Exam 4 Endocrine and Gastrointestinal

The nurse is interviewing a new patient with diabetes who takes rosiglitazone (Avandia). Which information would the nurse anticipate resulting in the health care provider discontinuing the medication? A. The patient's blood pressure is 154/92. B. The patient's blood glucose is 86 mg/dL. C. The patient reports a history of emphysema. D. The patient has chest pressure when walking.

ANS: D Rosiglitazone can cause myocardial ischemia. The nurse should immediately notify the health care provider and expect orders to discontinue the medication. A blood glucose level of 86 mg/dL indicates a positive effect from the medication. Hypertension and a history of emphysema do not contraindicate this medication.

Which finding indicates a need to contact the health care provider before the nurse administers metformin (Glucophage)? A. The patient's blood glucose level is 174 mg/dL. B. The patient is scheduled for a chest x-ray in an hour. C. The patient has gained 2 lb (0.9 kg) in the past 24 hours. D. The patient's estimated glomerular filtration rate is 42 mL/min.

ANS: D The glomerular filtration rate indicates possible renal impairment, and metformin should not be used in patients with significant renal impairment. The other findings are not contraindications to the use of metformin.

The nurse has been teaching a patient with type 2 diabetes about managing blood glucose levels and taking glipizide (Glucotrol). Which patient statement indicates a need for additional teaching? A. "If I overeat at a meal, I will still take the usual dose of medication." B. "Other medications besides the Glucotrol may affect my blood sugar." C. "When I am ill, I may have to take insulin to control my blood sugar." D. "My diabetes won't cause complications because I don't need insulin."

ANS: D The patient should understand that type 2 diabetes places the patient at risk for many complications and that good glucose control is as important when taking oral agents as when using insulin. The other statements are accurate and indicate good understanding of the use of glipizide.

After change-of-shift report, which patient will the nurse assess first? A. A 19-yr-old patient with type 1 diabetes who was admitted with dawn phenomenon B. A 35-yr-old patient with type 1 diabetes whose most recent blood glucose reading was 230 mg/dL C. A 68-yr-old patient with type 2 diabetes who has severe peripheral neuropathy and reports burning foot pain D. A 60-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa

ANS: D The patient's diagnosis of HHS and signs of dehydration indicate that the nurse should rapidly assess for signs of shock and determine whether increased fluid infusion is needed. The other patients also need assessment and intervention but do not have life-threatening complications.

A 28-yr-old male patient with type 1 diabetes reports how he manages his exercise and glucose control. Which behavior indicates that the nurse should implement additional teaching? A. The patient always carries hard candies when engaging in exercise. B. The patient goes for a vigorous walk when his glucose is 200 mg/dL. C. The patient has a peanut butter sandwich before going for a bicycle ride. D. The patient increases daily exercise when ketones are present in the urine.

ANS: D When the patient is ketotic, exercise may result in an increase in blood glucose level. Patients with type 1 diabetes should be taught to avoid exercise when ketosis is present. The other statements are correct.

The nurse is assigned to care for a patient diagnosed with type 2 diabetes. In formulating a teaching plan that encourages the patient to actively participate in managing diabetes, what should be the nurse's initial intervention? A. Assess patient's perception of what it means to have diabetes. B. Ask the patient to write down current knowledge about diabetes. C. Set goals for the patient to actively participate in managing his diabetes. D. Assume responsibility for all of the patient's care to decrease stress level.

A. assess the patient's perception of what is means to have diabetes. Correct Answer: Assess patient's perception of what it means to have diabetes. Rationale: For teaching to be effective, the first step is to assess the patient. Teaching can be individualized after the nurse is aware of what a diagnosis of diabetes means to the patient. After the initial assessment, current knowledge can be assessed, and goals should be set with the patient. Assuming responsibility for all of the patient's care will not facilitate the patient's health.

The nurse is assisting a patient with newly diagnosed type 2 diabetes to learn dietary planning as part of the initial management of diabetes. The nurse would encourage the patient to limit intake of which foods to help reduce the percent of fat in the diet? A. Cheese B. Broccoli C. Chicken D. Oranges

A. cheese Correct Answer: Cheese Rationale: Cheese is a product derived from animal sources and is higher in fat and calories than vegetables, fruit, and poultry. Excess fat in the diet is limited to help avoid macrovascular changes.

The nurse has been teaching a patient with diabetes how to perform self-monitoring of blood glucose (SMBG). During evaluation of the patient's technique, the nurse identifies a need for additional teaching when the patient does what? A. Chooses a puncture site in the center of the finger pad. B. Washes hands with soap and water to cleanse the site to be used. C. Warms the finger before puncturing the finger to obtain a drop of blood. D. Tells the nurse that the result of 110 mg/dL indicates good control of diabetes.

A. chooses a puncture site in the center of the finger pad. Correct Answer: Chooses a puncture site in the center of the finger pad. Rationale: The patient should select a site on the sides of the fingertips, not on the center of the finger pad because this area contains many nerve endings and would be unnecessarily painful. Washing hands, warming the finger, and knowing the results that indicate good control all show understanding of the teaching.

The nurse is providing discharge instructions to a patient with diabetes insipidus. Which instruction about desmopressin acetate would be most appropriate? A. Expect to have some nasal irritation while using this drug. B. Monitor for symptoms of hypernatremia as a drug side effect. C. Report any decrease in urinary output to the health care provider. D. Drink at least 3000 mL of water per day while taking this medication.

A. expect to have some nasal irritation while using this drug. Correct Answer: Expect to have some nasal irritation while using this drug. Rationale: Desmopressin acetate is used to treat diabetes insipidus by replacing the antidiuretic hormone that the patient is lacking. Diuresis will be decreased and is expected. Inhaled desmopressin can cause nasal irritation, headache, nausea, and other signs of hyponatremia, not hypernatremia. Drinking too much water or other fluids increases the risk of hyponatremia. The patient should follow the provider's directions for limiting fluids and be taught to seek medical attention if they have severe nausea; vomiting; severe headache; muscle weakness, spasms, or cramps; sudden weight gain; unusual tiredness; mental/mood changes; seizures; and slow or shallow breathing

The nurse is reviewing laboratory results for a patient with a 15-year history of type 2 diabetes. Which result reflects the expected pattern accompanying macrovascular disease as a complication of diabetes? A. Increased triglyceride levels B. Increased high-density lipoproteins (HDL) C. Decreased low-density lipoproteins (LDL) D. Decreased very-low-density lipoproteins (VLDL)

A. increased triglyceride levels Correct Answer: Increased triglyceride levels Rationale: Macrovascular complications of diabetes include changes to large- and medium-sized blood vessels. They include cerebrovascular, cardiovascular, and peripheral vascular disease. Increased triglyceride levels are associated with these macrovascular changes. Increased HDL, decreased LDL, and decreased VLDL are positive in relation to atherosclerosis development.

The nurse is caring for a patient receiving high-dose oral corticosteroid therapy after a kidney transplant. Which side effect would the nurse monitor for as it presents the greatest risk? A. Infection B. Low blood pressure C. Increased urine output D. Decreased blood glucose

A. infection Correct Answer: Infection Rationale: Side effects of corticosteroid therapy include increased susceptibility to infection, edema related to sodium and water retention (decreasing urine output), hypertension, and hyperglycemia.

Which question during the assessment of a patient who has diabetes will help the nurse identify autonomic neuropathy? A. "Do you feel bloated after eating?" B. "Have you seen any skin changes?" C. "Do you need to increase your insulin dosage when you are stressed?" D. "Have you noticed any painful new ulcerations or sores on your feet?"

ANS: A Autonomic neuropathy can cause delayed gastric emptying, which results in a bloated feeling for the patient. The other questions are also appropriate to ask but would not help in identifying autonomic neuropathy.

Which nursing action is most important in assisting an older patient who has diabetes to engage in moderate daily exercise? A. Determine what types of activities the patient enjoys. B. Remind the patient that exercise improves self-esteem. C. Teach the patient about the effects of exercise on glucose level. D. Give the patient a list of activities that are moderate in intensity.

ANS: A Because consistency with exercise is important, assessment for the types of exercise that the patient finds enjoyable is the most important action by the nurse in ensuring adherence to an exercise program. The other actions may be helpful but are not the most important in improving compliance.

The nurse is preparing to teach a 43-yr-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first? A. Assess the patient's perception of what it means to have diabetes. B. Ask the patient's family to participate in the diabetes education program. C. Demonstrate how to check glucose using capillary blood glucose monitoring. D. Discuss the need for the patient to actively participate in diabetes management.

