week 4 combined

When a patient asks what causes hyperglycemia in type 2 DM, how should the nurse respond? Hyperglycemia is a result of: a. Insulin deficiency b. Hyperinsulinemia c. Glucagon deficiency d. Liver dysfunction

b

When a staff member asks the nurse what causes the chronic complications of DM such as microvascular and macrovascular disease, how should the nurse respond? These complications are primarily related to: a. Pancreatic changes b. Hyperglycemia c. Ketone toxicity d. Hyperinsulinemia

b

Which of the following diseases should the nurse teach the patient to prevent as it is the ultimate cause of death in the patient with diabetes? a. Renal disease b. Stroke c. Cardiovascular disease d. Cancer

c

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.

A. Determine what types of activities the patient enjoys.

It is most important for the nurse to include which risk factors in a teaching plan associated with the development of type 2 diabetes mellitus? (Select all that apply.) A. Hypertension B. History of pancreatic trauma C. Weight gain of 30 pounds during pregnancy D. Body mass index greater than 25 kg/m E. Triglyceride levels between 150 and 200 mg/dL F. Delivery of a 4.99-kg baby

A. Hypertension D. Body mass index greater than 25 kg/m F. Delivery of a 4.99-kg baby

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.

C. Request that if testing is further delayed, the patient will eat lunch first.

The nurse is caring for a patient who has undergone a thyroidectomy. Which patient complaint is highest priority requiring further evaluation? a. Pain at surgical site b. Thirst c. Hoarseness d. Nausea

c. Hoarseness Thyroidectomy involves a surgical incision in the anterior neck. Hoarseness may be a sign of airway edema. A patent airway is always a priority of care for any post-operative patient. General anesthesia is used for this surgery requiring insertion of an artificial airway, therefore throat irritation and thirst is expected. Nausea may be a side effect from anesthesia. Pain is expected at the surgical site.

An adolescent who has been prescribed prednisone (Meticorten) and vincristine (Oncovin) for leukemia tells the nurse that he is very constipated. What should the nurse cite as the probable cause of the constipation? 1 It is a side effect of the vincristine. 2 The spleen is compressing the bowel. 3 It is a toxic effect from the prednisone. 4 The leukemic mass is obstructing the bowel.

1. Constipation is a side effect of vincristine (Oncovin) because it slows gastrointestinal motility. An enlarged spleen will put pressure on the stomach and diaphragm, not on the large bowel. Constipation is not a toxic effect of prednisone (Meticorten). It is unlikely that leukemia is causing an obstruction.

Metformin (Glucophage) 2 g by mouth is prescribed for a client with type 2 diabetes. Each tablet contains 500 mg. How many tablets should the nurse administer? Record your answer using a whole number. _____ tablets

4 tablets

The nurse knows to administer acarbose (Precose), an alpha-glucosidase inhibitor, at which time? a. 30 minutes before breakfast b. With the first bite of each main meal c. 30 minutes after breakfast d. Once daily at bedtime

ANS: B When an alpha-glucosidase inhibitor is taken with the first bite of a meal, excessive postprandial blood glucose elevation (a glucose spike) can be reduced or prevented. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 510 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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.

D. The patient has chest pressure when walking.

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.

A. Infuse 1 L of normal saline per hour.

A patient with type 2 diabetes has a new prescription for repaglinide (Prandin). After 1 week, she calls the office to ask what to do, because she keeps missing meals. "I work right through lunch sometimes, and I'm not sure whether I need to take it. What do I need to do?" What is the nurse's best response? A. "You need to try not to skip meals, but if that happens, you will need to skip that dose of Prandin." B. "We will probably need to change your prescription to insulin injections because you can't eat meals on a regular basis." C. "Go ahead and take the pill when you first remember that you missed it." D. "Take both pills with the next meal, and try to eat a little extra to make up for what you missed at lunchtime."

A. "You need to try not to skip meals, but if that happens, you will need to skip that dose of Prandin."

Which information should be included in a teaching plan for patients taking oral hypoglycemic drugs? (Select all that apply.) A. Limit your alcohol consumption. B. Report symptoms of anorexia and fatigue. C. Take your medication only as needed. D. Notify your physician if blood glucose levels rise above the level set for you.

A. Limit your alcohol consumption. Correct B. Report symptoms of anorexia and fatigue. Correct D. Notify your physician if blood glucose levels rise above the level set for you.Correct Oral hypoglycemic drugs must be taken on a daily scheduled basis to maintain euglycemia and prevent long-term complications of diabetes. All other options are correct.

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)

A. Lispro (Humalog)

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.

A. The patient will reach a glycosylated hemoglobin level of less than 7%.

Which of the following would be included in the assessment of a patient with diabetes mellitus who is experiencing a hypoglycemic reaction? (Select all that apply.) a. Tremors b. Nervousness c. Extreme thirst d. Flushed skin e. Profuse perspiration f. Constricted pupils

ANS: A, B, E When hypoglycemia occurs, blood glucose levels fall, resulting in sympathetic nervous system responses such as tremors, nervousness, and profuse perspiration. Dilated pupils would also occur, not constricted pupils. Extreme thirst, flushed skin, and constricted pupils are consistent with hyperglycemia.

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.

B. Give the patient a snack of peanut butter and crackers.

A diabetic patient is brought into the emergency department unresponsive. The arterial pH is 7.28. Besides the blood pH, which clinical manifestation is seen in uncontrolled diabetes mellitus and ketoacidosis? a. Oral temperature of 38.9° Celsius b. Severe orthostatic hypotension c. Increased rate and depth of respiration d. Extremity tremors followed by seizure activity

ANS: C Ketoacidosis decreases the pH of the blood, stimulating the respiratory control area of the brain to buffer the effects of the increasing acidosis. The rate and depth of respirations are increased (Kussmaul's respirations) to excrete more acids by exhalation.

The nurse recognizes which patient as having the greatest risk for undiagnosed diabetes mellitus? a. Young white man b. Middle-aged African-American man c. Young African-American woman d. Middle-aged Native American woman

ANS: D The highest incidence of diabetes in the United States occurs in Native Americans. With age, the incidence of diabetes increases in all races and ethnic groups.

When caring for a pregnant patient with gestational diabetes, the nurse should question a prescription for which drug? A. Insulin glargine (Lantus) B. Glipizide (Glucotrol) C. Insulin glulisine (Apidra) D. NPH insulin

B. Glipizide (Glucotrol) Correct Oral antidiabetic drugs are classified as pregnancy B or C drugs and are generally not recommended for pregnant patients.

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."

B. "I can choose any foods, as long as I use enough insulin to cover the calories."

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

B. A 23-yr-old patient with type 1 diabetes who has a blood glucose of 40 mg/dL

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.

B. Glomerular filtration rate is decreased.

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.

B. Glyburide stimulates insulin production and release from the pancreas.

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

B. Glycosylated hemoglobin

Which statement is appropriate for the nurse to include in patient teaching regarding type 2 diabetes? A. "Insulin injections are never used with type 2 diabetes." B. "You don't need to measure your blood glucose levels because you are not taking insulin injections." C. "A person with type 2 diabetes still has functioning beta cells in his or her pancreas." D. "Patients with type 2 diabetes usually have better control over their diabetes than those with type 1 diabetes."

C. "A person with type 2 diabetes still has functioning beta cells in his or her pancreas."

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

C. Abdomen

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.

C. Administer the prescribed lispro (Humalog) insulin before transporting the patient to surgery.

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

C. As soon as available

A patient with type 2 diabetes is scheduled for magnetic resonance imaging (MRI) with contrast dye. The nurse reviews the orders and notices that the patient is receiving metformin (Glucophage). Which action by the nurse is appropriate? A. Proceed with the MRI as scheduled. B. Notify the radiology department that the patient is receiving metformin. C. Expect to hold the metformin the day of the test and for 48 hours after the test is performed. D. Call the prescriber regarding holding the metformin for 2 days before the MRI is performed.

C. Expect to hold the metformin the day of the test and for 48 hours after the test is performed.

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

C. Lifestyle changes to lower blood glucose

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%.

C. Monitor blood glucose every 4 hours and contact the clinic if it rises.

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.

C. Obtain a glucose reading using a finger stick.

The nurse monitoring a patient for a therapeutic response to oral antidiabetic drugs will look for A. fewer episodes of diabetic ketoacidosis (DKA). B. weight loss of 5 pounds. C. hemoglobin A1C levels of less than 7%. D. glucose levels of 150 mg/dL.

C. hemoglobin A1C levels of less than 7%.

The patient is prescribed 30 units of regular insulin and 70 units of insulin isophane suspension (NPH insulin) subcutaneously every morning. The nurse should provide which instruction to the patient for insulin administration? A. "Inject the needle at a 30-degree angle." B. "Rotate sites at least once or twice a week." C. "Use a 23- to 25-gauge syringe with a 1-inch needle to increase insulin absorption." D. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin."

