EAQ + HESI- Diabetes

Question 1

Which is the etiological factor of nephrogenic diabetes insipidus (DI)?

Meningitis

Lithium therapy

Graves disease

Sulfonamide therapy

Answer 1

Lithium therapy

Lithium therapy is the etiological factor of nephrogenic DI. Central nervous system infections such as meningitis are etiological factors of central DI. Goiter, an enlarged thyroid gland, is commonly seen in clients with Graves disease. Sulfonamide is a goitrogen that can cause goiter.

Question 2

Which is a secondary cause of adrenal insufficiency?

Hemorrhage

Tuberculosis

Pituitary tumors

Metastatic cancer

Answer 2

Pituitary tumors

Adrenal insufficiency is also called Addison disease. Secondary causes of adrenal insufficiency include pituitary tumors. Primary causes, which are responsible for adrenal insufficiency, include hemorrhage, tuberculosis, and metastatic cancer.

Question 3

Which gland secretes melatonin?

Pineal gland

Thyroid gland

Adrenal gland

Parathyroid gland

Answer 3

Pineal gland

The pineal gland secretes the hormone melatonin, which regulates the circadian rhythm and reproductive system at the onset of puberty. The thyroid gland secretes thyroid hormones. The adrenal gland secretes androgens, corticosteroids, and catecholamines. The parathyroid gland secretes the hormone calcitonin.

Question 4

Which blood glucose levels would the nurse identify as hypoglycemia?

68 mg/dL (3.8 mmol/L)

78 mg/dL (4.3 mmol/L)

88 mg/dL (4.9 mmol/L)

98 mg/dL (5.4 mmol/L)

Answer 4

68 mg/dL (3.8 mmol/L)

Normal blood glucose level for an adult is 72 to 108 mg/dL (4-6 mmol/L). Clients who have blood glucose levels less than 72 mg/dL (4 mmol/L) may experience hypoglycemia; 78 mg/dL (4.3 mmol/L), 88 mg/dL (4.9 mmol/L), and 98 mg/dL (5.4 mmol/L) are normal blood glucose levels.

Question 5

Normal blood glucose level for an adult is ___________ mg/dL

Answer 5

72 to 108

Question 6

hypoglycemia symptoms occur when blood glucose levels fall below ___ mg/dL.

Answer 6

70

Question 7

Which disorder is caused by the deficiency of antidiuretic hormone?

Acromegaly

Diabetes insipidus

Cushing syndrome

Syndrome of inappropriate antidiuretic hormone

Answer 7

Diabetes insipidus

Question 8

Which term would the nurse use in a report to describe the absence of menstrual periods in a 35-year-old nonpregnant client?

Rhinorrhea

Menopause

Amenorrhea

Dyspareunia

Answer 8

Amenorrhea

Question 9

The absence of menstrual periods in a nonpregnant client younger than 55 years old is called ______________ .

Answer 9

amenorrhea

Question 10

Rhinorrhea is an ________ state that is manifested by a runny nose

Answer 10

allergic

Question 11

Dyspareunia is ______ during sexual intercourse

Answer 11

pain

Question 12

Which surgery will a client undergo if the pituitary gland must be removed?

Mastectomy

Prostatectomy

Thyroidectomy

Hypophysectomy

Answer 12

Hypophysectomy

A hypophysectomy is the surgical removal of the pituitary gland (hypophysis) or its tumor. A mastectomy is the surgical removal of breast tissue. A prostatectomy is the surgical removal of the prostate gland. A thyroidectomy is the surgical removal of the thyroid gland.

Question 13

Which hormone is released from the posterior pituitary gland?

Oxytocin

Prolactin

Growth hormone

Luteinizing hormone

Answer 13

Oxytocin

Question 14

Prolactin, growth hormone, and luteinizing hormone are produced by the __________ pituitary gland.

Answer 14

anterior

Question 15

Which hormone has both inhibiting and releasing action?

Prolactin

Somatostatin

Somatotropin

Gonadotropin

Answer 15

Prolactin

Question 16

Which hormone is formed from cholesterol?

Insulin

Cortisol

Prolactin

Growth hormone

Answer 16

Cortisol

All lipid-soluble hormones are synthesized from cholesterol. Cortisol, a lipid-soluble hormone, is secreted by the adrenal cortex. All water-soluble hormones are formed from amino acids. Insulin, prolactin, and growth hormone are water-soluble hormones. Insulin is secreted by the pancreas. Prolactin and growth hormone are secreted by the pituitary gland.

