Endocrine System Disorders
Endocrine System Disorders
Endocrine System Disorders
A. 2 to 5 g of a simple carbohydrate.
B. 10 to 15 g of a simple carbohydrate.
C. 18 to 20 g of a simple carbohydrate.
D. 25 to 30 g of a simple carbohydrate.
A. Dysuria
B. Leg cramps
C. Tachycardia
D. Blurred vision
A. Diabetes mellitus
B. Diabetes insipidus
C. Hypoparathyroidism
D. Hyperparathyroidism
8. When caring for a male client with diabetes insipidus, nurse Juliet
expects to administer:
9. The nurse is aware that the following is the most common cause of
hyperaldosteronism?
10. A male client with type 1 diabetes mellitus has a highly elevated
glycosylated hemoglobin (Hb) test result. In discussing the result with
the client, nurse Sharmaine would be most accurate in stating:
A. Muscle weakness
B. Tremors
C. Diaphoresis
D. Constipation
A. Diabetic ketoacidosis
B. Thyroid crisis
C. Hypoglycemia
D. Tetany
17. A female client has a serum calcium level of 7.2 mg/dl. During the
physical examination, nurse Noah expects to assess:
A. Trousseaus sign.
B. Homans sign.
C. Hegars sign.
D. Goodells sign.
19. Jemma, who weighs 210 lb (95 kg) and has been diagnosed with
hyperglycemia tells the nurse that her husband sleeps in another room
because her snoring keeps him awake. The nurse notices that she has
large hands and a hoarse voice. Which of the following would the nurse
suspect as a possible cause of the clients hyperglycemia?
A. Acromegaly
B. Type 1 diabetes mellitus
C. Hypothyroidism
D. Deficient growth hormone
22. A male client with type 1 diabetes mellitus asks the nurse about
taking an oral antidiabetic agent. Nurse Jack explains that these
medications are only effective if the client:
A. sulfisoxazole (Gantrisin)
B. mexiletine (Mexitil)
C. prednisone (Orasone)
D. lithium carbonate (Lithobid)
A. The head of your bed must remain flat for 24 hours after surgery.
B. You should avoid deep breathing and coughing after surgery.
C. You wont be able to swallow for the first day or two.
D. You must avoid hyperextending your neck after surgery.
A. Hypotension.
B. Thick, coarse skin.
C. Deposits of adipose tissue in the trunk and dorsocervical area.
D. Weight gain in arms and legs.
27. A male client with primary diabetes insipidus is ready for discharge
on desmopressin (DDAVP). Which instruction should nurse Lina
provide?
A. Hypocalcemia
B. Hyponatremia
C. Hypokalemia
D. Hypermagnesemia
A. Depression
B. Neuropathy
C. Hypoglycemia
D. Hyperthyroidism
A. Tetany
B. Hemorrhage
C. Thyroid storm
D. Laryngeal nerve damage
A. Primary hypothyroidism
B. Graves disease
C. Thyrotoxicosis
D. Euthyroidism
35. Which of these signs suggests that a male client with the syndrome
of inappropriate antidiuretic hormone (SIADH) secretion is
experiencing complications?
A. Tetanic contractions
B. Neck vein distention
C. Weight loss
D. Polyuria
A. phentolamine (Regitine).
B. methyldopa (Aldomet).
C. mannitol (Osmitrol).
D. felodipine (Plendil).
A. Adrenal cortex
B. Pancreas
C. Adrenal medulla
D. Parathyroid
38. Nurse Troy is aware that the most appropriate for a client with
Addisons disease?
42. For a diabetic male client with a foot ulcer, the physician orders bed
rest, a wet-to-dry dressing change every shift, and blood glucose
monitoring before meals and bedtime. Why are wet-to-dry dressings
used for this client?
A. Restricting fluids
B. Restricting sodium
C. Forcing fluids
D. Restricting potassium
44. Which nursing diagnosis takes highest priority for a female client
with hyperthyroidism?