D. "Draw up the regular insulin into the syringe first, followed by the cloudy NPH insulin." Correct When insulins are mixed, withdraw the regular insulin (clear) first, followed by withdrawing the NPH insulin (cloudy).

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."

D. "My diabetes won't cause complications because I don't need insulin."

A diabetic patient has proliferative retinopathy, nephropathy, and peripheral neuropathy. What should the nurse teach this patient about exercise? A. "Jogging for 20 minutes 5 to 7 days a week would most efficiently help you to lose weight." B. "One hour of vigorous exercise daily is needed to prevent progression of disease." C. "Avoid all forms of exercise because of your diabetic complications." D. "Swimming or water aerobics 30 minutes each day would be the safest exercise routine for you."

D. "Swimming or water aerobics 30 minutes each day would be the safest exercise routine for you."

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.

D. The patient increases daily exercise when ketones are present in the urine.

The nurse is caring for a patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What is the nurse's best action? a. Encourage increased fluid and water intake b. Teach about risk for malignancies c. Monitor for changes in level of consciousness d. Assess labwork for potassium level changes

c. Monitor for changes in level of consciousness As the name suggests, SIADH is a condition in which antidiuretic hormone (ADH) is secreted despite normal or low plasma osmolarity, resulting in water retention and dilutional hyponatremia. In response to increased plasma volume, aldosterone secretion increases and further contributes to sodium loss. Hyponatremia frequently manifests with changes in level of consciousness from confusion to coma. A large number of clinical conditions can cause SIADH including malignancies, pulmonary disorders, injury to the brain, and certain pharmacologic agents. Malignancies often lead to SIADH versus SIADH causing malignant conditions. Water intoxication can lead to hyponatremia, therefore water intake is restricted. The most affected electrolyte from SIADH is sodium versus potassium.

Following a parathyroidectomy, which electrolyte should the nurse most closely monitor? a. Potassium b. Sodium c. Magnesium d. Calcium

d. Calcium Because the parathyroids are located on the thyroid gland, similar concerns for postoperative monitoring apply. Additionally, calcium levels are monitored to avoid hypocalcemic crisis.

A nurse is monitoring a client's laboratory results for a fasting plasma glucose level. Within which range of a fasting plasma glucose level does the nurse conclude that a client is considered to be diabetic? 1.40 and 60 mg/dL 2.80 and 99 mg/dL 3.100 and 125 mg/dL 4.126 and 140 mg/dL

4.126 and 140 mg/dL

The nurse is teaching a group of patients about self-administration of insulin. What content is important to include? a. Patients need to use the injection site that is the most accessible. b. If two different insulins are ordered, they need to be given in separate injections. c. When mixing insulins, the cloudy (such as NPH) insulin is drawn up into the syringe first. d. When mixing insulins, the clear (such as regular) insulin is drawn up into the syringe first.

ANS: D If mixing insulins in one syringe, the clear (regular) insulin is always drawn up into the syringe first. Patients always need to rotate injection sites. Mixing of insulins may be ordered. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 516 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is teaching a review class to nurses about diabetes mellitus. Which statement by the nurse is correct? a. "Patients with type 2 diabetes will never need insulin." b. "Oral antidiabetic drugs are safe for use during pregnancy." c. "Pediatric patients cannot take insulin." d. "Insulin therapy is possible during pregnancy if managed carefully."

ANS: D Oral medications are generally not recommended for pregnant patients because of a lack of firm safety data. For this reason, insulin therapy is the only currently recommended drug therapy for pregnant women with diabetes. Insulin is given to pediatric patients, with extreme care. Patients with type 2 diabetes may require insulin in certain situations or as their disease progresses. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 506 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A health care provider prescribes 36 units of NPH insulin (Novolin N) and 12 units of regular insulin (Novolin R). The nurse plans to administer these drugs in one syringe. Identify the steps in this procedure by listing the numbers by each picture next to the step below in priority order. (Start with the number of the picture that represents the first step and end with the number by the picture that represents the last step.)

Air should be injected into the NPH insulin vile first, which allows withdrawal of the NPH insulin at a later step in the procedure without having to instill air into the vial from a syringe that contains regular insulin. Instilling air into the regular insulin vile increases the pressure in the vile, facilitating removal of the required dose. Removing the desired dose of insulin while the needle is still in the vile reduces the risk of contamination by repeated punctures, and maintains the sharpness of the needle. Having the syringe contain regular insulin first prevents the need to withdraw the regular insulin into a syringe that contains NPH insulin and inadvertently contaminating the regular insulin vial with the longer-acting NPH insulin; contaminating regular insulin with NPH insulin will reduce the speed at which the regular insulin functions, which in turn will delay treatment of a hyperglycemic event. Finally, the required dose of NPH insulin can be removed from the NPH insulin vile.

A 55-year-old female is admitted to the medical unit for complications of long-term, poorly controlled type 2 DM. Which of the following would the nurse expect to find in addition to elevated glucose? a. Atherosclerosis b. Metabolic alkalosis c. Elevated liver enzymes d. Anemia

a

A 19-year-old female with type 1 DM was admitted to the hospital with altered consciousness and the following lab values: serum glucose 500 mg/dl (high) and serum K+ 2 (low). Her parents state that she has been sick with the "flu" for a week. The diagnosis is hyperosmolar hyperglycemia nonketotic syndrome (HHNKS). What relationship do these values have with her insulin deficiency? a. Increased glucose utilization causes the shift of fluid from the intravascular to the intracellular space. b. Decreased insulin causes hyperglycemia and osmotic diuresis. c. Increased glucose and fatty acid metabolism stimulates renal diuresis and electrolyte loss. d. Increased insulin use results in protein catabolism, tissue wasting, and electrolyte loss.

b

A 12-year-old female is newly diagnosed with type 1 DM. When the parents ask what causes this, what is the nurse's best response? a. A familial, autosomal dominant gene defect b. Obesity and lack of exercise c. Immune destruction of the pancreas d. Hyperglycemia from eating too many sweets

c

A 19-year-old female with type 1 DM was admitted to the hospital with the following lab values: serum glucose 500 mg/dl (high), urine glucose and ketones 4+ (high), and arterial pH 7.20 (low). Her parents state that she has been sick with the "flu" for a week. Which of the following statements best explains her acidotic state? a. Increased insulin levels promote protein breakdown and ketone formation. b. Her uncontrolled diabetes has led to renal failure. c. Low serum insulin promotes lipid storage and a corresponding release of ketones. d. Insulin deficiency promotes lipid metabolism and ketone formation.

d

Diabetes insipidus, diabetes mellitus (DM), and SIADH share which of the following assessment manifestations? a. Polyuria b. Edema c. Vomiting and abdominal cramping d. Thirst

d

After assessing a client, a nurse concludes that the client may be experiencing hyperglycemia. Which clinical findings commonly associated with hyperglycemia support the nurse's conclusion? (Select all that apply.) 1.Polyuria 2.Polydipsia 3.Polyphagia 4.Polyphrasia 5.Polydysplasia

1.Polyuria 2.Polydipsia 3.Polyphagia

A nurse prepares to administer metformin (Glucophage XR) to an older adult who has asked that it be crushed because it is difficult to swallow. The nurse explains that this drug cannot be crushed because it: 1 Is released slowly. 2 Is difficult to crush. 3 Irritates mucosal tissue. 4 Has an unpleasant taste if crushed.

1. The slow-release formulary will be compromised, and the client will not receive the entire dose if it is chewed or crushed. The capsules are not difficult to crush. Irritation of the mucosal tissue is not the reason the medication should not be crushed; however, this drug should be given with meals to prevent gastrointestinal irritation. Although taste could be a factor, it is not the priority issue.

A 13-year-old-child with type 1 diabetes is receiving 15 units of Novolin R insulin and 20 units of Novolin N insulin at 7 am each day. At what time should the nurse anticipate a hypoglycemic reaction from the Novolin N to occur? 1. Before noon 2 In the afternoon 3 Within 30 minutes 4 During the evening

2 Novolin N is an intermediate-acting insulin that peaks approximately 6 to 8 hours after administration. It was administered at 7 am, so between 1 and 3 pm is when the nurse should anticipate that a hypoglycemic reaction will occur. During the evening or night is when a reaction from a long-acting insulin is expected. Long-acting insulin has a small peak 10 to 16 hours after administration. Noon is when a reaction from a short-acting insulin is expected. Short-acting insulin peaks in 2 to 4 hours after administration. Within 30 minutes of administration is when a reaction from a rapid-acting insulin is expected. Rapid-acting insulin peaks 30 to 60 minutes after administration.