Question 17

Which action would be appropriate to implement when collecting a 24-hour urine test?

Start the time of the test after discarding the first voiding.

Discard the last voiding in the 24-hour period for the test.

Insert a urinary retention catheter to promote the collection of urine.

Strain the urine after each voiding before adding the urine to the container.

Answer 17

Start the time of the test after discarding the first voiding.

Question 18

Which organ has only beta-1 receptors?

Liver

Heart

Bladder

Pancreas

Answer 18

The heart has only beta-1 receptors, which increase heart rate and contractility.

The liver has only alpha receptors.
The bladder and pancreas have both alpha and beta receptors.

Question 19

Which catecholamine receptor is responsible for increased heart rate?

Beta-1 receptor

Beta-2 receptor

Alpha-1 receptor

Alpha-2 receptor

Answer 19

Beta-1 receptors are responsible for increased heart rate.

Beta-2 receptors, alpha-1 receptors, and alpha-2 receptors are not present in the heart; therefore, they are not responsible for increasing the heart rate.
Beta receptors are present in such organs as blood vessels, kidneys, bronchioles, and bladder. Alpha receptors are present in such organs as eyes, skin, and liver.

Question 20

Which hormone regulates blood levels of calcium?

Parathyroid hormone (PTH)

Luteinizing hormone (LH)

Thyroid-stimulating hormone (TSH)

Adrenocorticotropic hormone (ACTH)

Answer 20

Parathyroid hormone (PTH)

Question 21

Which hormone is released from the pancreas?

Oxytocin

Prolactin

Calcitonin

Somatostatin

Answer 21

Somatostatin

Somatostatin is a hormone produced by the pancreas that inhibits the release of insulin and glucagon.

Oxytocin is a hormone produced by the posterior pituitary gland that acts on the uterus and mammary glands. Prolactin is a hormone produced by the anterior pituitary gland that targets the ovaries and mammary glands in women and testes in men. Calcitonin is a hormone produced by the thyroid gland that interacts with bone tissue.

Question 22

Which gland is an exocrine gland?

Thyroid gland

Salivary gland

Pituitary gland

Parathyroid gland

Answer 22

Salivary gland

Exocrine glands are glands with ducts that produce enzymes but not hormones. These glands secrete enzymes into ducts. The salivary gland secreting saliva is an example of an exocrine gland. Endocrine glands are ductless glands that produce hormones that are secreted into the blood. Thyroid, pituitary, and parathyroid glands are examples of endocrine glands.

Question 23

The nurse cares for a client with an abnormal cortisol level. The nurse recalls which information about cortisol?

Cortisol metabolizes free fatty acids.

Cortisol stimulates gluconeogenesis.

Cortisol stimulates protein synthesis.

Cortisol levels decline in stressful conditions.

Answer 23

Cortisol stimulates gluconeogenesis.

Cortisol maintains the blood glucose concentration by stimulating the liver for gluconeogenesis. Gluconeogenesis involves formation of glucose from amino acids and fatty acids. Cortisol mobilizes free fatty acids and inhibits protein synthesis. The blood levels of cortisol increase in stressful conditions.

Question 24

Which hormone would the nurse identify as inhibiting insulin and glucagon secretion?

Amylin

Somatostatin

Triiodothyronine (T 3)

Pancreatic polypeptide

Answer 24

Somatostatin

Question 25

Which adverse effect can be seen in a female client with gonadotropin deficiency and who is undergoing hormone replacement therapy?

Thrombosis

Hypotension

Dehydration

Increased thirst

Answer 25

Thrombosis

Question 26

To ensure a quality specimen and an accurate test result, which instruction would the nurse give a client who is scheduled to undergo urine endocrine testing?

“Start the urine collection when the bladder is full.”

“Store the urine specimen in a cooler with ice.”

“Store the urine specimen in a home refrigerator.”

“Save the urine specimen that begins the collection.”

Answer 26

“Store the urine specimen in a cooler with ice.”

The urine specimen that is collected for endocrine testing should be stored in a cooler with ice to prevent bacterial growth in the specimen. The nurse should instruct the client to start the urine collection after emptying the bladder. The client should be instructed not to store the urine specimen in a home refrigerator with other food and drinks because it could lead to cross-contamination. The client should be instructed to refrain from saving the urine specimen that begins the collection because the timing for urine collection starts from after the initial voiding specimen.

Question 27

Which procedure is preferred to find out the composition of a thyroid nodule and ascertain the need for further surgical intervention?

