Exam 3 - Practice Questions

After taking a rapid/short‑acting insulin (e.g., lispro, aspart, regular), when should the patient eat?

Immediately, within 15 minutes

what should be given with positive trousseau signs

calcium gluconate

what would be indicative of nephropathy due to diabetes

protein in the urine

main feature of grave’s disease

bulging eyes

why would a pt have cushing’s disease

too much steroids

MOA of sulfonylureas

promote release of insulin

how to prevent the development of kidney disease

give an ACE inhibitor (pril)

when does rapid acting insulin start

within 15 minutes

In renal insufficiency, what vital sign may you see change

Decreased BP

A patient with type 2 diabetes asks what belongs in their treatment plan. What do you emphasize?

Weight management, regular follow-up appointments, medication adherence, blood glucose monitoring, and lifestyle changes

What teaching do you give a patient on insulin who plans to drink alcohol (ETOH)?

Alcohol may cause an initial rise then a delayed drop in blood glucose—monitor frequently, don’t binge drink, eat a snack with alcohol

You suspect diabetic peripheral neuropathy. What symptom do you assess for?

Numbness, tingling, burning, or loss of sensation in extremities

Why might a prediabetic/diabetic surgical patient be placed on a sliding‑scale insulin protocol pre‑op and post‑op?

Surgical stress can raise blood glucose; frequent checks and scale dosing help maintain control

Cardiovascular risk in diabetes—what are key concerns?

Increased risk for MI, HTN, and other atherosclerotic disease

What non‑pharmacological measure reduces the body's need for insulin?

Regular exercise/physical activity

Early warning signs suggestive of new‑onset type 1 diabetes in many patients?

Recurrent infections

What is the mechanism of action of insulin at the cellular level?

Facilitates glucose uptake into cells (primarily muscle & fat) and promotes storage/utilization of nutrients

You find a patient anxious, tachycardic, and diaphoretic. What's your priority suspicion and treatment?

Hypoglycemia—give about 15g fast carbs (4 oz guice, glucose tabs), recheck in 15 min, then follow with protein/complex carb

Persistent protein (albumin) in the urine of a patient with diabetes suggests what complication?

Diabetic nephropathy

Key foot care teaching for patients with diabetes?

Wash daily in warm (not hot) water; dry thoroughly (especially between toes); apply lotion to dry skin (not between toes); wear clean socks (often white to spot drainage) and protective shoes at all times; inspect feet daily

Why should patients with diabetes always carry a fast‑acting carbohydrate snack?

To treat unexpected hypoglycemia promptly

What are the "3 Ps" of hyperglycemia?

Polydipsia, polyuria, polyphagia

Why do polyuria and polydipsia occur in hyperglycemia?

Osmotic diuresis causes fluid shifting into urine → dehydration → thirst

Why are ACE inhibitors or ARBs often prescribed in diabetes?

They help protect kidney function and reduce progression of diabetic nephropathy (especially with albuminuria)

What is the essential lifelong therapy for type 1 diabetes?

Insulin replacement

To prevent long‑term complications in diabetes, what two major targets must be controlled?

Blood glucose and blood pressure

Your diabetic patient is NPO but prescribed insulin. What nursing actions are important?

Check blood glucose; give basal insulin as ordered; hold/prn bolus doses; clarify plan with provider

How do sulfonylureas lower blood glucose?

They stimulate pancreatic beta cells to release insulin

Why rotate insulin injection sites?

To prevent lipodystrophy (lipoatrophy or lipohypertrophy) and ensure consistent absorption

Provide an example of a balanced meal pattern for someone with diabetes

Emphasize whole grains, high fiber, non‑starchy vegetables, lean proteins, and minimal processed/added‑sugar foods

Why might a patient with diabetes need more frequent blood glucose checks when ill or stressed?

Stress hormones raise glucose; insulin needs may change rapidly

What supplies should a person with insulin‑treated diabetes keep with them when traveling?

Insulin, glucose meter/strips, fast carbs for lows, snacks, ID/medical alert

What is the "rule of 15" for treating mild hypoglycemia?

Give 15g fast carbs, wait 15 minutes, recheck glucose; repeat if still low

Classic symptom pattern of hypothyroidism?

Cold intolerance, fatigue, "low & slow" metabolism (weight gain, bradycardia, slowed thinking)

Classic symptom pattern of hyperthyroidism?

Heat intolerance, restlessness/anxiety, tachycardia, weight loss despite appetite

In renal insufficiency, why is blood pressure control important in endocrine/metabolic care plans?

Reduced kidney function impairs fluid/electrolyte regulation; uncontrolled BP worsens renal decline

What is the hallmark fluid status issue in SIADH?

Excess total body water retention leading to dilutional hyponatremia (excess fluid)

Teaching for a patient prescribed an oral prednisone taper after an allergic reaction?

Taper as prescribed—abrupt stop after prolonged use risks adrenal insufficiency

After adrenalectomy, what lifelong therapy may be required?

