Chapter 14 Endocrine, Metabolic, and Test Bank + Answers

Chapter 14 Endocrine, Metabolic, and Nutritional Disorders

Multiple Choice

1. Mrs. Borden is 67 years old and her primary care physician wants her to be seen by a nurse practitioner who specializes in geriatric issues. On completing the interview and examination, the nurse practitioner tells Mrs. Borden that she will order a blood laboratory specimen for thyroid function and pancreatic function. Mrs. Borden asks what the reason is. Which of the following is the nurse practitioner’s best response?

1. Diabetes is more common in older patients.

2. Thyroid issues are less common in older patients.

3. These are common tests to be done on any new patient.

4. These tests are necessary to obtain baseline information.

2. Mr. Jones is 70 years old and sees the nurse practitioner for a yearly checkup. He states that he needs to urinate a lot and seems to always be thirsty. He also finds himself gaining some weight. In the process of the examination, the nurse practitioner detects that he is vague in his

1. Mr. Jones is cold and bundled in a sweater.

2. There is no family history of diabetes.

3. The symptoms seem to have appeared slowly.

4. He does not want to admit to eating too much.

3. Ms. Allen, 72 years old, is being evaluated by the nurse practitioner for type 2 diabetes. Because symptoms of endocrine disorders in older adults are vague, which of the following questions is best to ask?

1. Do you have any trouble carrying out your daily activities?

2. Can you tell me what you ate yesterday?

3. Have you seen a dentist in the last year?

4. Have you noticed that you have less hair?

4. Mrs. Smith, 80 years old, has been vomiting and having bouts of loose stools for several days. She is taking several medications that are prescribed. The nurse practitioner conducts a medication review because:

1. An accounting of all prescribed and over-the-counter (OTC) medications may uncover reasons for her symptoms.

2. There could be drug–drug interactions leading to her symptoms.

3. Side effects of the gastrointestinal tract are not seen in many medications.

4. The administration of some of her medications may be appropriate.

5. Mr. Jameson, 75 years old, comes to the clinic with complaints of severe sharp epigastric pain that radiates to his back. He has been nauseous and has vomited three times today. The nurse practitioner suspects which of the following?

1. Appendicitis

2. Gastrointestinal influenza

3. Acute pancreatitis

4. Insulin shock

6. The nurse practitioner is working in the emergency department and is called to assist with the diagnosis of a patient who just came in. Mr. Barn is 76 years old and complains of abdominal pain, and his serum amylase and lipase are three times the normal limit. The nurse practitioner confirms pancreatitis, as this meets which criteria?

1. CT severity index

2. Atlanta classification

3. APACHE II

4. Ranson criteria

7. Ms. Jenny is 72 years old and has managed her type 2 diabetes for 30 years. This condition is costly to her in more than one way. Which complications are common?

1. Financial challenges.

2. Good visual acuity.

3. Good renal functioning.

4. Increased circulation to lower extremities.

Multiple Response

8. The nurse practitioner is ordering laboratory testing to confirm her suspicion of acute pancreatitis. Which of the following findings would confirm her suspicions? Select all that apply.

1. Trypsinogen activation peptide (TAP).

2. Blood urea nitrogen (BUN), creatinine, glucose.

3. An abdominal x-ray.

4. Amylase and lipase amount three times the normal.

5. Stool culture.

9. John Brown, 60 years old, asks the nurse practitioner if a lack of functioning insulin is the only cause of diabetes. Which of the following is the nurse practitioner’s reply? Select all that apply.

1. More recently, other hormones have been found to be part of diabetes.

2. Besides insulin, glucagon, amylin, and incretin are involved.

3. Finding other factors of diabetes has resulted in new treatments.

4. The pancreas is not the only organ involved in diabetes.

5. Genetic factors lead to type 1diabetes only.

10. Mr. Ed, 46 years old, experienced a mild stroke and was hospitalized through the emergency room. The general work-up showed that his blood glucose was 300 mg/dl. He denied knowing that his sugar was so high. He did report frequency of urination and polyphagia. On further examination, the nurse practitioner asked about family history, and he identified that his mother and grandfather both had adult-onset diabetes. Although he is under 65 years old, the nurse practitioner teaches him which of the following? Select all that apply.

1. A urine sample that shows ketones in the urine, his age, and his body mass index (BMI) will tell if he is a type 1 or type 2 diabetic.

2. Having the mild stroke is connected to having diabetes.

3. Medications could be associated with diabetes.

4. Because he had a family history of type 2 diabetes, he should have been screened every year.

5. Screening would not have identified him as a risk.

11. The nurse practitioner is preparing home-going instructions for a 66-year-old man with newly diagnosed type 2 diabetes. The goals include which of the following? Select all that apply.

1. Maintenance of weight at present status

2. Glycemic control

3. Good nutritional status

4. More rest

5. Exercise

12. Mr. John has recently been given a diagnosis of diabetes. He asks the nurse practitioner if can try something nonpharmacological to control his diabetes. Which of the following would the nurse practitioner propose? Select all that apply.

1. Weight loss and exercise.

2. Self-monitoring blood glucose.

3. A moderate increase in activity.

4. Frequent follow-up appointments with the nurse practitioner.

5. Enrolling in a high-intensity physical activity program.

13. Annie is 89 years old and appears apathetic, unwilling to eat and drink, and shows functional decline. The nurse practitioner discusses with the family the possibility that Annie is experiencing a failure to thrive (FTT). The family asks how this happened. The nurse practitioner replies with which of the following statements? Select all that apply.

1. Adult FTT is a part of aging.

2. FTT can be associated with increased infections and diminished immunity.

3. FTT patients have often experienced multiple hospitalizations and several comorbidities.

4. FTT is complex, with many components.

5. The goal of early assessment is to prevent a decline in health.

14. Bob is 85 years old and is suspected of experiencing adult FTT. His family asks the nurse practitioner to evaluate what exactly is going on with him. The nurse practitioner knows to order which of the following? Select all that apply.

1. Complete blood count (CBC), serum albumin level, and thyroid-stimulating hormone (TSH).

2. Cholesterol levels and comprehensive metabolic panel.

3. Blood cultures.

4. A nutritional assessment.

5. Depression screening with Beck’s PP depression scale.

15. Mr. Waterson is 76 years old and involved in a weight-loss program. He weighs 250 pounds and is 5 feet and 5 inches tall. He asks his nurse practitioner what he should do for exercise to enhance his modified eating style. The nurse practitioner advises him with which of the following statements? Select all that apply.

1. Anything you do is better than nothing.

2. Try moderate walking for 2 ½ hours a week.

3. Try to increase your moderate activity to 600 minutes a week.

4. Perform muscle-strengthening activities that are moderate or high intensity on 4 or more days a week.

5. Do exercises that improve balance, which may prevent falls.

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