3. stimulation of the parasympathetic nervous system.
4. exercise.
2 (Gluconeogenesis is the formation of "new glucose".)
The process by which fat and protein nutrients are broken down into end products that are changed to glucose is:
1. glycogenolysis.
2. gluconeogenesis.
3. digestion.
4. biotransformation.
4 (The hypothalamus controls the release of hormones from the pituitary through release-inhibiting factors.)
The release of hormones by the pituitary gland is under the control of the:
1. cerebellum.
2. occipital lobe.
3. temporal lobe.
4. hypothalamus.
2 (Since ADH causes the patient to retain free water, the patient will have a dilutional hyponatremia.)
When large amounts of antidiuretic hormone (ADH) are released, the patient's sodium levels will be:
1. increased.
2. decreased.
3. unaffected.
4. altered inversely with potassium.
4 (ADH works primarily on the kidney tubules.)
ADH works primarily at:
1. the liver.
2. the pancreas.
3. the stomach.
4. the kidneys.
1 (Since alcohol inhibits ADH, the patient will have lots of free water and his serum osmolality will be elevated.)
The patient is brought to the hospital with a stab wound following a fight at a local bar. His alcohol level is twice the normal limit. The nurse would expect his serum osmolality to be:
1. elevated.
2. decreased.
3. unaffected.
4. equal to his sodium level.
3 (The presence of ketones in the blood (ketonemia) is indicative of hyperglycemia.)
Which of the following laboratory results is found in the patient with hyperglycemia?
1. Insulin level of 25 µU/ml
2. Absence of ketones in the blood
3. Presence of ketones in the urine
4. Serum osmolality of 270 mOsm/Kg H2O
1 (A hydration assessment includes skin integrity, skin turgor, and buccal membrane moisture.)
A hydration assessment consists of checking a variety of parameters, including:
1. skin turgor.
2. serum potassium.
3. capillary refill.
4. serum protein.
1 (Glycosylated hemoglobin provides information about the average amount of blood glucose that has been present over the previous 3 to 4 months.)
Glycosylated hemoglobin levels provide information about:
1. the average blood glucose over the previous 3 to 4 months.
2. blood glucose levels in comparison to serum hemoglobin.
3. serial glucose readings after ingestion of a concentrated glucose solution.
4. the difference between serum and urine glucose levels.
4 (Syndrome of inappropriate antidiuretic hormone occurs when there are increased levels of antidiuretic hormone in the blood compared with a low serum osmolality.)
The diagnosis of syndrome of inappropriate antidiuretic hormone (SIADH) is made when which of the following conditions are present?
1. Decreased antidiuretic hormone (ADH) level and hyperkalemia
2. Decreased ADH level and hypernatremia
3. Increased ADH level and serum ketones
4. Increased ADH level and low serum osmolality
2 (Decreased urine osmolality is a sign of diabetes insipidus.)
Decreased urine osmolality is a sign of:
1. hyperglycemia.
2. diabetes insipidus.
3. thyroid crisis.
4. SIADH.
4 (The vasopressin stimulation test is useful in identifying and differentiating between neurogenic and nephrogenic diabetes insipidus.)
Which of the following laboratory studies or diagnostic procedures is most useful in identifying nephrogenic or neurogenic diabetes insipidus?
1. Skull x-rays
2. Serum glucose
3. Water deprivation test
4. Vasopressin stimulation test
4 (The patient or significant other may relay information about recent, unexplained changes in weight, thirst, hunger, and urination patterns.)
Ms. K. is a 16-year-old woman admitted to the critical care unit with severe hyperglycemia secondary to new onset type I diabetes mellitus. Which of the following signs and symptoms obtained as part of Ms. K.'s history might indicate the presence of hyperglycemia?
1. Recent episodes of tachycardia and missed heart beats
2. Decreased urine output accompanied by peripheral edema
3. Periods of hyperactivity with weight gain
4. Increased thirst and increased urinary output
2 (Ketones are detected by a sweet, fruity odor on the exhaled breath. This odor occurs when the lungs release carbon dioxide in an attempt to decrease the accumulated acids.)
The nurse assesses a sweet-smelling odor on Ms. K.'s exhaled breath. This is a result of:
1. compensation for metabolic alkalosis.
2. the body attempting to decrease accumulated acids.
3. prior ingestion of high-calorie foods.
4. decreased serum osmolality.
4 (Blurred vision and memory loss are two signs of diabetes along with the more frequent signs of polyuria, polyphagia, and polydipsia.)
