1. Haley Joel Osment, a 13 year old patient comes into the Emergency room complaining of blurred vision, and
fatigue. His history reveals that he has been losing weight for several weeks. He denies any abnormal
symptoms, but when asked reveals that he drinks at least two 64 oz Big Gulps a day and that he always seems
to be hungry. He often wakes up to go the bathroom in the middle of the night. You notice that his breath
smells fruity. His respirations are 28/minute and he is taking fairly deep breaths. He has an older sister with
Type I Diabetes Mellitus.
What is the most appropriate diagnostic test for this patient?
a. Check his blood glucose immediately.
b. Wait until he fasting, and then check his glucose
c. Administer an oral glucose tolerance test.
d. Check his urine for ketones
2. What is Haley's bad breath most likely caused by?
a. Chewing Juicy Fruit gum
b. Breath mints
c. Exhalation of buffered acetone
d. Exhalation of glucose
3. The physician orders a BMP and urinalysis on Haley. The lab results are:
Electrolytes
Na: 128 mEq/L
Cl: 102 mEq/L
K: 3.1 mEq/L
BUN: 12 mg/dl
Creat.: 0.8 mg/dl
CO2: 15 mmol/L
Ca: 8.8 mg/dl
Mag: 2.1 MEq/L
Phos: 5.5 mg/dl
Gluc: 853 mg/dl
Albumin: 4.0 g/dl
Urinalysis
WBCs:-
Nitrites: -
RBCs: -
Protein +
Urobilinogen - Ketones: +++
Sp Grav: 1.001
Color: Clear
pH 3.5
glucose +++
Odor: -
ABG's
pH 7.33 PaCO2 25
HC03- 15 PaO2 89
His labs indicate
a. Fully compensate respiratory acidosis
b. Uncompensated respiratory alkalosis
c. Fully compensated metabolic alkalosis
d. Partially compensated metabolic acidosis
4. Haley's potassium level is:
a. Normal
b. Low because of his pH.
c. Low because of his polyuria
d. Causing his pH
5. Haley’s glucose level is considered
a. Prediabetes
b. High-normal
c. Moderately high
d. Dangerously high
6. What is the treatment of choice for Haley? (Check all that apply)
a. Insulin IV
b. Bicarbonate
c. Calcium gluconate
d. Potassium chloride
e. Dextrose
f. Metformin
7. Haley’s urine specific gravity indicates
a. Normal urine concentration
b. High urine concentration
c. Low urine concentration
8. Why is Haley most likely getting up in the middle of the night to go to the bathroom?
a. Benign Prostatic Hyperplasia
b. Excessive fluid intake
c. Hyperosmolar blood
d. Incompetent bladder training.
9. What is the cause of Haley's pH imbalance?
a. Asthma
b. Excess fat metabolism
c. Inadequate oxygen delivery to tissues
d. Hyperglycemia
10. Which explanation best explains Haley's respiratory rate?
a. Primary respiratory alkalosis
b. Compensation for Ketoacidosis
c. Because he is out of shape
d. Due to weightloss secondary to malnourishment
11. The physician decides that Haley needs to be admitted for treatment. Haley is most likely to
receive:
a. Aggressive Metformin Therapy
b. 75/25 NPH/R Insulin SC
c. Insulin Glargine (Lantus) IV
d. Regular Insulin IV
12. You know that as a result of Haley's therapy that he will need careful monitoring of the following
electrolytes (check all that apply)
a. Sodium
b. Calcium
c. Potassium
d. Magnesium
13. Haley has been diagnosed with Type I diabetes. He asks you when he is going to get better and be able to
stop taking insulin. You tell him:
a. Only until he completes puberty
b. Only until he becomes stable on oral hypoglycemics
c. There is no getting better, you'll have to take insulin for the rest of your life
d. He can stop taking it if he exercises more
14. Kathy Bates is 56 year old white patient who has never been diagnosed with Diabetes. She is 5'4" and
weighs 211 pounds. She says that she exercises by walking to the mailbox. Her HDL is 25, and her
Triglycerides are 500. Both her parents had diabetes. Her fasting plasma glucose this morning is 105. She denies
any polyuria, polydipsia, polyphagia. Her blood pressure is 142/88
You tell Kathy that (check all that apply):
a. She has nothing to worry about because she only has prediabetes.
b. She has metabolic syndrome, a sign of insulin resistance
c. She needs to begin losing weight and exercising immediately to reduce her risk of getting full
diabetes.
d. She already has the Diabetes disease process and is at a higher risk for heart attacks and stroke.
