Brunner and Suddarth 15th Edition, Ch 46

A woman with a progressively enlarging neck comes into the clinic. She mentions that she has been in a foreign country for the previous 3 months and that she didn't eat much while she was there because she didn't like the food. She also mentions that she becomes dizzy when lifting her arms to do normal household chores or when dressing. What endocrine condition should the nurse expect the health care provider to diagnose?

A. Goiter

B. Diabetes Mellitus

C. Diabetes Insipidus

D. Hypoglycemia

A

A nurse is caring for a diabetic patient with a diagnosis of nephropathy. What would the nurse expect the urinalysis report to indicate?

A. White blood cells

B. Bacteria

C. Red blood cells

D. Albumin

D

What is the duration of regular insulin

A. 4 to 6 hours

B. 3 to 5 hours

C. 12 to 16 hours.

D. 24 hours.

A

Which clinical characteristic is associated with type 1 diabetes (previously referred to as insulin-dependent diabetes mellitus)?

E. Rare ketosis

F. Presence of islet cell antibodies

G. Obesity

H. Requirement for oral hypoglycemic agents

F

Which combination of adverse effects should a nurse monitor for when administering IV insulin to a client with diabetic ketoacidosis?

A. Hypocalcemia and hyperkalemia

B. Hypokalemia and hypoglycemia

C. Hyperkalemia and hyperglycemia

D. Hypernatremia and hypercalcemia

C

Which information should be included in the teaching plan for a client receiving glargine, a "peakless" basal insulin?

A. It is rapidly absorbed and has a fast onset of action.

B. Administer the total daily dosage in two doses.

C. Draw up the drug first, then add regular insulin.

D. Do not mix with other insulins.

D

Which instruction about insulin administration should a nurse give to a client?

A. "Store unopened vials of insulin in the freezer at temperatures well below freezing."

B. "Always follow the same order when drawing the different insulins into the syringe."

C. "Discard the intermediate-acting insulin if it appears cloudy."

D. "Shake the vials before withdrawing the insulin."

B

A client is admitted to the unit with diabetic ketoacidosis (DKA). Which insulin would the nurse expect to administer intravenously?

A. Glargine

B. NPH

C. Lente

D. Regular

D

A nurse is preparing to administer two types of insulin to a client with diabetes mellitus. What is the correct procedure for preparing this medication?

E. The intermediate-acting insulin is withdrawn before the short-acting insulin.

F. If administered immediately, there is no requirement for withdrawing one type of insulin before another.

G. Different types of insulin are not to be mixed in the same syringe.

H. The short-acting insulin is withdrawn before the intermediate-acting insulin.

H

A client tells the nurse that she has been working hard for the past 3 months to control her type 2 diabetes with diet and exercise. To determine the effectiveness of the client's efforts, the nurse should check:

A. fasting blood glucose level.

B. serum fructosamine level.

C. urine glucose level.

D. glycosylated hemoglobin level. HgA1C

D

A client with a history of type 1 diabetes is demonstrating fast, deep, labored breathing and has fruity odor breath. What could be the cause of the client's current serious condition?

A. hepatic disorder

B. All options are correct.

C. hyperosmolar hyperglycemic nonketotic syndrome

D. ketoacidosis

D

Which is a characteristic of type 2 diabetes?

A. little or no insulin

B. presence of islet antibodies

C. insulin resistance

D. ketosis-prone when insulin is absent

C

A nurse educates a group of clients with diabetes mellitus on the prevention of diabetic nephropathy. Which of the following suggestions would be most important?

A. Drink plenty of fluids.

B. Eat a high-fiber diet.

C. Control blood glucose levels.

D. Take the antidiabetic drugs regularly.

C

A client is admitted with hyperosmolar hyperglycemic nonketotic syndrome (HHNS). Which laboratory findings should the nurse expect in this client?

A. Plasma bicarbonate 12 mEq/L

B. Arterial pH 7.25

C. Blood glucose level 1,100 mg/dl

D. Blood urea nitrogen (BUN) 15 mg/dl

C

A client with diabetes asks the nurse why shoes and socks are removed at each office visit. The nurse gives which assessment finding is the explanation for the inspection of feet?

A. Sensory neuropathy

B. Autonomic neuropathy

C. Nephropathy

D. Retinopathy

A

After teaching a client with type 1 diabetes who is scheduled to undergo an islet cell transplant, which client statement indicates successful teaching?

A. "I might need insulin later on, but probably not as much or as often."

B. "I will receive a whole organ with extra cells to produce insulin."

C. "They'll need to create a connection from the pancreas to allow enzymes to drain."

D. "This transplant will provide me with a cure for my diabetes."

A

The nurse is instructing a client on the self-administration of insulin. Place in order the steps that the nurse will instruct the client to take.

Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left.

• 1 Discard the syringe into a hard container.

• 2 Push the plunger of the syringe.

• 3 Pull the needle straight out of the skin.

• 4 Hold the syringe as if holding a pencil.

• 5 Insert the needle straight into the skin.

• 6 Stabilize the skin by pinching an area.

• 7 Press a cotton ball over the injection site.

6. Stabilize the skin by pinching an area.

4. Hold the syringe as if holding a pencil.

5. 5Insert the needle straight into the skin.