The nurse knows that which of the following signs may indicate diabetes?
1. Kidney stones
2. Indigestion and diarrhea
3. Loss of appetite
4. Blurred vision and memory loss
2 (A normal fasting glucose is 75 to 115 mg/dl. All patients experiencing stress will elevate their blood sugar due to the effects of adrenal hormones.)
The patient has a fasting glucose level of 150 mg/dl. The nurse knows this value is:
1. normal.
2. elevated but may be the result of the stress of hospitalization.
3. lower than what the nurse would expect in a patient with IV fluids.
4. elevated and indicates DKA.
1 (Glycosylated hemoglobin levels evaluate the average amount of glucose in the serum over the previous 3 to 4 months.)
Which of the following would be used to evaluate the patient's blood sugar levels over the past 3 months?
1. Glycosylated hemoglobin levels
2. Insulin levels
3. Serum glucose levels
4. Serum ketones
2 (1 liter of fluid is equal to 1 kilogram of body weight.)
The patient weighed 62 kilograms on admission yesterday. Today, the patient weighs 60 kilograms. The nurse knows this reflects a fluid loss of:
1. 1 liter.
2. 2 liters.
3. 4 liters.
4. 10 liters.
2 (Phenytoin decreases ADH levels and glucocorticoids increase ADH levels.)
When preparing the patient for a serum ADH level, the nurse must withhold:
1. insulin and furosemide.
2. phenytoin and glucocorticoids.
3. Lanoxin and potassium.
4. heparin and beta-blockers.
3 (A serum osmolality of 378 mOsm/kg is elevated, indicating an increased amount of particles in a solution.)
The nurse knows that a serum osmolality of 378 mOsm/kg indicates a patient who is:
1. overhydrated.
2. normal.
3. dehydrated.
4. hypokalemic.
4 (The vasopressin stimulation test is used to differentiate between central and nephrogenic diabetes insipidus.)
The nurse knows that the best test to differentiate between central and nephrogenic diabetes insipidus is:
1. the water deprivation test.
2. serum osmolality.
3. CT Scan.
4. the vasopressin stimulation test.
4 (If the urine osmolality remains unchanged after administering vasopressin, it indicates that the target cells are no longer receptive to ADH.)
The nurse knows that an abnormal response to a vasopressin stimulation test would be:
1. a slight increase in urine osmolality.
2. a decrease in urine output.
3. a decrease in serum osmolality.
4. no change in urine osmolality.
2 (The sella turcica at the base of the skull is the area to focus on in order to visualize the pituitary gland.)
When evaluating the patient for a pituitary tumor, attention on the CT scan should be focused on the:
1. frontal lobe.
2. sella turcica.
3. temporal lobe.
4. anterior fossa.
4 (The insulin deficiency results in a hyperglycemia that leads to hyperosmolality and dehydration as a result of the diuresis.)
The insulin deficiency in the patient with Type I, IDDM, results in:
1. serum hypoosmolality and water overload.
2. serum hypoosmolality and dehydration.
3. serum hyperosmolality and water overload.
4. serum hyperosmolality and dehydration.
3 (Etiologic factors of diabetes insipidus are numerous. Physiologic and psychologic stress can increase the blood glucose, leading to diabetic ketoacidosis (DKA). Other factors listed are hypoglycemic risks.)
The diabetic patient in the critical care unit is at risk for developing diabetic ketoacidosis (DKA) secondary to:
1. excess insulin administration.
2. inadequate food intake.
3. physiologic and psychologic stress.
4. increased release of antidiuretic hormone (ADH).
2 (The hallmarks of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) are extremely high levels of plasma glucose with resulting elevations in serum hyperosmolality and osmotic diuresis. The disorder occurs mainly in patients with Type II diabetes.)
. The hallmark of hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is:
1. hyperglycemia with low serum osmolality.
2. severe hyperglycemia with minimal or absent ketosis.
3. little or no ketosis in serum with rapidly escalating ketonuria.
4. hyperglycemia and ketosis.
1 (Rapid rehydration is the primary intervention for HHNS. Other interventions include electrolyte replacement, restoration of the insulin/glucagon ratio, and prevention/treatment of circulatory collapse.)
The primary intervention for HHNS is:
1. rapid rehydration.
2. monitoring vital signs.
3. high-dose intravenous insulin.
4. hourly urine sugar and acetone testing.
3 (Characteristics of diabetes insipidus (DI) are intense thirst and the passage of excessively large quantities of very dilute urine.)