46. A male client has just been diagnosed with type 1 diabetes mellitus.
When teaching the client and family how diet and exercise affect insulin
requirements, Nurse Joy should include which guideline?
A. Youll need more insulin when you exercise or increase your food intake.
B. Youll need less insulin when you exercise or reduce your food intake.
C. Youll need less insulin when you increase your food intake.
D. Youll need more insulin when you exercise or decrease your food intake.
A. Oral anticoagulants
B. Anabolic steroids
C. Beta-adrenergic blockers
D. Thiazide diuretics
48. Which instruction about insulin administration should nurse Kate
give to a client?
A. Always follow the same order when drawing the different insulins into the
syringe.
B. Shake the vials before withdrawing the insulin.
C. Store unopened vials of insulin in the freezer at temperatures well below
freezing.
D. Discard the intermediate-acting insulin if it appears cloudy.
49. Nurse Perry is caring for a female client with type 1 diabetes
mellitus who exhibits confusion, light-headedness, and aberrant
behavior. The client is still conscious. The nurse should first administer:
50. For the first 72 hours after thyroidectomy surgery, nurse Jamie
would assess the female client for Chvosteks sign and Trousseaus sign
because they indicate which of the following?
A. Hypocalcemia
B. Hypercalcemia
C. Hypokalemia
D. Hyperkalemia
The nurse should refer this client to a sex counselor or other professional.
Making appropriate referrals is a valid part of planning the clients care. The
nurse doesnt normally provide sex counseling.
Diabetic clients must exercise at least three times a week to meet the goals of
planned exercise lowering the blood glucose level, reducing or maintaining
the proper weight, increasing the serum high-density lipoprotein level,
decreasing serum triglyceride levels, reducing blood pressure, and minimizing
stress. Exercising once a week wouldnt achieve these goals. Exercising more
than three times a week, although beneficial, would exceed the minimum
requirement.
6. Answer: C. Tachycardia
7. Answer: D. Hyperparathyroidism
10. Answer: C. It tells us about your sugar control for the last 3
months.
ADH is the hormone clients with diabetes insipidus lack. The clients TSH, FSH,
and LH levels wont be affected.
To reduce water retention in a client with the SIADH, the nurse should restrict
fluids. Administering fluids by any route would further increase the clients
already heightened fluid load.
Oral antidiabetic agents are only effective in adult clients with type 2 diabetes.
Oral antidiabetic agents arent effective in type 1 diabetes. Pregnant and
lactating women arent prescribed oral antidiabetic agents because the effect on
the fetus is uncertain.
Many clients (25% to 60%) with secondary failure respond to a different oral
antidiabetic agent. Therefore, it wouldnt be appropriate to initiate insulin
therapy at this time. However, if a new oral antidiabetic agent is unsuccessful in
keeping glucose levels at an acceptable level, insulin may be used in addition to
the antidiabetic agent.
27. Answer: C. You may not be able to use desmopressin nasally if you
have nasal discharge or blockage.
Chvosteks sign is elicited by tapping the clients face lightly over the facial
nerve, just below the temple. If the clients facial muscles twitch, it indicates
hypocalcemia. Hyponatremia is indicated by weight loss, abdominal cramping,
muscle weakness, headache, and postural hypotension. Hypokalemia causes
paralytic ileus and muscle weakness. Clients with hypermagnesemia exhibit a
loss of deep tendon reflexes, coma, or cardiac arrest.
Tetany may result if the parathyroid glands are excised or damaged during
thyroid surgery. Hemorrhage is a potential complication after thyroid surgery
but is characterized by tachycardia, hypotension, frequent swallowing, feelings
of fullness at the incision site, choking, and bleeding. Thyroid storm is another
term for severe hyperthyroidism not a complication of thyroidectomy.
Laryngeal nerve damage may occur postoperatively, but its signs include a
hoarse voice and, possibly, acute airway obstruction.