Mass spectrometry

Computed tomography scans

Glycosylated hemoglobin test

Needle biopsy

Answer 27

Needle biopsy

Question 28

A nurse educator instructs a new nurse during orientation about the physiological processes of the endocrine system. Which statement made by the new nurse indicates effective learning?

“The endocrine system comprises glands with narrow ducts.”

“The endocrine system comprises salivary and lacrimal glands.”

“The hormones of the endocrine system exert their action by ‘lock and key’ mechanism.”

“The hormones secreted by endocrine system exert their action on all tissues they contact.”

Answer 28

“The hormones of the endocrine system exert their action by ‘lock and key’ mechanism.”

Question 29

Which gland is affected in aldosteronoma?

Kidney cortex

Thyroid gland

Pituitary gland

Adrenal cortex

Answer 29

Adrenal cortex

Question 30

The nurse is teaching a client newly diagnosed with type 1 diabetes about self-care. Which is the primary long-term goal?

Maintaining normoglycemia

Complying with the diabetic diet

Adhering to an exercise program

Developing a nonstressful lifestyle

Answer 30

Maintaining normoglycemia

Question 31

Which complication is the nurse’s main priority during the early postoperative period after a subtotal thyroidectomy?

Hemorrhage

Thyrotoxic crisis

Airway obstruction

Hypocalcemic tetany

Answer 31

Airway obstruction

Maintaining airway patency is always the priority to permit gas exchange necessary to maintain life. Although important, hemorrhage, thyrotoxic crisis, and hypocalcemic tetany do not exceed patency of the airway in priority.

Question 32

Why is 15 g of a simple sugar administered when a client with diabetes experiences hypoglycemia?

Inhibits glycogenesis

Stimulates release of insulin

Increases blood glucose levels

Provides more storage of glucose

Answer 32

Increases blood glucose levels

Question 33

Which hormones are secreted by the posterior pituitary gland? Select all that apply. One, some, or all responses may be correct.

Oxytocin

Prolactin

Corticotropin

Antidiuretic hormone

Melanocyte-stimulating hormone

Answer 33

Oxytocin

Antidiuretic hormone

Question 34

Which instruction would the nurse provide to a 6’ 0”, 160-pound client newly diagnosed with type 1 diabetes who wants to self-administer injections with an insulin pen? Select all that apply. One, some, or all responses may be correct.

Prime the needle with two units.

Use a 29-gauge insulin needle.

Give the injection at 45-degree angle.

Refrain from recapping the needle.

Dial the pen to deliver the unit dose.

Answer 34

All of the above

Question 35

Which sign or symptom would the nurse expect to find on assessment of a client with a blood glucose level of 55 mg/dL?

Increased thirst

Abdominal pain

Frequent urination

Cold, clammy skin

Answer 35

Cold, clammy skin

A client with a blood glucose level of 55 mg/dL indicates hypoglycemia. Clinical manifestations would include cold, clammy skin; tachycardia; nervousness; and slurred speech.

A client with hyperglycemia would present with increased thirst (polydipsia), abdominal pain, increased urination (polyuria), and polyphagia.

Question 36

A client with ______________ would present with increased thirst (polydipsia), abdominal pain, increased urination (polyuria), and polyphagia.

Answer 36

hyperglycemia

Question 37

Which action would the nurse include in the plan of care for a client undergoing a transsphenoidal hypophysectomy? Select all that apply. One, some, or all responses may be correct.

Assessing for clear nasal drainage

Maintaining strict intake and output

Increasing daily dietary fiber intake

Elevating the head of the bed 30 degrees

Instructing on the use of an incentive spirometer

Answer 37

All of the above

Question 38

A deficiency in which hormone causes breast atrophy in female clients?

Growth hormone

Luteinizing hormone

Thyroid-stimulating hormone

Adrenocorticotropic hormone

Answer 38

Luteinizing hormone

Question 39

Which medication can cause diabetes insipidus?

Cabergoline

Metyrapone

Demeclocycline

Aminoglutethimide

Answer 39

Demeclocycline

Question 40

A deficiency in which hormone reduces the growth of axillae and pubic hair in female clients?

Growth hormone

Antidiuretic hormone

Thyroid-stimulating hormone

Adrenocorticotropic hormone

Answer 40

Adrenocorticotropic hormone

Question 41

The nurse administers vasopressin to a client and recalls that the medication is which type of hormone?