Characteristics of diabetes insipidus are:
1. hyperglycemia and hyperosmolarity.
2. hyperglycemia and peripheral edema.
3. intense thirst and passage of excessively large quantities of dilute urine.
4. peripheral edema and pulmonary crackles.
1 (Patients with primary and secondary DI who are unable to synthesize antidiuretic hormone (ADH) require exogenous ADH (vasopressin) replacement therapy.)
Patients with primary and secondary diabetes insipidus are treated with:
1. vasopressin.
2. insulin.
3. glucagon.
4. propylthiouracil.
2 (In SIADH, profound fluid and electrolyte disturbances result from the unsolicited, continuous release of ADH into the bloodstream. Fluid is retained, resulting in dilutional hyponatremia and a critically low sodium level.)
In the syndrome of inappropriate antidiuretic hormone (SIADH), the physiologic effect is:
1. massive diuresis, leading to hemoconcentration.
2. dilutional hyponatremia, reducing sodium concentration to critically low levels.
3. hypokalemia from massive diuresis.
4. serum osmolality greater than 350 mOsm/kg.
3 (Seizure precautions for the patient with SIADH are provided regardless of the degree of hyponatremia.)
Which of the following nursing interventions should be initiated on all patients with SIADH?
1. Placing the patient on an air mattress
2. Forcing fluids
3. Initiating seizure precautions
4. Applying soft restraints
2 (Polydipsia, polyuria, and polyphagia are classic symptoms of diabetic ketoacidosis. Other symptoms include malaise, headache, nausea, vomiting, dehydration, and weight loss.)
Mr. M. is a 25-year-old man with a 10-year history of diabetes mellitus. He is admitted to the critical care unit with complaints of increased lethargy. Serum laboratory values validate the diagnosis of diabetic ketoacidosis.
10. Which of the following symptoms is most suggestive of DKA?
1. Irritability
2. Excessive thirst
3. Rapid weight gain
4. Peripheral edema
4 (Hypokalemia may occur as insulin drives potassium back into the cells.)
Which of the following statements best describes the rationale for administrating potassium supplements with Mr. M.'s insulin therapy?
1. Potassium replaces losses incurred with diuresis.
2. The patient has been in a long-term malnourished state.
3. Intravenous potassium renders the infused solution isotonic.
4. Insulin drives the potassium back into the cells.
1 (Once diagnosed, DKA requires aggressive medical and nursing management, including the replacement of fluid loss from significant dehydration.)
The treatment of diabetic ketoacidosis involves:
1. extensive hydration.
2. oral hypoglycemic agents.
3. large doses of IV insulin.
4. limiting food and fluids.
2 (In NIDDM the pancreatic B cells produce ineffective or insufficient insulin.)
The most common problem in the patient with type 2 NIDDM is:
1. a lack of insulin production.
2. an imbalance between insulin production and use.
3. an overproduction of glucose.
4. an increased uptake of glucose in the cells.
3 (This patient weighs 308 pounds and is only 5 feet tall. Diet management and exercise are interventions to facilitate weight loss in the NIDDM patient.)
The patient weighs 140 kilograms and is 60 inches tall. The patient's blood sugar is being controlled by glipizide. As the nurse discusses discharge instructions, the primary treatment goal with this NIDDM patient would be:
1. signs of hypoglycemia.
2. proper injection technique.
3. weight loss.
4. increased caloric intake.
3 (In IDDM, the B cells no longer secrete insulin and the cells must break down fatty acids for fuel.)
The nurse knows that instructions on diabetic ketoacidosis need to be given to:
1. all diabetic patients.
2. patients taking oral hypoglycemics.
3. type 1 IDDM patients.
4. patients taking insulin.
4 (Subcutaneous insulin pumps can malfunction. It is critical to assess glucose and ketone levels to evaluate for diabetic ketoacidosis.)
The patient is admitted to the unit with extreme fatigue, vomiting, and headache. This patient has IDDM but has been on an insulin pump for 6 months. He states, "I know it could not be my diabetes because my pump gives me 24-hour control." The nurse's best response would be:
1. "You know a lot about your pump and you are correct."
2. "You're right. This is probably a virus."
3. "We'll get an abdominal CT and see if your pancreas is inflamed."
4. "We'll check your serum blood glucose and ketones."
4 (Adrenal hormones released during stress elevate blood sugar by increasing insulin resistance and increasing hepatic gluconeogenesis.)