2. Push the plunger of the syringe.

3. Pull the needle straight out of the skin.

7. Press a cotton ball over the injection site.

Discard the syringe into a hard container.

A nurse expects to find which signs and symptoms in a client experiencing hypoglycemia?

A. Nervousness, diaphoresis, and confusion

B. Polyuria, headache, and fatigue

C. Polyphagia and flushed, dry skin

D. Polydipsia, pallor, and irritability

A

A nurse is teaching a client recovering from diabetic ketoacidosis (DKA) about the management of "sick days." The client asks the nurse why it is important to monitor the urine for ketones. Which statement is the nurse's best response?

A." Ketones accumulate in the blood and urine when fat breaks down in the absence of insulin. Ketones signal an insulin deficiency that will cause the body to start breaking down stored fat for energy."

B. "When the body does not have enough insulin, hyperglycemia occurs. Excess glucose is broken down by the liver, causing acidic by-products to be released."

C. "Ketones are formed when insufficient insulin leads to cellular starvation. As cells rupture, they release these acids into the blood."

D. "Excess glucose in the blood is metabolized by the liver and turned into ketones, which are an acid."

A

A nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia?

A. Decreased appetite

B. Increased urine output

C. Cheyne-Stokes respirations

D. Diaphoresis

B

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for whih early signs and symptoms are associated with hypoglycemia?

A. Dry skin, bradycardia, and somnolence

B. Sweating, tremors, and tachycardia

C. Bradycardia, thirst, and anxiety

D. Polyuria, polydipsia, and polyphagia

B

The client who is managing diabetes through diet and insulin control asks the nurse why exercise is important. Which is the best response by the nurse to support adding exercise to the daily routine?

A. Decreases risk of developing insulin resistance and hyperglycemia

B. Decreases need for pancreas to produce more cells

C. Creates an overall feeling of well-being and lowers risk of depression

D. Increases ability for glucose to get into the cell and lowers blood sugar

D

A client's blood glucose level is 45 mg/dl. The nurse should be alert for which signs and symptoms?

A. Polyuria, polydipsia, polyphagia, and weight loss

B. Coma, anxiety, confusion, headache, and cool, moist skin

C. Kussmaul respirations, dry skin, hypotension, and bradycardia

D. Polyuria, polydipsia, hypotension, and hypernatremia

B

The nurse is administering an insulin drip to a patient in ketoacidosis. What insulin does the nurse know is the only one that can be used intravenously?

A. Lispro

B. Regular

C. Lantus

d. NPH

B

The nurse is educating the client with diabetes on setting up a sick plan to manage blood glucose control during times of minor illness such as influenza. Which is the most important teaching item to include?

A. Take half the usual dose of insulin until symptoms resolve.

B. Do not take insulin if not eating.

C. Decrease food intake until nausea passes.

D. Increase frequency of glucose self-monitoring.

D

A client with status asthmaticus requires endotracheal intubation and mechanical ventilation. Twenty-four hours after intubation, the client is started on the insulin infusion protocol. The nurse must monitor the client's blood glucose levels hourly and watch for which early signs and symptoms associated with hypoglycemia?

A. Dry skin, bradycardia, and somnolence

B. Sweating, tremors, and tachycardia

C. Bradycardia, thirst, and anxiety

D. Polyuria, polydipsia, and polyphagia

B

A client is evaluated for type 1 diabetes. Which client comment correlates best with this disorder?

A. "I notice pain when I urinate."

B. "I'm thirsty all the time. I just can't get enough to drink."

C. "I have a cough and cold that just won't go away."

D. "It seems like I have no appetite. I have to make myself eat."

B

Which client comment correlates best with type 1 diabetes?

B. 'I'm thirsty all the time. I just can't get enough to drink.'

What process should the nurse describe as the etiology of type 1 diabetes?

B. Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down.

What step should be taken into consideration prior to making a meal plan for a patient with type 2 diabetes?

A. Determining whether the patient is on insulin or taking oral antidiabetic medication

What instruction should a nurse give to a client with diabetes mellitus when teaching about 'sick day rules'?

Test your blood glucose every 4 hours.

What should a client with hypoglycemia ingest?

10 to 15 g of a simple carbohydrate.

Who should a client with unstable blood glucose levels be referred to?

Dietitian

What is the most important assessment finding for a client with diabetes mellitus?

Fruity breath

What factor is a cause of type 1 diabetes?

Presence of autoantibodies against islet cells

How long before breakfast should lispro insulin be administered?

10 to 15 minutes

What is expected for a patient diagnosed with type 1 diabetes?

Need exogenous insulin

What is the most appropriate nursing intervention for a client with type 1 diabetes presenting with decreased level of consciousness and low glucose level?

Administering 1 ampule of 50% dextrose solution, per physician's order

What endocrine condition should the nurse expect the health care provider to diagnose for a woman with progressively enlarging neck, dizziness when lifting arms, and recent foreign travel?

Goiter

Which rapidly absorbed carbohydrate would be most effective for a client with diabetes mellitus and blood glucose level of 40 mg/dL?

A. 1/2 tbsp honey or syrup

B. 1/2 cup fruit juice or regular soft drink

C. three to five LifeSavers candies

D. 4 oz of skim milk

A

Which clinical characteristic is associated with type 1 diabetes?

Presence of islet cell antibodies

What is the duration of regular insulin?

4 to 6 hours