Levothyroxine (Synthroid) 12.5 mcg orally each day is prescribed for a client with hypothyroidism. Six weeks later, the health care provider increases the client's dose to 25 mcg daily and gives the client a prescription to be filled at the pharmacy. The client asks the nurse whether the original pill prescription can be completed before starting the new dose. How many of the original pills should the nurse instruct the client to take daily? Record your answer using a whole number. __________ tablets

2 tablets

What should a nurse teach the client to do to avoid lipodystrophy when self-administering insulin therapy? 1 Exercise regularly. 2 Rotate injection sites. 3 Use the Z-track technique. 4 Avoid massaging the injection site.

2. Fibrous scar tissue can result from the trauma of repeated injections at the same site. Exercise is unrelated to lipodystrophy, but it reduces blood glucose, which decreases insulin requirements. Insulin is given subcutaneously; the Z-track technique is used with some intramuscular injections. Gentle pressure over the injection site after insulin administration promotes absorption.

A 40-year-old male is prescribed Metformin XL (Glucophage) to control his type 2 diabetes mellitus. Which statement made by this client indicates the need for further education? 1"I will take the drug with food." 2 "I must swallow my medication whole and not crush or chew it." 3 "I will stop taking Metformin for 24 hours before and after having a test involving dye." 4 "I will notify my doctor if I develop muscular or abdominal discomfort."

3. Metformin must be withheld for 48 hours before the use of iodinated contrast materials to prevent lactic acidosis. Metformin is restarted when kidney function has returned to normal. Metformin is taken with food to avoid adverse gastrointestinal effects. If crushed or chewed, Metformin XL will be released too rapidly and may lead to hypoglycemia. Muscular and abdominal discomfort is a potential sign of lactic acidosis and must be reported to the health care provider.

Four hours after surgery the blood glucose level of a client who has type 1 diabetes is elevated. The nurse can expect to: 1.Administer an oral hypoglycemic 2.Institute urine glucose monitoring 3.Give supplemental doses of regular insulin 4.Decrease the rate of the intravenous infusion

3.Give supplemental doses of regular insulin

A client with type 2 diabetes is taking one glyburide (Micronase) tablet daily. The client asks whether an extra pill should be taken before exercise. What is the nurse's best reply? 1 "You will need to decrease how much you are exercising." 2 "An extra pill will help your body use glucose when exercising." 3 "The amount of medication you need to take is not related to exercising." 4 "Do not take an extra pill because you may become hypoglycemic when exercising."

4. Exercise improves glucose metabolism; exercise is associated with a risk for hypoglycemia, not hyperglycemia; an additional antidiabetic agent is contraindicated. Exercise should not be decreased because it improves glucose metabolism. Also, this response does not answer the client's question. An extra tablet probably will result in hypoglycemia because exercise alone improves glucose metabolism. Control of glucose metabolism is achieved through balanced diet, exercise, and pharmacologic therapy.

A nurse is teaching a 10-year-old child with type 1 diabetes about insulin requirements. When should the nurse explain that insulin needs will decrease? 1 When puberty is reached 2 When infection is present 3 When emotional stress occurs 4 When active exercise is performed

4. Exercise reduces the body's need for insulin. Increased muscle activity accelerates transport of glucose into muscle cells, thus producing an insulin-like effect. With increased growth and associated dietary intake, the need for insulin increases during puberty. An infectious process may require increased insulin. Emotional stress increases the need for insulin.

Which long-acting insulin mimics natural, basal insulin with no peak action and a duration of 24 hours? A. Insulin glargine (Lantus) B. Insulin glulisine (Apidra) C. Regular insulin (Humulin R) D. NPH insulin

A. Insulin glargine (Lantus) Insulin glargine has a duration of action of 24 hours with no peaks, mimicking the natural, basal insulin secretion of the pancreas.

Pramlintide (Symlin) is prescribed as supplemental drug therapy to the treatment plan for a patient with type 1 diabetes mellitus. What information should the nurse include when teaching the patient about the action of this medication? A. Pramlintide slows gastric emptying. B. Pramlintide increases glucagon excretion. C. Pramlintide stimulates glucose production. D. Pramlintide corrects insulin receptor sensitivity.

A. Pramlintide slows gastric emptying. Correct Pramlintide is a synthetic form of the naturally occurring hormone amylin. It works by slowing gastric emptying, suppressing glucagon secretion and hepatic glucose production, and increasing satiety (sense of having eaten enough). It is only administered via subcutaneously injection.

Which actions describe the beneficial effects produced by sulfonylurea oral hypoglycemics? (Select all that apply.) A. Stimulate insulin secretion from beta cells B. Increase hepatic glucose production C. Enhance action of insulin in various tissues D. Inhibit breakdown of insulin by liver

A. Stimulate insulin secretion from beta cells Correct C. Enhance action of insulin in various tissues Correct D. Inhibit breakdown of insulin by liver Correct The sulfonylureas stimulate insulin secretion from the beta cells of the pancreas; enhance the actions of insulin in muscle, liver, and adipose tissue; and prevent the liver from breaking insulin down as fast as it ordinarily would (reduced hepatic clearance). Increased hepatic glucose production would serve to increase serum glucose levels, the opposite effect of oral hypoglycemic drugs.

10. When the endocrinologist asks the staff how the releasing hormones that are made in the hypothalamus travel to the anterior pituitary, how should the staff reply? Via the: a. Vessels of the zona fasciculata b. Chromophils c. Median eminence d. Hypophysial portal system

ANS: D Neurons in the hypothalamus secrete releasing hormones into veins that carry the releasing hormones directly to the vessels of the adenohypophysis via the hypophysial portal system, thus bypassing the normal circulatory route. Zona fasciculata secretes abundant amounts of cortisol from the adrenal gland. Chromophils are the secretory cells of the adenohypophysis. The median eminence is a part of the posterior pituitary, not the anterior.

2. A nurse is teaching staff about protein hormones. Which information should the nurse include? One of the protein hormones is: a. Thyroxine (T4) b. Aldosterone c. Testosterone d.Insulin

ANS: D Protein hormones are also water-soluble hormones, and insulin is a part of this group. Thyroxine is a lipid soluble hormone and is not a protein hormone. Aldosterone is a lipid soluble hormone and is not a protein hormone. Testosterone is a lipid soluble hormone and is not a protein hormone.

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.

B. Check glucose level before, during, and after swimming.

Which is a rapid-acting insulin with an onset of action of less than 15 minutes? A. Insulin glargine (Lantus) B. Insulin aspart (NovoLog) C. Insulin detemir (Levemir) D. Regular insulin (Humulin R)

B. Insulin aspart (NovoLog) Correct Insulin aspart is a rapid-acting insulin. Insulin glargine and insulin detemir are long-acting insulins. Regular insulin is short acting.

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.

B. Schedule the patient for a fasting blood glucose level.

Assuming the patient eats breakfast at 8:30 AM, lunch at noon, and dinner at 6:00 PM, he or she is at highest risk of hypoglycemia after an 8:00 AM dose of NPH insulin at what time? A. 10:00 AM B. 2:00 PM C. 5:00 PM D. 8:00 PM

C. 5:00 PM Correct Breakfast eaten at 8:30 AM would cover the onset of NPH insulin, and lunch will cover the 2 PM time frame. However, if the patient does not eat a mid-afternoon snack, the NPH insulin may be peaking just before dinner without sufficient glucose on hand to prevent hypoglycemia.

A male patient who has a history of type 2 diabetes mellitus is admitted to the medical unit with a diagnosis of pneumonia. The patient has many questions regarding his care and asks the nurse why everyone keeps telling him about hemoglobin A1C. The nurse will inform the patient that hemoglobin A1C provides information regarding: C)patient compliance with treatment regimen for several months previously.

Correct answer: C Rationale: Hemoglobin A1C is a good indicator of the patient's compliance with the therapy regimen for several months previously.

A woman who has type II diabetes is now pregnant. She wants to know whether to take her oral antidiabetic medication. What instructions will she receive? C)She will be switched to insulin therapy while she is pregnant.

Correct answer: C Rationale: Oral antidiabetic medications are generally not recommended for pregnant patients because of a lack of firm safety data. Insulin therapy is the currently recommended drug therapy for pregnant women.

The nurse is preparing a patient for a computed tomography scan using iodine contrast media. Which medication should the nurse question if prescribed one day before the scheduled procedure? A. Acarbose (Precose) B. Pioglitazone (Actos) C. Repaglinide (Prandin) D. Metformin (Glucophage)

D. Metformin (Glucophage) Correct The concurrent use of metformin with iodinated (iodine-containing) radiologic contrast media has been associated with both acute renal failure and lactic acidosis. Therefore, metformin should be discontinued the day of the test and for at least 48 hours after the patient undergoes any radiologic study that requires the use of such contrast media.