A patient who has NIDDM is on the unit following aneurysm repair. His serum glucose levels have been elevated for the past 2 days. He is concerned that he is becoming dependent on insulin. The best response for the nurse would be:
1. "This surgery may have damaged your pancreas. We will have to do more evaluation."
2. "Perhaps your diabetes was more serious from the beginning."
3. "You will need to discuss this with your physician."
4. "The stress on your body has temporarily increased your blood sugar levels."
1 (The hyperglycemia in DKA results in hyperosmolality, which causes diuresis. The nitrogen waste products in ketoacidosis are metabolized as urea, which also increases the osmotic diuresis.)
The nurse knows that the dehydration associated with diabetic ketoacidosis results from:
1. increased serum osmolality and urea.
2. decreased serum osmolality and hyperglycemia.
3. ketones and potassium shifts.
4. acute renal failure.
4 (The catecholamine release results in increased glycogenolysis, lipolysis, gluconeogenesis, and ketogenesis.)
The nurse knows that the dehydration in DKA stimulates catecholamine release, which results in:
1. decreased glucose release.
2. increased insulin release.
3. decreased cardiac contractility.
4. increased gluconeogenesis.
2 (The major electrolytes lost in the diuresis are sodium, potassium, and phosphorus.)
The major electrolyte disturbances that result from diuresis are:
1. low calcium and high phosphorus levels.
2. low potassium and low sodium levels.
3. high sodium and low phosphorus levels.
4. low calcium and low potassium levels.
3 (The thirst sensation is the body's attempt to correct the fluid deficit. Water is the best replacement.)
The patient admitted in DKA has dry, cracked lips and is begging for something to drink. The nurse's best response would be to:
1. keep the patient NPO.
2. allow the patient a cup of coffee.
3. allow the patient water
4. allow the patient to drink anything he chooses.
3 (The metabolic acidosis is the result of inadequate glucose to the cells. Insulin and fluids will correct the underlying problem.)
The patient in DKA has the following ABGs: pH 7.25; pCO2 30; HCO3- 16. The patient has rapid, regular respirations. The nurse's best response would be to:
1. ask the patient to breathe in a paper bag to retain CO2.
2. administer sodium bicarbonate.
3. administer insulin IV and fluids.
4. prepare for intubation.
4 (The patient in DKA releases acetone in his breath to compensate for the carbonic acid build-up. Acetone gives the breath a "fruity" odor.)
The patient in DKA is very lethargic and has a "funny" odor to his breath. The nurse would suspect this to be a result of:
1. alcohol intoxication.
2. hyperglycemia.
3. hyperphosphatemia.
4. acetone.
3 (Infection may be the cause of the DKA and is the most common explanation for an elevated temperature.)
The patient in DKA is comatose with a temperature of 102.2° F. The nurse would suspect:
1. head injury.
2. infarct of the hypothalamus.
3. infection.
4. heat stroke.
1 (Starvation and alcoholism may result in a ketoacidotic state.)
The non-diabetic patient presents in ketoacidosis. Reasons may include:
1. starvation and alcoholism.
2. drug overdose.
3. severe vomiting.
4. hyperaldosteronism.
3 (The evaluation of hematocrit and BUN is a measurement of the percent of particles in solution. When patients are dehydrated, these values will be falsely elevated.)
Dehydration in the DKA patient will be supported by the following laboratory evidence.
1. Decreased hematocrit and BUN
2. Low urine specific gravity and high serum osmolality
3. Increased hematocrit and BUN
4. High urine specific gravity and low white count
1 (Potassium shifts back into the cell as the acidosis is corrected. Therefore the nurse must monitor the serum potassium frequently during the resuscitation phase. IV insulin will also push potassium into the cell.)
As the DKA patient receives insulin and fluids, the nurse knows careful assessment must be given to which of the following electrolytes?
1. Potassium
2. Sodium
3. Phosphorus
4. Calcium
2 (Giving fluids is a top priority to prevent cardiovascular collapse.)
The top priority in the initial treatment of DKA is:
1. lowering the blood sugar.
2. giving fluids.
3. giving sodium bicarbonate to reverse the acidosis.
4. determining the reason for the DKA.
3 (Once the blood glucose drops to 200 mg/dl, dextrose should be added to avoid hypoglycemia.)
The nurse knows that during the resuscitation of the DKA patient, the IV should be changed to a solution containing glucose when:
1. the patient becomes more alert.
2. the IV insulin has been infusing for 4 hours.
3. the blood glucose drops to 200 mg/dl.
4. the blood glucose drops to 100 mg/dl.