Growth hormone

Luteinizing hormone

Antidiuretic hormone

Thyroid-stimulating hormone

Answer 41

Antidiuretic hormone

Question 42

The nurse would observe a client for which side effect when administering androgen therapy?

Baldness

Headaches

Gastric irritation

Orthostatic hypotension

Answer 42

Baldness

Question 43

The nurse is reviewing the medical records of several clients. Which client has a condition that is an autoimmune disorder?

Addison disease

Cushing syndrome

Hashimoto disease

Sheehan syndrome

Answer 43

Hashimoto disease

Question 44

Which cells produce the thyrocalcitonin hormone?

Islet cells

Adrenal cells

Pituitary cells

Parafollicular cells

Answer 44

Parafollicular cells

Question 45

The nurse provides education about signs and symptoms of hypoglycemia to a client with newly diagnosed type 1 diabetes. The nurse concludes that the teaching was effective when the client acknowledges the need to drink orange juice when experiencing which symptoms?

Nervous and weak

Thirsty with a headache

Flushed and short of breath

Nausea and abdominal cramps

Answer 45

Nervous and weak

Nervousness and weakness are the most commonly reported symptoms of hypoglycemia and are related to increased sympathetic nervous system activity. Feeling flushed and short of breath are adaptations of hyperglycemia. Being thirsty, having a headache, being nauseated, or having abdominal cramps are symptoms of hyperglycemia.

Question 46

Nervousness and weakness are the most commonly reported symptoms of ____________ and are related to increased sympathetic nervous system activity.

Answer 46

hypoglycemia

Question 47

Feeling flushed and short of breath, Being thirsty, having a headache, being nauseated, or having abdominal cramps are symptoms of _____________ .

Answer 47

hyperglycemia

Question 48

Which information would the nurse provide a client with diabetes mellitus (DM) regarding alcohol consumption?

Before meals

One drink per week

Complete abstinence

With or shortly after meals

Answer 48

With or shortly after meals

Question 49

Which infection control measures would the nurse provide a client regarding blood glucose monitoring? Select all that apply. One, some, or all responses may be correct.

Wear gloves.

Reuse lancets.

Perform hand washing.

Clean site before fingerstick.

Share blood glucose monitor.

Answer 49

Perform hand washing.

Clean site before fingerstick.

Question 50

The nurse is educating a client about managing hypoglycemia unawareness. Which information would the nurse provide?

Refrain from alternative testing sites.

Use any available meter to monitor levels.

Initiate continuous blood glucose monitoring.

Calibrate the meter before managing hypoglycemia.

Answer 50

Refrain from alternative testing sites.

When the client is managing hypoglycemia, the same site should be used to obtain blood glucose levels. This provides consistent readings because blood glucose levels are changing rapidly. The client should use his or her meter to monitor blood glucose levels for consistency. Continuous blood glucose monitoring should be implemented when the client is stable, not during hypoglycemic episodes. The client should calibrate the meter once a day, but not when hypoglycemic. The client needs a meter that can provide instant results without waiting for tests to be performed on the meter itself.

Question 51

The nurse educator is providing information about different insulin types. Which type of insulin can be safely mixed with regular human insulin in the same syringe?

Insulin glargine

Insulin detemir

Insulin lispro mix 75/25

Isophane insulin neutral protamine hagedorn (NPH)

Answer 51

Isophane insulin neutral protamine hagedorn (NPH)

Question 52

Which information would the nurse provide to a client taking dulaglutide?

Give with insulin.

Administer medication orally.

Works without exercise.

Perform self-injection weekly.

Answer 52

Perform self-injection weekly.

Question 53

A client newly diagnosed with type 1 diabetes asks why it is necessary to exercise on a regular basis. Which response is accurate?

“Exercise decreases insulin sensitivity.”

“It stimulates glucagon production.”

“Exercise improves the cellular uptake of glucose.”

“It reduces metabolic requirements for glucose.”

Answer 53

“Exercise improves the cellular uptake of glucose.”

Question 54

Why is blood glucose self-monitoring preferred over urine glucose testing?

Blood glucose monitoring is more accurate.

Blood glucose monitoring is easier to perform.

Blood glucose monitoring is done by the client.

Blood glucose monitoring is not influenced by medications.

Answer 54

Blood glucose monitoring is more accurate.

Question 54

The nurse is formulating a teaching plan for a client recently diagnosed with type 2 diabetes. Which interventions would the nurse include to decrease the risk of complications? Select all that apply. One, some, or all responses may be correct.

Examine the feet daily.

Wear well-fitting shoes.