ANS: A Before planning teaching, the nurse should assess the patient's interest in and ability to self-manage the diabetes. After assessing the patient, the other nursing actions may be appropriate, but planning needs to be specific to each patient.

Which nursing action can the nurse delegate to experienced unlicensed assistive personnel (UAP) who are working in the diabetic clinic? A. Measure the ankle-brachial index. B. Check for changes in skin pigmentation. C. Assess for unilateral or bilateral foot drop. D. Ask the patient about symptoms of depression.

ANS: A Checking systolic pressure at the ankle and brachial areas and calculating the ankle-brachial index is a procedure that can be done by UAP who have been trained in the procedure. The other assessments require more education and critical thinking and should be done by the registered nurse (RN).

A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first? A. Place the patient on a cardiac monitor. B. Administer IV potassium supplements. C. Ask the patient about home insulin doses. D. Start an insulin infusion at 0.1 units/kg/hr

ANS: A Hypokalemia can lead to potentially fatal dysrhythmias such as ventricular tachycardia and ventricular fibrillation, which would be detected with electrocardiogram (ECG) monitoring. Because potassium must be infused over at least 1 hour, the nurse should initiate cardiac monitoring before infusion of potassium. Insulin should not be administered without cardiac monitoring because insulin infusion will further decrease potassium levels. Discussion of home insulin and possible causes can wait until the patient is stabilized.

Which patient action indicates an accurate understanding of the nurse's teaching about the use of an insulin pump? A. The patient programs the pump for an insulin bolus after eating. B. The patient changes the location of the insertion site every week. C. The patient takes the pump off at bedtime and starts it again each morning. D. The patient plans a diet with more calories than usual when using the pump.

ANS: A In addition to the basal rate of insulin infusion, the patient will adjust the pump to administer a bolus after each meal, with the dosage depending on the oral intake. The insertion site should be changed every 2 or 3 days. There is more flexibility in diet and exercise when an insulin pump is used, but it does not provide for consuming a higher calorie diet. The pump will deliver a basal insulin rate 24 hours a day.

A female patient is scheduled for an oral glucose tolerance test. Which information from the patient's health history is important for the nurse to communicate to the health care provider regarding this test? A. The patient uses oral contraceptives. B. The patient runs several days a week. C. The patient has been pregnant three times. D. The patient has a family history of diabetes.

ANS: A Oral contraceptive use may falsely elevate oral glucose tolerance test (OGTT) values. Exercise and a family history of diabetes both can affect blood glucose but will not lead to misleading information from the OGTT. History of previous pregnancies may provide informational about gestational glucose tolerance but will not lead to misleading information from the OGTT.

A patient with diabetes is starting on intensive insulin therapy. Which type of insulin will the nurse discuss using for mealtime coverage? A. Lispro (Humalog) B. Glargine (Lantus) C. Detemir (Levemir) D. NPH (Humulin N)

ANS: A Rapid- or short-acting insulin is used for mealtime coverage for patients receiving intensive insulin therapy. NPH, glargine, or detemir will be used as the basal insulin.

The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next? A. Give the patient 4 to 6 oz more orange juice. B. Administer the PRN glucagon (Glucagon) 1 mg IM. C. Have the patient eat some peanut butter with crackers. D. Notify the health care provider about the hypoglycemia.

ANS: A The "rule of 15" indicates that administration of quickly acting carbohydrates should be done two or three times for a conscious patient whose glucose remains less than 70 mg/dL before notifying the health care provider. More complex carbohydrates and fats may be used after the glucose has stabilized. Glucagon should be used if the patient's level of consciousness decreases so that oral carbohydrates can no longer be given.

6. The nurse is assessing a 55-yr-old female patient with type 2 diabetes who has a body mass index (BMI) of 31 kg/m2.Which goal in the plan of care is most important for this patient? A. The patient will reach a glycosylated hemoglobin level of less than 7%. B. The patient will follow a diet and exercise plan that results in weight loss. C. The patient will choose a diet that distributes calories throughout the day. D. The patient will state the reasons for eliminating simple sugars in the diet

ANS: A The complications of diabetes are related to elevated blood glucose and the most important patient outcome is the reduction of glucose to near-normal levels. A BMI of 30.9/kg/m2 or above is considered obese, so the other outcomes are appropriate but are not as high in priority.

A patient with diabetic ketoacidosis is brought to the emergency department. Which prescribed action should the nurse implement first? A. Infuse 1 L of normal saline per hour. B. Give sodium bicarbonate 50 mEq IV push. C. Administer regular insulin 10 U by IV push. D. Start a regular insulin infusion at 0.1 units/kg/hr

ANS: A The most urgent patient problem is the hypovolemia associated with diabetic ketoacidosis (DKA), and the priority is to infuse IV fluids. The other actions can be done after the infusion of normal saline is initiated.

Which information will the nurse include in teaching a female patient who has peripheral arterial disease, type 2 diabetes, and sensory neuropathy of the feet and legs? A. Choose flat-soled leather shoes. B. Set heating pads on a low temperature. C. Use a callus remover for corns or calluses. D. Soak feet in warm water for an hour each day

ANS: A The patient is taught to avoid high heels and that leather shoes are preferred. The feet should be washed, but not soaked, in warm water daily. Heating pad use should be avoided. Commercial callus and corn removers should be avoided. The patient should see a specialist to treat these problems.

A patient receives aspart (NovoLog) insulin at 8:00 AM. At which time would the nurse anticipate the highest risk for hypoglycemia? A. 10:00 AM B. 12:00 AM C. 2:00 PM D. 4:00 PM

ANS: A The rapid-acting insulins peak in 1 to 3 hours. The patient is not at a high risk for hypoglycemia at the other listed times, although hypoglycemia may occur

In which order will the nurse take these steps to prepare NPH 20 units and regular insulin 2 units using the same syringe? (Put a comma and a space between each answer choice [A, B, C, D, E]). A. Rotate NPH vial. B. Withdraw regular insulin. C. Withdraw 20 units of NPH. D. Inject 20 units of air into NPH vial. E. Inject 2 units of air into regular insulin vial

ANS: A, D, E, B, C When mixing regular insulin with NPH, it is important to avoid contact between the regular insulin and the additives in the NPH that slow the onset, peak, and duration of activity in the long-acting insulin.

After change-of-shift report, which patient should the nurse assess first? A. A 19-yr-old patient with type 1 diabetes who has a hemoglobin A1C of 12% B. A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg/dL C. A 50-yr-old patient who uses exenatide (Byetta) and is reporting acute abdominal pain D. A 40-yr-old patient who is pregnant and whose oral glucose tolerance test is 202 mg/dL

ANS: B Because the brain requires glucose to function, untreated hypoglycemia can cause unconsciousness, seizures, and death. The nurse will rapidly assess and treat the patient with low blood glucose. The other patients also have symptoms that require assessments or interventions, but they are not at immediate risk for life-threatening complications.

Which patient action indicates accurate understanding of the nurse's teaching about administration of aspart (NovoLog) insulin? A. The patient avoids injecting the insulin into the upper abdominal area. B. The patient cleans the skin with soap and water before insulin administration. C. The patient stores the insulin in the freezer after administering the prescribed dose. D. The patient pushes the plunger down while removing the syringe from the injection site.

ANS: B Cleaning the skin with soap and water is acceptable. Insulin should not be frozen. The patient should leave the syringe in place for about 5 seconds after injection to be sure that all the insulin has been injected. The upper abdominal area is one of the preferred areas for insulin injection.

An unresponsive patient who has type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemia syndrome (HHS). What should the nurse anticipate doing? A. Giving 50% dextrose B. Inserting an IV catheter C. Initiating O2 by nasal cannula D. Administering glargine (Lantus) insulin

ANS: B HHS is initially treated with large volumes of IV fluids to correct hypovolemia. Regular insulin is administered, not a long-acting insulin. There is no indication that the patient requires O2. Dextrose solutions will increase the patient's blood glucose and would be contraindicated

Which statement by the patient who has newly diagnosed type 1 diabetes indicates a need for additional instruction from the nurse? A. "I will need a bedtime snack because I take an evening dose of NPH insulin." B. "I can choose any foods, as long as I use enough insulin to cover the calories." C. "I can have an occasional beverage with alcohol if I include it in my meal plan." D. "I will eat something at meal times to prevent hypoglycemia, even if I am not hungry."