Glucocorticoid ± mineralocorticoid replacement (lifelong steroid supplementation)

If serum T3 and T4 levels drop, what happens to TSH (assuming normal pituitary)?

TSH increases (negative feedback)

From which gland are T3 and T4 secreted?

The thyroid gland (anterior pituitary secretes TSH that stimulates the thyroid)

Medication teaching priority for Addison's disease?

Lifelong steroid replacement; never skip doses; increase during stress as directed

Severe untreated hypothyroidism can progress to what life‑threatening state?

Myxedema coma

Untreated or poorly controlled hyperthyroidism can develop into what autoimmune disease?

Graves' disease (autoimmune hyperthyroidism)

Post‑thyroidectomy, what lab/clinical issue must be closely monitored?

Hypocalcemia (possible parathyroid injury)—treat with IV calcium if needed

What does the dexamethasone suppression test evaluate?

For Cushing syndrome—give dexamethasone (often at night) and check morning cortisol for suppression

In SIADH, what electrolyte is most critical to monitor?

Serum sodium (risk of hyponatremia)

Which medication helps lower serum calcium by promoting calcium movement into bone?

Calcitonin

Key signs/symptoms of diabetes insipidus (DI)?

Excessive thirst (polydipsia) and large volumes of dilute urine (polyuria)

Primary physical feature associated with acromegaly?

Enlarged hands, feet, and facial features (soft tissue and bone overgrowth)

In Cushing syndrome (excess steroids), what metabolic change is common?

Elevated blood glucose; need for glucose control and weight management

A patient with Graves' disease can't fully close their eyelids. What eye care teaching is needed?

Lubricating drops/ointment, periodic eye exams, protect corneas (tape lids closed at night if needed), emotional support

What hormone from the pituitary stimulates the thyroid to produce T3/T4?

Thyroid‑stimulating hormone (TSH)

What emergency risk exists if long‑term steroids are abruptly stopped?

Acute adrenal crisis (adrenal insufficiency), shock

What is the difference between SIADH and DI in terms of urine output?

SIADH = low urine output (water retained)

DI = high urine output (water loss)

In hypothyroidism, why might patients feel cold and gain weight?

Reduced basal metabolic rate decreases heat production and slows calorie burn

In hyperthyroidism, why might patients be tachycardic?

Excess thyroid hormone increases metabolic demand and beta‑adrenergic sensitivity

After thyroid surgery, what early sign of hypocalcemia should nurses watch for?

Perioral numbness, tingling, or positive Chvostek/Trousseau signs

In chronic kidney disease (CKD), what symptoms might indicate progressing uremia/insufficiency?

Pruritus, edema, fatigue, nausea, and other uremic signs

During the oliguric phase of acute kidney injury (AKI), what complication do you assess for?

Fluid overload with risk of pulmonary edema

What general diet teaching is common for patients with CKD (depends on labs & stage)?

Limit sodium/salt; moderate/low protein; avoid salt substitutes high in potassium; restrict phosphorus as directed

Home peritoneal dialysis catheter care—what key technique prevents infection?

Strict sterile/aseptic technique during exchanges

Major infection risk in peritoneal dialysis?

Peritonitis (abdominal/GI infection signs)

High serum potassium in renal disease—what system requires close monitoring?

Cardiac rhythm (ECG changes, arrhythmias)

Because CKD patients retain fluid, what routine nursing assessments are critical?

Daily weights, intake & output, lung sounds, edema

What is an AV fistula?

Surgically created connection between an artery and a vein (usually in the arm) for hemodialysis access

When should a phosphate binder be taken in CKD?

With meals (binds dietary phosphorus); not taken when NPO

Primary goal when initiating dialysis in advanced CKD?

Restore fluid and electrolyte balance and remove waste products

Which imaging test is commonly used to assess structural renal abnormalities without contrast risk?

Renal ultrasound

Why use caution with contrast CT scans in renal impairment?

Contrast can worsen kidney injury; avoid other nephrotoxic meds around the study

Which bedside test estimates residual bladder volume after voiding?

Bladder scan (post‑void residual)

What lab result suggests decreased glomerular filtration or glomerular damage?

Elevated BUN and creatinine; may also see proteinuria

What medications are used to treat anemia of CKD?

Iron supplementation and erythropoiesis‑stimulating agents (e.g., epoetin alfa)

How do you assess patency of an AV fistula?

Palpate for a thrill and auscultate for a bruit

How can a severe myocardial infarction lead to acute kidney injury?

Reduced cardiac output → renal hypoperfusion → ischemic (prerenal → intrinsic) AKI

-insufficient blood flow to the kidney

When distinguishing prerenal AKI, what common history finding supports a prerenal cause?

Volume depletion/dehydration (or anything reducing renal perfusion)

During the diuretic phase of AKI, what imbalances are you most vigilant for?

Hypotension, hypovolemia, and dehydration from high urine output

Why monitor phosphorus and calcium in CKD?

Disordered mineral metabolism leads to hyperphosphatemia, secondary hyperparathyroidism, and bone disease