Perform regular exercise.

Powder the feet after showering.

Visit the primary health care provider weekly.

Test bathwater with the toes before bathing.

Answer 54

Examine the feet daily.

Wear well-fitting shoes.

Perform regular exercise.

Question 55

Which client response is most important for the nurse in the postanesthesia care unit to monitor when caring for a client who had a thyroidectomy?

Urinary retention

Signs of restlessness

Decreased blood pressure

Signs of respiratory obstruction

Answer 55

Signs of respiratory obstruction

Question 56

Which intervention would the nurse implement for a client who has type 1 diabetes and has an elevated blood glucose?

Administer an oral hypoglycemic.

Institute urine glucose monitoring.

Give supplemental doses of regular insulin.

Decrease the rate of the intravenous infusion.

Answer 56

Give supplemental doses of regular insulin.

Question 57

Which gland secretes gonadotropin-releasing hormone to help control the events of puberty?

Hypothalamus

Thyroid

Anterior pituitary

Posterior pituitary

Answer 57

Hypothalamus

Question 58

In which order do the events of antidiuretic hormone (ADH) secretion stimulated by plasma osmolarity occur?

Osmoreceptors are activated.

Extracellular fluid is decreased.

Plasma osmolarity is increased.

Antidiuretic hormone (ADH) is released.

Water is reabsorbed from renal tubules.

Answer 58

1.Extracellular fluid is decreased.
2.Plasma osmolarity is increased.
3.Osmoreceptors are activated.
4.Antidiuretic hormone (ADH) is released.
5.Water is reabsorbed from renal tubules.

Question 59

Glucose transportation into the cells through cell membranes takes place in which order?

Attachment of insulin to cell receptors

Secretion of proinsulin by beta cells

Storage of proinsulin in the pancreas

Transformation of proinsulin into active insulin

Answer 59

Secretion of proinsulin by beta cells
Storage of proinsulin in the pancreas
Transformation of proinsulin into active insulin
Attachment of insulin to cell receptors

Question 60

Which is the target tissue for the parathyroid hormone?

Intestines

All body cells

Mammary glands

Sympathetic effectors

Answer 60

Intestines

The target tissue of the parathyroid hormone is the intestines. Growth hormone acts on all body cells. The mammary gland is the target tissue of oxytocin. Epinephrine and norepinephrine act on the sympathetic effectors.

Question 61

The ___________ gland is the target tissue of oxytocin

Answer 61

mammary

Question 62

Which exogenous conditions are responsible for increased cortisol secretion? Select all that apply. One, some, or all responses may be correct.

Asthma

Adrenal adenomas

Cancer chemotherapy

Organ transplantation

Carcinomas of the lung

Answer 62

Asthma

Cancer chemotherapy

Organ transplantation

Question 63

Which molecule excessively accumulates in the blood to precipitate the signs and symptoms associated with a diabetic coma?

Sodium bicarbonate, causing alkalosis

Ketones as a result of rapid fat breakdown, causing acidosis

Nitrogen from protein catabolism, causing ammonia intoxication

Glucose from rapid carbohydrate metabolism, causing drowsiness

Answer 63

Ketones as a result of rapid fat breakdown, causing acidosis

Question 64

Identify the primary causes of adrenal insufficiency. Select all that apply. One, some, or all responses may be correct.

Hemorrhage

Tuberculosis

Pituitary tumors

Postpartum pituitary necrosis

Acquired immunodeficiency syndrome (AIDS)

Answer 64

The primary causes of adrenal insufficiency are hemorrhage, tuberculosis, and AIDS.

Pituitary tumors and postpartum pituitary necrosis are the secondary cases of adrenal insufficiency.

Question 65

Which nursing intervention is appropriate during the first 24 hours after a thyroidectomy when the nurse is concerned about thyroid storm?

Perform range-of-motion exercises.

Humidify the room air continuously.

Assess for hoarseness every 2 hours.

Check vital signs every 2 hours after they stabilize.

Answer 65

Check vital signs every 2 hours after they stabilize.

Question 66

Before having surgery, a client with type 1 diabetes insulin requirements are elevated but well controlled. Which insulin requirements would the nurse anticipate for this client postoperatively?

Decrease

Fluctuate

Increase sharply

Remain elevated

Answer 66

Remain elevated

Question 67

When teaching a client with type 2 diabetes, which statement by the nurse reflects accurate information about preparing for a serum glucose test?

“Eat your usual breakfast.”