Which insulin can be administered by continuous intravenous (IV) infusion? A. Insulin glargine (Lantus) B. Insulin aspart (Novolog) C. Insulin detemir (Levemir) D. Regular insulin (Humulin R)

D. Regular insulin (Humulin R) Correct Regular insulin is the only insulin used for IV therapy.

A 12yearold male is newly diagnosed with type 1 DM. Which of the following tests should the nurse prepare the patient to best confirm the diagnosis? a. Fasting plasma glucose levels b. Random serum glucose levels c. Genetic testing d. Glycosylated hemoglobin measurements

a

A client with type 1 diabetes has an above-the-knee amputation because of severe lower extremity arterial disease. What is the nurse's primary responsibility two days after surgery when preparing the client to eat dinner? 1.Checking the client's serum glucose level 2.Assisting the client out of bed into a chair 3.Placing the client in the high-Fowler position 4.Ensuring the client's residual limb is elevated

1.Checking the client's serum glucose level

A client is admitted to the hospital with diabetic ketoacidosis. The nurse concludes that the client's elevated ketone level is caused by incomplete oxidation of which nutrient? 1.Fats 2.Protein 3.Potassium 4.Carbohydrates

1.Fats

A client with type 2 diabetes, who is taking an oral hypoglycemic agent, is to have a serum glucose test early in the morning. The client asks the nurse, "What do I have to do to prepare for this test?" Which statement by the nurse reflects accurate information? 1."Eat your usual breakfast." 2."Have clear liquids for breakfast." 3."Take your medication before the test." 4."Do not ingest anything before the test."

4."Do not ingest anything before the test."

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.

A. The patient programs the pump for an insulin bolus after eating.

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.

A. The patient uses oral contraceptives.

The nurse instructs a patient with type 1 diabetes mellitus to avoid which of the following drugs while taking insulin? a. Furosemide (Lasix) b. Dicumarol (Bishydroxycoumarin) c. Reserpine (Serpasil) d. Cimetidine (Tagamet)

ANS: A Furosemide is a loop diuretic and can increase serum glucose levels; its use is contraindicated with insulin. Dicumarol, an anticoagulant; reserpine, an anti-hypertensive; and cimetidine, an H2 receptor antagonist, do not affect blood glucose levels.

The nurse is teaching a group of patients about management of diabetes. Which statement about basal dosing is correct? a. "Basal dosing delivers a constant dose of insulin." b. "With basal dosing, you can eat what you want and then give yourself a dose of insulin." c. "Glargine insulin is given as a bolus with meals." d. "Basal-bolus dosing is the traditional method of managing blood glucose levels."

ANS: A Basal-bolus therapy is the attempt to mimic a healthy pancreas by delivering basal insulin constantly as a basal, and then as needed as a bolus. Glargine insulin is used as a basal dose, not as a bolus with meals. Basal-bolus therapy is a newer therapy; historically, sliding-scale coverage was implemented. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 508 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A 75-year-old woman with type 2 diabetes has recently been placed on glipizide (Glucotrol), 10 mg daily. She asks the nurse when the best time would be to take this medication. What is the nurse's best response? a. "Take this medication in the morning, 30 minutes before breakfast." b. "Take this medication in the evening with a snack." c. "This medication needs to be taken after the midday meal." d. "It does not matter what time of day you take this medication."

ANS: A Glipizide is taken in the morning, 30 minutes before breakfast. When taken at this time, it has a longer duration of action, causing a constant amount of insulin to be released. This may be beneficial in controlling blood glucose levels throughout the day. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 511 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

When a diabetic patient asks about maintaining adequate blood glucose levels, which of the following statements by the nurse relates most directly to the necessity of maintaining blood glucose levels no lower than about 74 mg/dl? a. "Glucose is the only type of fuel used by body cells to produce the energy needed for physiologic activity." b. "The central nervous system cannot store glucose and needs a continuous supply of glucose for fuel." c. "Without a minimum level of glucose circulating in the blood, erythrocytes cannot produce ATP." d. "The presence of glucose in the blood counteracts the formation of lactic acid and prevents acidosis."

ANS: B The brain cannot synthesize or store significant amounts of glucose; thus a continuous supply from the body's circulation is needed to meet the fuel demands of the central nervous system.

A patient with a history of chronic obstructive pulmonary disease (COPD) and type 2 diabetes has been treated for pneumonia for the past week. The patient has been receiving intravenous corticosteroids as well as antibiotics as part of his therapy. At this time, the pneumonia has resolved, but when monitoring the blood glucose levels, the nurse notices that the level is still elevated. What is the best explanation for this elevation? a. The antibiotics may cause an increase in glucose levels. b. The corticosteroids may cause an increase in glucose levels. c. His type 2 diabetes has converted to type 1. d. The hypoxia caused by the COPD causes an increased need for insulin.

ANS: B Corticosteroids can antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 515 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient has been diagnosed with metabolic syndrome and is started on the biguanide metformin (Glucophage). The nurse knows that the purpose of the metformin, in this situation, is which of these? a. To increase the pancreatic secretion of insulin b. To decrease insulin resistance c. To increase blood glucose levels d. To decrease the pancreatic secretion of insulin

ANS: B Metformin decreases glucose production by the liver; decreases intestinal absorption of glucose; and improves insulin receptor sensitivity in the liver, skeletal muscle, and adipose tissue, resulting in decreased insulin resistance. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 508 TOP: NURSING PROCESS: Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

The nurse is reviewing a patient's medication list and notes that sitagliptin (Januvia) is ordered. The nurse will question an additional order for which drug or drug class? a. Glitazone b. Insulin c. Metformin (Glucophage) d. Sulfonylurea

ANS: B Sitagliptin is indicated for management of type 2 diabetes either as monotherapy or in combination with metformin, a sulfonylurea, or a glitazone, but not with insulin. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 512 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

When administering morning medications for a newly admitted patient, the nurse notes that the patient has an allergy to sulfa drugs. There is an order for the sulfonylurea glipizide (Glucotrol). Which action by the nurse is correct? a. Give the drug as ordered 30 minutes before breakfast. b. Hold the drug, and check the order with the prescriber. c. Give a reduced dose of the drug with breakfast. d. Give the drug, and monitor for adverse effects.

ANS: B There is a potential for cross-allergy in patients who are allergic to sulfonamide antibiotics. Although such an allergy is listed as a contraindication by the manufacturer, most clinicians do prescribe sulfonylureas for such patients. The order needs to be clarified. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 509 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

1. A nurse recalls direct stimulation of the insulin-secreting cells of the pancreas by the autonomic nervous system is an example of _____ control. a. Negative feedback b. Positive feedback c. Neural d. Substrate-level dependent

ANS: C Direct stimulation of the insulin-secreting cells of the pancreas by the autonomic nervous system is a form of neural control. Stimulation of the insulin cells of the pancreas by the autonomic nervous system is a form of neural control and is not regulated as a form of negative feedback. Negative feedback works like a thermostat. Stimulation of the insulin cells of the pancreas by the autonomic nervous system is a form of neural control and is not regulated as a form of positive feedback. Stimulation of the insulin cells of the pancreas by the autonomic nervous system is a form of neural control and is not substrate-level dependent

11. An aide asks the nurse what activates tyrosine. What is the nurses best response? a. GH b. PRL c. Insulin d. Estrogen

ANS: C Insulin receptor binding activates tyrosine kinase autophosphorylation and sends a cascade of signals to activate glucose transporters. Insulin binding, not growth hormone, activates tyrosine. Insulin, not PRL, activates tyrosine. Insulin, not estrogen, activates tyrosine.

The nurse associates which assessment finding in the diabetic patient with decreasing renal function? a. Ketone bodies in the urine during acidosis b. Glucose in the urine during hyperglycemia c. Protein in the urine during a random urinalysis d. White blood cells in the urine during a random urinalysis

ANS: C Urine should not contain protein. Proteinuria in a diabetic heralds the beginning of renal insufficiency or diabetic nephropathy with subsequent progression to end stage renal disease. Chronic elevated blood glucose levels can cause renal hypertension and excess kidney perfusion with leakage from the renal vasculature. This leaking allows protein to be filtered into the urine.

The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites? a. Avoid the abdomen because absorption there is irregular. b. Choose a different site at random for each injection. c. Give the injection in the same area each time. d. Rotate sites within the same location for about 1 week before rotating to a new location.

ANS: D Patients taking insulin injections need to be instructed to rotate sites, but to do so within the same location for about 1 week (so that all injections are rotated in one area—for example, the right arm—before rotating to a new location, such as the left arm). Also, each injection needs to be at least 1/2 to 1 inch away from the previous site. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 517 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

After the 0700 report, the day shift nurse notices that a patient has a 0730 dose of insulin due and goes to the automated dispensing machine to retrieve the insulin. The nurse sees that the night shift nurse had removed the 0730 dose of insulin, but the medication administration record (MAR) has not been signed by the nurse. The patient is confused and says "she thinks" the night nurse gave her the insulin. The patient's blood glucose level is 142 mg/dL. What will the day shift nurse do? C)Ask the charge nurse to call the night nurse at home to clarify whether the insulin was given.

Correct answer: C Rationale: Never guess whether a drug was given. Taking the drug out of the machine does not mean it was given. The nurse should ask the night nurse what was done.