ANS: B Most patients with type 1 diabetes need to plan diet choices very carefully. Patients who are using intensified insulin therapy have considerable flexibility in diet choices but still should restrict dietary intake of items such as fat, protein, and alcohol. The other patient statements are correct and indicate good understanding of the diet instruction.

The nurse is taking a health history from a 29-yr-old patient at the first prenatal visit. The patient reports that she has no personal history of diabetes, but her mother has diabetes. Which action will the nurse plan to take? A. Teach the patient about administering regular insulin. B. Schedule the patient for a fasting blood glucose level. C. Teach about an increased risk for fetal problems with gestational diabetes. D. Schedule an oral glucose tolerance test for the twenty-fourth week of pregnancy

ANS: B Patients at high risk for gestational diabetes should be screened for diabetes on the initial prenatal visit. An oral glucose tolerance test may also be used to check for diabetes, but it would be done before the twenty-fourth week. Teaching plans would depend on the outcome of a fasting blood glucose test and other tests.

Which action should the nurse take after a patient treated with intramuscular glucagon for hypoglycemia regains consciousness? A. Assess the patient for symptoms of hyperglycemia. B. Give the patient a snack of peanut butter and crackers. C. Have the patient drink a glass of orange juice or nonfat milk. D. Administer a continuous infusion of 5% dextrose for 24 hours.

ANS: B Rebound hypoglycemia can occur after glucagon administration, but having a meal containing complex carbohydrates plus protein and fat will help prevent hypoglycemia. Orange juice and nonfat milk will elevate blood glucose rapidly, but the cheese and crackers will stabilize blood glucose. Administration of IV glucose might be used in patients who were unable to take in nutrition orally. The patient should be assessed for symptoms of hypoglycemia after glucagon administration.

Which patient statement to the nurse indicates a need for additional instruction in administering insulin? A. "I can buy the 0.5-mL syringes because the line markings are easier to see." B. "I need to rotate injection sites among my arms, legs, and abdomen each day." C. "I do not need to aspirate the plunger to check for blood before injecting insulin." D. "I should draw up the regular insulin first, after injecting air into the NPH bottle."

ANS: B Rotating sites is no longer recommended because there is more consistent insulin absorption when the same site is used consistently. The other patient statements are accurate and indicate that no additional instruction is needed.

A patient who has type 1 diabetes plans to swim laps for an hour daily at 1:00 PM. What advice should the clinic nurse plan to give the patient? A. Increase the morning dose of NPH insulin (Novolin N). B. Check glucose level before, during, and after swimming. C. Time the morning insulin injection to peak while swimming. D. Delay eating the noon meal until after finishing the swimming.

ANS: B The change in exercise will affect blood glucose, and the patient will need to monitor glucose carefully to determine the need for changes in diet and insulin administration. Because exercise tends to decrease blood glucose, patients are advised to eat before exercising. Increasing the morning NPH or timing the insulin to peak during exercise may lead to hypoglycemia, especially with the increased exercise

A few weeks after an 82-yr-old patient with a new diagnosis of type 2 diabetes has been placed on metformin (Glucophage) therapy, the home health nurse makes a visit. Which finding should the nurse promptly discuss with the health care provider? A. Hemoglobin A1C level is 7.9%. B. Glomerular filtration rate is decreased. C. Last eye examination was 18 months ago. D. Patient has questions about the prescribed diet.

ANS: B The decrease in renal function may indicate a need to adjust the dose of metformin or change to a different medication. In older patients, the goal for A1C may be higher in order to avoid complications associated with hypoglycemia. The nurse will plan on scheduling the patient for an eye examination and addressing the questions about diet, but the area for prompt intervention is the patient's decreased renal function.

A patient with type 2 diabetes is scheduled for a follow-up visit in the clinic several months from now. Which test will the nurse schedule to evaluate the effectiveness of treatment for the patient? A. Fasting blood glucose B. Glycosylated hemoglobin C. Oral glucose tolerance test D. Urine dipstick for glucose and ketones

ANS: B The glycosylated hemoglobin (A1C) test shows the overall control of glucose over 90 to 120 days. A fasting blood level indicates only the glucose level at one time. Urine glucose testing is not an accurate reflection of blood glucose level and does not reflect the glucose over a prolonged time. Oral glucose tolerance testing is done to diagnose diabetes but is not used for monitoring glucose control after diabetes has been diagnosed.

Which laboratory value reported by the unlicensed assistive personnel (UAP) indicates an urgent need for the nurse to assess the patient? A. Bedtime glucose of 140 mg/dL B. Noon blood glucose of 52 mg/dL C. Fasting blood glucose of 130 mg/dL D. 2-hr postprandial glucose of 220 mg/dL

ANS: B The nurse should assess the patient with a blood glucose level of 52 mg/dL for symptoms of hypoglycemia and give the patient a carbohydrate-containing beverage such as orange juice. The other values are within an acceptable range or not immediately dangerous for a patient with diabetes.

Which action by the patient who is self-monitoring blood glucose indicates a need for additional teaching? A. Washes the puncture site using warm water and soap. B. Chooses a puncture site in the center of the finger pad. C. Hangs the arm down for a minute before puncturing the site. D. Says the result of 120 mg indicates good blood sugar control.

ANS: B The patient is taught to choose a puncture site at the side of the finger pad because there are fewer nerve endings along the side of the finger pad. The other patient actions indicate that teaching has been effective.

Which information will the nurse include when teaching a patient who has type 2 diabetes about glyburide? A. Glyburide decreases glucagon secretion from the pancreas. B. Glyburide stimulates insulin production and release from the pancreas. C. Glyburide should be taken even if the morning blood glucose level is low. D. Glyburide should not be used for 48 hours after receiving IV contrast media.

ANS: B The sulfonylureas stimulate the production and release of insulin from the pancreas. If the glucose level is low, the patient should contact the health care provider before taking glyburide because hypoglycemia can occur with this class of medication. Metformin should be held for 48 hours after administration of IV contrast media, but this is not necessary for glyburide. Glyburide does not affect glucagon secretion.

A patient who has diabetes and reports burning foot pain at night receives a new prescription. Which information should the nurse teach the patient about amitriptyline? A. Amitriptyline decreases the depression caused by your foot pain. B. Amitriptyline helps prevent transmission of pain impulses to the brain. C. Amitriptyline corrects some of the blood vessel changes that cause pain. D. Amitriptyline improves sleep and makes you less aware of nighttime pain.

ANS: B Tricyclic antidepressants (TCAs) decrease the transmission of pain impulses to the spinal cord and brain. TCAs also improve sleep quality and are used for depression, but that is not the major purpose for their use in diabetic neuropathy. TCAs do not affect the blood vessel changes that contribute to neuropathy.

To monitor for complications in a patient with type 2 diabetes, which tests will the nurse in the diabetic clinic schedule at least annually? (Select all that apply.) A. Chest x-ray B. Blood pressure C. Serum creatinine D. Urine for microalbuminuria E. Complete blood count (CBC) F. Monofilament testing of the foot

ANS: B, C, D, F Blood pressure, serum creatinine, urine testing for microalbuminuria, and monofilament testing of the foot are recommended at least annually to screen for possible microvascular and macrovascular complications of diabetes. Chest x-ray and CBC might be ordered if the patient with diabetes presents with symptoms of respiratory or infectious problems but are not routinely included in screening.

A patient is admitted with diabetes, malnutrition, cellulitis, and a potassium level of 5.6 mEq/L. The nurse understands that what could be contributing factors for this laboratory result? (Select all that apply.) A. The level is consistent with renal insufficiency from renal nephropathy. B. The level may be high because of dehydration that accompanies hyperglycemia. C. The level may be raised due to metabolic ketoacidosis caused by hyperglycemia. D. The patient may be excreting sodium and retaining potassium from malnutrition. E. This level shows adequate treatment of the cellulitis and acceptable glucose control.

A,B and C Correct Answer: The level is consistent with renal insufficiency from renal nephropathy. The level may be high because of dehydration that accompanies hyperglycemia. The level may be raised due to metabolic ketoacidosis caused by hyperglycemia. Rationale: The additional stress of cellulitis may lead to an increase in the patient's serum glucose levels. Dehydration may cause hemoconcentration, resulting in elevated serum readings. The kidneys may have difficulty excreting potassium if renal insufficiency exists. Finally, the nurse must consider the potential for metabolic ketoacidosis because potassium will leave the cell when hydrogen enters in an attempt to compensate for a low pH. Malnutrition does not cause sodium excretion accompanied by potassium retention. Thus, it is not a contributing factor to this patient's potassium level. The increased potassium level does not show adequate treatment of cellulitis or acceptable glucose control.