“Have clear liquids for breakfast.”

“Take your medication before the test.”

“Do not ingest anything before the test.”

Answer 67

“Do not ingest anything before the test.”

Question 68

Which information would the nurse include in a teaching plan about what causes diabetic acidosis?

A breakdown of fat stores for energy

Ingestion of too many highly acidic foods

Excessive secretion of endogenous insulin

Increased amounts of cholesterol in the extracellular compartment

Answer 68

A breakdown of fat stores for energy

Question 69

When teaching the client about when to call the primary health care provider if they are showing signs of hypothyroidism after a thyroidectomy, which statement made by the client shows that teaching was effective?

“I will call if I get dry hair and can’t tolerate the cold.”

“I would call if I have muscle cramps and feel sluggish.”

“I will call if I am feeling fatigued and my pulse rate goes up.”

“I should call if my heart is beating really fast and I gain a lot of weight.”

Answer 69

“I will call if I get dry hair and can’t tolerate the cold.”

Dry, sparse hair and cold intolerance are characteristic responses to low serum thyroxine. Muscle cramping is associated with hypocalcemia. Low thyroxine levels reduce the metabolic rate, resulting in fatigue, but do not increase the pulse rate. Low thyroxine levels reduce the metabolic rate, resulting in weight gain and bradycardia, not tachycardia.

Question 70

A client with diabetes mellitus who shows decreased glucose tolerance is at risk for which complication?

Cystitis

Thin and dry skin

Decreased bone density

Frequent yeast infections

Answer 70

Frequent yeast infections

Question 71

What is the etiology of Kussmaul respirations?

To compensate for metabolic acidosis, respirations are deep and rapid.

To overcome respiratory acidosis, the respirations are fast and shallow.

Injury to the brain’s respiratory center results in periods of apnea.

Hypoxemia causes labored, gasping, and irregular respirations.

Answer 71

To compensate for metabolic acidosis, respirations are deep and rapid.

To compensate for ketoacidosis (metabolic acidosis), the lungs attempt to remove CO2 through a pattern of deep, rapid respirations referred to as Kussmaul respirations.

Question 72

To achieve the goal of restoring the client’s fluid volume, the nurse would expect to implement which intervention?

Insert a saline lock for PRN diuretic administration.

Administer an albumin/furosemide continuous infusion.

Maintain an infusion of normal saline solution.

Obtain a type and crossmatch for 2 units of packed RBCs.

Answer 72

Maintain an infusion of normal saline solution.

The treatment of hyperglycemia includes fluid replacement to correct dehydration caused by the increased concentration of glucose in the blood. Isotonic fluids, such as normal saline, are initially used to treat the dehydration.

Question 73

To restore the client’s [high] blood glucose to a normal level, what should the nurse prepare to administer?

An IV infusion containing regular insulin.

Humulin-N insulin subcutaneously (SQ) before meals.

50% dextrose IV push.

Glucagon SQ PRN per sliding scale.

Answer 73

An IV infusion containing regular insulin.

Continuous IV infusions containing regular insulin are used to reduce the client’s blood glucose level. The client’s IV solution will be changed to one that contains glucose when the blood glucose level reaches 250 mg/dL.

Question 74

The client tells the nurse that they know that diabetes (type 1) is a chronic condition and realizes they probably have had it for a while. The client wonders why they haven’t experienced any symptoms before now.

How should the nurse respond?

“The symptoms were so minor that you just didn’t notice them until you got the flu.”

“The type of diabetes you have is the acute form of diabetes, rather than the chronic form.”

“The onset of symptoms is so gradual that your body adjusts to the changes.”

“The symptoms have an abrupt onset that is often brought on by a viral illness like the flu.”

Answer 74

“The symptoms have an abrupt onset that is often brought on by a viral illness like the flu.”

Since type 1 diabetes seems to involve an interaction of genetic predisposition with an environmental trigger, the onset of symptoms is often abrupt and follows an illness like the flu.

Question 75

The client states that they wish they hadn’t gotten the flu so that the diabetes wouldn’t have been discovered and they could keep having a normal life.

What is the best initial response by the nurse?

“What do you mean when you say a normal life?”

“It’s better to find out now before complications develop.”

“Perhaps you would like to speak to someone who has diabetes.”

“It must be quite a shock to learn that you have diabetes.”

Answer 75

“It must be quite a shock to learn that you have diabetes.”

This statement acknowledges the client’s feelings and is open-ended to allow the client to continue to verbalize their feelings if they wish.