3 (The patient needs IV insulin for rapid onset but will also need subcutaneous insulin about 1 hour before the IV insulin is discontinued.)
The nurse knows that the patient with DKA will need:
1. subcutaneous insulin.
2. intravenous insulin.
3. subcutaneous and intravenous insulin.
4. combination 70%/30% insulin.
2 (Insulin promotes the return of potassium and phosphate into the cell.)
Once the patient in DKA has insulin infusing intravenously, the nurse expects a drop in the serum levels of:
1. sodium and potassium.
2. potassium and phosphate.
3. bicarbonate and calcium.
4. sodium and phosphate.
4 (A nasogastric tube will decompress the stomach contents, prevent aspiration, and improve ventilation.)
The patient arrives in DKA with a grossly distended abdomen. His wife states that he has vomited twice. The nurse knows that a priority would be:
1. endotracheal intubation.
2. stat CT scan.
3. antiemetics.
4. a nasogastric tube.
1 (Assessment for orthostatic hypotension and neck vein filling are important ways to evaluate hydration status.)
To assist the nurse in evaluating the patient's hydration status, assessment would include:
1. orthostatic hypotension and neck vein filling.
2. pupil checks and Kernig's sign.
3. Chvostek's and Trousseau's sign.
4. S4 gallop and edema.
3 (Central venous pressure and pulmonary artery pressure should return to normal, and the heart rate should decrease as cardiac output returns to normal.)
The nurse knows that three signs of effective fluid replacement include:
1. elevated CVP, increased heart rate, and elevated PAP.
2. elevated CVP, decreased heart rate, and elevated PAP.
3. normal CVP, decreased heart rate, and normal PAP.
4. decreased CVP, increased heart rate, and decreased PAP.
2 (Irritability and paresthesia are seen in hypoglycemia.)
The patient with DKA has an insulin drip infusing and the nurse has just administered subcutaneous insulin. The nurse is alert for signs of hypoglycemia, which would include:
1. Kussmaul's respirations and flushed skin.
2. irritability and paresthesia.
3. abdominal cramps and nausea.
4. hypotension and itching.
4 (It is common for the potassium to drop as insulin pushes it into the cell; this can result in ventricular irritability. The patient needs potassium supplements.)
The patient was admitted with DKA 1 hour ago and is on an insulin drip. Suddenly, the nurse notices frequent premature ventricular contractions (PVCs) on the ECG. The expected intervention would be to:
1. administer lidocaine bolus.
2. administer lidocaine drip.
3. synchronize cardioversion.
4. evaluate electrolytes.
4 (HHNS is characterized by extremely high levels of serum glucose, which lead to high serum osmolality.)
A patient with type II NIDDM is admitted. He is very lethargic and hypotensive. A diagnosis of HHNS is made based on laboratory values of:
1. decreased serum glucose and increased serum ketones.
2. increased urine ketones and decreased serum osmolality.
3. increased serum osmolality and increased serum potassium.
4. increased serum osmolality and increased serum glucose.
1 (Hyperalimentation contains large amounts of dextrose that may not be handled properly by the pancreas, resulting in hyperglycemia and hyperosmolality.)
The nurse identifies the nondiabetic patient at risk for HHNS as the patient receiving:
1. hyperalimentation.
2. aminoglycosides.
3. contrast for CT scan.
4. PEEP.
2 (The laboratory values indicate HHNS. The extremely high serum glucose results in hyperosmolality, which can lead to cardiovascular collapse.)
The elderly patient presents with a serum glucose of 900 mg/dl, hematocrit of 55%, and no serum ketones. Immediate attention must be given to:
1. clotting factors.
2. rehydration.
3. administration of insulin.
4. sodium replacement
3 (Normal saline is isotonic and would be the most appropriate fluid to correct the dehydration.)
The patient with HHNS has a serum glucose of 400 mg/dl and a serum sodium of 138 mEq/L. The intravenous fluid of choice would be:
1. D5W.
2. 0.45% NS.
3. 0.9% NS.
4. D5/NS.
1 (0.1 U/kg/hour most closely mimics the physiologic secretion of 30 U/day with increases at mealtime.)
The most common maintenance dose of intravenous insulin would be:
1. 0.1 U/kg/hour.
2. 1.0 U/kg/hour.
3. 2.0 U/kg/hour.
4. 5.0 U/kg/hour.
3 (This is a rare form of the disease that occurs with compulsive drinking of water.)