15. Kathy most likely has insulin resistance caused by (check all that apply):
a. Changes in insulin receptor affinity
b. Altered glut-4 insulin transporter proteins
c. Decreased number of insulin receptors on individual cells
d. Antibodies to insulin
16. Kathy asks you what she can do to reduce her insulin resistance. You tell her (Check all that apply):
a. Weight loss
b. Exercise
c. Calorie restriction
d. Increased Soluble Fiber
17. Kathy asks if any drugs might help reduce her risk of developing full diabetes. Which of the following
might help?
a. Glimepiride (Amaryl)
b. Glipizide (Glucotrol)
c. Metformin (Gluchophage)
d. Repaglinide (Prandin)
18. Kathy does not follow your advice and develops full diabetes. Her fasting glucose usually runs at 135. Her
physician follows the latest thinking in Diabetes management. Which of the following drugs is he most likely to
use first.
a. Glimepiride (Amaryl)
b. Glyburide (Micronase)
c. Chlorpramide (Diabinase)
d. Metformin (Glucophage)
19. The best measurement of Kathy's long term glucose control is:
a. Fasting Plasma Glucose
b. Triglycerides
c. Oral glucose tolerance test
d. Hemoglobin A1C
20. Kathy is not controlled on Metformin (Glucophage) alone. Her physician adds Acarbose (Precose). She
needs to be educated that: (Check all that apply)
a. If her drugs make her hypoglycemic that she should not use table sugar to bring her glucose levels
back to normal.
b. She should expect to have excess gas.
c. She needs to make sure that she eats within 30 minutes of taking the medication or she might
become hypoglycemic.
d. She should let the physician know if she has a sulfonamide allergy.
21. Which of the following is most likely to kill Kathy:
a. Heart attack
b. Kidney failure
c. Blindness
d. Nerve Damage
22. While educating Kathy, she asks why Neuropathy is such a big deal. You explain that it can lead to (Check
all that apply):
a. Nausea and Heartburn
b. Constipation
c. Blindness
d. Ulcers, Gangrene, and amputations
23. While discussing neuropathy, Kathy asks you what Charcot joints are. You tell her:
a. Joints that spontaneously dislocated
b. Gross deformities caused by calcium deposits
c. Destruction of the joints due to trauma secondary to loss of sensation (similar to the process in
leprosy)
d. Bunions that have worsened until the patient can no longer walk.
24. Kathy Bates tells you that her diabetes is controlled because she never has glucose in her urine. You tell her:
a. That she is correct.
b. That serum glucose must be at 180 before glycosuria occurs, but diabetes is defined by fasting
glucose > 125
c. That serum glucose must be at 160 before glycosuria occurs, but diabetes is defined by fasting
glucose > 125
d. That serum glucose must be at 180 before glycosuria occurs, but diabetes is defined by fasting
glucose > 99
25. Kathy Bates' physician has been telling her about some new fangled drugs for diabetes. It mimics some
crazy enzyme produced by the beta cells that tells the alpha cells to stop producing glucagon. It is:
a. an incretin (GLP-1) mimetic (exenatide, brand name Byetta)
b. dipeptidyl peptidase-4 (DPP-4) inhibitor (vildagliptin, brand name Galvus and Sitagliptin, brand
name Januvia)
c. artificial amylin (pramlintide, brand name Symlin)
26. A type 1 diabetes patient reports that he has been mixing his NPH and his insulin aspart to enable one
injection. The nurse should inform him that:
a. this is an acceptable practice.
b. these two forms of insulin are not compatible and thus cannot be mixed.
c. mixing these insulins may increase the overall potency of the products.
d. the short acting agent should be switched to ultralente he insists on mixing agents.