A patient with type 1 diabetes is admitted to the medical unit with an acute exacerbation of chronic obstructive pulmonary disease (COPD). He is placed on IVPB antibiotics, nebulizer treatments with albuterol, and an IV corticosteroid, and he is also taking a proton pump inhibitor for gastrointestinal esophageal reflux disease (GERD). He takes a dose of glargine insulin every evening. That evening the nurse notes that his blood glucose level is 170 mg/dL. The next morning, his fasting glucose level is 202 mg/dL. What is the most likely cause of his elevated glucose levels? D)The corticosteroid

Correct answer: D Rationale: Corticosteroids antagonize the hypoglycemic effects of insulin, resulting in elevated blood glucose levels.

A client newly diagnosed with type 2 diabetes is receiving glyburide (Micronase) and asks the nurse how this drug works. The nurse explains that glyburide: 1 Stimulates the pancreas to produce insulin 2 Accelerates the liver's release of stored glycogen 3 Increases glucose transport across the cell membrane 4 Lowers blood glucose in the absence of pancreatic function

1. Glyburide, an antidiabetic sulfonylurea, stimulates insulin production by the beta cells of the pancreas. Accelerating the liver's release of stored glycogen occurs when serum glucose drops below normal levels. Increasing glucose transport across the cell membrane occurs in the presence of insulin and potassium. Antidiabetic medications of the chemical class of biguanide improve sensitivity of peripheral tissue to insulin, which ultimately increases glucose transport into cells. Beta cells must have some function to enable this drug to be effective.

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

D. A 60-yr-old patient with hyperosmolar hyperglycemic syndrome who has poor skin turgor and dry oral mucosa

A nurse wants to determine if there is kidney dysfunction in a patient with diabetes. Which of the following is the earliest manifestation? a. Polyuria b. Glycosuria c. Microalbuminuria d. Decreased glomerular filtration

c

A nurse is reviewing lab results for glycosylated hemoglobin (hemoglobin A1c) levels. A nurse recalls the purpose of this test is to: a. Measure fasting glucose levels. b. Monitor long-term serum glucose control. c. Detect acute complications of diabetes. d. Check for hyperlipidemia.

b

An 11-year-old male is newly diagnosed with type 1 DM. Which classic symptoms should the nurse assess the patient for? a. Recurrent infections, visual changes, fatigue, and paresthesias b. Polydipsia, polyuria, polyphagia, and weight loss c. Vomiting; abdominal pain; sweet, fruity breath; dehydration; and Kussmaul breathing d. Weakness, vomiting, hypotension, and mental confusion

b

A 13-year-old male who uses insulin to control his type 1 diabetes experiences hunger, lightheadedness, tachycardia, pallor, headache, and confusion during gym class. The most probable cause of these symptoms is: a. Hyperglycemia resulting from incorrect insulin administration b. Dawn phenomenon caused by eating a snack before gym class c. Hypoglycemia caused by increased exercise d. Somogyi effect caused by insulin sensitivity

c

A nurse is caring for a client with a diagnosis of type 1 diabetes who has developed diabetic coma. Which element excessively accumulates in the blood to precipitate the signs and symptoms associated with this condition? 1.Sodium bicarbonate, causing alkalosis 2.Ketones as a result of rapid fat breakdown, causing acidosis 3.Nitrogen from protein catabolism, causing ammonia intoxication 4.Glucose from rapid carbohydrate metabolism, causing drowsiness

2.Ketones as a result of rapid fat breakdown, causing acidosis

An 8-year-old child is being given insulin glargine (Lantus) before breakfast. What is the most appropriate information for the nurse to give the parents concerning a bedtime snack? 1 Offer a snack to prevent hypoglycemia during the night. 2 Give the child a snack if signs of hyperglycemia are present. 3 Avoid a snack because the child is being treated with long-acting insulin. 4 Keep a snack at the bedside in case the child gets hungry during the night.

1. Insulin glargine is released continuously throughout the 24-hour period; a bedtime snack will prevent hypoglycemia during the night. Providing a snack when signs of hyperglycemia are present is unsafe because it intensifies hyperglycemia; if hyperglycemia is present, the child needs insulin. Because insulin glargine is a long-acting insulin, bedtime snacks are recommended to prevent a hypoglycemic episode during the night. When hypoglycemia develops, the child will be asleep; the snack should be eaten before going to bed.

A client is admitted to the hospital with diabetic ketoacidosis. The nurse identifies that the elevated ketone level present with this disorder is caused by the incomplete oxidation of: 1.Fats 2.Protein 3.Potassium 4.Carbohydrates

1.Fats

A nurse prepares to administer metformin (Glucophage XR) to an older adult who has asked that it be crushed because it is difficult to swallow. The nurse explains that this drug cannot be crushed because it: 1.Is released slowly. 2.Is difficult to crush. 3.Irritates mucosal tissue. 4.Has an unpleasant taste if crushed

1.Is released slowly.

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 states, "I will drink orange juice and eat a slice of bread when I feel: 1.Nervous and weak." 2.Flushed and short of breath." 3.Thirsty and have a headache." 4.Nauseated and have abdominal cramps."

1.Nervous and weak."

A client is receiving total parenteral nutrition. The nurse assesses for which client response that indicates hyperglycemia? 1.Polyuria 2.Paralytic ileus 3.Respiratory rate below 16 4.Serum glucose of 105 mg/100 mL

1.Polyuria

A nurse is caring for a client newly diagnosed with type 1 diabetes. When the health care provider tries to regulate this client's insulin regimen, the client experiences episodes of hypoglycemia and hyperglycemia, and 15 g of a simple sugar is prescribed. What is the reason this is administered when a client experiences hypoglycemia? 1.Inhibits glycogenesis 2.Stimulates release of insulin 3.Increases blood glucose levels 4.Provides more storage of glucose

3.Increases blood glucose levels

An adolescent with type 1 diabetes who has a history of inadequate adherence to therapy is admitted to the hospital with a blood glucose level of 700 mg/dL. A continuous insulin infusion is started. What complication should the nurse make a priority of detecting while the adolescent is receiving the infusion? 1 Hypovolemia 2 Hypokalemia 3 Hypernatremia 4 Hypercalcemia

2. Insulin causes potassium to move into the cells along with glucose, thereby reducing the serum potassium level. Hypokalemia can lead to lethal cardiac dysrhythmias. Insulin does not result in reduced blood volume, alter the sodium level directly, or affect calcium mobilization.

A client with type 1 diabetes is diagnosed with diabetic ketoacidosis and initially treated with intravenous (IV) fluids followed by an IV bolus of regular insulin. The nurse anticipates that the health care provider will prescribe a continuous infusion of: 1 Novolin L insulin. 2 Novolin R insulin. 3 Novolin N insulin. 4 Novolin U insulin.

2. Regular insulin is the only insulin that is administered intravenously. Novolin L insulin cannot be administered intravenously. Novolin N insulin cannot be administered intravenously. Novolin U insulin cannot be administered intravenously.

The nurse is teaching an adolescent with type 1 diabetes about taking a combination of regular insulin (Novolin R) and an intermediate-acting insulin (Novolin N). The nurse asks the adolescent at what time of day the second dose of Novolin N should be administered. Which response by the adolescent demonstrates that the teaching has been understood? 1 At lunch 2 At dinnertime 3 1 hour after lunch 4 1 hour after dinner

2. The second dose of the intermediate-acting insulin (Novolin N) should be given at dinnertime. Novolin N insulin peaks in 4 to 12 hours. A second dose is often prescribed approximately 10 to 12 hours after the first dose. A blood glucose reading at bedtime will determine the evening dose of regular insulin (Novolin R). At lunch is too early because it may precipitate a hypoglycemic reaction. One hour after lunch is too early because it may precipitate a hypoglycemic reaction. One hour after dinner is too late.

A client with history of multiple chronic illnesses comes to the emergency department (ED) complaining of a small progressive weight loss over the last month and feeling lethargic and thirsty all the time. The client's fasting blood glucose is 180 mg/dL and vital signs are blood pressure (BP) 118/78 mm Hg, oral temperature 99.6º F, pulse 72 beats per minute and regular, and respirations 22 breaths per minute and irregular. The nurse reviews the assessment findings and the client's medical record. What condition does the nurse conclude the client is experiencing? 1.Hypervolemia 2.Hyperglycemia 3.Infectious process 4.Respiratory distress

2.Hyperglycemia

A client with type 2 diabetes is admitted for elective surgery. The health care provider prescribes regular insulin even though oral antidiabetics were adequate before the client's hospitalization. The nurse concludes that regular insulin is needed because the: 1. Client will need a higher serum glucose level while on bed rest. 2. Possibility of acidosis is greater when a client is on oral hypoglycemics. 3 Dosage can be adjusted to changing needs during recovery from surgery. 4. Stress of surgery may precipitate uncontrollable periods of hypoglycemia.