The patient with systemic lupus erythematosus is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What interventions should be included in the plan of care? (Select all that apply.) A. Obtain daily weights. B. Limit fluids to 1000 mL/day. C. Administer diuretics as ordered. D. Monitor for signs of hypernatremia. E. Minimize turning and range of motion. F. Elevate the head of the bed at 10 degrees or less.

A,B,C, and F Correct Answer: Obtain daily weights. Limit fluids to 1000 mL/day. Administer diuretics as ordered. Elevate the head of the bed at 10 degrees or less. Rationale: The care for the patient with SIADH will include limiting fluids to 1000 mL/day or less to decrease weight, increase osmolality, and improve symptoms and keeping the head of the bed elevated at 10 degrees or less to enhance venous return to the heart and increase left atrial filling pressure, thereby reducing the release of ADH. Measure weights daily and maintain accurate intake and output. Monitor for signs of hyponatremia. Frequent turning, positioning, and range-of-motion exercises are important to maintain skin integrity and joint mobility.

The nurse is caring for a patient admitted with suspected hyperparathyroidism. Which manifestations would represent the expected electrolyte imbalance? (Select all that apply.) A. Nausea and vomiting B. Neurologic irritability C. Lethargy and weakness D. Increasing urine output E. Hyperactive bowel sounds

A,C, and D Correct Answer: Nausea and vomiting Lethargy and weakness Increasing urine output Rationale: Hyperparathyroidism can cause hypercalcemia. Signs of hypercalcemia include muscle weakness, polyuria, constipation, nausea and vomiting, lethargy, and memory impairment. Neurologic irritability and hyperactive bowel sounds do not occur with hypercalcemia.

Which assessment finding would the nurse expect in a patient who has been taking oral prednisone several weeks and is experiencing sudden withdrawal? (Select all that apply.) A. BP 80/50 B. Heart rate 54 C. Glucose 63 mg/dL D. Sodium 148 mEq/L E. Potassium 6.3 mEq/L F. Temperature 101.1° F

A,C,E and F Correct Answer: BP 80/50 Glucose 63 mg/dL Potassium 6.3 mEq/L Temperature 101.1° F Rationale: Sudden cessation of corticosteroid therapy can precipitate life-threatening adrenal insufficiency. During acute adrenal insufficiency, the patient exhibits severe manifestations of glucocorticoid and mineralocorticoid deficiencies, including hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, and confusion.

The nurse teaches a patient recently diagnosed with type 1 diabetes about insulin administration. Which statement by the patient requires an intervention by the nurse? A. "I will discard any insulin bottle that is cloudy in appearance." B. "The best injection site for insulin administration is in my abdomen." C. "I can wash the site with soap and water before insulin administration." D. "I may keep my insulin at room temperature (75° F) for up to 1 month."

A. "I will discard any insulin bottle that is cloudy in appearance." Correct Answer: "I will discard any insulin bottle that is cloudy in appearance." Rationale: Intermediate-acting insulin and combination-premixed insulin will be cloudy in appearance. Routine hygiene such as washing with soap and rinsing with water is adequate for skin preparation for the patient during self-injections. Insulin vials that the patient is currently using may be left at room temperature for up to 4 weeks unless the room temperature is higher than 86° F (30° C) or below freezing (<32°F [0°C]). Rotating sites to different anatomic sites is no longer recommended. Patients should rotate the injection within one particular site, such as the abdomen.

The nurse is teaching a patient with acromegaly from an unresectable benign pituitary tumor about octreotide therapy. The nurse should provide further teaching if the patient makes which statement? A. "The provider will infuse this medication through an IV." B. "I will inject the medication in the subcutaneous layer of the skin." C. "The medication should decrease the growth hormone production to normal." D. "I will have my growth hormone level measured every 2 weeks for several weeks."

A. "The provider will infuse this medication through an IV." Correct Answer: "The provider will infuse this medication through an IV." Rationale: Drug therapy is an option for patients whose tumors are not surgically resectable. The primary drug used is octreotide, a somatostatin analog. It reduces growth hormone (GH) levels to normal in many patients. Octreotide is given by subcutaneous injection three times a week. GH levels are measured every 2 weeks to K guide drug dosing, and then every 6 months until the desired response is obtained.

The nurse is reviewing laboratory results for the clinic patients to be seen today. Which patient meets the diagnostic criteria for diabetes? A. A 48-yr-old woman with a hemoglobin A1C of 8.4% B. A 58-yr-old man with a fasting blood glucose of 111 mg/dL C. A 68-yr-old woman with a random plasma glucose of 190 mg/dL D. A 78-yr-old man with a 2-hour glucose tolerance plasma glucose of 184 mg/dL

A. A 48-yr-old woman with a hemoglobin A1C of 8.4% Correct Answer: A 48-yr-old woman with a hemoglobin A1C of 8.4% Rationale: Criteria for a diagnosis of diabetes include a hemoglobin A1C of 6.5% or greater, fasting plasma glucose level of 126 mg/dL or greater, 2-hour plasma glucose level of 200 mg/dL or greater during an oral glucose tolerance test, or classic symptoms of hyperglycemia or hyperglycemic crisis with a random plasma glucose of 200 mg/dL or greater.

The nurse is assessing a patient newly diagnosed with type 2 diabetes. Which symptom reported by the patient correlates with the diagnosis? A. Excessive thirst B. Gradual weight gain C. Overwhelming fatigue D. Recurrent blurred vision

A. Excessive thirst Correct Answer: Excessive thirst Rationale: The classic symptoms of diabetes are polydipsia (excessive thirst), polyuria, (excessive urine output), and polyphagia (increased hunger). Weight gain, fatigue, and blurred vision may all occur with type 2 diabetes, but are not classic manifestations.

What is a nursing priority when caring for a patient with hypothyroidism? A. Patient teaching related to levothyroxine B. Providing a dark, low-stimulation environment C. Closely monitoring the patient's intake and output D. Initiating precautions related to radioactive iodine therapy

A. Patient teaching related to levothyroxine Correct Answer: Patient teaching related to levothyroxine Rationale: A euthyroid state is most often achieved in patients with hypothyroidism by the administration of levothyroxine. It is not necessary to closely monitor intake and output. Low stimulation and radioactive iodine therapy are used to treat hyperthyroidism.

Which patient statement indicates that the nurse's teaching about exenatide (Byetta) has been effective? A. "I may feel hungrier than usual when I take this medicine." B. "I will not need to worry about hypoglycemia with the Byetta." C. "I should take my daily aspirin at least an hour before the Byetta." D. "I will take the pill at the same time I eat breakfast in the morning."

ANS: C Because exenatide slows gastric emptying, oral medications should be taken at least 1 hour before the exenatide to avoid slowing absorption. Exenatide is injected and increases feelings of satiety. Hypoglycemia can occur with this medication

A 30-yr-old patient has a new diagnosis of type 2 diabetes. When should the nurse recommend the patient schedule a dilated eye examination? A. Every 2 years B. Every 6 months C. As soon as available D. At the age of 39 years

ANS: C Because many patients have some diabetic retinopathy when they are first diagnosed with type 2 diabetes, a dilated eye examination is recommended at the time of diagnosis and annually thereafter

A hospitalized patient who is diabetic received 38 U of NPH insulin at 7:00 AM. At 1:00 PM, the patient has been away from the nursing unit for 2 hours, missing the lunch delivery while awaiting a chest x-ray. What is the best action by the nurse to prevent hypoglycemia? A. Plan to discontinue the evening dose of insulin. B. Save the lunch tray for the patient's later return. C. Request that if testing is further delayed, the patient will eat lunch first. D. Send a glass of orange juice to the patient in the diagnostic testing area.

ANS: C Consistency for mealtimes assists with regulation of blood glucose, so the best option is for the patient to have lunch at the usual time. Waiting to eat until after the procedure is likely to cause hypoglycemia. Holding the insulin dose later will not prevent hypoglycemia form the peak of the NPH dose. A glass of juice will keep the patient from becoming hypoglycemic but will cause a rapid rise in blood glucose because of the rapid absorption of the simple carbohydrate in these items.

Which statement by a nurse to a patient newly diagnosed with type 2 diabetes is accurate? A. Insulin is not used to control blood glucose in patients with type 2 diabetes. B. Complications of type 2 diabetes are less serious than those of type 1 diabetes. C. Changes in diet and exercise may control blood glucose levels in type 2 diabetes. D. Type 2 diabetes is usually diagnosed when a patient is admitted in hyperglycemic coma.