Acarbose delays glucose absorption, so the client should take an oral form of
dextrose rather than a product containing table sugar when treating
hypoglycemia. The alpha-glucosidase inhibitors work by delaying the
carbohydrate digestion and glucose absorption. Its safe to be on a regimen that
includes insulin and an alpha-glucosidase inhibitor. The client should take the
drug at the start of a meal, not 30 minutes to an hour before.
40. Answer: B. You must avoid coughing, sneezing, and blowing your
nose.
The client should take glipizide twice a day, 30 minutes before a meal, because
food decreases its absorption. The drug doesnt cause hyponatremia and
therefore doesnt necessitate monthly serum sodium measurement. The client
must continue to monitor the blood glucose level during glipizide therapy.
For this client, wet-to-dry dressings are most appropriate because they clean
the foot ulcer by debriding exudate and necrotic tissue, thus promoting healing
by secondary intention. Moist, transparent dressings contain exudate and
provide a moist wound environment. Hydrocolloid dressings prevent the
entrance of microorganisms and minimize wound discomfort. Dry sterile
dressings protect the wound from mechanical trauma and promote healing.
43. Answer: C. Forcing fluids
Serum osmolarity is the most important test for confirming HHNS; its also used
to guide treatment strategies and determine evaluation criteria. A client with
HHNS typically has a serum osmolarity of more than 350 mOsm/L. Serum
potassium, serum sodium, and ABG values are also measured, but they arent
as important as serum osmolarity for confirming a diagnosis of HHNS. A client
with HHNS typically has hypernatremia and osmotic diuresis. ABG values reveal
acidosis, and the potassium level is variable.
46. Answer: B. Youll need less insulin when you exercise or reduce
your food intake.
48. Answer: A. Always follow the same order when drawing the
different insulins into the syringe.
The client should be instructed always to follow the same order when drawing
the different insulins into the syringe. Insulin should never be shaken because
the resulting froth prevents withdrawal of an accurate dose and may damage
the insulin protein molecules. Insulin also should never be frozen because the
insulin protein molecules may be damaged. Intermediate-acting insulin is
normally cloudy.
Diabetes Mellitus
1. Knowing that gluconeogenesis helps to maintain blood levels, a
nurse should:
1. Hypoglycemia
2. Hyponatremia
3. Ketonuria
4. Polyphagia
1. 90mg/dl
2. 115mg/dl
3. 126mg/dl
4. 180mg/dl
4. Rotation sites for insulin injection should be separated from one
another by 2.5 cm (1 inch) and should be used only every:
1. Third day
2. Week
3. 2-3 weeks
4. 2-4 weeks
1. Blurred vision
2. Diaphoresis
3. Nausea
4. Weakness
7. The nurse expects that a type 1 diabetic may receive ____ of his or
her morning dose of insulin preoperatively:
1. 10-20%
2. 25-40%
3. 50-60%
4. 85-90%
1. 6-8 hours
2. 10-14 hours
3. 16-20 hours
4. 24-28 hours
10. Albert refuses his bedtime snack. This should alert the nurse to
assess for:
12. An external insulin pump is prescribed for a client with DM. The
client asks the nurse about the functioning of the pump. The nurse
bases the response on the information that the pump:
1. Gives small continuous dose of regular insulin subcutaneously, and the client
can self-administer a bolus with an additional dosage from the pump before
each meal.
2. Is timed to release programmed doses of regular or NPH insulin into the
bloodstream at specific intervals.
3. Is surgically attached to the pancreas and infuses regular insulin into the
pancreas, which in turn releases the insulin into the bloodstream.
4. Continuously infuses small amounts of NPH insulin into the bloodstream while
regularly monitoring blood glucose levels.
1. Administer a sedative
2. Make sure the client knows all the correct medical terms to understand what
is happening.
3. Ignore the signs and symptoms of anxiety so that they will soon disappear
4. Convey empathy, trust, and respect toward the client.
16. A nurse is caring for a client admitted to the ER with DKA. In the
acute phase the priority nursing action is to prepare to:
1. Pulse
2. BP
3. Respiration
4. Temperature
18. A client with type 1 DM calls the nurse to report recurrent episodes
of hypoglycemia with exercise. Which statement by the client indicated
an inadequate understanding of the peak action of NPH insulin and
exercise?