The patient is admitted with a long history of mental illness. Her husband states she has been drinking up to 10 gallons of water each day for the past 2 days and refuses to eat. The patient is severely dehydrated and soaked with urine. The nurse suspects:
1. central diabetes insipidus.
2. cephrogenic diabetes insipidus.
3. psychogenic diabetes insipidus.
4. iatrogenic diabetes insipidus.
1 (Diabetes insipidus is the result of a deficiency in antidiuretic hormone and results in a loss of free water. The loss of free water causes an increased serum osmolality and serum sodium.)
The patient presenting with diabetes insipidus will exhibit:
1. hyperosmolality and hypernatremia.
2. hyperosmolality and hyponatremia.
3. hypoosmolality and hypernatremia.
4. hypoosmolality and hyponatremia.
3 (The lack of ADH leads to severe dehydration, which can lead to decreased perfusion to the brain and seizures.)
The onset of seizures in the patient with DI indicates:
1. increased potassium levels.
2. hyperosmolality.
3. severe dehydration.
4. toxic ammonia levels.
4 (Pitressin is a synthetic ADH that may correct the fluid loss. However, a fluid bolus is indicated to correct the hypovolemia associated with DI before starting a vasopressor such as dopamine.)
The patient with DI has a blood pressure of 80/60. The nurse is administering Pitressin intravenously. The nurse recognizes that the next step to correct the blood pressure would be to:
1. stop the Pitressin.
2. start dopamine.
3. increase the Pitressin.
4. give a fluid bolus.
4 (Daily weights on the same scale are an excellent assessment of fluid status. A weight gain/loss of 1 kilogram (2.2 pounds) is equal to 1 liter of fluid.)
A priority for patient education when discharged with long-term ADH deficiency is:
1. daily intake and output.
2. attention to thirst.
3. a low sodium diet.
4. daily weights.
3 (A decreased urine output, hyponatremia, hypoosmolality, and high urine specific gravity are classic signs of SIADH. Oat cell carcinoma is a precipitating factor for SIADH.)
The patient with bronchogenic oat cell carcinoma has a drop in urine output. The laboratory reports a serum sodium of 120 mEq/l, a serum osmolality of 220 mOsm/kg, and urine specific gravity of 1.035. The nurse would suspect:
1. diuresis.
2. diabetes insipidus.
3. syndrome of inappropriate ADH.
4. hyperaldosteronism.
4 (Tylenol increases the release of ADH.)
The patient at risk for developing SIADH may be taking:
1. adenosine (Adenocard).
2. diltiazem (Cardizem).
3. heparin sodium.
4. acetaminophen.
2 (Low sodium levels normally trigger the release of aldosterone, which retains sodium at the kidney tubules. However, in SIADH, aldosterone is suppressed.)
In evaluating the SIADH patient's hyponatremia, the nurse understands the problem is:
1. increased cortisol release.
2. decreased aldosterone release.
3. increased glucocorticoid release.
4. decreased glucagon release.
1 (Fluid restriction is a successful intervention for the water intoxication.)
Once the patient has been diagnosed with SIADH, the nurse would expect treatment to include:
1. fluid restriction.
2. hypotonic intravenous fluid.
3. D5W.
4. fluid bolus.
2 (To avoid neurologic complications, the serum sodium should be raised no more than 12 mEq/day.)
During the first 24 hours when the nurse administers hypertonic saline in the SIADH patient, the serum sodium should be raised no more than:
1. 5 mEq/day.
2. 12 mEq/day.
3. 20 mEq/day.
4. 25 mEq/day.
4 (Hypertension and lung crackles are signs of fluid overload. The hypertonic solution may pull fluid out of cells and tissues.)
While the patient with SIADH is receiving hypertonic saline, the nurse assesses for signs that the saline must be stopped. These signs would include:
1. decreased CVP and decreased PAP.
2. bradycardia and thirst.
3. hypotension and wheezing.
4. hypertension and lung crackles.
3 (Passive warming will minimize heat loss without shocking the system.)
The patient's temperature is 93° F, rectally. The most appropriate intervention with this patient would be:
1. aggressive therapy that includes warm peritoneal lavage.
2. to allow the patient to maintain this body temperature to decrease oxygen demands.
3. to use passive warming blankets to slowly warm the patient.
4. to wait until the patient shivers to start warming.
3 (A stool softener is the safest intervention for constipation.)
The patient in myxedema coma has not had a bowel movement for 3 days. The nurse's best intervention would be:
1. to administer a Fleets enema.
2. to wait 1 more day.
3. to administer a stool softener.
4. to assess for rectal impaction. [Show Less]