3. There is better control of blood glucose levels with short-acting (regular) insulin. The level of glucose must be maintained as close to normal as possible. The occurrence of acidosis is greater when the client is receiving exogenous insulin. The stress of surgery will precipitate hyperglycemia, which is best controlled with exogenous insulin

A nurse is caring for a newly admitted client with a diagnosis of Cushing syndrome. Why should the nurse monitor this client for clinical indicators of diabetes mellitus? 1.Cortical hormones stimulate rapid weight loss. 2.Tissue catabolism results in a negative nitrogen balance. 3.Glucocorticoids accelerate the process of gluco-neogenesis. 4.Excessive adrenocorticotropic hormone (ACTH) secretion damages pancreatic tissue

3.Glucocorticoids accelerate the process of gluco-neogenesis.

A client has a tentative diagnosis of Cushing syndrome. The nurse's physical assessment of this client is likely to reveal the presence of: 1.Fever and tachycardia 2.Lethargy and constipation 3.Hypertension and moon face 4.Hyperactivity and exophthalmos

3.Hypertension and moon face

A male client who is receiving prolonged steroid therapy complains of always being thirsty and urinating frequently. What is the nurse's best initial action? 1.Have the client assessed for an enlarged prostate. 2.Obtain a urine specimen from the client to test for ketonuria. 3.Perform a finger stick to test the client's blood glucose level. 4.Assess the client's lower extremities for the presence of pitting edema

3.Perform a finger stick to test the client's blood glucose level.

A client with diabetes is being taught to self-administer a subcutaneous injection of insulin. Identify the preferred site for the self-administration of this drug. 1.upper arm 2.buttocks 3.abdomen 4.thigh

3.abdomen

A 16-year-old adolescent with recently diagnosed type 1 diabetes will receive NPH (Novolin N) insulin subcutaneously. The nurse teaches the adolescent about peak action of the drug and the risk for hypoglycemia. How many hours after the drug does the NPH peak? 1 1 to 2 hours 2 2 to 4 hours 3 5 to 10 hours 4 4 to 12 hours

4. NPH (Novolin N) insulin peaks in 4 to 12 hours; it has an onset time of 1½ to 4 hours and a duration of 18 to 24 hours. NPH insulin does not peak 1 to 2 hours, 2 to 4 hours, or 5 to 10 hours after administration.

Which statement made by a 28-year-old client recently diagnosed with type 1 diabetes indicates that further education is necessary regarding the teaching plan? 1."I will need to have my eyes and vision examined once a year." 2."I will need to check my blood sugar at home to evaluate my response to my treatment plan." 3."I can improve metabolic and cardiac risk factors of this disease if I follow a low-calorie diet and lose weight." 4."Once I reach my target weight there is a good chance that I will be able to switch from insulin to an oral medication to control my blood sugar."

4."Once I reach my target weight there is a good chance that I will be able to switch from insulin to an oral medication to control my blood sugar."

A female client receiving cortisone therapy for adrenal insufficiency expresses concern about why she is developing facial hair. How should the nurse respond? 1."It is just another sign of the illness." 2."Do not worry because it will disappear with therapy." 3."This is not important as long as you are feeling better," 4."The drug contains a hormone that causes male characteristics."

4."The drug contains a hormone that causes male characteristics."

A client who was diagnosed recently with type 1 diabetes states, "I feel bad. I don't think I even want to go home. My spouse doesn't care about my diabetes." What is the most appropriate nursing response? 1."What can I do to make you feel better?" 2."It seems that you don't get along with your spouse." 3."It's probably temporary. Your spouse needs more time to adjust." 4."You are unhappy. Have you tried to talk with your spouse?"

4."You are unhappy. Have you tried to talk with your spouse?"

At 4:30 PM, a client who is receiving human insulin (Humulin N) every morning states, "I feel very nervous." The nurse observes that the client's skin is moist and cool. What is the nurse's most accurate interpretation of what the client is likely experiencing? 1.Polydipsia 2.Ketoacidosis 3.Glycogenesis 4.Hypoglycemia

4.Hypoglycemia

A client with type 1 diabetes receives 30 units of Humulin N insulin at 7 am. At 3:30 pm the client becomes diaphoretic, weak, and pale. The nurse determines that these physiological responses are associated with: 1.Diabetic coma 2.Somogyi effect 3.Diabetic ketoacidosis 4.Hypoglycemic reaction

4.Hypoglycemic reaction

A nurse administers a tube of glucose gel to a client who is hypoglycemic. What should the nurse consider about this reversal of hypoglycemia? 1.It liberates glucose from hepatic stores of glycogen. 2.Insulin action is blocked as it competes for tissue sites. 3.Glycogen is supplied to the brain as well as other vital organs. 4.It provides a glucose substitute for rapid replacement of deficits

4.It provides a glucose substitute for rapid replacement of deficits

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?"

A. "Do you feel bloated after eating?"

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

A. 10:00 AM

A patient is taking metformin for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects, the nurse will include information about: (Select all that apply.) A. Abdominal bloating B. Nausea C. Diarrhea D. Headache E. Weight gain F. Metallic taste

A. Abdominal bloating B. Nausea C. Diarrhea F. Metallic taste

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.

A. Assess the patient's perception of what it means to have diabetes.

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.

A. Choose flat-soled leather shoes.

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.

A. Give the patient 4 to 6 oz more orange juice.

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.

A. Measure the ankle-brachial index.

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.

A. Place the patient on a cardiac monitor

Which actions describe the beneficial effects produced by sulfonylurea oral hypoglycemics? (Select all that apply.) A. Stimulate insulin secretion from beta cells B. Increase hepatic glucose production C. Enhance action of insulin in various tissues D. Inhibit breakdown of insulin by liver

A. Stimulate insulin secretion from beta cells Correct C. Enhance action of insulin in various tissues Correct D. Inhibit breakdown of insulin by liver Correct The sulfonylureas stimulate insulin secretion from the beta cells of the pancreas; enhance the actions of insulin in muscle, liver, and adipose tissue; and prevent the liver from breaking insulin down as fast as it ordinarily would (reduced hepatic clearance). Increased hepatic glucose production would serve to

After starting treatment for type 2 diabetes mellitus 6 months earlier, a patient is in the office for a follow-up examination. The nurse will monitor which laboratory test to evaluate the patient's adherence to the antidiabetic therapy over the past few months? a. Hemoglobin levels b. Hemoglobin A1C level c. Fingerstick fasting blood glucose level d. Serum insulin levels

ANS: B The hemoglobin A1C level reflects the patient's adherence to the therapy regimen for several months previously, thus evaluating how well the patient has been doing with diet and drug therapy. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 517 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Health Promotion and Maintenance

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

B. Noon blood glucose of 52 mg/dL

A patient presents to the emergency room complaining of vomiting with severe back and leg pain. The patient's home medications include daily oral corticosteroids. Vital signs reveal a low blood pressure and there are peaked T waves on the electrocardiogram. What is the nurse's priority intervention? a. Start an intravenous line b. Collect urine specimen c. Administer antiemetic d. Administer narcotic analgesia

A. start an intravenous line The patient is exhibiting signs of adrenal insufficiency (Addison's disease) given the regular use of corticosteroids. Cortisone, hydrocortisone (Cortef), prednisone, and fludrocortisone (Florinef) are used for the treatment of adrenocorticoid deficiency. Treatment of Addisonian crisis includes administration of hydrocortisone, saline solution, and sugar (dextrose) to correct the insufficiency. The priority intervention is to start an intravenous line so that appropriate treatments may be administered. A urine specimen may be collected but is not the priority intervention. Since the patient is vomiting, administration of antiemetics or analgesia would be given through an intravenous line. The nurse should also assess for changes in the level of consciousness; so administration of analgesia may be contraindicated if any decrease in level of consciousness occurs.

What is the nurse's best response about developing diabetes to the patient whose father has type 1 diabetes mellitus? a. "You have a greater susceptibility for development of the disease because of your family history." b. "Your risk is the same as the general population, because there is no genetic risk for development of type 1 diabetes." c. "Type 1 diabetes is inherited in an autosomal dominant pattern. Therefore the risk for becoming diabetic is 50%." d. "Because you are a woman and your father is the parent with diabetes, your risk is not increased for eventual development of the disease. However, your brothers will become diabetic."

ANS: A Even though type 1 diabetes does not follow a specific genetic pattern of inheritance, those with one parent with type 1 diabetes are at an increased risk for development of the disease.

Which action is most appropriate regarding the nurse's administration of a rapid-acting insulin to a hospitalized patient? a. Give it within 15 minutes of mealtime. b. Give it after the meal has been completed. c. Administer it once daily at the time of the midday meal. d. Administer it with a snack before bedtime.