ANS: C For some patients with type 2 diabetes, changes in lifestyle are sufficient to achieve blood glucose control. Insulin is frequently used for type 2 diabetes, complications are equally severe as for type 1 diabetes, and type 2 diabetes is usually diagnosed with routine laboratory testing or after a patient develops complications such as frequent yeast infections.

When a patient who takes metformin (Glucophage) to manage type 2 diabetes develops an allergic rash from an unknown cause, the health care provider prescribes prednisone. What should the nurse anticipate? A. The patient may need a diet higher in calories while receiving prednisone. B. The patient may develop acute hypoglycemia while taking the prednisone. C. The patient may require administration of insulin while taking prednisone. D. The patient may have rashes caused by metformin-prednisone interactions.

ANS: C Glucose levels increase when patients are taking corticosteroids, and insulin may be required to control blood glucose. Hypoglycemia is not a side effect of prednisone. Rashes are not an adverse effect caused by taking metformin and prednisone simultaneously. The patient may have an increased appetite when taking prednisone but will not need a diet that is higher in calories

The health care provider suspects the Somogyi effect in a 50-yr-old patient whose 6:00 AMblood glucose is 230 mg/dL. Which action will the nurse teach the patient to take? A. Avoid snacking right before bedtime. B. Increase the rapid-acting insulin dose. C. Check the blood glucose during the night. D. Administer a larger dose of long-acting insulin.

ANS: C If the Somogyi effect is causing the patient's increased morning glucose level, the patient will experience hypoglycemia between 2:00 and 4:00 AM. The dose of insulin will be reduced, rather than increased. A bedtime snack is used to prevent hypoglycemic episodes during the night

A 26-yr-old female who has type 1 diabetes develops a sore throat and runny nose after caring for her sick toddler. The patient calls the clinic for advice about her symptoms and reports a blood glucose level of 210 mg/dL despite taking her usual glargine (Lantus) and lispro (Humalog) insulin. What should the nurse advise the patient to do? A. Use only the lispro insulin until the symptoms are resolved. B. Limit intake of calories until the glucose is less than 120 mg/dL. C. Monitor blood glucose every 4 hours and contact the clinic if it rises. D. Decrease carbohydrates until glycosylated hemoglobin is less than 7%.

ANS: C Infection and other stressors increase blood glucose levels and the patient will need to test blood glucose frequently, treat elevations appropriately with lispro insulin, and call the health care provider if glucose levels continue to be elevated. Discontinuing the glargine will contribute to hyperglycemia and may lead to diabetic ketoacidosis (DKA). Decreasing carbohydrate or caloric intake is not appropriate because the patient will need more calories when ill. Glycosylated hemoglobin testing is not used to evaluate short-term alterations in blood glucose.

Which action by a patient indicates that the home health nurse's teaching about glargine and regular insulin has been successful? A. The patient administers the glargine 30 minutes before each meal. B. The patient's family prefills the syringes with the mix of insulins weekly. C. The patient discards the open vials of glargine and regular insulin after 4 weeks. D. The patient draws up the regular insulin and then the glargine in the same syringe.

ANS: C Insulin can be stored at room temperature for 4 weeks. Glargine should not be mixed with other insulins or prefilled and stored. Short-acting regular insulin is administered before meals, and glargine is given once daily.

When a patient with type 2 diabetes is admitted for a cholecystectomy, which nursing action can the nurse delegate to a licensed practical/vocational nurse (LPN/VN)? A. Communicate the blood glucose level and insulin dose to the circulating nurse in surgery. B. Discuss the reason for the use of insulin therapy during the immediate postoperative period. C. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery. D. Plan strategies to minimize the risk for hypoglycemia or hyperglycemia during the postoperative period.

ANS: C LPN/LVN education and scope of practice includes administration of insulin. Communication about patient status with other departments, planning, and patient teaching are skills that require RN education and scope of practice.

A patient with diabetes rides a bicycle to and from work every day. Which site should the nurse teach the patient to use to administer the morning insulin? A. Thigh B. Buttock C. Abdomen D. Upper arm

ANS: C Patients should be taught not to administer insulin into a site that will be exercised because exercise will increase the rate of absorption. The thigh, buttock, and arm are all exercised by riding a bicycle.

A patient who was admitted with diabetic ketoacidosis secondary to a urinary tract infection has been weaned off an insulin drip 30 minutes ago. The patient reports feeling lightheaded and sweaty. Which action should the nurse take first? A. Infuse dextrose 50% by slow IV push. B. Administer 1 mg glucagon subcutaneously. C. Obtain a glucose reading using a finger stick. D. Have the patient drink 4 ounces of orange juice.

ANS: C The patient's clinical manifestations are consistent with hypoglycemia, and the initial action should be to check the patient's glucose with a finger stick or order a stat blood glucose. If the glucose is low, the patient should ingest a rapid-acting carbohydrate, such as orange juice. Glucagon or dextrose 50% might be given if the patient's symptoms become worse or if the patient is unconscious.

A patient screened for diabetes at a clinic has a fasting plasma glucose level of 120 mg/dL (6.7 mmol/L). What should the nurse plan to teach the patient? A. Self-monitoring of blood glucose B. Using low doses of regular insulin C. Lifestyle changes to lower blood glucose D. Effects of oral hypoglycemic medications

ANS: C The patient's impaired fasting glucose indicates prediabetes, and the patient should be counseled about lifestyle changes to prevent the development of type 2 diabetes. The patient with prediabetes does not require insulin or oral hypoglycemics for glucose control and does not need to self-monitor blood glucose.

A patient who has type 2 diabetes is being prepared for an elective coronary angiogram. Which information would the nurse anticipate might lead to rescheduling the test? A. The patient's most recent A1C was 7.5%. B. The patient's blood glucose is 128 mg/dL. C. The patient took the prescribed metformin today. D. The patient took the prescribed enalapril 4 hours ago.

ANS: C To avoid lactic acidosis, metformin should be discontinued a day or 2 before the coronary angiogram and should not be used for 48 hours after IV contrast media are administered. The other patient data will be reported but do not indicate any need to reschedule the procedure.

An active 32-yr-old male who has type 1 diabetes is being seen in the endocrine clinic. Which finding indicates a need for the nurse to discuss a possible a change in therapy with the health care provider? A. Hemoglobin A1C level of 6.2% B. Heart rate at rest of 58 beats/min C. Blood pressure of 140/88 mmHg D. High-density lipoprotein (HDL) level of 65 mg/dL

ANS: C To decrease the incidence of macrovascular and microvascular problems in patients with diabetes, the blood pressure should be kept in normal range. An A1C less than 6.5%, a low resting heart rate (consistent with regular aerobic exercise in a young adult), and an HDL level of 65 mg/dL all indicate that the patient's diabetes and risk factors for vascular disease are well controlled.

The nurse is assessing a 22-yr-old patient experiencing the onset of symptoms of type 1 diabetes. To which question would the nurse anticipate a positive response? A. "Are you anorexic?" B. "Is your urine dark colored?" C. "Have you lost weight lately?" D. "Do you crave sugary drinks?"

ANS: C Weight loss occurs because the body is no longer able to absorb glucose and starts to break down protein and fat for energy. The patient is thirsty but does not necessarily crave sugar-containing fluids. Increased appetite is a classic symptom of type 1 diabetes. With the classic symptom of polyuria, urine will be very dilute.

The nurse is teaching a patient with type 2 diabetes how to prevent diabetic nephropathy. Which statement made by the patient indicates that teaching has been successful? A. "Smokeless tobacco products decrease the risk of kidney damage." B. "I can help control my blood pressure by avoiding foods high in salt." C. "I should have yearly dilated eye examinations by an ophthalmologist." D. "I will avoid hypoglycemia by keeping my blood sugar above 180 mg/dL."

B. "I can help control my blood pressure by avoiding foods high in salt." Correct Answer: "I can help control my blood pressure by avoiding foods high in salt." Rationale: Patients with type 2 diabetes to have a dilated eye examination by an ophthalmologist or a specially trained optometrist at the time of diagnosis and annually thereafter for early detection and treatment. Diabetic nephropathy is a microvascular complication associated with damage to the small blood vessels that supply the glomeruli of the kidney. Risk factors for the development of diabetic nephropathy include hypertension, genetic predisposition, smoking, and chronic hyperglycemia. Patients with type 2 diabetes need to have a dilated eye examination by an ophthalmologist or a specially trained optometrist at the time of diagnosis and annually thereafter for early detection and treatment of retinopathy.