19. A client with diabetes mellitus visits a health care clinic. The
clients diabetes previously had been well controlled with glyburide
(Diabeta), 5 mg PO daily, but recently the fasting blood glucose has
been running 180-200mg/dl. Which medication, if added to the clients
regimen, may have contributed to the hyperglycemia?
1. Prednisone (Deltasone)
2. Atenolol (Tenormin)
3. Phenelzine (Nardil)
4. Allopurinol (Zyloprim)
1. Extraction of energy
2. Synthesis of protein
3. Building of genetic material
4. Formation of cell membranes.
21. When a client is first admitted with hyperglycemic hyperosmolar
nonketotic syndrome (HHNS), the nurses priority is to provide:
1. Oxygen
2. Carbohydrates
3. Fluid replacement
4. Dietary instruction
1. Thirst
2. Palpitations
3. Diaphoresis
4. Slurred speech
5. Hyperventilation
1. I need to rub my forearm vigorously until warm before testing at this site.
2. The fingertip is preferred for glucose monitoring if hyperglycemia is
suspected.
3. I have to make sure that my current glucose monitor can be used at an
alternate site.
4. Alternate site testing is unsafe if I am experiencing a rapid change in
glucose levels.
25. Which adaptations should the nurse caring for a client with diabetic
ketoacidosis expect the client to exhibit? Select all that apply:
1. Sweating
2. Low PCO2
3. Retinopathy
4. Acetone breath
5. Elevated serum bicarbonate
26. A clients blood gases reflect diabetic acidosis. The nurse should
expect:
1. Increased pH
2. Decreased PO2
3. Increased PCO2
4. Decreased HCO3
27. The nurse knows that glucagon may be given in the treatment of
hypoglycemia because it:
1. Inhibits gluconeogenesis
2. Stimulates the release of insulin
3. Increases blood glucose levels
4. Provides more storage of glucose.
29. The physician orders 36 units of NPH and 12 units of regular insulin.
The nurse plans to administer these drugs in 1 syringe. Identify the
steps in this procedure by listing them in priority order.
30. The insulin that has the most rapid onset of action would be:
1. Lente
2. Lispro
3. Ultralente
4. Humulin N
31. A client with DM states, I cannot eat big meals; I prefer to snack
throughout the day. The nurse should carefully explain that the:
1. Insulin edema
2. Insulin lipodystrophy
3. Insulin resistance
4. Systemic allergic reactions
37. Insulin forces which of the following electrolytes out of the plasma
and into the cells?
1. Calcium
2. Magnesium
3. Phosphorus
4. Potassium
1. Insulin overdose
2. Removal of the adrenal gland
3. Undiagnosed, untreated hyperpituitarism
4. Undiagnosed, untreated diabetes mellitus
40. Clients with type 1 diabetes may require which of the following
changes to their daily routine during periods of infection?
1. No changes
2. Less insulin
3. More insulin
4. Oral antidiabetic agents
2. Answer: 1. Hypoglycemia
3. Answer: 3. 126mg/dl
5. Answer: 2. Diaphoresis
7. Answer: 3. 50-60%
NPH is intermediate acting insulin. The onset of action is 1-2 hours, it peaks in
6-14 hours, and its duration of action is 24 hours. Hypoglycemic reactions most
likely occur during peak time.
12. Answer: 1. Gives small continuous dose of regular insulin
subcutaneously, and the client can self-administer a bolus with an
additional dosage from the pump before each meal.