Question 76

The goal of treatment with hypoglycemic agents is maintenance of stable blood glucose levels to prevent acute complications of hypoglycemia and hyperglycemia and long-term complications associated with hyperglycemia. The client will initially administer 70% NPH/30% regular insulin subcutaneously (SQ) every morning, a sliding scale dose of regular insulin SQ before lunch and dinner, and NPH (N) insulin at bedtime. Which statement made by the client indicates a correct understanding of insulin self-administration?

“My daily dose of 70% NPH/30% regular insulin is based on how much I ate the day before.”

“The amount of short-acting insulin I take every day is based on my blood sugar readings.”

“I should store my insulin in the refrigerator and remove it 30 minutes before I need it.”

“I will alternate my injection sites from leg to abdomen each day to avoid overuse.”

Answer 76

“The amount of short-acting insulin I take every day is based on my blood sugar readings.”

Question 77

The nurse observes the client administer the morning dose of insulin. The client pinches the skin on the front of the thigh and inserts the needle at a 90-degree angle.

Which action should the nurse implement?

Advise the client to remove the needle and reinsert it at a 45-degree angle.

Instruct the client to pull the plunger back slightly before injecting the insulin.

Tell the client to remove the needle and draw up a new dose of insulin.

Encourage the client to inject the insulin with the needle in place as inserted.

Answer 77

Encourage the client to inject the insulin with the needle in place as inserted.

The client has performed the steps for subcutaneous injection correctly. Since aspiration is not necessary, the client is ready to inject the insulin.

Question 78

An hour before the next dose of sliding scale insulin is scheduled, the client tells the nurse that they are really nervous about self-administering the insulin and shows the nurse their shaky and sweaty hands.

What is the priority nursing action?

Obtain the client’s vital signs.

Check the client’s blood glucose.

Assure the client that they will be able to give themself the injections.

Offer to bring the client an orange so they can practice giving injections.

Answer 78

Check the client’s blood glucose.

Being shaky and sweaty are symptoms of hypoglycemia. Therefore, it is most important to check the client’s blood glucose. If low, the nurse should provide a snack of milk and graham crackers.

Question 79

Once the client is feeling better, the client practices injection skills and later states that they feel more comfortable about self-administration. The next morning, the client is preparing to administer the insulin with the nurse’s supervision. However, the nurse is called back to the desk by the unit clerk and learns that several clients are having problems that require immediate attention.

Which action should the nurse take first?

Return to the client’s room to supervise the scheduled insulin injection.

Administer a dose of IV antibiotics to a diabetic with an infected foot ulcer.

Administer IV dextrose to a diabetic client with a blood glucose level of 25 mg/dL (1.39 mmol/L).

Hang a new bag of sodium chloride for a diabetic with a blood glucose level of 275 mg/dL (14.26 mmol/L).

Answer 79

Administer IV dextrose to a diabetic client with a blood glucose level of 25 mg/dL (1.39 mmol/L).

This is the most critical client care situation. The client’s blood glucose is dangerously low and lack of action by the nurse could endanger the client’s life. The charge nurse uses a form of triage based on the client with the most critical need.

Question 80

The client attends a series of classes on diabetes management. The client learns that goals of diet therapy for type 1 diabetes are to consume all essential nutrients, achieve and maintain ideal body weight, and maintain blood glucose levels as near normal as possible. The client tells the nurse that they understand the importance of a well-balanced diet, but they are in college and will want to go out for a beer every now and again. The client indicates that a can of beer has a lot of calories and they will watch what they eat if they plan to have a drink. What is the best response by the nurse?

“Drinking alcohol is prohibited on a diabetic diet because you can’t predict how your blood glucose will react.”

“Alcohol does contain a lot of empty calories, but it’s also likely to cause your blood glucose to decrease.”

“Plan to take extra insulin when you drink beer because drinking will increase your blood glucose.”

“A can of beer equals one carbohydrate exchange. Adjust your calories and food intake accordingly.”

Answer 80

“Alcohol does contain a lot of empty calories, but it’s also likely to cause your blood glucose to decrease.”

Twelve ounces of beer is the equivalent of two fat exchanges, which may elevate triglyceride levels, as well as adding empty calories. It is important that the diabetic understand that alcohol may induce hypoglycemia. Therefore, the client should drink alcohol only in moderation and with or shortly after meals.

Question 81

The client tells the nurse that they will make sure to drink plenty of water and will take a little extra regular insulin before beginning strenuous exercise.

What is the best response by the nurse?