The nurse teaches a patient with diabetes about a healthy eating plan. Which statement made by the patient indicates that teaching was successful? A. "I plan to lose 25 pounds this year by following a high-protein diet." B. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." C. "I should include more fiber in my diet than a person who does not have diabetes." D. "If I use an insulin pump, I will not need to limit foods with saturated fat in my diet."

B. "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach". Correct Answer: "I may have a hypoglycemic reaction if I drink alcohol on an empty stomach." Rationale: Eating carbohydrates when drinking alcohol reduces the risk for alcohol-induced hypoglycemia. Intensified insulin therapy, such as the use of an insulin pump, allows considerable flexibility in food selection and can be adjusted for alterations from usual eating and exercise habits. However, saturated fat intake should still be limited to less than 7% of total daily calories. Daily fiber intake of 14 g/1000 kcal is recommended for the general population and for patients with diabetes. High-protein diets are not recommended for weight loss.

The nurse has taught a patient admitted with diabetes principles of foot care. The nurse evaluates that the patient understands the instructions if the patient makes what statement? A. "I should only walk barefoot in nice dry weather." B. "I should look at the condition of my feet every day." C. "I will need to cut back the number of times I shower per week." D. "My shoes should fit nice and tight because they will give me firm support."

B. "I should look at the condition of my feet every day." Correct Answer: "I should look at the condition of my feet every day." Rationale: Patients with diabetes need to inspect their feet daily for broken areas that are at risk for infection and delayed wound healing. Properly fitted (not tight) shoes should be worn at all times. Routine care includes regular bathing.

The nurse receives a phone call from a patient taking cyclophosphamide for treatment of non-Hodgkin's lymphoma. The patient tells the nurse that she has muscle cramps, weakness, and very little urine output. Which response by the nurse is best? A. "Start taking supplemental potassium, calcium, and magnesium." B. "Stop taking the medication now and call your health care provider." C. "These symptoms will decrease with continued use of the medication." D. "Increase your fluid intake to 3000 mL for 24 hours to improve your urine output."

B. "Stop taking the medication now and call your health care provider" Correct Answer: "Stop taking the medication now and call your health care provider." Rationale: Cyclophosphamide may cause syndrome of inappropriate antidiuretic hormone (SIADH). Medications that stimulate the release of ADH should be avoided or discontinued. Treatment may include restriction of fluids to 800 to 1000 mL/day. A loop diuretic such as furosemide (Lasix) is used to promote diuresis, and supplements of potassium, calcium, and magnesium may be needed.

Which patient with type 1 diabetes would be at the highest risk for developing hypoglycemic unawareness? A. A 58-yr-old patient with diabetic retinopathy B. A 73-yr-old patient who takes propranolol (Inderal) C. A 19-yr-old patient who is on the school track team D. A 24-yr-old patient with a hemoglobin A1C of 8.9%

B. A 73-year-old patient who takes propranolol Correct Answer: A 73-yr-old patient who takes propranolol (Inderal) Rationale: Hypoglycemic unawareness is a condition in which a person does not have the warning signs and symptoms of hypoglycemia until the person becomes incoherent and combative or loses consciousness. Hypoglycemic awareness is related to autonomic neuropathy of diabetes that interferes with the secretion of counterregulatory hormones that produce these symptoms. Older patients and patients who use β-adrenergic blockers (e.g., propranolol) are at risk for hypoglycemic unawareness.

The nurse is caring for a patient recently started on levothyroxine for hypothyroidism. What information reported by the patient requires immediate action? A. Weight gain or weight loss B. Chest pain and palpitations C. Muscle weakness and fatigue D. Decreased appetite and constipation

B. Chest pain and palpitations Correct Answer: Chest pain and palpitations Rationale: Levothyroxine is used to treat hypothyroidism. With replacement, the patient can be overmedicated, causing hyperthyroidism. Any chest pain, heart palpitations, or heart rate greater than 100 beats/min experienced by a patient starting thyroid replacement should be reported immediately, and electrocardiography and serum cardiac enzyme tests should be performed.

The nurse is teaching a patient who has diabetes about vascular complications of diabetes. What information is appropriate for the nurse to include? A. Macroangiopathy only occurs in patients with type 2 diabetes who have severe disease. B. Microangiopathy most often affects the capillary membranes of the eyes, kidneys, and skin. C. Macroangiopathy causes slowed gastric emptying and the sexual impotency experienced by most patients with diabetes. D. Renal damage resulting from changes in large- and medium-sized blood vessels can be prevented by careful glucose control.

B. Microangiopathy most often affects the capillary membranes of the eyes, kidneys, and skin. Correct Answer: Microangiopathy most often affects the capillary membranes of the eyes, kidneys, and skin. Rationale: Microangiopathy occurs in diabetes. When it affects the eyes, it is called diabetic retinopathy. When the kidneys are affected, the patient has nephropathy. When the skin is affected, it can lead to diabetic foot ulcers. Macroangiopathy can occur in either type 1 or type 2 diabetes and contributes to cerebrovascular, cardiovascular, and peripheral vascular disease. Sexual impotency and slowed gastric emptying result from microangiopathy and neuropathy.

A patient with diabetes is scheduled for a fasting blood glucose level at 8:00 AM. The nurse teaches the patient to only drink water after what time? A. 6:00 PM on the evening before the test B. Midnight before the test C. 4:00 AM on the day of the test D. 7:00 AM on the day of the test

B. Midnight before the test Correct Answer: Midnight before the test Rationale: Typically, a patient is ordered to be NPO for 8 hours before a fasting blood glucose level. For this reason, the patient who has a lab draw at 8:00 AM should not have any food or beverages containing any calories after midnight.

A patient with diabetes who has multiple infections every year needs a mitral valve replacement. What is the most important preoperative teaching the nurse should provide to prevent a cardiac infection postoperatively? A. Avoid sick people and wash hands. B. Obtain comprehensive dental care. C. Maintain hemoglobin A1C below 7%. D. Coughing and deep breathing with splinting

B. Obtain comprehensive dental care Correct Answer: Obtain comprehensive dental care. Rationale: A person with diabetes is at high risk for postoperative infections. The most important preoperative teaching to prevent a postoperative infection in the heart is to have the patient obtain comprehensive dental care because the risk of septicemia and infective endocarditis increases with poor dental health. Avoiding sick people, hand washing, maintaining hemoglobin A1C below 7%, and coughing and deep breathing with splinting would be important for any type of surgery but are not the priority for this patient with mitral valve replacement.

The provider was unable to spare a patient's parathyroid gland during a thyroidectomy. Which assessments should the nurse prioritize when providing postoperative care for this patient? A. White blood cell levels and signs of infection B. Serum calcium levels and signs of hypocalcemia C. Hemoglobin, hematocrit, and red blood cell levels D. Level of consciousness and signs of acute delirium

B. Serum calcium levels and signs of hypocalcemia Correct Answer: Serum calcium levels and signs of hypocalcemia Rationale: Loss of the parathyroid gland is associated with hypocalcemia. Whereas infection and anemia are not associated with loss of the parathyroid gland, cognitive changes are less pronounced than the signs and symptoms of hypocalcemia.

The patient received regular insulin 10 units subcutaneously at 8:30 PM for a blood glucose level of 253 mg/dL. The nurse plans to monitor this patient for signs of hypoglycemia at which time related to the insulin's peak action? A. 8:40 PM to 9:00 PM B. 9:00 PM to 11:30 PM C. 10:30 PM to 1:30 AM D. 12:30 AM to 8:30 AM

C. 10:30 PM to 1:30 AM Correct Answer: 10:30 PM to 1:30 AM Rationale: Regular insulin exerts peak action in 2 to 5 hours, making the patient most at risk for hypoglycemia between 10:30 PM and 1:30 AM. Rapid-acting insulin's onset is between 10 and 30 minutes with peak action and hypoglycemia most likely to occur between 9:00 PM and 11:30 PM. With intermediate acting insulin, hypoglycemia may occur from 12:30 AM to 8:30 AM.