ANS: A Rapid-acting insulins, such as insulin lispro and insulin aspart, are able to mimic closely the body's natural rapid insulin output after eating a meal; for this reason, both insulins are usually administered within 15 minutes of the patient's mealtime. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 505 TOP: NURSING PROCESS: Planning MSC: NCLEX: Safe and Effective Care Environment: Management of Care

The nurse is administering insulin lispro (Humalog) and will keep in mind that this insulin will start to have an effect within which time frame? a. 15 minutes b. 1 to 2 hours c. 80 minutes d. 3 to 5 hours

ANS: A The onset of action for insulin lispro is 15 minutes. The peak plasma concentration is 1 to 2 hours; the elimination half-life is 80 minutes; and the duration of action is 3 to 5 hours. DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: p. 516 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient is taking a sulfonylurea medication for new-onset type 2 diabetes mellitus. When reviewing potential adverse effects during patient teaching, the nurse will include information about which of these effects? (Select all that apply.) a. Hypoglycemia b. Nausea c. Diarrhea d. Weight gain e. Peripheral edema

ANS: A, B, D The most common adverse effect of the sulfonylureas is hypoglycemia, the degree to which depends on the dose, eating habits, and presence of hepatic or renal disease. Another predictable adverse effect is weight gain because of the stimulation of insulin secretion. Other adverse effects include skin rash, nausea, epigastric fullness, and heartburn. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 509 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

25. A 30-year-old male is diagnosed with a hormone-secreting tumor of the pancreas alpha cells. Which of the following would the nurse expect to be most likely increased in this patient? a. Amylin b. Glucagon c. Insulin d. Somatostatin

ANS: B Glucagon is produced by the alpha cells of the pancreas. Amylin is secreted by the beta cells. Insulin is secreted by the beta cells. Somatostatin is produced by the delta cells.

24. A nurse is teaching a patient about insulin. Which information should the nurse include? Insulin is primarily regulated by: a. Metabolic rate b. Serum glucose levels c. Prostaglandins d. Enzyme activation

ANS: B Insulin secretion is promoted when blood levels of glucose rise. Insulin secretion is not based on metabolic rate but on blood levels of glucose. Insulin secretion is not based on prostaglandins but on blood levels of glucose. Insulin secretion is not based on enzyme activation but on blood levels of glucose.

9. When a patient asks about target cell receptors, which is the nurses best response? Target cell receptors for most water-soluble hormones are located in the: a. Cytosol b. Cell membrane c. Endoplasmic reticulum d. Nucleus

ANS: B Water-soluble hormones bind to cell surface receptors.

The nurse is preparing to administer insulin intravenously. Which statement about the administration of intravenous insulin is true? a. Insulin is never given intravenously. b. Only regular insulin can be administered intravenously. c. Insulin aspart or insulin lispro can be administered intravenously, but there must be a 50% dose reduction. d. Any form of insulin can be administered intravenously at the same dose as that is ordered for subcutaneous administration.

ANS: B Regular insulin is the usual insulin product to be dosed via intravenous bolus, intravenous infusion, or even intramuscularly. These routes, especially the intravenous infusion route, are often used in cases of diabetic ketoacidosis, or coma associated with uncontrolled type 1 diabetes. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 516 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

The insulin order reads, "Give 10 units of NPH insulin and 5 units of regular insulin, subcut, every morning before breakfast." Choose the proper syringe for this injection. a. 1 mL syringe b. 100 unit syringe c. 3 mL syringe d. 5 mL syringe

ANS: B The proper syringe for insulin injection is the insulin syringe, which is marked in units. The other syringes listed are not correct for use with insulin because they are not marked in units. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 506 TOP: NURSING PROCESS: Planning MSC: NCLEX: Safe and Effective Care Environment: Safety and Infection Control

When teaching about hypoglycemia, the nurse will make sure that the patient is aware of the early signs of hypoglycemia, including: a. hypothermia and seizures. b. nausea and diarrhea. c. confusion and sweating. d. fruity, acetone odor to the breath.

ANS: C Early symptoms of hypoglycemia include the central nervous system manifestations of confusion, irritability, tremor, and sweating. Hypothermia and seizures are later symptoms of hypoglycemia. The other options are incorrect. DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: p. 514 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Health Promotion and Maintenance

The nurse is reviewing instructions for a patient with type 2 diabetes who also takes insulin injections as part of the therapy. The nurse asks the patient, "What should you do if your fasting blood glucose is 47 mg/dL?" Which response by the patient reflects a correct understanding of insulin therapy? a. "I will call my doctor right away." b. "I will give myself the regular insulin." c. "I will take an oral form of glucose." d. "I will rest until the symptoms pass."

ANS: C Hypoglycemia can be reversed if the patient eats glucose tablets or gel, corn syrup, or honey, or drinks fruit juice or a nondiet soft drink or other quick sources of glucose, which must always be kept at hand. She should not wait for instructions from her physician, nor delay taking the glucose by resting. The regular insulin would only lower her blood glucose levels more. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 518 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

A patient in the emergency department was showing signs of hypoglycemia and had a fingerstick glucose level of 34 mg/dL. The patient has just become unconscious. What is the nurse's next action? a. Have the patient eat glucose tablets. b. Have the patient consume fruit juice, a nondiet soft drink, or crackers. c. Administer intravenous glucose (50% dextrose). d. Call the lab to order a fasting blood glucose level.

ANS: C Intravenous glucose raises blood glucose levels when the patient is unconscious and unable to take oral forms of glucose. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 514 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Safe and Effective Care Environment: Management of Care

When monitoring a patient's response to oral antidiabetic drugs, the nurse knows that which laboratory result would indicate a therapeutic response? a. Random blood glucose level 180 mg/dL b. Blood glucose level of 50 mg/dL after meals c. Fasting blood glucose level between 92 mg/dL d. Evening blood glucose level below 80 mg/dL

ANS: C The American Diabetes Association recommends a fasting blood glucose level of between 80 and 130 mg/dL for diabetic patients. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 504 TOP: NURSING PROCESS: Evaluation MSC: NCLEX: Physiological Integrity: Physiological Adaptation

A patient who has type 2 diabetes is scheduled for an oral endoscopy and has been NPO (nothing by mouth) since midnight. What is the best action by the nurse regarding the administration of her oral antidiabetic drugs? a. Administer half the original dose. b. Withhold all medications as ordered. c. Contact the prescriber for further orders. d. Give the medication with a sip of water.

ANS: C When the diabetic patient is NPO, the prescriber needs to be contacted for further orders regarding the administration of the oral antidiabetic drugs. The other options are incorrect. DIF: COGNITIVE LEVEL: Applying (Application) REF: p. 518 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

34. When catecholamines are released in a patient, what should the nurse assess for? a. Nutrient absorption b. Fluid retention c. Hypotension d. Hyperglycemia

ANS: D Catecholamines cause hyperglycemia and immune suppression.

5. When insulin binds to its receptors on muscle cells, an increase in glucose uptake by the muscle cells occurs. This is an example of a _____ effect by a hormone. a. Pharmacologic b. Permissive c. Biphasic d. Direct

ANS: D Direct effects are the obvious changes in cell function that result specifically from stimulation by a particular hormone as is true with insulin. Pharmacologic effects are the result of high doses of a drug. Permissive effects are less obvious hormone-induced changes that facilitate the maximal response or functioning of a cell. Biphasic effects are twofold effects.

26. A nurse recalls insulin has an effect on which of the following groups of electrolytes? a. Sodium, chloride, phosphate b. Calcium, magnesium, potassium c. Hydrogen, bicarbonate, chloride d. Potassium, magnesium, phosphate

ANS: D Insulin facilitates the intracellular transport of potassium (K+), phosphate, and magnesium.

When teaching a patient who is starting metformin (Glucophage), which instruction by the nurse is correct? a. "Take metformin if your blood glucose level is above 150 mg/dL." b. "Take this 60 minutes after breakfast." c. "Take the medication on an empty stomach 1 hour before meals." d. "Take the medication with food to reduce gastrointestinal (GI) effects."

ANS: D The GI adverse effects of metformin can be reduced by administering it with meals. The other options are incorrect. DIF: COGNITIVE LEVEL: Analyzing (Analysis) REF: p. 508 TOP: NURSING PROCESS: Implementation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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."

B. "I need to rotate injection sites among my arms, legs, and abdomen each day."

When teaching a patient about insulin glargine (Lantus), which statement by the nurse about this drug is correct? A. "You can mix this insulin with NPH insulin to enhance its effects on glucose metabolism." B. "You cannot mix this insulin with regular insulin and thus will have to take two injections." C. "It is often combined with regular insulin to decrease the number of insulin injections per day." D. "The duration of action for this insulin is 8 to10 hours, so you will need to take it twice a day."

B. "You cannot mix this insulin with regular insulin and thus will have to take two injections." Correct Insulin glargine is a long-acting insulin with duration of action up to 24 hours. It should not be mixed with any other insulins. It is usually dosed once daily, but it may be dosed every 12 hours depending on the patient's glycemic response.