27. A patient calls from home due to concern about the appearance of his insulin. He reports that when
drawing up his lispro insulin he noted that the solution appeared cloudy. The nurse’s best response should be:
a. agitate the solution and the granules should disperse.
b. discard the vial as the solution should be clear.
c. proceed with the injection. The process of drawing the solution into the syringe will mix the
particles sufficiently.
d. lispro is always cloudy. He should proceed with the injection.
28. A patient with type 1 diabetes on insulin reports that he is taking metoprolol for his hypertension. This
provokes the concern that:
a. Metoprolol can produce insulin resistance.
b. the two agents used together will increase the risk of ketoacidosis.
c. Metoprolol will increase insulin requirements due to receptor blocking.
d. Metoprolol can mask the symptoms of hypoglycemia.
29. Using the format 1234, order the following insulins from shortest acting to longest acting:
1. Regular
2. Lantus
3. NPH
4. Lispro
Answer: _______________
30. When should Lispro be given to the patient?
a. 30 Minutes before eating
b. As the patient begins eating
c. 30 minutes after eating
d. No relation to meals
31. When should Lantus be given?
a. 30 minutes before eating
b. As the patient begins eating
c. 30 minutes after eating
d. No relationship to meals
32. Which of the following drugs will cause hypoglycemia?
a. Acarbose (Precose)
b. Glipizide (Glucotrol)
c. metformin (Glucophage)
d. pioglitazone (Actos)
33. Which of the following drugs can cause weightloss?
a. Acarbose (Precose)
b. Glipizide (Glucotrol)
c. Metformin (Glucophage)
d. Pioglitazone (Actos)
34. Which of the following drugs can cause fluid retention, exacerbating Heart Failure?
a. Acarbose (Precose)
b. Glipizide (Glucotrol)
c. Metformin (Glucophage)
d. Pioglitazone (Actos)
35. Which of the following drugs should not be given to patients with renal insufficiency?
a. Acarbose (Precose)
b. Glipizide (Glucotrol)
c. Metformin (Glucophage)
d. Pioglitazone (Actos)
36. A patient complaining of fatigue has high TSH and low T4. What is the correct interpretation? The patient
most likely has
a. hyperthyroidism 2˚ Grave’s disease
b. hypothyroidism 2˚ Hashimoto’s disease
c. hypothyroidism 2˚ Lithium toxicity
d. normal thyroid function
37. Which of the following is a common sign of hypothyroidism
a. Excessive sweating
b. Straw like hair
c. high body temperatures
d. weight gain
38. If a patient with hypothyroidism does not respond adequately to levothyroxine (Synthroid) therapy, what is
the best alternative?
a. Switch the patient to T3
b. Add T3
c. Switch the patient to T4
d. Radioactive iodine
39. What does newborn hypothyroid lead to if untreated? (Check all that apply)
a. Short stature
b. Obesity
c. Mental retardation
d. Hypertension
40. What is the major clinical manifestation of Grave’s disease besides the hyperthyroidism?
a. Large tongue
b. Decrease wound healing
c. Exophthalmos
d. Skin pigmentation
41. What is the main advantage of surgery over radioactive iodine for the treatment of hyperthyroidism?
a. Works immediately
b. Easier to predict the correct amount of thyroid destruction
c. Less risk of infection
d. Less expensive
42. What is the main cause of Addison’s disease?
a. Autoimmune disease
b. Increased ACTH secretion
c. Too much stress
d. Non-adherence to steroids
43. Which of the following is a common symptom in Addison’s disease?
a. fatigue
b. weight gain
c. hypertension
d. warm body temperature
44. What is the treatment of choice for Addison’s disease?
a. Cortisone
b. Prednisone
c. Taper steroids slowly
d. Reduce the dose of steroids
45. What is the most common cause of Cushing’s Syndrome?
a. Viral illness
b. Autoimmune disease
c. Chronic steroid use
d. Thyroid malfunction