A patient, admitted with diabetes, has a glucose level of 580 mg/dL and a moderate level of ketones in the urine. As the nurse assesses for signs of ketoacidosis, which respiratory pattern would the nurse expect to find? A. Central apnea B. Hypoventilation C. Kussmaul respirations D. Cheyne-Stokes respirations

C. Kussmaul respirations Correct Answer: Kussmaul respirations Rationale: In diabetic ketoacidosis, the lungs try to compensate for the acidosis by blowing off volatile acids and carbon dioxide. This leads to a pattern of Kussmaul respirations, which are deep and nonlabored. Central apnea occurs because the brain temporarily stops sending signals to the muscles that control breathing, which is unrelated to ketoacidosis. Hypoventilation and Cheyne-Stokes respirations do not occur with ketoacidosis.

The newly diagnosed patient with type 2 diabetes has been prescribed metformin. What should the nurse teach the patient to explain how this medication works? A. Increases insulin production from the pancreas. B. Slows the absorption of carbohydrate in the small intestine. C. Reduces glucose production by the liver and enhances insulin sensitivity. D. Increases insulin release from the pancreas and inhibits glucagon secretion.

C. Reduces glucose production by the liver and enhances insulin sensitivity Correct Answer: Reduces glucose production by the liver and enhances insulin sensitivity. Rationale: Metformin is a biguanide that reduces glucose production by the liver and enhances the tissue's insulin sensitivity. Sulfonylureas and meglitinides increase insulin production from the pancreas. α-Glucosidase inhibitors slow the absorption of carbohydrate in the intestine. Glucagon-like peptide receptor agonists increase insulin synthesis and release from the pancreas, inhibit glucagon secretion, and decrease gastric emptying.

A patient with type 2 diabetes has a urinary tract infection (UTI), is difficult to arouse, and has a blood glucose of 642 mg/dL. When the nurse assesses the urine, there are no ketones present. What nursing action is appropriate at this time? A. Routine insulin therapy and exercise B. Administer a different antibiotic for the UTI C. Cardiac monitoring to detect potassium changes D. Administer IV fluids rapidly to correct dehydration

C. cardiac monitoring to detect potassium changes Correct Answer: Cardiac monitoring to detect potassium changes Rationale: This patient has manifestations of hyperosmolar hyperglycemic syndrome (HHS). Cardiac monitoring will be needed because of the changes in the potassium level related to fluid and insulin therapy and the osmotic diuresis from the elevated serum glucose level. Routine insulin would not be enough, and exercise could be dangerous for this patient. Extra insulin will be needed. The type of antibiotic will not affect HHS. There will be a large amount of IV fluid administered, but it will be given slowly because this patient is older and may have cardiac or renal compromise, requiring hemodynamic monitoring to avoid fluid overload during fluid replacement.

A patient is newly diagnosed with type 1 diabetes and reports a headache, changes in vision, and being anxious but does not have a portable blood glucose monitor present. Which action should the nurse advise the patient to take? A. Eat a piece of pizza. B. Drink some diet pop. C. Eat 15 g of simple carbohydrates. D. Take an extra dose of rapid-acting insulin.

C. eat 15 grams of simple carbohydrates Correct Answer: Eat 15 g of simple carbohydrates. Rationale: When a patient with type 1 diabetes is unsure about the meaning of the symptoms they are experiencing, they should treat for hypoglycemia to prevent seizures and coma from occurring. Have the patient check the blood glucose as soon as possible. The fat in the pizza and the diet pop would not allow the blood glucose to increase to eliminate the symptoms. The extra dose of rapid-acting insulin would further decrease the blood glucose.

A patient who smokes reports having significant stress and has some eye problems. On assessment, the nurse notes exophthalmos. What additional abnormal findings should the nurse assess for? A. Muscle weakness and slow movements B. Puffy face, decreased sweating, and dry hair C. Systolic hypertension and increased heart rate D. Decreased appetite, increased thirst, and pallor

C. systolic hypertension and increased heart rate Correct Answer: Systolic hypertension and increased heart rate Rationale: The manifestations are consistent with Graves' disease or hyperthyroidism. Systolic hypertension, increased heart rate, and increased thirst are associated with hyperthyroidism. Cigarette smoking places the patient at increased risk for Graves' disease. The inhaled cigarette toxins may absorb via the eye orbits, causing exophthalmos. A puffy face; decreased sweating; dry, coarse hair; muscle weakness and slow movements; decreased appetite; and pallor are all manifestations of hypothyroidism.

A patient admitted with type 2 diabetes asks the nurse what "type 2" means. What is the most appropriate response by the nurse? A. "With type 2 diabetes, the body of the pancreas becomes inflamed." B. "With type 2 diabetes, the patient is totally dependent on an outside source of insulin." C. "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." D. "With type 2 diabetes, the body produces autoantibodies that destroy β-cells in the pancreas."

Correct Answer: C "With type 2 diabetes, insulin secretion is decreased, and insulin resistance is increased." Rationale: In type 2 diabetes, the secretion of insulin by the pancreas is reduced and/or the cells of the body become resistant to insulin. The pancreas becomes inflamed with pancreatitis. The patient is totally dependent on exogenous insulin and may have had autoantibodies destroy the β-cells in the pancreas with type 1 diabetes.

After a hypophysectomy for acromegaly, immediate postoperative nursing care should focus on A. frequent monitoring of serum and urine osmolarity B. parenteral administration of a GH-receptor antagonist C. keeping the patient in a recumbent position at all times D. patient teaching about the need for lifelong hormone therapy

Correct answer: a Rationale: A possible postoperative complication after a hypophysectomy is transient diabetes insipidus (DI). It may occur because of the loss of antidiuretic hormone (ADH), which is stored in the posterior lobe of the pituitary gland, or because of cerebral edema related to manipulation of the pituitary gland during surgery. To assess for DI, urine output and serum and urine osmolarity should be monitored closely.

To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to A. increase calcium intake to 1500 mg/day B. perform glucose monitoring for hypoglycemia C. obtain immunizations due to high risk for infections D. avoid abrupt position changes because of orthostatic hypotension

Correct answer: a Rationale: Because patients often receive corticosteroid treatment for prolonged periods (more than 3 months), corticosteroid-induced osteoporosis is an important concern. Therapies to reduce bone resorption may include increased calcium intake, vitamin D supplementation, bisphosphonates (e.g., alendronate), and taking part in a low-impact exercise program.

Which statement by the patient with type 2 diabetes is accurate? A. "I will limit my alcohol intake to 1 drink each day." B. "I am not allowed to eat any sweets because of my diabetes." C. "I cannot exercise because I take a blood glucose-lowering medication." D. "The amount of fat in my diet is not important. Only carbohydrates raise my blood sugar."

Correct answer: a Rationale: The guideline for alcohol consumption in men with diabetes is 0-2 drinks per day. For women with diabetes it is 0-1 drink per day.

The health care provider prescribes levothyroxine for a patient with hypothyroidism. After teaching about this drug, the nurse determines that further instruction is needed when the patient says A. "I can expect the medication dose may need to be adjusted." B. "I only need to take this drug until my symptoms are improved." C. "I can expect to return to normal function with the use of this drug." D. " I will report any chest pain or difficulty breathing to the doctor right away."

Correct answer: b Rationale: Levothyroxine is the drug of choice to treat hypothyroidism. The need for thyroid replacement therapy is usually lifelong.

Polydipsia and polyuria related to diabetes are primarily due to A. the release of ketones from cells during the fat metabolism B. fluid shifts resulting from the osmotic effect of hyperglycemia C. damage to the kidneys from exposure to high levels of glucose D. changes in RBCs resulting from attachment of excess glucose to hemoglobin

Correct answer: b Rationale: The osmotic effect of glucose cause the manifestations of polydipsia and polyuria.

An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism is to A. monitor blood glucose level B. restrict fluid and sodium intake C. Administer potassium sparing diuretics D. advise the patient to make postural changes slowly

Correct answer: c Rationale: Before surgery, patients should be treated with potassium-sparing diuretics (spironolactone, eplerenone) to normalize serum potassium levels. Spironolactone and eplerenone block the binding of aldosterone to the mineralocorticoid receptor in the terminal distal tubules and collecting ducts of the kidney. This increases sodium excretion, water excretion, and potassium retention. Oral potassium supplements may be needed.