In diabetic acidosis, the arterial pH is less than 7.35. plasma bicarbonate is less
than 15mEq/L, and the blood glucose level is higher than 250mg/dl and ketones
are present in the blood and urine. The client would be experiencing polyuria,
and Kussmauls respirations would be present. A comatose state may occur if
DKA is not treated, but coma would not confirm the diagnosis
14. Answer: 4. Convey empathy, trust, and respect toward the client.
Increased blood glucose will cause the kidneys to excrete the glucose on the
urine. This glucose is accompanied by fluids and electrolytes, causing osmotic
diuresis leading to dehydration. This fluid loss must be replaced when it
becomes severe. Options B, C, and D are not related specifically to the issue of
the question.
16. Answer: 1. Administer regular insulin intravenously
25. Answer: 2, 3.
A value of 258mg/dl is above the expected range of 70-105 mg/dl; the nurse
should administer the insulin as ordered.
29. Answer: 1, 3, 2, 4.
Lispro has an immediate onset, a peak of 30-90 minutes, and duration of 2-4
hours.
Because the client has diabetes, it is essential that the blood glucose level be
determined before meals to evaluate the success of control of diabetes and the
possible need for insulin coverage.
33. Answer: 3. Monitor blood glucose closely, and look for signs of
hypoglycemia.
When a client who has taken an oral antidiabetic agent vomits, the nurse would
monitor glucose and assess him frequently for signs of hypoglycemia. Most of
the medication has probably been absorbed. Therefore, repeating the dose
would further lower glucose levels later in the day. Giving insulin would also
lower the glucose levels, causing hypoglycemic. The client wouldnt have
hyperglycemia if the glyburide was absorbed.
Coma and severe acidosis are ushered in with Kussmauls respirations (very
deep but not labored respirations) and a fruity odor on the breath (academia).
During periods of infection or illness, diabetics may need even more insulin to
compensate for increased blood glucose levels.
1. Marlisa has been diagnosed with diabetes mellitus type 1. She asks
Nurse Errol what this means. What is the best response by the nurse?
Select all that apply.
2. Dr. Shrunk orders intravenous (IV) insulin for Rita, a client with a
blood sugar of 563. Nurse AJ administers insulin lispro (Humalog)
intravenously (IV). What does the best evaluation of the nurse reveal?
Select all that apply.
A. The nurse could have given the insulin subcutaneously.
B. The nurse should have contacted the physician.
C. The nurse should have used regular insulin (Humulin R).
D. The nurse used the correct insulin.
3. Ben injects his insulin as prescribed, but then gets busy and forgets
to eat. What will the best assessment of the nurse reveal?
A. The 50-year-old client who does not get any physical exercise
B. The 56-year-old client who drinks three glasses of wine each evening
C. The 42-year-old client who is 50 pounds overweight
D. The 38-year-old client who smokes one pack of cigarettes per day
5. Steven John has type 1 diabetes mellitus and receives insulin. Which
laboratory test will the nurse assess?
A. Potassium
B. AST (aspartate aminotransferase)
C. Serum amylase
D. Sodium
A. 1, 2, 3, 4
B. 1, 3, 2, 4
C. 3, 1, 2, 4
D. 4, 3, 2, 1
11. Genevieve has diabetes type 1 and receives insulin for glycemic
control. She tells the nurse that she likes to have a glass of wine with
dinner. What will the best plan of the nurse for client education
include?
12. Dr. Wijangco orders insulin lispro (Humalog) 10 units for Alicia, a
client with diabetes mellitus. When will the nurse administer this
medication?
A. Instruct the client to label each vial with the date when opened.
B. Tell the client there is no need to keep additional vials.
C. Have the client place the insulin vials in the refrigerator.
D. Have the client discard the vials.
15. Gary has diabetes type 2. Nurse Martha has taught him about the
illness and evaluates learning has occurred when the client makes
which statement?
16. The principal goals of therapy for older patients who have poor
glycemic control are:
A. Uncontrolled diabetes
B. Somogyi phenomenon
C. Brittle diabetes
D. Diabetes insipidus
20. Rosemary has been taking Glargine (Lantus) to treat her condition.
One of the benefits of Glargine (Lantus) insulin is its ability to:
A. Release insulin rapidly throughout the day to help control basal glucose.
B. Release insulin evenly throughout the day and control basal glucose levels.
C. Simplify the dosing and better control blood glucose levels during the day.
D. Cause hypoglycemia with other manifestation of other adverse reactions.
22. An older woman with diabetes mellitus visits the clinic concerning
her condition. Of which of the following symptoms might an older
woman with diabetes mellitus complain?