When checking a patient's fingerstick blood glucose level, the nurse obtains a reading of 42 mg/dL. The patient is awake but states he feels a bit "cloudy-headed." After double-checking the patient's glucose level and getting the same reading, which action by the nurse is most appropriate? A. Administer two packets of table sugar. B. Administer oral glucose in the form of a semisolid gel. C. Administer 50% dextrose IV push. D. Administer the morning dose of lispro insulin.

B. Administer oral glucose in the form of a semisolid gel.

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.

B. Amitriptyline helps prevent transmission of pain impulses to the brain.

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

B. Blood pressure C. Serum creatinine D. Urine for microalbuminuria F. monofilament testing of the foot

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.

B. Chooses a puncture site in the center of the finger pad.

A patient who has a new diagnosis of type 2 diabetes asks the nurse about a new insulin that can be inhaled. "Is there a reason I can't take that drug?" Which condition, if present in the patient, would be a concern? A. Atrial fibrillation B. Chronic lung disease C. Hypothyroidism D. Rheumatoid arthritis

B. Chronic lung disease

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

B. Inserting an IV catheter

Which information should the nurse include in a teaching plan for patients taking oral hypoglycemic drugs? (Select all that apply.) A. Take your medication only as needed. B. Report symptoms of anorexia and fatigue. C. Explain dietary changes are not necessary. D. Advise to avoid smoking and alcohol consumption. E. Instruct that it is okay to skip breakfast 1 to 2 times per week.

B. Report symptoms of anorexia and fatigue. Correct D. Advise to avoid smoking and alcohol consumption. Corre long-term complications of diabetes. Skipping meals can cause low blood glucose levels and should be avoided. Patients with type 2 diabetes mellitus are managed with lifestyle changes. All other options are correct.

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.

B. The patient cleans the skin with soap and water before insulin administration.

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?"

C. "Have you lost weight lately?"

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."

C. "I should take my daily aspirin at least an hour before the Byetta."

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

C. Blood pressure of 140/88 mmHg

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.

C. Changes in diet and exercise may control blood glucose levels in type 2 diabetes.

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.

C. Check the blood glucose during the night.

The nurse will instruct the patient to treat hypoglycemia with which drug? A. Acarbose (Precose) B. Propranolol (Inderal) C. Glucagon (GlucaGen) D. Bumetanide (Bumex)

C. Glucagon (GlucaGen) Correct Glucagon stimulates glycogenolysis, raising serum glucose levels.

Which oral hypoglycemic drug has a quick onset and short duration of action, enabling the patient to take the medication 30 minutes before eating and skip the dose if he or she does not eat? A. Acarbose (Precose) B. Metformin (Glucophage) C. Repaglinide (Prandin) D. Pioglitazone (Actos)

C. Repaglinide (Prandin) Correct Repaglinide is known as the "Humalog of oral hypoglycemic drugs." The drug's very fast onset of action allows patients to take the drug with meals and skip a dose when they skip a meal.

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.

C. The patient discards the open vials of glargine and regular insulin after 4 weeks.

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.

C. The patient may require administration of insulin while taking prednisone.

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.

C. The patient took the prescribed metformin today.

The nurse enters the patient's room to complete the discharge process and finds the patient to be lying in bed unresponsive and breathing. The patient has a blood glucose reading of 48 mg/dL. What is the most appropriate response by the nurse? C) Roll the patient to the side and administer the ordered glucagon.

Correct answer: C Rationale: Glucagon, a natural hormone secreted by the pancreas, is available as a subcutaneous injection to be given when a quick response to severe hypoglycemia is needed. Because glucagon injection may induce vomiting, roll an unconscious patient onto his or her side before injection. Glucagon is useful in the unconscious hypoglycemic patient without established intravenous access. The patient is at risk for aspiration so nothing should be administered by mouth. CPR is not indicated.

The patient was taking metformin before this hospitalization. To facilitate better glucose control, the patient has been switched to insulin therapy while hospitalized. The patient asks the nurse why it is so important to time meals with the insulin injection and to give him an example of a long-acting insulin. Which drug will the nurse tell the patient is a long-acting insulin? C)Insulin detemir (Levemir)

Correct answer: C Rationale: The nurse should inform the patient that timing of meals with insulin and oral antidiabetic therapy is important to prevent hypoglycemia and to obtain the most optimal results from the antidiabetic therapy. Insulin detemir (Levemir) is a long-acting insulin while insulin glulisine (Apidra) is a rapid-acting insulin. Insulin isophane suspension (NPH) is an intermediate-acting insulin, and regular insulin (Humulin R) is a short-acting insulin.

The nurse has just administered the morning dose of a patient's lispro (Humalog) insulin. Just after the injection, the dietary department calls to inform the patient care unit that breakfast trays will be 45 minutes late. What will the nurse do next? D)Give the patient food, such as cereal and skim milk, and juice.

Correct answer: D Rationale: Lispro insulin's onset of action is 15 minutes. It is essential that a diabetic patient eat a meal after injection. Otherwise profound hypoglycemia may result.

The patient is being discharged home with insulin aspart (NovoLog) and insulin isophane suspension (NPH). Which information does the nurse include when providing discharge teaching to the patient? D)Draw up the insulin aspart (NovoLog) first, then the insulin isophane suspension (NPH) into the same syringe.

Correct answer: D Rationale: The rapid-acting (clear) then the intermediate-acting (cloudy) insulins should be mixed in the syringe after the appropriate amount of air has been injected. Insulin is stored at room temperature when it will be used within the month. The injection should be administered at a 90-degree angle for patients who have adequate body fat and at a 45-degree angle for patients who are very thin. Insulins should be rolled prior to administration and not shaken.

The nurse is providing education to a patient for the prescription glipizide (Glucotrol). The nurse explains this medication is more effective when administered at which time? A. At bedtime B. In the morning C. 15 minutes postprandial D. 30 minutes before a meal

D. 30 minutes before a meal Correct Glipizide works best if given 30 minutes before meals. This allows the timing of the insulin secretion induced by the glipizide to correspond to the elevation in the blood glucose level induced by the meal.

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.

D. The patient's estimated glomerular filtration rate is 42 mL/min.

Which statement made by a student nurse indicates the need for further teaching about pituitary insufficiency? a. "Synthetic human growth hormone may be prescribed for children who are small for gestational age." b. "Testosterone supplements may be prescribed for women with gonadotropin deficiency." c. "Estrogen is known to regulate the action of growth hormone in men and women." d. "Chronic kidney disease treatment may include synthetic growth hormone replacement."

b. "Testosterone supplements may be prescribed for women with gonadotropin deficiency." Synthetic human growth hormone (HGH) is used for growth hormone deficiencies caused by pituitary insufficiency, as well as other conditions such as Turner's syndrome, chronic kidney disease, and children small for gestation age. Testosterone is used as supplement for men with gonadotropin deficiency. Estrogen and progesterone supplements, also referred to as hormone replacement therapy (HRT), is indicated for women with gonadotropin deficiency and for the relief of post-menopausal symptoms. Estrogen is also known to regulate secretion and action of GH in men and women.

Radioactive iodine is indicated for the treatment of hyperthyroidism. The nurse should include which teaching in this patient's plan of care? a. Isolation is required for 6-8 weeks b. An additional dose may be needed c. Thyroid replacement therapy is prescribed d. An overnight hospital stay is required

b. An additional dose may be needed Radioactive iodine (RAI) is indicated for the treatment of hyperthyroidism. It is given as an oral preparation, usually as a single dose on an outpatient basis. The radioactive iodine makes its way to the thyroid gland where it destroys some of the cells that produce thyroid hormone. The RAI is completely eliminated from the body after about 4 weeks. The extent of thyroid cell destruction is variable, thus the patient has ongoing monitoring of thyroid function. If thyroid production remains too high a second dose may be needed. The goal of this procedure is to destroy thyroid hormone producing cells; additional thyroid hormone is not prescribed.

Which important teaching point should the nurse include in the plan of care for a patient diagnosed with Cushing's disease? a. Daily weight using same scale b. Wash hands frequently c. Use exfoliating soaps when bathing d. Avoid yearly influenza vaccine

b. Wash hands frequently Cushing's syndrome is characterized by chronic excess glucocorticoid (cortisol) secretion from the adrenal cortex. This is caused by the hypothalamus, or the anterior pituitary gland, or the adrenal cortex. Cushing's syndrome can also be caused by taking corticosteroids in the form of medication (such as prednisone) over time - referred to as exogenous Cushing syndrome. Regardless of the cause, excess secretion of cortisol has a systemic affect affecting immunity, metabolism, and fat distribution (truncal obesity), reduced muscle mass, loss of bone density, hypertension, fragility to microvasculature, as well as thinning of the skin. Washing hands is important because the patient's immune system is suppressed due to the excess glucocorticoid level. Daily weights are not indicated. Exfoliating soaps may damage thin skin. The patient should receive vaccinations due to being immunocompromised.