Remind the client to carry with them a simple carbohydrate snack.

Acknowledge the client’s understanding of correct pre-exercise measures.

Advise the client that extra insulin should not generally be taken before exercise.

Teach the client that extra insulin will provide more energy.

Answer 81

Advise the client that extra insulin should not generally be taken before exercise.

Exercise may cause hypoglycemia during or after the activity. Therefore, additional carbohydrates may be needed before, during, or after exercise. Clients should perform self-monitoring of blood glucose levels to determine the effects of exercise those levels. In addition, it is important to remember that exercise in a client with uncontrolled diabetes results in hyperglycemia and may lead to ketosis. Diabetics with ketonuria and a blood glucose of 250 mg/dL (11.10 mmol/L) or higher should avoid exercise.

Question 82

The Somogyi effect is the term for _____________________________ after nighttime hypoglycemia. It is often caused by too much insulin or lack of an adequate bedtime snack.

Answer 82

rebound morning hyperglycemia

Question 83

After discharge, the client is scheduled for a follow-up evaluation at the outpatient clinic. A glycosylated hemoglobin (Hgb) level is drawn and the result is 11%.

Which statement by the client reflects an understanding of glycosylated Hgb?

“The results of the test are probably high because I was not fasting before my blood was drawn this morning.”

“The results of my test are probably high because I went to a party last night and did not follow my diet.”

“I know that I need to check my glycosolated Hgb before each meal and at bedtime, but I don’t always have time.”

“At least I won’t have this done again for 3 months. I will work really hard at following my diet between now and then.”

Answer 83

“At least I won’t have this done again for 3 months. I will work really hard at following my diet between now and then.”

This test reflects average blood glucose levels over a period of approximately 120 days, the life of the average red blood cell (RBC). Glucose molecules attach to hemoglobin in RBCs. The longer the glucose in the blood is above normal, the higher the percentage of glycosylated hemoglobin. Normal levels range from 4% to 6% (0.04 to 0.06%), with levels over 8% (0.08%) indicating poor glycemic control. Note: Normal values may differ, depending on the lab.

Question 84

The client’s 15-year-old sister had a fasting blood glucose test last week. The client’s sister felt that she had some of the same symptoms that the client had before being diagnosed with diabetes. The client tells the nurse that the sister’s results were 135 mg/dL (7.49 mmol/L).

How should the nurse respond?

“She needs a second test performed before a diagnosis is made.”

“Since her value is high, it sounds like both of you have diabetes.”

“Her value is low and indicates that she does not have diabetes.”

“She is too young to develop type 1 diabetes. She may have type 2.”

Answer 84

“She needs a second test performed before a diagnosis is made.”

The diagnosis of diabetes is based on two fasting blood glucose levels greater than 126 mg/dL (6.99 mmol/L).

Question 85

The diagnosis of diabetes is based on two fasting blood glucose levels greater than ____ mg/dL (6.99 mmol/L).

Answer 85

126

Question 86

Illness increases the risk for dehydration and _______glycemia

Answer 86

hyper

Question 87

The highest risk for the onset of type 1 diabetes is linked to the presence of certain _________

Answer 87

antigens

Question 88

Women with gestational diabetes have a high risk for developing diabetes after __________, but not all will get the disease.

Answer 88

pregnancy

Question 89

The client asks the nurse to describe the differences between HHS and DKA.

How should the nurse respond?

HHS is the result of excess insulin, rather than hyperglycemia and ketosis.

HHS is primarily caused by excess ketone bodies, although hyperglycemia occurs.

HHS is caused by persistent hyperglycemia, but ketosis does not occur.

HHS is the result of fluid and electrolyte imbalance, not blood glucose.

Answer 89

HHS is caused by persistent hyperglycemia, but ketosis does not occur.

HHS is caused by persistent hyperglycemia resulting in osmotic diuresis, which results in fluid and electrolyte losses. There is enough insulin present to prevent breakdown of fats that leads to ketosis. Therefore, ketones are not found in the urine.

Question 90

HHS primarily affects type ___ diabetics who are significantly dehydrated.

Answer 90

2

Question 91

Which finding indicates that the client is experiencing a complication of diabetes? (Select all that apply.)
Select all that apply

Burning sensation in the toes.

Visual acuity of 20/60.

Protein in the urine.

Blood pressure of 110/60.

A sore on the foot that is not healing.

Answer 91

-Burning sensation in her toes
-Protein in her urine
-A sore on her foot that is having trouble healing.