A. Anorexia
B. Pain intolerance
C. Weight loss
D. Perineal itching
25. During a visit in the hospital, the student nurses are asked which of
the following persons would most likely be diagnosed with diabetes
mellitus. They are correct if they answered a 44-year-old:
A. Caucasian woman.
B. Asian woman.
C. African-American woman.
D. Hispanic male.
29. After visiting the physician, Angela found out that she has a thyroid
problem. In line with her condition, which of the following diagnostic
studies is done to determine the size and composition of the thyroid
gland?
1. Answer: C, D, E
2. Answer: B, C
Regular insulin is the only insulin that can be given intravenously (IV). The
nurse did not use correct insulin as it was not regular insulin. Contact the
provider to clarify the order, regular insulin is the only insulin that can be given
intravenously (IV). The nurse cannot give the insulin subcutaneously when it is
ordered to be given intravenously (IV).
Moist skin is the sign of hypoglycemia, which the client would experience if he
injected himself with insulin and did not eat. Thirst, nausea, and increased
urination are signs of hyperglycemia.
Insulin causes potassium to move into the cell and may cause hypokalemia.
There is no need to monitor the sodium, serum amylase, and AST levels.
6. Answer: B, C, E
7. Answer: A. 1, 2, 3, 4
When a patient with diabetes mellitus type 1 is unresponsive, the nurse should
focus on and treat for hypoglycemia, as this is more likely than hyperglycemia.
This is an emergency situation where the nurse must act before calling the
physician. Vital signs should be taken after the client is treated for
hypoglycemia. Assessment for ABCs should precede calling a code; there is no
information that the client is not breathing.
It is best to notify the clients physician and request orders. The client should
not receive the medication during NPO status unless directed by the physician.
The medications should not be given upon return unless the physician orders
this; the client may still need to be NPO. The radiologist in the diagnostic
department might give orders, but it would be best to check with the clients
physician first.
10. Answer: D. I should only use calibrated insulin syringe for the
injections.
To ensure the correct insulin dose, a calibrated insulin syringe must be used.
Insulin injections should be rotated to the arm and thigh, not just the abdominal
area. There is no need to apply direct pressure over the site following an insulin
injection. There is no need to check blood glucose immediately prior to the
injection.
The onset action for the insulin lispro (Humalog) is 10 to 15 minutes so it must
be given when the client is eating to prevent hypoglycemia. It must be given
when the client is eating, not when the meal trays arrive on the floor and not
thirty minutes before meals.
13. Answer: C. Have the client place the insulin vials in the refrigerator.
With type 2 diabetes mellitus, the pancreas produces insulin, but the cells
cannot use it. Peripheral cells have a decreased, not an increased, sensitivity to
insulin. The beta cells continue to produce insulin with type 2 diabetes. There is
a decrease, not an increase, in receptor sites with type 2 diabetes.
The principal goals of therapy for older persons with diabetes mellitus and poor
glycemic control are enhancing quality of life, decreasing the chance of
complications, improving self-care through education, and maintaining or
improving general health status.
Sulfonylureas such as glyburide are used only with patients who have some
remaining pancreatic-beta cell function. These drugs stimulate insulin secretion,
which reduces liver glucose output and increases cell uptake of glucose,
enhancing the number of and sensitivity of cell receptor sites for interaction
with insulin.
20. Answer: B. Release insulin evenly throughout the day and control
basal glucose levels.
The onset of hyperglycemia in the older adult can occur more slowly. When the
older adult reports rapid-onset weight loss, elevated blood glucose levels, and
polyphagia, the healthcare provider should consider pancreatic tumor.