A patient with a head injury develops SIADH. Manifestations the nurse would expect to find include A. hypernatremia and edema B. muscle spasticity and hypertension C. low urine output and hyponatremia D. weight gain and decreased glomerular filtration rate

Correct answer: c Rationale: Excess ADH increases the permeability of the renal distal tubule and collecting ducts, which leads to the reabsorption of water into the circulation. Thus, extracellular fluid volume expands, plasma osmolality declines, the glomerular filtration rate increases, and sodium levels decline (i.e., dilutional hyponatremia). Hyponatremia causes muscle cramping, pain, and weakness. At first, the patient has thirst, dyspnea on exertion, and fatigue. Patients with the syndrome of inappropriate antidiuretic hormone secretion (SIADH) have low urinary output and increased body weight. As the serum sodium level falls (usually to less than 120 mEq/L), manifestations become more severe and include headache, vomiting, abdominal cramps, muscle twitching, and seizures. As plasma osmolality and serum sodium levels continue to decline, cerebral edema may occur, leading to lethargy, anorexia, confusion, seizures, and coma.

A patient with diabetes has a serum glucose level of 824 mg/dL (45.7 mmol/L) and is unresponsive. After assessing the patient, the nurse suspects diabetes-related ketoacidosis rather than hyperosmolar hyperglycemia syndrome based on the finding of A. polyuria B. severe dehydration C. rapid, deep respirations D. decreased serum potassium

Correct answer: c Rationale: Signs and symptoms of DKA include manifestations of dehydration, such as poor skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension. Early symptoms may include lethargy and weakness. As the patient becomes severely dehydrated, the skin becomes dry and loose, and the eyeballs become soft and sunken. Abdominal pain is another symptom of DKA that may be accompanied by anorexia and vomiting. Kussmaul respirations (i.e., rapid, deep breathing associated with dyspnea) are the body's attempt to reverse metabolic acidosis through the exhalation of excess carbon dioxide. Acetone is identified on the breath as a sweet, fruity odor. Laboratory findings include a blood glucose level greater than 250 mg/dL, arterial blood pH less than 7.30, serum bicarbonate level less than 15 mEq/L, and moderate to high ketone levels in the urine or blood.

What is the priority action for the nurse to take if the patient with type 2 diabetes reports blurred vision and irritability? A. call the provider B. give insulin as ordered C. assess for other neurological symptoms D. check the patient's blood glucose level

Correct answer: d Rationale: Check blood glucose whenever hypoglycemia is suspected so that immediate action can be taken if necessary.

Which statement would be correct for a patient with type 2 diabetes who was admitted to the hospital with pneumonia? A. the patient must receive insulin therapy to prevent ketoacidosis B. the patient has islet cell antibodies that have destroyed the pancreas's ability to make insulin. C. the patient has minimal or absent endogenous insulin secretion and requires daily insulin injections D. the patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemia syndrome

Correct answer: d Rationale: Hyperosmolar hyperglycemia syndrome (HHS) is a life-threatening syndrome that can occur in a patient with diabetes who is able to make enough insulin to prevent diabetes related ketoacidosis (DKA) but not enough to prevent severe hyperglycemia, osmotic diuresis, and extracellular fluid depletion.

After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops A. muscle weakness and weight loss B. hyperthermia and severe tachycardia C. hypertension and difficulty swallowing D. laryngospasms and tingling in the hands and feet

Correct answer: d Rationale: Painful tonic spasms of smooth and skeletal muscles can cause laryngospasms that may compromise breathing. These spasms may be related to tetany, which occurs if the parathyroid glands are removed or damaged during surgery, which leads to hypocalcemia

Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? A. A1C 9% B. BP 126/80 mmHG C. FBG 130 mg/dL (7.2 mmol/L) D. LDL cholesterol 100 mg/dL (2.6 mmol/L)

Correct answers: a Rationale: Lowering hemoglobin A1C (to less than 7%) reduces microvascular and neuropathic complications. Keeping blood glucose levels in a tighter range (normal hemoglobin A1C level, less than 6%) may further reduce complications but increases hypoglycemia risk.

Which are appropriate therapies for patients with diabetes? (select all that apply) A. use of statins to reduce CVD risk B. use of diuretics to treat nephropathy C. use of ACE inhibitors to treat nephropathy D. use of serotonin agonists to decrease appetite E. use of laser photocoagulation to treat retinopathy

Correct answers: a, c, e Rationale: In patients with diabetes who have albuminuria, angiotensin-converting enzyme (ACE) inhibitors (e.g., lisinopril [Prinivil, Zestril]) or angiotensin II receptor antagonists (ARBs) (e.g., losartan [Cozaar]) are used. Both classes of drugs are used to treat hypertension and delay the progression of nephropathy in patients with diabetes. The statin drugs are the most widely used lipid-lowering agents. Laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with proliferative retinopathy, in those with macular edema, and in some cases of Nonproliferative retinopathy.

You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital? (select all that apply) A. insulin administration B. elimination of sugar from diet C. need to reduce physical activity D. use of a portable blood glucose monitor E. hypoglycemia prevention, symptoms, and treatment

Correct answers: a, d, e Rationale: The nurse ensures that the patient understands the proper use of insulin. The nurse teaches the patient how to use the portable blood glucose monitor and how to recognize and treat signs and symptoms of hypoglycemia and hyperglycemia. These are referred to as "survival skills."

Important nursing intervention(s) when caring for a patient with Cushing syndrome include (select all that apply) A. restricting protein intake B. monitoring blood glucose levels C. observing for signs of hypotension D. administering medication in equal doses E. protecting patient from exposure to infection

Correct answers: b, e Rationale: Hyperglycemia occurs with Cushing disease because of glucose intolerance associated with cortisol-induced insulin resistance and increased gluconeogenesis by the liver. High levels of corticosteroids increase risk of infection and delay wound healing.

The nurse is teaching a patient with type 2 diabetes about exercise to help control blood glucose. The nurse knows the patient understands when the patient elicits which exercise plan? A. "I will go running when my blood sugar is too high to lower it." B. "I will go fishing frequently and pack a healthy lunch with plenty of water." C. "I do not need to increase my exercise routine since I am on my feet all day at work." D. "I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week."

D. "I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week." Correct Answer: "I will take a brisk 30-minute walk 5 days/wk and do resistance training 3 times a week." Rationale: The best exercise plan for the person with type 2 diabetes is for 30 minutes of moderate activity 5 days/wk and resistance training 3 times a week. Brisk walking is moderate activity. Fishing and walking at work are light activity, and running is considered vigorous activity.

A patient with a severe pounding headache has been diagnosed with hypertension. However, the hypertension is not responding to traditional treatment. What should the nurse expect as the next step in determining a diagnosis for this patient? A. Administration of β-blocker medications B. Abdominal palpation to search for a tumor C. Administration of potassium-sparing diuretics D. A 24-hour urine collection for fractionated metanephrines

D. A 24-hour urine collection for fractionated metanephrines Correct Answer: A 24-hour urine collection for fractionated metanephrines Rationale: Pheochromocytoma should be suspected when hypertension does not respond to traditional treatment. The 24-hour urine collection for fractionated metanephrines is simple and reliable with elevated values in 95% of people with pheochromocytoma. In a patient with pheochromocytoma, an α-adrenergic receptor blocker is used preoperatively to reduce blood pressure. Abdominal palpation is avoided to avoid a sudden release of catecholamines and severe hypertension. Potassium-sparing diuretics are not needed. Most likely they would be used for hyperaldosteronism, which is another cause of hypertension.

The nurse caring for a patient hospitalized with diabetes would look for which laboratory test result to obtain information on the patient's past glucose control? A. Prealbumin level B. Urine ketone level C. Fasting glucose level D. Glycosylated hemoglobin level

D. Glycosylated hemoglobin level Correct Answer: Glycosylated hemoglobin level Rationale: A glycosylated hemoglobin level detects the amount of glucose that is bound to red blood cells (RBCs). When circulating glucose levels are high, glucose attaches to the RBCs and remains there for the life of the blood cell, which is approximately 120 days. Thus, the test can give an indication of glycemic control over approximately 2 to 3 months. The prealbumin level is used to establish nutritional status and is unrelated to past glucose control. The urine ketone level will only show that hyperglycemia or starvation is probably currently occurring. The fasting glucose level only indicates current glucose control.

The patient with an adrenal hyperplasia is returning from surgery after an adrenalectomy. The nurse should monitor the patient for what immediate postoperative complication? A. Vomiting B. Infection C. Thromboembolism D. Rapid blood pressure changes

D. Rapid blood pressure changes Correct Answer: Rapid blood pressure changes Rationale: The risk of hemorrhage is increased with surgery on the adrenal glands as well as large amounts of hormones being released in the circulation, which may produce hypertension and cause fluid and electrolyte imbalances to occur for the first 24 to 48 hours after surgery. Vomiting, infection, and thromboembolism may occur postoperatively with any surgery.