23. Answer: A, B
When an older person is identified as high-risk for diabetes, appropriate testing
would include FPG and OGTT. An FPG greater than 140 mg/dL usually
indicates diabetes. The OGTT is to determine how the body responds to the
ingestion of carbohydrates in a meal. HbA1C evaluates long-term glucose
control. A finger stick glucose three times daily spot-checks blood glucose
levels.
24. Answer: A, B, D
Aging results in reduced ability of beta cells to respond with insulin effectively.
Overweight with waist/hip ratio increase is part of the metabolic syndrome of
DM II. There is an increase in atherosclerosis with DM due to the metabolic
syndrome and sedentary lifestyle.
Illness, especially with the frail elderly patient whose appetite is poor, can result
in dehydration and HHNC. Insulin resistance usually is indicated by a daily
insulin requirement of 200 units or more. Diabetic ketoacidosis, an acute
metabolic condition, usually is caused by absent or markedly decreased
amounts of insulin.
Although thyroid scans frequently are done to evaluate the thyroid gland, I 123
is used to destroy overactive thyroid cells such as are seen in thyroid cancer.
Ultrasonography can be used early in the evaluation process to rule out Graves
disease, nodular goiter, or other thyroid dysfunction.
1. During lecture, the clinical instructor tells the students that 50% to
60% of daily calories should come from carbohydrates. What should the
nurse say about the types of carbohydrates that can be eaten?
A. Try to limit simple sugars to between 10% and 20% of daily calories.
B. Simple carbohydrates are absorbed more rapidly than complex
carbohydrates.
C. Simple sugars cause rapid spike in glucose levels and should be avoided.
D. Simple sugars should never be consumed by someone with diabetes.
3. Joko has recently been diagnosed with Type I diabetes and asks
Nurse Jessica for help formulating a nutrition plan. Which of the
following recommendations would the nurse make to help the client
increase calorie consumption to offset absorption problems?
A. Eat small meals with two or three snacks throughout the day to keep blood
glucose levels steady
B. Increase consumption of simple carbohydrates
C. Eating small meals with two or three snacks may be more helpful in
maintaining blood glucose levels than three large meals.
D. Skip meals to help lose weight
A. alcohol use.
B. cigarette smoking.
C. diabetes mellitus.
D. high-protein diet.
6. The goal for pre-prandial blood glucose for those with Type
1 diabetes mellitus is:
A. <80 mg/dl
B. <130 mg/dl
C. <180 mg/dl
D. <6%
A. Excessive intake of calories, rapid weight gain, and difficulty losing weight
B. An increase in three areas: thirst, intake of fluids, and hunger
C. Poor circulation, wound healing, and leg ulcers,
D. Lack of energy, weight gain, and depression
10. The nurse is working with an overweight client who has a high-
stress job and smokes. This client has just received a diagnosis of Type
II Diabetes and has just been started on an oral hypoglycemic agent.
Which of the following goals for the client which if met, would be most
likely to lead to an improvement in insulin efficiency to the point the
client would no longer require oral hypoglycemic agents?
13. You are doing some teaching with a client who is starting on a
sulfonylurea antidiabetic agent. The client mentions that he usually has
a couple of beers each night and takes an aspirin each day to
prevent heart attack and/or strokes. Which of the following responses
would be best on the part of the nurse?
A. As long as you only drink two beers and take one aspirin, this should not be a
problem
B. The aspirin is alright but you need to give up drinking any alcoholic
beverages
C. Taking alcohol and/or aspirin with a sulfonylurea drug can cause development
of hypoglycemia
D. Aspirin and alcohol will cause the stomach to bleed more when on a
sulfonylurea drug
16. Nurse Pira is explaining to the client about Type II Diabetes. Risk
factors of such condition include all of the following except:
A. Advanced age
B. Physical inactivity
C. Obesity
D. Smoking
A. Below 5.7%
B. Between 12%-15%
C. Less than 180 mg/dL
D. Between 90 and 130 mg/dL
A. Alpha-glucosidase inhibitors
B. Biguanides
C. Meglitinides
D. Sulfonylureas
A. Caucasian woman.
B. Asian woman.
C. African-American woman.
D. Hispanic male.
22. Which of the following factors are risks for the development
of Diabetes Mellitus? Select all that apply.
23. Anton brought his grandfather to the clinic to confirm his blood
sugar levels. Which laboratory test should a nurse anticipate a
physician would order when an older person is identified as high-risk
for Diabetes Mellitus? Select all that apply.
24. A patient received 6 units of regular insulin 3 hours ago. The nurse
would be MOST concerned if which of the following was observed?
25. Mr. Wesley is newly diagnosed with Type I DM and is being seen by
the home health nurse. The doctors orders include: 1200 calorie ADA
diet, 15 units NPH insulin before breakfast, and check blood sugar qid.
When the nurse visits the patient at 5 pm, the nurse observes the man
performing blood sugar analysis. The result is 50 mg/dL. The nurse
would expect the patient to be
Here are the answers for this exam. Gauge your performance by counter
checking your answers to those below. If you have any disputes or clarifications,
please direct them to the comments section.
2. Answer: D. acidosis
3. Answer: C. Eating small meals with two or three snacks may be more
helpful in maintaining blood glucose levels than three large meals.
Eating small meals with two or three snacks may be more helpful in maintaining
blood glucose levels than three large meals.
Alcohol use is one of the most common risk factors for pancreatitis in the United
States.
5. Answer: A, B, C, D
Gestational diabetes can occur between the 16th and 28th week of pregnancy.
If not responsive to diet and exercise, insulin injections may be necessary.
Concentrated sugars should be avoided. Weight gain should continue, but not in
excessive amounts. Usually, gestational diabetes disappears after the infant is
born. However, diabetes can develop 5 to 10 years after the pregnancy.
The goal for pre-prandial blood glucose for those with Type 1 diabetes
mellitus is <130 mg/dl.
10. Answer: C. Lose a pound a week until weight is in normal range for
height and exercise 30 minutes daily
When Type II diabetics lose weight through diet and exercise they sometimes
have an improvement in insulin efficiency sufficient to the degree they no longer
require oral hypoglycemic agents.
The seven risk criteria include: greater than 120% of standard body weight,
Certain races but not including Caucasian, delivery of a baby weighing more
than 9 pounds or a diagnosis of gestational diabetes, hypertensive, HDL greater
than 35 mg/dl or triglyceride level greater than 250 or a triglyceride level of
greater than 250 mg/dl, and, lastly, impaired glucose tolerance or impaired
fasting glucose on prior testing.
The best angle for a thin person is 90 degrees with the skin pinched up. The
area is not massaged and it is not necessary to warm it.
Additional risk factors for type 2 diabetes are a family history of diabetes,
impaired glucose metabolism, history of gestational diabetes, and
race/ethnicity. African-Americans, Hispanics/Latinos, Asian Americans, Native
Hawaiians, Pacific Islanders, and Native Americans are at greater risk of
developing diabetes than whites.
Because the client is awake and complaining of symptoms, the nurse should
first give him 15 grams of carbohydrate to treat hypoglycemia. This could be 4
to 6 oz of fruit juice, five to six hard candies such as Lifesavers, or 1 tablespoon
of sugar. When a client has worsening symptoms of hypoglycemia or is
unconscious, treatment includes 1 mg of glucagon subcutaneously or
intramuscularly, or 50 mL of 50% glucose I.V. The nurse may also give two to
three glucose tablets for a hypoglycemic reaction.
22. Answer: A, B, D
Aging results in reduced ability of beta cells to respond with insulin effectively.
Overweight with waist/hip ratio increase is part of the metabolic syndrome of
DM II. There is an increase in atherosclerosis with DM due to the metabolic
syndrome and sedentary lifestyle.
23. Answer: A, B
25. Answer: A. confused with cold, clammy skin and pulse of 110
Confused with cold, clammy skin and pulse of 110 indicate hypoglycemia.